ADHD

ADHD

The principal characteristics of Attention Hyperacivity Disorder (ADHD) are inattention, hyperactivity, and impulsivity. These symptoms appear early in a child’s life. Because many normal children may have these symptoms, but at a low level, or the symptoms may be caused by another disorder, it is important that the child receive a thorough examination and appropriate diagnosis by a well-qualified professional.

It is a condition that becomes apparent in some children in the preschool and early school years. It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

ADHD was first described in 1845. There have since been many names for ADHD, including hyperactive child syndrome, hyperkinetic reaction of childhood, minimal brain dysfunction, and attention deficit disorder (with or without hyperactivity). ADHD is the most extensively studied mental disorder of children, with several thousands of peer-reviewed papers in the scientific literature devoted to this topic.

There have been a number of theories about the etiology of ADHD. While the exact etiology remains unknown, there are increasing studies showing underactivity in certain parts of the brain, neurotransmitter deficits, genetics, and perinatal complications. MRI, SPECT, and PET scan studies reflect brain functioning that is different than brains without ADHD. It tends to run in families. Between 10 and 35 percent of children with ADHD have a first-degree relative with past or present ADHD. Approximately one-half of parents who had ADHD have a child with the disorder.

ADHD Assessment

If there are questions about the possibility of ADHD, the first step is to begin the evaluation process. This is most often done by mental health professionals, and/or pediatricians. Unless there are complicating factors, it is usually unnecessary for this evaluation to be done by psychiatrists or neurologists. In addition to a clinical interview with the parents and child and a developmental history, behavior rating forms are generally completed by the parents and teachers. There are no blood tests or other simple medical procedures to establish a diagnosis. While brain scans continue to be researched, they are not routinely used by most clinicians. The added benefit to performing brain scans has yet to be demonstrated.

ADHD Treatment

Stimulant medications, such as Ritalin are the most widely used treatment and have been used since the 1950s. They are effective for most and are considered safe and generally well tolerated. Medications, when indicated, are usually prescribed by the pediatrician or family physician.

Behavioral strategies are often helpful. It is ineffective to say "Be good for a week and you'll get a reward." Immediate reinforcement for on-task behavior and good efforts are what will work best. The person needs to learn to monitor themselves and bring themselves back to the task on hand. Children are not able to do this. They often require frequent redirection. They also do much better when adults are able to provide structure for them. Yelling and punishment will almost always make things worse.

A form of biofeedback called neurofeedback is probably effective. However, it needs to be performed several times a week and is not covered by insurance. Another experimental technique is called mindfulness. This method trains people to focus only on the moment, bringing their mind back from wherever it wanders.

Adult ADHD

For many decades, the prevailing theory was ADHD was something that was outgrown somewhere during adolescence. Since the 1980's, there has been increasing awareness that many adults do NOT outgrow ADHD. Increased research and the use of brain scans have confirmed this. It has been estimated that there are three times the number of adults with ADHD than children. Adults who were never diagnosed or treated show a higher rate of alcohol/substance abuse, vocational, marital, social problems, as well as increased tendencies for anxiety and depression.

A GREAT new book for adults is More attention. Less deficit. Success strategies for adults with ADHD by Ari Tuckman. He also has a website that should be checked out www.adultadhdbook.com. There are a good number of 5 to 7 minute "podcasts" that are taken from the book. The book is written in short sections, making this much more user friendly to adults with ADHD.

A quarterly magazine addressing ADHD is Additude magazine. They have numerous, free articles on all aspects of ADHD. You can also sign up for free newsletters. It is definitely worth checking out at Additude Magazine.

Call me for an ADHD Assessment and/or Treatment.