WHAT IS ADHD?

ADHD is a real illness that starts in childhood. It can change the way children act, think, and feel. Nearly all children are overactive and inattentive at times, but for ADHD children and their families their behavior can be extreme and disruptive.

ADHD is thought to affect between 3 and 5% of the school age population. In general ADHD is estimated to be 3 or 4 times common in boys. For some there is remission at puberty but for others the condition, if untreated, continues to blight their adult life.

Generally the ADHD child is unable to concentrate, constantly moves around, and has poor school performance compared with intelligence. Their behavior at home and at school is disruptive.




ADHD symptoms in infants

Extreme restlessness, crying, poor sleep patterns
Difficult to feed
Constant thirst
Frequent tantrums, head banging and rocks the cot.





ADHD symptoms in older children

Poor concentration and brief attention span
Increased activity - always on the go
Impulsive - doesn't stop to think
Fearless and takes undue risks
Poor coordination
Weak short term memory
Inflexible personality
Lacks self esteem
Sleep and appetite problems continue
Normal or high 10 but under perform at school
Not all infants and children with ADHD have all the features of the condition and there are different degrees of severity
Info from:
ADHD.com


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This is from the Central Penn Parent Magazine, November 1998, p. 20. HEALTH CLINIC Dealing with ADHD by Mark Domoto

It's generally accepted that children with ADHD, attention deficit hyperactive disorder, lack the ability to focus attention on "meaningful" stimuli, inhibit impulsiveness, and, in some cases, control motor excess. These deficits have the potential to create dysfunction or inhibit optimal performance at home, at school and socially.

Children with ADHD also lack internal neurological controls and may require a great deal of monitoring from parents and teachers to compensate for or help them adapt to insufficiencies.




Diagnosing ADHD

When an accurate diagnosis is determined early in a person's life, it is easier to develop effective external monitoring strategies which can prevent secondary complications.

If the child is not diagnosed early and accurately, there's a good chance that parents and teachers will experience anxiety, frustration and even anger with the child. The child himself may also feel anger and frustration and may develop poor self-esteem.

There is no formal test to diagnose ADHD, so the accumulation of information, observations and evaluations from parents, teachers, physicians, mental-health professionals and the child is vital. The following steps should be taken in diagnosing the condition.




Parent interview

The parent interview provides information pertaining to the pregnancy, labor and delivery of the child. Descriptions of infant and toddler temperament may reveal characteristics of poor neurological organization and problematic social/behavioral functioning. Medical history of the child and family may unmask or rule out an underlying medical condition, which is associated with ADHD. Discussion with the family also provides an understanding of dynamics within the home.




Educators interview

Information from school personnel may provide a "clean" perspective of the way a child functions, whereas parents may be emotionally influenced in making observations.

The school setting will also provide a gauge by which to judge the child's behavior. The evaluator will want to know how the child deals with the daily routine and with work demands and how the child compares with his peers. Once the child is evaluated, it may be determined that he actually has a learning disability which has displayed characteristics similar to ADHD.




Evaluation by a physician

Evaluation by a physician who is knowledgeable in children's developmental and behavioral issues is needed. Since ADHD is a neurological dysfunction, thorough assessment of the neurological system is important. A clinical evaluation may identify dysfunctions or inadequacies that influence performance. A cluster of findings on examination and information from both parent and school personnel enables the physician to sort out the diagnosis of ADHD vs. other conditions.




Treatment

Comprehensive treatment involves the same systems used in the evaluation process. Part of a child's treatment may mean parenting and teaching styles and performance evaluation should be adapted to assist the child in compensating for weaknesses.

Assisting a child in understanding his strengths and weaknesses through discussion of specific situations allows the child to organize and evaluate his performance. This involves the child in problem solving and gives him a feeling of control and the potential of developing self-confidence.

Selective use of medication therapy is another avenue of treatment. Expectations, limitations and potential side effects of the specific medication should be presented. The understanding that medication use is not a cure-all is vital.

Parents and teachers need to convey a unified message to the child that they understand his difficulties and that support and assistance is available. They also need to make clear that a commitment is expected from the child.

Communication, cooperation and compromise from the treatment team will help nurture this goal.

Mark Domoto, M.Ed., is a clinical developmental specialist with Penn State Guessing Health System, Milton S. Hershey Medical Center, Hershey, PA.



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ADHD in Adults

ADHD or Attention-deficit/hyperactivity disorder affects thirty to fifty percent of ADULTS who had ADHD in childhood. Accurate diagnosis of ADHD in adults is challenging and requires attention to early development, and symptoms of inattention, distractibility, impulsivity and emotional lability.

Diagnosis is further complicated by the overlap between the symptoms of adult ADHD and the symptoms of other common psychiatric conditions such as depression and substance abuse. While stimulants are a common treatment for adult patients with ADHD, antidepressants may also be effective.

ADHD receives considerable attention in both medical literature and the lay media. Historically, ADHD was considered to be primarily a childhood condition. However, recent data suggest that symptoms of ADHD continue into adulthood in up to fifty percent of persons with childhood ADHD.

Since ADHD is such a well-known disorder, adults with both objective and subjective symptoms of poor concentration and inattention have got the probabilities for evaluation. While the symptoms of ADHD have been extended developmentally upward to adults, most of the information about the etiology, symptoms and treatment of this disorder comes from observations of, and studies in, children (Weiss, 2001).

For several reasons, family physicians may be uncomfortable evaluating and treating adult patients with symptoms of ADHD, particularly those without a previously established ADHD diagnosis. First, the criteria for ADHD are not objectively verifiable and require reliance on the patient's subjective report of symptoms. Second, the criteria for ADHD do not describe the subtle cognitive-behavioral symptoms that may affect adults more than children.

The family physician's role as diagnostician is further complicated by the high rates of self-diagnosis of ADHD in adults. Many of these persons are influenced by the popular press. Studies of self-referral suggest that only one third to one half of adults who believe they have ADHD actually meet formal diagnostic criteria.

Even as family physicians are knowledgeable about childhood ADHD, there is a noticeable absence of guidelines for primary care evaluation and treatment of adults with symptoms of the disorder (Goldstein and Ellison, 2002).



The diagnostic criteria describe the disorder in three subtypes.
The first is the predominantly hyperactive,
the second is the predominantly inattentive,
and the third is a mixed type with symptoms of the first and the second.


Symptoms should be persistently present since age seven.
While a longstanding symptom history is often difficult to elicit clearly in adults, it is a key feature of the disorder.




The following are the symptoms:

Inattention:
where a person often fails to give close attention to details or makes careless mistakes, often has difficulty sustaining attention in tasks, often does not seem to listen when spoken to directly, or often does not follow through on instructions.


Tasks:
Where a person often has difficulty organizing tasks and activities, often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort, often loses things necessary for tasks or activities, often easily gets distracted by extraneous stimuli, or is often forgetful in daily activities.


Hyperactivity:
Where a person often fidgets with hands or feet or squirms in seat, often feels restless, often has difficulty engaging in leisure activities quietly, or often talks excessively.


Impulsivity:
Where a person often blurts out answers before questions have been completed, or often interrupts or intrudes on others.


There is a growing consensus that the central feature of ADHD is disinhibition.

Patients are unable to stop themselves from immediately responding, and they have deficits in their capacity for monitoring their own behavior.
Hyperactivity, while a common feature among children, is likely to be less overt in adults. Utah criteria may be called the imperative criteria for this.
For adults, it is used like this:
What is the childhood history consistent with ADHD? What are the adult symptoms?
Does the adult have hyperactivity and poor concentration?
Is there any affective lability or hot temper?
Is there the inability to complete tasks and disorganization?
Is there any stress intolerance, or impulsivity?
(Wender, 1998)


Wender developed these ADHD criteria, known as the Utah criteria, which reflect the distinct features of the disorder in adults.


The diagnosis of ADHD in an adult requires a longstanding history of ADHD symptoms, dating back to at least age seven.

In the absence of treatment, such symptoms should have been consistently present without remission.

In addition, hyperactivity and poor concentration should be present in adulthood, along with two of the five additional symptoms: affective lability; hot temper; inability to complete tasks and disorganization; stress intolerance; and impulsivity.


The Utah criteria include the emotional aspects of the syndrome.
Affective lability is characterized by brief, intense affective outbursts ranging from euphoria to despair to anger, and is experienced by the ADHD adult as being out of control.
Under conditions of increased emotional arousal from external demands, the patient becomes more disorganized and distractible.




Some treatments of ADHD are as follows:

Stimulants:
The pathophysiologic basis of ADHD centers on an imbalance in catecholamine metabolism in the cerebral cortex, and the agents that treat this disorder in adults enhance the availability of dopamine and norepinephrine.


Antidepressants:
As a means of increasing the concentration of catecholamines in the central nervous system, antidepressants that inhibit reuptake of norepinephrine have been evaluated for the treatment of ADHD.


Other Medications:
Sympatholytics have also been used in the management of ADHD.


Self-Management Strategies:
Adults with ADHD benefit considerably from direct education about the disorder. They can use information about their deficits to develop compensatory strategies. Planning and organization can be improved by encouraging patients to make lists and use methodically written schedules.


References

Wender, Paul (1998). Attention-Deficit Hyperactivity Disorder in Adults . Oxford University Press.

Weiss, Margaret (2001). Adhd in Adulthood: A Guide to Current Theory, Diagnosis, and Treatment . Johns Hopkins University Press.

Goldstein, Sam; Ellison, Anne (2002). Clinicians' Guide to Adult ADHD: Assessment and Intervention . Academic Press.




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Other good Web Paged for ADHD (Children & Adults):


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CHADD (Children and Adults With Attention Deficit/Hyperactivity Disorder)
www.chadd.org



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ADDA (Attention Deficit Disorder Association)
Attention Deficit Disorder Association, ADDA, provides information, resources and networking opportunities to help adults with Attention Deficit/Hyperactivity Disorder (AD/HD) lead better lives. We provide hope, empowerment and connections worldwide by bringing together science and the human experience for both adults with AD/HD and professionals who serve them.

AD/HD is a Lifespan Disorder

AD/HD is a disorder that affects individuals across the life span. There are a series of key issues that individuals with AD/HD typically face at different phases of life. CHADD will be there throughout your life so that you will stay connected and have all of the information available through each stage of your life.
Learn more About ADDA
www.add.org



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www.SchwabLearning.org - AD/HD














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