ADHD1

Descriptions of ADHD symptoms have been stable since the mid-19th century. Even as early as 1863, the publics view of the disorder started to emerge in a poem by a German physicist which depicted Fidgety Phils classic signs of ADHD (6). In 1902, experts classified children suffering form ADHD as mentally retarded, socially inept or even emotionally disturbed. It wasnt until the 1940s that experts classified it as a neurological disorder. Its discovery actually occurred in 1937(6). Dr. Bradley of Providence, Rhode Island discovered that while treating severely destructive children using amphetamines, a stimulant, the children would become more tranquil and could concentrate better. Since his discovery, many others in his field have continued his work; however, Attention Deficit Disorder wasn’t known by the vast public until the last decade (6).

Attention Deficit Hyperactivity Disorder is a neurological syndrome rooted in the central nervous system which affects approximately three to five percent of the child population (second only to asthma in childhood problems) in the United States and makes up 50% of child psychiatry populations(4a). Shown both in clinical and epidemiological samples, the condition is much more prevalent in males, shown 9-1 clinically and 4-1 epidemiologically, then females (4a). This suggests selective basis of analysis due to the female prevalence to show primarily inattentive and cognitive problems rather than the aggressive/impulsive behavior classic to most male subjects (3). Also noted is that children with A.D.H.D. have a 70% chance of caring it on into the teen years and will have a 65% chance of retaining most symptoms into adulthood (5).
Symptoms are based primarily upon three areas: inattention, impulsiveness, and hyperactivity (7). The most common symptom of A.D.H.D. is inattention which can be defined simply as difficulty remaining on a task until it is completed (4a). The inattention is primarily seen in school work, work or even playtime activities which usually lead to careless mistakes. A lack of listening, inability to follow simple directions, lack of effort or organization in basic daily tasks, forgetfulness and distractibility are all positive signs for inattention (DSM-IV). The next required symptoms are impulsiveness, which is characterized by sudden outbursts, mostly while others are talking, and hyperactivity, which is the most difficult to diagnose in adults (4a). To meet the DSM-IV criteria, the subject will fidget or squirm being unable to sit still for a length of time. There is also a need to stand when sitting is required and also a difficulty to remain quiet or calm when the situation demands it. There is usually a lack of any leisure activities in the life of one diagnosed with A.D.H.D due to a constant need to be on the go (DSM-IV). All three symptoms must be present before the age of seven and must be present in two or more settings (school, work, or home) (DSM-IV). There also must be clear evidence that the symptoms cause problems in the social, school or work setting. The symptoms also cannot be the result of pervasive development disorder, schizophrenia or any other mental disorders (DSM-IV).
The American Psychiatric Association has established criteria for diagnosing attention deficit hyperactivity disorder (ADHD) that divides the condition into 3 basic types. Each type is identified by a main symptom (inattention, impulsivity, or hyperactivity) (6). The first type is ADHD, combined type. This is characterized by having at least 6 or more symptoms of each inattention and hyperactivity and impulsivity (DSM-IV). The next is ADHD, predominantly inattentive type. This was once called Attention Deficit Disorder without hyperactivity (ADD) (6) and is characterized by 6 or more inattentive symptoms and fewer than 6 of hyperactivity and/or impulsivity symptoms. The final is ADHD, predominantly hyperactive-impulsive type (DSM-IV). This is characterized by 6 or more hyperactivity and/or impulsivity symptoms and fewer than 6 inattentive symptoms; however inattentiveness may still be very strong. This type is most common in small children (4a).
The American Academy of Pediatrics recommends that a child who has symptoms of inattention, hyperactivity, impulsiveness, poor school performance, or behavior problems be evaluated for ADHD (medical exam is required before any other testing is done) (6). However, since symptoms do vary, much discretion is put into the hands of parents and teachers to distinguish normal versus abnormal behavior. Children who have difficulty getting along with others are prime suspects for analysis (2). Children with ADHD are often unpopular with their peers and have difficulties with parents, siblings, and teachers. They may make friends easily but have a difficult time keeping them. Most children also have difficulty working to their full potential in school (6). Children with ADHD may have difficulty reading, spelling, and/or doing math. They may have problems organizing work, memorizing, and writing. They often forget or lose their homework. There is also difficulty sleeping and adjusting to changes in routines, such as getting up in the morning, putting on shoes, or going to bed (4a). The final sign to look for is an extreme difficulty with complex coordination (6). Some children with ADHD have problems with tasks that require coordination of their hands and eyes, such as tying their shoes, coloring, and riding a bicycle. There is also research showing that children with ADHD have a great deal of sensitivity to sights, sounds, and touch. This can be related to sensory processing defects that do not allow the child to process information from his or her senses in a normal way (3). For example, the child may complain that lights are bright when others say the lights are dim. He or she may be unable to hear something or may become overwhelmed if there are too many sounds, such as on a playground. This is not a symptom of ADHD. However, if it is present, it can make the symptoms of ADHD worse.
In teenagers, the diagnosis becomes much more difficult due to the prevalence of many other problems along with the basic criteria for ADHD (6). Teens with the disorder are more likely to take risks. Because of their impulsiveness, teens with ADHD are more likely to engage in risky behaviors, such as having unprotected sex or using alcohol or drugs (4a). They also tend to have extreme behavior problems. Children with ADHD may also have oppositional defiant disorder (ODD). If a child has ODD, it may lead to conduct disorder during the teen years. They may also become involved in criminal activities. The most difficulty is in the development of emotional problems (4a). Children with ADHD may develop low self-esteem. Low self-esteem is most likely related to the child’s difficulty with relationships and poor performance in school. Because of their ADHD symptoms and risk for low self-esteem, teens with ADHD may become depressed or develop other emotional illnesses. This makes diagnosis difficult due to high prevalence of depression in teenagers due to standard changes and adjustments (4a).
Adults have the greatest difficulty facing the diagnosis due to the association of ADHD with children (4a). Adults with ADHD are more likely to have poor job performance (6). Their work performance may be inconsistent because they have problems organizing their work, managing their time, and concentrating on one task at a time. They may be forgetful and misplace or lose things (6). They may quit their jobs out of boredom. People with ADHD may have difficulty maintaining relationships as well. They may have problems focusing their attention on conversations, reading the behavior and moods of others, and expressing their own feelings. Adults with ADHD also have difficulty tolerating stress and will often overreact in a temperous outcome (6). They become easily frustrated and may have a short, quick temper. And finally, adults with ADHD may have difficulty waiting for things they want (6). They also may not be able to accurately foresee the consequences of their actions and so they may engage in risky behaviors, such as unprotected sex, alcohol and drug use, or unwise financial ventures.

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There are numerous amounts of research into the cause of ADHD. Genetic studies have shown concordance up to 92% monozygotic and 33% in dizygotic twins; although, a signal marker has not been found (12). This is further strengthened by the 50% prevalence of parents who have ADHD to bear children with the disorder (6). Other potential causes include abnormal functioning of the chemical systems within the brain (6). People who have ADHD may have an imbalance of brain chemicals (such as dopamine, which helps control attention, and norepinephrine, which helps control activity) (3). It has also been shown that abnormal functioning of the prefrontal lobe occurs. Areas of the prefrontal lobe in people with ADHD appear different from these areas in those who do not have ADHD (3). Special brain scans (positron emission tomography or PET) of adults with ADHD have indicated problems in the use of nutrients in the portion of the brain that controls attention and movement. However, results of these tests cannot be used to diagnose ADHD (6). Other possible causes of ADHD symptoms include: alcohol, cigarette, or other drug use during pregnancy, problems during pregnancy or delivery that cause injury to the brain, infections that cause brain damage, poor nutrition during a baby’s first year of life, and lead poisoning (DSM-IV). Children who have even small amounts of lead in their bodies can have symptoms similar to ADHD. Contrary to a widespread belief among parents and many child-care workers, ADHD is very rarely caused by food allergies (specific foods, food coloring, or food additives) (6). If a child is known to have food allergies and avoids those foods, he or she might be better able to deal with ADHD symptoms. Only a very small number of children with ADHD have been helped by following a diet that eliminates many food additives (6). There is no evidence that eating too much sugar causes ADHD symptoms (6).

Treatment for attention deficit hyperactivity disorder (ADHD) cannot cure the condition (4a). However, treatment can help control the symptoms (inattention, hyperactivity, and impulsivity). Teamwork among the person with ADHD and his or her family, teachers, and health professionals is needed for the treatment to be most successful (6). Certain medications (psychostimulant medications, such as dextroamphetamine Dexedrine or methylphenidate Ritalin) may be the most effective treatment for the symptoms of ADHD (10). In about 70% of people who have ADHD, these medications improve their ADHD symptoms (6). These medications often cause sudden and dramatic improvements in the person’s behavior. Some medications used to treat depression may be beneficial for adults with ADHD and children who do not get better with psychostimulant medications or who have other conditions along with ADHD (10). Other treatments may be needed to help a person learn to recognize and change his or her behaviors (6). Behavior management includes using time out and reward systems to help the child learn appropriate behaviors for the classroom and home. Parent training in behavior management skills takes a series of 8 to 10 counseling sessions of 1 to 2 hours per week (6). Social skills training helps the child learn to be less aggressive and impulsive, manage anger, and behave in a more socially acceptable way. Counseling, including family therapy, may be needed to help the child and the family deal with the child’s behavior in an effective way (8). These treatments may be tried first in children with ADHD and are tailored to the person’s unique symptoms and problems. However, these treatments alone usually are not effective in treating the symptoms of ADHD. One large long-term study found that behavior treatment (parent training, child intensive behavioral interventions, and teacher training) combined with medication treatment improved behaviors associated with ADHD (8). However, the combination did not improve ADHD symptoms beyond treatment with medication alone. If other medical conditions are present, the person may need additional treatment for those conditions. The most important treatment is education (6). The child or teen with ADHD needs to be informed and willing to participate in the treatment. He or she must understand the need for medication and other treatments and not view them as punishment. By actively participating in treatment, the child will be more likely to take the medication as prescribed and participate in the other treatments (6).

Education is the greatest tool available to parents (6). The parents of children diagnosed with ADHD are very likely to develop problems of their own and it has been shown that parents of children with ADHD are more likely to develop health and emotional disorders (4a). Parents face the fact that treatment is a long arduous process and need to remain calm in the midst of confusion and frustration. Education can help ease this pain because it helps parents know that not only is it a common disorder, but that they are not the only ones dealing with it (4a). It is also very important to understand the disorder because it will help parents deal with questions children have about why they are different from others. The more capable parents are to take care of these questions the more likely they are to ease the childs worries and to lessen the problems the child has with self-esteem (4a). The next thing parents must deal with is the pressure of the medication process. It is very important that the medication be administered consistently and correctly (4a). There is no set guideline for medication as the childs need changes throughout the day. It is up to parents to look into symptoms and regulate how much is needed and when. This is again linked to a thorough understanding of what is being dealt with.
Behavior problems are also more than likely to pop up and it is up to the parents to remain calm, loving, and strict (5). This usually requires the parents to attend training in maintaining behavioral management skills with a certified therapist. Parents need these skills to find ways of praise and reward without bribery and ways to set up clear consequences for misbehavior (without punishment) along with the rewards (6). There is also a need for set guidelines of rules and routines (usually routines must be modified to keep the childs attention long enough to get to the desired goal). This is especially important when speaking of proper behavior at school and outside the home. Parents have to inform children of whats expected as well as inform teachers of what to look for and how to deal with it (6). The work put in with show positive results for most families dealing with the disorder.
Adults dealing with ADHD are more likely to find success in medication alone, but still have a need for life altering skills (17). The first step is to get organized (17). It is organizational skills that present the most difficulty to adults due to the need to maintain billing and work schedules. This is usually combated by writing as much down as possible in order to combat not only the disorganization but also the forgetfulness (17). It is also important to lose any environmental distractions, mainly noisy workplaces that could affect concentration (17). To combat possible impulsiveness, it is important to stop and think before acting (6). This works for those who are prone to make regretful statements and for those who are prone to bursts of temper. It only takes several trials to teach the body to think before reacting and can be helped along by health professionals. It is also to control hyperactivity by trying to fidget without distracting others by possibly keeping busy while still (taking notes or using that time to organize) (17). The last and most important is of course to seek education on web sites, from health professionals and from others suffering through the disorder as well (6).


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