Current interest in Attention Deficit Hyperactivity Disorder (ADHD) is soaring. Magazine articles, newspaper reports, network newscasts, and television talk show hosts have found this to be a timely topic. Scientific journals report thousands upon thousands of studies of ADHD children and youth and ADHD support groups continue to grow at an astounding rate as parents seek to learn more about this disorder in an effort to help their youngsters succeed at home and at school.
While some of this interest in ADHD arose from the controversies surrounding this condition, the growing recognition that ADHD can be a seriously debilitating disorder with lifelong effects has caused tremendous concern. Controversy about ADHD revolves around disagreements as to the cause of the disorder as well as differing opinions regarding treatment. Apprehension with respect to the dispensing of medication to ADHD children had captured media attention in the mid to late 1990s. Disagreement as to the educational needs of ADHD children and whether they should be eligible to receive special education services when their disorder severely impacts upon their academic performance has been a hotly debated issue.
A Harris Interactive survey done in 2000 polled parents and grandparents of children with ADHD as well as adults with the condition. One in three (34%) parents and grandparents said they did not know where to go for information when their child was diagnosed. The majority of parents and grandparents said confusing media reports (91%) and lack of reliable information (94%) prevent children from getting the treatment they need for ADHD. The purpose of this article is to briefly summarize some of the facts we know about ADHD related to characteristics, prevalence, cause, identification, treatment and outcome. Other articles contained on the addwarehouse.com site provide additional information about the disorder.
The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), published by the American Psychiatric Association, defined three types of attention deficit hyperactivity disorder: ADHD, predominantly hyperactive-impulsive type; ADHD, predominantly inattentive type; and ADHD, combined type. ADHD is characterized by symptoms of inattention, impulsivity or hyperactivity which have an onset before age seven, which persist for at least six months, and which are not due primarily to other psychiatric disorders or environmental circumstances, such as reaction to family stresses, etc. ADHD, predominantly inattentive type refers to disturbances in which the primary characteristic is significant inattentiveness without signs of hyperactivity. ADHD, predominantly hyperactive-impulsive type refers to disturbances in which the primary characteristics are hyperactivity and impulsivity, without inattention. Recent study of ADHD children who are the inattentive type indicates that this group of children tend to show more signs of anxiety and learning problems, qualitatively different inattention, and may have different outcomes than the hyperactive group who show more externalizing behavior problems associated with the oppositional and conduct disorders.
Prevalence reports of ADHD have varied over the past several years and range from 3 to 9 percent of the population of children and adolescents, with boy significantly out numbering girls. The number of children and adolescents affected by ADHD in the United States is probably well over 2 million. Adults can also be affected as it is estimated that from 30 to 70 percent of children with the disorder will continue to have symptoms throughout adulthood.
There are still many unanswered questions as to the cause of the disorder. Over the years the presence of ADHD has been weakly associated with a variety of conditions including: prenatal and/or perinatal trauma, maturational delay, environmentally caused toxicity such as fetal alcohol syndrome or lead toxicity, and food allergies. History of such conditions may be found in some individuals with ADHD, however, in most cases there is no history of any of the above.
Researchers have turned their attention to altered brain biochemistry and brain anatomy as possible causes of ADHD. Presumed differences in brain chemistry or structure may be the cause of poor regulation of attention, impulsivity and motor activity. A great deal more research has to be done to reach more definitive answers. However, we do know that there is no evidence that ADHD is caused by poor parenting, food allergies, excess sugar, or exposure to television. Other disorders may cause similar symptoms, which is why it is important to get a comprehensive diagnosis from a specialist.
The identification and diagnosis of children with ADHD requires a combination of clinical judgement and objective assessment. Since there is a high rate of coexistence of ADHD with other psychiatric disorders of childhood and adolescence any comprehensive assessment should include an evaluation of the individual's medical, psychological, educational and behavioral functioning. The more domains assessed the greater certainty there can be of a comprehensive, valid, and reliable diagnosis. The taking of a detailed history including medical, family, psychological, developmental, social and educational factors is essential in order to establish a pattern of chronicity and pervasiveness of symptoms. Augmenting the history are the use of standardized parent and teacher behavioral rating scales which are essential to quantifiably assess the normality of the individual with respect to adaptive functioning in a variety of settings such as home and school. Psychoeducational assessment investigating intellectual functioning and cognitive processes including reasoning skills, use of language, perception, attention, memory, and visual-motor functioning as well as academic achievement should be performed.
Most experts agree that a multi-modality approach to treatment of the disorder aimed at assisting the child medically, psychologically, educationally and behaviorally is often needed. This requires the coordinated efforts of a team of health care professionals, educators and parents who work together to identify treatment goals, design and implement interventions, and evaluate the results of their efforts.
Medications used to treat ADHD primarily include psychostimulants such as: Ritalin, Focalyn, Dexedrine, Adderall and Adderall XR, Metadate CD, and Concerta which have been shown to have dramatically positive effects on attention, over activity, visual motor skills, and even aggression in 70% or more ADHD children. The tricyclic antidepressant medications, Tofranil, Desipramine, Elavil, and others have been studied and used clinically to treat the disorder. Other types of antidepressants (i.e., Prozac, Paxil, etc.) called selective serotinin reuptake inhibitors are used less frequently because they have little impact on attention and hyperactivity or impulsivity. However, they do help regulate mood. Catapres and Tenex, antihypertensive agents, and Tegretol, an anti-convulsant, have been shown to be effective for some children as well.
Ideally, treatment should also include consideration of the individual's psychological adjustment targeting problems involving self-esteem, anxiety, and difficulties with family and peer interaction. Frequently family therapy is useful along with behavioral and cognitive interventions to improve behavior, attention span, and social skills.
Educational interventions such as accommodations made within the regular education classroom, compensatory educational instruction, or placement in special education may be required depending upon the particular child's needs. A 1999 study by the NIMH (the MTA study) concluded that medication treatment was very effective in helping children with ADHD and that psychosocial treatments provided additional benefit.