Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD)

ADHD is one of the most talked about topics children’s contemporary health and education. Sometimes called ADD, a recent television news show reported that ADHD is being found in up to one in seven males today under the age of seven; a one in fifteen incidence was reported in females. It is not clear whether the true incidence is rising or whether current diagnostic tools and tests are picking it up where it wasn’t recognized before. It has been stated that ADHD is the second most prevalent mental disorder behind major depression; its reported incidence is four to six million children and adults. The recognition that ADHD symptoms can persist into adulthood is a relatively new concept. In fact, The Diagnostic and Statistical Manual, which is generally considered the Bible of The American Psychiatric Association, is about to come out with its fifth edition. In the new manual, rather than incidence defined as occurring under the age of seven, the age parameter is being adjusted to seventeen. It will additionally recognize the syndrome which has its own set of described symptoms in adulthood.

Let’s begin by specifying some of the important characteristics which define the disorder. Symptoms are said to occur before the age of seven, though the rules bend a bit to include the seven to twelve age group. The symptoms must be present for a minimum of six months, so if the child just acts “hyper” at the babysitter’s house, that doesn’t count. The disruptive or inattentive symptoms must occur and affect order and relationships in at least two places, for instance, school and home and must be different from the expected behavior for other children of the same age. Just as a matter of observation, girls seem to have the inattentive set of symptoms, while boys tend to be hyperactive.

Now let’s discuss the symptoms themselves. The DSRM has divided symptoms into two classes: Inattentive and Hyperactive. In order to make the diagnosis the affected person must have at least six of nine possible symptoms from one of the two categories. There is however, a category called mixed ADHD, and this could include symptoms from both groups.

In the inattentive category, the diagnostician must determine if there is repeated failure to give close attention to details. Does the person have difficulty sustaining attention? Does he appear not to listen when addressed directly? Does he often not follow through on instructions or fail to complete class work? Does he have difficulty organizing tasks or activities? Does he avoid tasks which require sustained mental attention? Does he often lose things necessary for tasks? Is he easily distracted, or is he forgetful in daily activities?

In the hyperactive or impulsive category, does he often fidget with his hands and feet? Does he keep hopping out of his seat when expected to remain sitting? Does he run or climb excessively? Does he have a hard time being quiet in leisure or play activities? Does he seem to go like he’s driven by a motor? Does he talk excessively, or does he blurt out answers before the question is even finished? Does he have difficulty awaiting his turn? Does he interrupt or intrude on others?

All these things have to be considered. The big question is how is it affecting his quality of life? Are others shunning or avoiding him? Does he have few friends, and is he in constant trouble for his academic achievement? Is his family exhausted or exasperated with how he does things?

The problem with adult ADHD is that these same kind of problems are translated into the adult environment. The ADHD person may change jobs frequently, have multiple divorces, or sink into excessive debt due to impulsive spending.He may have problems additionally with depression over the course of his life, either caused by or causing other behavioral problems. The incidence of substance abuse disorders and antisocial behavior is significantly increased in ADHD.

We have some pretty good treatments for ADHD. The most common treatment is with centrally acting stimulants. These medicines include pemoline and amphetamine derivatives. There is a non-amphetamine called atomexitine which acts in a different fashion, though it does take longer to work. Other medicines such as SSRI antidepressants have been found to help in certain cases.

The important thing is for parents to make observations about the child’s social adjustment at school and at home. If there is a question of ADHD based on the characteristics outlined in this article, it is time to visit one’s pediatric or primary care provider. If the provider is not comfortable with the diagnosis and treatment of ADHD, he can refer you to someone who is. If the patient is an adult, consultation with a psychiatrist is recommended. It has been shown that the combination of medicine and behavioral therapy is more effective than either treatment alone.

If you have a child with ADHD, it is important that you spend a lot of loving time with him. Praise him when he does well, and set up time outs when behavior is not acceptable. Be consistent in your parenting, and try to set up a regular schedule of daily activities. There have been a lot of suggested contemporary diets where one avoids high carbohydrates and artificial coloring agents; it wouldn’t hurt to try to make the diet as natural as possible. Your child should have medication check-ups with the prescribing physician at least every six months to check the adequacy of the medication and to ascertain the absence of adverse side effects.

If you’re pregnant, don’t smoke, drink, or abuse drugs. These are correlated with the incidence of ADHD. Be careful to follow your obstetrician’s advice in doing everything to prevent premature delivery, as this has been associated with ADHD. If your child has ADHD, take heart. With proper care, parenting, and medication, these children can grow up to be healthy vibrant adults.

John Drew Laurusonis M.D.Doctors Medical Center