Attention-Deficit/Hyperactivity Disorder

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Attention-Deficit/Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a condition that affects an individual's self-control, causing problems with attention span, impulse control, and activity level. ADHD causes difficulty with concentration, persistence, and attention span. Although many individuals with ADHD often find it difficult to concentrate on the task at hand, some experts argue that the term "attention deficit" is somewhat misleading. Instead, they suggest that persons with ADHD actually have difficulty controlling or regulating their attention in general.

For example, they may find it very hard not to pay attention to irrelevant, distracting stimuli in their environment, such as noises or the mere presence of others. At other times, however, they may be so absorbed in what they are doing—especially if it is an activity in which they are very interested—that they do not notice anything else, such as a teacher calling on them. This kind of focus (or "hyperfocus") is also a sign of poor attention regulation, and it, too, may be part of ADHD.

Signs of ADHD

Youths with ADHD show an extremely high level of activity in many situations. The high level of activity becomes most apparent when a low level of activity is called for, such as in a classroom where children are asked to focus on particular tasks. ADHD children typically are impulsive , restless, and easily distracted. For example, they may repeatedly leave their desk or work area to wander about, checking out what is going on in other parts of the classroom.

The ability to control impulses is also affected in children with ADHD. Some children and adolescents act out or display their feelings, frustrations, and emotional conflicts more than others. In a typical classroom, the child who acts out is one who consistently blurts out his or her first reactions without waiting to be called upon or recognizing that others may be speaking. When the behavior of acting out becomes severe and out of control of the individual, these youths may be diagnosed with ADHD. Some people use the term "attention deficit disorder" (or ADD for short) instead of ADHD, while others may refer to ADHD without the hyperactive component as ADD.

Diagnosing ADHD

Experts often do not agree on how to diagnose ADHD. Some believe the criteria for judging whether a child or adult has ADHD are too vague. Most of them do agree, however, that a doctor should not diagnose a child with ADHD based only on one short office visit. According to guidelines set by the American Psychiatric Association, some hyperactive, impulsive, or inattentive symptoms must have been present before age 7, last for at least six months, and not be the consequence of an overall problem in the child's development. In addition, the behavior must be causing problems in at least two different settings (for example, in the classroom and at home) for this diagnosis to be assigned.

Who Has ADHD? Approximately 9 percent of boys and 3 percent of girls in the general population qualify for a diagnosis of ADHD. Boys and girls tend to show different symptoms, with girls being somewhat older than boys at the time of first diagnosis. Girls usually have more mood changes, fears, and social withdrawal than boys but are less aggressive and impulsive. There is some disagreement regarding the likelihood that a child with ADHD will also have the disorder as an adult, with estimates ranging between 30 and 80 percent. In general, hyperactive symptoms tend to decrease with age, but the attention problems are often carried over into adulthood.

Comorbid Disorders. Up to 60 percent of children with ADHD also have some comorbid disorders, including conduct disorder , oppositional defiant disorder , and anxiety disorders. Adults with a history of ADHD may experience other disorders, the most common being substance abuse and depression. Youths with ADHD do not always have these disorders later on, but they are at increased risk for these outcomes.

Treating ADHD

Several methods have been used successfully for treating ADHD, including the use of medications, behavioral treatments, and a combination of both.

Medication. Drugs known as psychostimulants are helpful for approximately 75 percent of ADHD children and adults. The most commonly used medications are methylphenidate (Ritalin), amphetamine and dextroamphetamine (Adderall), and pemoline (Cylert). Some antidepressants are also effective in many cases. More than a hundred research studies have shown that these medications are useful for reducing problem behaviors of ADHD.

Although psychostimulants have been found to be effective for ADHD, some concerns have been raised regarding a possible connection between their long-term use and the development of addiction . The results of scientific research into this question have been mixed. One study has found a connection between stimulant medication treatment in ADHD youths and later adult dependence on cocaine and tobacco. But the results of several other studies indicate that stimulant medication may actually reduce the risk of substance abuse for young people with ADHD. In one study, for example, children who had been given stimulant medication for their ADHD had lower rates of marijuana, cocaine, and alcohol abuse when they grew up, compared to children with ADHD who had not received medication.

Lifestyle. A healthy lifestyle should be encouraged for all children with ADHD. This includes a regular schedule of bedtime, meals, homework, and recreation. Nutrition is important; however, contrary to popular belief, there is no substantive evidence linking diet or food allergies to ADHD. There is also no scientific evidence indicating that a special diet or some nutritional supplements can help relieve the symptoms of ADHD.

Environmental Changes. Structuring the environment so that there are few distractions is an important step. In the home, distracting stimulation from radio or television should be kept to a minimum, especially while the youth is doing homework. In the classroom, the teacher should consider the best seat location for an ADHD child, so that he or she is not distracted by other students and has fewer opportunities to be disruptive.

Behavior Modification. A youth with ADHD can be trained to control inappropriate impulses and to improve his or her behavior. This can be achieved by the use of various behavior modification techniques, which involve rewarding desirable behavior and providing negative consequences for inappropriate behavior. For example, when a parent catches a child doing something good (completing homework or going to bed on time, for instance), the child would be praised and given some reward (points or tokens that could later be converted into extra privileges, such as going to a movie). But when the child misbehaves (talks back or refuses to go to bed at night, for example), he or she would lose some points or tokens.

Behavior modification techniques such as these can be used alone or in combination with medication and other treatment methods to improve troublesome behavior related to ADHD. For further information about treatment, access to support groups, and some additional, helpful advice relating to this controversial but common disorder, visit the following Web sites:

Children and Adults with Attention-Deficit/Hyperactivity Disorder (http://www.chadd.org/)
National Attention Deficit Disorder Association (http://www.add.org/)
U.S. Centers for Disease Control and Prevention (http://www.cdc.gov/ncbddd/adhd/)
About.com (http://add.about.com/)

POSSIBLE SIGNS OF ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Everybody has problems staying focused at one time or another, but Attention-Deficit/Hyperactivity Disorder is an ongoing inability to concentrate. Below are some signs that a person may have a more serious problem and should consult a professional: