Attention Deficit Hyperactivity Disorder / Attention Deficit Disorder (ADHD/ADD)

What is attention deficit hyperactivity disorder/attention deficit disorder (ADHD/ADD)?
Attention deficit hyperactivity disorder (ADHD) is the official name of the clinical diagnosis of this disorder. However, the term attention deficit disorder (ADD) is frequently used. Both terms refer to the same condition.

ADD without hyperactivity is also known as ADD/WO (Without) or Undifferentiated ADD. In years past, the disorder was known by other names, including minimal brain dysfunction (MBD), hyperactivity or hyperkinesis, or conduct or behavior disorder.

ADHD/ADD is a syndrome (a group of symptoms or signs) that is usually characterized by serious and persistent difficulties resulting in:

• inattentiveness or "distractibility" - poorly sustained attention span
• impulsivity - weak impulse control and delay of gratifications
• hyperactivity - excessive activity or restlessness (but, not in all cases). Up to 30 percent of children with ADHD/ADD are not hyperactive at all, but still have trouble focusing.

Who has ADHD/ADD?
ADHD/ADD is a treatable, but not curable, complex disorder that affects approximately 4 to 6 percent of the general population. Two to three times more boys than girls are affected. On average, at least one child in every classroom in the U.S. is affected by this disorder. ADHD/ADD often continues into adolescence and adulthood, requiring lifelong physical and emotional adjustments.

What are the symptoms of ADHD/ADD?
The following are the most common symptoms for ADHD/ADD, however, individuals may experience symptoms differently.

A person with the symptoms of ADHD/ADD often:

• fidgets or squirms excessively
• has difficulty remaining seated
• is easily distracted
• has difficulty waiting his/her turn in games
• blurts out answers to questions
• has difficulty following instructions
• has difficulty sustaining attention
• shifts from one activity to another
• has difficulty playing quietly
• talks excessively
• interrupts
• does not listen to what is said
• loses things
• engages in dangerous activities

The symptoms of ADHD/ADD may resemble other conditions or medical problems. Consult a child's physician for a diagnosis.

What causes ADHD/ADD?
Health professionals are finding more and more evidence that ADHD/ADD does not stem from a troubled home environment, but from biological causes. A single cause of ADHD/ADD has not yet been identified.

Suggested theories for the cause of ADHD/ADD:

Researchers, now, have been able to test more theories regarding the causes of ADHD/ADD. Among the theories are:

• Researchers measured the level of glucose used by the areas of the brain that inhibit impulses and control attention and found important differences between people who have ADHD and those who do not. Because glucose is the brain's main source of energy, measuring it is a good indicator of the brain's activity level. The researchers found that in people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. From this research, it appears that a lower level of activity in some parts of the brain may cause inattention.

• Researchers are searching for other differences between those who have and do not have ADHD by studying how the brain normally develops in the fetus. With a better understanding of how the brain works when the nerve cells are connected correctly and incorrectly, they hope to determine what might prevent nerve cells from forming the proper connections. Some of the factors they are studying include drug use during pregnancy, toxins, and genetics:

• a mother's use of cigarettes, alcohol, or other drugs during pregnancy may have damaging effects on the unborn child.
• drugs such as cocaine, including crack, seem to affect the normal development of brain receptors.
• toxins in the environment may also disrupt brain development or brain processes.
• Attention disorders also tend to run in families:
  • Children who have ADHD usually have at least one close relative who also has ADHD.
  • At least one-third of all fathers who had ADHD in their youth bear children who have ADHD.
  • The majority of identical twins share the trait.

What does evaluation for ADHD/ADD involve?
A healthcare professional knowledgeable about and experienced at working with people with ADHD should be involved with the clinical diagnosis of ADHD/ADD. A comprehensive evaluation should involve:

• a thorough medical and developmental history
• behavior-rating system to indicate type and severity of symptoms
• screening for learning problems or emotional problems
• screening for co-morbid conditions, such as depression, anxiety disorders, substance abuse, or learning problems

What are diagnostic criteria for ADHD/ADD?
According to the Diagnostic and Statistical Manual of Mental Disorders, Volume 4 (DSM-IV), criteria for a diagnosis requires:

• Six (or more) symptoms of inattention have persisted for at least 6 months - to a degree that is maladaptive and inconsistent with developmental level.
  OR
  Six (or more) symptoms of hyperactivity-impulsivity have persisted for at least 6 months - to a degree that is maladaptive and inconsistent with developmental level.
• Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.
• Some impairment from the symptoms is present in two or more settings (such as at school and at home).
• There must be clear evidence of significant impairment in social, academic or occupational functioning.

ADHD/ADD can only be identified by looking for certain characteristic behaviors. They must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings.

Once the disorder is diagnosed, a combination of educational, medical, and emotional help can be appropriately provided.

Complications commonly associated with ADHD/ADD:
Complications of ADHD/ADD may be associated with other problems of the central nervous system (CNS) such as:

• learning disabilities (LDs)
• gross and fine motor control delays (coordination)
• Tourette's syndrome - tics and other movements like eye blinks or facial twitches that cannot be controlled
• developmental delays (such as speech)
• obsessive-compulsive disorders (OCD)
• oppositional defiant disorder (overreact or lash out with outbursts of temper; act belligerent or defiant)
• depression or anxiety

Treatments for ADHD/ADD:
Specific treatment will be determined by the child's physician(s) based on:

• patient's age, overall health, and medical history
• extent of the disorder
• expectations for the course of the disorder
• patient's tolerance for specific medications, procedures, or therapies
• patient's or family's opinion or preference

Treatment options include:

• medications
  For many people with ADHD/ADD, medication helps to reduce hyperactivity and improve an individual's ability to focus, work, and learn.

• therapeutic intervention
  These may involve parent and child, and often include:

• psychotherapy
• cognitive-behavioral therapy
• social skills training
• support groups

• counseling and education
  This may be appropriate for parents and children. With children, this may include such methods as: modeling, self-verbalization, and self-reinforcement.

• school-based accommodations and interventions