Attention deficit hyperactivity disorder
Attention deficit hyperactivity disorderAttention Deficit Hyperactivity Disorder
Attention Deficit Disorders have become a very highly controversial
topic during the last decade. Attention Deficit Disorder, also known as ADD,
is a broad, almost generic term for the different types of Attention Deficit
Hyperactivity Disorders. The Diagnostic and Statistical manual of the
American Psychiatric Association offers us this definition: �ADHD is a disorder
that can include a list of nine specific symptoms of inattention and nine
symptoms of hyperactivity/impulsivity.� In addition, the Concise Columbia
Electronic Encyclopedia provides this interpretation: � (a) chronic,
neurologically based syndrome, characterized by any or all of three types of
behavior: hyperactivity, distractibility, and impulsivity. Unlike similar
behaviors caused by emotional problems or anxiety, ADHD does not
fluctuate with emotional states.�
About 1-3% of the school aged population has the full ADHD
syndrome, without symptoms of other disorders. Another 5-10% have
partial ADHD syndrome with one or more other problems, such as anxiety or
depression.(CHADD) Gender and age affect the way the patients display
their symptoms. Boys are more likely to have the disorder than girls. The
symptoms of ADHD usually decrease with age, but those symptoms related
with other similar disorders are said to increase with age. 30-50% of
children with ADHD may display symptoms, although often times less
severe, into adulthood.
ADHD may be observed in children before the age of four, but it�s signs
are often missed until the child begins school. ADHD is often accompanied
by learning difficulties, excessive physical activity, impulsive actions,
inattention and social inappropriateness. Many of the children affected by
ADHD exhibit a low threshold for frustration, which predisposes them to
uncontrollable tantrums, and inability to concentrate in a controlled setting,
such as a classroom. The behavioral symptoms associated with ADHD must
last more than six months to be diagnosed as an attention disorder,
although, it is not uncommon for medical doctors promote the idea of office
diagnosis. Diagnosis of ADHD syndrome in a doctor�s office however,
presents an evaluation in a controlled environment, which are subject to
error. Office diagnosis entails a child being put in a observation room,
usually alone, which enable the doctor to observe their behavior. This
observation does not produce accurate results due to the fact that the
environment is not one of which the child frequently has problems in.
Frequently the behaviors of children affected by ADHD will parallel those of a
normal child, other times, the child can be uncontrollable. Most children with
ADHD have problems with interacting with other children or when asked to
complete a task, especially if additional distractions are present. More
frequently, children suspected of having ADHD are evaluated by their
intellectual, academic, social and emotional functioning. The evaluation
often includes input from the child�s teacher(s), parent(s), and others adults
that frequently interact with the child. There are questionnaires that will
rate the child behavior that are often used by the parents and teacher of the
child. (See Addendum 1) Being that the behavior must last for at least six
months, a log of behavior is also encouraged to be kept.
According to Children and Adults with Attention Deficit/Hyperactivity
Disorders (CHADD), four subtypes of ADHD have been defined as follows:
ADHD -- Inattentive type is defined by an individual
experiencing at least six of the following characteristics:
1. fails to give close attention to details or makes careless mistakes
2. difficulty sustaining attention
3. does not appear to listen
4. struggles to follow through on instructions
5. difficulty with organization
6. avoids or dislikes requiring sustained mental effort
7. often loses things necessary for tasks
8. easily distracted
9. forgetful in daily activities
ADHD -- Hyperactive/Impulsive type is defined by an
individual experiencing six of the following characteristics:
1. fidgets with hands or feet or squirms in seat
2. difficulty remaining seated
3. runs about or climbs excessively (in adults may be limited to subjective feelings of restlessness)
4. difficulty engaging in activities quietly
5. talks excessively
6. blurts out answers before question have been completed
7. difficulty waiting in turn taking situations
8. interrupts or intrudes upon others
ADHD -- Combined type is defined by an individual meeting
both sets of attention and hyperactive/impulsive criteria.
ADHD -- Not otherwise specified is defined by an individual
who demonstrates some characteristics but an insufficient number of
symptoms to reach a full diagnosis. These symptoms, however, disrupt
everyday life.
Although we mostly hear of children having the disorder, many adults
are also affected by ADHD. Adults often try and shape their lifestyles to
compensate their abilities by seeking jobs in fields that: do not require long
periods of focused attention, allow them the freedom to move about, do not
require close attention to detail, etc. (Wender, 15) In adults, their are
greater problems with stress, which lead to greater expressed emotions.
(CHADD)
Other psychiatric disorders, known as comorbidity, are also found in
ADHD patients. Oppositional Defiant Disorder , Conduct Disorder, and
Learning Disorders can confuse the diagnosis and treatment of ADHD. These
disorders display similar characteristics and can be negatively influenced if
the patient is treated for disorders they do not have.
Treatment of ADHD is often done through behavior management,
parent training, psychiatric treatment, educational intervention and
psychostimulant medications. The combination of medication and
psychosocial intervention is called multimodality treatment. 70-80% of
children treated with ADHD respond positively to psychostimulants. (CHADD)
Medications primarily used in treatment include Ritalin (methylphenidate),
which is the most commonly prescribed, Dexedrine (dextroamphetamine),
and Cylert (pemoline). (CHADD) The most common side effects of these are
loss of appetite, loss of weight, and problems with falling asleep. The loss of
appetite typically lasts while the drug is working, and after it has worn off,
the patients hunger returns, often stronger. Weight loss occurs rarely, and
after research, growth is not revealed to be affected. Insomnia and sleeping
problems are mainly credited to doses taken too late in the day. It is
common practice to give the last dose no later than 4:00 p.m. (Diller, 263)
Ritalin, which is a stimulant, confuses many people on why it is used to
treat ADHD patients. The reasoning is that ADHD patients have a chemical
imbalance within their brains, which causes Amphetamines, such as Ritalin,
to have a reverse, typically calming affect. These effects allow the patient to
concentrate more and interact better with others.
Schools are developing better programs to aid children with attention
deficit disorders. IDEA (Individuals with Disabilities Act) and ADA
(Americans with Disabilities Act) ensure that students with all types of
disabilities, including ADHD, receive a free and appropriate education. ADHD
students have an IEP (Individualized Educational Program) which can result
in placement in resource or SDC (Special Day) classes. IEP�s involve the
child�s parent(s), teacher(s), school psychologist, and even a school
administrator. The IEP�s provide the student�s current level of performance,
a plan of educational goals, both long and short term, and how these goals
will be implemented.
The prognosis with children affected by ADHD is encouraging,
especially for those whose symptoms are identified early and treated
accordingly. Many children can cope with their disorder and become
productive members of society. Untreated cases of ADHD can lead to failure
in school and emotional and social difficulties, which puts them at a
disadvantage compared to their peers. Numerous studies are underway and
will hopefully produce more answers and a better understanding of the
disorder.
Works Cited
American Psychiatric Association. The Diagnostic and Statistical
manual of Psychiatric Diagnoses. (4th ed.). Washington, 1994
Barkley, Russell. Attention-Deficit Hyperactivity Disorder: A Handbook
for Diagnosis and Treatment. New York: Guilford, 1998
Concise Columbia Electronic Encyclopedia, (3rd. Ed), 20 Nov. 1999
Children and Adults with Attention-Deficit Hyperactivity Disorder, 9
Nov. 1999
Diller, Lawrence. Running on Ritalin. New York: Bantam, 1998
Farley, Dixie. �Helping Children with Attention Disorder,� FDA
Consumer, February 1989
Fontanelle, D.H. Understanding and Managing Overactive Children,
1983
Garber, Stephen W., Ph.D, Marianne Daniels Garber, Ph.D, and Robyn
Freedman Spitzman. Beyond Ritalin. New York: Villard, 1996
Hahn, Dale B. and Wayne A. Payne. Focus on Health. (4th. Ed), New
York: Mc Graw-Hill, 1999
Nordby, Stephen M., �Problems in Identification and Assessment of
ADHD�, October, 1994. 26 Nov. 1999
Parker, Harvey C., Ph.D, The ADD Hyperactivity Workbook for Parents,
Teachers, and Kids.
Patricelli, P. �Attention Deficit can be improved�, Lane Living, p.7,
June 18, 1994
Ryan, Kevin and James M. Cooper, Those Who Can, Teach. (4th. Ed),
Boston: Houghton Mifflin, 1998
Weiss, Gabrielle, and Hechtman, L.T. Hyperactive Children Grown Up.
1987
Wender, Paul H. Attention-Deficit Hyperactivity Disorder in Adults.
New York: Oxford, 1995