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ADHD

Attention-deficit/hyperactivity Disorder


ADHD is a group of chronic disorders that begin in childhood and sometimes last into adult life. In general, children and adults with ADHD have a hard time paying attention and concentrating (inattention), sitting still (hyperactivity) and controlling impulsive behavior (impulsivity).

These problems can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.

At various times ADHD has been called attention-deficit disorder (ADD), hyperactivity and even minimal brain dysfunction. But today ADHD is the preferred term because it more accurately describes all aspects of the condition. Yet changing the name hasn't made ADHD less controversial.

For some time, experts disagreed on how ADHD should be diagnosed and even on whether it was a real disorder. But in 1998 the National Institute of Mental Health agreed that ADHD is a legitimate condition. In addition, most doctors believe that a child shouldn't receive a diagnosis of ADHD unless the core symptoms of hyperactivity, impulsivity and inattention have created significant problems at home and at school for at least 6 months. Even so, it often can be hard to distinguish the behavior of a child with ADHD from that of normal, active children.

Just what constitutes the best treatment for ADHD is also a matter of debate. Currently, psychostimulant drugs such as methylphenidate (Ritalin, Concerta) or dextroamphetamine (Dexedrine) are the most common treatment. But the use of these drugs is under scrutiny. Psychostimulant medications can relieve many symptoms of ADHD, but they don't cure the disorder. In addition, some studies show that counseling, special accommodations in the classroom along with family and community support are just as, if not more, important in solving the problems affecting a child's life.

Experts agree that without any treatment some children with ADHD will likely continue to have poor learning skills and low self-esteem. They may also have social difficulties that last into adulthood. The good news is that when children receive appropriate treatment for ADHD, their confidence, social skills and even academic performance may improve dramatically.

Signs and Symptoms

The symptoms of ADHD are grouped into two broad categories: inattention and hyperactivity-impulsive behavior. In general, children are said to have ADHD if they show six or more symptoms from each category for at least 6 months. These symptoms must significantly affect a child's ability to function in at least two social settings typically at home and at school. This helps ensure that the problem isn't with a particular teacher or only with parents. Children who have problems in school but get along well at home are not considered to have ADHD. In most children, symptoms appear between 4 and 6 years of age, although they sometimes may occur even earlier. The signs and symptoms of ADHD include the following:

Inattention, often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities, often has trouble sustaining attention during tasks or play, often doesn't seem to listen when spoken to directly, often doesn't follow through on instructions and fails to finish schoolwork, chores or other tasks, often has difficulty organizing tasks or activities, often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework, often loses things needed for tasks or activities, such as books, pencils, toys or tools, is often easily distracted, is often forgetful.

Hyperactivity-impulsivity:

Often fidgets with hands or feet or squirms in seat, often leaves seat in the classroom or in other situations where remaining seated is expected, often runs or climbs excessively when it's not appropriate, adolescents or adults may not literally run or climb but may constantly feel restless, often has difficulty playing quietly, is often "on the go" or acts as if "driven by a motor," often talks excessively, often blurts out the answers before questions have been completely asked, often has difficulty waiting his or her turn, often interrupts or intrudes on others by butting into conversations or games.

Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't listen to a story from beginning to end or finish a drawing may have ADHD. But preschoolers normally have a short attention span and aren't able to stick with one activity for long. This doesn't mean they're inattentive it simply means they're normal preschoolers.

Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to their friends for hours but may be a lot less focused about homework.

The same is true of hyperactivity. Young children are naturally energetic they often wear their parents out long before they're worn out themselves. And they may become even more active when they're tired, hungry, anxious or in a new environment. In addition, some children just naturally have a higher activity level than others.

When children have ADHD, however, they tend to be especially sensitive to stimuli such as sights, sounds and touch. When overstimulated, they can quickly get out of control, becoming giddy and sometimes aggressive or even physically or verbally abusive. Children with the inattentive form of ADHD may seem to drift away into their own thoughts or lose track of what's going on around them.

Most children with ADHD don't have all the signs and symptoms of the disorder. Furthermore, symptoms may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.

Symptoms of ADHD in adults

ADHD always begins in childhood, but it may last into adult life. The core symptoms of inattention, hyperactivity and impulsive behavior are the same for adults as for children. Most adults have just one or two of the symptoms, not all three.

Adults who have problems with inattention may daydream during lectures or presentations at work and have trouble finishing tasks. Hyperactive adults aren't likely to be as physically active as hyperactive children, but they may find it hard to sit through movies or concerts or frequently shift positions or tap their fingers or feet. Impulsive adults often have trouble waiting in line and driving in heavy traffic, and they may be tempted to take unnecessary risks. Adults with ADHD also may have mood swings, a quick temper, a low tolerance for stress and problems with relationships.

Causes

Although the exact cause of ADHD isn't well understood, researchers have identified several factors that may play a role in the disorder. Altered brain function

The parts of the brain that regulate attention, planning and motor control seem to be less active in children with ADHD. In addition, adults and children with ADHD appear to have low levels of dopamine a brain chemical with a number of important functions. Among other things, dopamine sends messages to the part of the brain that controls movement, helps regulate attention and affects motivation.

One study found that adults with ADHD had very low levels of the enzyme that produces dopamine (dopa decarboxylase). Other people with ADHD seem to have too many dopamine transporters, which remove dopamine after it is produced.

Heredity

ADHD tends to run in families. Most children with ADHD have at least one relative with the disorder, and approximately one-third of men with a history of ADHD have children who also have ADHD. Furthermore, when one identical twin has ADHD, the other twin almost always has the disorder as well.

Maternal smoking, drug use and exposure to toxins A number of studies have found that pregnant women who smoke are at increased risk of having children with ADHD. Some studies also suggest that alcohol or drug abuse during pregnancy may reduce activity of the nerve cells (neurons) that produce dopamine. In addition, at least one study found that pregnant women who are exposed to environmental poisons such as dioxins and PCBs are more likely to have children with ADHD.