A youngster who
doesn’t pay attention in class, who can’t sit still, is frequently loud and
disruptive, feisty on the playground, and repeatedly gets into trouble, may be
struggling with a behavioral condition known as Attention Deficit Disorder (ADD)
or more recently Attention Deficit Hyperactivity Disorder (ADHD). It is a
highly treatable condition that responds well to certain medications and
behavioral management. Left untreated, it can cause unwanted educational,
job, career, and social problems. Although wide gaps still exist in our
knowledge and understanding of ADHD, recent research points toward it having a
biological basis…caused by a chemical imbalance in the part of the brain
associated with paying attention, impulse control and activity level. It
appears a large percentage of ADHD can be genetically linked, though some
physical circumstances, e.g. brain damage, and health conditions can also be
precipitating factors. It is important to recognize that persons with ADHD
usually have normal to above average intelligence, are often very creative, and
usually exhibit high energy levels.
Though it’s possible
for ADHD to be diagnosed as early as ages 2-3, it usually shows up when a
youngster becomes involved in the more complex social interactions associated
with starting to school. According to some estimates, 3%-5% of school age
children are affected. Other estimates run as high as 20%. Three
times as many boys are diagnosed with the disorder as girls. One
explanation for this disparity is that girls are most affected by not paying
attention, whereas the boys are most likely to demonstrate more aggressive,
disruptive behavior patterns that gain the attention of family members and
teachers. Many children appear to outgrow the problem, but it’s now
known that for some the condition continues on through adolescence into
adulthood.
Some of the more
recognizable symptoms are poor attention, poor concentration, poor impulse
control, being easily distracted, being fidgety, and becoming disruptive or
getting “carried away” in play situations. Families of persons with
ADHD may be more susceptible to conflict and increased levels of stress.
Adults with the disorder often have difficulties with employment and
interpersonal relationships and frequently have other health problems or
secondary conditions that compound their situation.
To date there is no
known independent diagnostic test for ADHD. To find out if a person has ADHD it
is imperative to have the disorder diagnosed by a knowledgeable professional.
This is important to rule out other medical conditions that may have similar
symptoms. ADHD can be misdiagnosed when it is mistaken for youthful
exuberance and excitement or plain old misbehavior.
There is currently no
cure for ADHD. Treatment with medication such as central nervous system
(CNS) stimulants has been used for years. It’s thought that these drugs
improve the chemical imbalance in the brain that’s responsible for the
disorder and allows the brain to function normally while the medication is
working. Some recent research supports this conclusion.
The most frequently used
CNS stimulant drug is methylphenidate (Ritalin®). There has been some
controversy over its use, and other stimulant drugs, to treat ADHD. The
FDA classifies these drugs as having abuse potential. One side believes
their use can lead to their abuse as well as other drugs and alcohol. The
other side considers any abusive/experimental use of drugs to be prompted by the
nature of the disorder itself…the natural tendency toward impulsive,
risk–taking behavior...and not the drugs. There are no long-term studies
(longer than one year) to support either allegation. No conclusive
evidence has surfaced that the careful therapeutic use of CNS stimulants is
harmful.
Another method of
treatment is behavior modification. Both psychotherapy and pharmacotherapy
have their proponents. There seems to be no substantive benefit from
combining the two treatments. There is indication of some improvement in
social behavior that is greatly appreciated by both teachers and family.
One other reason for considering treatment with both methods is the possibility
of reducing the drug dosage. Some limited research suggests this may be
true, but again this is not supported by long-term studies.
Additional information
about ADD/ADHD is available on the internet. Some suggested sites:
www.chadd.org
www.add.org
www.mentalhealth.com
www.onhealth.webmd.com
www.nih.gov/publicat/helpchild.cfm
www.nih.gov/publicat/adhdqa.cfm
January 2001