What is Attention Deficit Hyperactivity Disorder ADHD?

Main Category: ADHD
Article Date: 16 May 2004 - 0:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

ADHD (Attention Deficit Hyperactivity Disorder) is one of the most common neurobehavioral disorders of childhood and can persist through adolescence and into adulthood. Currently the causes are unknown.

A person with ADHD has a chronic level of inattention, impulsive hyperactivity, or both such that daily functioning is compromised.

The symptoms of the disorder must be present at levels that are higher than expected for a person's developmental stage and must interfere with the person's ability to function in different settings (e.g., in school and at home).

A person with ADHD may struggle in important areas of life, such as peer and family relationships, and school or work performance.

The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) estimates that 3%-7% of children suffer from ADHD. Some studies have estimated higher rates in community samples. ADHD is diagnosed approximately three times more often in boys than in girls.

Three types of ADHD have been established according to which symptoms are strongest in the individual. These types are described below:

1. PREDOMINANTLY INATTENTIVE TYPE: It is hard for the individual to organize or finish a task, to pay attention to details, or to follow instructions or conversations. The person is easily distracted or forgets details of daily routines.

2. PREDOMINANTLY HYPERACTIVE-IMPULSIVE TYPE: The person fidgets and talks a lot. It is hard to sit still for long (e.g., for a meal or while doing homework). Smaller children may run, jump or climb constantly. The individual feels restless and has trouble with impulsivity. Someone who is impulsive may interrupt others a lot, grab things from people, or speak at inappropriate times. It is hard for the person to wait their turn or listen to directions. A person with impulsiveness may have more accidents and injuries than others.

3. COMBINED TYPE: Symptoms of the above two types are equally predominant in the person.

As many as half of those with ADHD also have other mental disorders. These comorbidities of ADHD (other disorders that occur along with ADHD) can make it harder to diagnose and treat ADHD. They may also present further challenges to the individual with ADHD.

Used by mental health professionals, the DSM-IV-TR provides criteria for diagnosing ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine the public health impact of ADHD.

Treating ADHD can be done through medical or behavioral therapies, or a combination of the two.

IS THERE A SIMPLE TEST TO DIAGNOSE AD/HD?

No; unfortunately, there is no simple test (like a blood test or a short written test) to determine whether someone has AD/HD. This is true of many medical conditions (for example, there is no "test" for a simple headache, yet anyone who has had a headache knows it's real!).

Accurate diagnosis is made only by a trained clinician after an extensive evaluation. This evaluation should include ruling out other possible causes for the symptoms involved, a thorough physical examination, and a series of interviews with the individual (child or adult) and other key persons in the individual's life (for example, parents, spouse, teachers, and others).

I'M AN ADULT; DOESN'T AD/HD ONLY AFFECT CHILDREN?

No. Although it is most often diagnosed in children, AD/HD is a lifespan disorder that affects individuals at all ages. Although there are limited data on the prevalence of AD/HD in adults, it is currently believed that the condition is found in 2-4% of the adult population.

For more information on this topic, see the CHADD Fact Sheet # 7, AD/HD in Adults (http://www.chadd.org/fs/fs7.htm) and the NRC Information and Resource Sheet #1, Diagnosis of AD/HD in Adults (http://www.help4adhd.org/diagnosis.cfm).

THE SCHOOL SAYS MY CHILD HAS AD/HD; NOW WHAT DO I DO?

AD/HD is a medical condition and the educational staff of a school are not qualified to diagnose AD/HD. If you or other adults in your child's life (e.g. teachers, grandparents, other caregivers) believe your child may have symptoms of AD/HD, then you should consult with your family doctor, your child's pediatrician, or other licensed medical/mental health professional who is trained in the diagnosis and treatment of AD/HD.

Teachers and other school personnel can play an important role by evaluating your child's learning ability and determine educational deficits. This information should be part of the comprehensive evaluation done by the medical/mental health professional.

MY CHILD STARTED TAKING MEDICATION AND HAS DEVELOPED TICS. WHAT DO I DO?

A relatively uncommon side effect of psychostimulant medications is the unmasking of latent tics -- the medical term for involuntary motor movements, such as eye blinking, shrugging and clearing of the throat. Psychostimulant medications can facilitate the emergence of a tic disorder in susceptible individuals. Often, but not always, the tic will disappear when the medication is stopped.

For many youth with AD/HD, vocal tics (throat clearing, sniffing, or coughing beyond what is normal) or motor tics (blinking, facial grimacing, shrugging, or head-turning) will occur as a time-limited phenomenon. The medications may bring them to notice earlier, or make them more prominent than they would be without medication, but they often eventually go away, even while the individual is still on medication.

Tourette's syndrome is a chronic tic disorder that involves vocal and motor tics. Experts estimate that 7 percent of children with AD/HD have tics or Tourette's syndrome that is often mild but can have social impact in the severe but rare form, while 60 percent of children with Tourette's have AD/HD.

Recent research suggests that the development of Tourette's syndrome in children with AD/HD is not related to psychostimulant medication. However, a cautious approach to treatment is recommended when there is a family history of tics or Tourette's syndrome, as certain patients will experience worsening of their tics with stimulant treatment.

(This information is from CHADD Fact Sheet No. 3, "Evidence-based Medication Management for Children and Adolescents with AD/HD (http://www.chadd.org/fs/fs3.htm)."

SYMPTOMS & DIAGNOSTIC CRITERIA

The Diagnostic and Statitistical Manual of Mental Disorders, Fourth Edition (DSM-IV) lays out the criteria to be used by doctors, mental health professionals, and other qualified clinicians in the USA when making a diagnosis of AD/HD.

As with all DSM-IV diagnoses, it is essential first to rule out other conditions that may be the true cause of symptoms. The DSM-IV identifies three sub-types of AD/HD, depending on the presence or absence of particular symptoms: Inattentive type, Hyperactive type, and Combined type.

Because everyone shows signs of these behaviors at one time or another, the guidelines for determining whether a person has AD/HD are very specific. To be diagnosed with AD/HD, individuals must have six of the nine characteristics in either or both DSM-IV categories listed below.

In children and teenagers, the symptoms must be more frequent or severe compared to other children the same age. In adults, the symptoms must affect the ability to function in daily life and persist from childhood.

In addition, the behaviors must create significant difficulty in at least two areas of life, such as home, social settings, school, or work. Symptoms must be present for at least six months.

Criteria for the three primary subtypes are:

AD/HD - INATTENTIVE TYPE

-- Fails to give close attention to details or makes careless mistakes.
-- Has difficulty sustaining attention.
-- Does not appear to listen.
-- Struggles to follow through on instructions.
-- Has difficulty with organization.
-- Avoids or dislikes tasks requiring sustained mental effort.
-- Loses things.
-- Is easily distracted.
-- Is forgetful in daily activities.

AD/HD - HYPERACTIVE TYPE

-- Fidgets with hands or feet or squirms in chair.
-- Has difficulty remaining seated.
-- Runs about or climbs excessively.
-- Difficulty engaging in activities quietly.
-- Acts as if driven by a motor.
-- Talks excessively.
-- Blurts out answers before questions have been completed.
-- Difficulty waiting or taking turns.
-- Interrupts or intrudes upon others.

AD/HD - COMBINED TYPE

-- Individual meets both sets of inattention and hyperactive/impulsive criteria. From The National Resource Center for ADHD (USA) http://www.help4adhd.org/faqs.cfm#faq5