ADHD affects 3 or 5% of the American population

Main Category: ADHD
Article Date: 12 Apr 2004 - 0:00 PDT


According to the Attention Deficit Disorder Association, attention-deficit hyperactivity disorder (ADHD) affects 3% to 5% of the American population.

There is no medical diagnostic tool, such as a blood test, computed tomography scan, or magnetic resonance imaging that can definitively inform physicians whether or not a patient has ADHD.

Andrea M. Chronis, PhD, says that performing behavioral assessment screenings of parents can improve the treatments for the disorder in both adults and their children.

"Many adults who had ADHD as children continue to have some type of impairment into adulthood," says Dr. Chronis. "The impairment tends to be present across many different settings, such as at home, work, and in social relationships, and ADHD does not remit in most cases even though the symptom profiles may change with time."

Physicians are recommended to conduct a behavioral assessment for patients suspected of having ADHD. This includes gathering information about an individual's behavior and impairments across different settings. "For children, we review their behavior at home, school, and with peers. For adults, the behavioral assessment examines situations where the individual has difficulty concentrating, problems with impulsive behavior (e.g. poor money management), or performance at work," says Dr. Chronis.

Dr. Chronis says it is more challenging to assess ADHD in adults than in children. "With children, a physician can ask different people in the child's life, such as a parent or teacher, about behavioral patterns. However, adults with ADHD generally do not have good insight or awareness of their problem. It can be problematic to ask an adult's employer about their behavior at work because it might affect their job."

According to Dr. Chronis, physicians need to be detective-like when diagnosing ADHD in adults. "We need to first establish that the symptoms have been present throughout the lifespan. The Diagnostic and Statistical Manual of Mental Disorders says the symptoms must be present before age seven. Physicians need to conduct research to determine if ADHD symptoms were prevalent throughout the patient's youth. This may require gathering information from the patient's parents, spouse, or roommates about their behavior as a child and an adult, or reviewing old report cards or discipline records."

"Diagnosing ADHD in adults is also complicated because the diag-nostic criteria for ADHD were developed for children with the disorder more than adults. The manual describes symptoms that can be difficult to apply to adults. Symptoms of ADHD can also be mimicked by other disorders, such as anxiety or depression (see figure 1). It is imperative that physicians make sure these symptoms are not transient or are a result of another disorder or substance abuse. We must establish that it is a lifelong pattern."

Methylphenidate, methylphenidate HCl, and dextroamphetamine are commonly prescribed medications for ADHD, and more recently atomoxetine HCl, a non-stimulant, has been studied in adults with ADHD. Studies have found many patients fail to adhere to the drug regimen required to treat ADHD, but Dr. Chronis says the side effects are minor considering the potentially beneficial effects. "Difficulty in sleeping and suppression of appetite are the most common side effects, but those adverse effects are not very debilitating compared to medications for other disorders. Overall, stimulant medication has been studied in the treatment of children with ADHD for over 40 years, and the research suggests they are safe and effective."

Children are often recommended for behavior therapy, which involves modifying the environment at home and school to help the child successfully handle the disorder without medication. While behavior therapy is an empirically-supported treatment for children with the disorder, Dr. Chronis says there are currently no established non-medication treatments for adults with ADHD. "The development of such treatments is a major research agenda."

There is a significant genetic component to the development of ADHD, says Dr. Chronis. "That means that many parents of children with ADHD also have the disorder themselves. The therapies for children with the disorder rely on the parents. If the parent is battling the disorder, then they are more prone to forget to give their child the medication on a day-to-day basis and may not keep many of the child's doctor appointments. When the parents are taught behavioral strategies when dealing with their child, they may not implement those strategies on a consistent basis because the parents themselves require structure and organization to do so."

Only recently have researchers acknowledged that ADHD can continue to exist into adulthood. "Screening parents of children with ADHD is necessary because the literature shows parents are less capable of assisting a child in getting effective therapies when they have psychological disorders themselves," explains Dr. Chronis. "We can't take a narrow approach to the assessment of treatment of children with ADHD. We need to look more broadly at the family context and to identify potential barriers to effective treatments for children, including parental psychopathology."

To continue reading go to:
http://www.physweekly.com/article.asp?issueid=121&articleid=1264

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