Adhd

ADHD is a developmental disorder that appears early in a child’s life. The principle characteristics include inattention, hyperactivity, or impulsivity. Whereas all children exhibit these symptoms to a degree, individuals with ADHD exhibit these behaviors at a higher level than is expected for the child’s developmental stage.

A child who is inattentive has difficulty focusing on one thing at a time. They may start a task but fail to finish. Unless they are doing something that is enjoyable to them, they tend to get bored after only a few minutes. The child is easily distracted by stimuli that are irrelevant to the task at hand. They have a tendency to daydream or “space out”. Because paying attention is a problem, they have a problem learning and understanding new material. They also have a tendency towards being disorganized, forgetful, and making careless mistakes.

Hyperactive children have a difficult time sitting still. When they do sit, they usually fidget with their hands and feet. Their attention bounces from one thing to another, playing with whatever is around them.

Impulsivity is characterized by an inability to think before acting. They often talk excessively and intrude on others, without thinking of what the consequences of their actions will be. They also have a difficult time waiting their turn or taking turns.

The DSM-IV-TR recognizes three subtypes of ADHD: Predominantly Inattentive Type, Predominantly Hyperactive-Impulsive Type, and Combined Type. To be diagnosed as either ADHD Predominantly Inattentive Type or ADHD Predominantly HyperactiveвЂ"Impulsive, a person must exhibit symptoms for at least 6 months “to a degree that is maladaptive and inconsistent with developmental level.” Each subtype has a list of 9 symptoms, and 6 of those must be present for a diagnosis. ADHD Combined Type requires 6 symptoms out of the possible 18 for the same length of time and extent. However, symptom count alone is insufficient for diagnosis; the symptoms must be impairing in more than one setting, have an age of onset before age 7 years, and not be better explained by another disorder.

In addition to the DSM criteria for diagnoses, there are also several tests that are often administered. Some of the more common ones are the Connors Rating Scale, the Behavior Assessment System for Children (BASC), and the (Test of Variables in Attention) TOVA. However, there is no single physical, mental, or genetic test that exists for diagnosing ADHD. The ones that do exist are often of the parent, teacher, or self report nature, which can’t always be counted on to be objective.

As a result of the lack of clarity in diagnosing ADHD, the statistics on the prevalence of the disorder vary as well. The DSM-IV-TR reports that 3-5% of school age children are diagnosed with ADHD. They also report that the male to female ratio is between 4:1 and 9:1. However, other sources put the rate higher. The American Academy of Pediatrics indicates 4-12% of school age children are diagnosed with ADHD (American Academy of Pediatrics 2001). Other sources put the figure as high as 20-24% (Purdie et al. 2002). No good data exists regarding the prevalence rates or gender ratios for the 3 types of ADHD. Internationally, “there is no convincing difference between the prevalence of this disorder in the USA and most other countries or cultures” (Faroane et al. 2003). Moreover, “the apparent 20-fold difference in the prevalence of hyperactivity reflects differences in the definition of the condition rather than real differences in behavior”.

In response to the difficulties in diagnosing ADHD, the American Academy of Pediatrics issued guidelines for the diagnosis and evaluation of children aged 6вЂ"12 years of age (American Acadamy of Pediatrics 2001). These are intended for primary care physicians and provide guidance for assessing school performance, behavior, family functioning, and adaptation.

Teachers or caregivers typically identify children early who present with impulsivity and/or hyperactivity (usually also having inattention), as these children are often disruptive in the classroom or daycare setting. With inattentive type ADHD, referral is usually prompted by academic underachievement, delaying diagnosis until academic demands become overwhelming.

When left untreated, children with ADHD may experience peer rejection, academic and vocational underachievement, and a reputation for disruptive behavior, potentially resulting in low self-esteem (Zametkin & Ernst 1999).

Children with ADHD are at increased risk of developing mood, anxiety, and substance use disorders, and exhibiting delinquent behavior and academic and vocational underachievement (Biederman 1991). Later in adolescence and young adulthood, ADHD is associated with an increased risk of cigarette smoking, alcohol and other substance abuse, and motor vehicle violations and accidents (Willens 2002).

The prevalence of ADHD declines from childhood to adolescence (Biederman 2000). Although ADHD begins in childhood, symptoms can continue to persist into adolescence and adulthood (Zametkin & Ernst 1999). Problems of inattention were more likely to persist into adolescence than hyperactivity or impulsivity.

Individuals with ADHD may experience greater functional impairment in the adolescent years than in earlier childhood owing to an increased demand on their executive function skills. In some circumstances, this increased demand may expose attentional deficits that were not obvious in earlier childhood (Wolraich 2005). Adolescents are expected to manage greater workload than younger children and to be more self-sufficient in their studies. Other challenges include the need to be able to adhere to a school timetable, bring the correct material for various classes, prioritize work and concentrate for longer periods without interruption. In addition, adolescents need to manage a more complex set of social interactions involving various teachers and a wide and often shifting peer group.

There are several common approaches to ADHD treatment. Medication is the most common approach. (Purdie et al 2002). Typically, the most effective class of drugs used is stimulants. Stimulants act to increase the release of dopamine in the brain. Included in this group are methylphenidate (Ritalin), Adderall, and Concerta. These drugs have been shown to be 70% effective in reducing some of the symptoms of hyperactivity, impulsiveness and improving concentration (Biederman et al 2001). Another drug recently approved for use is Strattera, a norepinephrine reuptake inhibiter. An estimated 70% of children diagnosed with ADHD show significant improvements in core behavioral symptoms with the first