Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a behavioral disorder that is typified by distractibility, inability to sit still, restlessness, and difficulty concentrating on one thing for any period of time. ADHD generally occurs in children; however a rising amount of adults are being diagnosed with the disorder. In the United States, ADHD is the most frequently diagnosed childhood psychiatric disorder, as it accounts for 30-50% of all mental health referrals (Nigg, 2006). ADHD is present in approximately 3-6% of all children and males are twice as likely as females to be diagnosed (Nigg, 2006). Unfortunately, ADHD does not have an easily recognized set of symptoms or a single test to pinpoint its existence.

The current system for diagnosis is set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. The last major revision of the DSM was published in 1994, and is the current edition used by healthcare providers. ADHD is classified into three subtypes: ADHD-C, ADHD-PI, and ADHD-PHI. Inattention symptoms may dominate in some cases, hyperactivity in others, and in the combined type of ADHD the two occur together. The inattentive type (ADHD-PI) is differentiated by the inability to pay attention to a specific task or the inability to concentrate; the academic performance of this type of child may subsequently suffer. The hyperactive-impulsive type (ADHD-PHI) is differentiated by behavioral issues such as: excessive talking, fidgeting, making unnecessary noises, and bothering others. The combined type (ADHD-C) is a combination of inattention and hyperactive-impulsive; according to Trueit (2004) 50 вЂ" 70% of all children diagnosed with ADHD fit into this category. Diagnosing ADHD is a multi-stepped process that involves gathering information from teachers, parents, and other caregivers in order to diagnose the disorder. A physician will usually review the information given and conduct a medical history to make a proper diagnosis. The most important guidelines for diagnosis are laid out in the DSM-IV. In order to receive a diagnosis of ADHD the child must have six or more inattention symptoms or six or more of the hyperactivity and/or impulsivity symptoms. The symptoms must have been “present for at least six months to a point that is disruptive and inappropriate for developmental level” (American Psychiatric Association, 1994). Typically, the onset of symptoms should have occurred prior to age seven and be present in two or more settings such as home and school. In addition, the symptoms should not be better accounted for by another mental disorder.

According to the American Psychiatric Association the symptoms are as follows:

Inattention:

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

2. Often has trouble keeping attention on tasks or play activities.

3. Often does not seem to listen when spoken to directly.

4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior, or failure to understand instructions).

5. Often have trouble organizing activities.

6. Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).

7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

8. Is often easily distracted.

9. Is often forgetful in daily activities.

Hyperactivity:

1. Often fidgets wit hands or feet or squirms in seat.

2. Often gets up from seat when remaining in seat is expected.

3. Often runs about or climbs when a where it is not appropriate (adolescents or adults may feel very restless).

4. Often has trouble playing or enjoying leisure activities quietly.

5. Is often “on the go” or often acts as if “driven by a motor”.

6. Often talks excessively.

Impulsivity:

1. Often blurts out answers before questions have been finished.

2. Often has trouble waiting one’s turn.

3. Often interrupts or intrudes on others.

Many theories are available for the underlying causes of ADHD, but many have been shown to be false. Some of these disproven causes are bad parenting, too much sugar, food additives, food colorings, and food allergies, lack of vitamins, too much television or video games. The precise cause of ADHD is unknown and is thought to be a combination of both inherited and environmental factors. Heredity is a large contributing factor to ADHD as “about 40 percent of children with the condition have a parent who has ADHD, and 35 percent have a sibling who is affected” (Encyclopedia Britannica, 2007).

Prenatal complications such as low birth weight, premature delivery and lack of oxygen to the fetus are also thought to be possible causes. Numerous studies have found a significant association between prenatal environmental tobacco smoke exposure and ADHD. According to Science News (2006), “Children whose mothers smoked before giving birth but not those exposed later were 2.5 times as likely as other children to have ADHD.” Environmental lead exposure, measured in the blood or dentin, has been associated with higher rates of inattention and impulsivity.

ADHD is a neurological disorder that affects the areas of the brain that control the executive functions. The precise brain areas affected are the prefrontal cortices, the basal ganglia, and the cerebellum. Using positron emission tomography and functional magnetic resonance imaging neurobiologists have observed slight differences in the structure and function of the brains of people affected by ADHD.

In the prefrontal cortices the key areas that are relevant are the dorsolateral prefrontal cortex which is associated with working memory or the ability to keep plans in mind; the orbital prefrontal cortex which is associated with the ability to inhibit inappropriate actions and the anterior cingulate