What Is Attention-Deficit/Hyperactivity Disorder (ADHD)?

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that can occur in children and adolescents but often persists into adulthood. There are a lot of misconceptions about what causes ADHD, the role of the environment, cultural factors leading to over-diagnosis and the safety of treatments for the condition. There has been a  41% rise in ADHD diagnosis in the past decade.

Evidence based treatments for ADHD include stimulants, atomoxetine, guanfacine bupropion and non medication treatments like behavioral parent  training and summer treatment programs. Adults with ADHD may benefit from CBT, DBT and time management training.

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What Is ADHD (Attention Deficit Hyperactivity Disorder)?

 

ADHD is a neurodevelopmental disorder that occurs in children and adolescents that can persist into adulthood. It is characterized by symptoms of inattention and/or hyperactivity-impulsivity starting before the age of 12

Inattention Symptoms

- Inattention to details and careless mistakes in schoolwork or other work

- Difficulty remaining focused on lectures or conversations

- Does not listen when spoken to or does not follow through on instructions

- Difficulty organizing tasks and activities particularly those that require sustained mental effort

- Often loses things or is distracted by extraneous stimuli

Hyperactivity-Impulsivity

- Often fidgets or leaves seat in situations when not warranted

- Inappropriate running about, climbing, and inability to play quietly

- Talks excessively or acts “like driven by a motor”

- Has difficulty waiting his turn and blurts out answers

- Interrupts or intrudes on others

11% of school aged children in the US have received a diagnosis of ADHD

Worldwide prevalence of ADHD is around 5%

Risk of ADHD is 4-6 times greater in first degree relatives of patients

State with the highest rates of ADHD diagnosis:  Arkansas, KentuckyLouisiana, Tennessee, South Carolina, North Carolina

41% Rise in ADHD diagnosis in US in the last decade

The Ratio of ADHD in males vs females is 2:1

Adults with ADHD who have been diagnosed or treated is less than 20%

Heritability estimates of ADHD from twin studies is around 80%

Attention Deficit Hyperactivity Disorder is commonly comorbid with: learning and conduct problems, anxiety disorders and depressive disorders.


How Does ADHD Affect Children Versus Adults?

 

Pre-schoolchildren with ADHD are more likely to present with hyperactivity

Adults with ADHD are more likely to have inattention rather than hyperactivity

 

Common Myths About Attention Deficit Hyperactivity Disorder

 

- It is just a way to explain bad behavior

- Children will grow out of ADHD

- ADHD is caused by watching too much TV or eating the wrong foods


The History of ADHD


1798 – The first example of a disorder that appears to be similar to ADHD was given by Sir Alexander Crichton in 1798.

1844 – In 1844, the German physician Heinrich Hoffmann created some illustrated children’s stories, which is nowadays a popular allegory for children with ADHD.            

1902 – The Goulstonian Lectures of Sir George Frederic Still in 1902 are by many authors considered to be the scientific starting point of the history of ADHD.

1937 – The first treatment of hyperactivity.

1944 – Methylphenidate is first synthesized. It is regarded by as a very effective psychostimulant and is the most frequently prescribed drug in the treatment of ADHD.

1968 – In 1968, a definition of the concept of hyperactivity was incorporated in the official diagnostic nomenclature (DSM-II).

1980 – Attention deficit disorder: with and without hyperactivity is added to the third edition of the DSM-III.

2013 – The DSM-5 makes new changes to ADHD.


Did You Know?

Studies have shown a link between environmental factors and an increased risk of ADHD.

 

ADHD  in the DSM-5

 

Changes in DSM-5 criteria for Attention Deficit Hyperactivity Disorder:

- Older adolescents and adults need only 5 symptoms of inattention or hyperactivity for diagnosis ( children need at least 6)

- Age of onset of symptoms is now defined as several symptoms before age 12

- ADHD can now be comorbid with autism spectrum disorder


How is a Person Diagnosed With ADHD?


There is no accepted single diagnostic test for ADHD. Therefore, several steps are taken to diagnose a person with ADHD. For example, one step could involve a health professional who performs a thorough mental status examination and medical evaluation.

Computer based tests of attention and memory, EEG including a FDA approved scan that relies on readings of theta and beta waves, and functional MRI can all be used to confirm the diagnosis.

The diagnosis can be based on symptoms and signs with input from parents and teachers combined with rating scales.

The common differential diagnosis of ADHD includes: Bipolar disorder, major depression, learning disorders and autism spectrum disorders (even though they may coexist in some patients.)


What Causes ADHD?


The exact, single cause of ADHD is not fully known, but a number of factors appear to contribute to its development.

Brain Injuries

Some children with brain injuries can exhibit ADHD-like symptoms

Genetics

Studies have shown that ADHD runs in families. Several genes have been identified that may increase the risk of developing the disorder.

Environment

Studies have shown a link between smoking and alcohol use in pregnant mothers and an increased risk of ADHD in their children. Preschoolers exposed to lead have a higher risk of developing ADHD.

Pre-school children with ADHD are 80 times more likely to be suspended or expelled from school setting


How Do Doctors Treat ADHD?


Non-Medication Treatments

Proven non medication treatments for children with ADHD include behavioral parent training, and summer treatment programs. Proven non medication treatments for adults with ADHD include CBT, dialectical behavior therapy and time management training.

Medication Treatments

Psychostimulants like dextroamphetamine or methylphenidate should be first line treatment followed by atomoxetine , guanfacine, bupropion and  other antidepressants and modafinil. Emerging medication treatments for ADHD include nicotinic agents, histaminergic agents, cholinesterase inhibitors, atypical antipsychotics and newer antidepressants.

Sales of stimulants have doubled in the last five  years to $9 billion in 2012.


Common Myths About Medication Treatment of ADHD


- ADHD medications will cause my child to become a drug addict

- ADHD medication increases the risk of sudden death

- ADHD medication will make my kid into a zombie


Can Someone With ADHD Still Lead a Successful Life?


There are many successful people who have ADHD:

 - Michelle Rodriquez

- Jim Carrey

- Paris Hilton

- James Carville

- Ty Pennington

- Will Smith

- Justin Timberlake

- Michael Phelps

- Karina Smirnoff