ADHD - Attention Deficit Disorder in Children

Attention Deficit Hyperactivity Disorder – ADHD sometimes known as Attention Deficit Disorder – ADD is a condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. It is estimated that between 3 and 5 percent of children have meet criteria for diagnosis, or approximately 2 million children in the United States. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD. The condition was first described by Dr. Heinrich Hoffman in 1845. A physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn’t find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. “The Story of Fidgety Philip” was an accurate description of a little boy who had attention deficit hyperactivity disorder. Yet it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing—children who today would be easily recognized as having ADHD.  Since then, several thousand scientific papers on the disorder have been published, providing information on its nature, course, causes, impairments, and treatments.
A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system. This document offers information on the condition and its management, including research on medications and behavioral interventions, as well as helpful resources on educational options.

Diagnosis of Attention Hyperactivity Deficit Disorder

In the most current assessment guidelines published by the American Psychiatric Association, Diagnostic and Statistical Manual for Mental Disorders IV (DSM4), the disorder is known as ADHD and has several types including: (1) predominantly inattentive; (2) predominantly impulsive or (3) combined. Individuals with this condition usually have many (but not all) of the following symptoms:

Inattention: often fails to finish what he starts doesn’t seem to listen easily distracted has difficulty concentration or paying attention doesn’t stick with a play activity Impulsivity: often acts without thinking & later feels sorry shifts excessively from one activity to another has difficulty organizing work needs a lot of supervision speaks out loud in class doesn’t wait to take turns in games or groups

Hyperactivity: runs about or climbs on things excessively can’t sit still and is fidgety has difficulty staying in his seat and bothers classmates excessive activity during sleep always on the “go” and acts as if “driven” Emotional Instability: angry outbursts social loner blames others for problems fights with others quickly very sensitive to criticism

The diagnosis is made by “ruling out” other medical or psychiatric causes for the symptoms and by then determining that the patient meets the DSM4 criteria for ADHD. Psychological testing can be useful to rule out learning disabilities and Continuous Performance Tests (Connor’s CPT, TOVA, IVA, Gordon Diagnostic) may help confirm the diagnosis and be helpful with titration of medication. At this time the use of imaging such as PET or SPECT is recommended for research purposes. Several professional organizations recommend against the use of these techniques due to unwarranted exposure to radiation and lack of sufficient data to enable accurate diagnosis.  This diagnosis may coexist with anxiety, depression, Tourette’s, bipolar disorder, conduct disorder and learning disabilities.
True ADHD patients usually start showing symptoms by the time they start school.  Some very impulsive children are diagnosed as early as 2 or 3 years old.   Another group appears to develop more severe symptoms around the fourth grade. These children may have always had ADHD but were able to compensate for the condition.  As school requires more work and more organization skills, these children may reach a point where they become unable to compensate and exhibit “full blown” ADHD symptoms. Some children may remain undiagnosed until they are in their teens. More recently adults have been diagnosed as having Attention Deficit Disorder. These individuals had the disorder as children but were not properly identified during their childhood. [More Information See: Symptoms - Diagnosis]

Causes of Attention Deficit Hyperactivity Disorder

The symptoms are caused by a neurological dysfunction within the brain. Several studies using PET scans have confirmed that there is a definite difference in brain functioning between a group of individuals diagnosed with ADHD and those without it. The underlying physiological mechanism behind the causes is still not thoroughly understood and remains under scientific study.
The disorder may be either inherited (70%) or acquired (30%). Recent research in genetics has definitely shown that the condition runs in families. ADHD may be acquired through various conditions that cause insult (damage) to the brain.  During pregnancy and delivery these include the use of drugs during pregnancy, smoking during pregnancy, toxemia, infectious diseases, overexposure to radiation, prematurity, complicated delivery. After birth these include meningitis, encephalitis, seizures from fever, head injury and lead toxicity.  [More on Causes]

ADHD Treatment

Medications such as stimulants have long been employed in ADHD treatment.  hese medications improve a chemical imbalance in the brain which is causing the symptoms. A number of neuro-imaging studies have shown that the brain functioning of these patients does improve and appears to be more like the normal group after they have taken their prescribed medication.
Medications usually used in treatment improve the availability in the synapse of two neurotransmitters, dopamine and norepinephrine. Specific neurotransmitters (brain chemicals) are necessary to carry a nerve impulse (message) along a neuropathway (circuit). When a neurotransmitter is not fully available, a message may be stopped short of its intended destination. When this happens, the function regulated by that circuit may not work as well as it should.
Medications that treat ADHD children are not tranquilizers or sedatives. They do not slow down the nervous system. They actually improve functioning in various areas of the brain involved with attention, concentration and self-control. Over 200 well controlled studies have shown that these medications are the safest and most effective psychiatric medications. Failure to treat with medications may result in increased risk of substance abuse and decreased white matter volumes in the brain.
Common Medications:

• Adderall
• Concerta
• Dexedrine
• Focalin
• Metadate
• Methylin
• Ritalin
• Straterra (SNRI not a stimulant)

In difficult cases antidepressants or anti-hypertensive medications may be used. [More on Medications]
There is no scientific evidence to support the use of diet, supplements or biofeedback as treatment. Medication is the most frequently employed ADHD treatment method . It is often employed along with psychological techniques such as behavior modification and patient/family education. For an objective review please see Complementary and Alternative Treatments from National Resource Center.
The American Academy of Pediatrics (AAP) recommends that treatment for the disorder should consist of a comprehensive plan using MEDICATION AND OR PSYCHOLOGICAL TREATMENT. ADHD children with mild to moderate symptoms may ONLY NEED PSYCHOLOGICAL INTERVENTIONS to show significant improvement. The treatment should involve the physician, child, parents, family members and school personnel working together. The basics of the treatment plan must be carried out consistently for a long period of time (years) in order for maximum and enduring benefits to be achieved. For a review of recommended psychological interventions see Psychological Treatment for Children and Adolescents from National Resource Center and Evidence-Based Psychological Treatment for Children from Child Development Institute. According to a study conducted at State University of New York at Buffalo “combining behavior modification therapy with medication is the most effective way to improve the behavior of many ADHD children. In fact, when the two are combined, the study showed, the amount of medication required to achieve the same results as use of medication alone can be reduced by two-thirds”.

Total Focus Program

Due to cost and time factors significant Psychological Treatment interventions are often overlooked.   Dr Bob Myers of Child Development Institute recognized this and has produced a multi-media program known as Total Focus™ that involves the parents and children working together as a team to help the child achieve success at school and enjoy life at home and in the community.
This adhd self-help program is based on 30 years of clinical experience of the author as well as his personal experience as the father of a son with ADHD.  It is produced by a leading publisher of parenting programs and has received endorsements of recognized experts in Attention Deficit/Hyperactivity Disorder including Dr Stephen Henshaw. This cost effective, evidenced based program provides workbook materials and audio lessons and even a temperature biofeedback devise for use by both parents and kids that teach coping skills based on proven treatment strategies including:

• Parent Education
• Behavior Modification Programs for Home and School
• Relaxation Training to Improve Emotional Control
• Cognitive Behavioral Therapy to Improve Motivation, Problem Solving Skills and Self-Esteem
• Fun Cognitive Rehabilitation Exercises (Brain Training) to Improve Attention, Concentration and Executive Functioning Parent Coached Social Skill Training

Complete, easy to follow instructions are provided along with numerous questionnaires, charts and handouts for implementing behavior change programs and monitoring progress. Even telephone coaching by mental health professionals trained by the author of the program is available when desired.  [More on Total Focus]

Long Term Outlook for Individuals With Attention Deficit Hyperactivity/Disorder

When properly treated, children and adolescents can lead very normal and productive lives. In fact, many traits found in these individuals can help them to become very successful later in life. It should be noted that a loving, supportive and consistent environment is essential for the positive growth and develop of all children and especially those with attention deficit disorder or other learning disabilities. People with ADHD tend to have average or above average intelligence. They are often very creative and usually have a high energy level. These individuals also are frequently very sensitive and highly affectionate.
In the last few years, it has become more likely for adults to be diagnosed with the disorder and start on medication. These may be individuals who were not properly identified when they were children. In other cases, adults have learned to compensate for their disorder and become very successful individuals. In fact, some may “over compensate” and become extraordinarily successful.