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Facts About
Attention Deficit Disorder

Harvey C. Parker, Ph.D. Clinical Psychologist
Author of The ADD Hyperactivity Workbook for Parents, Teachers, and Kids.

Introduction

Current interest in Attention Deficit Hyperactivity Disorder (ADHD/ADD) is soaring. Magazine articles, newspaper reports, network newscasts, and television talk show hosts have found this to be a timely topic. Scientific journals report thousands upon thousands of studies of ADHD children and youth and ADHD support groups continue to grow at an astounding rate as parents seek to learn more about this disorder in an effort to help their youngsters succeed at home and at school.

While some of this interest in ADHD arose from the controversies surrounding this condition, the growing recognition that ADHD can be a seriously debilitating disorder with lifelong effects has caused tremendous concern. Controversy about ADHD revolves around disagreements as to the cause of the disorder as well as differing opinions regarding treatment. Apprehension with respect to the dispensing of medication to ADHD children had captured media attention in the mid to late . Disagreement as to the educational needs of ADHD children and whether they should be eligible to receive special education services when their disorder severely impacts upon their academic performance has been a hotly debated issue.

The purpose of this article is to briefly summarize some of the facts we know about ADHD related to characteristics, prevalence, cause, identification, treatment and outcome of the disorder.

Characteristics of ADHD

The Diagnostic and Statistical Manual III-R published by the American Psychiatric Association defined two types of attention deficit: Attention Deficit Hyperactivity Disorder and Undifferentiated Attention Deficit Disorder. The former was characterized by symptoms of inattention, impulsivity and hyperactivity which have an onset before age seven, which persist for at least six months, and which are not due primarily to other psychiatric disorders or environmental circumstances, such as reaction to family stresses, etc. Undifferentiated Attention Deficit Disorder refers to disturbances in which the primary characteristic is significant inattentiveness without signs of hyperactivity. Recent study of ADHD children without hyperactivity indicates that this group of children tend to show more signs of anxiety and learning problems, qualitatively different inattention, and may have different outcomes than the hyperactive group who show more externalizing behavior problems associated with the oppositional and conduct disorders.

Prevalence of ADHD

Prevalence reports of ADHD have varied over the past several years, but it has become relatively well accepted that the rate of the disorder is from 3% to 5% with boys significantly out numbering girls. The number of children and adolescents affected by ADHD in the United States probably ranges from 1.4 to 2.2 million.

Cause of ADHD

There are still many unanswered questions as to the cause of the disorder. Over the years the presence of ADHD has been weakly associated with a variety of conditions including: prenatal and/or perinatal trauma, maturational delay, environmentally caused toxicity such as fetal alcohol syndrome or lead toxicity, and food allergies. History of such conditions may be found in some individuals with ADHD, however, in most cases there is no history of any of the above.

Recently, researchers have turned their attention to altered brain biochemistry as a cause of ADHD and presume differences in biochemistry may be the cause of poor regulation of attention, impulsivity and motor activity. A recent landmark study by Dr. Alan Zametkin and researchers at NIMH have traced ADHD for the first time to a specific metabolic abnormality in the brain. A great deal more research has to be done to reach more definitive answers.

Identification of ADHD

The identification and diagnosis of children with ADHD requires a combination of clinical judgement and objective assessment. Since there is a high rate of coexistence of ADHD with other psychiatric disorders of childhood and adolescence any comprehensive assessment should include an evaluation of the individual's medical, psychological, educational and behavioral functioning. The more domains assessed the greater certainty there can be of a comprehensive, valid, and reliable diagnosis. The taking of a detailed history including medical, family, psychological, developmental, social and educational factors is essential in order to establish a pattern of chronicity and pervasiveness of symptoms. Augmenting the history are the use of standardized parent and teacher behavioral rating scales which are essential to quantifiably assess the normality of the individual with respect to adaptive functioning in a variety of settings such as home and school. Psycoeducational assessment investigating intellectual functioning and cognitive processes including reasoning skills, use of language, perception, attention, memory, and visual-motor functioning as well as academic achievement should be performed.

Treatment of ADHD

Most experts agree that a multi-modality approach to treatment of the disorder aimed at assisting the child medically, psychologically, educationally and behaviorally is often needed. This requires the coordinated efforts of a team of health care professionals, educators and parents who work together to identify treatment goals, design and implement interventions, and evaluate the results of their efforts.

Medications used to treat ADHD are no longer limited to psychostimulants such as methylphenidate (Ritalin), dextroamphetamine (Dexedrine) and pemoline (Cylert) which have been shown to have dramatically positive effects on attention, over activity, visual motor skills, and even aggression in 70% or more ADHD children. Within the past several years the tricyclic antidepressant medications, imipramine (Tofranil) and nopramine (Desipramine), have been studied and used clinically to treat the disorder with other types of antidepressants: fluxetine, chlorimipramine, and buproprion much less frequentlyprescribed. Clonidine (Catapress), an antihypertensive, and carbamazepine (Tegretol), an anti-convulsant, have been shown to be effective for some children as well.

Ideally, treatment should also include consideration of the individual's psychological adjustment targeting problems involving self=esteem, anxiety, and difficulties with family and peer interaction. Frequently family therapy is useful along with behavioral and cognitive interventions to improve behavior, attention span, and social skills.

Educational interventions such as accommodations made within the regular education classroom, compensatory educational instruction, or placement in special education may be required depending upon the particular child's needs.

   
 
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