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Attention-Deficit/Hyperactivity Disorder (ADHD)
HCA 240 19 September 2011
Attention-Deficit/ Hyperactivity Disorder (ADHD) Attention deficit hyperactivity disorder (ADHD) is characterized by prominent symptoms of inattention and/or hyperactivity and impulsivity. ADHD affects males more often than females and persists into adolescence and adulthood. Contrary to common belief, ADHD is not limited to childhood. ADHD has a chronic lifelong course and, if untreated, results in school and work failure, substance use disorders, legal difficulties, car accidents and fatalities, and sexual indiscretions. ADHD commonly occurs with depressive disorders, anxiety disorders, conduct disorder, oppositional defiant disorder, and learning disorders. Like many psychiatric disorders, ADHD often requires multimodal treatment that may include medication, cognitive-behavioral therapy, counseling, and collaboration among a variety of clinical professionals. The majority of children with ADHD are effectively treated with stimulant medications. Stimulant medications are the oldest and most established pharmacological agents in children with ADHD. Behavior therapy can improve academic achievement and reduce targeted conduct problems, especially in children with a co-occurring conduct disorder (Zelman, etc, 2010).
Attention-deficit/hyperactivity disorder, or ADHD, has assumed many aliases over time from hyperkinesis to hyperactivity in the early 1970s. In the 1980s, Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) dubbed the syndrome attention deficit disorder (ADD), which could be diagnosed with or without hyperactivity. This definition was created to underline the importance of the inattentiveness or attention deficit that is often but not always accompanied by hyperactivity. The revised edition of DSM-III, the DSM-III-R, published in 1987, returned the emphasis back to the inclusion of hyperactivity within the diagnosis, with the official name of ADHD. With the publication of DSM-IV, the name ADHD still stands, but there are varying types within this classification to include symptoms of both inattention and
hyperactivity-impulsivity, signifying that there are some individuals in whom one or another pattern is predominant (―Attention Deficit Hyperactivity Disorder,‖ 2010).
In addition to the name changes, the treatment for ADHD symptoms has greatly evolved over time as well. Once described as a moral defect, the most recommended strategy given to parents was to punish the child. But over time medication was postulated as a possible treatment for the symptoms of this disorder. Ritalin was first introduced in 1956 as a way to reduce hyperactive behavior in children. By 1996 the medication called Adderall gained FDA approval for the treatment of ADHD, followed by Concerta in 1999, Focalin in 2001, and Strattera in 2002. Other medications soon were added to the list to help treat the symptoms of ADHD including Vyvanse and Daytrana (―ADHD Past and Present,‖ 2009). Many myths and misconceptions surround the diagnosis of ADHD. Many believe there is no such medical condition as ADHD. They believe children simply choose to misbehave. Many others believe ADHD is caused by bad parenting and all the child needs is good discipline. Individuals with ADHD are often considered lazy or dumb. Many believe children can ―outgrow‖ ADHD and that it is always diagnosed in the doctor’s office (―Common Myths, Misconceptions, and Stigma Surrounding ADHD,‖ 2010).
Individuals with ADHD often have the following signs and symptoms of inattention: failure to pay close attention to details or making careless mistakes in schoolwork or other activities, trouble sustaining attention during tasks or play, not listening even when spoken to directly, and difficulty following through on instructions and often fails to finish schoolwork, chores or other tasks. Individuals may also have problems organizing tasks or activities, dislike tasks that require sustained mental effort, frequently lose needed items, be easily distracted, and are often forgetful. Signs and symptoms of hyperactive and impulsive behavior may include: fidgeting or
squirming frequently, leaving one’s seat in the classroom or in other situations when remaining seated is expected, running or climbing excessively when it's not appropriate, and difficulty playing quietly. One may also seem on the go all the time, talk excessively, and blurt out answers before the question is completely asked (Mayo Foundation, 2011).
The neurotransmitter dopamine is involved in controlling emotions and reactions, concentrating, reasoning, and coordinating movement. An abnormally low level of dopamine can cause the three primary symptoms of ADHD: inattention, impulsiveness, and hyperactivity. Mechanisms involved in the function of dopamine may cause this low level. The fact that stimulants increase levels of dopamine and other neurotransmitters (i.e., epinephrine and serotonin) and help reduce ADHD symptoms suggests that complex interactions between these neurotransmitters are involved in ADHD (―ADHD Causes and Risk Factors,‖ 2011).
There is no specific test for ADHD. An appointment to check for ADHD usually begins with a complete medical exam and a number of questions about one’s health, medical problems, difficulties, and issues that occur at school and at home. Children diagnosed with ADHD have symptoms over a long period of time and have particular trouble in stressful, demanding situations or in activities that require sustained attention, such as reading, doing math problems or playing board games. To be diagnosed with ADHD, one must meet the criteria spelled out in the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), published by the American Psychiatric Association. For a diagnosis of ADHD, one must have six or more signs and symptoms from one of the two categories listed above. In addition to having at least six signs or symptoms from one of the two categories, one with ADHD, has inattentive or hyperactiveimpulsive signs and symptoms that caused impairment and were present before age 7, has
behaviors that aren't normal for persons the same age who don't have ADHD, have symptoms for at least six months, and have symptoms that affect school, home life or relationships in more than one setting (Mayo Foundation, 2011). Qualified professionals trained in diagnosing ADD/ADHD can include clinical psychologists, physicians, or clinical social workers.
Treatment for ADHD varies, depending on a number of factors, including the type and severity of the condition, the child's age, and whether the child has any co-existing medical conditions. ADHD treatment may involve medication or behavioral therapy—and often involves a combination of both. Environmental factors often influence the severity of ADHD and the degree of impairment and suffering the person may experience. Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the child. As a precaution, it is best to refrain from both cigarette and alcohol use during pregnancy. Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels of lead is not as prevalent as it once was. People who live in old buildings where lead still exists in the plumbing or in lead paint that has been painted over may be at risk.
Attention deficit hyperactivity disorder (ADHD) was recognized and described long before it became known as ADD and eventually as ADHD. In 1902, an English pediatrician, Sir George Still, described a group of children who were disobedient, emotional, and uninhibited. He blamed these behaviors on biology, having discovered that some of the children had other family members with psychiatric disorders. Early theories were that these children were the victims of poor parenting, and more discipline was the best treatment. By the latter part of the 20th century,
ADHD was recognized as a true mental disorder, but was thought to be due to brain damage. ADHD is now one of the most common childhood disorders diagnosed and it is increasingly recognized as continuing into adulthood. The CDC reports that approximately 4.4 million children – about 8 percent of all U.S. children aged 4 to 17 -- have been diagnosed with ADHD, and 2.5 million of them are taking medication for the disorder (―The Past, Present, and Future of ADHD,‖ 2011).
ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for a child's age and development. ADHD is the most commonly diagnosed behavioral disorder of childhood. It affects about 3 - 5% of school aged children. ADHD is diagnosed much more often in boys than in girls. ADHD may run in families, but it is not clear exactly what causes it. Whatever the cause may be, it seems to be set in motion early in life as the brain is developing. Symptoms of ADHD include lack of attention, hyperactivity, and impulsive behavior. Children should have at least 6 attention symptoms or 6 hyperactivity/impulsivity symptoms, with some symptoms present before age 7. A combination of medication and behavioral treatment works best. There are several different types of ADHD medications that may be used alone or in combination.
ADHD Causes and Risk Factors. (2011). Retrieved from http://www.healthcommunities.com/adhd/causes.shtml
Attention Deficit Hyperactivity Disorder. (2010). Retrieved from http://www.medicinenet.com/attention_deficit_hyperactivity_disorder_adhd/page9.htm
Common Myths, Misconceptions, and Stigma Surrounding ADHD. (2010). Retrieved from http://www.health.com/health/article/0,,20434636,00.html
Mayo Foundation for Medical Education and Research. (2011). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved from http://www.mayoclinic.com/health/adhd/DS00275
The Past, Present, and Future of ADHD. (2011). Retrieved from http://www.everydayhealth.com/adhd-awareness/an-adhd-timeline.aspx
Zelman, M., Tompary, E., Raymond, J., Holdaway, P., & Mulvihill, M. (2010). Human diseases: A systemic approach (7th ed.). Upper Saddle River, NJ: Pearson.
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