Attention Deficit Hyperactivity Disorder (ADHD) – Attention Deficit Disorder (ADD)
Although normal individuals, particularly young children, show some of these features, what distinguishes ADHD is the greater degree and frequency with which these characteristics are displayed for a person of a particular age.
• Inattention or poor persistence on many tasks, particularly those that are tedious, boring, and long.
The individual becomes bored rapidly during repetitive tasks, shifts from one uncompleted activity to another, frequently loses concentration during tasks, and fails to complete assignments.
• Impulsivity or difficulty delaying gratification.
Difficulty being able to stop and think before acting; difficulty waiting his or her turn; not being able to work for larger, longer-term rewards; and not being able to inhibit behavior, as a situation demands.
• Excessive irrelevant activity or poorly regulated activity to situational demands.
Individuals with ADHD are often excessively fidgety, restless, and “on the go.” They display movement that is not needed to complete a task, such as wriggling feet and legs, tapping things, rocking, or shifting position while performing relatively boring tasks. Trouble sitting still or inhibiting movement as a situation demands is often seen in younger children.
ADD without Hyperactivity: Individuals who exhibit attention problems but do not display excessive activity levels are considered to have ADHD, Predominately Inattentive, (formerly called Undifferentiated Attention Deficit Disorder). This disorder appears less likely to be associated with aggression or conduct problems and may have a greater association with learning disabilities and with a personal or family history of anxiety. Also, this subtype is less likely to have early onset and may not be noticeable until academic demands requiring attention increase.
1. Early onset. Many ADHD individuals begin to show problems in early childhood, often at 3 to 4 years of age, and most have had their difficulties since the age of 7. However, it is believed that those with the mostly inattentive subtype (without prominent hyperactivity) of ADHD may not have shown noticeable symptoms at an early age.
2. Inconsistent performance of repeated tasks. ADHD individuals show wide swings in the quality, correctness, and speed with which they perform work. This may be seen in highly variable school or work performance. This variability is seen less in one-to-one activities with others, particularly if they are with their fathers or other authority figures. They also do better when the activities they are doing are new, highly interesting, or involve an immediate consequence for completing them. Group situations or relatively repetitive, familiar, and uninteresting activities are likely to cause the most problems for them.
3. Trouble following rules. ADHD individuals often have difficulty following through on instructions or assignments. This is not due to poor language comprehension, defiance, or memory impairment. Instructions do not guide behavior as well.
Frequently Associated Conditions
Persons with ADHD are more likely than others to have the following conditions:
1. Academic underachievement and learning disabilities. The vast majority of individuals with ADHD often perform below their expected levels of achievement in school relative to their tested intellectual and academic abilities. As many as 30% may also have reading disorders, while an additional 10 to 15% may have other academic disabilities, such as difficulties in math or writing.
2. Aggression or conduct problems. Studies suggest that up to 65% of individuals with ADHD have a co-existing condition known as Oppositional Defiant Disorder or aggression. This is shown by defiance toward adults or other authorities, stubbornness or disobedience of instructions, temper outbursts, destructiveness, and verbal or physical aggression toward others.
3. Emotional Immaturity. A pattern of exaggerated emotional expressions may be observed, particularly in children with ADHD, in which the individual tend to overreact emotionally to frustrating, provocative, or stressful situations. These individuals may be described as having a lower frustration tolerance and as being more moody or emotionally sensitive than others. A quickness to display anger, sadness, elation, and other normal emotions occurs frequently in ADHD children. Low self-esteem is common by late childhood or early adolescence.
4. Social skills deficits. At least 50% of ADHD individuals have problems with social relationships. They may be described as self-centered, demanding, intrusive, insensitive to the feelings of others, and unappreciative of assistance from others.
ADHD occurs in approximately 3 to 5% of the population. It is more common in individuals with a history of aggression, delinquency, substance abuse, truancy, learning, tics, or Tourette’s Syndrome and Obsessive Compulsive (OCD).
ADHD appears to have a strong biological basis, and may run in families. In a few cases, it may be connected with greater-than-normal pregnancy or birth complications. In even fewer cases, it comes as a direct result of disease or trauma to the central nervous system.
Research has not supported the view that ADHD is frequently due to the consumption of food additives, preservatives, or sugar. While in a few individuals their allergies can contribute to a worsening of ADHD, these allergies are not viewed as the cause of ADHD. Individuals with seizures or anticonvulsant drugs may develop ADHD as a side effect of their medication or may find their pre-existing ADHD features made worse by these medications. Although ADHD itself is believed to be a neurologically based disorder, many studies have shown that attention, concentration, and oppositional behavior are adversely affected by turmoil, conflict and instability in an individual’s life. This is true whether someone has ADHD.
It has been estimated that between 15 and 30% of children with ADHD ultimately “outgrow” their problems. Most individuals will continue to display their characteristics into young adulthood. Children with ADHD who begin to exhibit serious aggressiveness, defiance, and lying/stealing during the elementary school years are most likely to be at serious risk for later antisocial behavior problems. Yet some well-behaved ADHD children may also be at risk.
Evaluation / Diagnosis
There is no single medical or psychological test that diagnoses ADHD. A quality evaluation is one that is: conducted by a licensed health care professional with explicit training and experience in evaluating ADHD; comprehensive collection of information from multiple sources including family, educators, and the individual; able to “rule-in” the symptoms that make up this syndrome; and complete enough to “rule-out” other disorders that might co-exist with ADHD or that might explain ADHD.
Psychologists and other mental health professionals often integrate data collected from parents and teachers who complete rating scales about a child. Results of such tests can provide important clues as to whether a child’s difficulties are related to ADHD and/or other problems with learning, behavior, or emotional adjustment. Such scales offer measurable, information about the child, thus providing a way to compare a child’s behavior to others of the same sex and age. Psychological and educational tests of cognition, perception, attention span, visual-motor skills, memory, achievement, and social/emotional adjustment are often part of a valid and comprehensive evaluation.
No treatments have been found to “cure” this disability, but many exist that have shown effectiveness in reducing either the level of symptoms or the degree to which they impair adjustment. The most substantiated treatment is the use of medications. However, most experts agree that medication alone is never the treatment of choice. Most medications used with ADHD to help first thing in the morning or at the end of the day. Medication does not teach the child anything they have failed to learn adequately (e.g. study skills & social skills). Medications often do not return the child to “normal.” Also, medications are not effective with 100% of the people who take them.
It is often recommended that other treatments be used first or in conjunction with the stimulant medications. These other treatments include training the parents of ADHD children in more effective child-management skills, modifying teachers’ classroom behavior-management methods, adjusting the length and number of assignments given to ADHD children at one time, and providing special educational services to those ADHD children with more serious degrees of the disorder.
Other treatments that show promise are social skills training, training in self-control methods (i.e., acquiring better problem-solving skills, learning to use self-directed instructions, anger control, and questions to slow down impulsive thinking).
For ADHD adults, educating them in practical methods of coping with their disability and enlisting the assistance of others in helping to better organize and structure ADHD individuals’ work-related activities may prove helpful. Also, the impact of ADHD on relationships may need to be addressed in individual or couples therapy. Stimulant medications may be effective.
Treatments with little or no or very limited scientifically valid evidence for their effectiveness in treating the core symptoms of ADHD including elimination of sugar or food additives, high doses of vitamins, chiropractic treatment, or sensory-integration therapy.
The treatment of ADHD requires education of the individuals or their caregivers as to the nature of the disorder and the methods proven to assist with its management. Treatment is likely to be multi-disciplinary, requiring the assistance of the mental health, educational, and medical professions at various points in its course. Treatment may be needed periodically over long intervals to assist ADHD individuals in coping with their behavioral disability.
ADHD Child / Adolescent / Adult Evaluation
A comprehensive and valid assessment of symptoms of ADHD to evaluate and rule-out disorders which may co-exist with ADHD or which may explain its symptoms. Information is obtained from parents, spouses, educators, and the individual child or adult. A doctoral-level psychologist conducts this evaluation. Conclusions guide medical management, educational therapy and other interventions.