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Attention Deficit Disorder Hyperactivity (ADHD/ADD)

What Is Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Attention Deficit Hyperactivity Disorder (ADHD, ADD) is a prevalent childhood disorder, which can continue into adulthood, affecting approximately 11% of children 4-17 years of age and approximately 4% of the adult population. The average age of onset is age 7, but children reported by their parents as having more severe ADHD are typically diagnosed earlier. Boys are three to four times more likely to be diagnosed with ADHD than girls. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that 5% of children have ADHD. However, studies in the US have estimated higher rates in community samples. These studies show that the rate of ADHD diagnosis has been steadily increasing for the past several years. ADHD diagnosis increased an average of 3% per year from 1997 to 2006 to 5% per year from 2003 to 2011. The increase in diagnosis is joined by an increase in the percentage of children with ADHD, from 7.8% in 2003 to 9.5% in 2007 to 11.0% in 2011. Prevalence of ADHD diagnosis also varies substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.

The rate of prescription for ADHD medication has also increased over the past years, from 4.8% in 2007 to 6.1% in 2011. More US children were receiving ADHD treatment (medication and or therapy/counseling) in 2011 compared to 2007; however, as many as 17.5% of children with current ADHD were not receiving either medication for ADHD or mental health counseling in 2011. Rates of medication prescriptions vary by state, from a low of 2% in Nevada to a high of 10.4% in Louisiana.

ADHD has three subtypes:

  • Predominantly Hyperactive-Impulsive. This person will be restless, have difficulty being quiet – blurting out answers before hearing the entire question, constantly needing to move.
  • Predominantly Inattentive. This person is easily distracted, can’t focus on details, makes careless mistakes, is forgetful.
  • Combined Hyperactive-Impulsive and Inattentive. This is the most common form of ADHD, and is a combination of the above types.
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What Causes Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Studies have shown that the brains of individuals with ADHD develop differently than those without ADHD. In ADHD patients, certain areas of the brain, including those used in thinking, paying attention, and planning, develop about three years more slowly than non-ADHD patients. Scientists believe that this accounts for many of the ADHD symptoms, including inability to focus and hyperactivity. The exact cause of this different developmental pattern has not been identified, though studies have suggested possible links with genetics, environmental elements, brain injuries, food additives, and smoking cigarettes. To learn more about the causes that may be behind ADHD, read about ADHD risk factors.

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Risk Factors For Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Potential risk factors for ADHD include:

  • Genetics. Several studies suggest a link between certain genes and ADHD. According to the National Institute of Health, a study of children with ADHD found that those who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. Certain “copy number variations” or duplicates of particular DNA segments have also been found to be more prevalent in those with ADHD.
  • Family History. Closely intertwined with genetics, studies on ADHD in twins and families have shown that the disease often runs in families. A child with ADHD is four times as likely to have a relative who has also been diagnosed. Among twins, ADHD is more likely to occur in those who are identical than among those who are fraternal.
  • Premature birth. A study of more than a million children in Sweden found that those who were born very early (23 to 28 weeks) had more than double the risk of developing ADHD than those born in normal term (39 to 41 weeks).
  • Sex. New York University Langone Medical Center reports that Children with ADHD is more prevalent in boys than girls, with the ratio estimated at anywhere from 4:1 to 9:1
  • Environmental toxins. Exposure to certain environmental toxins, especially during pregnancy, can increase a child’s risk of developing ADHD. Studies show that the prefrontal cortex, the area of the brain responsible for attention, hyperactivity, learning disorders, and anti-social behaviors, is especially vulnerable to environmental toxins. Mercury, lead, polychlorinated biphenyls (PCBs) and cigarette smoke exposure have all been linked to higher rates of ADHD.
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Diagnosing Attention Deficit Disorder Hyperactivity (ADHD/ADD)

There is no single test to diagnose ADHD. Symptoms of ADHD vary from person to person, and regular child-like behavior can often be mistaken for ADHD. ADHD symptoms are often noticed first by parents or teachers; who may observe the child’s inability to focus or tendency to act out in class. General physicians and/or specialists can help to determine whether or not the child’s symptoms are a result of ADHD or another condition. Often, ADHD-like symptoms can be triggered by life events such as family death or divorce, or by health conditions such as vision/hearing problems, inner ear infections, or anxiety/depression.

The following are the diagnostic criteria for ADHD patients as outlined by the Diagnostic and Standard Manual for Mental Disorders.

For a diagnosis of inattentive ADHD, patients must experience 6 or more of the following symptoms:

  • Fails to give close attention to details or makes careless mistakes.
  • Has difficulty sustaining attention.
  • Does not appear to listen.
  • Struggles to follow through on instructions.
  • Has difficulty with organization.
  • Avoids or dislikes tasks requiring a lot of thinking.
  • Loses things.
  • Is easily distracted.
  • Is forgetful in daily activities.

For a diagnosis of hyperactive – impulsive ADHD, patients must experience 6 or more of the following symptoms:

  • Fidgets with hands or feet or squirms in chair.
  • Has difficulty remaining seated.
  • Runs about or climbs excessively in children; extreme restlessness in adults.
  • Difficulty engaging in activities quietly.
  • Acts as if driven by a motor; adults will often feel inside like they were driven by a motor.
  • Talks excessively.
  • Blurts out answers before questions have been completed.
  • Difficulty waiting or taking turns.
  • Interrupts or intrudes upon others.

For a diagnosis of inattentive & hyperactive – impulsive ADHD, patients must experience a combination of the above symptoms. Additionally, the following criteria must be met:

  • Symptoms must cause impairment in two or more settings (i.e. home and school) to avoid misdiagnosing a smaller, more isolated behavioral problem
  • Symptoms must cause significant impairment in social, academic, or occupational functioning. Evidence of impairment must be clear.
  • Some symptoms must have been present before the age of twelve years of age. Symptoms do not necessarily need to have been disruptive. Symptomatic behaviors before the age of twelve suggest a lag in brain development associated with ADHD.

Primary care clinicians should also assess the patient for other conditions that might occur along with ADHD. These include:

  • Emotional or behavioral
    • Depression
    • Anxiety
    • Conduct disorders
  • Developmental
    • Learning Disabilities
    • Language delay or processing disorders
    • Sleep apnea
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Symptoms of Attention Deficit Disorder Hyperactivity (ADHD/ADD)

ADHD can occur in children, teens, and adults. The symptoms of ADHD at each stage of life can present themselves differently.

Children and Teens with ADHD                                                                                                                                                                                       According to the National Institute of Mental Health, children with ADHD may exhibit the following symptoms:

  • Inattention. Individuals may:
    • Be easily distracted, miss details, forget things, and frequently switch from one activity to another
    • Have difficulty focusing on one thing
    • Become bored with a task after only a few minutes, unless they are doing something enjoyable
    • Have difficulty focusing attention on organizing and completing a task or learning something new
    • Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
    • Not seem to listen when spoken to
    • Daydream, become easily confused, and move slowly
    • Have difficulty processing information as quickly and accurately as others
    • Struggle to follow instructions
  • Hyperactivity. Individuals may:
    • Fidget and squirm in their seats
    • Talk nonstop
    • Dash around, touching or playing with anything and everything in sight
    • Have trouble sitting still during dinner, school, and story time
    • Be constantly in motion
    • Have difficulty doing quiet tasks or activities.
  • Impulsivity. Individuals may:
    • Be very impatient
    • Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
    • Have difficulty waiting for things they want or waiting their turns in games
    • Often interrupt conversations or others’ activities.

Adults with ADHD                                                                                                                                                                                                                          Adult ADHD symptoms are experienced and perceived in a different manner than are childhood ADHD symptoms. Many of the symptoms of ADHD experienced during childhood can continue on into adulthood.

The following symptoms may be signs of adult ADHD:

  • Difficulty getting and/or staying organized. This may be missed during childhood but becomes more evident with the responsibilities of adult life (i.e. paying bills, cleaning the house, raising children, etc.)
  • Reckless driving. Since a hallmark of ADHD is difficulty staying focused, adults with ADHD are more likely to speed or be involved in traffic accidents.
  • Poor listening skills. Since many people with ADHD can’t focus well, it can be hard to listen to your spouse, boss, etc. This can make it difficult to finish tasks and maintain healthy intimate relationships.
  • Restlessness. Children with ADHD are called “hyperactive”; in adults it is perceived as having more difficulty relaxing, feeling edgy, and constantly being tense.
  • Explosions of anger. Minor triggers can lead to tantrums, since emotions are not always easily controlled.
  • Procrastination. Starting tasks and finding the self-motivation to begin projects may be difficult.
  • Difficulty setting priorities. Individuals might have a hard time determining which tasks are more critical, and may prioritize in a manner that is not beneficial to them. (i.e. Choosing to play a video game over finishing a crucial work presentation due the next day.)
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Prognosis

Approximately 1/3 of children with ADHD grow out of the disorder as they near adulthood. Another 1/3 continue to experience some symptoms, and the final 1/3 suffer severe symptoms.

Managing symptoms with medications, cognitive therapy, and life coaching significantly improves quality of life. Unfortunately just 11% of adults with this disorder receive treatment. Thus it is not surprising that nearly 50% of adults with ADHD also have an anxiety disorder, almost 40% have a mood disorder and 15% develop substance-abuse issues.

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Living With Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Though the symptoms of ADHD can be disruptive, there are strategies you can implement to help manage this disorder.

  • Cognitive Behavior Therapy (CBT). Don’t rely exclusively on medication to manage your symptoms. Research has suggested that CBT works very well for ADHD. This form of therapy is short – term – 12 to 15 one-hour sessions. The focus is not on the past but on your thought patterns and how to change those irrational, destructive thoughts and belief systems.
  • Be organized. Since lack of focus and easy distraction are hallmarks of ADHD, plan ahead for the fogginess. For instance, use a day planner or calendar app to help you remember appointments and must-make deadlines. Create a space in your house where each night you put items you will need the next day. It is also helpful to have specific areas for things that are easy to lose – such as keys and bills.
  • Time management tricks. Decide on a specific time period for each task – set a timer to go off when the time is up. Allow yourself 15 minutes more per task than you think you will need. Use a wristwatch or desk clock (one in your sightline) to help you keep track of time. When you have an appointment, tell yourself you need to be there at least 15 minutes earlier than the set time.
  • Create a system for managing your money. Online banking helps you keep better track of your finances. You can set up electronic reminders for bill paying and use free services such as Mint to keep track of budgets and bank and credit accounts.
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Screening

As with many disorders, there is no single screening test for ADHD. Your doctor will take your medical history, give you a physical exam, perhaps talk to your spouse and other family members to aid in the assessment of your behavior. Part of the clinical assessment will likely include a rating scale.

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Prevention

There are no proven ways to prevent ADHD, although avoiding smoking and drinking during pregnancy may help lower the risk of your child developing ADHD.

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Medication And Treatment

Psychotherapy and Non-Medical Treatments for ADHD                                                                                                                                                                                                                          There are a number of behaviorally aimed therapies that can help lessen ADHD symptoms. These include:

  • Cognitive Behavioral Therapy (CBT) is aimed at controlling behavioral symptoms of ADHD through discussion-based therapy sessions. In these sessions, patients work with therapists to identify problematic thought patterns and learn to think constructively through the disorder. This can help both patients and families better control the symptoms and promote change in behavioral patterns.
  • Social skills training is aimed at assisting a child with ADHD in learning the importance of common social behaviors like basic manners, sharing, and waiting for a turn. This can be helpful in ensuring that the child functions normally in social settings and is able to make friends and acquaintances.

Medication Treatment for ADHD                                                                                                                                                                                                                                                                     The same kinds of medications used to treat childhood ADHD are used for adults. The ages listed indicate FDA approval for the specified age group.

Stimulants                                                                                                                                                                                                                                                                                                       According to the National Institute of Mental Health, although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior. Medications also may improve physical coordination.

  Short – acting stimulants:

  • amphetamine (Adderall) 3 and older
  • dexmethylphenidate (Focalin) 6 and older
  • dextroamphetamine (Dexedrine, Dextrostat) 3 and older
  • lisdexamfetamine dimesylate (Vyvanse) 6 and older
  • methamphetamine (Desoxyn) 6 and older
  • methylphenidate (Ritalin) 6 and older
  • methylphenidate patch (Daytrana) 6 and older
  • methylphenidate (oral solution and chewable tablets) (Methylin) 6 and older

     Extended release and long-acting stimulants:

  • extended release amphetamine (Adderall XR) 6 and older
  • extended release dexmethylphenidate (Focalin XR) 6 and older
  • extended release methylphenidate (Metadate CD, Metadate ER, Ritalin SR) 6 and older
  • long – acting methylphenidate (Ritalin LA, Concerta) 6 and older

Non – stimulant medications

  • atomoxetine (Strattera) 6 and older
  • guanfacine (Intuniv) 6 and older

Side Effects for ADHD Medications 

According to the National Institute for Mental Health, most side effects of ADHD medications are minor and disappear when dosage levels are lowered.

Minor side effects include:

  • Decreased appetite. Children seem to be less hungry during the middle of the day, but they are often hungry by dinnertime as the medication wears off.
  • Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose. The doctor might also suggest that parents give the medication to their child earlier in the day, or stop the afternoon or evening dose. To help ease sleeping problems, a doctor may add a prescription for a low dose of an antidepressant or a medication called clonidine.
  • Stomachaches and headaches.
  • A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may appear to have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.

Possible Rare, Serious Side effects:                                                                                                                                                                                                                                                                                  The National Institute of Mental Health reports that in 2007 the FDA required that all makers of ADHD medications develop Patient Medication Guides because a review of data found that       ADHD patients with heart conditions had a slightly higher risk of the following:

  • Strokes
  • Heart attacks
  • Sudden death

The review also found a slightly higher risk (about 1 in 1,000) for medication-related psychiatric problems in patients who had no history of psychiatric problems, such as:

  • Hearing voices
  • Having hallucinations
  • Becoming suspicious for no reason
  • Becoming manic.

In addition, the non-stimulant ADHD medication called atomoxetine (Strattera) carries a warning that children and teenagers with ADHD who take the drug are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take atomoxetine. Call a doctor right away if your child shows any of the following symptoms:

  • Acting more subdued or withdrawn than usual
  • Feeling helpless, hopeless, or worthless
  • New or worsening depression
  • Thinking or talking about hurting himself or herself
  • Extreme worry
  • Agitation
  • Panic attacks
  • Trouble sleeping
  • Irritability
  • Aggressive or violent behavior
  • Acting without thinking
  • Extreme increase in activity or talking
  • Frenzied, abnormal excitement
  • Any sudden or unusual changes in behavior.

 

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Complementary and Alternative Treatment

In addition to medication and therapy, there are a number of alternative treatments that may help treat the symptoms of ADHD. Talk to your physician about any possible drawbacks and potential benefits to some of these alternative treatments:

  • Meditation or Yoga. These activities are relaxing and also teach discipline.
  • Supplements. There is no evidence that vitamins, minerals or herbal supplements affect ADHD symptoms. The National Center for Complementary and Alternative Medicine (NCCAM) warns that If you are considering a dietary supplement for ADHD, you should keep in mind that “natural” does not necessarily mean “safe.” Some dietary supplements may have side effects, and some may interact with medications or other dietary supplements. Some vitamins and minerals are toxic at high doses. Before using dietary supplements or other complementary approaches for ADHD, consult your health care provider.
  • Nutrition. Studies have not proven a conclusive link but it has been recommended to eliminate caffeine, sugar and other foods associated with hyperactivity, as well as allergens such as eggs, milk and wheat. While there is also no conclusive evidence that eliminating food additives and colorings helps prevent symptoms, it is another option to discuss with your doctor. NCCAM note that research regarding whether or not omega-3 fatty acids help in the treatments of ADHD has been inconclusive.
  • Biofeedback Training. Also known as neurofeedback, this involves sessions where you are hooked up to a machine monitoring brain wave patterns while you focus on certain tasks. No conclusive scientific proof exists that this treatment works.
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Care Guide

Here are some helpful tips to make living with ADHD easier:

  • Get Enough Sleep. According to the experts at the Mayo clinic, fatigue often makes ADHD symptoms worse.
  • Don’t Self-Attack. Having ADHD is a fact of life. Accept this and do everything you can to manage the condition.
  • Keep Track Of Meds. A pill container is likely your best strategy. It’s been suggested that buying three weekly pill containers and filling them at the same time helps keep you organized.
  • Control Negative Impulses. Strategies to achieve this include stimulating your mind in healthy ways like puzzles, exercise and music.
  • Solicit Support. It’s okay to ask for help. Hire a housekeeper if chores are getting out-of-hand; ask your friends and family to be an ear when you need it…
  • Manage Your Clutter. Visually gazing at “stuff” can be overwhelming. Organize your home and throw away or donate what you do not need. Do it in spurts – you’ll never do it all in one sitting! Garbage bags are your friend.
  • Just Say No. You don’t need to sign on for every volunteer opportunity or every committee that comes your way. Set priorities and don’t take on more extra curriculums than you can easily handle.
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When To Contact A Doctor

If you or your children suffer from classic symptoms of ADHD such as lack of focus, restlessness, or forgetfulness, contact a doctor for an evaluation.

Call your doctor if you or your children have side effects of ADHD medications, especially sudden and unusual changes and behavior including thoughts of self – harm and feelings of agitation.

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Questions For A Doctor

Here are some questions to ask:

  • Have other conditions been ruled out?
  • What are the pros and cons of stimulants versus non-stimulant ADHD meds? What are the alternatives to medications?
  • How will ADHD affect me? Does it put me at risk for developing other psychiatric disorders?
  • What are some resources I should know about for ADHD?
  • How closely do I need to be monitored?
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Resources

For more information about ADHD:

Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) is a nationally recognized non-profit authority on ADHD with local and virtual chapters and a virtual conference series with experts.

The Attention Deficit Disorder Association is dedicated to helping adults with ADHD lead better lives. The organization, which was founded in 1989, holds and annual conference and offers an online resource guide, webinars, an online store with books on ADHD.

ADHD & You offers advice for people with ADHD, parents and caregivers, and educators and other school personnel. There is a section for Spanish-speaking visitors.

The National Center for Learning Disabilities has advice and resources about ADHD as well as information about how ADHD can co-exist with other learning disabilities.

Studying with ADHD

For information about medications for ADHD:

The National Institute of Mental Health lists FDA-approved medications for ADHD along with the possible side effects.

 

To join a support group:

Daily Strength offers an ADHD/ADD online support group.

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