ADHD/ADD IN CHILDREN AND ADULTS
Parents are distressed when they receive a note from school saying that their child won't listen to the teacher or causes trouble in class. One possible reason for this kind of behavior is Attention Deficit/Hyperactivity Disorder (ADHD).
Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is misbehaving or different but they may not be able to tell exactly what is wrong.
Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level. ADHD occurs in 3-5% of school age children. ADHD must begin before the age of seven and it can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.
A child with ADHD often shows some of the following:
- trouble paying attention
- inattention to details and makes careless mistakes
- easily distracted
- loses school supplies, forgets to turn in homework
- trouble finishing class work and homework
- trouble listening
- trouble following multiple adult commands
- blurts out answers
- fidgets or squirms
- leaves seat and runs about or climbs excessively
- seems "on the go"
- talks too much and has difficulty playing quietly
- interrupts or intrudes on others
There are three types of ADHD. Some people have only difficulty with attention and organization. This is also sometimes called Attention Deficit Disorder or ADD. This is ADHD inattentive subtype. Other people have only the hyperactive and impulsive symptoms. This is ADHD-hyperactive subtype. The Third, and most commonly identified group consists of those people who have difficulties with attention and hyperactivity, or the combined type.
A child presenting with ADHD symptoms should have a comprehensive evaluation. Parents should ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat this medical condition. A child with ADHD may also have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or bipolar disorder. These children may also have learning disabilities.
Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer. The child experiences more failure than success and is criticized by teachers and family who do not recognize a health problem.
Research clearly demonstrates that medication can help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non-stimulant, straterra (atomoxetine). Other medications such as intuniv, guanfacine, kapvay, clonidine, and some antidepressants may also be helpful.
Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be more productive. Cognitive therapy can help a child build self-esteem, reduce negative thoughts, and improve problem-solving skills. Parents can learn management skills such as issuing instructions one-step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.
Symptoms of attention deficit hyperactivity disorder (ADHD) in children and adolescents are predominantly external and easy to observe, such as physical hyperactivity. An exception is predominantly inattentive ADHD, more common in girls. With age, a decrease in observable symptoms of ADHD seems to occur. Adults with ADHD have a longer delay before refocusing when their attention is misdirected, and they have difficulty switching tasks. The hyperactivity and impulsivity of the adult with ADHD are often more subtle than those symptoms types in children. For example, while hyperactivity may result in children being fidgety and frequently getting up from sitting, this symptom in adults may involve the adult getting bored easily and being unhappy about having to sit still rather than having to frequently change their position. On neuropsychological tests, these individuals often have trouble with sustained effort, planning, organization, visual tracking, and listening attentively.
ADHD is characterized by a long-term history of inattention, impulsiveness, and variable amounts of hyperactivity. Remember that all of these symptoms are normal human characteristics, so ADHD is not diagnosed solely based on the presence of these normal human behaviors. ADHD is determined by the degree of these behaviors. People with ADHD have these normal human characteristics to an excessive degree, with a poor ability to easily control them.
The Evolution of ADHD Characteristics from Childhood to Adulthood
Cannot sit still
Always on the go
Inability to relax
Unhappy/discontent when inactive
Can't stay in line
Temper tantrums or outbursts
Snap decisions, recklessness
Switching tasks rapidly
Felling "down" when bored or "up" when excited/stimulated
Cannot finish work
Does not appear to hear
Poor time management
Misses part of conversation
Although some adults with ADHD may not meet the full criteria used to diagnose ADHD in children, they may still experience significant impairment in certain aspects of life. Depending on their professional or domestic situation, these adults may need to deal with more complex abstract issues that can be difficult depending on their degree of ADHD severity. Consequently, a given individual's perception of his or her own degree of impairment my vary.
Some characteristics of adult ADHD include the following (remember these are normal human behaviors; ADHD is diagnosed based on the presence and severity of more than one of these characteristics):
- Persistent motor hyperactivity: You may feel restless, be unable to relax or settle down, or be discontent while active.
- Attention difficulties: You may have trouble keeping your mind on a conversation. You may be constantly aware of other things going on around you even when you try to filter them out. You may have difficulty reading, finishing a task, or with focus or you may experience frequent forgetfulness.
- Affective lability: This means that you can shift from a normal mood to depression or excitement, and these shifts can be either reactive or spontaneous.
- Disorganization or inability to complete tasks: You may be disorganized at work, home, or school. You frequently do not complete tasks or you switch from one task to another.
- Short temper with short-lived explosive outbursts: You may lose control for short times or be easily provoked to anger or constantly irritable, and these problems may interfere with your personal relationships.
- Impulsivity: Impulsiveness may be minor (for example, talking before thinking, interrupting conversation, impatience) or major. Abruptly starting or stopping relationships (for example, multiple marriages, separations), antisocial behavior (for example, shoplifting), and excessive involvement in pleasurable activities without recognizing possible consequences (for example, buying spree) are examples of major impulsivity. The bottom line is that if you wait to do something, you experience discomfort.
- Emotional overreaction: You react excessively or inappropriately with depression, confusion, uncertainty, anxiety, or anger to ordinary stresses. These emotional responses interfere with your ability to solve problems