ADHD stands for attention deficit hyperactivity disorder. Before this disorder was changed to its current name in 1994, the condition was known as attention deficit disorder, or ADD. However, today, ADD, ADHD, and AD/HD are all used interchangeably to mean the same condition. For this article, we will use ADD, ADHD, and AD/HD interchangeably.
In recent years, attention deficit disorder has been a subject of great public attention and concern. ADD is one of the most common psychiatric disorders that appears in childhood. Children with ADD can't stay focused on a task or sit still. They often act without thinking and can rarely finish anything.
If left untreated, attention deficit disorder can have long-term effects on a child's ability to make friends or do well at school or work. Over time, children with ADD may develop
depression, poor self-esteem, and other emotional problems.
A child with ADD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from important figures such as parents, guidance counselors, and the public education system.
Some of the warning signs of ADD and ADHD include:
- Failure to listen to instructions
- Inability to organize oneself and school work
- Fidgeting with hands and feet
- Talking too much
- Leaving projects, chores, and homework unfinished
- Having trouble paying attention to and responding to details.
(Click ADD Symptoms for a more detailed list of symptoms.)
There are 3 types of
ADHD:
- ADHD, Predominantly Inattentive Type (not showing significant hyperactive-impulsive behavior)
- ADHD, Predominantly Hyperactive-Impulsive Type
- ADHD, Combined Type.
Effective treatment depends on appropriate diagnosis of ADD. A comprehensive medical evaluation of the child must be conducted to establish a correct diagnosis of ADD and to rule out other potential causes of the symptoms. ADD can be reliably diagnosed when appropriate guidelines are used. Ideally, a healthcare practitioner making a diagnosis should include input from both parents and teachers. However, some health practitioners choose to diagnose ADD without all this information and tend to either overdiagnose it or underdiagnose it.
ADD is usually diagnosed in childhood, although the condition can continue into the adult years.
Treatment Options for ADD
Research has shown that certain medications (stimulants in most cases) and behavioral therapies that help children with this condition control their activity level and impulsiveness, pay attention, and focus on tasks are the most beneficial treatments. Medications commonly prescribed for ADD include:
Despite data showing that stimulant medications are safe, there are widespread misunderstandings about the safety and use of these drugs, and some healthcare practitioners are reluctant to prescribe them. Like all medications, those used to treat ADD do have side effects and need to be closely monitored.
Most experts agree that treatment for ADD should address multiple aspects of the individual's functioning and should not be limited to the use of medications alone. Treatment should also include:
- Structured classroom management
- Parent education (to address discipline and limit-setting)
- Tutoring and/or behavioral therapy for the child.
Problems Families May Face
Parents need to carefully evaluate treatment choices when their child receives a diagnosis of ADD. When they pursue treatment for their children, families face high out-of-pocket expenses because treatment for ADD (and other mental illnesses) is often not covered by insurance policies. In schools, treatment plans are often poorly integrated. In addition, there are few special education funds directed specifically for ADD. All of these factors lead to children who do not receive proper and adequate treatment. To overcome these barriers, parents may want to look for school-based programs that have a team approach involving parents, teachers, school psychologists, other mental health specialists, and physicians.
There is no cure for ADD. Children with the disorder seldom outgrow it; however, some may find adaptive ways to accommodate the ADD as they mature.
Brain imaging research using a technique called magnetic resonance imaging (MRI) has shown that differences exist between the brains of children with and without ADD. In addition, there appears to be a link between a person's ability to pay continued attention and the use of glucose -- the body's major fuel -- in the brain. In adults with ADD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention.
Research also shows that the condition tends to run in families, so there are likely to be genetic influences. Children who have ADD usually have at least 1 close relative who also has it. At least one-third of all fathers who had ADD in their youth have children with ADD. Even more convincing of a possible genetic link is that when 1 twin of an identical twin pair has the disorder, the other is likely to have it too.
Research has also shown that the use of stimulants alone is more effective than behavioral therapies in controlling the core symptoms of ADD -- inattention and aggression. In other areas of functioning (such as
anxiety symptoms, academic performance, and social skills) the combination of stimulant use with intensive behavioral therapies was consistently more effective. Researchers continue to track these children into adolescence to evaluate the long-term outcomes of these treatments, and ongoing reports will be published.
ADD was first described by Dr. Heinrich Hoffman in 1845. As a physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit disorder. Yet it was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing -- children who today would be easily recognized as having ADD. Since then, several thousand scientific papers on the disorder have been published, providing information on its nature, course, causes, impairments, and treatments.
ADD, which is the most commonly diagnosed behavioral disorder of childhood, occurs in 3 percent to 5 percent of school-age children in a 6-month period.
Pediatricians report that approximately 4 percent of their patients have ADD, but in practice, the diagnosis is often made in children who meet some, but not all, of the criteria.
Boys are 2 to 3 times more likely to have ADD than girls are.
This condition is found in all cultures, although prevalences differ; differences are thought to stem more from differences in diagnostic criteria than from differences in presentation.
Key information about this condition includes:
- Attention deficit disorder, or ADD, is an outdated name for ADHD. When used today, ADD refers to a type of ADHD -- predominantly inattentive type (that does not show significant hyperactive-impulsive behavior). In 1994, ADD was changed to ADHD, or attention deficit hyperactivity disorder. However, in popular conversation, ADD, ADHD, and AD/HD are used interchangeably.
- ADD affects an estimated 4.1 percent of youths ages 9 to 17 in a 6-month period. This means that in a classroom of 25 to 30 children, it is likely that at least 1 child will have attention deficit disorder.
- About 2 to 3 times more boys than girls have ADD.
- Children with untreated ADD have higher than normal rates of injury.
- ADD often co-occurs with other problems, such as depressive and anxiety disorders, conduct disorder, drug abuse, or antisocial behavior.
- Symptoms usually become evident in preschool or early elementary years. The disorder frequently persists into adolescence and occasionally into adulthood.
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