Download MOORPARK COLLEGE

MOORPARK COLLEGE
AN OVERVIEW OF ADHD
Accessibility Coordination Center & Educational Support Services
What is ADHD (ADD)?
The official definition of Attention Deficit Hyperactivity Disorder (ADHD) as it appears in the
Diagnostic and Statistical manual of the American Psychiatric Association is:
ADHD is a disorder that can include a list of nine specific symptoms of inattention and
nine symptoms of hyperactivity/impulsivity.
Individuals with ADHD may know what to do but do not consistently do what they know
because of their inability to efficiently stop and think prior to responding, regardless of the
setting or task.
Characteristics of ADHD have been demonstrated to arise in early childhood for most
individuals. This disorder is marked by chronic behaviors lasting at least six months with an
onset often before seven years of age. At this time, four subtypes of ADHD have been defined.
These include the following:
1. ADHD – Inattentive type is defined by an individual experiencing at least six of the following
characteristics:
a. Fails to give close attention to details or makes careless mistakes
b. Difficulty sustaining attention
c. Does not appear to listen
d. Struggles to follow through on instructions
e. Difficulty with organization
f. Avoids or dislikes requiring sustained mental effort
g. Often loses things necessary for tasks
h. Easily distracted
i. Forgetful in daily activities
2. ADHD – hyperactive/impulsive type is defined by an individual experiencing six of the
following characteristics:
a. Fidgets with hands or feet or squirms in seat
b. Difficulty remaining seated
c. Runs about or climbs excessively (in adults may be limited to subjective feelings
of restlessness)
d. Difficulty engaging in activities quietly
e. Acts as if driven by a motor
f. Talks excessively
g. Blurts out answers before questions have been completed
h. Difficulty waiting in turn taking situations
i. Interrupts or intrudes upon others
3. ADHD – combined type is defined by an individual meeting both sets of attention and
hyperactive/impulsive criteria.
4. ADHD – not otherwise specified is defined by an individual who demonstrates some
characteristics but an insufficient number of symptoms to reach a full diagnosis. These
symptoms, however, disrupt everyday life.
The majority of adults with ADHD have been described as experiencing symptoms very similar
to the problems experienced by children. They are often restless, easily distracted, struggle to
sustain attention, are impulsive and impatient. They have been described as experiencing
problems with stress intolerance leading to greater expressed emotion. Within the workplace
they may not achieve vocational positions or status commensurate with their siblings or
intellectual ability.
Children and adults who have ADHD exhibit degrees of inattention or hyperactivity/impulsivity
that are abnormal for their ages. This can result in serious social problems, or impairment, of
family relationships, success at school or work or in other life endeavors.
Children and adults can exhibit other psychiatric disorders (medically known as comorbidity),
along with their ADHD symptoms. Most commonly, these include oppositional defiant or
conduct disorder, along with or separate from internalizing disorders, such as anxiety and
depression.
Other definitions have existed, such as that for Attention Deficit disorder, or ADD. These use
different labels for the same conditions and can be interchanged with ADHD. For the purposes
of this fact sheet, however, we will continue to use ADHD.
Statistics:
About 1% to 3% of the school-aged population has the full ADHD syndrome, without symptoms
of other disorders. Another 5% to 10% of the school-aged population have a partial ADHD
syndrome or one with other problems, such as anxiety and depression present.
Another 15% to 20% of the school-aged population may show transient, subclinical, or
masquerading behaviors suggestive of ADHD. A diagnosis of ADHD is not warranted if these
behaviors are situational, do not produce impairment at home and school, or are clearly
identified as symptoms of other disorders.
Gender and age affect the ways in which people with ADHD express their symptoms. Boys are
about three times more likely than girls to have symptoms of ADHD. Symptoms of ADHD
decrease with age, but symptoms of associated features and related disorders increase with
age. Between 30% and 50% of children still manifest symptoms into adulthood.
Causes:
Experts have investigated genetic and environmental causes for ADHD. Some children may
inherit a biochemical condition, which influences the expression of ADHD symptoms. Other
children may acquire the condition due to abnormal fetal development, which has subtle effects
on brain regions that control attention and movement.
Recently, scientists have uncovered research based on brain imaging to localize the brain
areas involved in ADHD and have found that areas in the frontal lobe and basal ganglia are
reduced by about 10 percent in size and activity in ADHD children.
Recent research based on genetic mechanisms has focused on dopamine as the primary
neurotransmitter involved in ADHD. Dopamine pathways in the brain, which link the basal
ganglia and frontal cortex, appear to play a major role in ADHD.
Commonly suspected causes of ADHD have included toxins, developmental impairments, diet,
injury, ineffective parenting and heredity.
How is ADHD diagnosed?
While there is no biological or psychological test that makes a definitive diagnosis of ADHD, a
diagnosis can be made based on one's clinical history of abnormality and impairment.
An evaluation for ADHD will often include assessment of intellectual, academic, social and
emotional functioning. Medical examination is also important to rule out low occurring but
possible causes of ADHD like symptoms (e.g., adverse reaction to medications, thyroid
problems, etc.). The diagnostic process must also include gathering data from teachers as well
as other adults who may interact on a routine basis with the individual being evaluated.
It is even more important in the ADHD adult diagnostic process to obtain a careful history of
childhood, academic, behavioral and vocational problems. With the increased recognition that
ADHD is a disorder presenting throughout the life span, questionnaires and related diagnostic
tools for the assessment of adult ADHD have been standardized and are increasingly
available.
ADHD diagnoses are based on a person having three different symptoms. The full syndrome is
diagnosed when at least nine symptoms from both sets of subtypes (above) are present.
Partial syndromes, which are predominantly inattentive or hyperactivity/impulsivity subtypes,
are diagnosed when six or more symptoms are present from just one set.
Treatment:
There are two modalities of treatment that specifically target symptoms of ADHD. One uses
medication and the other is a non-medical treatment with psychosocial interventions. The
combination of these treatments is called multimodality treatment.
Treating ADHD in children requires a coordinated effort between medical, mental health and
educational professionals in conjunction with parents. This combined set of treatments offered
by a variety of individuals is referred to as multi-modal intervention. A multi-modal treatment
program should include: . Parent training concerning the nature of ADHD as well as effective
behavior management strategies . An appropriate educational program . Individual and family
counseling, when needed, to minimize the escalation of family problems . Medication when
required
Psychostimulants are the most widely used medications for the management of ADHD
symptoms. At least 70% to 80% of children and adults with ADHD respond positively to
psychostimulant medications.
Stimulant medications have been used to treat the cognitive and behavioral symptoms of
ADHD for more than 50 years. A study by Wilens and Biederman (1997) summarized the
findings of controlled trials validating the use of these medications. Treatment with stimulants is
beneficial in about 80% of children with ADHD.
Behavior modification techniques have been used to treat the behavioral symptoms of ADHD
for more than a quarter of a century. A summary of the literature on trials that have validated
the efficacy of this approach shows that, in many cases, behavior modification alone has not
been sufficient to address severe symptoms of ADHD.
Classroom success for children with ADHD often requires a range of interventions. Most
children with ADHD can be taught in the regular classroom with either minor adjustments in the
classroom setting, the addition of support personnel, and/or special education programs
provided outside of the classroom. The most severely affected children with ADHD often
experience a number of occurring problems and require specialized classrooms.
Laws passed during the last five years have mandated educational interventions for children
with ADHD. Today, modifications and special placements in public school settings are part of
treatment of ADHD. The coordination of school-based interventions with medical interventions
has become possible (but remains difficult) due to these changes in educational law
regulations.
Research:
Controversial and important areas of ADHD research include investigations into the definitions
of this disorder. These include the validity of partial syndromes, the need for gender-specific
criteria and age-specific criteria, and the importance of accompanying troublesome conditions.
In the areas of current ADHD statistical research: Epidemiological investigations of the true
prevalence to determine how many children have the symptoms of ADHD and of administrative
prevalence to determine how many children are recognized and treated are controversial and
important topics.
Scientists are also researching the causes of ADHD by performing investigations of the brain
and genetics. Brain asymmetries and developmental changes in specific anatomical structures
linked to ADHD and a genome scan to confirm and refute multiple hypothesized genes and to
identify unexpected genes linked to ADHD are also controversial and important research topics
in this area of research on ADHD.
Research into the treatment of ADHD is aimed at developing new pharmacological treatments
for ADHD, evaluating long-term outcomes of multi-modality treatments. Pharmaceutical
companies are developing new medications and longer acting medications.
Prognosis:
Children with ADHD are at risk for school failure, emotional difficulties and significant, negative
adult outcome in comparison to their peers. However, early identification and treatment has
demonstrated that these children can overcome many of these hurdles and achieve success.
The topic of ADHD probably will continue to be one of the most widely researched and debated
in mental health and child development.
The five-year multi-modal ADHD treatment study underway by the NIMH will provide many
answers to remaining questions regarding the diagnosis, treatment and outcome of individuals
with ADHD. Increasing awareness in the community of the nature and symptoms of ADHD also
offers encouraging signs of support and understanding for individuals with ADHD and their
families.
Resources
The information in this Fact sheet was summarized from and can be reviewed in greater depth
in the following authoritative sources:
Barkley, R.A. (1990).
Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York, NY; Guilford Press
Barkley, R.A. (in press).
Attention Deficit Hyperactivity Disorder: a Handbook for Diagnosis and Treatment -–2nd edition. New York, NY;
Guilford Press Barkley, R.A. (1997).
ADHD and the Nature of Self-Control.New York, NY: Guilford Press DuPaul, G.J. & Stoner, G. (1994).
ADHD in the Schools: Assessment and Intervention Strategies. New York, NY: Guilford Press. Goldstein, S. (1997).
Managing Attention and Learning Disorders in Late Adolescence and Adulthood: A Guide for Practitioners.
New York, NY: Wiley Interscience Press.
Goldstein, S. & Goldstein, M. (1990). Managing Attention Disorders in Children: A Guide for Practitioners. New
York, NY: Wiley Interscience Press.
Goldstein, S. & Goldstein, M. (in press). Attention Deficit Hyperactivity Disorder: A Guide for Practitioners.
New York, NY: Wiley Interscience Press.
Greenhill, L.L. & Osman, B.B. (1991). Ritalin, Theory and Patient Management. New York, NY: Mary Ann Liebert,
Inc. Publisher
Matson, J.L. (1993). Handbook for Hyperactivity in Children. Boston, MA: Allyn & Bacon
Nadeau, K.G. (1995). A Comprehensive Guide to Attention Deficit Disorder in Adults. New York, NY:
Brunner/Mazel Publishers.
Credit
CHADD gratefully acknowledges the contribution of James Swanson, Ph.D., UCI Child Development Center, a
member of CHADD's Professional Advisory Board, and Timothy Wilens, M.D., Associate Professor at Harvard
Medical School, Department of Child Psychology, in the development of facts and information presented in this
overview.
8181 Professional Place, Suite 201, Landover, MD 20785
(800) 233-4050 ---301-306-7070---FAX 301-306-7090
For questions about AD/HD or CHADD, please see the Frequently Asked Questions
http://www.chadd.org/facts/add_facts01.htm
Alternate Format Available -- Call (805) 378-1461