Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) has become one of this country's most talked about medical issues regarding children. Since ADHD spans the developmental spectrum for children and adults, this information pertains to all age groups.
One of the leading diagnostic manuals used in the mental health profession is the Diagnostic and Statistical Manual - IV (current version is the fourth revision). When a person sees a medical or mental health professional and receives a diagnosis of ADHD, it is generally this manual's definition that is used. So, according to the DSM-IV just what is ADHD?
There are three categories of ADHD:
- ADHD/Predominantly Inattentive Type
- ADHD/Predominantly Impulsive Type
- ADHD/Combined Type
As the name implies, the ADHD Predominately Inattentive Type refers to those individuals who present with characteristics often called "dreamy", "in a fog", "not listening", "in his own world", etc. These individuals do not display many (if any) of the hyperactive or impulsive behaviors of the Predominately Impulsive Type. Impulsive (or hyperactive) individuals often are described as "like her motor is always running", "always on the go", "can't sit still", and so forth. These individuals are usually noticed right away when in a structured setting (like school). The Inattentive types often go unnoticed for years because they don't disrupt and generally do not draw attention to themselves. Those individuals with the Combined Type present with significant characteristics of both Inattentive and Impulsive behaviors. Each of the three categories, by DSM-IV definition, has a specific number and pattern of symptoms as part of the definition.
One of the key points in the definition and diagnosis of ADHD is the age of onset (earliest age when symptoms were present). Simply put, ADHD by definition MUST have been present since early childhood. This requires parents and professionals to conduct a careful social and developmental history that will aid in the diagnosis. If age of onset is after early childhood - after age 7- then the primary diagnosis will not likely be ADHD. Older children and adults who are being considered for ADHD will have to have reports of symptoms or characteristics dating back to early childhood before ADHD will be diagnosed.
Assisting in the diagnosis of ADHD are several useful surveys of behaviors commonly completed by those who spend the most time with the individual. Parents and teachers are the most common reporters of children's behaviors. The surveys consist of rating scales that can help in identifying when Johnnie's impulsivity is "normal" or "beyond normal". Which brings up an important point regarding ADHD: Everyone, young and old alike, has impulsive behaviors from time to time. All of us "drift off "and are not always attentive to things or people around us. It is when these behaviors are very frequent and regularly interfere with daily activities that we begin to question the need for assessment for ADHD and/or other possible causes. Interestingly, ADHD characteristics look pretty much the same across age groups. The same descriptors apply to the young child, adolescent and adult.
To summarize, ADHD (as currently defined by the DSM-IV) has two distinct components: Inattentive behaviors and Impulsive Behaviors. They can present as one or the other or in combination. The professional who is diagnosing will take a careful history of the patient, will obtain ratings from persons who best know the patient and will make a diagnosis based on the specific criteria defined by the DSM for each possible type.
Following a diagnosis of ADHD, the family (or individual if adult age) will have to make decisions regarding treatment. Available alternatives include medication, counseling and behavior management. The research is lengthy on treatment efficacy (does it work) and professionals sometimes prefer one type of treatment over the others available. Family values and belief systems often play a major role in the decision of one treatment over another.
If choosing medication as a treatment plan, several types are available each of which impacts the body's chemical system in a different way. Since some people respond to one type and not another, trial and error is often the approach taken in identifying the most effective medication. Each type carries with it the potential for minor as well as possible major side effects. Again, each individual is different and, as is the case for any medication, side effects vary widely.
Counseling and behavior management strategies can be very useful to the individual and family. Learning what to expect from the disorder, what not to expect and how to create a supportive family environment are essential goals of these therapies.
School age children will have to have particular attention paid to the characteristics of ADHD that interfere with learning. Parents are encouraged to speak with their child's teachers about the specific areas that cause learning problems (listening with attention, rule-breaking, etc.) Together, parents, teachers and student can cooperatively determine what accommodations (if any) will be needed to assist the ADHD student to learn more effectively.
The following web sites provide in depth information that may be useful to those who wish to further explore this topic:
http://www.help4adhd.org/This site is the National Resource Center on ADHD. Information is current and comprehensive.
http://psychcentral.com/lib/2007/an-introduction-to-adhd/ An easy to read piece with lots of additional resources.
Updated June 2014