What is ADHD?
Robert D. Smith, PhD
Robert D. Smith, PhD
Attention-deficit/hyperactivity disorder (ADHD) is a developmental brain disorder with symptoms of hyperactivity, impulsiveness and/or inattention.
Many of the symptoms of ADHD occur from time to time in everyone. For people with ADHD, the number and frequency of these symptoms is greater than most people and significantly impairs educational achievement, career success and life success in general.
Symptoms
The distinct symptom DSM-IV categories of ADHD are:
Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt other peoples' conversations.
Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.
Inattention: easily distracted, day-dreaming, not finishing work, difficulty listening.
The DSM-IV identifies three ADHD subtypes: (1) Inattentive; (2) hyperactive/impulsive; and (3) combined.
There is growing discussion between experts that the inattentive type may be two different types. A Unique ADD Type, not yet officially recognized is a distinct different information processing disorder characterized by sluggish cognitive tempo.
Diagnosis is based on criteria specified in the DSM-IV or the ICD-10. No objective test has been identified as sufficient evidence to make a diagnosis of ADHD. Diagnosis is therefore based on clinical judgment. However, neuropsychological tests can provide significant objective evidence supporting clinical judgment. In addition, impairment of executive functioning is often present.
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) is published by the World Health Organization. The ICD-10 provides criteria and codes to classify diseases. The American Psychiatric Association used the general outline of mental disorder classifications in the ICD-10 and tried to improve the diagnostic criteria and developed the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
In North America, the DSM-IV criteria are used to make a diagnosis of ADHD, while European countries usually use the ICD-10. Previous editions of the ICD series have used the term Attention Deficit Disorder (ADD) with and without hyperactivity/impulsiveness. The DSM-IV has adopted the term Attention Deficit/Hyperactivity Disorder (ADHD) with and without hyperactivity/impulsiveness. The two terms mean essentially the same thing and have resulted in confusion. However, the use of the term ADD to refer to ADHD, predominantly inattentive type makes good common sense.
Many of the symptoms of ADHD occur from time to time in everyone. For people with ADHD, the number and frequency of these symptoms is greater than most people and significantly impairs educational achievement, career success and life success in general.
Symptoms
The distinct symptom DSM-IV categories of ADHD are:
Impulsiveness: acting before thinking of consequences, jumping from one activity to another, disorganization, tendency to interrupt other peoples' conversations.
Hyperactivity: restlessness, often characterized by an inability to sit still, fidgeting, squirminess, climbing on things, restless sleep.
Inattention: easily distracted, day-dreaming, not finishing work, difficulty listening.
The DSM-IV identifies three ADHD subtypes: (1) Inattentive; (2) hyperactive/impulsive; and (3) combined.
There is growing discussion between experts that the inattentive type may be two different types. A Unique ADD Type, not yet officially recognized is a distinct different information processing disorder characterized by sluggish cognitive tempo.
Diagnosis is based on criteria specified in the DSM-IV or the ICD-10. No objective test has been identified as sufficient evidence to make a diagnosis of ADHD. Diagnosis is therefore based on clinical judgment. However, neuropsychological tests can provide significant objective evidence supporting clinical judgment. In addition, impairment of executive functioning is often present.
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) is published by the World Health Organization. The ICD-10 provides criteria and codes to classify diseases. The American Psychiatric Association used the general outline of mental disorder classifications in the ICD-10 and tried to improve the diagnostic criteria and developed the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).
In North America, the DSM-IV criteria are used to make a diagnosis of ADHD, while European countries usually use the ICD-10. Previous editions of the ICD series have used the term Attention Deficit Disorder (ADD) with and without hyperactivity/impulsiveness. The DSM-IV has adopted the term Attention Deficit/Hyperactivity Disorder (ADHD) with and without hyperactivity/impulsiveness. The two terms mean essentially the same thing and have resulted in confusion. However, the use of the term ADD to refer to ADHD, predominantly inattentive type makes good common sense.
Adolescents and adults with ADHD often develop coping mechanisms for hypeactivity/impulsivness that mask their impairment. Problems with inattention and executive functions persist and are not readily observable. Adults are diagnosed under the DSM-IV criteria. However, the existing DSM-IV criteria were established based on how the condition is manifested in elementary age children. Adults usually having more symptoms of inattention and fewer of hyperactivity or impulsiveness than children do. Consequently, criteria for adult manifestation are not well established.
Frequency
It affects about 3 to 5% of children. It is characterized by a persistent pattern of impulsiveness, hyperactivity and/or inattention. ADHD has been reported to be twice as common in boys as in girls, but this discrepancy appears to be due to bias in research methodology. ADHD is generally a chronic disorder with 30 to 50% of individuals diagnosed in childhood continuing to have symptoms into adulthood.
Normal vs. ADHD behavior
In general, children with ADHD have a hard time with normal activities of everyday life because of significant problems with inattention, hyperactivity or impulsive behavior. Unlike the normally high level of activity sometimes seen in children who do not have ADHD, the hyperactivity of ADHD happens more often and is typically more haphazard, poorly organized and not goal directed (has no real purpose).
Signs in children include making careless mistakes in school work, being easily distracted from play, appearing as if they are not listening when spoken to, not following instructions, and avoiding or disliking tasks that require concentration, schoolwork in particular. Parents therefore need to be aware of some of the signs of ADHD, and know how and where to seek help if they feel their child may have this condition. Parents may not be aware that their child has ADHD, though they usually know that something is not right.
It can be difficult to recognize the signs that your teen may have ADD or ADHD because ADD and ADHD teens display symptoms that are much like just being a teenager, only more exaggerated. Inattentiveness, forgetfulness, under achievement, procrastination, impulsiveness, and disorganization can be found in many teenagers, but they may be worse in teens with ADD or ADHD. They may forget to write down an assignment or leave it at school. They may forget to bring a book home or will bring the wrong one.
Treatment
Methods of treatment usually involve some combination of medications, behavior modifications, life-style changes, and counseling. Stimulant medications such as Adderall and Ritalin and some anti-depressant medications such as Strattera and Welbutrin are the primary medications used to treat ADHD. Medications are generally considered safe. However, recent findings have questioned that conclusion and ongoing studies are currently underway.
Frequency
It affects about 3 to 5% of children. It is characterized by a persistent pattern of impulsiveness, hyperactivity and/or inattention. ADHD has been reported to be twice as common in boys as in girls, but this discrepancy appears to be due to bias in research methodology. ADHD is generally a chronic disorder with 30 to 50% of individuals diagnosed in childhood continuing to have symptoms into adulthood.
Normal vs. ADHD behavior
In general, children with ADHD have a hard time with normal activities of everyday life because of significant problems with inattention, hyperactivity or impulsive behavior. Unlike the normally high level of activity sometimes seen in children who do not have ADHD, the hyperactivity of ADHD happens more often and is typically more haphazard, poorly organized and not goal directed (has no real purpose).
Signs in children include making careless mistakes in school work, being easily distracted from play, appearing as if they are not listening when spoken to, not following instructions, and avoiding or disliking tasks that require concentration, schoolwork in particular. Parents therefore need to be aware of some of the signs of ADHD, and know how and where to seek help if they feel their child may have this condition. Parents may not be aware that their child has ADHD, though they usually know that something is not right.
It can be difficult to recognize the signs that your teen may have ADD or ADHD because ADD and ADHD teens display symptoms that are much like just being a teenager, only more exaggerated. Inattentiveness, forgetfulness, under achievement, procrastination, impulsiveness, and disorganization can be found in many teenagers, but they may be worse in teens with ADD or ADHD. They may forget to write down an assignment or leave it at school. They may forget to bring a book home or will bring the wrong one.
Treatment
Methods of treatment usually involve some combination of medications, behavior modifications, life-style changes, and counseling. Stimulant medications such as Adderall and Ritalin and some anti-depressant medications such as Strattera and Welbutrin are the primary medications used to treat ADHD. Medications are generally considered safe. However, recent findings have questioned that conclusion and ongoing studies are currently underway.