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What is ADHD?

Attention-deficit hyperactivity disorder (ADHD) is a medical condition characterized by difficulties with inattention or hyperactivity and impulsivity.

Symptoms of inattention, or hyperactivity and impulsivity must be severe enough to cause impairment in the daily functioning of the person in at least two settings: at home, in school, in the community or in the workplace.

ADHD is a serious public health problem. Sufferers have higher rates of other psychiatric and behavior disorders and are at greater risk for problems in academic performance, career attainment and accidental injury.

The U.S. Surgeon General, the American Medical Association (AMA), the American Psychiatric Association, the American Academy of Child and Adolescent Psychiatry (AACAP), the American Psychological Association and the American Academy of Pediatrics (AAP), among others, all recognize ADHD as a valid disorder.

Prior to the age of 5, ADHD symptoms may be difficult to accurately diagnose, because many preschoolers are highly active and prone to being easily distracted and overly impulsive. As the young child gets older, problems with hyperactivity, inattention, or impulsivity tend to stand out, gaps in school performance become clearer, and problems with behavior or learning become more of concern to parents and teachers causing referrals to health providers and educators to determine if a problem with ADHD exitis.

Prevalence of ADHD

In the United States, ADHD affects about seven percent of the population. However, ADHD exists throughout the world. Children with ADHD have been identified in every country in which this condition has been studied. ADHD is three to five times more common in boys than girls.

ADHD used to be thought of as a childhood disorder with symptoms diminishing during adolescence and outgrown by adulthood. We now realize that, more often than not, children with ADHD continue to exhibit the disorder through adolescence and into adult years. The lack of consensus on the criteria and procedures for the diagnosis of ADHD in adults impedes our understanding of the prevalence of this condition in the adult population. Adult prevalence has been estimated between two to four percent.

ADHD can have a profound effect on a person’s quality of life. Children and adolescents with the disorder often have difficulty with socialization, school performance and behavior. Adults with ADHD can exhibit problems in college, in the work force and in social relationships. Failure to perform as well as others can lead to problems with self-esteem, anxiety and depression.

Health care professionals have been diagnosing and treating children and adolescents with ADHD for dozens of years. In fact, almost half the referrals to mental health practitioners in schools, clinics or private practices are to treat children and adolescents who have problems related to inattention, hyperactivity, or impulsivity. Early identification and proper treatment can improve the quality of life for those with ADHD leading to improved school and work performance, social adjustment and success in accomplishing one’s goals.

Problems with Self-Regulation

ADHD affects a person’s ability to regulate behavior and attention. Students with ADHD often have problems sustaining attention, controlling hyperactivity and managing impulses. The brain is responsible for self-regulation–planning, organizing and carrying out complex behavior. These are called “executive functions” of the brain. Executive functions refer to the variety of functions within the brain that activate, organize, integrate and manage other functions (Barkley, 2005; Brown, 2005, Cooper-Kahn et al., 2008).

Difficulties in self-regulation exist to some degree in everyone. Many people have experienced problems with concentration. Sometimes it's a result of being tired, bored, hungry or distracted by something. We have all had times when we were overly restless or hyperactive, we couldn't sit still and pay attention, became overly impatient, or too easily excited and too quick to respond. Does this mean we all have ADHD? No. although problems with self-regulation are found in everyone from time to time, these problems are far more likely to occur in people with ADHD. And they lead to significant impairment in one’s ability to function at home, in school, at work or in social situations.

Types of ADHD

The Diagnostic and Statistical Manual of Mental Disorders (DSM IV-TR), published by the American Psychiatric Association in 2000, provides healthcare professionals with the criteria that need to be met to diagnose a person with ADHD. To receive a diagnosis of ADHD, a person must exhibit a certain number of behavioral characteristics reflecting either inattention or hyperactivity and impulsivity for at least six months to a degree that is “maladaptive and inconsistent with developmental level.” These behavioral characteristics must have begun in childhood, must be evident in two or more settings (home, school, work, community) and must not be due to any other mental disorder such as a mood disorder, anxiety, learning disability, etc.

There are three types of ADHD. Some children with ADHD show symptoms of inattention and are not hyperactive or impulsive. Others only show symptoms of hyperactivity-impulsivity. Most, however, show symptoms of both inattention and hyperactivity-impulsivity.

While the term ADHD is the technically correct term for either of the three types indicated above, in the past, the term attention deficit disorder (ADD) was used, and still is by many. For the past ten years ADD and ADHD have been used synonymously in publications and in public policy.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR (4th ed.). Washington, DC: Author.

Barkley, R.A. (2005). Attention-Deficit Hyperactivity Disorder: A handbook for diagnosis and treatment. (3rd ed.) New York: Guilford Press

Barkley, R. A. (2005). ADHD and the nature of self-control. New York: Guilford Press.

Brown, T. E. (2005). Attention deficit disorder: The unfocused mind in children and adults. New Haven,CT: Yale University Press.

Brown, T.E. (2000) Attention-deficit disorders and comorbidities in children, adolescents, and adults. Washington, D.C.: American Psychiatric Press, Inc.

International Consensus Statement on AD/HD. January 2002. Clinical Child and Family Psychology Review, 5 (2), 89-111.

Jensen, P.S., & Cooper, J.R. (2002). Attention Deficit Hyperactivity Disorder: State of science •best prac-tice. New Jersey: Civic Research Institute.

Johnston, C. (2002) The Impact of Attention Deficit Hyperactivity Disorder on Social and Vocational Functioning in Adults. In P.S. Jensen & J.R. Cooper (Ed.), Attention Deficit Hyperactivity Disorder: State of the science • best practices (pp 6-1 – 6-16) New Jersey: Civic Research Institute, Inc.

Recommended Reading

Barkley, R. A. (2000). Taking charge of ADHD. The complete authoritative guide for parents. New York: Guilford Press.

Brown, T.E. (2000). Attention-deficit disorders and comorbidities in children, adolescents, and adults. Washington, D.C.: American Psychiatric Press, Inc.

Brown, T. E. (2005). Attention deficit disorder: Theunfocused mind in children and adults. New Haven,CT: Yale University Press.

Cooper-Kahn, J., & Dietzel, L. (2008). Late, Lost, and Unprepared: A parents guide to helping children with executive functioning. Maryland: Woodbine House.

Hallowell, E., & Ratey, J. (1994). Driven to distraction. New York: Pantheon Books

Nadeau, K. G., & Quinn, P. (2002) Understanding women with AD/HD. Silver Spring, MD: Advantage Books.

Parker, H.C. (2005). The ADHD workbook for parents. Plantation, FL: Specialty Press, Inc.

Solden, S. (2002). Journeys through ADDulthood. New York: Walker & Company.
Internet Resources

Centers for Disease Control and Prevention (NCBDDD)

CDCs National Center on Birth Defects and Developmental Disabilities


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