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Attention Deficit Disorder Hyperactivity (ADHD/ADD)

What Is Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Attention Deficit Hyperactivity Disorder (ADHD, ADD) is a prevalent childhood disorder, which can continue into adulthood, affecting approximately 11% of children 4-17 years of age and approximately 4% of the adult population. The average age of onset is age 7, but children reported by their parents as having more severe ADHD are typically diagnosed earlier. Boys are three to four times more likely to be diagnosed with ADHD than girls. The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) that 5% of children have ADHD. However, studies in the US have estimated higher rates in community samples. These studies show that the rate of ADHD diagnosis has been steadily increasing for the past several years. ADHD diagnosis increased an average of 3% per year from 1997 to 2006 to 5% per year from 2003 to 2011. The increase in diagnosis is joined by an increase in the percentage of children with ADHD, from 7.8% in 2003 to 9.5% in 2007 to 11.0% in 2011. Prevalence of ADHD diagnosis also varies substantially by state, from a low of 5.6% in Nevada to a high of 18.7% in Kentucky.

The rate of prescription for ADHD medication has also increased over the past years, from 4.8% in 2007 to 6.1% in 2011. More US children were receiving ADHD treatment (medication and or therapy/counseling) in 2011 compared to 2007; however, as many as 17.5% of children with current ADHD were not receiving either medication for ADHD or mental health counseling in 2011. Rates of medication prescriptions vary by state, from a low of 2% in Nevada to a high of 10.4% in Louisiana.

ADHD has three subtypes:

Predominantly Hyperactive-Impulsive. This person will be restless, have difficulty being quiet – blurting out answers before hearing the entire question, constantly needing to move.
Predominantly Inattentive. This person is easily distracted, can’t focus on details, makes careless mistakes, is forgetful.
Combined Hyperactive-Impulsive and Inattentive. This is the most common form of ADHD, and is a combination of the above types.

What Causes Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Risk Factors For Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Diagnosing Attention Deficit Disorder Hyperactivity (ADHD/ADD)

There is no single test to diagnose ADHD. Symptoms of ADHD vary from person to person, and regular child-like behavior can often be mistaken for ADHD. ADHD symptoms are often noticed first by parents or teachers; who may observe the child’s inability to focus or tendency to act out in class. General physicians and/or specialists can help to determine whether or not the child’s symptoms are a result of ADHD or another condition. Often, ADHD-like symptoms can be triggered by life events such as family death or divorce, or by health conditions such as vision/hearing problems, inner ear infections, or anxiety/depression.

The following are the diagnostic criteria for ADHD patients as outlined by the Diagnostic and Standard Manual for Mental Disorders.

For a diagnosis of inattentive ADHD, patients must experience 6 or more of the following symptoms:

Fails to give close attention to details or makes careless mistakes.
Has difficulty sustaining attention.
Does not appear to listen.
Struggles to follow through on instructions.
Has difficulty with organization.
Avoids or dislikes tasks requiring a lot of thinking.
Loses things.
Is easily distracted.
Is forgetful in daily activities.

For a diagnosis of hyperactive – impulsive ADHD, patients must experience 6 or more of the following symptoms:

Fidgets with hands or feet or squirms in chair.
Has difficulty remaining seated.
Runs about or climbs excessively in children; extreme restlessness in adults.
Difficulty engaging in activities quietly.
Acts as if driven by a motor; adults will often feel inside like they were driven by a motor.
Talks excessively.
Blurts out answers before questions have been completed.
Difficulty waiting or taking turns.
Interrupts or intrudes upon others.

For a diagnosis of inattentive & hyperactive – impulsive ADHD, patients must experience a combination of the above symptoms. Additionally, the following criteria must be met:

Symptoms must cause impairment in two or more settings (i.e. home and school) to avoid misdiagnosing a smaller, more isolated behavioral problem
Symptoms must cause significant impairment in social, academic, or occupational functioning. Evidence of impairment must be clear.
Some symptoms must have been present before the age of twelve years of age. Symptoms do not necessarily need to have been disruptive. Symptomatic behaviors before the age of twelve suggest a lag in brain development associated with ADHD.

Primary care clinicians should also assess the patient for other conditions that might occur along with ADHD. These include:

Emotional or behavioral
- Depression
- Anxiety
- Conduct disorders
Developmental
- Learning Disabilities
- Language delay or processing disorders
- Sleep apnea

Symptoms of Attention Deficit Disorder Hyperactivity (ADHD/ADD)

ADHD can occur in children, teens, and adults. The symptoms of ADHD at each stage of life can present themselves differently.

Children and Teens with ADHD According to the National Institute of Mental Health, children with ADHD may exhibit the following symptoms:

Inattention. Individuals may:
- Be easily distracted, miss details, forget things, and frequently switch from one activity to another
- Have difficulty focusing on one thing
- Become bored with a task after only a few minutes, unless they are doing something enjoyable
- Have difficulty focusing attention on organizing and completing a task or learning something new
- Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
- Not seem to listen when spoken to
- Daydream, become easily confused, and move slowly
- Have difficulty processing information as quickly and accurately as others
- Struggle to follow instructions
Hyperactivity. Individuals may:
- Fidget and squirm in their seats
- Talk nonstop
- Dash around, touching or playing with anything and everything in sight
- Have trouble sitting still during dinner, school, and story time
- Be constantly in motion
- Have difficulty doing quiet tasks or activities.
Impulsivity. Individuals may:
- Be very impatient
- Blurt out inappropriate comments, show their emotions without restraint, and act without regard for consequences
- Have difficulty waiting for things they want or waiting their turns in games
- Often interrupt conversations or others’ activities.

Adults with ADHD Adult ADHD symptoms are experienced and perceived in a different manner than are childhood ADHD symptoms. Many of the symptoms of ADHD experienced during childhood can continue on into adulthood.

The following symptoms may be signs of adult ADHD:

Difficulty getting and/or staying organized. This may be missed during childhood but becomes more evident with the responsibilities of adult life (i.e. paying bills, cleaning the house, raising children, etc.)
Reckless driving. Since a hallmark of ADHD is difficulty staying focused, adults with ADHD are more likely to speed or be involved in traffic accidents.
Poor listening skills. Since many people with ADHD can’t focus well, it can be hard to listen to your spouse, boss, etc. This can make it difficult to finish tasks and maintain healthy intimate relationships.
Restlessness. Children with ADHD are called “hyperactive”; in adults it is perceived as having more difficulty relaxing, feeling edgy, and constantly being tense.
Explosions of anger. Minor triggers can lead to tantrums, since emotions are not always easily controlled.
Procrastination. Starting tasks and finding the self-motivation to begin projects may be difficult.
Difficulty setting priorities. Individuals might have a hard time determining which tasks are more critical, and may prioritize in a manner that is not beneficial to them. (i.e. Choosing to play a video game over finishing a crucial work presentation due the next day.)

Prognosis

Living With Attention Deficit Disorder Hyperactivity (ADHD/ADD)

Screening

Prevention

Medication And Treatment

Psychotherapy and Non-Medical Treatments for ADHD There are a number of behaviorally aimed therapies that can help lessen ADHD symptoms. These include:

Cognitive Behavioral Therapy (CBT) is aimed at controlling behavioral symptoms of ADHD through discussion-based therapy sessions. In these sessions, patients work with therapists to identify problematic thought patterns and learn to think constructively through the disorder. This can help both patients and families better control the symptoms and promote change in behavioral patterns.
Social skills training is aimed at assisting a child with ADHD in learning the importance of common social behaviors like basic manners, sharing, and waiting for a turn. This can be helpful in ensuring that the child functions normally in social settings and is able to make friends and acquaintances.

Medication Treatment for ADHD The same kinds of medications used to treat childhood ADHD are used for adults. The ages listed indicate FDA approval for the specified age group.

Stimulants According to the National Institute of Mental Health, although it may seem counterintuitive to treat hyperactivity with a stimulant, these medications actually activate brain circuits that support attention and focused behavior. Medications also may improve physical coordination.

Short – acting stimulants:

amphetamine (Adderall) 3 and older
dexmethylphenidate (Focalin) 6 and older
dextroamphetamine (Dexedrine, Dextrostat) 3 and older
lisdexamfetamine dimesylate (Vyvanse) 6 and older
methamphetamine (Desoxyn) 6 and older
methylphenidate (Ritalin) 6 and older
methylphenidate patch (Daytrana) 6 and older
methylphenidate (oral solution and chewable tablets) (Methylin) 6 and older

Extended release and long-acting stimulants:

extended release amphetamine (Adderall XR) 6 and older
extended release dexmethylphenidate (Focalin XR) 6 and older
extended release methylphenidate (Metadate CD, Metadate ER, Ritalin SR) 6 and older
long – acting methylphenidate (Ritalin LA, Concerta) 6 and older

Non – stimulant medications

atomoxetine (Strattera) 6 and older
guanfacine (Intuniv) 6 and older

Side Effects for ADHD Medications

According to the National Institute for Mental Health, most side effects of ADHD medications are minor and disappear when dosage levels are lowered.

Minor side effects include:

Decreased appetite. Children seem to be less hungry during the middle of the day, but they are often hungry by dinnertime as the medication wears off.
Sleep problems. If a child cannot fall asleep, the doctor may prescribe a lower dose. The doctor might also suggest that parents give the medication to their child earlier in the day, or stop the afternoon or evening dose. To help ease sleeping problems, a doctor may add a prescription for a low dose of an antidepressant or a medication called clonidine.
Stomachaches and headaches.
A few children develop sudden, repetitive movements or sounds called tics. These tics may or may not be noticeable. Changing the medication dosage may make tics go away. Some children also may appear to have a personality change, such as appearing “flat” or without emotion. Talk with your child’s doctor if you see any of these side effects.

Possible Rare, Serious Side effects: The National Institute of Mental Health reports that in 2007 the FDA required that all makers of ADHD medications develop Patient Medication Guides because a review of data found that ADHD patients with heart conditions had a slightly higher risk of the following:

Strokes
Heart attacks
Sudden death

The review also found a slightly higher risk (about 1 in 1,000) for medication-related psychiatric problems in patients who had no history of psychiatric problems, such as:

Hearing voices
Having hallucinations
Becoming suspicious for no reason
Becoming manic.

In addition, the non-stimulant ADHD medication called atomoxetine (Strattera) carries a warning that children and teenagers with ADHD who take the drug are more likely to have suicidal thoughts than children and teenagers with ADHD who do not take atomoxetine. Call a doctor right away if your child shows any of the following symptoms:

Acting more subdued or withdrawn than usual
Feeling helpless, hopeless, or worthless
New or worsening depression
Thinking or talking about hurting himself or herself
Extreme worry
Agitation
Panic attacks
Trouble sleeping
Irritability
Aggressive or violent behavior
Acting without thinking
Extreme increase in activity or talking
Frenzied, abnormal excitement
Any sudden or unusual changes in behavior.