Attention Deficit Disorders (ADD & ADHD)

ADD and ADHD are among the most controversial of all mental health disorders, primarily because the diagnosis occurs mostly with children and the treatment of choice is medication.  There are many who believe that children are being medicated for normal childhood behaviors that the adult caregivers simply do not want to deal with.  There have been many schools of thought as to what causes or exacerbates ADD/ADHD, including toxins, diet, poor parenting, and abnormal fetal development. Some children who are diagnosed with ADHD end up being diagnosed with Bipolar Disorder in adolescence or adulthood.  

Today, scientists are scrutinizing genetics for answers.  Many now suspect that a series of malfunctioning genes may block the normal manufacture of chemicals that guide communication in the areas of the brain that control inhibition and self-control.  This breakdown leads to a loss of self-control and interferes with other brain functions responsible for maintaining attention.  Brain scans taken of children with ADHD have shown that the areas of their brains controlling these functions are smaller and less active compared to the brain scans of non-ADHD children. Furthermore, the child of a parent with ADHD has up to a 50% chance of developing it as well.

A responsible primary care physician or child psychiatrist who makes the diagnosis of an Attention Deficit Disorder will first do a thorough assessment, including checklists completed by both the child's caregivers and teachers, and evaluate every angle before making that determination and prescribing medication. Sometimes the behavior is determined to be the effect of other stressors in the child's life, such as a divorce or illness in the family, and treatment can focus on those issues.  If it is determined that the child's behavior is indeed within normal, age-appropriate limits, the professional will work with the caregivers on more effective parenting strategies to help them deal with the behavior as the child develops. 

The common factor in these two disorders is developmentally inappropriate short attention span and poor concentration.  The main difference between the two are the presence of hyperactivity and impulsivity in ADHD.  These days the diagnosis is generally made in childhood, and the disorder sometimes resolves in adolescence or may persist into adulthood. Because the disorder was not recognized or diagnosed when many of today's adults were kids, we also find adults being diagnosed with an Attention Deficit Disorder for the first time in adulthood.

The formal diagnostic names may be confusing to parents who wonder why their child is labeled ADHD when he or she is not all that hyperactive.  The formal diagnoses distinguish between ADHD, predominately hyperactive type, and ADHD, predominately inattentive type (what we tend to think of as ADD).  Regardless of the language, these kids either have bodies that are racing about, or thoughts that are racing about, and both will greatly benefit from treatment.  The following symptoms suggest seeking a professional's opinion as to whether an Attention Deficit diagnosis might be appropriate:

     *poor concentration

     *disorganized

     *poor planning ability

     *absentminded

     *inattentive

     *difficulty following directions

     *short attention span

     *easily distracted

     *difficulty sustaining attention

     *difficulty completing tasks

     *loses things frequently

     *achieves below ability in school

     * constantly on the move, racing from one activity to the next

Diagnosing an adult with an Attention Deficit disorder is not as easy as it is with kids.  Many times, when a child is diagnosed with the disorder, a parent will recognize that he or she has many of the same symptoms the child has and, for the first time, will begin to udnerstand some of the traits that have given him trouble for years such as distractibility, impulsivity, or restlessness.  Other adults will seek professional help for depression or anxiety and will find out the root cause of some of their emotional problems is ADHD.  They may have a history of school failures or problems at work.  Others may have been involved in frequent automobile accidents.

To be diagnosed with ADHD, an adult must have childhood onset, persistent, and current symptoms.  The accuracy of the diagnosis of adult ADHD is of utmost importance and should be made by a clinician with expertise int he area of attention dysfunction.  For an accurate diagnosis, a history of the person's childhood behavior is necessary, and an interview with the person's life partner, a parent, close friend or other close associate, may be needed.  A physical examination is recommended and appropriate psychological tests may be given.  The disorder may co-exist with other conditions such as learning disabilities, anxiety or other mood disorders.

A correct diagnosis of ADHD can bring a sense of relief.  The individual has brought into adulthood many negative perceptions of him- or herself that may have led to low self-esteem.  Now there can be an understanding of problems and a way to face them.

Symptoms of adult ADHD are similar to those of children and may include the following:

     *Difficulty staying focused on necessary tasks

     *Making careless mistakes due to not paying attention to details

     *Difficulty finishing work or other tasks

     *Often losing things

     *Easily distracted by thoughts or external stimuli

     *Frequently forgetful in daily life

     *Can't sit still without fidgeting

     *Always "on the go", trying to accomplish more each day

     *Excessive talking

     *Frequent feelings of restlessness or hyperactivity

     *Often interrupting or intruding on others

     *Difficulty waiting in lines

     *Acting before thinking

The following characteristics may also be associated with ADHD in adults:

     *Disorganization in work situations as well as at home

     *"Short fuse" resulting in episodic, explosive reactions followed by rapid

          calming down

     *Frequent mood shifts from "up" and excited to feelings of boredom or

          discontent in short periods of time, with or without an external event

     *Overly reactive to stress--becomes easily overwhelmed or "stressed

          out"

     *Impulsive decision making with respect to work, friends, or family life

     *"Underachiever," academic or vacational success below individual's

          potential or expectations

     *Relationship instability compared to others of the same age and

          educational level

Adults generally are more capable of developing coping strategies for their ADHD than kids are.  Don't diagnose yourself and become educated about ADHD.  Make lists whenver possible, give yourself more time for important tasks, have realistic expectations about what you can accomplish in a certain time frame, reward yourself when you finish tasks, and structure your lifestyle to include more activities that result in success.

Successful treatment for ADHD generally includes both medication and therapy.  If you or your child are receiving medication for ADHD from a family physician, don't forget that related emotional issues may be ignored without appropriate therapeutic support. 

The most common medications for ADHD are stimulant medications, which may seem strange, but the medicine actually works to stimulate the parts of the brain that are responsible for impulse control and attention. Ritalin, Concerta, Dexedrine, Adderall, and their generic forms are examples of stimulant medications.  These medications are used both with children and adults.  Because of the abuse potential of these meds, non-stimulant drugs are being developed for the treatment of ADHD.  One such medication, Strattera, was originally developed as an anti-depressant and though research showed no great effect on depression, there was, however, a positive impact on ADHD symptoms.  The stimulant medications, when prescribed, will be closely monitored and each refill will require a new written prescription.  

For more information about ADHD, visit http://www.adhd.com/index.html