One of the newer, more common diagnoses encountered in Attending Physician Statements today, attention deficit hyperactivity disorder (ADHD) is being found and is under treatment not only in children but adults as well. Defined as a poor or short attention span with impulsive activity inappropriate for age, the diagnosis may be extended past the typical ages of childhood and maintained on medication or therapy long thereafter.
ADHD currently affects about 5-10% of school aged children, and even that number may be an underestimate. Males are affected more commonly than females, up to ten times more often. ADHD can be diagnosed as early as age 3, and most cases are suspected by beginning school age years, by age 7 or 8. School work may not be substantially affected until middle school years however.
The etiology of ADHD is still being investigated, but is currently thought to be inherited. Research leans toward abnormalities in neurotransmitters, or substances that transmit nerve impulses in the brain. The disorder may be exaggerated by home or school environment.
Most children who have diagnosed ADHD have problems with sustaining attention, maintaining concentration, and staying with (or completing) a task. ADHD children may show impulsive behavior and overactivity. They are often anxious, have problems communicating and interacting, and are behavior problems for teachers and parents. In later childhood, ADHD children have trouble sitting still, fidget constantly, talk impulsively and out of turn at school, and may be disorganized and very distracted. Most are not aggressive, although this is sometimes the case when behavior becomes frustrating. 20% have coexisting learning disabilities, and most have some sort of academic problems.
Of consequence, older children begin to experience low frustration tolerance as they edge into adulthood. Impulsiveness and hyperactivity do tend to diminish with age, but inattentiveness and related symptoms do persist into adulthood.
The diagnosis of ADHD is made by a psychologist or psychiatrist on the basis of having eight of 14 different symptoms, many of which are subjective findings. Diagnosis of ADHD may be difficult because it depends on the judgment of the observer. Many symptoms are not unique to children with ADHD, and most all children have one or more of the symptoms that can be diagnosed at some point in their lives.
Treatment for ADHD is still controversial. Psychostimulant drugs are still the medications of choice, and may be combined with behavior therapy. Children who are not aggressive and who come from supportive home environments can be managed usually by medication alone. Methylphenidate (Ritalin or Adderall) are still the drugs prescribed most with the highest benefit. Many children continue the medication into adulthood.
Many adults also seek therapy and medication for ADHD. In these cases, diagnoses are made retrospectively, as well as on the basis of current complaints and symptoms. ADHD is far more commonly diagnosed today than it was twenty or thirty years ago, and it is unclear whether the prevalence of the disorder has actually increased or doctors are more aware of the diagnosis early.
By age 21 ADHD often remits, although a sizable minority carry symptoms into adulthood. Children with ADHD are often diagnosed with a coexisting conduct disorder. This may increase the incidence of accidents, injuries, and auto collisions. Studies have shown a higher drug use incidence than in the general population. Alcohol abuse, substance abuse and even the rate of suicide are higher amongst those with diagnosed ADHD.
The information contained on this page is not intended to provide medical advice, which should be obtained directly from your physician.