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Attention Defecit Disorder/Attention Hyperactivity Disorder

 

What is ADHD (ADD)?

The official definition of Attention Deficit Hyperactivity Disorder (ADHD) as it appears in the Diagnostic and Statistical manual of the American Psychiatric Association is: ADHD is a disorder that can include a list of nine specific symptoms of inattention and nine symptoms of hyperactivity/impulsivity.

Individuals with ADHD may know what to do but do not consistently do what they know because of their inability to efficiently stop and think prior to responding, regardless of the setting or task.

Characteristics of ADHD have been demonstrated to arise in early childhood for most individuals. This disorder is marked by chronic behaviors lasting at least six months with an onset often before seven years of age. At this time, four subtypes of ADHD have been defined. These include the following:

1. ADHD – Inattentive type is defined by an individual experiencing at least six of the following characteristics:

Fails to give close attention to details or makes careless mistakes
Difficulty sustaining attention
Does not appear to listen
Struggles to follow through on instructions
Difficulty with organization
Avoids or dislikes requiring sustained mental effort
Often loses things necessary for tasks
Easily distracted
Forgetful in daily activities

2. ADHD – hyperactive/impulsive type is defined by an individual experiencing six of the following characteristics:

Fidgets with hands or feet or squirms in seat
Difficulty remaining seated
Runs about or climbs excessively (in adults may be limited to subjective feelings of restlessness)
Difficulty engaging in activities quietly
Acts as if driven by a motor
Talks excessively
Blurts out answers before questions have been completed
Difficulty waiting in turn taking situations
Interrupts or intrudes upon others

3. ADHD – combined type is defined by an individual meeting both sets of attention and hyperactive/impulsive criteria.

4. ADHD – not otherwise specified is defined by an individual who demonstrates some characteristics but an insufficient number of symptoms to reach a full diagnosis. These symptoms, however, disrupt everyday life.


The majority of adults with ADHD have been described as experiencing symptoms very similar to the problems experienced by children. They are often restless, easily distracted, struggle to sustain attention, are impulsive and impatient. They have been described as experiencing problems with stress intolerance leading to greater expressed emotion. Within the workplace they may not achieve vocational positions or status commensurate with their siblings or intellectual ability.

Children and adults who have ADHD exhibit degrees of inattention or hyperactivity/impulsivity that are abnormal for their ages. This can result in serious social problems, or impairment, of family relationships, success at school or work or in other life endeavors.

Children and adults can exhibit other psychiatric disorders (medically known as comorbidity), along with their ADHD symptoms. Most commonly, these include oppositional defiant or conduct disorder, along with or separate from internalizing disorders, such as anxiety and depression.

Other definitions have existed, such as that for Attention Deficit disorder, or ADD. These use different labels for the same conditions and can be interchanged with ADHD. For the purposes of this fact sheet, however, we will continue to use ADHD.


Treatment:


There are two modalities of treatment that specifically target symptoms of ADHD. One uses medication and the other is a non-medical treatment with psychosocial interventions. The combination of these treatments is called multimodality treatment.

Treating ADHD in children requires a coordinated effort between medical, mental health and educational professionals in conjunction with parents. This combined set of treatments offered by a variety of individuals is referred to as multi-modal intervention. A multi-modal treatment program should include: . Parent training concerning the nature of ADHD as well as effective behavior management strategies . An appropriate educational program . Individual and family counseling, when needed, to minimize the escalation of family problems . Medication when required

Psychostimulants are the most widely used medications for the management of ADHD symptoms. At least 70% to 80% of children and adults with ADHD respond positively to psychostimulant medications.

Stimulant medications have been used to treat the cognitive and behavioral symptoms of ADHD for more than 50 years. A study by Wilens and Biederman (1997) summarized the findings of controlled trials validating the use of these medications. Treatment with stimulants is beneficial in about 80% of children with ADHD.

Behavior modification techniques have been used to treat the behavioral symptoms of ADHD for more than a quarter of a century. A summary of the literature on trials that have validated the efficacy of this approach shows that, in many cases, behavior modification alone has not been sufficient to address severe symptoms of ADHD.

Classroom success for children with ADHD often requires a range of interventions. Most children with ADHD can be taught in the regular classroom with either minor adjustments in the classroom setting, the addition of support personnel, and/or special education programs provided outside of the classroom. The most severely affected children with ADHD often experience a number of occurring problems and require specialized classrooms.

Laws passed during the last five years have mandated educational interventions for children with ADHD. Today, modifications and special placements in public school settings are part of treatment of ADHD. The coordination of school-based interventions with medical interventions has become possible (but remains difficult) due to these changes in educational law regulations.


Resources:

The information provided here were summarized from and can be reviewed in greater depth in the following authoritative sources:

Barkley, R.A. (1990).
Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York, NY; Guilford Press

Barkley, R.A. (in press).
Attention Deficit Hyperactivity Disorder: a Handbook for Diagnosis and Treatment -–2nd edition. New York, NY; Guilford Press

Barkley, R.A. (1997).
ADHD and the Nature of Self-Control.New York, NY: Guilford Press

DuPaul, G.J. & Stoner, G. (1994).
ADHD in the Schools: Assessment and Intervention Strategies. New York, NY: Guilford Press.

Goldstein, S. (1997).
Managing Attention and Learning Disorders in Late Adolescence and Adulthood: A Guide for Practitioners. New York, NY: Wiley Interscience Press.

Goldstein, S. & Goldstein, M. (1990).
Managing Attention Disorders in Children: A Guide for Practitioners. New York, NY: Wiley Interscience Press.

Goldstein, S. & Goldstein, M. (in press).
Attention Deficit Hyperactivity Disorder: A Guide for Practitioners. New York, NY: Wiley Interscience Press.

Greenhill, L.L. & Osman, B.B. (1991).
Ritalin, Theory and Patient Management. New York, NY: Mary Ann Liebert, Inc. Publisher

Matson, J.L. (1993).
Handbook for Hyperactivity in Children. Boston, MA: Allyn & Bacon

Nadeau, K.G. (1995).
A Comprehensive Guide to Attention Deficit Disorder in Adults. New York, NY: Brunner/Mazel Publishers.


Notes:

Parenting a child who has ADD can be an exhausting and, at times, frustrating experience. Parents play a key role in managing the disability. They usually need specialized training in behavior management and benefit greatly from parent support groups.

Parents often find that approaches to parenting that work well with children who do not have ADD, do not work as well -- or at all -- with children who have ADD.
Parents often feel helpless, frustrated and exhausted. Too often, family members become angry and withdraw from each other. If untreated, the situation only worsens.
Children with ADD often need their parents to identify their areas of strength. By focusing on these areas, children can develop the confidence and skills to tackle other, difficult situations. Parents of children who have ADD must work on the task of not overreacting to their children's mistakes. They can find parent support groups, such as those offered by local CH.A.D.D. chapters, an invaluable aid.


Parent Training:

Parent training can be one of the most important and effective interventions for a child with ADD. Effective training will teach parents how to apply strategies to manage their child's behavior and improve their relationship with their child.
Without consistent structure and clearly defined expectations and limits, children with ADD can become quite confused about the behaviors that are expected of them.
A technique called "charting" is often the first step in any behavior modification program. It requires that parents specifically define the behavior they are concerned about so that it can be observed and counted. Charting makes parents more aware of their own behavior and children more aware of a problem behavior.
Parents are encouraged to designate 10 to 15 minutes of each day as "very special time." Parents use this time to focus on being with the child, attending to what he is doing, listening to the child, and providing occasional positive feedback.
Parents are taught how to effectively use positive reinforcement by attending to their child's positive behavior while ignoring, as much as possible, negative behavior.
Parents are also taught how to decrease inappropriate behavior through a series of progressively more active responses -- ignoring behavior; natural consequences, such as not replacing a toy left out in the rain; logical consequences, such as loss of television time if the child leaves the room without turning the television off; and time-out. Time-out involves having the child sit quietly in a designated place for a specific time after he has misbehaved.
Parents learn to give commands and directions that can be understood and attended to by the child with ADD.


Peer Relations:

Making and keeping friends is a difficult task for children with ADD. A variety of behavioral excesses and deficits common to these children get in the way of friendships. They may talk too much, dominate activities, intrude in others' games, or quit a game before its done. They may be unable to pay attention to what another child is saying, not respond when someone else tries to initiate an activity, or exhibit inappropriate behavior. Parents of a child with ADD need to be concerned about their child's peer relations. Problems in this area can lead to loneliness, low self-esteem, depressed mood, and increased risk for anti-social behavior.
Parents can help provide opportunities for their child to have positive interactions with peers. There are a number of concrete steps parents can take:
setting up a home reward program that focuses on one or two important social behaviors observing the child in peer interactions to discover good behaviors and poor, or absent, behaviors directly coaching, modeling and role-playing important behaviors "catching the child" at good behavior so as to provide praise and rewards
Other strategies include structuring initial activities for the child and a friend that are not highly interactive, such as trips to the library or playground; using short breaks from peer interactions when the arousal level becomes high; and working to reduce aggressive behavior in the home.

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