Attention deficit disorder

Overview

Inattentive, impulsive, in trouble

Attention deficit disorder and attention deficit hyperactivity disorder (ADD/ADHD) may go unrecognized for years, since its main signs — inattention, impulsiveness, and hyperactivity — often overlap with children's normal behaviors.

But children with ADD/ADHD who go undiagnosed and untreated can suffer profound impairments in their ability to learn and socialize. Unable to keep friends or learn easily, a source of frustration to parents and teachers alike, untreated children fall further and further behind at every meaningful developmental stage of life.

ADD/ADHD may persist into adulthood — in possibly as many as 65% of childhood cases. As adults, their destructive behavior may alienate family and friends. They may not finish school or keep a job, and are also more likely to abuse alcohol and drugs and to commit suicide.

Currently, more than two million North American schoolchildren have been diagnosed with ADD/ADHD. Doctors are successfully treating many of them with stimulant medications such as Ritalin. But controversy continues about how doctors may overdiagnose attention deficit disorder, and how frequently they prescribe stimulant medications. Some people argue that medication is an easy answer that ignores more complex problems such as overcrowded classrooms and dissatisfaction with school.

Detailed Description

Attention deficit disorder is a neuropsychological condition that affects children and adults. Its hallmarks are inattention, impulsiveness, and hyperactivity. But there is also a type of ADD/ADHD that causes only inattention, and since hyperactive behaviors are the most noticeable, it is easier to overlook children with this variation.

ADD/ADHD is often evident by age 4. However, doctors usually diagnose children around age 7 when problems erupt at school, where structured routines and mental requirements often make symptoms more noticeable. Many children with attention deficit disorder have symptoms through their teenage years and into adulthood. As adults, they may find more flexible situations for their needs, and recruit the help of loved ones to keep them on track.

Since attention is important in any mental task, attention deficit disorder can impair school and work performance over many years. Most children and adults can offset the "deficits" through organizational skills, behavioral techniques and therapy, and, in many cases, with the help of medications.

How Common Is ADD/ADHD?

Attention deficit hyperactivity disorder is thought to affect about 5% of school-aged children, and can affect people from early childhood through adulthood. In childhood, males are 2-to-6 time more likely to have ADD/ADHD.

Conventional Treatment

Goals of Treatment

Researchers have not found a cure, but the available treatments can greatly improve attention span, reduce hyperactivity, stop disruptive behavior, improve ability to adjust and cope, and enhance academic performance.

Treatment Overview

Treatment for both children and adults is a true combination of behavioral, psychological, academic, and drug therapies. Applied properly, this treatment can make dramatic changes that will vastly improve social and intellectual growth.

Drug Therapy

Drugs most commonly prescribed
It may seem paradoxical, but stimulant drugs may relieve hyperactivity and improve attention. Although you should possibly talk with your doctor about potential side effects � such as weight loss, suppressed appetite, motor tics, and temporarily stunted growth � nine of 10 children improve on one of these drugs:
Strattera http://www.nmihi.com/a/atomoxetine.html
Cylert (Pemoline)
Dexedrine (Dextroamphetamine)
Ritalin (Methylphenidate)
Ritalin is by far the most commonly used drug for attention deficit disorder (ADHD). In some cases, it will partly relieve symptoms after a single dose.
Second choices
Drugs that have had some success treating attention deficit disorder, although the FDA has not approved them for that purpose, include:
Zyban http://www.nmihi.com/b/bupropion.html
Prozac
Tofranil
Catapres (Clonidine)
Norpramin (Desipramine)
Tegretol
Tenex (Guanfacine)
Neurontin http://www.nmihi.com/f/gabapentin.html
Aricept
Zoloft http://www.nmihi.com/s/sertraline.html
Luvox

Behavior modification

Parents and teachers can learn practical techniques to encourage appropriate actions in children, such as waiting for a turn, sharing toys, and asking for help. Children with ADD/ADHD can also benefit from structured routines.

Psychological counseling

Counseling may uncover problems that contribute to ADD/ADHD. Adults with the disorder may benefit by talking about how ADD/ADHD affects their lives.

Academic or vocational counseling

Children might need — and are federally mandated to receive — assistance in class, while adults might require job training or re-education.

Activity & Diet Recommendations

You should "child-proof" your home to accommodate the increased activity of a child with ADD/ADHD without fear of injury.

No dietary changes have been proven to help attention deficit disorder. While many parents restrict sugar, believing it makes children hyperactive, studies show this is not true. Vanderbilt University researchers analyzed 16 studies and concluded that "sugar does not affect the behavior or cognitive performance of children."

Monitoring the Condition

Your doctor may request parent/teacher rating scales at diagnosis, again at two weeks after starting treatment, and regularly thereafter. Your child should visit the doctor every quarter to monitor side effects and the progress of the drug therapy. Some things your doctor will look out for:

• Increased blood pressure
• Insomnia
• Headache
• Abdominal pain
• Poor growth

In a substantial number of cases, doctors can gradually withdraw Ritalin after two years of continual use. If necessary, they can resume Ritalin therapy.

Possible Complications

ADD/ADHD drug treatments may cause:

• Headaches
• Abdominal pain (unless taken with meals)
• Sleep disturbances
• Appetite loss
• Depression
• Tics

Untreated ADD/ADHD can lead to an increased risk of:

• Poor academic performance
• Parental neglect or abuse
• Social isolation
• Poor self-esteem
• Alcohol or substance abuse
• Suicide

Considerations for Women

Women with ADD/ADHD are less likely to be hyperactive.

Pregnancy

Talk with your doctor. While no medication is absolutely safe, Ritalin is relatively safe to use during pregnancy.

Nursing mothers

Talk with your doctor. Medications may pass through the breast milk and harm the infant.