ADHD – Attention Deficit / Hyperactivity Disorder

Sir George F. Still is credited with being the first to describe, in a set of published lectures to the Royal College of Physicians in England in 1902, the symptoms of what today we would call Attention-Deficit / Hyperactivity Disorder (AD/HD). It is important to understand that AD/HD is not a new problem or disorder but has existed in medical literature for over one hundred years. One of the reasons that significant confusion and suspicion surround AD/HD is that its name and diagnostic criteria have changed many times through the years.


Beginning in the late 1930s, studies of children with brain injuries resulting from a variety of causes (e.g., birth trauma, infections, lead toxicity, epilepsy, head injury) found profound cognitive and behavioral problems in these individuals. These studies ultimately led to a theory of brain injury and the term minimal brain dysfunction (MBD) to describe children with significant cognitive and behavioral disturbances, including the symptoms of AD/HD. This designation was used until the late 1960s and publication of the second edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-II).


The DSM-II used a new and more specific term, hyperkinetic reaction of childhood, to describe a disorder that was “characterized by overactivity, restlessness, distractibility and short attention span, especially in young children.” Research during the 1970s led to a better understanding of the role attention plays in the disorder, so hyperkinetic reaction of childhood gave way to the appellation attention-deficit disorder (with or without hyperactivity) in the DSM-III. The diagnostic criteria were further refined and the name changed yet again to attention-deficit / hyperactivity disorder (AD/HD) with the publication of the DSM-III-R.

 



Characteristic Symptoms

The essential feature of AD/HD is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. Inattention manifest behaviorally in AD/HD as wandering off task, lacking persistence, having difficulty sustaining focus and being disorganized and is not due to defiance or lack of comprehension. Hyperactivity refers to excessive motor activity when it is not appropriate or excessive fidgeting, tapping or talkativeness. Impulsivity refers to hasty actions that occur in the moment without forethought and that have high potential for harm to the individual. Impulsivity may reflect a desire for immediate rewards or an inability to delay gratification. Impulsive behaviors may manifest as social intrusiveness and/or as making important decisions without consideration of long-term consequences.

 

Types of Attention Deficit / Hyperactivity Disorder

For purposes of diagnosis, AD/HD is broken down into three subtypes based on the predominant symptom.

AD/HD, Predominantly Inattentive Presentation

AD/HD, predominantly inattentive presentation is characterized by six (or more) symptoms of inattention (but fewer than six symptoms of hyperactivity-impulsivity) that have persisted for at least six months. Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.

AD/HD, Predominantly Hyperactive Presentation

AD/HD, predominantly hyperactive/impulsive presentation is characterized by six (or more) symptoms of hyperactivity-impulsivity (but fewer than six symptoms of inattention) that have persisted for at least six months. Hyperactive children always seem to be “on the go” or are constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once. Impulsive children seem unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct.

AD/HD, Combined Presentation

AD/HD, combined presentation is characterized by six (or more) symptoms of inattention and six (or more) symptoms of hyperactivity-impulsivity that have persisted for at least six months. Most children and adolescents diagnosed with AD/HD have the combined type.


Prevalence and Age of Onset

Population surveys suggest that AD/HD occurs in about 5% of children and adolescents. AD/HD is usually first diagnosed during the elementary school years, although children with the predominantly inattentive type may not come to clinical attention until late childhood. Boys are more than twice as likely to be diagnosed with AD/HD as girls. While AD/HD is most commonly thought of as a disorder involving children and adolescents, the symptoms can persist either fully or partially into adulthood.




Treatment & Support

There are a number of traditional (e.g., medication, behavior modification) and alternative (e.g., diet restrictions) treatment options available for AD/HD. What is important is that you determine which one is best for your child. In many instances a combination of several treatments will be most effective.

Psychostimulants

The most widely used medications for the treatment of AD/HD are methylphenidate (e.g., Ritalin, Concerta, Metadate, Focalin) and amphetamine (e.g., Adderall, Dexedrine). These medications are classified as stimulants and have been approved by the Food and Drug Administration (FDA) since the 1950s for treating behavioral problems in children. They appear to work by increasing activity in areas of the brain that are underactivated (e.g., frontal lobes) in children with AD/HD. This increase in brain activation causes an improvement in attention and reduces impulsiveness and hyperactivity. A beneficial response is seen in greater than 70 percent of individuals treated for AD/HD with these psychostimulants. Common side effects include weight loss, decreased appetite, insomnia, and slowed growth.

Behavior Modification Therapy

The goal of behavior modification is to increase the frequency of positive behaviors and decrease the frequency of undesirable ones. This is accomplished by clearly identifying a behavior to be changed, establishing reasonable expectations (setting a goal), developing a fair system of consequences for success and/or failure, and applying these standards consistently. Parents, teachers, and therapists all play a role in helping the child learn how to behave appropriately. Behavior modification is a very structured, intensive, and time-consuming approach to treatment. Because of the time commitment required, most parents are unable or unwilling to try this approach and opt for medication only. Children who receive both medication and behavior therapy respond better to treatment, and children who receive behavior therapy have been shown to require lower doses of medication for successful treatment compared to those who receive medication alone.

 

A Spiritual Perspective

What does the parent struggling to care for a child with AD/HD need more than anything? Encouragement! Those who minister to children with AD/HD and their parents must be careful not to become judgmental and focused only on discipline. While there are certainly heart issues that must be addressed with the child, these issues should be approached with a spirit of love. Parents are to be encouraged in the Lord, and children are to be shown that God loves them unconditionally. True spiritual grow is possible only when parents begin to see their child as God sees him or her and the child begins to accept that truth as well.


Finding Care

The links and information below will provide you with a starting point in terms of finding mental health care providers, treatment facilities and support groups for those struggling with AD/HD.

Mental Health Care Providers

When assisting an individual it is important to help them to find the right type of mental health care provider. Theses links will assist you in beginning your provider search, but knowing and building relationships with providers in your area can prove invaluable. Both in aiding the individual in getting an appointment and being able to better support them as they begin receiving professional treatment.

An individual struggling with AD/HD will most likely need to see both, a clinical psychologist / therapist for psychotherapy (talk therapy) and a psychiatrist for medication.

By providing your zip code the following search engines will give you information about local mental health care providers.

Clinical Psychologists / Therapists Psychiatrists


Supporting the Family

Many times the family caring for an individual with a mental illness is overlooked. They are often the front line support for the individual. The responsibility of care can take a physical and psychological toll on caregivers, who are many times in as much need of support as the individual that has the illness. Caregiver support groups are available for the families of those struggling with AD/HD.

These links will give you information on caregiver (family) support groups in your area.

National Association for the Mentally Ill – Family Support Group National Association for the Mentally Ill – Family to Family Support GroupGrace Alliance



Educational Resources

Here are some links to aid you in learning more about the depressive disorders. The more information you have, the better you will be able to help those seeking your guidance.

National Institute of Mental Health Mental Health America


Downloadable Resources 

First Step – What to do once a diagnosis has been made.

Daily Steps – Developing a holistic mental health care plan.

Difficult Steps – Navigating destructive behavior and legal issues.