Attention Deficit Hyperactivity Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition related, in part, to the brain's chemistry and anatomy. ADHD manifests itself as a persistent pattern of inattention and/or hyperactivity/impulsivity that occurs more frequently and more severely than is typically observed in people at comparable levels of development.

People who have ADHD have trouble paying attention in school, at home or at work. They may be much more active and/or impulsive than what is usual for their age. These behaviors contribute to significant problems in relationships, learning and behaviors. For this reason, children who have ADHD are sometimes seen as being "difficult" or as having behavior problems.

ADHD is common, affecting 4% to 12% of school-age children. It is more common in boys than in girls. ADHD begins in childhood and can persist into adulthood as well. While some children outgrow ADHD, about 60% continue to have symptoms well into adulthood.

One of the first questions a parent will have is "Why?" "What went wrong?" "Did I do something to cause it?" There is little compelling evidence at this time that ADHD can arise purely from social factors or child-rearing methods. Most causes appear to fall in the realm of neurology and genetics. This is not to say that environmental factors may not influence the severity of the disorder and especially the degree of impairment and suffering the child may experience, but that such factors do not seem to give rise to the condition by themselves.

THINGS THAT DO NOT CAUSE ADHD :

• Bad parenting.
• Too much sugar.
• Too little sugar.
• Food additives or coloring agents.
• Food allergies or other allergies.
• Lack of vitamins.
• Fluorescent lights.
• Too much TV watching.
• Video games.

Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Most people sometimes blurt out things they did not mean to say or jump from one task to another or become disorganized and forgetful, so, how can a doctor tell if the problem is ADHD?

Because everyone shows some of these behavior at times, the diagnosis requires that such behavior be demonstrated to a degree that is inappropriate for the person's age.

Many of the symptoms of ADHD occur from time to time in everyone. The frequency of these symptoms is much higher and impair regular life functionality, typically at school or at work. Not only will they perform poorly in task oriented settings, but they will also have difficulty with social functioning with their peers.

No objective physical tests exist to diagnose ADHD in a patient. Based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), 4th edition, criteria listed below, 3 types of ADHD are classified :

• ADHD, Combined Type : If both criteria A and B are met for the past 6 months.
• ADHD, Predominantly Inattentive Type : If criteria A is met, but criteria B is not met for the past 6 months.
• ADHD, Predominently Hyperactive-Impulsive Type : If criteria B is met, but criteria A is not met for the past 6 months.

DSM-IV criteria for ADHD :

Criteria A : Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for develpmental level :

1. Often does not give close attention to details or makes careless mistakes in school work, work or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes or does not want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks or activities (for example toys, school assignments, pencils, books or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.

Criteria B : Six or more of the following symtoms of hyperactive impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level :

• Hyperactivity
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from the seat when remaining in the seat is what is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
• Impulsiveness
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting for one's turn.
3. Often interrupts or intrudes on others (for example, butts into conversations or games).

Talk with the doctor. A diagnosis of ADHD can be made only by getting information about your child's behavior from several people who know your child. The doctor will ask you questions and may want to get information from your child's teachers or anyone else who is familiar with your child's behavior. This will help you and your doctor compare your child's behavior with other children's behavior.

ADHD treatment is best approached as a partnership between the child, family, school personnel and healthcare professionals.

ADHD is a complex disorder and each person with ADHD is unique, so, it is hard to make recommendations that are right for every child or adult, but some of the following suggestions may help :

Children at home

• Show your child lots of affection.
• Children need to hear that they are loved and appreciated. Focusing only on the negative aspects of your child's behavior can harm your relationship with him or her and affect self confidence and self esteem. If your child has a hard time accepting verbal signs of affection, a smile, a pat on the shoulder or a hug can show you care.
• Be patient. Try to remain patient and calm when dealing with your child, even when your child is out of control. If you are calm, your child is more likely to calm down too.
• Keep things in perspective.
• Take time to enjoy with your child.
• Try to keep a regular schedule for meals, naps and bedtime.
• Make sure your child is rested.
• Identify difficult situations. Try to avoid situations that are difficult for your child, such as sitting through long presentations or shopping in malls and supermarkets where the array of merchandise can be overwhelming.
• Use timeouts or the loss of privilege to discipline your child.
• Work on organization.
• Find ways to enhance your child's self-esteem and sense of discipline.
• Use simple words and demonstrate when giving your child directions.
• Take a break yourself.

Children in school

• Ask about school programs.
• Talk to your child's teachers.
• Ask about having your child use a computer in the classroom.

Adults in the workplace

• Ask your boss to repeat instructions rather than guess at what is meant.
• Try to work at home, at least part time.
• Ask for a private office. If that is not possible, work in a quiet area and use headphones to muffle noise. Arriving before most of your co-workers also can help reduce distractions.
• Work on more than one project at a time. When you get bored with one, switch to the other.
• Work on boring tasks when you feel most alert.
• Break up big jobs into smaller tasks.
• Use deadlines for structure.
• Make lists of things to do and use them to prioritize your day.
• Use a day planner and to-do lists. Post notes for yourself.
• Ask your secretary or office assitant to help with details.

Adult relationships

The behavior of many adults diagnosed with ADHD can be unpredictable and sometimes difficult. Forgotten appointments, missed deadlines, impulsive or irrational decisions and angry outbursts can strain the patience of the most forgiving co-worker, friend or partner.

Therapy that focuses on these issues and helps adults better monitor their own behavior can be extremely helpful. So can classes to imporve communication skills, conflict resolution and problem solving. Couple therapy and classes in which family members learn more about ADHD can sometimes significantly improve relationships.