WFMH: New Initiatives: ADHD (Last Updated On: ) Attention Deficit Hyperactivity Disorder (ADHD) Background Information What is ADHD? Attention-deficit/hyperactivity disorder, or ADHD, is a biological, brain-based condition thought to be caused by an imbalance of some of the brains neurotransmitters, substances used to signal between nerve cells. [1] ADHD is one of the most common disorders of childhood and adolescence.[2] The condition is characterized by hyperactive or impulsive behaviours and attention-deficit problems that cannot be explained by any other psychiatric condition and are not in keeping with the childs intellectual ability or stage of development.2 Who has ADHD? ADHD is thought to affect 3-7 per cent of school-aged children.[3] Evidence suggest that boys are three times more likely to have ADHD than girls,1 although the higher rate may be due to the greater prevalence of behavioural and conduct problems in boys, leading to a higher referral rate.[4] ADHD is a strongly hereditary condition. If a family has one child with ADHD there is a 30-40 per cent chance that a brother or sister will also have the condition.1 More than half of all parents with ADHD will have a child with ADHD.[5] Experts estimate that up to 60 per cent of children with the disorder carry their symptoms into adulthood.[6] What are the symptoms of ADHD? ADHD is a dimensional disorder that is, it can be exhibited in mild, moderate and severe forms. 1 The symptoms of ADHD include hyperactive or impulsive behaviours, and deficits in attention. Most people with ADHD have a mixture of these symptoms (Combined type) but others may have mainly one type of symptoms (Predominantly Impulsive type or Predominantly Inattentive type).6 To meet standard diagnostic criteria, some symptoms of ADHD must appear before the age of seven, cause impairment, and persist for at least six months to a degree unusual for the persons age. The symptoms must cause impairment in two or more settings, e.g. at home and at school.6 Symptoms of inattention Failure to give close attention to detail Difficulty sustaining attention in tasks or play Not appearing to listen when spoken to directly Not following through on instructions Difficulty organising tasks and activities Avoiding or disliking tasks that require sustained mental effort Often losing necessary things Easily distracted Forgetful in daily activities Symptoms of hyperactivity Fidgeting often with hands or feet Often leaves seat in situations where remaining seated is expected Runs about inappropriately Difficulty playing quietly Symptoms of impulsivity Blurting out answers before questions are complete Difficulty awaiting turn Often interrupting or intruding on others6 Excessive talk Often on the go What are the causes of ADHD? The precise cause of ADHD remains undetermined. A large body of medical research, however, points to a biological cause and a genetic link. Social factors, such as bad parenting, diet or lifestyle do not cause ADHD, although they can make the symptoms worse.1 How is ADHD diagnosed? Like many disorders, ADHD is a clinical diagnosis based on a review of the patients history and the observations of others. There is no single blood analysis or similar physical tests that can be used to diagnose the condition. Instead, physicians evaluate a patient based on the persons overall patterns of behaviour and the symptoms of the disorder, using the diagnostic criteria DSM-IV.6 Only specially trained healthcare professionals can officially diagnose ADHD. Healthcare professionals secure information regarding behaviour in all facets of the persons life directly from the family and, when appropriate, their teachers (using standard rating scales). Physicians must also evaluate individuals for other possible causes of inattentive or overactive behaviour, as well as for common coexisting conditions, including depression and anxiety.6 What are the potential long-term effects of ADHD? ADHD may have serious consequences if undiagnosed, including under-performance at school or work, depression, problems with relationships, as well as with finding and keeping employment.1 How is ADHD treated? Most experts agree that an appropriate treatment strategy should include a combination of medical, educational and behavioural approaches.1 Historically, the only medications approved to treat ADHD have been psycho-stimulants. Psycho-stimulants work by normalising the neurotransmitters in the brain, which appear to be altered in people with ADHD. Stimulant medications do have some side effects and do not work for all patients. Furthermore, many patients go untreated because of the stigma association with stimulant treatment.1 New non-stimulant therapies are currently being investigated for the treatment of ADHD. [1] Green C, Chee K. Understanding ADHD A Parents Guide to Attention Deficit Hyperactivity Disorder in Children. Vermillion Publishing 1997 ISBN 0 009 181700 5 [2] Practice Parameter for the Assessment and Treatment of Children, Adolescents and Adults with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc. Psych. 36:10 85S-119S [3] American Academy of Pediatrics. Clinical practice guidelines: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 2000; 105:1158-1170 [4] Fredman SJ, Korn ML. ADHD and Comorbidity. 154th Annual Meeting of the American Psychiatric Association, May 2001, New Orleans, Louisiana, USA [5] Weiss M et al. ADHD in Parents. Ch & Adolesc Psych. 2000; 39:1059-1061 [6] American Psychiatric Association. DSM-IV Text Revision. 2000: 85-93