Conduct Disorders

Attention-Deficit/Hyperactivity Disorder (ADHD)

 

Attention-Deficit/Hyperactivity Disorder (ADHD) (sometimes referred to as ADD when only inattentiveness and distractability are problematic) is, as a putative neurological disorder initially appearing in childhood which manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractability.[1] In neurological terms, ADHD is currently considered to be a persistent and chronic syndrome for which no medical cure is available. ADHD is believed to affect between 3-5% of the United States population, including both children and adults.[2]

Within society, there is disagreement if a diagnosis denotes a genuine impairment/disability or simply serves as a label for different but normal behaviour. Some believe that the disorder does not exist or that it need not be treated. According to a majority of medical research in the United States, as well as other countries, ADHD is today generally regarded to be a non-curable neurological disorder for which, however, a wide range of effective treatments are available. A wide body of evidence has shown that stimulant medication is the most effective way to treat the disorder[3] [4]. Methods of treatment usually involve some combination of medication, psychotherapy, and other techniques. Some patients are able to control their symptoms over time, without the use of medication.

ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.[5]

Definitions and terminology

The most appropriate designation of ADHD is currently disputed; the terms below are known to be used to describe the condition. A difficulty in the condition's nomenclature arises when some scientific research suggests that certain behaviors are directly attributable to ADHD, while other research concludes that the same behaviors constitute disorders that need to be classified independently of ADHD. [citation needed]

DSM

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) states that ADHD is a developmental disorder that presents during childhood, with at least some symptoms causing impairment before the age of seven. It is characterized by developmentally inappropriate levels of inattention and/or hyperactive-impulsive behavior, with significant impairment occurring in at least two settings. Adults with ADHD are diagnosed under the same criteria, including the stipulation that their symptoms must have been present prior to the age of seven.[6] The DSM-IV-TR divides ADHD into three subtypes: predominantly inattentive (sometimes referred to as ADD), predominantly hyperactive-impulsive, and combined. Those presenting impairing symptoms of ADHD who do not fully fit the criteria for any of the three subtypes can be diagnosed with "ADHD Not Otherwise Specified".[6]

ICD

In the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) the symptoms of ADHD are given the name "Hyperkinetic disorders". When a conduct disorder (as defined by ICD-10,[7]) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".[7] Because the editors of the ICD believe that the inability to pay attention constitutes a separate disorder,[citation needed] a person must be hyperactive in order to be diagnosed with a Hyperkinetic disorder.

Other

Symptoms

The symptoms of ADHD fall into the following two broad categories:[8]

Inattention:

  1. Failure to pay close attention to details or making careless mistakes when doing schoolwork or other activities
  2. Trouble keeping attention focused during play or tasks
  3. Appearing not to listen when spoken to
  4. Failure to follow instructions or finish tasks
  5. Avoiding tasks that require a high amount of mental effort and organization, such as school projects
  6. Frequently losing items required to facilitate tasks or activities, such as school supplies
  7. Excessive distractibility
  8. Forgetfulness
  9. Procrastination, inability to begin an activity
  10. Difficulties with household activities (cleaning, paying bills, etc.)
  11. Difficulty falling asleep, may be due to too many thoughts at night
  12. Frequent emotional outbursts
  13. Easily frustrated
  14. Easily distracted

Hyperactivity-impulsive behaviour

  1. Fidgeting with hands or feet or squirming in seat
  2. Leaving seat often, even when inappropriate
  3. Running or climbing at inappropriate times
  4. Difficulty in quiet play
  5. Frequently feeling restless
  6. Excessive speech
  7. Answering a question before the speaker has finished
  8. Failure to await one's turn
  9. Interrupting the activities of others at inappropriate times
  10. Impulsive spending, leading to financial difficulties

A positive diagnosis is usually only made if the person has experienced six of the above symptoms for at least three months. Symptoms must appear consistently in varied environments (e.g., not only at home or only at school) and interfere with function.

Children who grow up with ADHD often continue to have symptoms as they grow into adulthood. Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as executive functioning (see executive functions); having usually more symptoms of inattention and less of Hyperactivity-impulsive behavior than children. [citation needed]

One of the difficulties in diagnosis is the incidence of co-morbid conditions, especially the presence of bipolar disorder which is being reported at earlier ages than previously described [9]. If the patient is not treated appropriately, other co-morbid conditions, such as depression, anxiety and self-medicating substance abuse may present as well.

Diagnosis

The Centers for Disease Control and Prevention (CDC) state that a diagnosis of ADHD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physiological disorders, such as hyperthyroidism. It is not uncommon that physically and mentally nonpathological individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.

Clinical testing

The American Academy of Pediatrics Clinical Practice Guideline for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:[10]

  1. The use of explicit criteria for the diagnosis using the DSM-IV-TR.
  2. The importance of obtaining information about the child’s symptoms in more than one setting.
  3. The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.

The first criteria can be satisfied by using an ADHD-specific instrument such as the Conners' Rating Scale [11][12]. The second criteria is best fulfilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory.[13] The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of intelligence and psychological testing (to satisfy the third criteria) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.[14]

Analytical testing

Due to the lack of objectivity that surrounds the critical factors, there is some question as to the reliability of ADHD diagnosis. The American Academy of Pediatrics Clinical Practice has published guidelines to aid providers in making an objective diagnosis, but even if strictly adhered to, doubt still remains among some patients, as well as providers. Other diagnostic methods, such as those involving magnetic resonance imaging (MRI), may detect the presence of ADHD by analyzing images of the patient's brain, are usually not recommended (see brain scans). In a majority of cases, diagnosis is dependent on self reported and observed symtoms and behavior.

Computerized tests

Computerized tests of attention are not especially helpful in providing a further independent assessment because they have a high rate of false negatives (real cases of ADHD can pass the tests 35% of the time or more),[15] they do not correlate well with actual behavioral problems at home or school, and are not especially helpful in determining treatments. Both the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have recommended against the use of such computerized tests for now in view of their lack of appropriate scientific validation as diagnostic tools.[citation needed] In the USA, the process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.[citation needed]

Brain scans

Currently, brain scans are able to detect only differences between groups with ADHD and groups without ADHD, not a difference in a single individual. An October 2005 meta-analysis by Alan Zametkin, M.D., with the NIMH, concluded that not enough scientific research has been done on the accuracy of these potential diagnostic methods for them to be used for diagnosis.[16] They remain, however, useful research tools when studying groups of patients with ADHD. However, it has been alleged that this type of research has not beel well-executed and that the data is not made available to scientists who want to verify it and/or reanalyze it, which is common in most scientific fields Broken Brains or Flawed Studies? A Critical Review of ADHD Neuroimaging Research

Epidemiology

ADHD has been found to exist in every country and culture studied to date. While it is most commonly diagnosed in the United States, rates of diagnosis are rising in most industrialized countries; the reasons for this are multifactorial. The prevalence among children is estimated to be in the range of 5% to 8%, and 4% to 8% in adults. 10% of males, and (only) 4% of females have been diagnosed.[17] This apparent sex difference may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.[18][19]

Causes

An early PET scan study found that global cerebral glucose metabolism was 8.1% lower in medication-naive adults who had been diagnosed as ADHD while children. The image on the left illustrates glucose metabolism in the brain of an 'normal' adult while doing an assigned auditory attention task; the image on the right illustrates the areas of activity of the brain of an adult who had been diagnosed with ADHD as a child when given that same task; these are not pictures of individual brains, which would contain substantial overlap, these are images constructed to illustrate group-levl differences. Additionally, the regions with the greatest deficit of activity in the ADHD patients (relative to the controls) included the premotor cortex and the superior prefrontal cortex. [20] A second study in adolescents failed to find statistically significant differences in global glucose metabolism between ADHD patients and controls, but did find statistically significant deficits in 6 specific regions of the brains of the ADHD patients (relative to the controls). Most notably, lower metabolic activity in one specific region of the left anterior frontal lobe was significantly inversely correlated with symptom severity. >[21] These findings strongly imply that lowered activity in specific regions of the brain, rather than a broad global deficit, is involved in ADHD symptoms.

The exact cause of ADHD remains unknown, but there is no shortage of speculation concerning its etiology,[22][23] most of which centers around the brain.

Hereditary dopamine deficiency

Research suggests that ADHD arises from a combination of various genes, many of which affect dopamine transporters.[24] Suspect genes include the 10-repeat allele of the DAT1 gene,[25] the 7-repeat allele of the DRD4 gene,[25] and the dopamine beta hydroxylase gene (DBH TaqI).[26] Additionally, SPECT scans found people with ADHD to have reduced blood circulation,[27] and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead.[28]

A new study by the U.S. Department of Energy’s Brookhaven National Laboratory in collaboration with Mount Sinai School of Medicine in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control subjects with a radiotracer that attaches itself to dopamine transporters. The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of dopamine across the board. They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor. Researchers generally agree that dopamine imbalance is a telling factor in ADHD.[1]

Diet

Recent studies have begun to find metabolic differences in these children, indicating that an inability to handle certain elements of one's diet might contribute to the development of ADHD, or at least ADHD-like symptoms. For example, in 1990 the English chemist, Neil Ward,[29] showed that children with ADHD lose zinc when exposed to the food dye tartrazine. Some studies suggest that a lack of fatty acids, specifically omega-3 fatty acids can trigger the development of ADHD. Support for this theory comes from findings that children who are breastfed for six or more months seem to be less likely to have ADHD than their bottlefed counterparts and until very recently, infant formula did not contain any omega-3 fatty acids at all.[30] Time and further investigation will perhaps tell whether this correlation is reliable or merely a coincidence.

Despite the uncertainty of nutrition as a cause of ADHD in some cases it may play a role in the diagnosis and treatment of the disorder. Certain dietary issues, most commonly a moderate to severe protein deficiency, can cause symptoms consistent with ADHD.[31][32]

Environmental factors

There is no compelling evidence that social factors alone can create ADHD. The few environmental factors implicated fall in the realm of biohazards and include alcohol, tobacco smoke, and lead poisoning. Complications during pregnancy and birth--including premature birth--might also play a role.

It has been observed that women who smoke while pregnant are more likely to have children with ADHD.[33] Since nicotine is known to cause hypoxia (lack of oxygen) in utero, smoking during pregnancy could increase the odds of a child having ADHD.

Head injuries can cause a person to present ADHD-like symptoms,[34] possibly because of damage done to the patient's frontal lobes. Because symptoms were attributable to brain damage, the earliest designation for ADHD was "Minimal Brain Damage".[35]

Violence, abuse, and other emotional traumas

Many clinicians believe that attachments and relationships with caregivers and other features of a child's environment have profound effects on attentional and self-regulatory capacities. It is noteworthy that a study of foster children found that an inordinate number of them had symptoms closely resembling ADHD. What Keeps Children in Foster Care from Succeeding in School. An editorial in a special edition of Clinical Psychology in 2004 stated that "our impression from spending time with young people, their families and indeed colleagues from other disciplines is that a medical diagnosis and medication is not enough":

"In our clinical experience, without exception, we are finding that the same conduct typically labelled ADHD is shown by children in the context of violence and abuse, impaired parental attachments and other experiences of emotional trauma."[36]

While no conclusive evidence has been offered that parenting methods can cause ADHD in otherwise normal children a sizable minority of clinicians believe this is the case.[citation needed] A different perspective holds that while evidence shows that parents of ADHD children experience more stress and give more commands,[37] further research has suggested that such parenting behavior is in large part a reaction to the child's ADHD and related disruptive and oppositional behavior, and to a minor extent the result of the parent's own ADHD.[38]

Treatment

There are many options available to treat people diagnosed with ADHD. The options with the greatest scientific support include a variety of medications, behavior modification, and educational interventions. The results of a large randomized controlled trial[39][40] suggested that medication alone is superior to behavioral therapy alone, but that the combination of behavioral therapy and medication has a small additional benefit over medication alone if the subjects had a comorbid disorder like anxiety that responds to therapy. Behaviour therapy made no difference to those subjects who had ADHD only.

Mainstream treatments

Adderall 25 mg XR. Adderall XR is one of the medications used to treat ADHD.

The most frequently prescribed medications for ADHD are stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. The use of stimulants to treat a syndrome often characterized by hyperactivity is sometimes referred to as a paradoxical effect. But there is no real paradox in that stimulants activate brain inhibitory and self-organizing mechanisms permitting the individual to have greater self-regulation. Frequently prescribed stimulants are Methylphenidate (better known by the brand names Ritalin and Concerta), Amphetamines (Adderall) and dextroamphetamines (Dexedrine). A fourth stimulant, Modafinil (Provigil) is commonly prescribed off-label[citation needed] and is not approved for ADHD. A fifth stimulant, Cylert was used until the late 1980s when it was discovered that this medication could cause liver damage. In March 2005, the makers of Cylert announced that it would discontinue the medication's production. It is no longer available in the United States. A sixth stimulant, Amineptine (Survector), is an atypical Tricyclic anti-Depressant commonly not available in most of the world and when it was approved was prescribed only off-label for ADHD, though this is not due to side effects but rather the perception that it might be addictive (despite no evidence showing it is more addictive than other drugs mentioned in this paragraph).[citation needed] A seventh medication, bupropion is classified as an anti-depressant, but inhibits the reuptake of norepinephrine, and to a lesser extent, dopamine, in neuronal synspases.[41], and so is noted in this paragraph. Unlike many of the stimulants used to treat ADHD, bupropion is not a controlled substance. See further information on Bupropion in the paragraph below.

There are also several nonstimulant medications that are used either by themselves or in conjunction with the stimulants. These are commonly Selective Norepinephrine Reuptake Inhibitors (SNRIs but not to be confused with Serotonin-Norepinephrine Reuptake Inhibitors also referred to as SNRIs) such as Atomoxetine (Strattera). These are also sometimes classified as Norepinephrine Reuptake Inhibitors (NRIs) for the confusion issue. Also, tricyclic anti-Depressants are occasionally prescribed, but they seem to only treat the hyperactive part of the condition. There is research on a class of medications called Selective Serotonin Reuptake Enhancers (SSREs); currently, the only one available is Tianeptine (brand name Stablon; it is not available in North America or the English World); this is an atypical tricyclic anti-depressant which is inconclusive in its efficacy. Bupropion (Wellbutrin, commonly prescribed as Wellbutrin XL in a timed release form due to risk of side effects) is an anti-depressant which weakly inhibits the neuronal re-uptake of both norepinephrine and dopamine, but has little or no effect on seratonergic re-uptake[42]. It is approved for ADHD [citation needed] and is not particularly known for its stimulant properties because at high doses it tends to cause seizures in a large portion of the population.

Because many of the medications used to treat ADHD are Schedule II under the U.S. Drug Enforcement Administration schedule system, and are considered powerful stimulants with a potential for abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research studying ADHD patients who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.[43]

See Also: List of prescription medications for ADHD

Only recently, studies on the cost-effectiveness of ADHD treatment have begun to appear. To date valid information is limited, although a review presented at the 17th World Congress of the International Association for Child and Adolescent Psychiatry and Allied Professions(IACAPAP) in Melbourne, Victoria, September 10-14, 2006, identified 11 health technology assessments and cost-effectiveness analyses, all of which compared the economic merits of at least two treatment alternatives.[44]

Alternative treatments

Many alternative treatments have been proposed for ADHD. There are no credible scientific studies to support the efficacy of these interventions.

Nutrition

Ginkgo is a natural supplement used by some to help control their ADHD symptoms.

There are indications that children with ADHD are metabolically different from others,[45][46][47] and it has therefore been suggested that diet modification may play a role in the management of ADHD. Perhaps the best known of the dietary alternatives is the Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets.[48] In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness. Later, zinc and multivitamins have been promoted as cures, and currently the addition of certain fatty acids such as omega-3 has been proposed as beneficial.[49][50]

For some people with ADHD mild stimulants such as caffeine and theobromine have similar effects to the more powerful drugs commonly used in treating the disorder.[citation needed] There is some empirical data suggesting caffeine can improve the function of children suffering from ADHD.[51][52]

Herbal supplements such as ginkgo biloba are also sometimes cited.[citation needed]

Other alternatives

Audio-visual entrainment uses light and sound stimulation to guide and change brainwave patterns.[53] While safe for most, it cannot be used by those suffering from photosensitive epilepsy due to the risk of triggering a seizure.

Cerebellar stimulation assumes that by improving the patient’s cerebellar function, many ADHD symptoms can be reduced or even eliminated permanently. Several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts. [citation needed] Several programs of balance, coordination, eye and sensory exercises that specifically involve the functions of the cerebellum are used to treat ADHD, Asperger's syndrome, and many learning difficulties such as dyslexia and dyspraxia. Most prominent are the DORE program,[54] the Learning Breakthrough Program, and the Brain Gym. No substantial body of research exists to support these treatment approaches.

Finally, a study by the University of Pennsylvania Cancer Center has shown that people who suffer from ADHD may be more likely to start smoking. The study's author suggest that this may be true because patients use the nicotine in cigarettes as a form of treatment for ADHD symptoms.[55]

Coaching

Main article: ADHD Coaching

ADHD Coaching is a program where coaches work with ADHD individuals to help them prioritize, organize, and develop life skills. Coaching is aimed at helping clients to be more realistic in setting goals for themselves by learning about their individual challenges and gifts, and emphasizes spending more time in areas of strength, while minimizing time spent dealing with areas of difficulty.

Controversy

The ADHD diagnosis has been questioned by some vocal critics. They point out the positive traits that people with ADHD have, such as "hyperfocusing." Others believe ADHD is a divergent or normal-variant human behavior, and use the term neurodiversity to describe it, emphasizing that there are an immense number of variations in genetics which could favor a greater or lesser ability to concentrate and/or to remain calm under varying circumstances.[56]

Another source of controversy, especially in the United States, is the use of psychotropic medications to treat the disorder.[citation needed] In the United States outpatient treatment for ADHD has grown from 0.9 children per 100 (1987) to 3.4 per 100 (1997).[57] However it has held steady since then.[58]

Skepticism towards diagnosis

The number of people diagnosed with ADHD in the U.S. and UK grew dramatically in the 90's. Critics of the diagnosis, such as Dan P. Hallahan and James M. Kauffman in their book Exceptional Learners: Introduction to Special Education, have argued that this increase is due to the ADHD diagnostic criteria being sufficiently general or vague to allow virtually anybody with persistent unwanted behaviors to be classified as having ADHD of one type or another, and that the symptoms are not supported by sufficient empirical data.[59]

Publications that are designed to analyze a person's behavior, such as the Brown Scale or the Conners Scale, for example, attempt to assist parents and providers in making a diagnosis by evaluating an individual on typical behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of these behaviors range from "never" to "very often". [citation needed] Conners states that, based on the scale, a valid diagnosis can be achieved; critics, however, counter Conners' proposition by pointing out the breadth with which these behaviors may be interpreted. This becomes especially relevant when family and cultural norms are taken into consideration; this premise leads to the assumption that a diagnosis based on such a scale may actually be more subjective than objective (see cultural subjectivism). However, DSM IV-TR Diagnostic criteria does take into account behaviors related to cultural and social norms.

A study by Adam Rafalovich has found that many doctors are no more confident in the diagnosis and treatment of ADHD than are many parents.[60] Another source of skepticism is that most people with ADHD have no difficulties concentrating when they are doing something that interests them, whether it is educational or entertainment.[61] However, these objections have been rejected by the American Psychiatric Association, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics and the U.S. Surgeon General.[62] Moreover the fact that comorbidity is common, somewhere between 60 and 80% of children diagnosed with ADHD have a second diagnosis, indicates that the nuances of diagnosis have not been adequately described. Simple uncomplicated ADHD may well turn out to be different from ADHD with comorbid conduct disorder, and different again from ADHD with comorbid Tourette's or Asperger's syndrome to name but two of the conditions that commonly occur in conjunction with ADHD.

Positive aspects

Although ADHD is considered a disorder, some view it in a neutral or positive light. Rather than assuming that ADHD is inherently negative, some argue that ADHD is simply a different method of learning as opposed to an inferior one. "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and pondering if it still works on a cloudy day" (Underwood). The aspects of ADHD which are generally viewed negatively can be a potential source of strength, such as willingness to take risks. "Impulsivity isn't always bad. Instead of dithering over a decision, they're willing to take risks" (Underwood). Both a proponent and an example of this point is JetBlue Airways founder David Neeleman. He considers ADHD one of his greatest assets and refuses to take medication.[63][64] There has been little serious research into either the intellectual advantages it can provide, or into conditions which might be necessary for taking advantage of ADHD traits. Many professional counselors emphasize to persons diagnosed with ADHD and their families the perspective that the condition does not necessarily block, and may even facilitate, great accomplishments.[citation needed] Most frequently cited as potentially useful is the mental state of hyperfocus. Lists of famous persons either diagnosed with ADHD or suspected (but not necessarily known to have had ADHD) are numerous, such as Albert Einstein, Thomas Edison, and former Pittsburgh Steelers Hall of Fame quarterback Terry Bradshaw, but currently lack scientific proof because ADHD was not a documented medical condition until its appearance in the DSM-III in 1980. Still, a wide body of evidence statistically points to numerous diminished outcomes throughout the lifetime of those with ADHD [2].

History

There is considerable evidence to suggest that ADHD is not a recent phenomenon.

  • 493 BC, the great physician-scientist Hippocrates described a condition that seems to be compatible with what we now know as ADHD. He described patients who had "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression". Hippocrates attributed this condition to an "overbalance of fire over water”. His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities."[65]
  • 1845. ADHD was alluded to by Dr. Heinrich Hoffmann, a German physician who wrote books on medicine and psychiatry. Dr. Hoffmann was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their undesirable behaviours. "Die Geschichte vom Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having attention deficit hyperactivity disorder.[66] Alternatively, it may be seen as merely a moral fable to amuse young children at the same time as encouraging them to behave properly.
  • 1902 – The English pediatrician George Still, in a series of lectures to the Royal College of Physicians in England, described a condition which some have claimed is analogous to ADHD. Still described a group of children with significant behavioral problems, caused, he believed, by an innate genetic dysfunction and not by poor child rearing or environment.[67] Analysis of Still's descriptions by Palmer and Finger indicated that the qualities Still described are not "considered primary symptoms of ADHD".[68]
  • The 1918–1919 influenza pandemic left many survivors with encephalitis, affecting their neurological functions. Some of these exhibited immediate behavioral problems which correspond to ADD. This caused many to believe that the condition was the result of injury rather than genetics.
  • 1937 – Dr. Bradley in Providence, RI reported that a group of children with behavioral problems improved after being treated with stimulant medication.[69]
  • 1957 – The stimulant methylphenidate (Ritalin) became available. It remains one of the most widely prescribed medications for ADHD in its various forms (Ritalin, Focalin, Concerta, Metadate, and Methylin).
  • 1960 – Stella Chess described "Hyperactive Child Syndrome", introducing the concept of hyperactivity not being caused by brain damage.[70]
  • By 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from Minimal Brain Damage to Minimal Brain Dysfunction.[71]
  • 1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente Medical Center in San Francisco, claimed that hyperactivity was increasing in proportion to the level of food additives.
  • 1975 – Pemoline (Cylert) is approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in at least 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market.
  • 1980 – The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition.
  • 1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder."[72]
  • 1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination.
  • 1996 – ADHD accounted for at least 40% of child psychiatry references.[73]
  • 1999 – New delivery systems for medications are invented that eliminate the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta).
  • 1999 – The largest study of treatment for ADHD in history is published in the American Journal of Psychiatry. Known as the Multimodal Treatment Study of ADHD (MTA Study), it involved more than 570 children with ADHD at 6 sites in the United States and Canada randomly assigned to 4 treatment groups. Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.
  • 2001 – The International Consensus Statement on ADHD is published and signed by more than 80 of the world's leading experts on ADHD to counteract periodic media misrepresentation. The statement reaffirms ADHD is a "genuine disorder because the scientific evidence indicating it is so is overwhelming", "recognizes the mounting evidence of neurological and genetic contributions to this disorder", and that medications are justified as a treatment for the disorder. In 2005, another 100 European experts on ADHD added their signatures to this historic document certifying the validity of ADHD as a valid mental disorder.
  • 2003 – Atomoxetine (Strattera), the first new medication for ADHD in 25 years, receives FDA approval for use in children, teens, and adults with ADHD.

See also

Footnotes

  1. Attention-Deficit/Hyperactivity Disorder (ADHD). Behavenet.com. Retrieved on December 11, 2006.
  2. ADD/ADHD Health Center. WebMD.com. Retrieved on December 11, 2006.
  3. http://www.continuingedcourses.net/
  4. http://www.continuingedcourses.net/
  5. Attention-Deficit / Hyperactivity Disorder: ADHD in Adults. WebMd.com. Retrieved on December 11, 2006.
  6. a b Attention-Deficit/Hyperactivity Disorder. psychiatryonline.com. Retrieved on December 11, 2006.
  7. a b ICD Version 2006: F91. World Health Organization. Retrieved on December 11, 2006.
  8. What we know National Resource Center on AD/HD
  9. Biederman J, Faraone S, Mick E, Wozniak J, Chen L, Ouellette C, Marrs A, Moore P, Garcia J, Mennin D, Lelon E (1996). "Attention-deficit hyperactivity disorder and juvenile mania: an overlooked comorbidity?". J Am Acad Child Adolesc Psychiatry 35 (8): 997-1008. PMID 8755796. 
  10. Perrin JM, Stein MT, Amler RW, Blondius TA. 2001. "Clinical practice guideline: treatment of school-aged children with Attention Deficit/Hyperactivity Disorder". Pediatrics 108 (4):1033-1044. PMID 11581465
  11. Conners, K. (1998). "Revision and restandardization of the Conners teacher rating scale (CTRS-R): factor structure, reliability, and criterion validity". J Abnorm Child Psychol 26: 279-291. 
  12. Conners, K. (1998). "Revision and restandardization of the Conners parent rating scale (CPRS-R): factor structure, reliability, and criterion validity". J Abnorm Child Psychol (26): 279-291. 
  13. Ratey, John; Hallowell, Edward. Driven to Distraction first edition, pg 42
  14. Ninivaggi, F. J. "Borderline intellectual functioning and academic problem." In: Sadock B.J. Sadock, V.A., eds. Kaplan & Sadock's Comprehensive Textbook of psychiatry. 8th ed. Vol. II. Baltimore: Lippincott William and Wilkins; 2005: 2272-2276.
  15. Barkley, R. A. (2006). Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment (3rd ed.). New York: Guilford.
  16. Alan Zametkin, Elizabeth Schroth, and Dara Faden, (2005) Role of Brain Imaging in the Diagnosis and Management of ADHD The ADHD Report, Volume: 13(5)
  17. CDC. "National Health Interview survey, 2002" (PDF) (March, 2004) Retrieved on December 11, 2006.
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Further reading

  • Barkley, Russell A. Take Charge of ADHD: The Complete Authoritative Guide for Parents (2005) New York: Guilford Publications
  • Bellak L, Kay SR, Opler LA. (1987) "Attention deficit disorder psychosis as a diagnostic category". Psychiatric Developments, 5 (3), 239-63. PMID 3454965
  • Carey,Benedict Debate Over Children and Psychiatric Drugs
  • Conrad, Peter Identifying Hyperactive Children (Ashgate, 2006).
  • Green, Christopher, Kit Chee, Understanding ADD; Doubleday 1994; ISBN 0-86824-587-9
  • Hanna,Mohab "Making the Connection: A Parent's Guide to Medication in AD/HD" (2006)Washington D.C. : Ladner-Drysdale
  • Joseph, J. (2000). Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder. Developmental Review, 20, 539-567.
  • Kelly, Kate, Peggy Ramundo. You Mean I'm Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder (1993) ISBN 0-684-81531-1
  • Ninivaggi, F.J., "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases," Connecticut Medicine. September 1999; Vol. 63, No. 9, 515-521. PMID 10531701
  • Timimi, Sami. Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture(2005) London Palgrave McMillan ISBN 1-4039-4511-X

Debate Over Children and Psychiatric Drugs

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This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Attention-deficit hyperactivity disorder".

 

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