- What is attention deficit hyperactivity disorder (ADHD)?
- Symptoms of ADHD
- Diagnosing ADHD: what professionals look at
- Getting an ADHD diagnosis
- ADHD and teenagers
- Everyday life for children with ADHD
- Risk factors for ADHD
- Schools may benefit from a whole school approach to understanding and managing ADHD and the learning difficulties and mental health issues associated with it. It would be preferable for all SENCO’S (Special Educational Needs coordinators) to access training on how to successfully manage ADHD within the learning environment, in order to support both staff and children and raise levels of achievement and academic attainment. However, there appears to be no compulsory or legal requirement for schools to access training on ADHD, although, it is good practice for schools to keep up to date with all the learning needs and practices surrounding ‘Special Educational Needs’ and disability. Many schools are very successful at meeting the needs of children with additional needs.Where can I get further information?Below a list of research, together with web site addresses which may be helpful to you in understanding ADHD. UK Study – How ADHD Affects Siblings ADHD Expert Dr.Levin’s response to research ‘Misrepresentation of Neuroscience Data…’ New Zealand Research Project – Effect of a Nutritional Supplement on Attention and Mood in Adults with ADHD UK Research Project – Learning Attitudes New Clues on Causes of ADHD Recruitment of Adolescent Boys for ADHD Study at IoP New Research Project by Dr Billy Levin with adders.org A Watch for ADDers by Nick Jordan ADHD and Adjustment to College Children and Adults with ADHD Bridging the Gap – The Need for Creative Collaboration between CAMHS and Adult Mental Health Services The Association Between Hyperkinesis and Breakdown of Parenting in Clinic Populations Delta Plots in the Study of Individual Differences: New Tools Reveal Response Inhibition Deficits in AD/HD That Are Eliminated by Methylphenidate Treatment Regional cerebral blood flow in children with ADHD: changes with age Atomoxetine Ingestions in Children: A Report from Poison Centers Modeling ADHD child and family relationships Comparative Study of Cerebral White Matter in Autism and Attention-deficit/Hyperactivity Disorder by Means of Magnetic Resonance Spectroscopy(1) Coping Skills and Parent Support Mediate the Association Between Childhood Attention-Deficit/Hyperactivity Disorder and Adolescent Cigarette Use Ropinirole in a Child With Attention-Deficit Hyperactivity Disorder and Restless Legs Syndrome Medication Combined with Behaviour Therapy Works Best for ADHD Children, Study Finds Help needed for research at Southampton University – UK Atomoxetine and Stimulants in Combination for Treatment of Attention Deficit Hyperactivity Disorder: Four Case Reports ADHD Least Understood In The UK – New Global Survey Reveals UK Parents Hardest Hit By Child’s ADHD Unrecognised Dyslexia and the Route to Offending New Results from the MTA Study – Do treatment effects persist? The role of Disability Living Allowance in the management of Attention-Deficit/Hyperactivity Disorder ADHD: Increased Costs For Patients And Their Families Understanding and Recognizing ADHD by Dr Nikos Myttas Stigma Of Disorder, Lack Of Information Significant Barriers To Treatment Of ADHD Among African Americans, Hispanics A Whole-Genome Scan in 164 Dutch Sib Pairs with Attention-Deficit/ Hyperactivity Disorder: Suggestive Evidence for Linkage on Chromosomes 7p and 15q Assessing the molecular genetics of attention networks A qualitative study of Australian GPs’ attitudes and practices in the diagnosis and management of attention-deficit/hyperactivity disorder (ADHD) Low self-esteem and psychiatric patients: Part I – The relationship between low selfesteem and psychiatric diagnosis Recent Advances in the Genetics of Attention Deficit Hyperactivity Disorder Is primary care ready to take on Attention Deficit Hyperactivity Disorder? Does routine child health surveillance contribute to the early detection of children with pervasive developmental disorders? – An epidemiological study in Kent, U.K. Methylphenidate Enhances Working Memory by Modulating Discrete Frontal and Parietal Lobe Regions in the Human Brain Methylphenidate Improves Response Inhibition in Adults with Attention-Deficit/Hyperactivity Disorder Long term medical conditions: career prospects Help needed for research at Southampton University – UK A genomewide scan for attention-deficit/hyperactivity disorder in an extended sample: suggestive linkage on 17p11 Genetic linkage of attention-deficit/hyperactivity disorder on chromosome 16p13, in a region implicated in autism A genome wide scan for loci involved in attention-deficit/hyperactivity disorder. Genetics OF ADHD Understanding and recognizing ADHD – Article by Dr Nikos Myttas Extracts from Institute of Psychiatry Research Report 2002 Developmental neuropsychopathology of attention deficit and impulsiveness. Hypescheme International Entry System IMAGE – Mapping susceptibility genes for attention deficity hyperactivity disorder Sail (Study Of Activity And Impulsivity Levels In Children) Prior juvenile diagnoses in adults with mental disorder: developmental follow-back of a prospective-longitudinal cohort Treatment In Childhood Could Halve Rates Of Mental Disorders Hyperactivity and Conduct Problems as Risk Factors for Adolescent Development Neuropsychological analyses of impulsiveness in childhood hyperactivity Study Confirms Concerta (methylphenidate HCl) Effective, Safe Treatment For Attention Deficit Hyperactivity Disorder AD(H)D Research Project – Psychological Aspects of ADD Ritalin “does not lead to drug abuse” A pilot study of methylphenidate, clonidine, or the combination in ADHD comorbid with aggressive oppositional defiant or conduct disorder Nonstimulant Therapy Shows Effectiveness in ADHD More about SPECT Scans, Cancer and ADHD by Thom Hartmann Study Raises Hopes for Adhd Medical Test, more about PET Scans Further Study on ADDerall Brain Areas Critical To Human Time Sense Identified Mapping susceptibility genes for attention deficit hyperactivity disorder Increase in ADHD And Comorbid Disorders Seen in Families of Girls With ADHD New Study on ADDerall ADHD in Girls Study Finds Careful Medication Management Of ADHD Superior To Behavioural Treatment Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder Multimodality Integrated Biofeedback Brain Scan Shows ADHD Serotonin May Hold Key to Hyperactivity Disorder Disorder Treatment Paying Attention Treating Children’s Sleep Disorders Improves Attention Deficit Symptoms ADHD can cause lifelong problems, study finds
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- ADD or ADHD: Are They Different?
- Attention-Deficit/Hyperactivity Disorder
What is attention deficit hyperactivity disorder (ADHD)?
If children have attention deficit hyperactivity disorder (ADHD), it means they have difficulties with:
- paying attention – for example, they find it hard to concentrate on tasks
- being hyperactive – for example, they find it hard to sit still for long
- controlling impulses – for example, they might do things before thinking them through.
In ADHD the different parts of the brain don’t ‘talk’ to each other in a typical way. Because of this, children with ADHD might have more trouble than their peers with thinking, learning, expressing feelings or controlling behaviour.
Many children have these kinds of difficulties sometimes, but in children with ADHD, these difficulties happen most of the time and have a big effect on their daily lives.
We don’t know the exact cause of ADHD. But we do know that ADHD isn’t caused by bad parents or parenting. It’s not because of inconsistent parenting or a lack of limits on behaviour.
Symptoms of ADHD
Attention deficit hyperactivity disorder (ADHD) symptoms fall into two groups.
This means that a child:
- doesn’t pay close attention to details and makes ‘careless’ mistakes
- has difficulty following instructions and finishing tasks like homework or chores
- has difficulty keeping attention on things and is easily distracted
- is often distracted by little things
- has trouble remembering everyday things
- avoids tasks that require a lot of mental effort like schoolwork or homework
- doesn’t seem to listen when spoken to
- has trouble getting things in order or doing things on time
- often loses things like schoolwork, pencils, books, wallets, keys or mobile phones.
Hyperactive and impulsive symptoms
This means that a child:
- fidgets a lot and can’t sit still
- runs around and climbs on things in inappropriate situations
- is on the go all the time
- finds it hard to play or take part in activities quietly
- talks a lot
- has difficulty staying seated at school or the dinner table
- is impatient and doesn’t wait for a turn
- blurts out answers before questions are finished
- interrupts other people’s conversations or games or uses things without asking.
Even if your child has symptoms like the ones listed above, it doesn’t always mean your child has ADHD. There are other problems that could cause behaviour that looks like ADHD – for example, problems with health, emotions, sleep or school. This is why your child needs to be properly assessed.
Diagnosing ADHD: what professionals look at
Children might be diagnosed with one of three types of attention deficit hyperactivity disorder (ADHD), depending on symptoms:
- ADHD combined type: children with this type have both hyperactive/impulsive and inattentive symptoms. They tend to have trouble concentrating, are fidgety or restless and are always on the go. They often act without thinking.
- ADHD inattentive type: children with this type mainly have inattentive symptoms. They tend to have trouble concentrating, remembering instructions, paying attention and finishing tasks.
- ADHD hyperactive/impulsive type: children with this type mainly have hyperactive/impulsive symptoms. They’re always on the go, have trouble slowing down and often act without thinking.
When health professionals are working out whether a child has ADHD, they use careful guidelines to check the child’s symptoms. They’ll look at things like:
- Child’s age: the child’s symptoms must begin before the age of 12 years. Children are often at least five years old before ADHD is diagnosed because there might be lots of other reasons for difficult behaviour in younger children.
- Number of symptoms: the particular ADHD diagnosis depends on how many inattentive and hyperactive/impulsive symptoms a child has.
- Duration of symptoms: the child must have had symptoms for at least six months.
- Severity of symptoms: a child’s symptoms must be worse than children of the same age and happen most of the time. Also, the symptoms must interfere with at least two areas of the child’s life – for example, school, home or child care.
Diagnosing ADHD isn’t easy, because ADHD can overlap with other medical and behaviour conditions. But the right diagnosis means a child can get the right therapies and management plan for his condition.
Getting an ADHD diagnosis
It’s very important to diagnose and treat attention deficit hyperactivity disorder (ADHD) as early as possible. The earlier it’s diagnosed, the earlier you and your child’s health professionals can work on a plan to manage your child’s symptoms.
If you’re concerned about your child’s behaviour, your GP is a good place to start. Your GP might refer your child to a paediatrician, a psychologist or a child psychiatrist, who can look at your child’s symptoms and consider possible diagnoses.
The diagnosis process might include most, if not all, of the following:
- an interview with you and other primary carers of your child
- an interview with your child
- behaviour checklists that you and/or your child’s carers and teachers fill out
- discussions with your child’s teachers or carers.
Your child might also have other tests, including:
- developmental, learning, educational or IQ checks
- language, speech and movement checks
- general health checks
- vision and hearing tests.
Sometimes ADHD isn’t diagnosed until later childhood or the teenage years. This is when children have more schoolwork and go through social and emotional changes. Symptoms that you hadn’t noticed before might become more obvious because of these challenges.
ADHD and teenagers
Your child with attention deficit hyperactivity disorder (ADHD) might find the teenage years bring extra challenges. On the other hand, your child might also have built up some strategies to manage her symptoms more effectively.
As your child with ADHD gets older, his ADHD symptoms might change or tone down. For example, your child might still have trouble focusing, remembering things and thinking before he acts, but he might be less obviously hyperactive.
Some children with ADHD don’t have symptoms any more when they’re adults.
Everyday life for children with ADHD
Children with attention deficit hyperactivity disorder (ADHD) can be highly creative and can spend lots of time doing things they love. They might also be more open to trying new things than other children.
But life with ADHD can sometimes be challenging for children and their families.
For example, some children with ADHD can have trouble falling asleep and staying asleep overnight.
Also, children with ADHD often have problems at school, including learning disabilities, language impairment and movement difficulties.
And some children with ADHD also develop oppositional defiant disorder and conduct disorder, childhood anxiety, teenage anxiety and/or teenage depression.
But ADHD is manageable. Your child’s health professionals can work with you to develop strategies to help your child manage her ADHD at home and at school.
Some children with ADHD might enjoy using their energy on sport or dancing. Finding positive ways for your child to use his energy can be good for his self-esteem and help protect him against mental health problems.
Risk factors for ADHD
A combination of genes and environmental factors might increase the risk for attention deficit hyperactivity disorder (ADHD).
There’s no evidence that food intolerances cause children to develop ADHD symptoms.
There are some conditions that don’t necessarily cause ADHD but do cause behaviour that looks like ADHD or makes ADHD symptoms worse. These include various genetic syndromes, seizures and hydrocephalus. Conditions like intellectual disability and cerebral palsy also affect the way the different parts of the brain talk to each other.
If you’re worried that your child’s behaviour might be caused by other developmental problems, make an appointment to see your GP or paediatrician.
(HealthDay)—If children with attention-deficit/hyperactivity disorder, or ADHD, continue to have the condition in adulthood, a new study suggests that they may face an array of physical and mental health issues.
The study, which spanned more than 30 years, found that people who had ADHD as teens and adults face a greater risk of stress, work problems, financial troubles, physical health issues and additional mental health issues, such as depression or antisocial personality disorder.
“When children who had ADHD in adolescence became adults with ADHD, they had a higher probability of depressive mood and anxiety, and they were much more likely to have antisocial personality disorder. They also had difficulty in terms of work and experienced a great deal of financial stress,” said study author Judith Brook, a professor of psychiatry at New York University School of Medicine in New York City.
“The other thing we found was that marijuana had pervasive adverse effects and was associated with a number of other factors, such as impaired work performance,” noted Brook.
The findings were released online Dec. 10 in advance of publication in the January print issue of the journal Pediatrics.
The study included 551 children. Seventy-two of those children were diagnosed with ADHD in 1975 when they were between the ages of 14 and 16. The researchers followed up with the children as they grew, and the final of five outcome surveys was given at an average age of 37.
Study volunteers were asked about their overall health with questions like: “How true or false is it that you seem to get sick a little easier than other people?” They were also asked about their mental health and possible stressors, with questions such as: “How much of the time have you been very nervous?” and “Have you been in physical fights repeatedly?” or “Because of your current financial situation, is it true that you sometimes worry about losing your job?”
Compared to people without ADHD in their teens and adulthood, those with the disorder had 82 percent higher odds of having impaired physical health. They were also more than twice as likely to have another mental health problem and more than three times as likely to have antisocial personality disorder, a condition in which a person often manipulates or even violates the rights of others. This behavior is often criminal in nature, according to the U.S. National Institutes of Health.
Adults with ADHD were also 2.5 times more likely to have problems at work, and more than three times as likely to have high financial stress, the investigators found.
“Work difficulties are probably the result of impulsivity and a lack of persistence. People with ADHD get distracted,” Brook explained.
As to how ADHD might affect overall physical health, she said it wasn’t clear why people with ADHD might have poorer health. But, she theorized that this finding might also have to do with impulsive, distractable behavior. People may not eat the foods they should or follow-up with their doctors, she suggested.
Brook said the researchers were surprised by the magnitude of the antisocial personality disorder finding, and they suspect it may have something to do with a less than ideal parent-child attachment, as well as being rejected by their peers.
So, are children with ADHD doomed to have difficult lives full of stress and struggle?
Not necessarily, said Brook. Many children and teens with ADHD will outgrow the disorder before they reach adulthood. And, today, more treatments are available to help those who continue to have ADHD than were available to the people in this study.
“With treatment, a certain number of these youngsters will develop techniques to cope, which helps a great deal. And, many will choose fields where they can excel,” said Brook, who added that those affected by the disorder today may not be as stigmatized by society, either. “ADHD is more accepted today. Overall, it’s just more acceptable now to have a psychological disorder than it was in 1975,” said Brook.
Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at the Steven and Alexandra Cohen Children’s Medical Center of New York in New Hyde Park, said it’s extremely important to realize that the findings are based on treatments that were available in the 1970s and 1980s, and that children diagnosed today have many more treatment options available to them.
“I don’t want to suggest that there aren’t increased risks for these kids, because there are. But, what was an outcome for kids who were diagnosed in 1975 may have relatively little relevance for children diagnosed with ADHD today,” Adesman said.
“We have improvements in medications, educational accommodations and even higher education that could change outcomes. We can’t ignore this study, but we need to look at it in context,” he added.
Adesman said it’s also important to remember that this is likely a very small percentage of the general population.
Both experts said it’s important for parents to be attuned to their children and to get them evaluated right away if they suspect a problem.
“Problem behaviors can be minimized early on for the best possible outcomes,” Adesman said.
Brook said the parent-child relationship is also key, but acknowledged that having a child with ADHD can be very hard on parents. She suggested encouraging children to develop the strengths they have.
“Try to pick areas where they can succeed, so they get positive reinforcement,” she advised. “When they have some success, it can help offset other areas, and they’ll be more likely to be accepted by their peers and less likely to feel depressed or anxious.”
While the study found an association between ADHD in adulthood and a raised risk of problems with mental and physical health, it did not prove a cause-and-effect relationship.
Continued use of ADHD drugs may reduce criminal behavior, study says More information: Learn more about ADHD from the U.S. Centers for Disease Control and Prevention. Journal information: Pediatrics
Copyright © 2012 HealthDay. All rights reserved.
Citation: ADHD can cause lifelong problems, study finds (2012, December 10) retrieved 2 February 2020 from https://medicalxpress.com/news/2012-12-adhd-lifelong-problems.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.
Are ADD and ADHD the same thing?
Andrew Harper, MD, child and adolescent psychiatrist and clinical professor at the Texas A&M College of Medicine, explains attention deficit hyperactivity disorder (ADHD), common symptoms, medications and why it’s no longer referred to as ADD.
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Mary Leigh Meyer: Howdy, everybody. My name is Mary Leigh Meyer.
Sam Craft: And I’m her co-host, Sam Craft.
Mary Leigh Meyer: And we are here today with Andrew Harper. He’s with us from the Texas A&M College of Medicine. Tell us a little bit about who you are and what you do.
Andrew Harper: Howdy. I’m Dr. Andrew Harper and I’m a clinical professor here in the department of psychiatry, and I’m involved in the clinical work of the department and I’m a child and adolescent psychiatrist.
Mary Leigh Meyer: Okay, perfect. So, we picked you and you’re the perfect person to come talk to us today about our topic.
Andrew Harper: Oh, well thank you!
Mary Leigh Meyer: We are talking about ADD and ADHD.
Sam Craft: What’s that? I’ve already lost track. What are we talking about?
Andrew Harper: Exactly.
Sam Craft: See?
Mary Leigh Meyer: Yeah.
Sam Craft: You just lost it too, didn’t you?
Mary Leigh Meyer: Oh, okay.
Sam Craft: What just happened to you?
Mary Leigh Meyer: I don’t know.
Sam Craft: You’re like a deer in the headlights. I can’t even make a joke with you anymore.
Mary Leigh Meyer: Oh.
Andrew Harper: That’s a distractability. That’s a characteristic. It is.
Sam Craft: We’re already talking about it. We’re already here.
Mary Leigh Meyer: Gosh, you’re so distractable, Sam.
Sam Craft: I was just playing into the topic today because the way I understand ADHD and all of the other ones, to me it’s like you’re doing one thing but you can’t pay attention to doing other things and either you’re really focused or you’re trying to do too many things and your brain is going other places.
Andrew Harper: That’s exactly right. Distractability is a big characteristic. And technically, the diagnosis is attention-deficit hyperactivity disorder, ADHD. Although a lot of people will talk about ADD, that’s sort of not the correct or official terminology, if you will, but there are three subtypes.
Mary Leigh Meyer: Oh, I always thought they were two separate diagnoses.
Sam Craft: Yeah, that’s me, too. So those are actually the same thing, but people confuse them as different things or did I mix that up?
Andrew Harper: Well, the attention-deficit disorder is old terminology, if you will. It was updated by the field and now everything is attention-deficit hyperactivity disorder, but there are three subtypes. One of the subtypes is inattentive type and that would cover what was previously called just ADD. There’s also a hyperactive and impulsive type, and then the third type is combined where they have symptoms in all three areas, the inattention, the impulsivity and the hyperactivity.
Sam Craft: I didn’t realize there were so many subcategories of things. I mean, when people get diagnosed, they’re put into one of these three areas?
Andrew Harper: Typically. One of the reasons it was split out like this is there are some gender differences. For example, girls tend to be the inattentive subtype, and it’s thought that they are underdiagnosed because they’re not causing a behavioral problem typically.
Sam Craft: Is that just genetics that causes that, I mean, in the different male/female, or I mean, do we even know?
Andrew Harper: It’s genetics, but it’s also physiology and the way the brain develops. We know that boys’ brains develop at a slower rate than girls, but we do catch up.
Mary Leigh Meyer: Are boys typically diagnosed later in life or…
Andrew Harper: Earlier.
Mary Leigh Meyer: Earlier? Ooh, interesting.
Andrew Harper: Right, because what typically causes a kid to be diagnosed is their behavior. For example, if a little girl is sitting in a classroom but not causing a problem, not attending to her work, she may get sort of judged to be, “Well, maybe she’s just a little bit slower or not as bright,” when she could be intelligent, just the distractability and an attentiveness interferes with her work completion.
Sam Craft: So kinda like when people say…I know sometimes young kids are saying they get bored in class, so either they’re just way past that in life, at least as far as knowledge or whatever, or it could be something like this where there really is something wrong.
Andrew Harper: That’s a good point because a really bright kid may get bored because they’re not academically challenged. That’s why it’s important to get assessed when you suspect that there’s a problem.
Mary Leigh Meyer: And how do you know? Say you’re the teacher in the classroom and little Susie’s not paying attention, kind of not following along. How do you know if … That seems like a very wide range of possibilities on how to approach helping little Susie.
Andrew Harper: Well, that’s correct. And that’s why I would say it would be hard for the teacher to know. He or she could suspect, but it’s important to get an evaluation because kids can be inattentive for lots of reasons. For example, if they’re having trouble at home or if their caretaking environment is disrupted or perhaps, unfortunately, in an abusive caretaking environment, that can also lead to behavior problems in the classroom.
Sam Craft: So, over the years, I was born in 1980, and so growing up in the ’90s, I think all of this was still really fresh and it seemed like kids just not behaving got blamed or categorized as this a lot. It felt like they just fed us drugs just to calm us down. For what we know now, with the research that’s been done over the years, looking back on that kind of situation, were they right in doing so and just kind of guessing on if this is the right diagnosis? I know nowadays, it’s probably, again, a lot more easier for us to diagnose because we’ve seen all this stuff before.
Mary Leigh Meyer: Well, then to that vein, I also feel like there is a lot of not diagnosed children, but then a lot of children who are incorrectly diagnosed.
Sam Craft: Yeah, along the same lines. Yeah.
Mary Leigh Meyer: Medication plays a weird, tricky part on both sides of that.
Andrew Harper: You both are right in that there are kids that are missed or not diagnosed correctly, but also kids that are misdiagnosed, because it’s assumed that the problem is the ADHD versus other issues going on with the child. For example, even depressed kids can sometimes have trouble paying attention and may have some irritability that looks like hyperactivity or impulsivity.
Sam Craft: Like I was saying, most of the time it’s just like, “Oh, well, he’s got ADHD,” and that’s just what it is. And it’s like, “Well, maybe that’s not what it is. Maybe we need to get deeper into this and see what it is.” Again, me growing up, a lot of my friends, they just gave them whatever it was I took for it and we just moved on. But I don’t think that was always the case. I think sometimes it was just misdiagnosed.
Andrew Harper: Yeah, I think you’re probably right. And I think there are probably kids on medication that don’t really need it.
Sam Craft: Speaking of medication, if that were to occur, I mean, it does happen, obviously, does it hurt the child in any way? I mean, what do those drugs really do?
Andrew Harper: Well, there’s several classes of drugs that are used to treat ADHD. The most common class are the stimulant medications. And we have a lot of experience with those medications. They’ve been around for many years. Tons of kids have been exposed to them and they’re viewed as one of the safer medications that we use for psychiatric problems in children and adolescents.
Mary Leigh Meyer: I feel like a lot of these medications, some students take when they don’t have these diagnoses to help themselves in school, help them study, help them focus here and there. Is that…
Sam Craft: I had plenty of friends that did it over overnighters and finals and that kind of stuff. I mean, I can honestly say it wasn’t me. I grew up with the pharmacist’s son, so I knew better, but I had plenty of friends that were like, “Yeah, this is it.”
Andrew Harper: No, I think you’re right. Unfortunately, these drugs can be diverted and used for other purposes. I think a couple of things to think about in that regard. Well, first off, I would say that the effects on attention are nonspecific, so it’s not a diagnostic test. If you have an inattentive kid, you give them a stimulant and their attention span improves, doesn’t prove that they have ADHD. We could all take stimulants and our attention span would be longer. The question would be is do we really need it? Even though the safety profile is good, it’s not without side effects. You’re medicating a kid whose brain is still growing and developing. I think you have to think really carefully before you commit a kid to a medication trial.
Mary Leigh Meyer: And so, what you said, “medicating a kid who is still growing and developing”, is that a bad thing to give medication to these kids or is it more of something where the kid is not learning behaviors and they’re reacting with their medicine? Do you get what I’m asking? I feel like I didn’t ask that very well.
Andrew Harper: I don’t think it’s just about learning behaviors, although there are some behaviors that are helpful for the child and adolescent and even an adult because this is a disorder that can persist into adulthood. What we think in part is happening is that the regulatory parts of the brain in folks who are dealing with ADHD are maturing at a slower rate or may not be as effective for those individuals as they are for other folks.
Mary Leigh Meyer: Oh, that’s interesting.
Sam Craft: So, it’s a good point you bring up about the adults you mentioned. I’ve never heard of ADHD being an adult situation. I mean, not one that … I guess my question is, as an adult, if you’ve never had it before, can you be diagnosed with it as an adult?
Mary Leigh Meyer: And then do kids grow out of it?
Sam Craft: Yeah. And that that’s kind of along the same lines. As a kid, can you grow out of it?
Andrew Harper: Well, some kids will grow out of it. Typically, the hyperactivity diminishes, but the inattentiveness is the symptom that’s most likely to persist into adulthood. Your question about can it be diagnosed in adults, it can be, but there needs to be a history of symptoms in childhood to correctly make the diagnosis. I think what happens in some adults is folks who have maybe a milder case and who might be brighter kids develop some compensatory strategies and are able to kind of manage themselves and they may not get diagnosed until they’re in college or pursuing graduate education where the academic load becomes more challenging.
Sam Craft: So more than likely, it’s always been there. They just might not notice it until something triggers it or it just becomes more aware?
Andrew Harper: Correct. And remember, there’s a normal range of attention spans, probably and activity levels. Probably everybody has someone that they consider hyper or know that they’re distractable. But what we look for when we’re making a diagnosis is we’re looking for impairment. Is it really causing a problem, and is it causing a problem in more than one setting? For example, if the child only acts up at school, but at home there are no problems, none of these behaviors or symptoms are seen, maybe there’s something at the school environment that’s disruptive for the child or maybe this child has an undiagnosed learning disability and is frustrated at school and it’s easier to be the kid who’s the class clown than the kid who can’t do their work.
Sam Craft: Yeah. Maybe they’re just four years old and angry. I have one of those.
Mary Leigh Meyer: Or they’re just a teenager or they’re just a college kid or they’re just an adult who’s bored at his job, Sam.
Andrew Harper: And I’m glad you said the four-year-old because…
Sam Craft: Oh, that’s not very nice.
Andrew Harper: I’m glad you said the four-year-old, right, because I think it needs to be diagnosed very carefully in very young children, right, because sometimes the initial line of intervention should be maybe working with the caretaking environment and helping with some parent management strategies.
Sam Craft: So, speaking of four-year-olds, as we are, because I have one and now I’m curious, I just attribute him not listening or doing just sporadic things to being four years old. What kind of symptoms should you be looking for at a child that young knowing that they really haven’t developed their…I say, societal norms?
Mary Leigh Meyer: Classroom etiquette.
Sam Craft: Yeah, or even home etiquette or that kind of thing.
Andrew Harper: I think at that age, obviously you’re right. There’s going to be some developmental considerations that have to be put into place because four-year-olds are going to be more impulsive. They’re going to be more distractable. They’re going to be oppositional at times, and that’s all completely normal.
Sam Craft: It’s like dealing with a terrorist.
Andrew Harper: Right. And they can have temper outbursts and that’s not a surprise.
Sam Craft: Yes, yes, they can.
Andrew Harper: So, what you’re looking for are kids who might be outliers from their peer group, with the caveat that kids have different dispositions. Within a family, so those of you that have more than one kid, you probably recognized early on that their little personalities are quite different. And it’s typically evident at a very young age. You can tell that some kids are just calmer and risk adverse and other kids are more adventure seeking and they never saw something that they couldn’t touch or climb on, that kind of thing, and that can be normal.
Sam Craft: That’s mine. Yes.
Andrew Harper: Yeah. Exactly.
Mary Leigh Meyer: I definitely see that personality difference in my cats.
Andrew Harper: I can’t speak to ADHD in cats.
Sam Craft: She just recently adopted a little one, what, a few days ago?
Mary Leigh Meyer: He’s so precious. Less than a week ago.
Sam Craft: Well, hopefully they don’t exhibit any of those crazy signs.
Mary Leigh Meyer: Well, they’re kittens. They act like there’s a ghost in the room at all times and fly against walls and if there’s a water glass on the table, there’s no longer a water glass on the table.
Sam Craft: Just lay out the cat nip for everybody’s sake.
Mary Leigh Meyer: Okay.
Andrew Harper: Well, at least you’ll have interesting videos to post.
Mary Leigh Meyer: Oh yeah.
Sam Craft: Valid point.
Mary Leigh Meyer: Oh yeah. My phone is full of them. When you think your kid has these symptoms, who do you bring them into, your primary, to a psychiatrist like you, and then what are these medical professionals looking for?
Andrew Harper: Well, I think a primary care physician could certainly diagnose attention-deficit hyperactivity disorder, and that would be a really good place to start. If that physician is uncomfortable making the diagnosis or is thinking that it might be more complicated than a simple ADHD, then a referral to a mental health professional might be in order. And that could be a child psychiatrist, it might be a nurse practitioner who’s adept with psychiatry.
In the assessment, we’re looking for symptoms in three major areas. There’s inattentiveness, hyperactivity and impulsivity. The things that we would look for are kids who have trouble following sequential instructions. Maybe they do the first thing and then can’t remember any of the other instructions, kids who have trouble collecting items together for a task. Obviously, the hyperactivity, kids whose baseline activity is higher than their peers, or they can’t contain themselves so that in a school environment they’re jumping up and down out of their seat, they’re running around the classroom, and kids who are externally distractable. They have a lot of difficulty attending to really anything except things that they are very interested in, so that’s not a sort of killer of the diagnosis if they can play video games for hours. And in fact video games, if you think about what’s going on there is there’s constant shifting of attention, right? Because things are flying in or blowing up or coming up behind you or coming out of the sky or up from the ground, so there’s always stuff going on. They could still have ADHD and be attentive to certain activities.
Mary Leigh Meyer: And are there any other therapies or ways to manage these symptoms other than medication?
Andrew Harper: There actually are some strategies, some organizational strategies that can be helpful for these kids in the classroom. If they can sit up front to minimize external distractions, that can be helpful, as well. Physical activity can help. So if you can intersperse physical activity with their academic work, for a lot of kids, that is helpful. The other question I would always ask about diagnoses is I always want the symptoms to be present in more than one setting, right? If they’re only having these symptoms at home, but at school they behave well, they’re doing well academically, the teacher when you talk to them says, “I don’t know what you’re talking about this kid,” then you would think about, is there some stress in the home environment? And vice versa. If they’re only having difficulties at school and not at home, then I would wonder if there’s some educational issue, learning disability perhaps. We do know that learning disabilities are frequently associated with ADHD, so usually we encourage educational testing for those kids.
Mary Leigh Meyer: And is that done through a psychiatrist like yourself or is that through a different professional?
Andrew Harper: So, psychologists do the testing and that can be done through the school. Parents can request that from their school if the child is showing symptoms of academic difficulties.
Sam Craft: I think that sometimes parents, including me for that matter, because I am a parent, I don’t want to say we feel bad about getting these diagnoses. Maybe nervous, maybe scared, I guess. What’s your advice to parents that think there might be a problem, but don’t want to pursue it because of what might be actually happening?
Mary Leigh Meyer: They don’t want to put a label.
Sam Craft: Yeah, I mean, I think because kids are mean, and if one kid hears this about another kid, even though it’s something that is very common that I know of. What’s your advice to parents in that aspect of things?
Andrew Harper: Well, I think recognizing that there is potentially a stigma, I would encourage parents to think of it as any other medical issue that their child might have. For example, if their child had trouble with asthma, they would seek correct evaluation and pursue treatment. And as you mentioned, it’s not uncommon. We think 3 to 5 percent of school-aged kids have some degree of attention-deficit hyperactivity disorder. Some kids may be able to develop compensatory strategies and others may need medication and other assistance to manage.
Mary Leigh Meyer: Tell us more about the medications. We kind of talked about it a little bit earlier, but are they different? Is there a difference in them?
Andrew Harper: Well, there are different classes of medications that can help. The gold standard are the stimulant medications, and there tend to be two groups of those. One groups are the methylphenidates and related compounds, and the other group are the amphetamines and amphetamine salts and related compounds. And they come in different formulations and they’re marketed under different names, but really they go back to those two molecules. And many times, the difference is the extended release formulations and how they are put together and kind of the mechanics if you will of the delivery system for that extended release feature.
Mary Leigh Meyer: Growing up, I had a friend who took … I don’t know what type of medication, but some sort of medication for her ADHD. And she almost had … You could tell when the medication wore off because she almost had a crash or her behavior was drastically different. Is there some sort of, I’m going to air quote the word crash, after these medications wear off?
Andrew Harper: For some kids, there can be. These are very short duration medications, so unless they’re an extended release formulation, the medications only last three to four hours, so that obviously won’t cover the school day. What that means is the child may have to go to the nurse’s office to get a dose of medication, and I think the issue was stigma was brought up a little bit earlier and certainly in that case, if the child has to go take a medicine in the middle of the day, that can become very obvious to their peers. So most folks recommend using the extended release formulations.
That kind of gets at two things. It gets them through the school day and the immediate afterschool period, but it also can eliminate this sort of up and down kind of feature that you may see with the short-acting meds. Even with the extended release, though, some kids will have a little bit of rebound at the end of the day when the medications wear off.
Mary Leigh Meyer: Is there a benefit to the short-acting medications?
Andrew Harper: Depending on the situation. For example, an adult with ADHD may only need a short-acting for a portion of the day and not need the extended release formulation or someone who maybe sleeps in and doesn’t want to take an extended release that’s then going to interfere with their sleep onset when they go to bed.
Mary Leigh Meyer: Ooh, that’s interesting. Do they interfere with sleep and diet and what about other lifestyle things like those?
Andrew Harper: Right. If you take it too late in the day, it will interfere with sleep, and the appetite suppression is very common, so we usually recommend to families is that they get a good breakfast in the child before he or she heads off to school and then they may have appetite suppression at lunchtime and not eat well at lunch, but when they come home from school, then maybe a little bit heavier snack or really focus on a nice substantial supper in the evening.
Mary Leigh Meyer: Then what about the impact of caffeine?
Andrew Harper: Well, caffeine is a stimulant, right? But it’s not the same kind of stimulant and caffeine has been tried in kids with ADHD and it’s really not effective in their symptoms.
Mary Leigh Meyer: Interesting. And then for adults, what about the impact of alcohol on someone taking these medications?
Andrew Harper: For adults that are on stimulant medication, alcohol is not contra-indicated. Obviously, everyone should watch their drinking and drink in moderation and all of the other sort of caveats that we have when we’re talking about adult drinking, but it’s not forbidden, if you will, in someone who’s taking stimulants.
Mary Leigh Meyer: Do people need to ever adjust their dosage of these medications?
Andrew Harper: Some people do need … Especially if they are started on medication as a very young child, as they grow and develop, typically, the medication may need to be increased or titrated.
Mary Leigh Meyer: What about families who are hesitant to put their child on a stimulant?
Andrew Harper: Well, that’s certainly understandable. There is some, I guess, concern in some folks about using stimulants. The first thing I would say is that we know the stimulants hit all three symptom areas, the hyperactivity, impulsivity and inattentiveness. But there are other medications that can be helpful. Oddly, one group of medications are traditionally used for hypertension. That’s guanfacine and clonidine. They act in a way that tends to help with the impulsivity and hyperactivity and can help a little bit with kids who have some irritability. And for kids who have really on the extreme side behavioral difficulties, sometimes the medications that are used for more serious mental illnesses may be tried in low doses in these kids.
There is another alternative, a non-stimulant medication called atomoxetine, which people may have heard of. It’s thought to be a little bit less effective than the traditional stimulants but can be a choice for milder cases or early in the course of treatment to see if it’s effective, as well.
Mary Leigh Meyer: But the connotation of the word stimulant, it isn’t a bad thing necessarily … Are people that have that worried…
Sam Craft: When you say stimulant to me as a parent, it freaks me out.
Mary Leigh Meyer: Yeah. Is that worry founded?
Andrew Harper: Well, it sounds like a street drug, right? So I think families worry about that, and it can be diverted. Some kids will sell it. It does have a street value. Unfortunately, it can be a drug of abuse.
Sam Craft: It’s like anything else in the medicine cabinet nowadays. I mean, I don’t want to call this one thing out because I mean, all prescription drugs can be that way nowadays it feels like.
Andrew Harper: Right, or some parents may even worry, “If I start my child on a stimulant, am I predisposing him or her to”…
Sam Craft: It’s a gateway drug.
Andrew Harper: Exactly. Are they going to have problems with drug abuse later?
Sam Craft: Sure.
Andrew Harper: So, there’s actually research on that. We know, unfortunately, individuals with ADHD have a higher incidence of substance use disorders later in life. That’s just an unfortunate co-occurring feature of this diagnosis. But it appears, and there’s some mixed evidence on that, it appears that ADHD kids who are treated have a lower incidence of substance use than ADHD kids that are not treated. And interestingly, it appears that treatment that starts earlier, in school age, elementary school age, has a more preventive effect if you will, on later substance use. It doesn’t prevent completely, but it may reduce the ultimate risk that the child engages in risky substance use behavior later in life.
Mary Leigh Meyer: So you definitely don’t want to ignore these symptoms out of fear for a diagnosis.
Andrew Harper: Right. And the other thing to remember is that a young child with ADHD can be very annoying to his or her peers because they have trouble playing in team sports, taking turns, waiting in lines, that kind of thing. And a lot of important social development is going on early in elementary school, and you don’t want the child to fall behind in that area. And the other thing about school obviously is the academic work. You want them to be able to stay on track with their academic development so as the coursework becomes more challenging in middle school and high school, they have the fundamentals and the basics in place to do that work.
Mary Leigh Meyer: Yeah. Well, I think that’s a good thing to wrap up on. It’s a good thought. Anything else that we need to say to our listeners about ADHD? Not ADD, ADHD?
Andrew Harper: I think it’s important to get a complete evaluation. That would be, I think, the primary concern I would have. Sometimes schools can be very insistent when a particular school official decides that the child has the diagnosis. Really, really encourage you to get the child professionally assessed. Again, that could be in a primary care office or if you have access to a child psychiatrist, that’s another option as well.
Mary Leigh Meyer: Well, okay. Dr. Harper, I think this has been a good show. Hopefully our listeners learned quite a bit and hopefully that stigma we talked about a little bit can start to disappear. Thank you for coming on the show.
Andrew Harper: Thanks for having me!
Mary Leigh Meyer: All right. Thank you all for listening. This has been another episode of Sounds Like Health.
What is the difference between ADD and ADHD?
ADD, or attention-deficit disorder, is an old term, now out of date, for the disorder we call ADHD, or attention-deficit hyperactivity disorder.
It was called ADD up until 1987, when the word “hyperactivity” was added to the name.
Before that, say in 1980, a child would be diagnosed with ADD, either with or without hyperactivity. But starting in the early 1990s, that child would be diagnosed with ADHD.
From the early ’90s until recently diagnosis included one of three types. Children who only had the inattentive symptoms were called inattentive type. Kids who were only hyperactive and impulsive were hyperactive/impulsive type. Kids who had all three symptoms were called combined type.
A lot of people still use the old term ADD, either out of habit or because it’s a more familiar term than ADHD. Some people use it to refer to inattentive type ADHD — without the hyperactivity. But it was never meant to be used that way, and continuing to use an almost 30-year-old term is getting more confusing.
The newest way of thinking about ADHD is actually to get rid of types altogether and just think about which symptoms present prominently. We still use the same clusters of symptoms (inattentive and hyperactive-impulsive), we just don’t consider them separate types. There are also adjustments to reflect new research on how ADHD symptoms present in adolescence or adulthood.
The bottom line is that the diagnosis of ADHD can still apply even if a child doesn’t have hyperactive or impulsive behaviors. That can be confusing for parents. We get this question all the time: “I don’t think my kid has hyperactive/impulsive symptoms—could he still have ADHD?” Yes, he can! And it’s especially crucial that kids with prominent inattentive symptoms of ADHD are still evaluated by a trained clinician, as these children could be more likely to be overlooked at school.
We want to make sure that people understand that kids who aren’t fidgeting or running out of class can still have really significant brain-based difficulties and related ADHD symptoms. The important thing is that a child who has a real problem paying attention, even without the other symptoms that tend to result in more disruptive or problematic behavior, still needs to be understood and to get help.
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ADD or ADHD: Are They Different?
Source: Weston Boyd, derived by Minh Nguyễn
You’ve probably heard someone say they have ADD. Others have ADHD. So what does ADD look like? How about ADHD? Are they different? In today’s blog, we’ll look a little deeper at ADD, ADHD, and the link between them.
While ADD is short for “attention deficit disorder,” ADHD is the abbreviation for “attention deficit hyperactivity disorder.” Both have been clinical diagnoses in the past, but ADHD is the official name for the syndrome these days. ADD and ADHD are actually both more recent labels for the condition. Decades ago, it went by such names as Hyperkinetic Disorder of Childhood and Minimal Brain Dysfunction.
Whatever the title, ADHD has been recognized for about the past 200 years. For most of that time it was considered a childhood problem that kids grew out of. Early on, ADHD symptoms such as hyperactivity and poor focus in kids were attributed to moral defects or willfulness. But those simplistic explanations gradually gave away to more sophisticated models of ADHD. Additionally, in the past decade or so, it’s become clearer that aspects of ADHD can linger on into adulthood.
The labels of ADD and ADHD both came from the American Psychiatric Association. Every decade or two a new manual of official psychiatric diagnoses comes out. It’s called the DSM, as in Diagnostic and Statistical Manual. The manual is published by the American Psychiatric Association and it’s widely used by mental health clinicians and researchers. The last version of the DSM (DSM-5) was released in 2013. Both ADHD and ADD come from previous editions of the DSM.
ADD made its debut in 1980. It was the official name in DSM-III for what has since become ADHD. The reason for using ADD was that at the time it was thought that inattention and poor focus were the main problems in the disorder, rather than hyperactivity. Before that, hyperactivity was seen as the core problem. More recently, hyperactivity and impulsivity have been regarded as equally important as inattention in ADHD.
By 1987, the title of ADD was renamed ADHD, and it’s remained so ever since. A few tweaks have been made here and there on symptoms and age onset, but the concept of what ADHD is and is not have remained pretty stable.
In the current view, there are three forms of ADHD: the kind with inattentive symptoms; the kind with hyperactive and impulsive symptoms; and the kind with all of these: inattentive, hyperactive, and impulsive symptoms.
ADD is no longer part of the official language for ADHD, but it is used as a kind of shorthand for the inattentive subtype of ADHD among both clients and treatment providers. It means the type of ADHD that involves things like inattention, procrastination, frequently lost items, and distractibility. So ADD, while no longer an official diagnosis, refers to the inattentive type of ADHD.
Treatments for both ADD and ADHD are similar, with medication and cognitive-behavioral therapy or specialized skills coaching as probably the most common interventions. Very broadly speaking, all three forms of ADHD are commonly seen in boys, while girls and adults are a bit more likely to show the inattentive symptoms of ADHD (ADD).
Both ADHD and ADD can look like other neurologic or psychiatric conditions. Moreover, ADHD and ADD frequently present with other problems, such as substance abuse, depression, anxiety, learning disabilities, and tic disorders.
Although there are brief 5-10 minute screening tools available to help diagnose ADD and ADHD, they have a number of serious drawbacks. For instance, they tend to be self-report in format, do a poor job of eliminating other possible explanations for the symptoms endorsed, rely heavily on past recollections, and do little if any assessment of systematic over- or under-reporting of symptoms. At best these are a rough sketch of what might be going on concerning possible ADHD or ADD, much like an online IQ test versus the real thing.
Because of the complexity of ADHD, its similarities to other conditions, and its frequent co-occurrence with still other disorders, there is really no substitute for a detailed and solid clinical evaluation to establish the diagnosis and develop an effective treatment plan. This involves a thorough clinical interview and series of cognitive and psychological tests. That is currently the best way to know if ADHD or ADD is really present, and whatever else might be along with it.
The National Resource Center on ADHD, a program of Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD®) supported by the Centers for Disease Control and Prevention (CDC), has information and many resources. You can reach this center online or by phone at 1-866-200-8098.
For more information on psychotherapy, see the Psychotherapies webpage on the NIMH website.
Tips to Help Kids and Adults with ADHD Stay Organized
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
- Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
- Organizing everyday items. Have a place for everything, (such as clothing, backpacks, and toys), and keep everything in its place.
- Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
- Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
- Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior and praise it.
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
- Keeping routines
- Making lists for different tasks and activities
- Using a calendar for scheduling events
- Using reminder notes
- Assigning a special place for keys, bills, and paperwork
- Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.