An Overview of Attention-Deficit Hyperactivity Disorder (ADHD)

Tommy is a sweet and sensitive child, but he has never liked school.  From the time he was in kindergarten, he was always in trouble for his impulsive behavior.  He seems incapable of slowing down his internal motor and is highly distractible.  He just can’t seem to sit still and sustain his attention on one thing, except for when he plays video games then he can sit for hours.  His room is a mess and his desk at school is completely disorganized.

Sarah is a middle school student, who has always done fairly well in school until this year.  She is bright and never really a behavior problem, but seems more aloof and lazy than other children her age.  Her teachers are frustrated with her because when she puts out enough effort, she does well, but this is not the norm.  She has so much potential.  If only she were motivated, she would do anything!  Yet, she complains of being bored most of the time.  She has a few friends, but is more passive than active when it comes to socializing.  Although she says she’s happy, she appears to feel sad often.

Robert disobeys or challenges his parents frequently. He is impulsive and does not seem to learn from consequences.  When he was younger, his only explanation for his behavior was, “I wasn’t thinking,” but now that he is older, he tends to blame others for his shortcomings.    School has been a constant struggle.  Getting him to read books and complete his homework consistently has been difficult and his teachers have questioned if he has a learning disability.  His parents suspect he has begun to experiment with drugs and he was in a car accident a few days ago.

Michael’s wife constantly complains that he ignores her often, especially when he is immersed in TV.  He has never advanced far in his career because he only stays in one job for a couple of years and then moves on.   He has a degree in business, but can’t stand the idea of working in an office.  He tried outside sales, but because of a lack of organization and follow through he failed to make his quota and was fired.  He beats himself up for being lazy, and is angry that his wife is always nagging him.

 

These four cases all may describe someone who suffers from Attention-Deficit Hyperactivity Disorder (ADHD).  ADHD is a disorder that effects between 3%-7% of America’s school-aged children and up to 5% of adults.

Although some media figures and politicians have advanced a number of misconceptions about ADHD, including that ADHD is over-diagnosed and not a real disorder, research consistently shows that these are myths.  ADHD and its interventions have been extensively researched, particularly in the last 25 years.  A group of 80 of the world’s leading clinical researchers on ADHD developed the National Institute of Health’s “International Consensus Statement on ADHD.”  This document outlines the current state of research with respect to ADHD (see  http://consensus.nih.gov/ for more information).

Signs/Symptoms
Attention Deficit Hyperactivity Disorder is a classification given to those people who have “clinically significant impairment” in social, academic, or occupational functioning across at least two areas (e.g., at school and at home) as a result of specific core behavioral difficulties.  Namely, the person has clinically significant difficulty with inattention and/or hyperactivity and impulsivity.  Thus, someone can display only the symptoms of inattention (ADHD-Predominately Inattentive Type what used to be called ADD), only symptoms of hyperactivity and impulsivity (ADHD-Predominately Hyperactive/Impulsive Type) or both (ADHD-Combined Type).

Symptoms of Inattention include:

• Failing to give close attention to details or making careless mistakes
• Having difficulty sustaining attention
• Does not seem to listen when spoken to
• Poor follow through on tasks
• Often having difficulty organizing tasks and activities
• Often avoiding tasks that require sustained mental effort
• Often loses things
• Is easily distracted by extraneous things
• Often is forgetful

Symptoms of Hyperactivity and Impulsivity include:

• Being fidgety
• Has difficulty sitting still
• Talks excessively
• Is often “on the go”
• Has trouble playing quietly
• Is restless (either via subjective feeling or in observation)
• Often blurts out answers
• Has difficulty waiting turn
• Often interrupts

Guidelines for the Assessment of ADHD
If you or someone you know has a number of the above symptoms, ADHD may be present.  However, it is important to note that there are a number of other conditions (e.g., depression, anxiety, bipolar disorder, Oppositional-Defiant Disorder, Asperger’s Disorder) that have similar symptoms.  In addition, ADHD often co-exists with other disorders.  That is, another disorder (e.g., mood disorder, substance abuse, oppositional behavior, learning disabilities) may also be present in addition to ADHD, complicating diagnosis, treatment and prognosis.  As a result, a comprehensive evaluation is imperative in assessing a client’s problems.

An assessment for persons suspected of experiencing ADHD may include the following:

• Medical examination by the person’s physician
• Diagnostic interview with the client and the client’s parents (if a minor) or spouse/significant other (if an adult). The focus of this interview is to obtain a thorough psychosocial history, identify clinically significant symptoms, assess work/school functioning
• Parent, teacher and/or self rating scales designed to quantify behaviors the client is experiencing and displaying
• Psycho-educational assessment to identify intellectual ability, school achievement, and learning/memory function. This is important in the diagnosis of ADHD as well as other co-existing conditions
• Psychological assessment to identify any mood or mental health issues that may be present and are contributing to and masking as ADHD.

Evaluations are likely to vary based on the issues involved in each case.  However, for most children and adolescents, it is important to address all of the assessment issues given the significance of being diagnosed with ADHD and that treatment is guided by the client’s full diagnosis picture.  An abridged or shortened assessment may result in a treatment course that is lacking or counterproductive.

Treatment Options
The best research studies to date suggest that medication alone and medication plus behavior-based treatment are effective in treating ADHD.  Behavioral interventions alone, unfortunately, do not appear to be as effective.  However, these are often attempted because of concerns about dispensing medications to children and/or the client has difficulty tolerating the side effects of medication.  Medication, if chosen as an intervention, should be prescribed by your physician or a psychiatrist.

There are a number of non-medication treatment options for persons diagnosed with ADHD.  Dietary management has been anecdotally effective, but research overall has not shown this to be a reliable treatment for ADHD.  Individual insight-oriented therapy has not, to date, been shown to be effective.  This is because treatment needs to be conducted at the “point of performance.”  This is because most persons with ADHD know what to do, it is putting that knowledge into practice that is a problem. The following components may be helpful for persons with ADHD:

• Contingency management such as point/token systems conducted at home, school or both
• Parent training to establish principles for parenting a child with ADHD and
• home-based contingency intervention strategies
• School-based treatment including classroom accommodations and interventions
• ADHD Coaching for motivated adolescents and adults to teach study skills, organizational strategies, behavioral self-management, and cognitive-behavioral

Collaboration among treatment providers (e.g., psychiatrist/physician, psychologist, teachers, school counselors, parents) should be a part of any treatment plan!

To learn more about testing services for ADHD at The Summit, click here