What is Attention
Deficit Hyperactivity Disorder (ADHD)?
Attention Deficit
Hyperactivity Disorder (ADHD) is a condition that emerges in some children
during preschool and early school years. It is very difficult for children with
ADHD to control their behavior, and/or to
adequately pay attention. It is estimated that between 3 and 5 percent of
children have ADHD, or approximately 2 million children in the United States.
This means that in a classroom of 25 to 30 children, it is likely that at least
one will have ADHD.
ADHD was first described
by Dr. Heinrich Hoffman in 1845. He was a physician who wrote books on medicine
and psychiatry, Dr. Hoffman became interested in writing for children when he
was unable to 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
characteristics. "The Story of Fidgety Philip" was an accurate
description of a little boy who had attention deficit hyperactivity disorder.
Yet it was not until 1902 that Sir George F. Still published a series of
lectures to the Royal College of Physicians in England in which he described a
group of impulsive children with significant behavioral problems, caused by a
genetic dysfunction and NOT by poor child rearing children
who today would be easily recognized as having ADHD. Since then, there have been
literally thousands of scientific papers on the disorder have been published,
providing information on its nature, course, causes, impairments, and
treatments.
Children with ADHD face
many of difficult, however they are not insurmountable. In order to achieve his
or her full potential, s/he should receive assistance from parents, guidance
counselors, as well as the public education system. In an ideal world children
should also have the advantage of seeing a mental health professional as well.
Because ADHD often
continues into adulthood, we have included a section dedicated to ADHD in
adults.
What are the symptoms of
ADHD / ADD ?
First of all, back in the
old days we had ADHD and ADD. Today we still do, but we now call it all ADHD
with 3 subtypes:
As far as symptoms, the
main characteristics of ADHD are:
These symptoms first
emerge in childhood usually early on. Because many (most) children who do not
have ADHD generally do have these symptoms, but at a low level, or the
symptoms may be caused by another disorder. For this reason it is very important
that the child be thoroughly evaluated accurately diagnosis by a
well-qualified professional.
Accurate Diagnosis:
As stated earlier, not every child with these symptoms has ADHD, so who is qualified to diagnose and treat ADHD as ADHD?
| Specialty | Can Diagnose ADHD | Can prescribe medication, if needed | Provides counseling or training |
| Psychiatrists | yes | yes | yes |
| Psychologists | yes | yes* | yes |
| Psychiatric Nurse Practitioners | yes | yes | yes |
| Pediatricians or Family Physicians | yes | yes | no |
| Pediatriac, or Family Nurse Practitioners | yes | yes | no |
| Neurologists | yes | yes | no |
| Clinical Social workers | yes | no | yes |
*
in New Mexico and Louisiana (hopefully the rest of the
states soon)
Attention
Deficit Hyperactivity Disorder in Adults
Attention deficit
hyperactivity disorder is a well-known childhood disorder that affects
approximately 3 percent to 5 percent of all children. Until recently, it has
been widely believed that children somehow always “grow out of ADHD”. This
is simply not true. While some children do adapt to the extent they are able to
function in society without treatment as adults, there are many others that will
still have ADHD as adults. This some stop having problems in adulthood and some
do not is true of other disorders affecting the mind, such as seizure disorders.
There have been a number of studies done in recent years which indicate that
from 30 percent up to 70 percent of children with ADHD continue to exhibit
symptoms as an adult.
Adults with ADHD are
often unaware that they have this disorder. They just feel that it’s
impossible to get organized, to stick to a job, to keep an appointment, stay on
track, or normalize it as being “flighty”. The everyday tasks of getting up,
getting dressed and ready for the day’s work, getting to work on time, and
being productive on the job can be major challenges for the ADHD adult.
Treatment of ADHD in
an Adult
Medications. As with
children, if adults take a medication for ADHD, they often start with a
stimulant medication. The stimulant medications affect the regulation of two
neurotransmitters, norepinephrine and dopamine. The newest medication approved
for ADHD by the FDA, atomoxetine (Strattera®), has been tested in controlled
studies in both children and adults and has been found to be effective.
Antidepressants are
considered a second choice for treatment of adults with ADHD. The older
antidepressants, the tricyclics, are sometimes used because they, like the
stimulants, affect norepinephrine and dopamine. Venlafaxine (Effexor®), a newer
antidepressant, is also used for its effect on norepinephrine. Bupropion (Wellbutrin®),
an antidepressant with an indirect effect on the neurotransmitter dopamine, has
been useful in clinical trials on the treatment of ADHD in both children and
adults. It has the added attraction of being useful in reducing cigarette
smoking.
In prescribing for an
adult, special considerations are made. The adult may need less of the
medication for his weight. A medication may have a longer “half-life” in an
adult. The adult may take other medications for physical problems such as
diabetes or high blood pressure. Often the adult is also taking a medication for
anxiety or depression. All of these variables must be taken into account before
a medication is prescribed.
Education and
psychotherapy. Although medication gives needed support, the individual must
succeed on her/his own. To help in this struggle, both “Psychoeducation” and
individual psychotherapy can be helpful. A professional psychotherapist can help
the ADHD adult learn how to organize his life. Above all, ADHD adults should
learn as much as they can about their disorder.
Psychotherapy can be a
useful adjunct to medication and education. First, just remembering to keep an
appointment with the therapist is a step toward keeping to a routine. Therapy
can help change a long-standing poor self-image by examining the experiences
that produced it. The therapist can encourage the ADHD patient to adjust to
changes brought into his life by treatment the perceived loss of impulsivity and
love of risk-taking, the new sensation of thinking before acting. As the patient
begins to have small successes in his new ability to bring organization out of
the complexities of his or her life, he or she can begin to appreciate the
characteristics of ADHD that are positive boundless energy, warmth, and
enthusiasm.
About the Author:
Donald W. Ahrens Jr, PMH-NP, A.R.N.P. is a
psychiatric Nurse Practitioner who provides full spectrum psychiatric service
(both psychotherapy and medication therapy) to the people of Wichita and the
surrounding metropolitan area.