Attention deficit hyperactivity disorder
Understanding And Treating ADHD
Attention Deficit Disorder or ADD is a very complicated, and time and again misinterpreted, disorder. Its beginning is physiological, but it can have a multitude of consequences that come alongside with it. That apart, what is the differentiation between ADHD and ADD ADHD is the abbreviated form of Attention Deficit Hyperactive Disorder, its major indications being noticeable hyperactivity and impulsivity.
ADHD and learning disability frequently occur together, but they are not the same. Learning disabilities include difficulty with receiving, organizing, processing, understanding, remembering, and offering information. ADHD involves difficulty with paying attention to information. Between 10 percent and 20 percent of all school-age children have learning disabilities. Of those with learning disabilities, between 4 percent and 12 percent of all school-age children will also have ADHD, making it the most common childhood neurobehavioral disorder. Although ADHD is a common childhood behavioral disorder, it can be difficult to diagnose and even harder to understand. Once viewed as a disorder of childhood primarily involving hyperactiv-ity and the inability to pay attention, ADHD is now seen as a lifelong condition that may not include physical restlessness or hyperactive behavior at all. It may also be the source of unusual talents or gift-edness in specific areas. In recent years there...
Children and Adults with Attention Deficit Hyperactivity Disorder (CHADD) A nonprofit organization founded in 1987 in response to the frustration and sense of isolation experienced by parents and their children with ADHD. At that time, there were very few places for support or information, and people misunderstood ADHD. Many clinicians and educators knew little about the disability, and individuals with ADHD were often mistakenly labeled a behavior problem, unmotivated, or unintelligent. From one parent support group in Florida, the organization grew dramatically to become the leading nonprofit national organization for children and adults with ADHD. Today the organization continues to be run by volunteers, with the support of a small national staff, and offers education, advocacy, and support. (For contact information, see Appendix I.)
The above bivariate genetic analyses have also been performed for reading deficits and ADHD. ADHD has commonly been diagnosed in the United States by asking teachers and or parents to rate their children on a list of symptoms for attention deficits and hyperactivity. If a sufficiently high number of symptoms are checked, the children are categorized as ADHD. Researchers in the United States have noted a high rate of ADHD among children with dyslexia, ranging from about 20 to 40 across studies. We now have evidence from the Colorado twin study that part of this comorbidity is due to shared genetic influences, particularly for dyslexia and the attention-deficit symptoms (Willcutt et al., 2002).
ADHD can coexist with a number of psychological conditions, including conduct disorders, mood disorders (such as depression), anxiety disorders, and impulse control disorders (such as eating disorders and alcohol abuse). Some children may be depressed as a result of having ADHD, whereas others may have a mood disorder that exists independently of ADHD. Nearly half of all children with ADHD also have oppositional defiant disorder characterized by stubbornness, outbursts of temper, and defiance. Many children with ADHD also have a specific learning disability, which means that they might have trouble mastering language or other skills, such as math, reading, or handwriting. Although ADHD is not categorized as a learning disability, its interference with concentration and attention can make it even more difficult for a child to perform well in school. The issue of coexisting conditions makes diagnosis, treatment, and understanding of ADHD particularly complex. There is no cure for ADHD,...
Many children with pervasive developmental disorders such as Asperger's disorder also meet the diagnostic criteria for attention deficit hyperactivity disorder (ADHD). However, ADHD should not be diagnosed when there is Asperger's, since all the ADHD symptoms can be attributed to the other condition. Clinicians who overlook other symptoms of Asperger's tend to diagnose these children as having ADHD.
Disorders of language are common and account for a sizable proportion of all communication disorders. Within the various classification systems for language disorders, it is widely recognized that there are multiple causes. Most systems acknowledge deficits at the representational level, including the rules used to govern these representations. Deficits at this level are often referred to as deficits of linguistic competence. A variety of performance factors are also recognized that can cause an otherwise competent or intact linguistic system to malfunction. Examples of performance deficits include disorders of linguistic-specific memory processes (Baddeley, 1993 Crosson, 2001b) and slowed perceptual or cognitive mechanisms (Tallal, Stark, and Mellits, 1985). Disorders of various aspects of the attentional system include orienting of attention (Robin and Rizzo, 1989), selective attention (Petry et al., 1994 Murray, Holland, and Beeson, 1998), inability to engage or disengage attention...
But an appropriate remedial reading program can help learners make great strides. With age, and appropriate help from parents and clinicians, children with ADHD become better able to suppress their hyperactivity and to channel it into more socially acceptable behaviors.
Several populations of school-age children are at risk for language disorders. These populations include children with developmental disabilities, such as children with mental retardation, autism, or a pervasive developmental disorder, and also children in whom only subtle cognitive deficits are implicated. Among the latter are children with learning disabilities or disorders as well as children with attention deficit disorder, characterized by frequent instances of inattention and impulsiveness, and children with disruptive behavior disorder, marked by aggressive behavior or the violation of social norms. Children with hearing impairments are also at risk for language disorders. Although most school-age language disorders are developmental, children may have acquired language disorders resulting from closed head injuries, seizure disorders, or focal lesions such as stroke or tumors. Taken together, children with language disorders constitute a large group of students for whom...
Historically, minimal brain dysfunction (MBD) was the term used to define and classify learning and behavioral difficulties now classified under the category of attention deficit hyperactivity disorder. It generally includes hyperactivity, impulsivity, and any of a number of learning and language disabilities such as dyslexia and problems with math.
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD). Ritalin has effects similar to, but more potent than, caffeine but weaker than amphetamines. It has a notably calming effect on hyperactive children and a focusing effect on those with ADHD. Scientists think ADHD occurs in part because certain receptors in the brain involved in focusing attention and reining in impulsiveness fail to respond to dopamine and norepinephrine, the brain's natural neurotransmitters. It is the interaction between these chemicals and the brain's receptors that help most people stick with tedious chores or rein in inappropriate impulses. Researchers think that drugs like Ritalin boost the level of these brain chemicals and stimulate the inhibitory receptors which is why a stimulant drug can increase inhibition. The drugs enter the body quickly, curing nothing but helping a child focus on the important work of learning. Although the drug clearly reduces the symptoms of ADHD, and many students have been taking the...
Are difficulties with coordination (dyspraxia) or with attention control (ADHD). The cause of this comorbidity may be the sharing of brain mechanisms involved in the two disorders or because they share similar risk factors (e.g., family adversity). In cases of children with comorbid disorders, it is easy to mistake a behavioral symptom of one disorder for that of the other. Many dyslexic children are clumsy, but not all are by any means. It is important therefore, not to build a theory of dyslexia on the assumption that motor impairments play a causal role. Similarly, one of the key cognitive features of ADHD is a difficulty in inhibiting automatic responses, an aspect of executive function. However, there is evidence to suggest that children with comorbid ADHD and dyslexia show phonological deficits rather than executive deficits (Pennington, Grossier, & Welsh, 1993). The implication of this finding is that the ADHD symptoms have different roots in comorbid cases to those seen in...
One of the best predictors of their progress, while their IQ is not. But, even in the most effective interventions, there is a proportion of children who resist treatment (Torgesen et al., 1999). Much more needs to be known about why this is so. Generally, it is the children with the most severe phonological deficits. Do these children have co-occurring speech-language difficulties Or ADHD Perhaps some suffer from some kind of psychological problem, such as low self-esteem, or are they subject to social and family adversity We simply don't have the answers at the present time. A related issue is what accounts for the maintenance of treatment gains when specialist teaching stops. A critical factor seems to be levels of print exposure but how do you encourage a dyslexic who dislikes reading to read Such questions turn on the talent of teachers who can assess the needs of their dyslexic students with a high degree of precision. 5. Don't assume that every difficulty experienced by a...
The mental, behavioral, and developmental problems that affect children and teenagers include autism, attention-deficit hyperactivity disorder, learning disorders, bulimia and anorexia, behavioral disorders, and emotional disturbances. In their diagnostic examinations, child psychiatrists look at many components, from physical to cognitive, and from genetic to emotional. They take an integrative biopsychosocial approach, and consult with physicians and professionals from schools, social agencies, and juvenile courts. Working with kids
Cornoldi et al. (1999) report impairment in strategic memory in children with ADHD. They found that, in comparison to controls, children with ADHD had weak recall and many intrusion errors. However, when they were given a strategy to use, their performance improved to become as good as controls. They had to be shown how to use the strategy, as otherwise their recall remained poor. Cornoldi et al. (1999) interpreted these results as reflecting an executive impairment in memory. They also gave the children with ADHD and controls other executive tasks to perform and found that performance on the other executive tasks predicted memory skills. These strategic difficulties with memory may be similar to some of the difficulties discussed above in relation to Reye's syndrome.
Hyperactivity A behavior pattern in which a person is constantly moving around and making rapid, often disorganized, motions. A general term, hyperactivity is used loosely to refer to a wide range of behaviors and is considered to be part of a wider complex of behaviors called attention DEFICIT HYPERACTIVITY DISORDER (ADHD). Some experts may use the term hyperkinesis to refer to this phenomenon. hyperkinetic syndrome (hyperkinesis) Another term for hyperactivity, now generally called attention DEFICIT HYPERACTIVITY DISORDER (ADHD).
Strattera (atomoxetine) The first nonstimulant medication approved for the treatment of ADHD (attention deficit hyperactivity disorder) in children, adolescents, and adults. The U.S. Food and Drug Administration (FDA) approved Strattera, November 26, 2002, judging it safe and effective for the treatment of ADHD. Strattera is a selective norepinephrine reuptake inhibitor a class of drugs that works differently from the other ADHD medications available. Strattera works by selectively blocking the reuptake of norepinephrine, a chemical neurotransmitter, by certain nerve cells in the brain. This action increases the availability of norepinephrine, which experts believe is essential in regulating impulse control, organization, and attention. The precise mechanism by which Strat-tera works on ADHD is not known. Because Strattera does not appear to have a potential for abuse, it is not classified as a controlled substance and is therefore simpler to obtain, although it is still a...
A 10-year-old male with a history of learning disabilities, developmental delay, and attention deficit hyperactivity disorder (ADHD) suffered a nonfebrile seizure after he hit his knee while getting into the shower. The patient had no prior history of seizure, but his mother had experienced multiple pain-induced seizures. The patient was in no apparent distress and his respiration, pulse, and blood pressure were normal. He denied headaches or visual problems and had no evidence of a head injury. An EEG and head CT were normal. STAT serum chemistry tests revealed hypercalcemia (Table 31.1). The following values were found
Abstract In this chapter we review current neuroimaging research on the structure of the corpus callosum. The corpus callosum is the main fiber tract connecting the two brain hemispheres, consisting of approximately 200-350 million fibers in humans. Given the corpus callosum's importance in communicating perceptual, cognitive, mnemonic, learned, and volitional information between the hemispheres, it has not surprisingly been a focus of many studies examining structural and functional neuropathology. We and other groups have investigated callosal abnormalities in Alzheimer's disease, multi-infarct dementia, schizophrenia, attention deficit hyperactivity disorder, and multiple sclerosis and during normal and aberrant development. Nonetheless, extreme variations in brain structure make it difficult to design computerized strategies that detect and classify abnormal structural patterns. Intense controversy exists on the question of whether different callosal regions undergo selective...
Future investigations may reveal that variability in children with language impairments is better accounted for by uncontrolled confounding factors. For example, although many studies suggest that SLI and attention-deficit hyperactivity disorder commonly co-occur (cf. Cohen et al., 2000) the potential influence of this com-orbidity on social skill development has not yet been considered. Likewise, a small portion of children diagnosed with SLI demonstrate limitations in social cognition commonly associated with autism and pervasive developmental delay. There has been a longstanding controversy over the diagnostic boundaries between SLI and autism spectrum disorders (cf. Bishop, 2000), and social skill outcomes may be an important distinguishing characteristic of children who fall outside preconceived categories. Large-scale investigations comparing the social skills of children with SLI only with those of children with SLI and other comorbid disorders are needed to delineate which...
Individual variation in callosal size is striking (Giedd et al., 1996, 1999 Parashos, Wilkinson, & Coffey, 1995) and large samples are required to adequately assess morphological characteristics of the callosum in relation to other variables such as handedness, gender, or presence of dyslexia (for reviews, see Beaton, 1997 Bishop & Wahlsten, 1997 Driesen & Raz, 1995). Given that Pennington et al. (1999) investigated the largest number of poor readers studied to date, their negative results might indicate that the positive findings reported in other studies represent merely chance findings. It is possible, of course, that individuals diagnosed as dyslexic according to differing criteria or with different accompanying difficulties may differ in their callosal morphology. However, in the study by Pennington et al. (1999), the findings were not affected by excluding those individuals who also had a diagnosis of ADHD.
In a few cases, disorders such as fragile x syndrome, tuberous sclerosis, untreated phenylketonuria (PKU), and congenital German measles cause autistic behavior. Other disorders, including tourette's syndrome, learning disability, and attention deficit disorder often occur with autism but do not cause it. While people with schizophrenia may show some autistic-like behavior, their symptoms usually do not appear until the late teens or early adulthood. Most people with schizophrenia also have hallucinations and delusions, which do not occur in autism.
Disorder (ADHD). ritalin (methylphenidate) is most commonly prescribed. Other stimulant medications that are frequently prescribed include Dexedrine (dextroamphetamine), Adderall (amphetamine and dextroamphetamine), and Cylert (pemoline). For more than 50 years, these drugs have been used to treat the behavior of children with hyperactive symptoms as many as 80 percent of students with ADHD respond to these drugs. Exactly what makes these medications effective against ADHD is unknown, although experts suspect they affect the rate and balance of specific neurotrans-mitters in certain areas of the brain. This results in a greater ability to pay attention and stay focused, and a decrease in hyperactivity. Since these children also tend to become less impulsive, aggressive, and destructive, the drugs also help improve social acceptance. These medications are often used in combination with behavioral and educational interventions. Children who respond to stimulant medications generally...
(Drake, 1968) wrote in the cerebral hemispheres, anomalies were noted in the convolution pattern of the parietal lobes bilaterally. The cortical pattern was disrupted by penetrating deep gyri that appeared disconnected. Related areas of the corpus callosum appeared thin (p. 496). Billy was said to have marked difficulty with reading and writing, and some difficulty with arithmetic, although by age 12 years 2 months his performance on standard tests suggests that he performed at a more or less satisfactory level in reading and spelling. Other aspects of the report suggest that he would today be classified as showing attention-deficit hyperactivity disorder (ADHD). Billy's medical history included dizzy spells and blackouts occurring from age 6 as well as recurring left frontal headaches during the 2 years prior to his death. In short, the extent to which Billy could be regarded as a representative dyslexic person is unclear.
Many patients with Tourette's syndrome also have other conditions, such as attention deficit HYPERACTIVITY DISORDER (ADHD), obsessive-compulsive disorder, or learning disability. symptoms include obsessions, compulsions, impulsive behavior, and mood swings. Tourette's is commonly associated with other syndromes, including ADHD, anxiety, mood or panic disorders, obsessive-compulsive disorder, behavior problems, and learning disabilities. Anxiety, stress, and fatigue often intensify tics, which usually diminish during sleep or when the patient is focused on an activity. Psychoactive drugs, particularly cocaine and stimulants, have a tendency to worsen tics.
Symptoms Snoring is the most common symptom other signs include color changes, labored breathing or gasping for air during sleep or sleeping in unusual positions. Because obstructive sleep apnea may disturb sleep patterns, these children may wake up sleepy and continue to complain of fatigue and attention problems throughout the day that may affect school performance. One recent study suggests that some children diagnosed with attention deficit hyperactivity disorder (ADHD) actually have attention problems in school because of disrupted sleep patterns caused by obstructive sleep apnea.
Because the manic periods (with impulsive behavior and bursts of energy) can be similar to symptoms of attention deficit hyperactivity disorder, a good diagnosis is important for any child experiencing repeated episodes of mania or depression. The feelings of depression, inadequacy, fatigue, and sadness are also similar to emotions experienced by children with other disorders.
The term tracking skills is sometimes used to describe subjective estimates of ocular motor function in relation to reading performance. Unfortunately, the term is vague and is used variously to refer to saccadic eye movements (e.g., performance when changing fixation between two pens), saccadation of pursuit (e.g., the presence of nonsmooth movements when following a slowly moving pen), or a remote near point of convergence (e.g., eyes appear unable to converge on a pen approaching the nose). These three types of eye movements are very different, but it is possible that all three types of observation may be related to lapses of concentration by the subject. Dyslexia is often associated with attention deficit disorder (with or without hyperactivity) and this might account for much of the controversy relating to the relationship between eye movement dysfunction and dyslexia (Evans, 2001). It should also be noted that even when subjects can converge to their nose, when asked to make the...
Cylert (pemoline) A stimulant medication sometimes used to treat attention deficit hyperactivity disorder (adhd). Because of its association with life-threatening liver failure, Cylert is not ordinarily considered as first-line drug therapy for ADHD, and it was withdrawn from sale in Canada in September 1999 because of complications.
It is also important to understand what is not included in the LD category. For example, attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are not learning disabilities, but there is a 20 percent probability that someone with ADD or ADHD also has one or more learning disabilities. other conditions that are not considered to be learning disabilities include autism, blindness and deafness, emotional problems, hyperactivity, illiteracy, mental retardation, slow learner, or physical disability.
Historically, MBD was the term used to define and classify learning and behavioral difficulties now classified under the category of attention deficit hyperactivity disorder. It generally includes hyperactivity, impulsivity, various neurological soft signs and any of a number of learning and language disabilities such as dyslexia and dyscalculia.
At work, adults with ADHD often have trouble organizing tasks or completing their work. They do not seem to listen to or follow directions. Their work may be messy and appear careless. fetal alcohol syndrome, a condition that can lead to low birth weight, intellectual impairment, hyperactivity, and certain physical defects. Any alcohol use during pregnancy may influence the child's development and lead to problems with learning, attention, memory, or problem solving. Drugs such as cocaine (especially crack cocaine) seem to affect the normal development of brain receptors that help to transmit incoming signals from skin, eyes, and ears. Because children with certain learning disabilities have trouble understanding speech sounds or letters, some researchers believe that learning disabilities (as well as ADHD) may be related to faulty receptors. Current research points to drug abuse as a possible cause of receptor damage.
Bookshop shelves are heaving with manuals of pop psychology and numerous websites provide similar wisdom in an easily accessible form for the internet generation. Both often provide handy checklists against which readers can assess whether they qualify for the diagnosis of co-dependency (the answer, of course, is yes). Two young men have come into the surgery, having completed one such checklist confirming the diagnosis of the adult form of attention deficit hyperactivity disorder. Indeed both had poor records at school, difficulties in maintaining jobs and relationships, problems with the law how about some Ritalin (the amphetamine-type drug recommended for ADHD) The propaganda of addiction finds a ready resonance in a society in which people are all too ready to accept a medical label for their difficulties.
Cohen, N., Vallance, D., Barwick, M., Im, N., Menna, R., Horodezky, N., and Issacson, L. (2000). The interface between ADHD and language impairment An examination of language, achievement, and cognitive processing. Journal of Child Psychology and Psychiatry, 41, 353-362.
Perfectionism A set of self-defeating thoughts and behaviors aimed at reaching excessively high and unrealistic goals. Many children who have trouble with writing or finishing school projects have problems with perfectionism, which may be closely related to anxiety, or to obsessive-compulsive disorder. Children with attention deficit hyperactivity disorder (ADHD) often have perfectionist tendencies, particularly in areas which they feel are important.
Older children with learning issues in school can also benefit from seeing a developmentalist. Although the general pediatrician should feel comfortable diagnosing and treating attention-deficit hyperactivity disorder, some children may have receptive or expressive deficits at the root of their problem that, if diagnosed, could lead to more effective strategies for therapy. Currently, a fellowship in developmental pediatrics lasts 3 years. In the near future, this fellowship will become part of a 6-year residency leading to triple board certification in pediatrics, neurology, and development.
Lems can range from benign headaches, seizures that disappear in late childhood, and attention deficit disorder to severe and progressively fatal diseases such as Duchenne muscular dystrophy, progressive seizure disorders such as infantile spasms and tuberous sclerosis, and various congenital brain malformations such as Dandy-Walker syndrome and pachygyria. Their careful examination skills help to find focal deficits, leading to quicker diagnosis and appropriate treatment. Many find this field frustrating because it seems like symptoms are only controlled and patients are rarely cured. But pediatric neurologists are drawn to their field because they know their interventions can improve their patient's quality of life. A fellowship in pediatric neurology is usually part of a combined residency (2 years of pediatrics, 1 year of general adult neurology, and 2 years as a fellow in pediatric neurology).
Narcolepsy can occur in children as young as age five, but it most commonly occurs during adolescence. Children with narcolepsy (see Chapter 13) suffer from extreme sleepiness and may experience uncontrollable sleep attacks several times a day, leading them to nod off while eating, talking, or even playing. Additional signs of early onset narcolepsy include great difficulty getting up in the morning and a tendency to become confused or aggressive upon waking. Children can also demonstrate cataplexy, the sudden loss of muscle tone during wakefulness, and temporary paralysis or vivid dreaming on falling asleep or awakening. Cataplexy is often described as fainting in young children. Narcolepsy is often misdiagnosed as a learning disability or attention deficit disorder, delaying treatment for many years.
Two cases of confirmed mosaic trisomy 17 have been reported (157,158). The trisomic cells were not seen in lymphocytes, but were found in high percentage in skin fibroblasts. One patient, age 8 years at the time of reporting, had mental and growth retardation, microcephaly, minor dysmorphism, seizures, hearing loss, attention deficit hyperactivity disorder, and autistic behavior. The other patient had mild dysmorphic features and moderate neurological involvement that the authors suggested could be related to prematurity. Two cases of mosaic trisomy 19 are in the literature, one of them was a stillborn male and the other died on day 13. Clinical features were varied and included facial dysmorphism with no report of major malformation (159,160).
Of the speech and language disorders, children who have an articulation or an expressive language disorder are the least likely to have long-term problems. Despite initial delays, most children do learn to speak. For people with dyslexia, the outlook is mixed. But an appropriate remedial reading program can help learners make great strides. With age, and appropriate help from parents and clinicians, children with ADHD become better able to suppress their hyperactivity and to channel it into more socially acceptable behaviors.
While phenylalanine-restricted diets have proven to be highly effective in preventing mental retardation, it is now recognized that there may still be subtle cognitive deficits. usually the individual has a normal IQ, but the incidence of attention DEFICIT HYPERACTIVITY DISORDER (ADHD) and learning disabilities is higher compared to those children who do not have PKU.
ADHD is primarily diagnosed through a combination of individual and family history, individual behavioral assessments, and information about behavior from parents, teachers, and others. Some tests also contain factors for inattention, dis-tractibility, and memory that can be affected by ADHD, and may contribute to a diagnosis. Formerly called attention deficit disorder, with or without hyperactivity, this disorder was recently renamed attention deficit hyperactivity disorder (ADHD) and includes three subtypes inattentive subtype (formerly known as attention deficit disorder, or ADD) with signs that include being easily distracted, an inability to pay attention to details, not following directions, losing or forgetting things like toys, notebooks, or homework hyperactive-impulsive subtype (formerly known as attention deficit hyperactivity disorder, or ADHD) include fidgeting, squirming, blurting out answers before hearing the full question, difficulty waiting, running or jumping out of...
While phenylalanine restricted diets have proven to be highly effective in preventing mental retardation, it is now recognized that there may still be subtle cognitive deficits. Usually the individual has a normal IQ, but the incidence of attention deficit hyperactivity disorder (adhd) and learning disabilities is higher compared to those children who do not have PKU.