ADHD stands for 'Attention Deficit Hyperactivity Disorder' and is a development condition that makes concentration and attention difficult and often leads to hyperactivity and behavioural problems. The condition is actually the most commonly diagnosed psychiatric disorder in children and is thought to affect around 5% of children. The condition is chronic and around 30-50% of sufferers will continue the problem into adulthood, though most will develop coping mechanisms to aid their concentration in later life. The main concern with ADHD is that it affects the child's education during their formative years which may of course have implications that echo in their adult lives. It affects four times as many boys as girls – though it may be that more female cases go undiagnosed.
Symptoms and Diagnosis
The definition of ADHD is somewhat blurred and there is a subjective element in diagnosis – it's hard to know where to draw the line between ADHD and 'normal' levels of hyperactivity and impulsivity. Usually a teacher will refer a child who is misbehaving and who they believe may suffer from ADHD, but to classify the child must be observed in two different settings (for instance home and school – to counteract environmental factors) for six months or longer.
After this a child might be diagnosed as having one of three types of ADHD, which are 'predominantly inattentive', 'predominantly hyperactive-impulsive' or 'combined type' (the latter of course being a combination of the two former types). Classic symptoms of each include:
Predominantly Inattentive Type:
Of course most people, and particularly children will exhibit some of these behaviours from time and this is why diagnosis can be difficult. However if the child demonstrates these symptoms to a greater extent than their peers over a course of six months then it is highly possible that they suffer from ADHD.
ADHD is also associated with other conditions and only 1/3rd of children will exhibit the symptoms of ADHD on their own. Common comorbid disorders include bed wetting, dyspraxia, language delay, anxiety, depression and general mood disorders, borderline personality disorder, obsessive-compulsive disorder and conduct disorder.
Management of ADHD usually involves the combination of behavioural treatment and medication – though in some case either of these may be used on their own. The most common medication used here is Ritalin (methylphenidate), while Dexedrine and Adderall are also commonly used. In terms of behavioural management psychotherapy or cognitive behavioural therapy may be used, as well as behaviour modification techniques and training for the working memory. While there is clinical evidence for these strategies being effective, the success of the treatment will vary greatly depending on the individual and the circumstances.
The causes of ADHD are not known, though there are various factors known to contribute. For instance twin studies have demonstrated high heritability for the condition – which seems to be a factor in around 75 percent of cases. Further studies suggest that this may be a result of genes affecting dopamine transportation. Dopamine being the 'reward' hormone in the brain, this concurs with the 'low arousal theory' of ADHD which suggests that those with ADHD have a lower base rate of arousal meaning that they need more stimuli in order to reach normal levels. This also explains why stimulant drugs can be effective in treating the condition.
However non genetic environmental factors which could include diet, ingestion of toxins (pesticides have been suggested to have a link to ADHD) and social elements such as family dysfunction have also been shown to play a role and explain around 25% of cases. One theory suggests that ADHD is linked to a child's relationship with their primary caregiver, and studies have shown links between ADHD and violence and emotional abuse. Studies have also suggested that adopted children are more likely to develop ADHD.
There are many controversies surrounding the subject of ADHD and its treatments. Many of these revolve around the question of whether ADHD is a 'genuine disorder' or whether treatment simply equates to using drugs to alter a child's personality so that it might be more 'socially acceptable'. Likewise there is also controversy around the use of medications – with some leading to side effects or dependence or causing rebound and withdrawal effects. For instance, prolonged use of Adderall followed by withdrawal can lead to insomnia, fatigue and depression. Continued overdose meanwhile can lead to amphetamine psychosis. The long term effects meanwhile of other drugs such as methylphenidate have not been fully explored.
However despite these controversies, the general consensus among healthcare workers and the American Medical Association is that ADHD is a real condition – as suggested by the genetic links and the connections with other conditions and a large amount of research. Of course however it does rely on the correct diagnosis and management and could be open to abuse.