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Attention Deficit Hyperactivity Disorder

Part 1



Credits



Source

National Institute of Mental Health
U.S. Department of Health and Human Service

Contents

Understanding The Problem

What Are the Symptoms of ADHD?

Can Any Other Conditions Produce These Symptoms?

What Can Look Like ADHD?

Can Other Disorders Accompany ADHD?

What Causes ADHD?

ADHD Is Not Usually Caused by:

Getting Help

How Is ADHD Identified and Diagnosed?

Types of Professionals Who Make the Diagnosis

Steps In Making a Diagnosis

What Are the Educational Options?

Right to a Free Public Education

Some Coping Strategies for Teens and Adults With ADHD

What Treatments Are Available?

Use of Stimulant Drugs

The Medication Debate

The Medication Debate

Myths About Stimulant Medication

Controversial Treatments

Sustaining Hope

Can ADHD Be Outgrown or Cured?

What Hope Does Research Offer?

What Are Sources of Information and Support?


Forums

Learning and Other Disabilities


Related Articles

Attention-Deficit / Hyperactivity Disorder (from NICHCY)

Students with Attention Deficit Disorder (from HEATH Resource Center)

Diet Therapy For Attention Deficit Hyperactivity Disorder (from Feingold Assoc.)

Attention Deficit - Hyperactivity Disorder A Guide for Parents (from LDA)



Imagine living in a fast-moving kaleidoscope, where sounds, images, and thoughts are constantly shifting. Feeling easily bored, yet helpless to keep your mind on tasks you need to complete. Distracted by unimportant sights and sounds, your mind drives you from one thought or activity to the next. Perhaps you are so wrapped up in a collage of thoughts and images that you don't notice when someone speaks to you.

For many people, this is what it's like to have Attention Deficit Hyperactivity Disorder, or ADHD. They may be unable to sit still, plan ahead, finish tasks, or be fully aware of what's going on around them. To their family, classmates or coworkers, they seem to exist in a whirlwind of disorganized or frenzied activity. Unexpectedly--on some days and in some situations--they seem fine, often leading others to think the person with ADHD can actually control these behaviors. As a result, the disorder can mar the person's relationships with others in addition to disrupting their daily life, consuming energy, and diminishing self-esteem.

ADHD, once called hyperkinesis or minimal brain dysfunction, is one of the most common mental disorders among children. It affects 3 to 5 percent of all children, perhaps as many as 2 million American children. Two to three times more boys than girls are affected. On the average, at least one child in every classroom in the United States needs help for the disorder. ADHD often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain.

But there is help...and hope. In the last decade, scientists have learned much about the course of the disorder and are now able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are already available to help people with ADHD focus their attention, build self-esteem, and function in new ways.

In addition, new avenues of research promise to further improve diagnosis and treatment. With so many American children diagnosed as having attention disorder, research on ADHD has become a national priority. During the 1990s--which the President and Congress have declared the "Decade of the Brain"--it is possible that scientists will pinpoint the biological basis of ADHD and learn how to prevent or treat it even more effectively.

This booklet is provided by the National Institute of Mental Health (NIMH), the Federal agency that supports research nationwide on the brain, mental illnesses, and mental health. Scientists supported by NIMH are dedicated to understanding the workings and interrelationships of the various regions of the brain, and to developing preventive measures and new treatments to overcome brain disorders that handicap people in school, work, and play.

The booklet offers up-to-date information on attention deficit disorders and the role of NIMH-sponsored research in discovering underlying causes and effective treatments. It describes treatment options, strategies for coping, and sources of information and support. You'll find out what it's like to have ADHD from the stories of Mark, Lisa, and Henry. You'll see their early frustrations, their steps toward getting help, and their hopes for the future.

(The individuals referred to in this brochure are not real, but their stories are representative of people who show symptoms of ADHD.)

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Understanding The Problem

Mark

Mark, age 14, has more energy than most boys his age. But then, he's always been overly active. Starting at age 3, he was a human tornado, dashing around and disrupting everything in his path. At home, he darted from one activity to the next, leaving a trail of toys behind him. At meals, he upset dishes and chattered nonstop. He was reckless and impulsive, running into the street with oncoming cars, no matter how many times his mother explained the danger or scolded him. On the playground, he seemed no wilder than the other kids. But his tendency to overreact--like socking playmates simply for bumping into him--had already gotten him into trouble several times. His parents didn't know what to do. Mark's doting grandparents reassured them, "Boys will be boys. Don't worry, he'll grow out of it." But he didn't.

Lisa

At age 17, Lisa still struggles to pay attention and act appropriately. But this has always been hard for her. She still gets embarrassed thinking about that night her parents took her to a restaurant to celebrate her 10th birthday. She had gotten so distracted by the waitress' bright red hair that her father called her name three times before she remembered to order. Then before she could stop herself, she blurted, "Your hair dye looks awful!"

In elementary and junior high school, Lisa was quiet and cooperative but often seemed to be daydreaming. She was smart, yet couldn't improve her grades no matter how hard she tried. Several times, she failed exams. Even though she knew most of the answers, she couldn't keep her mind on the test. Her parents responded to her low grades by taking away privileges and scolding, "You're just lazy. You could get better grades if you only tried." One day, after Lisa had failed yet another exam, the teacher found her sobbing, "What's wrong with me?"

Henry

Although he loves puttering around in his shop, for years Henry has had dozens of unfinished carpentry projects and ideas for new ones he knew he would never complete. His garage was piled so high with wood, he and his wife joked about holding a fire sale.

Every day Henry faced the real frustration of not being able to concentrate long enough to complete a task. He was fired from his job as stock clerk because he lost inventory and carelessly filled out forms. Over the years, afraid that he might be losing his mind, he had seen psychotherapists and tried several medications, but none ever helped him concentrate. He saw the same lack of focus in his young son and worried.

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What Are the Symptoms of ADHD?

The three people you've just met, Mark, Lisa, and Henry, all have a form of ADHD--Attention Deficit Hyperactivity Disorder. ADHD is not like a broken arm, or strep throat. Unlike these two disorders, ADHD does not have clear physical signs that can be seen in an x-ray or a lab test. ADHD can only be identified by looking for certain characteristic behaviors, and as with Mark, Lisa, and Henry, these behaviors vary from person to person. Scientists have not yet identified a single cause behind all the different patterns of behavior--and they may never find just one. Rather, someday scientists may find that ADHD is actually an umbrella term for several slightly different disorders.

At present, ADHD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention, hyperactivity, and impulsivity.

Inattention. People who are inattentive have a hard time keeping their mind on any one thing and may get bored with a task after only a few minutes. They may give effortless, automatic attention to activities and things they enjoy. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult.

For example, Lisa found it agonizing to do homework. Often, she forgot to plan ahead by writing down the assignment or bringing home the right books. And when trying to work, every few minutes she found her mind drifting to something else. As a result, she rarely finished and her work was full of errors.

Hyperactivity. People who are hyperactive always seem to be in motion. They can't sit still. Like Mark, they may dash around or talk incessantly. Sitting still through a lesson can be an impossible task. Hyperactive children squirm in their seat or roam around the room. Or they might wiggle their feet, touch everything, or noisily tap their pencil. Hyperactive teens and adults may feel intensely restless. They may be fidgety or, like Henry, they may try to do several things at once, bouncing around from one activity to the next.

Impulsivity. People who are overly impulsive seem unable to curb their immediate reactions or think before they act. As a result, like Lisa, they may blurt out inappropriate comments. Or like Mark, they may run into the street without looking. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they are upset.

Not everyone who is overly hyperactive, inattentive, or impulsive has an attention disorder. Since most people sometimes blurt out things they didn't mean to say, bounce from one task to another, or become disorganized and forgetful, how can specialists tell if the problem is ADHD?

To assess whether a person has ADHD, specialists consider several critical questions: Are these behaviors excessive, long-term, and pervasive? That is, do they occur more often than in other people the same age? Are they a continuous problem, not just a response to a temporary situation? Do the behaviors occur in several settings or only in one specific place like the playground or the office? The person's pattern of behavior is compared against a set of criteria and characteristics of the disorder. These criteria appear in a diagnostic reference book called the DSM (short for the "Diagnostic and Statistical Manual of Mental Disorders").

According to the diagnostic manual, there are three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive. Or they may show all three types of behavior.

According to the DSM, signs of inattention include:

  • becoming easily distracted by irrelevant sights and sounds
  • failing to pay attention to details and making careless mistakes
  • rarely following instructions carefully and completely
  • losing or forgetting things like toys, or pencils, books, and tools needed for a task

Some signs of hyperactivity and impulsivity are:

  • feeling restless, often fidgeting with hands or feet, or squirming
  • running, climbing, or leaving a seat, in situations where sitting or quiet behavior is expected
  • blurting out answers before hearing the whole question
  • having difficulty waiting in line or for a turn

Because everyone shows some of these behaviors at times, the DSM contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least 6 months. In children, they must be more frequent or severe than in others the same age. Above all, the behaviors must create a real handicap in at least two areas of a person's life, such as school, home, work, or social settings. So someone whose work or friendships are not impaired by these behaviors would not be diagnosed with ADHD. Nor would a child who seems overly active at school but functions well elsewhere.

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