attention-deficit hyperactivity disorder

Symptoms

Signs may be minimal or absent when the person is under strict control or is engaged in esp. interesting or challenging situations. They are more likely to occur in group situations. Although behaviors vary widely, affected people typically exhibit motor restlessness, impulsivity, and difficulty concentrating on a single task or chore. They tend to do more poorly in school than one might predict based on assessments of their intelligence alone. While characteristics of ADHD are found in many people at one time or another, a key feature of ADHD is the excessive or unusual pattern of behavior outside normal bounds of exuberance or excitement. The findings must be severe enough to be maladaptive and inconsistent with specified levels of development, and last at least six months.

Diagnosis

CAUTION!

The disorder is difficult to diagnose in children under age 5. It is important to distinguish ADHD from age-appropriate behavior in active children and from disorders such as mental retardation, primary learning disabilities, alteration of mood, anxiety, petit mal seizures, or personality changes caused by illness, family stress, or drugs. The criteria determined by the American Psychiatric Association include specific limits concerning the duration and severity of symptoms of inattention and hyperactivity-impulsivity. The findings must be severe enough to be maladaptive and inconsistent with specified levels of development.

Treatment

In both children and adults, the domestic, school, social, and occupational environments are evaluated to determine contributing factors and their relative importance. Standard treatment includes behavioral and psychological therapy, environmental changes, and medication. Medications commonly used to treat ADHD include methylphenidate, dextroamphetamine, atomoxetine, and pemoline. These agents, with the exception of atomoxetine, are central nervous system (CNS) stimulants. Adverse reactions to CNS stimulants include decreased appetite, difficulty sleeping, anxiety, stomach ache, headache, jitteriness, and social withdrawal (the latter in children).

Behavior therapy for patients with ADHD includes positive reinforcement, time-out, response cost (loss of rewards or privileges for problem behaviors) and token economy (a combination of positive reinforcement and response cost). Combinations of drug therapy and behavioral therapies, or drug therapies alone, appear to have a more beneficial effect than behavioral therapy, psychotherapy, or parent skills training alone.