Harvey C. Parker, Ph.D.
Clinical Psychologist
Author of The ADHD Workbook for Parents, The ADHD Handbook for Schools, and Problem Solver Guide for Students with ADHD
Current interest in Attention Deficit Hyperactivity Disorder (ADHD) is soaring.
Magazine articles, newspaper reports, network newscasts, and television talk show hosts
have found this to be a timely topic. Scientific journals report thousands upon thousands
of studies of ADHD children and youth and ADHD support groups continue to grow at an
astounding rate as parents seek to learn more about this disorder in an effort to help
their youngsters succeed at home and at school.
While some of this interest in ADHD arose from the controversies surrounding this
condition, the growing recognition that ADHD can be a seriously debilitating disorder with
lifelong effects has caused tremendous concern. Controversy about ADHD revolves around
disagreements as to the cause of the disorder as well as differing opinions regarding
treatment. Apprehension with respect to the dispensing of medication to ADHD children had
captured media attention in the mid to late 1990s. Disagreement as to the educational needs of
ADHD children and whether they should be eligible to receive special education services
when their disorder severely impacts upon their academic performance has been a hotly
debated issue.
A Harris Interactive survey done in 2000 polled parents and grandparents of children with ADHD as well as adults with the condition. One in three (34%) parents and grandparents said they did not know where to go for information when their child was diagnosed. The majority of parents and grandparents said confusing media reports (91%) and lack of reliable information (94%) prevent children from getting the treatment they need for ADHD. The purpose of this article is to briefly summarize some of the facts we know about
ADHD related to characteristics, prevalence, cause, identification, treatment and outcome. Other articles contained on the addwarehouse.com site provide additional information about
the disorder.
Characteristics of ADHD
The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV), published by the American Psychiatric
Association, defined three types of attention deficit hyperactivity
disorder: ADHD, predominantly hyperactive-impulsive type; ADHD, predominantly inattentive type; and ADHD, combined type. ADHD is characterized by
symptoms of inattention, impulsivity or hyperactivity which have an onset before age
seven, which persist for at least six months, and which are not due primarily to other
psychiatric disorders or environmental circumstances, such as reaction to family stresses,
etc. ADHD, predominantly inattentive type refers to disturbances in which the
primary characteristic is significant inattentiveness without signs of hyperactivity. ADHD, predominantly hyperactive-impulsive type refers to disturbances in which the primary characteristics are hyperactivity and impulsivity, without inattention.
Recent study of ADHD children who are the inattentive type indicates that this group of children
tend to show more signs of anxiety and learning problems, qualitatively different
inattention, and may have different outcomes than the hyperactive group who show more
externalizing behavior problems associated with the oppositional and conduct disorders.
Prevalence of ADHD
Prevalence reports of ADHD have varied over the past several years and range from 3 to 9 percent of the population of children and adolescents, with boy
significantly out numbering girls. The number of children and adolescents affected by ADHD
in the United States is probably well over 2 million. Adults can also be affected as it is estimated that from 30 to 70 percent of children with the disorder will continue to have symptoms throughout adulthood.
Cause of ADHD
There are still many unanswered questions as to the cause of the disorder. Over the
years the presence of ADHD has been weakly associated with a variety of conditions
including: prenatal and/or perinatal trauma, maturational delay, environmentally caused
toxicity such as fetal alcohol syndrome or lead toxicity, and food allergies. History of
such conditions may be found in some individuals with ADHD, however, in most cases there
is no history of any of the above.
Researchers have turned their attention to altered brain biochemistry and brain anatomy as possible
causes of ADHD. Presumed differences in brain chemistry or structure may be the cause of poor regulation
of attention, impulsivity and motor activity. A great deal more research has to be done to reach more
definitive answers. However, we do know that there is no evidence that ADHD is caused by poor parenting, food allergies, excess sugar, or exposure to television. Other disorders may cause similar symptoms, which is why it is important to get a comprehensive diagnosis from a specialist.
Identification of ADHD
The identification and diagnosis of children with ADHD requires a combination of
clinical judgement and objective assessment. Since there is a high rate of coexistence of
ADHD with other psychiatric disorders of childhood and adolescence any comprehensive
assessment should include an evaluation of the individual's medical, psychological,
educational and behavioral functioning. The more domains assessed the greater certainty
there can be of a comprehensive, valid, and reliable diagnosis. The taking of a detailed
history including medical, family, psychological, developmental, social and educational
factors is essential in order to establish a pattern of chronicity and pervasiveness of
symptoms. Augmenting the history are the use of standardized parent and teacher behavioral
rating scales which are essential to quantifiably assess the normality of the individual
with respect to adaptive functioning in a variety of settings such as home and school.
Psychoeducational assessment investigating intellectual functioning and cognitive processes
including reasoning skills, use of language, perception, attention, memory, and
visual-motor functioning as well as academic achievement should be performed.
Treatment of ADHD
Most experts agree that a multi-modality approach to treatment of the disorder aimed at
assisting the child medically, psychologically, educationally and behaviorally is often
needed. This requires the coordinated efforts of a team of health care professionals,
educators and parents who work together to identify treatment goals, design and implement
interventions, and evaluate the results of their efforts.
Medications used to treat ADHD primarily include psychostimulants such as:
Ritalin, Focalyn, Dexedrine, Adderall and Adderall XR, Metadate CD, and Concerta which have
been shown to have dramatically positive effects on attention, over activity, visual motor
skills, and even aggression in 70% or more ADHD children.
The tricyclic antidepressant medications, Tofranil, Desipramine, Elavil, and others have been studied and used clinically to treat the disorder. Other
types of antidepressants (i.e., Prozac, Paxil, etc.) called selective serotinin reuptake inhibitors are used less frequently because they have little impact on attention and hyperactivity or impulsivity. However, they do help regulate mood. Catapres and Tenex, antihypertensive agents, and Tegretol, an
anti-convulsant, have been shown to be effective for some children as well.
Ideally, treatment should also include consideration of the individual's psychological
adjustment targeting problems involving self-esteem, anxiety, and difficulties with family
and peer interaction. Frequently family therapy is useful along with behavioral and
cognitive interventions to improve behavior, attention span, and social skills.
Educational interventions such as accommodations made within the regular education
classroom, compensatory educational instruction, or placement in special education may be
required depending upon the particular child's needs. A 1999 study by the NIMH (the MTA study) concluded that medication treatment was very effective in helping children with ADHD and that psychosocial treatments provided additional benefit.
