What is ADHD?

  2010 by Stephanie Burkhead, MPH

Attention deficit hyperactivity disorder (ADHD) is a mental disorder that causes above-normal levels of hyperactive and disruptive behaviors. People with ADHD tend to have difficulty concentrating, sitting still, paying attention, staying organized, following instructions, remembering details, and/or controlling impulses. One of the unfortunate complications for people with untreated ADHD is that they often have trouble getting along with their peers, family members at home, and coworkers.

For children, ADHD is perhaps most associated with problems at school. Children with ADHD often have difficulty succeeding in a controlled classroom setting; assignments become difficult obstacles, instead of productive learning experiences. Perhaps because of this—although it affects people of all ages—ADHD is more commonly diagnosed in children than in adults: A 2006 survey conducted by the Centers for Disease Control and Prevention (CDC) found that ADHD affects about four to six percent of American children ages five to 17 (approximately 4.5 million overall), making ADHD one of the most common childhood disorders in the United States. The survey also found that boys are twice as likely to be diagnosed as girls. The majority (50 to 70 percent) of these children will retain symptoms into adulthood, but many get better over time. 

Unfortunately, ADHD can be difficult to diagnose, and many children who suffer from the condition are labeled simply as troublemakers, problem children, or, even worse, stupid or lazy.  ADHD is, however, a real and serious condition, not a means of explaining away behavioral problems. Luckily, with an early diagnosis and proper treatment, children with ADHD can be just as successful as children who do not have the condition.

Treatment Options for ADHD

Reviewed on July 29, 2010 by Stephanie Burkhead, MPH

 

While there is no known cure for attention deficit hyperactivity disorder (ADHD), there are a number of options that can help those with the condition effectively manage their symptoms. Treatments range from behavioral intervention to prescription medication. While research has found that medication alone is an effective therapy for ADHD, a large-scale study conducted by the National Institutes of Mental Health found that a combination approach to therapy—using medications and behavioral treatment together—was most useful in helping patients manage the condition.

ADHD Medications

According to the large-scale National Survey of Children's Health taken in 2003, around 2.5 million youth four to 17 years old (56 percent of those diagnosed) were receiving medication treatment for ADHD. Medication use is highest among children with ADHD who are 9 to 12 years old. Medication is often an important and difficult reality for parents of children with ADHD. To found out which medications are safe and right for you or your child, be sure to research and discuss information with your doctor and/or healthcare professional.

Central Nervous System Stimulants

Central nervous system (CNS) stimulants are the most commonly prescribed class of ADHD drug. Although scientists are not sure precisely how these drugs work, it is believed that CNS stimulants balance the levels of certain neurotransmitters (brain chemicals) such as dopamine that may be unstable in ADHD patients. CNS stimulants come in a range of forms including pill, capsule, liquid, and skin patch, and they may also come in short-acting, long-acting, or extended-release varieties. Long-acting or extended-release forms often allow a child to take the medication just once a day before school, so they don't have to make a daily trip to the school nurse for an afternoon dose. Parents and doctors should decide together which medication is best for the child and whether the child needs medication during school hours only or on evenings and weekends as well.

Common CNS stimulants include:

•Amphetamine-based stimulants (Adderall, Dexedrine, Dextrostat)

•Dextromethamphetamine (Desoxyn)

•Dextromethylphenidate (Focalin)

•Methylphenidate (Concerta, Daytrana, Metadate, Ritalin)

Nonstimulant Medications

Nonstimulant medications are often considered when stimulants haven’t worked or have caused intolerable side effects. Nonstimulant medications used to treat ADHD include:

•Atomoxetine (Strattera)

•Blood Pressure Medication (such as guanfacine; brand name Intuniv)

•Antidepressants

•Atypical antipsychotics

Therapeutic ADHD Treatments

Psychotherapy

Psychotherapy can be useful, especially with slightly older children, in getting a child to open up about his or her feelings of coping with ADHD. ADHD might cause problems with authority figures and peers; psychotherapy can help children handle these relationships appropriately. In psychotherapy, a child may also be able to explore his or her behavioral patterns and learn how to make the right choices moving forward.Family therapy can be a great venue for figuring out how best to work through disruptive behaviors.

Behavior Therapy

Behavior therapy (BT) attempts to teach a child how to better monitor his or her behaviors and then modify those behaviors appropriately. Often, the child and the child’s parents and/or teacher(s) will work together to develop strategies for dealing with certain situations and resulting behaviors. This frequently involves some sort of direct feedback so that the child learns appropriate behaviors; for example, a token reward system could be devised to reinforce positive behaviors.

Social Skills Training

Social skills training can sometimes be useful if a child shows significant issues functioning in social environments. Like BT, social skills training attempts to teach new and more appropriate behaviors—specifically those that can help a child with ADHD play and work better with others. For example, a therapist may try to teach behaviors such as waiting in turn, sharing toys, asking for help, or dealing with teasing.

Support Groups

Support groups are great for helping parents connect to others who may share similar experiences, concerns, and successes with ADHD children. Ideally, support groups will meet regularly so relationships and support networks can be built. Knowing you’re not alone in dealing with ADHD can be a huge mental fortification. Support groups can also be a great resource for specialist recommendations and practical strategies, especially if you are a parent of a child newly diagnosed with ADHD.

Parenting Skills Training

This training gives parents tools and techniques for understanding and managing their child’s behaviors. Some techniques may include:

•A point system or other means of immediately rewarding good behavior or work

•How to utilize a time-out when the child becomes too unruly or out of control. For some children, being pulled out of a stressful or overstimulating situation can help him or her learn how to react appropriately the next time it comes up.

•Finding time every week to share a pleasurable or relaxing activity. During this time together, a parent should look for opportunities to point out what the child does well and praise his or her strengths and abilities.

•Structuring situations in a way that allows the child to find success. For example, allowing only one or two playmates at a time, so that the child doesn’t get overstimulated.

•Stress management methods such as meditation, relaxation techniques, and exercise

Behavioral Interventions for Home and School

Organization

One of the biggest concerns for parents of children with ADHD is their child’s success in school, a lot of which hinges on organization—a skill with which many children with ADHD struggle. Simple interventions such as the ones listed below can be an immense help.

•Schedule. Set the same routine every day, from waking up to bedtime, including homework and playtime. Post the schedule in a visible place; if a change must be made, make it as far in advance as possible.

•Organize everyday items. Clothing, backpacks, school supplies, and play items all should have a designated, clearly marked space.

•Use homework and notebook organizers. Stress the importance of writing down assignments and bringing home anything needed to complete homework.

•Ask about using a computer in class. For some children with ADHD, handwriting is another stumbling block on the road to success. See if his or her teacher will allow for computer use in the classroom.

Positive Reinforcement

Children with ADHD often receive, and then start to expect, criticism from authority figures. If they get only negative feedback without ever hearing nice things about themselves, they’ll start to think of themselves as “bad.” If rules are followed and behavior is good—even in seemingly inconsequential situations—give small rewards and praise to boost your child’s self-esteem and reinforce good behavior significantly.

Extracurricular Activities

Children with ADHD often do very well with activities such as art class, music or dance lessons, or martial arts classes because energy can be channeled creatively and productively. These activities can be a source of positive reward for children with ADHD and can also foster mental discipline. Find out what your child is interested in, but remember not to force them into anything.

ADHD Drugs & Medication


Reviewed on July 29, 2010 by Stephanie Burkhead, MPH

 

Central Nervous System Stimulants

Central nervous system (CNS) stimulants are the most common type of medication prescribed for attention deficit hyperactivity disorder (ADHD). They have the longest track record for treating ADHD and have the most research to back up their effectiveness. Scientists are not sure exactly how CNS stimulants ease the symptoms of ADHD, but it is believed that these drugs work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter (brain chemical) associated with motivation, pleasure, attention, and movement. For many people with ADHD, stimulant medications can increase their ability to concentrate and focus, while at the same time easing hyperactive and impulsive behaviors.

CNS stimulants for ADHD come in both short- and long-acting dosages. Short-acting stimulants peak after several hours and must be taken two to three times a day. These usually come in pill or capsule form. Long-acting or extended-release stimulants last eight to 12 hours and are usually taken just once a day, in the morning. Extended-release stimulants are the same drug as their short-acting forms; the difference is solely in the way in which the drug is delivered into the body. Extended-release stimulants too are usually taken in the form of a pill or capsule. However, an extended-release methylphenidate patch was recently put on the market as an alternative to oral ingestion. CNS stimulants used to treat ADHD include:

•Amphetamine-based stimulants (Adderall, Dexedrine, Dextrostat). These medicines are made up of either dextroamphetamine or a combination of dextroamphetamine and levoamphetamine.

•Dextromethamphetamine (Desoxyn)

•Dextromethylphenidate (Focalin)

•Methylphenidate (Concerta, Daytrana, Metadate, Ritalin)

CNS stimulants are highly addictive and should only be used under the supervision of a doctor. The medications can cause some undesired side effects, including decreased appetite, weight loss, problems sleeping, irritability when the medication wears off, and, in some rare cases, development of facial tics or heart-related conditions.

Although stimulants are commonly prescribed for pharmacologic treatment of ADHD, recent research has stated that the cardiovascular impacts of stimulants on children may be detrimental, especially in cases where a child has a pre-existing condition such as diabetes, hypertension, or heart-rhythm abnormalities. A practice-guidelines task force of the American Heart Association (AHA) and American College of Cardiology (ACC) recently revised their recommendations to include a provision about cardiovascular assessment and monitoring in children who require stimulant medication for ADHD. The US Food and Drug Administration (FDA) has also added warnings to the labels of stimulant medication to warn patients about an increased risk cardiovascular problems and psychiatric problems.

Nonstimulant Medication

Nonstimulant medications are often considered when stimulants haven’t worked or have caused intolerable side effects.

Atomoxetine (Strattera)

Atomoxetine is one of only two nonstimulant medications approved by the FDA for ADHD treatment. As with CNS stimulants, scientists are not sure exactly why atomoxetine works. Atomoxetine, like stimulants, affects levels of neurotransmitters in the brain. However, unlike stimulants, which affect dopamine, atomoxetine boosts levels of the neurotransmitter norepinephrine. Atomoxetine is longer-acting than stimulant drugs; its effects last more than 24 hours.

Because it also has some antidepressant properties, atomoxetine may be a good option for ADHD patients who are also experiencing symptoms of anxiety or depression. However, atomoxetine doesn’t appear to be as effective as the stimulant medications for treating symptoms of hyperactivity. Side effects of atomoxetine can include nausea, sedation, reduced appetite, and weight loss.

Blood Pressure Medications (Guanfacine)

Guanfacine (Intuniv) is a nonstimulant approved by the FDA in 2009 for treating ADHD. In 2011, it was also approved as an adjunctive therapy option for use alongside CNS drugs in treating ADHD in children. Guanfacine is primarily a blood pressure medication, but it has also been shown in trials to effectively treat ADHD’s symptoms of hyperactivity, impulsivity, and aggression. It is less helpful when it comes to attention problems. Other blood pressure drugs (especially clonidine) are sometimes prescribed off-brand to treat ADHD.

Antidepressants

Although the FDA has not approved antidepressants as a treatment for ADHD, doctors will sometimes prescribe this class of medication to those patients who do not respond well to stimulants or to atomoxetine.

Atypical Antipsychotics

Certain atypical, or second generation, antipsychotics, which target multiple neurotransmitters in the brain, are also sometimes prescribed off-brand to treat ADHD in patients who don’t respond well to stimulants or atomoxetine.

ADHD meds: an increasing source of ED visits

The number of ED visits involving attention deficit/hyperactivity disorder stimulant medications more than doubled , according to a report by the Substance Abuse and Mental Health Services Administration.

The greatest rates of increase occurred among those ages 18 and older, while the level among those younger than 18 remained largely unchanged. In all, the number of visits rose from 13,379 in 31,244 five years later (there were 2.3 million ED visits related to the use of all drugs ).

The number of ED visits involving ADHD medications that were used nonmedically also nearly tripled during the period, from 5,212 to 15,585. In nonmedical use of ADHD medications accounted for half of all ED visits involving ADHD medications.

Differences in the rates of ED visits related to the nonmedical use of ADHD medications narrowed considerably between males and females during a similar time frame. The breakdown by gender was 3,770 such visits for males and 1,439 for females in 2005, compared with 8,650 for males and 6,932 for females

"ADHD medications, when properly prescribed and used, can be of enormous benefit to those suffering from ADHD, but like any other medication they can pose serious risks — particularly when they are misused," SAMHSA Administrator Pamela S. Hyde said in a news release. "This study indicates that a better job has to be done alerting all segments of society — not just the young — that misuse of these medications is extremely dangerous."

The report is based on findings from the Drug Abuse Warning Network report. DAWN is a public health surveillance

Here are some of the questions I grappled with daily:

Why am I so tired all the time?

I know I'm very bright, so why is it that I constantly forget my train of thought, and why am I so forgetful of silly things that should be so easy to remember? Birthdays, appointments, phone numbers, directions are just a few examples of the details I could never keep track of.

Why do I feel so overwhelmed at doing ordinary tasks like grocery shopping, following a recipe, or going to the post office when other people seem to do these activities effortlessly?

Why can't I just sit and play a game with my kids or read them a book without getting impatient or restless?

Why is it that some days I can accomplish so much, and then other days I don't even seem to be able to get out of bed?

Here are a few things that might be helpful to know about ADD.

ADD is a disorder that makes filtering information or stimuli almost impossible. The non-ADD brain can choose what things it wants to focus on while the ADD brain has to take it all in regardless of the priority in attention they might want to give. It's this reason why people with ADD are tired all the time. As they age, they get less tolerant of this hallmark symptom, and can become very sensitive to their surroundings especially if they are loud, bright, or busy. This constant feeling of being bombarded by their surroundings can also cause feelings of isolation and depression over time.

People with ADD can hyper focus or super focus on things that they are stimulated by physically, intellectually or emotionally. When people with ADD are faced with less interesting or stimulating situations they are unable to remain engaged due to a neurological issue that makes them seem distracted, forgetful, or impulsive. Paradoxically as well, when an individual with ADD is exerting effort to pay attention, they can become very restless; and have been known to exhibit the "fidget for focus" phenomena.

Most people with the disorder are engaging, intelligent, kind, and highly creative. It is very helpful to know that some of the most famous thinkers and celebrities are also challenged with ADD.

Individuals with ADD often develop "coping mechanisms" that help them manage the symptoms of ADD. Many have a tendency to self medicate with "stimulants" or other substances such as alcohol, sugar, caffeine, and many different drugs as an unconscious way of helping them feel better, or think more clearly.

ADD is way more common than people think and data suggests that 3-5% (some as high as 8%) of the population has the disorder although a large percentage of suspected adults are as yet undiagnosed.

As a forty-two year old mother of two, I find myself feeling a wellspring of gratitude for finally having a name for the way I have felt all these years. Inside, I have always known that I was different from many of my peers, and yet like them, I desperately wanted to excel in my studies, please my parents, and go on to have a successful career and family. I can honestly say that I have had many achievements in my life regardless of the disorder; however, I also know that I am one of the lucky ones and that many adults who remain undiagnosed continue to experience job loss, marital issues and divorce, substance abuse, depression, and worse. I also realize how important it is that the medical community, teachers, parents and other individuals become informed about the disorder so that those who need an evaluation and possible treatment can be helped in ways that support, enrich, and validate their experience so that they can go on to have deeply fulfilling lives.