A neurobiological condition characterized by developmentally inappropriate level of attention, concentration, activity, distractability, and impulsivity.

Alternative Names

ADD; ADHD; Attention deficit hyperactive disorder; Childhood hyperkinesis

Causes, incidence, and risk factors

Attention Deficit Disorder (ADD) is the most commonly diagnosed behavioral disorder of childhood, affecting an estimated 3% to 5% of school aged children. Symptoms include developmentally inappropriate levels of attention, concentration, activity, distractibility, and impulsivity. There are three sub-categories of attention deficit disorder:

attention deficit/

hyperactivity disorder: combined type

attention deficit/hyperactivity disorder: predominantly inattentive

attention deficit/hyperactivity disorder: predominantly

hyperactive or impulsive Despite much progress in the diagnosis and treatment of ADD, this disorder remains highly controversial. The diverse and conflicting opinions about ADD have resulted in confusion for families and caregivers alike. While the cause of attention deficit disorder is unknown, scientists have determined that there is a neurobiological basis for the disease. There may be a familial component involved (genetic) in some, but not all cases. This may be seen with an increased incidence of ADD in children with a first degree relative with ADHD, conduct disorders, antisocial personality, substance abuse, and others. Genes are being identified that are thought to be involved in ADD. The apparent incidence of ADD has been increasing over the last 15 years, possibly related to better diagnosis, changing expectations, or problems with supportive social structures. The disorder is 3 to 10 times more common in males than females. Typically affected children, whether intellectually handicapped or not, perform poorly in school because of the inability to attend to tasks at hand or to sit still during the school day. The diagnosis is generally not considered until school age, although there may be earlier indicators of pending problems.

Signs and tests

Clinical evaluation is indicated if A.D.D. is suspected. Evaluation may include:

parent and teacher questionnaires (Connors, Burks)

psychological evaluation of the child AND family including

IQ testing and psychological testing

complete developmental, mental, nutritional, physical, and psychosocial examination

Treatment

Many different methods of treatment have been used for ADD including psychotropic medications, psychosocial interventions, dietary management, herbal and homeopathic remedies, biofeedback, meditation, and perception stimulation/training. Of these treatment strategies, the most research has been done on stimulant medications and psychosocial interventions. Overall, these studies suggest stimulants to be superior relative to psychosocial interventions. However, there is no long term information comparing the two. The primary medications used to treat attention deficit disorder include:

Dexedrine (dextroamphetamine) and other amphetamines (such as Adderall) may also be used in older children and adolescents

Ritalin (methylphenidate)

Cylert (magnesium pemoline)

other classes of medications have been tried, such as antidepressants (such as amitriptyline or fluoxetine), tranquilizers (such as thioridazine), alpha-adrenergic agonist (clonidine), and others. However, they have met with little success and are not part of the general armamentarium.

caffeine

has been tried, but with little success.

Psychosocial therapeutic techniques include:

contingency management (e.g., point reward systems, time out...)

cognitive-behavioral treatment (self monitoring, verbal self instruction, problem solving strategies, self reinforcement)

parent counseling

individual psychotherapy

While studies show that cognitive-behavioral treatment tends not to yield beneficial effects for children with ADD, contingency management, parent counseling, and training, have proven to improve functioning. Unfortunately, there are no studies comparing these psychosocial interventions alone versus in combination with medications. Other helpful techniques may include:

modifying the environment to limit distracting factors

providing one-on-one instruction with teacher

Expectations (prognosis)

Studies now have shown that the problems of attention deficit disorder may persist into adulthood. However, adults are usually more capable of controlling behavior and masking difficulties. Careful attention to education, socialization, and understanding your expectations should allow the child to develop into a functional adult. Statistics show that there is an increased incidence in juvenile delinquency and adult encounters with the law among individuals who had ADHD as a child. Every effort must be made to manage symptoms and direct the child's energy to constructive and educational paths.

Complications

There are a high number of adults with ADD who are in successful jobs. Possible complications, if ADD is not adequately treated, could include failure in school or other similar problems.

Calling your health care provider

Call your health care provider if you or your child's school personnel suspect the possibility of attention deficit disorder.

Prevention

Attention deficit disorder is a complex issue, and many preventive measures have been proposed. None have been proven at this time.