Attention deficit/hyperactivity disorder (ADHD)
ADHD is one of the best established and well studied illnesses in western medicine.
Even so, it has always disturbed psychiatrists that the disease does not have
pathogonomic features like a Gon complex (tuberculosis) or Koplick spots (measles) or
heterophile (mononucleosis). The signs and symptoms of impulsivity, hyperactivity, and
inattention are too nonspecific and occur indiscriminately in sleeplessness, illness,
fatigue, or drunkenness. Successful people often exhibit these characteristics without
seeming to suffer any consequences.
The diagnoses of schizophrenia(decreased)and bipolar disorder (much increased) in
USA continues to undergo a self-correction with as we compare to the rest of the world’s
prevalence rates. Yet in America we do a much better job with the diagnosis and
treatment of ADHD compared to continental Europe and Great Britain. This is as
Americanized as a condition could be, reflected in our hurry, lack of planning in our towns,
suburban/urban sprawl, fast food, and emphasis of violence in our lives.
Probably many immigrants from Europe were disenfranchised from their countries of
origin. They were also restless, often impossibly dogmatic, intolerant, and unhappy.
Instead of being content to stay in Boston or New York or somewhere in the thirteen
colonies, they had to see what was around the corner or over the next hill or mountain.
Getting too far ahead of the wagon train or merely in over their heads, a crisis involving
survival meant life or death. So, the traits of impulsivity and inattentiveness, or hyper focus-
different sides of the same coin- and hyperactivity, were selected for future generations.
Anywhere from three to seven percent of children in United States, an equivalent to about
2 million children have Attention Deficit/Hyperactivity Disorder (ADHD).
These kids have ADHD with high rates of comorbidities. Most children continue to have
persistent problems all their life; in an almost absurd manner the “expert” consensus
about the number of adults with functional problems with hyperactivity, impulsively,
inattention, or motivational problems continues to increase towards 100%. Little evidence
indicates that children with ADHD do not grow up to have the same problems and needs.
Problems of behaving in acceptable or appropriate ways plague people with ADHD.
Children cannot easily regulate themselves without excessive external controls. Adults
have problems living up to either their own or other peoples’ expectations. Behavioral
problems leads to difficulties with family functioning, academic success, developmental
course and outcome, and even treatment response. Adults diagnosed in childhood will
have problems adapting to their environment. So when children are diagnosed and
treated for attention deficit hyperactivity disorder, their functional impairment may be
magnified by mood and anxiety disorders, learning disorders, substance-related
disorders and anti-social personality disorders that are inherited in families.
All of the cognitive deficits associated ADHD are always present in some way at social,
occupational, and academic settings.
Assessing someone for ADHD:
The ADHD evaluation starts with someone trained and experienced with the entire gamut
of childhood neuropsychiatric disorders. From the beginning to the end the process is:
Optional: Rating scales. Anyone with a good grasp of these conditions does not need to
use rating scales for any reason. Semi-structured interviews are helpful for reflecting the
occurrence and severity of symptoms; they can also measure treatment, but experts in the
clinical setting rarely bother with them, except to enhance the treatment process in some
way and for some specific reason. Research has shown that no one scale will provide
enough evidence to reliably make the diagnosis of ADHD. But the expert can reliably
make a diagnosis with his clinical skills.
Other optional studies:
Highly recommended:
Occasionally:
Diagnostic formulation:
Diagnoses (according to DSM-IV-TR):
Diagnoses of a disruptive disorder such as Oppositional Defiant Disorder and
Conduct disorder should not be made without a diagnosis pointing to etiology. Disruptive
disorders are “descriptive disorders.” Social, biological, or familial factors always lurk in
the background of disruptive disorders and should be made.
25% of children with ADHD have an anxiety disorder meeting the full criteria. Children that
do not met full criteria are more numerous.
25% of children with ADHD have a depressive disorder meeting the full criteria. Children
that do not met full criteria for an affective disorder make up much more than 25%. A child
with ADHD who says anything about wanting to die or wishing he were dead at other
times besides feeling frustrated needs further evaluation immediately.
16% of children with ADHD have a bipolar disorder of some type
12%-24% of children with ADHD develop a substance use disorder in adulthood
Sometimes the long established problems with ADHD cause anxiety and depression
then clear up with treatment of ADHD. Frequently the anxiety and depression or mood
swings need to be treated separately. A child psychiatrist is uniquely trained to tease out
the different problems and address each one optimally.
24%-52% of adults with ADHD have an anxiety disorder
In summary:
Parent tips:
1) Consider taking parenting or child management classes. The most effective, easy,
successful, and efficient way(versus trying to change a child with interventions) to deal
with behavioral problems is to find out if there are better ways to avoid or manage a
child's problems.
2) Addressing inadequate parenting gives you the most bang for your buck in terms of
non medical solutions. Another excellent solution when misbehavior is involved is moving
to better neighborhoods with better schools; when deviant peer groups are involved this
removes exposure to criminal elements and disorganized, ineffective schools.
3) Provide a lot of encouragement and support. Children need to feel a sense com-
passion from their parents or guardians.
4) Remember that changes are hard on people. Try and maintain consistent schedules
for homework, chores, TV, dinner,etc.).
5) Hold both yourself and your child accountable for his or her attitude and poor
decisions. Making good choices and behaving appropriately comes from experience and
active, loving, parental guidance.
6) Acknowledge and praise strengths. Focus on weaknesses in such a mild and self-
assuring way that accomplishments are both obtainable and build self-esteem.
7) Set goals and recognize progress all along the way with written charts, graphs, or lists.
Often people do much better with activation of multiple senses in order to get organized
and reminded; visual aids help a lot.
8) Encourage physical activity. Extra oxygen to the brain helps thinking. Limit TV watching
and video gaming to about one hour per day. Take televisions out of the bed-rooms and
DO NOT keep any TV on as background noise.
9) Emphasize the importance of thinking clearly. Clarity develops in fits and starts over a
lifetime.
ADHD is one of the best established and well studied illnesses in western medicine.
Even so, it has always disturbed psychiatrists that the disease does not have
pathogonomic features like a Gon complex (tuberculosis) or Koplick spots (measles) or
heterophile (mononucleosis). The signs and symptoms of impulsivity, hyperactivity, and
inattention are too nonspecific and occur indiscriminately in sleeplessness, illness,
fatigue, or drunkenness. Successful people often exhibit these characteristics without
seeming to suffer any consequences.
A better way to describe the ADHD syndrome is to depict it as a brain disease of
the areas that control words or actions that are poorly thought out, i.e., ill-
conceived, ill-considered behavior. People with ADHD put their “foot in their
mouth;” "fail to “plan for a rainy day;” or take to heart the proverb, “A stitch in time
saves nine.” They procrastinate, arrive late for appointments, cannot wait their turn,
and constantly regret their past actions.
The diagnoses of schizophrenia(decreased)and bipolar disorder (much increased) in
USA continues to undergo a self-correction with as we compare to the rest of the world’s
prevalence rates. Yet in America we do a much better job with the diagnosis and
treatment of ADHD compared to continental Europe and Great Britain. This is as
Americanized as a condition could be, reflected in our hurry, lack of planning in our towns,
suburban/urban sprawl, fast food, and emphasis of violence in our lives.
Probably many immigrants from Europe were disenfranchised from their countries of
origin. They were also restless, often impossibly dogmatic, intolerant, and unhappy.
Instead of being content to stay in Boston or New York or somewhere in the thirteen
colonies, they had to see what was around the corner or over the next hill or mountain.
Getting too far ahead of the wagon train or merely in over their heads, a crisis involving
survival meant life or death. So, the traits of impulsivity and inattentiveness, or hyper focus-
different sides of the same coin- and hyperactivity, were selected for future generations.
Anywhere from three to seven percent of children in United States, an equivalent to about
2 million children have Attention Deficit/Hyperactivity Disorder (ADHD).
These kids have ADHD with high rates of comorbidities. Most children continue to have
persistent problems all their life; in an almost absurd manner the “expert” consensus
about the number of adults with functional problems with hyperactivity, impulsively,
inattention, or motivational problems continues to increase towards 100%. Little evidence
indicates that children with ADHD do not grow up to have the same problems and needs.
Problems of behaving in acceptable or appropriate ways plague people with ADHD.
Children cannot easily regulate themselves without excessive external controls. Adults
have problems living up to either their own or other peoples’ expectations. Behavioral
problems leads to difficulties with family functioning, academic success, developmental
course and outcome, and even treatment response. Adults diagnosed in childhood will
have problems adapting to their environment. So when children are diagnosed and
treated for attention deficit hyperactivity disorder, their functional impairment may be
magnified by mood and anxiety disorders, learning disorders, substance-related
disorders and anti-social personality disorders that are inherited in families.
All of the cognitive deficits associated ADHD are always present in some way at social,
occupational, and academic settings.
Assessing someone for ADHD:
The ADHD evaluation starts with someone trained and experienced with the entire gamut
of childhood neuropsychiatric disorders. From the beginning to the end the process is:
A general history
Medical history
Past treatment regimens
Family history
Educational history
Occupational history
Legal problems
ADHD screening with a few questions or observations
Psychiatric interview
Optional: Rating scales. Anyone with a good grasp of these conditions does not need to
use rating scales for any reason. Semi-structured interviews are helpful for reflecting the
occurrence and severity of symptoms; they can also measure treatment, but experts in the
clinical setting rarely bother with them, except to enhance the treatment process in some
way and for some specific reason. Research has shown that no one scale will provide
enough evidence to reliably make the diagnosis of ADHD. But the expert can reliably
make a diagnosis with his clinical skills.
Other optional studies:
Highly recommended:
- Gross motor skills( Physical therapy evaluation)
Fine motor skills(Occupational therapy evaluation)
Occasionally:
- Neurology evaluation
Speech evaluation
Hearing evaluation
Pretreatment lab or radiology studies
EEG
EKG
Diagnostic formulation:
Diagnoses (according to DSM-IV-TR):
Diagnoses of a disruptive disorder such as Oppositional Defiant Disorder and
Conduct disorder should not be made without a diagnosis pointing to etiology. Disruptive
disorders are “descriptive disorders.” Social, biological, or familial factors always lurk in
the background of disruptive disorders and should be made.
25% of children with ADHD have an anxiety disorder meeting the full criteria. Children that
do not met full criteria are more numerous.
25% of children with ADHD have a depressive disorder meeting the full criteria. Children
that do not met full criteria for an affective disorder make up much more than 25%. A child
with ADHD who says anything about wanting to die or wishing he were dead at other
times besides feeling frustrated needs further evaluation immediately.
16% of children with ADHD have a bipolar disorder of some type
12%-24% of children with ADHD develop a substance use disorder in adulthood
Sometimes the long established problems with ADHD cause anxiety and depression
then clear up with treatment of ADHD. Frequently the anxiety and depression or mood
swings need to be treated separately. A child psychiatrist is uniquely trained to tease out
the different problems and address each one optimally.
24%-52% of adults with ADHD have an anxiety disorder
In summary:
1) Few, if any, people grow out of having ADHD.
2) Most people evaluated for ADHD need to be evaluated for other psychiatric
diseases.
3) The evaluating professional should be willing to make comprehensive
diagnoses that cover the entire spectrum of neuropsychiatric childhood diseases.
A diagnosis of ADHD alone means that no other diagnoses was detected.
- 4) Treatment of ADHD, even if only in preadolescence, very drastically reduces
substance abuse in adolescence and substantially reduces substance abuse in
early young adulthood(20s).
- 5) The most up-to-date description of ADHD suggests that deficits in behavioral
inhibition is the principal problem.
- 6) ADHD has a huge impact on peoples’ lives. To do nothing is a clear action. Do
people suffer more with the evil necessity of taking medication, or suffer greater
risk from no treatment? Make no mistake: trial after trial shows medication trumps
psycho education by a long shot, and is barely less effective than medication and
psycho education together.
Parent tips:
1) Consider taking parenting or child management classes. The most effective, easy,
successful, and efficient way(versus trying to change a child with interventions) to deal
with behavioral problems is to find out if there are better ways to avoid or manage a
child's problems.
2) Addressing inadequate parenting gives you the most bang for your buck in terms of
non medical solutions. Another excellent solution when misbehavior is involved is moving
to better neighborhoods with better schools; when deviant peer groups are involved this
removes exposure to criminal elements and disorganized, ineffective schools.
3) Provide a lot of encouragement and support. Children need to feel a sense com-
passion from their parents or guardians.
4) Remember that changes are hard on people. Try and maintain consistent schedules
for homework, chores, TV, dinner,etc.).
5) Hold both yourself and your child accountable for his or her attitude and poor
decisions. Making good choices and behaving appropriately comes from experience and
active, loving, parental guidance.
6) Acknowledge and praise strengths. Focus on weaknesses in such a mild and self-
assuring way that accomplishments are both obtainable and build self-esteem.
7) Set goals and recognize progress all along the way with written charts, graphs, or lists.
Often people do much better with activation of multiple senses in order to get organized
and reminded; visual aids help a lot.
8) Encourage physical activity. Extra oxygen to the brain helps thinking. Limit TV watching
and video gaming to about one hour per day. Take televisions out of the bed-rooms and
DO NOT keep any TV on as background noise.
9) Emphasize the importance of thinking clearly. Clarity develops in fits and starts over a
lifetime.
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| ADULT ADHD CLICK HERE |
| ADULT ADHD CLICK HERE |