Mary "Molly" L. Murray, Licensed Clinical Psychologist

At times, we may all have difficulty paying attention, sitting still, or controlling impulsive behavior. For some people, the problems are so severe and persistent that they interfere with their lives, including home, school, social and work settings. Attention-deficit/hyperactivity disorder (AD/HD) is characterized by developmentally inappropriate levels of inattention, impulsivity, and hyperactivity. AD/HD is a neurobiological disorder that affects 3 to 7 percent of school-age children. Until relatively recently, it was believed that children outgrew AD/HD in adolescence as hyperactivity often diminishes during the teen years. However, it is now known that AD/HD nearly always persists from childhood through adolescence and that many symptoms continue into adulthood. In fact, current research reflects rates of roughly 2 to 4 percent among adults. Although individuals with this disorder can be very successful in life, without identification and proper treatment, AD/HD may have serious consequences, including school failure, family stress and disruption, depression, problems with relationships, substance abuse, delinquency, risk for accidental injuries and job failure. Early identification and treatment are extremely important.

THE SYMPTOMS: Typically, AD/HD symptoms arise in early childhood, unless associated with some type of brain injury later in life. Some symptoms persist into adulthood and may pose life-long challenges. Although the official diagnostic criteria state that the onset of symptoms must occur before age seven, leading researchers in the field of AD/HD argue that criterion should be broadened to include onset anytime during childhood. The symptom-related criteria for the three primary subtypes are adapted from DSM-IV and summarized as follows: AD/HD predominantly inattentive type: (AD/HD-I) Fails to give close attention to details or makes careless mistakes. Has difficulty sustaining attention. Does not appear to listen. Struggles to follow through on instructions. Has difficulty with organization. Avoids or dislikes tasks requiring sustained mental effort. Loses things. Is easily distracted. Is forgetful in daily activities. AD/HD predominantly hyperactive-impulsive type: (AD/HD-HI) Fidgets with hands or feet or squirms in chair. Has difficulty remaining seated. Runs about or climbs excessively. Difficulty engaging in activities quietly. Acts as if driven by a motor. Talks excessively. Blurts out answers before questions have been completed. Difficulty waiting or taking turns. Interrupts or intrudes upon others. AD/HD combined type: (AD/HD-C) Individual meets both sets of inattention and hyperactive/impulsive criteria. Youngsters with AD/HD often experience delays in independent functioning and may therefore behave in ways more like younger children. In addition, AD/HD frequently co-occurs with other conditions, such as depression, anxiety or learning disabilities. For example, in 1999, NIMH research indicated that two- thirds of children with AD/HD have a least one other co-existing condition. When co-existing conditions are present, academic and behavioral problems, as well as emotional issues, may be more complex. Teens with AD/HD present a special challenge. During these years, academic and organizational demands increase. In addition, these impulsive youngsters are facing typical adolescent issues: discovering their identity, establishing independence, dealing with peer pressure, exposure to illegal drugs, emerging sexuality, and the challenges of teen driving. Recently, deficits in executive function have emerged as key factors impacting academic and career success. Simply stated, executive function refers to the “variety of functions within the brain that activate, organize, integrate and manage other functions.” This permits individuals to appreciate the longer-term consequences of their actions and guide their behavior across time more effectively. Critical concerns include deficits in working memory and the ability to plan for the future, as well as maintaining and shifting strategies in the service of long-term goals.

THE DIAGNOSIS: Determining if a child has AD/HD is a multifaceted process. Many biological and psychological problems can contribute to symptoms similar to those exhibited by children with AD/HD. For example, anxiety, depression and certain types of learning disabilities may cause similar symptoms. In some cases, these other conditions may actually be the primary diagnosis; in others, these conditions may co-exist with AD/HD. Therefore, a comprehensive evaluation is necessary to establish a diagnosis, rule out other causes and determine the presence or absence of co-existing conditions. Such an evaluation requires time and effort and should include a careful history and a clinical assessment of the individual’s academic, social, and emotional functioning and developmental level. A careful history should be taken from the parents and teachers, as well as the child, when appropriate. Clinicians often use checklists for diagnosing AD/HD and ruling out other disabilities. These age-normed instruments help to ensure that the symptoms are extreme for the child’s developmental level. The Neurolex report by Lexicor www.lexicor.com provides an objective analysis of physiological data. The child or adult's brainwaves are recorded and then measured against the patterns of both ADHD and non-ADHD subjects. The result is a tool that provides an objective, physiological indicator for ADHD. More specific than any other ADHD evaluation tool available today. The report can classify those with ADHD to an accuracy of 90% and identify those who do not have ADHD to an accuracy of 94%. There are several types of professionals who can diagnose AD/HD, including school psychologists, clinical psychologists, clinical social workers, nurse practitioners, neurologists, psychiatrists and pediatricians. Regardless of who does the evaluation, the use of the Diagnostic and Statistical Manual IV diagnostic criteria for AD/HD is necessary. A medical exam by a physician is important and should include a thorough physical examination, including assessment of hearing and vision, to rule out other medical problems that may be causing symptoms similar to AD/HD. In rare cases, persons with AD/HD also may have a thyroid dysfunction. Only medical doctors can prescribe medication if it is needed. Diagnosing AD/HD in an adult requires an evaluation of the history of childhood problems in behavior and academic domains, as well as examination of current symptoms and copying strategies. THE CAUSES: Multiple studies have been conducted to discover the cause of the disorder. Research clearly indicates that AD/HD tends to run in families and that the patterns of transmission are to a large extent genetic. More than 20 genetic studies, in fact, have shown evidence that AD/HD is strongly inherited. Yet AD/HD is a complex disorder, which is undoubtedly the result of multiple interacting genes. Other causal factors (such as low birthweight, prenatal maternal smoking, and additional prenatal problems) may contribute to other cases of AD/HD. Problems in parenting or parenting styles may make AD/HD better or worse, but these do not cause the disorder. AD/HD is clearly a brain-based disorder. Currently research is underway to better define the areas and pathways that are involved. PROGNOSIS AND LONG-TERM OUTCOMES: Children with AD/HD are at risk for potentially serious problems in adolescence: academic underachievement and school failure, problems in social relations, risk for antisocial behavior patterns, teen pregnancy, and adverse driving consequences. As noted above, AD/HD persists from childhood to adolescence in the vast majority of cases, although the symptom area of motor activity tends to diminish with time. Furthermore, up to two-thirds of children with AD/HD continue to experience significant symptoms in adulthood. Yet many adults with AD/HD learn coping strategies and compensate quite well. A key to good outcome is early identification and treatment.