Attention Deficit Hyperactivity Disorder (AD/HD, also called ADD) is a neurobiological condition that affects an estimated 4-7% of the adult U.S. population. It is an ongoing condition that affects children, adolescents, and adults of all ages. It occurs in both males and females, (Males are about three times more likely than females to be diagnosed) and in people of all races, socioeconomic status, and cultural backgrounds.
AD/HD may cause significant impairments in many areas of life such as school, home, the workplace, and in family and social relationships.
A person with AD/HD has a chronic level of inattention, impulsive hyperactivity, or both such that daily functioning is compromised. The symptoms of the disorder must be present at levels that are higher than expected for a person's developmental stage and must interfere with the person's ability to function in different settings (e.g., at work, in school, and at home). A person with AD/HD may struggle in important areas of life, such as peer and family relationships, and school or work performance.
Since medical science first documented AD/HD using the terminology “Brain Damaged Syndrome” in 1902 the body of scientific literature validating the reality of this condition has grown enormously. Yet there are still so many myths alive and well.
Let us begin with this brief overview.
First, a word about semantics...
You will see many different abbreviations for ADD, everyone seems to have their own name for it. Technically, the term ADD is no longer used. We have some people who just refer to it as a “gift”. Some people who call themselves “Hunters” and others “Mavericks” but a rose by any other name still smells as sweet. Well, I think you get the idea, even the naming of ADD can be confusing.
We even have a new pseudo AD/HD for the general population recognized by Dr. Edward Hallowell. He calls it “ADT” for Attention Deficit Trait and has written a new book on the topic, “Crazy Busy, Over Stretched, Over Booked and About To Snap- Strategies For Coping In A World Gone ADD” and no, you can’t get a script of Adderall for it.
However, the latest abbreviated name is AADD, Adult with Attention Deficit Disorder.
Bottom line the correct current diagnostic label for this condition is AD/HD, Attention-deficit/hyperactivity disorder since 1994. The diagnostic manual compiled by the American Psychiatric Association, the Diagnostic and Statistical Manual, fourth edition (DSM-IV) classification system, identifies three types of ADHD. APA is presently reviewing both the label and diagnostic criteria for AD/HD for children and adults.
Types of ADHD
A clinical diagnosis is made using the guidelines from the American Psychiatric Association for AD/HD. A diagnostic manual compiled by the APA identifies three types of ADHD:
Predominantly Inattentive, Predominantly Hyperactive-impulsive, and Combined.
They have trouble focusing on activities, organizing and finishing tasks, and following instructions.
They often blurt out inappropriate comments, don't wait their turn, show excessively intense emotions, or hit others when upset. Hyperactive and impulsive adults feel restless, are constantly "on the go," and try to do multiple tasks at once. They are often perceived as not thinking before they act or speak.
Displays characteristics of both Predominantly Inattentive and Predominantly Hyperactive-Impulsive.
One of the reasons personal coaching with a knowledgeable ADHD specialist coach works so well is that no two people experience ADHD in the same way and each coaching relationship is unique. There are many other aspects to consider. Example questions like “Does the person who has ADHD have any other diagnoses, what is their IQ, their emotional intelligence, their environment, social support, strengths and income?” It frustrates me to hear some people’s well meaning advice of “just delegate tasks or hire someone to do the parts of the project you’re not good at”. But reality check here! Not everyone can afford to hire a lawn person, a maid, and/or send all their clothes to the cleaner, etc. I don’t believe in one answer fits all in every situation.
The Down Side
AD/HD is a medical disorder that affects over 15 million Americans. We still do not know exactly what causes it, we only have a clinical diagnosis, a subjective evaluation, for which there are no laboratory or radiological confirmatory tests or specific physical features and there’s no curative treatment.
The Up Side
At this point, no truly definitive statements about the cause of ADHD are possible. Based on presently obtainable evidence, it appears that a variety of biological factors may predispose some people to have significant problems with attention and/or higher levels of activity and impulsivity.
Research shows that ADHD tends to run in families, so there are likely to be genetic influences. About 75 percent of all ADHD cases are related to heredity. Children who have ADHD usually have at least one close relative who also has ADHD. And at least one–third of all fathers who had ADHD in their youth have children with ADHD. Even more convincing of a possible genetic link is that when one twin of an identical twin pair has the disorder, the other is likely to have it too.
Specifically, recent evidence suggests that for individuals who develop AD/HD, hereditary factors may affect brain functioning in those areas that are responsible for inhibiting and modulating behavior. Scientists continue to scrutinize genetics to discover more answers. They have found that the brain regions involved have been shown to be smaller and less active on scans taken from children with ADHD compared to those taken from healthy children. Just what may be causing the reduced size of these brain regions is not yet known.
Myths and facts about Attention Deficit Hyperactivity Disorder
We are also making progress on destroying myths. One of the most painful myths is the one that “it does not exist as medical condition”. Another is that “ADHD is caused by bad parenting. All the child needs is good discipline.” ADHD is not caused by bad parenting; although, parenting techniques can often improve some symptoms and make others worse.
“Having ADHD means the person is lazy or dumb.”
ADHD has nothing to do with a person's intellectual ability. Some highly intelligent people have ADHD.
“Medication for ADHD will make a person seem drugged.”
Properly adjusted medication for ADHD sharpens a person's focus and increases his or her ability to control behavior.
“ADD is a life sentence.”
Although ADHD symptoms usually continue into adulthood, the person learns ways to cope with the symptoms. People with ADHD have plenty of energy, are creative, and can often accomplish more than people who do not have the condition.
“Medication prescriptions for ADHD have greatly increased in the past few years because the condition is being overdiagnosed.”
ADHD is estimated to affect approximately 3% to 7% of all school-age children in the United States. There is little evidence to support claims that ADHD is overdiagnosed and ADHD medications overprescribed.
“People with ADHD are learning to use the condition as an excuse for their behavior.”
ADHD is a disability. People with ADHD have to learn ways to deal with their symptoms (inattention, impulsivity, and hyperactivity) that cause them to have difficulties in life.
“Children outgrow ADHD.”
About 70% to 80% of children with ADHD continue to have symptoms during their teen years and about 50% have symptoms into adulthood.
Common Behaviors and Problems of Adult ADHD
The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties:
Comorbidity means having two or more diagnosable conditions at the same time. There has been increasing awareness that many adults and children with AD/HD may also meet criteria for one or more other psychiatric diagnoses.
Previous research has suggested that substantial comorbidity exists among childhood externalizing disorders, specifically attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD).
There is evidence that the incidence of comorbidity is higher in adults than in children. Research studies showed that over 70 percent of adults with AD/HD will have one or more comorbid condition(s) at some point in their lives.
Since comorbid conditions are associated with greater cognitive, social, and psychological impairments, it is important to address all comorbidities in order to improve the individual’s total quality of life.
Cantwell, Dennis, Spring 1999 Greater Rochester Attention Deficit Disorder Newsletter.
Faraone SV. Patterns of comorbidity in ADHD: artifact or reality? Program and abstracts of the 154th Annual Meeting of the American Psychiatric Association; May 5-10, 2001; New Orleans, Louisiana. Industry Symposium 46B.
Geller B, Zimerman B, Williams M, et al. Bipolar disorder at prospective follow-up of adults who had prepubertal major depressive disorder. Am J Psychiatry. 2001;158:125-127.
Gammon GD, Brown TE. Fluoxetine and methylphenidate in combination for treatment of attention deficit disorder and comorbid depressive disorder. J Child Adolesc Psychopharmacol. 1993;3:1-10.
Wilens TE, Biederman J, Mick E, Faraone SV, Spencer T. Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. J Nerv Ment Dis. 1997;185:475-482.
Wilens TE, Spencer TJ, Biederman J, et al. A controlled clinical trial of bupropion for attention deficit hyperactivity disorder in adults. Am J Psychiatry. 2001;158:282-288.
Robin AL (1999). Attention-deficit/hyperactivity disorder in adolescents: Common pediatric concerns. Pediatric Clinics of North America, 46(5): 1027–1038.
American Psychiatric Association (2000). Attention-deficit and disruptive behavior disorders. In Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev., pp. 85–103. Washington, DC: American Psychiatric Association.
Brown RT, et al. (2001). Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. Pediatrics, 107(3): 1–11.
National Institute of Mental Health (2003). Attention Deficit Hyperactivity Disorder (NIH Publication No. 03-3572).
Available online: http://www.nimh.nih.gov/publicat/adhd.cfm.
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