Attention Deficit Hyperactivity Disorder (ADHD)
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Attention Deficit Hyperactivity Disorder (ADHD)

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ADHD refers to a pattern of ongoing, long-standing ("chronic") behavior disorders that have three core symptoms: hyperactivity, impulsivity, and inattention. These are defined as "disorders" based on the child's stage of development. No one expects much quiet activity, impulse control, or attention span from the average, normal 2-year-old. But by age 5 or 6, it is expected that the child is beginning to regulate his activity level, control his behavior, and attend to tasks. The ADHD child has not achieved these capacities. Problems generally associated with ADHD include inattention, hyperactivity and impulsive behavior. They can affect nearly every aspect of life. Children and adults with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or at work.

The best treatment for ADHD is a matter of debate. Currently, psychostimulant drugs are the most commonly prescribed medications for treating ADHD. But although these drugs can relieve many symptoms, they don't cure ADHD, and they can sometimes cause troubling side effects. Counseling, special accommodations in the classroom, and family and community support are other key parts of treatment.

How is it diagnosed?

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.

The diagnosis is based on very specific symptoms, which must be present in more than one setting (including at school). Every evaluation should include a search for possible additional conditions including conduct disorder, oppositional defiant disorder, mood disorders/depression, anxiety, and learning disabilities.

To be diagnosed with ADHD, children should have at least 6 of the attention symptoms or 6 of the activity/impulsivity symptoms listed in the DSM-IV. They must display these to a degree beyond what would be expected for children their age.

The symptoms must be present for at least 6 months, observable in 2 or more settings, and not caused by another problem. The symptoms must be severe enough to cause significant difficulties. Some defining symptoms must be present before age 7.

Older children who still have symptoms but no longer meet the full definition have ADHD in partial remission.

Some children with ADHD primarily have the Inattentive Type, some the Hyperactive-Impulsive Type, and some the Combined Type. Those with the Inattentive type are less disruptive and are easier to miss being diagnosed with ADHD.

There can be some confusion when using the term because there is no single type of dual diagnosis. The reason is, that there are multiple types of psychiatric illnesses, also many forms of drug abuse. Because of this, a wide range of dual or multiple disorders exist.

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Treatments and drugs

Optimal treatment for ADHD is still a matter of debate. Current treatments typically involve therapy, medication or both. However, recent research indicates that a combination of therapy and medication may be the most helpful depression treatment.

Therapy
Children and adults with ADHD often greatly benefit from counseling or behavior therapy, which may be provided by a psychiatrist, psychologist, social worker or other mental health care professional. Some people with ADHD may also have other conditions such as anxiety disorder or depression. In these cases, counseling may help both ADHD and the coexisting problem.

Counseling therapies may include:

  • Psychotherapy. This allows older children and adults with ADHD to talk about issues that bother them, explore negative behavioral patterns and learn ways to deal with their symptoms.
  • Behavior therapy. This type of therapy helps teachers and parents learn strategies (contingency management procedures) for dealing with children's behavior. These strategies may include token reward systems and timeouts. Behavior modification using contingency management techniques has proved especially beneficial for people with ADHD.
  • Family therapy. Family therapy can help parents and siblings deal with the stress of living with someone who has ADHD.
  • Social skills training. This can help children learn appropriate social behaviors.
  • Support groups. Support groups can offer adults and children with ADHD and their parents a network of social support, information and education.
  • Parenting skills training. This can help parents develop ways to understand and guide their child's behavior.

The best results usually occur when a team approach is used, with teachers, parents, and therapists or physicians working together. You can help by making every effort to work with your child's teachers and by referring them to reliable sources of information to support their efforts in the classroom.



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