September 2003

What is attention deficit/hyperactivity disorder and are there gender racial/ethnic differences in its prevalence?

Attention /Hyperactivity Deficit Disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood. It is most often characterized by a chronic pattern of impulsive, hyperactive behaviors, but inattentiveness can also be a symptom of ADHD. Although individuals with this disorder can be very successful in life, without identification and proper treatment, these individuals may experience serious consequences, including school failure, depression, problems with relationships, conduct disorder, substance abuse, and difficulty maintaining a job.

Early identification and treatment are extremely important. ADHD occurs in 3 to 5 percent of school-age children. Pediatricians report that approximately 4 percent of their patients have ADHD, but in practice the diagnosis is often made in children who meet SOME, but not all, of the criteria recommended in DSM- IV. Boys are four times more likely to be diagnosed than girls. However, it is possible that girls are being underdiagnosed because they are more apt to be inattentive than hyperactive. The disorder is found in all cultures, although prevalence differs; differences are thought to stem more from differences in diagnostic criteria than from differences in presentation (DSM-IV). Thus, racial/ethnic biases can influence the assessment process and the diagnosis.

There is no definitive answer for the cause of ADHD, but most research suggests a neurobiological basis. ADHD also seems to have a genetic basis because for certain individuals, family history appears to be an important factor.

 

Diagnostic Criteria (DSM IV) for Attention -Deficit/Hyperactivity Disorder:

A. Either (1) or (2):

(1) six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

Inattention

(a) often fails to give close attention to details or makes careless mistakes in schoolwork or other activities

(b) often has difficulty sustaining attention in tasks or play activities (c) often does not seem to listen when spoken to directly

(d) often does not follow through on instructions and fails to finish school work, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)

(e) often has difficulty organizing tasks and activities

(f) often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)

(g) often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books or tools)

(h) is often easily distracted by extraneous stimuli (i) is often forgetful in daily activities

(2) six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6months to a degree that is maladaptive and inconsistent with developmental level

Hyperactivity

(a) often fidgets with hands or feet or squirms in seat

(b) often leaves seat in classroom or in other situations in which remaining seated is expected (c) often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness) (d) often has difficulty playing or engaging in leisure activities quietly (e) is often "on the go" or often acts as if "driven by a motor" (f) often talks excessively

Impulsivity

(g) often blurts out answers before questions have been completed (h) often has difficulty awaiting turn (i) often interrupts or intrudes on others (e.g., butts into conversations or games)

B. Some hyperactivity-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or more settings (e.g., at school and at home).

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

Source: DSM

 

Psychosocial Treatment

Important options for the management of ADHD are psychosocial treatments, particularly in the form of training in behavioral techniques for parents and teachers.

Behavioral Approaches

The main psychosocial treatments for ADHD are behavioral training for parent and teacher as well as systematic programs of contingency management.

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy (CBT), primarily training in problem solving and social skills, has not been shown to provide clinically important changes in behavior and academic performance of children with ADHD. However, CBT might be helpful in treating symptoms of accompanying disorders such as oppositional defiant disorder, depression, or anxiety disorders.

Psychoeducation

 

Although there are no studies evaluating the efficacy of psychoeducation as a treatment modality for ADHD, providing information to parents, children, and teachers about ADHD and treatment options is considered critical in the development of a comprehensive treatment plan.

Medication

Stimulants ? Ritalin, Dexedrine, Adderal, Cylert ? are the most effective and commonly prescribed psychosocial medications for ADHD.

Multimodal Treatments

Many researchers and families have long suspected that multimodal treatment ? medication used together with multiple psychosocial interventions in multiple settings ? should be more effective than medication alone. Results of a major study indicated that carefully managed and monitored stimulant medication, alone or combined with behavioral treatment, is effective for ADHD over a period of 14 months. However, when medication and psychosocial modalities are combined, less medication is needed to have an impact on symptoms and there were fewer other negative symptoms (i.e., defiance, aggression).