What is ADHD/ADD?

• Attention Deficit Disorder
• Attention Deficit Hyperactivity Disorder
• A diagnosable mental disorder whose hallmark symptoms include inattention and impulsivity with or without hyperactivity
• Significant impairments seen in social, academic and/or occupational functioning

Symptoms (CHILDREN AND TEENS)

1. Inattention
• Great difficulty sustaining attention
• Most notable in dull, boring, repetitive tasks
• Diminished persistence not necessarily more distracted
• “Doesn't seem to listen”
• “Fails to finish assignments”
• “Daydreams”
• “Often loses things necessary for school”
• “Can't concentrate”
• “Easily distracted”
• “Shifts from one uncompleted activity to another”
• “Can't work independently”
2. Impulsivity or Behavioral Disinhibition
• Considered hallmark symptom of ADD
• Poorly regulated activity and impulsivity
• “Trouble waiting turn”
• “Doesn't cooperate”
• “Rude”
• “Blurts out in class and at home”
• “Interrupts others”
• “Takes frequent unnecessary risks”
• “Immature and childish”
3. Hyperactivity
• More active than normal
• Even when asleep!
• Situational fluctuations exist
• Failure to regulate self consistent with setting or situation
• “Always on the go”
• “Acts as if driven by a motor”
• “Can't sit still” (e.g., in class seat or at dinner)
• “Talks excessively”
• “Taps, fidgets, drums fingers constantly”
• “Often hums or makes odd noises”
4. Other behaviors
• Great variability of task performance
• Differing behavior towards fathers than mothers-well established
• Average 7-15 points lower on IQ tests; 10-15 on achievement tests
• Delay in onset of talking (2-5% of normals; 6-35% of ADDs)
• Speech problems (2-25% of normals; 10-54% of ADDs)
• More minor physical abnormalities
• More health problems (24% of normals; 51% of ADDs)
• More accident-prone (46% accident-prone with 15% having 4+ serious accidents; three times higher than non-ADD)
• Sleep problems (falling asleep 23% vs. 56%; tired upon waking 27% vs. 55%)
• Emotional disturbance (44% have one other diagnosable problem; 32% have two problems; 11% have three or more)
• 30% anxiety disorder
• 40% mood disorder
• 50% Conduct or Oppositional Defiant Disorder
• 25% Learning Disabilities
• Conduct problems (50% have significant social relationship problems)
• Estimated in 3-5% of child population
• Average age of onset between 3-4 but varies from 0-7
• 3:1 male to female ratio
• 63% of females and 78% of males have ADHD
• 70-80% will continue symptoms into adolescence
• hyperactivity tends to lessen
• 58% fail at least one grade

Symptoms (ADULTS)

• Sometimes called “ADD Residual Type”
• Symptoms vary but can include any of the following:

1. Inattention
• Fails to finish what started
• Often does not seem to listen
• Easily distracted
• Difficulty concentrating on sustained-attention tasks
• Difficulty sticking to an activity
2. Impulsivity
• Often acts before thinking
• Shifts excessively from one activity to another
• Difficulty working independently
• Frequently talks out or interrupts
• Difficulty waiting turn
3. Hyperactivity
• Excessive pacing or fidgeting
• Difficulty staying seated
• Moves about excessively during sleep
• Always on the go
4. Emotionality
• Overly sensitive to rejection and frustration
• Shifts mood suddenly and unexpectedly
• Frequent negative thinking after a success
• Unexplained, chronic, recurrent depression
• Finds being soothed and held difficult
• Needs excessive sensory input (TV, music) to blot out extraneous noise
5. Other facts:
• 50-65% of children will continue symptoms into adulthood but only 20% hyper
• Only 3% are free from other diagnoses
• 80% anxiety symptoms
• 75% interpersonal problems (vs. 50% controls)
• 20% sexual adjustment problems (vs. 2.4% of controls)
• 10% attempt suicide
• 5% die from suicide or accident (10x that of controls)
• 30% drop out and never finish high school
• Only 5% continue into college (vs. 41% controls)

Bottom line: ADHD is a serious developmental impairment

CAUSES

• ADHD a biochemical brain disorder, largely hereditary: 80-90% genetic, 10-20% environmental
• (twin studies: 90% identical vs. 25% fraternal)
• If child is diagnosed with ADD, 15-20% of their mothers have ADD; 20-30% of fathers; 25% of siblings vs. 2% in controls
• Environmental causes: food allergies/diet 5%; head injury; poor maternal health; poor infant health.

Alternate ADD Theories (none proven)

• Allergic or toxic reactions to food and diet
• Feingold theory (dietary techniques for better behavior, learning and health)
• Sugar theory
• Tempo of life theory
• Child raising theory
• Head injury theory
• Blood lead level theory
• Too much TV theory
• Bad home environment theory
• Poor schooling/teacher theory

ADD Myths

• Just normal childhood rambunctiousness
• Over diagnosed and medications over prescribed
• Basically due to bad parenting and lack of discipline
• Ritalin, and other psychostimulants, are addictive
• Stimulant medication stunts growth
• Stimulant medication turns kids into “zombies”
• No evidence for stimulant medication
• Kids with ADD are learning to make excuses
• Teachers push pills to control children's behaviors
• Children outgrow ADD
• It is not possible to accurately diagnose ADD

Treatment: Medications

• Stimulants (thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron and increase the release of these monoamines into the extraneuronal space)
• Methylphenidate (Concerta, Metadate, Ritalin)
• Adderall
• Dexedrine
• Nonstimulant: Strattera (relatively new; not a controlled substance)

Stimulants Found to Improve

• Core Symptoms
• Inattention
• Impulsivity
• Hyperactivity

• Secondary Concerns
• Noncompliance
• Impulsive aggression
• Social interactions
• Academic efficiency
• Academic accuracy

Documented Side Effects

• Loss of appetite/weight loss*
• Trouble sleeping/insomnia*
• Stomach pain
• Rapid heart rate/high blood pressure
• Possible slow growth pattern
• Dizziness, drowsiness or changes in vision
• Diarrhea
• Dry mouth
• Tics
• Impotence (teens and adults)

*most common side effects

Summary of Medications

• Stimulants and Strattera are FDA approved first line agents for treatment of ADD/ADHD
• Antidepressants are second line agents (Welbutrin and SSRIs)
• Antihypertensives (HBP) are alternate agents typically used adjunctively with other medications

Treatment: Behavioral

• Children: Alter parental response to elicit desired behaviors and diminish undesired behaviors; provide parent training
• Adolescents: Increase attention to consequences; provide family and individual therapy
• Adults: Coaching the adult in self-management of ADD; provide individual and couple's therapy

For More Information

CHADD www.chadd.org
Attention Deficit Disorder Association
Driven to Distraction (1994). Hallowell, E. & Ratey, J.
A Parents Guide to ADD (1991). Bain, D.
ADHD in Adults (1995). Nadeau, K.
Adolescents and ADD: Gaining the Advantage (1995). Quinn, P.
ADHD/Hyperactivity: A Consumer's Guide (1991). Gordon, M.

Joe Peraino, Ph.D. works as a professional coach and psychologist. Contact him at joe@joeperaino.com.