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ADD Across the Lifespan:
Symptoms and Treatment Options

Joe Peraino, Ph.D.

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

Keywords: Family, ADD, ADHD, Hyperactivity

 

For more information, contact Joe Peraino by phone (713-859-7759)
or by e-mail joe@joeperaino.com