Summary

ADD/ADHD is a chronic, developmental, possibly handicapping condition.
It is neurochemical in nature and by far the most effective treatment is stimulant medication. However, children and adults require counseling on how to cope with symptoms that are not affected by medication or return after the medication has worn off.

Many other mental disorders co-exist with ADD, especially the older one becomes. These disorders are treated separately from ADD symptoms.

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Specialty Areas

ADHD

ADD/ADHD is a chronic, developmental, possibly handicapping condition. It is neurochemical in nature and by far the most effective treatment is stimulant medication. However, children and
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Relationships

Opposites sometimes attract but they tend not to last. People assume that they need someone to complement them so they look for someone who has characteristics they do not possess.
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Depression

Depression occurs in both adults and children. The symptoms may be masked by alcohol or drug abuse or by physical symptomalogy.
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Anxiety

Anxiety, along with depression, are the most common mental health concerns. Anxiety affects work, relationships, and parenting. It often is manifested as a physical or medical disorder.
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Child Behavior Problems

Parents are Shepherds, Not Engineers: Strive to Enjoy Your Children as Individuals; Rather Than Trying to Redesign Them to Be Like Others;Use Immediate Feedback; Act, Don't Yak
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Stress Management

A list of 101 ways to help you manage stress. Keep it handy and refer to it when you feel things are starting to overload for you.
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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