ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD):

Fact and Fiction

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1. The hallmark of childhood ADHD is difficulty - difficulty getting things done, both at home and at school, and difficulty getting along, both with adults and with other children. This difficulty usually occurs in a context where there is no obvious explanation for it.

2. ADHD frequently occurs with other disorders or symptoms, such as depression, anxiety, conduct disorders, or oppositional-defiant disorder.

3. ADHD is considered to be a neurologically-based, general learning disorder, and in many instances is accompanied by a specific learning disorder, such as a receptive or expressive language difficulty (eg. dyslexia), difficulty performing calculations (dyscalclia), or difficulty with fine or gross motor coordination (eg. dysgraphia). ADHD is commontly found in very bright children who are found to be functioning significantly below their level of ability.

4. ADHD frequently has a significant interpersonal or social component. Hyperactive children are often perceived as annoying and aversive, immature, or inept.

5. ADHD does not necessarily vanish with puberty. A portion of ADHD children continue to have difficulties throughout their adult lives. For many, adulthood is marked by above-average rates of job changes, traffic accidents, marital disruptions, and legal infractions. At the same time, approximately half of ADHD children appear to function reasonably well as adults.

6. ADHD children are multi-problem youngsters who require multiple interventions. These interventions typically include:

• Tailored educational programming;
• Special help with social-interpersonal functioning, often through counseling;
• Behavior management using rewards, response-costs, and contingency controls;
• Coaching/counseling of parents to provide information and knowledgeable support, along with assistance in coping with family conflict and learning more effective management techniques;
• Medications, often stimulants in the form of Methylphenidate (Ritalin), or Dextroamphetamine (Dexedrine), or Pemoline (Cylert), the tricyclic antidepressant Imipramine (Tofranil), or one of the newer anti-depressants (Prozac, Zoloft, Welbutrin).

7. Stimulant therapy (medication) is the most prevalent, most studied, and in many cases the most effective treatment of ADHD. It is also the most controversial. Medication can be as effective with adolescent age children as with younger children.

8. The impact of stimulant medication (Ritalin, Dexedrine) is usually immediate and short-lived, with behavior changes usually emerging within 30 minutes and fading after four or five hours. The dosage range for Ritalin is 20-60 mg. (1-2 mg./kilogram of body weight) and is usually taken one or two times a day, usually before meals.

See "Hints for Dealing with Difficult Children"

REFERENCES:

• Whalen, C.K. & Henker, B. (1976) Psychostimulants and children: A review and analysis. Psychological Bulletin, 83, 1113-1130.
• Henker, B. & Whalen, C.K. (1989), Hyperactivity and attention deficits. American Psychologist, 44 (2), 216-223.

See the Consensus Development Conference Statement on "Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder", conducted by the National Institutes of Health on November 16-18, 1998.

References for Adulthood ADHD:

• National Institutes of Health, (November, 1998). Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, NIH Consensus Statement, 16(2), 1-37.
• Barkley, R.A. (1998). Developmental course, adult outcome, and clinic-referred ADHD adults. In R.A. Barkley (Ed.), Attention Deficit Hyperactivity Disorder. 2nd Ed., New York: Guilford.
• Hallowell, E.M. & Ratey, J.J. (1994). Driven to Distraction:Recognizing and Coping with Attention Deficit Disorder from Childhood through Adulthood. New York: Simon & Sschuster.
• Manuzza, S., Klein, R., Bessler A., Malloy, P. & La Padula, M. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565-576.
• Weiss, G. & Hechtman, L. (1993). Hperactive children grown up: ADHD in children, adolescents, and adults. New York: Guilford.
• Wender, P.H. (1987). The Hyperactive Child, Adolescent and Adult: Attention Deficit Disorder through the Lifespan. New York: Oxford University Press.

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