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| What is Attention Deficit Hyperactivity Disorder? What is Attention Deficit Hyperactivity Disorder? Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder. It is an illness or deficit of the nervous system most often caused by genetic or biological factors. ADHD is highly hereditary, occurring at a level of more than seven on a scale of one to ten, similar to height. ADHD is not new. It has been described in literature and medically documented for more than two centuries. ADHD is a chronic condition that can present at different levels of severity and rarely occurs by itself. There are three core symptoms: the inability to regulate attention; the inability to regulate activity; and difficulty with inhibitory behaviour resulting in impulsivity. Difficulty with regulating emotions is often an issue as well. It is important to note that symptoms of ADHD can vary from day to day, hour to hour and, while many children and adults may exhibit these symptoms, it is the degree of presentation, the inability to regulate them and the level of impairment that results in a diagnosis. What are the Findings of New Research? New research has shown us that children and adults with ADHD often have weaknesses in the areas of Executive Functioning (EF). Executive functioning is the mental process that allows us to plan ahead, evaluate the past, start and finish a task and manage our time. Executive functioning skills enable us to identify a problem, find solutions, organize ourselves, regulate our behaviour and emotions, control our attention levels and resist distractions. Executive functions have been referred to as the CEO, or conductor of the brain. Working memory, an executive function, is used when we need to hold and use several things from our memory, in our minds, at the same time. Think of a computer having several files open at once with the operator constantly flipping from one file to another accessing information. Working memory directly impacts reading comprehension, written expression and math skills. Students with ADHD may also process information coming in and going out at a slower speed. Children with deficits in these areas, also referred to as hidden learning disorders, are frequently mislabeled as unmotivated, defiant, and lazy. How Often Does ADHD Occur? ADHD is the most common psychiatric disorder of childhood. Studies throughout the world report an incidence of ADHD in school age children of between 5% and 12%. This means, on average, there are at least one to three children in every class with ADHD. More boys than girls are diagnosed at a rate of three to one. However, since girls are less likely to display outward hyperactivity and since as many women as men are diagnosed in adulthood, we know many girls with ADHD are undiagnosed in childhood. Females are equally impaired in the areas of attention and social and academic problems as males. Eighty percent of adolescents with ADHD in childhood continue to meet the criteria for diagnosis in adolescence and more than sixty percent of adults with childhood ADHD report suffering from the symptoms of ADHD. Are There Different Types of ADHD? ADHD is classified into three categories based upon the clustering of the three core symptoms. Children and adults who have only hyperactive and impulsive symptoms are diagnosed as “ADHD, primarily hyperactive-impulsive subtype” (very rare and perhaps nonexistent); those who display only inattention are referred to as “ADHD, primarily inattentive subtype” (formerly known as ADD); and those who have both of these clusters are referred to as “ADHD, combined subtype” (the most common). What causes ADHD? Current research points to a decreased level of dopamine in certain parts of the brain as one of the causes of ADHD. Dopamine is a chemical manufactured by the brain which carries signals across the synapses of the brain. Norepinephrine, another chemical that also helps signals flow though the brain, may also be affected in people with ADHD. Magnetic Resonance Imaging (MRI), show certain parts of the brain are smaller in children with ADHD and that there is a decrease in blood flow, especially in the frontal lobes of the brain. How is ADHD Diagnosed? Every child or adolescent entering a doctor’s office presenting with symptoms of inattention, impulsiveness and/or hyperactivity, does not immediately qualify for a diagnosis of ADHD. At this time there are no blood tests or any one definitive test that can confirm a diagnosis of ADHD. Physicians diagnose ADHD by first ruling out other possible conditions that could account for the symptoms and secondly, by confirming that the symptoms truly fit an ADHD diagnosis. Tests are used to rule out any physical causes. A full medical history is taken, symptom rating scales are used to compare the level of behavior with what is considered within a range of average for a child of his/her age, and the child's academic functioning is looked at. Both the child’s parents and teachers are asked to complete similar rating scales so the level of functioning in the classroom setting can be compared with the level of functioning at home. It is often in the school environment where symptoms of attention, hyperactivity and impulsivity stand out the most. ADHD is never diagnosed unless symptoms occur in more than one setting. How is ADHD Treated? The treatment of choice is a combination of medication, special education accommodations in the classroom and education about ADHD for family members and individuals affected by ADHD. It should be noted that not all people with ADHD require medication and it is the level of impairment that dictates this. Studies have shown that providing education on ADHD greatly increases the chance that individuals will continue with their treatment long term. The best approach to treating ADHD includes: regular follow-up visits with a medical practitioner; continued support for families with information about ADHD and its management; patient, parent and teacher training; special educational accommodations; and behavioral interventions along with medication. Unfortunately, this level of care is virtually nonexistent in Canada. In uncomplicated cases of ADHD, medication management is fairly straightforward and typically effective with minimal side effects. The medications most often used to manage ADHD are stimulant medications. These drugs have been around for over fifty years with thousands of research papers on their safety and effectiveness. However, in the past five years, the development of once-a-day, time-released medications, both stimulant and non-stimulant, have significantly improved the lives of many children and adults with ADHD. These new medications are difficult to abuse, reduce the stigma of having to take medication in front of others, prevent gaps in symptom relief and decrease the chances of exaggerated rebound symptoms happening several times a day when the short-acting medication wears off. Unfortunately, these new medications can be expensive if paid out of pocket. Due to rigorous advocacy work, a few provinces have now made it easier to access these newer medications through provincial drug plans. For some people the older medications are still the best “fit” and, as with all medication, reaching the highest level of effectiveness with the least amount of side effects is always the aim of treatment. Building a strong patient-practitioner working relationship is key. Studies show that, even with medication use alone, doctors are now able to improve the main symptoms of ADHD in a very short period of time. However, a multi-modal approach is much more effective and is always recommended. |