ADHD is not just a childhood disorder

[Guest guest]

ADHD is not just a childhood disorder

By Greta Hale

http://www.southernillinoisan.com/articles/2005/12/24/health/doc43ad71b01181a572\

300956.txt

It's frustrating to read something 45 times before you know what it said

because your mind keeps wandering.

This is one symptom of attention-deficit/hyperactivity disorder (ADHD).

While ADHD has traditionally been thought of as a disorder that causes

children to fidget and misbehave, it also affects many adults.

In fact, there has been a dramatic increase in the number of adults

taking medication to treat ADHD.

[increased sales of medications can be interpreted as a beneficial

effect of hypertoxinosis and hypervaccinosis - if a person has invested

sufficiently in pharmaceutical stock. -]

A recent study found that the number of adults under age 45 who are

prescribed drugs to treat ADHD has doubled in the past four years,

according to a Nov. 5 article on the USA Today Web site.

Studies show that 30 to 70 percent of children with ADHD never outgrow

the condition. But Dr. Simeon Grater, MD, a psychiatrist at St. 's

Good Samaritan Behavioral Health Services in Carbondale, said that in

his office, 100 percent of children with ADHD have it as adults. He

believes studies underestimate the percentage.

" ADHD is a biological, neurological, physical disease that begins at

conception, " Dr. Grater said.

[Are there citations with actual data supporting Grater's " at

conception " statement? -]

ADHD becomes apparent in some children in the preschool and early school

years, according to the National Institute of Mental Health Web site. It

is difficult for these children to control their behavior and/or pay

attention. In the United States, 3 to 5 percent of children, or about 2

million, have ADHD.

Symptoms

The characteristics of ADHD are inattention, hyperactivity and

impulsivity. They occur over the course of many months. Impulsivity and

hyperactivity precede inattention, which may not emerge for a year or more.

While all children are sometimes restless, act without thinking or

daydream, when symptoms affect school performance or social

relationships, ADHD may be suspected.

" It wrecks havoc on relationships, " said Dana DeLong, the adult

counseling services manager at Southern Illinois Regional Social

Services (SIRSS).

Hyperactivity- Impulsivity

Hyperactive children are in constant motion. They move around and touch

or play with whatever is in sight or talk incessantly, according to the

National Institute of Mental Health Web site. It is difficult for them

to sit at the dinner table or through a school lesson. They often fidget

or wiggle their feet.

In adults, hyperactivity can manifest itself as an irritable or anxious

mood, in frequent job changes and stimulus-seeking behaviors like

high-speed driving or drug use.

Hyperactive adults would be successful in a fast-paced career, DeLong said.

Impulsive children seem unable to curb immediate reactions or think

before they act, according to the National Institute of Mental Health

Web site. They often blurt out inappropriate comments, act without

regard for the consequences of their actions and display their emotions

without restraint.

" They may act on a thought before realizing that it's not appropriate, "

said Rosenberg, the clinical director at SIRSS.

Impulsivity often decreases at adolescence, but hyperactivity changes

from an external problem in childhood to an internal feeling of pressure

in adulthood, Dr. Grater said.

Signs of hyperactivity-impulsivity are:

* Feeling restless, often fidgeting with hands or feet, or squirming

while seated.

* Running, climbing or leaving a seat in situations where sitting or

quiet behavior is expected.

* Blurting out answers before hearing the whole question.

* Having difficulty waiting in line or taking turns.

Inattention

Children who are inattentive have a difficult time keeping their minds

on any one thing and may get bored with a task after just a few minutes,

according to the National Institute of Mental Health Web site.

But if they are doing something they enjoy, they have no trouble paying

attention.

" If something really catches their attention, they can hyper focus on

it, " DeLong said. She used the example of an ADHD child playing video

games for several hours.

But it is difficult for them to focus deliberate attention on completing

a task or learning something new.

" The person who has ADHD may have to work twice as hard to keep staying

focused, " DeLong said.

Homework is particularly hard for these children. They often forget to

write down homework assignments or bring books home.

Signs of inattention include:

* Often becoming easily distracted by irrelevant sights and sounds.

* Often failing to pay attention to details and making careless mistakes.

* Rarely following instruction carefully and completely losing or

forgetting things like toys, pencils, books and tools.

* Often skipping from one uncompleted activity to another.

Symptoms of inattention include forgetfulness, putting off starting

tasks that take sustained effort, short term memory problems, not

finishing tasks and problems with organization, Rosenberg said.

" Everybody can identify with some of this, " she said. However, people

with ADHD have a life-long pattern of these symptoms, even when they

create negative consequences.

While ADHD has negative symptoms, people with ADHD are also often highly

creative and flexible thinkers, DeLong said.

Diagnosis

ADHD is difficult to diagnose because symptoms very across different

settings. Each person with ADHD has slightly different symptoms. But,

there are three patterns of behavior that indicate ADHD.

They include:

* Predominately hyperactive-impulsive type - that does not show

significant inattention

* Predominately inattentive type - that does not show significant

hyperactive-impulsive behavior

* The combined type - that shows both inattentive and

hyperactive-impulsive symptoms, which is also the most common, Dr.

Grater said.

Diagnosis is also difficult because everyone occasionally shows some of

the symptoms. But for a diagnosis, a person must demonstrate the

behaviors to a degree that is inappropriate for the person's age. The

behaviors must appear early in life, before age 7, and continue for at

least six months, according to the National Institute of Mental Health

Web site.

In addition, the person's behavior must create problems in at least two

areas of the person's life, such as in the schoolroom, on the

playground, at home or in relationships.

Doctors and therapists sometimes mistake ADHD for anxiety disorder or

depression, DeLong said.

In the past, critics have argued that ADHD has been over diagnosed and

Ritalin has been over prescribed to children.

But neither Rosenberg nor DeLong believe ADHD is over diagnosed.

" It's under diagnosed, " Rosenberg said.

There are more diagnostic tools to find out if children have ADHD than

for adults, Rosenberg said.

" There's a poverty of research on adult (ADHD), " DeLong said.

She is working on a dissertation to test if the personality assessment

inventory can identify adults whose problems might be attributed to ADHD.

Increase in Diagnosis

While males have traditionally been more likely to take ADHD medication

than females, the gender gap is closing among adults.

More women ages 20 to 44 are being diagnosed and treated for ADHD than

in the past, according to a Nov. 5 article on the USA Today Web site.

Prescriptions of ADHD medication for adults ages 20 to 45 doubled in the

past four years.

Dr. Grater suggested the increase could be caused by an increased

awareness that adults have ADHD, the production of new medications

marketed to treat adult ADHD and people realizing they have ADHD

symptoms after reading about the disorder.

Direct-to-consumer advertising could also be one cause, pediatrician

Adesman told USA Today in the Nov. 5 article.

More children and teen-agers are also taking ADHD drugs. It has

increased from 3 to 4.4 percent over four years, according to the report.

Causes

There are several theories of what causes ADHD. Evidence indicates that

ADHD does not stem from home environment, but from biological causes.

Studies have shown a possible correlation between the use of cigarettes

and alcohol during pregnancy and risk for ADHD in the child. High levels

of lead in the bodies of young preschool children may also be associated

with a higher risk for ADHD.

ADHD runs in families, so there is likely to be a genetic influence. In

fact, studies indicate that 25 percent of the close relatives in the

families of ADHD children also have ADHD, according to the National

Institute of Mental Health Web site.

" This is a disorder that has a very strong hereditary component, "

Rosenberg said.

DeLong said children with ADHD often have a parent who also has ADHD.

Dr. Grater stressed that ADHD is a biologically inherited disease and it

needs to be treated medically. It is not caused by poor child rearing,

he said.

Treatments

DeLong said the first step in treatment is becoming educated about the

disorder.

" Medication is one way, but it's not the absolutely only way, " she said.

Several drugs, mostly stimulants, have been used to treat the symptoms

of ADHD.

" The current theory is that there's a part of the brain that controls

executive functioning, and the stimulant activates that part of the

brain, " Dr. Grater said.

Common drugs to treat ADHD include Adderall, Dexedrine, Converta and

Ritalin. The stimulants work on the neurotransmitter dopamine. Straterra

was recently approved as a treatment for ADHD, but it is not a

stimulant. It works on the neurotransmitter norepinephrine.

DeLong said ADHD is caused when neurotransmitters in the frontal lobe of

the brain, which are responsible for executive decision making, don't

function correctly.

About 80 percent of children who need medication for ADHD still need it

as teen-agers and more than 50 percent need it as adults, according to

the National Institute of Mental Health Web site.

" Medication alone is never all that is needed, " DeLong said.

Experts disagree on the use of medication to treat ADHD. Some believe

behavior modification therapy or psychotherapy are better ways to treat

ADHD. Dr. Grater said behavioral therapy in addition to medication can

help people with ADHD become more organized.

Other treatment options include support groups, social skills training

and parenting skills training for parents to learn ways to provide

structure for their child with ADHD.

" ADHD kids are harder to raise than other kids, " Dr. Grater said.

Simple Behavioral Interventions

Children who have ADHD need help getting organized, and can benefit from

a routine schedule, using homework and notebook organizers and getting

organized. A professional coach can help an adult with ADHD learn how

to organize his life by using items, like a large calendar posted where

it will be seen in the morning, date books, lists, reminder notes and

having a special place for keys, bills and paperwork.

" A lot of these strategies are good for everybody, " Rosenberg said.

*

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