Attention Deficit Disorder - An inability to control behaviour due to difficulty in processing neural stimuli.
Attention Deficit Hyperactivity Disorder - A condition seen
in children where there is increased motor activity in association with
poor attention span. Often treated with amphetamine medications.
Since the early part of the last century, doctors have ascribed an
array of names to this constellation of behaviors - among them
hyperkinesis, hyperactivity, minimal brain damage and minimal brain
dysfunction. In the late 1970s, attention deficit hyperactivity
disorder (ADHD) became the accepted term. According to the American
Psychiatric Association's Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV), ADHD is characterized by a persistent pattern of
inattention and/or hyperactivity or impulsivity that is more frequent
and severe than is typically observed in individuals at a comparable
level of development.
Imagine living in a fast-moving kaleidoscope, where sounds, images,
and thoughts are constantly shifting. Feeling easily bored, yet
helpless to keep your mind on tasks you need to complete. Distracted by
unimportant sights and sounds, your mind drives you from one thought or
activity to the next. Perhaps you are so wrapped up in a collage of
thoughts and images that you don't notice when someone speaks to you.
For many people, this is what it's like to have Attention Deficit
Hyperactivity Disorder, or ADHD. They may be unable to sit still, plan
ahead, finish tasks, or be fully aware of what's going on around them.
To their family, classmates or coworkers, they seem to exist in a
whirlwind of disorganized or frenzied activity. Unexpectedly--on some
days and in some situations--they seem fine, often leading others to
think the person with ADHD can actually control these behaviors. As a
result, the disorder can mar the person's relationships with others in
addition to disrupting their daily life, consuming energy, and
diminishing self-esteem.
Doctors do not know exactly what causes ADHD. Through the years,
they have speculated that toxins, abnormal fetal development, diet,
injury or poor parenting are to blame.
Today, scientists are scrutinizing genetics for answers. Many now
suspect a series of malfunctioning genes may obstruct the normal
secretion of chemicals that guide communication among cells in areas of
the brain responsible for inhibition and self-control.
In the last decade, scientists have learned much about the course of
the disorder and are now able to identify and treat children,
adolescents, and adults who have it. A variety of medications,
behavior-changing therapies, and educational options are already
available to help people with ADHD focus their attention, build
self-esteem, and function in new ways. Research has shown that
medication alone is not always sufficient. For more than two decades,
psychosocial interventions such as parent training and behavioral
modifications have been used for children with ADHD.
Used properly, medicines such as methylphenidate hydrochloride
(Ritalin) and other stimulants help suppress and regulate impulsive
behavior. Most experts agree that treatment for ADD should address
multiple aspects of the individual's functioning and should not be
limited to the use of medications alone.
At present, ADHD is a diagnosis applied to children and adults who
consistently display certain characteristic behaviors over a period of
time. The most common behaviors fall into three categories:
inattention, hyperactivity, and impulsivity.
Inattention. People who are inattentive have a hard time
keeping their mind on any one thing and may get bored with a task after
only a few minutes. They may give effortless, automatic attention to
activities and things they enjoy. But focusing deliberate conscious
attention to organizing and completing a task or learning something new
is difficult.
Hyperactivity. People who are hyperactive always seem to be
in motion. They can't sit still, they may dash around or talk
incessantly. Sitting still through a lesson can be an impossible task.
Hyperactive children squirm in their seat or roam around the room. Or
they might wiggle their feet, touch everything, or noisily tap their
pencil. Hyperactive teens and adults may feel intensely restless.
Impulsivity - People who are overly impulsive seem unable to curb their immediate reactions or think before they act.
The fact is, many things can produce these behaviors. Anything from
chronic fear to mild seizures can make a child seem overactive,
quarrelsome, impulsive, or inattentive. For example, a formerly
cooperative child who becomes overactive and easily distracted after a
parent's death is dealing with an emotional problem, not ADHD. A
chronic middle ear infection can also make a child seem distracted and
uncooperative. So can living with family members who are physically
abusive or addicted to drugs or alcohol.
In other children, ADHD-like behaviors may be their response to a
defeating classroom situation. Perhaps the child has a learning
disability and is not developmentally ready to learn to read and write
at the time these are taught. Or maybe the work is too hard or too
easy, leaving the child frustrated or bored.
One of the difficulties in diagnosing ADHD is that it is often
accompanied by other problems. For example, many children with ADHD
also have a specific learning disability (LD), which means they have
trouble mastering language or certain academic skills, typically
reading and math. ADHD is not in itself a specific learning disability.
But because it can interfere with concentration and attention, ADHD can
make it doubly hard for a child with LD to do well in school.
A very small proportion of people with ADHD have a rare disorder
called Tourette's syndrome. People with Tourette's have tics and other
movements like eye blinks or facial twitches that they cannot control.
Others may grimace, shrug, sniff, or bark out words. Fortunately, these
behaviors can be controlled with medication.
Health professionals stress that since no one knows what causes
ADHD, it doesn't help parents to look backward to search for possible
reasons. There are too many possibilities to pin down the cause with
certainty. It is far more important for the family to move forward in
finding ways to get the right help.
One disappointing theory was that all attention disorders and
learning disabilities were caused by minor head injuries or
undetectable damage to the brain, perhaps from early infection or
complications at birth. Based on this theory, for many years both
disorders were called "minimal brain damage" or "minimal brain
dysfunction." Although certain types of head injury can explain some
cases of attention disorder, the theory was rejected because it could
explain only a very small number of cases. Not everyone with ADHD or LD
has a history of head trauma or birth complications.
Another theory was that refined sugar and food additives make
children hyperactive and inattentive. As a result, parents were
encouraged to stop serving children foods containing artificial
flavorings, preservatives, and sugars. However, this theory, too, came
under question. In 1982, the National Institutes of Health (NIH), the
Federal agency responsible for biomedical research, held a major
scientific conference to discuss the issue. After studying the data,
the scientists concluded that the restricted diet only seemed to help
about 5 percent of children with ADHD, mostly either young children or
children with food allergies.
Research shows that a mother's use of cigarettes, alcohol, or other
drugs during pregnancy may have damaging effects on the unborn child.
These substances may be dangerous to the fetus's developing brain. It
appears that alcohol and the nicotine in cigarettes may distort
developing nerve cells. For example, heavy alcohol use during pregnancy
has been linked to fetal alcohol syndrome (FAS), a condition that can
lead to low birth weight, intellectual impairment, and certain physical
defects. Many children born with FAS show much the same hyperactivity,
inattention, and impulsivity as children with ADHD.
Drugs such as cocaine--including the smokable form known as
crack--seem to affect the normal development of brain receptors. These
brain cell parts help to transmit incoming signals from our skin, eyes,
and ears, and help control our responses to the environment. Current
research suggests that drug abuse may harm these receptors. Some
scientists believe that such damage may lead to ADHD.
Toxins in the environment may also disrupt brain development or
brain processes, which may lead to ADHD. Lead is one such possible
toxin. It is found in dust, soil, and flaking paint in areas where
leaded gasoline and paint were once used. It is also present in some
water pipes. Some animal studies suggest that children exposed to lead
may develop symptoms associated with ADHD, but only a few cases have
actually been found.
Other research shows that attention disorders tend to run in
families, so there are likely to be genetic influences. Children who
have ADHD usually have at least one close relative who also has ADHD.
And at least one-third of all fathers who had ADHD in their youth bear
children who have ADHD. Even more convincing: the majority of identical
twins share the trait. At the National Institutes of Health,
researchers are also on the trail of a gene that may be involved in
transmitting ADHD in a small number of families with a genetic thyroid
disorder.
Understandably, parents who are eager to help their children want to
explore every possible option. Many newly touted treatments sound
reasonable. Many even come with glowing reports. A few are pure
quackery. Some are even developed by reputable doctors or
specialists--but when tested scientifically, cannot be proven to help.
Here are a few types of treatment that have not been scientifically
shown to be effective in treating the majority of children or adults
with ADHD:
- biofeedback
- restricted diets
- allergy treatments
- medicines to correct problems in the inner ear
- megavitamins
- chiropractic adjustment and bone re-alignment
- treatment for yeast infection
- eye training
- special colored glasses
A few success stories can't substitute for scientific evidence.
Until sound, scientific testing shows a treatment to be effective,
families risk spending time, money, and hope on fads and false promises.
