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  Attention Deficit Disorder(ADD)/Attention Deficit Hyperactive Disorder(ADHD)- Surviving the Active Brain
Bhavana NairBhavana Nair
 

Introduction

Inattention

Hyperactivity

Impulsivity

Types of ADHD

ADHD in adults

Causes

Treatment in ADHD

ADD/ADHD Self Test


Introduction

David is an eleven year old, sixth grade student who has reading and math skills one to two years below grade level. He is failing every subject and seems destined to repeat the sixth grade. His teachers describe him as disruptive and oppositional in class and state that he has difficulty paying attention during structured and unstructured activities. The school administrators have contacted his parents and have suggested that he is likely to be suffering from an Attention-Deficit Hyperactivity Disorder (ADHD). They recommend that he be taken to his pediatrician for a confirmed diagnosis. Even at home David is rebellious. He refuses to obey his curfews, goes to bed late at night and fails to rise for school in the morning. Intermittently he wets his bed.

Susan, a 20 year old executive in a multi national company exhibits many relationship problems when in the presence of other people. She is constantly aware of others and how they are seeing her, trying to get some kind of attention from them. She seems to be worried about what impression is being made by her on others. She is constantly “on stage,’ trying to get a person to like her, and if this doesn’t work, to get them angry at her she pushes the limits to see just how angry the person will get. She is often “well-behaved” in the presence of an authority figure (her boss), but rude and annoying to her peer group the next moment—almost as a release of the strain of pretending to be perfect for the boss. She is known for her lies, is annoying on purpose, interrupts during conversations and is void of good manners.

Mina a 7 year old girl was having problems following instructions and was facing difficulties organizing tasks and activities. She would often avoid to engage in tasks that required sustained concentration, made careless mistakes in homework and other activities, often had difficulties sustaining attention in tasks and play activities and did not seem to listen when spoken to directly. She would often lose things necessary for tasks or activities (e.g. toys, school assignments, pencils, books) and would be easily distracted by extraneous stimuli

Ali aged 18 often fidgets with his hands or feet or squirms in his seat during his classes in college. He often leaves his seat in the middle of a lecture and in other situations in which remaining seated is expected. Outside the classroom, he walks about and complains of many thoughts ’going on in his head’ making it impossible for him to focus on anything in particular.

Ravi, a 14 year old was described as always being "on the go" or often acting as if "driven by a motor". He would talk excessively and he would find it impossible to finish a task that he had started. He would blurt out answers before questions had been completed. He had difficulty waiting for his turn and would often interrupt or intrude on others (e.g. butt into conversations or games)

(All above names have been changed for purpose of confidentiality)

You may have already identified someone you know who could probably fit one of the above descriptions. Most of the behavior mentioned above is present in most of us so what is the criteria that one follows to make a diagnosis of ADHD

The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD.

Inattention

1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks or play activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activity.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Is often forgetful in daily activities.

Hyperactivity

1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go"
6. Often talks excessively.

Impulsivity

1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

• Six or more of the following symptoms of inattention/hyperactivity/impulsivity have to be present for at least 6 months to a point that is disruptive and inappropriate for developmental level
• Some symptoms that cause impairment would be present before the age of 7 years.
• Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
• There must be clear evidence of significant impairment in social, school, or work functioning.

Based on these criteria, three types of ADHD have been identified:

1. ADHD, Predominantly Inattentive Type (previously known as ADD – Attention Deficit Disorder which is marked by impaired attention and concentration )
2. ADHD, Predominantly Hyperactive-Impulsive Type (which is marked by hyperactivity without inattentiveness)
3. ADHD, Combined Type (the most common type, involves all the symptoms)

An Overview of ADHD in adults

Attention deficit hyperactivity disorder (ADHD) is well recognized in children and is increasingly recognized in adult populations With ADHD in adults, there may be some variation in symptoms. For instance, an adult may experience restlessness instead of hyperactivity. In addition, adults with ADHD consistently have problems with interpersonal relationships and employment.

The exact characteristics or symptoms defining this set of problems continue to be defined. ADHD is not considered just a problem with poor attention but is additionally a problem with moderating emotions and effective self-regulation. Dealing with the demands of everyday life requires self-regulation to develop successful life skills. For people with ADHD, problems with self-regulation cause difficulty managing emotions, so they might respond to small events with excessive behavior and emotion while not noticing more important events. Also, problems with self-regulation make it difficult to develop good habits. Compared with other people, those with ADHD require more practice over longer periods of time to develop effective behavior that is self-regulated or habitual.

Again, the root problem in ADHD is not a simple problem of not paying attention. When people with ADHD are involved in an area that naturally holds their interest, they can pay attention as well as, or nearly as well as, others. However, when tasks are repetitive or hold no interest for that person, these individuals experience greater difficulty staying focused and remaining on task.

ADHD is a well-recognized diagnosis in children that has been formally identified in adults for about the past 20 years. As children with ADHD grow up, their hyperactive-impulsive qualities often diminish, while the inattentive and disorganized patterns of behavior remain constant. Adults with ADHD fit this pattern: inattention and disorganization, combined with the childhood history of inattention, hyperactivity, and impulsivity. The level of impulsiveness in childhood seems to be the best predictor of symptoms later in life. High levels of childhood impulsivity predict more serious adult dysfunction

Recognizing that ADHD can continue from childhood into adulthood has taken a significant time. Current estimates are that one third of children receiving diagnoses of ADHD may outgrow many symptoms; however, not all symptoms are outgrown. The remaining two thirds of children with ADHD continue to have most symptoms but also experience significant co-occurring psychiatric and life problems, such as borderline and impulse personality problems, substance abuse and a significant risk for depression and anxiety disorders.

Causes

Biologically, ADHD is a neuro-hormonal and neuro-anatomical disorder. People with ADHD have several chemicals (still to be determined) in the brain that are not present in the right quantities in the right places at the right times. These chemicals may work sometimes, but not always, and they are not under the individual's control. This is why people with ADHD have variable performance. Also, some nerve groups seem to be a bit out of position in the brain, causing delays or accelerations of nerve signals

Heredity as a Cause of ADHD Heredity is the most common cause of ADHD. Most of our information about the heritability of ADHD comes from family studies, adoption studies, twin studies and molecular genetic research.

Exposure to Toxic Substances as a Cause of ADHD Researchers have found an association between mothers who used tobacco products or used alcohol during their pregnancy and the development of behavior and learning problems in their children. A similar association between lead exposure and hyperactivity has been found, especially when the lead exposure occurs in the first three years. Nicotine, alcohol, and lead can be toxic to developing brain tissue and may have sustained effects on the behavior of the children exposed to these substances at early ages. However, it is unlikely that such exposure accounts for differences in brain development in the vast majority of children and adolescents with ADHD.

Injury to the Brain from Trauma, Brain Tumors, Strokes or Disease Injury to the brain can be the result of trauma (serious blow to the head), brain tumor, stroke or disease. These factors can cause problems with inattention and poor regulation of motor activity and impulses. While such circumstances can result in a diagnosis of ADHD, the occurrence of such is atypical.

Treatment in ADHD

Medical Treatment
Cognitive Behavior Therapy
Life Coaching

MEDICAL TREATMENT

When medication is used appropriately for attention deficit hyperactivity disorder (ADHD), patients notice a significant improvement in control. Objective observers, such as acquaintances or coworkers, should notice more focus, better concentration, and improved task completion.

Remembering what medicine does and does not do is very important. Medicine, when used appropriately, simply makes a person with ADHD function more like a person without ADHD. As a comparison, using medication is like putting on glasses. It makes the system function more appropriately, just like glasses help a person achieve 20/20 vision. Medication alone will not make a person with ADHD sit down and write a paper any more than glasses alone will. Medication allows the nervous system to send its chemical messages more efficiently, but it does not provide skills or motivation to perform.

Medication is designed to help a person with ADHD be less forgetful and distracted, so that he or she can stick to a plan and achieve daily goals. People with ADHD who are on effective medication can have improved attention span, concentration, memory, coordination, mood, and task completion. At the same time, daydreaming, hyperactivity, anger, and immature or oppositional behavior may decrease. Medical treatment allows a person's intellectual capabilities that were already present to function more appropriately.

The medications available for attention deficit hyperactivity disorder (ADHD) can have slightly different effects from individual to individual, and currently no way exists to tell which will work best. Medications indicated for ADHD are thought to work by improving the imbalance of neurochemicals that are thought to contribute to ADHD. Some commonly prescribed medications include the following:

Stimulants include different formulations of methylphenidate:

• short acting, such as Ritalin ( Methyphenidate )and Focalin ( dexmethylphenidate ), with a duration of 3-5 hours

• intermediate acting, such as Ritalin SR, Metadate ER (Methylphenidate hydrochloride extended release ), and Methylin ER (methylphenidate ), with a duration of 3-8 hours

• long acting, such as Concerta ( methylphenidate ), Rilatin LA and Metadate CD, with a duration of 8-12 hours and which can be used just once a day

The other type of stimulant includes different formulations of amphetamine:

• short acting, such as Dexedrine ( d-Amphetamine ) and Dextrostat (d-amphetamine), with a duration of 4-6 hours intermediate acting, such as Adderall ( mixture of amphetamine and d-amphetamine ) and Dexedrine spansule, with a duration of 6-8 hours

• long acting, such as Adderall-XR

Medication should help in the following areas:

• Academic underachieving and inattentiveness
• Hyperactivity or fidgeting
• Verbal and/or behavioral impulsivity (for example, blurting out, interrupting others, acting before thinking)
• Difficulty falling asleep at night
• Trouble waking up (not getting out of bed in the morning)
• Excessive irritability without cause and/or easy frustration
• Episodic explosiveness, emotional outbursts, or temper tantrums
• Unexplained and persistent emotional negativity

COGNITIVE BEHAVIOUR THERAPY

Cognitive behavioral therapy is a form of treatment which helps people make concrete, observable changes in their lives. There is a focus on the ways a person's thoughts and attitudes affect his feelings and behavior. The premise is that some people develop negative and distorted beliefs about themselves which interfere with their functioning. This can lead to depression and anxiety, as well as the procrastination that affects so many adults with Attention Deficit Hyperactivity Disorder. Cognitive behavior therapy helps people examine the beliefs that are holding them back and learn strategies to counteract those beliefs.

Cognitive behavioral therapy is also a practical method of treatment that helps clients deal with the day to day issues that impede their success. Many adults with ADHD have difficulty with organization, prioritizing, and follow-through. Some adults with attentional difficulties tend to ramble, have trouble remaining on topic, and often forget what they've committed to do.

LIFE COACHING

ADHD Coaching-This specialized branch of coaching is designed specifically to help individuals create strategies for ADHD management. Using a coach is especially helpful in areas of procrastination, follow-through, task management, attention and concentration. One of the biggest challenges in managing ADHD is getting past the overwhelming task of completing daily seemingly simple things. The consistent accountability, education and support that an ADHD coach offers is vital to creating long lasting strategies and habits.

Emerging evidence suggests that the combination of medication, cognitive therapy and life coaching appears to significantly benefit adults with ADHD.

ADD/ADHD Self Test :

Take this self ADD/ADHD test with an open mind if you suspect problems with hyperactivity or distractibility. The test is purely subjective
Some parents find it helpful to have several people, including the child, fill out the self ADHD /ADD test. By having more than one person complete the test you can compare the results and discuss discrepancies.
More than 20 checked items on the test indicates a strong tendency toward Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder.

__ Does not work to potential in school, receives "not working to potential" teacher comments.
__ Has short attention span unless very interested in a particular subject.
__ Has a family history of Attention Deficit Disorder, Attention Deficit Hyperactivity Disorder, learning problems or substance abuse.
__ Is easily distracted.
__ Lacks attention to detail.
__ Has sloppy handwriting.
__ Has difficulty putting thoughts on paper.
__ Has trouble listening carefully to directions.
__ Frequently forgets or misplaces things.
__ Skips around while reading.
__ Has difficulty learning new games and new skills.
__ Has poor listening skills.
__ Transposes numbers, letters or words.
__ Is restless or in constant motion, is always "on the go."
__ Concentrates better when moving or fidgeting.
__ Has trouble sitting still or sitting in one place too long.
__ Has increased anxiety or nervousness.
__ Has a history of bed wetting beyond the age 5.
__ Has poor communication skills.
__ Lacks tact, often spurting out the first thing that comes to mind.
__ Acts impulsively or dangerously without considering the consequences.
__ Is easily bored.
__ Says things without thinking and later regrets having said them.
__ Starts to answer questions before the questions are fully asked.
__ Is impatient.
__ Has trouble following verbal directions.
__ Makes careless mistakes in schoolwork.
__ Has tendency to embarrass others.
__ Lies or steals on impulse.
__ Has trouble maintaining an organized work or living area.
__ Is often late.
__ Procrastinates, especially with multi-faceted tasks.
__ Is easily overwhelmed by everyday tasks.

Most children will display every character statement in this ADHD test and Attention Deficit Disorder test at least once in their childhood. It is only when hyperactivity and attentional characteristics occur on a frequent and regular basis and it disrupts their regular functioning at school/work and at home that they are identified as Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder.

This test can be used as a basis to go in for a formal diagnosis with a clinical psychologist who can then advise you on how to start treatment (cognitive therapy and life coaching) and refer you to a doctor ( for medication if required) qualified to do the same