Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders among children. It was formerly called hyperkinetic syndrome (HKS) or minimal cerebral dysfunction (MCD). Almost everything about ADHD has been the subject of intense debate and many have been critical against the use of this diagnosis.

ADHD affects 3 to 5 percent of all children. This implies about one in every classroom or perhaps as many as 2 million American children. Two to three times more boys than girls are affected. Today ADHD is considered a problem all over the industrialized world. ADHD often continues into adolescence and adulthood, and can cause a lifetime of frustrated dreams and emotional pain.

According to latest studies ADHD is an inheritable dysfunction of the dopamine metabolism mainly in the frontostriatal region of the human brain. New studies consider the posibility that the norepinephrine metabolism also affects this disorder. (see: Krause,Dresel,Krause in psycho 26/2000 p.199ff.)

Symptoms

• In children the disorder is characterised by inattentiveness, impulsive behaviour and restlessness.
• In adults the main problem is often their inability to structure their lives and plan simple daily tasks. Thus inattentiveness and restlessness often become secondary problems.

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 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.

Evidence for ADHD as a real disease

Brain imaging research using a technique called magnetic resonance imaging (MRI) has shown that differences exist between the brains of children with and without ADHD. Many scientists consider these results to be more than vague but in addition PET studies have shown, that there might be a link between a person's ability to pay continued attention and the use of glucose &endash; the body's major fuel &endash; in the brain. In adults with ADHD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention (Zametkin et al.). Maybe even more interesting are the results of some studies using SPECT[?]. Lou et al. have found out that people with ADHD have a reduced blood circulation in the striatum (Lou et al. in Arch.Neurol.46(1989) 48-52). But even more important might be the discovery that people with ADHD seem to have a significantly higher concentration of dopamine transporters in the striatum (Dougherty et al. in Lancet 354 (1999) 2132-2133 ; Dresel et al. in Eur.J.Nucl.Med. 25 (1998) 31-39).

Research shows that ADHD tends 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 have children with ADHD. Even more convincing of a possible genetic link is that when one twin of an identical twin pair has the disorder, the other is likely to have it too.

Treatment

In the last decade, scientists believe that they have learned much about the course of the disorder and now believe that they are able to identify and treat children, adolescents, and adults who have it. A variety of medications, behavior-changing therapies, and educational options are available to treat people diagnosed with ADHD.

Data from 1995 show that physicians treating children and adolescents wrote 6 million prescriptions for stimulants. Of all the drugs used to treat psychiatric disorders in children, stimulant medications are the most well studied. A 1998 Consensus Development Conference on ADHD sponsored by the National Institutes of Health and a recent, comprehensive scientific report confirmed many earlier studies showing that short-term use of stimulants is safe and effective for children with ADHD.

In December 1999, NIMH released the results of a study of nearly 600 elementary school children, ages 7 to 9, which evaluated the safety and relative effectiveness of the leading treatments for ADHD for a period up to 14 months. The results indicate that the use of stimulants alone is more effective than behavioral therapies in controlling the core symptoms of ADHD &endash; inattention, hyperactivity/impulsiveness, and aggression. In other areas of functioning, such as anxiety symptoms, academic performance, and social skills, the combination of stimulant use with intensive behavioral therapies was consistently more effective. (Of note, families and teachers reported somewhat higher levels of satisfaction for those treatments that included the behavioral therapy components.) NIMH researchers will continue to track these children into adolescence to evaluate the long-term outcomes of these treatments, and ongoing reports will be published.

Positive aspects

Though ADHD is classified as a serious disorder, many people have a different perspective. They see it as a gift. In his book ADD - Attention Deficit Disorder, Thom Hartmann brought up the idea that people having ADHD are the descendants of the stone age hunters.

People who believe that ADHD is a gift find hints on ADHD in the lives of many famous people in history. Though this post mortem diagnosis is not to be seen as valid, these people are said to have ADHD. Examples are Hans Christian Andersen, Ludwig van Beethoven, Winston Spencer Churchill, Walt Disney, Thomas Edison, Benjamin Franklin, Robert and John F. Kennedy, Theodore Roosevelt, Jules Verne and the Wright brothers.

But if the information of the author is reliable, there are also many famous persons in present times, who are positively diagnosed to have ADHD. (e.g. George W. Bush, William J. Clinton, Whoopi Goldberg or Dustin Hoffman)

To see ADHD as a gift may seem somewhat obscure to the reader but it is at least a perspective that should be kept in mind.

Skepticism towards ADHD as a diagnosis

Critics claim that the ADHD diagnosis is vague; almost any type of unwanted behavior in a child could be claimed to be the result of ADHD. A few claim that the entire ADHD diagnosis should be abolished, while most feel that it is important to assess whether a certain child really suffers from ADHD or whether other factors are at work.

Behavioral problems need not, but may be, just that. For instance a child that disrupts teaching may simply need encouragement to concentrate and age-appropriate consequences for disturbing. This however, critics claim, requires more work than simply giving the diagnosis ADHD and administering a drug that calms down the child.

Further, a child experiencing learning difficulties perhaps needs more attention from teachers, greater involvement from parents or a specialized curriculum. Critics claim some of these children simply receive a drug such as Ritalin.

Others claim that children who feel alienated react with violence. Rather than receiving the love and attention they need and deserve, they are kept quiet using drugs.

External links

• http://www.ADHS.info/ (german)
• http://www.nimh.nih.gov/publicat/adhd.cfm (a public domain resource)
• A skeptical view of ADHD (http://www.cpa.ca/Psynopsis/ADHD.htm)
• NIH consensus statement (http://consensus.nih.gov/cons/110/110_statement.htm)