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Attention-deficit hyperactivity disorder (ADHD) is a neurologic syndrome that exhibits symptoms such as hyperactivity, forgetfulness, mood shifts, poor impulse control, and distractibility, when judged to be chronic, as symptoms of a neurological pathology. It is seen in both children and adults and is believed to affect about 10% of the population. [citation needed]
Much controversy surrounds the diagnosis. There is disagreement over whether or not the diagnosis denotes a genuine disability or simply serves as a label for something else. Of those who believe that ADHD is a true disorder, there is debate over how it should be treated, if it should be treated at all. Medical science generally regards ADHD to be a valid disorder, that, although not curable, can be treated with a wide range of medication.
ADHD is most commonly diagnosed in children. When diagnosed in adults, it is regarded as adult attention-deficit disorder (AADD). It is believed that anywhere between 30 to 70% of children diagnosed with ADHD retain the disorder as adults
Terminology
There is not yet a naming consensus. Below are listed several terms that have been used, past and present. One challenge in taxonomy is that some patterns of behavior are labeled by experts symptoms or sub-types of ADHD, while other experts label those same patterns as their own disorders, independent of ADHD. For the purposes of this article, the "Terminology" section will be used only to name ADHD and its near equivalents, while the names for its manifestations and subtypes will be listed in 'Symptoms', below.
Attention-deficit hyperactivity disorder (ADHD): In 1987, ADD was in effect renamed to ADHD in the DSM-III-R. In it, ADHD was broken down into three subtypes (see 'symptoms' for more details):
predominantly inattentive ADHD
predominantly hyperactive-impulsive ADHD
combined type ADHD
Attention deficit disorder (ADD): This term was first introduced in DSM-III, the 1980 edition. Is considered by some to be obsolete, and by others to be a synonym for the predominantly inattentive type of ADHD.
Undifferentiated attention-deficit disorder (UADD): This term was first introduced in the DSM-III-R, the 1987 edition. This was a miscellaneous category, and no formal diagnostic criteria were provided. UADD is approximately the predominantly inattentive type of ADHD in the DSM-IV-TR. The DSM-III-R diagnosis of attention-deficit hyperactivity disorder required hyperactive-impulsive symptoms in addition to the inattentive symptoms.
Attention-deficit syndrome (ADS): Equivalent to ADHD, but used to avoid the connotations of "disorder".
Hyperkinetic disorders (F90) is the ICD-10 equivalent to ADHD. The ICD-10 does not include a predominantly inattentive type of ADHD because the editors of Chapter V of the ICD-10 believe the inattentivity syndrome may constitute a nosologically distinct disorder.
Disturbance of activity and attention (F90.0)
Hyperkinetic conduct disorder (F90.1) is a mixed disorder involving hyperkinetic symptoms along with presence of conduct disorder
Other hyperkinetic disorders (F90.8)
Hyperkinetic disorder, unspecified (F90.9)
Hyperkinetic syndrome (HKS): Equivalent to ADHD, but largely obsolete in the United States, still used in some places world wide.
Minimal cerebral dysfunction (MCD): Equivalent to ADHD, but largely obsolete in the United States, though still commonly used internationally.
Minimal brain dysfunction or Minimal brain damage (MBD): Similar to ADHD, now obsolete.
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Formal definitions
According to the U.S. Surgeon General and ICD-10-CM, ADHD is a metabolic form of encephalopathy, impairing the release and homeostasis of neurological chemicals, and thereby possibly reducing the function of the limbic system.[citation needed]
According to the Diagnostic and Statistical Manual of Mental Disorders-IV-TR, ADHD is a developmental disorder that arises in childhood, in most cases before the age of 7 years, is characterized by developmentally inappropriate levels of inattention and/or hyperactive-impulsive behavior, and results in impairment in one or more major life activities, such as family, peer, educational, occupational, social, or adaptive functioning. ADHD may be diagnosed in adulthood, but in order to make a positive diagnosis, the behavioral characteristics must have already been present prior to age 7.
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Symptoms
In children the disorder is characterized by inattentiveness, impulsive behavior, and restlessness. Children with ADHD often procrastinate on their homework, are very easily distracted, lose things easily, have difficulty taking turns and waiting in line. They are often described as chatterboxes and/or daydreamers. Although they can be quite bright and have considerable potential, they frequently have trouble applying themselves for long periods of time, or finishing things that they have started.
As children with ADHD come into adulthood, their childhood problems continue. Their greatest difficulties are in self-control, self motivation, and executive functioning, also known as working memory). Adults with untreated or undertreated ADHD often also have Depression and Anxiety. These two co-morbid disorders are frequently caused by the problems created by the ADHD.
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Diagnosis
The Centers for Disease Control and Prevention (CDC) emphasizes that a diagnosis of ADHD should only be made by trained health care providers. This is important, as many of the criteria are shared between other disorders. Different psychiatric disorders may present with the symptoms of inattentiveness (depressive and anxiety disorders) or hyperactivity and distractibility (manic phase of bipolar illness). It is also important to note that ADHD symptoms to a certain degree are also present in a high proportion of "normal" individuals. What makes it a disorder is a significant severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships). ADHD is, under no circumstances, a contagious disease, as the disorder is inside a person's mind and not outside of it.
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Clinical Testing
The American Academy of Pediatrics Clinical Practice Guideline for children with ADHD [1] emphasizes that a reliable diagnosis requires:
The use of explicit criteria for the diagnosis using the DSM-IV-TR.
The importance of obtaining information about the child’s symptoms in more than 1 setting (especially from schools).
The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.
A proper diagnosis is dependant upon a physician fufilling all three of these criteria. The first criteria can be satisfied by using an ADHD-specific instrument such as the Connor's Scale. "The second criteria is best fufilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory.[2] The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of intelligence and psychological testing (to satisfy the third criteria) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.[3]
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Computerized tests
Computerized tests of attention are not especially helpful in providing a further independent assessment because they have a high rate of false negatives (real cases of ADHD can pass the tests in 35% or more of cases), they do not correlate well with actual behavioral problems at home or school, and are not especially helpful in determining treatments. Both the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have recommended against the use of such computerized tests for now in view of their lack of appropriate scientific validation as diagnostic tools. In the USA, the process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.
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Brain scans
Neurometrics, PET scans, FMRI, or SPECT scans have the potential to provide a more objective diagnosis. However, these are not typically suitable for very young children, and may unnecessarily expose the patient to harmful radiation. Because the etiology of the disorder is unknown, and a complete neurological definition of this disorder is lacking, a majority of clinicians doubt the current predictive power of these objective tests to detect ADHD to be used to direct clinical treatment. [citation needed] Currently, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry recommend against using these neuro-imaging methods for clinical diagnosis of individuals who may have ADHD. They remain, however, useful research tools when studying groups of patients with ADHD. An October 2005 meta-analysis by Alan Zametkin, M.D., with the NIMH entitled "The ADHD Report", concluded that these diagnostic methods lack adequate scientific research on accuracy and specificity to be used as a primary diagnostic tool.[citation needed]
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Incidence
ADHD has been found to exist in every country and culture studied to date. While it is most commonly diagnosed in the United States of America, rates of diagnosis are rising in most industrialized countries as they become more aware of the disorder, its diagnosis, and its management.
Nearly 4 million children younger than 18 in the United States had been diagnosed with attention deficit hyperactivity disorder (ADHD). In general, 5–8% of children likely have ADHD while 4–5% of adults do so. More than twice as many boys have been diagnosed than girls (10% vs. 4%).[4]
The ADHD treatment rate among Caucasian children is significantly higher than among African and Hispanic Americans (4.4% Caucasian, 1.7% African, 1.5% Hispanic in 1997)[5]. The same study notes that outpatient treatment for ADHD has grown from 0.9 children per 100 (1987) to 3.4 per 100 (1997).
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Possible causes
Research indicates that the frontal lobes, their connections to the basal ganglia, and the central aspects of the cerebellum (vermis) are most likely to be involved in this disorder, as may be a region in the middle or medial aspect of the frontal lobe, known as the anterior cingulate.[citation needed] The cerebellum, which is believed to play important roles in "short-term memory, attention, impulse control, emotion, higher cognition, [and] the ability to schedule and plan tasks,[6] has been shown to be smaller in the brains of those who have ADHD. [7] A 1990 study at the U.S. National Institute of Mental Health correlated ADHD with a series of metabolic abnormalities in the brain, providing further evidence that ADHD is a neurological disorder.
The source of these differences is not yet known, but a couple of theories have been presented.
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Heriditary dopamine deficiency
Research suggests that ADHD arises from a combination of various genes, many of which have something to do with dopamine transporters. [8]. Suspect genes include the 10-repeat allele of the DAT1 gene[9] and the 7-repeat allele of the DRD4 gene, [10] Other studies have documented an association between ADHD and the dopamine beta hydrozylase gene (DBH TaqI).[citation needed]
SPECT scans found people labeled as ADHD have reduced blood circulation, [11] and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead. [12].
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Metabolism
It has long been suggested that ADHD could be the result of a nutritional problem. Recent studies have begun to find metabolic differences in these children, indicating that an inability to handle certain elements of ones diet might contribute to the development of ADHD, or at least ADHD-like symptoms. For example, in 1990 the English chemist N.I. Ward showed that children with ADHD lose zinc when exposed to a food dye. Waring, McFadden, and others have shown that children with autism or ADHD are low in sulfation metabolism, in particular the enzyme Phenol Sulfotransferase-P. Some studies suggest that a lack of fatty acids, specifically omega-3 fatty acids can trigger the development of ADHD. Support for this theory comes from findings that breast-fed children are less likely to have ADHD than their bottlefed counterparts and until very recently, infant formula did not contain any omega-3 fatty acids at all. Time will tell whether or not this is coincidence or a true correlation.
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External Factors
There is no compelling evidence that social factors, alone, can create ADHD. The few enviromental factors implicated fall in the realm of biohazards including alcohol, tobacco smoke, and lead poisoning. Allergies (including those to artificial additives)[13] as well as complications during pregnancy and birth-- including premature birth--might also play a role.
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Smoking during pregnancy
It has been observed that women who smoke while pregnant are more likely to have children with ADHD.[14]. Nicotine is known to cause hypoxia (lack of oxygen) in the uterus. Hypoxia causes brain damage. Therefore it is entirely possible that smoking during pregnancy could cause the fetus to suffer brain damage.
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Head injuries
It has been known for some time that head injuries can cause a person to display ADHD-like symptoms. This is possibly because of the damage done to the victim's frontal lobes. This is also why one of the earliest names for ADHD was "Minimal Brain Damage".
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Dopamine deficiency caused by sleep apnea
Another theory is that ADHD is caused by brief pauses in breathing (apnea) during infancy. In October 2004, Dr. Glenda Keating and Dr. Michael Decker of Emory University presented data at the Society for Neuroscience's annual meeting showing that repetitive drops in blood oxygen levels in newborn rats similar to that caused by apnea in some human infants is followed by a long-lasting reduction in dopamine levels, associated with ADHD. Apnea occurs in up to 85% of prematurely born human infants[15]. It remains to be seen whether or not these findings can be replicated in human babies.
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Treatment
There are many options available to treat people diagnosed with ADHD. The options with the greatest scientific support include a variety of medications, behavior-changing therapies, and educational interventions.
Findings of a large randomized controlled trial[16][17] suggest that:
Medication alone is superior to behavioral therapy alone.
The combination of behavioral therapy and medication has a small benefit over medication alone.
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Mainstream treatments
The first-line medication used to treat ADHD are mostly stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. The use of stimulants to treat a syndrome often characterized by hyperactivity is sometimes referred to as a paradoxical effect. But there is no real paradox in that stimulants activate brain inhibitory and self-organizing mechanisms permitting the individual to have greater self-regulation. The stimulants used include:
Methylphenidate — Available in:
Regular formulation, sold as Ritalin, Metadate, Focalin, or Methylin. Duration: 4–6 hours per dose. Usually taken morning, lunchtime, and in some cases, afternoon.
Long acting formulation, sold as Ritalin SR, Metadate ER. Duration: 6–8 hours per dose. Usually taken twice daily.
All-day formulation, sold as Ritalin LA, Metadate CD, Concerta (Methylphenidate Hydrochloride), Focalin XR. Duration: 10–12 hours per dose. Usually taken once a day.
Amphetamines —
Dextroamphetamine — Available in:
Regular formulation, sold as Dexedrine. Duration: 4–6 hours per dose. Usually taken 2–3 times daily.
Long-acting formulation, sold as Dexedrine Spansules. Duration: 8–12 hours per dose. Taken once a day.
Adderall, a trade name for a mixture of dextroamphetamine and laevoamphetamine salts. — Available in:
Regular formulation, Adderall. Duration: 4–6 hours a dose.
Long-acting formulation, Adderall XR. Duration: 12 hours. Taken once a day.
Methamphetamine — Available in:
Regular formulation, sold as Desoxyn by Ovation Pharmaceutical Company. Usually taken twice daily.
Bupropion. A dopamine and norepinephrine reuptake inhibitor, marketed under the brand name Wellbutrin.
Atomoxetine. A norepinephrine reuptake inhibitor (NRI) introduced in 2003, it is the newest class of drug used to treat ADHD, and the first non-stimulant medication to be used as a first-line treatment for ADHD. Available in:
Once daily formulation, sold by Eli Lilly and Company as Strattera. This medicine doesn't have an exact duration. It is to be taken once or twice a day, depending on the individual, every day, and takes up to 6 weeks to begin working fully. If the intake schedule is interrupted, it may take a few weeks to begin working correctly again.
Second-line medications include:
Benzphetamine — a less powerful stimulant. Research on the effectiveness of this drug is not yet complete.
Provigil/Alertec/modafinil — Research on this drug is not yet complete.
Cylert/Pemoline — a stimulant used with great success until the late 1980s when it was discovered that this medication could cause liver damage. Although some physicians do continue to prescribe Cylert, it can no longer be considered a first-line medicine. In March 2005, the makers of Cylert announced that it would discontinue the medication's production.
Clonidine — Initially developed as a treatment for high blood pressure, low doses in evenings and/or afternoons are sometimes used in conjunction with stimulants to help with sleep and because Clonidine sometimes helps moderate impulsive and oppositional behavior and may reduce tics.article
Because most of the medications used to treat ADHD are Schedule II under the U.S. DEA schedule system, and are considered powerful stimulants with a potential for diversion and abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research studying ADHD sufferers who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are in fact much less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.[18]
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Alternative treatments
There are many alternative treatments for ADHD, most of them heavily disputed or relegated to adjunct status with medication treatment. This section attempts to deal with the most prominent of the alternative treatments. Bear in mind that the term "alternative" may mean unscientific because there are little or no credible scientific studies to support these suggested interventions, rather than there being experimental evidence against the intervention.
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Nutrition
As noted above there are indications that children with ADHD are metabolically different from others, [19] Therefore it is believed that diet modification may play a major role in the management of ADHD. Perhaps the best known of the dietary alternatives is the Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets. Granted, according to a recent meta-analysis, there is little scientific evidence for the effectiveness of the Feingold diet in treating ADHD specifically, but this could be because much research has focused on food dyes, and the diet eliminates much more than that. [20]
In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness. After that, zinc was promoted for ADD and autism. Multivitamins later became the claimed solution. Thus far, no reputable research has appeared to support either of these claims, except in cases of malnutrition. Currently the addition of certain fatty acids such as omega-3, is thought to be beneficial, but there is not much evidence to support this either. [21] [22]
It is claimed by some with ADHD that commonly available mild stimulants such as caffeine and theobromine have similar effects to the more powerful drugs commonly used in treating the disorder. Herbal supplements such as Gingko biloba are also sometimes cited. While there is no scientific evidence to support this claim, it is widely accepted by those who wish to avoid strong medication.
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Technology-based alternatives
There has been a lot of interesting work done with neurofeedback and ADHD. Children are taught, using video game-like technology, how to control their brain waves. Although some clinical professionals consider the treatment promising, there is not yet sufficient evidence that it remains effective after the immediate treatment is complete. A thorough review of the scientific research by Sandra Loo, Ph.D. and Russell Barkley, Ph.D. (Developmental Neuropsychology 2005) concluded that neurofeedback does not have adequate support from appropriately conducted scientific studies to support it as an intervention at this time.[23]
Audio visual entrainment uses light and sound stimulation to guide and change brainwave patterns.[24] Compared to other technology based alternative treatments it is inexpensive but probably not covered by health insurance. It is safe for most but cannot be used by those suffering from photosensitive epilepsy due to the risk of triggering a seizure. There is no scientific evidence to support this treatment at this time nor does it appear to be consistent with current evidence on the causes of ADHD.
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Cerebellar Stimulation
There exist several exercise programs based on cerebellar stimulation that are used to treat ADHD, Asperger's syndrome and many learning difficulties like dyslexia, dyspraxia, etc. Most prominent are the DORE program,[25] the Learning Breakthrough Program⢠and the Brain Gym®, based on Educational Kinesiology.
These programs include balance, coordination, eye and sensory exercises that specifically stimulate the cerebellum. As noted above several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts. Cerebellar stimulation assumes that by improving the patient’s cerebellar function many of the symptoms can be reduced or even eliminated permanently.
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Controversy
Main article: Controversy about ADHD
While ADD/ADHD is a known psychiatric condition, there are various theories about the cause and some controversy over the number of persons diagnosed and the cost of medications. Some denial in families may also relate to the negative perception of the condition as a hereditary brain disorder.
The ADHD diagnosis is controversial and has been questioned by some professionals, adults diagnosed with ADHD, and parents of diagnosed children. They point out the positive traits that children with ADD have, such as "hyperfocusing." Others believe ADHD is a divergent or normal-variant human behavior, and use the term neurodiversity to describe it.
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Skepticism towards ADHD as a diagnosis
Many have wondered why the number of children diagnosed with ADHD in the U.S. and UK has grown so dramatically over a short period of time. However, doctors often claim that improving methods of diagnosis and greater awareness are probably in part, if not mostly the reason for this increase. Critics have complained that the ADHD diagnostic criteria are sufficiently general or vague to allow virtually any child with persistent unwanted behaviors to be classified as having ADHD of one type or another.
One critic[2] [26]points out that most children with ADHD have no difficulties concentrating when they are doing activities that are fun, such as playing video games which they can do for hours completely focused. This critic argues that the symptoms of ADHD describe children when they are bored and unconnected to a task.
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Lack of definitive evidence
The biological evidence, though repeated and repeated, when scrutinized more closely is not what it seems. For example Zametkin's impressive looking brain image at the beginning of this article, contrasting differences in brain activity in those with the diagnosis is a picture of those with and without the diagnosis while doing an assigned task. Thus a person (with ADHD) who is not doing the assigned task will have a different looking picture of the brain's activity on that basis alone. If brain imaging is done while one person moves their arm and another doesn't there will also be a demonstrable difference. In this particular case the so-called biological evidence may turn out to be inconclusive.
While a believer that ADHD is a biological condition Xavier Castellanos M.D.,then head of ADHD research at the National Institute of Mental Health (NIMH) (interviewed October 10, 2000 on Frontline [27] was very explicit about the extent of our biological information.
Frontline:
"How does ADHD work on the brain? What do we know about it?"
Castellanos:
"We don't yet know what's going on in ADHD..."
Frontline:
"Give me one true fact about ADHD."
Castellanos
"The posterior inferior vermis of the cerebellum is smaller in ADHD. I think that that is a true fact. It's taken about five years to convince myself that that's the case. That's about as much as I know--that I'm confident about..."
[...]
Frontline:
"Are you uncomfortable with how little you know about this?"
Castellanos
"Yes. But I'm also glad that I know more than I used to. It's both half full and half empty. It's not even half full. It's about a tenth full..."
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Parental role
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There is no compelling evidence that parenting methods can cause ADHD in otherwise normal children. Evidence does show that parents of ADHD children experience more stress and depression, give more commands, spend less leisure time with their children, and vacillate between lax and harsh punishment.[citation needed] But further research suggests that such parenting behavior is in large part a reaction to the child's ADHD and related disruptive and oppositional behavior and in a small part the result of the parent's own ADHD.[citation needed] Clinicians observe and assert, that attachments and relationships with caregivers and other features of the environment in which the child's development occurs, have profound effects on attentional and self-regulatory capacities.[citation needed]. Indeed, whether it has been proven to the satisfaction of "experts" the importance of parenting in guiding children to settle down and remain on task has been assumed to be a critical role of parents for centuries. Anyone with a child knows this is a major challenge and before it became a focus of "experts" seeking to prove that failures in this area must be biological and unconnected to child rearing, this assertion would hardly seem controversial or in need of "proof". Teaching a child how to gain self control, act with consideration for others, and do tasks that are not fun has always been considered one of the most important challenges for parents and educators, since, if not taught, a child will most certainly display all of the symptoms of ADHD. All children will have the symptoms of ADHD until this is accomplished, hence the constant efforts of parents and educators in the past to bring the wildness of children under control (without doing too much damage in the process). The fact that citations corroborating this point of view must now be produced is truly a phenomenon in itself, part of a narrowly defined "science" paradigm that claims to speak in the name of experts but, in fact, narrows the focus of discussions to exclude important criticisms. A historical perspective about child rearing before doctors claimed they were experts in this area, as well as challenges to the science, and a discussion of how and why the "expert" point of view flourishes despite our very real ignorance about the casuses of ADDHD is found in a controversial article by a self declared non expert. ADHD And Other Sins of Our Children While challenging to measure and prove, there are some who believe that the focus on psychopharmacological approaches to treatment fails to address this etiological complexity.[citation needed]
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Reliability of diagnosis
Even if the American Academy of Pediatrics Clinical Practice Guideline is followed rigorously, questions still remain about the reliability of diagnosis. Since methods that attempt to detect it directly are not recommended (see brain scans), diagnosis is dependent on the observation and opinion of adults. The Conners Scale, for example, asks adults to rate a child on behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'". These are rated from "not at all" to "very much". Although Conners argues for the validity of the scale, the breadth of interpretation, particularly when family and cultural norms are considered indicates that it may be far more subjective rather than objective. A further criticism of the scale is that it was originally developed to measure the effectiveness of stimulant medication, not to detect ADHD. Consequently what it may be measuring is the potential for behavior modification with stimulants such as Ritalin rather than the presence of ADHD.
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Positive aspects
Though ADHD is classified as a serious disorder, some people have a different perspective and note the positive aspects. They argue that ADHD children tend to look at situations in a different manner, and that those with ADD tend to look beyond the norm. "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and pondering if it still works on a cloudy day" (Underwood). Some children might be uneasy about getting into a situation. One positive side of impulsive behavior is the ability to try new things without trepidation. This can be a strength and a weakness: "Impulsivity isn't always bad. Instead of dithering over a decision, they're willing to take risks" (Underwood). jetBlue Airways founder David Neeleman believes that ADHD contributed to his business acumen and refuses to take medication for fear that he will lose his creativity. [citation needed] It should be kept in mind that more than 6000 studies have been done in this field and not a single one has found ADHD to convey any advantage over normal or control groups in these studies. [citation needed] However, this result can be predicted as it has long been a scientific assumption that ADHD is disadvantageous, and therefore there has been little serious research into the intellectual advantages it can provide.
Many professional counselors find it useful to emphasize to persons diagnosed with ADHD and their families the perspective that the condition does not necessarily block, and may even facilitate, great accomplishments. Most frequently cited as potentially useful is the mental state of hyperfocus. Lists of famous persons either diagnosed with ADHD or suspected (but not necessarily known to have had ADHD) are numerous.
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Timeline
1845. ADHD was first alluded to by Dr. Heinrich Hoffmann, a physician who wrote books on medicine and psychiatry, Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their characteristics. "Die Geschichte vom Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having attention deficit hyperactivity disorder.http://www.fln.vcu.edu/struwwel/philipp_e.html
1867 – The term "hyperactive" is first used in reference to the "condition of the brain in acute mania." (Source: Oxford English Dictionary Online)
1902 – The English pediatrician George Still, in a series of lectures to the Royal College of Physicians in England, described a condition which some have claimed is analogous to ADHD. Still described a group of children with significant behavioral problems, caused, he believed, by an innate genetic dysfunction and not by poor child rearing or environment.[28]. Analysis of Still's descriptions by Palmer and Finger[29] indicated that the qualities Still described are not "considered primary symptoms of ADHD".
The 1918–1919 influenza pandemic left many survivors with encephalitis, affecting their neurological functions. Some of these exhibited immediate behavioral problems which correspond to ADD. This caused many to believe that the condition was the result of injury rather than genetics.
1937 – Dr. Bradley in Providence RI reported that a group of children with behavioral problems improved after being treated with stimulant medication. [3]
1957 – The stimulant Methylphenidate (Ritalin) became available. It remains one of the most widely prescribed medications for ADHD in its various forms (Ritalin, Focalin, Concerta, Medadate, and Methylin).
1960 – Stella Chess described "Hyperactive Child Syndrome" introducing the concept of hyperactivity not being caused by brain damage. (http://campus.houghton.edu/orgs/psychology/student/adhd/sld004.htm)
1961 – Ritalin first indicated for "various behaviour problems in children".
By 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from Minimal Brain Damage to Minimal Brain Dysfunction. (Source: Oxford English Dictionary Online)
1970 – News reports that Ritalin was being prescribed to 5-10% of children in Omaha lead to national outcry and a Congressional inquiry.
1970s – Canadian Virginia Douglas released various publications to promote the idea that attention deficit was of more significance than the hyperactivity, influencing the American Psychiatric Association. http://faculty.ashrosary.org/faculty/counseling/ADHDNotes.htm
~1971 – The Church of Scientology set up the Citizen's Commission on Human Rights (CCHR), which lobbied using the media against psychiatric medication in general, and Ritalin in particular.
1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente Medical Center in San Francisco, claimed that hyperactivity was increasing in proportion to the level of food additives.
1975 – Pemoline (Cylert) is approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in at least 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market.
1980 – The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition.
1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder." [4]
1991 – The U.S. Department of Education rules that ADHD is an eligible condition for receipt of special educational services provided that it interferes with academic functioning. Most cases are dealt with under the "Other Health Impaired" category of special education while others qualify under the categories for learning and emotional disorders.
1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination.
1996 – ADHD accounted for at least 40% of child psychiatry references.[30]
1998 – the NIH developed and issued a Consensus Statement attesting to the existence of ADHD. A link is provided in the External Links section below.
1999 – New delivery systems for medications are invented that eliminate the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time release substances to permit medications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta).
1999 – The largest study of treatment for ADHD in history is published in the American Journal of Psychiatry. Known as the Multimodal Treatment Study of ADHD (MTA Study), it involved more than 570 ADHD children at 6 sites in the United States and Canada randomly assigned to 4 treatment groups. Results generally showed that medication alone was more effective than psychosocial treatments alone but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.
2001 – The International Consensus Statement on ADHD is published (Clinical Child and Family Psychology Review) and signed by more than 80 of the world's leading experts on ADHD to counteract periodic media misrepresentation that ADHD is not a real disorder and that medications are not justified as a treatment for the disorder. In 2005, another 100 European experts on ADHD added their signatures to this historic document certifying the validity of ADHD as a valid mental disorder.
2003 – Atomoxetine, the first new medication for ADHD in 25 years, receives FDA approval for use in children, teens, and adults with ADHD.