Attention deficit disorder

According to the American Academy of Pediatrics, almost half of all children with ADD also suffer from other conditions, such as depression and learning disabilities. Usually, effectively treating the coexisting condition makes ADD easier to manage.

Danielle, an adult sufferer of ADD, was first diagnosed when she was in middle school. “I used to think I was dumb. I would learn my schoolwork, then quickly forget everything I had just learned.” Danielle’s teachers accused her of simply having a short attention span. It was not until she learned that her father, and later her brother, had also been diagnosed with ADD, that she understood that she was not dumb and that her short attention span was caused by ADD.

Defining the disorder
The major symptoms of ADD include hyperactivity, inattentiveness, and impulsiveness. According to the Diagnostic and Statistical Manual of Mental Disorders, such symptoms must be apparent for six months or more and must be excessive and pervasive. They must be a continuous problem as opposed to a response to a temporary situation, such as a family member dying, moving to a new town, or some other circumstance. The behaviors also must occur in more than one setting, such as the classroom and playground, home and day camp, or home and office.

In addition, there must be clear evidence of impairment in social, academic, or occupational functioning as a result of the individual’s behavior. The symptoms should also not be accounted for by another mental health problem, such as depression or a personality disorder.

Treatment
Psychosocial interventions such as parent training and behavioral modifications are used for children diagnosed with ADD. The goal of intervention is to teach parents and educators methods that will allow them to better handle situations when they arise. Through psychosocial intervention, they learn how to reward a child for positive behaviors and how to discourage negative behaviors.

Drugs such as methylphenidate hydrochloride (Ritalin), dextroamphetamine sulfate (Dexedrine or Dextrostat), a dextroamphetamine/amphetamine formulation (Adderall), and other stimulants seem to suppress behaviors associated with ADD. The medication squelches hyperactivity and improves social interactions. It also helps users to concentrate, enabling them to perform better in school and at work.

Other drugs are prescribed when the more popular medications are not effective, including bupropion hydrochloride (Wellbutrin), imipramine hydrochloride (Tofranil), or nortriptyline hydrochloride (Pamelor), which are antidepressants that have been shown to improve hyperactivity and inattentiveness; clonidine hydrochloride (Catapres), which is used to treat high blood pressure and also is effective in managing ADD and treating conduct disorder, sleep disturbances, and tic disorders; and guanfacine hydrochloride (Tenex), which decreases fidgeting and restlessness andincreases attention and the ability to tolerate frustration. These medications are by no means a cure-all, but studies indicate that they can be highly effective when used as directed. In fact, as many as 9 out of 10 children show fewer symptoms while taking one of the most commonly used stimulants. When drugs are combined with behavior modification or counseling, symptoms may improve even more.

Further reading

• Diagnostic and Statistical Manual of Mental Disorders, DSM-IV-TR; American Psychiatric Association: Washington, DC, 2000.
• Discovery Health. http://health.discovery.com/.
• National Institutes of Health. www.nimh.nih.gov/publicat/adhd.cfm.