Wednesday, May 27, 2009

Attention Deficit Hyperactivity Disorder part 2

This is the second in a series on Attention Deficit Hyperactivity Disorder (ADHD). I said yesterday that I would describe the disorder and it's associated features. ADHD affects about
3% of the school age population. Some studies put the number at 6-7% but I believe that those figures include over diagnosis as the rates of the disorder before there were medications and while still called minimal brain dysfunction were about 3%. Males are affected at higher rates than females. ADHD symptoms change with maturation but the disorder does persist into adulthood. It is a very common co-occurring problem we see here at Cottonwood as one of the problems with ADHD is a much higher rate of substance abuse problems.

Attention Deficit Hyperactivity disorder begins in childhood. It represents a neurodevelopmental problem from birth and truly is a brain disorder. It cannot be diagnosed before age 5 as the symptoms overlap with normal childhood development. But in order to diagnose ADHD there must be symptoms present before age 7. ADHD is often not diagnosed until much later but the disorder begins early. Attentional and behavioral problems with onset after seven are very likely due to other causes. Two additional factors must be present for the diagnosis. The symptoms must occur in two or more settings such as home and school or at home and at work. There also must be significant social, academic, or occupational impairment as to adversely affect the ability to function as needed.

Attention Deficit Hyperactivity disorder is characterized by inattentive symptoms, hyperactivity and impulsivity or both as well as a number of associated features that are not part of the diagnostic criteria. The associated features are often the more disabling aspects of this illness. It can be diagnosed as ADHD - inattentive type or ADHD hyperactive type, or more commonly ADHD - combined type.

The symptoms of inattentiveness include failing to give close attention to details or making careless mistakes in schoolwork work or other activities, difficulty sustaining attention in tasks or play, difficulty listening when directly spoken to, inability to follow through on instructions and failure to finish tasks, difficulty organizing work or play activities, avoidance of tasks that require sustained mental effort, tendency to lose things, be easily distracted by extraneous stimuli, and forgetful in daily activities.

The symptoms of hyperactivity and impulsivity include tendency to fidget or be restless, leaving seat or situation in which it is expected to stay, runs about or climbs excessively or in adults easy restlessness or boredom, difficulty with engaging in leisure activities, tendency to be often on the go or act as if driven by a motor, talking excessively, blurting out things, difficulty waiting or taking turns and a tendency to interrupt.

The associated features include low frustration tolerance, temper outbursts, bossiness, excessive expectation and insistence that needs be met, mood swings, depression, demoralization, peer rejection, poor self esteem, academic impairment and development of oppositional and defiant behavior. In addition there is an increased risk of developing a substance abuse problem.

So we can see that this disorder is all pervasive, is not restricted to attention alone, and clearly is not made up by the pharmaceutical companies. I will talk some about treatment tomorrow.

Thought for the day

" Those who don't follow the movements of their own soul will be unhappy".

Marcus Aurelius

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