ATTENTION DEFICIT/HYPERACTIVITY DISORDER

Attention Deficit/Hyperactivity Disorder



Attention Deficit/Hyperactivity Disorder

Attention deficit/hyperactivity disorder (AD/HD) is the most common childhood behavior disorder. It is characterized by developmentally elevated levels of inattention, impulsivity, and hyperactivity. These three symptoms are so imperative that they have been referred to as the “holy trinity” of AD/HD. Over the years, the disorder has gone by a number of different names, including minimal brain dysfunction (MBD), hyperkinesis, hyperkinetic reaction of childhood, and attention deficit disorder (ADD). Regardless of the name, some variation of those three symptoms has been included as a part of the diagnosis. Concerns related to symptoms of AD/HD represent 30% to 40% of all psychologically based referrals made to primary care medical practices.

In the past, it was widely assumed that children outgrew AD/HD during their adolescent or early adult years. While some individuals do appear to no longer be affected by the disorder once they reach their early 20s, there is increasing evidence that 40% to 60% of children will continue to experience debilitating symptoms of AD/HD well into adulthood.

Attention deficit/hyperactivity disorder negatively affects not only the affected individual, but also those around him or her. Consequently the assessment and treatment of AD/HD needs to be comprehensive and systemic. Research suggests that pharmacological and behavioral treatments are quite effective in reducing the severity of the symptoms and resulting negative effects. In addition, individuals receiving treatment are less likely to develop additional psychiatric disorders as they get older.

Prevalence

While there is variability in the estimated prevalence of the disorder, most researchers agree that AD/HD affects between 3% and 7% of the school-age population. The reported prevalence differences likely reflect variations in assessment methodologies, such as sampling procedures, assessment instruments, and diagnostic criteria. For example, the estimates of affected children tend to be inflated when sampling procedures do not assess for the degree of functional impairment. There is currently limited information regarding the prevalence of AD/HD in adults, but based upon extrapolations from childhood estimates, some researchers have suggested that AD/HD affects between 2% and 6% of the adult population.

Prevalence variation also appears to be related to gender. There is a large body of empirical evidence to suggest that males are much more likely to be diagnosed with AD/HD than females. Estimated male-to-female ratios for the disorder range from 2:1 to 9:1 depending upon the setting (community sample vs. clinic referred sample). It also appears that the gender discrepancy is lower for individuals with the predominantly inattentive subtype of AD/HD.

Diagnostic Criteria

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) specifies 18 symptoms that compose the disorder. Nine of the criteria are related to symptoms of inattention, and nine are related to symptoms of hyperactivity/impulsivity. Symptoms of inattention include failure to pay attention, having difficulty with sustained attention, not listening, not following through on instructions, poor organization skills, avoiding tasks requiring sustained mental effort, often losing things, being easily distracted, and being forgetful. Symptoms of hyperactivity include fidgeting often, getting out of one's seat at inappropriate times, behaving ...