Monday, August 8, 2016

Attention Deficit Hyperactivity Disorder (ADHD) - An Overview

Be Extraordinary, CHADD 2016
Source: CHADD


ADHD stands for Attention Deficit Hyperactivity Disorder, a condition with symptoms such as inattentiveness, impulsivity, and hyperactivity. 
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
The symptoms differ from person to person. ADHD was formerly called ADD, or attention deficit disorder. Both children and adults can have ADHD, but the symptoms always begin in childhood. Adults with ADHD may have trouble managing time, being organized, setting goals, and holding down a job. 


  • Inattention means a person wanders off task, lacks persistence, has difficulty sustaining focus, and is disorganized; and these problems are not due to defiance or lack of comprehension.
  • Hyperactivity means a person seems to move about constantly, including situations in which it is not appropriate when it is not appropriate, excessively fidgets, taps, or talks. In adults, it may be extreme restlessness or wearing others out with their activity.
  • Impulsivity means a person makes hasty actions that occur in the moment without first thinking about them and that may have high potential for harm; or a desire for immediate rewards or inability to delay gratification. An impulsive person may be socially intrusive and excessively interrupt others or make important decisions without considering the long-term consequences.



ADHD SYMPTOMS
Could someone you know have ADHD? Maybe they're inattentive. Or they might be hyperactive and impulsive. They might have all those traits.

There are three groups of symptoms:

  1. Inattention
  2. Hyperactivity
  3. Impulsivity

Get the facts on all of them, and learn examples of behaviors that can come with each.

Inattention
You might not notice it until a child goes to school. In adults, it may be easier to notice at work or in social situations.

The person might procrastinate, not complete tasks like homework or chores, or frequently move from one uncompleted activity to another.

People with symptoms of inattention may often:

  • Overlook or miss details, make careless mistakes in schoolwork, at work, or during other activities
  • Be disorganized
  • Lack focus
  • Have problems sustaining attention in tasks or play, including conversations, lectures, or lengthy reading
  • Have a hard time paying attention to details and a tendency to make careless mistakes. Their work might be messy and seem careless.
  • Have trouble staying on topic while talking, not listening to others, and not following social rules
  • Not follow through on instructions and fail to finish schoolwork, chores, or duties in the workplace or start tasks but quickly lose focus and get easily sidetracked
  • Have problems organizing tasks and activities, such as what to do in sequence, keeping materials and belongings in order, having messy work and poor time management, and failing to meet deadlines
  • Avoid or dislike tasks that require sustained mental effort, such as schoolwork or homework, or for teens and older adults, preparing reports, completing forms or reviewing lengthy papers
  • Lose things necessary for tasks or activities, such as school supplies, pencils, books, tools, wallets, keys, paperwork, eyeglasses, and cell phones
  • Be easily distracted by things like trivial noises or events that are usually ignored by others.
  • Be forgetful about daily activities (for example, missing appointments, forgetting to bring lunch)
Hyperactivity
It may vary with age. You might be able to notice it in preschoolers. ADHD symptoms nearly always show up before middle school.

Kids with hyperactivity may:

  • Fidget and squirm when seated.
  • Get up frequently to walk or run around.
  • Run or climb a lot when it's not appropriate. (In teens this may seem like restlessness.)
  • Have trouble playing quietly or doing quiet hobbies
  • Always be "on the go"
  • Talk excessively
Toddlers and preschoolers with ADHD tend to be constantly in motion, jumping on furniture and having trouble participating in group activities that call for them to sit still. For instance, they may have a hard time listening to a story.

School-age children have similar habits, but you may notice those less often. They are unable to stay seated, squirm a lot, fidget, or talk a lot.

Hyperactivity can show up as feelings of restlessness in teens and adults. They may also have a hard time doing quiet activities where you sit still.

Impulsivity
Symptoms of this include:

  • Impatience
  • Having a hard time waiting to talk or react
The person might:

  • Have a hard time waiting for their turn.
  • Blurt out answers before someone finishes asking them a question.
  • Frequently interrupt or intrude on others. This often happens so much that it causes problems in social or work settings.
  • Start conversations at inappropriate times.
Impulsivity can lead to accidents, like knocking over objects or banging into people. Children with ADHD may also do risky things without stopping to think about the consequences. For instance, they may climb and put themselves in danger.
Many of these symptoms happen from time to time in all youngsters. But in children with the disorder they happen a lot -- at home and school, or when visiting with friends. They also mess with the child's ability to function like other children who are the same age or developmental level.


ADHD TYPES
When it comes to ADHD, no one diagnosis or treatment fits all. Everyone is different. The American Psychiatric Association has identified three types. Each has different symptoms, and treatments are based on those symptoms.

Inattentive Type
A person with this type must have at least six of these nine symptoms, and very few of the symptoms of hyperactive-impulsive type:

  • Not paying attention to detail
  • Making careless mistakes
  • Failing to pay attention and keep on task
  • Not listening
  • Being unable to follow or understand instructions
  • Avoiding tasks that involve effort
  • Being distracted
  • Being forgetful
  • Losing things that are needed to complete tasks
Hyperactive-Impulsive Type
To have this type, a person has to have at least six of these nine symptoms, and very few of the symptoms of inattentive type:

  • Fidgeting
  • Squirming
  • Getting up often when seated
  • Running or climbing at inappropriate times
  • Having trouble playing quietly
  • Talking too much
  • Talking out of turn or blurting out
  • Interrupting
  • Often “on the go” as if “driven by a motor”
Combined Type
This is the most common type of ADHD. People with it have symptoms of both inattentive and hyperactive-impulsive types.  


GETTING DIAGNOSED
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.

ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
Doctors check for behavior that's:

  • Not typical for the person’s age. (Most children can behave in those ways at some point or another, though.)
  • Has a negative impact on the person’s ability to function at home, in social environments, or at work.

They also have to consistently display at least six of the above symptoms:

  • For at least 6 months
  • And in at least two settings, such as at home and in school
ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.

Long-Term Outlook
Overall, hyperactivity tends to diminish with age. But inattention tends to last into adulthood.
Treatment can help. And a great many children with ADHD ultimately adjust. Some -- about 20% to 30% -- have learning problems that ADHD treatment may not help, though.

As they grow older, some teens who've had the disorder since childhood may have periods of anxiety or depression. When there are more demands at school or home, symptoms of ADHD may get worse.

A child with hyperactive behavior may get symptoms of other disruptive disorders, like oppositional-defiant disorder.

These children are especially at risk to be more likely to drop out of school. If you’re concerned, talk to your or your child’s doctor about your treatment options. Medications, behavioral therapy, and other tactics can help.


RISK FACTORS
Scientists are not sure what causes ADHD. Like many other illnesses, a number of factors can contribute to ADHD, such as:

  • Genes
  • Cigarette smoking, alcohol use, or drug use during pregnancy
  • Exposure to environmental toxins during pregnancy
  • Exposure to environmental toxins, such as high levels of lead, at a young age
  • Low birth weight
  • Brain injuries
ADHD is more common in males than females, and females with ADHD are more likely to have problems primarily with inattention. Other conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance abuse, are common in people with ADHD.


TREATMENT AND THERAPIES
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.

For detail explanation of each treatments, you could read here


ADHD, Infographic
 Source: CDC


ADHD, Infographic
Source: CDC

Medication for ADHD

Behaviour therapy for young children with ADHD


ADHD THROUGHOUT THE YEARS
The timeline below shows estimates across the years for the percent of children in the United States with ADHD. Alongside the estimates of how many children have the condition, the timeline also illustrates how the criteria used to diagnose the condition have evolved. Finally, the timeline also marks the approval of medication treatments by the Food and Drug Administration (FDA) beginning with Benzedrine in 1936.

Consistent with previous reports, the estimates for the percent of children in the population who have ADHD varied widely across time. The difference in these numbers is likely based on variations in how the diagnostic criteria were applied. In addition, there may have been some differences in the demographic characteristics of the samples used to calculate the estimates. It is also possible that the samples were exposed to factors that affect ADHD, but until more is known about these factors, it is not possible to know whether they explain some of the variation.


Timeline of ADHD diagnostic criteria, prevalence and treatment 

ADHD, Infographic, CDC
Source: CDC

CDC provides larger version here.


TIPS TO HELP KIDS AND ADULTS WITH ADHD STAY ORGANIZED

For Kids:
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:

  • Keeping a routine and a schedule. Keep the same routine every day, from wake-up time to bedtime. Include times for homework, outdoor play, and indoor activities. Keep the schedule on the refrigerator or on a bulletin board in the kitchen. Write changes on the schedule as far in advance as possible.
  • Organizing everyday items. Have a place for everything, and keep everything in its place. This includes clothing, backpacks, and toys.
  • Using homework and notebook organizers. Use organizers for school material and supplies. Stress to your child the importance of writing down assignments and bringing home the necessary books.
  • Being clear and consistent. Children with ADHD need consistent rules they can understand and follow.
  • Giving praise or rewards when rules are followed. Children with ADHD often receive and expect criticism. Look for good behavior, and praise it.
For Adults:
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:

  • Keeping routines
  • Making lists for different tasks and activities
  • Using a calendar for scheduling events
  • Using reminder notes
  • Assigning a special place for keys, bills, and paperwork
  • Breaking down large tasks into more manageable, smaller steps so that completing each part of the task provides a sense of accomplishment.


SYMPTOM CHECKLIST
Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Psychiatric Association's Diagnostic and Statistical Manual, Fifth edition (DSM-5) is used by mental health professionals to help diagnose ADHD. It was released in May 2013 and replaces the previous version, the text revision of the fourth edition (DSM-IV-TR). This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. Using the same standard across communities will help determine how many children have ADHD, and how public health is impacted by this condition.

There were some changes in the DSM-5 for the diagnosis of ADHD: symptoms can now occur by age 12 rather than by age 6; several symptoms now need to be present in more than one setting rather than just some impairment in more than one setting; new descriptions were added to show what symptoms might look like at older ages; and for adults and adolescents age 17 or older, only 5 symptoms are needed instead of the 6 needed for younger children.

The criteria are presented in shortened form. Please note that they are provided just for your information. Only trained health care providers can diagnose or treat ADHD.

If a parent or other adult is concerned about a child’s behavior, it is important to discuss these concerns with the child’s health care provider.

You could download ADHD Symptom Checklist here.


10 PPROBLEMS THAT COULD MEAN ADULT ADHD
A lot of the time it’s not hard to spot ADHD in kids. But adults can have more subtle symptoms. This means many adults struggle with ADHD and may not know they have it. They may not realize that many of the problems they face, including staying organized or being on time, relate back to ADHD.

Here are 10 potential warning signs of adult ADHD:

No. 1: Trouble Getting Organized
For people with ADHD, the responsibilities of adulthood -- bills, jobs, and children, to name a few -- can make problems with organization more obvious and more problematic than in childhood.

No. 2: Reckless Driving and Traffic Accidents 
ADHD makes it hard to keep your attention on a task, so spending time behind the wheel of a car can be hard. ADHD symptoms can make some people more likely to speed, have traffic accidents, and lose their driver’s licenses.

No. 3: Marital Trouble
Many people without ADHD have marital problems, so a troubled marriage shouldn’t necessarily be seen as a red flag for adult ADHD. But there are some marriage problems that are likely to affect the relationships of those with ADHD. Often, the partners of people with undiagnosed ADHD take poor listening skills and an inability to honor commitments as a sign that their partner doesn’t care. If you’re the person with ADHD, you may not understand why your partner is upset, and you may feel you’re being nagged or blamed for something that’s not your fault.

No. 4: Extremely Distractible
ADHD is a problem with attention, so adult ADHD can make it hard to succeed in today’s fast-paced, hustle-bustle world. Many people find that distractibility can lead to a history of career under-performance, especially in noisy or busy offices. If you have adult ADHD, you might find that phone calls or email derail your attention, making it hard for you to finish tasks. 
 
No. 5: Poor Listening Skills
Do you zone out during long business meetings? Did your husband forget to pick up your child at baseball practice, even though you called to remind him on his way home? Problems with attention result in poor listening skills in many adults with ADHD, leading to a lot of missed appointments and misunderstandings.

No. 6: Restlessness, Trouble Relaxing
While many children with ADHD are “hyperactive,” this ADHD symptom often appears differently in adults. Rather than bouncing off the walls, adults with ADHD are more likely to be restless or find they can’t relax. If you have adult ADHD, others might describe you as edgy or tense.

No. 7: Trouble Starting a Task
Just as children with ADHD often put off doing homework, adults with ADHD often drag their feet when starting tasks that require a lot of attention. This procrastination often adds to existing problems, including marital disagreements, workplace issues, and problems with friends.

No. 8: Lateness
There are many reasons for this. First, adults with ADHD are often distracted on the way to an event, maybe realizing the car needs to be washed and then noticing they’re low on gas, and before they know it an hour has gone by. People with adult ADHD also tend to underestimate how much time it takes to finish a task, whether it’s a major assignment at work or a simple home repair.

No. 9: Angry Outbursts
ADHD often leads to problems with controlling emotions. Many people with adult ADHD are quick to explode over minor problems. Often, they feel as if they have no control over their emotions. Many times, their anger fades as quickly as it flared, long before the people who dealt with the outburst have gotten over the incident.

No. 10: Prioritizing Issues
Often, people with adult ADHD mis-prioritize, failing to meet big obligations, like a deadline at work, while spending countless hours on something insignificant.
Getting a Diagnosed
If you think you have adult ADHD, get examined by a trained and experienced mental health professional. It can be hard to diagnose because some possible symptoms -- like poor concentration or motivation, or relationship problems -- can also be signs of other conditions. Depression or substance abuse can have similar symptoms. Once you get checked out, you can get the best help for you and start feeling better.



Free Booklet and Brocures about ADHD here.

You could read ADHD Fact Sheet here.



Source:
WebMD-ADHD Overview
WebMD-Symptoms of ADHD
WebMD-Types of ADHD
WebMD-10 Symptoms on Adult ADHD 
NIMH-NIH-USA-Attention Deficit Hyperactivity Disorder
CDC-Symptom Checklist
CDC-ADHD-Free Materials  
CDC-Timeline-ADHD Throughout the Years
 

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