Attention deficit disorder (ADD)

• attention deficit/ hyperactivity disorder: combined type
• attention deficit/hyperactivity disorder: predominantly inattentive
• attention deficit/hyperactivity disorder: predominantly hyperactive or impulsive

The cause of attention deficit disorder is unknown. Some contributing factors include prenatal toxic exposure and prematurity . There frequently is a family history of school problems, behavioral disorders, or other psychosocial problems. There is sometimes a history of injuries to the central nervous system . However, there is no scientific evidence that shows conclusively that ANY of these factors directly cause attention deficit disorder. There may be a familial component involved (genetic) in some but not all cases. This may be seen with an increased incidence of ADHA in children with a first degree relative with ADHD, conduct disorders, antisocial personality, substance abuse and others.
The apparent incidence of A.D.D. has been increasing over the last 15 years, possibly related to better diagnosis, changing expectations, or problems with supportive social structures. There is a wide ranging estimate of the prevalence from 1.5 percent to 10 percent of children. The disorder is 3 to 10 times more common in males than females.

Typically affected children, whether intellectually handicapped or not, perform poorly in school because of the inability to attend to tasks at hand or to sit still during the school day. The diagnosis is generally not considered until school age, although there may be earlier indicators of pending problems.

Prevention:

Attention deficit disorder is a complex issue, and many preventive measures have been proposed. None have been proven at this time.

Symptoms:

The symptoms typically begin by 3 years of age.

Attention deficit:

• does not pay close attention to details; may make careless mistakes at work, school, or other activities
• failure to complete tasks
• has difficulty maintaining attention in tasks or play activities
• does not listen when spoken to directly
• has difficulty organizing tasks
• is easily distracted
• unable to follow more than one instruction at a time

Hyperactivity :

• fidgeting, squirming in seat, or moving constantly
• wandering, may leave the seat in the classroom when expected to stay
• has trouble participating in "quiet" activities such as reading
• runs and climbs in inappropriate situations
• talks excessively

Impulsivity:

• may blurt out answers before questions have been completed
• has difficulty awaiting turn
• interrupts others
• disruptive behavior

Other:

• sleep problems
• inability to delay gratification
• social outcasts or loners (possibly inability to play in groups but may perform in one-on-one situation)
• apparent disregard for own safety
• behavior not usually modified by reward or punishment
• may have other specific learning disabilities
• failure to meet normal intellectual developmental milestones

Signs and Tests:

Clinical evaluation is indicated if A.D.D. is suspected.

Evaluation may include:

• parent and teacher questionnaires (Connors, Burks)
• psychological evaluation of the child AND family including IQ testing and psychological testing
• complete developmental, mental, nutritional, physical, and psychosocial examination

Treatment:

Many medication methods of treatment have been tried. Attention deficit/ hyperactivity disorder is usually treated with a course of medications followed by therapy and appropriate school placement. The primary medications used to treat attention deficit disorder include:

• Dexedrine (dextroamphetamine) and other amphetamines such as Adderal may also be used in older children and adolescents
• Ritalin (methylphenidate)
• Cylert (magnesium pemoline)
• other classes of medications have been tried such as antidepressants (such as amitriptyline or fluoxetine), tranquilizers (such as thioridazine), alpha-adrenergic agonist (clonidine), and others but have met with little success and are not part of the general armamentarium.
• caffeine has been tried but with little success.
  
  Therapy techniques include:
• behavior modification
• parent counseling
• individual psychotherapy

Other helpful techniques may include

• modifying the environment to limit distracting factors
• providing one-on-one instruction with teacher

Prognosis:

Studies now have shown that the problems of attention deficit disorder may persist into adulthood; however, adults are usually more capable of controlling behavior and masking difficulties. Careful attention to education, socialization, and understanding your expectations should allow the child to develop into a functional adult. Statistics show that there is an increased incidence in juvenile delinquency and adult encounters with the law among individuals who had ADHD as a child. Every effort must be made to manage symptoms and direct the child Ã? s energy to constructive and educational paths.

Complications:

• school failure
• school drop-out
• delinquency
• criminal behavior

Call Your Healthcare Provider:

Call your health care provider if you or your child's school personnel suspect the possibility of attention deficit disorder.