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Challenges and Choices: Attention-Deficit and Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) is one of the main reasons why children are referred for mental health services. ADHD affects a child's attention span and concentration. It can also affect how impulsive and active the child is. The energetic way in which children normally behave shouldn't be confused with symptoms of ADHD. Children who have ADHD are much more active, distracted, persistent and impulsive than other children. Symptoms of ADHD persist over time.

An Ontario study predicts that five to nine per cent of school-aged children may have ADHD. ADHD is three to four times more common in boys than girls. About two-thirds of children with ADHD continue to have the symptoms in adolescence.

ADHD is less common in adults. Adults with ADHD may be easily distracted (e.g., continually bored, forgetful or anxious). They may also be depressed, have low self-esteem, mood swings and difficulties at work and at other activities.

ADHD, according to the Diagnostic and Statistical Manual — fourth edition of the DSM-IV (American Psychiatric Association, 1994), is the most common psychiatric disorder in childhood, with three main impairing symptoms: impulsivity, inattention and motor hyperactivity. Motor activity tends to subside by adulthood, although an individual may present as restless and fidgety. Some outcome studies (Barkley, 1990; Weiss & Hechtman, 1989) suggest that ADHD is robust into adulthood with a prevalence rate around 3% to 5% of all adults.

Common symptoms and characteristics in adults with ADHD include low self-esteem, underachievement, poor concentration, lack of organization, impulsive behaviour, emotional lability, chronic boredom, and interpersonal relationship problems.. Impulsivity is a central feature of the disorder and seems to result from disruptions in the brain’s inhibitory control processes.

Individuals with ADHD have difficulty maintaining adequate levels of stimulation in some brain centres. They apparently compensate for this by having a heightened sensory arousal system that draws in more information than usual from the environment and tends to process it indiscriminately. This results in distractibility, racing thoughts and a scattered presentation. Individuals act impulsively on sensory information before they consider consequences. They also seek out novel or changing stimulation from the environment and without such stimulation they are easily bored. When they engage in this type of activity, and gambling is a good example, they tend to become excessively involved to the point of hyperfocus and the exclusion of other stimuli. Novelty seeking and high exploratory behavior, as in gambling and ADHD, can be akin to self-medication for a low mood state.  

Diagnosis

It is vital that a doctor who specializes in this area investigate concerns about ADHD. Self-diagnosis and self-medication are to be discouraged. Connecting to ADHD clinics may not be easy but they are available by referral from family doctors. A minimal assessment should involve a psychiatric interview to exclude other disorders, self-report questionnaires that establish a threshold for including ADHD as a diagnosis, a collateral history to establish childhood symptoms and some assessment of functioning to establish impairment in various domains.

Individuals with ADHD often seek medical treatment. Stimulants such as Ritalin are often the treatment of choice to address impulsivity. For depression, the addition of a serotonin-based medication is likely. Of course, careful monitoring and an evaluation of the efficacy of this intervention are indicated.

Support

There are organizations offering education and support such as the national chapter of Children and Adults with Attention Deficit Disorder (CHADD www.chadd.org ) and the local support group Attention Deficit Disorder Association (ADDA www.add.org ). The ADDO has monthly meetings for adults as well as for parents of children with the disorder. There are over 44,000 Web sites on the topic of ADHD, which can be overwhelming, however, it is a useful forum to deal with some issues. Popular texts on the subject include Driven to Distraction: Recognizing and Coping with Attention Deficit Disorder from Childhood Through Adulthood (Hallowell & Ratey, 1996) and You Mean I’m Not Lazy, Crazy or Stupid?!: A Self-Help Book for Adults with Attention Deficit Disorder (Kelly & Ramundo, 1995). Centres that offer resources on learning disabilities can be helpful with referrals and materials.

You may also wish to read Other Bumps in the Road: Adult Attention Deficit Disorder

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