Defining Attention-Deficit/Hyperactivity Disorder
Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental psychiatric disorder characterized by a constant pattern of inattention and/or hyperactive and impulsive behavior that interferes with normal functioning. The first person to describe a version of ADHD was physician Heinrich Hoffmann, in the 1920s. The first official recognition of the disorder was "attention deficit disorder with and without hyperactivity," in the DSM-III (published in 1980). Revisions to the DSM eventually renamed the disorder as attention-deficit/hyperactivity disorder (ADHD).
Despite being the most commonly studied and diagnosed psychiatric disorder in children and adolescents, the cause in the majority of cases is unknown. The World Health Organization estimates that it affected about 39 million people as of 2013. It affects about 6%–7% of children when diagnosed using the earlier DSM-IV criteria; the incidence is about three times higher in boys than in girls. Approximately 30%–50% of children diagnosed with ADHD continue to experience symptoms as adolescents and adults.
ADHD continues to be very controversial and has elicited the input of parents, clinicians, teachers, policymakers, and even the media. Many critics argue that it is highly over-diagnosed, leading to stigmatization of the diagnosis and creating significant barriers for individuals who "legitimately" have the disorder. Children with diagnoses of ADHD are often judged as lazy and unfocused by choice. This over-diagnosis has led to a colloquial use of the term "ADHD" among children, adolescents, and adults alike, to indicate a general tendency toward distractibility and inattention.
DSM-5 Diagnostic Criteria
General symptoms of ADHD include inattention, hyperactivity (restlessness in adults), disruptive behavior, impulsivity, forgetfulness, inability to concentrate, impatience, thrill-seeking, excessive daydreaming, and unusual/disruptive sleep patterns. Academic difficulties and problems with relationships may be frequent. The symptoms can be difficult to define, as it is hard to draw a line between normal levels of inattention, hyperactivity, and impulsivity and significant levels that require intervention.
As a result of sometimes-unusual patterns in thought processing, children with ADHD may be very creative and/or able to grasp big-picture concepts more quickly. Many people with a diagnosis of ADHD are very successful; however, the disorder can make academic and work performance more challenging.
ADHD and academic performance
Many children with ADHD are unable to pay attention at school, leading to poor academic performance and sometimes isolation from peers.
The DSM-5 indicates three subtypes of ADHD:
- ADHD, Predominantly Inattentive Type (ADHD-PI): Symptoms include being easily distracted, forgetful, or disorganized; excessive daydreaming; poor concentration; and difficulty completing tasks. Often people refer to ADHD-PI as "attention deficit disorder" (ADD); however, the latter has not been officially accepted since the 1994 revision of the DSM. Children with the inattention subtype are less likely to act out or have difficulties getting along with other children.
- ADHD, Predominantly Hyperactive-Impulsive Type (ADHD-PHI): Symptoms include excessive fidgetiness and restlessness, hyperactivity, difficulty waiting or remaining seated, immature behavior, and sometimes destructive behaviors. Hyperactivity symptoms tend to go away with age and turn into "inner restlessness" in teens and adults with ADHD.
- ADHD, Combined Type is a combination of the two other subtypes. Most children with ADHD have the combined type.
To be diagnosed per DSM-5, at least six out of nine symptoms of inattention, hyperactivity-impulsivity, or both must be present for at least six months and to a degree that is much greater than others of the same age. To be considered, the symptoms must have appeared between the ages of 6 and 12 and must be observed in more than one environment (such as at home, at school, or at work). The signs must be inappropriate for a child of that age, and there must be evidence that it is causing social, academic, or work-related problems.
The cause of ADHD is unknown and still being heavily researched. Most researchers agree that it is an interaction between genetic and environmental factors, as is the case with most psychiatric disorders. Some cases of ADHD are related to previous infections or neurological trauma.
Environmental factors are also thought to play a significant role in the development of ADHD. Ingestion of alcohol or tobacco during pregnancy can affect central-nervous-system development and can increase the risk of offspring developing the disorder. ADHD is more common in children of anxious or stressed parents, and so some argue that ADHD is an adaptation that helps children face a stressful or dangerous environment with, for example, increased impulsivity and exploratory behavior. ADHD has also been linked to excessive television watching at an early age.
While there is no known cure for ADHD, there are several treatment approaches that help to manage its symptoms. ADHD management usually involves some combination of therapy, medication, and deliberate lifestyle change. While treatment may improve long-term outcomes, it does not entirely eliminate negative outcomes. Medications are only recommended as a first-line treatment in children who have severe symptoms and may be considered for those with moderate symptoms who fail to improve with counseling. Common medications include psychostimulants and some antidepressants; however, medicating children is a controversial issue because of drugs' ability to interfere with normal development.
Dietary modifications may also be of benefit, with evidence supporting the use of fatty acids and reduced exposure to food coloring. A low-carbohydrate diet can help keep blood sugar stable, which in turn helps with mood stability. Active exercise, similarly, can help keep mood stable; some balance-improving techniques may have an effect on the hypothalamus that can help with the ability to focus on tasks.