Attention-Deficit/Hyperactivity Disorder (ADD or ADHD) is one of the most common neurobehavioral disorders of childhood and unfortunately most of its causes are unknown. It can persist through adolescence and into adulthood. According to the estimation of American Psychiatric Association’s Diagnostic and Statistical Manual-IV (DSM-IV-TR) 3%-7% of children suffer from ADHD. Some studies have estimated higher rates in community samples. Surprisingly, ADHD is diagnosed approximately three times more often in boys than in girls.
ADHD is a diagnosis applied to children and adults who consistently display certain characteristic behaviors over a period of time. The most common core features include:
- Distractibility (less concentration and poor sustained attention to tasks)
- Impulsivity (impaired impulse control and delay of gratification)
- Hyperactivity (excessive activity and physical restlessness)
ADHD does not often come alone and there are many other conditions that are commonly associated with ADHD like depression, bipolar disorder, oppositional defiant disorder, conduct disorders and learning disabilities. These are just some of the conditions that can appear with ADHD. Some studies have indicated that between 50% and 70% of individuals with ADHD also have some other conditions.
Early diagnosis and treatment can often times prevent problems later. According to studies, anywhere from 24% to 30% of patients with ADHD also suffer from depression. In the past it was thought that depression might have been the result of constant failures due to ADHD symptoms. Therefore, if ADHD was successfully treated, the depression should disappear. Based on this assumption, ADHD was considered to be the primary diagnosis and the depression was ignored. However, a study by the Pediatric Pharmacology Department at Massachusetts General Hospital in Boston indicated that depression and ADHD are separate and both should be treated one after the other or sometimes simultaneously (depending upon the individual case).
Clinical experience has shown that the most effective treatment for ADHD is a combination of medication (when necessary), therapy or counseling to learn coping skills and adaptive behaviors, and ADD coaching for adults.
Indeed, diagnosis can be very difficult. Stimulant medications, commonly used to treat ADHD, can sometimes cause side effects that mimic depressive symptoms. These medications can also increase symptoms of depression and bipolar disorders, making it hard to distinquish what are the true symptoms and which are caused from medication. Many physicians will, therefore, treat the depression first, and, once that has been controlled will begin to treat ADHD.
So in that case pepression becomes the “primary” diagnosis and ADHD becomes the “secondary” diagnosis. Other physicians will argue that treatment must be simultaneous, with treatment occurring at the same time. Arguments for this method of treatment say that in order to have either condition under control, both must be under control.
We should also understand that medication is often used to help normalize brain activity, as prescribed by a physician. Stimulant medications, like Ritalin, Dexedrine and Adderall are commonly used because they have been shown to be most effective for most people with ADHD. However, many other medications may also be used at the discretion of the physician.
Not just the medication, but behavior therapy and cognitive therapy are also often helpful to modify certain behaviors and to deal with the emotional effects of ADHD. Many adults also benefit from working with an ADHD coach to help manage problem behaviors and develop coping skills, such as improving organizational skills and improving productivity. Moreover, the role of parents cannot be underestimated in either case.
As it is one of the most common and deadly diseases, so it is recognized as a disability under federal legislation (the Rehabilitation Act of 1973; the Americans With Disabilities Act; and the Individuals With Disabilities Education Act). Appropriate and reasonable accommodations are sometimes made at school for children with ADHD, and in the workplace for adults with ADHD, which help the individual to work more efficiently and productively. The idea is to make them feel comfortable as they are already challenged as a human being we should help and respect them.
It is also believed that psychology does nothing to treat or even to address the real ADHD symptoms. Usually a psychologist and counselor help you and your child live with and accept the condition. So everybody, including the doctors, agree that the current state-of-the-art treatment for ADHD does nothing really to treat the actual disorder. Some experts recommend that all individuals receiving a diagnosis of ADHD should also have a complete and thorough psychological evaluation to determine the presence (or absence) of any co-existing disorders. Once this has been completed, a treatment team, sometimes consisting of family physician, psychologist and psychiatrist, can work together to create a treatment plan geared specifically for that individual.