MEDICAL SURFARI: HOPE EXISTS FOR THOSE WHO HAVE ATTENTION DISORDER

This column originally ran Aug. 17. It is being rerun to correct editing errors.

Not a day passes without each of us encountering someone who displays inattention, impulsiveness or hyperactivity. But when these behaviors are observed in children, and when they clearly interfere with development, they may be a sign of attention-deficit/hyperactivity disorder (ADHD).

This condition has been given a variety of names that attempt to frame the constellation of behaviors. ADHD has been described as hyperkinesis, hyperactivity, minimal brain damage and minimal brain dysfunction. It was not until the late 1970s that the American Psychiatric Association coined the term attention-deficit/hyperactivity disorder and defined it as a "persistent pattern of inattention and/or hyperactivity or (impulsiveness) that is more frequent and severe than is typically observed in individuals at a comparable level of development."

Attention-deficit/hyperactivity disorder is the most commonly diagnosed behavioral disorder of childhood and has been estimated to affect 3-5 percent of school age children. Children with ADHD have a lot of trouble sitting still and paying attention in class and their behaviors are often quite disruptive.

The developmentally inappropriate levels of attention, concentration, activity, distractibility and impulsiveness lead to functional impairment at home, at school and in peer relationships. This may cause long-term problems in school, work and social situations. As these children grow older and remain untreated they may develop other conduct disorders and experience drug abuse, anti-social behavior and even physical injury.

Signs of inattention include poor listening skills, forgetfulness, easy distractibility and incompletion of activities, as well as difficulty focusing on any one task for a sustained period. These children also often demonstrate failure to follow instructions accurately and completely. The signs of impulsiveness include frequent interruption, shouting out answers before a question has been completed and difficulty taking turns while playing or when waiting is required. Signs of hyperactivity include wiggling, fidgeting, constant talking and/or a seemingly endless source of energy.

There are a lot of confusion and conflicting opinions about ADHD, especially about whether this is a real disorder and if it can be reliably diagnosed and effectively treated. Another major controversy regarding ADHD involves the use of psychostimulants (medications) and their potential overuse. World experts on ADHD recently agreed that the diagnosis of ADHD can be made reliably using well-tested diagnostic interview methods.

There are a wide variety of treatments for ADHD including medications, psychosocial treatment and dietary and herbal management, as well as biofeedback and perceptual stimulation training. Studies have shown that medical and psychosocial treatments have been effective in treating this condition, but there is no information on long-term outcomes.

It is thought that at least 2 percent of the general adult population remains affected by ADHD. This condition crosses ethnic boundaries and has been demonstrated in every nation and culture. It is not clear what causes ADHD, although many researchers believe that it may have a genetic basis that may be worsened by social factors.

Although, after years of research, the cause of ADHD remains speculative, there are effective treatments for this condition. Not everyone who is inattentive, impulsive or hyperactive has ADHD, but when these behaviors have been displayed for more than 6 months and before 7 years of age, the child should be evaluated by a family physician or pediatrician for the possibility of this disorder.

Web Resources

Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder

www.odp.od.nih.gov/consensus

This web site provided by the National Institutes of Health discusses diagnosing and treating people with attention deficit disorder.

What are the Symptoms of ADHD?

www.nimh.nih/gov/publicat/adhd.cfm

This web site provided by the National Institutes of Mental Health discusses the symptoms of ADHD and specific treatments. This site also provides information on support groups available.

Diagnosis and Evaluation of the Child With Attention Deficit/Hyperactivity Disorder

www.aap.org/policy/ac0002.html

This web site provided by the American Academy of Pediatrics discusses the evaluation, diagnosis, and treatment of children with ADHD. This site also provides specific criteria for diagnosing ADHD.

Dr. Scott Gibbs is a Cape Girardeau neurosurgeon and editor-in-chief of Mosby's Medical Surfari. You may e-mail questions to him at drgibbs@semissourian.com or write in care of the Southeast Missourian, P.O. Box 699, Cape Girardeau, Mo., 63702-0699.