ATTENTION DEFICIT - HYPERACTIVITY DISORDER
Dennis B. Kottler, MD
Westlake Village, CA
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See also: ADULT ADHD
Attention Deficit / Hyperactivity Disorder is a complex of behaviors that begin in childhood (prior to age 7) and often persist into adolescence or even adulthood. Not all psychiatrists are in agreement about the criteria used to diagnose this disorder. In the past, such terms as MDB (minimal brain dysfunction) and hyperkinetic disorder were used to describe aspects of this problem. The disorder is more prevalent in males, although it may be under-diagnosed in females. There seems to be some genetic factor involved, since first-degree relatives of patients (i.e., parents and siblings) also have a higher incidence of this disorder.
Some individuals have mainly the attention deficit components of this disorder, while others have mainly the hyperactivity components. However, the majority of individuals have symptoms of both components (combined type of the disorder).
Typical Attention Deficit Symptoms Include:
difficulty paying attention to details and making careless mistakes
difficulty maintaining focus on a task
difficulty listening when spoken to
difficulty with follow-through on tasks or undertaking many different tasks simultaneously and not completing them
difficulty with organization
avoiding activities requiring sustained attention and effort
losing things necessary for task completion
distracted easily by external stimuli
Typical Hyperactivity Symptoms Include:
fidgeting or squirming
difficulty staying seated in school (or work)
running or climbing about when not apppropriate
difficulty in engaging in recreational or other activities that require being quite
seeming to be in perpetual motion
impulsivity manisfested by not being able to await turn, blurting out answers, or interrupting others
By definition ("Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition") an individual must have at least 6 of the symptoms in either category above to be diagnosed with that component of the disorder (Attention Deficit or Hyperactivity). Also, some of these symptoms must have become manifest before age 7 years, the disorder must have persisted at least 6 months, behavior must be inappropriate for age level, the symptoms must exist in two or more different settings (e.g. school - work - home), and finally, there must be evidence of interference with social, educational, or occupational functioning.
In the case of adults, the Attention Deficit / Hyperactivity Disorder may show variations from the symptoms typically seen in children. For example, adults may be better able to control the impulse to get up and move about, but they will feel intense restlessness. Adults may also have learned that they can mitigate symptoms by use of substances, such as nicotine, amphetamines, or coccaine. Finally, adults, having more choices than children, may have engineered a lifestyle and occupation which is more tolerant of their attention or hyperactivity problems. Such an individual might avoid a desk job in favor of a job involving travel, for example. Many adults with this disorder experience marital and relationship problems or problems in the workplace.
Diagnosis and Treatment
Diagnosis and treatment of Attention Deficit / Hyperactivity Disorder is best left to a psychiatrist who has had considerable experience in treating this disorder. Most psychiatrists follow the diagnostic criteria contained within "The Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition,"-- see above. Treatment approaches generally involve the use of cognitive and behavioral techniques as well as medication, particularly with psychostimulants.
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