Attention Deficit Disorder (ADD)

What is an Attention Deficit Disorder?

Attention Deficit Disorder (ADD) is a syndrome which is usually characterized by serious and persistent difficulties resulting in:

poor attention span
weak impulse control
hyperactivity

ADD also has a subtype which includes hyperactivity (ADHD). It is a treatable (note not curable) complex disorder which affects approximately 3 to 6 percent of the population (70% in relatives of ADD children). Inattentiveness, impulsivity, and often times, hyperactivity, are common characteristics of the disorder. Boys with ADD tend to outnumber girls by 3 to 1, although ADD in girls is under diagnosed. ADD without hyperactivity is also known as ADD/WO (With Out) or Undifferentiated ADD.

What are some common symptoms of ADD?

Excessively fidgets ( 1. To behave or move nervously or restlessly. 2. To play or fuss; fiddle: He fidgeted with his notes while lecturing)

Excessively  squirms (Wriggle or twist the body from side to side, esp. as a result of nervousness or discomfort: "all my efforts to squirm out of his grasp were useless".)

Difficulty remaining seated
Easily distracted
Difficulty awaiting turn in games
Blurts out answers to questions
Difficulty following instructions
Difficulty sustaining attention
Shifts from one activity to another
Difficulty playing quietly
Often talks excessively
Often interrupts
Often doesn't listen to what is said
Often loses things
Often engages in dangerous activities

Recent literature proposes 2 subtypes of ADHD, Behavioral and Cognitive (being split 80/20).

How is ADHD diagnosed?

The list above is taken directly from the American Psychiatric Association's (APA) latest "Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R). To qualify for a diagnosis of ADHD, a child must exhibit 8 of these for a period longer than 6 months and have appeared before the age of 7 years. However, you don't have to be hyperactive to have attention deficit disorder. In fact, up to 30% of children with ADD are not hyperactive at all, but still have a lot of trouble focusing.

What other names has this disease been known by?

Minimal brain dysfunction (MBD) and hyperactivity (hyper-kinetic) or (in Britain) conduct disorder (not the same implications as the North American reference in the DSM-III-R).

What causes ADHD (Etiology)?

A single cause has not been conclusively proven (idiopathic). Some possibilities are:

Genetic/Hereditary (strongest correlation) Brain damage (head trauma) before, after and during birth (twice as likely to have had labour & gt; 13hrs) Brain damage by toxins (internal bacterial and viral, external fetal alcohol syndrome, metal intoxication, eg. lead) Strongly held belief by some people (including at least one book Feingold's "Cookbook for Hyperactive children") that food allergies cause ADD. This has not been proven scientifically.

What is the long term prognosis?

One book states 20% outgrow it by puberty but other problems can interfere. ADD that lasts into adulthood is referred to as ADD-RT (Residual Type).

Are there other complications of this disease?

Yes. Not really complications in the classical sense but rather clusters of other problems of the Central Nervous System (CNS) such as:

Learning Disabilities (LDs)
TIC disorders (such as Tourette's) 20 % of ADD children whereas 40 to 60% of TIC children have ADD Gross and Fine Motor control delays (coordination) 50% of ADD children developmental delays (such as speech)
Obsessive-compulsive disorders (OCD)

What treatment is there for ADHD?

No simple treatment. Must be a multi-modal approach including (but not limited to):

Medication
Training of parents
counselling training of child: such as modeling, self-verbalization and self-reinforcement. Special education environment

What are some controversial ADD Treatments?

(This section was condensed from an article Controversial Treatments for Children with ADHD by S. Goldstein Ph.D. & B. Ingersoll Ph.D.)

Dietary Intervention.
The changing of a child's diet to prevent ADHD. Conclusion: No scientific evidence of effectiveness.

Megavitamin and Mineral SupplementsW
The use of very high does of
vitamins and/or minerals to treat ADHD. Conclusion: No scientific evidence of effectiveness.

Anti-Motion Sickness Medication
. The advocates of this believe that a relationship exists between ADHD and the inner-ear. Conclusion: No scientific evidence of effectiveness.

What medications can be used in treatment?

(ALL MEDICATION SHOULD BE TAKEN UNDER PSYCHIATRIC SUPERVISION )

This is a constantly evolving area. The current line of thinking appears to be to treat Adults first with Antidepressants and children (depending on symptoms) with Stimulants. The 2 main lines of attack are with Stimulants and Antidepressants with the remainder of the drugs generally used as adjuncts. The drugs are listed as trade name (and chemical name in brackets). At the time of the writing (4/17/94) of this FAQ and known to this author are:

Psychostimulants (Trade name and chemical name)

Ritalin (methylphenidate) also SR Ritalin (Slow Release) Dexedrine (dextroamphetamine)
Cylert (pemoline)

Antidepressants (Tricyclic or TCAs; often used to treat bed wetting and depression)

Tofranil or Janimine (impramine)
Norpramin or Pertofane (desipramine)
Pamelor (nortriptyline) principle metabolite of ELavil (amitripyline) Wellbutrin (buproprion)

Neuroleptics (adjunct)

thioridazine
Propericiazine
chlorpromazine (unsure of category)

Tranquilizers

Mellaril
Atarax

Impulsive/Tantrums (adjuncts)

Corgard (nadolol)
Inderal (propranol)

Mood Stabilizers (adjuncts)

Prozac (fluoxetine)
BuSpar (Buspirone)
Catapres (clonidine) antihypertensive
lithium
Tegretol (anticonvolsant caramazepine) Depakoate (valproate)

Note none of these (listed in other) have been extensively studied for use with children.

What about caffeine?

Although caffeine is a stimulant it does not focus specifically enough in the areas of the brain to be effective. The dose required to be effective introduces too many negative side effects.

What are some myth-conceptions about ADD?

Note: This section was lifted from an article published in the Fall 1991 Chadder titled 'Medical Management of Children with ADD Commonly Asked Questions' by Parker et al.

Medication should be stopped when a child reaches teen years

Research clearly shows that there is continued benefit to medication for those teens who meet criteria for diagnosis of ADD.

Children build up a tolerance to medication

Although the dose of medication may need adjusting from time to time there is no evidence that children build up a tolerance to medication.

Taking medication for ADD leads to greater likelihood of later drug addiction

There is no evidence to indicate that ADD medication leads to an increased likelihood of later drug addiction.

Positive response to medication is confirmation of a diagnosis of ADD

The fact that a child shows improvement of attention span or a reduction of activity while taking ADD medication does not substantiate the diagnosis of ADD. Even some normal children will show a marked improvement in attentiveness when they take ADD medications.

Medication stunts growth

ADD medications may cause an initial and mild slowing of growth, but over time the growth suppression effect is minimal if non-existent in most cases.

Taking ADD medications as a child makes you more reliant on drugs as an adult

There is no evidence of increased medication taking when medicated ADD children become adults, nor is there evidence that ADD children become addicted to their medications.

ADD children who take medication attribute their success only to medication

When self-esteem is encouraged, a child taking medication attributes his success not only to the medication but to himself as well.

Note this section was lifted from an article published in the Fall 1991 Chadder titled "Medical Management of Children with ADD Commonly Asked Questions" by Parker et al.