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What is Attention Deficit Disorder?
Attention Deficit Disorder (ADD) is a syndrome which is usually
characterized by serious and persistent difficulties resulting in:
a) poor attention span
b) weak impulse control
c) hyperactivity (not in all cases)
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 oftentimes, hyperactivity,
are common characteristics of the disorder. Boys with ADD tend to
outnumber girls by 3 to 1, although ADD in girls is under identified.
The term ADD is usually referring to ADHD. ADD without hyperactivity
is also known as ADD/WO (Without) or Undifferentiated ADD.
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What are some common symptoms of ADD?
1. Excessively fidgets or squirms.
2. Difficulty remaining seated
3. Easily distracted
4. Difficulty awaiting turn in games
5. Blurts out answers to questions
6. Difficulty following instructions
7. Difficulty sustaining attention
8. Shifts from one activity to another
9. Difficulty playing quietly
10. Often talks excessively
11. Often interrupts
12. Often doesn't listen to what is said
13. Often loses things
14. Often engages in dangerous activities
Recent literature proposes 2 subtypes of ADHD: Behavioral and
Cognitive (being split 80/20).
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How is ADD diagnosed?
The list above is taken directly from the American Psychiatric
Association's (APA) latest "Diagnostics 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.
EEG abnormalities can appear in up to 50% of ADD children (not used in
diagnoses).
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.
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Is this a new disease?
No. It had been identified in medical literature more than 100 years
ago. A popular German tale (Hoffmann's "Struwel Peter") written in
rhyme for children portrays a child with ADHD.
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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 ADD (Etiology)?
A single cause has not been conclusively proven (idiopathic). Some
possibilities are:
1. Genetic/ Hereditary (strongest correlation)
2. Brain damage (head trauma) before, after or during birth (twice
as likely to have had labor> 13hrs)
3. Brain damage by toxins (internal: bacterial and viral, external:
fetal alcohol syndrome, metal intoxication, eg lead)
4. 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.
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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).
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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:
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Learning Disabilities (LDs)
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TIC disorders (such as
Tourette`s) 20 % of ADD children whereas 40 to 60% of TIC children have ADD
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Gross
and Fine Motor control delays (coordination) 50% of ADD children
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developmental
delays (such as speech)
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Obsessive-compulsive disorders (OCD)
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What treatment is there for ADD?
No simple treatment. Must be a multi-modal approach including (but not
limited to):
a. Medication
b. Training of parents
c. Counseling/training of child:
such as modeling, self-verbalization and self-reinforcement.
d. Special education environment
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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.
a) Dietary Intervention. The changing of a child's diet to prevent
ADHD.
Conclusion: No scientific evidence of effectiveness.
b) Megavitamin and Mineral Supplements. The use of very high does of
vitamins and/or minerals to treat ADHD.
Conclusion: No scientific evidence of effectiveness.
c) 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.
d) Candida Yeast. Those who support this model believe that toxins
created by the yeast overgrow and weaken the immune system making
the individual susceptible to many illnesses including ADHD.
Conclusion: No scientific evidence of effectiveness.
e) EEG Biofeedback. Proponents of this approach believe that ADHD
children can be trained to increase the type of brain-wave activity
associated with sustained attention.
Conclusion: No scientific evidence of effectiveness.
f) Applied Kinesiology (Chiropractic approach). This theory believes
that Learning Disabilities are caused by 2 specific bones in the
skull.
Conclusion: No scientific evidence of effectiveness.
g) Optometric Vision Training. This proposes that reading related
Learning Disabilities are caused by visual problems.
Conclusion: No scientific evidence of effectiveness.
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What medications can be used in
treatment?
This is a constantly evolving area. At the time of the writing (Jan
93) of this FAQ and known to this author are:
Psychostimulants (Trade name and chemical name):
1. Ritalin (methylphenidate) also SR Ritalin (Slow Release)
2. Dexedrine (dextroamphetamine)
3. Adderall
4. Concerta
5. Stratera
6. Focalin
Antidepressants (Tricyclic or TCAs) used to treat bed wetting and
depression:
1. Tofranil or Janimine (impramine)
2. Norpramin or Pertofane (desipramine)
3. Pamelor (nortriptyline) principle metabolite of ELavil
(amitripyline)
Neuroleptics (usually used with stimulant):
1. thioridazine
2. Propericiazine
3. chlorpromazine (unsure of category)
Tranquilizers:
1. Mellaril
2. Atarax
Antihypertensive:
1. Catapres (clonidine)
Others:
1. antidepressants ( called monoamin oxidase inhibitors MAO)
fluoxetine or burproprion
2. lithium
3. Tegretol (anticonvulsant caramazepine) mood stabilizer
Note: None of these (listed in other) have been extensively studied for
use with children.
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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.
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What are some monitoring tools/scales:
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Conner's Teacher/Parents Rating scales (CTRS,CPRS) *
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ADD-H Comprehensive teacher rating scale (ACTeRS)
*
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Child Attention Problems (CAP) Rating scale
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Yale Children's Inventory (YCI)
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Attention Battery (includes Continuous Performance Task,
Progressive Maze Test and Sequential Organization Test (SOT).
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DSM-III-R
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Wechsler Intelligence Scales for Children (WISC-R)
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Child Behavior Checklist (CBCL)
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T.O.V.A - Test of Variables of
Attention*
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Learning Efficiency Test II (LETT-II)*
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Developmental Test of Visual Motor Integration (VIM)
*
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Wide Range Achievement Test (WRAT-R) *
* (Can be purchased from ADD Warehouse)
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What are some myth-conceptions about ADD?
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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Are there any support groups?
Yes. Largest is CHADD.
Children & Adults with Attention Deficit Disorder
-- - - -
National Office
499 N.W. 70th Ave.
Suite 308
Plantation, Florida 33317
Phone 305-587-3700
Fax 305-587-4599
LDA
Learning Disabilities Association
4156 Library Road
Pittsburg, Pennsylvania 15234
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Is there a good commercial source for information?
Yes. ADD Warehouse.
1-800-233-9273 (US only)
Phone 305-792-8944
Fax 305-792-8545
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