Attention Deficit Hyperactive Disorder (ADHD)

Attention Deficit Hyperactivity Disorder (ADHD) or Attention Deficit Disorder without the Hyperactivity (ADD) is a condition of the brain that makes it difficult for children to control their behavior in school and social settings. This condition is also known by various names: hyperactivity, minimal brain dysfunction, minimal brain damage and hyperkinetic syndrome. In 1968 the name was changed to hyperkinectic, meaning wildly fast-paced or excited, reaction of childhood. The focus was on hyperactive children who had a lot of trouble sitting still in the classroom and getting there work completed (Peter Jaska, Ph.D). In the 1980's the name was changed to attention Deficit Disorder because it became recognized that severe attention problems
and poor impulse control were characteristic as well. It also became clear that ADHD did not go away in childhood but continue through adulthood.
According to Peter Jaska, Ph.D., President of the ADDA, this genetic, inherited condition is not due to brain damage at all but rather to a variation in how the brain functions. All of these terms describe a condition that affects a child's ability to concentrate, to learn, and to maintain a normal level of activity Peter Jaska, Ph.D, 1999 National ADDA.
A child with ADHD/ADD has difficulty finishing any activity that requires concentration, they don’t seem to listen, their impulsive, restless even during sleep, they tend to call out in class and have an incredibly hard time waiting their turn in games or groups. The symptoms of ADHD are grouped into two broad categories: inattention and hyperactivity-impulsive behavior. In general, children are said to
have ADHD if they show six or more symptoms from each category for at least 6 months. These symptoms must significantly affect a child's ability to function in at least two social settings -- at home and at school. This helps ensure that the problem isn't with a particular teacher or only with parents. Children who have problems in school but get along well at home are not considered to have ADHD. In most children, symptoms appear between 4 and 6 years of age, although they sometimes may occur even earlier. Mayo clinic- Last Updated: May 18, 2007: Most children with ADHD don't have all the signs and symptoms of the disorder. Furthermore, symptoms may be different in boys and girls; boys are more likely to be hyperactive, and girls tend to be inattentive. Attention Deficit Hyperactivity disorder is thought to be more common in boys than in girls, this disorder often develops before the age of seven but is most often diagnosed when the child is between ages eight and ten. (American Psychiatric Association). In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys also tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous. While studies of the effects of ADHD/ADD on children are important, there are many researchers who have suggested other theories. However, their validity has not been established. One theory was that all attention disorders and learning disabilities were caused by minor head injuries or undetectable damage to the brain, perhaps from early infection or complications at birth. Based on this theory, for many years both disorders were called "minimal brain damage" or "minimal brain dysfunction." Although certain types of head injury can explain some cases of attention disorder, the theory was rejected because it could explain only a very small number of cases. Not everyone with ADHD has a history of head trauma or birth complications. Another theory was that refined sugar and food additives make children hyperactive and inattentive. As a result, parents were encouraged to stop serving children foods containing artificial flavorings, preservatives, and sugars. However, this theory, too, came under question. In 1982, the National Institutes of Health (NIH), the Federal agency responsible for biomedical research, held a major scientific conference to discuss the issue. After studying the data, the scientists concluded that the restricted diet only seemed to help about 5 percent of children with ADHD, mostly either young children or children with food allergies. What is it like to have ADHD? "It's like driving in the rain with bad windshield wipers. Everything is smudged and blurred and you're speeding along, and it's reeeeally frustrating not being able to see". How does it feel to have ADD? "Buzzing. Being here and there and everywhere". (Interview: American Psychiatric Association) In ADD, time collapses. Time becomes a black hole. To a person with ADD it feels that everything is happening all at once, creating a sense of panic and inner turmoil always on the go to keep the world from caving in. (Edward M. Hllowell, M.D., 1999.)Treatment usually includes behavioral therapy and emotional counseling combined with medications that correct neurochemical imbalances in the brain. (The Columbia Electronic Encyclopedia, Sixth Edition Copyright © 2006, Columbia University Press.)"The U.S. Drug Enforcement Administration (DEA) of the U.S. Department of Justice, which treats methylphenidate as a controlled substance, reports that manufacturers' sales increased nearly five-fold between 1990 and 1998 and that the U.S. now consumes 90 percent of the methylphenidate produced throughout the world. While prescriptions for methylphenidate began leveling off between 1995 and 1997, prescriptions for amphetamines, which are also used to treat ADHD, tripled, so overall use of stimulant drugs has continued to rise. One reason for the increase is that more elementary-school children are remaining on those drugs into their teens." Methylphenidate, most commonly known as Ritalin, is a stimulant often prescribed to children with attention deficit disorder. Use of the drug has become controversial in recent years, with many parent and consumer groups upset over widespread use of the drug in very young children. (Journal of American College Health 49).
Subtle structural abnormalities in the brain circuit that inhibits thoughts have been confirmed in the first comprehensive brain imaging study of ADHD. Three structures in the affected circuit on the right side of the brain -- prefrontal cortex, caudate nucleus and globus pallidus -- were smaller than normal in the boys with ADHD, when examined as a group. The prefrontal cortex, located in the frontal lobe just behind the forehead, is believed to serve as the brain's command center. The caudate nucleus and globus pallidus, located near the middle of the brain, translate the commands into action. "If the prefrontal cortex is the steering wheel, the caudate and globus are the accelerator and brakes, and it's this braking or inhibitory function that is likely impaired in ADHD. Xavier Castellanos, M.D., of the National Institute of Mental Health and colleagues report on their findings in the July issue of the Archives of General Psychiatry. ADHD is thought to be rooted in an inability to inhibit thoughts. Finding smaller right hemisphere brain structures responsible for such "executive" functions strengthens support for this hypothesis. Judith Rapoport, M.D., senior author on the paper and chief of the NIMH Child Psychiatry Branch, reports "However, because of normal genetic variation in brain structure, MRI scans cannot be used to definitively diagnose the disorder in any given individual"(Subtle Brain Circuit Abnormalities Confirmed in ADHD. Oct. 23, 1999)
It has been shown that people with ADHD have less activity in areas of the brain that control attention. By studying brain development in animals and humans, scientists are gaining a better understanding of how the brain works when the nerve cells are connected correctly and incorrectly. Scientists at NIMH and other research institutions are tracking clues to determine what might prevent nerve cells from forming the proper connections. Some of the factors they are studying include drug use during pregnancy, toxins, and genetics. NIMH grantees are also trying to determine if there are different varieties of attention deficit. With further study, researchers may find that ADHD actually covers a number of different disorders, each with its own cluster of symptoms and treatment requirements. For example, scientists are exploring whether there are any critical differences between children with ADHD who also have anxiety, depression, or conduct disorders and those who do not. Other researchers are studying slight physical differences that might distinguish one type of ADHD from another. If clusters of differences can be found, scientists can begin to distinguish the treatment each type needs.(1999-2001, Brain.com, c/o Hot Brain,Inc.)
Caring for a child with ADHD can be challenging for the whole family.
Parents may be hurt by their child's behavior as well as by the way other people respond to it. And the stress of dealing with ADHD can sometimes lead to marital problems and even divorce. These troubles may be compounded by the financial burden that ADHD can place on families. Siblings of an ADHD child also may have special difficulties. They can be affected by a brother or sister with ADHD who is demanding or aggressive, and they may also receive less attention because the ADHD child requires so much of a parent's time. There is still hope with several publications, organization and support groups to help parents, teachers and individuals to understand and cope with attention
disorders.
Difficulty staying mentally focused is a primary symptom of ADHD, which affects about 5 percent of school age children. Magnetic Resonance Imaging (MRI) scans of 57 boys with ADHD, aged 5-18, also revealed that their brains were more symmetrical than those of 55 age-matched controls. The NIMH researchers also found that the entire right cerebral hemispheres in boys with ADHD were, on average, 5.2% smaller than those of controls. The right side of the brain is normally larger than the left. Hence, the ADHD children, as a group, had abnormally symmetrical brains. Although the same brain circuit had been implicated earlier, Castellanos and colleagues examined a dozen times more brain areas in a three-fold larger sample than had been studied previously. “These subtle differences, discernible when comparing group data, hold promise as telltale markers for future family, genetic and treatment studies of ADHD". (Castellanos) The newly confirmed markers may provide clues about the causes of ADHD. The investigators found a significant correlation between decreased normal asymmetry of the caudate nucleus and histories of prenatal, perinatal and birth complications, leading them to speculate that events in the womb may affect the normal development of brain asymmetry and may underlie ADHD. Since there is evidence for a genetic component in at least some cases of ADHD, factors such as a predisposition to prenatal viral infections could be involved, said Dr. Rapoport of Princeton University. The NIMH researchers are currently following up on a recent discovery of a link between ADHD and a gene variant known to code for a particular receptor subtype for the neurotransmitter dopamine. "We want to see the extent to which children with this gene variant also have the brain structural abnormalities revealed in this study," said Dr. Castellanos. The researchers are currently extending confirmation of the markers in girls as well as boys who have not been exposed to medication. They are also using functional MRI scanning to visualize brain activity in ADHD.(National Institute of Neurological Disorders and Stroke.)