Major Characteristics
Although normal individuals, particularly young children, show some of these features, what distinguishes ADHD is the greater degree and frequency with which these characteristics are displayed for a person of a particular age.  More specifically, children with ADHD have difficulty making use of educational resources and experience symptoms that significantly impair their ability to function in academic, family, and social settings.  The following challenges are often found in children and adults with ADHD:

•   Inattention or poor persistence on many tasks, particularly those that are tedious, boring, and long.  The individual becomes bored rapidly during repetitive tasks, shifts from one uncompleted activity to another, frequently loses concentration during tasks, and fails to complete assignments.

•    Impulsivity or difficulty delaying gratification.  Difficulty being able to stop and think before acting; difficulty waiting his or her turn; not being able to work for larger, longer-term rewards; and not being able to inhibit behavior, as a situation demands.

•    Excessive irrelevant activity or poorly regulated activity to situational demands.  Individuals with ADHD are often excessively fidgety, restless, and “on the go.” They display movement that is not needed to complete a task, such as wriggling feet and legs, tapping things, rocking, or shifting position while performing relatively boring tasks. Trouble sitting still or inhibiting movement as a situation demands is often seen in younger children.

·         Disorganization.  Individuals with ADHD often exhibit difficulties with planning and organization.  This may be manifested by a disorganized approach to homework or other tasks, as well as feelings of being overwhelmed by large amounts of work.  The individual may also have a messy room or locker, and may forget to bring books home from school or take their homework with them to class.  Adults may misplace their keys or struggle to keep their schedule organized.

·         Executive Function Difficulties.  Executive functioning is the brain's ability to absorb information, interpret this information, and make decisions based upon this information.  A primary function of the executive system is directing, sustaining and coordinating attention.  Individuals with ADHD often have difficulty with executive functions and may display high levels of physical activity, inappropriate physical responses to others, a tendency to interrupt and disrupt group activities, or trouble with emotion regulation.

 

Types of ADHD

ADHD, Combined Type: Individuals who exhibit attention problems, as well as symptoms of hyperactivity and impulsivity.

ADHD, Predominantly Inattentive Type: Individuals who exhibit attention problems but do not display excessive activity levels are considered to have ADHD, Predominately Inattentive, (formerly called Undifferentiated Attention Deficit Disorder). This disorder appears less likely to be associated with aggression or conduct problems and may have a greater association with learning disabilities and with a personal or family history of anxiety. Also, this subtype is less likely to have early onset and may not be noticeable until academic demands requiring attention increase.

ADHD, Predominantly Hyperactive-Impulsive Type: Individuals who exhibit behaviors consistent with hyperactivity and impulsivity, but do not display attention problems.  This is often associated with a pattern of poor behavior and emotion regulation that is recognizable from a young age.  Individuals with this disorder often experience more social difficulties, such as peer rejection.

Other Characteristics
1. Early onset. Many ADHD individuals begin to show problems in early childhood, often at 3 to 4 years of age, and most have had their difficulties since the age of 7. However, it is believed that those with the mostly inattentive subtype (without prominent hyperactivity) of ADHD may not have shown noticeable symptoms at an early age.

2. Inconsistent performance of repeated tasks. ADHD individuals show wide swings in the quality, correctness, and speed with which they perform work. This may be seen in highly variable school or work performance. This variability is seen less in one-to-one activities with others, particularly if they are with their fathers or other authority figures. They also do better when the activities they are doing are new, highly interesting, or involve an immediate consequence for completing them. Group situations or relatively repetitive, familiar, and uninteresting activities are likely to cause the most problems for them.

3. Trouble following rules. ADHD individuals often have difficulty following through on instructions or assignments. This is not due to poor language comprehension, defiance, or memory impairment. Instructions do not guide behavior as well.

Frequently Associated Conditions
Persons with ADHD are more likely than others to have the following conditions:

1. Academic underachievement and learning disabilities. The vast majority of individuals with ADHD often perform below their expected levels of achievement in school relative to their tested intellectual and academic abilities. As many as 30% may also have reading disorders, while an additional 10 to 15% may have other academic disabilities, such as difficulties in math or writing.

2. Aggression or conduct problems. Studies suggest that up to 65% of individuals with ADHD have a co-existing condition known as Oppositional Defiant Disorder or aggression. This is shown by defiance toward adults or other authorities, stubbornness or disobedience of instructions, temper outbursts, destructiveness, and verbal or physical aggression toward others.  Teenagers with ADHD, particularly if not treated, are also at higher risk for drug and alcohol abuse.

3. Emotional Immaturity. A pattern of exaggerated emotional expressions may be observed, particularly in children with ADHD, in which the individual tend to overreact emotionally to frustrating, provocative, or stressful situations. These individuals may be described as having a lower frustration tolerance and as being more moody or emotionally sensitive than others. A quickness to display anger, sadness, elation, and other normal emotions occurs frequently in ADHD children. Low self-esteem is common by late childhood or early adolescence.

4. Anxiety and Depression. Individuals with ADHD are at greater risk for developing symptoms of anxiety and depression.  School or work-related problems may have a negative effect on self-esteem, leading the individual to question their competence.  In addition, highly active and impulsive individuals can be misunderstood by peers and as a result may have difficulty initiating and maintaining friendships, which may in turn negatively impact self-esteem, leading to mood disturbances. 

5. Social skills deficits. At least 50% of ADHD individuals have problems with social relationships. They may be described as self-centered, demanding, intrusive, insensitive to the feelings of others, and unappreciative of assistance from others.

6. Language Deficits. Language disorders are frequently associated with ADHD.  It is estimated that about 45% of individuals with ADHD also have at least one element of language impairment, including difficulty with verbal short-term memory.

7. Motor incoordination. Poor motor coordination is often associated with ADHD.  It can be an early symptom of ADHD among preschool-aged children and usually predicts the later development of additional ADHD symptoms.

Frequency
ADHD occurs in approximately 3 to 5% of the population. It is more common in individuals with a history of aggression, delinquency, substance abuse, truancy, learning, tics, or Tourette’s Syndrome and Obsessive Compulsive (OCD).

Causes
ADHD appears to have a strong biological basis, and may run in families. It is estimated that parents with ADHD have a 50% chance of having a child with ADHD, and about 25% of children with the disorder have parents who also meet criteria for ADHD. Biologically, ADHD affects chemicals in the brain that play a role in learning, motivation, goals, drives, and alertness.

In some cases, behaviors associated with ADHD can arise from environmental factors that affect brain development. For example, it may be connected with greater-than-normal pregnancy or birth complications. Exposure to chemicals during pregnancy, including cigarettes and alcohol, has also been linked to a higher risk of developing ADHD. In even fewer cases, it comes as a direct result of disease or trauma to the central nervous system that causes behaviors consistent with ADHD. The behaviors associated with genetic or acquired ADHD are often indistinguishable, and it is not unusual for individuals to have both forms of the disorder.

Research has not supported the view that ADHD is frequently due to the consumption of food additives, preservatives, or sugar. While in a few individuals their allergies can contribute to a worsening of ADHD, these allergies are not viewed as the cause of ADHD. Individuals with seizures or anticonvulsant drugs may develop ADHD as a side effect of their medication or may find their pre-existing ADHD features made worse by these medications. Although ADHD itself is believed to be a neurologically based disorder, many studies have shown that attention, concentration, and oppositional behavior are adversely affected by turmoil, conflict and instability in an individual’s life. This is true whether someone has ADHD.

Adult Outcome
It has been estimated that between 15 and 30% of children with ADHD ultimately “outgrow” their problems. Most individuals will continue to display their characteristics into young adulthood. Children with ADHD who begin to exhibit serious aggressiveness, defiance, and lying/stealing during the elementary school years are most likely to be at serious risk for later antisocial behavior problems. Yet some well-behaved ADHD children may also be at risk.

Evaluation / Diagnosis
There is no single medical or psychological test that diagnoses ADHD. A quality evaluation is one that is: conducted by a licensed health care professional with explicit training and experience in evaluating ADHD; comprehensive collection of information from multiple sources including family, educators, and the individual; able to “rule-in” the symptoms that make up this syndrome; and complete enough to “rule-out” other disorders that might co-exist with ADHD or that might explain ADHD.

Psychologists and other mental health professionals often integrate data collected from parents and teachers who complete rating scales about a child. Results of such tests can provide important clues as to whether a child’s difficulties are related to ADHD and/or other problems with learning, behavior, or emotional adjustment. Such scales offer measurable, information about the child, thus providing a way to compare a child’s behavior to others of the same sex and age. Psychological and educational tests of cognition, perception, attention span, visual-motor skills, memory, achievement, and social/emotional adjustment are often part of a valid and comprehensive evaluation.

Treatment
No treatments have been found to “cure” this disability, but many exist that have shown effectiveness in reducing either the level of symptoms or the degree to which they impair adjustment. The most substantiated treatment is the use of medications. However, most experts agree that medication alone is never the treatment of choice. Most medications used with ADHD to help first thing in the morning or at the end of the day. Medication does not teach the child anything they have failed to learn adequately (e.g. study skills & social skills). Medications often do not return the child to “normal.” Also, medications are not effective with 100% of the people who take them.

It is often recommended that other treatments be used first or in conjunction with the stimulant medications. These other treatments include training the parents of ADHD children in more effective child-management skills, modifying teachers’ classroom behavior-management methods, adjusting the length and number of assignments given to ADHD children at one time, and providing special educational services to those ADHD children with more serious degrees of the disorder.
Other treatments that show promise are social skills training, training in self-control methods (i.e., acquiring better problem-solving skills, learning to use self-directed instructions, anger control, and questions to slow down impulsive thinking).

For ADHD adults, educating them in practical methods of coping with their disability and enlisting the assistance of others in helping to better organize and structure ADHD individuals’ work-related activities may prove helpful. Also, the impact of ADHD on relationships may need to be addressed in individual or couples therapy. Stimulant medications may be effective.

For ADHD children and adolescents maximum organization, structure, and consistency across all environments (home & school) are major principles of intervention.  

Treatments with little or no or very limited scientifically valid evidence for their effectiveness in treating the core symptoms of ADHD including elimination of sugar or food additives, high doses of vitamins, chiropractic treatment, or sensory-integration therapy.

The treatment of ADHD requires education of the individuals or their caregivers as to the nature of the disorder and the methods proven to assist with its management. Treatment is likely to be multi-disciplinary, requiring the assistance of the mental health, educational, and medical professions at various points in its course. Treatment may be needed periodically over long intervals to assist ADHD individuals in coping with their behavioral disability.

 

Comprehensive Services for ADHD / ADD

ADHD Child / Adolescent / Adult Evaluation
A comprehensive and valid assessment of symptoms of ADHD to evaluate and rule-out disorders which may co-exist with ADHD or which may explain its symptoms. Information is obtained from parents, spouses, educators, and the individual child or adult. A doctoral-level psychologist conducts this evaluation. Conclusions guide medical management, educational therapy and other interventions.

Medical Management
When a trial of a medication is deemed an important part of the treatment for ADHD, such treatment is effectively coordinated with the referring physician, primary care physician or with our own consulting prescribing clinicians; Kathy Andolina, MS, RN, CNS, Nan Herron, M.D., Mona Huk, M.D. and Kirk Lum, M.D. However, most experts agree that medication alone is never the treatment of choice for ADHD and is best as part of a multi-modal treatment approach.

Neuropsychological / Learning Evaluation
Comprehensive testing to assess learning style and evaluate learning disabilities.

Child Behavior Management Training for Parents
This 12 week group program is designed to address non-compliance and oppositional behavior with parents of children between 4 & 11. This is accomplished by increasing parental knowledge of the causes of misbehavior and providing parents with more effective methods of dealing with child behavior problems.

Adolescent / Parent Family Therapy
Family therapy with adolescents who have ADHD is often focused on helping the family work together to improve their ability to communicate with each other and resolve conflicts on their own.

Self-Control Therapy for Children
Either in a group or individual, children are taught strategies that help them learn to use their thoughts to control their behavior (e.g. anger management). When combined with Behavior Management Training for parents and medical interventions, Self-control Therapy often leads to additional improvement in behavioral problems at home.

Group Therapy
A trained therapist works with children in pairs or small groups to address: social skills, social anxiety, and peer relationship difficulties amongst other things.

Therapies for Adults with ADHD
Individual and couples therapies are available for adults diagnosed with ADHD/ADD.

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