Attention Deficit Hyperactivity Disorder

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ADHD Overview

Attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD), is a condition in which a person's inability to focus and concentrate on a task or purpose interferes with his or her ability to be productive. It can also affect how people develop social relationships or self-esteem.

Children with ADHD are often seen as unable to settle down —impulsive, hyperactive, disruptive, and even aggressive in classroom and social settings.

The medical community recognizes 3 basic forms of the disorder, as follows:

• Primarily inattentive: Inattentiveness to tasks or activities is the primary problem.
  
  
• Primarily hyperactive-impulsive: Impulsivity and inappropriate movement (fidgeting, inability to keep still) or restlessness are the primary problems.
  
  
• Combined: This is a combination of the inattentive and hyperactive-impulsive forms.

The combined type of ADHD is the most common. The predominantly inattentive type is being recognized more and more, especially in girls and in both sexes of adults. The predominantly hyperactive-impulsive type, without significant attention problems, is rare.

We are still learning about ADHD, and experts' ideas of the disorder are still being shaped. Some believe, for example, that the term attention deficit is misleading.

• They maintain that people with ADHD are actually able to pay attention too well, rather than too little, but have difficulty regulating their attention, leaving them unable to properly focus.
  
  
• Others have trouble ignoring irrelevant details and/or focus so intensely on specific details that they miss the bigger, more important, picture.
  
  
• Many cannot shift gears from one thing to another when they need to, leaving them unable to focus on what needs to be done. Extreme difficulty getting a child to stop playing a video game to come to dinner is a common example.

Contrary to some media accounts, attention disorders are not new. Childhood hyperactivity was a focus of interest in the early 1900s. Today, hyperactivity, impulsivity, and inattention are the focus, but disability related to hyperactivity and distractibility has been alluded to throughout medical history. What is new is the greater awareness of ADHD thanks to rapidly mounting research findings.

In the United States, ADHD affects about 3-7% of children. Similar rates are reported in other developed countries such as Germany, New Zealand, and Canada.

• In most cases, the unusual behaviors are noticed by the time the child is about 7 years old, although ADHD is occasionally diagnosed in teenagers or young adults.
  
  
• Boys are much more likely than girls to be diagnosed with ADHD. At one time, the ratio of boys to girls with ADHD was thought to be as high as 4:1 or 3:1. This ratio has been decreasing, however, as more is known about ADHD. For instance, greater recognition of the inattentive form of ADHD has increased the number of girls diagnosed with the disorder.
  
  
• People identified with ADHD in adulthood are almost as likely to be women as men, suggesting that we may have been missing the diagnosis in many young girls.

There is disagreement over whether ADHD persists as children grow into adults.

• Some believe that most children simply grow out of ADHD. Others believe that ADHD persists into adulthood in most cases. Estimates of the number of children with ADHD who continue to have the disorder in adulthood range from 30%-80%.
  
  
• Hyperactive symptoms may decrease with age, usually diminishing at puberty, perhaps because people tend to learn how to gain greater self-control as they mature.
  
  
• Inattention symptoms are less likely to fade with maturity and tend to remain constant into adulthood.
  
  
• As we learn more about ADHD, certain subtypes will likely be found to cause more adult dysfunction than others.

People with ADHD are much more likely than the general population to have other related conditions such as learning disorders, restless legs syndrome, ophthalmic convergence insufficiency, depression, anxiety disorder, antisocial personality disorder, substance abuse disorder, conduct disorder, and obsessive-compulsive behavior. People with ADHD are also more likely than the general population to have a family member with ADHD or one of the related conditions.

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Last Editorial Review: 11/18/2005