Attention Deficit Hyperactivity Disorder (cont.)

History of ADHD

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. Historical figures of diverse backgrounds and accomplishment have demonstrated behavior compatible with ADHD. Mozart composed and remembered entire musical compositions but disliked the tedious task and attention to detail necessary when transcribing to paper. Einstein would spend hours and even days sitting quietly in a chair doing "thought experiments," including complex series of mathematical calculations and revisions. Ben Franklin failed in school due to his perfectionist and impulsive behaviors. He later mastered five languages (self-taught) and was highly respected as an author, scientist, inventor, and businessman (publisher). What is new is the greater awareness of ADHD thanks to rapidly mounting research findings.

In the United States, ADHD affects about 8%-10% 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. Children with ADHD are often noted to be emotionally delayed, with some individuals having a delay in maturity of up to 30% when compared with their peers. Thus a 10-year-old student may behave like a 7-year-old; a 20-year-old young adult may respond more like a 14-year-old teenager.
• Boys are 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. Approximately one-quarter of those with ADHD have significant learning disabilities, including problems with oral expression, listening skills, reading comprehension, and mathematics.

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. Estimates of the number of children with ADHD who continue to have the disorder in adulthood range from 40%-50%.
• 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.