Attention deficit disorder: characteristics, diagnosis, and management

Attention Deficit Disorder: Yes, It Does Exist

The existence of the syndrome that has come to be known in recent decades as either Attention Deficit Disorder (ADD) or Attention Deficit Hyperactivity Disorder (ADHD) (ADHD, as opposed to ADD, is Attention Deficit Disorder with hyperactive symptoms) (Hallowell and Ratey, 1994; Wender, 1995; Barkley, 1997) was first identified in 1937 when Dr. Charles Bradley, discovered "effective treatment of children with stimulants ("Does ADHD Exist?," 2005). Moreover, "ADHD has received more scientific scrutiny than any other childhood psychiatric disorder" ("Does ADHD Exist?"). Still, some, including concerned parents (Collier, 2005) and even one pediatric neurologist, Fred Baughman, M.D., continue to insist that ADD and/or ADHD have been "made up" for the combined benefit of teachers wanting tranquil children in class, and drug companies. ("Does ADHD Exist? PBS Frontline 2005). However, in January 2002, in response to such arguments, 75 international scientists issued the following statement:

We fear that inaccurate storied rendering ADHD as myth, fraud, or benign condition may cause thousands of sufferers not to seek treatment for their disorder.

It also leaved the public with a general sense that this disorder is not valid or real or consists of a rather trivial affliction. (ADHD International Consensus Statement)

It is my opinion, therefore, based on a preponderance of both medical and anecdotal evidence, that despite some (mostly non-medical) resistance to the idea of its existence, Attention Deficit Hyperactivity Disorder (ADHD) does indeed exist, as a neurobiological disorder, and that it is both medically and socially irresponsible to deny its existence, to ignore its presence in children or adults, or to leave it untreated.

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition

(DSM IV), a standard reference source published by the American Psychiatric Association, considers ADHD an identified neurobiological disorder, characterized by "three patterns of behavior that indicate ADEHD: inattention, hyperactivity, and impulsivity (difficulty controlling one's actions). ("Difficulties with Attention," 2005) Typical symptoms of the disorder, according to DSM-IV, may include: (1) becoming easily distracted by irrelevant sights and sounds; (2) failing to pay attention to details and making careless mistakes; (3) rarely following instructions carefully and completely; and (4) losing or forgetting things like toys, or pencils, books, and tools needed for a task ("Difficulties with Attention"). Signs of hyperactivity and impulsivity that often accompany the former, non-hyperactive symptoms, may include: (1) feeling restless, often fidgeting with hands or feet, or squirming; (2) running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected; (3) blurting out answers before hearing the whole question; and (4) having difficulty waiting in line or for a turn ("Difficulties with Attention," p. 1).

Moreover, according to "Difficulties with Attention," (2005): "Because everyone shows some of these behaviors at times, the DSM IV contains very specific guidelines for determining when they indicate ADHD. The behaviors must appear early in life, before age 7, and continue for at least six months" (p. 1). In a personal interview I conducted with a friend, Janet Eames, age 19 (Eames, "Personal Interview, March 24, 2005) who has had a diagnosis of Attention Deficit Disorder (ADD) without hyperactive symptoms (as opposed to ADHD, with hyperactive symptoms) since age 10, she stated:

Without my medications, if I forget them or something, I get forgetful, absent-minded unorganized, restless, impatient. I misplace stuff, can't concentrate. I also get really sensitive to noises, like the television, music I don't want to listen to, stuff like that. Things that don't bother my roommates at all will drive me out of my mind, and I won't be able to study or do anything.

Janet said she took Ritalin from age 10 to age 16, then quit. When she got to college, she was having a lot of problems with concentration again, though, so she started taking a sustained release version of Ritalin, called Concerta. She takes 54 milligrams of Concerta once in the morning, and it lasts her all day. She also said "I just feel more focused, more attentive, less irritable and distracted when I take it. I didn't want to start ADD drugs again, but I wouldn't make it in college otherwise." Janet's GPA her first semester, without taking Concerta, was 2.3. In her second semester, with Concerta, her GPA was 3.4.