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Attention-Deficit Hyperactivity Disorder (ADHD) is a neurobiologically-based disorder manifested by hyperactivity, distractibility, and/or impulsivity. Children and adolescents with this disorder might have one, two, or all three of these behaviors. Hyperactivity refers to an increased activity level, often reflected in fidgety behavior. Distractibility refers to an inability to block out unimportant stimuli in the environment, resulting in a short attention span. For some, the problem is with auditory distractibility, for some visual distractibility, and for others, both. Impulsivity refers to an inability to stop and think before one speaks and/or acts. ADHD is most frequently found in children and adolescents; however, it may continue, into adulthood in anywhere from 30 to 70 percent of cases.
Current research strongly suggests that ADHD is caused by deficiency of norepinephrine in the ascending reticular activating system. Treatment, as discussed later, uses medication to increase the production of this neurotransmitter in combination with therapeutic, educational, and/or behavioral interventions, as appropriate.
The formal criteria for the diagnosis of ADHD can be found in DSM IV (the diagnostic manual published by the American Psychiatric Association). At this time there are neither formal physical nor psychological tests that can establish the diagnosis. Instead, the condition is diagnosed through the combined assessment of clinical history, examinations, and clinical rating scales. Individuals with ADHD have a "chronic" and "pervasive" history of hyperactivity, distractibility, and/or impulsivity. The history is "chronic" because the difficulties have been present for most or all of the individual's life and "pervasive" because symptoms are observable in any setting or situation that demands sustained attention. However, because many situations do not demand sustained attention, such as a visit to a pediatrician's office or unstructured play, the disorder may be unobservable in some environments.
There are many reasons why an individual will show behaviors of hyperactivity, distractibility, and/or impulsivity; only one is ADHD. Thus, the differential diagnosis is important. One must differentiate an emotional problem that might result from anxiety and/or depression. Each of these emotional conditions can produce behaviors of hyperactivity, distractibility, and/or impulsivity. However, the history will reveal that the behaviors started at a particular time or occur only at specific times. Such behaviors, when associated with anxiety and/or depression, as opposed to ADHD, are not chronic and pervasive. There are also certain types of learning disabilities and language disabilities that can result in behaviors suggestive of distractibility and a short attention span. These disorders must also be differentiated in establishing the diagnosis of ADHD.
Many children and adolescents with ADHD are not identified and treated. They become frustrated, have difficulty coping with stress, and may act out behaviorally. They may present clinically as having disruptive behavioral disorders such as Oppositional Defiant Disorder or Conduct Disorder. It is critical for the clinician to determine if the presenting disruptive behavioral disorder is the primary diagnosis or if it is secondary to an underlying ADHD. If ADHD is the underlying cause, it must be diagnosed and treated in order to successfully treat the secondary disruptive behavioral disorder.
ADHD is often associated with other neurobiologically-based disorders, specifically learning disabilities, language disabilities, and Tourette Syndrome. Each of these disabilities must be considered and ruled in or out if ADHD is diagnosed.
There are psychopharmacologic medications available for treating ADHD. There is a group of medications that work by increasing the availability of norepinephrine in the reticular activating system. With the proper medication and dosage, most individuals with ADHD show significant improvement. Behavior management techniques, family and individual treatment, and educational interventions ranging from classroom modifications to self contained special education settings are also needed to ensure a successful outcome. Individuals with ADHD who are properly treated are no more likely to become depressed, a suicide risk, or abuse of alcohol or drugs than anyone else of their age, sex, and socioeconomic status.
The organizations listed below are concerned that some benefit plans do not provide adequate coverage for the treatment of Attention-Deficit Hyperactivity Disorder (ADHD). ADHD is a medical condition that improves with treatment, and we strongly encourage the inclusion of coverage for this disorder in benefit plans. This document, endorsed by the organizations below, provides information on ADHD and explains the impact and importance of covering treatment for this disorder.
AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY
AMERICAN ACADEMY OF NEUROLOGY
AMERICAN ACADEMY OF PEDIATRICS
AMERICAN ASSOCIATION OF CHILDREN'S RESIDENTIAL CENTERS
AMERICAN ASSOCIATION FOR PARTIAL HOSPITALIZATION
AMERICAN PSYCHIATRIC ASSOCIATION
CHILDREN AND ADULTS WITH ATTENTION DEFICIT DISORDERS
INSTITUTE FOR BEHAVIORAL HEALTHCARE
NATIONAL ALLIANCE FOR THE MENTALLY ILL
NATIONAL ASSOCIATION OF SOCIAL WORKERS
NATIONAL DEPRESSIVE AND MANIC DEPRESSIVE ASSOCIATION
NATIONAL ORGANIZATION FOR RARE DISEASES
NATIONAL TREATMENT CONSORTIUM, INC.
OBSESSIVE COMPULSIVE FOUNDATION
TOURETTE SYNDROME ASSOCIATION, INC.
©2007 Tourette Syndrome Association, Inc. 42-40 Bell Boulevard / Bayside NY 11361 / 718-224-2999