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| Volume 1, Issue 10 | FEBRUARY 2003 |
| Inside This Issue | |||||
| 1 | Attention-deficit/hyperactivity disorder (ADHD) | ||||
| 2 | Dyslexia | ||||
| 2 | Updates and Announcements | ||||
Medical Information Fact Sheet
Attention-deficit/hyperactivity disorder (ADHD):
Attention-deficit/hyperactivity disorder (ADHD) is a group of chronic disorders that begin in childhood and can last into adult life. In general, those with ADHD have a hard time paying attention and concentrating (inattention), sitting still (hyperactivity) and controlling impulsive behavior (impulsivity).
Those with ADHD often struggle with low self-esteem, troubled personal relationships and poor performance in school or work.
ADHD at times has been called Attention-deficit disorder (ADD), hyperactivity and even minimal brain dysfunction. Currently ADHD is the preferred term because it more accurately describes all aspects of the condition. No matter what the name, it still remains a controversy.
For many years, experts disagreed on how ADHD should be diagnosed or even if it was a real disorder. In 1998 the National Institute of Mental Health agreed that ADHD is a legitimate condition. In addition, most doctors believe that a child should not receive a diagnosis of ADHD unless the core symptoms of hyperactivity, impulsivity and inattention have created significant problems at home and at school for at least 6 months. Even so, it is often very difficult to distinguish the behavior of a child with ADHD from that of a normal, active child.
Causes:
The exact cause of ADHD is not well understood. Researchers have identified several factors that may play a role in the disorder.
- Altered Brain function- The parts of the brain that regulate attention, planning and motor control seem to be less active in children with ADHD. In addition, some children and adults with ADHD seem to have low levels of dopamine-a brain chemical with a number of important functions. Among other things, dopamine sends messages to the part of the brain that controls movement, helps regulate attention and affects motivation.
- Heredity- ADHD tends to run in families. Most children with ADHD have at least one relative with the disorder and approximately 1/3 of men with a history of ADHD have children who also have ADHD. Furthermore if one twin has ADHD, the other twin almost always has the disorder as well.
- Maternal smoking, drug use and exposure to toxins- Recent studies have found that pregnant women who smoke are at an increased risk of having children with ADHD. Some studies suggest that alcohol and drug use during pregnancy may reduce activity of the cells that produce dopamine. Another study also showed that pregnant women exposed to environmental toxins are more likely to have children with ADHD.
The symptoms of ADHD are grouped into two broad categories: inattention and hyperactivity-impulsive behavior. Children are said to have ADHD if they show 6 or more symptoms from each of the categories for at least 6 months. These symptoms must significantly affect a child's ability to function in at least 2 social settings-typically at home and at school. This ensures that the problem is not just with a particular teacher or only with parents. Children who have problems at school but get along well at home are not considered to have ADHD. In most children, symptoms appear between the ages of 4 and 6, although they can occur earlier. The symptoms of ADHD include the following:
Inattention
- Often fails to pay close attention to details or makes careless mistakes in schoolwork or other activities
- Often has trouble sustaining attention during tasks or play
- Often doesn't seem to listen when spoken directly to
- Often doesn't follow through on instructions and fails to finish schoolwork, chores or tasks
- Often has difficulty organizing tasks or activities
- Often avoids or dislikes tasks that require sustained mental effort, such as schoolwork or homework
- Often lose things needed for tasks or activities, such as books, pencils, toys or tools
- Is often easily distracted
- Is often forgetful
Hyperactivity-impulsivity
- Often fidgets with hands or feet or squirms in seat
- Often leaves seat in the classroom or in other situations where remaining seated is expected
- Often runs or climbs excessively when it is not appropriate. Adolescents or adults may not literally run or climb but may constantly feel restless
- Often has difficulty playing quietly
- Is often "on the go" or acts as if "driven by a motor"
- Often talks excessively
- Often blurts out the answers before questions have been completely asked
- Often has difficulty waiting his or her turn
- Often interrupts or intrudes on others by butting into conversations or games.
Most healthy children exhibit many of these behaviors at one time or another. For instance, parents may worry that a 3-year-old who can't finish a drawing may have ADHD. But preschoolers normally do not have a very long attention span. Even in older children and adolescents, attention span often depends on the level of interest in a particular activity. Most teenagers can listen to music or talk to friends for hours but may be less focused on homework.
The same is true of hyperactivity. Young children are naturally energetic and may wear their parents out real quick. They may even become more active when they are tired, hungry, anxious or in a new environment. Children with ADHD, however, tend to be especially sensitive to stimuli such as sights, sounds and touch. When overstimulated, they can get quickly out of control, become giddy and sometimes even aggressive or even physically or verbally abusive.
Symptoms may be different in boys and girls. Boys are more likely to be hyperactive, and girls tend to be inattentive. In addition, girls who have trouble paying attention often daydream, but inattentive boys are more likely to play or fiddle aimlessly. Boys tend to be less compliant with teachers and other adults, so their behavior is often more conspicuous.
Symptoms of ADHD in adults
ADHD always begins in childhood, but may last into adult life. The core symptoms of inattention, hyperactivity and impulsive behaviors are the same for adults as for children. Most adults have just one or two symptoms not all three.
Adults who have problems with inattention may daydream during lectures or presentations at work and have trouble finishing tasks. Hyperactive adults aren't likely to be as physically active as hyperactive children, but they may find it hard to sit through movies or concerts or frequently shift positions or tap their fingers or feet. Impulsive adults have trouble waiting in line and driving in heavy traffic, and they may be tempted to take unnecessary risks. Adults with ADHD also may have mood swings, a quick temper, a low tolerance for stress and problems with relationships.
No single test for ADHD exists, making the disorder difficult to diagnose. A variety of exams are used to differentiate ADHD from learning disabilities and mood disorders.
Assessing a child for ADHD usually begins with complete medical, school and family histories and medical exam to exclude other causes for the child's symptoms. The doctor may use teacher questionnaires. The doctor may use ADHD-specific rating scales to help collect and evaluate information about the child. Sometimes the child may be referred to a psychologist or psychiatrist for further evaluation or treatment.
Evaluating adults usually relies on interviews and extensive medical and behavioral histories. School and job records may be used as clues to past behavior. Some specialists may use tests that objectively measure attentiveness and concentration.
About one third of children with ADHD also have other psychological or developmental conditions including Oppositional Defiant Disorder (ODD), Depression, Anxiety disorders, learning disabilities or Tourette's syndrome.
Children with ADHD struggle in school and can be ridiculed for academic failure. Children with ADHD may also be punished for behavior they can't control. Children with ADHD are more likely to experience minor trauma, such as fractures and lacerations. Teenagers and adults with ADHD are more likely to be involved in car accidents. People with ADHD in general tend to have more injuries and accidents than those without the disorder.
ADHD has also been associated with increase risk of alcohol and drug abuse and delinquency.
Treatment may include therapy, medication or both. Children and adults often benefit from counseling and behavior therapy. Many people with ADHD may have other conditions such as anxiety disorder or depression. In some cases, counseling may help both ADHD and the coexisting problem. Counseling therapies may include psychotherapy, clinical behavior therapy, family therapy, social skills training, support groups and parenting skills training.
Drugs known as psychostimulants are the most commonly prescribed medication for treating ADHD in children. Sometimes antidepressants may be used-especially for adults and for children who don't respond to stimulants or are depressed or have other problems. Parents often wonder why stimulants are given to children who are already overstimulated. Scientists believe that the stimulants appear to boost and balance the levels of the brain chemicals dopamine and serotonin. Methylphenidate (Ritalin, Concerta) is the primary medication used to treat ADHD. This medication seems to increase levels of dopamine in the brain.
Psychostimulant medications may help to alleviate the core symptoms of inattention and hyperactivity, sometimes dramatically.
Other medications that have been used are Adderall and Dexedrine.
The most common side effects include loss of appetite, nervousness and problems sleeping. Some children experience irritability and increase activity as the medication tapers off. Adjustment in the dosages can offset these effects. At this point, addiction/dependence to these drugs has not been reported.
Other treatments (experimental) may include biofeedback (stress-reduction technique), Neurobiofeedback (teaching people to control own brain patterns), and special diets/supplements.
Mayo Clinic. (2001, May 18). Attention-deficit/hyperactivity disorder. Retrieved on January 20, 2003 from the World Wide Web: http://www.mayoclinic.com/invoke.cfm?id=ds00275
Dyslexia is an impairment in the brain's ability to translate written images received form your eyes into meaningful language. Dyslexia is the most common learning disability in children. A learning disability is a condition that produces a gap between someone's ability and their performance. People with dyslexia have normal intelligence but read at levels significantly lower than expected. Dyslexia is the most common cause for children to receive special education services.
Children with dyslexia will have normal vision, normal intelligence and normal speech but often have difficulty interpreting spoken language and writing. The cause is unknown, but there may be a malfunction in areas of the brain that are concerned with language. There tends to be a family history of language disorders.
Signs and symptoms of dyslexia may include:
- Inability to recognize word and letters on a printed page
- Reading ability level much below the expected level for the age of the child.
Children with dyslexia commonly have problems with processing and understanding what they hear. They may have difficulty with rapid instructions, more than one command and remembering sequences of things. They may reverse letters (b or d) or words (was for saw). Reversals are common for children under 6 but with dyslexia the problem persists. The child may read from left to right, fail to see similarities and differences in letters and words and have problems with pronunciation with familiar words.
Treatment is by remedial education. Use of techniques improving hearing, vision and touch may improve reading skills. Frequent instruction using multisensory methods is most important. Tutoring may be needed. However, a child with severe dyslexia may never be able to read well and may need training for vocations that don't require good reading skills.
Mayo Clinic. (2002, February 28). Dyslexia. Retrieved on January 20, 2003 from the World Wide Web: http://www.mayoclinic.com/invoke.cfm?id=ds00224
HCPCFC PROGRAM UPDATES and ANNOUNCEMENTS!!!
We would like to welcome Michelle Haynes to our program.
She will be covering the Banning/Hemet region.We would also like to welcome Marion Clarke who will be assisting us part time in our endeavors to serve all the foster children in Riverside County.
We would like to welcome back Daisy Shelton. She will be covering the Metro region.
Welcome!!!!!
Editor: Kristen Thompson, PHN; and Karen MacLeod, PHN
Contributors: Kim Robitaille, PHN, MSN, Assistant Nurse Manager; and Judy Earp, MHA, Director of Public Health Nursing.
