About Attention-Deficit Hyperactivity Disorder (ADHD)
Although studies often cite a prevalence rate of 3-5% of school age children, discrepancies in the definition of diagnosis have led to wide variations of reported prevalence that range from one percent to nearly 20 percent of school age children in the USA and Australia. International studies have shown that the lowest rates of ADHD are reported in Japan and Finland, with the highest rates found in Jamaica and Thailand, with Australia and the USA in the middle range.
Many professionals feel that ADHD is not an actual diagnosis reliant upon certain conditions being met, but is a catch-all term for a range of difficult behaviours with different causes.
The Diagnostic & Statistical Manual for Mental Disorders provides the following criteria for diagnosing ADHD.
Inattention
Defined as:
1.Child often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2.Child often has trouble keeping attention on tasks or play activities.
3.Child often does not seem to listen when spoken to directly.
4.Child often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions).
5.Child often has trouble organizing activities.
6.Child often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7.Child often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
8.Child is often easily distracted.
9.Child is often forgetful in daily activities.
Hyperactivity
Defined as:
1.Child often fidgets with hands or feet or squirms in seat.
2.Child often gets up from seat when remaining in seat is expected.
3.Child often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4.Child often has trouble playing or enjoying leisure activities quietly.
5.Child is often “on the go” or often acts as if “driven by a motor”.
6.Child often talks excessively.
Impulsivity
Defined as:
1.Child often blurts out answers before questions have been finished.
2.Child often has trouble waiting one’s turn.
3.Child often interrupts or intrudes on others (e.g., butts into conversations or games).
How ADHD affects the community
ADHD is a chronic public health problem from early childhood through adulthood. It causes problems for home life, at school, and in social life and general lack of effectiveness as a person. Interventions have not been effective in the long term, including drugs that affect the brain. The cause of ADHD is unknown, but genetic factors are believed to be important. Other factors may include prenatal parental alcohol use and smoking, and low birth weight. Eating sugar or food additives has been ruled out as causes of ADHD, and specialised diets have met with little success in treating it.
Problems for the community and the public health system include the enormous social, educational, health and economic burden of people who are not fully functioning throughout their lifespan including interpersonal relationship problems with the family, peers, co-workers, teachers, etc. There has been a great deal of research over the past 30 years, but without a standard definition of ADHD because it covers so much ground, and the resulting studies have not been comparable. Therefore, the research has been contradictory or too variable to be useful.
Current Treatments: Psychiatric drugs, behaviour modification, and counselling
One key concern to the general community is the safety of pharmacological interventions since prescribing mind-altering drugs, such as Ritalin, is extremely common. Ritalin is categorised by the Therapeutic Goods Administration as Schedule 8, a Drug of Addiction. Assessing the health risks and benefits of this drug use to very young children should be a high priority. Children who begin medication therapies very early in life and receive it on a long-term basis may have unknown outcomes, although recent research has shown that these children are no more likely to experiment with illegal drugs than are other children. But these drug interventions may not normalise behaviour. The existing research suggests that children and adults with ADHD experience substantial problems in the school, home, workplace, and community settings despite the drugs they take to control it. If drug therapy is already not proven to be effective in the long term, we join the child advocates who question if the risks involved are really worth taking? The UN High Commission on Human Rights has also criticised the use of psycho-stimulants to children with difficult behaviours.
Behaviour modification therapies and counselling, for young people in particular, have been proven to be beneficial for the treatment of various behavioural disorders including ADHD. The effectiveness of behavioural interventions must be further studied in the treatment of ADHD, to better understand their potential to normalize the behaviour and functioning of those with the disorder, especially when combined with pharmacotherapy.
Experimental Treatments
Some studies have found that supplementation with Omega 3 oils, such as flaxseed or fish oil capsules, which are cheap and readily available, can halve the symptoms of ADHD. Although specialised diets have met with little success in treating ADHD there is still a great deal of ongoing research in that area.
Recommendation for future research
One suggestion from Australian experts is for each state to establish a voluntary Registry of individuals treated for ADHD, in order to monitor the health effects and potential benefits of their long-term treatment for ADHD. Additionally, collecting other related life-outcomes such as school attainment, interface with judicial system, work performance, and other pertinent variables, would provide evidence for comparison of treatments.
For further information:
http://www.livingwithadhd.com.au/
http://www.health.nsw.gov.au/public-health/adhd/index.html
http://www.adhd.org.au/
References:
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
http://www.cdc.gov/ncbddd/adhd/symptom.htm
Barkley, RA, Fischer, M, Smallish, L, Fletcher, K. Does the Treatment of Attention-Deficit/Hyperactivity Disorder With Stimulants Contribute to Drug Use/Abuse? A 13-Year Prospective Study. Pediatrics Vol. 111 No 1 January 2003 pp 97-109.
