Biology 202
1998 First Web Reports
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Attention Deficit Hyperactivity Disorder

HimaBindu K Krishna

Attention Deficit Hyperactivity Disorder (ADHD), more commonly referred to as ADD (Attention Deficit Disorder), has only recently come to notice of scientists. It affects 3.5 million people under the age of 18 and 5 million people over the age of 18. Its current cause of existence is due to defects at neurotransmitter sites, rendering patients inattentive and impulsive. However, every year more progress is made in locating the cause and finding more effective treatments. ADHD's first diagnosis was made in 1902 by Dr. George Still. He observed 20 children who were inattentive, impulsive, hyperactive, and showed mood swings. He initially attributed their behavior to mild brain damage. By 1917 ADHD or constantly active was still thought to have this cause. At this time, viral encephalitis seemed to be linked to the disease because, after being infected, children had impaired attention, memory, and impulse control. In 1937 ADHD was known as minimal brain dysfunction and began to be treated with amphetamines, which made children with the disorder much calmer.

The Diagnostical and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV, the classification manual that all psychologists and psychiatrists use in the United States) has cumulated all the various behaviors of children with ADHD and listed 9 trademark symptoms of ADHD:

lookarea-- some who have ADHD but are not diagnosed or so at the developmental history of the child as well as his/her current behavior. This eliminates other maladaptive behaviors, such as conduct disorder.

The most popular method of diagnosis of ADHD is the Attention Deficit Disorder Behavior Rating Scale (ADDBR, just a little, pretty much, or very). In this scale observers rate children's behavior (i.e. the presence of fidgeting)on the basis of"not at all", "just a little", "pretty much", or "very much". The results are then compared with the nation's norms to indicate whether or not a disorder exists in the child. The criticism of ADDBR is its lack or rigidity. There are no set cutoffs between each level, therefore there is much left up to the observer's discretion. There is not interobserver agreement. That is, what is "pretty much" to one observer may only be "just a little" to another. This may place many children in the gray area-- some who have ADHD but are not diagnosed or some who do not have hit, yet who are diagnosed.

Finding the cause of the disorder is crucial for proper treatment to be administered. There is much physiological evidence for the cause of ADHD. The most widely accepted cause is placed as a result of neurotransmitter deficiencies. Dopamine and Nerepenephrin regulate the attention and impulsiveness areas of the brain. Without sufficient amounts of these neurotransmitters, low concentration and lack of control over impulses result.

Recent findings suggest other biological symptoms which may be associated with ADHD. Patients have decreased blood flow and lower levels of electrical activity in the frontal lobes. People with ADHD also have lower glucose metabolism in regions that regulate movement and attention. This slows the metabolic activity in these areas, due to the low energy, and thus may cause difficulty in concentrating. Also, a trace percentage of children with ADHD are resistant to the thyroid hormone. Though there is no definite connection between the resistance and ADHD., medication given to ameliorate the former condition has also produced improvements in the latter condition.

Since the cause of ADHD points to biological disturbances, medications are used to diminish the disorderTyronil increases attentiveness in children and adults. They act upon norepeniphrine and dopamine by blocking their reuptake into the presynaptic neuron. The rate or release is subsequently altered and norepenephrine and dopamine activity increases in the frontal lobes. The antidepressants are most effective if administered at low levels.

More commonly used to alleviate the symptoms of ADHD are stimulants. Ritalin, Dexedrine, and Cylert are the most popular among the stimulants. They reduce most distractive symptoms of ADHD. Specifically, Ritalin is a reuptake blocker while Dexedrine uses feedback inhibition. These, too, are prescribed at low doses.

Sometimes other medication is need in addition to either the stimulants or antidepressants. Beta-blockers decrease anxiety and tension. Clonidine helps to increase calmness and, perhaps, increases the effectiveness of the stimulant. In adults, depression is a common complaint of ADHD patients. BuSpar and Prozac are used to counteract this symptom.

Some psychologists feel that, in the case of children, ADHD patients need special education and therapy more than medication. This view has been argued by research of the treatments as well as the biological origin of the disorder. Therapy does aid in adjustment to the disorder, but medication helps the actual symptoms.

Though there is much to be learned about Attention Deficit Disorder, current treatments are effective. Newer theories of causation are continuously being release, and the medication is altered accordingly. Presently, though, most people with the disorder are able to find a treatment which will help them at least on a minimal level to decrease such behaviors as irritability, depression, impulsiveness, distractibility, and faulty memory. Antidepressants and stimulants seem to be the most effective and other medications are often given to increase their potency or alleviate other symptoms. Since it directly affects the academic and social performance in children, the sooner ADHD is detected, the sooner the child can live a more normal lifestyle into his/her adulthood.

WWW Sources

Oedipus and the Momma's Boys: Attention Deficit Disorder paper/resource page from an ADDer
Abstract of above
Clinical Criteria for the Diagnosis of ADD
Physiology of ADD


Pharmocotherapy for ADHD in Adults by John J. Ratey, M.D., Edward M. Hallowell, M.D. and Catherine L. Lereroni, B.A.

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