ADHD, ADD, attention deficit disorder

What do the following people have in common?

• A 10-year-old boy with a high IQ who still cannot read or write;
• A 12-year-old girl with the nickname 'motor mouth' who cannot stop talking;
• A 4-year-old from a stable home who has been expelled from kindergarten for leading a mass escape;
• A mother of two whose home is in chaos because no job ever gets finished;
• A teenager who is a chronic TV channel surfer and a constant fidget;
• A father of many kids by numerous partners who keeps moving on because he is bored;
• A soldier who volunteered for bomb disposal and found a minefield in Cambodia to be the most fulfilling place of his life.

The answer may well be attention deficit hyperactivity disorder (ADHD).

The problem is not new - it was first accurately described in children by Dr Still in 1902. The effectiveness of stimulants in its treatment was first observed in 1937. Its modern title, ADHD, goes back to 1983. But the realisation that ADHD is not just a childhood disorder came not much more than 10 years ago.

ADHD is a problem that affects about 5% of the population. Even so, it has taken a long time for ADHD to be accepted as an important problem, and it remains a very controversial topic.

How is ADHD defined?

ADHD is defined as being excessively distracted, and this is usually accompanied by impulsiveness. It is present by the age of seven years and it should be apparent in more than one setting, for example at home and in the classroom.

People can be distracted from an idea, an emotion, an action or a relationship. The distraction may come from outside or be within our own thoughts. With the tendency to be distracted usually goes poor short-term memory.

What are the consequences of ADHD?

In children, this combination (distraction and poor short-term memory) can cause learning difficulties and underachievement compared with the child's actual ability. Sometimes, this includes dyslexia, even to the point of illiteracy.

In adults, distraction will cause forgetfulness for names, phone numbers, appointments, car keys, cell phones and wallets. One man with ADHD claimed he had broken into his own house 30 times during the last year.

Poor organisation is stressful for everyone involved, and stress often leads to conflict and depression. More than 50% of the adults I have seen with ADHD have been diagnosed with, and often treated for, depression.

Impulsiveness is the tendency to speak or act without thinking of the consequence. Most people have a thought, and then hold a 'mental committee meeting' to consider the effect of the plan. Very often, the committee will abandon the idea for the sake of the individual or others.

In ADHD, the committee is always 'out to lunch'. The result is actions that cause damage to many relationships - family, friends, teachers, employers, marriages. This can take many forms, for example, opening the mouth and 'putting the foot in it', substance abuse, criminal behaviour, violence, suicide, gambling, dangerous driving.

Some recent statistics on ADHD are deeply disturbing. Untreated ADHD sufferers are twice as likely to be substance abusers, five times as likely to be in jail and four times more often involved in traffic accidents than the rest of the population.

Frequent myths about ADHD

Young people with ADHD may be hyperactive, particularly up to intermediate school age, but it is a common misconception that no hyperactivity means no ADHD. The condition presents as a spectrum, from the extremely hyperactive and impulsive through to the inattentive dreamer. Many of those at the dreaming end of the scale are missed throughout the school system and just written off as lazy or dumb.

Another frequent misconception is that this is a disease of boys. While it is true that boys are diagnosed with ADHD about four times more frequently than girls, there is probably no difference between the sexes in true incidence. Certainly, among adults, the numbers of men and women with ADHD are about equal. Since, by definition, the problem had to be there by the age of seven years, it is obvious that the girls were missed because their behaviour did not create enough trouble to bring them to attention.

What is the cause of ADHD?

Many explanations of the causes of ADHD have been fashionable. Head or birth injuries, chemical poisoning from sprays, additives, or heavy metals, allergies and poor parenting have all been blamed. Any of these factors may have aggravated the problem, but there is no evidence they are causes of true ADHD.

Head injuries are more common in ADHD patients than the rest of the population simply because poor concentration and impulsiveness frequently make them accident-prone.

ADD is jokingly defined by some as 'Absent Dad Disorder', but this is an effect not the cause. Certainly, a far higher proportion of ADHD kids than one would expect are living in solo-parent families but often the family story reveals the solo status being the result of having a parent with ADHD.

Coping with an ADHD child can be immensely demanding, and just one burden too many in an already struggling marriage. A loving, stable, two-parent home moderates the effects of ADHD but it does not prevent the condition. Dr Christopher Green, a world expert on ADHD, says that often the parents of ADHD kids are the best in the world - they have to be!

The evidence is now clear from much research that the disease process behind ADHD is a relative lack of the brain chemical dopamine (important in concentration) in certain areas of the brain.

This relative deficiency has a strong genetic basis. Specific gene sites have been demonstrated in some affected families. It is often helpful to draw up a family tree and identify the family members probably affected by ADHD. Difficult family relationships are then easier to understand.

In general, if one parent is affected, there's about a 50% chance the child will have the same problem. I have some families in which both parents have ADHD, in which case the risk of ADHD children rises to about 75%. In other families I am aware of ADHD through four generations.

It is important to remember this sort of exercise is not there to allow people to blame others. Identifying family members with the same problem is a way to allow better understanding, not attribute guilt.

See also: ADHD - How is it diagnosed?

See also: ADHD - how is it treated?

Recommended further reading:

• Understanding ADHD by Dr Christopher Green
• The Hidden Handicap by Dr Gordon Serfontein
• You and Your ADD Child by Ian Wallace
• ADD in Adults by Dr Gordon Serfontein
• Driven to Distraction by Drs Hallowell and Ratey
• Answers to Distraction by Drs Hallowell and Ratey

All of these are available from good bookshops or the library.

This article was written by Dr Tony Hanne, an Auckland GP who specialises in ADHD. Originally published in Pharmacy Today newspaper. Copyright 2003 UBM Medica (NZ) Ltd.

Your own family doctor will be able to provide help with ADHD.