$Unique_ID{BRK03507} $Pretitle{} $Title{Attention Deficit Hyperactivity Disorder} $Subject{Attention Deficit Hyperactivity Disorder ADD ADHD Attention Deficit Disorder Hyperactivity Hyperkinetic Syndrome Mental Retardation Pervasive Developmental Disorders Undifferentiated Attention Deficit Disorders} $Volume{} $Log{} Copyright (C) 1988, 1989, 1992 National Organization for Rare Disorders, Inc. 593: Attention Deficit Hyperactivity Disorder ** IMPORTANT ** It is possible that the main title of this article (Attention Deficit Hyperactivity Disorder) is not the name you expected. Please check the SYNONYM list to find the alternate names and disorder subdivisions covered by this article. Synonyms ADD ADHD Attention Deficit Disorder Hyperactivity Hyperkinetic Syndrome Information on the following disorders can be found in the Related Disorders section of this report: Mental Retardation Pervasive Developmental Disorders Undifferentiated Attention Deficit Disorders General Discussion ** REMINDER ** The information contained in the Rare Disease Database is provided for educational purposes only. It should not be used for diagnostic or treatment purposes. If you wish to obtain more information about this disorder, please contact your physician and/or the agencies listed in the "Resources" section of this report. Attention Deficit Hyperactivity Disorder is a behavioral disorder of childhood characterized by short attention span, excessive impulsiveness, and inappropriate hyperactivity. Symptoms Attention Deficit Hyperactivity Disorder (ADHD) usually starts before age 4, but may not be diagnosed until the child enters school. This disorder is characterized by a very short attention span, impulsiveness, and hyperactivity. Symptoms usually occur to varying degrees depending on environmental factors. Symptoms typically get worse in situations requiring sustained attention, such as listening to a teacher in a classroom, attending meetings, or doing class assignments or chores at home. Signs of the disorder may be minimal or absent when a person with the disorder is receiving frequent reinforcement, in a very structured setting or in a one- to-one situation where there are no distractions. Often, symptoms improve with maturity, and adults with ADHD learn how to compensate for their handicap. In the classroom or workplace, inattention and impulsiveness are shown by not sticking with tasks sufficiently to finish them and/or by having difficulty organizing or completing work correctly. The patient often gives the impression that he or she is not listening or has not heard what has been said. Work is often messy, and performed carelessly or impulsively. Impulsiveness is often demonstrated by blurting out answers to questions before they are completed, making comments out of turn, failing to await one's turn in group situations, failing to heed directions fully before beginning assignments, interrupting people while they are talking, and inappropriate or disruptive behaviors during quiet work periods. Hyperactivity may be evidenced by difficulty remaining seated, excessive jumping about, running in restricted areas, fidgeting, manipulating objects, and/or twisting and wiggling in one's seat. At home, inattention may be displayed by failure to follow instructions, and frequent shifts from one uncompleted activity to another. Problems with impulsiveness are often expressed by interrupting or intruding on other family members and by accident-prone behavior arising out of clumsiness or impulsivity. Hyperactivity may be evidenced by an inability to stay still when expected to do so, and by excessively noisy activities. With peers, inattention is evident by failure to follow the rules of structured games or to listen to other children. Impulsiveness is frequently demonstrated by failing to await one's turn in games, interrupting, grabbing objects, and engaging in potentially dangerous activities without considering the possible consequences. Hyperactivity may be shown by excessive talking and by an inability to play quietly and/or to follow instructions. In preschool children with Attention Deficit Hyperactivity Disorder, the most prominent features are usually signs of gross motor overactivity such as excessive running or climbing. Inattention and impulsivity are likely to be shown by frequent shifting from one activity to another. In older children and adolescents, the most prominent features tend to be excessive fidgeting and restlessness. Inattention and impulsiveness may contribute to failure to complete assigned tasks or follow instructions, or careless performance of assigned work. In adolescents, impulsiveness is often displayed in social activities, such as initiating a diverting activity on the spur of the moment instead of attending to a previous commitment, such as doing homework. In the majority of cases, symptoms of ADHD persist throughout childhood. Follow-up studies indicate that approximately one-third of children with this disorder continue to show some signs of the disorder during adulthood. Specific learning disabilities in reading or math can also occur in conjunction with ADHD. Associated features vary according to the age of the person with Attention Deficit Hyperactivity Disorder. These include low self-esteem, moodiness, low frustration tolerance, and temper outbursts. Academic underachievement is characteristic of many children with this disorder. Children with Tourette Syndrome often have ADHD as well. (For more information, choose "Tourette" as your search term in the Rare Disease Database.) Non-localized associated neurologic signs and poor eye-hand coordination may also occur. Diagnosis may be complicated because it is difficult to determine the point at which normal energetic children might have the types of behavior that may characterize ADHD. Causes The exact cause of Attention Deficit Hyperactivity Disorder is not known. The disorder is thought to be more common in first-degree relatives of people with the disorder. Among family members of persons with ADHD, the following disorders may occur more than among the general population: Specific developmental disorders, alcohol dependence or abuse, conduct disorder, Antisocial Personality Disorder and learning disabilities. ADD Disorder may, in some cases, be closely related to a generalized resistance to thyroid hormone. Researchers have studied the subject with the conclusion being that there is evidence of a familial predisposition to the disorder in some persons with a generalized resistance to thyroid hormone. Affected Population Attention Deficit Hyperactivity Disorder is a common disorder. The disorder is from 6 to 9 times more common in males than in females. Related Disorders Symptoms of the following disorders can resemble those of Attention Deficit Hyperactivity Disorder. Comparisons may be useful for a differential diagnosis: In Mental Retardation, many of the features of ADHD may occur because of the generalized delay in intellectual development. The additional diagnosis of ADHD is made only if the relevant symptoms are excessive for the child's mental age and if hyperactivity and impulsiveness also occur. Pervasive Developmental Disorders are characterized by qualitative impairment in the development of social skills, the development of verbal and nonverbal communication skills, and in imaginative activity. A markedly restricted repertoire of activities and interests, which frequently are stereotyped and repetitive occurs. The severity and expression of these impairments vary greatly between affected children. Undifferentiated Attention Deficit Disorders are a group of disorders characterized by the developmentally inappropriate and marked inattention that is not a symptom of another disorder, such as Mental Retardation or Attention Deficit Hyperactivity Disorder, or a result of a disorganized and chaotic environment. Signs of impulsivity and hyperactivity do not occur in this disorder. Therapies: Standard Attention Deficit Hyperactivity Disorder can be treated by counseling and/or stimulant drugs such as methylphenidate (Ritalin). A structured environment (such as a special class or school for children with learning disabilities) with minimal distractions, can also be beneficial. Therapies: Investigational Clinical trials are underway to study the effect of Thyroid Hormone on Attention Deficit Hyperactivity Disorder. Interested persons may wish to contact: Roy E. Weiss, M.D., Ph.D. Thyroid Study Unit, Box 138 University of Chicago 5841 South Maryland Ave. Chicago, IL 60637 (312) 702-6939 to see if further patients are needed for this research. This disease entry is based upon medical information available through April 1993. Since NORD's resources are limited, it is not possible to keep every entry in the Rare Disease Database completely current and accurate. Please check with the agencies listed in the Resources section for the most current information about this disorder. Resources For more information on Attention Deficit Hyperactivity Disorder, please contact: National Organization for Rare Disorders (NORD) P.O. Box 8923 New Fairfield, CT 06812-1783 (203) 746-6518 C.H.A.D.D. Children with Attention Deficit Disorders 1859 N. Pine Island Rd. Plantation, FL 33322 (305) 587-3700 Attention Deficit Disorder Association 2620 Ivy Place Toledo, OH 43613 (800) 487-2282 National Alliance for the Mentally Ill 1901 N. Fort Meyer Dr., Suite 500 Arlington, VA 22209 (703) 524-7600 National Mental Health Consumer Self-Help Clearinghouse 311 S. Juniper St., Rm. 902 Philadelphia, PA 19107 (215) 735-2481 NIH/National Institute of Neurological Disorders & Stroke (NINDS) 9000 Rockville Pike Bethesda, MD 20892 (301) 496-5751 (800) 352-9424 NIH/National Institute of Mental Health (NIMH) 9000 Rockville Pike Bethesda, MD 20205 (301) 443-4515 or (301) 496-1752 (800) 421-4211 (24 hrs.) Association for Children and Adults with Learning Disabilities 4156 Library Road Pittsburgh, PA 15234 (412) 341-1515 (412) 341-8077 References SUSTAINED RELEASE AND STANDARD METHYLPHENIDATE EFFECTS ON COGNITIVE AND SOCIAL BEHAVIOR IN CHILDREN WITH ATTENTION DEFICIT DISORDER: W.E. Pelham, Jr., et al.; Pediatrics (October 1987: issue 80(4)). Pp. 491-501. ATTENTION DEFICIT DISORDER WITH HYPERACTIVITY: DIFFERENTIAL EFFECTS OF METHYLPHENIDATE ON IMPULSIVITY: M.D. Rapport, et al.; Pediatrics (December 1985: issue 76(6)). Pp. 938-943. FIFTEEN-YEAR FOLLOW-UP OF A BEHAVIORAL HISTORY OF ATTENTION DEFICIT DISORDER: D.C. Howell, et al.; Pediatrics (August 1985: issue 76(2)). Pp. 185-190. HIGH RATE OF AFFECTIVE DISORDERS IN PROBANDS WITH ATTENTION DEFICIT DISORDER AND IN THEIR RELATIVES: A CONTROLLED FAMILY STUDY: J Biederman, et al.; American Journal Psychiatry (March 1987: issue 144(3)). Pp. 330-333.