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$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
     [phone]

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
     [phone]

     C.H.A.D.D.
     Children with Attention Deficit Disorders
     1859 N. Pine Island Rd.
     Plantation, FL  33322
     [phone]

     Attention Deficit Disorder Association
     2620 Ivy Place
     Toledo, OH  43613
     [phone]

     National Alliance for the Mentally Ill
     1901 N. Fort Meyer Dr., Suite 500
     Arlington, VA  22209
     [phone]

     National Mental Health Consumer Self-Help Clearinghouse
     311 S. Juniper St., Rm. 902
     Philadelphia, PA  19107
     [phone]

     NIH/National Institute of Neurological Disorders & Stroke (NINDS)
     9000 Rockville Pike
     Bethesda, MD  20892
     [phone]
     [phone]

     NIH/National Institute of Mental Health (NIMH)
     9000 Rockville Pike
     Bethesda, MD 20205
     [phone] or [phone]
     [phone] (24 hrs.)

     Association for Children and Adults with Learning Disabilities
     4156 Library Road
     Pittsburgh, PA  15234
     [phone]
     [phone]

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.