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Attention Deficiet / Attention Deficient Hyperactivity Disorder 

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Attention Deficit Hyperactivity Disorder

  Symptoms of ADHD      
  Types of ADHD      
  ADHD Diagnosis      
    Inattention    
    Hyperactivity    
    Impulsivity    
  Types of ADHD: Making the Diagnosis  
  How Is ADHD Usually Diagnosed?
  ADHD Diagnosis Based on Brain Scans -- An Alternative Approach
  Long-Term Prognosis With ADHD
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Symptoms of ADHD

The symptoms of ADHD include inattention and/or hyperactivity and impulsivity. These are traits that most children display at some point or another. But to establish a diagnosis of ADHD, sometimes referred to as ADD, the symptoms should be inappropriate for the child's age.

Adults also can have ADHD; in fact, up to half of adults diagnosed with the disorder had it as children.  When ADHD persists into adulthood, symptoms may vary. For instance, an adult may experience restlessness instead of hyperactivity. In addition, adults with ADHD often have problems with interpersonal relationships and employment.

The symptoms of ADHD include inattention and/or hyperactivity and impulsivity. These are traits that most children display at some point or another. But to establish a diagnosis of ADHD, sometimes referred to as ADD, the symptoms should be inappropriate for the child's age.

Adults also can have ADHD; in fact, up to half of adults diagnosed with the disorder had it as children.  When ADHD persists into adulthood, symptoms may vary. For instance, an adult may experience restlessness instead of hyperactivity. In addition, adults with ADHD often have problems with interpersonal relationships and employment.

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Types of ADHD
There are three different subtypes of ADHD, including:
  • Combined ADHD (the most common subtype), which involves symptoms of of both inattentiveness and hyperactivity/impulsivity
  • Inattentive ADHD (previously known as ADD), which is marked by impaired attention and concentration
  • Hyperactive-impulsive ADHD, which is marked by hyperactivity without inattentiveness

For a diagnosis of ADHD, some symptoms that cause impairment must be present before age seven. Also, some impairment from the symptoms must be present in more than one setting. For instance, the person may be impaired at home and school or home and work. Also, there must be clear evidence the symptoms interfere with the person's ability to function at home, in social environments, or at work.

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ADHD Diagnosis
There are three different categories of ADHD symptoms: inattention, hyperactivity, impulsivity.
Inattention

Inattention may not become apparent until a child enters the challenging environment of school. In adults, symptoms of inattention may manifest in work or in social situations.

A person with ADHD may have some or all of the following symptoms:

  • Difficulty paying attention to details and tendency to make careless mistakes in school or other activities; producing work that is often messy and careless
  • Easily distracted by irrelevant stimuli and frequently interrupting ongoing tasks to attend to trivial noises or events that are usually ignored by others
  • Inability to sustain attention on tasks or activities
  • Difficulty finishing schoolwork or paperwork or performing tasks that require concentration
  • Frequent shifts from one uncompleted activity to another
  • Procrastination
  • Disorganized work habits
  • Forgetfulness in daily activities (for example, missing appointments, forgetting to bring lunch)
  • Failure to complete tasks such as homework or chores
  • Frequent shifts in conversation, not listening to others, not keeping one's mind on conversations, and not following details or rules of activities in social situations.
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Hyperactivity

Hyperactivity symptoms may be apparent in very young preschoolers and are nearly always present before the age of seven. Symptoms include:

  • Fidgeting, squirming when seated
  • Getting up frequently to walk or run around
  • Running or climbing excessively when it's inappropriate (in teens this may appear as restlessness)
  • Having difficulty playing quietly or engaging in quiet leisure activities
  • Always being 'on the go'
  • Often talking excessively

Hyperactivity may vary with age and developmental stage.

Toddlers and preschoolers with ADHD tend to be constantly in motion, jumping on furniture, and having difficulty participating in sedentary group activities. For instance, they may have trouble listening to a story.

School-age children display similar behavior but with less frequency. They are unable to remain seated, squirm a lot, fidget, or talk excessively.

In adolescents and adults, hyperactivity may manifest itself as feelings of restlessness and difficulty engaging in quiet sedentary activities.

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Impulsivity symptoms include:
  • Impatience
  • Difficulty delaying responses
  • Blurting out answers before questions have been completed
  • Difficulty awaiting one's turn
  • Frequently interrupting or intruding on others to the point of causing problems in social or work settings
  • Initiating conversations at inappropriate times

Impulsivity may lead to accidents such as knocking over objects or banging into people. Children with ADHD may also engage in potentially dangerous activities without considering the consequences. For instance, they may climb to precarious positions.

Many of these symptoms occur from time to time in normal youngsters. However, in children with ADHD they occur frequently -- at home and at school or when visiting with friends. They also interfere with the child's ability to function as other children of the same age or developmental level. 

ADHD is diagnosed only when children consistently display some or all of the above behaviors in at least two settings, such as at home and in school, for at least six months.

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Types of ADHD: Making the Diagnosis

In some people, the signs of ADHD seem obvious -- fidgeting constantly, difficulty paying attention in school or at work, and leaving tasks unfinished. For others, particularly those without behaviors problems, ADHD may be more difficult to diagnose.  

The symptoms of ADHD may mimic those of other conditions, and sometimes the signs are subtler and harder to distinguish. One psychiatrist, Daniel Amen, MD, believes that to get a truly accurate diagnosis of ADHD, it is necessary to look inside the brain to see how well various areas are functioning. He has developed his own set of ADHD subtypes based on brain scans of children with ADHD, which he says can better target treatment and determine which areas are not working as they should.

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How Is ADHD Usually Diagnosed?

Most psychologists, psychiatrists, and pediatricians diagnose ADHD based on a set of inattention and hyperactivity symptoms along with other criteria outlined in the Diagnostic & Statistical Manual for Mental Disorders- Fifth Edition (DSM-V). For someone to be diagnosed with ADHD, the behaviors must have lasted for at least six months, and symptoms must be present in school and in other aspects of the individual's life.

Inattention symptoms of ADHD include:

  • Not paying attention to detail
  • Making careless mistakes
  • Failing to pay attention and keep on task
  • Not listening
  • Being unable to follow or understand instructions
  • Avoiding tasks that involve effort
  • Being distracted or forgetful
  • Losing things that are needed to complete tasks

Hyperactivity-impulsivity symptoms of ADHD include:

  • Fidgeting
  • Squirming
  • Getting up often when seated
  • Running or climbing at inappropriate times
  • Having trouble playing quietly
  • Talking excessively or out of turn
  • Interrupting

Based on the above symptoms listed in its Diagnostic and Statistical Manual, the American Psychiatric Association has identified three subtypes of ADHD: 

1. ADHD, Combined Type: Both inattention and hyperactivity-impulsivity symptoms

2. ADHD, Predominantly Inattentive Type: Inattention, but not enough (at least 6 out of 9 for children less than 18 years old) hyperactivity-impulsivity symptoms

3. ADHD, Predominantly Hyperactive-Impulsive Type: Hyperactivity-impulsivity, but not enough (at least 6 out of 9) inattention symptoms

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ADHD Diagnosis Based on Brain Scans -- An Alternative Approach

Amen, a child, adolescent, and adult psychiatrist who serves as medical director of the Amen Clinics in California, Washington, and Virginia, has used a combination of symptoms and brain scans to come up with his own types of ADHD.

Amen considers these to be the hallmark symptoms of ADHD:

  • Short attention span
  • Distractibility
  • Disorganization
  • Procrastination
  • Poor judgment and ability to plan ahead
  • Difficulty with impulse control

Based on these symptoms, and the use of  brain scans to measure blood flow (SPECT), to highlight activity in the parts of the brain related to attention, short-term memory, and forethought, Amen described these six types of ADHD:

  • Type 1 -- Classic ADHD. Symptoms of ADHD, plus hyperactivity and impulsivity; responds well to stimulant medications
  • Type 2 -- Inattentive ADHD. Features of ADHD, but instead of hyperactivity, there is low energy; responds well to stimulant medications
  • Type 3 -- Overfocused ADHD. Symptoms of ADHD and negative thoughts and behaviors, such as opposition and arguing; tends to respond better to an antidepressant (such as Prozac) combined with a stimulant
  • Type 4 -- Temporal Lobe ADHD. The hallmark features of ADHD, plus irritability, aggressiveness, and memory and learning problems; responds better to antiseizure medications (like Neurontin) than to stimulants
  • Type 5 -- Limbic ADHD. Combines ADHD with depression and low energy and decreased motivation; responds better to stimulating antidepressants than to stimulants
  • Type 6 -- The Ring of Fire. Cross between ADHD and bipolar disorder; characterized by moodiness, aggressiveness, and anger; Anticonvulsants or newer antipsychotic medications tend to work better than stimulants
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Long-Term Prognosis With ADHD
Some children with ADHD -- approximately 20% to 30% -- develop learning problems that may not improve with ADHD treatment. Hyperactive behavior may be associated with the development of other disruptive disorders, particularly conduct and oppositional-defiant disorder. Why this association exists is not known.

A great many children with ADHD ultimately adjust. Some, though, especially those with an associated conduct or oppositional-defiant disorder, are more likely to drop out of school. These individuals fare more poorly in their later careers.

Inattention tends to persist through childhood and adolescence and on into adulthood, while hyperactivity tends to diminish with age.

As they grow older, some teens that have had ADHD since childhood may experience periods of anxiety or depression.

Several  of the symptoms of ADHD may get worse as the demands at school or home increase. They include:

  • Difficulty following instructions
  • Being unable to get organized, either at home or at school
  • Fidgeting, especially with the hands and feet
  • Talking too much
  • Failing to finish projects, including chores and homework
  • Not paying attention to and responding to details
  • Getting poor grades in school
  • Being isolated from peers due to poor grades and secondary depression
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