Introduction
‘Attention deficit hyperactivity disorder’, ‘attention deficit disorder’, ‘hyperkinetic disorder’, ‘hyper kinesis’ and ‘minimal brain dysfunction’ are some of the terms used for a syndrome characterized by persistent over activity, impulsivity, and difficulties in sustaining attention (Taylor, 1994, Wender, 1997). The clinicians noticed that adolescents, too, could benefit from stimulant medication while they are generally neglected. Beliefs arise in psychiatry either because many nonscientific clinicians observe the same phenomena over and over again or because scientific studies affirm and demonstrate the clinicians’ observations. Twenty years ago, psychiatrists were conducting careful studies in which they traced the development and outcome of a large group of ADD adolescents.
In diagnosing patients, psychiatrists employ a manual that specifies the exact characteristics of psychiatric disorders. This manual now recognizes not only ADD and specific developmental disorders (SDD) but also ADD persisting into adolescent life. The official designation for the adolescent form of ADD is attention deficit disorder, residual type (ADD,RT) — that is, attention deficit disorder leaving a residue. The manual states that if the symptom of hyperactivity is present in childhood ADD it tends to disappear, but the other major symptoms of ADD — concentration problems, impulsivity, and so forth — may persist. How common this is and what the other symptoms are in adolescents are not clearly stated because evidence was just beginning to accumulate on ADD, RT when the manual was published in 1980.
Information on the persistence of attention deficit disorder into adolescent life has also come from psychiatric case reports of individual patients with different diagnoses who had had ADD. The ADD problems seemed to be present to some extent in the adolescents; in some instances they changed with age. Several extremely important questions remain. The first is how common ADD is in adolescents. The second is what its distinguishing symptoms are. In our research, we have listed the symptoms we believe are present in adolescents with ADD. In various researches, all the techniques customarily used to reduce chances of self-deceit — that is, to reduce the chances of our persuading ourselves that what we expect to find is true. However, the help of other psychiatric researchers is needed not only to confirm our findings but also to aid in independently identifying the symptoms of ADD in adolescents. (Biederman, 1996) Their help is particularly necessary for sorting out ADD, RT symptoms that are very similar to and can be confused with those of biological (chemical) depressions.
Origin and symptoms of Attention Deficit Disorder
Most scientists now believe that a brain dysfunction or abnormality in brain chemistry could be to blame for the symptoms of Attention Deficit Disorder. The frontal lobes of the brain are thought to be most responsible for the regulation of behavior and attention. They receive information from the lower brain, which regulated arousal and screens incoming messages from within and outside of the body. The limbic system, a group of related nervous system structures located in the midbrain and linked to emotions and feelings, also sends messages to the frontal lobes. (Young, 2002) Finally, the frontal lobes are suspected to be the site of working memory, the place where information about the immediate environment is considered for memory storage, planning, and future-directed behavior. (Hartmann, 2003) Scientists believe the activity in the frontal lobes is depressed in people with ADD.
Studies show a decrease in the ability of the ADD brain to use glucose, the body’s main source of energy, leading to slower and less efficient activity. Neurotransmitters provide the connection between one nerve cell and another. In essence, neurotransmitters allow electrical impulses to pass across synapses from one neuron to another. It is now suspected that people with Attention Deficit Disorder have a chemical imbalance of a class of neurotransmitters called catecholamine. Dopamine, helps to form a pathway between the motor center of the midbrain and the frontal lobes, as well as a pathway between the limbic system and the frontal lobes.
Without enough dopamine and related catecholamine, such as serotonin and norepinephrine, the frontal lobes are under stimulated and thus unable to perform their complex functions efficiently. Attention Deficit Disorder is strongly considered genetically inherited; however, not all cases of ADD may be genetically linked. . Studies have shown that 20-30% of all hyperactive patients have a least one parent with ADD. (Wasserstein, 2001) The environment is a big influence on a child during pregnancy and after. Some studies show that a small percentage of ADD cases were influenced by smoking, drinking alcohol, and using drugs during pregnancy.
Exposure to toxins, such as lead, may also alter the brain chemistry and function. If you suspect that you are suffering from Attention Deficit Disorder you will need to discuss it with your medical doctor. In most cases the doctor will recommend that you visit a psychologist for an evaluation. The psychologist is professionally trained in human behavior and will be able to provide counseling and testing in areas related to mental health. The psychologist is not able to prescribe medication to help you, but may send you to a psychiatrist to prescribe and monitor medication. A neurologist may be consulted in order to rule out neurological conditions causing your symptoms. (Cantwell, 1999) Your doctor will gather information about your past and present difficulties, medical history , current psychological makeup, educational and behavioral functioning.
Depending on your symptoms, your diagnosis may be categorized as ADD, inattentive type ADD, or hyperactive/impulsive type ADD. After your diagnosis you may learn that you are also suffering from a learning disability, depression, or substance abuse, which is often associated with ADD. There is no cure for Attention Deficit Disorder. ‘Along with increasing awareness of the problem, a better understanding of its causes and treatment has developed
(Wender, 1995). There is medication for ADD which will only alleviate the symptoms. The medication will not permanently restore the chemical balance.
Approximately 70% of adolescents with ADD find that their symptoms significantly improve after they take medication prescribed by their doctors. (Wilens, 2002) The patient is able to concentrate on difficult and time-consuming tasks, stop impulsive behavior , and tame the restless twitches that have been experienced in the past. Some ADD patient’s psychological and behavioral problems are not solved by medication alone, and are required more therapy or training. There are two types of drugs that work to balance the neurotransmitters and have been found to be most effective in treating ADD. Stimulants are drugs that stimulate or activate brain activity. Stimulants work by increasing the amount of dopamine either produced in the brain or used by the frontal lobes of the brain. There are several different stimulants that may work to alleviate the symptoms of ADD, including methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert).
Treatment of ADD
Stimulants are by far the most effective medications in the treatment of ADD. Some patients respond well to antidepressants. Antidepressants also stimulate brain activity in the frontal lobes, but they affect the production and use of other chemicals, usually norepinephrine and serotonin. The antidepressants considered most useful for ADD include imipramine (Tofranil), desipramine (Norpramin), bupropion ( Wellbutrin), and fluoxetine hydrochloride (Prozac). All stimulants have the same set of side effects. Some patients complain of feeling nauseous or headachy at the outset of treatment, but find that these side effects pass within a few days. (Purdie, 2002)
Others find that their appetites are suppressed and or that they have difficulty sleeping. If the stimulant dosage is too high the patient may experience feelings of nervousness, agitation, and anxiety, in rare cases, increased heart rate and high blood pressure can result with the use of stimulants, especially if the patient has an underlying predisposition toward hypertension. Ritalin is the most widely prescribed drug used to treat ADD in adolescents. Ritalin appears to work by stimulating the production of the neurotransmitter dopamine. The benefits of Ritalin include improved concentration and reduced distractibility and disorganization. Dextroamphetamine is another stimulant medication that appears to have a slightly different pharmacological action than Ritalin. Both work to boost the amount of available dopamine. Dextroamphetamine, however, blocks the reuptake of the neurotransmitter while Ritalin increases its production (334 Kelly, Ramundo, Press).
All the drugs used to treat ADD have the same goal: to provide the brain with the raw materials it needs to concentrate over a sustained period of time, control impulses, and regulate motor activity. The drug or combination of drugs that work best for you depends on the individuals’ brain chemistry and constellation of symptoms. The process of finding the right drug can be tricky for each individual. The physicians are not able to accurately predict how any one individual will respond to various doses or types of Attention Deficit Disorder medication.
Medication is rarely enough for the patient. Most Attention Deficit Disorder patients require therapy to give guidance. adolescent patients have the burden of the past that often hinders their progress. The patient then needs help with the relief of disappointment, frustration, and nagging sense of self-doubt that often weighs upon the ADD patient. Some ADD patients suffer from low-grade depression or anxiety, others with a dependence on alcohol or drugs, and most with low self-esteem and feelings of helplessness. (Taylor, 1994, Pelham, 1999)
ADD and Therapy
Therapy also helps the ADD patient fully understand the disorder and how it controls the patient’s life. The knowledge of ADD will make the patient and parents more capable of changing the behaviors or circumstances disliked and enhancing strengths and assets. A second and most crucial part of the education process involves informing those around you about the disorder and its effects. Family members, friends, employers, and colleagues have been playing roles in the drama called ADD without ever being aware of it. (Bemporad, 2001) Explaining how the disorder may affect the relationships around the patient will help repair any past damage as well as pave the way to a stable future.
Attention Deficit Disorder is difficult for any family. ADD challenges the relationships and the issues of daily family life. Getting a family household to function smoothly is challenging for any family, with or without the presence of ADD. adolescents suffering from Attention Deficit Disorder have trouble establishing and maintaining physical order, coordinating schedules and activities, and accepting and meeting responsibilities. adolescents dealing with ADD often have chronic employment problems, impulsive spending, and erratic bookkeeping and bill paying. Raising healthy, well-adjusted individuals requires patience, sound judgment, good humor, and, discipline which is difficult for an ADD parent to do. The presence of ADD often hinders the development of intimate relationships for a variety of reasons. Although many adolescents with ADD enjoy successful, satisfying marriages, the disorder almost always adds a certain amount of extra tension and pressure to the union. The non-ADD spouse bears an additional burden of responsibility for keeping the household running smoothly and meeting the needs of the individuals, the spouse with ADD, and, if he or she has time, his or her own priorities. (Meisler, 2002)
Parenting a young individual who has ADD can be an exhausting and, at times, frustrating experience. Parents play a key role in managing the disability. They usually need specialized training in behavior management and benefit greatly from parent support groups. Parents often feel helpless, frustrated and exhausted. Too often, family members become angry and withdraw from each other. If untreated, the situation only worsens. Parent training can be one of the most important and effective interventions for ADD. Effective training will teach parents how to apply strategies to manage behavior and improve their relationship with the patient. (Accardo, 1999)
All stimulants have the same set of side effects. Some patients complain of feeling nauseous or headachy at the outset of treatment, but find that these side effects pass within a few days. Others find that their appetites are suppressed and or that they have difficulty sleeping. If the stimulant dosage is too high the patient may experience feelings of nervousness, agitation, and anxiety, In rare cases, increased heart rate and high blood pressure can result with the use of stimulants, especially if the patient has an underlying predisposition toward hypertension.
All the drugs used to treat ADD have the same goal: to provide the brain with the raw materials it needs to concentrate over a sustained period of time, control impulses, and regulate motor activity. The drug or combination of drugs that work best for you depends on the individual’s brain chemistry and constellation of symptoms. The process of finding the right drug can be tricky for each individual. The physicians are not able to accurately predict how any one individual will respond to various doses or types of Attention Deficit Disorder medication.
Medication is rarely enough for the patient. Most Attention Deficit Disorder patients require therapy to give guidance. adolescent patients have the burden of the past that often hinders their progress. The patient then needs help with the relief of disappointment, frustration, and nagging sense of self-doubt that often weighs upon the ADD patient. Some ADD patients suffer from low-grade depression or anxiety, others with a dependence on alcohol or drugs, and most with low self-esteem and feelings of helplessness. (Spencer, 2000)
Conclusion
ADD is a particularly serious problem because adolescents with the core difficulties of inattention, over activity and impulsivity may develop a wide range of secondary academic and relationship problems. Attentional difficulties may lead to poor attainment in school. Impulsivity and aggression may lead to difficulties making and maintaining appropriate peer relationships and developing a supportive peer group. Inattention, impulsivity and over activity make it difficult for youngsters with these attributes to conform to parental expectations, and so children with ADD often become embroiled in chronic conflictual relationships with their parents. In adolescence, impulsivity may lead to excessive risk taking with consequent complications such as drug abuse, road traffic accidents and dropping out of school. All of these risk-taking behaviors have knock-on effects and compromise later adjustment. As youngsters with ADD become aware of their difficulties with regulating attention, activity and impulsivity and the failure that these deficits lead to within the family, peer group and school, they may also develop low self-esteem and depression. In the light of the primary problems and secondary difficulties that may evolve in cases of ADD, it is not surprising that for some the prognosis is poor. For two-thirds of cases, the primary problems of inattention, impulsivity and hyperactivity persist into late adolescence, and for some of these the primary symptoms persist into adolescence. Roughly a third develops significant antisocial behavior problems in adolescence, including conduct disorder and substance abuse, and for most of this subgroup these problems persist into adolescence, leading to criminality. Occupational adjustment problems and suicide attempts occur in a small but significant minority of cases.
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