Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is one of the most common types of childhood disorders. Individuals with ADHD exhibit attention problems as well as hyperactive and impulsive behaviors. Children and adolescents with ADHD may have difficulty sitting still, listening to instructions or classroom lectures, organizing materials, completing schoolwork or homework, or playing or engaging in activities quietly. These individuals frequently make careless mistakes in their schoolwork or they may forget or lose things.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000), there are three subtypes of ADHD:

• 1.
  ADHD, Predominantly Inattentive Type
• 2.
  ADHD, Predominantly Hyperactive-Impulsive Type
• 3.
  ADHD, Combined Type

The ADHD, Combined Type is the most common, and individuals with this subtype exhibit inattentive and hyperactive-impulsive behaviors. To meet the diagnostic criteria for this subtype, individuals must exhibit both of the following:

• At least six of the nine inattentive symptoms (fails to attend to details, does not seem to listen, has difficulty sustaining attention in tasks and play activities, does not follow through on instructions, has difficulty organizing tasks and activities, avoids tasks requiring sustained mental effort, often loses necessary things, is easily distracted, and is often forgetful in daily activities)
• At least six of the nine hyperactive-impulsive symptoms (e.g., often fidgets with hands or feet, often leaves seat in the classroom, often runs about or climbs excessively, has difficulty playing or engaging in leisure activities, acts if “on the go” or “driven by a motor,” interrupts others, has difficulty awaiting turn, blurts out responses, and talks excessively)

Inattentiveness characterizes the ADHD, Predominantly Inattentive Type. Individuals with this subtype must exhibit at least six inattentive symptoms and fewer than six hyperactive-impulsive symptoms. In contrast, the symptoms of motor excess and impulsive responding characterize individuals with ADHD, Predominantly Hyperactive-Impulsive Type. Individuals with this subtype must exhibit six or more hyperactiveimpulsive symptoms and fewer than six inattentive symptoms. For all three subtypes, the symptoms must be present for at least six months and some of the symptoms must have appeared before seven years of age. Impairment associated with these symptoms is exhibited in at least two settings (e.g., home and school), and the impairment affects social or academic functioning and is clinically significant.

As with other disorders, the prevalence of ADHD among children and adolescents has been difficult to [Page 33]ascertain. Prevalence estimates have ranged from 1% to 14%, with 3% to 7% as the most common prevalence estimates reported in recent years. ADHD is reported to be more common in males than in females, with male-to-female ratios ranging from 2:1 to 9:1 (American Psychiatric Association, 2000).

Children and adolescents with ADHD are at risk for developing comorbid disorders. More than 50% of these individuals are reported to have one or more co-occurring disorders (Barkley, 1998), with the most prevalent co-occurring disorders being oppositional defiant disorders, conduct disorders, mood disorders (i.e., bipolar disorders and unipolar depression), anxiety disorders, learning disorders, and communication disorders. Of these disorders, the disruptive behavior disorders (i.e., oppositional defiant disorders and conduct disorders) are the most common comorbid conditions (American Psychiatric Association, 2000).

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