Attention Deficit Hyperactivity Disorder

Attention deficit hyperactivity disorder (ADHD) is a behavior problem that is characterized by hyperactivity, inattention, restlessness, and impulsivity and, until [Page 63]recently, was diagnosed primarily in children. It was first defined as Hyperkinetic Disorder of Childhood in 1957 and was commonly known as hyperactivity or hyperactive syndrome until it was renamed ADHD in 1987. The renaming also represented a shift in focus from hyperactive behavior to the inattention as a major characteristic of the disorder.

In the United States the Centers for Disease Control and Prevention (CDC) estimates 7 percent of school-age (6–10) children have ADHD, with a ratio of 3 to 1 boys to girls. White children tend to have higher rates of ADHD diagnosis than minority children. In recent years the definition of ADHD has broadened. Now, in addition to school-age children, ADHD is diagnosed in preschool children, adolescents, and adults, which contributes to the rising prevalence.

The most common medical treatment for ADHD is with psychoactive medications, especially ethyl-phenidate (Ritalin) and other stimulant medications (Cylert, Adderall, and Concerta). Treatment rates have increased enormously in recent years; in 2004 the Department of Health and Human Services estimated 5 million children ages 5 to 17 were treated for ADHD in 2000–02, up from 2.6 million in 1994. The diagnosis and treatment of ADHD is much higher in the United States than in other countries, but evidence suggests that since the 1990s it has been rising in other countries as well, for example, in the United Kingdom.

The causes of ADHD are not well understood, although various theories have been offered, including dietary, genetic, psychological, and social ones. In the past 2 decades, medical researchers have reported genetic susceptibilities to ADHD and found differences in brain imaging results from individuals with ADHD and individuals without ADHD. Although bio-medical theories of ADHD predominate, the causes of ADHD are still largely unknown. Some contend that even if there are biological differences between children with ADHD and other children, what is observed may be a reflection of differences in temperament rather than a specific disorder.

ADHD and its treatment have been controversial at least since the 1970s. Critics have expressed concern with the drugging of schoolchildren, contending that ADHD is merely a label for childhood deviant behavior. Others grant that some children may have a neurological disorder, but maintain that there has been an overdiagnosis of ADHD. From time to time some educators and parents have raised concerns about adverse effects from long-term use of stimulant medications. Child psychiatrists see ADHD as the most common childhood psychiatric disorder and consider psychoactive medication treatment as well established and safe. Parent and consumer groups, such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder), tend to support the medical perspective of ADHD.

Since the 1990s there has been a significant rise in the diagnosis and treatment of adult ADHD. Whereas childhood ADHD is usually school or parent identified, adult ADHD seems to be largely self-identified. Some researchers have noted that many apparently successful adults seek an ADHD diagnosis and medication treatment as a result of learning about the disorder from professionals, the media, or others, and then seeing their own life problems reflected in the description of ADHD (e.g., disorganized life, inability to sustain attention, moving from job to job). Adult ADHD remains controversial, however. Many psychiatrists have embraced adult ADHD as a major social problem, with claims of tens of billions of dollars in lost productivity and household income due to the disorder, whereas critics have suggested it is “the med-icalization of underperformance.”

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