ADHD Symptoms Are Not Always Obvious during Childhood

The criteria set out in DSM-IV stipulate that at least some of the impairing ADHD symptoms must have been present before age seven. But this requirement has no basis in empirical research it was arbitrarily stipulated by the committee that wrote the diagnostic criteria for DSM-IV. Presumably the rationale was to establish that ADHD does not appear de novo later in life. Such a view makes no sense when ADHD is seen as a developmental impairment of executive functions, an impairment that in some...

Tailoring Treatments for Individuals and Families with ADHD

Some clinicians claim that every patient with ADHD should receive multimodal treatment. This fancy phrase simply means that medication alone is often not enough to fully treat ADHD. Typically, behavioral treatments and education are added to the list of treatment modalities that should be provided for every patient. But although it is true that educating the patient and family about the nature of ADHD and its treatment is an essential component of any adequate treatment plan, it is not true...

Brain Centers That Regulate Alertness and Fine Tune Cognition

At the back of the brain are circuits that play important roles in regulating alertness and fine-tuning cognitive processes. Systems of the brain that control motivation, memory, and so forth are linked to the brain's alertness and to cycles of wakefulness and sleep. Aspects of the warning system for potential danger continue to operate during sleep so that, for example, a person might awaken from slumber to the smell of smoke or a sudden, unfamiliar sound. Yet for the most part, executive...

Antihypertensives

Clonidine and guanfacine, marketed as Catapres and Tenex, respectively, were originally developed as medications to reduce high blood pressure. They have been found helpful for reducing excessive hyperactivity and impulsivity in children with ADHD, but there is currently no evidence that these agents improve the cognitive impairments of ADHD. The effects for clonidine usually persist for about six hours, while guanfacine usually lasts a bit longer. Usual daily doses reported by the group led by...

The MTA Study

Sometimes parents and clinicians wonder which type of treatment, behavioral or medication, is more effective for treatment of ADHD. Until recently there was very little empirical data to address that question. This situation changed with completion of the Multimodal Treatment Study of Children with ADHD (MTA Cooperative Group 1999). This massive research project, sponsored jointly by the National Institute of Mental Health and the U.S. Department of Education, sought to answer three questions...

Cluster 4 Managing Frustration and Modulating Emotions

The diagnostic criteria for attention-deficit hyperactivity disorder in the DSM-IV do not include any items referring to emotions. Yet many clinicians report that patients with ADHD struggle with managing their emotions. Paul Wender (1987, 1995) described how individuals with ADHD have affective lability and frequently demonstrate a bored or demoralized mood, irritable complaining, angry outbursts, or insufficiently controlled excitability. Wender also noted that individuals with ADHD appear to...

Cluster 6 Monitoring and Self Regulating Action

Most descriptions of the disorder now known as ADHD emphasize problems with hyperactive and impulsive behavior. Many persons identified with this disorder tend to act without sufficient forethought, or are chronically restless and hyperactive, finding it very difficult to slow down and adequately control their actions. Children with ADHD have often been seen as wild, restless, and impulsive, unable sufficiently to control their words and bodies and so needing much more supervision from teachers...

Conduct Disorder

Mike is a sixteen-year-old boy whose ADHD diagnosis describes only a small portion of his chronic difficulties. He has been getting failing grades in most of his high school courses for the past two years since he moved into a new foster home placement. Often he cuts classes or just doesn't show up for school. Mike has been in foster care since he was seven years old he is currently in his fourth placement. Each of his previous placements has ended because of serious behavior problems, for...

Fact Add is a complex disorder that involves impairments in focus organization motivation emotional modulation memory

Imagine a large carton filled with photographs taken throughout your life. The carton is filled with snapshots of you and various family members roller skating or riding bikes, fishing off a pier or swimming in a lake, dressing up for Halloween or setting off for the first day of school. Some are posed with you in your Scout or Little League uniform or in costume for a dance recital. Others are candid shots taken around a birthday cake, in the midst of holiday celebrations, or at other...

Bipolar Disorder

Bipolar disorder (BPD) is also among diagnoses classified by Pennington as disorders of motivation and arousal. Formerly known as manic-depressive disorder, this syndrome is characterized by episodes during which the individual manifests an intense increase in elation, grandiosity, and rapid or racing thoughts, usually with decreased need for sleep and often with hypersexuality or increased frequency of other activities that may be pleasurable, but are likely to create serious difficulties for...

Nonstimulant Medications for ADHD

Although stimulant medications are effective in alleviating ADHD symptoms in most children, adolescents, and adults who suffer from the disorder, about 20 to 30 percent do not respond well to stimulants. For these individuals, nonstimulant medications may be effective. Even among those who do experience significant relief from their symptoms when taking stimulants, there are many who experience significant difficulties with mood, anxiety, tics, or other problems that may be exacerbated, or at...

Very Intelligent People with ADHD Are Often Overlooked

Sometimes persons with a higher overall IQ who suffer from ADHD are at greater risk of having their impairments overlooked. At Yale, Donald Quinlan and I studied adults who sought evaluation for chronic atten-tional problems, all of whom had a tested IQ in the superior range in terms of intelligence, they were in the top 1 to 9 percent of the general population. Despite their very high IQ scores, 42 percent of these men and women had dropped out of their postsecondary schooling at least once,...

Learning to Read and Write

Reading and writing are additional modes of communication that become increasingly important from early childhood on. Both of these involve considerable work to develop needed skills. One mother described problems in motivating her son to work at learning. Our son Wally is a very bright boy, but he just won't work in school. When they do things that interest him, he will join in the conversation and contribute some good ideas, but he has never had any patience for when the teachers or...

Many with ADHD Are Not Hyper

For decades the primary marker used to identify individuals with ADHD impairments was hyperactivity. Children who were very obviously hyperactive were considered candidates for evaluation for ADHD, especially if they were being disruptive or making trouble for their teachers. ADHD diagnosis was not even considered for those who were not hyperactive and not disruptive in school. An elementary-school janitor described this as he came seeking evaluation for his ten-year-old daughter I could always...