Attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder in children, affecting 3 to 5 percent of school-age children. Its main symptoms include inappropriately developed levels of attention, concentration, activity, inattention, and impulsivity.
Children with ADHD are often functionally impaired in a variety of settings including family, school, and in peer relationships. ADHD has also been shown to have long-term adverse effects on academic performance, work success, and socio-emotional development.
Despite advances in the assessment, diagnosis, and treatment of children and adults with ADHD, the disorder remains controversial. The diverse and conflicting opinions on ADHD have confused families, health care providers, educators, and policymakers.
Controversy raises questions about the literal existence of the disorder, whether it can be reliably diagnosed, and if treated, what interventions are most effective. One of the major controversies regarding ADHD concerns use of psychostimulants to treat the condition. psychostimulants, including amphetamine, methylphenidate, and pemoline, are by far the most studied and prescribed treatments for ADHD. With psychostimulants more readily available and more frequently prescribed, concern has grown over the potential for their abuse and misuse.
What scientific evidence proves ADHD is a disorder?
A diagnosis of ADHD can be reliably made using well-tested diagnostic interview methods. However, to date, there are no valid independent tests for ADHD. Although research has suggested a central nervous system basis for ADHD, more research is needed to definitively define ADHD as a brain disorder.
This applies not only to ADHD, but also to most psychiatric disorders, including disabling conditions such as schizophrenia. Evidence supporting the validity of ADHD includes the long-term development of ADHD over times, cross-country studies showing similar risk factors, familial subset ADHD (possibly heredity or environment) and heritability.
More effort is needed to confirm the disorder: accurate description of cases, using specific diagnostic criteria, repeat follow-up studies, family studies (including studies of twins birth and on adoption), epidemiological studies and long-term treatment studies. To the extent possible, these studies should include a variety of controls, including normal subjects and subjects with other clinical conditions. Such studies may suggest subgroups of patients found to be associated with different outcomes, responses to different treatments, and different patterns of Family characteristics and disease.
Several questions regarding the diagnosis of ADHD have been raised indicating the need for further research to confirm the diagnostic methods.
- Clinicians diagnosing this disorder have been criticized for simply taking a normal percentage of the population , who have the most evidence of persistent inattention and activity and label them sick. In fact, it is not clear whether markers of ADHD represent a bimodal distribution in the population or one end of a continuum of traits. This is not unique to ADHD as other medical diagnoses, such as baseline hypertension and hyperlipidemia, are ongoing in the general population, but the usefulness of diagnosis and treatment has proven. However, the diagnostic issues involved include distinguishing this entity from other behavioral problems and determining the appropriate boundary between the normal population and individuals with ADHD.
- ADHD does not usually present as an isolated disorder, and the comorbidities (co-existing conditions) may complicate the studies, which may explain some of the inconsistencies in the study. research results.
- Although the prevalence of ADHD in the United States is estimated to be around 3-5% in the United States, a broader range of prevalence has been reported in studies. Rates reported in some other countries are much lower. This suggests the need for further research on ADHD in different populations and for a better definition of the disorder.
- All of the official ADHD diagnostic criteria were designed to diagnose young children and were unadjusted for older children and adults. Therefore, an appropriate revision of these criteria to facilitate the diagnosis of these persons is recommended.
In summary, there is validity in the diagnosis of ADHD as a disorder with broadly accepted symptoms and behavioral characteristics that define the disorder.
What Are the Effective Treatments for ADHD?
Many treatments have been used for ADHD including but not limited to various psychotropic drugs, psychosocial treatments, dietary management, herbs and methods homeopathy, biofeedback, meditation, and perceptual stimulation/training. Of these treatment strategies, stimulant drugs and psychosocial interventions were the focus of research. Efficacy studies of psychosocial medications and treatments for ADHD have focused primarily on the combined DSM IV class equivalent that meets the criteria for inattention and hyperactive / impulsive. Until recently, most RCTs were short-term, up to about 3 months. Overall, these studies support the efficacy of stimulants and psychosocial treatments for ADHD and the superiority of stimulants over psychosocial treatments. However, there were no longitudinal studies that tested stimulants or psychosocial treatments over several years. There is no information available on the long-term discharge of people with ADHD treated with medication in terms of educational and career achievement, police involvement, or other areas of social activity.Stimulant short-term trials confirmed the effectiveness of methylphenidate (MPH) dextroamphetamine and pemoline in children with ADHD. On average, little, if any, difference was found between these stimulants. However, MPH is the most widely studied and used stimulant. These short-term trials showed beneficial effects on identified ADHD symptoms and associated aggression during drug administration. However, stimulant treatment may not "normalize" all behavioral problems, and children receiving treatment may still exhibit higher levels of behavioral problems than with normal children. The consistent findings that despite improvement in baseline symptoms, had little improvement in academic performance or social skills were of concern.
Several short-term studies of antidepressants have shown that imipramine improved over placebo in the evaluation of ADHD symptoms in parents and teachers. Studies on the effectiveness of imipramine are conflicting. Several other psychotropic drugs have been used to treat ADHD, but the current outcome data available from these studies cannot draw conclusions about their effectiveness.
Psychosocial treatment for ADHD has included some behavioral strategies such as prevention management (p. Skills), clinical behavioral therapy (parents, teachers, or both learning to use them). use preventive management processes) and oral cognitive processing (eg, self-bringing, verbal self-direction, problem-solving strategies, personal reinforcement). Cognitive behavioral treatment has not been shown to have beneficial effects in children with ADHD. In contrast, clinical behavioral therapy, parent training, and preventive management produced beneficial effects. Intensive direct interventions in children with ADHD produced improvements in key performance areas. However, no randomized controlled trials have been conducted in some of these intensive interventions alone or in combination with medication. Studies comparing stimulants with psychosocial treatment including have reported a higher effectiveness of stimulants. Superiority to conventional community care, often associated with stimulant use a potentially significant benefit to behavioral treatment is the ability to improve function with stimulant doses reduce. This ability has not been tested.
There is a long history of some other interventions for ADHD. These include dietary replacements, exclusions, or supplements, diets rich in vitamins, minerals or herbs, biofeedback perceptual stimulation; and another host.
Although there has been considerable interest in these interventions and there are a few controlled and uncontrolled studies using different strategies, the status of the empirical evidence on these interventions were uneven, ranging from missing data to controlled trials.
Several dietary elimination strategies have shown compelling results suggesting the need for future research. The current state of the empirical literature on the treatment of ADHD is such that it is impossible to answer at least five, important questions. First, it was not possible to determine whether a combination of stimulants and psychosocial treatments could improve its function with a reduced dose of the stimulant.
Second, there are no data on the treatment of ADHD, type attention deficit, which may include a high proportion of girls. Third, have no conclusive data on treatment in adolescents and adults with ADHD. Fourth, no information is available on the effects of long-term treatment (treatment lasting more than 1 year), indicated in this persistent disorder.
Finally, presented evidence regarding the cognitive problems associated with ADHD, such as impaired working memory and impaired language processing, and demonstrated underperformance of current treatments to improve learning outcomes, it is necessary to adopt and develop methods that target these weaknesses.