Applied History of Psychology/Attention-Deficit/Hyperactivity Disorder

Attention-Deficit/Hyperactivity Disorder (ADHD)

Some of the controversies surrounding ADHD include whether it is overdiagnosed, whether it is a "new disorder", who diagnoses are made to benefit (children or teachers and parents), the appropriateness of medicating young children, the high rates of co-occurrence with a variety of other disorders (i.e., conduct disorder, oppositional defiant disorder, anxiety, depression, Tourette's Disorder), and whether the disorder persists past childhood.

History

Contrary to much popular belief, the symptoms of ADHD have been recognized for more than 150 years. In 1844 Dr. Heinrich Hoffman wrote the following story about a little boy he called Fidgety Philip:

Let me see if Philip can

Be a little gentleman

Let me see, if he is able

To sit still for once at table:

Thus Papa bade Phil behave;

And Mamma look'd very grave.

But fidgety Phil,

He won't sit still;

He wriggles

and giggles,

And then, I declare

Swings backwards and forwards

And tilts up his chair,

Just like any rocking horse; -

"Philip! I am getting cross!"

See the naughty restless child

Growing still more rude and wild.

Till his chair falls over quite.

Philip screams with all his might.

Catches at the cloth, but then

That makes matters worse again.

Down upon the ground they fall.

Glasses, plates, knives, forks and all.

How Mamma did fret and frown.

When she saw them tumbling down!

And Papa made such a face!

Philip is in sad disgrace.

Where is Philip, where is he?

Fairly cover'd up you see!

Cloth and all are lying on him;

He has pull'd down all upon him.

What a terrible to-do!

Dishes, glasses, snapt in two!

Here a knife, and there a fork!

Philip, this is cruel work.

Table all so bare, and ah!

Poor Papa, and poor Mamma

Look quite cross, and wonder how

They shall make their dinner now.

Interestingly, this poem covers many known aspects of ADHD: the hyperactivity, the inability to make predictions, and family relation difficulties.

Diagnosis

The DSM-IV-TR criteria for ADHD propose three different subtypes for the disorder:

Predominantly Inattentive Type, Predominantly Hyperactive-Impulsive Type, and Combined Type.

Although these subtypes were intended to clarify prognosis and treatment, there is some suggestion that the subtypes really represent a developmental progression, with young children with ADHD more likely to show the hyperactive-impulsive type, school-age children more likely to show combined type, and adolescents and adults more likely to show the inattentive type.

There is some controversy around the "laxness" of this definition. ICD-10 for instance, uses far stricter criteria for its nearest equivalent disorder to ADHD: hyperkinesis. While approximately 5% of US children meet criteria for DSM-IV ADHD, only 1% meet criteria for hyperkinesis.

Barkley, a prominent researcher and theorist on ADHD, has proposed that the main deficit in ADHD is in behavioural inhibition. Further to this point, he feels that the inattentive subtype of ADHD is a separate disorder from the hyperactive-impulsive and combined types.

There is accumulating evidence to suggest that ADHD does indeed persist into adulthood. Current conceptualizations of the disorder in adults, suggest some common symptomology with depression. A problem with diagnosing ADHD in adulthood is that the diagnostic criteria have been set up around what one would see in a child with the disorder and that these criteria are not necessarily appropriate for use with children.

Treatment

Pharmacological Treatment

Two main types of medications are used to treat the core symptoms of ADHD. These are stimulants and non-stimulants. Other medications, most often atypical antipsychotics are used at times to address behavioural difficulties.

The main stimulant medications are Ritalin (generic: methylphenidate), Concerta (a slow-releasing version of Ritalin), and Dexedrine

The first non-stimulant medication approved for treatment of ADHD was Straterra, a selective norepinephrine reuptake inhibitor. Effexor is also often used in children with co-occurring anxiety and ADHD.

Clonidine, an atypical, is often used in children with Tourrette's Disorder and ADHD.

Behavioural Treatment

Parent training

COPE