Attention deficit disorder (ADD), formerly known as attention
deficit/hyper-activity disorder (ADHD), is one of the most common mental
disorders among children today. It is estimated that approximately 3 percent to
5 percent of all children (two to three times as many boys are affected than
girls) or nearly 2 million American children (which correlates to one child in
each classroom in the United States) have ADHD according to the National
Institute of Mental Health.1 ADHD does not only affect children, as
symptoms can progress into adulthood as well.
The specific causes of ADHD are currently unknown, with several factors being
responsible in different people. No solitary causative factor has been
identified as being responsible for the different behavior patterns observed in
ADHD. ADHD is only diagnosed by certain characteristic behavior patterns that
are observed over time; no other clear physical signs can be seen. Common
behavioral pattern categories in ADHD include inattention, impulsivity, and
hyper-activity.
• Inattention: This is marked by difficulty in keeping the mind focused on
any one subject and a short attention span. People with ADHD often become bored
after only a few minutes at work on a subject, and placing focused attention on
new or unfamiliar topics can be challenging.
• Impulsivity: This is marked by an inability to refrain from immediate
reactions, making it difficult to wait and first think before speaking or
acting.
• Hyperactivity: This is marked by constant perpetual motion; staying in one
place and sitting still can be difficult. Adults may feel quite restless and may
start several projects and have a difficult time finishing them.
Diagnosis of ADHD is based upon an analysis of the person’s behavioral
patterns, which are compared to established criteria. These criteria are defined
in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV). The manual outlines the three previously mentioned behavior
patterns, and people may display varying amounts of each pattern or only one.
Because nearly everyone displays some of these symptoms at some time in their
life, certain criteria, including age of onset (early in life, before age
seven), duration of symptoms (continuous for at least six months), frequency
(occurring more often in themselves than others of similar age), and most
importantly, behavior(s), must occur in at least two different areas of the
person’s life, namely, school, home, work, or social settings.
A recent report issued by the Centers for Disease Control and Prevention
claimed that nearly 1.6 million elementary school–aged children have a diagnosis
of ADHD, and a national survey revealed that the parents of 7 percent of
children ages 6–11 years old were told by a healthcare professional that their
child had ADHD.2 The report also included the following demographic
information: boys are nearly three times as likely to have ADHD than girls;
white children are twice as likely than Hispanic and black children to have a
diagnosis of ADHD; children with health insurance are diagnosed with ADHD more
often than children without health insurance; and children with ADHD use more
healthcare services, including mental health services, than those without ADHD.
This report went on to propose that ADHD is probably overdiagnosed in those with
regular access and may be underdiagnosed in those with limited healthcare
access.
A common neurodevelopmental disorder, ADHD results in impaired educational
processes, social growth, and adaptation that lead to increasing rates of
behavioral difficulty, depression, school dropouts, and substance
abuse,3 which have lead to the mass prescription of stimulant
psychotropic medications in children affected with this disorder. With no fully
established biological causes recognized, ADHD does display prominent
heritability. Mainstream treatment focuses on the use of mainly stimulant drugs,
and because of the perceived relative success of these drugs in alleviating ADHD
symptoms, many studies have focused mainly on genes that are responsible for the
development and regulation of brain neurotransmitter systems, specifically that
of dopamine, wherein the physiologic basis for the action of these drugs
exists.
Genetic factors do play a role in the genesis of ADHD; estimates of
herita-bility are greater than those of nearly every other child and adolescent
psychiatric disorder and first-degree relatives have increased rates of ADHD,
including conduct and affective disorders as well as substance abuse and
dependency. Additionally, the subtypes of ADHD (impulsivity, hyperactivity,
inattention) do not correlate with that of additional family members, leading
researchers to conclude that nongenetic factors are responsible for
intrafamialial variability.4 Factors other than genetics have been
implicated in the development of ADHD prior to birth. Prenatal exposure to
nicotine and psychosocial adversity have been identified as risk factors for ADHD; a review of the studies in ADHD literature
exploring the relationship between prenatal exposure to these factors and the
risk of developing ADHD revealed that smoking (specifically nicotine exposure)
and exposure to psychosocial stress during pregnancy indicated greater and
modest risk, respectively, in contributing to the development of
ADHD.5 Other causes/contributors of ADHD that have been implicated in
the literature include food sensitivities and allergies, food additive
intolerance, imbalance and deficiency of nutrients, environmental toxicity
(including heavy metal poisoning, thyroid irregularities, and other toxic
pollutants).
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