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Stimulants are typically formulated in short and long-acting formulations as well as fast and slow-acting.
Stimulants are typically formulated in short and long-acting formulations as well as fast and slow-acting.


The fast-acting [[methylphenidate]] (or MPH), with short and long-acting formulations, is often the first-line therapy. In the short term, [[methylphenidate]] is well tolerated. However, long term studies have not been conducted in adults and concerns about increases in blood pressure have not been established.<ref name="Safety of therapeutic methylphenidate in adults: a systematic review of the evidence"/> [[Methylphenidate]] acts to hold the available [[dopamine]] and [[norepinephrine]] in the brain longer for increased neurotransmission. It acts to block the [[Norepinephrine-dopamine reuptake inhibitor|dopamine and norepinephrine reuptake transporters]], thus slowing the removal at which these [[neurotransmitters]] are cleared from the synapses.
The fast-acting [[methylphenidate]] (or MPH), with short and long-acting formulations, is often the first-line therapy. In the short term, [[methylphenidate]] is well tolerated. However, long term studies have not been conducted in adults and concerns about increases in blood pressure have not been established.<ref name="Safety of therapeutic methylphenidate in adults: a systematic review of the evidence">{{cite journal|author=Godfrey J |title=Safety of therapeutic methylphenidate in adults: a systematic review of the evidence |journal=J. Psychopharmacol. (Oxford) |volume= 23|issue= 2|year=2008 |month=May |pmid=18515459 |doi=10.1177/0269881108089809 |url=|pages=194–205}}</ref> [[Methylphenidate]] acts to hold the available [[dopamine]] and [[norepinephrine]] in the brain longer for increased neurotransmission. It acts to block the [[Norepinephrine-dopamine reuptake inhibitor|dopamine and norepinephrine reuptake transporters]], thus slowing the removal at which these [[neurotransmitters]] are cleared from the synapses.


Also with the same action but with an addition is, the also fast-acting, [[amphetamine]] and its derivatives also with short and long-acting formulations. In addition to reuptake inhibition, it increases the release of these neurotransmitters into the [[synaptic cleft]].<ref name="junginger"/> They may have a better side-effect profile than methylphenidate [[Cardiovascular disease|cardiovascularly]] and potentially better tolerated.<ref name="kolar"/>
Also with the same action but with an addition is, the also fast-acting, [[amphetamine]] and its derivatives also with short and long-acting formulations. In addition to reuptake inhibition, it increases the release of these neurotransmitters into the [[synaptic cleft]].<ref name="junginger">{{cite journal |author=Retz W, Retz-Junginger P, Thome J, Rösler M |title=Pharmacological treatment of adult ADHD in Europe |journal=World J. Biol. Psychiatry |volume=12 Suppl 1 |issue= |pages=89–94 |year=2011 |month=September |pmid=21906003 |doi=10.3109/15622975.2011.603229}}</ref> They may have a better side-effect profile than methylphenidate [[Cardiovascular disease|cardiovascularly]] and potentially better tolerated.<ref name="kolar">{{cite journal |author=Kolar D, Keller A, Golfinopoulos M, Cumyn L, Syer C, Hechtman L |title=Treatment of adults with attention-deficit/hyperactivity disorder |journal=Neuropsychiatr Dis Treat |volume=4 |issue=2 |pages=389–403 |year=2008 |month=April |pmid=18728745 |pmc=2518387 |doi=}}</ref>


The slow and long-acting stimulant [[atomoxetine]] (Strattera), is also an effective treatment for adult ADHD. It is particularly effective for those with predominantly inattentive concentration due to being primarily a [[norepinephrine reuptake inhibitor]].<ref name="atom"/> It is often prescribed in adults who cannot tolerate the side effects of amphetamines or methylphenidate. It is also approved for [[ADHD]] by the US [[Food and Drug Administration]]. A rare but potentially severe side effect includes [[liver damage]] and increased [[suicidal ideation]].<ref name="santosh"/>
The slow and long-acting stimulant [[atomoxetine]] (Strattera), is also an effective treatment for adult ADHD. It is particularly effective for those with predominantly inattentive concentration due to being primarily a [[norepinephrine reuptake inhibitor]].<ref name="atom">{{cite journal |author=Simpson D, Plosker GL |title=Spotlight on atomoxetine in adults with attention-deficit hyperactivity disorder |journal=CNS Drugs |volume=18 |issue=6 |pages=397–401 |year=2004 |pmid=15089111 |doi= 10.2165/00023210-200418060-00011|url=}}</ref> It is often prescribed in adults who cannot tolerate the side effects of amphetamines or methylphenidate. It is also approved for [[ADHD]] by the US [[Food and Drug Administration]]. A rare but potentially severe side effect includes [[liver damage]] and increased [[suicidal ideation]].<ref name="santosh">{{cite journal |author=Santosh PJ, Sattar S, Canagaratnam M |title=Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults |journal=CNS Drugs |volume=25 |issue=9 |pages=737–63 |year=2011 |month=September |pmid=21870887 |doi=10.2165/11593070-000000000-00000}}</ref>


==Research==
==Research==

Revision as of 13:12, 12 October 2013

"ADD" redirects here. For other uses, see ADD (disambiguation).

Attention deficit hyperactivity disorder predominantly inattentive (ADHD-PI), also called attention deficit disorder (ADD), is one of the two types of attention deficit hyperactivity disorder (ADHD). The term was formally changed in 1994 in the new Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)[1] to "ADHD predominantly inattentive" (ADHD-PI or ADHD-I), though the term attention deficit disorder is still widely used. ADHD-PI is similar to the other subtypes of ADHD in that it is characterized primarily by inattention, easy distractibility, disorganization, procrastination, and forgetfulness; where it differs is in lethargy/fatigue, and having fewer or no symptoms of hyperactivity or impulsiveness typical of the other ADHD subtypes. Different countries have used different ways of diagnosing ADHD-PI. In the United Kingdom, diagnosis is based on quite a narrow set of symptoms, and about 0.5–1% of children are thought to have attention or hyperactivity problems.[citation needed] The United States used a much broader definition of the term ADHD. As a result, up to 10% of children in the U.S. were described as having ADHD.[citation needed] Current estimates suggest that ADHD is present throughout the world in about 1–5% of the population.[citation needed] About five times more boys than girls are diagnosed with ADHD.[citation needed] Medications include two classes of drugs, stimulants and non-stimulants.[citation needed] Drugs for ADHD are divided into 2 classes: first-line and second-line medications. First-line medications include several of the stimulants, and tend to have a higher response rate and effect size than second-line medications.[citation needed] Although medication can help improve concentration, it does not cure ADHD and the symptoms will come back once the medication stops.

Differences from other ADHD subtypes

ADHD-Predominantly Inattentive is an Attention Concentration Deficit that has everything in common with ADHD except that it has less hyperactivity or impulsivity symptoms and has more directed attention fatigue symptoms.[2] In some cases, children who enjoy learning may develop a sense of fear when faced with structured or planned work, especially long or group-based that requires extended focus, even if they thoroughly understand the topic. Children with ADD may be at greater risk of academic failures and early withdrawal from school.[3] Teachers and parents may make incorrect assumptions about the behaviours and attitudes of a child with ADHD-PI, and may provide them with frequent and erroneous negative feedback (e.g. "careless", "you're irresponsible", "you're immature", "you're lazy", "you don't care/show any effort", "you just aren't trying", etc.).[4]

The inattentive children may realize on some level that they are somehow different internally from their peers. However, they are also likely to accept and internalize the continuous negative feedback, creating a negative self-image that becomes self-reinforcing. If these children progress into adulthood undiagnosed or untreated, their inattentiveness, ongoing frustrations, and poor self-image frequently create numerous and severe problems maintaining healthy relationships, succeeding in postsecondary schooling, or succeeding in the workplace. These problems can compound frustrations and low self-esteem, and will often lead to the development of secondary pathologies including anxiety disorders, sexual promiscuity, mood disorders, and substance abuse.[3]

It has been suggested[2] that some of the symptoms of ADHD present in childhood appear to be less overt in adulthood. This is likely due to an adult's ability to make cognitive adjustments and develop coping skills minimizing the impact of inattentive or hyperactive symptoms. However, the core problems of ADHD do not disappear with age.[3] Some researchers have suggested that individuals with reduced or less overt hyperactivity symptoms should receive the ADHD-combined diagnosis. Hallowell and Ratey (2005) suggest[5] that the manifestation of hyperactivity simply changes with adolescence and adulthood, becoming a more generalized restlessness or tendency to fidget.

In the DSM-III, sluggishness, drowsiness, and daydreaming were listed as characteristics of ADD without hyperactivity. The symptoms were removed from the ADHD criteria in DSM-IV because, although those with ADHD were found to have these symptoms, this only occurred with the absence of hyperactive symptoms. These distinct symptoms were described as sluggish cognitive tempo (SCT).

A meta-analysis of 37 studies on cognitive differences between those with ADHD-Inattentive type and ADHD-Combined type found that "the ADHD/C subtype performed better than the ADHD/I subtype in the areas of processing speed, attention, performance IQ, memory, and fluency. The ADHD/I subtype performed better than the ADHD/C group on measures of flexibility, working memory, visual/spatial ability, motor ability, and language. Both the ADHD/C and ADHD/I groups were found to perform more poorly than the control group on measures of inhibition, however, there was no difference found between the two groups. Furthermore the ADHD/C and ADHD/I subtypes did not differ on measures of sustained attention."[6]

Some experts, such as Dr. Russell Barkley, have argued that ADD is exactly the same as ADHD, and should not be regarded as a distinct disorder.[7][8] However, Barkley currently maintains that the "other attention disorder" is sluggish cognitive tempo (SCT), that there are no meaningful "subtypes" of ADHD, and that the term ADD should no longer be used to avoid confusion.[9] ADD is noted for the almost complete lack of conduct disorders and high-risk, thrill-seeking behavior, and additionally have higher rates of anxiety.[6][10][11] Further research needs to be done to discover differences among those with attention disorders.[7]

Symptoms

DSM-IV criteria

The DSM-IV allows for diagnosis of the predominantly inattentive subtype of ADHD (under code 314.00) if the individual presents six or more of the following symptoms of inattention for at least six months to a point that is disruptive and inappropriate for developmental level:

  • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  • Often has trouble keeping attention on tasks or play activities
  • Often does not seem to listen when spoken to directly.
  • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  • Often has trouble organizing activities.
  • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period (such as schoolwork or homework).
  • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
  • Is often easily distracted.
  • Is often forgetful in daily activities.[12]

An ADD diagnosis is contingent upon the symptoms of impairment presenting themselves in two or more settings (e.g., at school or work and at home). There must also be clear evidence of clinically significant impairment in social, academic, or occupational functioning. Lastly, the symptoms must not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder).

Examples of observed symptoms
Life Period Example
Children[13] Failing to pay close attention to details or making careless mistakes when doing school-work or other activities
Trouble keeping attention focused during play or tasks
Appearing not to listen when spoken to (often being accused of "daydreaming")
Failing to follow instructions or finish tasks
Avoiding tasks that require a high amount of longer-term mental effort and organization, such as school projects
Frequently losing items required to facilitate tasks or activities, such as school supplies
Excessive distractibility
Forgetfulness
Procrastination, inability to begin an activity
Adults[14] Often making careless mistakes when having to work on uninteresting or difficult projects
Often having difficulty keeping attention during work; difficulty holding down a job for a significant amount of time
Often having difficulty concentrating on conversations or losing concentration for brief moments while someone is talking
Having trouble finishing projects; having many things "on the go" at the same time
Often having difficulty organizing onesself for, or planning for the completion of tasks
Avoiding or delaying starting projects that require a lot of thought, a lot of "mental effort"
Often misplacing or having difficulty finding things at home or at work
Keeping personal items in a disorganized state (sometimes keeping items that are old and therefore useless to the individual); keeping excessive "clutter" (in the home, car, etc.)
Often distracted by activity or noise
Often having problems remembering appointments or obligations
Changing plans on a regular basis, to the inconvenience of others

Prevalence in children

It is difficult to say exactly how many children worldwide have ADHD because different countries have used different ways of diagnosing it, while some do not diagnose it at all. In the UK, diagnosis is based on quite a narrow set of symptoms, and about 0.5–1% of children are thought to have attention or hyperactivity problems. In comparison, until recently, professionals in the U.S. used a much broader definition of the term ADHD. As a result, up to 10% of children in the U.S. were described as having ADHD. Current estimates suggest that ADHD is present throughout the world in about 1–5% of the population. About five times more boys than girls are diagnosed with ADHD. Boys are seen as the prototypical ADHD child, therefore they are often overdiagnosed with ADHD than girls.[15] This may be partly because of the particular ways they express their difficulties. Boys and girls both have attention problems, but boys are more likely to be overactive and difficult to manage. Children from all cultures and social groups are diagnosed with ADHD. However, children from certain backgrounds may be particularly likely to be diagnosed with ADHD, because of different expectations about how they should behave. It is therefore important to ensure that a child's cultural background is understood and taken into account as part of the assessment.[16]

Treatment

Although ADHD has most often been treated with medication there are questions as to the efficacy of these medications. Medications do not cure ADHD; they are used solely to treat the symptoms associated with this disorder.[17] The symptoms will come back once the medication stops. Also, medication works better for some patients while it barely works for others.[18][19] [20]

Medications

Stimulants are typically formulated in short and long-acting formulations as well as fast and slow-acting.

The fast-acting methylphenidate (or MPH), with short and long-acting formulations, is often the first-line therapy. In the short term, methylphenidate is well tolerated. However, long term studies have not been conducted in adults and concerns about increases in blood pressure have not been established.[21] Methylphenidate acts to hold the available dopamine and norepinephrine in the brain longer for increased neurotransmission. It acts to block the dopamine and norepinephrine reuptake transporters, thus slowing the removal at which these neurotransmitters are cleared from the synapses.

Also with the same action but with an addition is, the also fast-acting, amphetamine and its derivatives also with short and long-acting formulations. In addition to reuptake inhibition, it increases the release of these neurotransmitters into the synaptic cleft.[22] They may have a better side-effect profile than methylphenidate cardiovascularly and potentially better tolerated.[23]

The slow and long-acting stimulant atomoxetine (Strattera), is also an effective treatment for adult ADHD. It is particularly effective for those with predominantly inattentive concentration due to being primarily a norepinephrine reuptake inhibitor.[24] It is often prescribed in adults who cannot tolerate the side effects of amphetamines or methylphenidate. It is also approved for ADHD by the US Food and Drug Administration. A rare but potentially severe side effect includes liver damage and increased suicidal ideation.[25]

Research

A study at the Mount Sinai AD/HD Center, supported by grants from the National Institutes of Health (NIH), will examine the use of functional Magnetic Resonance Imaging in identifying unique patterns of brain activation in children with Inattentive AD/HD.[26]

Strategies for parents of afflicted children

Parents are recommended to learn about this disorder to first be able to help themselves and then their children. Behavioral strategies are of great help; they include creating routines, getting organized, avoiding distractions, limiting choices, using goals and rewards, and ignoring behaviors.[27]

Children with ADHD can be extremely disorganized. Parents should work with them to find specific places for everything and teach kids to use calendars and schedules. Parents are advised to get children into sports to help them build discipline, confidence, and improve their social skills. Physical activity boosts the brain’s dopamine, norepinephrine, and serotonin levels, and all these neurotransmitters affect focus and attention. Some sports may be too challenging and can add frustration. Parents should talk with their children about what activities and exercises most stimulate and satisfy them before signing them up for classes or sports.[28]

Parents should establish close communication with the school[29] to develop an education plan to address the child’s needs. Accommodations in school, such as extended time for tests or more frequent feedback from teachers, are beneficial for these individuals.[30]

See also

References

  1. ^ http://business.highbeam.com/5884/article-1G1-20383058/correspondence-between-dsmiiir-and-dsmiv-attentiondeficithyperactivity
  2. ^ a b Quinn, Patricia (1994). ADD and the College Student: A Guide for High School and College Students with Attention Deficit Disorder. New York, NY: Magination Press. pp. 2–3. ISBN 1-55798-663-0. Cite error: The named reference "add_college" was defined multiple times with different content (see the help page).
  3. ^ a b c Triolo, Santo (1998). Attention Deficit Hyperactivity Disorder in Adulthood: A Practitioner's Handbook. Philadelphia, PA: Brunner-Routledge. pp. 65–69. ISBN 0-87630-890-6.
  4. ^ Kelly, Kate (2006). You Mean I'm Not Lazy, Stupid or Crazy?! The Classic Self-Help Book For Adults with Attention Deficit Disorder. New York, NY: Scribner. pp. 11–12. ISBN 0-7432-6448-7. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  5. ^ Hallowell, Edward M. (2005). Delivered from Distraction: Getting the Most out of Life with Attention Deficit Disorder. New York: Ballantine Books. pp. 253–5. ISBN 0-345-44231-8. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  6. ^ a b Lane, B. (2004). The differential neuropsychological/cognitive profiles of ADHD subtypes: A meta-analysis. Dissertation Abstracts International, 64, Retrieved from PsycINFO database.
  7. ^ a b Barkley, Russell A. (2001). "The Inattentive Type of ADHD As a Distinct Disorder: What Remains To Be Done". Clinical Psychology: Science and Practice. 8 (4): 489–501. doi:10.1093/clipsy/8.4.489.
  8. ^ Milich, Richard. "ADHD Combined Type and ADHD Predominantly Inattentive Type Are Distinct and Unrelated Disorders". Clinical Psychology: Science and Practice. 8 (4): 463–488. doi:10.1093/clipsy/8.4.463. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  9. ^ Barkley, R. A. (2012). Distinguishing sluggish cognitive tempo from attention-deficit/hyperactivity disorder in adults. Journal of Abnormal Psychology, 121(4), 978–990. doi:10.1037/a0023961
  10. ^ Murphy, K., Barkley, R., & Bush, T. (2002). Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. The Journal Of Nervous And Mental Disease, 190(3), 147-157. Retrieved from MEDLINE database.
  11. ^ Bauermeister, J., Matos, M., Reina, G., Salas, C., Martínez, J., Cumba, E., et al. (2005). Comparison of the DSM-IV combined and inattentive types of ADHD in a school-based sample of Latino/Hispanic children. Journal Of Child Psychology And Psychiatry, And Allied Disciplines, 46(2), 166-179. Retrieved from MEDLINE database.
  12. ^ "Attention-Deficit/Hyperactivity Disorder". Retrieved 17 April 2013. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  13. ^ "The Disorder Named ADHD (WWK1)". Retrieved 17 April 2013. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  14. ^ "AD/HD Predominantly Inattentive Type" (pdf). National Resource Center on ADHD. Retrieved 17 April 2013. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  15. ^ Bruchmuller, Katrin (2012). "Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis". Journal of Consulting and Clinical Psychology. 80: 128–138. doi:10.1037/a0026582. Retrieved 17 April 2013. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  16. ^ "What is ADD". Retrieved 17 April 2013.
  17. ^ "Attention deficit hyperactivity disorder". National Institute of Mental health.
  18. ^ "Are ADHD Drugs Right for You or Your Child?". Archived from the original on 11 April 2010. Retrieved 2010-04-08. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  19. ^ "ADHD treament can take on a range of types and methods". Archived from the original on 2008-04-14. Retrieved 17 April 2013. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  20. ^ Pharmaceutical treatments for ADHD-Medications. Retrieved 2011-04-09
  21. ^ Godfrey J (2008). "Safety of therapeutic methylphenidate in adults: a systematic review of the evidence". J. Psychopharmacol. (Oxford). 23 (2): 194–205. doi:10.1177/0269881108089809. PMID 18515459. {{cite journal}}: Unknown parameter |month= ignored (help)
  22. ^ Retz W, Retz-Junginger P, Thome J, Rösler M (2011). "Pharmacological treatment of adult ADHD in Europe". World J. Biol. Psychiatry. 12 Suppl 1: 89–94. doi:10.3109/15622975.2011.603229. PMID 21906003. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  23. ^ Kolar D, Keller A, Golfinopoulos M, Cumyn L, Syer C, Hechtman L (2008). "Treatment of adults with attention-deficit/hyperactivity disorder". Neuropsychiatr Dis Treat. 4 (2): 389–403. PMC 2518387. PMID 18728745. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  24. ^ Simpson D, Plosker GL (2004). "Spotlight on atomoxetine in adults with attention-deficit hyperactivity disorder". CNS Drugs. 18 (6): 397–401. doi:10.2165/00023210-200418060-00011. PMID 15089111.
  25. ^ Santosh PJ, Sattar S, Canagaratnam M (2011). "Efficacy and tolerability of pharmacotherapies for attention-deficit hyperactivity disorder in adults". CNS Drugs. 25 (9): 737–63. doi:10.2165/11593070-000000000-00000. PMID 21870887. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  26. ^ "Inattentive AD/HD: Overlooked and Undertreated?". Retrieved 2010-04-08.
  27. ^ "ADHD Fact Sheet". Archived from the original on 17 April 2010. Retrieved 2010-04-08. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  28. ^ "The Best Summer Sports for ADHD Kids". Archived from the original on 20 April 2010. Retrieved 2010-04-08. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  29. ^ "Ten Tips for the Parents of an ADHD Inattentive Child". Archived from the original on 12 April 2010. Retrieved 2010-04-08. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)
  30. ^ "AD/HD Predominantly Inattentive Type (WWK8)". Archived from the original on 6 April 2010. Retrieved 2010-04-08. {{cite web}}: Unknown parameter |deadurl= ignored (|url-status= suggested) (help)

External links

Look up ADHD-PI or ADHD in Wiktionary, the free dictionary.
Wikimedia Commons has media related to Attention Deficit Hyperactivity Disorder.
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