Attention deficit hyperactivity disorder

PET scans measure brain activity. The image on the left illustrates areas of activity in the brain of a person without ADHD while doing an assigned task. The image on the right illustrates the areas of activity of the brain of someone with ADHD when given that same task.

Attention-deficit/hyperactivity disorder (ADHD) (sometimes referred to as ADD) is thought to be a neurological disorder, always present from childhood, which manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractibility. In neurological pathology, ADHD is currently considered to be a chronic syndrome for which no medical cure is available. Both children and adults may present with ADHD, which is believed to affect between 3-5% of the population.

Much controversy surrounds the diagnosis of ADHD, such as over whether or not the diagnosis denotes a disability in its traditional sense, or simply describes a neurological property of an individual. There is also a sizable minority of clinicians who believe that the condition is not biological, but psychological in origin. Those who believe that ADHD is a traditional disability or disorder often debate over how it should be treated, if at all. According to a majority of medical research in the United States, as well as other countries, ADHD is today generally regarded to be a non-curable neurological disorder for which, however, a wide range of effective treatments are available. Methods of treatment usually involve some combination of medication, psychotherapy, and other techniques. Some patients are able to control their symptoms over time, even without the use of medication. Other individuals who meet the diagnostic criteria of ADHD do not consider themselves to be handicapped by the disorder and therefore may remain undiagnosed or, after a positive diagnosis, untreated.

ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.

Definitions and Terminology

Attention deficit hyperactivity disorder
Specialty	Psychiatry, child and adolescent psychiatry

The most appropriate designation of ADHD is currently disputed; the terms below are known to be used to describe the condition. A difficulty in the condition's nomenclature arises when some scientific research suggests that certain behaviors are directly attributable to ADHD, while other research concludes that the same behaviors constitute disorders that need to be classified independently of ADHD.

Diagnostic and Statistical Manual of Mental Disorders

The latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) states that ADHD is a developmental disorder that presents during childhood, in most cases before the age of seven, and is characterized by developmentally inappropriate levels of inattention and/or hyperactive-impulsive behavior. It also stipulates that in order to be diagnosed, the condition must cause significant impairment in at least two settings. In order for an adult to be diagnosed with ADHD, their symptoms must have been present prior to the age of seven. The DSM-IV-TR divides ADHD into three subtypes: predominantly inattentive (sometimes referred to as ADD), predominantly hyperactive-impulsive, and combined. People presenting with symptoms of ADHD who don't quite fit any of the subtypes can be diagnosed with "AD/HD Not Otherwise Specified".

International Statistical Classification of Diseases and Related Health Problems

In the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) the symptoms of ADHD are given the name "Hyperkinetic disorders". When a conduct disorder (as defined by ICD-10, F91) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome". Because the editors of the ICD believe that the inability to pay attention constitutes a separate disorder, a person must be hyperactive in order to be diagnosed with a Hyperkinetic disorder.

Other Designations

• Attention-deficit syndrome (ADS): Equivalent to ADHD, but used to avoid the connotations of "disorder".
• Minimal cerebral dysfunction (MCD): Equivalent to ADHD, but largely obsolete in the United States, though still commonly used internationally.
• Deficits in Attention, Motor control and Perception (DAMP): A name for ADHD that is recognized only in Denmark and Sweden.

Symptoms

The symptoms of ADHD fall into the following two broad categories:

Inattention:

1. Failing to pay close attention to details or making careless mistakes when doing schoolwork or other activities
2. Trouble keeping attention focused during play or tasks
3. Appearing not to listen when spoken to
4. Failing to follow instructions or finish tasks
5. Avoiding tasks that require a high amount of mental effort and organization, such as school projects
6. Frequently losing items required to facilitate tasks or activities, such as school supplies
7. Excessive distractibility
8. Forgetfulness

Hyperactivity-impulsive behavior

1. Fidgeting with hands or feet or squirming in seat
2. Leaving seat often, even when inappropriate
3. Running or climbing at inappropriate times
4. Difficulty in quiet play
5. Frequently feeling restless
6. Excessive speech
7. Mood swings
8. Answering a question before the speaker has finished
9. Failing to await one's turn
10. Interrupting the activities of others at inappropriate times

A positive diagnosis is usually only made if the patient has experienced six of the above symptoms for at least three months. Symptoms must appear consistently in varied environments (e.g., not only at home or only at school) and interfere with function. One of the difficulties in diagnosis is the incidence of co-morbid conditions, especially the presence of Bipolar disorder which is being reported at earlier ages than previously described.

Children who grow up with ADHD often continue to have symptoms as they grow into adulthood. Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as executive functioning (also known as working memory). If the patient is not treated appropriately, co-morbid conditions, such as depression, anxiety and self-medicating substance abuse may present as well. If a patient presents with such conditions as well, the co-morbid condition may be treated first, or simultaneously.

Diagnosis

The Centers for Disease Control and Prevention (CDC) state that a diagnosis of ADHD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physical disorders, such as hyperthyroidism. Further, it is not uncommon that physically and mentally nonpathological individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.

Clinical Testing

The American Academy of Pediatrics Clinical Practice Guideline for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fufillment of three criteria:

1. The use of explicit criteria for the diagnosis using the DSM-IV-TR.
2. The importance of obtaining information about the child’s symptoms in more than one setting.
3. The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.

The first criteria can be satisfied by using an ADHD-specific instrument such as the Conners Scale. The second criteria is best fulfilled by examining the individual's history. This history can be obtained from parents and teachers, or a patient's memory. The requirement that symptoms be present in more than one setting is very important because the problem may not be with the child, but instead with teachers or parents who are too demanding. The use of intelligence and psychological testing (to satisfy the third criteria) is essential in order to find or rule out other factors that might be causing or complicating the problems experienced by the patient.

Analytical Testing

Due to the lack of objectivity that surrounds the critical factors, there is some question as to the reliability of ADHD diagnosis. The American Academy of Pediatrics Clinical Practice has published guidelines to aid providers in making an objective diagnosis, but even if strictly adhered to, doubt still remains among some patients, as well as providers. Other diagnostic methods, such as those involving magnetic resonance imaging (MRI), may detect the presence of ADHD by analyzing images of the patient's brain, are usually not recommended (see brain scans). In a majority of cases, diagnosis is therefore dependent upon the observations and opinions of those who are close to the patient; in many patients, especially as they approach adulthood, self-diagnosis is not uncommon.

Computerized tests

Computerized tests of attention are not especially helpful in providing a further independent assessment because they have a high rate of false negatives (real cases of ADHD can pass the tests in 35% or more of cases) (Barkley, 2006) they do not correlate well with actual behavioral problems at home or school, and are not especially helpful in determining treatments. Both the American Academy of Pediatrics and American Academy of Child and Adolescent Psychiatry have recommended against the use of such computerized tests for now in view of their lack of appropriate scientific validation as diagnostic tools. In the USA, the process of obtaining referrals for such assessments is being promoted vigorously by the President's New Freedom Commission on Mental Health.

Brain scans

Neurometrics, PET scans, FMRI, or SPECT scans may someday be able to provide a more objective diagnosis. However, with the etiology of the disorder is unknown, the current predictive power of brain scans to detect ADHD is in doubt. An October 2005 meta-analysis by Alan Zametkin, M.D., with the NIMH, concluded that not enough scientific research has been done on the accuracy of these potential diagnostic methods for them to be used for diagnosis. They remain, however, useful research tools when studying groups of patients with ADHD.

Epidemiology

ADHD has been found to exist in every country and culture studied to date. While it is most commonly diagnosed in the United States, rates of diagnosis are rising in most industrialized countries as they become more aware of the disorder, its diagnosis, and its management. The prevalence among children is estimated to be in the range of 5% to 8% in children, and 4% to 8% in adults. 10% of males, but only 4% of females have been diagnosed.. This apparent sex difference may either reflect a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.

Possible causes

The exact cause of ADHD remains unknown, but there is no shortage of speculation concerning its etiology , most of which centers around the brain. The cerebellum in particular has been shown to be smaller in the brains of those with this disorder. Another possible culprit is a region in the middle or medial aspect of the frontal lobe, known as the anterior cingulate cortex division. The source of these differences is not yet known, but some hypotheses have been presented.

Hereditary dopamine deficiency

Research suggests that ADHD arises from a combination of various genes, many of which have something to do with dopamine transporters. Suspect genes include the 10-repeat allele of the DAT1 gene, the 7-repeat allele of the DRD4 gene, and the dopamine beta hydroxylase gene (DBH TaqI). Additionally, SPECT scans found people with ADHD to have reduced blood circulation, and a significantly higher concentration of dopamine transporters in the striatum which is in charge of planning ahead.

Diet

It has long been suggested that ADHD could be the result of a nutritional problem. Recent studies have begun to find metabolic differences in these children, indicating that an inability to handle certain elements of one's diet might contribute to the development of ADHD, or at least ADHD-like symptoms. For example, in 1990 the English chemist, Neil Ward, showed that children with ADHD lose zinc when exposed to a food dye. Some studies suggest that a lack of fatty acids, specifically omega-3 fatty acids can trigger the development of ADHD. Support for this theory comes from findings that children who are breastfed for six or more months seem to be less likely to have ADHD than their bottlefed counterparts and until very recently, infant formula did not contain any omega-3 fatty acids at all. Time and futher investigation will perhaps tell whether this correlation is reliable or merely a coincidence.

Despite the uncertainty of nutrition as a cause of ADHD it does play a role in the diagnosis and treatment of the disorder. Certain dietary issues, most commonly a moderate to severe protein deficiency, can cause symptoms consistent with ADHD.

External Factors

There is no compelling evidence that social factors, alone, can create ADHD. The few environmental factors implicated fall in the realm of biohazards including alcohol, tobacco smoke, and lead poisoning. Allergies (including those to artificial additives) as well as complications during pregnancy and birth--including premature birth--might also play a role.

It has been observed that women who smoke while pregnant are more likely to have children with ADHD. Since Nicotine is known to cause hypoxia (lack of oxygen) in utero, smoking during pregnancy could increase the odds of a child having ADHD.

Head injuries can cause a person to present ADHD-like symptoms, possibly because of damage done to the patient's frontal lobes. Because symptoms were attributable to brain damage, the earliest designation for ADHD was "Minimal Brain Damage".

Treatment

There are many options available to treat people diagnosed with ADHD. The options with the greatest scientific support include a variety of medications, behavior modification, and educational interventions. The results of a large randomized controlled trial suggested that medication alone is superior to behavioral therapy alone, but that the combination of behavioral therapy and medication has a small additional benefit over medication alone.

Mainstream treatments

The most frequently prescribed medications for ADHD are stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. The use of stimulants to treat a syndrome often characterized by hyperactivity is sometimes referred to as a paradoxical effect. But there is no real paradox in that stimulants activate brain inhibitory and self-organizing mechanisms permitting the individual to have greater self-regulation. Frequently perscribed stimulants are Methylphenidate (better known by the names Ritalin and Concerta), Amphetamines (Adderall) and dextroamphetamines (Dexedrine). A fourth stimulant, Cylert was used until the late 1980s when it was discovered that this medication could cause liver damage. In March 2005, the makers of Cylert announced that it would discontinue the medication's production. It is no longer available in the United States.

There are also several nonstimulant medications that are used either by themselves or in conjunction with the stimulants. Most prominent among these are Bupropion (Wellbutrin) and Atomoxetine (Strattera).

Because many of the medications used to treat ADHD are Schedule II under the U.S. Drug Enforcement Administration schedule system, and are considered powerful stimulants with a potential for abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research studying ADHD sufferers who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are in fact much less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.

See Also: List of prescription medications for ADHD

Alternative treatments

Many alternative treatments have been proposed for ADHD. There are few or no credible scientific studies to support these suggested interventions.

Nutrition

As noted above there are indications that children with ADHD are metabolically different from others, and it has therefore been suggested that diet modification may play a role in the management of ADHD. Perhaps the best known of the dietary alternatives is the Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets. In the 1980s vitamin B₆ was promoted as a helpful remedy for children with learning difficulties including inattentiveness. Later, zinc and multivitamins have been promoted as cures, and currently the addition of certain fatty acids such as omega-3 has been proposed as beneficial.

For some people with ADHD mild stimulants such as caffeine and theobromine have similar effects to the more powerful drugs commonly used in treating the disorder. Herbal supplements such as ginkgo biloba are also sometimes cited. There is some empirical data suggesting caffeine can improve the function of children suffering from ADHD.

Other alternatives

Neurofeedback is a proposed ADHD remedy which involves teaching children to control their brain waves by the use of video-game technology. A thorough review by Sandra Loo and Russell Barkley of the research done on this in Developmental Neuropsychology 2005 concluded that neurofeedback does not have adequate support from appropriately conducted scientific studies to support it as an intervention at this time.

Audio-visual entrainment uses light and sound stimulation to guide and change brainwave patterns. While safe for most, it cannot be used by those suffering from photosensitive epilepsy due to the risk of triggering a seizure.

Cerebellar stimulation assumes that by improving the patient’s cerebellar function, many ADHD symptoms can be reduced or even eliminated permanently. As noted above, several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts. Several programs of balance, coordination, eye and sensory exercises that specifically involve the functions of the cerebellum are used to treat ADHD, Asperger's syndrome, and many learning difficulties such as dyslexia and dyspraxia. Most prominent are the DORE program, the Learning Breakthrough Program, and the Brain Gym. No substantial body of research exists to support these treatment approaches.

Finally, a study by the University of Pennsylvania Cancer Center has shown that people who suffer from ADD or ADHD may be more likely to start smoking. The study's author suggest that this may be true because patients use the nicotine in cigarettes as a form of treatment for ADD symptoms.

Coaching

Main article: ADD Coaching

ADD Coaching is a program where coaches work with ADHD individuals to help them prioritize, organize, and develop life skills. Coaching is aimed at helping clients to be more realistic in setting goals for themselves by learning about their individual challenges and gifts, and emphasizes spending more time in areas of strength, while minimizing time spent dealing with areas of difficulty.

Controversy

Main article: Controversy about ADHD

The ADHD diagnosis is controversial and has been questioned by some professionals, adults diagnosed with ADHD, and parents of diagnosed children. They point out the positive traits that people with ADHD have, such as "hyperfocusing." Others believe ADHD is a divergent or normal-variant human behavior, and use the term neurodiversity to describe it, emphasizing that there are an immense number of variations in genetics which could favor a greater or lesser ability to concentrate and/or to remain calm under varying circumstances.

Another source of controversy, especially in the United States, is the use of psychotropic medications to treat the disorder. In the United States outpatient treatment for ADHD has grown from 0.9 children per 100 (1987) to 3.4 per 100 (1997).. However it has held steady since then. Furthermore, a recent Washington University in St. Louis study indicated that almost 50% of ADHD cases in America may not be detected and treated.

Skepticism towards ADHD as a diagnosis

The number of people diagnosed with ADHD in the U.S. and UK has grown dramatically over a short period of time. Critics of the diagnosis, such as Dan P. Hallahan and James M. Kauffman in their book Exceptional Learners: Introduction to Special Education, have argued that this increase is due to the ADHD diagnostic criteria being sufficiently general or vague to allow virtually anybody with persistent unwanted behaviors to be classified as having ADHD of one type or another, and that the symptoms are not supported by sufficient empirical data.

Publications that are designed to analyze a person's behavior, such as the Brown Scale or the Conners Scale, for example, attempt to assist parents and providers in making a diagnosis by evaluating an individual on typical behaviors such as "Hums or makes other odd noises", "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of these behaviors range from "never" to "very often". Connors states that, based on the scale, a valid diagnosis can be achieved; critics, however, counter Connors' proposition by pointing out the breadth with which these behaviors may be interpreted. This becomes especially relevant when family and cultural norms are taken into consideration; this premise leads to the assumption that a diagnosis based on such a scale may actually be more subjective than objective (see cultural subjectivism).

Additionally, a recent study by Adam Rafalovich has found that many doctors are no more confident in the diagnosis and treatment of ADHD than are many parents. Another source of skepticism is that most people with ADHD have no difficulties concentrating when they are doing something that interests them, whether it is educational or entertainment. However, these objections have been rejected by the American Psychiatric Association, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics and the U.S. Surgeon General.Moreover the fact that comorbidity is commmon, somewhere between 60 and 80% of children diagnosed with adhd have a second diagnosis, indicates that the nuances of diagnosis have not been adequately described. Simple uncomplicated ADHD may well turn out to be different from ADHD with comorbid conduct disorder, and different again from ADHD with comorbid tourettes or asperger's to name but three of the conditions that commonly occur in conjunction with ADHD.

Parental role

Many clinicians believe that attachments and relationships with caregivers and other features of a child's environment have profound effects on attentional and self-regulatory capacities. An editorial in a special editon of Clinical Psychology in 2004 stated that "our impression from spending time with young people, their families and indeed colleagues from other disciplines is that a medical diagnosis and medication is not enough":

"In our clinical experience, without exception, we are finding that the same conduct typically labelled ADHD is shown by children in the context of violence and abuse, impaired parental attachments and other experiences of emotional trauma."

While no compelling evidence has been offered that parenting methods can cause ADHD in otherwise normal children a sizable minority of clinicians believe this is the case. A different perspective holds that while evidence shows that parents of ADHD children experience more stress and give more commands, further research has suggested that such parenting behavior is in large part a reaction to the child's ADHD and related disruptive and oppositional behavior, and to a minor extent the result of the parent's own ADHD.

Positive aspects

Although ADHD is considered a disorder, some view it in a neutral or positive light. Rather than assuming that ADHD is inherently negative, some argue that ADHD is simply a different method of learning as opposed to an inferior one. "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and pondering if it still works on a cloudy day" (Underwood). The aspects of ADHD which are generally viewed negatively can be a potential source of strength, such as willingness to take risks. "Impulsivity isn't always bad. Instead of dithering over a decision, they're willing to take risks" (Underwood). Both a proponent and an example of this point is JetBlue Airways founder David Neeleman. He considers ADHD one of his greatest assets and refuses to take medication. There has been little serious research into either the intellectual advantages it can provide, or into conditions which might be necessary for taking advantage of ADHD traits.

Many professional counselors emphasize to persons diagnosed with ADHD and their families the perspective that the condition does not necessarily block, and may even facilitate, great accomplishments. Most frequently cited as potentially useful is the mental state of hyperfocus. Lists of famous persons either diagnosed with ADHD or suspected (but not necessarily known to have had ADHD) are numerous, such as Albert Einstein and Thomas Edison, but currently lack scientific proof because ADHD was not a documented medical condition until its appearance in the DSM-III in 1980.

History

There is considerable evidence to suggest that ADHD is not a recent phenomenon.

• 493 BC, the great physician-scientist Hippocrates described a condition that seems to be compatible with what we now know as ADHD. He described patients who had "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression". Hippocrates attributed this condition to an "overbalance of fire over water”. His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities."
• 1845. ADHD was alluded to by Dr. Heinrich Hoffmann, a physician who wrote books on medicine and psychiatry. Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their undesirable behaviours. "Die Geschichte vom Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having attention deficit hyperactivity disorder. Alternatively, it may be seen as merely a moral fable to amuse young children at the same time as encouraging them to behave properly.
• 1902 – The English pediatrician George Still, in a series of lectures to the Royal College of Physicians in England, described a condition which some have claimed is analogous to ADHD. Still described a group of children with significant behavioral problems, caused, he believed, by an innate genetic dysfunction and not by poor child rearing or environment.. Analysis of Still's descriptions by Palmer and Finger indicated that the qualities Still described are not "considered primary symptoms of ADHD".
• The 1918–1919 influenza pandemic left many survivors with encephalitis, affecting their neurological functions. Some of these exhibited immediate behavioral problems which correspond to ADD. This caused many to believe that the condition was the result of injury rather than genetics.
• 1937 – Dr. Bradley in Providence RI reported that a group of children with behavioral problems improved after being treated with stimulant medication.
• 1957 – The stimulant methylphenidate (Ritalin) became available. It remains one of the most widely prescribed medications for ADHD in its various forms (Ritalin, Focalin, Concerta, Metadate, and Methylin).
• 1960 – Stella Chess described "Hyperactive Child Syndrome", introducing the concept of hyperactivity not being caused by brain damage.
• By 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from Minimal Brain Damage to Minimal Brain Dysfunction.
• 1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente Medical Center in San Francisco, claimed that hyperactivity was increasing in proportion to the level of food additives.
• 1975 – Pemoline (Cylert) is approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in at least 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market.
• 1980 – The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition.
• 1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder."
• 1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination.
• 1996 – ADHD accounted for at least 40% of child psychiatry references.
• 1999 – New delivery systems for medications are invented that eliminate the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta).
• 1999 – The largest study of treatment for ADHD in history is published in the American Journal of Psychiatry. Known as the Multimodal Treatment Study of ADHD (MTA Study), it involved more than 570 ADHD children at 6 sites in the United States and Canada randomly assigned to 4 treatment groups. Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.
• 2001 – The International Consensus Statement on ADHD is published and signed by more than 80 of the world's leading experts on ADHD to counteract periodic media misrepresentation that ADHD is a real disorder and that medications are justified as a treatment for the disorder. In 2005, another 100 European experts on ADHD added their signatures to this historic document certifying the validity of ADHD as a valid mental disorder.
• 2003 – Atomoxetine, the first new medication for ADHD in 25 years, receives FDA approval for use in children, teens, and adults with ADHD.

See also

• Adult attention-deficit disorder
• Anti-psychiatry
• Auditory processing disorder
• Chemical imbalance theory
• David Keirsey
• Developmental disability
• Educational psychology
• Edward Hallowell
• John Ratey
• Sensory integration disorder
• Sluggish cognitive tempo
• Texas Medication Algorithm Project

Further reading

• Barkley, Russell A. Take Charge of ADHD: The Complete Authoritative Guide for Parents (2005) New York: Guilford Publications
• Hanna, Mohab "Making the Connection: A Parent's Guide to Medication in AD/HD" (2006)Washington D.C. : Ladner-Drysdale
• Conrad, Peter Identifying Hyperactive Children (Ashgate, 2006).

• Timimi, Sami: Naughty Boys: Anti-Social Behaviour, ADHD and the Role of Culture(2005) London Palgrave McMillan ISBN 1-4039-4511-X
• National Institute for Clinical Excellence: Comments on ADHD
• The Adult ADD Reader published by ADD Resources
• Green, Christopher, Kit Chee, Understanding ADD; Doubleday 1994; ISBN 0-86824-587-9
• Joseph, J. (2000). Not in Their Genes: A Critical View of the Genetics of Attention-Deficit Hyperactivity Disorder. Developmental Review, 20, 539-567.
• Ninivaggi, F.J., "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases," Connecticut Medicine. September 1999; Vol. 63, No. 9, 515-521.
• Kelly, Kate, Peggy Ramundo; You Mean I'm Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder (1993) ISBN 0-684-81531-1

External links

• CDC's "Learn the Signs. Act Early.” campaign - Information for parents on early childhood development and developmental disabilities such as ADHD
• ADD Resources
• Attention-Deficit / Hyperactivity Disorder (ADHD) at the Center for Disease Control
• Bellak L, Kay SR, Opler LA. (1987) Attention deficit disorder psychosis as a diagnostic category. Psychiatric Developments, 5 (3), 239-63.
• Defending ADHD - By Steven Novella MD
• Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder at NIH
• “Evaluation of an exercise-based treatment for children with reading difficulties" by David Reynolds, Roderick I. Nicolson and Helen Hambly, Version 3.4. Final (2003), retrieved December 1st, 2005.
• Denver Academy A private school in Denver Colorado, USA that specializes in the education of students with a wide variety "Learning Differences" such as ADD, ADHD, Dyslexia and OCD.
• Information for anyone living with ADHD
• National Institute of Mental Health on ADHD
• National Resource Center on AD/HD
• Why someone is called ADHD by Mark Fineman