ATTENTION DEFICIT DISORDER

Major Clinical Features

 

Attention deficit disorder (ADD) affects between 3-5% of children.  It is now widely held that this disorder is largely due to a neurochemical disturbance (likely involving dysregulation of dopamine and/or norepinephrine in the reticular system and frontal cortex).

 

Recent longitudinal/follow-up studies indicate that as many as 70% of ADD children continue to exhibit symptoms well into adolescence and adult life, thus suggesting that potentially 2-3% of that adult population experience ADD symptoms.

 

With age and maturation 30% of ADD kids “grow out of it” and exhibit no on-going symptoms.   The remaining 70% tend to see a gradual reduction in restlessness and “hyperactivity” although other core ADD symptoms remain.

 

ADD kids and teenagers often encounter considerable social/peer rejection and academic failure.  Self-esteem problems and frank clinical depression are not uncommon.  Rates of substance abuse in untreated ADD adolescents are high (probably best seen as an attempt to medicate-away feelings of sadness and inadequacy).

 

The mainstay of pharmacologic treatment of ADD is the use of stimulants.  Please note that the three fast-acting stimulants listed (methylphenidate, amphetamine, and dextroamphetamine) can become drugs of abuse in those predisposed to chemical dependency.  Thus caution should be exercised in treating patients with a substance abuse history. (Note: studies of ADD children, adolescents and adults without a personal or family history of substance abuse, show no tendency to abuse these stimulant drugs.) 

 

Because ADD (in adults) is almost always a life-long condition, prolonged medication treatment is the rule rather than the exception.

SYMPTOMS OF ADD

 

• Impulsivity, e.g. acting before thinking, quick responses, poor judgment.
• Impaired abilities for attention and concentration; distractibility
• Difficulties organizing tasks and activities
• Restlessness and “hyperactivity”
• Impaired emotional controls
• Associated features:
• Leaning disabilities
• Low self-esteem

CHOOSING MEDICAITON

Generic Name             Brand Name

Stimulants

Methylphenidate                      Ritalin

Dextroamphetamine                 Dexedrine

Premoline                                 Cylert

d-and l-amphetamine                Adderall

 

Antidepressants

Desipramine                             Norpramin

Imipramine                               Tofranil

Buproprion, SR                        Wellbutrin, SR