Attention Deficit Disorder Essay

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Attention deficit disorder  (ADD), termed attention deficit/hyperactivity disorder predominantly inactive  by the Diagnostic  and Statistical  Manual of Mental Disorders, fourth edition (DSM-IV), represents  one of the two types of attention deficit hyperactivity disorder  (ADHD). ADD has much in common   with   the   other   subtypes   of  ADHD, although it differs in having fewer, if any, symptoms of impulsiveness  or hyperactivity. Instead,  ADD is characterized chiefly by inattentive concentration and  a deficit  of sustained  attention, which  often manifests   itself  as  forgetfulness,   hesitation, or procrastination in  patients. Untreated ADD  can greatly reduce the productivity of students  or workers.   Studies  examining   the  costs  of  illness related   to  ADD  indicate   that   it  averages  about $15,000 per student per year for those aged 18 and under.  These  costs  will increase  as patients  grow older.  As  a  result,  many  schools,  businesses,  or other  organizations, as  well  as  individuals   with ADD and their families, seek ways to respond  to a diagnosis of the disorder. A market  for pharmaceuticals that  treat  ADD has developed  as a result.

Background

The  definition  of ADD,  the  signs and  symptoms used  to  diagnose  it, the  classification  of patients with  the disorder,  and  the treatment options  have evolved  over  the  years.  The  third  edition  of  the DSM had identified daydreaming, drowsiness,  and sluggishness  as  characteristics  of  ADD,  but  the DSM-IV removed these symptoms. It is difficult to define precisely how many children and adults suffer from ADD globally, in part because of differing definitions  of the disorder.  In the United Kingdom, for  example,  less than  1  percent  of  children  are diagnosed  with  attention deficit  or  hyperactivity disorders. In the United States, by contrast, approximately 10 percent  of children  are diagnosed  with the disorder.  Many  believe that  1 to 5 percent  of humans  have ADHD  or ADD, and boys are more often diagnosed  with the disorder  than  girls.

Some have criticized definitions of ADD and ADHD  as being too  centered  on the behaviors  of children  and  consequently failing to identify  how the  disorder  is manifested  in  adults.  ADHD  has nine identified symptoms:

  1. Fidgeting with or tapping one’s hands  or squirming  in one’s seat
  2. Exhibiting an inability  to play or engage in other  activities quietly
  3. Leaving one’s seat in those situations where remaining seated is expected, such as in the classroom, the office or other workplace, or other situations where remaining  in place is the norm
  4. Running or climbing about  in inappropriate situations, although in adults  this may be manifested  by restlessness or other  movements
  5. Blurting out answers in class before the question has been completed, completing  the sentences of others,  or exhibiting  an inability  to await  one’s turn  in a conversation
  6. Demonstrating an inability to be still for extended periods of time, as is required in restaurants or meetings, which may be perceived as being restless or difficult to keep up with by others
  7. Interrupting or intruding on the conversations or activities of others or using others’ property without permission
  8. Having difficulty waiting  in line or waiting  for one’s turn

Because these behaviors are disruptive in classroom  or other settings, they are easily spotted and more frequently  reported than the more subtle indicators of ADD.

Like  ADHD,  ADD  has  nine  identified  symptoms, which must be noticed  by teachers,  parents, or others  before the process of making a diagnosis can begin. These nine symptoms  are as follows:

  1. Failing to follow through on instructions and failing to finish schoolwork, household chores, or assignments in the workplace
  2. Demonstrating difficulty sustaining attention while engaged in tasks or activities, such as being unable  to remain  focused during  lectures, while engaged in conversation, or while reading
  3. Overlooking or missing details while engaged in schoolwork or other tasks because of a failure to pay close attention or making  careless mistakes
  4. Appearing unable  or unwilling to listen when spoken  to directly, such as when one’s mind appears  to be elsewhere in the absence of obvious  distractions
  5. Displaying an inability  to follow through on instructions, starting  a task but then letting it fizzle out, or failing to finish schoolwork, chores, or duties in the workplace
  6. Allowing extraneous stimuli to easily distract one’s attention and focus
  7. Avoiding or demonstrating reluctance to engage in tasks requiring  sustained  mental  effort
  8. Losing or misplacing the tools, equipment, or data  necessary for tasks or activities
  9. Exhibiting excessive forgetfulness  in daily activities

For a diagnosis  of ADD, children  younger  than 17  years  must  exhibit   at  least  six  of  the  nine inattentive symptoms, while  those  older  than  17 years  must  exhibit  at  least  five of the  nine. This difference  in  the  number  of symptoms  exhibited occurs  because  symptoms  tend  to dissipate  as the individual grows older and a lower symptom threshold is necessary to make an accurate diagnosis. Those diagnosed with ADD are often offered  a  variety  of treatment options,  including counseling,   behavior   modification  training,  and drug therapy. If 5 percent of all children and adolescents  in the United States require  treatment, it could cost nearly $45 billion per year. The costs incurred  as a result of ADD include increased expenditures for education, the juvenile justice system, and discipline, as well as costs due to loss of parental work.

Treatment  And Prognosis

Although  a variety  of treatment options  exist for those  diagnosed  with  ADD,  these  therapies  often do not cure ADD. Indeed, when medication is used to treat  ADD, it ameliorates the symptoms  of the condition, but if the treatment stops, the symptoms will return. As a result, some prefer behavior  modification  therapy  as it tends  to provide  the patient with the tools needed to deal with the disorder.  In addition, some believe that ADD is sometimes “outgrown” as  patients   mature, with  symptoms declining in severity or disappearing completely.

Pharmaceutical treatment of ADD is attractive because  it ameliorates or masks  the symptoms  of the disorder,  permitting patients  to go about  their daily  lives with  fewer  impediments. Some of the more popular pharmaceuticals used to treat  those diagnosed with ADD are Adderall, Ritalin, and Strattera. Adderall, or amphetamine-mixed salts, is a fast-acting stimulant produced in both short-and long-acting   formulations. Adderall  induces  reuptake  inhibition of  dopamine and  norepinephrine while also increasing the incidence of the release of these neurotransmitters into the synaptic cleft. Because  Adderall   is  often   better   tolerated  in patients  than  methylphenidates (e.g., Ritalin)  and since it has a better  cardiovascular disease profile than  other  options,  Adderall  is often the first drug prescribed  to  those  with  ADD,  especially  adults with the disorder.

Ritalin   is  a  fast-acting   methylphenidate, produced in both short-and long-acting  formulations. Ritalin   produces   dopamine  reuptake  inhibition and also works to a lesser extent to encourage norepinephrine  reuptake  inhibition.  Ritalin   has been  demonstrated to  be  well  tolerated by  most patients,  including   adults,   in   the   short   term. Because Ritalin  can  cause  significant  increases  in blood  pressure,  however,  and  since few long-term studies  have  been  conducted regarding   its  long-term  effects  on  adults,  it  is used  less frequently with adults  with ADD than  other  options.

Strattera is the brand  name  for atomoxetine, a slow  and  long-acting   stimulant. Strattera  works chiefly as a norepinephrine reuptake inhibitor, and to a lesser extent as a dopamine reuptake inhibitor. Although    prescribed    for   those   with   ADHD, Strattera seems to be especially effective for those with ADD. Strattera is especially useful when prescribed  for  adults  who  do  not  obtain   sufficient vigilant  concentration response  from  Adderall  or who suffer too many side effects from other drugs. A variety of other alternative therapies  for treating ADD  exist,  including  histaminergic and  cholinergic medications, but  these  have  a  much  smaller research base than  other  treatment options.

Children  who  have  been  diagnosed  with  ADD are at greater  risk of academic  failure,  early withdrawal  from school, or other  problems  than  those who do not have ADD. The reasons for these problems are several. Parents  and  teachers  often  make incorrect  assumptions about  the  attitudes, behaviors, and  work  ethics of children  with ADD, providing them with plentiful and incorrect negative feedback  for their  efforts. Children  with ADD are often branded as lazy, careless, irresponsible, immature,  and  unconcerned about  their  academic  success. Children  with ADD may also develop a sense of fear when faced with structured assignments  or planned  work despite an inherent  love of learning. Diagnoses   of  ADD  have  increased   dramatically over the past 25 years, from approximately 600,000 children prescribed medication for ADD in 1990 to nearly 3.6 million today. While many estimate that approximately 5 percent  of American  youth  have ADD, nearly 15 percent  of high school children  in the United States have been diagnosed with this condition. This  overdiagnosis results  in  expenditure  of nearly  $100  billion  annually  for  unnecessary  treatment and  other  expenses.  Shortages  of certain   popular ADD  medications  may  also  be linked to the overdiagnosis of the condition.

The symptoms  of ADD are less overt  in adults. This is because  adults  are  able to make  cognitive adjustments  to  control   ADD  symptoms.  It  also seems  likely  that   over  time,  adults   are  able  to develop coping skills that minimize the effect of inattentiveness symptoms, which  allows  them  to compensate for problems and be more successful in academic  or  workplace settings.  Inattentive   individuals  often  come  to  understand that   they  are somehow  internally  different  from their peers. The continuous negative feedback that  many such individuals have received often becomes internalized, creating  a negative self-image that  in turn  becomes self-reinforcing.  Employers,  academic  institutions, and  the individuals  themselves  have an interest  in correcting this, as a poor self-image can create numerous and severe problems  related to the maintenance  of  healthy  peer  relationships, success  at workplace tasks, and success in training  initiatives.

Bibliography:

  1. American Psychiatric Association. Diagnostic  and Statistical Manual  of Mental Disorders,  5th ed. Arlington,  VA: American Psychiatric  Publishing, 2013.
  2. Brown, Thomas Attention Deficit  Disorder: The Unfocused  Mind  in Children  and Adults. New Haven, CT: Yale University Press, 2005.
  3. Hallowell, Edward  and John J. Ratey. Driven  to Distraction:  Recognizing  and Coping With  Attention Deficit  Disorder  From Childhood Through Adulthood. New York: Anchor  Books, 2011.

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