Improve Listening Skills in ADHD Children

ADHD Helping Your Anxious Child Audio

ADHD Helping Your Anxious Child Audio

Has Your Child Been Diagnosed With ADHD Is Coping With Your Child's Behavior Wearing You Out Are You Tired of Searching For Answers An ADHD child does not have to have a dark cloud over his or her head. If You've Got Burning Questions About ADHD, I've Got Answers.

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How To Improve Your Childs Behavior

How to Improve Your Child's Behavior The definitive program on how to teach Your Difficult Child better behavior and to help you become a more effective parent. You Will be Able to End the defiance, battles and vicious fighting in your home. Fix your relationship with your child. Bring peace and happiness to your home. Enjoy a more fulfilling relationship with your child. Have your child respect you. Regain control over your child, you life and your home. Put an to all the arguing, fighting, and talking back. Have your child obey you without complaining. Get rid of all the hostility. Gain absolute confidence as a parent and know how to handle any situation.

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The Parenting Adhd Resource Guide

You will find: 6 behavioral strategies. 6 behavioral strategies that you can use today to improve your child's behavior (page 52) The key to success. Why being Smart is the key to success with your child (page 53) The absolute best way. The absolute best way to tackle other people who say that Adhd is a myth and cop out for bad parenting (page 55) Rewards to improve your child's behaviors.Discover the exact type of rewards that you can use to improve your child's behaviors .and the exact type of rewards to avoid at all costs (page 57) 10 sure-fire techniques.10 sure-fire techniques to use when your child has problems in keeping attention; that will help them at home and in school (page 58) The real truth about Adhd and playing computer games.The real truth about Adhd and kids playing computer games (and believe me it's not what you might think.) (page 64) 8 practical tips.8 practical tips that you can use to deal with the challenges of a moody teenager with Adhd and reduce the conflict now (page 70) How to overcome the feelings of stress.How to overcome the feelings of stress and being overwhelmed when you are the parent of an Adhd child (page 74) The key actions.The key actions you must take if your Adhd child is becoming a danger at home; to make thing safer all round (page 79).

The Parenting Adhd Resource Guide Summary

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Neurobiologic Bases of ADHD

The etiology of ADHD is unknown, although the disorder is now considered a disorder of the brain and development. There has been a wave of recent genetic studies that suggest that a substantial genetic component contributes to the disorder. Most of the genetic research has focused on candidate genes involved in dopaminergic transmission. Dysfunction in both dopaminergic and norepineph-rinergic neurotransmitter systems are implicated in ADHD. Both clinical and preclinical pharmacological studies support the role of these neurotransmitters in ADHD, with additional confirmation for the role of catecholamine's involvement arising from the observation that compounds known to improve ADHD symptoms affect catecholamine transmission. Neuroimaging research into brain structure and the function of ADHD in children and adults has shown significant differences between subjects with ADHD and controls in frontal, basal ganglia, and cerebellar anatomy and function. A number of functional imaging...

Attention deficit hyperactivity disorder ADHD

The clinical features of ADHD can be mimicked by sleep fragmentation due to the restless legs syndrome, obstructive sleep apnoeas, and occasionally narcolepsy which leads to frequent awakenings during sleep. Polysomnography may be required to confirm these diagnoses. In ADHD it may be normal or show a low sleep efficiency, reduced total sleep time, an increased number of sleep cycles during the night and an increase in the duration of REM sleep. Limb movements are frequent in stages 1 and 2 NREM sleep.

Attention Deficit Hyperactivity Disorder

The validity of ADHD as a clinical diagnosis has long excited debate and controversy in both lay and scientific circles. An expert panel convened and sponsored by the National Institutes of Health recently reviewed and documented extensively within a Consensus Statement the validity of ADHD as a clinical disorder, its public health importance for children and families, and the effectiveness of its treatments (NIH, 2000). Among their many conclusions, the conference panelists concurred that ADHD meets or exceeds the standards for validity established by most other disorders defined in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Still unclear, however, is whether the disorder represents a behavioral syndrome that is qualitatively and etiologically distinct from the range of ADHD-like symptoms present in children within the general population. Attention deficit hyperactivity disorder comprises the symptomatic triad of inatten-tiveness,...

Bender Test and Child Neuropsychopathology

Bender (1938) reported on the abnormal test productions of Francine, a schizophrenic child. Additionally, the Bender Test has been used in the identification of children with learning difficulties (Koppitz, 1975), determination of the neuropsychological correlates of hyperactivity and inattention in school children (Brito, Pereira, & Santos-Morales, 1999), and neuropsychological assessment of the effects of stimulant medication (Brown & Borden, 1989) and biofeedback training of children with Attention Deficit Hyperactivity Disorder (Hodes, 1989).

Diagnosis Prevalence and Prognosis

Children's depressive disorders tend to be longer and more severe than those of adults. Although most children will recover, depression can leave them socially, cognitively, and educationally impaired. Several variables including severity, family dysfunction, and gender predict the duration of a depressive episode. The average duration of a major depressive episode is reported to be 32 to 36 weeks, with longer durations in females. The rate of recovery is slow, with the greatest improvement starting between the 24th and 36th week. Within 6 months of onset, the depressive episode has remitted for 40 of the children. At one year, 80 of the children are no longer experiencing a depressive episode. The average duration of dysthymia is 3 years. A chronic course is reported for a significant percentage of depressed children. Depressive disorders are recurrent, with about 75 experiencing another episode within 5 years. Most depressed youths simultaneously experience additional psychological...

Diagnostic Difficulties In Patients With Bipolar Disorder And Comorbid Suds

There is a marked difficulty in diagnosing bipolar affective disorder in the presence of comorbid SUD because substantial overlap may exist between the symptoms of bipolar disorder and the intoxication and withdrawal states resulting from psychoactive substances. For example, stimulant intoxication can produce a syndrome indistinguishable from mania or hypo-mania, and substantial depressive symptoms upon withdrawal from the stimulants. In addition, the phenomenological overlap between bipolar disorder and attention deficit disorder is significant. In both disorders patients may experience hyperactivity, impulsivity, agitation, racing thoughts, and distractibility, which often makes it difficult to distinguish between the two syndromes (51).

Fetal Alcohol Syndrome Diagnosis And Description

Auditory deficits, Attention-Deficit Hyperactivity Disorder, oppositional defiant and conduct disorders, and seizures. Many of the behavior deficits and excesses reflect deficits in rule-governed behavior suggestive of impaired frontal-lobe functioning (Sampson et al., 2000).

Relationships with Substance Use Disorders

In adults with ADHD histories, higher rates of SUD have been reported compared with control groups or expected rates from epidemiological studies (e.g., Refs. 76-78). In an adult sample, Wilens and colleagues (19) found that ADHD cases without other comorbid mental disorders had SUD rates higher than those of controls. Adults with SUD typically have relatively high ADHD rates (e.g., Refs. 79-81). Tarter and others (13) found that a group of primary alcoholics were more likely to have ADHD-type symptoms than the following groups 1) secondary alcoholics, 2) reference cases with other mental disorders, and 3) normal controls. The retrospective diagnostic method used with adult samples, however, limits diagnostic accuracy primarily because of the absence of information from collateral sources such as parents and teachers. High rates of ADHD have also been reported in SUD adolescents (82,83). In the PAARC sample (34), adolescents with alcohol dependence, compared to controls, had higher...

Oppositional Defiant Disorder

Precursors to ODD may start very early among inflexible infants with irritable temperaments (Loeber, 1990 Sanson & Prior, 1999). Likewise, early behavioral problems, such as impulsivity, overactivity, and mild aggression, may blossom into more serious forms of disruptive behaviors, including ODD (Sanson & Prior, 1999). Children with difficult temperaments and early emerging behavioral problems are at greater risk for failing to develop positive attachments with caregivers and becoming involved in increasingly coercive interchanges with parents and significant adults, such as teachers. Likewise, parents of children with disruptive behavior problems often display high rates of harsh, inconsistent discipline, have unclear rules and expectations, and have low rates of positive involvement, adaptive discipline strategies, and problem solving skills (Lochman & Wells, 1996 Patterson, 1986). Loeber (1990) hypothesized that children begin to generalize their use of coercive behaviors to other...

Medium Chain AcylCoA Dehydrogenase Deficiency

Most patients present between ages 3 and 15 months, rarely after 4 years. Phenotypical heterogeneity prevails, ranging from sudden infant death syndrome, to recurrent Reye's-like syndrome, to episodic nonketotic hypoglycemic coma. A common presentation is vomiting and lethargy, followed by fasting, associated with a prior viral respiratory or gastrointestinal infection. Presentation is usually to an emergency department as an acute toxic encephalopathy or coma, with hypoketotic hypoglycemia, hyperammonemia, and abnormal liver function tests. The serum carnitine value is low, and urine acylcarnitines are increased, with a specific profile. Enzyme assay for MCAD activity can be done on cultured skin fibroblasts, muscle, liver, or blood lymphocytes. The differential diagnosis includes other fatty acid oxidation disorders, exogenous toxic encephalopathies, and true Reye's syndrome. Specific management involves intravenous dextrose 10 percent, avoidance of fasting with frequent short...

Meeting Societys Needs The Public Policy Perspective

At the other end of the age continuum, there is widespread discussion among professionals and the general public as to the justification for medicating children. It has been argued that proper diagnosis is crucial in using medications for children with Attention Deficit Disorder or Attention-Deficit Hyperactivity Disorder. However, medica

Patrice L Weiss1 Rachel Kizony12 Uri Feintuch23 and Noomi Katz2

Task) of children with ADHD (Rizzo, 2000, 2002a) Providing leisure opportunities using video-based VR with young adults with physical and intellectual disabilities (Weiss et al., 2003) ADHD attention deficits hyperacture disorder. hyperactive disorder (ADHD), and a Virtual Office was developed for assessment of memory processes in patients with TBI. The virtual classroom contains the basic objects (e.g., tables, chairs, blackboard, windows) and subjects (e.g., female teacher, pupils) found in a typical classroom. Both visual (e.g., car outside the window, paper airplane flying above the classroom) and auditory (e.g., steps in the hallway) distracters inside and outside the classroom randomly appear, as a child who wears an HMD to view the environment, performs various tasks of selective, sustained and divided attention. The child's performance is measured in terms of reaction time. Behavioral factors such as head turning and gross motor movement related to distractibility and...

Hormones Mood and Cognition

Similar observations are reported with thyroid hormones (T3 and T4), which are crucial for normal brain development and function. Hypothyroidism during fetal life (a condition known as cretinism) produces short stature, sexual immaturity, and severe mental defects in afflicted individuals. In adulthood, hypothyroidism is often associated with depression, bipolar disorder, low energy, appetite and sleep changes, poor concentration, memory impairments, and apathy. The similarity of these symptoms with clinical depression routinely prompts clinicians to test thyroid functions to distinguish between the two conditions. The reverse interaction between affective illnesses, particularly major depression, and thyroid hypofunction has also been documented recently. As with cortisol, hyperthyroidism (as in Grave's disease) presents with several psychiatric symptoms including insomnia, irritability, agitation, major depression, Attention-Deficit Hyperactivity Disorder, paranoia, and most often,...

Obstructive sleep apnoeas in children

The most common clinical features are snoring-like noises during sleep associated with observation by the parents or carers that the child stops breathing and is a restless sleeper 31 . Unusual sleeping positions may be adopted and there may be enuresis. Excessive daytime sleepiness is unusual, but behavioural disturbances during the day are frequent, and include irritability, hyperactivity, aggression, poor school performance with problems with reading and visual attention, and rapid mood changes. Impulsivity may be sufficient to lead to an initial diagnosis of attention deficit hyperactivity disorder (ADHD). There is often

Neurodevelopmental disorders

Primary sleep disorders such as the restless legs syndrome and obstructive sleep apnoeas may exacerbate developmental problems and cause excessive daytime sleepiness, manifested as hyperactivity, aggression and poor cognitive development. Around 20 of those with attention deficit hyperactivity disorder are said to have the restless legs syndrome. In Down's syndrome and cerebral palsy there is a predisposition to sleep apnoeas.

Restless Legs Syndrome Diagnostic Criteria and Differential Diagnosis

Motor restlessness, characterized by an irresistible urge to move about can be confused with RLS (38). Because motor restlessness can be a manifestation of many medical disorders, a careful history and examination are needed for early diagnosis. Unfortunately, it is often poorly recognized and underdiagnosed in clinical practice, because patients do not seek medical attention or their complaints are thought to be secondary to anxiety. The two major conditions to consider for patients who present with motor restlessness are RLS and Neuroleptic-Induced Akathisia (NIA). Other differential diagnoses to consider include painful legs and moving toes syndrome, attention deficit hyperactivity disorder (ADHD), hyperactivity states due to hyperthyroidism and Tourette's syndrome (TS), anxiety disorders, levodopa-induced dyskinesias, orthostatic tremor, orthostatic hypotension, and nerve entrapment syndromes. Attention Deficit Hyperactivity Disorder ADHD is usually a childhood disorder...

Monoamine Reuptake Inhibitors

Reboxetine was approved for use as an antidepressant in much of western Europe, South America, and Mexico in 1998. Reboxetine is the only truly selective NRI being marketed as an antidepressant, although U.S. Food and Drug Administration (FDA) approval has recently been granted to atomoxetine, a selective NRI (Bymaster et al., 2002) approved for the treatment of attention deficit disorder. Reboxetine potently inhibits the reuptake of NE without having significant effects on the reuptake of 5-HT or DA. It does not inhibit MAO, nor does it bind to 5-HT1a or 5-HT2a, DA1 or DA2, a-or p-adrenergic, muscarinic cholinergic, gamma-aminobutyric acid (GABA), benzodi-azepine, or histamine H1 receptors. Reboxetine has primarily been studied in European trials involving about 665 nonelderly and 56 elderly (age 65 years) depressed patients (Burrows et al., 1998). It is administered twice per day at doses ranging from 4 to 12 mg day. The European data show that reboxetine is more effective than...

Gilles de la Tourette Syndrome and Other Tic Disorders

Clinical Manifestations and Associated Disorders.Tics are defined as simple or complex repetitive movements that occur out of background of normal motor activity. They are usually fast (myoclonic) but can be slow (dystonic). They increase with fatigue and after stress and decrease with concentration. y GTS is characterized by chronic waxing and waning motor and vocal tics, usually beginning between the ages of 2 and 21 years. It affects boys more frequently than girls. About half the patients start with simple motor tics, such as frequent eye blinking, facial grimacing, head jerking, or shoulder shrugging, or with simple vocal tics such as throat clearing, sniffing, grunting, snorting, hissing, barking, or other noises. Complex motor tics include squatting, hopping, skipping, hand shaking, and ritualized movements such as compulsive touching of objects, people, or self. Complex vocal tics include semantically meaningful utterances, including shouting of obscenities and profanities...

Dilemma Of Psychiatric Diagnostics Dsms And Beyond

The extent to which diagnostic schemes are influenced by societal standards is highlighted by the disappearance of homosexuality as a psychiatric disorder in the more recent versions of the manual. Partly, this has arisen from the scientific evidence that to some degree homosexuality reflects a natural variation in the organization of gender-specific brain circuitries during the second trimester of gestation (Chapter 4). It also partly reflects the emergence of new human rights movements. Scientific advances and cultural tensions will continue to permeate diagnostic practices since some disorders are only extremes of normal human temperamental variability (especially among the Axis II disorders), while others, to put it metaphorically, are more likely to reflect broken parts in the brain (most abundantly in the severe Axis I disorders). The issue of attention deficit hyperactivity disorder (ADHD) is an especially poignant example since so many children are given medications that may...

Activation in a Subgroup of Patients with Tourette Syndrome

Often accompanied by obsessive compulsive disorder (OCD) and attention-deficit hyperactivity disorder (ADHD).1718 Multigenerational family, twin, and adoption studies show evidence of autosomal dominant inheritance with varying penetrance and a more severe phenotype in cases of bilineal transmission.19-21 Despite the identification of large kindreds, the search for genes and linkage has been inconclusive to date.22

Evaluation Guidelines j Table163

Attention deficit disorder and obsessive compulsive behaviors are frequent problems in tic patients Neuropsychological Tests. These tests help document cognitive and affective dysfunction that can be useful in determining diagnoses like Huntington's disease and also in guiding potential decisions regarding medical therapy. For example, when movement disorders are associated with depression or dementia, drugs that are associated with side effects like depression, confusion, or psychosis need to be avoided or used in reduced doses. Some movement disorders commonly co-exist with specific types of behavioral patterns, for example Gilles de la Tourette syndrome and attention deficit disorder or obsessive-compulsive disorder, and

Purposes of Neuropsychological Examination

As with other psychological assessments, neuropsychological assessments can provide important information for educational planning, especially for children. Documentation of basic intellectual abilities helps determine appropriate classroom placement (e.g., enriched environment, special education) for school-age children. Such tests also aid in the identification of children with severe intellectual deficits, such as mental retardation. Differences between intellectual ability and academic achievement are used in the identification of specific learning disabilities. In neurological conditions like Gilles de la Tourette's syndrome, neuropsychological assessments can be an integral component to individual educational plans by identifying strengths and weaknesses in academic abilities, as well as indicating co-morbid conditions like attention deficit disorder, hyperactivity, and obsessive-compulsive behaviors.

Perfectionism In Gifted Adolescents

There are multiple reasons for being seen as lazy, including learning disabilities, attention-deficit hyperactivity disorder, drugs, psychosis, a death, or even a divorce. Many lazy students are early adolescents. They are extremely bright and sensitive and were often the teacher's favorite in elementary school. These gifted early adolescents suffer from a crippling triad of an endless drive for perfectionism coupled with an intense fear of failure, which then triggers an overwhelming shame. In addition, they fear their own unresolved anger and aggressiveness, which become fused with their assertion and prevent them from comfortably asserting themselves in competitive situations.

Treatment Implications

There is a paucity of data on treatment effects in comorbid ADHD in SUD adolescents. SUD adolescents with comorbid ADHD may have increased difficulty with maintaining SUD recovery because of increased cravings and restlessness as well as decreased concentration and compliance with treatment (84). ADHD treatment may improve outcomes in these cases. Stimulant treatment has been shown to be effective in reducing ADHD symptoms in children and adults (98-100). There has been a concern that, among SUD adolescents, stimulants may adversely influence abstinence by leading to abuse of stimulants themselves or other substances (101), although there have been reports to the contrary (102).

Roughand Tumble PLAYJoy System

Touch is essential for triggering normal play, and recent work suggests that animals besides humans also have tickle skin, stimulation of which facilitates playful moods. A laughterlike process has been identified even in laboratory rats (Panksepp and Burgdorf, 2003). Although our understanding of these brain systems remains incomplete, the implications for psychiatry may be profound. For instance, if new, affectively positive neurochemicals are discovered, they may find a niche in the treatment of depression. Linkages to the etiology of attention deficit hyperactivity disorders (ADHD) have also been proposed and evaluated in animal models with promising results (Panksepp et al., 2002, 2003). One idea that now needs to be tested is that abundant access to rough-and-tumble play during early development may facilitate If that turns out to be the case, as preliminary data suggest (Gordon et al., 2003), it is possible that sustained access to vigorous, emotionally positive, social...

Psychostimulant Treatment For Children

The putative efficacy of psychostimulants as a first-line treatment for children with Attention-Deficit Hyperactivity Disorder (ADHD) is well documented and deserved. Few treatments provide benefit to such a large percentage of individuals affected with a particular disorder and improve functioning in multiple domains. Positive effects are ascertained in an estimated 50 to 96 of children with ADHD, depending on the stringency with which positive response is defined and the particular outcome variable targeted. For example, positive treatment response is estimated to occur in 70 of children undergoing psychostimulant therapy, whereas an overall 96 improvement rate in behavior problems is demonstrated when response is defined as improvement on any one of several alternative psychostimulants. Conversely, others have shown response rates to vary between 53 and 94 for academic efficiency and teacher-rated classroom behavior, respectively, when positive response is evaluated using...

Neurotransmitter Abnormalities

Dopamine and Other Neurotransmitters. Dopaminergic dysfunction in OCD is suggested not only by the obsessive-compulsive symptoms in patients with basal ganglia disorders but also by the increase in obsessive-compulsive symptoms following high-dose stimulant administration (Frye and Arnold, 1981) and occasional amelioration of symptoms following dopamine blocking agents (Goodman et al., 1990 McDougle 1997). High-dose stimulant administration has been thought to produce simple stereotypies, rather than more complex compulsive or obsessive behavior however, compulsive symptoms have been observed in children with attention deficit disorder and hyperactivity during treatment with high-dose amphetamines (1 mg kg d-amphetamine or 2 mg kg methylphenidate) (Borcherding et al., 1990). For example, a 7-year-old boy spent several hours each evening vacuuming the carpet in his home, and another played with Lego blocks for 2 days, stopping only to eat and sleep. As in OCD, the children also became...

Description

Attention-Deficit Hyperactivity Disorder (ADHD) is most commonly characterized by persistent and chronic inattention and or excessive motor restlessness and impulsive behavior. Earlier names for ADHD included Minimal Brain Dysfunction, Hyperkinetic Impulse Disorder, and Attention Deficit Disorder with or without Hyperactivity. Since the 1994 publication of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), ADHD has been reorganized into three subtypes predominantly inattentive (ADHD-I), predominantly hyperactive-impulsive (ADHD-HI), and combined (ADHD-C). The inattentive subtype requires six or more symptoms of inattention and five or fewer hyperactive-impulsive symptoms. The hyperactive-impulsive subtype consists of six or more symptoms of hyperactivity-impulsivity and five or fewer inattentive symptoms. The combined subtype requires six or more out of nine symptoms from both the inattentive and hyperactive-

Diagnosis

The diagnosis of ADHD remains difficult, with no single test to assess it and a heavy reliance on subjective measures. A comprehensive evaluation of ADHD in adults or children should assess the presence or absence of symptomatology, differential diagnosis from other disorders that mimic ADHD, and the possibility of comorbid psychiatric disorders. At a minimum, the evaluation should include a clinical interview, a medical evaluation conducted within the past year, standardized behavior rating scales from parents and teachers, and direct observation of the patient. The evaluation for both children and adults includes a family history as well as documentation regarding developmental, social, and academic functioning. An evaluation for adults should also include information regarding their childhood via academic records and transcripts and retrospective-childhood ratings by the adult patient and a parent or another individual who knew the patient as a child. Common conditions that may...

Treatment

Treatment of ADHD should be individualized depending upon the presenting concerns. Treatment approaches may include behavioral interventions combined with medica tion. Interventions begin with education about ADHD, its etiology, and its treatment. Behavioral interventions for children include social skills training, school interventions, and parent training in contingency management. Behavioral treatments for adults often focus on developmentally appropriate self-monitoring techniques (e.g., a self-prescribed reward for completing a goal), time management skills, organizational skills, social skills, and vocational counseling. Adults may also choose to have an individual therapist or coach to monitor daily progress. The use of pharmacological interventions is warranted if the symptoms are interfering significantly with functioning at home, school, or work. Psychostimulant medications (e.g., methylphenidate and dextroamphetamine) are considered safe and effective treatments for ADHD...

Interventions

Stimulant medications, such as methylphenidate hydrochloride (MPH), are mixed dopaminergic-no-radrenergic agonists that are thought to improve the function of the fronto-striatal attentional network in the brain 91 . Children treated for cancer often exhibit symptoms similar to those who have attention-deficit hyperactivity disorder and may similarly respond to MPH. Thompson et al. demonstrated in a double-blind, placebo-controlled study of learning-impaired survivors of childhood cancer that MPH was associated with improvements in attention 93 . Mulhern et al. are currently completing a multi-institutional, NCI-funded trial of MPH in a randomized, double blind, 3-week home crossover study of children previously treated for cancer 64 . If there is evidence of objective improvement at the end of 3 weeks, MPH will be continued for 12 additional months. Preliminary analyses have demonstrated that most participants have had some response in the home crossover trial 92 . The long-term...

Candidate Genes

The candidate gene approach is useful if previous research has identified specific biological substrates that are associated with the disorder. For example, if a disorder is known to be associated with elevated or depleted levels of a specific neurotransmitter, plausible candidate genes can be identified that influence some aspect of this neurotransmitter system. Candidate gene studies have identified several intriguing associations between genes in the dopamine and serotonin systems and psychological traits and disorders such as novelty seeking, neuroticism, Attention-Deficit Hyperactivity Disorder, Schizophrenia, and Bipolar Disorder. However, subsequent studies often fail to replicate the initial results, suggesting that these genes may have relatively small effects.

Syndrome

Despite the heterogeneity of conditions that include motor excess, there appears to be a set of covarying factors resulting in the identification of a hyperactivity syndrome or disorder. Hyperactivity does not constitute a syndrome in the technical sense of the word, because the particular pattern of symptoms or characteristics does not form a unitary cluster, nor is there adequate evidence of common etiology, both sine qua non of a true syndrome. However, the disorder most closely associated with hyperactivity is Attention-Deficit Hyperactivity Disorder (ADHD American Psychiatric Association, 1994). The core symptoms are hyperac-tivity, distractibility, and impulsivity. Russell Barkley (1997a, 1997b, 1998) has summarized the research and developed a cohesive theory to explain ADHD and the disability it creates. As a developmental disorder, ADHD is present from birth, and symptoms manifest at a young age (before age 7). Symptoms are persistent rather than episodic and are present...

Impulsivity

In a general sense, impulsivity is part of a behavioral inhibition system that interacts with behavioral activation or impulse systems. The range of impulses in the activation system is broad, as evidenced by the number of behavioral disorders that include impulsivity as a symptom. Examples include disorders of personality (e.g., antisocial and borderline), eating, substance abuse, Attention-Deficit Hyperactivity Disorder, and impulsive aggression (Intermittent Explosive Disorders). University of Texas Houston Health Science Center See also ADHD Behavioral Inhibitions

Causal Models

Some longitudinal follow-up studies have observed that children with ADHD, compared with controls, have more substance use and related problems later in life, suggesting that ADHD leads to SUD (e.g., Refs. 86, 87). Not all studies, however, have found this relationship. ADHD predicts adolescent cigarette-smoking initiation in some studies (88) but not others (16). In a comparison of hyperactive children and normal controls for alcohol and drug use 15 years after initial contact, no differences between groups were found in substance use frequency or severity (89). Biederman and colleagues (90) reported that ADHD adolescents with and without ADHD had a similar risk for SUD that was mediated by conduct and bipolar disorders. Several possible mechanisms for a pathway from ADHD to SUD have been suggested. Particularly since stimulant use improves ADHD symptoms, substance use may be an attempt to self-medicate ADHD symptoms (91). Findings relating ADHD with specific drug use patterns,...

Assessment

Systematic diagnostic interviewing thus provides a more comprehensive assessment than the typical clinical procedures and has been advocated for clinical evaluations (186). In adolescents suspected as having substance abuse or dependence, the following other mental disorders should be specifically evaluated ADHD, ODD, CD, major depression, and PTSD. A follow-up assessment after an abstinent period of 4 weeks further refines the psychopathology assessment. In addition to evaluating a limited observation period for immediate clinical decisions, assessing the prior life course of substance use disorders may also be instructive (e.g., Ref. 188).

Types of RTH

Most people with RTH are euthyroid (normal thyroid function), have small to moderate goiters, and are otherwise normal in appearance. When they're children, some seem to have a behavior similar to attention deficit disorder with hyperactivity (ADHD). In the mid-1980s, as Dr. Refetoffs fellow (endocrinology trainee), I (Ken) was surprised to see, counterintuitively, that the hyperactivity diminished when the children were given high doses of thyroid hormone.

Comorbidity

The patterns of comorbidity among childhood-onset cases are generally comparable to those for adult samples, with tic disorders and specific developmental disorders appearing more frequently in the pediatric populations. The California HMO study found that attention deficit hyperactivity disorder (ADHD) occurred most commonly (34 percent), closely followed by major depression (33 percent), Tourette disorder (18 percent), oppositional defiant disorder (17 percent), and overanxious disorder (16 percent) (Fireman et al., 2001). The pattern of comorbidity found in this study was similar to that previously observed in the National Institute of Mental Health (NIMH) pediatric OCD cohort, where only 26 percent of the pediatric subjects had OCD as a single diagnosis. Tic disorders (30 percent), major depression (26 percent), and specific developmental disabilities (24 percent) were the most common comorbidities found. Rates were also increased for simple phobias (17 percent), overanxious...

Conclusions

The genetic liability underlying each of these conditions seems uniquely to affect particular neural systems in each of the disorders. Mesial temporal lobe structures that subserve socialization functions seem to be especially important in autism arrest of development of the association cortices caused by the MeCP2 deletion may generate the symptoms of Rett syndrome the hippocampus and other regions involved in learning and memory are important in fragile X and disturbances in parietal cortices likely subserve visuospatial deficits affecting children with Williams syndrome. Abnormalities in frontal, temporal, and possibly parietal lobes likely subserve the psychotic symptoms and cognitive disturbances observed in childhood-onset schizophrenia. Disturbances in the structure and function of particular portions of CSTC circuits seem to underlie the symptoms of Tourette syndrome, obsessive-compulsive disorder, and attention deficit hyperactivity disorder the portions of the circuits...

Cyclothymic Disorder

Cyclothymia often presents a problem in differential diagnosis (Goodwin & Jamison, 1990). Symptoms such as hyperactivity and distractability that are part of cyclothymic hypomanic periods are easily confused with Attention-Deficit Hyperactivity Disorder (ADHD). The key difference is that when these symptoms are part of cyclothymia, they are more episodic and more characterized by rapid swings in attention and activity level than when they are part of ADHD. The impulsive, reckless behaviors (e.g., shoplifting, substance abuse, hostility) seen in cyclothymic hypomanic periods can also be mistaken for Antisocial Personality Disorder. Here, the association of these behaviors with elevated or irritable mood states is central to the differential diagnosis.

Hyperactivity

The term hyperactivity refers to both a symptom associated with a variety of medical and behavioral disorders and a common psychopathological syndrome. A range of related terms are often treated interchangeably, including overactivity, hyperkinesis, minimal brain dysfunction, attention-deficit disorder, and Attention-Deficit Hyperactivity Disorder. This discussion will address hyperactivity as a descriptor, symptom, and syndrome, emphasizing the disorder currently called Attention-Deficit Hyperactivity Disorder.

Future Directions

The research to date suggests that ADHD may predispose toward SUD, but that other characteristics substantially influence this pathway. Additional family-genetic and longitudinal studies are needed to refine the causal models, particularly to define the genetic and environmental factors that lead ADHD to be associated with SUD and other related disorders. For ADHD, a combination of pharmacotherapy and psychotherapy, including individual, group social skills, parent training, and school-based methods, may be needed. Similar approaches may be effective for cases in which SUD and ADHD are comorbid. Systematic treatment studies are needed to determine the extent to which such comprehensive approaches are effective and, if they are shown to be promising, cost-effectiveness studies are needed to determine efficacy. The use of alternative medications for ADHD with minimal abuse potential, such as antidepressant medication, also needs to be considered in this population.

Amphetamine Analogs

Amphetamines have been used for several decades to promote weight loss. They are also used in the treatment of attention deficit disorder and narcolepsy and as an adjunctive treatment in patients with treatment-resistant depression. During the 1960s and early 1970s, amphetamines were widely abused by people involved in the so-called counterculture movements. During the 1980s and 1990s, most of these drugs were replaced by cocaine. Nevertheless, prescribed amphetamines remained a significant source of abusable drugs. More recently, drugs such as methamphetamine (METH, Ice) and

Serotonin

There is a relatively higher psychiatric comorbidity in subjects with RLS furthermore, RLS might be more prevalent in psychiatric patients. Systematic studies have linked RLS to depression (190), anxiety disorders (130,191,192), and attention-deficit hyperactivity disorder (193). A high proportion of RLS subjects are treated with antidepressant medications (177), and in a large survey study selective serotonin reuptake inhibitors (SSRIs) but not tricyclic antidepressants were associated