Understanding the Problem with ADHD
- A Public Health Perspective
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioral disorder that may affect more than two million school-aged children and can last into adulthood.
ADHD problems manifest as an unusually high and chronic level of
inattention, impulsive hyperactivity, or both. A person with ADHD may struggle
with impairments in crucial areas of life, including relationships with peers
and family members, and performance at school or work. Increases in
unintentional injuries and health care utilization have been noted in some
studies of people with ADHD.
As many as half of children with ADHD also have other
behavior disorders. Some studies have demonstrated increases in substance abuse,
risk-taking, and criminal behaviors among adolescents and adults who have ADHD
and these other disorders.
The American Psychiatric Association's Diagnostic &
Statistical Manual-IV-TR estimates that 3%-7% of children suffer from ADHD, and
some studies have estimated higher prevalence rates in community samples. The
cause(s) and risk factors contributing to ADHD are unknown, although it seems to
be more prevalent among boys than girls.
During the past decade, prescription for ADHD medications
increased dramatically across the United States, with consumption in many states
more than quadrupling. Reasons for the increase, and the more recent decline, in
the use of methylphenidate-containing drugs are not clear.
ADHD can be managed through medical and psychosocial
Recent research suggests that combining medical and behavioral therapies is an
especially effective approach to treating ADHD and its comorbidities. However,
information on the long-term effects of all treatments is lacking, as is
knowledge of the effects of long-term use of ADHD medications in children.
On-going, systematic monitoring of ADHD, comorbidities, and treatment modalities
is needed to better understand ADHD.
CDC acknowledges the need for further research in ADHD.
Specifically, key public health questions yet to be answered include:
- What are the causes and risk factors of ADHD?
- What is the prevalence of ADHD?
- Is the prevalence increasing?
What social and economic impacts does ADHD have on families;
schools; the workforce; and judicial and health systems?
Are ADHD and its comorbidities being appropriately diagnosed
Are people with ADHD able to access appropriate and timely
How effective are current interventions?
What are the long-term effects of drug treatments?
Mark, age 14, has more energy than most boys his age. But then, he's always
been overly active. Starting at age 3, he was a human tornado, dashing around
and disrupting everything in his path. At home, he darted from one activity to
the next, leaving a trail of toys behind him. At meals, he upset dishes and
chattered nonstop. He was reckless and impulsive, running into the street with
oncoming cars, no matter how many times his mother explained the danger or
scolded him. On the playground, he seemed no wilder than the other kids. But his
tendency to overreact--like socking playmates simply for bumping into him--had
already gotten him into trouble several times. His parents didn't know what to
do. Mark's doting grandparents reassured them, "Boys will be boys. Don't
worry, he'll grow out of it." But he didn't.
At age 17, Lisa still struggles to pay attention and act appropriately. But
this has always been hard for her. She still gets embarrassed thinking about
that night her parents took her to a restaurant to celebrate her 10th birthday.
She had gotten so distracted by the waitress' bright red hair that her father
called her name three times before she remembered to order. Then before she
could stop herself, she blurted, "Your hair dye looks awful!"
- In elementary and junior high school, Lisa was quiet and cooperative but
often seemed to be daydreaming. She was smart, yet couldn't improve her
grades no matter how hard she tried. Several times, she failed exams. Even
though she knew most of the answers, she couldn't keep her mind on the test.
Her parents responded to her low grades by taking away privileges and
scolding, "You're just lazy. You could get better grades if you only
tried." One day, after Lisa had failed yet another exam, the teacher
found her sobbing, "What's wrong with me?"
Although he loves puttering around in his shop, for years Henry has had
dozens of unfinished carpentry projects and ideas for new ones he knew he would
never complete. His garage was piled so high with wood, he and his wife joked
about holding a fire sale.
- Every day Henry faced the real frustration of not being able to
concentrate long enough to complete a task. He was fired from his job as
stock clerk because he lost inventory and carelessly filled out forms. Over
the years, afraid that he might be losing his mind, he had seen
psychotherapists and tried several medications, but none ever helped him
concentrate. He saw the same lack of focus in his young son and worried.