Maryland
Bar Bulletin
Publications :
Bar Bulletin
Editor: W.
Patrick Tandy
March, 2004
| LAP Zone |
The
Scope of Attention Deficit/Hyperactivity Disorder
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By
Carol P. Waldhauser
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Today, Matthew received
a letter of dismissal from the managing partner of the mid-size firm where
he has worked for nearly three years. Among the reasons listed were poor
working skills. Matthew felt strongly that this was a trumped-up charge;
after all, he had won a number of large-scale, complex cases. This case,
however, would be one that Matthew would not win.
Emptying his desk, Matthew
reflected on other places and distant times when he had felt like he did
today. Ironically, it seemed that for each box he packed a new memory of
past difficulties surfaced. Matthew remembered that his difficulties began
when he was very young. He is now 35 years old.
As a toddler, Matthew
recalled his parents’ stories of his very active and very stubborn
ways, as well as their (usually ineffective) attempts at discipline. In pre-school,
Matthew himself remembers how he would impulsively disrupt the class. Clearer
still were his memories of elementary school as the nuns reported their concerns
about his unacceptable behavior to his parents. By then, Matthew was not
only disruptive, but he was aggressive and antagonistic toward other children.
Unfortunately, this cycle
of behavior continued through grade school, high school and even undergraduate
school. In fact, both Matthew and his parents were amazed that he was able
to pull himself and his grades together long enough to successfully complete
law school. Matthew believed that he would realize the same success as a
practicing attorney; however, this was not the case. Problems surfaced almost
immediately. To make matters worse, Matthew’s personal life was a mess.
Fortunately, the memory
of this day stayed with Matthew. Rather than putting his head in the sand,
he decided to seek help from a licensed therapist. After a battery of tests,
Matthew was diagnosed with Adult Attention-Deficit/Hyperactivity Disorder
(ADHD). It was not until this psychiatrist diagnosed him with attention deficit
hyperactivity disorder that things began to turn around…
The
Scope of the Problem
Deciding to do something
about unwanted behavior in a child can be much more agonizing than making
a similar decision about an adult. Parents often feel responsible for everything
their children do and may feel especially guilty about admitting that their
child has a problem that is serious enough to require professional help.
Many problems, however, are easier to treat in children, since their behavior
patterns and interaction styles have not yet become firmly established. This
seems to be especially true with the diagnosis and treatment for ADHD.
What
is ADHD?
ADHD is the most common
behavior disorder diagnosed in children and teens. ADHD refers to a group
of symptoms that begin in early childhood and can continue into adulthood,
causing difficulties at home, school, work and within the community if not
recognized and treated.
What
are the Symptoms of ADHD?
There are three groups
of ADHD symptoms:
- Inattention: This is
the most common symptom. In addition to having difficulty paying attention,
people with this symptom often are unable to consistently focus, remember
and organize. They may be careless and have a hard time starting and completing
tasks that are boring, repetitive or challenging.
- Impulsiveness: People
who frequently act before thinking may not make sound judgments or solve
problems well. They may also have trouble developing and maintaining personal
relationships. An adult may not keep the same job for long or spend money
wisely.
- Hyperactivity: A hyperactive
child may squirm, fidget and climb or run when it is not appropriate. These
children often have difficulty playing with others. They may talk a great
deal and not be able to sit still for even a short time.
Teenagers and adults who
are hyperactive don’t usually have the more obvious physical behaviors
seen in children. Rather, they often feel restless and fidgety and are not
able to enjoy reading or other quiet activities. More specifically, many
adults with ADHD have not been diagnosed and treated. These people can develop
problems such as depression and difficulty maintaining a job. Additionally,
symptoms of ADHD may vary by individual, ranging from mild to severe, and
include learning disabilities, oppositional defiant disorder, conduct disorder,
anxiety disorder and depression.
These symptoms are sometimes
mistaken for ADHD. However, they may occur concurrently with ADHD, which
can make diagnosis of the primary problem difficult.
According to the Diagnostic
and Statistical Manual of Mental Disorders, American Psychiatric Association:
The essential feature
of Attention-Deficit/Hyperactivity Disorder is a persistent pattern of
inattention and/or hyperactivity-impulsivity that is more frequently displayed
and more severe than is typically observed in individuals at a comparable
level of development. (Criterion A). Some hyperactive-impulsive or inattentive
symptoms that cause impairment must have been present before age 7 years,
although many individuals are diagnosed after the symptoms have been present
for a number of years, especially in the case of individuals with the Predominantly
Inattentive Type (Criterion B). Some impairment from the symptoms must
be present in at least two settings (e.g., at home and at school or work)
(Criterion C). There must be a clear evidence of interference with developmentally
appropriate social, academic, or occupational functioning (Criterion D).
The disturbance does not occur exclusively during the course of a Pervasive
Developmental Disorder, schizophrenia, or other Psychotic Disorder and
is not better accounted for by another mental disorder (e.g., a Mood Disorder,
Anxiety Disorder, Dissociative Disorder, or Personality Disorder) (Criterion
E).
What
Causes ADHD?
The exact cause of ADHD
is not clear. However, it is known that chemical balances in the brain affect
temperament and behavior. According to the Diagnostic and Statistical
Manual of Mental Disorders:
Attention-Deficit/Hyperactivity
Disorder has been found to be more common in the first degree biological
relatives of children with Attention-Deficit/Hyperactivity Disorder than
in the general population. Considerable evidence attests to the strong
in-order than in the general population. Considerable evidence attests
to the strong influence of genetic factors on levels of hyperactivity,
impulsivity, and inattention as measured dimensionally. However, family,
school and peer influences are also crucial in determining the extent of
impairments and co morbidity. Studies also suggest that there is a higher
prevalence of Mood and Anxiety Disorders, Learning Disorders, Substance-Related
Disorders, and Antisocial Personality Disorder in family members of individuals
with Attention-Deficit/Hyperactivity Disorder.
Is
There Treatment for ADHD?
Although there is treatment
for ADHD, it does not cure the disorder. However, it can help control the
symptoms – inattention, hyperactivity and impulsiveness –
while improving:
- Relationships with
family, teachers, and peers
- Disruptive behaviors
- School performance,
including quality of work and the ability to complete assignments
- Independence in caring
for oneself and completing tasks
- Attention to and awareness
of everyday safety issues, such riding bicycles or driving
- Self-Esteem
An important first step
in treating ADHD is educating parents, teachers and other adults. With training,
they can learn what to expect and to recognize the signs. Other treatment
includes but may not be limited to behavior therapy and/or medication.
As for our attorney Matthew,
he claims to feel like a different person since he has been treated for ADHD. “I
have a grip,” he explains. In fact, Matthew seems to be one of an increasing
number of adults who now know that children are not the only individuals
that suffer from ADHD – an increasing number of adults do, too!
For more information on
this or other subjects, call (410) 685-7878, ext. 3041, or e-mail cwaldhauser@msba.org.
