Counseling Points - Psychiatric Nurse 11/08 - (Page 4)

Caring for Patients with ADHD Throughout the Lifespan An Introduction to ADHD A ttention deficit hyperactivity disorder (ADHD) is the most common psychiatric condition affecting children in the United States and often persists into adulthood, something that many clinicians and the public may not recognize.1 Health care professionals who treat people with ADHD should be aware that the condition manifests itself differently throughout the course of life, and that early identification and treatment can greatly improve outcomes and quality of life.2,3 When recognized and appropriately managed with pharmacologic and/or nonpharmacologic strategies, individuals with ADHD lead very productive lives. In fact, they can excel, as swimmer Michael Phelps, the star of the 2008 Beijing Olympics, demonstrates. Diagnosed with ADHD at age 9, Phelps’ mother Debbie was told by his teachers that he would never be able to focus on anything. She refused to accept this prognosis as his destiny, instead devising creative solutions to help her son overcome his inability to concentrate. She encouraged his athletic interest, which proved to be a great outlet for his energy. She countered his lack of focus to do his schoolwork by giving him the sports section of the newspaper to read and framing math problems in the context of swim times. “I knew that, if I collaborated with Michael, he could achieve anything he set his mind to,” Debbie has said.4 Michael Phelps demonstrates a striking scenario for managing ADHD throughout the lifespan.Through partnerships with his parent, school, and clinicians, he was able to identify his strengths and manage his weaknesses. His story offers hope for people with ADHD and their families, and provides insight into strategies we may employ to help our patients overcome their condition. age 7, be present for at least 6 months, and manifest themselves in two or more settings.5 Three subtypes of ADHD are defined: 1. ADHD that is predominantly inattentive (ADHD-I); 2. ADHD that is predominantly hyperactive-impulsive (ADHD-H/I); and 3. ADHD that combines both inattentive, hyperactive, and impulsive components (ADHD-C).5 Incidence and Prevalence ADHD is the most common chronic health condition seen in childhood, affecting an estimated 4.5 million children between the ages of 3 and 17.6 The incidence of ADHD varies by age. Diagnoses of ADHD begin in the preschool period, peak by the late school-age years, and then begin decreasing in adolescence.7 Widely disparate prevalence rates of ADHD in children have been reported, ranging from 0.2%-27%; generally accepted prevalence rates, however, range between 7% and 10% for children.8,9 The highest prevalence rates are found in school-age children, as this is the age when symptomatology congruent with the APA’s definition is most clearly identified. Current prevalence rates for preschool children are estimated at 2%-6%.10 The majority of adolescents diagnosed with ADHD earlier in life continue to meet the diagnostic criteria for an ADHD diagnosis. The prevalence of ADHD is higher in males than females. Boys are diagnosed more frequently than girls at a ratio of 2-4:1, probably because boys are more likely to exhibit hyperactivity and impulsivity and have their symptoms noticed. 9,11 Girls, who are more likely to have ADHD-I, tend to have symptoms that are less noticeable, which often leads to later or under-diagnosis. Children from low socioeconomic backgrounds and differing cultures may be diagnosed less frequently. Different diagnostic standards used by practitioners and the availability of community services affect prevalence rates, with under-, over-, and misdiagnosis of ADHD still being common problems. Estimated prevalence rates for adults are between 3.4% and 4.4%.9,12,13 Definition of ADHD The most widely accepted definition of ADHD is published in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual IV-TR (Table 1).5 ADHD is defined as a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.” 5 For a diagnosis of ADHD, a child’s symptomatology must interfere with academic performance, social functioning, and activities of daily living that would be appropriate for his/her developmental level.5 In addition, some symptoms must occur prior to COUNSELING POINTS™ 4 Socioeconomic Burden Because ADHD can lead to impairments in virtually every aspect of a child’s life, it has a considerable impact on the child, family, and community. Approximately 30%

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