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ADHD experts say it is often a pediatrician who does not spend the kind of time it takes to make an accurate diagnosis. The gold standard of ADHD diagnosis is an analysis of questionnaires, like those Connors developed, filled out by parents, teachers and other people who interact with the child and observe classroom behavior.


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Each child can take hours to analyze. Harold S. The CDC, however, defends its figures. In this case, scientists in the field do a full 2. The percentage of children taking drugs jumped by more than a quarter, from 4. In fall and spring , there was even a brief shortage of ADHD drugs, particularly generics, because the demand was outpacing the supply. They include acting before thinking, being unable to delay gratification, staying motived to finish a boring task, keeping strong emotions in check, remembering an assignment and how to complete it, or planning ahead.

But three other factors play a pivotal role in determining whether a child has a disorder or is just quirky, inattentive, or high-spirited. To be diagnosed with ADHD, children must have most of those 18 symptoms, most of the time, in most areas of their lives, from home to school to the neighborhood playground. While kids with ADHD can be gregarious, their impulsiveness can create problems, often alienating others, including siblings, teachers, and classmates.

Ellen Douglas

All of this carries enormous social cost in school and on the playground. But, in general, for a child with attention deficits, trying to focus on one thing is akin to trying to discern the chirping of crickets in Times Square.

Some are chronically late. ADHD is divided into subtypes—children just with attention problems, those with impulse control and hyperactivity issues, and a group with a combination of the two. The latter is the most common, occurring in two-thirds to three-quarters of people, estimates Barkley. Children with attention problems can have any or all of these symptoms, but may not be any more fidgety than the average child.

On the other hand, children who are hyperactive as well as distractible may not be able to stop moving or even to stop talking, including to themselves. An internal conversation for most people can become a conference call on speakerphone for a child with ADHD. The minute Saorla learned to walk she climbed—everything, and not skillfully. She was impulsive, fearless and, probably as a result, accident-prone. The Meenaghs once had to call the police and fire department to get Saorla, then a toddler, out of a bathroom where she had barricaded herself behind a locked door and a drawer she pulled out.

I worry about how this is going to play out.

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In fact, having ADHD makes you three times more likely to be dead by the age of Barkley is aware that he sounds alarmist, but he has good reason. ADHD struck close to home, and with tragic consequences. His brother was killed in a one-car accident after drinking. He was not wearing a seatbelt.


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  6. To say that ADHD is sometimes misdiagnosed—even over-diagnosed—is likely true, say many experts. Today we have brain scans, genetic studies, twin studies that show that this is a highly inherited neurobiological disorder, not some made-up condition. If the filter is too porous, too many stimuli get through. Scans show that those brain regions in children with ADHD are smaller than they are in children in the general population.

    In one study done jointly by the Child Psychiatry Branch of the National Institute of Mental Health and McGill University in Montreal, brain scans of children with ADHD showed that the thickening of cortical tissue was delayed by about three years compared to scans of a control group of equal numbers of normally developing youngsters. The ultimate source of these brain differences is likely genes—perhaps thousands of them.

    The heritability of ADHD is striking. But this chemical that carries information between nerve cells plays a far more important function in human life than providing us with a cocaine or cupcake high. It uses reward—the pleasurable feelings it supplies—to motivate us to pay attention, avoid distraction, to pick out the most relevant information circulating in short-term memory when solving a problem or completing a task.

    It also governs motion. There are dopamine receptors on certain neurons nerve cells to which dopamine delivers its various messages, such as pay attention, control yourself, feel good, and do that thing that made you feel good again, the latter reflecting its role in promoting both addiction and learning.

    more on this story

    Dopamine transporters also protrude from the neurons that produce dopamine. One particular gene, DAT-1, has been implicated in both ADHD and bi-polar disorder and is very active in the basal ganglia and pre-frontal cortex, the brain regions that are smaller in people with ADHD.


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    Other genes recently linked to the disorder strengthen the idea that ADHD is a fundamental communication system gone awry, a short-circuiting of the transmission between cells. There are some non-genetic risk factors for ADHD: premature birth, maternal smoking and alcohol use, lead exposure, frequent maternal infections during pregnancy, and brain injuries.

    A German study found a significant link between having eczema, a rash caused by allergies, and developing ADHD symptoms, giving more credence to a controversial theory that at least some ADHD is the result of allergies or sensitivities to certain foods, food additives, or other environmental chemicals. Organophosphate pesticides—the kind used on most of the U.

    The takeaway: eat organic produce or at least wash your veggies. See other approaches to try. He made it to the front office before he was stopped. He recently graduated from Penn with a degree in physics. One of the clues that lead researchers to look at the dopamine genes as possible markers of ADHD is the effect of methylphenidate—the drug known as Ritalin, a central nervous system stimulant and one of the early drugs used to treat ADHD.

    But the drugs work so well on symptoms that sales barely slowed in when the FDA—briefly—required them to carry a black box warning because of a small number less than 50 over 10 years of reported deaths, mostly related to heart damage.

    Who Was Sojourner Truth?

    Another FDA panel withdrew the black box warning within a month. So why does stimulant medication given to high-energy kids calm them down? Today we know that stimulants such as Ritalin, Adderall and Vyvanse, like other drugs, have the opposite effect on children than the one they have on adults. Diet, exercise, parenting techniques and therapy are extremely important as well. Yet the majority of children with ADHD are getting only medication. Drug Guide: Choosing the Right Medication. Parents turn to drugs alone for a number of reasons.

    Experts such as Pelham, Koplewicz, Hallowell, and Barkley are all proponents of medication, but not necessarily as a first-line treatment. He laments that the takeaway from the MTA research has been that pills alone work. Research has produced evidence that good parenting can even trump bad genes. They also learn how to give instructions to a child whose short-term working memory is impaired and who finds it tougher than normal to keep distractions at bay. Parents practice ways to minimize their responses to minor annoyances—like a year-old who repeatedly puts her feet on the dining room table.

    This does not help. Friedman, director of the psychopharmacology clinic at Weill Cornell Medical College, drew on the Kenya study, to suggest that many children with the genetic version of ADHD might benefit from education plans tailored to their needs for hands-on, fast-paced experiences high in novelty that, while unlikely to reduce their need for medication, could turn their disability into an asset.

    Kerri Meenagh was fortunate. That, she said, changed some of the expectations she and her husband have for their daughter—and themselves. While most kids can find something to occupy them for 45 minutes at Mass, Saorla has to go to the bathroom at least three times. So we go to Mass and Saorla has to go to the bathroom three times. If I know that happens because she has a brain disorder, why would I get upset? And Saorla seems to gravitate towards activities that channel some of her risk taking and her copious energy, particularly performing. Douglas died of heart failure at the age of 91 on November 7, Margalit Fox writes that Douglas's work "explored the epochal divide between the Old South and the New, examining vast, difficult subjects — race relations, tensions between the sexes, the conflict between the needs of the individual and those of the community — through the small, clear prism of domestic life.

    A Family's Affairs was awarded the Houghton Mifflin fellowship in and was recognized as one of the five best novels of the year by The New York Times. From Wikipedia, the free encyclopedia.

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    The Washington Post. The New York Times. November 12, Retrieved July 8,