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Attention-deficit hyperactivity disorder

2007 Schools Wikipedia Selection. Related subjects: Health and medicine

   Attention-Deficit/Hyperactivity Disorder (ADHD) (sometimes referred to
   as ADD for those without hyperactivity) is thought to be a neurological
   disorder, which isn't always present from early childhood, which
   manifests itself with symptoms such as hyperactivity, forgetfulness,
   poor impulse control, and distractibility. In neurological pathology,
   ADHD is currently considered to be a chronic syndrome for which no
   medical cure is available. ADHD is believed to affect between 3-5% of
   the United States population, including both children and adults.

   Much controversy surrounds the diagnosis of ADHD, such as whether or
   not the diagnosis denotes a disability in its traditional sense, or
   simply describes the neurological property of an individual. There is
   also a sizable minority of clinicians who believe that the condition is
   not biological, but psychological in origin. Those who believe that
   ADHD is a traditional disability or disorder often debate over how it
   should be treated, if at all. According to a majority of medical
   research in the United States, as well as other countries, ADHD is
   today generally regarded to be a non-curable neurological disorder for
   which, however, a wide range of effective treatments are available.
   Methods of treatment usually involve some combination of medication,
   psychotherapy, and other techniques. Some patients are able to control
   their symptoms over time, without the use of medication. Other
   individuals who meet the diagnostic criteria of ADHD do not consider
   themselves to be handicapped by the disorder and therefore may remain
   undiagnosed or, after a positive diagnosis, untreated.

   ADHD is most commonly diagnosed in children and, over the past decade,
   has been increasingly diagnosed in adults. It is believed that around
   60% of children diagnosed with ADHD retain the disorder as adults.

Definitions and Terminology

   CAPTION: Attention-deficit hyperactivity disorder
   Classifications and external resources

     ICD- 10   F 90.
     ICD- 9    314.00, 314.01
      OMIM     143465
   DiseasesDB  6158
   MedlinePlus 001551
    eMedicine  med/3103  ped/177

   The most appropriate designation of ADHD is currently disputed; the
   terms below are known to be used to describe the condition. A
   difficulty in the condition's nomenclature arises when some scientific
   research suggests that certain behaviors are directly attributable to
   ADHD, while other research concludes that the same behaviors constitute
   disorders that need to be classified independently of ADHD.

Diagnostic and Statistical Manual of Mental Disorders

   The latest edition of the Diagnostic and Statistical Manual of Mental
   Disorders (DSM-IV-TR) states that ADHD is a developmental disorder that
   presents during childhood, with at least some symptoms causing
   impairment before the age of seven. It is characterized by
   developmentally inappropriate levels of inattention and/or
   hyperactive-impulsive behaviour, with significant impairment occurring
   in at least two settings. Adults with ADHD are diagnosed under the same
   criteria, including the stipulation that their symptoms must have been
   present prior to the age of seven. The DSM-IV-TR divides ADHD into
   three subtypes: predominantly inattentive (sometimes referred to as ADD
   or Sluggish cognitive tempo), predominantly hyperactive-impulsive, and
   combined. Those presenting impairing symptoms of ADHD who do not fully
   fit the criteria for any of the three subtypes can be diagnosed with
   "ADHD Not Otherwise Specified".

International Statistical Classification of Diseases and Related Health
Problems

   In the tenth edition of the International Statistical Classification of
   Diseases and Related Health Problems (ICD-10) the symptoms of ADHD are
   given the name "Hyperkinetic disorders". When a conduct disorder (as
   defined by ICD-10, F91) is present, the condition is referred to as
   "Hyperkinetic conduct disorder". Otherwise the disorder is classified
   as "Disturbance of Activity and Attention", "Other Hyperkinetic
   Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is
   sometimes referred to as, "Hyperkinetic Syndrome". Because the editors
   of the ICD believe that the inability to pay attention constitutes a
   separate disorder, a person must be hyperactive in order to be
   diagnosed with a Hyperkinetic disorder.

Other Designations

     * Attention-deficit syndrome (ADS): Equivalent to ADHD, but used to
       avoid the connotations of "disorder".
     * Minimal cerebral dysfunction (MCD): Equivalent to ADHD, but largely
       obsolete in the United States, though still commonly used
       internationally.
     * Deficits in Attention, Motor control and Perception (DAMP): A name
       for ADHD in combination with dyspraxia that is recognized only in
       Denmark and Sweden.

Symptoms

   The symptoms of ADHD fall into the following two broad categories:

   Inattention:
    1. Failing to pay close attention to details or making careless
       mistakes when doing schoolwork or other activities
    2. Trouble keeping attention focused during play or tasks
    3. Appearing not to listen when spoken to
    4. Failing to follow instructions or finish tasks
    5. Avoiding tasks that require a high amount of mental effort and
       organization, such as school projects
    6. Frequently losing items required to facilitate tasks or activities,
       such as school supplies
    7. Excessive distractibility
    8. Forgetfulness
    9. Procrastination, inability to begin an activity
   10. Difficulties with household activities (cleaning, paying bills,
       etc.)

   Hyperactivity-impulsive behaviour
    1. Fidgeting with hands or feet or squirming in seat
    2. Leaving seat often, even when inappropriate
    3. Running or climbing at inappropriate times
    4. Difficulty in quiet play
    5. Frequently feeling restless
    6. Excessive speech
    7. Answering a question before the speaker has finished
    8. Failing to await one's turn
    9. Interrupting the activities of others at inappropriate times
   10. Impulsive spending, leading to financial difficulties

   A positive diagnosis is usually only made if the person has experienced
   six of the above symptoms for at least three months. Symptoms must
   appear consistently in varied environments (e.g., not only at home or
   only at school) and interfere with function. One of the difficulties in
   diagnosis is the incidence of co-morbid conditions, especially the
   presence of bipolar disorder which is being reported at earlier ages
   than previously described.

   Children who grow up with ADHD often continue to have symptoms as they
   grow into adulthood. Adults face some of their greatest challenges in
   the areas of self-control and self-motivation, as well as executive
   functioning (also known as working memory). If the patient is not
   treated appropriately, co-morbid conditions, such as depression,
   anxiety and self-medicating substance abuse may present as well. If a
   patient presents with such conditions as well, the co-morbid condition
   may be treated first, or simultaneously.

Diagnosis

   The Centers for Disease Control and Prevention (CDC) state that a
   diagnosis of ADHD should only be made by trained health care providers,
   as many of the symptoms may also be part of other conditions, such as
   bodily illness or other physical disorders, such as hyperthyroidism.
   Further, it is not uncommon that physically and mentally
   nonpathological individuals exhibit at least some of the symptoms from
   time to time. Severity and pervasiveness of the symptoms leading to
   prominent functional impairment across different settings (school,
   work, social relationships) are major factors in a positive diagnosis.

Clinical Testing

   The American Academy of Pediatrics Clinical Practice Guideline for
   children with ADHD emphasizes that a reliable diagnosis is dependent
   upon the fufillment of three criteria:
    1. The use of explicit criteria for the diagnosis using the DSM-IV-TR.
    2. The importance of obtaining information about the child’s symptoms
       in more than one setting.
    3. The search for coexisting conditions that may make the diagnosis
       more difficult or complicate treatment planning.

   The first criteria can be satisfied by using an ADHD-specific
   instrument such as the Conners Scale. The second criteria is best
   fulfilled by examining the individual's history. This history can be
   obtained from parents and teachers, or a patient's memory. The
   requirement that symptoms be present in more than one setting is very
   important because the problem may not be with the child, but instead
   with teachers or parents who are too demanding. The use of intelligence
   and psychological testing (to satisfy the third criteria) is essential
   in order to find or rule out other factors that might be causing or
   complicating the problems experienced by the patient.

Analytical Testing

   Due to the lack of objectivity that surrounds the critical factors,
   there is some question as to the reliability of ADHD diagnosis. The
   American Academy of Pediatrics Clinical Practice has published
   guidelines to aid providers in making an objective diagnosis, but even
   if strictly adhered to, doubt still remains among some patients, as
   well as providers. Other diagnostic methods, such as those involving
   magnetic resonance imaging (MRI), may detect the presence of ADHD by
   analyzing images of the patient's brain, are usually not recommended
   (see brain scans). In a majority of cases, diagnosis is therefore
   dependent upon the observations and opinions of those who are close to
   the patient; in many patients, especially as they approach adulthood,
   self-diagnosis is not uncommon.

Computerized tests

   Computerized tests of attention are not especially helpful in providing
   a further independent assessment because they have a high rate of false
   negatives (real cases of ADHD can pass the tests 35% of the time or
   more), they do not correlate well with actual behavioural problems at
   home or school, and are not especially helpful in determining
   treatments. Both the American Academy of Pediatrics and American
   Academy of Child and Adolescent Psychiatry have recommended against the
   use of such computerized tests for now in view of their lack of
   appropriate scientific validation as diagnostic tools. In the USA, the
   process of obtaining referrals for such assessments is being promoted
   vigorously by the President's New Freedom Commission on Mental Health.

Brain scans

   Currently, brain scans are able to detect only differences between
   groups with ADHD and groups without ADHD, not a difference in a single
   individual. However, FMRI, or SPECT scans may someday be able to
   provide a more objective diagnosis. An October 2005 meta-analysis by
   Alan Zametkin, M.D., with the NIMH, concluded that not enough
   scientific research has been done on the accuracy of these potential
   diagnostic methods for them to be used for diagnosis. They remain,
   however, useful research tools when studying groups of patients with
   ADHD.

Epidemiology

   ADHD has been found to exist in every country and culture studied to
   date. While it is most commonly diagnosed in the United States, rates
   of diagnosis are rising in most industrialized countries as they become
   more aware of the disorder, its diagnosis, and its management. The
   prevalence among children is estimated to be in the range of 5% to 8%
   in children, and 4% to 8% in adults. 10% of males, and (only) 4% of
   females have been diagnosed. This apparent sex difference may reflect
   either a difference in susceptibility or that females with ADHD are
   less likely to be diagnosed than males.

Possible causes

   An early PET scan study found that global cerebral glucose metabolism
   was 8.1% lower in ADHD patients. The image on the left illustrates
   glucose catabolism in the brain of a person without ADHD while doing an
   assigned auditory attention task. The image on the right illustrates
   the areas of activity of the brain of someone with ADHD when given that
   same task.
   An early PET scan study found that global cerebral glucose metabolism
   was 8.1% lower in ADHD patients. The image on the left illustrates
   glucose catabolism in the brain of a person without ADHD while doing an
   assigned auditory attention task. The image on the right illustrates
   the areas of activity of the brain of someone with ADHD when given that
   same task.

   The exact cause of ADHD remains unknown, but there is no shortage of
   speculation concerning its etiology, most of which centers around the
   brain.

Hereditary dopamine deficiency

   Research suggests that ADHD arises from a combination of various genes,
   many of which have something to do with dopamine transporters. Suspect
   genes include the 10-repeat allele of the DAT1 gene, the 7-repeat
   allele of the DRD4 gene, and the dopamine beta hydroxylase gene (DBH
   TaqI). Additionally, SPECT scans found people with ADHD to have reduced
   blood circulation, and a significantly higher concentration of dopamine
   transporters in the striatum which is in charge of planning ahead.

Diet

   It has long been suggested that ADHD could be the result of a
   nutritional problem. Recent studies have begun to find metabolic
   differences in these children, indicating that an inability to handle
   certain elements of one's diet might contribute to the development of
   ADHD, or at least ADHD-like symptoms. For example, in 1990 the English
   chemist, Neil Ward, showed that children with ADHD lose zinc when
   exposed to a food dye. Some studies suggest that a lack of fatty acids,
   specifically omega-3 fatty acids can trigger the development of ADHD.
   Support for this theory comes from findings that children who are
   breastfed for six or more months seem to be less likely to have ADHD
   than their bottlefed counterparts and until very recently, infant
   formula did not contain any omega-3 fatty acids at all. Time and
   further investigation will perhaps tell whether this correlation is
   reliable or merely a coincidence.

   Despite the uncertainty of nutrition as a cause of ADHD it does play a
   role in the diagnosis and treatment of the disorder. Certain dietary
   issues, most commonly a moderate to severe protein deficiency, can
   cause symptoms consistent with ADHD.

External Factors

   There is no compelling evidence that social factors alone can create
   ADHD. The few environmental factors implicated fall in the realm of
   biohazards including alcohol, tobacco smoke, and lead poisoning.
   Allergies (including those to artificial additives) as well as
   complications during pregnancy and birth--including premature
   birth--might also play a role.

   It has been observed that women who smoke while pregnant are more
   likely to have children with ADHD. Since nicotine is known to cause
   hypoxia (lack of oxygen) in utero, smoking during pregnancy could
   increase the odds of a child having ADHD.

   Head injuries can cause a person to present ADHD-like symptoms,
   possibly because of damage done to the patient's frontal lobes. Because
   symptoms were attributable to brain damage, the earliest designation
   for ADHD was "Minimal Brain Damage".

Treatment

   There are many options available to treat people diagnosed with ADHD.
   The options with the greatest scientific support include a variety of
   medications, behaviour modification, and educational interventions. The
   results of a large randomized controlled trial suggested that
   medication alone is superior to behavioral therapy alone, but that the
   combination of behavioural therapy and medication has a small
   additional benefit over medication alone.

Mainstream treatments

   The most frequently prescribed medications for ADHD are stimulants,
   which work by stimulating the areas of the brain responsible for focus,
   attention, and impulse control. The use of stimulants to treat a
   syndrome often characterized by hyperactivity is sometimes referred to
   as a paradoxical effect. But there is no real paradox in that
   stimulants activate brain inhibitory and self-organizing mechanisms
   permitting the individual to have greater self-regulation. Frequently
   prescribed stimulants are Methylphenidate (better known by the names
   Ritalin and Concerta), Amphetamines ( Adderall) and dextroamphetamines
   (Dexedrine). A fourth stimulant, Cylert was used until the late 1980s
   when it was discovered that this medication could cause liver damage.
   In March 2005, the makers of Cylert announced that it would discontinue
   the medication's production. It is no longer available in the United
   States.

   There are also several nonstimulant medications that are used either by
   themselves or in conjunction with the stimulants. Most prominent among
   these are Bupropion (Wellbutrin) and Atomoxetine (Strattera).

   Because many of the medications used to treat ADHD are Schedule II
   under the U.S. Drug Enforcement Administration schedule system, and are
   considered powerful stimulants with a potential for abuse, there is
   controversy surrounding prescribing these drugs for children and
   adolescents. However, research studying ADHD sufferers who either
   receive treatment with stimulants or go untreated has indicated that
   those treated with stimulants are in fact much less likely to abuse any
   substance than ADHD sufferers who are not treated with stimulants.

   Only recently, studies on the cost-effectiveness of ADHD treatment have
   begun to appear. To date valid information is limited, although a
   review presented at the 17th World Congress of the International
   Association for Child and Adolescent Psychiatry and Allied
   Professions(IACAPAP) in Melbourne, Victoria, September 10-14, 2006,
   identified 11 health technology assessments and cost-effectiveness
   analyses, all of which compared the economic merits of at least two
   treatment alternatives.

Alternative treatments

   Many alternative treatments have been proposed for ADHD. An example
   would be the homeopathic treatment "attend". There are few or no
   credible scientific studies to support these suggested interventions.

Nutrition

   As noted above there are indications that children with ADHD are
   metabolically different from others, and it has therefore been
   suggested that diet modification may play a role in the management of
   ADHD. Perhaps the best known of the dietary alternatives is the
   Feingold diet which involves removing salicylates, artificial colors
   and flavours, and certain synthetic preservatives from children's
   diets. In the 1980s vitamin B[6] was promoted as a helpful remedy for
   children with learning difficulties including inattentiveness. Later,
   zinc and multivitamins have been promoted as cures, and currently the
   addition of certain fatty acids such as omega-3 has been proposed as
   beneficial.

   For some people with ADHD mild stimulants such as caffeine and
   theobromine have similar effects to the more powerful drugs commonly
   used in treating the disorder. Herbal supplements such as ginkgo biloba
   are also sometimes cited. There is some empirical data suggesting
   caffeine can improve the function of children suffering from ADHD.

Other alternatives

   Audio-visual entrainment uses light and sound stimulation to guide and
   change brainwave patterns. While safe for most, it cannot be used by
   those suffering from photosensitive epilepsy due to the risk of
   triggering a seizure.

   Cerebellar stimulation assumes that by improving the patient’s
   cerebellar function, many ADHD symptoms can be reduced or even
   eliminated permanently. As noted above, several studies have shown that
   the cerebellums of children with ADHD are notably smaller than their
   non-ADHD counterparts. Several programs of balance, coordination, eye
   and sensory exercises that specifically involve the functions of the
   cerebellum are used to treat ADHD, Asperger's syndrome, and many
   learning difficulties such as dyslexia and dyspraxia. Most prominent
   are the DORE program, the Learning Breakthrough Program, and the Brain
   Gym. No substantial body of research exists to support these treatment
   approaches.

   Finally, a study by the University of Pennsylvania Cancer Centre has
   shown that people who suffer from ADD or ADHD may be more likely to
   start smoking. The study's author suggest that this may be true because
   patients use the nicotine in cigarettes as a form of treatment for ADD
   symptoms.

Coaching

   ADD Coaching is a program where coaches work with ADHD individuals to
   help them prioritize, organize, and develop life skills. Coaching is
   aimed at helping clients to be more realistic in setting goals for
   themselves by learning about their individual challenges and gifts, and
   emphasizes spending more time in areas of strength, while minimizing
   time spent dealing with areas of difficulty.

Controversy

   The ADHD diagnosis is controversial and has been questioned by some
   professionals, adults diagnosed with ADHD, and parents of diagnosed
   children. They point out the positive traits that people with ADHD
   have, such as " hyperfocusing." Others believe ADHD is a divergent or
   normal-variant human behaviour, and use the term neurodiversity to
   describe it, emphasizing that there are an immense number of variations
   in genetics which could favour a greater or lesser ability to
   concentrate and/or to remain calm under varying circumstances.

   Another source of controversy, especially in the United States, is the
   use of psychotropic medications to treat the disorder. In the United
   States outpatient treatment for ADHD has grown from 0.9 children per
   100 (1987) to 3.4 per 100 (1997). However it has held steady since
   then.

Skepticism towards ADHD as a diagnosis

   The number of people diagnosed with ADHD in the U.S. and UK has grown
   dramatically over a short period of time. Critics of the diagnosis,
   such as Dan P. Hallahan and James M. Kauffman in their book Exceptional
   Learners: Introduction to Special Education, have argued that this
   increase is due to the ADHD diagnostic criteria being sufficiently
   general or vague to allow virtually anybody with persistent unwanted
   behaviors to be classified as having ADHD of one type or another, and
   that the symptoms are not supported by sufficient empirical data.

   Publications that are designed to analyze a person's behaviour, such as
   the Brown Scale or the Conners Scale, for example, attempt to assist
   parents and providers in making a diagnosis by evaluating an individual
   on typical behaviors such as "Hums or makes other odd noises",
   "Daydreams" and "Acts 'smart'"; the scales rating the pervasiveness of
   these behaviors range from "never" to "very often". Connors states
   that, based on the scale, a valid diagnosis can be achieved; critics,
   however, counter Connors' proposition by pointing out the breadth with
   which these behaviors may be interpreted. This becomes especially
   relevant when family and cultural norms are taken into consideration;
   this premise leads to the assumption that a diagnosis based on such a
   scale may actually be more subjective than objective (see cultural
   subjectivism).

   Additionally, a recent study by Adam Rafalovich has found that many
   doctors are no more confident in the diagnosis and treatment of ADHD
   than are many parents. Another source of skepticism is that most people
   with ADHD have no difficulties concentrating when they are doing
   something that interests them, whether it is educational or
   entertainment. However, these objections have been rejected by the
   American Psychiatric Association, the American Psychological
   Association, the American Medical Association, the American Academy of
   Pediatrics and the U.S. Surgeon General.Moreover the fact that
   comorbidity is common, somewhere between 60 and 80% of children
   diagnosed with ADHD have a second diagnosis, indicates that the nuances
   of diagnosis have not been adequately described. Simple uncomplicated
   ADHD may well turn out to be different from ADHD with comorbid conduct
   disorder, and different again from ADHD with comorbid Tourette's or
   Asperger's syndrome to name but two of the conditions that commonly
   occur in conjunction with ADHD.

Parental role

   Many clinicians believe that attachments and relationships with
   caregivers and other features of a child's environment have profound
   effects on attentional and self-regulatory capacities. It is noteworthy
   that a study of foster children found that an inordinate number of them
   had symptoms closely resembling ADHD. What Keeps Children in Foster
   Care from Succeeding in School. An editorial in a special edition of
   Clinical Psychology in 2004 stated that "our impression from spending
   time with young people, their families and indeed colleagues from other
   disciplines is that a medical diagnosis and medication is not enough":

          "In our clinical experience, without exception, we are finding
          that the same conduct typically labelled ADHD is shown by
          children in the context of violence and abuse, impaired parental
          attachments and other experiences of emotional trauma."

   While no conclusive evidence has been offered that parenting methods
   can cause ADHD in otherwise normal children a sizable minority of
   clinicians believe this is the case. A different perspective holds that
   while evidence shows that parents of ADHD children experience more
   stress and give more commands, further research has suggested that such
   parenting behavior is in large part a reaction to the child's ADHD and
   related disruptive and oppositional behaviour, and to a minor extent
   the result of the parent's own ADHD.

Positive aspects

   Although ADHD is considered a disorder, some view it in a neutral or
   positive light. Rather than assuming that ADHD is inherently negative,
   some argue that ADHD is simply a different method of learning as
   opposed to an inferior one. "While the A students are learning the
   details of photosynthesis, the ADHD kids are staring out the window and
   pondering if it still works on a cloudy day" (Underwood). The aspects
   of ADHD which are generally viewed negatively can be a potential source
   of strength, such as willingness to take risks. "Impulsivity isn't
   always bad. Instead of dithering over a decision, they're willing to
   take risks" (Underwood). Both a proponent and an example of this point
   is JetBlue Airways founder David Neeleman. He considers ADHD one of his
   greatest assets and refuses to take medication. There has been little
   serious research into either the intellectual advantages it can
   provide, or into conditions which might be necessary for taking
   advantage of ADHD traits. Many professional counselors emphasize to
   persons diagnosed with ADHD and their families the perspective that the
   condition does not necessarily block, and may even facilitate, great
   accomplishments. Most frequently cited as potentially useful is the
   mental state of hyperfocus. Lists of famous persons either diagnosed
   with ADHD or suspected (but not necessarily known to have had ADHD) are
   numerous, such as Albert Einstein,Thomas Edison, and former Pittsburgh
   Steelers Hall of Fame quarterback Terry Bradshaw, but currently lack
   scientific proof because ADHD was not a documented medical condition
   until its appearance in the DSM-III in 1980.

History

   There is considerable evidence to suggest that ADHD is not a recent
   phenomenon.
     * 493 BC, the great physician-scientist Hippocrates described a
       condition that seems to be compatible with what we now know as
       ADHD. He described patients who had "quickened responses to sensory
       experience, but also less tenaciousness because the soul moves on
       quickly to the next impression". Hippocrates attributed this
       condition to an "overbalance of fire over water”. His remedy for
       this "overbalance" was "barley rather than wheat bread, fish rather
       than meat, water drinks, and many natural and diverse physical
       activities."
     * 1845. ADHD was alluded to by Dr. Heinrich Hoffmann, a German
       physician who wrote books on medicine and psychiatry. Dr. Hoffmann
       was also a poet who became interested in writing for children when
       he couldn't find suitable materials to read to his 3-year-old son.
       The result was a book of poems, complete with illustrations, about
       children and their undesirable behaviours. "Die Geschichte vom
       Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter
       was a description of a little boy who could be interpreted as
       having attention deficit hyperactivity disorder. Alternatively, it
       may be seen as merely a moral fable to amuse young children at the
       same time as encouraging them to behave properly.
     * 1902 – The English pediatrician George Still, in a series of
       lectures to the Royal College of Physicians in England, described a
       condition which some have claimed is analogous to ADHD. Still
       described a group of children with significant behavioural
       problems, caused, he believed, by an innate genetic dysfunction and
       not by poor child rearing or environment. Analysis of Still's
       descriptions by Palmer and Finger indicated that the qualities
       Still described are not "considered primary symptoms of ADHD".
     * The 1918–1919 influenza pandemic left many survivors with
       encephalitis, affecting their neurological functions. Some of these
       exhibited immediate behavioural problems which correspond to ADD.
       This caused many to believe that the condition was the result of
       injury rather than genetics.
     * 1937 – Dr. Bradley in Providence RI reported that a group of
       children with behavioural problems improved after being treated
       with stimulant medication.
     * 1957 – The stimulant methylphenidate ( Ritalin) became available.
       It remains one of the most widely prescribed medications for ADHD
       in its various forms (Ritalin, Focalin, Concerta, Metadate, and
       Methylin).
     * 1960 – Stella Chess described "Hyperactive Child Syndrome",
       introducing the concept of hyperactivity not being caused by brain
       damage.
     * By 1966, following observations that the condition existed without
       any objectively observed pathological disorder or injury,
       researchers changed the terminology from Minimal Brain Damage to
       Minimal Brain Dysfunction.
     * 1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente
       Medical Centre in San Francisco, claimed that hyperactivity was
       increasing in proportion to the level of food additives.
     * 1975 – Pemoline (Cylert) is approved by the FDA for use in the
       treatment of ADHD. While an effective agent for managing the
       symptoms, the development of liver failure in at least 14 cases
       over the next 27 years would result in the manufacturer withdrawing
       this medication from the market.
     * 1980 – The name Attention Deficit Disorder (ADD) was first
       introduced in DSM-III, the 1980 edition.
     * 1987 – The DSM-IIIR was released changing the diagnosis to
       "Undifferentiated Attention Deficit Disorder."
     * 1994 – DSM-IV described three groupings within ADHD, which can be
       simplified as: mainly inattentive; mainly hyperactive-impulsive;
       and both in combination.
     * 1996 – ADHD accounted for at least 40% of child psychiatry
       references.
     * 1999 – New delivery systems for medications are invented that
       eliminate the need for multiple doses across the day or taking
       medication at school. These new systems include pellets of
       medication coated with various time-release substances to permit
       medications to dissolve hourly across an 8–12 hour period (Medadate
       CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a
       liquid methylphenidate sludge across an 8–12 hour period after
       ingestion (Concerta).
     * 1999 – The largest study of treatment for ADHD in history is
       published in the American Journal of Psychiatry. Known as the
       Multimodal Treatment Study of ADHD (MTA Study), it involved more
       than 570 children with ADHD at 6 sites in the United States and
       Canada randomly assigned to 4 treatment groups. Results generally
       showed that medication alone was more effective than psychosocial
       treatments alone, but that their combination was beneficial for
       some subsets of ADHD children beyond the improvement achieved only
       by medication. More than 40 studies have subsequently been
       published from this massive dataset.
     * 2001 – The International Consensus Statement on ADHD is published
       and signed by more than 80 of the world's leading experts on ADHD
       to counteract periodic media misrepresentation that ADHD is a real
       disorder and that medications are justified as a treatment for the
       disorder. In 2005, another 100 European experts on ADHD added their
       signatures to this historic document certifying the validity of
       ADHD as a valid mental disorder.
     * 2003 – Atomoxetine (Strattera), the first new medication for ADHD
       in 25 years, receives FDA approval for use in children, teens, and
       adults with ADHD.

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