Attention-deficit defined

Younger children with manic symptoms tend to have severe functional impairment and comorbid psychopathology such as anxiety dysregulation, disruptive behaviors, and developmental delays that further complicate their clinical picture. In addition, these children may have mood symptoms that merge with other disorders, making manic episodes difficult to define. Irritability is part of the clinical picture of depression, anxiety, attention-deficit hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). Poor concen-... 

FIGURE 53.1 Cumulative distribution curves of final ADHD scores by treatment group in the MTA Study. The SNAP rating is average score of the 18 items corresponding to the DSMTV defining symptoms for attention-deficit-hyperactivity disorder and oppositional defiant disorder (range 0, not present to 3 very much). Beh, Behavior... 

Shaywitz BE, Fletcher JM, Shaywitz SE. Defining and classifying learning disabilities and attention-deficit/hyperactivity disorder. J Child Neuro, 1995 10 S50-S57... 

By 1970, only about 150,000 children were taking Ritalin. During the 1970s, the central problem of the condition was redefined as one of poor attention and distractibility with no mention of hyperactivity. In 1980, psychiatrists official guidelines on defining the condition were revised, and attention-deficit/hyperactivity disorder (ADHD), was added as a new disease. Millions of children who were not hyperactive fit the description of this new disease and could be prescribed Ritalin for their symptoms. Not surprisingly, the number of elementary school children taking Ritalin increased, from 270,000 to 541,000 in 1980 to 750,000 in 1987.3... 

The symptoms of inattention, distractibility, and/or hyperactivity that define attention-deficit/hyperactivity disorder (ADHD) improve when treated with the stimulant drug Ritalin. For long-term success, however, the behaviors associated with these symptoms can also addressed with different techniques, some of which have been described in Chapter 2. 

Although the etiology of autism is not understood, the defining or core symptoms of autistic disorder are considered to be impaired social interaction, impaired verbal and nonverbal communication, and restrictive, repetitive patterns of behavior. In addition, most patients with a primary diagnosis of autism exhibit other neurological or psychiatric symptoms, which may include seizures, sleep disorders, anxiety, panic attacks, attention deficit/hyperactivity, self-injury, and cognitive impairment (Simonoff et ah, 2008). It is not known to what extent these comorbidities reflect the primary pathology of autism and to what extent they represent unrelated vulnerabilities that are exacerbated by the impaired social interaction and communication that is characteristic of the disorder. 

A word about prevalence mental illness is more common than many people imagine. The current prevalence estimates are that about half the U.S. population meets the criteria for at least one mental disorder during a lifetime, with about 25 percent of the population meeting the criteria for at least one mental disorder during any given year.1 Of these disorders, the most prevalent are apparently anxiety disorders, followed by mood disorders (for example, major depressive disorder), impulse-control disorders (for example, attention deficit hyperactivity disorder [ADHD]), and substance disorders (for example, alcohol abuse). In contrast, the prevalence of psychosis as I define it here is only 2—3 percent of the U.S. population, and the world prevalence is about the same. 

In the last decades, attention deficit and hyperactivity disorders syndrome (ADHD) has been defined as a developmental disorder involving difficulties with sustained attention, distraction, poor impulse control and hyperactivity or inabihty to regulate activity level to situational demands. The disorder is befieved to occur early in childhood and is considered organic in pathology (Table 68.1). The current cfinical view is that the hyperactive—impulsive symptoms tend to emerge first in development, with those... 

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