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What is The DSM-IV and Why Should You Care?

The DSM-IV is the fourth edition of the Diagnostic & Statistical Manual for Mental Disorders, which is the book physicians rely on for diagnosis and treatment of brain-based problems. It’s where what counts as ADHD is defined (i.e., it is the official source of the current diagnostic criteria). I found the DSM-IV criteria for ADHD online here. The page includes the following disclaimer with the criteria:

The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.

Continue reading “What is The DSM-IV and Why Should You Care?”

Rock the SAT

A friend just sent me this:

P.S. More and more I see ADD strategies being mainlined to the public without being labeled as “ADD”. Here’s a link to an NPR story about using music to study for the SATs… http://www.npr.org/templates/story/story.php?storyId=6732411

It’s a story about a new system for studying the SATs using music: Rock the SAT. They wrote songs to help you memorize vocabulary for the SAT. Check it out.

Prevalence of ADHD

If you read up on ADHD, you’ll find all sorts of often conflicting information. That’s why I like Russell Barkley. He’s one of the best known researchers on ADHD. He has published 15 books, more than 200 scientific articles, and 7 videos on ADHD and related topics. The 3rd edition of his Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment just came out. It’s a handbook for clinicians, those people who diagnose and treat ADHD. Since I like science, and like knowing what I’m talking about, I got myself a copy. Leafing through it, I was only mildly astonished to read that there have been literally thousands of studies on ADHD. Barkley estimates the current number to be on the order of 6,000! And I swear, he and his contributors cite a large percentage of them in this 770-page reference book.

Prevalence was the first thing I wanted to get the latest information on. Just how prevalent is ADHD? In kids? In adults? Turns out, some of the difference in numbers we see bandied about can be attributed to using different definitions for what constitutes ADHD. The current definition of ADHD is what’s in the DSM-IV. By that definition, Barkley cites 7.4% of kids in this country ages 5-19 have ADHD. Another study by the CDC that came out in 2005 reveals that 7.8% of kids in this country ages 7-17 are diagnosed with ADHD (you can see a summary of that study’s results here).

For adults, a recent NIMH-funded survey tracking the prevalence of ADHD symptoms found that an estimated 4.4% of adults ages 18-44 in the United States experience symptoms and some disability. The survey is known as the National Comorbidity Survey Replication (NCS-R) and is part of a series of tracking surveys supported by NIMH and conducted by researchers at Harvard Medical School to assess the state of mental health of the nation. The rest of the summary of this study’s results is available here.

So, using current definitions and the most recent research, I have an answer regarding prevalence: 7.4%-7.8% of kids and 4.4% of adults in this country have ADHD.

(BTW, It’s useful to remember that these are a nation-wide averages. Your local results might vary!)

What's In a Name?

Our concept of Attention-Deficit/Hyperactivity Disorder (ADHD) continues to evolve. The first known reference to it is in a book by Dr. Heinrich Hoffman. The book is actually a series of children’s stories and poems. It was first published in 1844 in German. The poem about ADHD is called Fidgety Phil. Although that poem was penned over 150 years ago, the cluster of symptoms remains essentially the same. In contrast, our understanding of the underlying causes of the behavior has evolved tremendously.

To give you a quick run down on this evolution, here are some of the “highlights”.

  • 1902: the British medical journal Lancet characterized similar symptoms in children as Morbid Defects of Moral Control.
  • 1940s: the symptoms of distractibility, hyperactivity, and impulsivity were defined to be Minimal Brain Damage Syndrome.
  • 1962: when scientists were unable to associate anatomical brain damage with the symptoms in other children, they renamed it Minimal Brain Dysfunction.
  • 1968: the DSM-II defined this same cluster of symptoms as Hyperkinetic Syndrome of Childhood.
  • 1980: the DSM-III defined it based on behavioral and descriptive characteristics. Here’s where we first get Attention Deficit Disorder (with and without Hyperactivity).
  • 1987: the revised DSM-II changed the name again. The syndrome became known simply as Attention Deficit Hyperactivity Disorder.
  • 1994: the latest revision of the diagnostic manual, DSM-IV, was published with the definitions currently in use. The syndrome is now called Attention Deficit/Hyperactivity Disorder and includes three subtypes: Predominantly Hyperactive-Impulsive Type, Predominantly Inattentive Type, and Combined Type.

So currently, you’ll read in the literature or hear people refer to this syndrome as ADD, ADHD, or AD/HD. These are all ways to talk about the same thing, although some people will use ADD to refer to the inattentive type and ADHD to refer to both the hyperactive-impulsive type and the combined type.

Hope this has cleared up some of your confusion over terms!

Photo Mosaics – Play with Perspective

Here’s a fun way to play with perspective. You’ve seen those photo mosaics where a larger image is made up of many smaller ones. Up close you can see all the little snapshots. Stand back a few feet and you can’t see either the snapshots or the big picture very well. Stand back a few yards and the composite image becomes really clear.

Well, here’s a way to make your own photo mosaic with a downloadable shareware program. One of my family members did this. She took the finished file for professional printing and the effect was stunning. I can just imagine what a great gift your own montage might make for someone you love, or as a keepsake of a special event.

The software is available here. Enjoy!

ADHD and Exercise

One of the best things we can do for ourselves is exercise. Even if we haven’t yet experienced this for ourselves, abundant research demonstrates that exercise helps to:

  • Regulate your appetite
  • Regulate your weight
  • Improve your sleep
  • Improve your mood
  • Reduce symptoms of menopause
  • Improve your sex life

And, according to Dr. John Ratey, it’s also good for your brain. He says that 20 minutes of aerobic exercise is like giving yourself a little hit of Ritalin and a little hit of Prozac, helping you to achieve a focused relaxed state of mind. Additionally, new research is strongly suggesting that exercise can help the brain learn and stay young by developing new neural connections and optimizing existing ones, even if you’re old! Check out this very readable article from Newsweek. Click here for the link.

ADHD and Your Lifestyle

One of the fascinating things about ADHD is that although some of it is clearly related to genetics, some if it is clearly related to environmental factors. What’s great about that is it means there are non-pharmaceutical things we can do to help manage and mitigate ADHD symptoms. This is a growing area of interest and research in the field of ADHD. The book I co-authored, Fidget to Focus, is just one of the approaches being studied. When I come across interesting and relevant research regarding these environmental or lifestyle aspects of living well with ADHD, I’ll post it here.

Brain Basis for Differences in ADHD Identified

Some recent research out of MIT has interesting implications for the understanding and treatment of ADHD. The research demonstrates that it takes one part of the brain to concentrate and another to be distracted. The part that pays willful attention to tasks is right behind the forehead, towards the front of the brain. The part that notices sudden changes in the environment is located in the parietal cortex, towards the back of the brain.

This reflects what many of us already knew from our own experience: some people with ADHD have a harder time focusing, while others have a harder time filtering out distractions. And, of course, some struggle with both.

Earl Miller, a neuroscientist at the Massachusetts Institute of Technology, led the study which was published in the journal Science March 29th 2007. He had this to say about implications for treatment of ADHD:

The downside of most psychiatric drugs is they are too broad. It’s like hitting the problem with a sledgehammer; you get the benefits but also many unintended consequences. Our work suggests that we may one day be able to figure out what is the exact problem with each individual and specifically target those shortcomings.

You can find the website for the journal Science here, and more about Miller’s research here. Laura Neergaard wrote about this study for the Associated Press. Go here for her article.

How to Find an ADHD Savvy Doctor

Perhaps surprisingly, a lot of people are unhappy with their doctor, or are having trouble finding a doctor who knows anything about ADHD. Even though ADHD is the most common DSM-IV diagnosis in children, most doctors have received scant training in diagnosing and treating this disorder. They can open the DMS-IV and follow the guidelines, but they aren’t by any means experts.

So, how do you find a doctor that is both experienced and skilled in working with ADHD? You should start with this guideline from the Attention Deficit Disorder Association (ADDA). If you have a list of doctors from you health insurance in-service program, you can use the guideline to vet which ones really do know about ADHD. You can also contact your local CHADD chapter. Ask for their local resources directory. It may be a member-only benefit, but family membership in CHADD is inexpensive and definitely worth having. Or you can contact a local ADHD Coach. Coaches often have a list of doctors they recommend or refer to.

You can also use the online resources directories at ADDA, CHADD, ADD Resources, or the ADHD Physician Directory (sponsored by WebMD.com and Shire Pharmaceuticals). Note that professionals typically pay to be in these directories. That means only that they specialize in ADHD. It doesn’t say anything about how good they are. Just be sure to ask any doctor specific questions about their expertise with ADHD before you entrust them with your or your child’s care.

ADHD Information

There’s a lot of information on ADHD circulating on the web, in print, and other media. Some of that information is excellent. Some is just plain wrong. And much is in between. Being interested in science and having trained in science, my eye and mind are perhaps more analytical or critical in this area than most.

When I find useful and evidence-based information on ADHD, I’ll post it here. I’ll always make an effort to include links to the original sources so you can go read it for yourself and decide what you think so you can take charge of your own ADHD.

If you find an article you want me to look over and maybe include here, let me know!