Hyperactivity - not always a child's disorder

Sat 2 Apr 2005

Hyperactivity - not always a child's disorder

IAN JOHNSTON SCIENCE CORRESPONDENT

HYPERACTIVE children can grow up to become hyperactive adults, according to new research by a team of psychologists.

Attention Deficit Hyperactivity Disorder (ADHD) had been thought to be a condition that mainly affected children, but a study found that sufferers’ attention spans and powers of concentration did not improve with age.

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Older people who had been diagnosed with ADHD were better able to control impulsive responses than younger sufferers, but they experienced other problems believed to be connected to the condition.

These included higher levels of both anxiety and depression, which researchers said suggested the longer someone lived with the disorder the more distress they felt.

The findings of the study of more than 200 people aged 16 to 50 were reported to the Division of Clinical Psychology’s annual conference in Manchester.

The Scottish Executive said it had "no plans" to set up a treatment centre for adults with ADHD, but would examine the new research.

There is a centre in London but its acceptance of adult ADHD has remained controversial among health workers and there are few other specialist services available.

Dr Jessica Bramham, a chartered clinical psychologist who carried out the research with several colleagues from the Institute of Psychiatry in London, said adult ADHD sufferers were not being given adequate treatment because many health organisations did not recognise that the condition continued after childhood.

"These findings confirm that ADHD does not necessarily disappear by the time a child reaches their 18th birthday," she said.

"Some adults can continue to experience significant cognitive and emotional problems associated with the disorder.

"Treatment can substantially improve their functioning but still many services do not recognise that ADHD may persist beyond childhood."

The belief that ADHD was limited to childhood was partly based on some studies which showed improvements in several symptoms as the child grew older, but the study found this "trajectory is not clear through the disorder in adulthood".

Dr Bramham said the impression that ADHD went away as people got older was based on an improvement in some sufferers’ condition.

"It does go away for a proportion of people. As their brains develop the symptoms don’t manifest any more, probably about 50 per cent don’t have it any more," she said.

"But there is a proportion who still go on to have the full-blown syndrome and another proportion who will have some symptoms.

"They may have lots of psychological problems through growing up with this and may need help with anxiety, depression and substance abuse.

"A three-year-old climbing the walls with ADHD may not be doing so when they get older but they may be still fidgeting in their seat, they may feel internally restless.

"It could be they have learned from social situations that they cannot be climbing the walls."

ADHD is thought to cover a range of disorders caused by brain conditions, genetic problems and birth trauma.

Sufferers have reduced levels of the chemical dopamine in the brain. Symptoms can be relieved by the controversial drug Ritalin - known as the "chemical cosh" and which some fear can cause lasting damage - anti-depressants and amphetamine-based drugs.

Undiagnosed sufferers who do not receive treatment are highly likely to end up in prison - some believe as many as 50 per cent of prisoners either have ADHD or had it as a child. They also have a higher tendency to use illegal drugs, which some researchers view as a form of "self-medication".

Dr Bramham, who works at the adult ADHD centre in London, said: "If they are untreated they are more likely to be sensation-seeking and get into drugs. They can find things like speed calm them down a bit and make them feel more normal. Alcohol and cannabis are also used."

Police in Newcastle have started trying to identify and get help for ADHD sufferers, mainly teenagers, as a form of crime prevention.

The London ADHD centre began informally about ten years ago when a psychologist agreed to see sufferers who were being dropped on their 18th birthday by child health services but still needed help.

"Once word got round he was seeing adults with ADHD, people started referring cases," Dr Bramham said.

It now sees about 150 people a year. However despite a decade of work, there is still scepticism about the idea of hyperactive adults among many health professionals, with one doctor calling the London centre "experimental".

A Scottish Executive spokesman said: "We have no plans to set up a similar centre in Scotland, but would be interested to hear about any positive results which come out of the project."

However he said new guidelines were being drawn up for the treatment of ADHD "at all ages" by the National Institute for Clinical Excellence.

Treatment of jailed criminals with ADHD was a matter for the prison service.

"We recognise that there may be a higher than average proportion of the prison population with personality disorders. It is therefore vital that they receive the appropriate care on referral by the Prison Medical Service," the spokesman added.

Dr Bramham said she hoped her study would finally help win over those who remained doubtful.

But she added: "Even the people referring patients to us are sometimes a bit sceptical, saying ‘This person thinks they have ADHD, but I’m not so sure myself’."

Related topics

• Ritalin: http://news.scotsman.com/topics.cfm?tid=1228
• Scottish Executive: http://news.scotsman.com/topics.cfm?tid=867
  

This article: http://news.scotsman.com/topics.cfm?tid=1228&id=348272005

Vol. 8, No. 2, 2002 Page 1&3

ADHD in prisoners 'problem of great magnitude'

link to full article: http://www.autismwebsite.com/crimetimes/02b/w02bp1.htm

Mental Health Foundation Articles of interest

More than a third of children with attention deficit hyperactivity disorder (ADHD) have been excluded from school, a survey of parents claimed today.

The BBC reports that a poll of 526 families found 39% had had a child excluded from class, and in 11% of cases this was permanent.

link to full story: http://www.mentalhealth.org.uk/information/news/?EntryId=46131

Psychologist helps children with ADHD make friends

Many children with Attention-Deficit/Hyperactivity Disorder suffer through a range of problems, from poor grades to poor relations with parents and teachers. But more than half of these children also have serious problems making friends. Too often they live lonely lives, never learning to develop the social skills they need to make friends as children or as adults.

link to full story: http://www.mentalhealth.org.uk/information/news/?EntryId=48125

Mental Health Foundation Articles of interest

More than a third of children with attention deficit hyperactivity disorder (ADHD) have been excluded from school, a survey of parents claimed today.

The BBC reports that a poll of 526 families found 39% had had a child excluded from class, and in 11% of cases this was permanent.

link to full story: http://www.mentalhealth.org.uk/information/news/?EntryId=46131
Psychologist helps children with ADHD make friends

Many children with Attention-Deficit/Hyperactivity Disorder suffer through a range of problems, from poor grades to poor relations with parents and teachers. But more than half of these children also have serious problems making friends. Too often they live lonely lives, never learning to develop the social skills they need to make friends as children or as adults.

link to full story: http://www.mentalhealth.org.uk/information/news/?EntryId=48125

Personal Project Lit Review

Introduction

My personal project aim is to investigate new media technologies. The ways in which new media technologies can be implemented to assist teenagers and young adults with ADHD in their daily lives. Teaching them to use their so called deficits as skills. Thus providing them with a location-aware, non-hierarchical, social network which supports the social and behavioural nature of those with ADHD. Focusing on their deficits as strengths, stopping them feeling misunderstood and isolated which often causes them to get into trouble.

The review of literature begins with an overview of ADHD, the research findings, conclusions and hypotheses. It then goes on to a review of the eitology of ADHD looking into the Hunter Concept in more detail. The correlation with ADHD and creativity is reviewed and the effect Green Time has on the condition.

The following chapters review assistive technology , social computing and locative media. Concluding with a discussion of the way in which these emerging technologies can be implemented.

What is ADHD - research findings, conclusions and hypotheses

There has been a wealth of literature written on ADHD. There have been many journal and press articles, research papers, books and Government and charity publications published on the subject. In addition to those are many internet sites both unofficial and official dedicated to ADHD Worldwide.

Background Information on ADHD

The American National Information Center for Children and Youth with disabilities (NICHCY) describes the core symptoms of ADHD as developmentally inappropriate levels of inattention, hyperactivity, and impulsivity. These problems are persistent and usually cause difficulties in one or more major life areas: home, school, work, or social relationships. Clinicians base their diagnosis on the presence of the core characteristics and the problems they cause.

Not all children and youth have the same type of ADHD. Because the disorder varies among individuals, children with ADHD won't all have the same problems. Some may be hyperactive. Others may be under-active. Some may have great problems with attention. Others may be mildly inattentive but overly impulsive. Still others may have significant problems in all three areas (attention, hyperactivity, and impulsivity). Hence the three subtypes of ADHD:

1. Predominantly Inattentive Type
2. Predominantly Hyperactive-Impulsive Type
3. Combined Type (inattention, hyperactivity-impulsivity)

For instance, children with ADHD, without hyperactivity and impulsivity, do not show excessive activity or fidgeting but instead may daydream, act lethargic or restless, and frequently do not finish their academic work. Not all of these behaviours appear in all situations.

Of course, from time to time, practically every person can be a bit absent-minded, restless, fidgety, or impulsive. So why are these same patterns of behaviour considered normal for some people and symptoms of a disorder in others? It's partly a matter of degree. With ADHD, these behaviours occur far more than occasionally. They are the rule and not the exception.

According to the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) of the American Psychiatric Association, ADHD can be defined by behaviours exhibited. Individuals with ADHD exhibit combinations of the following behaviours:

• Fidgeting with hands or feet or squirming in their seat (adolescents with ADHD may appear restless);
• Difficulty remaining seated when required to do so;
• Difficulty sustaining attention and waiting for a turn in tasks, games, or group situations;
• Blurting out answers to questions before the questions have been completed;
• Difficulty following through on instructions and in organizing tasks;
• Shifting from one unfinished activity to another;
• Failing to give close attention to details and avoiding careless mistakes;
• Losing things necessary for tasks or activities;
• Difficulty in listening to others without being distracted or interrupting;
• Wide ranges in mood swings; and
• Great difficulty in delaying gratification.

According to Barkley (1997) Children with ADHD show different combinations of these behaviours and typically exhibit behaviour that is classified into two main categories: poor sustained attention and hyperactivity-impulsiveness. For instance, children with ADHD, without hyperactivity and impulsivity, do not show excessive activity or fidgeting but instead may daydream, act lethargic or restless, and frequently do not finish their academic work. Not all of these behaviours appear in all situations.

According to the fourth edition of the Diagnostic Statistical Manual of Mental Disorders (DSM-IV) Attention deficit hyperactivity disorder (ADHD) is a neurological condition, which affects those parts of the brain which control attention, impulses and concentration. It is thought to affect 3 to 7% of school age children.1 2 3 Research has shown that boys are three times more likely to suffer from ADHD than girls.4

The best description for ADHD is that a child who suffers from this condition shows disruptive behaviours, which cannot be explained by any other psychiatric condition and are not in keeping with those of the same-aged people with similar intelligence and development. These behaviours are usually first noticed in early childhood, and they are more extreme than simple “misbehaving”. Children with ADHD have difficulty focussing their attention to complete a specific task. Additionally they can be hyperactive and impulsive and can suffer from mood swings and “social clumsiness”.

Although people with ADHD can be very successful in life, without identification and proper treatment, ADHD may have serious consequences, which can include4:

• Under- performance at school
• Depression
• Problems with relationships
• Problems finding and keeping a job
• Criminal behaviour

Early identification by a healthcare professional is therefore very important to ensure that the child can fulfil his/her full potential.

Children with ADHD tend to display the following behaviours: -

• Hyperactivity
• Impulsive behaviour
• Inattention
• Social clumsiness
• Poor coordination
• Disorganisation
• Mood swings
• Specific learning disabilities such as dyslexia
• Language problems
• Difficulties with handwriting / written work

In people with ADHD, behavioural problems are seen in several places i.e. not just at school. Some children with ADHD have significant problems with concentration and attention but are not necessarily overactive or impulsive. It was thought until recent years that children outgrew ADHD in adolescence. However, it is now known that in approximately one third to one half of children with ADHD, the symptoms continue into adulthood.5

This is Netdoctor.co.uk’s response to the question “What are the symptoms of adult ADHD?”

Like childhood ADHD, adults share the symptoms of inattention, impulsiveness and hyperactivity. For some adults, the hyperactivity part of things calms down and is more controllable as they get older.

Research has shown that the experience of ADHD varies with age and symptoms can be quite different for people as the years go by.

Adults can experience ADHD in different ways, but some of the common symptoms include:

· concentration problems

· forgetfulness and poor short-term memory

· lack of organisation

· problems with creating and maintaining routines

· lack of self-discipline

· impulsive behaviour

· depression

· low self-esteem

· restless mind

· restlessness

· poor time management

· impatience and frustration

· poor social skills

· saying inappropriate remarks

· Feelings of underachievement.

Etiology of ADHD

There are many researched domains on the etiology of ADHD. Neurochemical, biological/gestational, evolutionary/genetic origins for the disease have been explored.

The neurochemical, focuses on the role of specific neurotransmitters that connect the neuronal circuits underlying attention. Neurological studies are converging on the conclusion that a dysfunction in the orbital limbic pathways of the frontal area is the probable impairment that gives rise to the primary features of ADHD (Barkley 1990,).

Most investigators in this area endorse a biological predisposition to the disorder (Barkley 1990, p.104). Barkley further discusses the biological origins in pregnancy, birth complications, toxins, infection, and heredity..

The evidence that some forms of ADHD have a genetic component come from a number of family aggregation, adoption, and twin studies over the past 30 years reviewed by DuPaul (1990). In the case of ADHD it would seem that hereditary factors play the largest role in the occurrence of these symptoms in children (Barkley, p.104). The development of ADHD need not have a hereditary origin, but heredity does correlate to a small percentage of this disease. Comings (1994) proposed that a site on the D2 gene coding may likely be responsible for ADHD and related syndromes.

Genetic studies on the segregation analysis of the twin and adoption studies suggest that there is a heritable component in some children and adults (Biederman, 1994:Faroane et, al. 1994, 1995). Multiple genes on chromosome 3 are related to compulsivity and aggression, (L.A. Phelps, Personal Communication Oct 20,1997). Phelps goes on to say that 80% of ADHD subjects have a first degree relative who is also ADHD. The review of literature by Lombroso (1994) clearly suggests that there are genetic factors involved in the etiology of many childhood psychiatric disorders. If the gene for this disorder can be identified then a greater degree of understanding and treatment may ultimately result for those afflicted with this disease.

Barkley discounts the fact that ADHD can arise purely from social and/or environmental factors. These factors, however, can contribute to the manifestation of the symptoms in each individual case. This is reflected in the treatment process being centred on social/environmental accommodations.

The evolutionary perspective lies in the fact that right brain development, or lack thereof, was especially important during our pre-agricultural evolutionary period (Shelley-Tremblay & Rosen, 1996). During this time our existence was more dependent on our ability to hunt. ADHD was perhaps beneficial during past evolutionary periods (Hallowell & Ratey, 1994). The genetic code was most likely valuable to survival in pre-agricultural human beings. The evolutionary perspective does not explore the possibility that these changes may be the first indicators of a threshold to new functions in the evolutionary development of the brain.

The ‘Hunter Concept’

Thom Hartmannn is an award-winning, bestselling author, international lecturer, teacher, radio talk show host and psychotherapist. Hartmann believes ADHD is not a disease or a disorder but merely a difference in the way people think. He came up with a metaphor to help describe his son Justin’s mind when he was diagnosed with ADHD.

“Justin, then 13 and a budding biologist, was devastated when a doctor told him he had a “brain disease” and would never go to college. Hartmann chose to explain it differently: he told Justin that the world was made up of hunter-gatherers and farmers and that 100,000 years ago the hunter-gatherer was vital to sustain humankind. He was prepared to risk his own life to get food and he was easily distracted by things, making him a good hunter and guard. As the world evolved and many of the risks were eliminated, the need for the hunter type diminished. He explained to Justin that he was “a hunter — and the world has been taken over by farmers. You can learn to be a farmer or you can take farmer pills.”

Hartmann (1993) later created and popularised ‘The Hunter Concept’ in the book ‘ADD - A Different Perception’ and In Hartmann’s ‘Beyond Add: Hunting for Reasons in the Past and Present ‘(1996).

In an article for The Times Online Abigail Rayner (2003) reports that what had started out as a metaphor was later backed up with science. Jay Fykes, a cultural anthropologist, found that the theory was exhibited in the different ways that American Indian tribes had evolved: “The Athabaskan are displaced hunters: give them a spear and a horse and they ruled the world, but when they tried to live in boxes and drive around in boxes and work in boxes, their society fell into crisis. The Pueblos had always been a thoughtful, fairly well-organised society and they did pretty well in modern America.”

In an online article entitled ‘Attention Deficit Hyperactivity Disorder and Green Time’ published on an information and resources site for parents and children 4ADHD St Clair writes

“ Dr. Richard P. Ebstein, a molecular geneticist and laboratory director at the Sarah Herzog Memorial Hospital in Jerusalem, has isolated the gene called DRD4 that seems to be a factor in ADHD.”

A couple of years ago Dr Robert Moyzis, of the University of California in Irvine, found that early human beings with ADHD traits were more likely to survive. The traits were associated with the DRD4 7R gene that is present in about half of ADHD individuals. Many other ADHD experts have disagreed with Hartmann’s theory, but they agree that the syndrome does exist in children and adults and cannot be ignored.

I

http://www.4-adhd.com/greentimeadhd.html hosts research projects with the conclusion exercise and working outside in a green environment reduces symptoms of ADHD.

The correlation between Add and creativity has been argued for several years. According to Crammond (1995) Being ADHD you see things that others miss. There are traits commonly associated with ADHD that are also associated with highly creative people. These are inattention, daydreaming, sensation seeking, and inability to finish projects, hyperactivity, enthusiasm and playfulness, difficult temperament, deficient social skills, academic underachievement, hypersensitivity to stimulation and mood swings

Russell A Barkley’s book ‘ADHD and the Nature of Self-Control’ reviews the diagnostic criteria (DSM-VI) of the disorder. It identifies the inadequacies of current conceptualisations and presents a new range of hypotheses about the nature of the disorder and construct of behavioural inhibition. The book provides an insight into the day-to-day adaptive functioning problems of children and adults affected by the disorder.

There have been a number of reports and articles written on the impact that ADHD has on the social interactions of those who suffer with the disorder. There are three major symptoms of AD/HD that can affect the way individuals get along with other people:

Inattention -- an individual has difficulty with paying attention, organization and following through on tasks

Impulsivity -- an individual has difficulty with talking or acting before thinking, or with self-control

Hyperactivity -- an individual is unusually active or restless

Add.about.com has published an on-line article ‘Communication skills (Bailey 2006). This provides insight into into ADHD symptoms and how they can become barriers in achieving effective communication. The article gives tips and suggestions but there is no evidence or references to support the statements made by Bailey. Research of literature in this area is needed and books highlighted for further reading are

‘Right-Brained Children in a Left-Brained World : Unlocking the Potential of Your Add Child’ by Jeffrey Freed, Laurie Parson, Laurie Parsons; Simon & Schuster,1997.Right-Brained Children in a Left-Brained World offers a step-by-step program that shows parents how to work with, not against, the special abilities of the ADD child.

‘ADHD and Teens : A Parent's Guide to Making It Through the Tough Years’ by Colleen Alexander-Roberts, Paul T. Elliott; Taylor Publishers,1995. ADHD (Attention Deficit Hyperactivity Disorder) is the most common behavioural disorder in American children. Teens with ADHD have an extremely high risk of failing in school, becoming drug abusers or alcoholics, breaking the law, and becoming teenage parents. This manual offers practical advice to help parent scope with these problems.

Windows into the A.D.D. Mind: Understanding and Treating Attention Deficit Disorders in the Everyday Lives of Children, Adolescents and Adults by Daniel G. Amen; Mindworks Press, 1997.

Visual Thinkers, Gifted People with Learning Difficulties, Computer Imaging, and the Ironies of Creativity, THOMAS G. WEST, ISBN 1-57392-155-6. West is a columnist, who has also been a manager and consultant in computer systems, energy research, and international technology. He directs the Visualization Research Institute of Washington, DC. In the Mind's Eye profiles gifted individuals who used non-traditional methods in their work as it explodes many myths about conventional intelligence and charts new vistas for today's computer visualization technologies. West examines the learning difficulties experienced by these people and others, and how recent neurological research shows an association between visual talents and verbal difficulties. In the Mind's Eye probes new data on dyslexics and ADHDers to see how computers enhance the creative potential of visual thinkers, as well as interactive computer applications to all levels of education and work.

Assistive Technology

Lindi Johnston’s research paper ‘How Assistive Technology Helps Overcome Learning Disabilities’ explores the various types of learning disabilities. Johnston looks at how assistive technology can play a beneficial role in those students’ lives that suffer from learning disabilities. The chapters relevant to my research are other disorders and the impact that ADHD has on social interactions.

Johnston states ADHD is a common inattention disorder that is characterised by inattention, impulsivity and hyperactivity. The learning difficulties experiences by those who have ADHD are poor organisational skills, problems categorising and memorising information, weakened interpersonal relation (poor social skills) a poor self concept, low co-ordination and motor functions and short attention spans.

According to Johnston the types of assistive technology available are

· pda (personal data assistant) for those who suffer organisation and memorisation problems

· Headphones for those who have social skills deficits. They are used to block out distractions.

· Amplification systems to aid concentration

· Varial speed tape recorders for adaptive listening

· CD-roms can be used for direct interactions

Social Computing

Social software networks and mobile software have seen a massive rise in popularity in the last few years. Social software comes in many different forms, the most well known being Web logs (aka blogs), wikis and social networking and tagging sites.

Blogs are easily updated online personal journals which are arranged in diary format. Blogs are accessible for all to read and leave comments on.

Wikis are online encyclopaedia s that can be extended and edited by users. The most popular of them being Wikipedia which was started in 2001, it currently contains 1,507,723 articles.

Social networking - My space. In May 2006 - Comscore’s Media Matrix reported that My Space had 51.4 Million unique visitors making it the 7th most frequented website in the world. Based on its size it would be the 12th largest country in the world.

Social Tagging sites such as del.icio.us and Blink list allow users to share their favourites/bookmarks with others. The bookmarks are tagged with keywords which enables the user to search for resources via others’ tags. This puts information in a social context, so you can find resources that others found useful and how they categorized them.

Leon Cych a consultant of emerging technologies in education believes blogs can be used for regular writing practice and the compilation of coursework. Saving the collection of books, writing and projects.

What Are Location-Based Services?

Location-based services (LBS) are applications that leverage the user's physical location to provide an enhanced service or experience. Location awareness can be used, for example, for mapping and navigation, shipment tracking, finding points of interest or a even virtual tour guide. Location awareness differentiates mobile applications from traditional PC and wired Internet services. GPS, RFID, Bluetooth are used in many locative media projects.

Ben Russell is the author of Headmap.org.uk (a blueprint for wireless technology, location aware devices) and one of the founders of the Locative Media Lab. In Russell’s on-line article for Vodafone Receiver Magazine, he discusses the social qualities of locative communication.

My research of social software led me to some motivating and innovative projects. Socialight was one of them.

Socialight is a mobile social networking system that was designed by students on an Interactive Telecommunications Program at New York University. Users initially join online and at first glance it looks like a run of the mill social networking site. However on closer inspection Socialight has much more exciting capabilities than it first lets on.

All users current locations are tracked by Socialight's central server. When two users are located in the same physical area they are notified of this. The user can view the other's profile and decide whether or not they wish to utilize the option of communicating with the other user. Teens and young adults with ADHD could really benefit from this adhoc networking as it takes the embarrassment of approaching a stranger in an attempt to initiate conversation with them.

There are a number of additional features which could also benefit an ADHD user. Socialight has a 'tap and tickle' function which requires little concentration to manipulate. This can be used to say "hi!" or give a 'nudge' to a friend. You can even make up your own secret morse code like vibing messages. The sticky notes feature could be an invaluable asset to a user with ADHD who suffers from memory problems

References

Barkley, R, A. (1997). ADHD and the Nature of Self-Control. New York: The Guilford Press 8. 1-350.

American Psychiatric Association DSM IV diagnostic criteria

Barkley, RA, ADHD: a handbook for diagnosis and treatment. New York 1998. Guilford Press

Wolraich ML (1996). Comparison of diagnostic criteria for ADHD in a countrywide sample. Journal of the America Academy of Child and Adolescent Psychiatry; 35:319-324

Green C and Chee K. (1997) Understanding ADHD – A Parent’s Guide to Attention Deficit Hyperactivity Disorder in Children. Vermillion Publishing

Murphy KR and Barkley RA. (1996). The prevalence of DSM-IV symptoms in adult licensed drivers. Implications for clinical diagnosis. Comprehensive Psychiatry; 37:393-401

NETDOCTOR http://premium.netdoktor.com/uk/adhd/adult/facts/article.jsp?articleIdent=uk.adhd.adult.facts.uk_adhd_xmlarticle_004624

Hartmann, T (1993) The Hunter Concept

Hartmann, T (1996) Beyond Add: Hunting for Reasons in the Past and Present

DuPaul, G.J. (1991) ’Parent and teachers ratings of ADHD symptoms:Psychometric properties in a community-based sample.’ Journal of Clinical Child Psychology

http://www.4-adhd.com/greentimeadhd.html

Lindi Johnston (2005) How Assistive Technology Helps Overcome Learning Disabilities

http://tiger.towson.edu/~ljohns15/research/paper.htm

Hartmann, T (1993) later created and popularised ‘The Hunter Concept’ in the book ‘ADD - A Different Perception’ and In Hartmann’s ‘Beyond Add: Hunting for Reasons in the Past and Present ‘(1996).

London Times on-line Is it ADHD that’s eating the boss? September 15 2004

http://timesonline.co.uk

Crammond, B. (1995). The Coincidence of Attention Deficit Hyperactivity Disorder and Creativity (RBDM 9508). Storrs, CT: The National Research Center on the Gifted and Talented, University of Connecticut

St Clair, J. 4adhd

Russell, B.(2003) Vodafone Receiver Magazine.

www.socialight.com

Adhd in prison

Young men in prison show high level of ADHD

9/12/2004

The population of young male prison inmates exhibits a considerable psychiatric morbidity, Swansea Clinical School's Professor of Psychiatry, Johannes Thome, has found.

In a recently published study in European Archives of Psychiatry and Clinical Neuroscience, Prof. Thome and others reported that the prevalence of Disturbance of Activity and Attention (DAA) and Hyperkinetic Conduct Disorder (HCD) or Attention Deficit/Hyperactivity Disorder (ADHD) in young adult prison inmates is significantly elevated when compared to non-delinquent controls.

�Of the total sample, 64% suffered from at least two disorders. Only 8.5% had no psychiatric diagnoses. This indicates the urgent need for more psychiatric expertise in young offender facilities,� the authors said.

The overall prevalence of ADHD was 45%. The Prevalence of DAA and HCD was 21.7%. The most common diagnostic combinations were DAA/HCD and substance use disorder/alcoholism.

According to the authors, ADHD is a condition with widespread co-morbid disorders in childhood, adolescence and in adulthood. In adolescence and early adulthood, substance use disorder and alcoholism occur with a prevalence of 50% and more. A comparable proportion of ADHD patients display personality disorders, in particular antisocial personality disorder and impulsivity personality disorder.

�The variety of co-morbid disorders creates a complex situation, which makes it difficult to unequivocally determine the influence of each single disorder on social outcome and delinquency,� they said.

The study investigated 129 prison inmates (mean age 19.2 years), and 54 healthy male control subjects for the presence of adult ADHD and co-morbid conditions using international diagnostic criteria as well as established rating scales and clinical interviews.

The study further found a significant difference between prisoners without any childhood or adult DAA psychopathology, and prisoners suffering from persistent adult DAA or having at least evidence of childhood ADHD-related symptoms, in terms of the prevalence of theft. Theft was two times more frequent amongst the two DAA/ADHD populations than in the controls.

The authors concluded that, �it seems evident that DAA/ADHD in association with co-morbid conditions has independent and joint influences on the onset, structure and outcome of delinquent behaviours.�

Source:	Swansea University
	Web Link

http://www.newswales.co.uk/?section=Health&F=1&id=7573

Interacting with Others: Tips for Adults with AD/HD (WWK 15 short version)

Interacting with Others: Tips for Adults with AD/HD (WWK 15 short version)

WWK refers to the What We Know series of information sheets on AD/HD. See the complete list.

People with attention-deficit/hyperactivity disorder (AD/HD) often have social problems. They may have problems with relationships and may be rejected by other people. The problems often come from their symptoms, which include inattention (not being able to pay attention); impulsivity (doing and saying things before they think); and hyperactivity (being overly active).
These social problems can be painful to people with AD/HD. They also may contribute to other psychiatric disorders such as depression or anxiety.
This What We Know sheet will help adults with AD/HD by:
describing how symptoms of AD/HD can result in social and relationship issues
suggesting ways to find out whether an adult with AD/HD interacts well with others
suggesting ways to help adults with AD/HD get along well with other people
AD/HD and Interacting with Others
It is not hard to understand why people with AD/HD often have a hard time interacting with other people. Fifty percent to 60 percent of children with AD/HD have difficulty getting along with other children. Adults with AD/HD very often are lonely and isolated because they haven't learned the social skills others expect them to have, such as listening, polite behavior and following through on responsibilities.
To get along well with others, people must be able to pay attention, to be responsible, and to control their impulses. Adults with AD/HD are often inattentive and forgetful, and they generally do not have good control over their impulses.
AD/HD is not a disability that others can see, so people who don't know what it is may think that the behavior of someone with AD/HD is simply rudeness or laziness or just being self-centered or irresponsible. These and other negative labels can lead to rejection of the person with AD/HD.
Rejection by others such as coworkers, family members and friends causes emotional pain, which can lead to low self-esteem and many other problems throughout life. Inappropriate behaviors may anger a friend or spouse and the friend or spouse may eventually "burn out" and give up on the friendship or marriage.
Teaching people with AD/HD, their loved ones and their friends about AD/HD and how it affects social skills and behavior can help lessen the blame, conflicts and rejection. People with AD/HD can learn to interact well with others and to improve their social lives.
Learning the Skills to Get Along with Other People
Social skills are generally learned by watching people, copying the behaviors of others, practicing and getting feedback. This normally begins in childhood and improves as one gets older.
People with good social skills are accepted by others. People with AD/HD or who don't have such skills are often rejected -- and rejection and isolation gives them even fewer chances to learn how to behave with family and others. This cycle leads to even more rejection, and so on. People begin to avoid the person or use other ways to show disapproval. Because it's considered rude to point out social errors, people with AD/HD are left on their own to improve something they may not even understand.
The Impact AD/HD Symptoms have on Interacting with Others
There are three major symptoms of AD/HD that can affect the way individuals get along with other people:
Inattention -- an individual has difficulty with paying attention, organization and following through on tasks
Impulsivity -- an individual has difficulty with talking or acting before thinking, or with self-control
Hyperactivity -- an individual is unusually active or restless

Inattention
An adult with AD/HD may miss important information in a conversation or in a social setting if they have difficulty paying attention, and others may get frustrated or annoyed if they believe the adult with AD/HD wasn't listening on purpose.
Here are some tips for adults with AD/HD to understand others and gain social skills:
Pay close attention to what others do and say. Know that sometimes people don't say what they really mean. Look for clues to understand what is really meant. Try to "read between the lines."
Be aware of body language, tone of voice, behavior, or the look in someone's eyes to better understand what they are saying and meaning.
Notice a person's choice of words to better understand real meaning. "I'd love to go" probably means "Yes." "If you want to" probably means "No, but I'll do it."
Actions speak louder than words. If someone's words say one thing but their actions say another, suspect that their actions might be telling you their real feelings.
Find someone to help you with this hidden language. Compare your understanding with their understanding. If you don't agree, try the other person's interpretation and see what happensespecially if you usually get it wrong.
Learn to see beyond polite behavior. Polite behavior sometimes disguises actual feelings.
Be alert to what others are doing. Look around for clues about proper behavior, dress, seating and talking.

Impulsivity
Impulsivity -- speaking or acting without thinking first -- can damage relationships. Not stopping to think first often causes unwanted situations for others.
Speaking without thinking first often results in opinions and thoughts being expressed in their raw form, without the thoughtful "being nice" that is socially appropriate. Interrupting others is common with impulsive people and not appreciated.
Rapid speech and talking too much can also be a sign of impulsivity. The rapid-fire speech of someone with AD/HD leaves little room for others who might want to speak too. This behavior can lead to losing friends and missing needed information.
Acting without thinking first can also cause problems. Doing something instantly and without thought often means poor decision-making. Impulsive actions include taking reckless chances, not studying or preparing for school or work, having affairs, quitting jobs, deciding to relocate, overspending and even aggressive actions such as hitting others or throwing things.
Hyperactivity
Physical hyperactivity can make it hard to take part in leisure activities. Being unable to sit still and concentrate for concerts, sports events, religious ceremonies, educational events, or even on vacations may be seen by others as not caring or not being concerned.
Evaluating Your Ability to Get Along with Others
During an evaluation for AD/HD, a health professional will do a complete evaluation to see how the adult interacts with others. Interviews and questionnaires are usually used to determine what social skills and problems an adult with AD/HD has. The questionnaire may include items like those listed here:
Not paying attention when spoken to; missing pieces of information
Seeming to ignore others
Not taking turns in conversation (interrupting frequently)
Not following through on tasks and/or responsibilities
Not using proper manners
Missing social cues
Having a disorganized lifestyle
Sharing information that is inappropriate to share
Being distracted by sounds or noises
Becoming flooded or overwhelmed, "shutting down"
Having disorganized or scattered thoughts
Rambling or straying off topic during conversations
Ending conversations abruptly
Ways to Treat AD/HD
Medications are often helpful for managing AD/HD symptoms. In many cases, medication will give an adult with AD/HD the boost in self-control and concentration he or she needs to use newly learned social skills at the appropriate time. However, medications alone usually are not enough to gain the necessary skills. Once an adult knows what social skills to work on, working with a therapist or coach who understands how AD/HD affects social skills should be considered. (A doctor or other professional may be able to recommend someone. For additional information on coaching, see What We Know #18, Coaching for Adults with AD/HD.")
Adults with AD/HD should think about the following when seeking help with social skills:
Knowledge. To learn better social skills, an adult with AD/HD needs to understand them and know which skills he or she needs to improve. Books that can help include What Does Everybody Know That I Don't (Michele Novotni), ADD and Romance (Jonathan Scott Halverstadt) and You, Your Relationship, & Your ADD (Michael T. Bell).
Attitude. Adults with AD/HD should have a positive attitude and be open to improving their social skills. It is also important to be open to -- and to appreciate -- feedback from others.
Goals. Adults with AD/HD may want to work on one goal at a time. Others close to the adult can help evaluate skills and problems. Tackling skills one at a time will help an individual master each skill before moving on to the next one.
The echo. Those who struggle with missing pieces of information because of problems paying attention in conversations may want to learn to check what they heard with others by saying and asking things like "I heard you say that...Did I get it right?" "Is there more?" or by asking others to check after giving important information. They could help by saying, "Please tell me what you heard me say." This is a good way to avoid social errors because of inattention.
Watching others. Adults with AD/HD can learn a great deal by watching others -- both at work and in their personal life -- do what they need to learn to do. Television may also provide role models.
Role playing. Practicing new skills with others is a good way to get feedback about what was learned.
Rehearsing. Individuals can rehearse by imagining themselves in a situation to practice skills by picturing the place and the people who will be there. This practice should be repeated as many times as possible to "overlearn" the skill and increase chances for success.
Using prompts. Using prompts to focus on particular goals helps, too. The prompts can be an index card with notes, a vibrating watch set every four minutes to remind a person to be quiet, or a gesture someone makes (such as rubbing his or her head) to remind the individual with AD/HD to work on a particular skill.
Increasing "likeability." Researchers have found that people who are likeable have certain characteristics. They are sincere, honest, understanding, loyal, truthful, trustworthy, intelligent, dependable, thoughtful, considerate, reliable, warm, kind, friendly, happy, unselfish, humorous, responsible, cheerful and trustful. Developing or improving any of these "likeability" characteristics should help improve the overall social life of an adult with AD/HD.
Summary
Although AD/HD certainly brings unique challenges to social relationships, information and resources are available to help adults with AD/HD improve their social skills. Most of this information is based upon sound clinical practice and research on social skills and AD/HD in children and teens; there is a great need for more research on social skills and AD/HD in adults. Adults with AD/HD are encouraged to seek help through reading, counseling or coaching and, above all, to build and maintain connections with other people.
The information provided in this information and resource sheet was supported by Cooperative Agreement Number R04/CCR321831-01 from the Centers for Disease Control and Prevention (CDC). The contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC. It was adapted from What We Know #15, "Social Skills in Adults with AD/HD," developed by the Attention Deficit Disorder Association, and approved by CHADD's Professional Advisory Board in 2003.
© 2003 Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
For further information about AD/HD or CHADD, please contact:
National Resource Center on AD/HD
Children and Adults with
Attention-Deficit/Hyperactivity Disorder
8181 Professional Place, Suite 150
Landover, MD 20785
800-233-4050
www.help4adhd.org
Please also visit the CHADD Web site at
www.chadd.org.
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