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ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is very much in the public eye. Increasing numbers of schoolchildren are diagnosed with the condition, and more than two million North American schoolchildren take ADHD medications. Colleges, graduate programs and test operators like the SAT are petitioned to make the necessary accommodations for people who are diagnosed with ADHD. What is a reasonable accommodation to one person may seem like “jumping the queue” to another.

The reported prevalence of ADHD is likely to excite a sense of urgency among the converted, and skepticism among the dubious. Thirty years ago, the prevalence was said to be 1-3% of all schoolchildren in North America, and then it was 3-5%. In 1997, 3-10% of schoolchildren in North American were said to have ADHD. The most recent data suggest a prevalence rate of 10%.

The increase is probably due to changes in diagnostic emphasis. The diagnosis has been broadened to include adults as well as children, and patients whose sole complaint is inattention and distractibility at school or work. The diagnosis is certainly in vogue. There have been a rash of popular books on the subject, and several companies are marketing new drugs for ADHD or new formulations of old drugs. Special services, including extra time on standardized tests, are afforded to children and adolescents diagnosed with ADHD. This sort of thing increases the likelihood of an ADHD diagnosis.

As long as the diagnosis of ADD is based on little more than subjective responses to questionnaires, there will be controversy surrounding the accuracy of the diagnosis. We have taken pains to develop a more objective evaluation system for ADD, and have published our methods and the results of our research in the medical literature. (For all practical purposes, ADD and ADHD are synonymous terms.)

ADD evaluation at the neuropsychiatry clinics is based on a neurological and psychiatric evaluation, medical history, information from various sources, and cognitive testing. It includes a "test dose" of either methylphenidate or amphetamine to evaluate the patient's response to a small dose of medication. As it happens, measurable psychostimulant effects occur about 45 minutes following the first oral dose. If the patient is evaluated in the morning, he or she might be given a test dose and then return after lunch to be re-evaluated.

Even the most careful initial evaluation, however, doesn't necessarily predict how the patient is going to do on a stimulant over the long-term. Patients usually need to compare the effects of different stimulant medications. Evaluation of stimulant side effects over time can be made by using a computerized symptom checklist that we have developed, and that different teachers can use, or else by using computerized tests of attention and executive function from this website.