Attention Deficit Hyperactivity Disorder

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    5 Takeaways From New Research About A.D.H.D.

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    Scientists who study the condition are wrestling with some fundamental questions about the way we define and treat it.As diagnoses of A.D.H.D. and prescriptions for medications hit new record highs, scientists who study the condition are wrestling with some fundamental questions about the way we define and treat it. More than 15 percent of American adolescents have been diagnosed with A.D.H.D., according to the Centers for Disease Control and Prevention, including 23 percent of 17-year-old boys. A total of seven million American children have received a diagnosis.Normally, when a diagnosis booms like this, it’s because of some novel scientific breakthrough — a newly discovered treatment or a fresh understanding of what causes the underlying symptoms. I spent the last year interviewing A.D.H.D. scientists around the world for my magazine article, and what I heard from them was, in fact, the opposite: In many ways, we now understand A.D.H.D. less well than we thought we did a couple of decades ago. Recent studies have shaken some of the field’s previous assumptions about A.D.H.D. At the same time, scientists have made important discoveries, including some that are leading to a new understanding of the role of a child’s environment in the progression of his symptoms.At a moment of national concern about our shrinking attention spans, this science suggests that there may be some new and more effective ways to help the millions of young people who are struggling to focus.Below are the key findings from the new research.A.D.H.D. is hard to define — and recent science has made it harder, not easier.A.D.H.D. has always been a tricky condition to diagnose. One patient’s behavior may look quite different from another’s, and certain A.D.H.D. symptoms can also be signs of other problems, from anxiety and depression to childhood trauma and autism spectrum disorder. Twenty years ago, researchers thought they were on the verge of ending that controversy by finding a distinct “biomarker” for A.D.H.D. — a single gene that would reliably predict the disorder, or a physical difference in the brain that you could spot on an M.R.I. But today scientists acknowledge that the search for a biomarker has mostly come up empty, which means the diagnosis remains fluid and somewhat subjective.Adding to the confusion, a study published last October found that only about one in nine children diagnosed with A.D.H.D. experiences consistent symptoms all the way through childhood. More often, the researchers found, symptoms come and go, sometimes disappearing for a few years, sometimes returning. Together with other research, this study has led some in the field to conclude that our traditional conception of A.D.H.D. as an inherent biological fact — something you simply have or don’t have, something wired deep in your brain — is both inaccurate and unhelpful. A new model considers A.D.H.D. differently: not as a disorder you always have in some essential way, but as a condition you experience, sometimes temporarily.Medications like Adderall and Ritalin can have a positive effect on children’s behavior – but the results often don’t last.The biggest long-term study of A.D.H.D. treatments found that after 14 months of treatment, a daily dose of Ritalin did a better job of reducing children’s symptoms than nondrug interventions like therapy or parent coaching. But then the effect started to fade, and by 36 months, the relative benefit of the drug treatment had disappeared altogether. The symptoms of the children in the medication treatment group were no better than those of the ones assigned to behavioral interventions — and no better than a comparison group that was given no intervention at all.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Understanding A.D.H.D.

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      What’s behind the surge in cases in the U.S.?This morning, my colleagues at The Times Magazine published a remarkable cover story by Paul Tough about a surge of A.D.H.D. cases in the United States — and the way we treat them. Today, 23 percent of 17-year-old boys have received a diagnosis of attention deficit hyperactivity disorder. The number of prescriptions rose nearly 60 percent in a decade. You almost certainly know people who take these stimulants.Why is this happening? One thing I love about Paul’s story is that it’s partly a tale about how science is made and changed. Researchers in the 1930s saw immediate benefits when they treated jumpy kids with amphetamines. Eventually, doctors crafted a diagnosis that could explain distracted and excitable personalities, and a consensus formed about how to treat them. Paul’s story describes how a few scientists have come to challenge that consensus — and some of the fundamental ideas behind A.D.H.D.For today’s newsletter, I spoke to Paul about his reporting.What got you interested in this story?I’ve been writing for decades about education and children, and I now have two boys of my own. A few years ago, I began to notice how many families I met were struggling with their kids’ attention issues. Attention was something I worried about in my own children — and in myself, too. But I didn’t know much about the science behind attention. So I started talking to scientists. When I did, I discovered they had a lot of big unresolved questions.What is A.D.H.D., and why is it so tricky to define?There is no biological test for A.D.H.D. So it has to be diagnosed by its symptoms, and those symptoms are sometimes hard to pin down. One patient’s behavior can look quite different from another’s, and certain A.D.H.D. symptoms can also be signs of other things — depression or childhood trauma or autism. Take a child who is constantly distracted by her anxiety. Does she have A.D.H.D., an anxiety disorder or both?So A.D.H.D. may not be a clear, distinct medical disorder with defined boundaries — something you either have or don’t have?Increasingly, the science shows that the condition exists on a continuum, and there is no clear dividing line between people who have A.D.H.D. and people who don’t. For many kids, A.D.H.D. symptoms fluctuate over time — worse one year, better the next — and those fluctuations may depend on their external environment as much as their internal wiring.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      Why Adult ADHD Is Hard to Diagnose

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      It’s one of the most common psychiatric disorders in adults. Yet there are no U.S. guidelines for diagnosing and treating patients beyond childhood.Just before Katie Marsh dropped out of college, she began to worry that she might have attention deficit hyperactivity disorder.“Boredom was like a burning sensation inside of me,” said Ms. Marsh, who is now 30 and lives in Portland, Ore. “I barely went to class. And when I did, I felt like I had a lot of pent-up energy. Like I had to just move around all the time.”So she asked for an A.D.H.D. evaluation — but the results, she was surprised to learn, were inconclusive. She never did return to school. And only after seeking help again four years later was she diagnosed by an A.D.H.D. specialist.“It was pretty frustrating,” she said.A.D.H.D. is one of the most common psychiatric disorders in adults. Yet many health care providers have uneven training on how to evaluate it, and there are no U.S. clinical practice guidelines for diagnosing and treating patients beyond childhood.Without clear rules, some providers, while well-intentioned, are just “making it up as they go along,” said Dr. David W. Goodman, an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine.This lack of clarity leaves providers and adult patients in a bind.“We desperately need something to help guide the field,” said Dr. Wendi Waits, a psychiatrist with Talkiatry, an online mental health company. “When everyone’s practicing somewhat differently, it makes it hard to know how best to approach it.”We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More

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      6 Books for Adults Living With ADHD

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      Psychiatrists, counselors and researchers shared their recommendations.Staying focused in a world of distractions can be incredibly challenging. But for people living with attention deficit hyperactivity disorder — a neurodevelopmental disorder often marked by difficulty maintaining attention, disorganization, hyperactivity and impulsivity — it can be even harder. Adults are diagnosed less often than children, but A.D.H.D. can still create problems at work and in friendships and romantic relationships.Books can be “the entree into understanding whether you should consider getting a diagnosis and evaluation for A.D.H.D.,” said Melissa Orlov, the founder of A.D.H.D. and Marriage, a website and consulting company that provides resources for couples living with the condition.Sharon Saline, author of “What Your A.D.H.D. Child Wishes You Knew: Working Together to Empower Kids for Success in School and Life,” says the right book can combat misinformation. It can also help people close to someone with A.D.H.D. by providing a “toolbox for engaging with them, supporting them and loving them,” she said.To demystify the subject, we asked experts — psychiatrists, counselors and researchers — to recommend books on A.D.H.D., focused on adults.1. Taking Charge of Adult A.D.H.D., by Russell A. Barkley with Christine M. BentonThis book, first published in 2010, is full of information and practical tools from Dr. Barkley, “one of the leading, if not the leading expert on A.D.H.D. in the world,” Dr. Saline said. It’s a “combo workbook/info book, which is great for people to get a better sense of who they are,” she said.We are having trouble retrieving the article content.Please enable JavaScript in your browser settings.Thank you for your patience while we verify access. If you are in Reader mode please exit and log into your Times account, or subscribe for all of The Times.Thank you for your patience while we verify access.Already a subscriber? Log in.Want all of The Times? Subscribe. More