Attention-deficit/hyperactivity disorder in adult life.

Many children and adolescents with ADHD become adults with ADHD. The clinical picture may be modified from that seen with youth; however, the hyperactivity, inattention, and impulsivity persist. These behaviors affect the individual in his or her education, work, relationship, and home settings. If this adult had learning disabilities as a child and adolescent, they will continue into adulthood. Many of the emotional, behavioral, and social problems of the past continue as well. If the child or adolescent with ADHD is identified early and treated properly throughout the school years, fewer secondary problems are carried into adulthood. If not identified early or if treated during childhood and not during adolescence, a greater number of emotional, behavioral, and social problems can occur in the adult. Identification of ADHD in adulthood is critical. Treatment with medications and with psychosocial interventions is essential. Educational, individual, and career counseling may be of significant importance. The consequence of missing this diagnosis or of not addressing the problems often related to ADHD is a less than functional and successful adult.

Alternative (nonstimulant) medications in the treatment of attention-deficit/hyperactivity disorder in children.

Medication to treat ADHD must be seen as part of a multimodal approach that includes education, counseling, behavioral management, and family work along with the medication. If in addition to ADHD the patient has other psychiatric disorders, they also must be treated. The stimulant medications are still the first choice in treating ADHD. Should there be reasons why they cannot be used, the TCAs become the second line of treatment. Other alternative medications such as buproprion, clonidine, and guanfacine also can be considered. This article provides information and guidelines for the use of the alternative, nonstimulant medications to treat ADHD. These medications can be used separately or in combination to reduce the primary behaviors of ADHD and comorbid conditions. The reader is encouraged to refer to reviews of the pharmaceutical company literature and the Physician's Desk Reference before initiating treatment with any of these medications.

Controversial therapies.

Parents of children or adolescents with disabilities want the best treatment. They are vulnerable to any person who reports having a quick solution and possibly a cure. It is important that professionals be informed of these controversial therapies so that they can educate parents on what is known about these treatments. There is a relationship between brain function and nutrition, as well as between brain function and allergic reactions. These relations appear to be true for children with learning disabilities, attention deficit hyperactivity disorder, and other neurologic disorders. At this time, however, we do not understand these relationships and there are no known treatments based on these relationships that have been shown to be clinically successful. Professionals must educate parents on proposed new treatments. Parents need to ask themselves why this amazing approach is not used by everyone. If the person proposing the treatment tells them that "most professionals are biased and do not believe the findings because they are different from the traditional treatments," they should feel free to ask to see the data supporting the concept and the treatment. They should not accept without question popular books published by the person proposing the treatment or information provided in a flyer or on a television show by the person proposing the treatment. They should not put their son or daughter through something unproved and unlikely to help.

Learning disabilities and vision problems: are they related?

Vision problems can interfere with the process of learning. However, vision problems are not the cause of learning disabilities. If a child or adolescent is diagnosed as having a learning disability, refraction and eye muscle function must be assessed. If no disorders are found or, if found and corrected, the treatment of choice for the learning disability is special education.

Frequency of adoption of children and adolescents with learning disabilities.

Students from three different facilities who were diagnosed as learning disabled were studied to determine the frequency of adoption with this population as compared to the national norm. The frequency of adoption was found to be 4.5 times higher than the norm, that is, 17.3% versus 3.9%. The possible reasons for this high incidence are discussed.

Psychological and family problems associated with learning disabilities: assessment and intervention.

Learning disabilities not only interfere with academic tasks; they interfere also with all stages of psychosocial development as well as with peer and family interactions. It is not uncommon, therefore, for children and adolescents with learning disabilities to have psychological, peer, and family problems. These secondary difficulties must be recognized, correctly diagnosed, and treated.

Controversial approaches to treating learning disabilities and attention deficit disorder.

It is estimated that between 3% and 7% of children and adolescents in this country--up to 4 million--are learning disabled. Of this group, about 20% also have attention deficit disorder. Many professionals in multiple disciplines have proposed treatment approaches. When research has been done to support the approach, the reports and data may be published in journals not normally read by the practicing physician. When research data are not available, the information may be in a popular book, newspapers, or lay magazines or on television. Thus, parents may know of ideas and suggestions before the professional in clinical practice. These acceptable and controversial approaches to treatment are reviewed. It is understandable that a parent would seek out improved ways of helping his or her child. I reviewed the significant literature in an effort to assist the practicing physician in providing appropriate parental guidance and clinical interventions.

Learning disabilities. The primary care role in multidisciplinary management.

Learning disability is not just a school disability; it is a total life disability. The same dysfunctions that interfere with normal learning processes also impact on self-image, peer relationships, family relationships, and social interactions. If attention deficit disorder is present, the same hyperactivity or distractibility that creates problems for the child in the classroom interferes with peer and family relationships. From initial request for help to final implementation of a model of intervention, a multidisciplinary team effort is needed. Since many areas of difficulty may be involved, this team ideally should consist of a primary care physician, psychiatrist, neurologist, psychologist, social worker, special educator, and speech pathologist. Each professional contributes to a full understanding of the total child. The primary care physician may participate as part of such a team or refer the child to other professionals and then coordinate the recommendations. When a learning disability is properly recognized, diagnosed, and treated, the child has the potential for a reasonably successful future. Without help, the child's disabilities may become incapacitating and function as a major handicap throughout life.

Attention deficit disorder in adolescents.

Attention deficit disorder may be part of a cluster of observable behaviors that reflect a dysfunctional central nervous system. The authors describe the differential diagnosis of attention deficit disorder in adolescents, a complex process in which the clinician must determine if observed distractibility, hyperactivity, or both are due to the disorder or are a reflection of anxiety, depression, or emotional, social, or family problems. In addition, the clinician must determine the relationship of these factors to the learning disabilities so often associated with attention deficit disorder. The authors discuss the clinical management of attention deficit disorder and review the literature on the clinical course and outcome of children and adolescents with the disorder.

The Cuban immigration of 1980: a special mental health challenge.

The 124,769 Cubans who entered the United States from Cuba in a boatlift in 1980 included a small minority of people who needed mental health care. Some had been taken involuntarily from psychiatric hospitals, mental retardation facilities, jails, and prisons. The National Institute of Mental Health, Public Health Service (PHS), was responsible for mental health screening, evaluation, and treatment of the Cuban Entrants. Bilingual psychiatrists and psychologists found that many Entrants given preliminary evaluations showed evidence of transient situational stress reactions, not psychiatric illnesses. Entrants who had not yet been sponsored were consolidated into one facility in October 1980, and about 100 of those with severe problems were transferred to an Immigration and Naturalization Service-PHS evaluation facility in Washington, DC. Between March 1, 1981, and March 1, 1982, a total of 3,035 Entrants were evaluated at both facilities. Among the 1,307 persons who presented symptoms, there was a primary diagnosis of personality disorders for 26 percent, schizophrenic disorders for 15 percent, adjustment disorders for 14.5 percent, mental retardation for 8.6 percent, chronic alcohol abuse for 8.6 percent, and major depression for 7.2 percent. Only 459 Cubans with symptoms were found to be in need of further psychiatric care. As of October 1984, many Entrants with psychiatric illnesses remained under inpatient or community-based halfway house psychiatric care as a direct Federal responsibility. A PHS program for further placement in community-based facilities is underway.

The 1990 objectives for the nation for control of stress and violent behavior: progress report.

The control of stress and violent behavior is 1 of the 15 priority areas addressed in the Public Health Service's Objectives for the Nation. The National Institute of Mental Health, which provides a national focus for the Federal effort to increase knowledge of, and promote effective strategies dealing with, issues associated with mental illness and mental health, has been designated the lead Federal agency in this priority area. The authors summarize progress achieved and further activities planned with respect to 10 objectives for control of stress and violent behavior that have been selected for Federal implementation. The objectives for control of stress include improved public and professional awareness of community agencies that can provide professional services, hotlines, and mutual support groups. The objectives for control of violent behavior address three major problems: deaths from homicide among young black males, suicide among the young, and child abuse. Achievement of several of the objectives is currently impeded by lack of a valid data base. Efforts have been initiated, both by individual agencies and through collaboration among the various participating Public Health Service components, to develop valid and reliable baseline data and surveillance procedures.