attention deficit hyperactivity disorder (ADHD)
A behavior disorder, often arising in early child-
hood, of marked difficulty or inability to concen-
trate and in particular to sit still. Though in some
children symptoms are apparent early in child-
hood, starting school provides the first insight into
ADHD for many children. Key symptoms include
- uncontrolled impulsive behavior
- difficulty listening to others
- poor attention to details
- inability to sit or stand without movement
(fidgeting) - excessive and impulsive talking
The diagnostic path includes comprehensive
medical examination and NEUROLOGIC EXAMINATION
to rule out physical causes for symptoms. Treat-
ment is often stimulant medications such as
methylphenidate, dextroamphetamine, or pemo-
line, which have the opposite effect of producing
calm in children who have ADHD. ANTIDEPRESSANT
MEDICATIONSare sometimes more effective for ado-
lescents. Often parents find it beneficial to attend
classes or workshops that teach methods for posi-
tive reinforcement to encourage more appropriate
behaviors. ADHD may persist into adulthood,
though many children outgrow most if not all of
the symptoms by late ADOLESCENCE.
See also CONDUCT DISORDER; OPPOSITIONAL DEFIANT
DISORDER; STIMULANTS.
autism A collective term for a spectrum of devel-
opmental disorders, also called autism spectrum
disorder or pervasive developmental disorders
(PDDs). Symptoms begin in early childhood, typi-
cally between the ages of 18 months and 3 years,
though when parents look back on the child’s
infancy they can often detect earlier indications of
problems. Autism ranges from mild to incapacitat-
ing in severity. Though most children experience
abnormal developmental progress from birth,
some appear to develop normally and then seem
to suddenly disengage from social interaction.
Autism is a lifelong condition that, in all but its
mildest form, requires ongoing attention and
treatment.
Symptoms and Diagnostic Path
The symptoms of autism become more clear as the
child passes developmental markers without
demonstrating the appropriate level of ability. The
first pivotal marker is around age one year, by
which time a child should be babbling and freely
interacting with other people and his or her envi-
ronment. The child who has autism, by contrast,
often appears socially withdrawn and may stare at
a particular toy or object for hours yet not play
with it. Other characteristic indications of autism
include a child who does not- smile or make eye contact with other people
- respond to his or her name
- like to be hugged or touched
- attempt to speak or communicate with others
- understand communication efforts from others
- display attachment to or affection toward his or
her parents
Many children who have autism engage in rep-
etitious actions that are potentially harmful to
themselves, such as banging their heads. The com-
munication difficulties affect both expression and
understanding; many children who have autism
lack the ability to perceive emotions or to predict
how others will respond. They may also fulfill
their needs by simply taking what they want,
which, until diagnosis, parents and other care-
givers may interpret as rudeness or inconsidera-
tion. In reality it is neither; it is the only
mechanism of communication available to the
child at the time.
The diagnostic path includes comprehensive
physical examination and NEUROLOGIC EXAMINATION,
age-appropriate psychologic evaluations (includ-
ing those specific for autism), and sometimes
GENETIC TESTING(autism is strongly associated with
FRAGILE X SYNDROME). Diagnosis is a process of rul-
ing out other conditions and confirming the
symptoms of developmental delay.Treatment Options and Outlook
Treatment is most successful when it begins by age
two and consists primarily of extensive therapy to
provide simple, clear, and consistent structure for364 Psychiatric Disorders and Psychologic Conditions