This article comes from a question from a reader, who asks: “I wanted to ask you, what causes ADHD (Attention Deficit Hyperactivity Disorder)? There is so little information about the causes of ADHD it seems the medical world is at a loss for words. Also if we new what caused it we might be able to cure it rather than treat it.”

(N.B. For this article, and throughout this blog, I use the term ADHD for both ADD and ADHD.)

We will approach this question in two ways:
1) What causes ADHD - in other words - what leads a person to get ADHD in the first place?
2) What causes ADHD symptoms - in other words - when one has ADHD, what leads them to have symptoms of not being able to pay attention, and being hyperactive/impulsive?

Part 1: What causes ADD or ADHD?

The first place to start with the cause of ADD or ADHD is genetics. ADHD is a very genetic disorder.

There is term called ‘heritability’, which refers to how genetic a disorder is. As an example - breast cancer is 30% heritable - meaning that about 30% of the possible causes of breast cancer can be attributed to genetics. Asthma is 40% heritable. Height is 80 to 85 percent heritable. ADHD is about 80 percent heritable.

That means that ADHD is highly genetic. This research comes from twin studies and other family studies, and shows that ADHD is almost as genetic as height.

Now if genes cause 80 percent that means there is about 20 percent that is not caused by genetics. What are the other causes? When it comes to the non-genetic causes of ADHD, we can call these ‘acquired’ cases. When we look at acquired cases, we can separate these into: Prenatal (i.e. causes that affect the person before birth), and Postnatal (i.e. causes that affect the person after birth).

The Prenatal Causes of ADHD:

These are the acquired causes of ADHD that occur during the pregnancy.

• Mother smoking during pregnancy: if the mother smokes cigarettes during pregnancy this increases the risk by 2.5 times (so the child is 2.5 times more likely to develop ADHD than if the mother didn’t smoke during pregnancy)
• Mother drinking alcohol during pregnancy: With alcohol during pregnancy, there is the same increased risk - 2.5 times.
• Prematurity: If there is prematurity at birth, there is a general increased risk for ADHD, however if there is bleeding in the baby’s brain there is a 45 percent chance that that individual will have ADHD.
• Increase in pregnancy complications: If there is an overall increase in pregnancy complications there is a non specific increased risk for ADHD.

Interestingly cocaine or crack exposure is not a risk factor for ADHD once you account for smoking cigarettes and drinking alcohol. Generally speaking a pregnant mother who is using cocaine will also tend to use cigarettes and alcohol.

The Postnatal Causes of ADHD:

These are acquired causes of ADHD that occur after the pregnancy (i.e. after the child is born).

• Head injuries/head Trauma: ADHD can develop after a significant head injury - by significant I mean one that results in loss of consciousness, or a serious concussion
• Brain Hypoxia which means not enough oxygen getting to the brain for a period of time. An example of this could be a near drowning or some other situation like that.
• Brain tumours
• Brain infection.
• Lead poisoning in the preschool years (i.e. before 3 years old)
• Survival from acute lymphoblastic leukemia (ALL) - because the chemotherapy itself can lead to brain changes.

Part 2: What Causes ADHD Symptoms?

The first place to start when talking about what causes ADHD symptoms is the fact that ADHD is a brain disorder. All of the research going into ADHD shows clearly that differences in the ADHD brain are what account for the symptoms.

This means that we can throw out the causes of ADHD which are ’social’. In other words, all of the descriptions of ADHD coming from: video games, TV, MTV, single parents families, stressed school systems, etc. are all wrong! There is no credibility to these explanations.

Brain research in ADHD is continually improving and progressing. Brain imaging shows that the main area of the brain involved in ADHD symptoms in the prefrontal cortex. This is in the frontal lobe - the part of the brain just behind the forehead. The frontal lobe is the command center of the brain. This is the part that does the planning that we need to do. The frontal lobe tells you to pay attention to this and disregard that because it’s a distraction that’s not important. It tells you to plan, it tells you how to adapt your plan when something comes up that’s difficult. It tells you to inhibit your response - so you don’t swear at someone, even if you’re angry, if it would get you into serious hot water.

So the prefrontal cortex, the part of the brain in the frontal lobe just behind the forehead, is the part that’s involved in ADHD.

Brain imaging studies that look at the brain chemicals - called neurotransmitters - show that there is a decrease in the brain chemical dopamine in that area. Another brain chemical impacted in ADHD is norepinephrine (or noradrenaline). Now when a person with ADHD takes an ADHD medicine, it increases the dopamine and/or noradrenaline. This improves the concentration, hyperactivity and impulisivity. If you examined that person under a PET scan - you would see that there is an increase in these brain chemicals in the area that is impacted

Parenting and ADHD:

While we are talking about the causes of ADHD, I need to take a moment and address this important issue: parenting and ADHD. It is very common in society at large to blame parents for their children’s ADHD and/or misbehavior associated with ADHD.

Bad parenting does not cause ADHD. This has been conclusively proven. I’ll repeat it: Bad parenting doesn’t cause ADHD.

If anything, having an ADHD child is very stressful, presents unique challenges, and creates low parenting satisfaction. Why? Because of the ADHD.

As a child psychiatrist and a parent myself - my experience is that most people have kids, and despite the fact that they are not experts in parenting, they try hard (and maybe learn about parenting through reading or classes) and their child turns out fine. You can call this ‘natural intuitive parenting’. Parents then pat themselves on the back and say ‘I’m a great parent’.

In contrast, the parent who has a child with ADHD can do the exact same things but they just don’t work. Instead of them being able to pat themselves on the back, everybody is trying to tell them how to parent their child because their child just doesn’t seem to listen. This leads to a lot of parenting frustration, and it makes it harder for the parents.

Research has shown that when parents use specific strategies designed to help with ADHD, this can improve their effectiveness as parents, and we will cover this more in a future article.

In this article, we have covered the causes of ADHD - i.e. what leads to a person having ADHD. This is mainly genetics, but some acquired causes as well. We have also talked about what causes ADHD symptoms - i.e. the brain! To finish the article, I covered the issue of parenting and ADHD - and how bad parenting is not a cause of ADHD.

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Or can ADHD be used as an excuse for bad behavior?

This is an edited transcript of my ADHD Audio Newsletter #4. To sign up for the newsletter, visit here: The ADHD Doctor.

Hi - it’s Dr. Kenny Handelman here with the next ADHD Audio Newsletter. The question this time is:
“How does one differentiate between true ADHD and behavior problems?”

In this edition of the newsletter, we will address this question, and put this issue to rest once and for all.

There are two ways to address this question:

1) Before the diagnosis of ADHD is made: The question could be reworded,
“How do you know if it is just a behavior problem and not ADHD?”

2) After the diagnosis of ADHD is made: The question could be reworded,
“Was that misbehavior due to ADHD of was it just bad behavior?”

Before addressing this question, we need to realize that all people have ‘behaviors’. We all use our behavior to function in this world. Sometimes our behavior moves us toward our goals (and is therefore adaptive, or appropriate behavior), and sometimes our behavior is a problem and interferes with our functioning (and is therefore maladaptive, or problematic behavior).

Now, let’s review this in the context of ADHD:

Behavior before the diagnosis of ADHD:

There are certain behaviors which are part of the actual diagnosis of ADHD.

For example, running and climbing excessively is one of the diagnostic criteria for ADHD, and this information is used to help to diagnose ADHD.

Some people may wonder - ‘maybe that child is just misbehaving, and it is not really ADHD’.

In the post which reviewed the diagnosis of ADHD, I explained that one has to have six of the nine criteria to make a diagnosis, plus many other criteria. In other words, a little misbehavior does not lead to the diagnosis. Please review the previous article for the full explanation.

Behavior after the diagnosis of ADHD:

I think a really important issue here is once a person has the diagnosis of ADHD, if they misbehave - is it because of the ADHD, or is it just ‘plain old bad behavior’?

This question leads to a real concern for many people - and that is: “If I explain the misbehavior because of ADHD, it will be making it into an excuse.”

We are going to put this issue to rest right here.

The answer is: “it’s both”.

That’s right - it is both ADHD and behavior - and I want you to consider that in every situation.

Let’s take an example: People with ADHD have trouble ’shifting sets’, so stopping one task and moving on to a second one can be a challenge.

Imagine there is an eight year old boy who is involved in playing and his mom says: “it’s time to stop playing and come to supper”. The boy has trouble stopping his play and coming to the meal. Hopefully the parents will use techniques like warnings - such as 10 minute warning, 7 minute warning, five minute etc. These ‘warnings’ allow the boy to gradually get ready to stop playing and have a chance to prepare himself.

Let’s say the boy doesn’t come to the meal, the parent gets frustrated, and the child has a ‘freak out’ (or a ‘behavioral issue’).

So here is the ultimate question: Is the bad behavior because of ADHD or just bad behavior?

When a child is misbehaving, a parent often asks: “Why didn’t you come when I called?”

I have yet to meet a child who says: “Well mom, I’ve got this deficit of dopamine in my prefrontal cortex and it’s very hard for me to use my executive function of shifting sets and disengage from this activity because of the ADHD that I have…”

Usually a child says: “… because I didn’t want to”.

That sounds very behavioral, doesn’t it?

But the reality is there is a significant component of ADHD in there. In other words, it is both ADHD and misbehavior.

Now let’s look at it from another angle.

Let’s say somebody has ADHD and they work hard to control it. They have supports, they have strategies, etc. They manage and function very well.

But they are having a bad day… And they are grumpy, not completing tasks, and displaying ‘behavior’.

Now when that sort of behavior is going on is there ADHD in there as well?

Of course there is. This situation may be more related to behavior than to ADHD, but one cannot ignore the ADHD, because it is still there.

So the short answer is whenever there is a question ‘is this behaviour? Or is this ADHD? The answer is it’s both.

Can ADHD be used as an excuse for bad behavior?

I don’t want people with ADHD to use it as an excuse, and it is my experience that if they do, it is very negative for them in many ways.

Rather, they can use it as an explanation.

What’s the difference between an excuse and an explanation?

Excuse: after negative behavior - a parent, or the individual with ADHD, says that it was beyond their control because of the ADHD, and people should just accept that.

Result of an excuse: no lessons learned, no responsibility taken for control of the behavior, because it was from the ADHD.

Explanation: after a negative behavior - a parent, or the individual with ADHD, reviews the situation for problems which occurred and opportunities to learn and adapt. The fact that ADHD is there is used as part of the explanation for the behaviour - and also helps to create the ’search for solutions’ - to learn from the situation and create plans for the next time that situation is encountered. The person with ADHD is still assumed to have responsibility for their behavior - but they are seen to need new skills to manage that type of situation.

Result of an explanation: lessons are learned, and responsibility is assumed for the behavior. The individual is better prepared to deal with that type of situation again in the future, and learning occurs.

In summary, misbehavior in ADHD is a combination of behavior, and the diagnosis itself.
It is important to use ADHD as part of an explanation of the behavior, and not as an excuse.

This will contribute to better learning for the individual with ADHD, and also better education to all of the other people around who will be learning about ADHD from this interaction.

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Hi - it’s Dr. Kenny Handelman here with the next edition of your ADHD Audio Newsletter (This is a transcription, please visit The ADHD Doctor to subscribe to the actual newsletter).

Last week we talked about the diagnostic criteria of ADHD coming from the question, “How do you know if you have ADHD?”

This week we’re going to pick up and talk about the assessment of ADHD because I think that this question requires more than one week.

To get the diagnosis you have to see a professional who is experienced in assessing and diagnosing Attention Deficit Hyperactivity Disorder.

First and foremost I want everyone to know there is no test for ADHD.

Brain Scans:

There is no blood test, there is no X-ray, no CT scan, no MRI, no PET scan, SPECT scan or anything.

Let’s go through brain imaging scans for ADHD. There have been research studies that have shown with brain imaging studies like MRI or PET scanning that there are brain differences in ADHD individuals. Now these are important research findings because we know that ADHD is a brain disorder, and these studies confirm that. Even though there are brain differences, having any one individual go for a brain scan would not necessarily show the findings. The reason is that when research studies are done, they show a population effect. In other words if you take 100 children or individuals with ADHD and compare them to 100 age matched controls you would see differences but any one individual may not show that difference. The way I view it is - it is not worth the exposure to radiation for the test unless you want to be part of a research trial.

Psychological Testing and Neuropsycholgical Testing

Psychological testing, or a psychoeducational assessment can be very helpful to look at learning strengths and weaknesses and intelligence. However, it does not diagnose ADHD. It may diagnose a learning disability or developmental delay.

There are some neuropsychological tests that look at aspects of neuropsychological functioning that may be impacted by ADHD, however they do not diagnose ADHD either. A full battery of these tests with a clinical interview may be helpful however there is a high false negative rate; at least 30% if not 50%. Now what is a false negative rate? This means that the result comes out false when it shouldn’t. In other words somebody has ADHD, they go through this testing and this testing shows that they don’t have ADHD. Now if you need a diagnosis of ADHD and you pay a lot of money to get a neuropsychological assessment and it says that there isn’t ADHD, when it is later diagnosed, that may be quite frustrating to you.

Neuropsychological testing may give you very important information which helps to understand what’s going on with the thinking and cognitive processes for the individual but it will not diagnose ADHD.

If there are no tests, how is ADHD actually diagnosed?

Well, we do it the old fashioned way. We ask questions.

ADHD is a clinical diagnosis, meaning it is made based on the clinical assessment (i.e. interview) and all of the information gathered. We do a thorough clinical interview and review all of the symptoms. It’s important to get reports from multiple sources. You’ll remember from last week that we wanted to have symptoms in multiple settings (at least two) - home and school in a child or teen, work in a teen/adult.

How do we get information from the other settings? It may be with an interview in person, a telephone interview, or at the most basic for a busy clinician is checklists from the school and parents for a child, or a spouse/partner for an adult. School report cards can be very helpful - and I generally ask all parents to bring in copies of old report cards, to see if there is a longstanding history. This is also helpful when assessing adults with ADHD. When reviewing report cards, I am looking mainly for comments, not necessarily marks. Report cards in kids with ADHD often say things like: ‘needs to put more effort into completing tasks next term’, or ‘needs to follow through next term’, or ‘although Michael has great social skills, he needs to talk less during class time’, etc. Observation of the individual in their natural environment is very helpful. It is often hard for a doctor to go to school or workplace to observe the behaviour as it is occurring, however this can be very useful information. Sometimes if a behavioural consultant is involved, he/she can do the observation.

The Mental Status Examination:

The mental status examination is an important part of the psychiatric assessment. It is the equivalent of the physical examination in other areas of medicine. The mental status examination is where the psychiatrist (or other clinician) reviews the mental state of the individual insofar as their behaviour, their eye contact, the way they speak, any motor movements noted (i.e. tics), their mood, how they describe their mood, how they interact with the individual, whether there are any thoughts of self harm (i.e. suicidal thoughts) or thoughts or harm to others, whether the individual has good insight into what is going on, whether they appear to have good judgment etc. So, instead of putting a stethoscope to the chest, the psychiatrist (or the psychologist, social worker, etc.) uses the mental status examination to assess the mental functioning. This is another important part of the assessment for ADHD.

After gathering all of the information it’s a matter of reviewing whether the individual meets the criteria of the DSM-IV TR for ADHD.

Next, one assesses for impairment. This means that the symptoms actually interfere with the individual’s functioning and changes their academic, social, and emotional development.

Criticisms of the Diagnosis of ADHD:

Now before we conclude on the issue of diagnosis of ADHD, some people criticize the process and say that it’s not as real as for many other medical conditions. For example if somebody has pneumonia they get an X-ray and it shows the pneumonia. Somebody has a broken bone you get an X-ray and see it. However, for ADHD, you can’t order tests, and so you ‘just talk about it’.

Critics of ADHD suggest that if you’re just talking about it, it must not be a real disorder, and the diagnosis must be ‘wishy-washy’.

The truth is that ADHD is a real disorder, with excellent research to back it up.

Let’s review the diagnostic process in all of medicine. Diagnosis in all areas of medicine boils down to one thing: pattern recognition.

The doctor is looking for a pattern of symptoms that fit together. When these symptoms fit together into a ‘diagnosis’, that is relevant because diagnoses help us to understand the current and future problems, which treatments may help, and what the prognosis may be.

Let’s talk about the diagnosis of pneumonia. Pneumonia isn’t just diagnosed with an X-ray. In fact pneumonia is diagnosed by thorough clinical interview and physical examination. This includes a history of how long the cough has been there, whether there was any fever, chills, sweats at night, etc. Was there colour to the sputum or the phlegm? Now the clinician listens to all this, assesses the patient, listens to their lungs, takes their temperature, their blood pressure etc., and then orders an X-ray. Now you would think this is very straightforward and there is tons of research on which antibiotics work for different pneumonias and how to treat it etc. etc.

Although the diagnosis of pneumonia seems very straight forward, I was amazed in my medical training when I stood in front of Chest X-rays with medical specialists trying to figure out if they truly confirmed the diagnosis. Sometimes the X-rays are very clear, and sometimes they just aren’t. In the end, the decision to treat with antibiotics was made in many cases based on the ‘old fashioned stuff’ - the history and physical examination.

Diagnosing a broken bone should be the most straightforward - you look at the X-rays. Is it broken or not broken? But what about some of the hairline fractures? It can get tricky. The point is that it ultimately comes down to history and physical examination and the clinician’s experience and understanding of the case.

To summarize, ADHD is a diagnosis which is made based on a clinical interview, and the other information gathered. There are no tests for it, however, with a well trained doctor, it is a very reliable diagnosis.

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Hi - it’s Dr. Kenny Handelman here with the next edition of your ADHD Audio Newsletter.
This is one of our members’ questions “How do you know if you have it”? This is an excellent question and a great place to begin.

Essentially to get the diagnosis of ADHD you really need to see a professional who has expertise in assessing and diagnosing ADHD. It may be helpful to listen to (or read) educational products like this or go to web sites or get other information but to really get the diagnosis you’re going to have to see a professional and have a thorough assessment.

But let’s help you to understand the diagnosis of ADHD and how it is done by the professional. We’ll start with the diagnostic criteria. In North America we use the DSM-IV TR. This is a publication by the American Psychiatric Association that stands for the Diagnostic and Statistic Manual Fourth Edition Text Revision. This is a manual which summarizes psychiatric research and knowledge, into the diagnostic criteria for all psychiatric conditions.

The DSM first editions came out many years ago and over time it’s gradually revised. In 1994 the DSM-IV came out and in 2004 they did a text revision which basically added more evidence based information to the diagnoses and the diagnostic criteria, though most criteria were not changed.

The American Psychiatric Association publishes that the purpose of the DSM-IV is to provide clear descriptions of the diagnostic categories in order to enable clinicians and investigators to diagnose, communicate about, study and treat people with various mental disorders.

There are other diagnostic classification systems. The World Health Organization has developed the ICD, which is the International Classification of Diseases. The ICD is on version 10. They have different diagnoses, and the equivalent diagnosis for ADHD in the ICD is hyperkinetic disorder (HKD). HKD refers to a more limited view of ADHD symptoms than the DSM diagnosis.

Now let’s go through the diagnostic criteria for ADHD. There are two main categories for the diagnosis: Inattention and Hyperactivity/Impulsivity.

For the inattentive criteria: there are nine symptoms (criteria) for inattention. To meet the diagnosis an individual has to have six or more of these symptoms. The symptoms have to be present for at least six months to a degree that is maladaptive and inconsistent with their developmental level.

Here are the DSM-IV criteria are for Inattention:

1. fails to give close attention to details and makes careless mistakes in school, work or other activities
2. often has difficulties sustaining attention in tasks or play activities
3. often does not seem to listen when spoken to directly
4. often does not follow through on instructions and fails to finish school work, chores or other duties in the work place (and this is not due to oppositional behaviour or failure to understand instructions)
5. often has difficulty organizing tasks and activities
6. often avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort like schoolwork or homework
7. often loses things necessary for tasks or activities like toys, school assignments, pencils, books or tools
8. is often easily distracted by extraneous stimuli
9. is often forgetful in daily activities

Now of course if you went into any grade two class and asked how many kids have any of these symptoms there would be a large number who had one symptom, a large number who had two, some who had three etc. but when your getting to six of nine it’s getting to the relevant range insofar as a disorder.

The next major group are nine criteria for hyperactivity impulsivity. Similarly, one needs to have six or more present for six months to a degree that is maladaptive and inconsistent with a developmental level.

Here are the DSM-IV criteria for Hyperactivity/Impulsivity:

1. often fidgets with hand or with feet or squirms in ones seat
2. often leaves seat in classroom or in other situations which remaining seated is expected i.e. church or family meals etc.
3. often runs about or climbs excessively in situations in which it is inappropriate. In adolescents or adults may be limited to subjective feelings of restlessness, so they may not be so overtly hyperactive.
4. often has difficulty playing or engaging in leisure activities quietly
5. is often on the go or acts as if driven by a motor
6. often talks excessively
7. often blurts out answers before questions have been completed
8. often has difficulty awaiting one’s turn
9. often interrupts or intrudes on others - like butting into conversations or games

So those are the core criteria for inattention and hyperactivity impulsivity. Now there are further criteria. The DSM further states that there have to be some symptoms that caused impairment before the age of seven years old. This is to help eliminate the concern that at the age of 27 because of other factors an individual finds they’re having trouble with concentration and that may be related to depression or anxiety or something else and not ADHD.

Other criteria include some impairment from the symptoms as present in two or more settings. It is important to see symptoms present in home and school, for example. Because if the symptoms are only present in one setting - then there is a problem with that one setting, and not necessarily a diagnosis of ADHD.

There must be clear evidence of clinically significant impairment in social, academic or occupational functioning. Now this is very important. Impairment makes this a disorder. If there is no impairment there is no disorder. If you have six of nine criteria and no impairment then you don’t have ADHD. In other words it is a problem, it is a disorder because it interferes and impairs with the functioning. The normal developmental tasks for the individual are not working properly.

The last criterion in the diagnosis of ADHD is that the symptoms do not occur during the course of another disorder such as schizophrenia, psychotic disorder, PDD or autism, mood disorder etc.

There are three possible diagnoses with ADHD. They include:

• ADHD Combined Type
• ADHD Predominantly Inattentive Type
• ADHD Predominantly Hyperactive Impulsive Type

ADHD Predominantly Inattentive Type: This diagnosis used to be called ‘ADD’, or attention deficit disorder (i.e. without hyperactivity). This term is no longer officially used, though you can find it in many settings. This diagnosis includes people who have trouble paying attention, but do not have hyperactivity, or impulsivity.

ADHD Predominantly Hyperactive Impulsive Type: This diagnosis refers to individuals who are quite hyperactive, fidgety, restless, and impulsive. However, they do not have significant trouble paying attention. This subgroup is the least commonly seen of the diagnoses of ADHD, and researchers suggest that by adolescence or adult life, most people with this diagnosis end up with the combined type.

ADHD Combined Type: This diagnosis refers to those individuals who have significant inattention as well as hyperactivity and impulsivity.

What are some of the criticisms of the DSM-IV ADHD Diagnostic Criteria?

1) Field trials were done on children with ADHD to help to establish the criteria and the cut off levels. However, the field trials were predominantly done in boys aged six to 12 years old. This means that these diagnostic criteria are not great for diagnosing girls with ADHD, as well as adults with ADHD. Expert clinicians will have to adjust the criteria to suit girls and adults.

2) This is the only disorder in the DSM that has an onset age where you have to have symptoms before the age of seven. When reviewing this with experts in the field I’ve learned that the scientists are challenging this. Now if somebody shows up at the age of 30 and never had trouble with inattention previously they wouldn’t get the diagnosis of ADHD. There would have to be something else going on. The reason for this criterion is that ADHD is a developmental disorder - i.e. it starts in childhood. However, the age of 7 is somewhat arbitrary, and it may be changed in the future editions of the DSM to ‘pre-puberty’.

So we started off with a question: How do you know if you have ADHD?

In summary, it is a clinical assessment - which means that you meet a professional with expertise in the field and you answer questions. There are no lab tests, xrays or brain scans which can diagnose ADHD.

This article served to review the DSM criteria and I will cover more of the diagnostic issues in our next newsletter.

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Hi - this is Dr. Kenny Handelman. I am very excited to share with you the first edition of the ADHD Audio Newsletter. The first topic is “Looking Back, the History of ADHD”.

ADHD was first described in 1902 by Dr. Still. He recognized significant behavioral difficulties in a number of children in his practice. He realized that these behaviors were not related to brain damage or poor parenting. This is not a belief which was held for many years after that. In 1918 and 1919 there was a flu pandemic which led to many people developing brain damage related to it. These people had neurological difficulties and there were some people who also had concentration difficulties. This led to the recognition or calling of people who had inattention as having ‘minimal brain damage’. This was a common term in the 1930’s for what later became known as ADHD.

In the late 1950’s and early 1960’s it was thought that there was not actually brain damage in these individuals who have trouble with concentration but rather ‘minimal brain dysfunction’ (or ‘MBD’) so this term was used.

In the late 1960’s hyperactivity was thought to be the main issue in ADHD children, and the name ‘Hyperkinetic Reaction of Childhood’ came out in 1968. Research of course carried on and it was a Canadian researcher named Virginia Douglas who came up with a concept that attention was the main issue and that ‘attention deficit’ was the core concept.

In 1980 the DSM-III which is the Diagnostic and Statistical Manual, 3rd edition, of the American Psychiatric Association came out with a term ‘Attention Deficit Disorder with or without Hyperactivity’. So it was ‘ADD +/- H’ for the hyperactivity.

In 1987 there was the term ‘Attention Deficit Hyperactivity Disorder’ which came out or ‘ADHD’.

In 1994, the newest edition of the DSM came out - being version 4 (DSM-IV). The terminology for ADD or ADHD became: ADHD inattentive type, ADHD hyperactive impulsive type, or ADHD combined type (for those with both the inattentive and hyperactive impulsive subtypes).

As of 1994, the term ‘ADD’ is no longer an official diagnosis. That said, it is still used quite commonly.

Now I want to be clear about this on the first newsletter because some people in my office practice get upset when I say “ADHD” because they say that they have ADD or their child has ADD. In this situation, I always acknowledge them and say, “I understand that, just please don’t be upset if I say ADHD because my training is that that is the current terminology.” And then I say something like ‘tomato (US accent) vs. tomato (British accent)’.

So even if you have ADD or your child has ADD please stick with me when I’m saying ADHD, we’re talking about the same thing. I would just call it ‘ADHD inattentive type’.

Now we will spend a lot of time talking about treatments in future editions of the newsletter, but I just wanted to let you know about some of the history in this first newsletter. In 1937 Dr. Bradley first used a stimulant medicine. The medicine was shown to help the hyperactive children that it was tested on.

In 1957 methylphenidate or Ritalin was introduced and this became the start of using medications regularly to treat ADHD. Of course over time there have been newer medications developed and changes in the preparations available such as longer acting formulations etc. The newest addition to the ADHD armamentarium is the introduction of Atomoxetine (Strattera) which is a non stimulant for ADHD that came out in the U.S. in 2003 and has come out in eight or nine other countries to date.

Well, there is quick overview of some of the history of ADHD. I will be in touch next week with the next edition of the ADHD audio newsletter.

Thank you very much for joining me.

Thanks very much.

Dr. Kenny Handelman

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In May 2005, I began to use the power of the internet to share information with people about ADHD. I had people submit questions on my website, and then I would choose a ‘frequently asked question’, and answer it with an audio recording. I would then email out the answer to my subscribers.

Some people emailed me and said: “Thank you for the great information, but I learn better with written information. Can I get the transcripts of the audio newsletter?”

I answered: “Yes, when I get the time”.

Well, it has taken a long time - and I have started to use a very useful technique to get this done, called: Outsourcing! This is a great technique for ADHD Adults as well - i.e. getting someone else to do the work for you, so that you can get more done. So, now that I have my team together for transcribing, and my team for the blog, I will be getting this content out to you. I may even post the audios here for people. Hmm… there are lots of possibilities.

(as an aside - one of the possibilities is that I may podcast these audio newsletters - I am just learning how to do that - so watch for it soon)

So, I will gradually update this category on my blog so that my subscribers can get access to the transcriptions of the newsletter - and of course you can email the links of any page to your friends or family who may benefit from reading this information.

Enjoy, and please remember to post comments on anything that you find interesting, controversial, educational, offensive, or just leave a comment for any reason at all.

Enjoy!

Dr. Kenny Handelman

p.s. when I speak about outsourcing for adults with ADHD - the most common exchange is money - i.e. I get someone to do my typing, and I pay them.

However, if you are in a position where you need to outsource something but don’t have the money for it - just get creative! Let’s say you hate doing your taxes or bookkeeping - you may be able to find someone who loves to do that. In exchange, you may be able to do something for them that you love doing, and they dislike - maybe helping with a spring cleaning, walking their dog, or gardening.

Be creative so that you can leverage others to help you to get done what you need to get done.

One of my mentors said: “Get people who like to play at what you work at”. For many of us, doing accounting is a lot of work. But for some, it is play. That’s why we get bookkeepers and accountants.

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