ADHD-Guide.Pdf

i ADHD: A GUIDE TO UNDERSTANDING SYMPTOMS, CAUSES, DIAGNOSIS, TREATMENT, AND CHANGES OVER TIME IN CHILDREN, ADOLESCENTS, AND ADULTS ii iii FIFTH✦ EDITION ADHD A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults PAUL H. WENDER, MD AND DAVID A. TOMB, MD 1 iv 1 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America. © Paul H. Wender and David A. Tomb 2017 First Edition published in 1973 Second Edition published in 1978 Tird Edition published in 1986 Fourth Edition published in 2000 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging- in- Publication Data Names: Wender, Paul H., 1934– author. | Tomb, David A., author. Title: ADHD : A Guide to Understanding Symptoms, Causes, Diagnosis, Treatment, and Changes Over Time in Children, Adolescents, and Adults/ Paul H. Wender, MD, and David A. Tomb, MD. Other titles: Attention-defcit hyperactivity disorder in children, adolescents and adults Description: Fifh edition. | Oxford ; New York : Oxford University Press, [2017] Identifers: LCCN 2016012844 (print) | LCCN 2016014571 (ebook) | ISBN 9780190240264 (paperback) | ISBN 9780190637675 (hardcover) | ISBN 9780190240271 (UPDF) | ISBN 9780190240288 (EPUB) Subjects: LCSH: Attention-defcit hyperactivity disorder. | Attention-defcit-disordered children. | Attention-defcit disorder in adolescence. | Attention-defcit-disordered adults. | BISAC: PSYCHOLOGY / Clinical Psychology. | MEDICAL / Psychiatry / Child & Adolescent. Classifcation: LCC RJ506.H9 W448 2017 (print) | LCC RJ506.H9 (ebook) | DDC 618.92/8589—dc23 LC record available at http://lccn.loc.gov/2016012844 9 8 7 6 5 4 3 2 1 Paperback printed by R.R. Donnelley, United States of America Hardback printed by Bridgeport National Bindery, Inc., United States of America v CONTENTS Preface vii 1. Introduction 1 2. Te Characteristics of Children with Attention- Defcit Hyperactivity Disorder 9 3. Te Causes of Attention- Defcit Hyperactivity Disorder 39 4. Te Development of the Child with Attention- Defcit Hyperactivity Disorder 61 5. Treatment of the Child with Attention- Defcit Hyperactivity Disorder 73 6. Attention- Defcit Hyperactivity Disorder in Adults 159 7. Finding Help 251 Appendix: Diagnostic Criteria: Diagnosis of Attention- Defcit Hyperactivity Disorder and Related Disorders in Childhood and Adulthood 265 Index 285 vi vii PREFACE To avoid possible confusion in terminology, let us explain what this book is about. Attention- defcit hyperactivity disorder (ADHD) has had several names in the past. Among the earlier names were “minimal brain dysfunction,” “hyperactivity,” and attention- defcit disorder (ADD). Te latest and what we hope is the fnal name is attention- defcit hyperactivity disorder (ADHD). In 1973, the senior author published the frst version of this book, Te Hyperactive Child. During several years of treating “hyperactive” children, he had discovered that the parents of such children needed information about the nature, causes, and treatment of “hyperactivity,” and that no book was available with such information in a form suit- able for the concerned layperson. Te Hyperactive Child was written in response to this need, drawing on clinical and research experience as previously summarized in a book for physicians and other professionals working with children (P. H. Wender, Minimal Brain Dysfunction in Children, New York: Wiley, 1971). viii viii | PREFACE In 1978, the second version of the book was published that contained new information about the medical and psy- chological management of “hyperactivity.” It also included a discussion of the learning disabilities that frequently— but not always— accompany hyperactivity. In 1986, the third version was published. It was written for two reasons: frst, as a continuing update and, second, to acquaint readers with “hyperactivity” in adults. It was based on information accumulated in our research on “hyperactivity” in adults that we had initiated in 1975. We believed that an understanding of the condition was as essential for ADHD adults as it was for the parents of ADHD children. Te third edition presented what we had learned about the symptoms, the diagnosis, and the treatment of ADHD in adults. Te fourth edition in 2000 presented an update of our knowledge of ADHD in children, but it also presented a much greater expansion of what we had learned about ADHD in adults across ffeen years of research. It examined what we had discovered about the symptoms and the char- acteristic problems that ADHD adults experience socially, vocationally, and interpersonally and provided two rat- ing scales we had developed for adults. Tese scales helped determine if the adult had ADHD as a child and they also included the symptoms we used to determine whether he or she had continuing symptoms of ADHD. Te book also contained an update of our knowledge of drug and psychologi- cal treatments. Finally, we included some case histories of ADHD children and ADHD adults so that the reader could get a more intimate feeling for the lives and experiences of the patients we treat. ix PREFACE | ix Te current edition of this book follows ffeen years of exciting progress in the study of ADHD during which time this condition has become widely recognized as common among both children and adults. Tis is an update of what has been learned over those years about what causes ADHD, how it is recognized, what happens to it as people age, and how best to treat it. In addition, Dr. Wender has added a second author to the book, David A. Tomb, MD, who has been a colleague of his for over thirty years and who also has extensive experience with ADHD. Tis book is dedicated to the ADHD children and their families who have taught us so much about the disorder. It is dedicated also to those ADHD adults who have educated us about their problems and have willingly participated in scientifc experiments over the past forty years, experiments that have taught all of us more about ADHD in adults. We continue to believe that better understanding will lead to better treatment of ADHD and learning disabilities, frequently misunderstood disorders of childhood, adolescence, and adulthood. x 1 ✦1 INTRODUCTION “Phil, stop acting like a worm, Te table’s not a place to squirm” Tus speaks the father to the son, Severely says, not in fun. Mother frowns and looks around, But Philip will not take advice, He’ll have his way at any price. He turns, And churns, He wiggles And giggles Here and there on the chair; “Phil, these twists I cannot bear.” (Afer which he leans backwards in his chair, and as he is falling grabs the tablecloth, tumbling him, the dishes, and the chair to the foor.) —“Fidgety Phil,” translated from a German book illustrating childhood misbehavior, 1845 ATTENTION- DEFICIT HYPERACTIVITY DISORDER (ADHD) is the most recent term given by psychiatrists to a childhood disorder that has had a variety of names in the past. Tis disorder was frst termed “hyperactivity,” then “attention- defcit disorder” (ADD), and then, to diferentiate between children who had ADD but did not exhibit hyperactivity, either (plain) ADD or ADD with hyperactivity. Te new “ofcial” 2 2 | ADHD term, attention- defcit hyperactivity disorder (ADHD), has been chosen by psychiatric experts, and its symptoms have been published by the American Psychiatric Association in its Diagnostic and Statistical Manual of Mental Disorders (DSM- 5). Te defnitions in this manual are widely acknowl- edged and are used among doctors, in research, and admin- istratively for purposes of insurance. Te earlier term, ADD, survives in the name of a major parent and patient support group, C.H.A.D.D. Probably 5– 10 percent of children and at least 3– 5 percent of adults sufer from attention- defcit hyperactivity disorder (ADHD). Although ADHD was described by physicians many years ago, its frequency has been recognized only recently. ADHD is frequently accompanied by learning disorders in reading, spelling, or arithmetic, and by other behavior and emotional disorders as well. ADHD is more common in boys than in girls. Child psychiatrists used to believe that the symptoms of ADHD diminished and dis- appeared as children grew older, but it is now recognized that ADHD is not a passing childhood disorder but is seri- ous and can ofen be lifelong, with the symptoms frequently persisting into adolescence and adult life. Along with an increasing awareness of the problem of ADHD, a better understanding of its causes and treatment has developed. Te purpose of this book is to explain to parents and adults the present thinking about the nature of this problem and how to manage it. Te book should, of course, be an aid— not a substitute— for diagnosis and treatment by a qualifed physician. It is designed to answer many of the most frequently asked questions and to describe many of the approaches and treatments that individuals have found 3 I NTRODUCTION | 3 helpful in dealing with ADHD in themselves and/ or their children.

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