Encyclopedia of Health and Medicine

364 Psychiatric Disorders and Psychologic Conditions
attention deficit hyperactivity disorder (ADHD)
A behavior disorder, often arising in early childhood,
of marked difficulty or inability to concentrate
and in particular to sit still. Though in some
children symptoms are apparent early in childhood,
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. Treatment
is often stimulant medications such as
methylphenidate, dextroamphetamine, or pemoline,
which have the opposite effect of producing
calm in children who have ADHD. ANTIDEPRESSANT
MEDICATIONS are sometimes more effective for adolescents.
Often parents find it beneficial to attend
classes or workshops that teach methods for positive
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 developmental
disorders, also called autism spectrum
disorder or pervasive developmental disorders
(PDDs). Symptoms begin in early childhood, typically
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 incapacitating
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 environment.
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often appears socially withdrawn and may stare at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 repetitious
actions that are potentially harmful to
themselves, such as banging their heads. The communication
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 caregivers
may interpret as rudeness or inconsideration.
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 (including
those specific for autism), and sometimes
GENETIC TESTING (autism is strongly associated with
FRAGILE X SYNDROME). Diagnosis is a process of ruling
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 for