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ADHD, CDD, and Related Conditions

  • Links
  • Definition and Background
  • Characteristics of ADHD-X
  • Therapeutics
  • References
  • rev. 07/15/2008

    Note: This page is a mixture of defensible evidence-based content and personal opinion. Use at your own risk. Be the Best You can Be is a weblog that is relevant to this topic. I wrote most of this in around 2002 or so, I'd change a good bit of it based on my ongoing experience and reading.


    Definition and Background

    Atttention-Deficit Hyperactivity Disorder (Disability) is a poorly characterized collection of persistent behaviors or traits that are maladaptive in a unavoidable setting. They may be adaptive in other settings. Restlessness and a need for novelty may be maladaptive in a grade school classroom, but they might be quite adaptive for a physics professor, entrepreneur, or traveling salesman. In the most severe forms of ADHD, however, there may be no modern setting in which the collection of traits are adaptive. This is particularly true when ADHD is associated with cognitive disabilities.

    ADHD traits or behaviors have likely been a part of human minds for hundreds of thousands of years. The disability, however, is now far more common. Our environment has changed. There are far fewer "ecological niches" where a person, especially a child, with ADHD will thrive.

    ADHD and related conditions are lifelong traits, but they are not necessarily lifelong disabilities. The brain changes dramatically during childhood and adolescence. An individuals environment also changes dramatically. Individuals learn. Learning, brain development and environmental change may change ADHD from a disorder to a trait, from a disability to a feature ... even an advantageous feature.

    There is a formal definition of ADHD, but it is not terribly useful. ADHD, like schizophrenia, is a label attached to a set of observed behaviors that probably arise from a diverse set of interactions between genes (85%) and intrauterine environment (15%) (with probably few postnatal contributions). We do not yet understand what genes are involved, what proteins are involved, and what are the interactions between proteins, neurons, and other neurologic subsystems. We may know much more in two years, we may know much more in 100 years. In the absence of deeper understanding our diagnosis and management must be empiric, though we may be helped by theories of the underlying disorder. We try things and see how they work.

    In this web page I use an extremely broad definition of ADHD. I use the term ADHD because it's the only "hook" we have to organize this discussion, and because I don't know a better term to use. CDD (complex developmental disorder) might be a better term for the range of conditions that share common characteristics. Oppositional Defiant Disorder (ODD) overlaps very strongly with ADHD (almost all children with ODD have a history of ADHD), it's unclear whether this involves other problems or whether it reflects a poor outcome of severe ADHD.

    Characteristics of Complex Developmental Disorder (CDD, ADHD-X)



    1. mitigate social isolation
    2. improve school performance: particularly reading and math skills
    3. reduce family stress (parents, siblings, proband)
    4. reduce probability of conduct disorder development esp. in adolescence (unclear if environmental interventions help, but this is at least plausible)


    In the midst of vast gulf of ignorance about use of medications in ADHD/CDD, one must be guided by conservatism, humility, close observation, and trial-of-one empiricism.




    Web Sites and Organizations

    ADD and CDD

    Autism/PDD Sites

    The Pervasive Developmental Disorder label can be applied to children with complex developmental disorders, even though they may not meet all the criteria for a diagnosis of autism/PDD. In addition the resources and focus applied to austism over the past several years has produced a range of techniques that may be applicable to many "difficult" children.


    Author: John G. Faughnan.  The views and opinions expressed in this page are strictly those of the page author. Pages are updated on an irregular schedule; suggestions/fixes are welcome but they may take weeks to years to be incorporated. Anyone may freely link to anything on this site and print any page; no permission is needed for citing, linking,  printing, or distributing printed copies.