Attention deficit hyperactivity disorder and First Lady of the United States: Difference between pages

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[[Image:Four first ladies.jpg|290px|thumb|right|Former first ladies (from left to right): [[Rosalynn Carter]], [[Hillary Rodham Clinton|Sen. Hillary Clinton]], [[Barbara Bush]] and First Lady [[Laura Bush]] at the dedication of the [[William J. Clinton Presidential Center and Park]] in 2004.]]
{{POV|date=October 2008}}
{{DiseaseDisorder infobox
| Name = Attention-Deficit Hyperactivity Disorder (USA)
| DiseasesDB = 6158
| ICD10 = {{ICD10|F|90||f|90}}
| ICD9 = {{ICD9|314.00}}, {{ICD9|314.01}}
| OMIM = 143465
| MedlinePlus = 001551
| eMedicineSubj = med
| eMedicineTopic = 3103
| eMedicine_mult = {{eMedicine2|ped|177}}
| MeshID = D001289
}}


'''First Lady of the United States''' is the unofficial title of the hostess of the [[White House]]. Because this position is traditionally filled by the wife of the [[President of the United States]], the title is sometimes taken to apply only to the wife of a sitting President. However, several women who were not Presidents' wives have served as [[First Lady]], as when the President was a bachelor or widower, or when the wife of the President was unable to fulfill the duties of the First Lady herself. In these cases, the position has been filled by a female relative or friend of the President.
'''Attention-Deficit Hyperactivity Disorder (ADHD)''' is a [[wikt:neurobehavioral|neurobehavioral]]<ref name="autogenerated1">[http://www.ninds.nih.gov/disorders/adhd/adhd.htm NINDS Attention Deficit-Hyperactivity Disorder Information Page.] National Institute of Neurological Disorders and Stroke (NINDS/NIH) February 9, 2007. Retrieved on 2007-08-13.</ref> [[wikt:developmental|developmental]] [[wikt:disorder|disorder]]<ref>[http://www.russellbarkley.org/adhd-facts.htm Dr. Russell A. Barkley Official Site, Authority ADHD, Attention Deficit Hyperactivity Disorder<!-- Bot generated title -->]</ref>affecting about 3-5% of the world's population.<ref name="Polanczyk"/> It typically presents during childhood, and is characterized by a persistent pattern of [[impulsivity|impulsiveness]] and inattention, with or without a component of [[hyperactivity]].<ref name=DSM-IV-TR>{{cite web |url=http://www.behavenet.com/capsules/disorders/adhd.htm |title=Diagnostic and Statistical Manual of American Psychiatric Association, 2000. |accessdate=2008-09-11 |work= |publisher= |year=2000 }}</ref> ADHD occurs twice as commonly in boys as in girls.<ref>{{cite journal |author=Dulcan M |title=Practice parameters for the assessment and treatment of children, adolescents, and adults with attention-deficit/hyperactivity disorder. American Academy of Child and Adolescent Psychiatry |journal=J Am Acad Child Adolesc Psychiatry |volume=36 |issue=10 Suppl |pages=85S–121S |year=1997 |month=October |pmid=9334567 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0890-8567&volume=36&issue=10&spage=85S}}</ref>
ADHD is generally a [[wikt:chronic|chronic]]<ref>{{cite journal |author=Van Cleave J, Leslie LK |title=Approaching ADHD as a chronic condition: implications for long-term adherence |journal=Journal of psychosocial nursing and mental health services |volume=46 |issue=8 |pages=28–37 |year=2008 |month=August |pmid=18777966 |doi= |url=}}</ref> disorder with 10 to 60% of individuals diagnosed in childhood continuing to meet diagnostic criteria in adulthood.<ref name=TI2008/><ref>{{cite journal |author=Elia J, Ambrosini PJ, Rapoport JL |title=Treatment of attention-deficit-hyperactivity disorder |journal=N. Engl. J. Med. |volume=340 |issue=10 |pages=780–8 |year=1999 |month=March |pmid=10072414 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=10072414&promo=ONFLNS19}}</ref> As they mature, adolescents and adults with ADHD are likely to develop [[coping skills|coping mechanisms]] to compensate for their impairment.<ref>{{cite journal |last=Gentile |first=Julie |authorlink= |coauthors= |year= |month= |title=Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management |journal=Psychiatry |volume=3 |issue=8 |pages=24-30 |id= |url=http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article218 |accessdate=2008-09-11 |quote= }}</ref>


To date, no woman has served as President. While a female President could theoretically serve as her own official hostess, it is not known what title would be applied to a President's husband, who might also serve as the host of the White House. There have been many female [[Governor#United States|governors]] of [[U.S. state]]s over the years; their spouses are typically referred to as the [[First Gentleman]].<ref>{{citation |last=Clift |first=Eleanor |title=On Being a First Gentleman |url=http://www.msnbc.msn.com/id/17422966/site/newsweek/ |accessdate=2007-09-15}}</ref>
Though previously regarded as a childhood diagnosis, studies completed during the last few decades have shown that ADHD often continues [[Adult ADHD|throughout adulthood]] - though generally with a reduction in hyperactivity. ADHD has a strong genetic component.<ref>{{cite journal |author=Hechtman L |title=Families of children with attention deficit hyperactivity disorder: a review |journal=Can J Psychiatry |volume=41 |issue=6 |pages=350–60 |year=1996 |month=August |pmid=8862854 |doi= |url=}}</ref>
Methods of treatment usually involve some combination of medications, behavior modifications, life style changes, and counseling. The American Academy of Pediatrics states that stimulant medications and/or behavior therapy are appropriate and generally safe treatments for ADHD.<ref name=AAP2001>{{cite journal |author= |title=Clinical practice guideline: treatment of the school-aged child with attention-deficit/hyperactivity disorder |journal=Pediatrics |volume=108 |issue=4 |pages=1033–44 |year=2001 |month=October |pmid=11581465 |doi= |url=http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=11581465}}</ref> Long term safety of stimulants however has not been determined<ref name=TI2008>{{cite web |url=http://ti.ubc.ca/en/letter69 |title=What is the evidence for using CNS stimulants to treat ADHD in children? |accessdate=2008-09-10 |work= |publisher= |date=March - May 2008 }}</ref> and drug treatment of pre-school children is not recommended.<ref name=NICE2008/>


Senator [[Hillary Rodham Clinton]] of New York, wife of former president [[Bill Clinton]], is the only spouse of a president to be elected to the [[United States Senate]] and become a [[United States Presidential election, 2008|leading Presidential contender]]. The current First Lady is [[Laura Bush]]. In addition, there are currently five former First Ladies still living: [[Betty Ford]], [[Rosalynn Carter]], [[Nancy Reagan]], [[Barbara Bush]] and [[Hillary Rodham Clinton]].
ADHD is one of the most controversial psychiatric disorders.<ref>{{cite web |url=http://www.ahrq.gov/clinic/epcsums/adhdsum.htm |title=Treatment of Attention-Deficit/Hyperactivity Disorder |accessdate=2008-10-02 |work= |publisher=US department of health and human services |month=December | year=1999 }}</ref><ref>{{cite journal |author=Mayes R, Bagwell C, Erkulwater J |title=ADHD and the rise in stimulant use among children |journal=Harv Rev Psychiatry |volume=16 |issue=3 |pages=151–66 |year=2008 |pmid=18569037 |doi=10.1080/10673220802167782 |url=}}</ref><ref>{{cite book |author=Cohen, Donald J.; Cicchetti, Dante |title=Developmental psychopathology |publisher=John Wiley & Sons |location=Chichester |year=2006 |pages= |isbn=0-471-23737-X |oclc= |doi= |accessdate=}}</ref> The controversy involving clinicians, teachers, policymakers, parents, and the media with opinions regarding ADHD ranging from those who do not believe it exists to those who believe that there is genetic and physiological basis for the condition.<ref>{{cite web |url=http://www.ahrq.gov/clinic/epcsums/adhdsum.htm |title=Treatment of Attention-Deficit/Hyperactivity Disorder |accessdate=2008-10-02 |work= |publisher=US department of health and human services |month=December | year=1999 }}</ref>


==Origins of the title==
==Classification==
[[Image:First-Ladies cropped.jpg|280px|right|thumb|Former First Ladies [[Nancy Reagan]], [[Lady Bird Johnson]], [[Hillary Rodham Clinton]], [[Rosalynn Carter]], [[Betty Ford]] and [[Barbara Bush]] sit together at the National Garden Gala, A Tribute to America's First Ladies, [[May 11]], [[1994]]. [[Jacqueline Kennedy Onassis]] was unable to attend due to illness, and died a week after this photograph was taken.]]


The use of the title ''[[first lady]]'' to describe the spouse or hostess of an executive began in the United States.
ADHD is best seen as the extreme of a continuous trait that is found throughout the population. <ref name = NICE2008>{{cite web |url=http://www.nice.org.uk/nicemedia/pdf/CG72FullGuideline.pdf |title=
CG72 Attention deficit hyperactivity disorder (ADHD): full guideline|accessdate=2008-10-08 |work= |publisher=NHS |date=24 September 2008 }}</ref>
It has been classified as a [[developmental disorder]], a [[conduct disorder|behavior disorder]] and a [[neurological disorder]]. ADHD is a [[developmental disorder]] where certain traits such as [[impulse control]] lag in development when compared to the general population<ref name="BarkleyContEd">{{cite web |url=http://www.continuingedcourses.net/active/courses/course003.php |title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity. |accessdate=2008-09-19 |work=Barkley, Russell |publisher= |date= }}</ref>. Using magnetic resonance imaging, this developmental lag has been estimated to range from 3 to 5 years in the prefrontal cortex.<ref>[http://www.sciencedaily.com/releases/2007/11/071112172200.htm Brain Matures A Few Years Late In ADHD, But Follows Normal Pattern]</ref>. These delays are considered to cause impairment. ADHD has also been classified as a [[conduct disorder|behavior disorder]] and a [[neurological disorder]]. <ref name="autogenerated4">{{cite web |url=http://www.loni.ucla.edu/Research/Projects/ADHD.shtml#CurrentResearch |title=LONI: Laboratory of Neuro Imaging |accessdate=2008-09-19 |work= |publisher= |date= }}</ref>


In the early days of the republic, there was no generally accepted title for the wife of the President. Many early first ladies expressed their own preference for how they were addressed, including the use of such titles as "Lady", "Mrs. President", and "Mrs. Presidentress," [[Martha Washington]] was often referred to as "Lady Washington."
==Symptoms==
The most common symptoms of ADHD are<ref>{{cite web |url=http://www.nimh.nih.gov/healthinformation/adhdmenu.cfm |title= Attention Deficit Hyperactivity Disorder (ADHD) |accessdate=2008-09-12 |work= |publisher=National Institute of Mental Health |date=April 3, 2008 }}</ref><ref name=UTP2008>{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293#5 |title=Evaluation and diagnosis of attention deficit hyperactivity disorder in children |accessdate=2008-09-12 |work= |publisher=Uptodate |date=December 5, 2007 }}</ref>:
*Impulsiveness: a person who acts quickly without thinking things through.
*Hyperactivity: a person who is unable to sit still.
*Inattention: a person who daydreams or seems to be in another world.


According to legend, [[Dolley Madison]] was referred to as "first lady" in 1849 at her funeral in a eulogy delivered by President [[Zachary Taylor]]. However, no written record of this eulogy exists.<ref>[http://www.firstladies.org/biographies/firstladies.aspx?biography=4 http://www.firstladies.org/biographies/firstladies.aspx?biography=4] ''Firstladies.org'' </ref>
The DSM IV categorises the symptoms of ADHD into two clusters: inattention symptoms and hyperactivity/impulsivity symptoms. Most ordinary people exhibit some of these behaviors but not to the point where they significantly interfere with the person's work, relationships, or studies or cause anxiety or depression.


Sometime after 1849, the title began being used in [[Washington, D.C.]] social circles. The earliest known written evidence of the title is from the [[November 3]], [[1863]] diary entry of [[William Howard Russell]], in which he referred to gossip about "the First Lady in the Land."
Hyperactivity is common among children with ADHD but tends to disappear during adulthood. However, over half of children with ADHD continue to have some symptoms of inattention throughout their lives.


The title first gained nationwide recognition in 1877, when newspaper journalist [[Mary C. Ames]] referred to [[Lucy Webb Hayes]] as "the First Lady of the land" while reporting on the inauguration of [[Rutherford B. Hayes]]. Mrs. Hayes was a tremendously popular First Lady, and the frequent reporting on her activities helped spread use of the title outside Washington.
Inattention and "hyperactive" behavior are not the only problems with children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Many of these co-existing conditions require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis. Some of the associated conditions are:
*[[Oppositional defiant disorder]] (35%) and [[Conduct disorder]] (26%). These are both characterized by anti-social behaviors such as aggression, frequent temper tantrums, deceitfulness, lying, or stealing.<ref name=UTP2008/>
*Primary disorder of vigilance. Characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch, and appear to be hyperactive in order to remain alert and active.<ref name=UTP2008/>
*[[Bipolar disorder]]. As many as 25% of children with ADHD have bipolar disorder. Children with this combination may demonstrate more aggression and behavioral problems than those with ADHD alone.<ref name=UTP2008/>
*[[Anxiety Disorders]]. Commonly accompany ADHD, particularly [[Obsessive-Compulsive Disorder]]. OCD is believed to share a genetic component with ADHD, and shares many of its characteristics.<ref name=UTP2008/>


A popular 1911 comedic play by playwright Charles Nirdlinger titled ''The First Lady in the Land'' popularized the title further. By the 1930s it was in wide use. Use of the title later spread from the United States to other nations. She also loved art too.
Although the reasons are not clear, it has long been observed (and is not controversial) that many children seem to "outgrow" ADHD. These individuals include those with and without various combinations of medication and/or therapy, although both have proven generally effective and safe in easing symptoms and reducing impairment. It is also known that many adolescents and adults develop [[coping skills]] as they mature to offset impairments. An individual's development of helpful coping skills may be enhanced by therapy, but also may result with or without conscious effort of the individual.


The acronym '''FLOTUS''' is sometimes used for "First Lady of the United States," by analogy to the more well-known acronym "POTUS" for "President of the United States."
==Causes==
ADHD is generally inherited, but it can also be caused by various problems, including difficulties with pregnancy, birth, early childhood severe illness, and environmental toxins.<ref>Caron, Samuel R., Ph.D. [http://www.adhd1.net/A-Short-Introduction-to-ADHD/ A Short Introduction to ADHD.] adhd1.net. Retrieved on 2008-07-01.</ref>


The wife of the [[Vice President of the United States]] is sometimes referred to as the [[Second Lady of the United States]], but this title is much less common. The term "first lady" is also used to describe the wife of other government [[chief executive]]s or a woman who has acted as a leading symbol for some activity, for example, [[Aretha Franklin]] has been called "the First Lady of [[soul music|Soul]]." The [[United States Presidential election, 2008|next First Lady]] will likely be either [[Cindy McCain]] or [[Michelle Obama]], the wives of the Republican and Democratic nominees, respectively.
===Genetic factors===
[[Twin study|Twin studies]] indicate that the disorder is highly heritable and that genetics cause about 75% of ADHD cases.<ref name="BarkleyContEd"/> Hyperactivity also seems to be primarily a genetic condition however other causes do have an effect.<ref>{{cite web|url=http://www.continuingedcourses.net/active/courses/course003.php|title=Attention-Deficit/Hyperactivity Disorder: Nature, Course, Outcomes, and Comorbidity|last=Barkley|first=Russel A.|accessdate=2006-06-26}}</ref>


==Role of the First Lady==
Researchers believe that a large majority of ADHD arises from a combination of various genes, many of which affect [[dopamine]] transporters. Candidate genes include [[dopamine transporter]], [[dopamine receptor]] D4, [[dopamine beta-hydroxylase]], [[monoamine oxidase]] A, [[catecholamine]]-methyl transferase, serotonin transporter promoter (SLC6A4), 5-hydroxytryptamine 2A receptor (5-HT2A), 5-hydroxytryptamine 1B receptor (5-HT1B),<ref name="dopamine">Roman T, Rohde LA, Hutz MH. (2004). "Polymorphisms of the dopamine transporter gene: influence on response to methylphenidate in attention deficit-hyperactivity disorder." ''American Journal of Pharmacogenomics'' 4(2):83–92 PMID 15059031 </ref> the 10-repeat allele of the DAT1 gene,<ref name="gene">Swanson JM, Flodman P, Kennedy J, et al. "Dopamine Genes and ADHD." ''Neurosci Biobehav Rev.'' 2000 Jan;24(1):21–5. PMID 10654656</ref> the 7-repeat allele of the DRD4 gene,<ref name="gene"/> and the dopamine beta hydroxylase gene (DBH TaqI).<ref>Smith KM, Daly M, Fischer M, et al. "Association of the dopamine beta hydroxylase gene with attention deficit hyperactivity disorder: genetic analysis of the Milwaukee longitudinal study." ''Am J Med Genet B Neuropsychiatr Genet.'' 2003 May 15;119(1):77–85. PMID 12707943</ref>
[[Image:First Ladies at Ronald Reagan Presidential Library.jpg|thumb|left|280px|First Ladies [[Lady Bird Johnson]], [[Pat Nixon]], [[Nancy Reagan]], [[Barbara Bush]], [[Rosalynn Carter]], and [[Betty Ford]] at the dedication of the [[Ronald Reagan Presidential Library]], November 1991]]
"First Lady" is not an elected position, carries no official duties, and receives no salary. Nonetheless, she attends many official ceremonies and functions of state either along with, or in place of, the President. There is a strong tradition against the First Lady holding outside employment while occupying the office.<ref>{{cite book |last=Caroli |first=Betty Boyd |title=First Ladies from Martha Washington to Laura Bush |publisher=Oxford University Press |date=2003 |pages=200}}</ref> The first lady frequently participates in [[humanitarian]] and [[Alms|charitable]] work; over the course of the 20th century it became increasingly common for first ladies to select specific causes to promote, usually ones that are not politically divisive. It is common for the first lady to hire a staff to support these activities. Additionally, many have taken an active role in campaigning for the President with whom they are associated. Hillary Rodham Clinton took the role one step further when she was, for a time, given a formal job in the Clinton administration to develop reforms to the health care system.


If the United States were to have a female President, it is commonly presumed that the husband of a female President would act as an analogous "First Gentleman". This was the situation portrayed in the fictitious television series ''[[Commander in Chief (television)|Commander In Chief]]'', in which President [[Mackenzie Allen]]'s husband Rod Calloway was titled as "First Gentleman", but President Allen's mother ultimately joined the [[First Family]] and acted as the official hostess at the White House.
The broad selection of targets indicates that ADHD does not follow the traditional model of a "genetic disease" and should be viewed as a complex interaction among genetic and environmental factors. Even though all these genes might play a role to date no single gene has been shown to make a major contribution to ADHD.<ref name="autogenerated2">{{cite journal | author=M. T. Acosta, M. Arcos-Burgos, M. Muenke | title=Attention deficit/hyperactivity disorder (ADHD): Complex phenotype, simple genotype? | journal=Genetics in Medicine | year=2004 | volume=6 | issue=1 | pages= 1–15 | doi = 10.1097/01.GIM.0000110413.07490.0B}}</ref>


==Office of the First Lady==
===Environmental factors===
The Office of the First Lady of the United States is accountable to the First Lady of the United States for her to carry out her duties as hostess of the White House, and is also in charge of all social and ceremonial events of the White House. The First Lady has her own staff that includes the [[White House Social Secretary]], a [[Chief of staff (politics)|Chief of Staff]], [[Press Secretary]], [[White House Chief Floral Designer|Chief Floral Designer]], [[White House Executive Chef|Executive Chef]], etc. The Office of the First Lady is a branch of the [[Executive Office of the President]] (EOP).
Twin studies to date have suggested that approximately 9-20 percent of the variance in hyperactive-impulsive-inattentive behavior or ADHD symptoms can be attributed to such nonshared environmental (nongenetic) factors.<ref>{Levy et al., 1997; Nigg, 2006; Sherman, Iacono et al., 1997; Silberg et al., 1996}</ref>


==First Ladies of the United States==
Environmental factors implicated include alcohol and tobacco smoke exposure during pregnancy and lead exposure after birth.<ref name="pmid17185283">{{cite journal |author=Braun JM, Kahn RS, Froehlich T, Auinger P, Lanphear BP |title=Exposures to environmental toxicants and attention deficit hyperactivity disorder in U.S. children |journal=Environ. Health Perspect. |volume=114 |issue=12 |pages=1904–9 |year=2006 |pmid=17185283 |doi=10.1289/ehp.10274}}</ref> Smoking relation to ADHD could be due nicotine causing [[Hypoxia (medical)|hypoxia]] (lack of oxygen) ''in utero'', however it could also be that women with ADHD are more likely to smoke and therefore due to the strong genetic component of ADHD more likely to have children with ADHD.{{Fact|date=September 2008}} Complications during pregnancy and birth&mdash;including [[premature birth]]&mdash;might also play a role.{{Fact|date=September 2008}}
:''For a complete list of the first ladies, see [[List of First Ladies of the United States]]''

[[Image:First Ladies National Historic Site - Saxton House.JPG|thumb|right|175px|The [[First Ladies National Historic Site]].]]
Current evidence does not support an association between head injuries and ADHD. <ref>{{cite web |url=http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec4.html |title=Mental Health: A report of the surgeon general |accessdate=2008-09-15 |work= |publisher= |year=1999 }}</ref>

====Diet====
A systematic review found that removing artificial food coloring from the diet improved ADHD symptoms.<ref>{{cite journal |author=Schab DW, Trinh NH |title=Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials |journal=J Dev Behav Pediatr |volume=25 |issue=6 |pages=423–34 |year=2004 |month=December |pmid=15613992 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0196-206X&volume=25&issue=6&spage=423}}</ref> Evidence however shows that [[sucrose]] (sugar) has no effect on behavior.<ref>{{cite journal |author=Benton D |title=Sucrose and behavioral problems |journal=Crit Rev Food Sci Nutr |volume=48 |issue=5 |pages=385–401 |year=2008 |month=May |pmid=18464029 |doi=10.1080/10408390701407316 |url=}}</ref><ref>{{cite web |url=http://www.nimh.nih.gov/health/publications/adhd/complete-publication.shtml#pub4 |title=Attention Deficit Hyperactivity Disorder |accessdate=2008-09-19 |work= |publisher= |date=April 3, 2008 }}</ref>

Preliminary evidence suggests that Omega-3/Omega-6 supplementation reduces ADHD symptoms.<ref>{{cite journal |author=Frölich J, Döpfner M |title=[The treatment of Attention-Deficit/Hyperactivity Disorders with polyunsaturated fatty acids - an effective treatment alternative?] |language=German |journal=Z Kinder Jugendpsychiatr Psychother |volume=36 |issue=2 |pages=109–16 |year=2008 |month=March |pmid=18622940 |doi=10.1024/1422-4917.36.2.109 |url=}}</ref><ref name="Johnson08">{{cite journal| author=Johnson M, Ostlund S, Fransson G, Kadesjö B, Gillberg C.| title = Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents| journal=J Atten Disord| year = 2008 Apr 30| pmid=18448859}}</ref>

===Social factors===
There is no compelling evidence that social factors alone can cause ADHD.<ref name="BarkleyContEd"/> Many researchers believe that relationships with caregivers have a profound effect on attentional and self-regulatory abilities. A study of foster children found that a high number of them had symptoms closely resembling ADHD,<ref>{{PDFlink|[http://www.vera.org/publication_pdf/169_280.pdf What Keeps Children in Foster Care from Succeeding in School.]|661&nbsp;KB}}</ref> while other researchers have found behavior typical of ADHD in children who have suffered violence and emotional abuse.<ref>Adam James (2004) [http://www.psychminded.co.uk/news/news2004/august04/Clinical%20psychology%20publishes%20critique%20of%20ADHD%20diagnosis%20and%20use%20of%20medication%20on%20children.htm ''Clinical psychology publishes critique of ADHD diagnosis and use of medication on children''] published on Psychminded.co.uk Psychminded Ltd</ref> Furthermore, [[Complex Post Traumatic Stress Disorder]] can result in attention problems that can look like ADHD, as can [[Sensory Integration Dysfunction|Sensory Integration Disorders]].

===Alternative theories===

====Hunter vs. farmer theory of ADHD====
{{main|Hunter vs. farmer theory}}

The hunter vs. farmer theory is a hypothesis proposed by [[Thom Hartmann]], a radio host, about the origins of attention-deficit hyperactivity disorder (ADHD). He believes that these conditions may be a result of adaptive behavior of the species. His theory believes that those with ADHD retained some of the older hunter characteristics.{{Fact|date=September 2008}}

====Neurodiversity====
{{main|Neurodiversity}}

Proponents of this theory assert that atypical (neurodivergent) neurological development is a normal human difference that is to be tolerated and respected as any other human difference. Social critics argue that while biological factors may obviously play a large role in difficulties sitting still and/or concentrating on schoolwork in some children, for a variety of reasons they have failed to integrate into the social expectations that others have of them. <ref>[http://www.palgrave.com/newsearch/title.aspx?PID=277194 Rethinking ADHD >> Palgrave.com : Title Page<!-- Bot generated title -->]</ref>

====Social construct theory of ADHD====
{{main|Social construct theory of ADHD}}

Social critics question whether ADHD is wholly or even predominantly a biological illness. A minority of these critics maintain that ADHD was, "invented and not discovered". They believe that no disorder exists and that the behaviour observed is not abnormal and can be better explained by environmental causes or just the personality of the "patient."<ref name = NICE2008/>

==Neurobiological mechanisms==
[[Image:Adhdbrain.gif|180px|framed|[[PET scan]]s measure the activity of various parts of the brain. The image on the right illustrates glucose metabolism in the brain of a person diagnosed with ADHD while doing an assigned task. The image on the left illustrates glucose metabolism in the brain of a normal subject when given that same task. The significance of the research by Dr. Alan Zametkin that produced these images is still not definitive.<ref>{{cite book |title=Add/Adhd Alternatives in the Classroom |last=Armstrong |first=Thomas |authorlink= |coauthors= |year=1999 |publisher=ASCD |location= |isbn=9780871203595 |pages=3-5 |url=http://books.google.ca/books?id=EzXt100I4A8C&pg=PA3&lpg=PA3&dq=National+Institute+of+Mental+Health+ADHD+PET+scan&source=web&ots=GlP-TIeiqN&sig=JADzxFyez-VM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1 }}</ref><ref>{{cite journal |author=Ernst M, Liebenauer LL, King AC, Fitzgerald GA, Cohen RM, Zametkin AJ |title=Reduced brain metabolism in hyperactive girls |journal=J Am Acad Child Adolesc Psychiatry |volume=33 |issue=6 |pages=858–68 |year=1994 |pmid=8083143 |doi= |url=}}</ref><ref>{{cite journal |author=Díaz-Heijtz R, Mulas F, Forssberg H |title=[Alterations in the pattern of dopaminergic markers in attention-deficit/hyperactivity disorder] |language=Spanish; Castilian |journal=Rev Neurol |volume=42 Suppl 2 |issue= |pages=S19–23 |year=2006 |month=February |pmid=16555214 |doi= |url=http://www.revneurol.com/LinkOut/formMedLine.asp?Refer=2005798&Revista=RevNeurol}}</ref>]]
The pathophysiology of ADHD is unclear and there are a number of competing theories.<ref>{{cite web |url=http://www.uptodate.com/online/content/topic.do?topicKey=behavior/8293&selectedTitle=4~150&source=search_result |title=Evaluation and diagnosis of attention deficit hyperactivity disorder in children |accessdate=2008-09-15 |work= |publisher= |date=December 5, 2007}}</ref>

In one study a delay in development of certain brain structures by an average of three years occurred in ADHD elementary school aged patients. The delay was most prominent in the [[frontal cortex]] and [[temporal lobe]], which are believed to be responsible for the ability to control and focus thinking. In contrast, the [[motor cortex]] in the ADHD patients was seen to mature faster than normal, suggesting that both slower development of behavioral control and advanced motor development might be required for the fidgetiness that characterize an ADHD diagnosis.<ref>[http://www.nimh.nih.gov/science-news/2007/brain-matures-a-few-years-late-in-adhd-but-follows-normal-pattern.shtml Brain Matures a Few Years Late in ADHD, But Follows Normal Pattern] NIMH Press Release, November 12, 2007 </ref>

The same laboratory had previously found involvement of the "7-repeat" variant of the [[D4DR|dopamine D4 receptor]] gene, which accounts for about 30 percent of the genetic risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however, in contrast to other variants of the gene found in ADHD patients, the region normalized in thickness during the teen years in these children, coinciding with clinical improvement.<ref>[http://www.nimh.nih.gov/science-news/2007/gene-predicts-better-outcome-as-cortex-normalizes-in-teens-with-adhd.shtml Gene Predicts Better Outcome as Cortex Normalizes in Teens with ADHD] NIMH Press Release, August 6, 2007 </ref>

Additionally, [[SPECT]] scans found people with ADHD to have reduced blood circulation (indicating low neural activity),<ref>Lou HC, Andresen J, Steinberg B, McLaughlin T, Friberg L. "The striatum in a putative cerebral network activated by verbal awareness in normals and in ADHD children." ''Eur J Neurol.'' 1998 Jan;5(1):67–74. PMID 10210814</ref> and a significantly higher concentration of dopamine transporters in the [[striatum]] which is in charge of planning ahead. <ref>{{cite journal |author=Dougherty DD, Bonab AA, Spencer TJ, Rauch SL, Madras BK, Fischman AJ |title=Dopamine transporter density in patients with attention deficit hyperactivity disorder |journal=Lancet |volume=354 |issue=9196 |pages=2132–-33 |year=1999 |pmid=10609822 | doi = 10.1016/S0140-6736(99)04030-1}}</ref><ref>{{cite journal |author=Dresel SH, Kung MP, Plössl K, Meegalla SK, Kung HF |title=Pharmacological effects of dopaminergic drugs on in vivo binding of [99mTc]TRODAT-1 to the central dopamine transporters in rats |journal=European journal of nuclear medicine |volume=25 |issue=1 |pages=31–9 |year=1998 |pmid=9396872}}</ref> Medications focused on treating ADHD (such as [[methylphenidate]]) work by reducing dopamine reuptake in certain areas of the brain, such as those that control and regulate concentration. As dopamine is a stimulant, this increases neural activity and thus blood flow in these areas (blood flow is a marker for neural activity). A study by the U.S. Department of Energy’s [[Brookhaven National Laboratory]] in collaboration with [[Mount Sinai School of Medicine]] in New York suggest that it is not the dopamine transporter levels that indicate ADHD, but the brain's ability to produce dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control subjects with a radiotracer that attaches itself to dopamine transporters. The study found that it was not the transporter levels that indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of dopamine across the board. They speculated that since ADHD subjects had lower levels of dopamine to begin with, the number of transporters in the brain was not the telling factor. In support of this notion, plasma [[homovanillic acid]], an index of dopamine levels, was found to be inversely related not only to childhood ADHD symptoms in adult psychiatric patients, but to "childhood learning problems" in healthy subjects as well.<ref name="pmid17113158">{{cite journal |author=Coccaro EF, Hirsch SL, Stein MA |title=Plasma homovanillic acid correlates inversely with history of learning problems in healthy volunteer and personality disordered subjects |journal=Psychiatry research |volume=149 |issue=1–3 |pages=297–302 |year=2007 |pmid=17113158 |doi=10.1016/j.psychres.2006.05.009}}</ref>

Although there is evidence for dopamine abnormalities in ADHD, it is not clear whether abnormalities of the dopamine system are the molecular abnormality of ADHD or a secondary consequence of a problem elsewhere. Researchers have described [[Hypokalemic sensory overstimulation|a form of ADHD]] in which the abnormality appears to be sensory overstimulation resulting from a disorder of ion channels in the peripheral nervous system.

An early [[Positron emission tomography|PET scan]] study found that global cerebral [[glucose catabolism|glucose metabolism]] was 8% lower in medication-naive adults who had been diagnosed as ADHD while children. The image on the left illustrates glucose metabolism in the brain of a 'normal' adult while doing an assigned auditory attention task; the image on the right illustrates the areas of activity in the brain of an adult who had been diagnosed with ADHD as a child when given that same task. The regions with the greatest deficit of activity included the [[premotor cortex]] and the superior [[prefrontal cortex]].<ref name="Zametkin">{{cite journal |author=Zametkin AJ, Nordahl TE, Gross M, ''et al'' |title=Cerebral glucose metabolism in adults with hyperactivity of childhood onset |journal=N. Engl. J. Med. |volume=323 |issue=20 |pages=1361–6 |year=1990 |month=November |pmid=2233902 |doi= |url=}}</ref> The significance of the research by Dr. Alan Zametkin that produced these images is still not definative.<ref>{{cite book |title=Add/Adhd Alternatives in the Classroom |last=Armstrong |first=Thomas |authorlink= |coauthors= |year=1999 |publisher=ASCD |location= |isbn=9780871203595 |pages=3-5 |url=http://books.google.ca/books?id=EzXt100I4A8C&pg=PA3&lpg=PA3&dq=National+Institute+of+Mental+Health+ADHD+PET+scan&source=web&ots=GlP-TIeiqN&sig=JADzxFyez-VM2K6SdAfcSf0nGYQ&hl=en&sa=X&oi=book_result&resnum=1&ct=result#PPA3,M1 }}</ref><ref>{{cite journal |author=Ernst M, Liebenauer LL, King AC, Fitzgerald GA, Cohen RM, Zametkin AJ |title=Reduced brain metabolism in hyperactive girls |journal=J Am Acad Child Adolesc Psychiatry |volume=33 |issue=6 |pages=858–68 |year=1994 |pmid=8083143 |doi= |url=}}</ref><ref>{{cite journal |author=Díaz-Heijtz R, Mulas F, Forssberg H |title=[Alterations in the pattern of dopaminergic markers in attention-deficit/hyperactivity disorder] |language=Spanish; Castilian |journal=Rev Neurol |volume=42 Suppl 2 |issue= |pages=S19–23 |year=2006 |month=February |pmid=16555214 |doi= |url=http://www.revneurol.com/LinkOut/formMedLine.asp?Refer=2005798&Revista=RevNeurol}}</ref>

==Diagnosis==

No objective test exists to make a diagnosis of ADHD. It thus remains a clinical diagnosis.<ref>{{cite journal |author=Joughin C, Ramchandani P, Zwi M |title=Attention-deficit/hyperactivity disorder |journal=Am Fam Physician |volume=67 |issue=9 |pages=1969–70 |year=2003 |month=May |pmid=12751659 |doi= |url=http://www.aafp.org/afp/20030501/british.html}}</ref>

In North America, the [[DSM-IV]] criteria are often the basis for a diagnosis while European countries usually use the [[ICD-10]].<ref>{{cite journal |author=Moffitt TE, Melchior M |title=Why does the worldwide prevalence of childhood attention deficit hyperactivity disorder matter? |journal=The American journal of psychiatry |volume=164 |issue=6 |pages=856–8 |year=2007 |month=June |pmid=17541041 |pmc=1994964 |doi=10.1176/appi.ajp.164.6.856 |url=}}</ref>

Many of the symptoms of ADHD occur from time to time in everyone; in patients with ADHD, the frequency of these symptoms is greater and significantly impairs their life. This impairment must occur in multiple settings to be classified as ADHD. As with many other psychiatric and medical disorders, the formal diagnosis is made by a qualified professional in the field based on a set number of criteria. In the USA these criteria are laid down by the American Psychiatric Association in their Diagnostic and Statistical Manual of Mental Disorders ([[DSM-IV]]), 4th edition. Based on the DSM-IV criteria listed below, three types of ADHD are classified:

# ADHD, Combined Type: if both criteria 1A and 1B are met for the past 6 months
# [[ADHD predominantly inattentive|ADHD Predominantly Inattentive]] Type: if criterion 1A is met but criterion 1B is not met for the past six months
# ADHD, Predominantly Hyperactive-Impulsive Type: if Criterion 1B is met but Criterion 1A is not met for the past six months.

The terminology of ADD expired with the revision of the most current version of the DSM. Consequently, ADHD is the current nomenclature used to describe the disorder as one distinct disorder which can manifest itself as being a primary deficit resulting in hyperactivity/impulsivity (ADHD, predominately hyperactive-impulsive type) or inattention (ADHD predominately inattentive type) or both (ADHD combined type).

===DSM-IV criteria===
I. Either A or B:
:A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:

:# Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
:# Often has trouble keeping attention on tasks or play activities.
:# Often does not seem to listen when spoken to directly.
:# Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
:# Often has trouble organizing activities.
:# Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
:# Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
:# Is often easily distracted.
:# Often forgetful in daily activities.

:B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

:*Hyperactivity:
:# Often fidgets with hands or feet or squirms in seat.
:# Often gets up from seat when remaining in seat is expected.
:# Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
:# Often has trouble playing or enjoying leisure activities quietly.
:# Is often "on the go" or often acts as if "driven by a motor".
:# Often talks excessively.

:*Impulsiveness:
:# Often blurts out answers before questions have been finished.
:# Often has trouble waiting one's turn.
:# Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, [[Schizophrenia]], or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

===ICD-10===
In the tenth edition of the ''[[International Statistical Classification of Diseases and Related Health Problems]]'' (ICD-10) the symptoms of ADHD are given the name "Hyperkinetic disorders". When a [[conduct disorder]] (as defined by ICD-10<ref name=ICD10> [http://www.who.int/classifications/apps/icd/icd10online/ ICD Version 2006: F91.] [[World Health Organization]]. Retrieved on December 11, 2006.</ref>) is present, the condition is referred to as "Hyperkinetic conduct disorder". Otherwise the disorder is classified as "Disturbance of Activity and Attention", "Other Hyperkinetic Disorders" or "Hyperkinetic Disorders, Unspecified". The latter is sometimes referred to as, "Hyperkinetic Syndrome".<ref name=ICD10/>

===Other diagnostic guidelines===

The [[American Academy of Pediatrics]] [[Guideline (medical)|Clinical Practice Guideline]] for children with ADHD emphasizes that a reliable diagnosis is dependent upon the fulfillment of three criteria:<ref>Perrin JM, Stein MT, Amler RW, Blondius TA. 2001. "Clinical practice guideline: treatment of school-aged children with Attention Deficit/Hyperactivity Disorder". ''Pediatrics'' 108 (4):1033-1044. PMID 11581465</ref>

* The use of explicit criteria for the diagnosis using the [[DSM-IV-TR]].
* The importance of obtaining information about the child’s symptoms in more than one setting.
* The search for coexisting conditions that may make the diagnosis more difficult or complicate treatment planning.

All three criteria are determined using the patients history given by the parents, teachers and/or the patient.

The [[Centers for Disease Control and Prevention]] (CDC) state that a diagnosis of ADD should only be made by trained health care providers, as many of the symptoms may also be part of other conditions, such as bodily illness or other physiological disorders, such as [[hypothyroidism]].{{fact}} It is not uncommon that physically and mentally [[Pathology|nonpathological]] individuals exhibit at least some of the symptoms from time to time. Severity and pervasiveness of the symptoms leading to prominent functional impairment across different settings (school, work, social relationships) are major factors in a positive diagnosis.{{fact}}

Adults often continue to be impaired by ADHD. Adults with ADHD are diagnosed under the same criteria, including the stipulation that their symptoms must have been present prior to the age of seven.<ref name="DSM">[http://www.psychiatryonline.com/content.aspx?aID=7721 Attention-Deficit/Hyperactivity Disorder.] Psychiatry Online. Retrieved on 2007-08-13.</ref> Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as [[executive functioning]], usually having more symptoms of inattention and fewer of hyperactivity or impulsiveness than children do.<ref>Jensen, PS. [http://medoffice.medscape.com/viewarticle/530193_2 Exploring the Neurocircuitry of the Brain and Its Impact on Treatment Selections in ADD.] Medscape. Retrieved on 2007-08-13.</ref>

Common comorbid conditions are [[Oppositional Defiance Disorder]] (ODD). About 20% to 25% of children with ADD meet criteria for a [[learning disorder]].<ref>{{cite journal |author=Pliszka S |title=Patterns of psychiatric comorbidity with attention-deficit/hyperactivity disorder |journal=Child Adolesc Psychiatr Clin N Am |volume=9 |issue=3 |pages=525–40, vii |year=2000 |pmid=10944655}}</ref> Learning disorders are more common when there are inattention symptoms.<ref>{{cite journal|title= Attention deficit hyperactivity disorder subtypes: Are there differences in academic problems?|journal=Dev neuropsychology|year=1995|author=Lamminmäky T '' et al''|issue=11|pages=297–310}}</ref>

==Management==
{{main|Attention-deficit hyperactivity disorder management}}

Methods of treatment often involve some combination of medications, behavior modifications, life style changes, and counseling.
===Behavioral interventions===
Family therapy has shown little benefit in the treatment of ADHD.<ref>{{cite web |url=http://www.cochrane.org/reviews/en/ab005042.html |title=Family therapy for attention-deficit disorder or attention-deficit/hyperactivity disorder in children and adolescents |accessdate=2008-09-19 |work= |publisher=The Cochrane Collaboration |date=April 20. 2005 }}</ref>
Education to help parents understand ADHD have shown short term benefits.<ref name="autogenerated3">Practice Parameter for the Assessment and Treatment of Children and Adolescents With Attention-Deficit/Hyperactivity Disorder http://www.aacap.org/galleries/PracticeParameters/JAACAP_ADHD_2007.pdf</ref>

===Pharmacological treatment===
Stimulant medications are the most clinically and cost effective method of treating ADHD. <ref name="autogenerated3" /><ref name = "Jensen">{{cite journal | author = Jensen, et al | title = Cost-Effectiveness of ADHD Treatments: Findings from the Multimodal Treatment Study of Children With ADHD | journal = American Journal of Psychiatry | volume = 162 | pages = 1628–1636 (Page:1633) | year = 2005 | pmid = 16135621 | doi = 10.1176/appi.ajp.162.9.1628}}</ref> No significant differences between the various drugs in terms of efficacy or side effects has been found.<ref>{{cite journal |author=King S, Griffin S, Hodges Z, ''et al'' |title=A systematic review and economic model of the effectiveness and cost-effectiveness of methylphenidate, dexamfetamine and atomoxetine for the treatment of attention deficit hyperactivity disorder in children and adolescents |journal=Health Technol Assess |volume=10 |issue=23 |pages=iii–iv, xiii–146 |year=2006 |month=July |pmid=16796929 |doi= |url=http://www.hta.ac.uk/execsumm/summ1023.htm}}</ref><ref>{{cite journal |author=Brown RT, Amler RW, Freeman WS, ''et al'' |title=Treatment of attention-deficit/hyperactivity disorder: overview of the evidence |journal=Pediatrics |volume=115 |issue=6 |pages=e749–57 |year=2005 |month=June |pmid=15930203 |doi=10.1542/peds.2004-2560 |url=}}</ref> About 70% of children improve after being treated with stimulants.<ref>{{cite journal |author=Schachter HM, Pham B, King J, Langford S, Moher D |title=How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis |journal=CMAJ |volume=165 |issue=11 |pages=1475–88 |year=2001 |month=November |pmid=11762571 |pmc=81663 |doi= |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=11762571}}</ref> Medications, however, are not recommended for pre-school children with ADHD.<ref>{{cite web |url=http://www.nice.org.uk/nicemedia/pdf/CG72NiceGuidelinev3.pdf |title=
CG72 Attention deficit hyperactivity disorder (ADHD): NICE guideline|accessdate=2008-10-08 |work= |publisher=NHS |date=24 September 2008 }}</ref>Stimulants, in the short term, have been found to be safe in the appropriately selected patient and appear well tolerated over 5 years of treatment.<ref name="stimulants">{{cite book| last = Barkley| first = Russell| title = Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment| publisher = The Guildford Press| year = 2006| location = New York| pages = 608-645| isbn = 2005016986}}</ref>

Long term safety, however, has not been determined. There are no randomized controlled trials assessing the harms or benefits of treatment beyond two years.<ref name=TI2008/> The [[American Heart Association]] and the [[American Academy of Pediatrics]] feels that it is prudent to carefully assess children for heart conditions before treating them with stimulant medications.<ref>{{cite journal |author= |title=American Academy of Pediatrics/American Heart Association clarification of statement on cardiovascular evaluation and monitoring of children and adolescents with heart disease receiving medications for ADHD: May 16, 2008 |journal=J Dev Behav Pediatr |volume=29 |issue=4 |pages=335 |year=2008 |month=August |pmid=18698199 |doi=10.1097/DBP.0b013e31318185dc14 |url=http://circ.ahajournals.org/cgi/content/full/117/18/2407}}</ref> The FDA has added black box warning to some ADHD medications.<ref>{{cite web |url=http://www.fda.gov/bbs/topics/NEWS/2007/NEW01568.html |title=FDA News |accessdate=2008-10-01 |work= |publisher=FDA|date=February 21, 2007 }}</ref> [[Amphetamines]] ( Adderall ) has warnings about potential for abuse, drug dependence, and sudden death.<ref>{{cite web |url=http://www.fda.gov/cder/foi/label/2007/011522s040lbl.pdf |title=ADDERALL® (CII) |accessdate=2008-10-01 |work= |publisher=FDA |month=MARCH | year=2007|format=PDF}}</ref>

[[Comorbid]] disorders or substance abuse can make the diagnosis and the treatment of ADHD more difficult. Psychosocial therapy is useful in treating some comorbid conditions.<ref>{{cite journal | author =Foster, et al | title = Treatment of ADHD: Is More Complex Treatment Cost-Effective for More Complex Cases? | journal =HSR: Health Services Research | volume = 42 | issue = 1 | pages = 165–182 (Page:177) | year = 2007 | pmid = 17355587 | doi = 10.1111/j.1475-6773.2006.00599.x}}</ref>

===Support groups===
In the UK, the Hyperactive Children's Support Group (HACSG) <ref>http://www.hacsg.org.uk/</ref> is a registered charity which aims to help ADHD/Hyperactive children and their families. The HACSG is a proponent of a dietary approach to the problem of hyperactivity.

==Prognosis==
ADHD diagnosed in childhood resolves in 40 to 90% of individuals by the time they reach adulthood.<ref name=TI2008/><ref>{{cite journal |author=Elia J, Ambrosini PJ, Rapoport JL |title=Treatment of attention-deficit-hyperactivity disorder |journal=N. Engl. J. Med. |volume=340 |issue=10 |pages=780–8 |year=1999 |month=March |pmid=10072414 |doi= |url=http://content.nejm.org/cgi/pmidlookup?view=short&pmid=10072414&promo=ONFLNS19}}</ref> Those affected are likely to develop [[coping skills|coping mechanisms]] as they mature thus compensating for their previous ADHD. <ref>{{cite journal |last=Gentile |first=Julie |authorlink= |coauthors= |year= |month= |title=Adult ADHD: Diagnosis, Differential Diagnosis, and Medication Management |journal=Psychiatry |volume=3 |issue=8 |pages=24-30 |id= |url=http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article218 |accessdate=2008-09-11 |quote= }}</ref>

37% of those with ADHD do not get a high school diploma even though many of them will receive special education services.<ref name="BarkleyContEd"/> The combined outcomes of the expulsion and dropout rates indicate that almost half of all ADHD students never finish high school.<ref>{{PDFlink|http://eric.ed.gov/ERICDocs/data/ericdocs2/content_storage_01/0000000b/80/22/94/d6.pdf}}</ref> In the United States, less than 5% of individuals with ADHD get a college degree<ref name="adhd_superman">{{cite book| last = Cimera| first = Robert| title = Making ADHD a gift: teaching Superman how to fly| publisher = Scarecrow Press, Inc.| year = 2002
| location = Lanham, Maryland| pages = pg. 116| url = http://www.rowmaneducation.com/Catalog/SingleBook.shtml?command=Search&db=^DB/CATALOG.db&eqSKUdata=0810843196| isbn = 0810843188}}</ref> compared to 28% of the general population.<ref name="us_census_2005">[http://www.census.gov/Press-Release/www/releases/archives/education/004214.html College Degree Nearly Doubles Annual Earnings,
Census Bureau Reports] U.S. Census Bureau March 28, 2005. Retrieved on 2008-08-02. </ref>

==Epidemiology==
ADHD's global [[prevalence]] is estimated at 5% in people under the age of 19. There is however wide variability in theses estimates with children in North America appearing to have a higher rate of ADHD than children in Africa and the Middle East.<ref name="Polanczyk">{{cite journal|author=Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA|title=The worldwide prevalence of ADHD: a systematic review and metaregression analysis|journal=Am J Psychiatry|year=2007|volume=164|issue=6|pages=942–48 |pmid=17541055|doi=10.1176/appi.ajp.164.6.942}}</ref> 10% of males and 4% of females have been diagnosed in the United States<ref> {{PDFlink|[http://www.cdc.gov/nchs/data/series/sr_10/sr10_221.pdf "National Health Interview survey, 2002"]|3.71&nbsp;MB}}. Centers for Disease Control (March, 2004). Retrieved on December 11, 2006.</ref> This difference between genders may reflect either a difference in susceptibility or that females with ADHD are less likely to be diagnosed than males.<ref>Staller J, Faraone SV. (2006) "Attention-deficit hyperactivity disorder in girls: epidemiology and management." ''CNS Drugs''. 2006;20(2):107–23. PMID 16478287</ref><ref>Biederman J, Faraone SV. (2004) "The [[Massachusetts General Hospital]] studies of gender influences on attention-deficit/hyperactivity disorder in youth and relatives." ''Psychiatr Clin North Am''. Jun;27(2):225–32. PMID 15063995</ref>

==History==
===Terminology===
It may be helpful to understand that "ADD" and "ADHD" are the same thing, and constitute a single syndrome, with several important and distinctive variations. The clinical definition of "ADHD" dates to the mid-20th century, but was known by other names. Physicians developed a diagnosis for a set of conditions variously referred to as "minimal brain damage", "minimal brain dysfunction", "learning/behavioural disabilities" and "hyperactivity". Some of these labels became problematic as knowledge expanded. For example, as they became aware that many children with no indication of brain damage also displayed the syndrome, the label which included the words "brain damage" didn't seem appropriate.

The DSM-II in 1968 began to call it "Hyperkinetic Reaction of Childhood" even though the professionals were aware that many of the children so diagnosed exhibited attention deficits without any signs of hyperactivity. In 1980, the DSM-III introduced "ADD (Attention-Deficit Disorder) with or without hyperactivity." That terminology (ADD) technically expired with the revision in 1987 to ADHD in the DSM-III-R. In the DSM-IV, published in 1994, ADHD with sub-types was presented. The current version (as of 2008), the DSM-IV-TR was released in 2000, primarily to correct factual errors and make changes to reflect recent research. (ADHD was basically unchanged).<ref> http://kadi.myweb.uga.edu/The_Development_of_the_DSM.html </ref>

Under the DSM-IV, within the ADHD syndrome, there are three sub-types, including one which lacks the hyperactivity component.<ref>[http://www.adhd.com/adults/adults_whatis_add.jsp What is Adult ADD?<!-- Bot generated title -->]</ref> Approximately one-third of people with ADHD have the [[ADHD predominantly inattentive|predominantly inattentive type (ADHD-I)]], meaning that they do not have the hyperactive or overactive behavior components of the other ADHD subtypes.

Even today, the ADHD terminology is objectionable to many. There is some preference for using the ADHD-I, ADD, and AADD terminology when describing individuals lacking the hyperactivity component, especially among older adolescents and adults who find the term "hyperactive" inaccurate, inappropriate and even derogatory.

===Hippocrates, Shakespeare===
Researchers speculate that earlier references to the condition as mentioned in the examples below, have been made throughout history. {{Fact|date=September 2008}}

In 493 BCE, physician-scientist [[Hippocrates]] described a condition that seems to be compatible with what we now know as ADHD.{{Fact|date=September 2008}} He described patients who had "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression". Hippocrates attributed this condition to an "overbalance of fire over water”. His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities."<ref>[http://www.adhd.org.nz/define1.html What is ADHD?] ADHD.org.nz. Retrieved on 2007-08-13.</ref>

Russell Barkley <ref name="Attention-Deficit Hyperactivity Disorder">{{cite book| last = Mash| first = Eric| title = Child Psychopathology| publisher = The Guildford Press| year = 2003
| location = New York| pages = 76| isbn = 1572306092}}</ref> has argued that Shakespeare made reference to a "malady of attention" in King Henry VII, although the actual quote appears to come from ''King Henry IV'', part II.

===20th century===
In 1902, the English [[pediatrician]] [[George Still]] gave a series of lectures to the [[Royal College of Physicians]] in England and described a condition which some have claimed is analogous to ADHD.{{Fact|date=September 2008}} Dr. Still described a group of children with significant behavioral problems, caused, he believed, by an innate hereditary dysfunction and not by poor child rearing or environment.<ref>Still GF. "Some abnormal psychical conditions in children: the Goulstonian lectures". ''Lancet'', 1902;1:1008-1012</ref> At the time it was commonly thought that inattention and lack of inhibitory control were the primary characteristics of the syndrome. <ref> http://www.healthcentral.com/adhd/c/7930/23979/adhds-history-effects </ref>

===Encephalitis epidemic 1917-1918===
The treatment of children with similar behavioral problems who had survived the epidemic of [[encephalitis lethargica]] from 1917 to 1918 and the pandemic of influenza from 1919 to 1920 led to terminology which referred to "brain damage." <ref> http://www.healthcentral.com/adhd/c/7930/23979/adhds-history-effects </ref>

===Response to stimulant medication===
The first reported evidence of stimulant medication used to treat children with concentration and hyperactivity problems came in 1937. <ref> http://www.healthcentral.com/adhd/c/7930/23979/adhds-history-effects </ref> Dr. Charles Bradley in [[Providence, Rhode Island|Providence, RI]] reported that a group of children with behavioral problems improved after being treated with the stimulant [[Benzedrine]].<ref>[http://ajp.psychiatryonline.org/cgi/content/full/155/7/968 ''Charles Bradley, M.D., 1902–1979''], retrieved September 15, 2008. American Journal of Psychiatry, 155:968</ref> In 1957, the stimulant [[methylphenidate]] ([[Ritalin]], which was first produced in 1950) became available under various names (including Focalin, Concerta, Metadate, and Methylin); it remains one of the most widely prescribed medications for ADHD. Initially the drug was used to treat [[narcolepsy]], chronic fatigue, depression, and to counter the sedating effects of other medications. The drug began to be used for ADHD in the 1960s and steadily rose in use.{{Fact|date=September 2008}}

In 1975, [[pemoline]] (Cylert) was approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market. New delivery systems for medications were invented in 1999 that eliminated the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8&ndash;12 hour period (Metadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8&ndash;12 hour period after ingestion (Concerta).{{Fact|date=September 2008}}

In 2003, [[atomoxetine]] (Strattera) received the first FDA approval for a nonstimulant drug to be used specifically for ADHD. In 2007, [[lisdexamfetamine]] (Vyvanse) becomes the first [[prodrug]] to receive FDA approval for ADHD. The landmark study of 1999 &ndash; The largest study of treatment for ADHD in history &ndash; is published in the ''[[American Journal of Psychiatry]]''. Known as the ''Multimodal Treatment Study of ADHD'' (MTA Study), it involved more than 570 children with ADHD at 6 sites in the United States and Canada randomly assigned to 4 [[treatment groups]]. Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.{{Fact|date=September 2008}}

===Adults===
In the 1970s researchers began to realize that the condition now known as ADHD did not always disappear in adolescence, as was once thought. At about the same time, some of the symptoms were also noted in many parents of the children under treatment. The condition was formally recognized as afflicting adults in 1978, often informally called [[Adult attention-deficit disorder|Adult ADD]], since symptoms associated with hyperactivity are generally less pronounced.

It has been estimated that about eight million adults have ADHD in the United States. <ref> http://www.uspharmacist.com/index.asp?page=ce/10135/default.htm </ref > Untreated adults with ADHD often have chaotic life-styles, may appear to be disorganized, and may rely on non-prescribed drugs and alcohol to get by. They often have such associated psychiatric comorbidities as depression, anxiety, bipolar disorder, substance abuse, or a learning disability. <ref> http://www.psychiatrymmc.com/displayArticle.cfm?articleID=article218 </ref> In 2004, noted researchers estimated the yearly income loss for adults with ADHD in the United States as $77 billion. This may be partially because it is also estimated that only 15% of adults in the U.S. with ADHD are aware that they have the disorder, although many adults struggle with it. <ref> http://news.healingwell.com/index.php?p=news1&id=521145 </ref>

A diagnosis of ADHD may offer an adult insight into their behaviors and allow the patient to become more aware and seek help with coping and treatment strategies. <ref> http://www.uspharmacist.com/index.asp?page=ce/10135/default.htm </ref> Studies show that adult ADHD is treated successfully with a combination of medication and behavior therapy.<ref>[http://www.additudemag.com/adhd/article/815.html You've Got Adult ADD… Now What?], ''ADDitude'' magazine, 2007</ref>

Many professionals have speculated that in the next DSM (tentatively DSM-V), ADHD in adults may be differentiated from the syndrome as it occurs in children. Only recognized as occurring in adults in 1978, it is currently not addressed separately. Obstacles that clinicians face when assessing adults who may have ADHD include developmentally inappropriate diagnostic criteria, age-related changes, comorbidities, and the possibility that high intelligence or situational factors can mask ADHD symptoms.<ref> http://www.neuropsychiatryreviews.com/feb00/npr_feb00_ADHD.html </ref> For adults, most treatments with medication and therapy are basically similar; a mature patient may more able to provide feedback and help self-direct the process.

==Cultural aspects==
{{weasel}}
People talk about ADHD in 5 different ways:
* appropriating the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) descriptors;
* schools as identity-construction sites
* resistance: biology versus moral culpability
* alternative solutions to a real problem
* relief and hope in naming experience
<ref> {{cite journal|title=Hyper Talk: Sampling the Social Construction of ADHD in Everyday Language|journal=Anthropology & Education Quarterly|year=2001|first=Scot|last=Danforth|coauthors=Joy Yogawin|volume=32|issue=2|pages=167–190|id= |doi= 10.1525/aeq.2001.32.2.167|accessdate=2008-04-07 }}</ref>

Another study looked at Colombian and Castillejos, Zambales schoolchildren to examine whether ADHD is merely a [[culture-specific syndrome|cultural phenomenon]], or a cultural phenomenon with a biological basis. The authors conclude: “If ADHD were explicable as a culturally formulated psychiatric phenomenon, then it would be predicted that the same hyperactive and inattentive behaviors displayed in different cultural contexts would be associated with differing degrees of harmful dysfunction. In this study we found that children's hyperactive and inattentive behavior were similarly expressed in diverse populations and systematically related to children's social and academic wellbeing across those varied cultural contexts.” <ref> {{cite journal|title=ADHD-Type Behavior and Harmful Dysfunction in Childhood: A Cross-Cultural Model|journal=American Anthropologist|date=2000-12|first=Alexandra|last=Brewis|coauthors=Karen L. Schmidt, Mary Meyer|volume=102|issue=4|pages=826|id= |doi= 10.1525/aa.2000.102.4.823|accessdate=2008-04-19 }}</ref> This study was later criticized for assuming a homogenous culture for the United States population, failing to mention the socioeconomic backgrounds of the populations, and using two study populations that share European cultural origins.<ref> {{cite journal|title=Comment on Brewis et al|journal=American Anthropologist|date=2002-03|first=Niccolo |last=Caldararo|coauthors=|volume=104|issue=1|pages=282–283|id= |doi= 10.1525/aa.2002.104.1.282|accessdate=2008-04-19 }}</ref>

==Controversies==
{{main|Attention-deficit hyperactivity disorder controversies}}

[[Attention-deficit hyperactivity disorder]] (ADHD) "is a highly controversial pediatric disorder despite being a well validated clinical diagnosis".<ref>{{cite journal |author=Mayes R, Bagwell C, Erkulwater J |title=ADHD and the rise in stimulant use among children |journal=Harv Rev Psychiatry |volume=16 |issue=3 |pages=151–66 |year=2008 |pmid=18569037 |doi=10.1080/10673220802167782 |url=}}</ref><ref> {{cite journal |author=Foreman DM |title=Attention deficit hyperactivity disorder: legal and ethical aspects |journal=Arch. Dis. Child. |volume=91 |issue=2 |pages=192–4 |year=2006 |month=February |pmid=16428370 |doi=10.1136/adc.2004.064576 |url=}} </ref> The controversy involving clinicians, teachers, policymakers, parents, and the media with opinions regarding ADHD ranging from those who do not believe it exists to those who believe that there is genetic and physiological basis for the condition.<ref>{{cite web |url=http://www.ahrq.gov/clinic/epcsums/adhdsum.htm |title=Treatment of Attention-Deficit/Hyperactivity Disorder |accessdate=2008-10-02 |work= |publisher=US department of health and human services |month=December | year=1999 }}</ref> The controversy is discussed in depth in the Sept. 2008 UK publication of the NICE guidelines on ADHD.<ref name = NICE2008/>

Researchers from McMaster identified six features of ADHD that contribute to its controversial nature: 1) it is a clinical diagnosis for which there are no laboratory or radiological confirmatory tests or specific physical features; 2) diagnostic criteria have changed frequently; 3) there is no curative treatment, so long-term therapies are required; 4) therapy often includes stimulant drugs that are thought to have abuse potential; and 5) the rates of diagnosis and of treatment substantially differ across countries.<ref>{{cite journal |author=Jadad AR, Booker L, Gauld M, ''et al'' |title=The treatment of attention-deficit hyperactivity disorder: an annotated bibliography and critical appraisal of published systematic reviews and metaanalyses |journal=Canadian journal of psychiatry. Revue canadienne de psychiatrie |volume=44 |issue=10 |pages=1025–35 |year=1999 |month=December |pmid=10637682 |doi= |url=https://ww1.cpa-apc.org/French_Site/Publications/Archives/CJP/1999/Dec/jadad.htm}}</ref>

The British Psychological Society states that: “The idea that children who don’t attend or who don’t sit still in school have a mental disorder is not entertained by most British clinicians.”<ref>{{cite journal |author=Reason R |title=ADHD: a psychological response to an evolving concept. (Report of a Working Party of the British Psychological Society) |journal=Journal of learning disabilities |volume=32 |issue=1 |pages=85–91 |year=1999 |pmid=15499890 |doi= |url=http://ldx.sagepub.com/cgi/pmidlookup?view=long&pmid=15499890}}</ref>

In the ''Harvard Review of Psychiatry'', three authors from Departments of Political Science and Psychology at the [[University of California]] campuses in [[Richmond, California|Richmond]] and [[Berkeley, California|Berkeley]] stated "ADHD is one of the most controversial psychiatric disorders, in part because it is also the most commonly diagnosed mental disorder among minors."<ref>{{cite journal |author=Mayes R, Bagwell C, Erkulwater J |title=ADHD and the rise in stimulant use among children |journal=Harv Rev Psychiatry |volume=16 |issue=3 |pages=151–66 |year=2008 |pmid=18569037 |doi=10.1080/10673220802167782 |url=}}</ref> There is concern about the effects of an ADHD diagnosis on the mental state and self-esteem of patients.<ref name="Tim&Rad"/><ref>[http://www.critpsynet.freeuk.com/TimimiEHPP.htm Article for Ethical Human Sciences and Services<!-- Bot generated title -->]</ref> There is disagreement over the cause of ADHD and there are questions about research methodologies <ref>http://www.psychminded.co.uk/news/news2006/feb06/Disordered%20thinking.htm Comment by James, Adam, “Disordered thinking?” ''Psychminded'' 14 Feb. 2006.</ref>, and skepticism toward its classification as a [[mental disorder]]. <ref name="Tim&Rad">{{cite book |author=Newnes, Craig; Nick Radcliffe |title=Making and Breaking Children's Lives |publisher=PCCS Books |location=Timimi, Sami & Radcliffe, Nick. “The Rise and Rise of ADHD.” |year=2005 |pages=63-70 |isbn=1-898059-70-5 |oclc= |doi= |accessdate=}}</ref> Social critics point to changing standards of diagnosis {{Fact|date=September 2008}}, such as the [[American Academy of Pediatrics]] (AAP) issuing a more careful set of standards in 2000 to aid clinicians than merely using [[DSM-IV]].<ref> [http://www.pbs.org/wgbh/pages/frontline/shows/medicating/adhd/aapguidelines.html PBS - frontline: medicating kids: adhd: american academy of pediatrics' guidelines<!-- Bot generated title -->]</ref>

Concern exists that "elevated but still developmentally normal levels of motor activity, impulsiveness, or inattention" traits of childhood could be inappropriately interpreted as ADHD.<ref>{{cite journal |author=Lakhan SE, Hagger-Johnson GE |title=The impact of prescribed psychotropics on youth |journal=Clin Pract Epidemol Ment Health |volume=3 |issue= |pages=21 |year=2007 |pmid=17949504 |pmc=2100041 |doi=10.1186/1745-0179-3-21 |url=http://www.cpementalhealth.com/content/3/1/21}}</ref> The [[National Institute of Mental Health]] states that, "stimulant drugs, when used with medical supervision, are usually considered quite safe."<ref>[http://www.nimh.nih.gov/health/publications/adhd/treatment.shtml NIMH · ADHD · The Treatment of ADHD<!-- Bot generated title -->]</ref> Some parents and professionals have raised questions about the side effects of drugs and their long term use.<ref>Lakhan SE; Hagger-Johnson G. http://www.cpementalhealth.com/content/3/1/21 The impact of prescribed psychotropics on youth. ''Clinical Practice and Epidemiology in Mental Health'' 2007;3(21).</ref> Calls for greater scrutiny are made by some news sources, social critics, religions, and medical professionals. Ethical and legal issues with regard to treatment have been key areas of concern for these critics. "Alternative theory" critics contend that the symptoms of ADHD can be better explained by the [[Hunter vs. farmer theory]] or [[Neurodiversity]]. Fringe critics question if ADHD exists at all as a disorder [[social construct theory of ADHD]]. Fringe critics question if ADHD exists at all as a disorder.


==See also==
==See also==
*[[First Lady]] - Use of the title outside the United States.
{{col-begin}}
*[[Second Lady of the United States]] - Wife of the Vice President of the United States.
{{col-3}}
*[[First Ladies National Historic Site]] - In [[Canton, Ohio]].
'''General'''
*[[List of United States First Ladies by Longevity]]
* [[Adult attention-deficit disorder]]
* [[Developmental disability]]
* [[Educational psychology]]
* [[Environmental health]]
* [[Neurodevelopmental disorder]]
* [[Sluggish cognitive tempo]]
{{col-3}}
'''Related disorders'''
* [[Auditory processing disorder]]
*[[Bipolar disorder in children]]
* [[Oppositional defiant disorder]]
* [[Sensory integration disorder]]
{{col-3}}
'''Controversy'''
* [[Attention-deficit hyperactivity disorder controversies]]
* [[Anti-psychiatry]]
* [[Biopsychiatry controversy]]
{{col-end}}


==References==
==External links==
*http://www.loc.gov/rr/print/list/058_flal.html
{{reflist|2}}
* {{cite web
|title=Office of the First Lady
|url=http://www.whitehouse.gov/firstlady/
|accessdate=October 7
|accessyear=2005
}}
* {{cite web
|title=First Lady's Gallery
|work=The White House
|url=http://www.whitehouse.gov/history/firstladies/
|accessdate=October 7
|accessyear=2005
}}
* {{cite web
|title=The National First Ladies' Library
|url=http://www.firstladies.org/
|accessdate=October 7
|accessyear=2005
}}
*[http://www.dadashopping.net/work.php?code=behind_every_great_man_stands_a_great_woman Paper on the role of the first lady and the influence she holds over the President]


==Further reading==
==References==
{{reflist}}
<div class="references-small">
*Barkley, Russell A. ''Take Charge of ADHD: The Complete Authoritative Guide for Parents'' (2005) New York: Guilford Publications.
*Conrad, Peter ''Identifying Hyperactive Children'' (Ashgate, 2006).
*Crawford, Teresa ''I'm Not Stupid! I'm ADHD!''
*Green, Christopher, Kit Chee, ''Understanding ADD''; Doubleday 1994; ISBN 0-86824-587-9
*Hanna, Mohab. (2006) ''Making the Connection: A Parent's Guide to Medication in AD/HD'', Washington D.C.: Ladner-Drysdale.
*Kelly, Kate, Peggy Ramundo. (1993) ''You Mean I'm Not Lazy, Stupid or Crazy?! A Self-Help Book for Adults with Attention deficit Disorder''. ISBN 0-684-81531-1
*Matlen, Terry. (2005) "Survival Tips for Women with AD/HD". ISBN 1886941599
*Ninivaggi, F.J. "Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Rethinking Diagnosis and Treatment Implications for Complicated Cases", ''Connecticut Medicine''. September 1999; Vol. 63, No. 9, 515-521. PMID 10531701
</div>

==External links==
*[http://www.cdc.gov/ncbddd/adhd/default.htm Attention-Deficit / Hyperactivity Disorder (ADHD)] at the Center for Disease Control
*[http://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110html.htm Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder] at NIH
*[http://www.nimh.nih.gov/publicat/adhd.cfm National Institute of Mental Health on ADHD]
*[http://video.yourtotalhealth.ivillage.com/player/?id=259833&ice=th%7Cvid_tout%7C1 [[Today (NBC program)|Today Show]] segment on adult ADHD, June 5, 2008]
*[http://www.nytimes.com/interactive/2008/05/21/health/healthguide/TE_ADHD_CLIPS.html Patient Voices: A.D.H.D] , NYTimes.com


{{Mental and behavioural disorders}}


{{Lists of US Presidents and Vice Presidents}}
[[Category:Attention]]
[[Category:Attention disorders]]
[[Category:Childhood psychiatric disorders]]
[[Category:Educational psychology]]
[[Category:Neurological disorders]]
[[Category:Special education]]
[[Category:People with ADHD]]


[[Category:First Ladies of the United States| ]]
<!-- interwiki -->


[[de:First Lady]]
[[af:Aandagsgebreksindroom]]
[[fa:بانوی اول ایالات متحده]]
[[ar:قصور الإنتباه و فرط الحركة]]
[[fr:Première dame des États-Unis]]
[[bg:Синдром на дефицит на вниманието и хиперактивност]]
[[he:הגברת הראשונה של ארצות הברית]]
[[cs:ADHD]]
[[nl:First Lady van de Verenigde Staten]]
[[da:ADHD]]
[[pt:Primeira-Dama dos Estados Unidos da América]]
[[de:Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung]]
[[simple:First Lady of the United States]]
[[es:Trastorno por déficit de atención con hiperactividad]]
[[fa:نقص توجه]]
[[sv:USA:s första dam]]
[[th:สุภาพสตรีหมายเลขหนึ่งแห่งสหรัฐอเมริกา]]
[[fr:Trouble déficitaire de l'attention]]
[[vi:Đệ nhất Phu nhân Hoa Kỳ]]
[[ko:주의력결핍 과다행동장애]]
[[hr:Poremećaj hiperaktivnosti i deficita pažnje]]
[[is:Athyglisbrestur]]
[[it:Sindrome da deficit di attenzione e iperattività]]
[[he:הפרעת קשב, ריכוז והיפראקטיביות]]
[[lt:Aktyvumo ir dėmesio sutrikimas]]
[[hu:Figyelemhiányos hiperaktivitás-zavar]]
[[nl:ADHD]]
[[ja:注意欠陥・多動性障害]]
[[no:Attention Deficit Hyperactivity Disorder]]
[[nn:ADHD]]
[[pl:ADHD]]
[[pt:Transtorno do déficit de atenção com hiperatividade]]
[[ro:ADHD]]
[[ru:Синдром дефицита внимания и гиперактивности]]
[[simple:Attention-deficit hyperactivity disorder]]
[[fi:Tarkkaavaisuus- ja ylivilkkaushäiriö]]
[[sv:ADHD]]
[[tr:Dikkat Eksikliği ve Hiperaktivite Bozukluğu]]
[[wuu:Attention Deficit Hyperactivity Disorder]]
[[zh:注意力不足過動症]]

Revision as of 15:31, 10 October 2008

Former first ladies (from left to right): Rosalynn Carter, Sen. Hillary Clinton, Barbara Bush and First Lady Laura Bush at the dedication of the William J. Clinton Presidential Center and Park in 2004.

First Lady of the United States is the unofficial title of the hostess of the White House. Because this position is traditionally filled by the wife of the President of the United States, the title is sometimes taken to apply only to the wife of a sitting President. However, several women who were not Presidents' wives have served as First Lady, as when the President was a bachelor or widower, or when the wife of the President was unable to fulfill the duties of the First Lady herself. In these cases, the position has been filled by a female relative or friend of the President.

To date, no woman has served as President. While a female President could theoretically serve as her own official hostess, it is not known what title would be applied to a President's husband, who might also serve as the host of the White House. There have been many female governors of U.S. states over the years; their spouses are typically referred to as the First Gentleman.[1]

Senator Hillary Rodham Clinton of New York, wife of former president Bill Clinton, is the only spouse of a president to be elected to the United States Senate and become a leading Presidential contender. The current First Lady is Laura Bush. In addition, there are currently five former First Ladies still living: Betty Ford, Rosalynn Carter, Nancy Reagan, Barbara Bush and Hillary Rodham Clinton.

Origins of the title

Former First Ladies Nancy Reagan, Lady Bird Johnson, Hillary Rodham Clinton, Rosalynn Carter, Betty Ford and Barbara Bush sit together at the National Garden Gala, A Tribute to America's First Ladies, May 11, 1994. Jacqueline Kennedy Onassis was unable to attend due to illness, and died a week after this photograph was taken.

The use of the title first lady to describe the spouse or hostess of an executive began in the United States.

In the early days of the republic, there was no generally accepted title for the wife of the President. Many early first ladies expressed their own preference for how they were addressed, including the use of such titles as "Lady", "Mrs. President", and "Mrs. Presidentress," Martha Washington was often referred to as "Lady Washington."

According to legend, Dolley Madison was referred to as "first lady" in 1849 at her funeral in a eulogy delivered by President Zachary Taylor. However, no written record of this eulogy exists.[2]

Sometime after 1849, the title began being used in Washington, D.C. social circles. The earliest known written evidence of the title is from the November 3, 1863 diary entry of William Howard Russell, in which he referred to gossip about "the First Lady in the Land."

The title first gained nationwide recognition in 1877, when newspaper journalist Mary C. Ames referred to Lucy Webb Hayes as "the First Lady of the land" while reporting on the inauguration of Rutherford B. Hayes. Mrs. Hayes was a tremendously popular First Lady, and the frequent reporting on her activities helped spread use of the title outside Washington.

A popular 1911 comedic play by playwright Charles Nirdlinger titled The First Lady in the Land popularized the title further. By the 1930s it was in wide use. Use of the title later spread from the United States to other nations. She also loved art too.

The acronym FLOTUS is sometimes used for "First Lady of the United States," by analogy to the more well-known acronym "POTUS" for "President of the United States."

The wife of the Vice President of the United States is sometimes referred to as the Second Lady of the United States, but this title is much less common. The term "first lady" is also used to describe the wife of other government chief executives or a woman who has acted as a leading symbol for some activity, for example, Aretha Franklin has been called "the First Lady of Soul." The next First Lady will likely be either Cindy McCain or Michelle Obama, the wives of the Republican and Democratic nominees, respectively.

Role of the First Lady

First Ladies Lady Bird Johnson, Pat Nixon, Nancy Reagan, Barbara Bush, Rosalynn Carter, and Betty Ford at the dedication of the Ronald Reagan Presidential Library, November 1991

"First Lady" is not an elected position, carries no official duties, and receives no salary. Nonetheless, she attends many official ceremonies and functions of state either along with, or in place of, the President. There is a strong tradition against the First Lady holding outside employment while occupying the office.[3] The first lady frequently participates in humanitarian and charitable work; over the course of the 20th century it became increasingly common for first ladies to select specific causes to promote, usually ones that are not politically divisive. It is common for the first lady to hire a staff to support these activities. Additionally, many have taken an active role in campaigning for the President with whom they are associated. Hillary Rodham Clinton took the role one step further when she was, for a time, given a formal job in the Clinton administration to develop reforms to the health care system.

If the United States were to have a female President, it is commonly presumed that the husband of a female President would act as an analogous "First Gentleman". This was the situation portrayed in the fictitious television series Commander In Chief, in which President Mackenzie Allen's husband Rod Calloway was titled as "First Gentleman", but President Allen's mother ultimately joined the First Family and acted as the official hostess at the White House.

Office of the First Lady

The Office of the First Lady of the United States is accountable to the First Lady of the United States for her to carry out her duties as hostess of the White House, and is also in charge of all social and ceremonial events of the White House. The First Lady has her own staff that includes the White House Social Secretary, a Chief of Staff, Press Secretary, Chief Floral Designer, Executive Chef, etc. The Office of the First Lady is a branch of the Executive Office of the President (EOP).

First Ladies of the United States

For a complete list of the first ladies, see List of First Ladies of the United States
The First Ladies National Historic Site.

See also

External links

  • http://www.loc.gov/rr/print/list/058_flal.html
  • "Office of the First Lady". Retrieved October 7. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  • "First Lady's Gallery". The White House. Retrieved October 7. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  • "The National First Ladies' Library". Retrieved October 7. {{cite web}}: Check date values in: |accessdate= (help); Unknown parameter |accessyear= ignored (|access-date= suggested) (help)
  • Paper on the role of the first lady and the influence she holds over the President

References

  1. ^ Clift, Eleanor, On Being a First Gentleman, retrieved 2007-09-15
  2. ^ http://www.firstladies.org/biographies/firstladies.aspx?biography=4 Firstladies.org
  3. ^ Caroli, Betty Boyd (2003). First Ladies from Martha Washington to Laura Bush. Oxford University Press. p. 200.


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