Around one in 20 people has attention-deficit hyperactivity disorder (ADHD). It’s one of the most common neurodevelopmental disorders in childhood and often continues into adulthood.

ADHD is diagnosed when people experience problems with inattention and/or hyperactivity and impulsivity that negatively impacts them at school or work, in social settings and at home.

Some people call the condition attention-deficit disorder, or ADD. So what’s the difference?

In short, what was previously called ADD is now known as ADHD. So how did we get here?

Let’s start with some history

The first clinical description of children with inattention, hyperactivity and impulsivity was in 1902. British paediatrician Professor George Still presented a series of lectures about his observations of 43 children who were defiant, aggressive, undisciplined and extremely emotional or passionate.

Since then, our understanding of the condition evolved and made its way into the Diagnostic and Statistical Manual of Mental Disorders, known as the DSM. Clinicians use the DSM to diagnose mental health and neurodevelopmental conditions.

The first DSM, published in 1952, did not include a specific related child or adolescent category. But the second edition, published in 1968, included a section on behaviour disorders in young people. It referred to ADHD-type characteristics as “hyperkinetic reaction of childhood or adolescence”. This described the excessive, involuntary movement of children with the disorder.

In the early 1980s, the third DSM added a condition it called “attention deficit disorder”, listing two types: attention deficit disorder with hyperactivity (ADDH) and attention deficit disorder as the subtype without the hyperactivity.

However, seven years later, a revised DSM (DSM-III-R) replaced ADD (and its two sub-types) with ADHD and three sub-types we have today:

• predominantly inattentive
• predominantly hyperactive-impulsive
• combined.

Why change ADD to ADHD?

ADHD replaced ADD in the DSM-III-R in 1987 for a number of reasons.

First was the controversy and debate over the presence or absence of hyperactivity: the “H” in ADHD. When ADD was initially named, little research had been done to determine the similarities and differences between the two sub-types.

The next issue was around the term “attention-deficit” and whether these deficits were similar or different across both sub-types. Questions also arose about the extent of these differences: if these sub-types were so different, were they actually different conditions?

Meanwhile, a new focus on inattention (an “attention deficit”) recognised that children with inattentive behaviours may not necessarily be disruptive and challenging but are more likely to be forgetful and daydreamers.

Why do some people use the term ADD?

There was a surge of diagnoses in the 1980s. So it’s understandable that some people still hold onto the term ADD.

Some may identify as having ADD because out of habit, because this is what they were originally diagnosed with or because they don’t have hyperactivity/impulsivity traits.

Others who don’t have ADHD may use the term they came across in the 80s or 90s, not knowing the terminology has changed.

How is ADHD currently diagnosed?

The three sub-types of ADHD, outlined in the DSM-5 are:

• predominantly inattentive. People with the inattentive sub-type have difficulty sustaining concentration, are easily distracted and forgetful, lose things frequently, and are unable to follow detailed instructions
• predominantly hyperactive-impulsive. Those with this sub-type find it hard to be still, need to move constantly in structured situations, frequently interrupt others, talk non-stop and struggle with self control
• combined. Those with the combined sub-type experience the characteristics of those who are inattentive and hyperactive-impulsive.

ADHD diagnoses continue to rise among children and adults. And while ADHD was commonly diagnosed in boys, more recently we have seen growing numbers of girls and women seeking diagnoses.

However, some international experts contest the expanded definition of ADHD, driven by clinical practice in the United States. They argue the challenges of unwanted behaviours and educational outcomes for young people with the condition are uniquely shaped by each country’s cultural, political and local factors.

Regardless of the name change to reflect what we know about the condition, ADHD continues to impact educational, social and life situations of many children, adolescents and adults.

Kathy Gibbs, Program Director for the Bachelor of Education, Griffith University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

In recent years, there’s been increasing hype about the potential health risks associated with so-called “ultra-processed” foods.

But new evidence published this week found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.

While this newly published research and associated editorial are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.

What are ultra-processed foods?

Ultra-processed foods are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.

Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.

In many other countries, ultra-processed foods make up a large proportion of what people eat. A recent study estimated they make up an average of 42% of total energy intake in Australia.

How do ultra-processed foods affect our health?

Previous studies have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a higher risk of type 2 diabetes, and death from heart disease and stroke.

Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been recognised as risk factors for a range of diseases.

It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process may lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.

It’s also possible certain food additives may impair normal body functions, such as the way our cells reproduce.

Is it harmful? It depends on the food’s nutrients

The new paper just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.

The study found a small increase in the risk of early death with higher ultra-processed food consumption.

But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.

This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.

When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.

This finding matches another recent study that suggests ultra-processed wholegrain foods are not a driver of poor health.

The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.

Should dietary guidelines advise against ultra-processed foods?

Existing national dietary guidelines have been developed and refined based on decades of nutrition evidence.

Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.

Dietary guidelines generally already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.

But some nutrition researchers have called for dietary guidelines to be amended to recommend avoiding ultra-processed foods.

Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.

Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.

Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the biggest contributor to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.

So how can we improve our diets?

There is strong consensus on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.

These policies are underpinned by well-established systems for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the Health Star Rating food labelling scheme.

Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.

Unhealthy diets and obesity are among the largest contributors to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.

Gary Sacks, Professor of Public Health Policy, Deakin University; Kathryn Backholer, Co-Director, Global Centre for Preventive Health and Nutrition, Deakin University; Kathryn Bradbury, Senior Research Fellow in the School of Population Health, University of Auckland, Waipapa Taumata Rau, and Sally Mackay, Senior Lecturer Epidemiology and Biostatistics, University of Auckland, Waipapa Taumata Rau

This article is republished from The Conversation under a Creative Commons license. Read the original article.