ATTENTION-DEFICIT/HYPERACTIVITY DISORDER

Attention-Deficit/Hyperactivity Disorder (ADHD) is thought to be a neurological disorder, and is sometimes referred to as ADD for those without hyperactivity. It is always present from childhood, which manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractibility. ADHD is currently considered to be a chronic syndrome for which no medical cure is available and is a co-morbid disorder associated with Autism Spectrum Disorders such as autism and Asperger's syndrome.

Controversy surrounds the designation of ADHD as a true medical disorder, such as whether or not the diagnosis denotes a disability in its traditional sense, or simply describes the neurological property of an individual. A wide body of evidence has shown that stimulant medication is the most effective way to treat the disorder. According to a majority of medical research in the United States, as well as other countries, ADHD is today generally regarded to be a non-curable neurological disorder for which, however, a wide range of effective treatments are available.

Methods of treatment usually involve some combination of medication, psychotherapy, and other techniques. Some patients are able to control their symptoms over time, without the use of medication. Other individuals who meet the diagnostic criteria of ADHD do not consider themselves to be handicapped by the disorder and therefore may remain undiagnosed or, after a positive diagnosis, untreated.

ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.

Symptoms of ADHD

The symptoms of ADHD fall into the following two broad categories:

The first is Inattention and can include:
• Failing to pay close attention to details
• Making careless mistakes when doing schoolwork or other activities
• Trouble keeping attention focused during play or tasks
• Appearing not to listen when spoken to
• Failing to follow instructions or finish tasks
• Avoiding tasks that require a high amount of mental effort and organization
• Frequently losing items required to facilitate tasks or activities
• Excessive distractibility and forgetfulness
• Procrastination, inability to begin an activity
• Difficulties with household activities.

The second category is Hyperactivity-impulsive behavior, including:
• Fidgeting with hands or feet or squirming in seat
• Leaving seat often, even when inappropriate
• Running or climbing at inappropriate times
• Difficulty in quiet play
• Frequently feeling restless
• Excessive speech
• Answering a question before the speaker has finished
• Failing to await one’s turn
• Interrupting the activities of others at inappropriate times
• Impulsive spending, leading to financial difficulties.

A positive diagnosis is usually only made if the person has experienced six of the above symptoms for at least three months. Symptoms must appear consistently in varied environments (e.g., not only at home or only at school) and interfere with function. One of the difficulties in diagnosis is the incidence of co-morbid conditions, especially the presence of Autism Spectrum Disorders, or bipolar disorder which is being reported at earlier ages than previously described.

Children who grow up with ADHD often continue to have symptoms as they grow into adulthood. Adults face some of their greatest challenges in the areas of self-control and self-motivation, as well as executive functioning (also known as working memory). If the child is not treated appropriately, co-morbid conditions, such as depression, anxiety and self-medicating substance abuse may present as well. If a patient presents with such conditions as well, the co-morbid condition may be treated first, or simultaneously.

Possible causes

Research has raised possible causes but with no definitive proof as yet. Some proposed causes include:
• A PET scan study revealing global cerebral glucose metabolism was 8.1% lower in ADHD patients
• A combination of various genes to do with dopamine transporters
• Children with ADHD lose zinc when exposed to a food dye
• A lack of fatty acids, specifically omega-3 fatty acids
• A moderate to severe protein deficiency.
• Biohazards including alcohol, tobacco smoke, and lead poisoning.
• Allergies, such as those to artificial additives
• Complications during pregnancy and birth
• Premature birth
• Babies of women who smoked while pregnant

• Head injuries.

Treatment of ADHD

There are many options available to treat people diagnosed with ADHD. The options with the greatest scientific support include a variety of medications, behavior modification, and educational interventions.

Medications for ADHD

The most frequently prescribed medications for ADHD are stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. Because many of the medications used to treat ADHD are powerful stimulants with a potential for abuse, there is controversy surrounding prescribing these drugs for children and adolescents. However, research on ADHD sufferers who either receive treatment with stimulants or go untreated has indicated that those treated with stimulants are in fact much less likely to abuse any substance than ADHD sufferers who are not treated with stimulants.

Diet modification for ADHD

As noted above there are indications that children with ADHD are metabolically different from others, and it has therefore been suggested that diet modification may play a role in the management of ADHD. Perhaps the best known of the dietary alternatives is the Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets. In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness. Later, zinc and multivitamins have been promoted as cures, and currently the addition of certain fatty acids such as omega-3 has been proposed as beneficial.

Herbs, coffee and ADHD

For some people with ADHD mild stimulants such as caffeine and theobromine have similar effects to the more powerful drugs commonly used in treating the disorder. Herbal supplements such as ginkgo biloba are also sometimes cited. There is some empirical data suggesting caffeine can improve the function of children suffering from ADHD.

Audio-visual therapy and ADHD

Other alternatives include audio-visual entrainment which uses light and sound stimulation to guide and change brainwave patterns. While safe for most, it cannot be used by those suffering from photosensitive epilepsy due to the risk of triggering a seizure.

Cerebellar stimulation

Cerebellar stimulation assumes that by improving the patient’s cerebellar function, many ADHD symptoms can be reduced or even eliminated permanently. As noted above, several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts. Several programs of balance, coordination, eye and sensory exercises that specifically involve the functions of the cerebellum are used to treat ADHD, Asperger’s syndrome, and many learning difficulties such as dyslexia and dyspraxia. Most prominent are the DORE program, the Learning Breakthrough Program, and the Brain Gym. No substantial body of research exists as yet to support these treatment approaches.

Controversy about ADHD

Some people argue that ADHD is simply a variant of normal human behavior. Others claim that the diagnostic criteria are vague enough to allow virtually anybody with persistent unwanted behaviors to be classified as having ADHD. It has also been noted that most people with ADHD have no difficulties concentrating when they are doing something that interests them, whether it is educational or entertainment. Others have argued that children in foster care or in violent abusive environments often have symptoms similar to ADHD, suggesting environmental factors may be involved.

Supporters of the ADHD diagnosis say that somewhere between 60 and 80% of children diagnosed with ADHD have a second diagnosis such as a comorbid conduct disorder, Tourette syndrome, or Asperger’s syndrome.

Further reading: Brain chemistry and autism

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