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ADHD
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What is ADHD?
Common in both children and adults, ADHD, or attention deficit hyperactivity disorder, is a brain disorder marked by an inability to focus, hyperactivity, impulsivity, and other disruptive behaviors. Also called attention deficit disorder, or ADD, the condition typically appears by age seven. Because the hyperactivity component of ADHD may seem to lessen during adolescence, a common myth is that most people "outgrow" the condition. But it is now recognized that in up to two thirds of cases, ADHD is a lifelong problem that carries over into the adult years. Unfortunately, effective medications are commonly discontinued at a very vulnerable time--during the teen years, when kids are entering high school or heading off to college and need all the help they can get.
An ADHD diagnosis may be particularly hard to make in adults because the disruptive behaviors that define this condition lie along a continuum, and it may not be clear that someone actually has the disorder. In addition, physicians rarely inquire whether a patient knew he had ADHD as a child or ask the two or three questions that could lead to a diagnosis.
Those with ADHD tend to share certain traits: chronic forgetfulness; an inability to carry out instructions or finish tasks; emotional storms triggered by relatively minor events; talking too much; and becoming easily distracted. People with ADHD are just as intelligent as their peers, but find it hard to focus and finish tasks at hand. Not surprisingly, people with ADHD will often pair-up with others who act as "finishers" for their "unfinished" projects.
ADHD in Children: According to the National Institute of Mental Health, ADHD is the most common mental health disorder in children, affecting some 5 million youngsters. Boys are diagnosed with it much more often than girls. This may be because girls are less likely to exhibit hyperactivity, and so less likely to be referred to a health-care professional for evaluation. In fact, hyperactivity need not even be present to make a diagnosis of ADHD at all.
In some studies, nearly 20% of kids have been found to have symptoms of the disorder, though many health professionals argue that the condition is over-diagnosed. Interestingly, the U.S. accounts for nearly 90% of the drugs that are prescribed for ADHD. In contrast, many primary-care physicians in Great Britain, for instance, are skeptical about the existence of ADHD at all. (Americans who move there may experience difficulty convincing a physician to write a prescription for medication.)
ADHD in Adults: While everyone can feel overwhelmed, distracted, and scattered from time to time, the estimated 2 to 5 million American men and women with ADHD often feel they are fighting a constant battle that threatens to spin out of control. Everyday tasks (balancing a checkbook, keeping appointments, paying bills) can become a daunting challenge, especially if a task is deemed "uninteresting." In an ADHD brain "executive" functions may be impaired, leading to poor planning and organizational skills. On the other hand, people with ADHD often function well when confronted with a job they find fascinating.
Consequences of ADHD: It is key that ADHD be identified and treated as early as possible. Otherwise, behavioral and school problems can progress to poor self esteem, serious accidents, and persistent underachievement. Poor self worth, frustration and irritation, depression, anxiety, poor sleep habits, and other issues may ensue, compounding the problem. In adults with ADHD, alcoholism and illicit drug use are common problems and it is not unusual for them to "self-medicate" with nicotine or caffeine. They often have a history of repeated mental health consultations, failed marriages and multiple jobs.
Key Symptoms
In children:
In adults:
What Causes ADHD?
Scientists have myriad theories for the origins of ADHD, but despite intensive research, the cause still remains murky. In the end, it's likely that many factors contribute to the array of symptoms of ADHD.
Genetics: Genes are thought to play an important role in ADHD, accounting for up to 80% of cases. ADHD also runs in families: If you have a child who has the disorder, there's a decent chance you may have it yourself. In fact, many times a kid is diagnosed first, before an affected parent or relative puts two and two together and realizes that they, too, have a name for their problem. As with many conditions, it's likely that carrying a certain gene or genes makes you susceptible to the disorder and other factors come into play. Conduct problems, anxiety, and addictions may likewise run in these families. In a small number of cases, ADHD may arise in those who have a genetic defect that makes them unresponsive to thyroid hormone.
Brain Defects: Irregularities in certain brain chemicals or structures may also play a role in ADHD. Some research suggests that the brains of people with ADHD can't effectively process glucose, the blood sugar that fuels energy. ADHD sufferers may also have problems processing dopamine or norepinephrine, chemical messengers in the brain called neurotransmitters that foster effective communication between nerve cells. Deficiencies in these chemicals, in fact, may boost the urge for seeking "rewards," such as those supplied by nicotine, alcohol, or illicit drugs, which may be one reason adults with ADHD are so susceptible to substance abuse and high-risk activities.
Aberrations in brain structures may also be to blame. Brain scans have revealed defects in the right side of the brain and in an area near the front, which acts as the brain's executive secretary, helping to organize and prioritize and put the brakes on excessive activity. Abnormalities in other areas near the brain's center may also lead to impulsive behavior.
Nutrition: Some (but not all) doctors believe that particular foods and food additives may alter levels of certain brain chemicals and contribute to ADHD. Certain research indicates that artificial colorings (especially red, yellow, or green dyes), milk, chocolate, eggs, wheat, and salicylates (an ingredient in aspirin and many fruits, vegetables, and spices) may be culprits. Deficiencies in zinc and certain essential fatty acids, the key components of fats and oils, may have similar effects on behavior. Sugar is often cited as contributing to hyperactivity, although study findings (especially those funded by the sugar industry) are mixed. Children who are malnourished as infants are also prone to developing ADHD.
Environmental Toxins: Complications during pregnancy or prenatal exposure to alcohol, nicotine, or environmental pollutants such as dioxins or PCBs may also be partly responsible. In addition, accumulation of even minimal amounts of lead in the body, which usually arises when children consume paint chips that are peeling off the walls of old homes, may cause distractibility and troubled thinking typical of ADHD.
Conventional Treatments
Medications and counseling are the cornerstones of conventional treatment for ADHD. Drug therapies can produce remarkable improvements in some people and are generally safe and effective. However, combining drugs with behavioral therapies usually produces the best results. With a two-pronged approach, school or job performance almost always improves. Depression and anxiety, if present, also often ease.
Medications
Drugs that have long been used in children with ADHD are also proving effective for adults with the disorder. You may notice a profound improvement soon after starting on a medication, usually a central nervous system stimulant such as Ritalin. It might take several weeks to see results. The dose may then have to be adjusted or a new drug tried. You may need to try various medicines or combinations to find a regimen that works for you. With the right medications, your concentration and ability to go about your daily tasks can improve dramatically.
Stimulants: The most commonly prescribed stimulant for ADHD is Ritalin (methylphenidate), which appears to work by boosting levels of dopamine in the brain. As an alternative, some people do better on a dextroamphetamine, such as Dexedrine or Adderall, a longer-acting mix of amphetamines. These drugs usually need to be taken several times a day.
Newer, long-acting forms of these stimulants that can be taken once a day are now available, including Ritalin-LA, Concerta, Metadate, and Adderall XR. They are less likely to produce "rebound" effects, in which symptoms surge again once a dose wears off. You may also need to take one of the regular short-acting stimulants in the morning to help "ramp up" for the day. Longer-acting medications are especially good for people with ADHD because by definition they are disorganized, forgetful, and tend to lose things (like their medication).
Another stimulant that may be effective is pemoline (Cylert), which may take several weeks to achieve effectiveness. However, because it can damage the liver, you will need to be monitored regularly by your doctor.
Antidepressants: Drugs that fight depression may also be tried, sometimes in combination with stimulants, as a second-line treatment for ADHD. They are an especially good choice if you're also depressed. Among the antidepressants that may be useful are venlafaxine (Effexor) and bupropion (Wellbutrin), which alter levels of the mood-enhancing brain chemicals norepinephrine, dopamine, and serotonin. Tricyclic antidepressants such as imipramine (Tofranil) and amitriptyline (Elavil) may also be beneficial. One recent study reported that lithium, which is commonly used to treat bipolar disorder (manic depression), might be as effective as Ritalin for adults with ADHD.
Additional Medications: Other medicines are being tested in adults with ADHD. One promising candidate is a new drug called atomoxetine (Strattera), a unique non-stimulant that floods the brain with norepinephrine. Another interesting possibility is the bio-engineered drug modafinil (Provigil), which keeps people awake without causing the buzz and jitteriness typical of stimulants. It is currently used to treat a disabling condition that causes people to drop off to sleep for brief periods throughout the day.
The blood pressure drugs clonidine (Catapres) and guanfacine (Tenex) are effective for some people, including those who also have Tourette's syndrome, a mysterious condition that sometimes accompanies ADHD and is characterized by verbal and physical outbursts and tics. Because these drugs also affect the heart, however, they must be used with extreme caution. Other drugs under investigation include the Alzheimer's drugs donepezil (Aricept) and tacrine (Cognex), and nicotine gums and patches.
Tests and Procedures
The most effective way to diagnose ADHD is to be aware of the signs and symptoms, including disruptive behavior patterns during childhood, that may have persisted into your adult years. Early reports from teachers or parents can be helpful in tracking down the diagnosis.
ADHD can't be diagnosed by a brain scan or lab test. However, researchers are studying various tests to track down physical or cognitive changes that may help to clarify the diagnosis. For example, investigators have conducted advanced imaging tests such as PET scans, MRIs, and something called SPECT and have noted alterations in brain wave patterns that may suggest a problem. Still, you shouldn't have to undergo these high-tech tests. They are very expensive and don't paint a clear picture of what's going on or what treatments might work for you.
In the rare instances where exposure to lead or other environmental toxins may be an issue, you can have your doctor test a hair or urine sample for the presence of toxic metals. If they are present, your doctor can prescribe medications to get these substances out of your body.
Nutritionally oriented doctors believe that certain food sensitivities may contribute to ADHD. They may recommend either a blood test to determine if your immune system is creating antibodies to culprit foods, or simply following a food sensitivity elimination diet and see if your symptoms improve.
Once it is confirmed that you do have ADHD, behavioral therapies are a noninvasive way to help you cope with the condition, though they do require an investment in time and money. Treatments might consist of one-on-one counseling sessions as well as family support and group sessions.
Treatment and Prevention
Because the causes of ADHD still remain somewhat poorly understood, there are no ways to prevent the disorder from occurring in the first place. Still, a number of supplements, alternative therapies, and dietary and lifestyle changes may help to bring symptoms under control and allow you to better manage your condition, and your life.
Most alternative therapies for ADHD have not been rigorously tested. And in the few small studies that do exist, they are often not as effective as the traditional stimulant drugs such as Ritalin that are commonly prescribed to treat the disorder. However, just as medications can be used along with behavioral therapies to boost effectiveness, alternative therapies and self-care measures can likewise complement the work of conventional treatments. Use of certain supplements and biofeedback techniques, for example, may eventually allow you to cut back on your Ritalin dosage.
In general, unless otherwise noted, these alternative therapies can be safely used along with drugs or other therapies. In many cases, these complementary and alternative therapies are aimed at what seem to be the root causes of the problem.
Note: The doses and treatments listed are for adults. If you have a child with ADHD, be sure to consult a physician who is experienced in using natural therapies in children.
How Supplements Can Help
Various nutritional supplements can help to ease distractibility, hyperactivity, and impulsive behavior. They won't work for everybody and are not intended as a cure, but they are safe and may be helpful. Effects are not immediate but are usually felt within about two months. They can all be taken together as well as with conventional stimulant drugs.
Just a reminder: If you have a serious medical condition or are taking medication, it's always a good idea to check with your doctor before beginning a supplement program.
The following nutritional supplements can be helpful in managing attention deficit hyperactivity disorder.
Self-Care Remedies
Nutritionally oriented physicians who treat ADHD typically wait to prescribe Ritalin and comparable stimulants until dietary and lifestyle changes have proven ineffective.
Dietary changes. So many foods and substances have been shown to enhance hyperactivity that it's truly worth the effort of at least giving the following dietary elimination program at least a six to eight week trial. If you notice improvement by eliminating certain foods, you can gradually reintroduce certain foods to determine which are the real culprits.
Lifestyle changes. In addition to dietary changes, a few simple strategies for dealing with everyday issues more effectively may help. Time-tested tips include:
Alternative Therapies
Certain alternative therapies can complement the effects of medications and other treatments for ADHD. Some are useful for treating the stress, anxiety, and depression that can accompany the disorder.
During a neurofeedback session, the person sits in front of a computer monitor, with sensory leads wired to the scalp that measure brain wave activity. When the mind becomes calm and focused, the computer program responds with a blip, beep, or other "reward." In this way, selected patients can train themselves to become attentive. Some studies have shown benefits after only a few sessions, with better attention, less impulsive behaviors and response times, and an increase in IQ. More typically, however, up to 40 to 50 costly sessions are required, and it does not work for everyone. For more information, see the Nutricraze Reference Library entry on biofeedback.
When to Call a Doctor
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