~ADHD (or ADD) - Attention Deficit Hyperactivity Disorder

~ADHD (or ADD) - Attention Deficit Hyperactivity Disorder
Reprinted with permission of Life Extension®.

  • Description
  • Conventional Treatments
  • Complementary Strategies
  • Summary

What is ADHD?

  • Diagnosis
  • Behavioral Signs
  • Physical Markers

If you or your child has just been diagnosed with attention deficit hyperactivity disorder (ADHD), don't despair. While in the past, a frightening regimen of powerful pharmaceuticals was used for this disorder, newer findings in nutrition and wellness are providing less invasive options for treating and preventing ADHD. ADHD is a condition marked by an inability to pay attention, concentrate, or complete tasks, sometimes accompanied by hyperactivity that occurs in both adults and children. Previously it was called simply attention deficit disorder (ADD), but clinicians now refer to this disorder as ADHD and differentiate three types: inattentive, hyperactive-compulsive, and combined. In the past, ADHD has been called hyperkinetic syndrome and even minimal brain syndrome, reflecting our poor understanding of this condition (Sangare 2000). Whatever the name, the prevalence of ADHD is soaring. According to the American Psychiatric Association's Diagnostic & Statistical Manual-IV-TR (DSM-IV), 3-7% of children currently have ADHD, with boys outnumbering girls 3 to 1. In addition, a study finds that 1-6% of adults meet formal diagnostic criteria for ADHD (Wender et al. 2001).

Obtaining a Diagnosis

The first step in deciding whether you or your child has ADHD is seeing a health professional qualified to make a diagnosis. Unfortunately, this can be a tricky process. ADHD has been called a "fad" and the condition "du jour" because so many people are suddenly "discovering" they have it due to the over-diagnosis of this disorder. One reason is that few health professionals can agree on just what ADHD is and fewer still follow the diagnostic criteria already established for it. Often diagnoses are made by a single health professional without adequate training in behavioral science. Since clear biochemical, genetic, and anatomical markers of ADHD are not yet available, diagnosing ADHD requires a detailed medical history along with observations and is best accomplished using a team approach.

According to the DSM-IV, a person needs to have first experienced ADHD in a persistent and disabling manner for 6 months before age 7 in order to qualify as having this condition. However, many people are diagnosed with ADHD without any early history of the ailment.

In addition, many other conditions can cause symptoms that mimic ADHD. Many children who have been sexually abused show symptoms that can often be confused with ADHD. For example, one study found that physical or sexual maltreatment and post-traumatic stress disorder (PTSD) (hyperarousal/hypervigilance) symptoms overlapped with those of ADHD (Ford et al. 2000). ADHD is also frequently confused with bipolar disorder but differs substantially in that bipolar children suffer from hypersexuality and parental conflicts that do not occur in ADHD (Geller et al. 2000).

Behavioral Signs

Despite the many difficulties in obtaining an accurate diagnosis, there are increasingly clear behavioral criteria for ADHD. Behavioral tests used to measure ADHD include assessments of how well patients can concentrate and process information because many ADHD children cannot think abstractly or isolate pieces of information and combine them into whole ideas, instead thinking in whole pictures. Here are some current signs to watch out for in both children and adults:

  • Motor Problems: Visual attention loss, hyperactivity, altered facial expression (such as oversized and sustained smile), abnormal motor skills, excessive fidgeting, and constant hand and leg movements (Kuhle et al. 2001)
  • Attention Problems: Procrastination, impulsive talking, difficulty starting or finishing tasks, reading disorders, low educational level, dependency on a rigid schedule to function, and extreme disorganization (Rasmussen et al. 2000)
  • Mood Disorders: Bursts of anger, frequent interrupting, inappropriate behavior in social situations, anxiety, depression, feelings of hopelessness, and low self-esteem
  • Addictions and Alienation: Drug addictions, alcohol abuse, criminal offenses, and difficulty maintaining a career or relationships (Mannuzza et al. 2000)

Physical Markers

Some exciting recent research is beginning to uncover the biochemical and genetic changes found in ADHD:

  • Low Neurotransmitters: According to a fascinating theory from evolutionary medicine called the "reward deficiency syndrome," due to genetic defects some people do not produce sufficient neurotransmitters, particularly dopamine, in response to pleasure drives for eating, love, and reproduction. As a result they seek dopamine release and sensations of pleasure via junk foods and drugs, such as sugar, alcohol, cocaine, methamphetamine, heroin, nicotine, marijuana, and by compulsive activities, such as gambling, eating, sex, and risk-taking behaviors (Comings et al. 2000). Other researchers support this theory, noting low levels of serotonin are linked to ADHD and are associated with increased aggression in humans and other animals (Mitsis et al. 2000). As we'll see below, nutritional and wellness strategies to increase these neurotransmitter levels naturally offer attractive treatment options for ADHD.
  • Genetic Defects: Following the rewards deficiency syndrome theory and the fact that stimulant medications act primarily by altering levels of dopamine, numerous genetic studies of ADHD have looked at defects in genes that control dopamine receptors. One allele of the dopamine D2 receptor gene is associated with alcoholism, drug abuse, smoking, obesity, compulsive gambling, and several personality traits (Comings et al. 2000). Other researchers support these findings, suggesting that defects in dopamine receptors genes are implicated in ADHD (Sunohara et al. 2000).

Conventional Treatments

  • Drug Addictions
  • Nonstimulant Drugs

When you or your child are first diagnosed with ADHD your primary care health professional will most likely suggest stimulant medications such as Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Desoxyn (methamphetamine), Cylert (pemoline), or Adderall. Adderall is a mixture of four different amphetamine salts and is considered the current drug of choice because it remains in the body longer than Ritalin and causes fewer ups and downs. Unfortunately, Adderall has the same side effects as other stimulant drugs used for ADHD, including drug interactions, insomnia, dizziness, headache, loss of appetite, growth impairment, tics, stomach aches, and zombie-like behavior (PDR 2002).

Stimulants for ADHD work by suppressing all spontaneous behavior. Chimps cease any self-generated behavior, while in humans, play, socializing, and exploration all decline (Breggin 1999). Stimulant medications are used for ADHD because people with this disorder have slower brainwaves in frontal and polar regions of the brain than people without it (Chabot et al. 2001). These drugs show short-term effectiveness for control of overactivity, impulsivity, inattention, aggressiveness, and low academic productivity but no long-term control. Long-term studies since the 1960s, using markers such as finishing high school, finding a job, and avoiding drugs, alcohol, or arrest, have found that children who took stimulants for ADHD did no better later in life than those who did not (Mannuzza et al. 2000).

Further, as already noted, stimulant drugs come with some severe side effects. For example, neurological side effects including insomnia, anxiety, social withdrawal, fatigue, passivity, emotional flatness, depression, and sadness due to neurotransmitter disturbances can all occur from using stimulant medications. Also, headaches, facial tics, stereotypical behavior (meaningless, compulsive activities), and obsessive-compulsive behavior (endless repetition of activities) can occur (Kooij et al 2001). A vicious cycle of medication occurs in conventional ADHD treatment in which antidepressants, sedatives, and mood stabilizers are prescribed to control emotional disturbances caused by initial stimulant medication.

Eventually, children as young as 10 years old can develop bipolar disorder due to the medications themselves. For example, one study found that bipolar adolescents with a history of stimulant exposure prior to the onset of bipolar disorder had an earlier age at onset than those without prior stimulant exposure. The study also found that bipolar adolescents treated with at least two stimulant medications were of a younger age at onset compared with those who were treated with one stimulant (DelBello et al. 2001). Other major possible side effects from stimulants include growth impairment due to decreased appetite, cardiovascular problems such as increased blood pressure, and liver damage.

When stimulants are not effective, tricyclic antidepressants such as Tofranil may be given. This class of drugs is usually prescribed to treat major depression. Tricyclic antidepressants work by increasing levels of the brain chemicals serotonin and norepinephrine that affect mood, emotions, and mental state.

Drug Addictions

Among the most troubling side effects of stimulant medications and possible cofactors in ADHD is an increased risk of drug addictions. The explosion of ADHD diagnoses and abuse of powerful stimulant drugs among children has the Drug Enforcement Agency (DEA) and National Institute of Mental Health (NIMH) concerned (Zito et al. 2000). Here are some of the major drug addictions that can occur with ADHD and stimulant medications:

  • Alcoholism. One study notes that indicators of ADHD are found among alcoholics, which may indicate high rates of ADHD in their earlier years of life. The study also points to the strong association between addiction and ADHD. Both disorders share clinical aspects and relevant biological markers, and for both, alterations in the same cerebral systems occur (Ponce Alfaro et al. 2000).

  • Smoking. A study by Kent et al. (2001) notes that nicotine addiction is more likely in people with ADHD since nicotine promotes the release of dopamine and has been shown to improve attention in adults with ADHD. Another study notes that ADHD is linked to cigarette smoking in children, and mothers who smoke are more likely to have children with ADHD (Levin et al. 2001).

  • Cocaine. Mothers who use cocaine are more likely to give birth to children with ADHD. A study of urban African-American children (Bandstra et al. 2001) suggests prenatal cocaine exposure can lead to long-lasting disruption of the brain systems regulating arousal and attention.

  • Ritalin Abuse. The DEA classifies methylphenidate and amphetamine as Schedule II drugs (those with the very highest potential for addiction and abuse), a category that also includes methamphetamine, cocaine, and the most potent opiates and barbiturates. Methylphenidate is derived from the same family as cocaine and gives a similar, brief 4-hour high (Vastag 2001), making it an increasingly popular recreational drug. The number of students who abuse Ritalin has exploded. In one survey at a public liberal arts college in Massachusetts, more than 16% of the students reported they had tried methylphenidate recreationally, and 12.7% reported they had taken the drug intranasally, about the same figures found for cocaine and amphetamine use (Babcock et al. 2000). Ritalin tablets are often taken crushed and snorted like cocaine for a quick burst of energy. Emergency room admissions due to Ritalin abuse have also climbed rapidly, and severe side effects such as hyperthermia, hypertension, strokes, seizures, and death are often observed.

Nonstimulant Drugs

To help reduce the harsh side effects of conventional treatments for ADHD, some alternative nonstimulant drugs are being developed. Be sure to check with your primary care health professional to see if some of these drugs might be right for you:

  • Atomoxetine is an investigational, nonstimulant drug that is thought to act by blocking norepinephrine transport in the brain and appears to be safe and well tolerated (Michelson et al. 2001).

  • Gabapentin is an anticonvulsant drug released in the United States in 1993 for use as adjunctive therapy in refractory partial epilepsy and is sometimes used for bipolar adults. The drug appears to have a good safety profile (Hamrin et al. 2001).

  • Bupropion appears to be effective and well tolerated in adolescents with ADHD and depression (Daviss et al. 2001).

  • Modafinil is a wake-promoting yet nonstimulant drug that is helpful in adults with ADHD (Taylor et al. 2000).

  • Tomoxetine is a novel noradrenergic-specific (stimulated or released by norepinephrine) antidepressant; Aricept (donepezil), cholinergic (acetylcholine releasing) cognitive enhancing anticholinesterase inhibitors; and ABT-418, a novel nicotinic analogue, also look promising (Biederman et al. 2000).

Continued . . .

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