ADHD

ADHD is the most common behavioural disorder in children. The problem is not new – it was first accurately described in children in 1902. Its modern title, ADHD, goes back to 1983. ADHD is increasingly being employed as a diagnostic label for individuals who display a wide range of symptoms, such as restlessness, inability to stay focused, mood swings, temper tantrums, problems completing tasks, disorganization, inability to cope with stress, and impulsivity. Frequently its symptoms are co-mingled with learning problems, oppositional conduct, and depression, which altogether compound the family’s emotional burden.

The cause of ADHD is likely to involve a variety of genetic and neurological factors.

Hereditary factors are thought to contribute most, accounting for 50 percent of the variance. An organic neurological problem in the brain also has considerable research support. Social factors alone are not considered an etiological cause but may make a pre-existing condition worse. In western countries, including New Zealand, 1-7 % of children were diagnosed and the disorder is responsible for 30-50 percent of the referrals to mental health services for children. ADHD is more prevalent in boys by a 3:1 margin.

Symptoms

ADHD is defined as being excessively distracted, and this is usually accompanied by impulsiveness. It is present by the age of seven years and it should be apparent in more than one setting, for example at home and in the classroom. Children may have problems with giving close attention to details or makes careless mistakes in schoolwork or other activities. There may also be trouble keeping attention on tasks or play activities. Often the child does not seem to listen when spoken to directly nor follow instructions, and often fails to finish schoolwork or chores. They often avoid or dislike things that take a lot of mental effort for a long period of time such as schoolwork or homework. There is trouble in organizing activities and frequently they may lose things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). They can be easily distracted and forgetful in daily activities.

ADHD can be present in adults, with a similar symptom picture but it may be less obvious. They may be distracted and forget names, phone numbers, appointments, car keys, cell phones and wallets. Hyperactivity and poor concentration should be present for a diagnosis of adulthood ADHD, along with two of the five additional symptoms: mood swings; hot temper; inability to complete tasks and disorganization; stress intolerance; and impulsivity. It is estimated that 30% of children with ADHD will have some kind of adult manifestation.

Diagnosis and Pharmaceutical Interventions

The definitive diagnosis must be deduced from a highly detailed clinical history, as taken from information provided by parents, teachers, and the afflicted individual. The conscientious clinician will do an in-depth parent and patient interview along with a physical examination, solicit corroborative information from adults in other settings (especially teachers), and obtain an assessment of academic functioning. Because ADHD is a developmental disorder, symptom manifestations are highly individualistic and core symptoms may shift with age. The main diagnostic criterion is from the Diagnostic and Statistical Manual of Mental Disorders (DSM-VI). Children receive a diagnosis if they have core symptoms of either attention problems or hyperactivity/impulsiveness, or both.

Pharmaceutical Medications

Common forms of medication given to children and adults with ADHD are methylphenidate (Ritalin, Rubifen, Concerta), atomoxetine (Strattera) and dexamphetamine. The most well known of these medications is methyphenidate. Methylphenidate acts on the central nervous system with a dopamine-agonistic effect that is slower in onset but mechanistically almost identical to cocaine and amphetamines. This degree of reliance on methylphenidate is unfortunate because its action is virtually identical with cocaine, to such an extent that in the United States it is a Schedule II controlled drug, which means that it is classified as having high potential for abuse. It can interact with some antidepressants, especially MAOIs. It should not be given to children that also have anxiety, as it can make anxiety and nervousness worse for some. It should also not be used for those children who have been diagnosed or have a family history of Tourettes’ syndrome. Atomoxetine is considered to be a non-stimulant treatment for ADHD, a fairly new medication that does not have long term studies. It has some side effects, most noticeably constipation and loss of or decreased appetite, upset or sore stomach, nausea or vomiting, which can cause weight loss. It causes mood swings, early morning waking, sleepiness, tiredness or irritability.

Lifestyle and Dietary Modifications

The two most studied dietary approaches to ADHD are the Feingold diet and a hypoallergenic diet. The Feingold diet was developed by Benjamin Feingold, M.D., on the premise that salicylates (chemicals similar to aspirin that are found in a wide variety of foods) are an underlying cause of hyperactivity. As many as 10 to 25% of children may be sensitive to salicylates. The Feingold diet also eliminates synthetic additives, dyes, and chemicals, which are commonly added to processed foods. The yellow dye tartrazine has been specifically shown to provoke symptoms in controlled studies of ADHD-affected children. Not every child reacts, but enough do so that a trial avoidance may be worthwhile. The Feingold diet is complex and usually requires guidance.

Eliminating individual allergenic foods and additives from the diet can help children with attention problems. A hypoallergenic diet can reduce food additives as well as intolerances to common foods like wheat, dairy, citrus, soy and eggs. Since some people find it difficult to manage dietary changes a food tolerance test can evaluate sensitivities via a simple blood test. . More information on Food tolerance testing.

Consuming sugar may aggravate ADHD. One study found that avoiding sugar reduced aggressiveness and restlessness in hyperactive children. Girls who restrict sugar have been reported to improve more than boys.

Smoking during pregnancy should be avoided, as it appears to increase the risk of giving birth to a child who develops ADHD.

Lead and other heavy-metal exposures have been linked to ADHD. If other therapies do not seem to be helping a child with ADHD, the possibility of heavy-metal exposure can be explored with a health practitioner.

Nutritional Factors Shown to be Beneficial

Magnesium

Some children with ADHD have lowered levels of magnesium. Those given magnesium supplementation had a significant decrease in hyperactive behaviour.
Dose: 100-200 mg a day

Vitamin B complex

B vitamins have been shown to be deficient in most children with ADHD. B vitamins function as cofactors in energy producing reactions, detoxification reactions and also in the formation of some neurotransmitters.
Dose: 50 mg of B complex twice a day

Vitamin B6

Vitamin B6 or pyridoxine, is involved in the body’s conversion of amino acids to serotonin, one of the main neurotransmitters involved in mood. It may alleviate hyperactivity; for some children it works better than methylphenidate (Ritalin).
Dose: 50-200 mg a day

Omega 3 Fish Oils

A deficiency of several essential fatty acids has been observed in some children with ADHD. Dose 1-2 grams a day for children, 2-6 grams a day for adults

Phosphatidylserine

Phosphatidylserine is the subject of many studies around the world, showing that it improves attention, concentration, short term memory and imparts a protective effect against stress chemicals.
Dose: 100 -300 mg day

DMAE (Dimethylaminoethanol)

DMAE can help alleviate the behavioural problems and hyperactivity associated with ADHD.
Dose: 100-300 mg a day

Proanthocyanidins

Proanthocyanidins are powerful antioxidants found in plants. Thier use may improve attention in ADHD.
Dose: 100 – 300 mg a day

ProBiotic supplementation

Lactobacillis acidophilus, Lactobacillus GG, Bifidobacterium bifidus and Saccharomyces boulardii are examples of good bacteria that can be used therapeutically, especially in children where there has been a history of antibiotic use.
Dose: One to two billion colony forming units (CFUs) per day of acidophilus is considered to be the minimum amount for the healthy maintenance of intestinal microflora.

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