Any child may show inattention, distractibility, impulsivity, or hyperactivity at times, but the child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level.
Even though the child with ADHD often wants to be a good student, the impulsive behavior and difficulty paying attention in class frequently interferes and causes problems. Teachers, parents, and friends know that the child is misbehaving or different but they may not be able to tell exactly what is wrong.
Parents are distressed when they receive a note from school saying that their child won't listen to the teacher or causes trouble in class. One possible reason for this kind of behavior is Attention Deficit/Hyperactivity Disorder (ADHD).
A child with ADHD often shows some of the following:
- blurts out answers
- easily distracted
- fidgets or squirms
- impatience
- inattention to details and makes careless mistakes
- interrupts or intrudes on others
- leaves seat and runs about or climbs excessively
- loses school supplies, forgets to turn in homework
- seems "on the go"
- talks too much and has difficulty playing quietly
- trouble finishing class work and homework
- trouble following multiple adult commands
- trouble listening
- trouble paying attention
A child presenting with ADHD symptoms should have a comprehensive evaluation. Parents should ask their pediatrician or family physician to refer them to a child and adolescent psychiatrist, who can diagnose and treat this medical condition.
A child with ADHD may also have other psychiatric disorders such as conduct disorder, anxiety disorder, depressive disorder, or bipolar disorder. These children may also have learning disabilities.
Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer. The child experiences more failure than success and is criticized by teachers and family who do not recognize a health problem.
Research clearly demonstrates that medication can help improve attention, focus, goal directed behavior, and organizational skills. Medications most likely to be helpful include the stimulants (various methylphenidate and amphetamine preparations) and the non-stimulant, atomoxetine. Other medications such as guanfacine, clonidine, and some antidepressants may also be helpful.
Cognitive therapy can help a child build self-esteem, reduce negative thoughts, and improve problem-solving skills. Parents can learn management skills such as issuing instructions one-step at a time rather than issuing multiple requests at once. Education modifications can address ADHD symptoms along with any coexisting learning disabilities.
Other treatment approaches may include cognitive-behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Behavioral therapy can help a child control aggression, modulate social behavior, and be more productive.
A child who is diagnosed with ADHD and treated appropriately can have a productive and successful life.
Treatment choices—
Children's hospitals that have psychiatric units with programs dedicated to treating ADHD are often a good place to receive treatment, but a psychiatrist's or neurologist's office will generally have staff who can understand and treat ADHD effectively.
ADHD can be treated by psychiatrists, psychiatric/mental health nurse practitioners, and neurologists; some practitioners of this type specialize in treating children with ADHD and others specialize in the treatment of adults with ADHD.
In the United States, an educational institution must make accommodations for a child with ADHD when the educational institution is provided with diagnostic documentation signed by a physician or psychologist (see section 503 of American Disabilities Act).
A pediatric psychiatrist/psychologist or neurologist can provide the child’s school with a written ADHD diagnosis that informs the school of accommodations that may aid the student in academic endeavors.
Accommodations may include:
- A distraction-free environment during examination
- Copies of lecture notes
- Extended due dates for homework
- Extended time for taking exams
- Permission to record lectures
Medications endorsed by American Psychiatric Association—
Amphetamine based medications:
Methylphenidate based medications:
Osmosis:
The only ADHD medication that currently utilizes osmotic pressure to achieve a controlled release of medicine is Concerta.
Transdermal:
Daytrana is applied to the skin in the morning and the drug is evenly absorbed throughout the day, the patient should expect to feel the effects of Daytrana until two hours after the patch was removed, so patients should expect to take the patch off a few hours before bedtime.
Prodrug:
A prodrug is a compound which is itself inactive, but when metabolized becomes pharmacologically active. Prodrugs are usually designed to improve oral bioavailability as the chemical properties of the active compound may cause it to be poorly absorbed from the gastrointestinal tract. Lisdexamfetamine (Sold as Vyvanse) is a prodrug of dextroamphetamine. Vyvanse is a geltin capsule that quickly disolves once swollowed releasing lisdexamfetamine dimesylate.
Medications not endorsed by American Psychiatric Association—
Benzphetamine (Didrex) — a less powerful stimulant. It has little psychoactive effects until the liver metabolizes it into amphetamine and methamphetamine. Since this acts as a sustained release mechanism, it has lower abuse potential and is schedule 3.
Amineptine (Survector/Maneon) — a tricyclic antidepressant now illegal in many countries for being thought to have a small potential for abuse. It is still legal in some parts of the EU, such as Spain and Italy; it is no longer available in the U.S., Canada, France or the UK.
Amantadine (Symmetrel) — an antiviral drug and dopamine agonist. There have been reports of low-dose amantadine having been successfully used off-label to treat ADHD.
Clonidine — Initially developed as a treatment for high blood pressure, low doses in evenings and/or afternoons are sometimes used in conjunction with stimulants to help with sleep and because Clonidine sometimes helps moderate impulsive and oppositional behavior and may reduce tics. It may be more useful for comorbid Tourette syndrome.
Bupropion (Wellbutrin) is classified as an antidepressant. It is the most common of off-label prescription for ADHD. It inhibits the reuptake of norepinephrine, and to a lesser extent, dopamine, in neuronal synapses, and has little or no effect on serotonergic re-uptake. Bupropion is not a controlled substance. It is commonly prescribed as a timed release formulation to decrease the risk of side effects. Bupropion is not particularly known for its stimulant properties because at high doses it tends to cause seizures in a large portion of the population.
Selegiline — an MAOI currently being investigated for ADHD.
Pemoline (Cylert) — a stimulant used with great success until the late 1980s when it was discovered that this medication could cause liver damage. In March 2005, the makers of Cylert announced that it would discontinue the medication's production. It is no longer available in the United States.
Modafinil (Provigil/Alertec/Sparlon) — In the U.S., it is currently off-label pending decision by the FDA on August 22, 2006. Was originally pending marketing on-label as Alertec but denied for a reported incidence of Stevens-Johnson Syndrome.
Emsam is a version of Selegiline delivered via transdermal patch.
Tricyclic anti-depressants are also occasionally prescribed, but they seem to only treat the hyperactive part of the condition. There is research on the selective serotonin reuptake enhancer class of medications (SSREs); currently, the only one available is tianeptine (trade name Stablon); this is an atypical tricyclic anti-depressant which is inconclusive in its efficacy and hence not approved. Tianeptine is not available in North America.
Experimental and alternative medicine treatments
Alternative medicine treatments:
Many alternative treatments have been proposed for ADHD. However, none of the treatments has widespread acceptance in the mainstream medical community, and none of the alternative treatments has proven to cause significant reduction of ADHD symptoms.
Experimental treatments:
There are indications that children with ADHD are metabolically different from others.
- 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. Some studies have linked ADHD to salicylate sensitivity. However, other studies have shown little if any affect of the Feingold diet on the behavior of children with ADHD.
- Medical cannabis is used by many people with ADHD, often self-medicated, or supervised by a doctor.
- In addition, some studies suggest that a lack of omega-3 fatty acids is associated with certain ADHD symptoms. and it has therefore been suggested that diet modification may play a role in the management of ADHD. People with ADHD were found to have significantly lower plasma phospholipids and erythrocytes omega-3 fatty acids. Their intake of saturated fat was found to be 30% higher than in controls, while the intake of many other nutrients was not different. In support of the idea that it is not the intake of essential fatty acids that causes low tissue levels, a preliminary study showed that exhaled ethane, a marker of omega-3 fatty acids peroxidation, was higher in children with ADHD relative to controls. Researchers from Australia's national science agency showed polyunsaturated fatty acids to provide "medium to strong positive treatment effects" in ADHD.
- Although the role of zinc in ADHD has not be elucidated, "numerous controlled studies report cross-sectional evidence of lower zinc tissue levels".
- In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness, however, a study of large doses of vitamins with ADHD children showed that they were ineffective in changing behavior.
- In 2006, a study demonstrated that children with autism had significantly lower magnesium than controls, and that the correction of this deficit was therapeutic: Mousain-Bosc et al showed that children with ADHD (n = 46) had significantly lower red blood cell magnesium levels than controls (n = 30). Intervention with magnesium and vitamin B6 (pyridoxine) reduced hyperactivity, hyperemotivity/aggressiveness and improved school attention.
- 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.
- In 2005, the official journal of the American Academy of Pediatrics, Pediatrics, published the case report of a child with ADHD with low ferritin who showed "considerable behavioral improvement" after his ferritin was normalized by iron supplementation. Based on earlier studies on iron deficiency and attentional function (notably the dopamine synthesis aspect), the screening of ferritin levels in children with ADHD was suggested.
- Evening Primrose Oil, as well as St.John's Wort, may reduce the severity of ADHD symptoms, but they are not the most effective treatments available. They may be suitable for people with mild ADHD symptoms.
- Mild stimulants such as caffeine, theobromine, and nicotine may improve the function of some children suffering from ADHD. However, since ADHD is thought to be related to deficiencies of dopamine and/or norepinephrine, such treatments are not medically recognized, as opposed to amphetamine-like drugs which have significant dopaminergic and norepinephrinergic action.
- There is some evidence that the anti-depressant drug Milnacipran may help alleviate the symptoms of ADHD in adults.
Psychotherapeutic approaches—
There are a variety of psychotherapy approaches employed by psychiatrists, the one used depends on the patient and the patient's symptoms.
Psychotherapy:
Psychotherapy is another option, with or without medication, that has been shown to be effective.
Coaching:
ADHD Coaching is a program where coaches work with ADHD individuals to help them prioritize, organize, and develop life skills. Coaching is aimed at helping clients to be more realistic in setting goals for themselves by learning about their individual challenges and gifts, and emphasizes spending more time in areas of strength, while minimizing time spent dealing with areas of difficulty.
Only recently, studies on the cost-effectiveness of ADHD treatment have begun to appear. To date valid information is limited, although a review presented identified 11 health technology assessments and cost-effectiveness analyses, all of which compared the economic merits of at least two treatment alternatives.
```````````````````````````````````````````````````````````````````Dr. John Breeding, professor, author and Ph.D. psychologist discusses ADHD.
Millions of American school children are placed on mind-altering stimulant medications for ADHD. Is there any biological basis for calling ADHD a mental illness? What test exists to diagnosis ADHD? What criteria are used to diagnosis a child with ADHD?
In these series of videos Dr. Breeding give you the straight truth about ADHD and ADD.
Medications like Ritalin, Concerta, Adderall, Dexedrine, Strattera, Focalin and Metadata all have undesirable side effects and can damage a person's organs.
So if you child is having difficulty, what can you do besides give them drugs? Dr. Breeding discusses how to deal with children effectively.
Visit Dr. Breedings Website at www.wildestcolts.com
The new edition of John's book, The Wildest Colts Make the Best Horses may be ordered from Chimpunka Publishing at chipmunkapublishing.co.uk/shop...
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