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Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioural disorder which mostly affects children, but can also affect adults. This disorder is characterised by the symptoms of impulsiveness, inattention and hyperactivity. While these symptoms may occur in normal, healthy children and adults, they are displayed to an extreme level in those with ADHD to the extend that they disrupt their life in many ways.
There are three types of ADHD according to which symptoms are the strongest:
- Mainly inattentive type - inability to pay attention to detail, listen to instructions or complete tasks
- Mainly hyperactive-impulsive type - unable to sit still, very restless and fidgety, wont wait and jumps in and interrupts others
- Combination of inattention and hyperactivity - this type is characterised by having symptoms of both the two types
Symptoms for ADHD are divided into two areas, with some people having predominantly one type of symptom over the other and some have a combination of all symptoms. Symptoms of impulsiveness and hyperactivity often precede those of inattention.
Symptoms need to be present for over 6 months before this condition can be diagnosed, as many other conditions can can also have some of the same symptoms.
Inattention symptoms
- Disorganised
- Difficulty with tasks that require planning
- Easily distracted
- Forgetting homework, papers, pens or other items at various places
- Has difficulty following instructions
- Losing or forgetting toys, pencils, paper or other items
- Not completing activities (or projects) and leaving them unfinished to go to the next one
- Unable to give close attention to details in any activity engaged in (school work or other activity)
Hyperactivity (or impulsiveness) symptoms
- Blurts out answers to questions before the question has even been finished
- Can't sit still and enjoy quiet activities, such as reading
- Constantly interrupts others
- Finds it difficult to stand in line or wait their turn
- "On the go" or constantly in motion
- Restless, fidgeting and squirming if in one place for too long
- Running and climbing
- Unable to sit quietly, leaving a seat and running around
Scientists still do not know what causes ADHD, although many theories have been proposed (most lie in the realms of neurobiology or genetics):
- Chemicals - studies show that certain environmental chemicals may play a role in causing ADHD to some extent
- Alcohol - studies show that women who drink alcohol while pregnant have a greater risk for having a child who will develop ADHD
- Cigarette smoke - studies show that women who smoke while pregnant have a greater risk for having a child who will develop ADHD
- Lead - studies show that children who are exposed to lead (either through lead paint in their house or from pollution from busy roads) are more likely to develop ADHD
- Food additives - a recent study completed in 2007 has suggested that food additives cause ADHD symptoms such as impulsive, hyperactivity, inattentiveness, impulsiveness and have advised to remove all food additives from children's diet in order to stop symptoms; the problem chemicals are artificial food colourings and preservatives
- Genetics - ADHD seems to run in families with about 25% of people in families of people with ADHD also have this condition (while the general populace has a rate of 5%)
- Sugar - some studies have shown either no effect (or a negligible one) of sugar on causing ADHD; other studies have shown that a diet high in refined sugar does cause behavioural problems in children especially
There is currently no proof that ADHD is caused solely by social factors or how a child is raised, but it is well-known that these (if negative) can play a detrimental role in exacerbating existing ADHD.
Diagnosis and testing
ADHD is diagnosed through a series of tests, questionnaires and assessment for other psychological disorders by a paediatrician, psychiatrist or registered psychologist.
Conventional treatment
It is now recommended to combine a few different types of treatments for the treatment of this condition. The combination of therapies used will depend on each case of ADHD:
- Behavioural therapy - there are various types of behavioural therapies and counselling that are used to treat ADHD (in conjunction with medication)
- Emotional counselling
- Family counselling
- Organisation training
- Parent skills training
- Psychotherapy
- Scheduling - how to
- Social skills training
- Time management training
- Medication - these consist of either non-stimulating or stimulating drugs
- Stimulating drugs - these drugs are commonly used in ADHD (since the 1930's) and regulate the activity of the neurotransmitters dopamine especially, and also norepinephrine (noradrenaline); the drugs have a time-span of action and can be short-term (4-5 hours), medium-term (6-8 hours) or long-term (10-12 hours); the most well-known drug in these class of medications is Ritalin; these drugs have known side effects which are mitigated though lowering dose or switching to a different type of drug in the same class
- Non-stimulating drugs - these drugs act as selective norepinephrine reuptake inhibitors (SNRIs), which modify the way the neurotransmitter is regulated in the brain to control ADHD
The drugs used to treat ADHD work on norepinephrine to regulate its activity in the brain. Scientists do not yet know the precise role that norepinephrine plays in ADHD, but they do believe that it is important in regulating attention, impulsiveness and activity levels.
Alternative / complementary treatment
There is some controversy about the prescription of the conventional drug Ritalin (or other psychotropic medications) for ADHD, with alternative practitioners advocating natural therapies over conventional drugs. There are many studies which show certain supplements and foods help to reduce symptoms of ADHD.
Always ensure that you notify your medical practitioner of any supplements that you want to take - it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take BEFORE you try it.
The following are the treatments advocated by alternative therapists:
- Iron - many children (and adults), especially females are deficient in iron, which may cause symptoms associated with ADHD; care should be made with supplementation as it is toxic in high doses to children and a blood test should be taken to determine blood iron and haemoglobin (as well as other levels of other nutrients0 to determine if it is necessary to be supplemented)
- Magnesium - studies show that children with ADHD may be displaying symptoms of mild magnesium deficiency which are alleviated through magnesium supplementation
- Essential fatty acids - numerous studies show that the essential fatty acids play an important role in regulating brain activity in children (and adults) with ADHD; studies have shown that children with ADHD greatly benefit from omega 3 fatty acids as many are deficient in essential fatty acids;
- Vitamin B6 - this important vitamin is required as a precursor to many of the brains important neurotransmitters such as dopamine, norepinephrine and serotonin; one study showed that this vitamin was helpful for alleviating symptoms, but more research is needed to determine if this vitamin alone is benefical or if it should be supplemented with the other B vitamins at the same time
- Zinc - this important mineral regulates essential fatty acids and the neurotransmitters activity in the body; some studies have shown that children with ADHD have a deficiency in zinc
- It is estimated that around 3-8% of children worldwide may have ADHD
- ADHD appears to be more common in boys than in girls
- ADHD was previously named ADD (attention deficit disorder) but was renamed in 1994 by the American Psychiatric Association (APA)
- Keep foods with artifical food colourings, preservatives or other other additives away from children with suspected ADHD as symptoms may become worse
- Children with ADHD need help to organise themselves and to help remember things
- Parents are the best tool to helping their children who have ADHD get better
- Set regular times for activities and help children stick to them to help them learn about organisation and planning
references
- Bateman B, Warner J O, Hutchinson E, Dean T, Rowlandson P, Gant C, Grundy J, Fitzgerald C, Stevenson J. The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children.
Archives of Disease in Childhood 2004;89:506-511 - Harding KL, Judah RD, Gant C. Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Altern Med Rev. 2003 Aug;8(3):319-30
- Joshi K, Lad S, Kale M, Patwardhan B, Mahadik SP, Patni B, Chaudhary A, Bhave S, Pandit A. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids. 2006 Jan;74(1):17-21. Epub 2005 Nov 28
- Mousain-Bosc M, Roche M, Polge A, Pradal-Prat D, Rapin J, Bali JP. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders. Magnes Res. 2006 Mar;19(1):46-52
- Mousain-Bosc M, Roche M, Rapin J, Bali JP. Magnesium VitB6 intake reduces central nervous system hyperexcitability in children. J Am Coll Nutr. 2004 Oct;23(5):545S-548S
- Sinha D, Efron D. Complementary and alternative medicine use in children with attention deficit hyperactivity disorder. J Paediatr Child Health. 2005 Jan-Feb;41(1-2):23-6
- Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr. 1995 Oct;62(4):761-8
- The MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit hyperactivity disorder (ADHD). Archives of General Psychiatry, 1999;56:1073-1086
- Winder PH, MD. ADHD: Attention-Deficit Hyperactivity Disorder in Children and Adults. Oxford University Press, 2002
To learn more, go to the following web sites:
- ADHD Australia
- ADHD - NSW Health (Australia)
- ADHD New Zealand
- American Academy of Pediatrics (USA)
