ADHD

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Term: Attention Deficit Disorder (ADHD)

Decription:ADHD is one of the most common neurobehavioral disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. ADHD is a problem with inattentiveness, over-activity, impulsivity, or a combination. For these problems to be diagnosed as ADHD, they must be out of the normal range for the child's age and development. Research shows that between 30% and 70% of children with ADHD continue to have symptoms of the disorder when they become adults.



Causes:Scientists are not sure what causes ADHD, although many studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD. However, here are some factors that may play a role in developing ADHD:
  • Genes: Researchers are looking at several genes that may make people more likely to develop the disorder. Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This National Institute of Mental Health research showed that the difference was not permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness.

  • Environemental Factors: Studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children.5,6 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD.
  • Brain Injuries: Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury.
  • Sugar: The idea that refined sugar causes ADHD or makes symptoms worse is popular, but more research discounts this theory than supports it. In studies that gave children either sugar or sugar subsitutes showed no difference in brain behavior.
  • Food Additives: Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity. Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity.

Symptoms:
Deciding if a child has ADHD is a several step process. There is no single test to diagnose ADHD, and many other problems, like anxiety, depression, and certain types of learning disabilities, can have similar symptoms.

The American Psychiatric Association's Diagnostic and Statistical Manual-IV, Text Revision (DSM-IV-TR) is used by mental health professionals to help diagnose ADHD. This diagnostic standard helps ensure that people are appropriately diagnosed and treated for ADHD. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.

DSM-IV Criteria for ADHD

I. Either A or B:
  • Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level: Inattention
  1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
  2. Often has trouble keeping attention on tasks or play activities.
  3. Often does not seem to listen when spoken to directly.
  4. Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
  5. Often has trouble organizing activities.
  6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
  7. Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
  8. Is often easily distracted.
  9. Is often forgetful in daily activities.

  • Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level: Hyperactivity
  1. Often fidgets with hands or feet or squirms in seat when sitting still is expected.
  2. Often gets up from seat when remaining in seat is expected.
  3. Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
  4. Often has trouble playing or doing leisure activities quietly.
  5. Is often "on the go" or often acts as if "driven by a motor".
  6. Often talks excessively.

Impulsivity
  1. Often blurts out answers before questions have been finished.
  2. Often has trouble waiting one's turn.
  3. Often interrupts or intrudes on others (e.g., butts into conversations or games).

II. Some symptoms that cause impairment were present before age 7 years.

III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).

IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.

V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

ADHD Subtypes:

Based on the critera established by the DSM-IV, three types of ADHD have been identified.
  1. Predominantly hyperactive-impulsive
    1. Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
    2. Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
  2. Predominantly inattentive
    1. The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present, although hyperactivity-impulsivity may still be present to some degree.
    2. Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing. Therefore, the child may be overlooked, and parents and teachers may not notice that he or she has ADHD.
  3. Combined hyperactive-impulsive and inattentive
    1. Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
    2. Most children have the combined type of ADHD.


Treatment:
In most cases, ADHD is best treated with a combination of medication and behavior therapy. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way. Currently available treatments focus on reducing the symptoms of ADHD and improving functioning. Treatments include medication(stimulant, non-stimulant) various types of psychotherapy, education or training, or a combination of treatments, as well as Clinical Trails.

Medications:
Currently, there are no medications that will cure ADHD, but helps control the symptoms as long as the medication is taken. The most common type of medication used for treating ADHD is called a "stimulant." It has a calming effect on children with ADHD. Stimulants are the best-known and most widely used treatments. Between 70-80 percent of children with ADHD respond positively to these medications. Many types of stimulant medications are available. A few other ADHD medications are non-stimulants and work differently than stimulants. Non-stimulants were approved for treating ADHD in 2003. This medication seems to have fewer side effects than stimulants and can last up to 24 hours. For many children, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. However, a one-size-fits-all approach does not apply for all children with ADHD. What works for one child might not work for another. Stimulant medications come in different forms, such as a pill, capsule, liquid, or skin patch. Some medications also come in short-acting, long-acting, or extended release varieties. In each of these varieties, the active ingredient is the same, but it is released differently in the body. In 2007, the FDA required that all makers of ADHD medications develop Patient Medication Guides that contain information about the risks associated with the medications. The guides must alert patients that the medications may lead to possible cardiovascular(heart and blood) or psychiatric problems. Most of theses medications like Adderall XR, Concerta, Vyvanse, Quilivant XR and Focalin XR are FDA approved for use in adults.


Below is a table that lists the medications available and each approved age limit.

Trade Name
Generic Name
Approved Age
Adderall
amphetamine
3 and older
Adderall XR
amphetamine (extended release)
6 and older
Concerta
methylphenidate (long acting)
6 and older
Daytrana
methylphenidate patch
6 and older
Desoxyn
methamphetamine hydrochloride
6 and older
Dexedrine
dextroamphetamine
3 and older
Dextrostat
dextroamphetamine
3 and older
Focalin
dexmethylphenidate
6 and older
Focalin XR
dexmethylphenidate (extended release)
6 and older
Metadate ER
methylphenidate (extended release)
6 and older
Metadate CD
methylphenidate (extended release)
6 and older
Methylin
methylphenidate (oral solution and chewable tablets)
6 and older
Ritalin
methylphenidate
6 and older
Ritalin SR
methylphenidate (extended release)
6 and older
Ritalin LA
methylphenidate (long acting)
6 and older
Strattera
atomoxetine
6 and older
Vyvanse
lisdexamfetamine dimesylate
6 and older
Quillivant XR
methylphenidate (extended release)
6 and older

Psychotherapy:
Different types of psychotherapy are used for ADHD. Behavioral therapy aims to help a child change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a child how to monitor his or her own behavior. Learning to give oneself praise or rewards for acting in a desired way, such as controlling anger or thinking before acting, is another goal of behavioral therapy. Parents and teachers also can give positive or negative feedback for certain behaviors. In addition, clear rules, chore lists, and other structured routines can help a child control his or her behavior.

Clinical Trails:

is a research program that tests the effectiveness and safety of various interventions for people with a certain conditions and find new and improved methods of evaluating/treating a condition. There are trails that have been conducted for diagnosis and treatment of ADHD in children. These trails included measuring drug treatment, behavioral treatment and/or combined treatment for children. Some of these trails involving children have tested the potential roles that lead exposure, exposure to other neurotoxins and psychosocial(social and psychological behavior) situations might play in causing ADHD.
Clinical Trails are divided in four phases:
Phase I- involves giving new treatment to a small number of participants. researchers determine the best way to give the new treatment and how much can be given safely.
Phase II- focus on learning whether the new treatment has an effect on a specific condition. Information of side-effects from the treatment is recorded.
Phase III-compares the new treatment with a placebo. researchers determine which study group has fewer side-effects and is shows the most improvement.
Phase IV-involves more people, are conducted after the treatment has been approved. provides opportunities to learn more details about the treatment and address questions from other phases of the trails that may have came up.

Technological Advances:
Neuro feedback:
This company is using video games in order to help children maintain focus and increase thier ablilty to concentrate at tasks at hand.

Invisible Clock:
An Invisible Clock is a small device that looks a lot like a pager. It is designed to send vibrations or beep at specific intervals to help keep a person on task.
Much like an Invisible Clock, a Motivator can also be programmed to sound when movement occurs. This can be helpful for an adult in the office who is on a deadline and needs to stay at his desk for long periods of time.

b-Calmsound:



Currently in ADHD News:
  • According to an article from the Washington Times, Doctors are finding that too many children are being diagnosed with ADHD resulting in children taking powerful medication that they do not need. There was a study by Rae Thomas at the Centre for Research in Evidence-Based Practice at Australia's Bond University. About 87 percent of children diagnosed with ADHD in the U.S in 2010, received medication(a large number received medications that was unnecessary and possible harmful treatment). The side-effects from these powerful medications can be very dangerous such as suicidal thoughts. To read more the article is click on the "Washington Times Article," link under Links.

  • New research just released provides insight into one of neuroscience's most intriguing mysteries: how the human brain learns and remembers. These studies - involving topics as diverse as musical memory, "change blindness," and attention deficit hyperactivity disorder(ADHD) - illustrate the profound influence that specific changes in either the brain's structure, function, or both, can have on human behavior.The research findings were presented at Neuroscience 2011, the Society for Neuroscience's annual meeting and the world's largest source of emerging news about brain science and health.
  • Women need ADHD meds as well: ADHD is usually thought of as a predominantly male problem, but a new report from Medco Health Solutions shows the number of women taking medication for ADHD is rising rapidly. Researchers studied trends in the use of mental health medications among about 2.5 million insured Americans and found that the number of women aged 20 to 44 on ADHD medicines shot up 250% from 2001 to 2010. In general, amongst women aged 20 to 44 around one in 50 took medicine to control ADHD. One factor that might play a role is the approval for use of all five medicines since 2001.

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