ADHD: Causes & Treatment with Medications

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ADHD/ADD, which is the abbreviation for Attention Deficit Disorder, is a common condition in people especially in children. Early diagnosis, intervention and treatment have been shown to help people with ADHD overcome their problems and achieve success in all areas of their lives.

What Causes ADHD?

Scientists have yet to discover the precise cause or causes of Attention-Deficit/Hyperactivity Disorder (ADHD), but increasing evidence is pointing to biological factors rather than dysfunctional families, too much television, poor schooling, food allergies, refined sugar, food additives or other environmental factors. Undetectable brain damage or minor head trauma, once theorized as a possible cause of ADHD, also have been largely disproved. Scientists recently have discovered that parts of the brain’s frontal lobe and basal ganglia are reduced by about 10 percent in size and activity in children with ADHD.

Clearly, any self-blame or guilt on the part of parents of ADHD children is counterproductive.

Using positron emission tomography (PET) scanning, scientists at the National Institute of Mental Health demonstrated a link between a person’s ability to pay continued attention and the level of activity in certain areas of the brain. In people with ADHD, the brain areas that control attention used less glucose, indicating that those areas were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention. Why this happens in some people but not others is under investigation.

Among theories being tested is whether prenatal exposure to cigarette smoke, crack-cocaine, alcohol or other substances raises a child’s risk for ADHD.

ADHD in the genes

There are reasons to believe that ADHD or the tendency toward the disorder may have a genetic component. For instance, most ADHD kids have at last one blood relative with an attention disorder. At least one in three fathers who had ADHD symptoms in their youth have children with ADHD tendencies. Another study, which analyzed data from 1,938 Australian families with twins and other children ages 4 to 12, found when one twin had ADHD, there was a 91 percent chance that the other identical twin would also have it.

Who diagnoses ADHD?

Unless the parent has already had the child evaluated for ADHD during the preschool years, a kindergarten teacher may be the first person to recognize a potential problem in your child. In such cases, the teacher generally requests parental permission to refer the child for a formal evaluation. The evaluation may be performed by a school psychologist or by a team, including the school psychologist and other specialists. Parents can consult the child’s pediatrician or family practitioner who either can do the evaluation personally or refer the child to a child psychiatrist, psychologist, neurologist or other specialist. State and local social service agencies as well as ADHD groups can help you find an appropriate specialist to evaluate your child.

Adults who believe they have ADD can consult a psychologist, psychiatrist or neurologist. Unfortunately, according to the NIMH, not all mental health specialists are skilled in identifying or treating ADD in adults. Before scheduling an appointment, ask whether the practitioner has specific training and experience with this problem. Or ask members of a local support group to recommend a qualified practitioner.

What Other Disorders Can Accompany Attention-Deficit/Hyperactivity Disorder?

Almost half of all children with attention-deficit/hyperactivity disorder (ADHD) also suffer from other conditions, such as depression or a learning disability (LD), according to the American Academy of Pediatrics. Often, by effectively treating the coexisting condition, ADHD will be easier to manage. The National Institute of Mental Health (NIMH) urges everyone diagnosed with ADHD to be further evaluated for each of the following conditions.

Emotional disorders

Many children with ADHD – mostly younger children and boys – develop emotional disorders. About 25 percent feel anxious, worried, tense, fearful or uneasy for no apparent reason. Because these feelings are scarier, stronger and more frequent than normal fears, they can affect the child’s thinking and behavior, according to the NIMH. Other ADHD sufferers become clinically depressed, feeling hopeless and chronically “down in the dumps.” Depression can disrupt sleep, appetite and cognitive functioning. According to a four-year study of a group of 140 children with ADHD, 23 percent also had bipolar depression, also known as manic-depression.

Learning disability

While ADHD is not an LD, the two sometimes coexist. Some learning disabilities make it difficult for children to master language or certain academic skills, usually reading and math. By interfering with a child’s ability to concentrate, ADHD can make success in school even more challenging for a child with an LD.

Oppositional defiant disorder

If your child has ADHD, he or she may also have another condition called oppositional defiant disorder (OPD), which affects about half of all children with ADHD, primarily boys. Children with OPD tend to be aggressive physically by punching playmates, overreacting or lashing out when feeling badly about themselves. Other hallmarks of OPD include stubbornness, temper outbursts, belligerence or defiance. In some cases, OPD worsens to more serious conduct disorders. According to the NIMH, children with both ADHD and OPD are at risk of getting in trouble at school or with the police. They may engage in unsafe or illegal behaviors such as stealing, setting fires, destroying property or driving recklessly. Early intervention can often mitigate the child’s problems and stem serious consequences.

Tourette’s syndrome

In a tiny percentage of cases, ADHD is accompanied by Tourette’s syndrome. Tourette’s usually manifests in tics or other involuntary movements or vocalizations. Fortunately, Tourette’s syndrome usually can be controlled with medication.

Treating ADHD With Medication

While there is no medicinal cure for Attention-Deficit/Hyperactivity Disorder (ADHD), certain medications can temporarily relieve symptoms so both children and adults can focus, work and learn more effectively. In particular, at least four psychostimulants are federally approved to treat ADHD: methylphenidate (Ritalin®), dextroamphetamine (Dexedrine® or Dextrostat®), pemoline (Cylert®) and Adderall® (an amphetamine comprised of dextroamphetamine saccharate, dextroamphetamine sulfate, amphetamine aspartate, and amphetamine sulfate).

Studies suggest about 80 percent of children with ADHD respond positively to psychostimulant medication and improvement is usually noticeable within a week after treatment begins. The length of symptomatic relief varies from three to nine hours, depending on which drug is taken, the dosage and the individual’s response to the drug. ADHD patients typically try two or three different drugs or dosage levels before discovering what works best.

According to the National Institute of Mental Health (NIMH), psychostimulants also may improve physical coordination, such as handwriting and athletic ability. Additionally, research suggests these medicines may help children with an accompanying conduct disorder to control their impulsive, destructive behaviors.

Psychostimulants alone will not improve a child’s grades or self-esteem, however. Preliminary research suggests the best results are achieved when drug therapy is combined with behavioral therapy, emotional counseling and practical support. A large study is under way to further investigate those findings.

Side effects

Using psychostimulants for ADHD is controversial in part because of their addictive potential and side effects. In children, psychostimulants are not generally addictive, but in teen-agers and adults, these medications can be. A significant black market exists for these drugs. Periodic monitoring by the prescribing physician is important to reduce the risk for dependency and abuse. Some children with ADHD who take psychostimulants lose weight or their appetite and temporarily grow more slowly. Trouble falling asleep is another side effect. Often, side effects lessen when the dosage is reduced.

One study found boys with ADHD who are treated with psychostimulants, such as Ritalin, are significantly less likely to abuse other drugs and alcohol as they get older.

Other ADHD controversies

There has been considerable debate regarding whether doctors over-prescribe Ritalin and allegations that ADHD is being over-diagnosed in general. While there was a dramatic rise in the number of ADHD diagnoses and psychostimulant prescriptions for ADHD between 1990 and 1995, a report in the Journal of the American Medical Association found little evidence of widespread over-diagnosis or misdiagnosis of ADHD or of widespread over-prescription of Ritalin by physicians. The researchers drew their conclusions after reviewing scientific studies of ADHD published from 1975 through March 1997. Similar conclusions were reached through epidemiological survey data obtained from 1,285 children and their parents across four U.S. communities. In fact, that NIMH study found children with ADHD were generally more likely to receive mental health counseling and/or school-based interventions than medication.

Educating Children With ADHD

Most educators prefer to keep children with attention-deficit/hyperactivity disorder (ADHD) in regular classrooms and accommodate their needs. This might include seating the ADHD child away from distractions, allowing the child to release excess energy in a designated area, establishing rules and rewarding appropriate behavior. In some cases, an aide is assigned to help the child in the regular classroom.

Children with severe ADHD may require a special education class either full or part time because they are too hyperactive or inattentive to function in a regular classroom, even with medication and a behavior-management plan. In some schools, the special ed and classroom teachers work together to meet an ADHD child’s unique needs.

Two federal laws — The Individuals with Disabilities Education Act (IDEA) and Section 504 of the National Rehabilitation Act — ensure children with ADHD or other disabilities receive special education services receive them when needed.

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