ADHD

Attention Deficit Hyperactivity Disorder

Definition. Attention Deficit Hyperactivity Disorder (ADHD) begins and is most often diagnosed in childhood. Some people are not diagnosed until adulthood, but, as they look back, they can document symptoms starting before age seven (Hallowell & Ratey, 1994).

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There are three sub-types of ADHD: primarily hyperactive, primarily inattentive, and a mixed type where one exhibits both hyperactive and inattentive symptoms. Regardless of type, ADHD is considered a cognitive and primary processing deficit disorder. The processing deficits found in those with ADHD are attention and effort, inhibition, arousal modification, and self-regulation. These problems cause symptoms such as impaired higher order reasoning, difficulty developing schemata, impaired metacognitions, and poor effectance motivation (Teeter, 1998). This processing problem leads to the various symptoms seem by parents, teachers, and doctors. Preston and Johnson (2008) note the symptoms for ADHD. They are impulsivity, difficulties with motivation, impaired attention and concentration, easy distraction, restlessness, hyperactivity, and emotional deregulation or impaired emotional control. Those who suffer from ADHD often suffer from learning disabilities and low self-esteem (Preston & Johnson), and they often have social-emotional problems and present with aggressive behavior (Teeter).

Causes. It is generally thought that ADHD is caused by neurochemical problems. It is believed that there is dysregulation of both dopamine (DA) and norepinephrine (NE) in the prefrontal cortex (Preston & Johnson, 2008) and to a lesser degree, serotonin (SE) (Teeter, 1998). These transmitters, DA and NE, work together to control attention, inhibition, and motor planning. Their deficiency is related to the underactivity of the brain region involved with them. This underactivity related to DA and NE is thought to cause the behavioral symptom such as disinhibition, hyperactivity, and irritability. Dysregulation of SE may be the cause of aggression seen in those diagnosed with ADHD. Other nontraditional hypothesis suggest that ADHD may have many different causes such as food allergies, heavy metal toxicity, low protein and high carbohydrate diets, mineral imbalances, essential fatty acid (EFA) and phospholipid deficiencies, amino acid deficiencies, vitamin B and phytonutrient deficiencies, and thyroid disorders (Harding et al., 2003).

Treatment Interventions for Attention Deficit Hyperactivity Disorder

Medication. Medication for all subtypes of ADHD target the hyperactive and inattention symptoms. As well, the associated symptoms such as anxiety, depression, and aggression are addressed with other medications as appropriate. The use of stimulant medication is the first choice for both the hyperactive and the attentive symptoms. These medications work by increasing the level of dopamine at the synapse (Ratey, n.d.). The most common stimulants used are Ritalin, Concerta, Dexedrine, Adderal, and Cylert. All of these except Cylert have abuse potential (Preston & Johnson, 2008). However, Cylert is not often the first line of treatment because of several possible deaths as a result of liver malfunction, which, according to Ratey, is sad. He feels that because Cylert is long-acting, working all day, it has better effects and is generally more stabilizing than shorter acting stimulants such as Ritalin, the shortest acting of all the stimulants. Dexedrine and Adderal are longer acting than Ritalin but not as long-acting as Cylert. Some antidepressants can be used to specifically treat ADHA. They are Wellbrutrin-SR and Strattera (Preston & Johnson) and Norpramin and Tofranil (Teeter, 1998). As well, there are two alpha-adrenergic agonists prescribed for the condition. These are Catapres and Tenex. These other medications are usually used in conjunction with a standard stimulant but can be used alone as well (Preston & Johnson).

Alternative Intervention. Nutritional supplements and fresh air can be used to address ADHD. Several are used together to address the dopamine and norepinephrine imbalances that are believed to be caused by several factors such as allergies, toxins, insufficient diet, and vitamin deficiency. One study prescribed tyrosine, B vitamins, cooper, iron, vitamin C, phospholipids, and EFA to 10 patients and Ritalin to 10 other patients. The research found that the nutritional prescription to be as efficacious as Ritalin in calming the symptoms of the patient (Harding, 2003). Another study found that if children spent more time out-of-doors in green and grassy areas, they exhibited fewer ADHD symptoms (Lawson, 2008).

Psychotherapy. The primary treatment modality for this disorder is supportive and psychoeducational. Both the sufferer and their families need understanding, compassion, and a way to manage this illness. Hallowell and Ratey (1994), suggest that this be accomplished by not only explaining the diagnosis to the parents and teachers but to the child sufferer, too. Once the diagnosis is thoroughly explained and the sufferer is also educated as to his or her active part of the treatment plan, learning to use structure becomes the focus. Structure means learning to use tools like lists, reminders, notepads, appointment books, filing systems, schedules, bulletin boards, an alarm clock, etc. Essentially, structure sets up external systems that are reliable because internal systems of the ADHD suffer are not. The therapist’s job is to help the sufferer and the families set up and utilize a structured environment.

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Hallowell, E. M. & Ratey, J. J. (1994). Driven to distraction: Recognizing and coping with Attention Deficit Disorder from childhood through adulthood. New York: Simon & Schuster.

Harding, K. L., Judah, R. D., & Gant, C. E. (2003). Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Alternative Medicine Review 8(3): 319-326. Retrieved on March 21, 2009 from Alternative Mental Health.com under ADD article “ADD: Nutrients Perform as well as Drugs.”

Lawson, W. 2004). ADHD’s outdoor cure. Psychology Today Magazine Mar/Apr 2004. Retrieved on March 20, 2009 from http://www.psychologytoday.com/articles/pto-20040406-000015.html via AlternativeMentalHealth .com ADD article titled, “Outdoor Greenery Improves ADHD Symptoms.”

Preston, J. & Johnson, J. (2008). Clinical psycholpharmacology made ridiculously simple (5th ed.). Miami, FL: MedMaster.

Ratey, J. (n.d.). An update on medications used in the treatment of Attention Deficit Disorder. Retrieved on March 20, 2009 from http://www.add.org/articles/updatemed.html

Teeter, P. A. (1998). Interventions for ADHD: Treatment in developmental context. New York: Guilford.