Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are both genetically transmitted behavioral and neurological conditions that most often manifest themselves in childhood and may continue into adulthood. Walters notes ADHD is considered a disability under the Americans with Disabilities Act, affecting approximately three to ten percent of all school-aged children. Brown further fine tunes this number, citing a U.S. Centers for Disease Control study which found that approximately 7.8% of American children between the ages of four and 17 were currently diagnosed with ADD or ADHD (22). Up to two-thirds of these children continue to exhibit symptoms in adulthood, according to Walters (21). Terchek states that approximately 50% of children diagnosed with ADD/ADHD continue to be affected into adulthood. As such, Terchekk concludes that 4.4% of American adults are affected by ADD/ADHD. This high level of incidence makes the continued study of the condition imperative. To further understand the topic, this literature review will present the symptoms associated with ADD/ADHD, the causes of the disorder, gender differences, and treatment options.
The behavioral symptoms of ADD include being distracted by environmental sights and sounds. Those diagnosed also often have a difficult time concentrating for long periods of time, on tasks that offer low levels of stimulation, such as homework. Daydreaming and being unable to complete tasks in a timely manner are also common symptoms. For those diagnosed with associated hyperactivity disorder, there is also often a tendency to be restless, impulsive and unable to control emotions (Brown; Ullman; Walters).
Ullman puts forth a model that describes the executive functions, from his research with children, adolescents and adults with ADD/ADHD. There are six components thaat contain a cluster of related cognitive functions. These include:
Activation: organizing, prioritizing, and activating for work.
Focus: focusing, sustaining, and shifting attention to tasks.
Effort: regulating alertness and sustaining effort and processing speed.
Emotion: managing frustration and modulating emotions.
Memory: using working memory and accessing recall.
Action: monitoring and self-regulating action (57).
Ullman concludes that those with ADD have significantly more impairment in their abilitiy to use the above executive functions than their peers.
The exact cause of ADD/ADHD has yet to be discovered; however, Walters surmises that past studies have demonstrated that there are changes that occur in the brains of people who have been diagnosed with this condition. Coghlan surmises that there is now evidence relating genetic abnormalities and ADD/ADHD. Citing the work of Anita Thapar of Cardiff University, DNA from 366 children with ADHD and 1,047 children without were screened for copy-number variants (CNVs). It was found that 16% of the children with ADHD had unusually high numbers of CNVs. Of the 15 specific CNVs the team looked at, 11 came from the children's parents. The other four appear to have emerged post-conception, which suggests that environmental factors account for these CNVs, contributing to the genetically received CNVs (01). Terchek concludes that some of these environmental factors may include: low birth weight, difficulties in child birth, prenatal exposure to nicotine or alcohol, marital distress in parents, low social class, maternal mental disorders, and large family size (2). Whether genetic or environmental, diagnosis is often made after a child regularly demonstrates some or all of the associated symptoms, over a period of six months or longer. Although there is no cure for the disorder, there are a variety of treatments to help manage symptoms.
Mahone notes that as with many neurological disorders, the prevalence of ADHD varies in males and females. He states, "By school age, males are diagnosed with ADHD three to four times as often as females, with genetic and hormonal factors cited as potential causes of the male preponderance of this condition" (790). However, Mahone theorizes that there are other factors that contribute to this disparity.
Limitations inherent in the DSMIVnomenclature may contribute to the underdiagnosis of ADHD in females, in whom ADHD presents with later age at onset and more subtle clinical manifestations. Additionally, rating scales may not adequately capture symptom severity among females. For example, females are also more likely to be rated with higher than average behavior ratings of ADHD symptoms, while still not meeting DSM-IV symptom count criteria. Teachers are also more likely to refer males than females for treatment for ADHD, even when all other information about symptom expression is equal. Thus, functional difficulties among females with ADHD may go unrecognized and untreated, and it remains unclear to what extent biological factors (genes, hormones) drive the preponderance of males diagnosed with ADHD (Mahone 790).
Mahone concludes that there is a weak relationship between fetal testosterone exposure markers and ADHD symptoms. In addition, both males and females have been shown to present functional impairment in ADHD. These two factors requires that further research needs to be conducted regarding the gender differences in the diagnosis disparity of ADHD.
As noted, there currently is not a cure for ADD/ADHD; however, medications are available to help control the symptoms. These treatments vary depending on the severity of the patient's symptoms. The level of severity is often determined based on the feedback from the patient's caregivers, such as parents and teachers. As Walters notes, "There is no single test used to diagnose the disorder, and during a medical evaluation, the patient's physician may see only a snapshot of the patient's actual behaviors" (21).
Stimulant medications are typically used to treat the symptoms of this condition, according to Walters. Stimulants improve symptoms in approximately 70% of patients with ADD/ADHD. Behavioral improvement can occur quickly and dramatically. Other treatment options include: antidepressant drugs, non-stimulant medications, high blood pressure medications, and behavioral management techniques to complement medications (22).
Antonucci, Manos, Kunins, Lopez, and Kerney researched the effectiveness of lisdexamfetamine dimesylate (LDX) in the use of treating ADHD in adults. The researchers surveyed adult patients who had begun treatment with LDX at the onset and six weeks after initial treatment. 15,053 participants completed the baseline survey; however, 2,660 followed through and completed the six-week follow up survey. Sixty-six percent of those who completed the follow-up survey were female. The 2,660 participants reported high levels of adherence to the regime that had been prescribed. Seventy-four percent indicated that they had taken every dose as directed, and 19% indicated that had taken nearly every dose as directed. The results of this study found a significant decrease in the interference ADHD symptoms presented with school and work tasks, leisure and social activities, and personal relationships. The participants indicated that had a higher satisfaction ratings with LDX than other treatments they had previously received. LDX was also highly rated on global improvement, convenience, tolerability, and satisfaction.
In contrast to those supportive of pharmaceutical remedies, Ullman surmises that homeopathic treatments are the best course of treatment. These, he insists, are safe and often effective for treating both children and adults, with ADD or ADHD (56). Elia and Vetter note that the pharmaceutical medications that are marketed for treatment of ADHD have been found to have central and peripheral catecholaminergic effects. These have been found to produce significant increases in blood pressure and heart rate. Although a resulting serious cardiovascular event is considered to be rare for healthy children taking these medications, children with cardiac pathology are at a greater risk. This has been reported as a causal factor in the generation of ventricular arrhythmias in adults that have been diagnosed with coronary artery disease. Physical exercise has been found to be a consistent trigger for increased risk of sudden cardiac death in athletes who have an underlying cardiovascular disease. This is in conjunction with the high level of co-morbidity of anxiety and depression with ADHD, which has been associated with cardiovascular risks. This can be compounded by the interaction that results from the pharmacotherpeutic treatments. Furthermore, Elia and Vetter note that there is an indication that there is a higher incidence of cardiac pathology in ADHD patients than the general population (165). All of these factors give concern regarding the use of pharmaceutical treatments. Frei and Thurneysen's study of 115 children diagnosed with ADD/ADHD provides support for homeopathic remedies, rather than pharmaceutical treatments.
In the study, each participant was first treated with a homeopathic medication. Those who did not show a sufficient improvement of symptoms were changed to Ritalin and evaluated after 90 days. After an average treatment time of three and a half months, 75% of the participants showed significant improvement of symptoms with the homeopathic remedies, with a 73% improvement rating of symptoms. In contrast, 22% of the children received Ritalin. These children only demonstrated a 65% improvement rating in symptoms. Using the Conners Global Index (CGI), to measure hyperactivity, those receiving homeopathic treatments experienced a 55% CGI amelioration, while the Ritalin participants only demonstrated a 48% reduction of CGI. It was concluded that the homeopathic treatments were just as effective as Ritalin (Frei & Thurneysen).
Frei, Everts, von Ammon, et al. found similar effectiveness with homeopathic treatments of ADHD. The authors conducted two studies, one a randomized, partially blinded trial…