Attention Deficit Hyperactivity Disorder in

Attention Deficit Hyperactivity Disorder in Children - Outline Confusion over definition Many different terms to mean same thing Argument Drugs first reaction by Pediatricians Not enough research completed Causes Not conclusively known Genetically transmitted Imbalance or deficiency in brain chemicals Use of glucose in brain NIMH studies Other Causes Prenatal development Birth complications Later neurological damage Environmental Poor diet Incomplete digestion of the whey protein Drug use by mother Right treatment important Multimodal approach Child and parent education Medication Behavior management techniques National Institute of Mental Health study Controversy Medication Charges medication used to control behavior Self-medication Stimulants Kratom Methylphenidates Amphetamines Atomoxetines Second-line medications Schedule II of the U.S.

DEA schedule system Ritalin over-use Side affects Conclusion Attention Deficit Hyperactivity Disorder in Children Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental disorders among children, although it is sometimes diagnosed in adults if there is an indication that the symptoms were present in childhood.

The official definition of ADHD according, to the United States (U.S.) Surgeon General and the International Classification of Disease Revised Edition 2005 (ICD-9-CM) is a neurological deficit classified as "metabolic encephalopathy" affecting the release and homeostasis of neurological chemicals and the functioning of the limbic system.

The definition of ADHD found in the American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV-TR), defines it as "a Disruptive Behavior Disorder characterized by on-going inattention and/or hyperactivity-impulsivity occurring in several settings and more frequently and severely than is typical for individuals in the same stage of development," and identifies three subtypes of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and the combined type. There have been a number of attempts to provide a consensus name for ADHD, with little success.

Some of the various names that have been applied to this disorder are attention deficit disorder (ADD), which was first introduced in DSM-III, the 1980 edition. It is considered by some to be obsolete, and by others to be a synonym for the predominantly inattentive type of ADHD. Another name applied is attention-deficit syndrome (ADS).

It is considered equivalent to ADHD, but used to avoid the connotations of a "disorder." Hyperkinetic syndrome (HKS) and Minimal cerebral dysfunction (MCD) are also equivalent to ADHD, and although largely obsolete in the United States, they are still used in some places internationally. Minimal brain dysfunction or Minimal brain damage (MBD), once considered similar to ADHD, is now an obsolete term. For consistency, and to avoid confusion, throughout this paper I will refer to the disorder as ADHD.

The first reaction of most pediatricians after diagnosing ADHD is to prescribe drugs. However, the long-term effects of drugs on children's biology has not been fully studied, and to prescribe powerful stimulants is dangerous, until further research is concluded. Children should not be exposed to drugs such as stimulants and antidepressants or any other form of drug to treat ADHD. The symptoms of ADHD are not solid enough to just prescribe a drug to treat children who may or may not have a serious mental or social disorder.

This paper will review both sides of this argument and present expert opinions to support the thesis. The proximate cause of ADHD is not conclusively known, although research is ongoing in many areas. Most scientific evidence suggests that, in many cases, the disorder is genetically transmitted and is caused by an imbalance or deficiency in particular chemicals that regulate the efficiency with which the brain controls behavior.

Brain scan technology has indicated differences in the symmetry, metabolism, chemistry, and size of the brain in those who have ADHD, although there is as yet no clear determination of the source of these differences. A 1990 study from the National Institute of Mental Health connected ADHD with a series of metabolic abnormalities in the brain, providing evidence that ADHD is a neurological disorder.

"There appears to be a link between a person's ability to pay continued attention and the use of glucose -- the body's major fuel -- in the brain. In adults with ADHD, the brain areas that control attention use less glucose and appear to be less active, suggesting that a lower level of activity in some parts of the brain may cause inattention." While heredity as a cause is indicated, some researchers believe that problems in prenatal development, birth complications, or later neurological damage may contribute to ADHD.

Some of the additional causes being investigated include genetic factors. It has been shown that children who have at least one parent diagnosed with ADHD have a higher probability of having ADHD themselves, and research is examining which genes may be involved in ADHD. Some other research indicates that environmental factors, passed down from generation to generation, may initiate the symptoms associated with ADHD.

There is also the possibility that data on heredity may be skewed because a family with one diagnosed member may have a heightened awareness of the disorder, along with an increased motivation to seek formal diagnosis, which could make detection and diagnosis more likely. There have also been indications that ADHD may result from a poor diet and external factors, rather than from any physiological source.

Studies of changes in diets of children provide some scientific evidence of this, but the majority of researchers currently seem to believe that the available evidence is not enough to prove or disprove this. It has been noticed that a number of children with ADHD seem to be addicted to milk, and there is speculation that the cause of the disorder can be attributed to additives in foods.

It has been proposed by Norwegian and British scientists that this is due to the casomorphins, which are peptides formed by incomplete digestion of the whey protein. Studies have shown that there is an adverse effect on the behavior of children, which is detectable by parents, caused by of artificial food coloring and benzoate preservatives. In addition, the brain development in utero, and throughout the first year of life, may possibly be related to drug use during pregnancy or environmental toxins.

Determining if a child has ADHD is a complicated process. Because there is no agreement on the exact cause of the disorder, that makes it very difficult to diagnose. Many other biological and psychological problems can lead to symptoms similar to those shown by children with ADHD. As an example, depression, anxiety, and certain types of learning disabilities may cause symptoms that are similar. Again because the cause for ADHD is unknown, there is no single test to diagnose it.

An extensive evaluation is required to establish a diagnosis, rule out other causes, and determine the absence or presence of co-existing conditions. This evaluation requires much time and effort, and must include a clinical assessment of the individual's social, academic and emotional functioning, and the child's developmental level. A complete history should be taken from the parents, teachers and the child, whenever possible. Clinicians often use checklists for rating ADHD symptoms and ruling out other disabilities.

In addition to pediatricians, there are several other types of professionals who can diagnose ADHD, including nurse practitioners, school psychologists, private psychologists, neurologists, clinical social workers, psychiatrists, and other medical doctors. No matter who does the evaluation, the use of the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria for ADHD is important.

An examination by a medical professional is also necessary and should include a complete physical examination, along with a hearing and vision assessment to rule out other medical problems that might be causing symptoms similar to ADHD. One of the other medical problems that may be misdiagnosed in rare cases for children with ADHD is a thyroid dysfunction. Getting the right treatment for ADHD is very important. There could be very serious negative consequences for children with ADHD who do not receive appropriate treatment.

These consequences can include academic failure, low self-esteem, substance abuse, and a possible increase in the risk of antisocial and criminal behavior. Treating children with ADHD requires educational, medical, psychological and behavioral interventions, and should be tailored to the unique needs of each child and family. This complete approach to treatment, called "multimodal," consists of child and parent education about treatment and diagnosis, stimulant medication, specific behavior management techniques, and school programs and supports. Behavior interventions are often a major component for children who have ADHD.

Psychosocial treatments that have been found helpful for ADHD include strategies using consistent, positive reinforcement, and teaching problem-solving, communication and self-advocacy skills. Children, particularly teenagers, must be actively involved as integral members of the school program planning and treatment teams. Many children with ADHD can be taught in the regular classroom with minor adjustments to the environment, but success in school may require a number of different interventions. Some children may require additional assistance provided by special education services.

These services may be provided within the regular education classroom setting or may require a special placement of the child outside of the regular classroom that fits the child's particular learning needs. The National Institute of Mental Health conducted a major research study, called the Multimodal Treatment Study of Children with ADHD, involving 579 children with ADHD-combined type. Each of the children received one of four possible treatments over a fourteen-month period - behavioral treatment, medication management, combination of the two, or usual community care.

The results of this study showed that children who were treated with medication alone, which was carefully managed and individually tailored, and children who received both medication management and behavioral treatment had the best outcomes with respect to improvement of ADHD symptoms. The best results in terms of the proportion of children showing excellent response regarding were provided by ADHD combination treatment and oppositional symptoms, and in other areas of functioning.

Overall, those who received closely monitored medical management had greater improvement in their ADHD symptoms than children who received either intensive behavioral treatment without medication or community care with less carefully monitored medication. Treatment for ADHD is not without controversy. For most children with the disorder, medication is an integral part of treatment. The primary medications used to treat ADHD are mostly stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control.

It has been charged that these medications are used to control behavior. While adult patients may sometimes choose to self-medicate with caffeine or nicotine, this is not usually an option with children. Indications that an individual is self-medicating would be the observation that his or her focus improves with the stimulant, and that he or she cannot function as well without the stimulant.

Stimulant medication, which can only be prescribed by certain medical professionals, should be used to improve the symptoms of ADHD so that the individual can function more effectively. Some research has shown that children and adults who take medication for symptoms of ADHD usually attribute their successes to themselves, not to the medication. One stimulant that is sometimes used is kratom, which is a plant that produces a stimulant-type effect in lower doses.

Little research has been done on the relation between ADHD and kratom, but it has been used for centuries in Thailand to help motivate laborers. In low doses, it increases awareness, and concentration, allowing someone to sustain work habits, making long tasks more enjoyable, suggesting that kratom may be an effective method to help treat ADHD. Some users have indicated remarkable success using this substance. It is not recommended for children however, and as the dose increases, it can cause euphoria. The traditional stimulants are grouped into several classes.

There are Methylphenidates, Amphetamines and Atomoxetines. Some of the Methylphenidates (and doses) used to treat ADHD are: Ritalin, Metadate, or Methylin (4-6 hours per dose). It is a regular formulation, usually taken in the morning, at lunchtime, and in some cases, in the afternoon. Longer-acting formulations are those such as Ritalin SR and Metadate ER (8 hours per dose), usually taken twice daily. There are also some all-day formulations such as Ritalin LA, Metadate CD and Concerta (10-12 hours per dose), usually taken once a day.

Amphetamines are Dextroamphetamine (4-6 hours per dose) available as a regular formulation and sold as Dexedrine. It is usually taken two to three times daily. A more longer-acting formulation is Dexedrine Spansules (8-12 hours per dose) taken once a day. There is also Adderall, a trade name for a mixture of dextroamphetamine and laevoamphetamine salts. It is available in a regular formulation, Adderall. (4-6 hours a dose), taken twice a day and the longer-acting formulation, Adderall XR (12 hours a dose), taken once a day.

Also part of this class is Methamphetamine, available in a regular formulation, and sold as Desoxyn by Ovation Pharmaceutical Company. It is usually taken twice daily. Atomoxetines are a Selective Norepinephrine Reuptake Inhibitor (SNRI), introduced in 2002. It is the newest class of drug used to treat ADHD, and the first non-stimulant medication to be used as a first-line treatment for ADHD. Available in a once daily formulation, sold by Eli Lilly and Company as Strattera (24 hours per dose), and taken once a day.

Second-line medications include benzphetamine, a less powerful stimulant, and Provigil/Alertec/modafinil. Research on the effectiveness of these drugs has not been completed. Cylert/Pemoline is a stimulant that was used with great success until the late 1980s, when it was discovered that it could cause liver damage. Although some physicians do continue to prescribe Cylert, it can no longer be considered a first-line medicine, and in March 2005 the makers of Cylert announced that it would discontinue the medication's production.

Because most of the medications used to treat ADHD are included in Schedule II of the U.S. DEA schedule system, and are considered powerful stimulants with a potential for abuse, there is a great deal of controversy surrounding prescribing these drugs for children and adolescents. Despite these concerns, researchers studying ADHD sufferers who either receive treatment with stimulants, or go untreated, have shown that those treated with stimulants are much less likely to abuse any substance than are ADHD sufferers who were not treated with stimulants.

In 1996 the World Health Organization warned that Ritalin over-use has reached dangerous proportions. Because of a lack of research, use of these drugs on a long-term basis is questionable. Safety of such long-term use is simply unknown, and increasingly many dangerous side effects have been observed. Ritalin, for instance, may cause seizures and suppress growth, or it may lead to angina, blood pressure changes, depression or any number of a long list of serious side effects. Dr.

Robert Mendelsohn has noted: "No one has ever been able to demonstrate that drugs such as Cylert and Ritalin® improve the academic performance of the children who take them...

The pupil is drugged to make life easier for his teacher, not to make it better and more productive for the child." relatively uncommon side effect of medication is the development of latent tics, which are involuntary vocalizations such as throat clearing, sniffing, or coughing beyond what is normal eye blinking, shrugging and clearing of the throat or motor movements such as blinking, facial grimacing, shrugging, or head-turning. The emergence of a tic disorder in susceptible individuals can be facilitated by certain Psychostimulant medications.

Sometimes the tic will disappear when the medication is stopped, and for many children with ADHD, vocal tics or motor tics will occur as a time-limited phenomenon. Medications may bring them to parents notice earlier, or make them more visible than they would be without medication. They sometimes eventually go away, even while the child is still on medication.

Studies have indicated that seven percent of children with ADHD have tics or Tourette's syndrome, which is often mild, but can have a negative social impact in the rare, severe form of the disorder. It is also estimated that 60% of children with Tourette's have ADHD. Tourette's syndrome is a chronic tic disorder that involves vocal and motor tics.

Some research indicates that the development of Tourette's syndrome in children with ADHD is not related to psychostimulant medication, however, where there is a family history of tics or Tourette's syndrome, a cautious approach to treatment is recommended. Certain children will experience worsening of their tics with stimulant medication. There is also a correlation with other disorders. "Nearly half of all children with ADHD (especially boys) tend to also have oppositional defiant disorder, characterized.