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MoonDragon's Health & Wellness
Disorders
Hyperactivity
(Attention Deficit Hyperactivity Disorder; ADHD)




BASIC INFORMATION

DESCRIPTION

Hyperactivity, medically termed Attention Deficit Hyperactivity Disorder (ADHD), is a disorder of certain mechanisms in the central nervous systems. It primarily affects children and teens and causes a variety of learning and behavioral problems. ADHD refers to a group of symptoms that begin in early childhood and can continue into adulthood, causing difficulties at home, at school, at work, and within the community if not recognized and treated.

Factors linked to hyperactivity include heredity, smoking during pregnancy, oxygen deprivation at birth, environmental pollutants, artificial food additives, lead poisoning, allergies, and prenatal trauma. Preservatives and foods containing salicylates also contribute to this disorder. A low-protein diet may be a contributing factor. Through the topic has been hotly debated for decades, studies have definitely shown that food additives do play a major role in hyperactivity.

The Feeling of Having ADHD: Having ADHD is like being put into a dark room with things scattered around to trip you. You don't get a flashlight.....but everyone else does. You trip around the room, bumping into things, until you finally learn the layout of the room. Then someone moves you to a new room, and the process starts again.

It's like having a whirlwind in your mind. Everything seems to be blowing around and nothing stays put. Some people have compared the feeling to watching someone change the channels on the TV every few seconds. You can get a general idea of what is going on, but you miss most of the content.

People with ADHD tend to be socially blind. They may miss rules and structures which other people see much more readily. An example of "socially blind" is - 5 boys are playing at recess, doing things they shouldn't. Suddenly, the teacher comes around the corner. Four of the boys stop almost immediately, while the ADHD child "just keeps going". The ADHD child feels singled out and treated unfairly. He was " just doing what everyone else did".

The Neurology of ADHD: The lower portion of the brain contains an area known as the Reticular Activating System. It keeps the higher brain centers alert and ready for input. There is some evidence that this area is not working properly in ADHD, and that the brain is, in effect, " going to sleep". Hyperactivity is really the brain's attempt to generate new stimulation to maintain alertness. For more information, see: Kinomura et. al., Science, Jan. 26,1996, Vol. 271, pp. 512-515

ADHD Brain Function

Demographics:

CAUSES

Physical Factors:
Advanced imaging techniques have detected differences in the brains of ADHD children compared to those of non-ADHD children. In some studies, brain scans reveal that the right side of the brain is smaller in ADHD children than in non-ADHD children (ordinarily the right and left sides of the brain are the same size). The right side contains three important areas: the prefrontal cortex; the caudate nucleus; and globus pallidus. The prefrontal cortex, which is located in the front of the brain, is thought to be the brain's command center and regulates the ability to inhibit responses. The caudate nucleus and globus pallidus, located near the center of the brain, speed up or stop orders coming from the prefrontal cortex. Abnormalities in these areas may impair a person's ability to brake actions, resulting in the impulsivity typical of ADHD people. Also located here are important neurotransmitters -- chemical messages in the brain -- including norepinephrine, dopamine, and serotonin, which affect mental and emotional functioning. Dopamine is under particular scrutiny. One recent study reported that adults with ADHD had abnormally low levels of DOPA decarboxylase, the enzyme that produces dopamine.

Problems Surrounding Pregnancy:
ADHD is often associated with problem pregnancies and with difficult deliveries. Infectious diseases, toxemia, overexposure to radiation, oxygen deprivation at birth and prenatal trauma are linked with ADHD. Generally, children who experience brain trauma during pregnancy, delivery,or immediately after birth, are at greater risk for ADHD. Maternal smoking (nicotine), alcohol, and drug abuse during pregnancy is also associated with a higher risk for ADHD. These can cause poor motor and muscular development and sensory impairment; problems with learning, memory, attention, and problem solving; and problems with mental health and social interactions. One study indicated that an increased risk also existed in children of women who were exposed to environmental toxins, including dioxins and polychlorinated biphenyls (PCBs), during pregnancy.

After birth, ADD may result from meningitis, seizures from fever, head injury, encephalitis, or heavy metal toxicity.

About 50% of children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal (strep) infections (PANDAS) have ADHD.

Lead poisoning found in infants and children exposed to paint that contains lead has been implicated in ADHD. Specifically, it causes irritability, poor concentration, and distractedness.

The National Institute of Mental Health estimates that 20% to 30% of the 4,000,000 children in the United States with learning disabilities also suffer from ADHD. And 20% to 40% of children with learning disabilities may be prone to recurrent defiance or malicious conduct and may be diagnosed with ADHD and either oppositional defiant disorder (ODD) or conduct disorder (CD).

Genetic Factors:
Evidence that genetic factors increase susceptibility is mounting. More than 20 genetic studies provide evidence that ADHD is an inherited disorder. Most children with ADHD have a close relative who also has it. The National Institute of Mental Health reports that about one-third of fathers who suffered from ADHD during childhood have children with it. Children with affected parents are three times more likely than other children to develop the disorder, and identical twins are both likely to be affected. In a study of twins, 90% of children with a full diagnosis of ADHD shared it with their twin. At least 2 genes have been associated with the disorder. More than one gene that may be responsible for inherited cases is not surprising, since there is no consensus that ADHD is even a single disorder. Researchers are reporting underlying genetic mechanisms that regulate hyperactivity, particularly those that affect the neurotransmitter dopamine. Studies are finding that a variation of a dopamine D4 receptor gene is common in a high proportion of people with addictions and ADHD, and appears to be associated with novelty-seeking and extroversion.

About 50% of adults and 70% of children with a genetic resistance to thyroid hormone have ADHD. The thyroid hormone is essential for normal brain development. People who have this condition appear to have a more severe form of ADHD. The thyroid disorder is not a common cause of ADHD, however, and only those with a family history of thyroid disease are at risk.

Diet:
Food Intolerances or Allergies are high on the list of offenders to provoke ADD/ADHD or other behavioral symptoms and problems. While milk, eggs, nuts, shellfish, wheat and soy products are common triggers for people with food sensitivities or allergies, simple sugar(s) have more of an effect on mood and hyperactivity than many other dietary factors, although some "experts" on ADD or ADHD continue to challenge or dispute that fact. According to a number of studies have suggested that sugar plays no role in hyperactivity. In fact, one study reported that ADHD children had fewer problems after a high-carbohydrate breakfast than after a high-protein one. Another reported that children actually moved more slowly after a high-sugar meal, suggesting that the carbohydrates may have a sedative effect. On the other hand a low-protein diet may be a contributing factor. Distinctions between simple sugars (simple carbohydrates), refined sugars (refined carbohydrates), and complex sugars (complex carbohydrates) may not be clearly defined in these studies. These carbohydrates are very different from one another. For more information about Carbohydrates/Sugars see: Sugar & Glycemic Index.

Studies on the effect of food and food-additive allergies are controversial. For example, one reported that 62% of ADHD children had symptoms provoked by various foods and additives. Another study indicated, however, that less than 5% of children with attention-deficit hyperactivity disorder are affected by food additives and even then, the effect is very slight. Among the additives, preservatives, and foods that parents report as culprits in inciting behavioral changes are any artificial flavors or coloring (particularly red), milk, chocolate, eggs, nuts, shellfish, soy products, and wheat. Additional problem sources to consider include pets, mold, artificial sweeteners (aspartame), dust mites, caffeine, and tobacco smoke. Allergies themselves have recently been associated with a higher risk for behavioral problems; children who respond to allergen-restrictive diets may not have had true ADHD in the first place.

Additional Links

ADD/ADHD & Behavioral Problems: Nutritional Causes, Prevention & Therapies
www.add-adhd.org: The Causes & Treatments of ADD-ADHD
Attention Deficit Hyperactivity Disorder: Overview & Theories on its Cause
NIMH: Attention Deficit Hyperactivity Disorder

SIGNS & SYMPTOMS

Hyperactivity may be characterized by one or a combination of some of the following:


Not all symptoms are present in one individual. Although hyperactivity is primarily a problem of childhood, adults can be affected, too.

The three groups of Attention Deficit Hyperactivity Disorder (ADHD) symptoms are:
  • Inattention. This is the most common symptom. In addition to having difficulty paying attention, people with this ADHD symptom often are unable to consistently focus, remember, and organize. They may be careless and have a hard time starting and completing tasks that are boring, repetitive, or challenging.

  • Impulsiveness. People who frequently act before thinking may not make sound judgments or solve problems well. They may also have trouble developing and maintaining personal relationships. An adult may not keep the same job for long or spend money wisely.

  • Hyperactivity. A hyperactive child may squirm, fidget, and climb or run when it is not appropriate. These children often have difficulty playing with others. They may talk a great deal and not be able to sit still for even a short time. Teenagers and adults who are hyperactive don't usually have the more obvious physical behaviors seen in children. Rather, they often feel restless and fidgety, and are not able to enjoy reading or other quiet activities.

Symptoms vary by individual and range from mild to severe.

Symptoms of ADHD can be similar to those of other conditions, such as:
  • Learning disabilities.
  • Oppositional defiant disorder (ODD).
  • Conduct disorder.
  • Anxiety disorder.
  • Depression.

These conditions are sometimes mistaken for ADHD. They may also occur along with ADHD, which can make diagnosis of the primary problem difficult.

The Diagnosis & Statistical Manual of Mental Disorders (DSM) IV
Definition of Attention-Deficit Hyperactivity Disorder (ADHD)


A. Inattention: Either (1) or (2)
    (1) Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
      (a) Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
      (b) Often has difficulty sustaining attention in tasks or play activities
      (c) Often does not seem to listen when spoken to directly.
      (d) 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).
      (e) Often has difficulty organizing tasks and activities.
      (f) Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort ( such as schoolwork or homework).
      (g) Often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books, or tools).
      (h) Is often easily distracted by extraneous stimuli.
      (i) Is often forgetful in daily activities.
    (2) Six (or more) of the following symptoms of hyperactivity-impulsivity have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:
      Hyperactivity: (a) Often fidgets with hands and feet or squirms in seat.
      (b) Often leaves seat in classroom or in other situations in which remaining seated is expected.
      (c) Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
      (d) Often has difficulty playing or engaging in leisure activities quietly.
      (e) Is often "on the go" or often acts as if "driven by a motor".
      (f) Often talks excessively.

      Impulsivity: (g) Often blurts out answers before questions have been completed.
      (h) Often has difficulty awaiting turn.
      (i) Often interrupts or intrudes on others (e.g. butts into conversations or games).
B. Some hyperactive-impulsive or inattentive symptoms that caused impairment were present before age 7 years.

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

D. There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning.

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

ADHD NOS: Attention- Deficit Hyperactivity Disorder Not Otherwise Specified. This category is for disorders with prominent symptoms of inattention or hyperactivity-impulsivity that do not meet criteria for Attention-Deficit/Hyperactivity Disorder.

Associated Diagnoses:

Conduct Disorder (312.8):
    A. A repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of 3 (or more) of the following criteria in the past 12 months, with at least one criterion present in the past 6 months:

  • Aggression to People/Animals:
      (1) Often bullies, threatens, or intimidates others.
      (2) Often initiates physical fights.
      (3) Has used a weapon that can cause serious physical harm to others (e.g. a bat, brick, broken bottle, knife, gun).
      (4) Has been physically cruel to people.
      (5) Has been physically cruel to animals.
      (6) Has stolen while confronting a victim (e.g. mugging, purse snatching, extortion, armed robbery).
      (7) Has forced someone into sexual activity.
  • Destruction of Property:
      (8) Has deliberately engaged in fire setting with the intention of causing serious damage.
      (9) Has deliberately destroyed other's property (other than by fire setting).
  • Serious Violations of Rules:
      (10) Often stays out at night despite parental prohibitions, beginning before 13 years old.
      (11) Has run away from home overnight at least twice while living in parental or parental surrogate home (or once without returning for a lengthy period).
      (12) Often truant from school, beginning before age 13 years.
    B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

    C. If the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Additional Specifiers:

  • Conduct Disorder: Age -
      Childhood-Onset Type: onset of at least one criterion characteristic of Conduct Disorder prior to age 10 years.

      Adolescent-Onset Type: absence of any criteria characteristic of Conduct Disorder prior to age 10 years.
  • Conduct Disorder: Severity -
      Mild: Few if any symptoms in excess of those required for diagnosis. Conduct problems cause only minor problems for others.

      Intermediate: Number of problems and effect on others. Intermediate between mild and severe.

      Severe: Many conduct problems in excess of those required for diagnosis. Conduct problems cause considerable harm to others.

    Learning Disabilities:

    Difficulties in learning are common in ADHD. Estimates range from 18 to 40 % of those with ADHD have associated learning disabilities. The most common learning problems seen in ADHD children and adults are:
    • Dysgraphia: There is often a difficulty in ADHD children connecting the input the muscles give to the brain. This makes otherwise simple tasks incredibly difficult. Imagine for a moment that you had to look for your hands every time you wanted to take hold of something. You would need to be paying much more attention than you do now, and would have difficulty every time you stopped paying attention. An unusual feature in many ADHD patients is that, while they have difficulty with writing legibly, they are often skilled artistically and able to make intricate pictures with little difficulty. The problem appears to be in the conversion of symbolic information. A dysgraphia joke: "What do you call someone with bad handwriting?" Answer: A DOCTOR! Remediation of handwriting, though often attempted, is often futile. Use of bypass methods, such as typewriters, computers, and tape recorders are often much more effective. A key goal is to allow the person to process information as fast as they can think. Trying to write if you are dysgraphic is like trying to pour an ocean through a garden hose.

      Some tips on bypass techniques:

      Tape Recorders-- Get one with a remote microphone jack and a tape counter. The recorder can be connected to an inexpensive handheld microphone with an On/Off switch on it. This allows the control of the recorder without having to constantly start and stop the machine with the buttons. It seems to be easier than the controls on the machine that many microcassette recorders use, as well. The tape counter allows for note taking by simply writing down a topic and the counter number. This allows review of information quickly without having to relisten to the entire tape. A simple foot pedal switch available for under $5 can allow the tape recorder to function as a dictation system, and leave the hands free for typing.

      Spelling-- children with ADHD are often phonetic (i.e. "poor") spellers. They have difficulty using an ordinary dictionary, because they can not look up the word the way it sounds. Small paperback dictionaries, such as the "Poor Speller's Dictionary" exist, and are often very useful. They contain words spelled phonetically along with their correct spellings. Just remember to lose the cover before the child takes it to school. Who wants to carry a book that says "I can't spell" on the cover?

      Computers-- Word processors and spelling checkers can help, but they only decrease the work on rewrites. Simple solutions include the use of macros in word processor (common phrases are typed with a single key stroke) and having someone type from a taped dictation. A high tech solution is to use one of the newer voice typing programs. VoiceDirect by IMSI is very inexpensive and quite good in voice recognition.

      Gerstmann's Syndrome: The developmental Gerstmann's syndrome is characterized by:

      • Finger agnosia.....difficulty locating body parts in space.
      • Dyscalculia..........difficulty with mathematics.
      • Right-Left disorientation.
      • Dygraphia...difficulty in writing.

      Dyslexia: Dyslexia is literally difficulty in reading. It may be associated with difficulty in spelling. It may be useful to use bypass techniques, such as books on tape, in severe cases. The Library of Congress provides access to the National Library for the Blind, a huge collection of taped books, for those who have been certified dyslexic by a licensed medical practitioner.

      Educational Interventions: See Educational Interventions for more information.

      Tourette's Syndrome: Tourette's Syndrome is a neurological condition in which many of the symptoms of ADHD are present. It has been diagnosed with increasing frequency in recent years, and there is variability in how the diagnosis is made by different health care providers. Classically, it is characterized by:
      • Tics - defined in DSM IV as "sudden, rapid, recurrent, non-rhythmic stereotyped motor movement or vocalization". These tics may be motor, vocal, or emotional.
      • Onset prior to 18 and tics occurring nearly daily and never free of tics for more than 3 consecutive months.
      • Impaired function or significant distress.
      Ritalin and other stimulants used to treat ADHD may produce an increased incidence of tics in some people. This remains an area of active investigation.

      Some not uncommon findings in ADHD children include:
      • Difficulty orienting themselves in space.....often manifested by running their hands down walls when they are in a new setting.
      • Poor social distance perception....watch at a large playground. The ADHD child is often "bounce out" of large play groups for failing to appreciate and follow the social norms.
      • Rapid, explosive anger that is quickly gone....this leaves those around them furious and upset, as they are still angry. The ADHD child is confused, as his anger has dissipated already.

    • RISK FACTORS

    So far, it appears that the greatest risk factor for developing attention deficit hyperactivity disorder (ADHD) is having an inherited tendency for the condition.

    Environmental factors, such as exposure to lead or certain parenting techniques, may influence how symptoms of ADHD are expressed.

    A stressful family situation may contribute to a child's symptoms. A child may feel guilty because of his or her symptoms and the problems they cause, which can increase the risk of developing another condition, such as anxiety, along with ADHD.

    PREVENTION

    There is no known way to prevent attention deficit hyperactivity disorder (ADHD). Avoiding alcohol, drugs, and smoking during pregnancy may help prevent a child from developing behavior similar to ADHD as well as many other health problems.

    Although ADHD cannot be prevented, parents can help their child have fewer learning and attention problems as they grow by:


    In addition, nurturing techniques that begin at birth and continue throughout childhood will help your child reach his or her potential whether or not ADHD is a concern.

    TREATMENT

    DIAGNOSIS & TESTS

    Exams and Tests

    The American Psychiatric Association (APA) has established criteria for diagnosing attention-deficit/hyperactivity disorder (ADHD). These criteria divide the condition into three basic types based upon major symptoms:


    In addition, some people are diagnosed with "ADHD, not otherwise specified" when symptoms of inattention, hyperactivity, and/or impulsiveness are present but do not fit into one of the three types.

    A health professional will use these criteria for diagnosing attention deficit hyperactivity disorders established by the APA to determine whether a child has ADHD. Information used to diagnose the condition includes:
    • An interview with the child.
    • Medical history, to include asking a parent about the social, emotional, educational, and behavioral history of the child.
    • Physical exam.
    • Behavior rating scales or checklists for ADHD given to parents and teachers to evaluate the child's symptoms.

    It can be difficult to determine whether a child's behavior problems are caused by ADHD, other conditions with similar symptoms, or a combination of ADHD and another condition. Several verbal and written tests for associated disorders are used to help with this determination.

    In addition, children with ADHD may have difficulty learning to read, write, or do math problems. Testing for learning disabilities will help teachers develop the best educational plan for a child with these difficulties.

    Additional tests may be done to identify other medical problems that might explain the child's symptoms, such as:
    • Hearing or vision impairment. This type of disability often interferes with school achievement.
    • Lead poisoning. Children who have even small amounts of lead in their bodies can have symptoms similar to ADHD.
    • Low red blood cell counts (anemia). This condition can cause low energy and poor concentration. It can be diagnosed with results from a complete blood count (CBC).
    • Thyroid disease. Blood tests can help determine if a person has too much or too little thyroid hormone, which also can affect energy and attention. This disease is more common in adults than children.
    • Seizures. Seizures can affect brain function and result in unusual behavior. Rarely, a person with ADHD symptoms has an electroencephalogram (EEG) to evaluate whether seizures are occurring.

    Some people are concerned that ADHD is over diagnosed. However, many health professionals and researchers believe that the increase in ADHD diagnoses results from improved detection techniques, especially the standardization of assessment criteria. Current and future research should help in answering this question more conclusively.

    Many adults with ADHD have never been diagnosed or treated. ADHD is a lifelong condition and, if left untreated, it can lead to low self-esteem, frustration, educational or job failure, drug abuse, and depression. To diagnose ADHD in an adult, a health professional may use the Wender Utah Rating Scale (WURS), a written test that consists of 25 questions about childhood difficulties that are often seen with the condition. The scale evaluates the presence and severity of ADHD symptoms during childhood.

    Adults with untreated ADHD are at an increased risk of abusing drugs or alcohol. If an adult is suspected of having or is diagnosed with ADHD, he or she may also be screened for alcohol and drug abuse.

    Early Detection: General screening of all children for attention deficit hyperactivity disorders (ADHD) is not recommended. However, if you are concerned about how your child's temperament, learning, or behavior is developing, talk with your health care provider during your next visit.

    Before meeting with your health care provider, think about at what age your child's symptoms began. In addition, you and other care givers should record information about the setting where the behavior occurs and how long it lasts. An important component of evaluation for ADHD includes what kinds of problems result from the behaviors and to what extent they affect academic performance and social behavior.

    Some adults do not recognize their own symptoms of ADHD until their child is diagnosed with the condition. If your child is diagnosed and you think you have symptoms, talk with your health care provider about being screened for ADHD.

    Tips For Teachers & Parents Working With ADHD Children



    CONVENTIONAL MEDICAL TREATMENT

    A variety of medications have been used in ADHD treatment. They include:

    Stimulants:
    • Short Acting Ritalin: The short acting form generally starts working about a half hour after it is given, peaks at 2 hours and is gone at 4 hours. It has a half life of 2-3 hours. It must be taken several times daily to maintain effectiveness. It comes in 5 mg, 10 mg, and 20 mg tablets. The tablets tend to be bitter, and are best swallowed whole. Common side effects are headache or stomach ache, usually minimized by taking the medication after having food.

    • Sustained Release Ritalin: The long acting form (Ritalin SR) comes only in a 20 mg tablet. It is designed to slowly release its contents from a series of "microchannels", and the tablet can not be cut. This dosage form is quite variable, working well for some people but poorly for others. It may be worth trying if a child on Ritalin is very resistant to taking medication at school. It tends to start acting more slowly than regular Ritalin, often taking 1.5 hours to start working. For this reason, it is often given with a small dose of regular Ritalin in the morning to provide initial coverage. Ritalin SR peaks at approximately 4.5 hours from the time it is administered. It is not uncommon to have parents report a "rebound hyperactivity" in the late afternoon as the long acting Ritalin wears off.

    • Dextroamphetamine: Dexedrine (or Dextroamphetamine) is a stimulant used in the treatment of ADHD. It comes in both long and short acting forms. The short acting tablet comes in 5 mg dosages, and reaches a peak level two hours after administration. The longer acting tablet is available in 5 mg, 10 mg, and 15 mg sizes and reaches a peak blood level eight to 10 hours after administration. This permits once daily dosing with the tablet. The half life of dexedrine (tablet) is approximately 10 hours, significantly longer than Short Acting Ritalin.

    • Cylert (Pemoline): Pemoline is similar to the other stimulants in its side effects, tending to cause insomnia and decreased appetite. It reaches a peak two to fours hours after it is taken, and has a half life of 12 hours. This relatively long half-life means that it can be taken once daily. Pemoline is metabolized by the liver, and has been associated with some cases of liver inflammation. Liver function should be tested prior to starting this medication and done periodically during the course of therapy to monitor for inflammation of the liver. Pemoline is the only stimulant which comes in a chewable form, making it useful for small children who can not otherwise take a bitter tasting stimulant. Cylert comes in 18.75, 37.5 and 75 mg tablets and in a chewable tablet in 37.5 mg. ATTENTION: the incidence of liver failure in children taking Cylert has prompted a recommendation that liver function tests be performed on a bi-weekly basis, and a number of programs no longer prescribe it.

    • Adderall: Adderall is a fairly new drug in the treatment of Attention Deficit Disorder. Adderall, a “cocktail” mixture of four different amphetamine salts, was first developed about 20 years ago and marketed under the name Obetrol for weight loss and diet control. In 1996 the FDA approved Adderall for unrestricted use for treatment of Attention Deficit Disorder and Adderall is quickly becoming a physician favorite for the treatment of Attention Deficit Disorder in children. If parents must choose a prescription ADHD medication, Adderall and Adderall XR is generally a better choice for many reasons. Adderall last about six hours per dose and remains active in the body longer than a dose of Ritalin. This longer acting dose alleviates the need for school day dosing but will interfere with sleep if taking the Adderall medication in the afternoon or evening hours. Adderall side effects are also often less harsh than Ritalin’s. Many patients report less “peaks and valleys” than Ritalin and less of a drop off (withdrawal) than Ritalin. Ritalin also tends to cause more stomach discomfort and tends to produce more moodiness than Adderall. But, all Attention Deficit Disorder medication - Adderall included - has potentially harmful side effects. Adderall is an amphetamine that works on children in the same way amphetamines work on adults. Children are subject to the same adverse Adderall side effects as adults using amphetamines, with the most common amphetamine and Adderall side effects being loss of appetite, weight loss and insomnia. In most cases, the Adderall side effects are mild but some Adderall side effects, though rare, are life threatening. Parents need to be clear about the benefits of Adderall medication as well as the potential Adderall side effects of using these drugs before choosing to place their child on prescription ADHD medication. Adderall medication can be helpful in the short term in controlling Attention Deficit Disorder symptoms but many health care providers feel the potential Adderall side effects should be carefully weighed before prescribing drugs like Adderall medication. Common Adderall side effects include:
      • loss of appetite
      • weight loss
      • insomnia
      • headache
      • dizziness

      Other Adderall side effects include:
      • nervousness
      • irritability
      • over stimulation
      • restlessness
      • unpleasant taste
      • dry mouth
      • nausea
      • stomach pain
      • diarrhea or constipation
      • euphoria
      • feelings of suspicion and paranoia
      • addiction
      • tolerance (constant need to raise the dose)

      The following, though rare, have also been reported as Adderall side effects:
      • Phonetic tics
      • high blood pressure
      • rapid pulse rate, elevated blood pressure
      • increased heart rate
      • hallucinations
      • Tourette's syndrome
      • cardiomyopathy
      • if similarities to Ritalin hold, Adderall abuse can result in death

      No one experiences Adderall side effects in exactly the same way. Parents should immediately alert their child's doctor to any Adderall side effects experienced. Fruit juices can lower absorption of Adderall. Alkalinizing agents such as Diamox heighten the absorption of Adderall medication. Thorazine, lithium, and Haldol can decrease the effects of Adderall medication. Tricyclic antidepressants may increase their levels when taken with Adderall medication. Parents should note that serious, even fatal, Adderall medication interactions can occur if Adderall is taken with MAO Inhibitors. Amphetamines like Adderall can impair judgment and the ability to engage in potentially hazardous activities like operating machinery, vehicles and sports participation. Adderall medication has a high potential for Adderall abuse as well as addiction. Amphetamines like Adderall should be administered at the lowest effective dosage and dosage should be individually adjusted to avoid Adderall abuse and harmful Adderall side effects. When possible, Adderall medication should be stopped occasionally to determine if there is sufficient need for continued Adderall medication therapy. It should also be noted that Adderall medication is not recommended for children under 5 years of age since safety and effectiveness has not been established in this age group.

      ADDERALL ABUSE: Adderall is a reformulated version and close cousin of the ADHD medication Dexedrine. Dextroamphetamine (Adderall, Dexedrine) is classified as Schedule II controlled substance, a classification given to medical drugs with the highest abuse potential and dependence profile. Drug Enforcement Agency data on methylphenidate (Ritalin, Conceta) and amphetamine (Dexedrine, Adderall) shows that both have high abuse liabilities. These substances are powerful stimulants and Adderall abuse, along with Ritalin abuse, is extensive. Adderall abuse can lead to marked tolerance, escalation in Adderall dosages and addiction. Although the majority of Adderall abuse cases cited pertain to adults, case studies also profile adolescents who abuse their Adderall medication. Other Adderall abuse reports students selling their Adderall medication to friends and schoolmates. Because Dextroamphetamine (street name “dexies”) can have a retail value in the high school parking lot, doctors often avoid prescribing Adderall medication to teenagers. Individuals respond differently to Adderall medication levels and dosages. While toxic overdose symptoms are rare with doses of less than 15 mg, toxic Adderall xr symptoms occasionally occur at Adderall medication doses as low as 5 mg. Methylphenidate (Ritalin, Concerta) and amphetamine (Dexedrine, Adderall) abuse produce behavioral and psychological effects similar to cocaine. The Adderall side effects of Adderall abuse include marked aggression and irritability, hyperactivity, and personality changes. Abruptly stopping Adderall after prolonged high dosage Adderall abuse results in extreme fatigue and mental depression. The most severe, though rare, Adderall side effects of Adderall abuse is psychosis. This Adderall abuse side effect is often clinically indistinguishable from schizophrenia. Long-term methylphenidate and amphetamine use has also been linked to abnormalities in brain development, similar to those found with long-term cocaine use. Changes on the sleep EEG are also noted with Adderall abuse. It is natural for parents to question whether taking a powerful stimulant like Adderall medication is in their child's best interests. Amphetamine stimulants like Adderall are worrisome for many reasons – predominately because of the potential for harmful Adderall side effects and high potential for Adderall abuse.

    Stimulant medications may be effective in 70-75% of patients diagnosed appropriately with ADHD. Cylert appears to be less potent in its activity, and often takes several weeks to start working. It is probably best reserved for younger children who need a chewable medication, or for situations where the patient has had an "overreaction" to other stimulants. Although not common, children will sometimes appear to be withdrawn, depressed and tearful if the dosage of stimulants is too high. It is best to start with a low dosage and gradually increase it as needed. Too high a dose of stimulant medications has lead to hallucinations and paranoid thinking in a small number of cases.

    Antidepressants:
    • Tricyclic Antidepressants: The Tricyclic ("three circles"...for the chemical structure of the molecule) antidepressants were once the mainstay of treatment in ADHD, but are used less frequently now. They have many side effects, especially dry mouth, dizziness when standing up quickly, blurring of vision, and constipation. They can be quite dangerous in overdose, especially compared to the newer SSRI's. Several cases of sudden death in children have been reported on the tricyclic antidepressant Desipramine. This should be taken seriously, but these medicines have been used for decades in children with good responses in many cases. An electrocardiogram is recommended prior to starting a tricyclic, and periodically while the medication is being given, or if the dose is raised significantly. There is not good evidence that this has any protective effect with regard to cardiac complications. Imipramine - 10, 25, 50 mg doses. Desipramine - 10, 25, 50, 75, 100, 150 mg doses. Nortriptyline - 10, 25, 50, 75 mg dose capsules

    • SSRI: The SSRI's (Prozac, Paxil,and Zoloft) all act by blocking the re-uptake of a chemical transmitter called serotonin into nerve cell endings. This keeps the concentration of serotonin higher. The net result of this is analogous to taking the static out of a static filled telephone system. Communication becomes easier and requires less effort. The SSRI's may produce some agitation or headache, and may decrease appetite. Unlike the Tricyclic Antidepressants, which are usually given at bedtime or in multiple doses, the SSRI's are usually given in the morning. All antidepressants are usually given with food. The SSRI's may take several weeks or more to start acting, as do the tricyclic antidepressants. There is insufficient information at present to determine which specific SSRI is best for a specific individual, although it is clear that some people respond better to one than another. Prozac - 10, 20 mg capsule/liquid, expensive, half-life is 84 hours. Zoloft - 50, 100 mg caplet, scored, half-life is 26 hours. Paxil - 20, 30, 40 mg caplet, scored, half-life is 21 hours.

    • Atypical Antidepressants: Buproprion (Wellbutrin) has been effective in treating ADHD in some children who have not responded to other medications. It is important to monitor the dosage carefully, as there is an increased risk of seizure when more than 150 mg/dose or 450 mg/day are used in adults. Monoamine Oxidase Inhibitors are rarely used to treat ADHD. They require a diet to control intake of tyramine which most children and many adults will not tolerate (who wants to give up pepperoni pizza?). Controlled studies have shown these medications to be beneficial, however, when other medications have been ineffective. For additional information, see: Spencer, Thomas, et. al., Pharmacotherapy of Attention-Deficit Hyperactivity Disorder across the Life Cycle, J.Am. Acad. Child Adolesc. Psychiatry, 35:4, April 1996

    Clonidine: Clonidine, also known as Catapress, is often prescribed in adults for high blood pressure. One of the common side effects with it is that it drops the blood pressure. This can result a "head rush", a sense of feeling faint due to too little blood reaching the brain because of low blood pressure. Clonidine is usually prescribed as a 0.1 mg tablet or as a patch. Small doses (0.05 mg or 1/2 of a TTS 1 patch) may be all that is needed to help control overly aggressive ADHD children. There have been some reports of adverse side effects of combining Ritalin and Clonidine. Clonidine is quite sedating, and should be used at the lowest effective dose. It should be tapered off and never stopped suddenly, as sudden cessation can cause rebound high blood pressure. The clonidine patch frequently is irritating to the skin, and may require use of a steroid cream and frequent movement of its location to avoid severe skin reactions. Tenex (Guanfacine) is another, similar alternative.

    Tegretol: The anti-manic/anticonvulsant Tegretol has also been used effectively.



    MEDICATION CONSIDERATIONS

  • Strattera: Although Strattera is a non-stimulant drug, it still alters the body chemistry un-naturally and has many un-pleasant side effects. Strattera is a selective norepinephrine re-uptake inhibitor, a class of ADHD treatment that works differently from the other ADHD medications available.

    Strattera Side Effects:
    • nausea
    • decreased appetite
    • vomiting
    • tiredness and upset stomach
    • Some adults indicate the following side effects: sleep problems, dry mouth, decreased appetite, nausea, dizziness and sexual problems. Medication can also interfere with monoamine oxidase inhibitor, an antidepressant and is not approved for use in patients with narrow angle glaucoma. It can increase blood pressure and heart rate and these should be routinely checked while on this medication.

  • Adderall: Never take Adderall within 14 days of taking an antidepressant classified as an MAO inhibitor. A potentially life-threatening spike in blood pressure could result.

    Most important fact about this drug: This drug, like all amphetamines, has a high potential for abuse. If used in large doses over long periods of time, it can cause dependence and addiction. Be careful to take Adderall only as prescribed or choose not to take it at all.

    Side effects may include:
    • changes in sex drive
    • constipation
    • depression
    • diarrhea
    • dizziness
    • dry mouth
    • exaggerated feelings of well-being
    • headache
    • high blood pressure
    • hives
    • impotence
    • insomnia
    • loss of appetite
    • mental disturbances
    • over stimulation
    • rapid or pounding heartbeat
    • restlessness
    • stomach and intestinal disturbances
    • tremor, twitches
    • unpleasant taste
    • weakened heart
    • weight loss
    • worsening of tics (including Tourette's syndrome)

    Special warnings about this medication: At present, there has been no experience with long-term Adderall therapy in children. However, other amphetamine-based medications have been known to stunt growth, so your health care provider will need to watch the child carefully.

    Drugs like Adderall only mask the true problem; the imbalance of the neurotransmitters serotonin, dopamine and norepinephrine. This CAN be balanced nutritionally.

  • Dexedrine: ADDERALL is the new name for a Dextroamphetamine/Amphetamine composite medication which has been around for more than 20 years. This formula was also used in a medication known as Obetrol, made in the past by Rexar and developed for "diet control."

    As a medication for ADHD, Adderall was approved for unrestricted use for treatment of ADHD by the FDA in March, 1996, and will almost certainly become one of the more widely prescribed medications for this condition very soon.

    Warnings on the Drug: Dexedrine (Generic name: Dextroamphetamine)
    Dexedrine Side Effects as reported by the "PHYSICIAN'S DESK REFERENCE®"

    DEXEDRINE® [dex'eh-dreen] (brand of dextroamphetamine sulfate)

    SPANSULE® CAPSULES, TABLETS and ELIXIR

      WARNING: AMPHETAMINES HAVE A HIGH POTENTIAL FOR ABUSE. THEY SHOULD THUS BE TRIED ONLY IN WEIGHT REDUCTION PROGRAMS FOR PATIENTS IN WHOM ALTERNATIVE THERAPY HAS BEEN INEFFECTIVE. ADMINISTRATION OF AMPHETAMINES FOR PROLONGED PERIODS OF TIME IN OBESITY MAY LEAD TO DRUG DEPENDENCE AND MUST BE AVOIDED. PARTICULAR ATTENTION SHOULD BE PAID TO THE POSSIBILITY OF SUBJECTS OBTAINING AMPHETAMINES FOR NON-THERAPEUTIC USE OR DISTRIBUTION TO OTHERS, AND THE DRUGS SHOULD BE PRESCRIBED OR DISPENSED SPARINGLY.

    Clinical experience suggests that in psychotic children, administration of amphetamines may exacerbate symptoms of behavior disturbance and thought disorder.

    Amphetamines have been reported to exacerbate motor and phonic tics and Tourette's Syndrome. Therefore, clinical evaluation for tics and Tourette's syndrome in children and their families should precede use of stimulant medications. Data are inadequate to determine whether chronic administration of amphetamines may be associated with growth inhibition; therefore, growth should be monitored during treatment.

    Drug treatment is not indicated in all cases of Attention Deficit Disorder with Hyperactivity and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe amphetamines should depend on the physician's assessment of the chronicity and severity of the child's symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics.

    When these symptoms are associated with acute stress reactions, treatment with amphetamines is usually not indicated.

    ADVERSE REACTIONS
    • Cardiovascular: Palpitations, tachycardia, elevation of blood pressure.
    • Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette's syndrome.
    • Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia or weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect.
    • Allergic: Urticaria.
    • Endocrine: Impotence, changes in libido.

    DRUG ABUSE AND DEPENDENCE: Dextroamphetamine sulfate (DEXEDRINE) is a Schedule II controlled substance. Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred.

  • Ritalin:

    Ritalin (methylphenidate) is classified among Schedule II controlled substances, which have a high abuse potential with severe psychic or physical dependence liability and in general, are substances that have therapeutic utility. Schedule II drugs include amphetamine (Dexedrine), cocaine, morphine, codeine, opium, oxycodone (Percodan), pentobarbital, and others. Ritalin has been sold on the black market as a form of speed.

    Ritalin side effects:
    • personality changes characterized by a state of excitement, confusion, depression or withdrawal
    • insomnia (sleeping problems)
    • appetite suppression (loss of appetite)
    • weight loss
    • headaches & stomachaches
    • rapid or irregular heartbeat
    • elevated blood pressure
    • sadness or irritability
    • tics (muscle twitches) of face and other parts of the body, which could lead to Tourette's Syndrome
    • possible suppression of growth (controversial)

  • Concerta: "These drugs make children more manageable, not necessarily better. ADHD is a phenomenon, not a brain disease. Because the diagnosis of ADHD is fraudulent, it doesn't matter whether a drug works. Children are being forced to take a drug that is stronger than cocaine for a disease that is yet to be proven."
      Beverly Eakman Author, President National Education Consortium 200
    Concerta Side Effects:
    • abdominal pain
    • aggravation, nervousness, hostility, sadness
    • drug dependence
    • dizziness
    • headache
    • tics
    • insomnia and prolonged sleepiness
    • loss of appetite
    • increased coughing, sinusitis, upper respiratory tract infection
    • vomiting
    • allergic reaction
    • increased blood pressure
    • psychosis (abnormal thinking or hallucinations).

    The Consequences of Stimulants for ADHD: Suicide and Death

    The Drug Abuse Warning Network (DAWN) indicated that between 1990 and 1993, most emergency room mentions for methylphenidate involved whites (75% to 89%) who were taking the drug orally (90% to 96%) to commit suicide (47% to 67%). The FDA reported on May 2, 2000, that "A total of 4,400 health-related complaints of adverse reactions to methylphenidate have been received since 1969".

    Thirty percent of those more than 1,300 complaints were reported in the last 15 months, including complaints of convulsions and tics, drug dependence, heart ailments, and death. Some estimate only about one percent of all complaints is ever reported to the FDA. The FDA reported 121 cases of people dying while taking methylphenidate and other medications.

    Drugs like Concerta only mask the true problem; the imbalance of the neurotransmitters serotonin, dopamine and norepinephrine. This CAN be balanced nutritionally.

    For more information about ADHD Medications:
  • WebMD: Medications for ADHD
  • WebMD: Psychostimulants for ADHD
  • WebMD: Antidepressants for ADHD
  • WebMD: Antihypertensives for ADHD



    HOME TREATMENT

    Many home treatment methods can help a person with attention deficit hyperactivity disorder (ADHD) symptoms. The approaches differ for children and adults, but treatment for all ages emphasizes understanding the condition, establishing daily structure, and using support systems. When your child has ADHD, working together can improve behavior and functioning at home and school. In addition, it is important for you to recognize that helping yourself will also help your child.

    HOME TREATMENT TIPS:

  • Take care of yourself. It is often challenging to raise a child with ADHD. Caring for your own physical and mental health is an important part of helping your child and will help provide the needed energy.

  • Educate yourself about ADHD. Learn as much as you can about the condition and your child's specific symptoms. You will be better able to help your child if you understand the condition.

  • Learn behavior management skills. Children usually need help learning how to interact appropriately with other people. You can help your child by learning behavior management skills, which usually includes counseling. An important component of behavior management is establishing natural and logical consequences for misbehavior.

  • Develop a healthy self-esteem in your child. Behaviors caused by ADHD can affect a child's feelings about himself or herself. You can help your child develop healthy self-esteem by encouraging a sense of belonging, confidence in learning, and an awareness of his or her contributions.

  • Help your child to be successful in school. The symptoms of ADHD can interfere with a child's ability to succeed in school. Promoting school success will help your child academically, socially, and developmentally.

  • Help your child accomplish tasks at home. Children with ADHD have more difficulty than other children paying attention to instructions, and they frequently get distracted before they can complete a task. Your patience, persistence, and creative thinking can help your child learn skills and accomplish tasks at home and school.

    NATURAL ALTERNATIVES TO ADD/ADHD MEDICATIONS

    BeCALM'd Nutritional Product for ADD/ADHD
      All natural product taken as a nutritional supplement, proven in clinical trials to help the symptoms of ADD/ADHD and work more effectively than the leading ADD/ADHD drugs without all the dangerous side effects.



    COMPLEMENTARY & ALTERNATIVE THERAPIES

    BIOFEEDBACK: Biofeedback uses repeated exercises to create or improve pathways of attention and impulse control. The desired result is to help a person create an appropriate mental state for a given situation, such as listening to instructions. Although biofeedback is unlikely to cause physical harm, more research is needed to determine if it might be effective in treating ADHD.

    HOMEOPATHY: Stramonium (for nervousness and tremors), cina (for restlessness), and hyoscyamus niger (for impulse control) are examples of homeopathic treatments.

    BEHAVIORAL INTERVENTIONS: Children with ADHD, according to Paul Wender,M.D. (Professor of Psychiatry, University of Utah) are "difficult to reward and difficult to punish". It is as if they lived in an "emotional raincoat", one which prevented them from fully experiencing emotions directed toward them. While this can keep them from feeling the full effects of their problematic behaviors, it makes modifying these behaviors very difficult. This is one of the reasons many parents report that behavior modification systems work for only a very short time (2-3 weeks at most) with these children.

    Among the most effective ways of dealing with ADHD children is Back In Control, a behavioral intervention program based on RULES.

    Back In Control: The "Back In Control©" program by Gregory Bodenhamer has unique advantages over many of the Reward/Punishment models of intervention with ADHD. It is a rule based system, which does not depend upon the desire of the child to comply. It is, in fact, a parent training system. It asks parents to:
    • Define a few clear, precise rules (you get exactly what you ask for, no more and no less).
    • Make the rules clear enough that a sitter could enforce them just as you would.
    • Enforce the rules absolutely.
    • Never reward or punish a rule.....ENFORCE it.
    • Never argue with a child about a rule.....use "unhooking" words like "Nevertheless" or "Be that as it may".

    Some Problems with Bodenhamer's System: Most parents are willing to give up rewarding. Few really want to give up punishing. Most parents have difficulty not yelling at a child when mad at them. This is only useful if you feel the child has a hearing problem. In fact, it tends to give the child the upper hand and to let the child divert you from the original rule. It is to the child's advantage to discuss with you "how unfair you are" rather than to clean up the room as originally directed.



    CONSIDERATIONS

  • A hair analysis to rule out heavy metal intoxication is important. Lead and copper have both been linked to behavioral problems. See Hair Analysis for more information.

  • A strong link has been established between learning disabilities and juvenile crime.

  • Researcher who performed 5-hour oral glucose tolerance tests on 261 hyperactive children found that 74 percent displayed abnormal glucose tolerance curves, suggesting a connection between hyperactive behavior and the consumption of sugar.

  • Studies indicate that administration of gamma-amino-butyric acid (GABA) decreases hyperactivity, as well as tendencies toward violence, epilepsy, mental retardation, and learning disabilities.

  • You can ask your health care provider to help you find a professional who specializes in treating people with attention deficit disorders, or seek a referral through one of the following groups:

    Attention Deficit Disorder Association (ADDA)
    P.O. Box 543
    Pottstown, PA 19464
    Phone: (484) 945-2101
    Fax: (610) 970-7520
    Website: http://www.add.org/

    Children With Attention-Deficit Disorders (CHADD)
    8181 Professional Place, Suite 150
    Landover, MD 20785
    National Resource Center on AD/HD (800) 233-4050
    Business (301) 306-7070
    FAX (301) 306-7090
    Website: http://www.chadd.org/

    Learning Disabilities Association of America (LDA)
    4156 Library Road
    Pittsburgh, PA 15234-1349
    Phone: (412) 341-1515
    Fax: (412) 344-0224
    Website: http://www.ldanatl.org/
    Email: info@ldaamerica.org

    RITALIN LINKS

    Druglord Ciba-Geigy Pushes Ritalin on Kids
    Ritalin Fraud (includes side effects of Ritalin)
    FDA Ritalin Studies
    PBS Transcript: Ritalin and CHADD, ADD
    PBS- Frontline: United Nation's Warnings on Ritalin
    PBS - Frontline: Medicating Kids: The business of ADHD
    DEA Report on Ritalin
    What Doctors Don't Tell You 2001-2
    Methylphenidate (Ritalin)

    SUPPORT GROUPS (ONLINE & OFFLINE)

    Online Resources

    ADD

    Bulletin Boards Chat Newsgroups
    On-line Groups
    Pen Pals
    Newsletters & Magazines
    Advocacy
    Offline Resources

    Information Packet

    Attention Deficit Disorder Information Packet and "Know Your Brain Fact Sheet." Both are available from NIH Neurological Institute, P.O. Box 5801; Bethesda, MD 20824 (800) 352-9424.

    National ADDA: A.D.D. Professionals Yellow Pages

    Yellow Pages

    Adult ADD Support Groups

    National Support Groups

    Another List of Support Groups

    Organizations

    AD-IN: Attention Deficit Information Network
    475 Hillside Avenue
    Needham, Massachusetts 02194
    (617) 455-9895

    CHADD: Children and Adults with Attention Deficit Disorders
    499 NW 70th Avenue, Suite 101
    Plantation, Florida 33317
    voice: (800) 233-4050
    voice: (305) 587-3700
    fax: (305) 587-4599
    Website: CHADD

    National ADDA
    1788 Second Street, Suite 200
    Highland Park, IL 60035
    E-mail: mail@add.org
    Phone: 847-432-ADDA
    Fax: 847-432-5874
    Website: http://www.add.org/

    The Whole Child/Adolescent Center
    750 Columbus Avenue 
    Suite 9S
    New York, NY 10025
    Website: http://wholechild.net/addadhd.htm

    Learning Disabilities Association of America (LDA)
    4156 Library Road, Pittsburg, PA 15234
    Phone: 412-341-1515

    National Center for Learning Disabilities (NCLD)
    381 Park Avenue South, Suite 1401
    New York, NY 10016
    Phone: 212-545-7510
    Website: http://www.NACLD.org

    Orton Dyslexia Society (ODS)
    Chester Building
    8600 LaSalle Rd., Suite 382
    Baltimore, MD 21286-2044
    Phone: 410-296-0232
    Website: http://www.InteDys.org

    ERIC Clearinghouse
    Disabilities & Gifted Education
    1920 Association Drive
    Reston, VA 20191-1589
    Phone: 800-328-0272 or 703-620-3660
    Website: http://www.ICEC.SpEd.org/ericec.htm

    Council for Learning Disabilities (CLD)
    P.O. Box 40303
    Overland Park, KS 66204
    Phone: 913-492-8755
    Website: http://www1.Winthrop.edu\CLD\

    HEATH Resource Center (Higher Education and Adult Training for People with Handicaps
    One Dupont Circle, Ste. 800
    Washington, DC 20036
    Phone: 800-544-3284
    Website: http://www.acenet.edu/programs/heath/home.html

    National Information Center for Children and Youth with Disabilities
    1875 Connecticut Avenue, 8th Floor
    Washington, DC 20009
    Phone: 800-695-0285
    http://www.NICHYorg

    National Council of Juvenile and Family Court Judges
    Book published by NCJFCJ: Juvenile & Family Court Journal: Learning Disabilities and the Juvenile
    Justice System $10.00
    P.O. Box 8970
    Reno, NV 89507
    Phone: 702-784-6012
    Website: http://www.ncjtcj.unr.edu/

    DIETARY RECOMMENDATIONS

  • Include in the diet all fruits and vegetables (except those containing salicylates, listed below), plus breads, cereals, and crackers that contain only rice and oats.

  • Remove from the diet all forms of refined sugar and any products that contain it. Also eliminate all foods that contain artificial colors, flavorings, or preservatives; processed and manufactured foods; and foods that contain salicylates. Certain foods naturally contain salicylates. These include almonds, apples, apricots, cherries, currants, all berries, peaches, plums, prunes, tomatoes, cucumbers, and oranges.

  • Do not consume any of the following: apple cider vinegar, bacon, butter, candy, catsup, chocolate, colored cheeses, chili sauce, corn, ham, hot dogs, luncheon meat, margarine, meat loaf, milk, mustard, pork, salami, salt, soft drinks, soy sauce, sausage, tea, and wheat. Do not use antacid tablets, cough drops, throat lozenges, or commercial toothpaste. Use a natural toothpaste from a health food store instead.

  • Avoid carbonated beverages, which contain large amounts of phosphates. Phosphate additives may be responsible for hyperkinesis (exaggerated muscle activity). High levels of phosphates and very low calcium and magnesium levels (which can be revealed through a hair analysis) can indicate a potential for hyperactivity and seizures. Meat and fat also are high in phosphates.

  • Use an elimination diet to identify foods that may be causing aggravating symptoms. See Allergies for more information.



    HERBS

  • Valerian root extract has been used for this disorder with dramatic results and no side effects. Mix the extract in juice (as directed on the product label according to age) and drink the mixture two to three times daily.

  • Other herbs that may be beneficial for hyperactivity include catnip, chamomile, hops, lobelia, passion flower, skullcap, thyme, and wood betony. Caution: Do not use chamomile or lobelia on an ongoing basis. Avoid chamomile completely if you are allergic to ragweed.

  • Herbal medicines and natural substances that some naturopaths use for treating ADHD include ginkgo biloba and lemon balm because of their reputed beneficial effects upon the brain. Kava and St. John's Wort, which can be harmful if taken incorrectly, are also sometimes used to try and help regulate mood and behavior problems associated with ADHD. Do not use these except under the direction of a health care provider.



    NUTRITIONAL SUPPLEMENTS

    Iron supplements: You should not use iron supplements or give them to your child without first discussing it with your health care provider. Although some children with ADHD have low levels of iron in their blood, too much iron can be poisonous and may lead to death.

    Vitamins: A daily multivitamin may help anyone meet his or her nutritional requirements and prevent any deficiencies, especially children who are picky eaters with reduced appetite from psychostimulant medication.

    Unless otherwise specified, the dosages recommended here are for adults. For a child between the ages of 12 and 17 years, reduce the dose to 3/4 the recommended amount. For a child between the ages of 6 and 12, use 1/2 the recommended dose, and for a child under the age of 6, use 1/4 the recommended amount.

    NUTRIENTS
    SupplementSuggested DosageComments
    Very Important
    Quercetin As directed on label. Prevents allergies from aggravating symptoms.
    Calcium and magnesium As directed on label, at bedtime. Has a calming effect.
    Gamma-aminobutyric acid (GABA) 750 mg daily. Calms the body much in the same way as some tranquilizers, without side effects or danger of addiction. See Amino Acids for more information.
    Vitamin B complex 50 mg 3 times daily. B vitamins are needed for correct brain function and digestion. Also enhance adrenal gland function.
    Plus extra
    Vitamin B3 (niacin)    		 100 mg daily. Do not exceed a total of 300 mg daily from all supplements. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure.
    And
    Pantothenic acid (Vitamin B5)    		 100 mg daily. The anti-stress vitamin.
    And
    Vitamin B6 (pyridoxine)    		 50 mg daily. Important for proper brain function.
    Helpful
    Bio-Strath from Bioforce As directed on label. Contains yeast, herbs, and all the B vitamins that have a calming effect.
    Brewer's Yeast Start with 1/4 teaspoon daily and slowly increase to the dose recommended on the label. A natural source of the B vitamins.
    L-Cysteine As directed on label, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B6 and 100 mg vitamin C for better absorption. Take this amino acid if a hair analysis reveals high levels of metals. See Amino Acids for more information.
    Multivitamin and mineral complex As directed on label. High amounts of all nutrients are needed for dietary deficiencies.
    Taurine Plus from American Biologics As directed on label. The most important antioxidant and immune regulator; necessary for white blood cell activation and neurological function.
    Vitamin C 1,000 mg 3 times daily. An anti-stress vitamin.

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    NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...

  • You notice that you or your child have symptoms of attention deficit hyperactivity disorder (ADHD) that began before age 7.

  • Your child is showing signs of ADHD, such as inattention, impulsivity, and/or hyperactivity, that are causing problems at home or school. Parents and teachers often notice this behavior during the child's first few years in school.

  • Your child shows signs of other mental health disorders, such as depression or anxiety, that last more than a few weeks or seem to be getting worse.

  • Your child is having academic or behavioral problems at school.

    Watchful Waiting - Preschool children: Watchful waiting is appropriate for young children who show signs of attention deficit hyperactivity disorder. However, it is difficult to diagnose ADHD in children younger than age 5. Young children generally have short attention spans, and their normal range of behavior includes periods of high activity and impulsiveness. If you notice any ADHD symptoms in your preschooler that do not seem age-appropriate, work with your child to improve behavior. Keep a record of your child's behavior for 6 months to see if it improves. If it continues or has consequences, such as being expelled from day care or preschool, talk with your health care provider about having your child evaluated.

    Watchful Waiting - School children and teens: Watchful waiting is not appropriate for school children and teens with ADHD symptoms. Children who have behavior problems that occur in more than one setting, such as poor relationships with parents and poor academic performance, need attention from a health professional. Problems caused by inattention may not become significant until the teen years, when greater self-reliance is expected. Typically, problems with inattention are triggered by a change in school (such as advancing to junior high or high school) or a new environment, such as moving to another city. If you suspect your child may have an inattention problem, see a health professional to determine if ADHD is the cause.

    Watchful Waiting - Adults: Watchful waiting may not be appropriate if you are an adult and suspect that you may have ADHD. Consider how long you have experienced symptoms, and think about any major changes or difficult situations that are affecting your life. Your symptoms may improve once you have addressed and worked on those issues. However, talk to a health professional if your symptoms concern you. In addition, if you have other symptoms, such as depression or anxiety, a health professional can help diagnose and treat your problems.

    Be sure to ask your health professional about his or her training and experience related to ADHD. Diagnosing and treating ADHD requires an ability to identify and distinguish behaviors that can be subtle and complicated. In addition, make sure your health professional has enough time to evaluate you or your child. Accurate diagnosis and successful treatment of ADHD takes repeated office visits and observations. It is also necessary that he or she be able to coordinate between other health professionals, family members, teachers, and caretakers.

  • Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
      -- by Phyllis A. Balch, James F. Balch




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