DESCRIPTION

Hyperactivity, medically termed Attention Deficit Hyperactivity Disorder (ADHD), or Attention Deficit Disorder (ADD) with hyperactivity, is the newest name given to a group of disorders of certain mechanisms in the central nervous systems. With the long list of names this disorder has been given over the years, it can be confusing as to exactly what the criteria are fro a diagnosis of ADHD or ADD. In the 4th Edition of Diagnostic & Statistical Manual of Mental Disorders (DSM_IV), the American Psychiatric Association describes three different categories of ADHD - ADHD inattentive, ADHD Hyperactive-impulsive, and a third category that is a combination of the two. For the sake of simplicity, ADD will be used when referring to the inattentive form without hyperactivity and ADHD will be used for the hyperactive-impulsive and combined forms.

The National Institute of Mental Health (NIMH) estimates that between 3 and 5 percent of children in the United States have ADHD. This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD. Three times as many boys are diagnosed with ADHD, but the condition is increasingly being diagnosed in girls as well.

Although it is primarily thought of as a childhood disorder affecting children and teens, ADD and ADHD can be found in adults as well. It is estimated by experts that as many as 8 million adults may be affected, but 80 percent of them do not realize it, and medical experts continue to debate whether children can expect to outgrow the symptoms. Some studies have shown a significant decline in ADHD symptoms as a person ages. Other experts estimate that between 30 and 70 percent of children will carry some symptoms into adulthood.

Adult ADHD is a more complex disorder. It manifests itself not so much as problems with the ability to pay attention or impulse control, but a problem with self-regulation. Without this control, an adult's ability to do tasks is impaired, because not only must the tasks be done, but they have to be scheduled, organized, and placed in proper perspective. The condition can lead to marital conflicts, substance abuse, and financial problems. Infidelity is common because ADHD adults easily become bored with things - including spouses.

ADHD causes a variety of learning and behavioral problems 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. It causes difficulties not only for the affected individual, but for the entire family. Although the ADD/ADHD child is often labeled as having a learning disability, the child usually is of average or above-average intelligence and is also highly creative.

Factors that have linked to the development of ADD/ADHD include heredity, anxiety, allergies, smoking during pregnancy, hyperinsulinemia, oxygen deprivation at birth, environmental pollutants or stress, artificial food additives, injuries, infection, lead poisoning, 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. Resent research suggests that watching too much television, with its fast-paced visual images, may permanently rewire the developing brain and cause ADHD-like symptoms. This is especially true in the first 2 to 3 years of life.

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



DEMOGRAPHICS:

• ADHD is 5 to 7 times more common in boys.
• ADHD occurs in people of every level of intelligence.
• ADHD tends to run in families, and there is an association with a family history of alcoholism and/or depression.
• There is some suggestion clinically that asthma may be more prevalent in ADHD children.
• ADHD children often show considerable ability with artistic endeavors, but may have difficulty forming symbols (writing) unless "drawing", going very slowly and precisely.
• ADHD is much more commonly diagnosed in the United States than in Europe, and the stimulant medications are used vastly more in the United States as an intervention strategy.

---

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 SURROUND 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 INTO CHILDHOOD

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 & ALLERGIES

In recent years, more emphasis has been placed on the role of diet in ADD/ADHD. Many people with these conditions react to certain preservatives, dyes, and salicylates in foods. These items can throw off the balance in the chemistry of the brain, often producing undesirable changes in behavior. A low protein diet may be a contributing factor. Though the topic has been hotly debated for decades, studies have definitively shown that food additives do play a major role in hyperactivity.

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

There is no single test to determine if a person has ADHD. A specialist makes the diagnosis by comparing a person's behavior pattern against a set of criteria established by the American Psychiatric Association.

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

• Head-knocking.
• Lack of concentration.
• A tendency to disturb other children.
• Self-destructive behavior.
• Emotional instability; daily or hourly mood swings.
• Disorders of speech and hearing.
• Temper tantrums.
• Impatience; difficulty waiting.
• Extreme distractibility.
• Forgetfulness.
• Absentmindedness.
• Inability to finish tasks.
• Difficulty in solving problems or managing time.
• Low tolerance for stress and otherwise ordinary problems.
• Learning disabilities.
• A tendency to become frustrated quickly.
• An inability to sit still for any length of time, even at mealtimes.
• Clumsiness.
• Sleep disturbances.
• Failure in school despite average or above average intelligence.

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 while maintaining a healthy diet and positive lifestyle 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:

• Having good medical care and practicing healthy habits during pregnancy.
• Learning and applying good parenting skills, including setting consistent behavior limits.
• Maximizing preschool learning by reading to your child and providing new learning experiences.

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

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:

• ADHD, combined type.
• ADHD, predominantly inattentive type.
• ADHD, predominantly hyperactive-impulsive type.

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.

The ADD child may be harder to diagnose than the ADHD child because the hyperactivity is more obvious than the inattentiveness. However, the procrastination, difficulty in concentrating, and inability to start or finish projects that is characteristic of the disorder can have damaging effects that can last through adulthood. ADHD produces hyperactive, restless, impatient, and impulsive behavior.

Despite this, children with ADHD can have the ability to pay attention and complete assignments, often spending hours doing things that interest them. Adults with ADHD seem to constantly be going and getting things done, but they often grow impatient easily and have a tendency to lose their tempers quickly. The combined form of ADD/ADHD can be the most debilitating. Children with this type of disorder often have low self esteem, are impatient, do not follow rules or act responsibly, are often clumsy, think they are always right, do not want to accept change, and do not adapt well.

OVER-DIAGNOSIS OF ADD/ADHD OR BETTER DIAGNOSTIC CRITERIA?

With the enormous increase in the number of recently diagnosed cases of ADD and ADHD, many people, including researchers, are concerned that ADD/ADHD is being over diagnosed. It is difficult to diagnose accurately because many of the symptoms appear in normal healthy children at many times during childhood. In fact, more than 60 percent of parents suspect that their child has ADD or ADHD as some point during the child's upbringing.

What may merely be creativity or a high energy level can be misdiagnosed as ADD or ADHD. A diagnosis of ADD/ADHD should be made by a team of specialists who are experts in the disorder, and it is wise to get a second (or third) opinion from an unrelated source or sources if your child is diagnosed as having ADD or ADHD. Be careful about jumping to medications. While medications are certainly helpful, a study released in the Journal of the American Medical Association (JAMA) discussed safety concerns and the rising number of 2 to 4 year old children who are now on medication.

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.

UNDIAGNOSED ADULTS

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 ADD/ADHD CHILDREN

1. Consistency is the key to helping ADD/ADHD children. They are really poor at dealing with change, even if it is positive change. They need to have a sense of external structure, as they tend to lack a sense of internal structure.

2. ADD/ADHD kids have two kinds of time... plenty and none. They are usually poor at organizing their time and need you to help them break tasks down into small components.

3. Placing ADD/ADHD kids at the front of the room (nearest the blackboard or where the teacher gives instruction) is often helpful. If the child is right handed, placing them at the right front of the class minimizes the number of children they watch wiggle when they write.

4. Try to avoid placing ADD/ADHD children in loft classrooms or in situations with multiple children at a single desk. This maximizes their distractibility.

5. Use colors and shapes to help them organize.

6. Try to provide a quiet study area, free from distraction, when seat work is required.

7. Try to work within the child's attention span. Keep changing the type of work frequently and the child can continue to work productively. Medication is NOT the only solution.

8. Remember, these children have a tendency to get people around them fighting. Try to avoid getting into "blaming mode", either as a parent or a teacher.

9. Many of these children are VISUAL learners. Try making things more visual or tactile and they may grasp them better. Instead of memorizing words, ask them to "make a movie in their head and play it back".

10. Don't worry if you feel frustrated... so do their parents and so do the kids. Just don't take their behavior as personally directed , because it isn't in most cases.

ADHD PATIENT'S PLAY VIDEO GAMES AS PART OF TREATMENT Posted 3/9/2006 7:56 PM By Susan Jenks , Florida Today A generation raised on video games is inspiring researchers' efforts to unlock the mysteries of a puzzling learning disorder that afflicts millions of school-age children and even some adults. Whether speeding down a virtual street in Sony's Gran Turismo or slaying Spyro the Dragon, researchers hope games such as these will improve the lives of those with attention-deficit hyperactivity disorder, commonly known as ADHD, or cognitive-processing difficulties. People with these disorders experience "constant frustration," says Henry Owens, a Melbourne, Fla., clinical psychologist who recently began offering a patented video game system, which evolved from NASA technology, to some of his patients. "If they just play video games on their own, they will zone out," he says. "When they play on this system, if they zone out, the video game doesn't respond any more," acting as an incentive to improve focus and concentration. That comes through controlling brain-wave activity, which some researchers say is too slow or too fast in certain areas of the brain when patients have ADHD. Video game play is a form of neuro-feedback, Owens says, which teaches patients to self-regulate brain-wave patterns to improve learning. But some researchers remain cautious. "It's still controversial," says Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Schneider Children's Hospital in New Hyde Park, N.Y. He says studies have yet to show video game play with a neuro-feedback component has either a short-term or long-term benefit, despite parents' desire to explore other options in the wake of recent concerns about Ritalin and other stimulants used to treat ADHD. They need to ask, "Does it help, and is it the best treatment available?" says Adesman, a spokesman for Children and Adults with Attention-Deficit/Hyperactivity Disorder, a non-profit education, advocacy and support group in Maryland. The concern, he adds, is parents might abandon mainstay treatments - a combination of pharmacological and educational interventions that have been tested and proved over time. Owens, however, says some patients have been using the video game system, developed by the San Diego company CyberLearning Technology, in combination with medications, while others want to try the non-drug alternative first, before turning to drug therapy. Owens says he has four patients playing Smart Brain Games (www.smartbraingames.com), as the system is known, at home - a recent alternative to in-office sessions, which began about a year ago. Of the home training, he says, "Its advantage is intensity," although he advises against playing more than 20 minutes a day for children younger than 10, and no more than a half-hour daily for everyone else. And while the company makes the system available directly to consumers - and it is compatible with any Sony off-the-shelf video game - Owens says that without an initial evaluation with an electroencephalogram or EEG, to map brain activity, "how would you know what's being treated?" "Because this is so new and such a commitment," he says, "we don't want parents to do it lightly." FDA APPROVED In Florida, Owens is one of only five practitioners authorized by the company to offer its gaming system. Lindsay Greco, a co-founder of CyberLearning, says the company has 54 providers Nationwide, identified by "licensure and their expertise in neuro-feedback." She says the system has approval from the U.S. Food and Drug Administration, and that by mid-2003 the company had acquired an exclusive license from NASA to take Langley Research Center's technology, enabling researchers to measure the brain waves of pilots during flight simulations, into the gaming arena. The device works through a specially designed helmet, with built-in sensors that monitor a player's brain waves. Signals from the sensors are fed through a signal-processing unit and then to a video controller as a game is played. "There are other systems with computer-based technologies where the bar goes up and down," Greco says. "But these are rudimentary. Our games empower you to change your own brain's physiology." Like Owens, she says the best games are jumping and racing games that provide consistent movement and a better ability to measure feedback response. Also, where there is a diagnosis of ADHD, she says, patients should seek providers' expertise on how best to use the system. Of the roughly 700 systems sold, she says, about 70% have gone to patients using them under the supervision of a health care professional, while 30% have been bought by people for entertainment or those "simply wanting to sharpen their attention or memory." Greco says in-office neuro-feedback programs normally cost from $4,000 to $5,000, while their system costs $584, with in-office network provider supervision running less than $2,000. Insurance typically does not cover any of these expenses. "Cost has been a huge challenge for many consumers," she says. 'QUITE HELPFUL' Although he has not worked with the video game system, Thomas Peake, another Melbourne clinical psychologist, supports the concept "in the right hands." "If it's done right, these things, in and of themselves, can be quite helpful," Peake says. "And kids are used to playing games and like them." He says he used to do biofeedback to help patients control pain and has seen it used in major medical centers to help speed recovery in stroke patients. "Most people off the street would not know how to use these devices, however," he cautions. "But, to me, the principle is a good one."

---

CONVENTIONAL MEDICAL TREATMENT

A variety of medications have been used in ADD/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, Concerta) 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:

Tegretol, an anti-manic/anticonvulsant drug, 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.

---

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

A better approach to consider for the treatment and management of ADD/ADHD than using drug therapy would be to consider nutritional and dietary measures. Keep in mind, as with all treatments, not any single drug or nutritional therapy will work for all cases of ADHD/ADD. Every person is unique and there is usually a trial and error phase when trying to find a specific treatment program that will work for that individual. Here are some helpful suggestions for alternatives to drug therapy in treating ADD/ADHD and hyperactivity problems:

BeCalm'd is an 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.



See below for more helpful products and suggestions.

---

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: Homeopathic remedies, taken in small doses, may be helpful in relieving certain symptoms of ADD/ADHD. These are some examples of homeopathic treatments:

• Stramonium (for nervousness and tremors).
• Cina (for restlessness).
• Hyoscyamus niger (for impulse control).
• Gelsemium (can help relieve anticipatory anxiety).
• Ignatia (can help to alleviate anger or temper tantrums).

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.

---

DIETARY RECOMMENDATIONS

INCLUDE IN THE DIET

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.

Include cold-water fish such as tuna, salmon, and herring in your diet. These are all good sources of docosahexaenoic acid (DHA), an essential fatty acid that is thought to be vital for brain development and is often deficient in those with ADD/ADHD.

Follow a high-protein diet, similar to the one prescribed for hypoglycemia. Proteins are needed to supply the body with amino acids. Some researchers are studying the similarities between hypoglycemia and ADD/ADHD. It is possible that a large number of ADD/ADHD diagnoses are in actuality hypoglycemia in disguise. The symptoms are so similar it is difficult to separate them. A low-carbohydrate, high-protein diet, particularly at breakfast, should assist in reducing symptoms if it is truly hypoglycemia.

MoonDragon's Health & Wellness: Hypoglycemia

MoonDragon's Nutrition Information: Hypoglycemic Diet

MoonDragon's Nutrition Information: Gestational Diabetes Diet

Be sure that your child is getting his or her carbohydrates from foods that contain complex carbohydrates and cut down on simple carbohydrates. Complex carbohydrates can be found in fresh vegetables, fresh fruits, beans, and natural whole grains. They provide dietary fiber and have only a third of the calories found in fats and simple carbohydrates. Simple carbohydrates, such as glucose, fructose, and galactose, are found in all forms of sugars, some juices, and in processed and refined grains (not whole grains).

ELIMINATE FROM THE DIET

Limit dairy products if you notice behavioral changes after they are consumed. Dairy foods have been known to cause behavioral problems in some ADD/ADHD sufferers.

Remove from the diet all forms of refined sugar (simple carbohydrates) and any products that contain it. Also eliminate all junk food and 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.

High levels of phosphorus 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 are also vary high in phosphorus.

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

OTHER RECOMMENDATIONS

Do not use antacid tablets, cough drops, perfume, throat lozenges, or commercial toothpaste. Use a natural toothpaste from a health food store or make your own using natural products.

MoonDragon's Health Therapy: Herbal Personal Care Recipes - Toothpaste

Limit exposure to television, video and electronic games, and loud music. Instead, encourage outdoor physical activities or other activities to expand creativity.

Consider trying cognitive-behavioral therapy. This can often alleviate or eliminate many of the behavior problems caused by ADD/ADHD.

---

HERBS

If you are giving herbs to a child, be sure to adjust the dosage for age as recommended by the manufacturer.

Bacopin is an extract of the Ayurvedic herb Bacopa (Bacopa Monniera). It is useful as a good memory enhancer.

Ginkgo Biloba is helpful for brain function and concentration.

Herbal Remedies: Ginkgo Leaf (Ginkgo Biloba) Powder, 4 oz. Bulk

Herbal Remedies: Ginkgold Ginkgo Biloba Extract, Nature's Way, Vegetarian, Standardized, 60 mg, 150 Tabs

Herbal Remedies: Ginkgo Biloba Extract, Standardized, Nature's Way, 60 mg, 120 VCaps

Herbal Remedies: Ginkgo Biloba Herbal Tea, 20 Tea Bags

Ginseng or Mullein Oil may be helpful for memory.

Herbal Remedies: Ginseng Information & Products

Herbal Remedies: Mullein Oil, 100% Organic, 2 fl. oz.

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.

Herbal Remedies: Valerian Root Extract, Standardized, 510 mg, 90 Caps

Herbal Remedies: Valerian Root Glycerite, 100% Organic, 2 fl. oz.

Mountain Rose Herbs: Valerian Extract, Certified Organic, 1 oz & 4 oz. Size Choice

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
Supplement	Suggested Dosage	Comments
Essential
Calcium	As directed on label, at bedtime.	Has a calming effect. Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz., Liquid Calcium W/ConcenTrace, Orange Vanilla, Trace Minerals, 1000 mg, 32 fl. oz., Cal-Mag Pre-Chelated Calcium & Magnesium, Vital Earth, 240 Gelcaps
Magnesium	As directed on label, at bedtime.	Has a calming effect. Helps uptake of calcium. Magnesium Ionic Mineral Supplement, Fully Absorbable, 350 +/- ppm, 16 fl. oz., Just An Ounce Calcium & Magnesium Liquid, Almond Flavor, 16 fl. oz., Calcium & Magnesium Mineral Complex, 100% Natural, Nature's Way, 500 mg / 250 mg, 250 Caps
Efalex Focus - ADD	As directed on label.	Provides essential fatty acids and helps to maintain eye and brain function.
Or Kyolic EPA	As directed on label.	Restores proper fatty acid balance.
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. GABA (Gamma Aminobutyric Acid) Supplement, NOW Foods, 500 mg, Plus B-6, 2 mg, 100 Caps, GABA Powder (Gamma Aminobutyric Acid), NOW Foods, 100% Pure, Vegetarian, 500 mg, 6 oz.
Multi-Vitamin & Multi-Mineral Complex	As directed on label.	All nutrients are needed for equilibrium within the body. Use a liquid form / gelcaps, if available, for best absorption. Super Multi-Vitamin & Multi-Mineral, Pure Vital Earth, 32 fl. oz. (98% Bio-Available for Absorption), Damage Control Master Formula, High Potency, Multi-Vitamin & Mineral, 60 Packets (30 Day Supply), Liquid Multi-Vitamin & Mineral, Strawberry-Raspberry Flavor, Trace Minerals, 32 fl. oz., Alive! Whole Food Energizer, Liquid Multi-Vitamin, Citrus Flavor, Nature's Way, 30 oz.
Pycnogenol Or Grape Seed Extract	As directed on label. As directed on label.	Powerful antioxidants offering cellular protection for the body and brain. Pycnogenol W/ Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs, Grape Seed (Grapeseed) (Vitus vinifera), 100% Pure, NOW Foods, 16 fl. oz.
Quercetin	As directed on label.	Prevents allergies from aggravating symptoms. Quercetin, NOW Foods, 500 mg, 100 VCaps, Quercetin With Bromelain, Hypoallergenic, Bioflavonoid, NOW Foods, 800 mg, 120 VCaps
S-Adenosylmethionine (SAM-e)	As directed on label.	Aids in relieving stress and depression. Caution: Do not use if you have manic-depressive disorder or take prescription antidepressants. Do not give to a child under 12 years. SAM-e, Enteric Coated, NOW Foods, 100 mg, 30 Tabs, SAM-e With B Vitamin Cofactors, Vegetarian, Enteric Coated, NOW Foods, 200 mg, 60 Tabs
Vitamin B Complex	50 mg of each B vitamin daily, with meals 3 times daily (amounts of individual vitamins in a complex will vary).	B vitamins are needed for correct brain function and digestion. Also enhance adrenal gland function. Ultimate B (Vitamin B Complex), Nature's Secret, 60 Tabs, Vitamin B-100 Complex, w/ Coenzyme B-2, Nature's Way, 631 mg, 100 Caps
Plus Extra Vitamin B-3 (Niacin)	100 mg daily. Do not exceed a total of 300 mg daily from all supplements.	B vitamins improve circulation, build up red blood cells and aid liver function. Caution: Do not take niacin if you have a liver disorder, gout, or high blood pressure. Niacin Supplement (Vitamin B-3), 100% Natural, Nature's Way, 100 mg, 100 Caps
And Vitamin B-5 (Pantothenic Acid)	100 mg daily.	The anti-stress vitamin. Pantothenic Acid, 100% Natural Vitamin B-5, Nature's Way, 250 mg, 100 Caps
And Vitamin B-6 (Pyridoxine)	50 mg daily.	Important for proper brain function. Extremely important for formation of red blood cells and neurotransmitters. Vitamin B-6 / Pyridoxine, Nature's Way, 100 mg, 100 Caps
Helpful
Acetylcholine	As directed on label.	Can improve memory and ability to pay attention. Phosphatidylcholine, a primary component of lecithin, is converted in the brain into the neurotransmitter acetylcholine. Phosphatidylcholine, Derived From Soy, Allergy Research Group / Nutricology, 100 Softgels
Attend (Vaxa International)	As directed on label.	A homeopathic nutritional combination designed to address the specific dietary and neurochemical deficiencies thought to occur in people with ADD/ADHD. Can be used by both children and adults.
Bio-Strath	As directed on label.	Contains yeast, herbs, and all the B vitamins that have a calming effect.
Dimethylaminoethanol (DMAE)	As directed on label.	Aids in concentration by improving nerve impulse transmission in the brain. May also produce antidepressant effects. Caution: This supplement should be used by adults only. Do not give it to a child. DMAE Supplement (Dimethylaminoethanol), Vegetarian, NOW Foods, 250 mg, 100 VCaps, BrainAid (With Choline, DMAE, & Phosphatidylcholine), Allergy Research Group / Nutricology, 60 Tabs
EFA Attention Formula	As directed on label.	Contains essential fatty acids, vitamins, minerals, and Ayurvedic herbs that support normal brain, nerve, and eye function. Suitable for both children and adults.
Brewer's Yeast	Start with 1/4 teaspoon daily and slowly increase to the dose recommended on the label.	A natural source of B vitamins. Brewer's Yeast, Debittered, NOW Foods, 1 lb., Brewer's Yeast, NOW Foods, 650 mg, 200 Tabs
L-Cysteine	Take as directed on label, on an empty stomach. Take with water or juice. Do not take with milk. Take with 50 mg vitamin B-6 and 100 mg of vitamin C for better absorption.	Take this amino acid if a hair analysis reveals high levels of metals. See Amino Acids for more information. L-Cysteine Structural Support With Vitamin B-6 & C, Vegetarian, NOW Foods, 500 mg, 100 Tabs, NAC (N-Acetyl-Cysteine), NOW Foods, Selenium, Molybdenum, 600 mg, 100 Caps
Pedia-Calm (Olympian)	As directed on label.	A combination formula for hyperactive children that includes phoshatidyl serine, phosphatidyl choline, cephalin, phosphoinositides, DMAE, and GABA. It can be taken in capsule form or sprinkled on food.
Phosphatidyl Serine	Take as directed on label.	May aid in balancing neurotransmitters in the brain. Also may alleviate depression. Phosphatidyl Serine, Nature's Way, 500 mg, 30 Softgels, Phosphatidyl Serine Supplement (PS), Nature's Way, 500 mg, 60 Softgels, Phosphatidyl Serine (PS), NOW Foods, 100 mg, 60 VCaps
Taurine Plus (American Biologics)	As directed on label.	The most important antioxidant and immune regulator; necessary for white blood cell activation and neurological function. Taurine, Free Form, NOW Foods, 500 mg, 100 Caps, Taurine, Free Form, NOW Foods, 500 mg, 100 Caps, Taurine, Double Strength, Free Form Amino Acid, NOW Foods, 1000 mg, 100 Caps,
Vitamin C With Bioflavonoids	Adults & Children Over 12: 1,000 mg 3 times daily. Children Under 12: 500 mg 3 times daily.	An anti-stress vitamin. Vitamin C Liquid w/ Rose Hips & Bioflavonoids, Kosher, Natural Citrus Flavor, Dynamic Health, 1000 mg, 16 fl. oz., Ester C With Bioflavonoids, Nature's Way, 1000 mg, 90 Tabs, Vitamin C 1000 With Bioflavonoids, Nature's Way, 100% Natural, 1000 mg, 250 VCaps, The Right C, Nature's Way, 1000 mg, 120 Tabs
Zinc	As directed on label.	Many ADHD children are zinc-deficient. Take in addition to the multi-vitamin and mineral complex. Do not exceed a total of 100 mg daily (or, for children, the appropriate fraction of 100 mg) from all supplements. Zinc Ionic Mineral Supplement, Fully Absorbable, 100 +/- ppm, 16 fl. oz., Colloidal Silver & Zinc Lozenges, Silva Solution, 90 Lozenges, Zinc Lozenges W/ Echinacea & Vitamin C, Nature's Way, 23 mg, 60 Lozenges, Zinc (Chelated), 100% Natural, Nature's Way, 30 mg, 100 Caps

---

ADD/ADHD SUPPLEMENTS & PRODUCTS

Attention Deficit Disorder, ADD, ADHD Supplements, Information and Products for ADD/ADHD symptoms which cause problems at home, at school, on the job and in social situations.

Aconite Homeopathic Clikpak, 30C, 84 Pellets Homeopathic Nelson's Aconite in the new clikpak is easy to carry and dispense for high fever, anxiety and restlessness and therefore much better suited to a busy lifestyle.

ADD & ADHD Diet, A Comprehensive Look at Contributing Factors & Natural Treatments for Symptoms of Attention Deficit Disorder and Hyperactivity, By Rachel Bell & Dr. Howard Peiper This book offers the latest information on what to eat, what to avoid and the supplements that may help if you have ADD or ADHD. It also covers non-dietary approaches, problems with chemicals and more.

ADD/ADHD Formula Tincture, 100% Organic, 2 fl. oz. Helps with common symptoms of ADD / ADHD such as short attention span, inability to finish tasks and hyperactivity.

ADHD Alternatives - A Natural Approach To Treating Attention Deficit Hyperactivity Disorder, By Aviva Jill Romm, Herbalist AHG & Tracy Romm, Ed.D In this thoughtful ADHD book, Aviva and Tracy Romm guide parents and educators in taking a more holistic, natural, and effective approach to problems of attention, impulsivity, and hyperactivity.

Alive! Whole Food Energizer Multi-Vitamin & Mineral With Naturally Occurring Iron (No Iron Added), Nature's Way, 180 Tabs No other supplement contains more life-giving nutrients than Nature's Way Alive. This supplements is better absorbed into your blood stream because its tablets disintegrate up to 5X faster than other leading brands.

Barlean's Organic Oil, Fresh Catch Fish Oil, EPA-DHA Concentrate, 60 Softgels Fresh Catch® Barlean's Organic Oil Super High Potency EPA - DHA is a pure and pristine source of fish oil providing highly concentrated EPA Omega-3 to support cardiovascular, joint, immune and colon health for your vibrant health and energy.

Calcium Ionic Mineral Supplement, Fully Absorbable, 700 +/- ppm, 16 fl. oz. WaterOz Ionic Calcium is a pure liquid Calcium supplement. Calcium is one of the most essential of the major biochemical elements needed in human nutrition. It is needed in every organ of the body, including the brain. Calcium is called the "knitter" because it promotes healing or knitting everywhere in the body. It is valuable for tone, power, strength, longevity, vitality, and endurance, healing of wounds, counter-acting acids, and helping regulate metabolism.

Chromium Ionic Mineral Supplement, Fully Absorbable, 50 +/- ppm, 16 fl. oz. WaterOz Ionic Chromium is a pure liquid chromium supplement. Chromium helps the body regulate metabolism, regulate insulin and blood sugar levels, helps the body lose weight by stimulating enzymes that metabolize glucose, burns fat. Chromium deficiencies may contribute to Infertility and decreased sperm count.

Daytime Stress Formula, Stress Supplement, TheraVeda Usha, 60 VCaps TheraVedas Usha Daytime Stress Supplement was developed to assist your mind in maintaining concentration and focus, while pushing away distractions due to a stressful environment.

DHA & Omega-3 From Fish Oil, NOW Foods, 250 mg With 100 mg EPA, 120 Softgels Numerous published studies have provided strong evidence that the Omega-3 fatty acids found in fish oil may reduce the risk of coronary artery disease (CAD) and sudden death from cardiac causes.

DMAE Supplement, Dimethylaminoethanol, Vegetarian, NOW Foods, 250 mg, 100 VCaps Taken as a maintenance supplement, DMAE Supplement works synergistically with other smart nutrients like Ginkgo Biloba, GABA, Phosphatidyl Serine and L-Tyrosine, or can be taken alone.

DMG Supplement N,N Dimethyl Glycine, NOW Foods, 125 mg, 100 Caps NOW Foods' DMG Supplement is a methylated amino acid found in all cells. DMG is an antioxidant and methyl donor that has a number of beneficial effects. It has shown to have potential in increasing immune response to the flu and salmonella.

EFA Blend Essential Fatty Acids Supplement, Attention Focus for Children, Nature's Way, 445 mg, 120 Softgels EFA, Essential Fatty Acid Supplement, provides the fluid membrane environment needed for proper transmission of brain and nerve signals.

GABA, Pharmaceutical Grade Gamma Aminobutyric Acid, 250 mg, 90 Tabs Gamma-Aminobutyric acid (GABA) is an amino acid that acts as a Neurotransmitter in the central nervous system. Together with niacinamide and Inositol, it prevents anxiety and stress related messages from reaching the motor centers of the brain by occupying the receptor sites.

GABA Powder (Gamma Aminobutyric Acid), NOW Foods, 100% Pure, Vegetarian, 500 mg, 6 oz. GABA is a non-essential amino acid found mainly in the human brain and eyes and it is considered an inhibitory neurotransmitter, which means it regulates brain and nerve cell activity by inhibiting the number of neurons firing in the brain - GABA is referred to as the brain's natural calming agent.

Get Better Bear Homeopathic Calm For Infants & Toddlers, Improvita, 2 fl. oz. Get Better Bear Homeopathic Calm for Infants and Toddlers has a combination of six single remedies. It is an over-the-counter day time sedative that relieves symptoms of restlessness, hyperactivity, and attention deficit disorder (ADD/ADHD) and promotes concentration.

Irwin Naturals Advanced Ginkgo Smart, 90 Gel Caps Irwin Naturals Advanced Ginkgo Smart combines botanical extracts and phytonutrients to support memory, mental clarity, concentration, alertness & focus.

Is Your Child's Brain Starving? Food Not Drugs For Life & Learning While all of the information in the book is based upon relevant science, technical detail has been kept to a minimum to make it easy to read and very practical.

Mental Clarity, Promotes Memory & Intelligence, Banyan Botanicals, 90 Tabs The herbs in Mental Clarity have traditionally been used to enhance all aspects of mental performance, including intelligence, concentration, awareness, perception and learning capacity. This effective blend sharpens the mind and is useful for those prone to forgetfulness, confusion or indecisiveness. Mental Clarity is an ideal supplement for anyone with a mentally demanding workload, students, and those experiencing loss of memory.

Multi-Vitamin & Multi-Mineral, Baby & Children's Liquid, Childlife, 8 fl. oz. Children's liquid Multi-Vitamin & Multi-Mineral formula provides the optimal dosage of all the essential vitamins and minerals with trace elements for infants and children of all ages and it tastes great!

Natural Approach To Attention Deficit Disorder (ADD), By Ronald Hoffman, M.D. "Good Health Guide" Ranging from food or chemical sensitivities and hypoglycemia to specific nutritional deficiencies, the underlying causes of ADD are complex, yet responsive to a wide variety of natural therapies.

Neuromins DHA Supplement (Docosahexaenoic Acid), Nature's Way, 100 mg, 60 Softgels Neuromins brand high quality DHA Supplement is sourced from microalgae and fortified with Vitamin C and E.

Omega 3-6-9 Oil, Mega EFA Blend, Lime Flavored, Nature's Way, 1350 mg, 90 Softgels Omega 3-6-9 Oil Mega EFA Blend is the most complete daily source of Omega 3-6-9 fatty acids for healthy skin, joints and cardiovascular function.

Organic Flax Protein / Fiber / Lignan, Cold Milled Powder, Plus Omega-3, Certified, Nature's Way, 16 oz. Nature's Way EFAGold is the highest quality flax seed protein powder, and one of nature's richest sources of protein, fiber & essential fatty acids.

Pycnogenol With Vitamin E, 100% Natural, Nature's Way, 50 mg, 30 Tabs Pycnogenol is an extract made from the bark of the European coastal pine. Pycnogenol is a concentrated source of proanthocyanidins, organic acids and other biologically active components.

12 Effective Ways To Help Your ADD or ADHD Child: Drug-Free Alternatives For Attention Deficit Disorder, By Laura J. Stevens, M.S.A. Steven's 12 ground breaking recommendations are completely drug-free and backed by scientific studies. By improving diet, eliminating allergens and adding vitamin and mineral supplements, parents can effectively diminish symptoms of hyperactivity.

Herbal Remedies: Attention Deficit Disorder / ADD / ADHD Supplements, Information & Products

Herbal Remedies: Attention Deficit Disorder / ADD / ADHD Information

---

CONSIDERATIONS

When you are dealing with this disorder, it is best to think of the diet as feeding the brain rather than the stomach. Many researchers believe that if the contributors are removed from the diets of the patients and the right nutritional supplements are added, numerous symptoms often disappear, and medications used to treat ADD/ADHD (some of which cause serious side effects) can often be eliminated.

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.

Family- or allergy-related problems can elicit ADD/ADHD-related behaviors. It is important to explore the possibility with your specialist.

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

The prescription medication methylphenidate (Ritalin) has become the most commonly prescribed medication to ease hyperactivity. Researchers are discovering, however, that this medication has many potentially serious, long-term side effects including decreased appetite, weight loss, insomnia, slowed growth, increased heart rate, increased blood pressure, a period of increased irritability and intolerance at the onset of use, and the possibility of developing Parkinson's disease. Adverse reports have been released in recent years warning parents of the possible side effects of Ritalin - with some reports even comparing it to cocaine.

other prescription medications often prescribed include dextroamphetamine (Dexadrine, a stimulant that produces calming effects equivalent to Ritalin), pemoline (Cylert, a stimulant that has been restricted by the FDA to use as a secondary medication because it can cause liver failure), methamphetamine (Desoxyn), amphetamine-dextroamphetamine combination (Adderall), and tricyclic antidepressants (if depression is suspected). For periods of extreme anger and aggression, a tranquilizer called thiordazine (Mellaril) may be prescribed, but it should be used only as a last resort. Various side effects, some of them serious, have been reported with all of these medications.

Due to the many potentially harmful side effects of the medications available for ADD/ADHD sufferers, a growing number of parents and health professionals are turning to all or a combination of the following as a way to reduce and even possibly eliminate the symptoms of ADD/ADHD:

• Alteration of diet.
• Vitamin & mineral supplementation.
• Herbal remedies.
• Counseling.
• The love & support of family, teachers, and friends.

Many believe that medicating the problem is merely masking the symptoms without getting to the root of the problem.

Researchers 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.

Some studies have found that many children with ADD/ADHD have high levels of toxic by-products of yeast and other harmful bacteria in their urine. The use of probiotics (supplements that add beneficial bacteria to the body, such as acidophilus) can help to alleviate this problem.

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

More and more evidence is showing that those with ADD/ADHD are at greater risk for depression, alcoholism, restlessness, difficulties with careers and relationships, and antisocial behavior as adults.

Parents of children with ADD/ADHD often have a very difficult time dealing with the behavioral problems of their children. These parents deserve a lot of credit. It is important to remember, though, that the children deserve a lot of credit, too. When things seem as though they are getting out of control, it can be helpful to remember that a child with ADD or ADHD is dealing with a physiological disability. Although they desire to please and want to be good, their minds can go in and out of overload without their control. Because of this, they often feel confused and ashamed, and they can eventually develop low self-esteem. When problems arise, it is important to explain to them what they did wrong, and why it was wrong, in a calm, one-on-one fashion whenever possible. These children need a great deal of love, support, and encouragement from everyone around them - but most of all, from their parents.

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

(Please note; these links and resources may have changed since this list was formed (2004). Informational links are always changing or disappearing and they can be difficult to keep up and current. If you find a link(s) not there any longer, try doing a "google" search for current information.)

ADD Adults Group - *ADDULT@JUVM.STJOHNS.EDU

To Subscribe:
1. Send e-mail message to: listserv@sjuvm.stjohns.edu
2. Leave the Subject blank
3. In the body of the e-mail message type: subscribe ADDult firstname lastname ADD/ADHD News Groups

ADDults: ADDadults is for adult issues. Relationships, work related issues, medications, sexual issues etc. While we realize that many ADDadults have children, we ask that the parenting issues be addressed to ADDtalk. You can subscribe to ADDadults at http://www.onelist.com/subscribe/addadults

ADDKids
The list for children with Attention Deficit Disorder.

ADD Parents Group - MAJORDOMO@MV.COM

To Subscribe:
1. Send e-mail to address: majordomo@mv.mv.com
2. Leave the Subject blank
3. In the body of the e-mail message type: subscribe ADD-PARENTS (yourname)

Spouses/SOs of people with ADHD

ADD-Holistic Internet Discussion Group

ADD-HOLISTIC is an ADD/ADHD discussion group for the discussion of alternative medicine techniques for treating Attention Deficit Disorder and related disorders.

HOW TO SUBSCRIBE

Send an email to: add-request@holisticmed.com with the following command in the BODY of the email:

subscribe

Parenting: Subscribe to ADDtalk, an email support group. Help and support is as close as your email program. Here they discuss parenting issues such as behavior, medication and IEP's. Click here to subscribe to ADDTalk

ADDictions: One of the many things that ADDadults feel that is an issue directly related to the ADHD is addictions. Whether it be food, sex, substance abuse or spending addictions, ADDicts is a list for addults only. The list has no archives and the member list is confidential. To join ADDicts go to http://www.onelist.com/subscribe/addicts

Alternative Treatment: For the discussion of alternative treatments with others who wish to do the same. There is no advertising of products on this list so you can feel free to share your experiences with alternatives and learn from the experiences of others without being solicited. Click here to subscribe to ADHD_alternatives.

ADD Professionals
ADD Professionals is a mailing list for professionals in the field of ADD, to discuss clinical and research topics.
Open to psychiatrists, psychologists, social workers, educators, coaches, advocates, etc. Admission must be approved by moderator.

---

BULLETIN BOARDS

Mental Health Sanctuary ADD Bulletin Board

Parenting the child with ADD or ADHD (read only)

ADD Forum

---

CHAT

Attention Deficit (Hyperactivity) Disorder Chat Room

ADD/ADHD Chatroom
Meetings for Attention Deficit Disorder will be held on each Wednesday at 6:30 CST.

Another ADD Chatroom

---

NEWSGROUPS

alt.support.attn-deficit


Attention Deficit Disorder In Europe

---

ON-LINE GROUPS

AOL - Wednesdays
10 PM EST, 7 PM PST
For directions e-mail
Annie12345@aol.com Group is "held" in private room to control interruptions - Open to all women

Support for Spouses and Significant Others of People with ADD/ADHD
Online chat that meets on Wednesday evenings from:
6-8 pm (pacific standard time)
7-9 pm (mountain standard time)
8-10 pm (central standard time)
9-11 pm (eastern standard time)
Everyone is welcome.

Chat originating from the U.K.

---

PEN PALS

Pen Pal Page

---

NEWSLETTERS & MAGAZINES

National Newsletter Devoted to Medications on Attention Deficit Disorder

Chadd's Attention Magazine

ADD National Resources

ADDvance (for women with ADD)

About.com ADD Newsletter

ADHD Research Update

Quarterly Newsletter

The ADD/ADHD Online Newsletter

Mind Matters

Newsletters

ADDed Attractions

ADDitude

---

ADVOCACY

Mental Health Advocacy Webpage
"(Hi, I'm David Harkins and I'm a Mental Health Advocate. Please email me if you are a Mental Health Client, Guardian, or interested family member of a Mental Health Client and have questions about Mental Health Advocacy or are having a problem dealing with people or institutions and feel you are being discriminated against).




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/



NOTIFY YOUR 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.

---

HELPFUL RELATED LINKS

Natural & Drug-Free ADD & ADHD Treatment

Adult ADD Information

---

For a full list of available products from Mountain Rose Herbs, click on banner below:





HELPFUL PRODUCTS & FURTHER EDUCATION

Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 2nd Edition

Prescription for Nutritional Healing: The A-To-Z Guide To Supplements
-- by Phyllis A. Balch, James F. Balch - 4th Edition

Prescription for Herbal Healing: The A-To-Z Reference To Common Disorders
-- by Phyllis A. Balch

The Complete Guide to Natural Healing



If you see a suggested Amazon product "not there" as indicated by an orange box with the Amazon logo, this only means the specific product link has been changed by Amazon.com. Use the "click here" icon on the orange box and it will bring you to Amazon.com and you can do a search for a specific product using keywords and a new list of available products and prices will show. Their product and resource links are constantly changing and being upgraded. Many times there are more than one link to a specific product. Prices will vary between product distributors so it pays to shop around and do price comparisons.

Educational materials and health products are available through Amazon.com. Use the search box provided below to search for a particular item.

---

HERBS, OILS, & SUPPLIES

MoonDragon's Health & Wellness: Manufacturers & Distributors



Mountain Rose Bulk Herbs

Mountain Rose Herbs, Bulk Herbs A Mountain Rose Herbs, Bulk Herbs B Mountain Rose Herbs, Bulk Herbs C Mountain Rose Herbs, Bulk Herbs D Mountain Rose Herbs, Bulk Herbs E Mountain Rose Herbs, Bulk Herbs F Mountain Rose Herbs, Bulk Herbs G Mountain Rose Herbs, Bulk Herbs H Mountain Rose Herbs, Bulk Herbs I Mountain Rose Herbs, Bulk Herbs J Mountain Rose Herbs, Bulk Herbs K Mountain Rose Herbs, Bulk Herbs L

Mountain Rose Herbs, Bulk Herbs M Mountain Rose Herbs, Bulk Herbs N Mountain Rose Herbs, Bulk Herbs O Mountain Rose Herbs, Bulk Herbs P Mountain Rose Herbs, Bulk Herbs R Mountain Rose Herbs, Bulk Herbs S Mountain Rose Herbs, Bulk Herbs T Mountain Rose Herbs, Bulk Herbs U Mountain Rose Herbs, Bulk Herbs V Mountain Rose Herbs, Bulk Herbs W Mountain Rose Herbs, Bulk Herbs Y

Mountain Rose Aromatherapy Oils

Mountain Rose Herbs, Aromatherapy Oils A-B Mountain Rose Herbs, Aromatherapy Oils C-E Mountain Rose Herbs, Aromatherapy Oils F-L Mountain Rose Herbs, Aromatherapy Oils M-P Mountain Rose Herbs, Aromatherapy Oils Q-Z Mountain Rose Herbs, Aromatherapy Oils: Oil Blends & Resins Mountain Rose Herbs, Aromatherapy Oils: Diffusers, Nebulizers, & Burners Mountain Rose Herbs, Aromatherapy Oils: Oil Kits

Mountain Rose Herbs.com: Order Online

Accessories & Tools Aromatherapy Aroma Sprays and Flower Waters Babies/Children Body and Bath Bottles, Jars & Containers Bulk Herbs Bulk Ingredients Bulk Oils Butters Capsules Clays Dental Care Essential Oils Facial Care Green & Black Teas Hair Care Herbal Extracts Herbal Oils Herbal Salves & Balms Herbal Teas Herbs for Pets Incense, Resins and Candles Lotions Massage Oils Medicinal Herb Seeds Tea Brewing Supplies Women's Products

Click Here To Visit Herbal Remedies Product Page

A Source For Medicinal & Ritual Herbs & Supplies Aphrodisiacs Aromatherapy Bath & Body Care Bulk Herbs By The Pound Capsules, Tablets & Extracts Chinese Herbals Electronics Extracts First Aid Products Food Products, Mixes, Seeds, Snacks & More! Hair Care Products & Supplies Herbs & Oils, Kilo & Ton Hydroponics & Gardening Kava Products Kitchen & Housewares Mushrooms Musical Instruments Oral Care & Dental Products PC & IT - Computer Supplies & Assessories Skin Care, Cosmetics, & Gift Sets Smokes, Seeds, Cacti Spices, Salts, Sweeteners, & Seasonings Sports, Toys & Games Sweets, Candy, Chips & Snacks Stimulants Sedatives Teas & Coffees Shaman Shop Home Page

---

MoonDragon's Nutrition Information Index

MoonDragon's Health & Wellness: Nutrition Basics Index

MoonDragon's Health & Wellness: Therapy Index

MoonDragon's Nutrition Therapy Index

MoonDragon's Alternative Health Information Index

MoonDragon's Aromatherapy Information Index

MoonDragon's Health & Wellness Index

MoonDragon's ObGyn Information Index by Subject Order

MoonDragon's ObGyn Information Index by Alphabetical Order

MoonDragon's Main Indexlisting

MoonDragon's Home Page