Causes of ADHD

Of all the public perceptions and misunderstandings about ADHD causes the belief that parents are responsible for their children’s poor behavior is the most difficult to dispel.  Parenting characteristics (e.g. being too critical) home environment lifestyles and even pre-natal problems are said to exacerbate symptoms or place a child at high risk for developing ADHD.  Let us examine this myth by discerning the facts from fiction.

Fact: There is a genetic basis for ADHD

Yes parents are responsible for their child’s ADHD but only indirectly! There is a lot of research that shows the relationship between genetics and ADHD; in fact most medical doctors believe that genetics is the sole cause of the disorder.  Studies show that children are more likely to develop ADHD if one or both parents also experienced the disorder.  The genetic basis has been confirmed by twin studies which reveal that identical twins are more likely to share the disorder than fraternal twins even if they have been raised in different homes.  There are no tests that can determine the presence of an “ADHD gene” and there is little to be done about which genes your child inherits. However you can lower the risk of ADHD by removing the environmental factors known to trigger the disorder.

Fact: Certain home environments trigger ADHD

Just because a child is genetically predisposed to ADHD does not necessarily mean that the disorder will develop. ADHD occurs only when certain factors in the environment trigger it. Among these are lifestyle habits and the child’s diet and nutrition. We have articles that discuss these environmental triggers in detail but suffice it to say that a diet of refined carbohydrates food additives and empty calories aggravates nutrient deficiencies or food intolerances an ADHD child might already have.

 A lifestyle filled with sedentary activities like video games also contributes to ADHD symptoms. What helps children overcome ADHD with lasting results is not medication but a comprehensive treatment plan that includes lots of physical activity and a nutritious diet.

Fact: Exposure to cigarette smoke and alcohol during pregnancy and childbirth places the child at risk for ADHD

There are a number of studies that show how exposure to cigarette smoke and alcohol during pregnancy paves the way for ADHD and other neurological disorders. In fact simply being around secondhand smoke is enough to interfere with a child’s growing nervous system.  There are many other toxins found in the home environment that can trigger ADHD such as pesticides certain cleaning chemicals lead from old paint and mercury from amalgam fillings.

Myth: ADHD is caused by poor parenting skills  

his is what most people mean when they say that parents are responsible for the onset of ADHD in children.  However they are seriously misinformed. Children with ADHD can come from any family from any culture and socio-economic class.  The onset of ADHD is not caused by parenting style; rather it is triggered by the environmental factors mentioned above.  This doesn’t mean that there is little parents can do.  Your child can recover from the disorder of you are willing to make environmental changes and provide a lot of parental support and involvement.  Ask your health care specialist about what you can do to help your child overcome ADHD naturally.

ADHD has become more widely known as a children’s disorder but it is also something adults have to contend with. Read more about it here.

Attention-deficit/hyperactivity disorder or ADHD is usually diagnosed in children thought it can often continue on into adulthood. In recent years adult ADHD has become quite common though it manifests slightly different symptoms than it normally does in children.

Adult ADHD is usually diagnosed in adults who exhibit inattentiveness in their personal relationships at work and at home with their family. Adult sufferers often find it difficult to sustain a job and a relationship.

Recognizing ADHD in adults

In general adult sufferers tend to experience problems at work which usually results in frequent job changes. Because of these problems they tend to have a lower socioeconomic status by virtue of being unable to sustain a job long-term which is a primary requirement of career development.

Adult sufferers of ADHD usually have a history of failure in professional and personal endeavors and end up in lower-level jobs that don’t require organizational skills and have less responsibility.

Adults with ADHD tend to find it difficult to support themselves and their families which often results in the breakdown of the family unit. Adults suffering from ADHD often have a history of multiple relationships and marriages.

Diagnosing ADHD in adults

No one should take it upon themselves to diagnose a friend or self-diagnose. This can lead to misunderstanding. But the more you know about an illness the quicker you can suggest to a friend to get help. Or if you recognise symptoms in yourself awareness can help you seek the proper help.

ADHD sufferers fall into three types:

1. The inattentive type

2. The hyperactive and impulsive type

3. A combination of types 1 and 2.

The above types of symptoms generally need to be present for at least six months and a person must be experiencing difficulties in normal social functioning. If you recognize any of these types then seek professional help immediately.

A new ADHD drug Attenace will likely hit pharmacy shelves in early 2006. This “new” ADHD drug isn’t actually so new to the about 20000 people currently taking Provigil “off-label” for ADHD. Attenace contains modafinil the same active ingredient in the narcolepsy drug Provigil.

Modafinil is a stimulant drug that is chemically unrelated to the other stimulant ADHD medications. Although Attenace is a stimulant medication it is not classified as a controlled substance under the Controlled Substance Act. This translates to the convenience of phone-in refills and less prescription hassles at the pharmacy.

Attenace has a different chemical structure but it still poses many side effects consistent with the side effects of the other stimulant ADHD medications. There are also a few new side effects like sexual dysfunction that adults might find less than pleasant.

Before you knock on your doctor’s door asking for a prescription there are a few things you should know about this new ADHD medication.

First it is not known how well Attenance will work or how it compares in effectiveness to the current ADHD drugs since the three trials conducted on Attenace only compared Attenace to a placebo instead of to its potential competitors. Cephalon conducted three 9-week double-blind placebo-controlled studies of more than 600 children and adolescents between the ages of six and 17 with ADHD. Cephalon reports that Attenace “significantly improved” the symptoms of ADHD in children and adolescents when compared to placebo in three studies of the drug.

Secondly Attenace (modafinil) has side effects ranging from mildly disturbing to potentially life-threatening. Given the relatively small test sampling to date Attenace side effects are not fully known at this point. It can be assumed that Attenace will have similar side effects to Provigil since they are made from the same drug.

Below are a listing of common Provigil (modafinil) side effects.

_ Headache.

_ Blurred vision.

_ Dry mouth.

_ Nausea vomiting abdominal pain.

_ Constipation or diarrhea.

_ Sleep disturbances/insomnia.

_ Loss of appetite/weight loss.

_ Stuffy nose.

_ Back pain.

_ Confusion.

_ Anxiety and agitation.

_ Nervousness aggression hostility.

_ Unstable moods.

_ Depression.

_ Decreased sex drive.

_ “Pins and Needles” feeling.

_ Rash or itching.

_ Dizziness.

_ Widening of blood vessels.

_ Weakness or loss of strength.

_ High/increased blood pressure.

_ Alteration in results of liver function tests.

_ Chest pain.

_ Increased heart rate.

_ Drug dependence.

_ Allergic reaction.

Attenace may be habit forming and has the potential for abuse and dependence . You should discuss the abuse and dependence potential of Attenace with your doctor. This drug should not be taken by anyone who has been or currently is dependent on alcohol or drugs.

Symptoms of an Attenace overdose might include excitation agitation insomnia sleep disturbances anxiety irritability aggressiveness confusion nervousness tremor palpitations nausea and diarrhea.

Contact your doctor immediately or seek emergency medical attention if you experience any of the following uncommon but serious side effects:

_ An allergic reaction (difficulty breathing; closing of the throat;

_ swelling of the lips tongue or face; or hives).

_ Irregular heartbeats.

_ Low or high blood pressure.

_ Shortness of breath.

Before taking Attenace tell your doctor if you have;

_ Left ventricular hypertrophy.

_ Chest pain.

_ Irregular heartbeats.

_ History of heart attack.

_ High blood pressure.

_ Unstable angina.

_ History of mental illness.

_ Kidney disease

_ Liver disease.

Attenace along with all other ADHD medications currently on the market is not recommended for children under the age of six since its safety and effectiveness has not been determined. Despite ADHD drug manufacturer’s own labels warning against prescribing these powerful drugs to young children doctors increasingly prescribe ADD medications to children under the manufacturer recommended age.

A Journal of the American Medical Association (JAMA) article in 2000 noted a “disturbing” increase in the amount of stimulants and anti-depressants prescribed for children under the age of five. Parents should carefully consider the health effects of placing small children on powerful ADHD medications even if the child’s health care provider prescribes a medication for ADHD or ADD.

People using ADHD medications know that these little pills are never the “cure-all” answer. Attention Deficit requires a multifaceted approach which requires many different tactics and combination of tactics. What works is highly individual depending on individual needs.

Many people with Attention Deficit Disorder and parents of children with Attention Deficit Disorder find great Attention Deficit Disorder and ADHD success from diet supplementation – especially with amino acids and essential fatty acids – a shift in parenting tactics modifying the home and school environment biofeedback neuro-linguistic programming stress relief measures and exercise. The greatest successes are found by being bold and trying a combination of many measures.

In memory of 14 year old Matthew Smith; 11 year old Stephanie Hall; and 10 year old Shaina Dunkle and other children who have died from the use of psychotropic drugs for “ADHD”.

The Eli Lilly company has been marketing a new drug for those who are labeled as ADHD known as Strattera. This drug is purported to be a non-stimulant medication however the side effects are similar. Rather than effecting the dopamine system as do the stimulants such as methylphenidate and dextroamphetamine it works upon the norepinephrine neurotransmitter. Strattera is considered a Norepinephrine reuptake inhibitor. Norepinephrine is the brain’s adrenalin. Norephinephrine is involved in the increased rate and force of the heart muscle constriction of heart muscles pulmonary function (Hedaya 1999).

If these functions are increased it would be evident that Strattera could produce possible untoward effects on the cardiovascular system. It is interesting to note that in the safety information that Eli Lilly provides on its website it refers to possible hazards to those who have heart disease or high blood pressure. Information provided by Eli Lilly accompanying prescriptions of this drug note the possibility of tachycardia and increased blood pressure. Tourette’s disorder though the etiology is not fully known is being examined as difficulties arising in the metabolism of dopamine serotonin and norepinephrine. it is known that stimulant drugs can produce Tourette’s like behavior in some children (Breggin 1998).

If Strattera affects the norepinephrine system then it would seem evident that the possibility of such Tourette’s like behavior could also become manifest in some children using Strattera. Therefore though Strattera is being marketed in the fashion of being a non-stimulant drug its ill effects are quite similar to that manifested by the stimulant medications. Eli Lilly’s website notes that growth suppression is a common side effect and needs to be monitored in children making use of this drug. Loss of appetitite and weight loss is also seen. The most common side effects as listed by Lilly are upset stomach decreased appetite nausea and vomiting dizziness tiredness and mood swings. These are not unlike that associated with the stimulant medications.

Lilly states in its press release in regards to Strattera’s introduction: “It’s not known precisely how Strattera reduces ADHD symptoms. Scientists believe it works by blocking or slowing reabsorption of norepinephrine a brain chemical considered important in regulating attention impulsivity and activity levels. This keeps more norepinephrine at work in the tiny spaces between neurons in the brain.” If we examine this statement carefully we see it states ‘it is not precisely known’ therefore once again a drug is being prescribed whose effects are not fully known for a’disorder’ whose psychopathology is not yet delineated. Clinical trials for Strattera have been limited and any information on long term effects has only been studied by Lilly itself. It is interesting to note that before Strattera was actually placed on the market and had just received FDA approval that the stocks for Eli Lilly rose 6% at the announcement (CBS Marketwatch November 27 2002). Lilly is aware that it will profit highly by being able to market a drug as a non-stimulant (though its ill effects are similar) that is not a Schedule II drug thus less subject to scrutiny and regulation. Hemant K. Shah an independent analyst qouted in an AP Health News Report (August 15 2002) states that Strattera’s market potential is large at a time when Eli Lilly is seeking to offset recent setbacks.

“Parents who have refused stimulant dangers because of their knowledge of the hazards involved will now be coerced to utilize Strattera being led to believe it is somehow safer because it does not fall into the category of a stimulant/ Schedule II drug.

There is no test for ADHD and neurological testing shows these children to be perfectly normal. Dr. William Carey of Children’s Hospital in Philadelphia states “common assumptions about ADHD include that it is clearly distinguishable from normal behavior constitutes a neurodevelopmental (brain) disability is relatively uninfluenced by the environment (home school)…all of these assumptions…must be challenged because of the lack of empirical support and the strength of contrary evidence…what is now described in the US as ADHD is a set of normal behavioral variations. This discrepancy leaves the validity (of ADHD) in doubt.” The U.S. National Institutes of Health Consensus Development Conference on ADHD in 1998 reported ” we have do not have an independent valid test for ADHD and there are no data to indicate that ADHD is due to a brain malfunction…and finally after years of clinical research and experience with ADHD our knowledge about the cause or causes of ADHD remains speculative.” Further Dr. Edward C. Hamlyn a founding member of the Royal College of General Practitioners in 1998 stated “ADHD is fraud intended to justify starting children on a life of drug addiction.” The U.S. Surgeon General Report declares “the exact etiology of ADHD is unknown.” Lastly Dr. Joe Kosterich Federal Chair of the Australian Medical Association states ” “The diagnosis of ADD is entirely subjective…. There is no test. It is just down to interpretation.

Maybe a child blurts out in class or doesn’t sit still. The lines between an ADD sufferer and a healthy exuberant kid can be very blurred.” What we are experiencing are children in conflict. We cannot blame and denigrate the child and not respect his dignity. We cannot label and suppress behaviors. If a child is conflict we must take responsibility to see why this child is in conflict and to use responsible and carefully planned interventions to aid this child in being successful. Some believe that they see enormous benefits from children on medication. I will give them this benefit only if we see suppression of behavior basically chemical restraint and the creation of zombies as our idea of ‘progress’ or ‘success’. But once again we are taking normal children and drugging them to suppress their behaviors. In order to achieve such a ‘result’ just what is going on in this child’s body? Stanley I. Greenspan a clinical professor of psychiatry at George Washington University states that ” The growing use of medication on their own is a worrisome trend while more and more people on Prozac or Ritalin are becoming bolder and less distractible at the same time more and more people are altering their moods without understanding what is happening to them or how it relates to their core personalities.”

He also states “given appropriate nurturing many affected children may not require medication.” University of South Florida Professor of Psychology Diane McGuinness comments “The first factor of being put on drugs is to attribute your bad behavior to factors beyond your control.

Drugs become a substitute for learning self-discipline. This problem is compounded when children are taken off medication and problem behavior initially rebounds to fantastic proportions. Second longitudinal studies have confirmed that children on drugs actually deteriorate in academic performance over time. And we must consider the sense of worthlessness most of these young people experience. (McGuinness 1985). Paul Wender M.D. lists criteria when beginning medication he states that a child must first understand why he is receiving medication yet as Greenspan states above this isn’t always happening. Wender states “Most acknowledge problems in his own behavior that he himself does not like so that -he will not feel that medicine is being given to him simply so that other people can tolerate him more.” Now Wender is one who began the first tests on the use of methylphenidate and is in support of its use in treatment.

I have had instances of being kicked and even bitten by children going through behavioral difficulties but at the same time I found methods to help a child be able to deal with behaviors and to have progress while at the same time encouraging the child’s own responsibility and sovereignty and working on the creative strengths of the child. Greenspan comments “working with the strengths of a child can create motivation.” A child needs to be able to recognize and be motivated to change behaviors and work on strengths. Even Wender states that getting a child to ‘label’ behaviors is effective that a child must recognize what is appropriate and what is not and that parents should not encourage the idea that because the medication was wearing off or so forth that such excuses a level of knowledge and responsibility for certain behaviors. In my experiences I would argue that a child often has complete knowledge of some of his or her behaviors and may develop a manipulative manner and ‘test’ the parent and find various triggers and weaknesses where he the parent will give in to his immediate desire. My concern lies too in that whereas some may feel medication to create some responsive in level of focus and so forth it comes with a cost in side effects. Some may take the view that the potential for progress outweighs the potential side effects.

This is where I disagree and feel it better to avoid that which would cause any side effects that psychotherapy alone can manage the difficulties. These are some of the things that bring alarm to me. Wender states “Most common side effects of the stimulant medications are appetite loss…difficulty in falling asleep.” He suggests the use of a small dose of sedative ‘major tranquilizer’ an hour before bedtime to solve this in some cases. So here a see a cycle of drugs needing to be used and that’s worrisome. Wender states “Research is being conducted to determine the -exact- effects of stimulant medication on growth.” This tells me they are prescribing something which they really do not know yet what the effects are on growth. He states as well that stimulant medication IS addictive in adults but says “The results suggest that there is no increased risk for drug abuse associated with treatment although -more research is needed to rule this out conclusively.-” Here again if it is addictive to adults I ask why not children too and he says that research is yet conclusive. With effects on the cardiovascular system Barkley states “studies have -not- specifically addressed this important issue.” So they are prescribing something for which they are unsure of the effects on growth as well as the cardiovascular system.

Barkley states as well “The side effect that should receive serious attention from clinicians is the possible increase in motor or vocal tics produced by stimulant medication.” He continues- “It still seems prudent to screen children with ADHD adequately for a personal or family history of tics or Tourette’s Syndrome.” I recall having a session with a child with the mother first and being informed that he was being treated with Ritalin I later had subsequent time with the father and he had visible tics this really alarmed me in reading about the issue of tics and Tourette’s and I had to question not to the family but within myself if this was really the best option for the child faced with this risk. Barkley also states “Isolated cases may arise in which parents note that a child is no longer ‘spontaneous’ or childlike in his or her behavior and appears -controlled- or -socially aloof-. This is concerning and it appears that stimulants do have an affect in gaining control and conformity. Many of the stated results of the stimulant medication are too subjective and Barkley states clearly that “an improved ability to master increasingly difficult or higher-level academic material such as that assessed in achievement tests has -not- been demonstrated.

Here we have an example that it would not have been as a result of stimulant medication if we see academic progress. Barkley also says that ‘low and moderate doses of methylphenidate do reduce the frequency of aggression and noncompliance in groups of children but have no appreciate effect on either direction on prosocial or nonsocial behaviors.” So I will acknowledge that stimulants can help with short-term behavioral inhibition but what about long term? This is my main concern with the side effects and without evidence of a long-term result and without knowledge of long-term results on growth and cardiovascular development is this really the best option? Barkley states ” Few studies employing rigorous methodology have evaluated the long term efficacy of stimulant medication. Those that have examined the issue have generally found little advantage of medication over no medication when evaluated over extended periods (Pelham 1985 Weiss & Hechtman 1993) Children who had been on drugs but were off at the time of follow-up were not found to differ in any important respect from those who had never received pharmacotherapy.”

Another concern is the effects in mood I worked with one child who was already experiencing social withdrawal and was going through the trauma of losing a loved one. After receiving stimulant medication this intensified. Wender states “Instead of becoming high or excited these drugs in general calm down ADHD children and sometimes they may even become somewhat sad.” Barkley states “some children may evidence various mild negative moods or emotions in reaction to stimulants…Some children describe feeling ‘funny’ ‘different’ or dizzy as a function of medication.” What about self-esteem and confidence Greenspan acknowledges that creativity can be affected and Barkley states ” some concern has been raised that diminished self-esteem could be a emanative effect of methylphenidate as children may attribute the source of their success while on medication to external rather than internal factors.”

It is known that Attention-Deficit Hyperactivity Disorder or ADHD is a disorder in a person’s neurobehavioral development. This is mainly characterized by hyperactivity and attention problems co-existence wherein each of these behaviors can occur infrequently alone and a person may start exhibiting symptoms before the age of seven years. People who are believed to suffer from ADHD can usually have a combination of the different symptoms which could include hyperactivity impulsive behavior and inattention. There are three subtypes of ADHD that psychiatrists recognize which are the Inattentive type the Hyperactive type and the Combined subtype. And as for the question “Is there a need for ADHD medication?” you would probably know the answer as you read on. You will find out that the need for ADHD medication could do a lot regarding the three subtypes of ADHD as well as the symptoms of impulsive behavior’s presence or absence.

Psychiatrists have said that a person’s emotion is essential in having to understand and manage ADHD well especially on the anterior cingulate’s role on controlling impulses in ADHD. There are also studies that show that the anterior cingulate is unable to control emotions in people who have Impulsive symptoms of ADHD as it does in people who have non-impulsive controls in ADHD. An increased display of frustration and anger aggression impatience and excitability could be the results of lack of activity in a person’s anterior cingulated. A person’s inability to inhibit or control emotions could also lead to poor outcomes that are associated with ADHD such as having difficulty in maintaining relationships substance abuse conduct disorders and even social difficulties.

A person’s emotions have a lot to do with his ability to work properly and to succeed in what he does at work at home as well as in social relationships. People who suffer from ADHD could experience total havoc in their lives because of their lack of emotional control. This is when the need for ADHD medication becomes crucial. Amphetamines or methylphenidate in stimulant therapy has been shown to contribute a lot in controlling impulsive symptoms which are associated with ADHD.

It could be quite normal for parents to feel ambivalent about their children having a need for ADHD medication. If their children are diagnosed with ADHD which includes impulsive behavior then they should not be having second thoughts whether there is truly a need for ADHD medication or not.

There are different ways of treating ADHD including Behavioral Therapy medication and psychotherapy. Finding the best treatment for ADHD all depends on the condition of the person with ADHD. There is a need for ADHD medication if a person is diagnosed with ADHD with impulsive behavior. So if your child suffers from this condition don’t be hesitant to give him the proper treatment as this will help him improve his way of life as well as help him become a successful person in the future.