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Deficit Hyperactivity Disorder (ADHD - ADD) and Autism
permission from Bill Faloon of The Life Extension Foundation
What is ADHD?
If you or your child has just been diagnosed with
attention deficit hyperactivity
disorder (ADHD-ADD) don't despair. While in the past a frightening
regimen of powerful pharmaceuticals was used for this disorder, new
findings in nutrition and wellness are providing less invasive options for
treating and preventing ADHD. ADHD is a condition marked by an inability
to pay attention, concentrate, or complete tasks, sometimes accompanied by
hyperactivity that occurs in both adults and children. Previously it was
called simply attention deficit disorder (ADD), but clinicians now refer
to this disorder as ADHD and differentiate three types: inattentive,
hyperactive-compulsive, and combined. In the past, ADHD has been called
hyperkinetic syndrome and even minimal brain syndrome, reflecting our poor
understanding of this condition (Sangare 2000). Whatever the name, the
prevalence of ADHD is soaring. According to the American Psychiatric
Association's Diagnostic & Statistical Manual-IV-TR, 3-7% of children
currently have ADHD, with boys outnumbering girls 3 to 1. In addition, a
recent study finds that 1-6% of adults meet formal diagnostic criteria for
ADHD (Wender et al. 2001).
Obtaining a Diagnosis
The first step in deciding whether you or your child has ADHD is
seeing a health professional qualified to make a diagnosis. Unfortunately,
this can be a tricky process. ADHD has been called a "fad" and the
condition "du jour" because so many people are suddenly "discovering" they
have it due to over-diagnosis of this disorder. One reason is that few
health professionals can agree on just what ADHD is and fewer still follow
the diagnostic criteria already established for it. Often diagnoses are
made by a single health professional without adequate training in
behavioral science. Since clear biochemical, genetic, and anatomical
markers of ADHD are not available yet, diagnosing ADHD requires a detailed
medical history along with observations and is best accomplished using a
According to the DSM-IV, a person needs to
have first experienced ADHD in a persistent and disabling manner for 6
months before age 7 in order to qualify as having this condition. However,
many people are diagnosed with ADHD without any early history of the
In addition, many other conditions can
cause symptoms that mimic ADHD. Many children who have been sexually
abused show symptoms that can often be confused with ADHD. For example,
one study found that physical or sexual maltreatment and post-traumatic
stress disorder (PTSD) (hyperarousal/hypervigilance) symptoms overlapped
with those of ADHD (Ford et al. 2000). ADHD is also frequently confused
with bipolar disorder but differs substantially in that bipolar children
suffer from hyper-sexuality and parental conflicts that don't occur in
ADHD (Geller et al. 2000).
Despite the many difficulties in obtaining an accurate diagnosis,
there are increasingly clear behavioral criteria for ADHD. Behavioral
tests used to measure ADHD include assessments of how well patients can
concentrate and process information because many ADHD children cannot
think abstractly or isolate pieces of information and combine them into
whole ideas, instead thinking in whole pictures. Here are some current
signs to watch out for in both children and adults:
Motor Problems: Visual attention loss,
hyperactivity, altered facial expression, such as oversized and
sustained smile, abnormal motor skills, excessive fidgeting, and
constant hand and leg movements (Kuhle et al. 2001).
Attention Problems: Procrastination,
impulsive talking, difficulty starting or finishing tasks, reading
disorders, low educational level, dependency on a rigid schedule to
function, and extreme disorganization (Rasmussen et al. 2000).
Mood Disorders: Bursts of anger, frequent
interrupting, inappropriate behavior in social situations, anxiety,
depression, feelings of hopelessness, and low self-esteem.
Addictions and Alienation: Drug addictions,
alcohol abuse, criminal offenses, and difficulty maintaining a career or
relationships (Mannuzza et al. 2000).
In addition, some exciting recent research is beginning to uncover the
biochemical and genetic changes found in ADHD:
Low Neurotransmitters. According to a
fascinating new theory from evolutionary medicine called the "reward
deficiency syndrome," due to genetic defects some people do not produce
sufficient neurotransmitters, particularly dopamine, in response to
pleasure drives for eating, love, and reproduction. As a result they
seek dopamine release and sensations of pleasure via junk foods and
drugs, such as sugar, alcohol, cocaine, methamphetamine, heroin,
nicotine, marijuana, and by compulsive activities, such as gambling,
eating, sex, and risk taking behaviors (Comings et al. 2000). Other
researchers support this theory, noting low levels of serotonin are
linked to ADHD and are associated with increased aggression in humans
and other animals (Mitsis et al. 2000). As we'll see below, nutritional
and wellness strategies to increase these neurotransmitter levels
naturally offer attractive treatment options for ADHD.
Genetic Defects. Following the rewards
deficiency syndrome theory and the fact that stimulant medications act
primarily by altering levels of dopamine, numerous genetic studies of
ADHD have looked at defects in genes that control dopamine receptors.
One allele of the dopamine D2 receptor gene is associated with
alcoholism, drug abuse, smoking, obesity, compulsive gambling, and
several personality traits (Comings et al. 2000). Other researchers
support these findings, suggesting that defects in dopamine receptors
genes are implicated in ADHD (Sunohara et al. 2000).
When you are first diagnosed with ADHD your primary care health
professional will most likely suggest stimulant medications such as
Ritalin (methylphenidate), Dexedrine (dextroamphetamine), Desoxyn
(methamphetamine), Cylert (pemoline), or Adderall. Adderall is a mixture
of four different amphetamine salts and is considered the current drug of
choice because it remains in the body longer than Ritalin and causes fewer
ups and downs. Unfortunately, Adderall has the same side effects as other
stimulant drugs used for ADHD, including drug interactions, insomnia,
dizziness, headache, loss of appetite, growth impairment, tics, stomach
aches, and zombie-like behavior (PDR 2002).
Stimulants for ADHD work by suppressing all
spontaneous behavior. Chimps cease any self-generated behavior, while in
humans, play, socializing, and exploration all decline (Breggin 1999).
Stimulant medications are used for ADHD because people with this disorder
have slower brainwaves in frontal and polar regions of the brain than
people without it (Chabot et al. 2001). These drugs show short-term
effectiveness for control of over-activity, impulsivity, inattention,
aggressiveness, and low academic productivity but no long-term control.
Long-term studies since the 1960s, using markers such as finishing high
school, finding a job, and avoiding drugs, alcohol, or arrest, have found
that children who took stimulants for ADHD did no better later in life
than those who did not (Mannuzza et al. 2000). If stimulants are not
effective in controlling ADHD, tricyclic antidepressants may be
Further, as already noted, stimulant drugs
come with some severe side effects. For example, neurological side effects
including insomnia, anxiety, social withdrawal, fatigue, passivity,
emotional flatness, depression, and sadness due to neurotransmitter
disturbances can all occur from using stimulant medications. Also,
headaches, facial tics, stereotypical behavior (meaningless, compulsive
activities), and obsessive-compulsive behavior (endless repetition of
activities) can occur (Kooij et al 2001). A vicious cycle of medication
occurs in conventional ADHD treatment in which antidepressants, sedatives,
and mood stabilizers are prescribed to control emotional disturbances
caused by initial stimulant medication.
Eventually, children as young as 10 years
old can develop bipolar disorder due to the medications themselves. For
example, one study found that bipolar adolescents with a history of
stimulant exposure prior to the onset of bipolar disorder had an earlier
age at onset than those without prior stimulant exposure. The study also
found that bipolar adolescents treated with at least two stimulant
medications had a younger age at onset compared with those who were
treated with one stimulant (DelBello et al. 2001). Other major possible
side effects from stimulants include growth impairment due to decreased
appetite, cardiovascular problems such as increased blood pressure, and
Among the most troubling side effects of stimulant medications and
possible co-factors in ADHD is an increased risk of drug addictions. The
explosion of ADHD diagnoses and abuse of powerful stimulant drugs among
children has the DEA (Drug Enforcement Agency) and NIMH (National
Institute of Mental Health) concerned (Zito et al. 2000). Here are some of
the major drug addictions that can occur with ADHD and stimulant
Alcoholism. One recent study notes that
indicators of ADHD are found among alcoholics which may indicate high
rates of ADHD in their earlier years of life. The study also points to
the strong association between addiction and ADHD. Both disorders share
clinical aspects and relevant biological markers, and for both,
alterations in the same cerebral systems occur (Ponce Alfaro et al.
Smoking. A recent study by Kent et al.
(2001) notes that nicotine addiction is more likely in people with ADHD
since nicotine promotes the release of dopamine and has been shown to
improve attention in adults with ADHD. Another study notes that ADHD is
linked to cigarette smoking in children, and mothers who smoke are more
likely to have children with ADHD (Levin et al. 2001).
Cocaine. Mothers who use cocaine are more
likely to give birth to children with ADHD. A study of urban
African-American children (Bandstra et al. 2001) suggests prenatal
cocaine exposure can lead to long-lasting disruption of the brain
systems regulating arousal and attention.
Ritalin Abuse. The DEA classifies
methylphenidate and amphetamine as Schedule II drugs (those with the
very highest potential for addiction and abuse), a category that also
includes methamphetamine, cocaine, and the most potent opiates and
barbiturates. Methylphenidate is derived from the same family as cocaine
and gives a similar, brief 4-hour high (Vastag 2001), making it an
increasingly popular recreational drug. The number of students who abuse
Ritalin has exploded. In one survey at a public liberal arts college in
Massachusetts, more than 16% of the students reported they had tried
methylphenidate recreationally, and 12.7% reported they had taken the
drug intranasally, about the same figures found for cocaine and
amphetamine use (Babcock et al. 2000). Ritalin tablets are often taken
crushed and snorted like cocaine for a quick burst of energy. Emergency
room admissions due to Ritalin abuse have also climbed rapidly, and
severe side effects such as hyperthermia, hypertension, strokes,
seizures, and death are often observed.
To help reduce the harsh side effects of conventional treatments for
ADHD, some alternative non-stimulant drugs are being developed. Be sure to
check with your primary care health professional to see if some of these
drugs might be right for you:
Atomoxetine is an investigational,
non-stimulant drug that is thought to act by blocking norepinephrine
transport in the brain and appears to be safe and well tolerated
(Michelson et al. 2001).
Gabapentin is an anticonvulsant drug
released in the United States in 1993 for use as adjunctive therapy in
refractory partial epilepsy and is sometimes used for bipolar adults.
The drug appears to have a good safety profile (Hamrin et al. 2001).
Bupropion appears to be effective and
well-tolerated in adolescents with ADHD and depression (Daviss et al.
Modafinil is a new wake-promoting yet
non-stimulant drug that is helpful in adults with ADHD (Taylor et al.
Tomoxetine, a novel noradrenergic-specific
(stimulated or released by norepinephrine) antidepressant; Aricept (donepezil),
cholinergic (acetylcholine releasing) cognitive enhancing
anticholinesterase inhibitors; and ABT-418, a novel nicotinic analogue,
also look promising (Biederman et al. 2000).
Given the perils of conventional approaches to ADHD and the
frightening problems that can arise if untreated, it is fortunate that a
wide variety of less invasive, safer, and effective approaches to ADHD are
currently available. These include mind-body approaches, environmental
strategies, exercise, dietary changes, and supplements.
A good first step in addressing ADHD non-pharmaceutically is using a
few key behavioral techniques:
Establish Routines. Setting routines is an
important component of treatment for people with ADHD and should include
set times for bed, play, bathing, TV, dinner, school, and homework.
Maintain Eye Contact. People with ADHD
should be encouraged to look people in the eyes when spoken to and
acknowledge what was said.
Practice Meditation. Techniques to enhance
focus and attention such as meditation are useful. One new therapy
called the interactive metronome improves attention, motor control, and
selected academic skills in boys with ADHD.) Note: An interactive
metronome works by combining a computer with a metronome to help the
user match his or her timing during tapping exercises to that of a
reference tone (Shaffer et al. 2001).
Avoid Information Overload. Information
technologies are creating attention disorders among business executives
who have to handle vast amounts of information (Davenport et al. 2000).
Because people with ADHD have slow brain processing speeds, they
perceive time as moving more quickly and have difficulty processing the
glut of new information all around us (Goddard 2000).
Try Biofeedback. Biofeedback
electroencephalograph (EEG) training works to teach children with ADHD
to enter a calm, alpha brainwave state and use different neurological
pathways, which improves impulse control, increases attention, and
allows more efficient processing of information. Biofeedback may be
particularly effective for ADHD because people with this disorder have
slower brainwaves in frontal and polar regions of the brain than people
without it, which explains the use of stimulant medications (Chabot
2001). Biofeedback has also been used to treat alcoholism and appears to
work so well that many children with ADHD can stop their drug therapies
using this technique. Typically 20-40 sessions are required.
The next strategy to try is using an exercise routine. Exercise is a
rather obvious but overlooked way to help control the symptoms of ADHD.
One recent study looked at the rate of spontaneous eye blinks, the
acoustic startle eye blink response (ASER), and motor activity in children
with ADHD. Researchers subjected subjects to a treadmill exercise bout at
65-75% VO2 max (the maximum oxygen uptake by the lungs). The results
suggest vigorous exercise can improve symptoms of ADHD via dopamine
release (Tantillo et al. 2002). A current position paper on exercise and
children by the
American Heart Association recommends 30 minutes of moderate intensity
activity on most days of the week and a minimum of 30 minutes of vigorous
activity 3-4 days a week. This level of activity is shown to help prevent
a wide variety of behavioral and physical disorders in children.
While a bit more difficult to perform than mind-body or exercise
protocols, a thorough evaluation and clean up of environmental toxins
should be made immediately upon diagnosis with ADHD. Very current research
suggests that environmental chemicals, molds, fungi, and
neurodevelopmental toxins such as heavy metals and organohalide pollutants
are possibly linked to ADHD. Changes in thyroid function may be one reason
environmental toxins can affect ADHD (Kidd 2000). One recent review notes
parallels between the features of ADHD and the behavior of monkeys exposed
developmentally to lead or polychlorinated biphenyls (PCBs) (Rice 2000).
Mercury vapor from dental amalgam fillings
can cause many of the symptoms of ADHD. Mercury toxicity in mothers can
cause learning disabilities, autism (more on page 2), and ADHD in unborn
children by fast placental transfer and could explain the explosion in
learning and behavioral problems since World War II when mercury was first
used in dentistry. Symptoms of mercury toxicity include irritability,
anxiety, restlessness, memory and attention problems, confusion, and loss
of coordination. In addition,
vaccines ranging from childhood inoculations to flu shots contain
dangerous levels of mercury.
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