Focus ADHD New Medication and ADHD
Diet - Proven Natural Herbal Treatment
ADHD Symptoms,
Diagnosis and Management.
What are the Symptoms
of ADHD?
ADHD is not like a broken arm, or strep throat.
Unlike these two disorders, ADHD does not have clear physical
signs that can be seen in an x-ray or a lab test. ADHD can only be
identified by looking for certain characteristic behaviors, and
these behaviors vary from person to person. Scientists have not
yet identified a single cause behind all the different patterns of
behavior--and they may never find just one. Rather, someday
scientists may find that ADHD is actually an umbrella term for
several slightly different disorders.
At present, ADHD is a diagnosis applied to
children and adults who consistently display certain
characteristic behaviors over a period of time. The most common
behaviors fall into three categories: inattention,
hyperactivity, and impulsivity.
Inattention. People who are inattentive
have a hard time keeping their mind on any one thing and may get
bored with a task after only a few minutes. They may give
effortless, automatic attention to activities and things they
enjoy. But focusing deliberate, conscious attention to organizing
and completing a task or learning something new is difficult.
Hyperactivity. People who are hyperactive
always seem to be in motion. They can't sit still. They may dash
around or talk incessantly. Sitting still through a lesson can be
an impossible task. Hyperactive children squirm in their seat or
roam around the room. Or they might wiggle their feet, touch
everything, or noisily tap their pencil. Hyperactive teens and
adults may feel intensely restless. They may be fidgety or they
may try to do several things at once, bouncing around from one
activity to the next.
Impulsivity. People who are overly
impulsive seem unable to curb their immediate reactions or think
before they act. As a result, hey may blurt out inappropriate
comments. Or, they may run into the street without looking. Their
impulsivity may make it hard for them to wait for things they want
or to take their turn in games. They may grab a toy from another
child or hit when they're upset.
Assessing ADHD
Not everyone who is overly hyperactive,
inattentive, or impulsive has an attention disorder. Since most
people sometimes blurt out things they didn't mean to say, bounce
from one task to another, or become disorganized and forgetful,
how can specialists tell if the problem is ADHD?
To assess whether a person has ADHD, specialists consider
several critical questions: Are these behaviors excessive,
long-term, and pervasive? That is, do they occur more often than
in other people the same age? Are they a continuous problem, not
just a response to a temporary situation? Do the behaviors occur
in several settings or only in one specific place like the
playground or the office? The person's pattern of behavior is
compared against a set of criteria and characteristics of the
disorder. These criteria appear in a diagnostic reference book
called the DSM (short for the Diagnostic and Statistical
Manual of Mental Disorders).
According to the diagnostic manual, there are three patterns of
behavior that indicate ADHD. People with ADHD may show several
signs of being consistently inattentive. They may have a pattern
of being hyperactive and impulsive. Or they may show all three
types of behavior.
According to the DSM, signs of inattention
include:
Because everyone shows some of these behaviors at times, the
DSM contains very specific guidelines for determining when they
indicate ADHD. The behaviors must appear early in life, before age
7, and continue for at least 6 months. In children, they must be
more frequent or severe than in others the same age. Above all,
the behaviors must create a real handicap in at least two areas of
a person's life, such as school, home, work, or social settings.
So someone whose work or friendships are not impaired by these
behaviors would not be diagnosed with ADHD. Nor would a child who
seems overly active at school but functions well elsewhere.
Can other conditions cause these
symptoms?
The fact is, many things can produce these behaviors. Anything
from chronic fear to mild seizures can make a child seem
overactive, quarrelsome, impulsive, or inattentive. For example, a
formerly cooperative child who becomes overactive and easily
distracted after a parent's death is dealing with an emotional
problem, not ADHD. A chronic middle ear infection can also make a
child seem distracted and uncooperative. So can living with family
members who are physically abusive or addicted to drugs or
alcohol. Can you imagine a child trying to focus on a math lesson
when his or her safety and well-being are in danger each day? Such
children are showing the effects of other problems, not ADHD.
In other children, ADHD-like behaviors may be their response to
a defeating classroom situation. Perhaps the child has a learning
disability and is not developmentally ready to learn to read and
write at the time these are taught. Or maybe the work is too hard
or too easy, leaving the child frustrated or bored.
Some children's attention and class participation improve when
the class structure and lessons are adjusted a bit to meet their
emotional needs, instructional level, or learning style. Although
such children need a little help to get on track at school, they
probably don't have ADHD.
It's also important to realize that during certain stages of
development, the majority of children that age tend to be
inattentive, hyperactive, or impulsive--but do not have ADHD.
Preschoolers have lots of energy and run everywhere they go, but
this doesn't mean they are hyperactive. And many teenagers go
through a phase when they are messy, disorganized, and reject
authority. It doesn't mean they will have a lifelong problem
controlling their impulses.
ADHD is a serious diagnosis that may require long-term
treatment with counseling and medication. So it's important that a
person first be assessed for any other causes for these behaviors.
What Can Look Like ADHD?
Can other disorders accompany ADHD?
One of the difficulties in diagnosing ADHD is that it is often
accompanied by other problems. For example, many children with
ADHD also have a specific learning disability (LD), which means
they have trouble mastering language or certain academic skills,
typically reading and math. ADHD is not in itself a specific
learning disability. But because it can interfere with
concentration and attention, ADHD can make it doubly hard for a
child with LD to do well in school.
A very small proportion of people with ADHD have a rare
disorder called Tourette's syndrome. People with Tourette's have
tics and other movements like eye blinks or facial twitches that
they cannot control. Others may grimace, shrug, sniff, or bark out
words.
More serious, nearly half of all children with ADHD--mostly
boys--tend to have another condition, called oppositional defiant
disorder. These children may overreact or lash out when they feel
bad about themselves. They may be stubborn, have outbursts of
temper, or act belligerent or defiant. Sometimes this progresses
to more serious conduct disorders. Children with this combination
of problems are at risk of getting in trouble at school, and even
with the police. They may take unsafe risks and break laws--they
may steal, set fires, destroy property, and drive recklessly. It's
important that children with these conditions receive help before
the behaviors lead to more serious problems.
At some point, many children with ADHD--mostly younger children
and boys--experience other emotional disorders. About one-fourth
feel anxious. They feel tremendous worry, tension, or uneasiness,
even when there's nothing to fear. Because the feelings are
scarier, stronger, and more frequent than normal fears, they can
affect the child's thinking and behavior. Others experience
depression. Depression goes beyond ordinary sadness--people may
feel so "down" that they feel hopeless and unable to deal with
everyday tasks. Depression can disrupt sleep, appetite, and the
ability to think.
Because emotional disorders and attention disorders so often go
hand in hand, every child who has ADHD should be checked for
accompanying anxiety and depression. Anxiety and depression can be
treated, and helping children handle such strong, painful feelings
will help them cope with and overcome the effects of ADHD.
Of course, not all children with ADHD have an additional
disorder. Nor do all people with learning disabilities, Tourette's
syndrome, oppositional defiant disorder, conduct disorder,
anxiety, or depression have ADHD. But when they do occur together,
the combination of problems can seriously complicate a person's
life. For this reason, it's important to watch for other disorders
in children who have ADHD.
What causes ADHD?
Understandably, one of the first questions parents ask when
they learn their child has an attention disorder is "Why? What
went wrong?"
Health professionals stress that since no one knows what causes
ADHD, it doesn't help parents to look backward to search for
possible reasons. There are too many possibilities to pin down the
cause with certainty. It is far more important for the family to
move forward in finding ways to get the right help.
Scientists, however, do need to study causes in an effort to
identify better ways to treat, and perhaps some day, prevent ADHD.
They are finding more and more evidence that ADHD does not stem
from home environment, but from biological causes. When you think
about it, there is no clear relationship between home life and
ADHD. Not all children from unstable or dysfunctional homes have
ADHD. And not all children with ADHD come from dysfunctional
families. Knowing this can remove a huge burden of guilt from
parents who might blame themselves for their child's behavior.
Over the last decades, scientists have come up with possible
theories about what causes ADHD. Some of these theories have led
to dead ends, some to exciting new avenues of investigation.
One disappointing theory was that all attention disorders and
learning disabilities were caused by minor head injuries or
undetectable damage to the brain, perhaps from early infection or
complications at birth. Based on this theory, for many years both
disorders were called "minimal brain damage" or "minimal brain
dysfunction." Although certain types of head injury can explain
some cases of attention disorder, the theory was rejected because
it could explain only a very small number of cases. Not everyone
with ADHD or LD has a history of head trauma or birth
complications.
ADHD Is Not Usually Caused by:
Research shows that a mother's use of cigarettes, alcohol, or
other drugs during pregnancy may have damaging effects on the
unborn child. These substances may be dangerous to the fetus's
developing brain. It appears that alcohol and the nicotine in
cigarettes may distort developing nerve cells. For example, heavy
alcohol use during pregnancy has been linked to fetal alcohol
syndrome (FAS), a condition that can lead to low birth weight,
intellectual impairment, and certain physical defects. Many
children born with FAS show much the same hyperactivity,
inattention, and impulsivity as children with ADHD.
Drugs such as cocaine--including the smokable form known as
crack--seem to affect the normal development of brain receptors.
These brain cell parts help to transmit incoming signals from our
skin, eyes, and ears, and help control our responses to the
environment. Current research suggests that drug abuse may harm
these receptors. Some scientists believe that such damage may lead
to ADHD.
Toxins in the environment may also disrupt brain development or
brain processes, which may lead to ADHD. Lead is one such possible
toxin. It is found in dust, soil, and flaking paint in areas where
leaded gasoline and paint were once used. It is also present in
some water pipes. Some animal studies suggest that children
exposed to lead may develop symptoms associated with ADHD, but
only a few cases have actually been found.
Other research shows that attention disorders tend to run in
families, so there are likely to be genetic influences. Children
who have ADHD usually have at least one close relative who also
has ADHD. And at least one-third of all fathers who had ADHD in
their youth bear children who have ADHD. Even more convincing: the
majority of identical twins share the trait. At the National
Institutes of Health, researchers are also on the trail of a gene
that may be involved in transmitting ADHD in a small number of
families with a genetic thyroid disorder.
Treatment Options
For decades, medications have been used to treat the symptoms
of ADHD. Three of these medications are methylphenidate (Ritalin),
dextroamphetamine (Dexedrine or Dextrostat), and pemoline (Cylert).
However, most prescription psychiatric drugs also carry
far-reaching negative side effects and risks (see below).
Unfortunately, people think medication is all that's needed.
For lasting improvement, numerous clinicians believe that the most
significant, long-lasting gains appear when medication is combined
with behavioral therapy, emotional counseling, dietary control and
practical support.
The Medication Debate
Ritalin and the other stimulants have sparked a great deal of
controversy. The potential side effects should be carefully
weighed against the benefits before prescribing the drugs. While
on these medications, some children may lose weight, have less
appetite, and temporarily grow more slowly. Others may have
problems falling asleep. Some doctors believe that stimulants may
also make the symptoms of Tourette's syndrome worse. Some doctors
say if they carefully watch the child's height, weight, and
overall development, the benefits of medication far outweigh the
potential side effects. Side effects that do occur can often be
handled by reducing the dosage. However, that is not necessarily
true, and you should educate yourself on all aspects of the debate
before making a decision.
A far safer approach is often found with natural (herbal or
homeopathic) remedies, which should be considered as a first step
ahead of prescription psychiatric drugs. When combined with strong
dietary control, counseling as necessary and a healthy lifestyle,
natural remedies have been show to be effective in helping to
alleviate the symptoms of ADHD.
Another debate is whether Ritalin and other stimulant drugs are
prescribed unnecessarily for too many children. Remember that many
things, including anxiety, depression, allergies, seizures, or
problems with the home or school environment can make children
seem overactive, impulsive, or inattentive. Critics argue that
many children who do not have a true attention disorder are
medicated as a way to control their disruptive behaviors.
Treatments To Help People With ADHD
and
Their Families Learn To Cope
Life can be hard for children with ADHD. They're the ones who
are so often in trouble at school, can't finish a game, and lose
friends. They may spend agonizing hours each night struggling to
keep their mind on their homework, then forget to bring it to
school.
It's not easy coping with these frustrations day after day.
Some children release their frustration by acting contrary,
starting fights, or destroying property. Some turn the frustration
into body ailments, like the child who gets a stomachache each day
before school. Others hold their needs and fears inside, so that
no one sees how badly they feel.
It's also difficult having a sister, brother, or classmate who
gets angry, grabs your toys, and loses your things. Children who
live with or share a classroom with a child who has ADHD get
frustrated, too. They may feel neglected as their parents or
teachers try to cope with the hyperactive child. They may resent
their brother or sister never finishing chores, or being pushed
around by a classmate. They want to love their sibling and get
along with their classmate, but sometimes it's so hard!
It's especially hard being the parent of a child who is full of
uncontrolled activity, leaves messes, throws tantrums, and doesn't
listen or follow instructions. Parents often feel powerless and at
a loss. The usual methods of discipline, like reasoning and
scolding, don't work with this child, because the child doesn't
really choose to act in these ways. It's just that their
self-control comes and goes. Out of sheer frustration, parents
sometimes find themselves spanking, ridiculing, or screaming at
the child, even though they know it's not appropriate. Their
response leaves everyone more upset than before. Then they blame
themselves for not being better parents. Once children are
diagnosed and receiving treatment, some of the emotional upset
within the family may fade.
Medication can help to control some of the behavior problems
that may have lead to family turmoil. But more often, there are
other aspects of the problem that medication can't touch. Even
though ADHD primarily affects a person's behavior, having the
disorder has broad emotional repercussions. For some children,
being scolded is the only attention they ever get. They have few
experiences that build their sense of worth and competence. If
they're hyperactive, they're often told they're bad and punished
for being disruptive. If they are too disorganized and unfocused
to complete tasks, others may call them lazy. If they impulsively
grab toys, butt in, or shove classmates, they may lose friends.
And if they have a related conduct disorder, they may get in
trouble at school or with the law. Facing the daily frustrations
that can come with having ADHD can make people fear that they are
strange, abnormal, or stupid.
Often, the cycle of frustration, blame, and anger has gone on
so long that it will take some time to undo. Both parents and
their children may need special help to develop techniques for
managing the patterns of behavior. In such cases, mental health
professionals can counsel the child and the family, helping them
to develop new skills, attitudes, and ways of relating to each
other. In individual counseling, the therapist helps children or
adults with ADHD learn to feel better about themselves. They learn
to recognize that having a disability does not reflect who they
are as a person. The therapist can also help people with ADHD
identify and build on their strengths, cope with daily problems,
and control their attention and aggression. In group counseling,
people learn that they are not alone in their frustration and that
others want to help. Sometimes only the individual with ADHD needs
counseling support. But in many cases, because the problem affects
the family as well as the person with ADHD, the entire family may
need help. The therapist assists the family in finding better ways
to handle the disruptive behaviors and promote change. If the
child is young, most of the therapist's work is with the parents,
teaching them techniques for coping with and improving their
child's behavior.
Several intervention approaches are available and different
therapists tend to prefer one approach or another. Knowing
something about the various types of interventions makes it easier
for families to choose a therapist that is right for their needs.
Psychotherapy works to help people with ADHD to like
and accept themselves despite their disorder. In psychotherapy,
patients talk with the therapist about upsetting thoughts and
feelings, explore self-defeating patterns of behavior, and learn
alternative ways to handle their emotions. As they talk, the
therapist tries to help them understand how they can change.
However, people dealing with ADHD usually want to gain control of
their symptomatic behaviors more directly. If so, more direct
kinds of intervention are needed.
Cognitive-behavioral therapy helps people work on
immediate issues. Rather than helping people understand their
feelings and actions, it supports them directly in changing their
behavior. The support might be practical assistance, like helping
Henry learn to think through tasks and organize his work. Or the
support might be to encourage new behaviors by giving praise or
rewards each time the person acts in the desired way. A
cognitive-behavioral therapist might use such techniques to help a
belligerent child learn to control his fighting, or an impulsive
teenager to think before she speaks.
Social skills training can also help children learn
new behaviors. In social skills training, the therapist discusses
and models appropriate behaviors like waiting for a turn, sharing
toys, asking for help, or responding to teasing, then gives
children a chance to practice. For example, a child might learn to
"read" other people's facial expression and tone of voice, in
order to respond more appropriately. Social skills training helps
ADHD children learn to join in group activities, make appropriate
comments, and ask for help. A child might learn to see how his
behavior affects others and develop new ways to respond when angry
or pushed.
Support groups connect people who have common
concerns. Many adults with ADHD and parents of children with ADHD
find it useful to join a local or national support group. Many
groups deal with issues of children's disorders, and even ADHD
specifically. The national associations listed at the back of this
booklet can explain how to contact a local chapter. Members of
support groups share frustrations and successes, referrals to
qualified specialists, and information about what works, as well
as their hopes for themselves and their children. There is
strength in numbers--and sharing experiences with others who have
similar problems helps people know that they aren't alone.
Parenting skills training, offered by therapists or in
special classes, gives parents tools and techniques for managing
their child's behavior. One such technique is the use of "time
out" when the child becomes too unruly or out of control. During
time outs, the child is removed from the agitating situation and
sits alone quietly for a short time to calm down. Parents may also
be taught to give the child "quality time" each day, in which they
share a pleasurable or relaxed activity. During this time
together, the parent looks for opportunities to notice and point
out what the child does well, and praise his or her strengths and
abilities.
An effective way to modify a child's behavior is through a
system of rewards and penalties. The parents (or teacher)
identify a few desirable behaviors that they want to encourage in
the child--such as asking for a toy instead of grabbing it, or
completing a simple task. The child is told exactly what is
expected in order to earn the reward. The child receives the
reward when he performs the desired behavior and a mild penalty
when he doesn't. A reward can be small, perhaps a token that can
be exchanged for special privileges, but it should be something
the child wants and is eager to earn. The penalty might be removal
of a token or a brief "time out." The goal, over time, is to help
children learn to control their own behavior and to choose the
more desired behavior. The technique works well with all children,
although children with ADHD may need more frequent rewards.
In addition, parents may learn to structure situations in ways
that will allow their child to succeed. This may include allowing
only one or two playmates at a time, so that their child doesn't
get over stimulated. Or if their child has trouble completing
tasks, they may learn to help the child divide a large task into
small steps, then praise the child as each step is completed.
Parents may also learn to use stress management methods, such
as meditation, relaxation techniques, and exercise to increase
their own tolerance for frustration, so that they can respond more
calmly to their child's behavior.
Controversial Treatments
Understandably, parents who are eager to help their children
want to explore every possible option. Many newly touted
treatments sound reasonable. Many even come with glowing reports.
A few are pure quackery. Some are even developed by reputable
doctors or specialists--but when tested scientifically, cannot be
proven to help.
Here are a few types of treatment that have not been
scientifically shown to be effective in treating the majority of
children or adults with ADHD:
