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Adhdbrain

PET scans of glucose metabolism in the brains of a normal adult (left) compared to an adult diagnosed with ADHD (right).[1]

Attention-Deficit/Hyperactivity Disorder (ADHD) is generally considered to be a developmental disorder, largely neurological in nature, affecting 3-5 percent of the population. [2] The disorder is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity.[3] ADHD initially appears in childhood and manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control and distractibility.[4] ADHD is currently considered to be a persistent and chronic syndrome for which no medical cure is available. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.[5]

Many children are diagnosed with both ADHD and Asperger syndrome, because the conditions share many of the same characteristics. Both ADHD and autism manifest as problems with organization, social skills and attention, as well as sensory issues.

The distinction between the two conditions is confusing for many parents. [6]

Signs & symptoms

Signs and symptoms of ADHD may be categorized under two broader groups:

  • Inattention
  • Hyperactivity-impulsive behavior

According Mayo Clinic, "In general, children are said to have ADHD if they show six or more signs or symptoms from each category for at least six months. These symptoms must significantly affect a child's ability to function in at least two areas of life — typically at home and at school. This helps ensure that the problem isn't with only a particular teacher or with only parents. Children who have problems in school but get along well at home or with friends are not considered to have ADHD. The same is true of children who are hyperactive or inattentive only at home but whose schoolwork and friendships aren't affected by their behavior."[7]

Major signs and symptoms of inattention include
  1. Inability or problem sustaining attention during specific tasks or plays,
  2. Inability to pay close details to school assignments or other works and/ or making careless mistakes in school assignments,
  3. Inability to understand and difficulty in complying with instructions resulting into failure to finish school work and other tasks,
  4. Inability to pay specific and pointed attention when directly spoken to,
  5. Inability to remember details - being forgetfulness,
  6. Inability to continue to pay sustained attention - getting easily distracted,
  7. Inability to properly keep things and articles like books, toys, etc. in order,
  8. Inability to organize tasks and activities, and
  9. Inability to undertake tasks that require sustained mental effort like avoiding schoolworks.
Major signs and symptoms of hyperactivity-impulsive behavior include
  1. Excessive talking.
  2. Answering without even listening to the question completely,
  3. Nature of intruding on other persons' conversations or games,
  4. Difficulty in waiting for his/ her turn,
  5. Frequent fidgets or squirming,
  6. Problems in playing quietly,
  7. Always restless if adult, and if child, runs or climbs excessively or indulges in similar activities,
  8. Moves around in the classroom or leaves his seat where remaining seated is a requirement.

Causes & complications

Causes

Sometimes parents blame themselves if the their child is diagnosed with ADHD. Contrary to this belief, current studies indicate that "structural changes in the brain, not parenting, may be a leading cause of the disorder." Certain environmental factors may also be the contributory factors. Exact reasons for ADHD are yet to be identified, and several factors are beleived to have a role in the development of ADHD including the following:

  • Hereditary factors: In many instances, children with ADHD, has one or more close relatives with the same disorder.
  • Altered brain function and anatomy: Researches indicate major differences in the brains of the people with ADHD and brains of people without this disorder. For instance, the brains of people with ADHD fail to use properly the neurotransmitters, the brain's chemical messengers or brains of the people with ADHD indicate less activity in the parts of the brain that control attention and activity. Further, children with ADHD have a little smaller brains than the children of their age - their brains, on an average, are 4 percent smaller in volume.
  • Smoking by mother and exposure to drugs and toxins: Smoking, use of alcohol and drug abuse by pregnant women expose the unborn to ADHD. Similarly, pregnant women, exposed to environmental toxins like industrial toxic chemicals, may give birth to children with symptoms of ADHD.
  • Childhood exposure to toxins: Exposure to toxins like lead put the children at a risk of developing ADHD.

Complications

ADHD results into several other complications both for the children and the adults. It makes school life difficult for the children as they have to struggle with school work and their poor performance may be negatively commented upon by teachers and class mates. Children with this disorder are more prone to injuries and accidents. As they grow, they are at a higher risk of alcohol and drug abuse, and may find problems in establishing normal relationship. Although ADHD may not result into very serious psychological and developmental problems, around one in three children with ADHD may develop one or more of the other disorders including the following[8]:

  • Conduct disorder: About 20 to 40 percent of ADHD children may eventually develop conduct disorder (CD), a more serious pattern of antisocial behavior. These children frequently lie or steal, fight with or bully others, and are at a real risk of getting into trouble at school or with the police. They need immediate help.
  • Depression & Anxiety: Some children with ADHD often have co-occurring anxiety or depression. If the anxiety or depression is recognized and treated, the child will be better able to handle the problems that accompany ADHD. Conversely, effective treatment of ADHD can have a positive impact on anxiety as the child is better able to master academic tasks.
  • Learning disabilities: Many children with ADHD (around 20 to 30 percent) have a specific learning disability (LD). In preschool years, these disabilities include difficulty in understanding certain sounds or words and/ or difficulty in expressing oneself in words. In school age children, reading or spelling disabilities, writing disorders, and arithmetic disorders may appear. A type of reading disorder, dyslexia, is quite widespread. Reading disabilities affect up to 8 percent of elementary school children.
  • Tourette syndrome: A very small proportion of people with ADHD have a neurological disorder called Tourette syndrome. People with Tourette syndrome have various nervous tics and repetitive mannerisms, such as eye blinks, facial twitches, or grimacing. Others may clear their throats frequently, snort, sniff, or bark out words. These behaviors can be controlled with medication. While very few children have this syndrome, many of the cases of Tourette syndrome have associated ADHD. In such cases, both disorders often require treatment that may include medications.
  • Oppositional defiant disorder (ODD): As many as one-third to one-half of all children with ADHD — mostly boys— have another condition, known as oppositional defiant disorder (ODD). These children are often defiant, stubborn, non-compliant, have outbursts of temper, or become belligerent. They argue with adults and refuse to obey.

Treatment

The best possible treatment for Attention Deficit/Hyperactivity Disorder (ADHD) is still being debated. Current treatment involves a combination of therapy or medications, generally a combination of both. Further, there is a number of treatments which fall under the domain of experimental treatments.

Therapy

It has been observed that children and adults with ADHD benefit immensely with therapy like general or specific counseling and/ or behavioral therapy. This is more useful to children and adults with associated disorders like depression and anxiety. Such therapy may be rendered by psychiatrists, psychologists, mental health care personnel and social workers. Some of the forms of therapy may take the following form:

  • Family therapy: Family therapy involves counseling to members of the family as a unit - parents and sibling/s. This assists the family members to understand the stress and dealing with stress of living with someone with ADHD.
  • Training for social skills: Such trainings are directed to teach and train the children with ADHD to develop social skills.
  • Skills for parenting: The objective of parenting skill training is to assist parents to understand their child's behavior and guide him/ her properly.
  • Behavior therapy: The objective of behavior therapy is to assist the parents and the teachers to imbibe and practice strategies to deal with children's behavior.
  • Psychotherapy: This is directed generally against older children and adults with ADHD. This affords an opportunity to the affected person to talk about themselves and allow them to be explored by experts in the field of psychotherapy. The affected persons are advised to properly to deal with the disabilities.
  • Support therapy: Support therapy provides affected children and adults, and their parents, a network of support groups - "a network of social support, information and education".

Medications

Generally psycho-stimulant drugs like Methylphenidate (Ritalin, Concerta), Dextroamphetamine/amphetamine (Adderall), and Dextroamphetamine (Dexedrine) are used to treat ADHD. in some cases, particularly when the children and adults affected with ADHD also suffer from depression, anti-depressant drugs are used to treat ADHD.

Experimental

The two most prevalant treatment of Attention Deficit/Hyperactivity Disorder (ADHD) involve therapy and medication as outlines above. However, certain experimental treatments are also being tried to treat ADHD. These are largely unproven treatments and include the following:

  • Biofeedback: This is basically a stress reduction technique aimed to train people to control certain body responses like heart beat rate and muscle tension. The technique is applied to train children and adults affected with ADHD to enable them to try to change their brain waves to more normal level.
  • Brain wave biofeedback: It is also called Neurobiofeedback, and it endeavors to "teach people to control their own brain wave patterns using electroencephalography (EEG) feedback". [[EEG[[ maps and measures the electrical activities of the brain. Brain wave biofeedback is sometimes combined with a video game.
  • Special diets and supplements: For last several years, attention of some activists have revolved around special diets and supplements to reduce the symptoms of and treat Attention Deficit/Hyperactivity Disorder (ADHD). Foods with additives are eliminated and foods beleived to increase hyperactivity like sugar and caffeine are also eliminated. Sometimes foods with common allergens containing wheat and eggs are also eliminated. However, there is no conclusive proof that special diets reduce ADHD symptoms.

External links

References

  1. Zametkin AJ, Nordahl TE, Gross M, et al. "Cerebral glucose metabolism in adults with hyperactivity of childhood onset." N Engl J Med. 1990 November 15;323(20):1361-6. PMID 2233902
  2. (January 2002) "International Consensus Statement on ADHD". Clinical Child and Family Psychological Review 5 (2): 89-111.  Also available in PDF format.
  3. Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition, American Psychiatric Association, 2000.
  4. Attention-Deficit/Hyperactivity Disorder (ADHD). Behavenet.com. Retrieved on December 11, 2006.
  5. Attention-Deficit / Hyperactivity Disorder: ADHD in Adults. WebMd.com. Retrieved on December 11, 2006.
  6. The National Autistic Society: "Attention deficit hyperactivity disorder and autism"
  7. Attention-deficit/hyperactivity disorder (ADHD) - Signs and symptoms
  8. Disorders that Sometimes Accompany ADHD
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