Attention Deficit Hyperactivity Disorder

1. Attention Deficit Hyperactivity Disorder A Review of An Overview of ADHD: Past and Present Presented by Dr. Chris Babbitt Compiled by Patrice Edgar 1/22/07

2. ADHD Facts • ADHD is a brain based disorder. It is not primarily behavioral. • 3-5% of school age children have ADHD. • ADHD is under diagnosed most often in girls. • 80% of children with ADHD continue to have symptoms into adulthood. • Ritilin has been used to treat ADHD since the 1950’s.

3. ADHD is a disability, a handicapping condition that is treated, but not cured.

4. Children with ADHD need stimulation to keep going. • They act out to gain that stimulation.

5. Causes of ADHD • Although there is no one proven cause of ADHD, there is a strong genetic component. 50% of children with the disorder have a parent with ADHD. • Head injury. • Environmental issues such as lead exposure are another area of concern.

6. Children with ADHD may have multiple symptoms. • Conduct disorders 24% • Oppositional Defiant Disorder 50% • Learning Disabilities 30% • Depression 15-20% • Aspergers • Sensitivity/skin allergies

7. Official New Labels • Attention Deficit Hyperactivity Disorder –Primarily Inattentive. • Attention Deficit Hyperactivity Disorder-Primarily Hyperactive and Impulsive. • Attention Deficit Hyperactivity Disorder-Combined

8. Diagnostic Criteria • Six or more symptoms of inattention, hyperactivity-impulsivity must have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level. • Diagnostic Systems Manual (DSMIV)

9. Research by Daniel Amen • Amen used SPECT Scans to look at blood flow in the brain. The scans showed that the frontal lobes of the brain of children with ADHD are poorly infused with blood. • An increase of blood and a decrease in symptoms occurred with medication and diet.

10. Amen identified six types of ADHD based on the scans.

11. Type 1 • Classic ADHD-over active, poorly attentive, fidgety, impulsive, poor judgment, and organization. • Scans showed frontal lobe issues in the Prefrontal Cortex. • Stimulant medication was appropriate when used at the right dose. It showed blood getting into the frontal lobe efficiently. Adderal and Concerta were the medicines of choice. • A high protein-low carbohydrate diet was helpful along with aerobic exercise.

12. Type 2 • Inattentive ADHD-disorganization, poor follow through, and under activity. • The areas of poor blood infusion were more spread over the brain. • Stimulant medications such as Adderal and Concerta were appropriate. • A high protein-low carbohydrate diet and aerobic exercise was recommended.

13. Type 3 • Over focused ADHD-rigid thought process, stubborn, difficulty shifting tasks, rule governed, not a flexible thinker, addictive personality. • Stimulants will not work. An antidepressant such as Effexor is recommended. • Add more carbohydrates to diet and aerobic exercise is appropriate.

14. Type 4 • Lymbic- The lymbic system is in the middle of the brain and deals with emotion and expression. • This person is distractible, poorly organized, etc, but also very moody. • Amen treated this type with Welbutrin. • A well balanced diet is recommended.

15. Type 5 • Temperal ADHD-occurs in the temperal lobe of the brain. • All the classic ADHD symptoms in addition to memory problems. These children are poor predictors and can’t place themselves in time. • Anticonvulsive medicines such as Depacote and Tegratal are recommended. • A high protein diet along with simple carbohydrates was recommended.

16. Type 6 • Ring of Fire ADHD • The child appears behaviorally disordered, defiant, unable to sit still and attend. May look Bipolar. • Problems with infusion all around the brain which interferes with regulation of behavior, emotion, and judgment. • An antipsychotic medication such as Risperdal and Zyprexa are recommended. • Diet should include high protein and simple carbohydrates.

17. Long Term Study of Treatment for ADHD By the MTA Cooperative Group • Four types of treatment were studied. 1. Medication alone 2. Intensive behavioral therapy alone 3. Combination of medication and behavior 4. Routine community care

18. Study Results • Medication alone and the combination treatment were more effective than behavioral therapy and routine community care. • The combination of medication and therapy was not proven to be better than medication alone. • Combined treatment outcomes were achieved with significantly lower medication doses than used in medication management.

19. Study Results • In the study, children generally tolerated their medication well, including a third dose given in the afternoon. • 36% no side effects • 50% mild side effects • 11% moderate side effects • 3% severe side effects

20. Using Medication With an ADHD ChildTaken From Northwest Counseling Services, S.C. • Myth: Using medication to treat ADHD will lead to other problems down the road. • Fact: Untreated ADHD has far greater consequences than an ADHD that is treated with appropriate medication.

21. Using Medication With an ADHD Child continued • Children whose ADHD is not treated with medicine are far more likely to develop problems with drug and alcohol abuse in their teens and early twenties. • By some estimates as many as 35% of untreated ADHD children never finish High School. • Almost twice as many untreated ADHD children will choose to smoke cigarettes (19%) as opposed to their treated peers (10%).

22. Using Medication With an ADHD Child continued • Research indicates that 43% of untreated ADHD boys who are hyperactive will be arrested for a felony by age 16. • Parents of untreated ADHD children divorce at a much higher rate that those of treated ADHD children. • Adolescent & adult drivers with untreated ADHD take more risks and have more accidents.

23. Myths About ADHD • Myth: Stimulants such as Ritilin agitate children with ADHD. • Fact: Stimulants slow them down and help them to be calm.

24. Myths About ADHD • Antidepressants are a suicide risk. False: The risk is not caused by the pill. A depressed person may lack the energy to harm him/herself. When the person starts to get better they gain energy to complete the act.

25. Myths About ADHD • Stimulants cause cardiac problems. False: A pre-existing condition is the cause. • Watching television causes ADHD. False: The problem is having a TV in the child’s bedroom. It increases issues like social isolation, not ADHD.