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ADHD Treatments: A review between traditional drug treatments and alternative treatments Raman Nazari, Michael Cvetich, Stephanie Valenzuela University of California, Merced December 7, 2009. Introduction.

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  1. ADHD Treatments: A review between traditional drug treatments and alternative treatmentsRaman Nazari, Michael Cvetich, Stephanie ValenzuelaUniversity of California, Merced December 7, 2009

  2. Introduction • Recent surveys demonstrate general public concern with increase of ADHD diagnosis and the prescriptions of psycho-stimulant medications in children between the ages of three to eighteen. • All subjects must have met the Diagnostics and Statistics Manual (DSM-IV) criteria for ADHD. • Drug therapy is the common method of treatment. • Parents of children prefer alternative natural treatments. • Reviewed traditional and alternative treatments for ADHD in children. • Focus more on the controversial alternative treatments

  3. Traditional Drug Treatments • Two classes of drug treatments that are FDA approved • Psychostimulants • Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) • Psychostimulants are most popular drug treatments: • Methylphenidate • Dexmethylphenidate • Amphetamine • Dextroamphetamine • SNRI’s • Atomoxetine • Fluoxetine

  4. Methylphenidate • Most commonly prescribed medication. • FDA approved • Pharmaceutical name Ritalin. • Prior studies show rapid improvement of core and associated ADHD symptoms (Shachar, Tannock, Cunningham and Cokhum, 1997). • Study that showed increase of compliance in activities with different dosage amounts (Barkley, 1988). Reference: MedScape CME, 2009.

  5. Fluoxetine • Fluoxetine is an SSRI • Pharmaceutical name is Prozac. • Not FDA approved for ADHD • Originally created as an anti-depressant. However, recent studies have discovered to that are beneficial effects on ADHD (Barrickman, Kuperman, Noyes, Schumacher and Verda, 1991). • Barrickman and colleagues have discovered positive impacts towards ADHD symptoms. • Although there is promise in future, there are a number of adverse side effects. • Reference: Mail Online UK, 2009

  6. Atomoxetine • Non-stimulant, pharmacotherapy • FDA approved • Acts as an Serotonin-Norepinephrine Reuptake Inhibitor (SNRI). • Proven to reduce anxiety and depressive symptoms, however, it has a negative side effect of increased blood pressure and pulse. • Atomoxetine is a safe and well tolerated drug treatment that should be considered as a method of therapy for children with ADHD (Kratochvil, Newcorn, Arnold, Duesenberg, Emslie, Quintana, et al., 2005). Reference: Time Magazine, 2009.

  7. Alternative Treatments • Though prescription medication has shown to be an effective method of treatment, there has been an increase in the demand for alternative treatments. • Dietary interventions • Interactive Metronome Training • EEG Neurofeedback • Yoga • Massage • Homeopathic remedies

  8. Dietary Interventions • Unclear whether or not diet can improve behavior, hyper activity, and inattention. • Researchers believe that children are sensitive to certain foods they consume. (Rojas and Chan, 2005). • Feingold Diet is most widely known dietary intervention. • Sensitive to artificial sugars, added coloring, flavors, and preservatives. • Supplementation • No controlled studies support this claim. Reference: How To Do Just About Everything, 2009.

  9. Interactive Metronome Training • New training program that emerged in the early 1990’s. • Help improve ability to selectively attend to activities for extended periods of time without disruption. • 53 of 58 variables affecting ADHD were found significantly improved (Shaffer, Jacokes, Cassily, Greenspan, Tuchman and Stemmer, 2001). • Attention, motor control, language, and processing • Promising future • Limited number of preliminary trials. Further controlled studies with larger sample sizes are needed. • Reference: Interactive Metronome Training, 2009

  10. EEG Neurofeedback • New ground breaking technique • Challenges brain to function better as a whole by performing brain exercises • Applying electrodes to brain scalp to measure brainwave activity • Recent study consisting of 23 subjects measured both subjective and objective conditions (Lubar, Swartwood, Swartwood, and O’Donnell, 1995). • Found to be appropriate and efficacious treatment for ADHD Reference: Hirani Wellness Medical Center, 2009

  11. Yoga • Hindu discipline that targets the training of human consciousness to a state of perfect spiritual insight and tranquility. • Children with ADHD and other concentration disabilities report a greater ability to focus, balance, and compose their daily lives after practicing yoga. • Only one controlled study showed effects on ADHD symptoms. Sessions included respiratory, relaxation, postural, and concentration training (Jensen and Kenny, 2004). Reference: Family Education, 2009

  12. Massage • Involves manual manipulation to the soft tissue in the body promoting blood flow and relief of muscular tension. • Recent study shows children who received massage therapy for a two week period reported themselves as less fidgety, happier, and more on task (Field, Quintino, Hernandez-Rief and Koslovsky, 1998). • Due to small sample sizes, study results are still considered preliminary. • Reference: North Texas Spinal Health & Wellness, 2009

  13. Homeopathic Remedies • Founded by German physician, Samuel Hahnemann over 200 years ago. • Homeopathic medicine comprises of treatments that involve small doses of natural substances in order to counter symptoms of disease. • Even though homeopathic substances are deemed to be safe, liquid remedies containing alcohol are not suitable for children (Rojas et al., 2005). • When a child with ADHD seeks homeopathic treatment, not only will attention improve, but also physical problems, such as headaches, allergies, and asthma. • Reference: • How To Do Just About Everything, 2009

  14. Conclusion • Drug treatments used for ADHD were found more popular. Some of the effective drugs were Methylphenidate and Fluoxetine. However, there are many adverse side effects. • Through the use of alternative treatments, such as dietary interventions, yoga, and homeopathic remedies, there is hope that ADHD symptoms will be diminished. • There are numerous clinical trials needed in order to successful demonstrate that alternative methods help children with ADHD. • Overall, we believe that the medical drug treatments have better results but alternative therapies are safer. • We believe that the best method of treatment in ADHD with children is a mix combination of drug treatments and alternative treatments.

  15. References • Barkley, R.A. (1988). The effects of methylphenidate on the interactions of preschool ADHD children with their mothers. Journal of American Academy of Child & Adolescent Psychiatry, 27(3), 336-341. • Barrickman, L., Kuperman, S., Noyes, R., Schumacher, E., & Verda, M. (1991). Treatment of ADHD with Fluoxetine: A preliminary trial. Journal of the American Academy of Child & Adolescent Psychiatry,30(5), 762-767. • Field, T.M., Quintino O., Hernandez-Reif, M., & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Journal of Adolescence, 33(1), 103–108. • Jensen, P.S., & Kenny, D.T. (2004). The effects of yoga on the attention and behavior of boys with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 7(4), 205-216. • Kratochvil, C.J., Newcorn, J.H., Arnold, L.E., Duesenberg, D., Emslie, G.J., Quintana, H., Sarkis, E.H., Wagner, K.D., Gao, H., Michelson, D., & Biederman, J. (2005). Atomoxetine alone or combined with Fluoxetine for treating ADHD with co-morbid depressive or anxiety symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 44(9), 915-924.

  16. References • Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O’Donnell, P.H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Journal of Applied Psychophysiology and Biofeedback, 28(1), 83-99. • Rojas, N.L., & Chan, E. (2005). Old and new controversies in the alternative treatment of attention deficit hyperactive disorder. Journal of Mental Retardation and Developmental Disabilities, 11(2), 116-130. • Shaffer, R.J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., & Stemmer, P.J. (2001). Effect of interactive metronome training on children with ADHD. American Journal of Occupational Therapy, 55(1), 155-162. • Schachar, R.J., Tannock, R., Cunningham, C., & Corkum, P.V. (1997). Behavioral, situational, and temporal effects of treatment of ADHD with Methylphenidate. Journal of the American Academy of Child & Adolescent Psychiatry, 36(6), 754-763.

  17. Contributions • Raman – I helped contribute to the presentation by compiling key points from the literature review, come up with visuals, videos, cite references for the photos, and edit the PowerPoint. • Michael – I helped contribute to creating and formatting the power presentation. I helped come up with key points and revised the entire presentation. • Stephanie – I helped find find some of the references for the paper and citing the reference page. I did some of the research and I found a few of the photos for the PowerPoint presentation.

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