Attention Deficit Hyperactivity Disorder Inappropriate behavior including poor

Attention Deficit Hyperactivity Disorder Inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity

Attention Deficit Hyperactivity Disorder Here are some Facts • Behavioral disorder emerges before the age of seven • Symptoms include inattentive, impulsive and hyperactive behaviors • ADHD is not a reflection of a child's intelligence nor caused by poor parenting • ADHD is more common in people who have a close relative with the condition • Twice as many boys are diagnosed with ADHD as girls

What Is The Difference Between ADD and ADHD • The current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) outlines the diagnostic criteria for mental conditions. • Although the terms ADD and ADHD are used interchangeably, ADHD is the official name used by the American Psychiatric Association, and it encompasses hyperactive, impulsive, and/or inattentive behaviors. • ADD is the older term thus in some older literature you will find this term as a synonym for ADHD

TYPES OF ADHD • Combined Type (Inattentive/Hyperactive/Impulsive). Children with this type of ADHD show all three symptoms. This is the most common form of ADHD. • Hyperactive/Impulsive Type. Children show both hyperactive and impulsive behavior, but are able to pay attention. • Inattentive Type. Formerly known as attention deficit disorder (ADD), these children are not overly active. They do not disrupt the classroom or other activities, so their symptoms might not be noticed.

Attention Deficit Hyperactivity Disorder: Prevalence • Affects children, adolescents and adults • The National Institute of Mental Health (NIMH) estimates that 5 million children in the United States have ADHD – that is about 5% of all children! • Studies show that up to 70% of children with ADHD continue to have symptoms as adults

Attention Deficit Hyperactivity Disorder: In Children • Childhood ADHD is diagnosed after a child has shown six or more specific symptoms of inactivity and/or hyperactivity on a regular basis for more than six months in more than two settings. • There is no single test for ADHD • Diagnosis is based on questionnaires

Attention Deficit Hyperactivity Disorder: In Children • A doctor can diagnose ADHD with the help of standard guidelines. • The diagnosis of ADHD involves the gathering of information from several sources, including school, caregivers, and parents. • The doctor will consider how a child's behavior compares with that of other children the same age.

Attention Deficit Hyperactivity Disorder: In Teens • Typically diagnosed in childhood, ADHD still affects many teens. • The symptoms -- inattention, impulsivity, and hyperactivity - are intrusive, which means they interrupt and seriously interfere with a teen's life. • During teen years, especially as the hormonal changes of adolescence are going on, symptoms of ADHD may intensify.

Attention Deficit Hyperactivity Disorder: In Teens • It's not uncommon for teens with ADHD to forget assignments, misplace textbooks, and become easily bored with their daily class work. • Teens may become inattentive, or excessively attentive -- not waiting for their turn before blurting out answers.

Attention Deficit Hyperactivity Disorder: In Teens • Teens with ADHD may also be fidgety and have a difficult time sitting still in class. • The lack of attention to what they're doing often leads to poor performance on tests and being rejected from sports teams, extracurricular activities, and peer groups.

Attention Deficit Hyperactivity Disorder: In Teens • Teens with ADHD are more likely to be heavy alcoholic drinkers than teens without ADHD. • In clinical studies, researchers confirmed that teens with ADHD were twice as likely to have abused alcohol within the past 6 months.

Attention Deficit Hyperactivity Disorder: In Teens • They also found that teens with ADHD were likely to abuse drugs and three times more likely to abuse drugs other than marijuana. • Getting proper treatment for ADHD in teens may cut the risk of later alcohol and drug abuse.

Attention Deficit Hyperactivity Disorder: In Adults • It is now known that these symptoms continue into adulthood for about 70% of children with ADHD. • That translates into 4% of the US adult population, or 8 million adults. • Few adults are identified or treated for adult ADHD.

Attention Deficit Hyperactivity Disorder: In Adults • Adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits. • If these difficulties are not managed appropriately, they can cause associated behavioral, emotional, social, vocational and academic problems.

Attention Deficit Hyperactivity Disorder: In Adults • The following behaviors and problems may stem directly from ADHD or may be the result of related adjustment difficulties: – Chronic lateness and forgetfulness. – Anxiety. – Low self-esteem. – Employment problems. – Difficulty controlling anger. – Impulsiveness.

Attention Deficit Hyperactivity Disorder: In Adults – Substance abuse or addiction. – Poor organization skills. – Procrastination. – Low frustration tolerance. – Chronic boredom. – Difficulty concentrating when reading. – Mood swings. – Depression. – Relationship problems.

Attention Deficit Hyperactivity Disorder: Adults - Interesting Facts • Adults with ADHD are more likely to: – Change employers frequently and perform poorly. – Have had fewer occupational achievements – Have a lower socioeconomic status. – Have driving violations such as: be cited for speeding; have their licenses suspended; and be involved in more crashes

Attention Deficit Hyperactivity Disorder: Adults - Interesting Facts • Adults with ADHD are more likely to: – – – Use illegal substances more frequently. Smoke cigarettes. Self-report psychological maladjustment more often Have more marital problems and multiple marriages. Have higher incidence of separation and divorce. • Much of this functional impairment diminishes with remission of the disorder and can be mitigated by appropriate treatment.

Common Conditions That Coexist With ADHD COMORBIDITY Learning Disorders Anxiety & Depression Bipolar Disorder Oppositional Defiance Disorder Conduct Disorder Tourette’s Syndrome Substance Abuse Obsessive Compulsive Disorder Intermittent Explosive Disorder Panic Disorder Specific Phobia CHILDREN ADOLESCENT X X X X ADULT X X X X

Attention Deficit Hyperactivity Disorder The Medical Approach

Cocaine or Ritalin? • Euphoria, confidence and wellbeing, loss of appetite, a feeling of increased alertness and energy, excitability, restlessness, aggression, nervousness, increased blood pressure, heart rate and respiration, a rise in body temperature, dilated pupils, and rapid body movements, psychological dependence and death.

Cocaine or Ritalin? • Increase blood pressure, heart rate respirations and temperature, appetite suppression, weight loss, growth retardation, facial tics, muscle twitching, CNS stimulation, euphoria, irritability and agitation, psychotic episodes, violent behavior, heart arrhythmias and palpations, high blood pressure, psychological dependence and death

Medication for ADHD • A class of drugs called psychostimulants or stimulants have been used to effectively treat ADHD for years. • They work by increasing the production of two neurotransmitters – dopamine and norepinephrine

Medication for ADHD • Stimulants – Work by increasing dopamine output from basal ganglia and increase activity in the prefrontal cortex and temporal lobes • Adderall • Ritalin (SR) • Dexedrine • Tricyclic Antidepressants – Increase norepinephrine, dopamine, serotonin used when depression and bed-wetting are also symptoms • Imipramine (Tofranil) • SSRI – Increase serotonin availability used when excessive worrying, over focus, or temper problems are also symptoms • Effexor

Medication for ADHD • These medicines help users to focus their thoughts and ignore distractions. • Stimulant medications are effective in 70% to 80% of patients. • However there are short and long term effects related to these drugs

Medication for ADHD • Stimulant drugs to treat ADHD include: – Adderall and Adderall XR – Concerta – Dexedrine – Focalin and Focalin XR – Metadate CD and Metadate ER – Methylin – Ritalin, Ritalin LA – Vyvanse – Desoxyn

Side Effects of ADHD Drugs • ADHD drugs sometimes have side effects • The most common side effects of ADHD drugs include: – Decreased appetite/weight loss – Sleep problems – Headaches – Jitteriness – Social withdrawal – Stomach aches

Side Effects of ADHD Drugs • Rarely, medications for ADHD can cause more serious side effects. • For instance, some stimulants are associated with an increased risk of cardiovascular problems and sudden death. • They may also exacerbate psychiatric conditions like depression or anxiety.

Stimulant Safety Concerns Effect On The Developing Brain • The long-term impact of ADD / ADHD medication on the youthful, developing brain is not yet known. • Some researchers are concerned that the use of drugs such as Ritalin in children and teens might interfere with normal brain development.

Stimulant Safety Concerns Heart Related Problems • ADHD stimulant medications have been found to cause sudden death in children and adults with heart conditions. • The American Heart Association recommends that all individuals, including children, have a cardiac evaluation prior to starting a stimulant. • An electrocardiogram is recommended if the person has a history of heart problems.

Stimulant Safety Concerns Psychiatric Problems • Stimulants for ADD / ADHD can trigger or exacerbate symptoms of hostility, aggression, anxiety, depression, and paranoia. • • People with a personal or family history of suicide, depression, or bipolar disorder are at a particularly high risk, and should be carefully monitored when taking stimulants.

Stimulant Safety Concerns Potential for Abuse • Stimulant abuse is a growing problem. • College students take them for a boost when cramming for exams or pulling all-nighters. • Others abuse stimulant meds for their weight-loss properties. • Children taking stimulants should not be sharing the pills or selling them.

Stimulant Contraindications • ADD / ADHD stimulants are not recommended for those with: – Any type of heart defect or diseases – High blood pressure – Hyperthyroidism – Glaucoma – High levels of anxiety – A history of drug abuse

Ritalin and Violence • 1997 a 14 year old boy opened fire at a prayer meeting killing 3 teenagers and seriously wounding 5 others • 1998 two boys, 11 and 14 years old shot 15 people killing 5 and wounding 10 others • 1998 a 15 year old boy murdered his parents and then 2 students at his high school plus wounded 22 others…

Sugar • High consumption of sugar leads to insulin spike which takes too much glucose from the blood causing hypoglycemia • Due to the hypoglycemic state, adrenaline is released which causes the fight or flight energy surge • This agitation, irritability and shakiness from the adrenaline could be falsely labeled as ADHD • Could also be caused from not eating often enough and not enough protein

Sugar Studies • Yale study where adults and children were fed a comparable amount of sugar based on percentage of body weight. • Blood glucose and blood adrenaline levels were measured every half hour for five hours • Adrenaline levels in children were 10 times higher than normal up to 5 hours later Journal of Pediatrics, Jones, Tini, Borg 1995

School Lunch • Lunches were changed from processed foods and sugars as well as eliminating BHT and BHA to fruits vegetables, whole grains and proteins in 803 public schools and 9 juvenile correctional facilities • After 4 years the academic performance in the schools rose 16% and learning disabilities fell 40% in the public schools • In the juvenile correction facilities violent and non-violent anti -social behavior fell 48% Schoenthaler, et al. "The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools, " International Journal of Biosocial Research, Vo. L 8(2): 185. 196, 1986

Chiropractic and ADHD Study • Improvement Attention in Patients Undergoing Network Spinal Analysis, Pauli, 2010, Journal of Vertebral Subluxation Study • 9 adults (4 men, 5 women) diagnosed with ADHD, were analyzed for attention using TOVA tests (Test of Variable Attention) before the treatment began, 30 days into treatment and at conclusion of treatment (8 weeks) • After 8 weeks of chiropractic care, those who work in the study group experienced a substantial improvement within their TOVA scores in addition to a normalizing of their ADHD symptoms

Chiropractic and ADHD Retrospective Study • 4 males age 9 -13 medically diagnosed with ADHD through parent/teacher questionnaires were treated using chiropractic manipulative therapy for 5 months. • At the conclusion of treatment the questionnaires were administered to parents and teachers. • All 4 patients showed improvement in ADHD symptoms such as, hyperactivity, impulsivity, and inattentiveness, as well as behavioral, social, or emotional difficulties

Cervical Kyphosis is a Possible Link to ADHD • 5 year old medically diagnosed with ADHD and treated with Ritalin and Aderall for 3 years received 35 Chiropractic adjustments over the course of 8 weeks. • Cervical lordosis was measured before and after treatment • A change from 12 degrees to 32 degrees cervical lordosis was observed as well as resolution of facial tics and improvement in behavior. • “Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication. ” JMPT, 2004, Harrison, Bastecki, Haas