What Causes Attention Deficit Disorders?

Although there are no exact causes of ADHD, doctors have narrowed down certain themes that are common in its occurence.

By Regina Bussing, MD

Doctors do not know exactly what causes ADHD. Through the years, they have speculated that toxins, abnormal fetal development, diet, injury or poor parenting are to blame.

The earliest research into what is now known as ADHD dates back to 1902, when a British pediatrician described 20 children who were "passionate," obstinant and unable to control their impulses. At the time, he suggested a brain injury might be the key. This has not been confirmed as a cause in most cases. Since then, practitioners have observed that faulty genetics is the more likely culprit.

Today, scientists are scrutinizing genetics for answers. Many now suspect a series of malfunctioning genes may obstruct the normal secretion of chemicals that guide communication among cells in areas of the brain responsible for inhibition and self-control. This breakdown leads to a loss of self-control, impeding other brain functions responsible for maintaining attention. In fact, the brain regions involved have been shown to be smaller and less active on scans taken from children with ADHD compared to those taken from healthy children.

Just what may be causing the reduced size of these brain regions is not yet known. Again, researchers hypothesize a genetic mutation may be to blame. Many now believe that more than one gene plays a role in ADHD. Evidence shows relatives of children with the disorder are significantly more likely to develop it than children from unaffected families. Furthermore, the children of a parent who has adult ADHD have up to a one in two chance of also developing it. And studies of twins have placed the risk of ADHD in a child whose identical twin has the disorder at up to 18 times that of a non-twin sibling of a child with ADHD.

While birth injuries and maternal alcohol or tobacco use may be factors in some cases of ADHD, most experts agree those factors account for less than 10 percent of cases.

As scientists seek clues in the hunt for a definitive cause, many insist that a number of the world's great inventors, artists and thinkers have exhibited traits of attention deficit disorder — and have succeeded because of it, not despite it.

Robert Frost, Frank Lloyd Wright, Samuel Taylor Coleridge, Virginia Woolf, Thomas Edison and Nikola Tesla are examples of creative individuals whose behavior could also be interpreted as the inattention, impulsivity and hyperactivity of ADHD.

Does poor parenting cause ADHD?

No. But some parenting practices can complicate the course of ADHD and lower the success of treatment, such as inconsistent discipline, inconsistency between parents or between parents and the child's caretaker, or inconsistency over time (such as enforcing rules one day but not the next). These practices do not cause ADHD, but they can make life more difficult for these children and complicate treatment.

(www.everydayhealth.com)

An ADHD Treatment to Improve Behavior

With ADHD, parenting can be a nightmare. But an ADHD treatment called behavioral intervention may help. Discover why.

By Kristen Stewart

Medically reviewed by Pat F. Bass III, MD, MPH

ADHD behavior issues can range from difficulty in paying attention and staying on task to impulsivity and hyperactivity. So for children with ADHD, or attention deficit hyperactivity disorder, even simple tasks like cleaning their rooms and doing their homework can border on the impossible.

But a treatment called behavioral intervention could help. “The focus of behavioral interventions [that is, behavior modification] is to change behavior,” says Erin M. Floyd, PhD, a clinical psychologist in Atlanta. Behavioral interventions involve reinforcing desirable behaviors through rewards, and discouraging unruly behavior through punishment and limit setting.

Behavioral Intervention as an ADHD Treatment

The uses of behavioral interventions can range from implementing routine and structure, to teaching social skills, and even working with caregivers on how to provide constructive feedback. They can be used at home, at school, and even in special places such as summer camp.

“Adults and kids with inattentive ADHD cannot start and sustain boring or semi-boring activities such as homework (over time ‘cannot’ gradually becomes ‘can’ with proper accommodations),” says Gary M. Unruh, MSW, LCSW, a practicing clinician in

Colorado Springs, Colo., and author of Unleashing the Power of Parental Love. “The treatment is behavioral intervention: What the ADHD person and support persons [parents and teachers] must do is to accommodate for what the ADHD person currently cannot do.”

For example, a common approach to help a child with ADHD is to assign fewer math problems for homework and use a reward chart to encourage the child to complete the assignment given. Then over time, as the child has begun to succeed with the lightened workload, additional problems are added until the student is united with the rest of the class.

Does This ADHD Treatment Really Work?

The success of behavioral intervention depends on the severity of the individual’s ADHD behavior and the level of seriousness with which adults are able to make accommodations and offer rewards.

If the problem is moderate to severe — meaning that inattention or hyperactivity and impulsivity noticeably affect the person’s life 75 percent of the time or more, then behavioral intervention alone will not allow the person to reach his potential, says Unruh. “In this situation, medication, physical activity, and accommodations need to be utilized.”

Teachers and caregivers must also realize the importance of their role in child ADHD treatment. Many wrongly believe kids with ADHD are being lazy or irresponsible and are hesitant to offer accommodations to allow a child with ADHD to finish a task. Goals must also be reasonable, with the aim of starting small and building to bigger successes.

Pros and Cons of Behavioral Intervention

On the plus side of behavioral intervention, the treatment offers a concrete approach for improved behavior. “It provides structure and a plan for change,” says Richard Horowitz, EdD, a parenting and relationship coach in Flemington, N.J. and author of Peaceful Parenting: Parent Empowerment & Child Empowerment. “Small steps can be rewarded and built upon as the child progresses.” Also, as the individual experiences regular success, his self-esteem will grow.

As for the cons, behavioral intervention involves lots of time and effort. Caregivers must follow through on, and sustain, the behavioral strategies to continue benefits, says Floyd. For example, when rewards are stopped, or become less interesting to the child, the improved behavior is often affected. Behavioral intervention can also require a lot of consultation and coordination between experts and caregivers, which can be difficult and time consuming.

Before setting up a behavioral intervention plan, it’s important for the child to have a personalized psychological evaluation for a proper diagnosis and to understand what symptoms — inattention, hyperactivity, impulsivity — need to be addressed. Once these determinations are made, a doctor or therapist can help set up a specific intervention plan.

That said, there are some general parameters that can be helpful with many children, with and without ADHD.

For example:

• Choose just one or two behaviors to try to change at the outset — more than that can be overwhelming.
• Make sure you have the child’s attention. “Lower yourself to the child’s eye level and make sure he or she is looking at you when you are speaking,” says Nancy Konigsberg, MA, an occupational therapist specializing in pediatrics in N.J. “If you’re not sure the child listened — ask her to repeat back what you said. In doing so you will know whether she heard you and in repeating the directive, the child reinforces it to herself.” Also, remove anything that can be distracting such as TVs, computers, doodle paper, and so on.
• Use reward charts and keep them visible for reinforcement. If results are not being met, consider modifying the chart for different goals and rewards.
• Don’t be afraid to use time-outs for younger children and loss of privileges for older children when they do not follow directions.
• Be consistent. “Caregivers need to be consistent and follow through,” says Konigsberg. “Once you have taken a stand, you cannot change even if you think you made a bad choice. It sends the message that you might change your mind if they try hard enough.”

There’s no doubt ADHD parenting can tax your mental, physical, and emotional energies, but with some effort, behavioral intervention can often help. 

(www.everydayhealth.com)

7 Natural Ways to Treat ADHD Depression

Is ADHD causing depression? Help is on the way with these depression remedies.

By Marie Suszynski

Medically reviewed by Pat F. Bass III, MD, MPH

Living with attention deficit hyperactivity disorder (ADHD) can be difficult, and that can take a toll on all aspects of your life. Experts say that a full two-thirds of adults with ADHD have at least one other condition. For many, it’s depression.

In one study, researchers found that among 129 people who were referred to the clinic for anxiety, 28 percent had ADHD, and the most common disorder occurring with ADHD was depression.

“Folks with ADHD struggle more than folks without it, and more than people with other mental health diagnoses,” says Ari Tuckman, PsyD, a clinical psychologist in West Chester, Penn., and author of More Attention, Less Deficit.

What Links Adult ADHD and Depression

Part of the reason people with ADHD struggle so much is because the disorder is constantly there. “It’s present from childhood and doesn’t go away,” Tuckman says. “For folks with ADHD, there’s a constant and slow erosion of their quality of life.”

It also affects every aspect of life, including work, romantic relationships, friendships, and daily life management such as paying bills on time and staying organized.

Kids who have it are significantly less likely to graduate from high school and college, and adults with it are more likely to get divorced and to be fired from a job. “One study found that the average annual income [for an adult with ADHD] is something like $10,000 less per year,” Tuckman says.

Adult ADHD and Depression: Signs to Look For

It’s no wonder that people with ADHD can be prone to depression, but when you’re depressed it will be harder to manage ADHD symptoms. Keep a lookout for these signs of depression, Tuckman says.

• The things you once found enjoyable don’t bring you pleasure anymore.
• You don’t have the usual get-up-and-go.
• You feel sad, tearful, more irritated.
• You wake up too early in the morning and you’re not rested.
• You eat more and gain weight or eat less and lose weight.

If you are depressed, you don’t have to spiral into a deeper depression. Taking an antidepressant medication is one way to get treatment, but other things such as therapy may actually be just as or even more effective, Tuckman says. And there are other depression remedies that don’t require turning to a prescription drug.

1. Spend some time in a therapist’s office. A recent literature review found that cognitive-behavioral therapy is extremely effective in treating depression, whether used by itself, or in conjunction with an antidepressant.

2. Get a move on. Another way to beat depression: Sweat a little. Researchers split 202 people with major depression into four groups: one exercised with a group under supervision, another exercised at home, a third took an antidepressant, and the last took a placebo pill. After four months, 45 percent of those who were exercising in a group under supervision and 40 percent of those exercising at home were no longer depressed — comparable to the 47 percent who beat depression with medication.

“The irony is that when you’re depressed you’re less likely to get up and go,” Tuckman says. But if you force yourself — even if you tell yourself you’ll walk for only five minutes and see how you feel — you’ll be much better off and may gain the momentum to go even longer.

3. Consider omega-3 supplements. Although Tuckman says the research isn’t definitive, some studies have found that taking omega-3 fatty acids can help with both ADHD and depression. In a review of studies, researchers found that when children with ADHD took supplements to raise their blood levels of essential fatty acids, which includes omega-3s, ADHD symptoms improved. However, randomized trials designed to measure a treatment effect have generally been unsuccessful.

4. Try an herbal treatment. In a review of studies, researchers found that St. John’s wort did a better job than a placebo at improving depression symptoms and was comparable to antidepressants. It also has fewer side effects than antidepressants. But like omega-3 supplements, research is inconclusive about whether St. John’s wort really helps depression, Tuckman says. If you try it, be sure to follow the correct dosing on the label.

5. Stay connected to friends. It may be easy to stay home and wallow in a blue mood, but forcing yourself to go out and spend time with family and friends can boost your mood and help you feel less depressed.

6. Spend time in a support group for depression. Support groups remind you that you’re not the only one feeling this way, which can make you feel better, Tuckman says.

7. Treat yourself well. Eating healthy, getting enough sleep, and staying active aren’t necessarily treatments for depression, but because they are important for physical well being, they are naturally important for emotional and psychological well being. Tuckman says they can help with a variety of problems, including depression, ADHD, anxiety, and others.

Most of the studies on natural remedies for depression involved people with major depression, but not ADHD. If you are considering taking a supplement, it is important to discuss it with your doctor, as supplements can interfere with medications you are already taking. It is never a good idea to stop taking medications without first consulting your doctor. 

(www.everydayhealth.com)

Beat ADHD Anxiety and Stress

Stress levels can peak with ADHD, so it's vital to learn how to cope with anxiety. Try these steps to stay stress-free.

By Marie Suszynski

Medically reviewed by Pat F. Bass III, MD, MPH

If Simma Lieberman isn't careful to lower her stress and anxiety levels, her mind will race so much that she can’t get much done. “It’s like I’m on a highway and I don’t take an exit, ever,” says Lieberman, an organizational development consultant in Albany, Calif., who has adult attention deficit hyperactivity disorder, or ADHD.

Dealing with anxiety and stress is vital for managing ADHD symptoms, partly because people with ADHD have more stress in their lives than the average person, says Ari Tuckman, PsyD, a clinical psychologist in West Chester, Penn., and author of More Attention, Less Deficit.

Still, Lieberman has learned stress-busting strategies to keep her ADHD symptoms under control and has become a successful consultant.

The Connection Between ADHD and Anxiety

People with ADHD genuinely have more things to be stressed over than people without the disorder, Tuckman says.

By definition, people with ADHD have trouble paying attention, controlling impulses, and dealing with hyperactivity. As a result, they’re less efficient at getting work done and they tend to make more mistakes than people without ADHD, he says. Adults with ADHD are more likely to lose their jobs and tend to make less money than the general population, he says.

In the meantime, the medications used to treat ADHD, like methylphenidate (Ritalin) and dextroamphetamine-amphetamine (Adderall), are stimulants and can cause people to feel more jittery and anxious.

However, Tuckman says those side effects typically fade after taking the medication for about a week. Ultimately, the medications should make you feel more in control and calm because they should help you feel on top of things and manage ADHD symptoms.

The first step for treating anxiety, of course, is to take your prescribed medication. Here’s what else you can do:

1. Get educated about ADHD. Tuckman tells his patients to learn everything they can about ADHD. It helps to see yourself in a different light, and to understand that “it’s not that I’m lazy or passive-aggressive,” he says. “I have this brain-based information processing disorder.” That alone can help you feel less anxious about your symptoms.

2. Take practical advice from a coach. Working with an ADHD coach or therapist on gaining the practical skills you need to be more successful with things like time management will help you get better control of your life and your symptoms, which will help you feel less stressed.

3. Consider neurofeedback. Lieberman has started doing neurofeedback to work on calming her brain. A practitioner measures her brain waves while she watches a movie. During the session, she works on staying focused and relaxed.

However, Tuckman says neurofeedback is still in the “maybe” category of treatments that work. One problem is the lack of good quality studies on it. But practitioners may also be using different neurofeedback techniques, some more effective than others.

His advice: Go to a licensed psychologist for the treatment and be realistic about the results. “Some people out there make outlandish promises” about what neurofeedback can do, he says.

4. Center yourself. This is a term Lieberman uses to slow her mind when she feels it’s running too fast. She stops and asks herself, “What are you doing right now?” Then she visualizes herself doing what needs to be done in a calm way.

5. Try meditation. When Lieberman meditates first thing in the morning, she’s able to start the day in a very calm, focused place. Meditation makes you feel less anxious, so that alone will help you feel better, Tuckman says. Because people with ADHD tend to have trouble sitting still, it’s perfectly fine to meditate while you’re pacing around the room, he says.

6. Breathe. Lieberman uses breathing exercises almost every day during meditation and at night before going to sleep. “It really makes me calm and I can close my eyes and fall asleep quickly,” she says. “I separate from stress.”

7. Simplify your life. It’s advice everyone can benefit from, especially people with ADHD anxiety. “Have less stuff and fewer commitments so that what you have is easier to manage,” Tuckman says.

8. Set yourself up for success. Being organized is a big part of managing ADHD and anxiety, so Lieberman does everything she can to help her day go smoothly. She uses an appointment book, but also puts Post-It notes on her computer to remind herself to make phone calls and do other tasks.

Lieberman is also working on a book proposal, but sitting at a computer long enough to write can be difficult. So she works once a month with three people who also are writing book proposals. “We keep each other focused,” she says.

But perhaps the most important thing: Accept that when you have ADHD you have to deal with anxiety and stress. Once you’ve done that, Lieberman says, keep trying new strategies to manage them, until anxiety attacks are a thing of the past.

(http://www.everydayhealth.com)

Coping With a Very Aggressive Child

Controlling your child's aggressive behavior can be daunting, especially when it poses a risk to others. Here are some ways to handle it smoothly.

By Lawrence Kutner, PhD

It's difficult for adults not to attribute malicious motives to children who consistently appear to be trying to drive their parents and teachers to distraction. Often it's equally difficult for parents not to assume that children are behaving this way because of something the parents have done wrong or have forgotten to do right. Such casting of blame, however, is not only inaccurate but usually useless as well.

The first step in helping an overly aggressive child is to look for patterns in what triggers the assaults, especially if the child is a toddler or preschooler. The aggression may happen only at home or only in public places. It may occur mostly in the afternoon or when the child is frustrated. Also, most of these children go through a predictable sequence of behaviors before they lose control. It's a bit like watching a car going through a normal acceleration and then suddenly kicking into overdrive.

Once you can determine the most common triggers and can spot the escalating behavior, the simplest thing is to remove the child from that environment before he loses control. Take him away from the sandbox or the playgroup for a minute or two until he regains his composure. As the child develops, he will become less frustrated and, therefore, less aggressive because he has a wider variety of ways to respond to a challenging situation.

It's also very useful to provide these aggressive and distractible children with a lot of structure and routine in their daily lives since predictability helps children remain calm and in control. Tempting as it may be at the time, spanking these children for being aggressive often does more harm than good. It is simply modeling the very thing you don't want children to do. It teaches them that big people hit when they're angry or upset, and that is precisely the aggressive child's problem.

For older children and adolescents, teaching new and more appropriate ways of getting what they want can be very helpful. These children often have not learned the skills that their classmates picked up years earlier. As with bullies, formal assertiveness training can be particularly helpful to overly aggressive children since they have difficulty distinguishing between assertiveness and aggression.

It's also useful to help these children look at life from a slightly different perspective. Psychologists have found that both aggressive children and their parents tend to focus on what's wrong with a situation rather than what's right with it. That makes their respective problems all the more frustrating for each of them, since neither pays any attention to the children's improvement when it occurs.

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An Overview of Inattentive ADD

Inattentive ADHD is one of the three subtypes of Attention Deficit Hyperactivity Disorder (ADHD). Inattentive ADHD is sometimes referred to as ADD which is short for Attention Deficit Disorder. This subtype of ADHD is also called ADHD predominantly inattentive (ADHD-I, ADHD-PI). I will use all these terms interchangeably.

Symptoms:

ADD differs from the other two subtypes in several ways. The characteristic symptoms of the inattentive subtype are inattention, easy distractibility, disorganization, procrastination and forgetfulness.

About a third of people with the Inattentive subtype also have coexisting lethargy and fatigue and people with this variant of ADD are said to have Sluggish Cognitive Tempo or SCT.

People with ADD and Sluggish Cognitive Tempo have fewer or no symptoms of hyperactivity or impulsiveness and they are less likely to have a co-existing diagnosis of Oppositional Defiance Disorder or Conduct disorder. Hyperactivity and Impulsiveness are symptoms that are the hallmark of the other two subtypes of ADHD, the Combined type of ADHD referred to as ADHD-C and the Hyperactive/Impulsive subtype of ADHD which is referred to as ADHD-HI.

People with this condition have been shown in studies to perform more poorly in school than people with the other subtypes of ADHD but they are less likely to suffer the adverse life outcomes, such as substance abuse disorder or law enforcement problems, seen more commonly in people with the other two subtypes of ADHD.

Causes:

The cause of ADHD-PI is unknown but genetic influences are thought to play a major role. It is estimated that up to 70% of people with ADD have a relative with Inattentive ADD. Other factors that may play a causative roll in ADD and SCT include:

Dietary allergies-It is possible that certain people may have increased ADHD-PI symptoms after consuming certain foods or food dyes.

Environmental Factors and Toxins - pesticides and lead have both been implicated in causing increased symptoms.

Prematurity and Traumatic head injuries- may be related to an increased risk of symptoms.

Social Influences- maternal separation and other social factors are being studied to determine their role in causing this condition.

Testing:

ADHD questionnaires are standardly administered to diagnose this condition. These questionnaires consist of a series of symptoms questions where parents and teachers rate the severity of symptom sand the perceived degree of disability caused by each symptom.

Other diagnostic methods include computerized programs that measure attention, hyperactivity and impulsive behavior. The computerized test can give a more objective view of symptoms which is important because parent and teacher questionnaires responses can vary greatly and often do not agree on the severity of disabling characteristic of the ADHD symptom.

Treatment:

The appropriate dose of medication, which may be lower in the case of treating ADD than it is for the other subgroups of ADHD.

The following is a list of medications used to treat Inattention:

Dextroamphetamine (Adderall, Dexedrine,Vyvanse) - most commonly used stimulant treatment (along with methylphenidate) for all subtypes of this condition.

Methylphenidate (Ritalin, Concerta, Focalin, Daytrana,Metadate) - some people may have a genetic basis for NOT responding to methylphenidate.

Atomexitine (Strattera) - non-stimulant therapy.

Alpha-2A-Adrenoceptor Agonist (Intuniv, Clonidine) - especially useful for combined ADHD and Tourette's syndrome

Selective Serotonin Re-uptake Inhibitors (Paxil, Zoloft, Prozac) - useful for the treatment of associated depression or as a second line treatment for ADHD-PI when stimulants fail.

Try-cyclic Antidepressants (Norparmine,Tofranil) - also used for treating co-existing depression but the try-cyclics can have unpleasant side effects and must be used with extreme caution in children.

Bupropion (Wellbutrin) - Wellbutrin is a norepinephrine and dopamine reuptake inhibitor and is another second line treatment for the inattentive subtype.

Behavioral therapy is useful sometimes alone and sometimes combined with medication to better treat issues related to motivation, persistence, academic issues and social skill problems. Behavioral therapy may be more useful for ADHD-PI than it is for the other subtypes.

Lifestyle skills treatment generally addresses lifestyle issues such as diet, exercise and stress reduction.

Classroom treatment methods include: Classroom management, parent support training and classroom accommodation.

Additional useful treatment methods include:

Vitamin supplementation - to address potential deficiencies in Omega-3 fatty acids, iron or zinc.

Behavioral therapy and Coaching.

Psychotherapy - to treat the problems that can co-exist with Inattentive ADHD such as anxiety, depression and social phobias.

Cognitive-behavioral therapy (CBT) - to address common areas of cognitive weaknesses.

Social skills training methods - to address the problems that result socially from the inattentive symptoms of ADHD-PI.

The symptoms and treatment for Inattentive ADHD are different from the symptoms and treatment of the other subtypes of ADHD. People with Inattentive ADHD and parents of children with ADHD must assure that an appropriate diagnosis of ADHD is made in order that this subtype of ADHD be appropriately managed.

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Mood Swings May Signal Overlap Between Bipolar Disorder and ADHD

The mood swings characteristic of bipolar disorder may be connected to attention deficit hyperactivity disorder (ADHD), according to one study. In 2005, Norwegian researchers began a long-term project to discover medical and biological factors that could influence development of ADHD and how it presents itself in the population.

The researchers studied biological and clinical samples from the records of of ADHD patients and their families in an attempt to bridge a connection between ADHD symptoms and other mental conditions such as bipolar disorder. According to project manager Jan Haavik, the researchers discovered that patients with ADHD often exhibit rapid, dramatic mood swings similar to those of bipolar disorder. As a result, they’re speculating that mood swings may need be an official part of the ADHD diagnosis.

Between 2 and 5 percent of the world's population is affected by ADHD. Despite the fact that ADHD has been recognized as a condition for more than a century, researchers still know little about what causes it or how to prevent it.

The Norwegian researchers plan to expand the study internationally in upcoming years. ScienceDaily

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