ADD/ADHD — Cause and Effects

The Babble Staff

Mainstream science classifies ADD/ADHD as a neurobiological disorder, most likely genetic, best treated by medication in combination with behavioral therapy. But ADD/ADHD rates are far higher in America than elsewhere, causing speculation that there may be environmental factors. Some say ADD is over-diagnosed, the label slapped on children with a wide variety of behavioral problems. Leading British child psychiatrist Michael Rutter has even raised doubts as to whether or not ADD exists. Some doctors feel the benefits of medications like Ritalin far outweigh the negatives. Others warn that we still know little of the long-term effects of such medicines on growing brains. They advocate medication only as a last resort.

Too often, difficult children are incorrectly labeled with ADHD. On the other hand, many children who do have ADHD remain undiagnosed. In either case, related learning disabilities or mood problems are often missed. The American Academy of Pediatrics (AAP) has issued guidelines to bring more clarity to this issue.

ADHD is a frustrating problem. A number of alternative remedies have become quite popular, including herbs and supplements, chiropractic manipulation, and dietary changes. While there is evidence suggesting the value of a healthy, varied diet, with plenty of fiber and other basic nutrients (the diet that would be best for most children), there is little or no solid evidence for many remedies that are marketed to parents. Adequate sleep has been proven to help ADHD symptoms.

Children who receive both behavioral treatment and medication often do the best. Medications should not be used just to make life easier for the parents or the school. There are now several different classes of ADHD medications that may be used alone or in combination.

A: Let's begin with the "A." A.D.H.D. is not always a problem with attention . Often, these kids have a selective attention problem. They are able to go into a state of hyperfocus (pay deep attention) to things that interest them; but assign a task that seems trivial or lacks personal relevance (like most homework) and they will often tune out. When recognized and channeled properly, the ability to hyperfocus can work to the child's advantage, both now and later on in life.

Rather than a deficit , what your child is experiencing may simply be the child's individual style of learning. Keep in mind that "learning disability" is a relative term. In some cases, the problem ultimately lies with the school system rather than the child.

A.D.D. is not a disorder in the usual sense. "Disorder" implies illness or pathology. A.D.D. is not a disorder (like a thyroid disorder, for example). It is merely a difference, in the same way as being left-handed is a difference.

A.D.D. NOTE
To parents and professionals: Consider medication in addition to, but not instead of, other treatments, such as behavior and learning strategies.

Stimulants are generally regarded as safe drugs. They were first used for hyperactive children in the 1930s, so they have been in use now for more than sixty years. Yet, like all medication, they are not a problem-free pill. I first began prescribing Ritalin for A.D.D. in 1972. Thirty years and hundreds of prescriptions later, I am impressed by how few undesirable side effects occur. When side effects do occur, they are minor and wear off quickly when the drug is stopped.

It would be great if these medications worked selectively, that is, only on the brain functions concerned with attention or focusing ability (A.D.D.) or the areas that control movement and impulsiveness (A.D.H.D.), but they don't. Ritalin and other stimulants have a wider action in the brain, which is clear from the four side effects that have been identified by placebo-controlled research: decreased appetite, insomnia, headaches, and stomachaches.

Stimulant drugs change the neurochemistry of the brain, but the long-term effects are unknown. When the action of neurotransmitters is artificially stimulated for a long time, might the brain eventually slow down its own production of these chemicals? By giving a child stimulant medication, you are "fooling" the brain into thinking it makes more neurotransmitters than it really does. Might this interfere with the neurological system's ability to regulate itself?

Rarely, stimulant medications can unmask an underlying, severe tic disorder, called Tourette Syndrome. This is not really considered a side effect of the medication, since the disorder is genetic, although brought out by the medication.

Pills tell children that something is wrong with them and they need to take a pill to fix it. Children may feel that they do better because of the pill, not because of themselves. Their success is attributed to the pill rather than to their own efforts.

It is difficult to diagnose ADHD in children 5 years of age and younger. This is because many preschool children have some ADHD symptoms in various situations. In addition, children change very rapidly during the preschool years. It is also difficult to diagnose ADHD once a child becomes a teenager.

Most experts recommend using both medication and behavior therapy to treat ADHD. There are many forms of behavior therapy, but all have a common goal — to change the child's physical and social environments to help the child improve his behavior.

Behavior therapy recognizes the limits that having ADHD puts on a child. It focuses on how the important people and places in the child's life can adapt to encourage good behavior and discourage unwanted behavior. It is different from play therapy or other therapies that focus mainly on the child and his emotions.

For most children, stimulant medications are a safe and effective way to relieve Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms. As glasses help people focus their eyes to see, these medications help children with ADHD focus their thoughts better and ignore distractions. This makes them more able to pay attention and control their behavior. Stimulants may be used alone or combined with behavior therapy. Studies show that about 80 percent of children with ADHD who are treated with stimulants improve a great deal.

You may have heard media reports or seen advertisements for "miracle cures" for ADHD. Carefully research any such claims. Consider whether the source of the information is valid. At this time, there is no scientifically proven cure for this condition.

Always tell your pediatrician about any alternative therapies, supplements or medications that your child is using. These may interact with prescribed medications and harm your child.

I believe ADD is both over-diagnosed and over-treated. Many children who don't have ADD are impulsive and have a low tolerance for frustration. The pattern can take root at an early age, when a toddler fails to acquire proper frustration-management skills and a sense of boundaries. Parents play a major role in the early acquisition of these skills, and inconsistent responses to a toddler's frustration can foster this behavior. These kids become so preoccupied with control issues that they lose their ability to focus on other matters, such as a school curriculum, an art project, or a play activity. This can lead to low self-esteem and unhappiness, which in turn reinforce the impulsiveness. Too frequently, these kids end up misdiagnosed and treated for ADD. This quick fix suggests that the problem stems from some faulty wiring in Jimmy's brain rather than from fundamental issues of parenting and discipline.

The treatment of true ADD relies primarily on brain stimulants (the most popular being Ritalin), which do not "cure" the condition; they simply help kids focus and calm down. We don't know exactly why these medications work and to what extent. It's hard to study them, because the initial diagnosis of ADD is so subjective and the tangible improvements hard to measure. Other classes of drugs are being investigated, such as antidepressants, but it's too early to judge their efficacy.

Psychotherapy is unfortunately not that effective either. Again, the only alternative that I would recommend — whether or not "real" ADD is the culprit — is establishing consistent boundaries.

Although health professionals often state that ADD/ADHD is a brain-based biological disorder caused by a brain chemical imbalance, there is simply no reliable test to prove this — no physical or chemical abnormality validates ADHD as a medical disease.  As there can be no diagnosis without a disease, what is there?

Although no chemical imbalance has ever been proven, health professionals prescribe psychostimulant medication (such as Ritalin, Strattera, Adderall) as the primary treatment in correcting the 'chemical imbalance'. 

Parents should know that the psychostimulants normally prescribed for ADD/ADHD help all people — with or without an ADD/ADHD diagnosis — to focus attention more easily, depending on the dose.

However, these drugs are not without serious risk. Between the years of 1990-2000, over 569 children were hospitalized, 38 of them were life-threatening hospitalizations, and 186 died from Ritalin.

It is well known that psychostimulants have abuse potential. Very high doses of psychostimulants, particularly of amphetamines, may cause central nervous system damage, cardiovascular damage, and hypertension.  In addition, high doses have been associated with compulsive behaviors and, in certain vulnerable individuals, movement disorders.  There is a rare percentage of children and adults treated at high doses who have hallucinogenic responses. 

Many parents do not realize that if their child takes Ritalin or other psychostimulant medication past the age of 12, according to the 1999 Military Recruitment Manual, that child may not join the Army, Air Force, Navy, Marines, Coast Guard, or National Guard until after a doctor has signed a paper stating that the person has been off the medication for four years.

Also, if a child uses Ritalin or other psychostimulant medication, the state or federal government cannot hire him or her if the job involves state secrets or national security, because that child is a Class 2 drug user.

Students who take ADD/ADHD medication are often asked to sell or trade their drugs, and many know students who have given away or sold their medication.