ADHD final form

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Public health PM501 Attention-Deficit-Hyperactivity Disorder

What is ADHD?

Attention Deficit/Hyperactivity Disorder (ADHD) is a condition which includes

difficulties with attention, increased activity, and difficulties with impulsivity. Estimatesshow that between 3 and 7 percent of school-aged children and about 4 percent of adults

have ADHD. It is usually first identified when children are school-aged, although it also

can be diagnosed in people of all age groups. In an average classroom of 30 children,

research suggests that at least one will have ADHD.

AD/HD is a neurobiological disorder resulting from problems in the dopamine

neurotransmitter systems in the brain. Most cases are genetically inherited. If a parent or

close relative has AD/HD there is a 30% chance that a child will have AD/HD. Twin

studies show that if an identical twin has AD/HD, there is a 50% chance the other twin

will have it also

No single biological cause for ADHD has been found. But most research points to genes

inherited from parents as the leading contributor to ADHD. ADHD often runs in

families. . AD/HD is not caused by poor nutrition, ineffective parenting, drugs, or

allergies. Other medical conditions may cause AD/HD-like symptoms (such as severe

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head trauma, thyroid problems, fetal alcohol syndrome and lead intoxication), however,

and for this reason a professional evaluation should be obtained to rule out other medical

conditions

People who can focus only on things that interest them, and disregard less interesting

things, are often faced with additional problems such as an academic underachievement,

lack of social skills, disorganization, or difficulty completing important tasks. These

often result in difficulty with personal relationships, staying employed, or completing an

education. People may also stimulate themselves by doing reckless or dangerous

activities and thus complicate their lives with physical and legal problems

The good news is that there are safe and effective treatments for children and adolescents

with ADHD. Treatment is most effective when it begins early and when intervention is

individualized to the needs of the child

History

In this day and age, you would think that ADHD has been around forever. The disorder

itself has been around for quite some time, but it was only recently that it was given the

name Attention Deficit Disorder. Before that, the disorder had various names that

changed over the years.

In 1902, there is the first documented disorder relating to impulsiveness. This was in

Britain, and the doctor who diagnosed the impulsive disorder was named Dr. Still. He

called this disorder "Defect of Moral Control" and he believed that the diagnosed

individual had a medical disorder beyond their control.

After this event, the next documentation of similar symptoms was in 1922. Here, the

symptoms we associate with ADHD were given the name "Post-Encephalitic Behavior

Disorder." What this title means I am not quite sure, but that was the name during this

time period.The next event in the history of ADHD was in 1937, where Dr. Charles

Bradley introduced the use of stimulants in children who were hyperactive. I still find it

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interesting that stimulants were thought of to treat hyperactive children when they were

already bouncing off the walls. While it is true that stimulants calm hyperactive kids

down, how did someone hypothesize that this would occur? After this, in 1956, Ritalin

was introduced as the drug of choice to treat hyperactivity.

In the 1960s, stimulants were used by a wider population. The only symptom that was

really documented at this point was hyperactivity. In the early 1960s, the disorder was

called "Minimal Brain Dysfunction". At the end of the decade, though, the name of the

disorder was changed to "Hyperkinetic Disorder of Childhood."The next event that

occurred in relation of ADHD was that new symptoms were added to the realm of the

disorder. Along with hyperactivity, added symptoms were lack of focus and spaceyness

associated with impulsiveness. Impulsiveness now included verbal, cognitive and motorimpulsiveness.

In 1980, the disorder was given its current name of Attention Deficit Disorder, with or

without hyperactivity. This was documented in the DSM-III put out by the American

Psychiatric Association. ADD and ADHD were two different diagnoses.

Next, in 1987, ADD was changed to Attention Deficit Hyperactivity Disorder. The

American Psychiatric Associated noted that this was a medical diagnosis, and not purelypsychological. They also noted that ADHD could cause behavioral issues.In 1996, a new

medication called Adderall was approved by the FDA for the treatment of ADHD. After

a period of time, it was deemed to be better at treating the disorder since it lasted longer

and was easier to come down off of. In 1999, other medications were added to treat

ADHD such as Concerta and Focalin. In 2003, Strattera was introduced as the first

ADHD medication that was not a stimulant. This drug acted like an antidepressant, but

increased the amount of norepinephrine in the brain.

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Causes of ADHD:

There is no single cause for ADHD. Scientists agree that ADHD is a medical disorder

affecting the several areas of the brain with the frontal area likely having the greatestinvolvement. Those areas involved are responsible for certain executive functions that

control the regulation of behavior, working memory, thinking, planning and organizing.

Heredity is the most common cause of ADHD. This has been confirmed in studies

looking at the rates of occurrence of ADHD within families, studies of adopted ADHD

children and twin studies. Molecular genetic research has focused on the specific genes

that may be responsible for characteristics of ADHD. Other risk factors for ADHD have

to do with factors that can influence brain development and functioning such as exposure

to toxic substances in the developing fetus and acquired brain injury due to trauma or

disease. Factors such as diet, vestibular dysfunction, television viewing and parenting

have not been proven to be causes of

*Brain Functioning in ADHD:

ADHD is not the result of laziness, poor motivation, low intelligence, disobedience, poor

upbringing or selfishnessto name a few. Although having ADHD doesnt exclude you

from having some of these difficulties, these problems do not cause chronic inattention,

hyperactivity and impulsivenessthe core symptoms of ADHD. ADHD is a medical

disorder, and it can be caused by a number of factors that affect how the brain develops

and functions.

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Current research indicates the frontal lobe, basal ganglia, caudate nucleus, cerebellum, as

well as other areas of the brain, play a significant role in ADHD because they are

involved in complex processes that regulate behavior (Teeter, 1998). These higher order

processes are referred to as executive functions. Executive functions include such

processes as inhibition, working memory, planning, self-monitoring, verbal regulation,

motor control, maintaining and changing mental set and emotional regulation. According

to a current model of ADHD developed by Dr. Russell Barkley, problems in response

inhibition is the core deficit in ADHD. This has a cascading effect on the other executive

functions listed above (Barkley, 1997).

What factors could account for neurological differences in brain development and

functioning that could contribute to ADHD? The main factors studied to date have been:fetal exposure to toxic substances (e.g., alcohol and tobacco) during pregnancy, exposure

to lead, trauma to the brain from head injury or illness and differences that could be

attributed to heredity. These causes are discussed below.

*Heredity as a Cause of ADHD

Heredity is the most common cause of ADHD. Most of the information about the

heritability of ADHD comes from family studies, adoption studies, twin studies and

molecular genetic research.

**Family Studies: If a trait has a genetic basis we would expect the rate of occurrence to

be higher with the biological family members (e.g., brown-eyed people tend to have

family members with brown eyes). Dr. Joseph Biederman (1990) and his colleagues at

the Massachusetts General Hospital have studied families of children with ADHD. They

have learned that ADHD runs in families. They found that over 25% of the first-degree

relatives of the families of ADHD children also had ADHD, whereas this rate was only

about 5% in each of the control groups. Therefore, if a child has ADHD there is a five-

fold increase in the risk to other family members.

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**Adoption Studies: If a trait is genetic, adopted children should resemble theirbiological relatives more closely than they do their adoptive relatives. Studies conducted

by psychiatrist Dr. Dennis Cantwell compared adoptive children with hyperactivity to

their adoptive and biological parents. Hyperactive children resembled their biological

parents more than they did their adoptive parents with respect to hyperactivity.

**Twin Studies:Another way to determine if there is a genetic basis for a disorderis by studying large groups of identical and non-identical twins. Identical twins have the

exact same genetic information while non-identical twins do not. Therefore, if a disorder

is transmitted genetically, both identical twins should be affected in the same way and the

concordance ratethe probability of them both being affectedshould be higher than

that found in non-identical twins. There have been several major twin studies in the past

few years that provide strong evidence that ADHD is highly heritable. They have had

remarkably consistent results in spite of the fact that they were done by different

researchers in different parts of the world. In one such study, Dr. Florence Levy and her

colleagues studied 1,938 families with twins and siblings in Australia. They found that

ADHD has an exceptionally high heritability as compared to other behavioral disorders.

They reported an 82 percent concordance rate for ADHD in identical twins as compared

to a 38 percent concordance rate for ADHD in non-identical twins.**Molecular Genetic Research: Twins studies support the hypothesis of theimportant contribution that genes play in causing ADHD, but these studies do not

identify specific genes linked to the disorder. Genetic research in ADHD has taken off in

the past five years. This research has focused on specific genes that may be involved in

the transmission of ADHD. Dopamine genes have been the starting point for

investigation. Two dopamine genes, DAT1 and DRD4 have been reported to be

associated with ADHD by a number of scientists. Genetic studies revealed promising

results, and we should look for more information about this soon.

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*Exposure to Toxic Substances as a Cause of ADHD:

Researchers have found an association between mothers who smoked tobacco products

or used alcohol during their pregnancy and the development of behavior and learning

problems in their children. A similar association between lead exposure and hyperactivity

has been found, especially when the lead exposure occurs in the first three years.

Nicotine, alcohol, and lead can be toxic to developing brain tissue and may have

sustained effects on the behavior of the children exposed to these substances at early

ages. However, it is unlikely that such exposure accounts for differences in brain

development in the vast majority of children and adolescents with ADHD.

*Injury to the Brain from Trauma, Brain Tumors, Strokes or Disease:

Injury to the brain can be the result of trauma (serious blow to the head), brain tumor,

stroke or disease. These factors can cause problems with inattention and poor regulation

of motor activity and impulses. While such circumstances can result in a diagnosis of

ADHD, the occurrence of such is atypical.

What Does Not Cause ADHD:

Diet: In the 1970s it became popular to view ADHD as resulting from allergies or

sensitivities to certain food substances. However, much of the research done over the past

two decades was unable to support the claim that diet played a significant role in causing

ADHD. Despite this, the popular media continues to discuss the role of food in ADHD,particularly that sugar may cause children to become hyperactive and impulsive. There is

no research to back up this claim. In fact, Dr. Mark Wolraich and his colleagues found no

significant effects of sugar on either behavior or learning in children.

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Hormones: No studies have found any significant connection between problems with

hormone functioning and hyperactivity or ADHD.

The vestibular system: . For a number of years some clinicians have proposed the

theory that ADHD and some learning and emotional problems could be the result of

problems within the vestibular system of the brain which affects balance. They contend

that treatment with anti-motion sickness medicine could correct these problems. This

theory is unsupported by scientific research and is inconsistent with what is known about

ADHD and the vestibular system.

Poor parenting or problems in family life: No studies support the idea that ADHD is

the result of poor parenting practices or other family environment variables. While

parents of children with ADHD are likely to give more negative commands to their

ADHD child and less positive attention, this may be due to the fact that ADHD children

are often non-compliant and, therefore, parents are more likely to be more negative in

their interaction with them. Furthermore, the interactions of parents of ADHD children

whose behavior was not oppositional were no different than they were from non-ADHD

children. It is important to note, however, that symptoms of ADHD and the degree to

which such symptoms can impact the childs functioning, can be reduced by parents who

provide appropriate accommodations and interventions.

Television: No studies have found any connection between television viewing and

ADHD. Nor have any studies indicated that children with ADHD watch more television

than do those without ADHD.

Classification:

ADHD has three subtypes:

Predominantly hyperactive-impulsive

o Most symptoms (six or more) are in the hyperactivity-impulsivity

categories.

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o Fewer than six symptoms of inattention are present, although inattention

may still be present to some degree.

Predominantly inattentive

o The majority of symptoms (six or more) are in the inattention category

and fewer than six symptoms of hyperactivity-impulsivity are present,

although hyperactivity-impulsivity may still be present to some degree.

o Children with this subtype are less likely to act out or have difficulties

getting along with other children. They may sit quietly, but they are not

paying attention to what they are doing. Therefore, the child may be

overlooked, and parents and teachers may not notice symptoms of ADHD.

Combined hyperactive-impulsive and inattentive

o Six or more symptoms of inattention and six or more symptoms of

hyperactivity-impulsivity are present.

o Most children with ADHD have the combined type.

Epidemiology:

Percent of United States youth 4-17 years of age ever diagnosed with ADHD as of 2003.

A review of 102 studies estimated ADHD's worldwide prevalence in people under the

age of 19 to be 5.29%. There was wide variability in prevalence estimates, mostly due to

the methodological characteristics of studies (for example, diagnostic criteria used) and,

to a lesser extent, geographic location (North America having a significantly higher rate

of ADHD than Africa and the Middle East). 10% of males and (only) 4% of females have

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been diagnosed in the U.S. This apparent sex difference may reflect either a difference in

susceptibility or that female with ADHD is less likely to be diagnosed than males.

ADHD's global prevalence is estimated at 3-5% in people under the age of 19. There is,

however, both geographical and local variability among studies. Geographically, children

in North America appear to have a higher rate of ADHD than children in Africa and the

Middle East, well published studies have found rates of ADHD as low as 2% and as high

as 14% among school aged children. The rates of diagnosis and treatment of ADHD are

also much higher on the East Coast of the USA than on the West Coast. The frequency of

the diagnosis differs between male children (10%) and female children (4%) in the

United States. this difference between genders may reflect either a difference in

susceptibility or that females with ADHD are less likely to be diagnosed than males.

Rates of ADHD diagnosis and treatment have increased in both the UK and the USA

since the 1970s. In the UK an estimated 0.5 per 1,000 children had ADHD in the 1970s,

while 3 per 1,000 received ADHD medications in the late 1990s. In the USA in the 1970s

12 per 1,000 children had the diagnosis, while in the late 1990s 34 per 1,000 had the

diagnosis and the numbers continue to increase.

Adults are likely not to be diagnosed or treated for ADHD. This may result in asubstantial underestimation of prevalence in most populations. Awareness about

Hyperactivity and ADHD or its signs and symptoms has been rudimentary until early

1990 across Europe.

In the UK in 2003 a prevalence of 3.6% is reported in male children and less than 1% is

reported in female children.

Pathophysiology

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Diagram of the human brain

Thepathophysiology of ADHD is unclear and there are a number of competing

theories. Research on children with ADHD has shown a general reduction of brain

volume, but with a proportionally greater reduction in the volume of the left-sided

prefrontal cortex. These findings suggest that the core ADHD features of inattention,

hyperactivity, and impulsivity may reflect frontal lobe dysfunction, but other brain

regions particularly the cerebellum have also been implicated. Neuroimaging studies in

ADHD have not always given consistent results and as of 2008 are only used for research

not diagnostic purposes. A 2005 review of published studies involving neuroimaging,

neuropsychological genetics, and neurochemistry found converging lines of evidence to

suggest that four connected frontostriatal regions play a role in the pathophysiology of

ADHD: The lateral prefrontal cortex, dorsal anterior cingulate cortex, caudate, and

putamen.

In one study a delay in development of certain brain structures by an average of

three years occurred in ADHD elementary school aged patients. The delay was most

prominent in the frontal cortex and temporal lobe, which are believed to be responsible

for the ability to control and focus thinking. In contrast, the motor cortex in the ADHD

patients was seen to mature faster than normal, suggesting that both slower development

of behavioral control and advanced motor development might be required for the

fidgetiness that characterizes ADHD. It should be noted that stimulant medication itself

may affect growth factors of the central nervous system.

The same laboratory had previously found involvement of the "7-repeat" variant

of the dopamine D4 receptorgene, which accounts for about 30 percent of the genetic

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risk for ADHD, in unusual thinness of the cortex of the right side of the brain; however,

in contrast to other variants of the gene found in ADHD patients, the region normalized

in thickness during the teen years in these children, coinciding with clinical

improvement.

Additionally, SPECT scans found people with ADHD to have reduced blood

circulation (indicating low neural activity), and a significantly higher concentration of

dopamine transporters in the striatum which is in charge of planning ahead. A study by

the U.S. Department of Energys Brookhaven National Laboratory in collaboration with

Mount Sinai School of Medicine in New York suggest that it is not the dopamine

transporter levels that indicate ADHD, but the brain's ability to produce neurotransmitters

like dopamine itself. The study was done by injecting 20 ADHD subjects and 25 control

subjects with a radiotracer that attaches itself to dopamine transporters. The study found

that it was not the transporter levels that

indicated ADHD, but the dopamine itself. ADHD subjects showed lower levels of

dopamine (hypodopaminergia) across the board. They speculated that since ADHD

subjects had lower levels of dopamine to begin with, the number of transporters in the

brain was not the telling factor. In support of this notion, plasma homovanillic acid, anindex of dopamine levels, was found to be inversely related not only to childhood ADHD

symptoms in adult psychiatric patients, but to "childhood learning problems" in healthy

subjects as well. One interpretation of dopamine pathway tracers is that the biochemical

"reward" mechanism works for those with ADHD only when the task performed is

inherently motivating; low levels of dopamine raise the threshold at which someone can

maintain focus on a task which is otherwise boring. Neuroimaging studies also found that

neurotransmitters level (e.g. dopamine and serotonin) in the synaptic cleft goes down

during depression.

A 1990 PET scan study by Alan J. Zametkin et al. found that global cerebral

glucose metabolism was 8% lower in medication-naive adults who had been hyperactive

since childhood. Further studies found that chronic stimulant treatment had little effect on

global glucose metabolism, a 1993 study in girls failed to find a decreased global glucose

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metabolism, but found significant differences in glucose metabolism in 6 specific regions

of the brains of ADHD girls as compared to control subjects. The study also found that

differences in one specific region of the frontal lobe were statistically correlated with

symptom severity. A further study in 1997 also failed to find global

differences in glucose metabolism, but similarly found differences in glucose

normalization in specific regions of the brain. The 1997 study also noted that their

findings were somewhat different than those in the 1993 study, and concluded that sexual

maturation may have played a role in this discrepancy. The significance of the research

by Zametkin has not been determined and neither his group nor any other has been able

to replicate the 1990 results.

Critics, such as Jonathan Leo and David Cohen, who reject the characterization of

ADHD as a disorder, contend that the controls for stimulant medication usage were

inadequate in some lobar volumetric studies which makes it impossible to determine

whether ADHD itself orpsychotropic medication used to treat ADHD is responsible for

the decreased thickness observed in certain brain regions. While the main study in

question used age-matched controls, it did not provide information on height and weight

of the subjects. These variables it has been argued could account for the regional brain

size differences rather than ADHD itself. They believe many neuroimaging studies areoversimplified in both popular and scientific discourse and given undue weight despite

deficiencies in experimental methodology.

Symptoms:

Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. The

symptoms of ADHD are especially difficult to define because it is hard to draw the line

at where normal levels of inattention, hyperactivity, and impulsivity end and clinically

significant levels requiring intervention begin. To be diagnosed with ADHD, symptomsmust be observed in two different settings for six months or more and to a degree that is

greater than other children of the same age.

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Predominantly inattentive type symptoms may include:

Be easily distracted, miss details, forget things, and frequently switch from one

activity to another

Have difficulty focusing on one thing

Become bored with a task after only a few minutes, unless doing something

enjoyable

Have difficulty focusing attention on organizing and completing a task or learning

something new

Have trouble completing or turning in homework assignments, often losing things

(e.g., pencils, toys, assignments) needed to complete tasks or activities

Not seem to listen when spoken to

Daydream, become easily confused, and move slowly

Have difficulty processing information as quickly and accurately as others

Struggle to follow instructions.

Predominantly hyperactive-impulsive type symptoms may include:

Fidget and squirm in their seats

Talk nonstop

Dash around, touching or playing with anything and everything in sight

Have trouble sitting still during dinner, school, and story time

Be constantly in motion

Have difficulty doing quiet tasks or activities.

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and also these manifestations primarily of impulsivity:

Be very impatient

Blurt out inappropriate comments, show their emotions without restraint, and act

without regard for consequences

Have difficulty waiting for things they want or waiting their turns in games

Most people exhibit some of these behaviors, but not to the degree where such behaviors

significantly interfere with a person's work, relationships, or studies. The core

impairments are consistent even in different cultural contexts.

Symptoms may persist into adulthood for up to half of children diagnosed with ADHD.

Estimating this is difficult as there are no official diagnostic criteria for ADHD inadults. ADHD in adults remains a clinical diagnosis. The signs and symptoms may differ

from those during childhood and adolescence due to the adaptive processes and

avoidance mechanisms learned during the process of socialisation.

A 2009 study found that children with ADHD move around a lot because it helps them

stay alert enough to complete challenging tasks.

Comorbidities

ADHD may accompany other disorders such as anxiety or depression. Such

combinations can greatly complicate diagnosis and treatment. Academic studies and

research in private practice suggest that depression in ADHD appears to be increasingly

prevalent in children as they get older, with a higher rate of increase in girls than in boys,

and to vary in prevalence with the subtype of ADHD. Where a mood disorder

complicates ADHD it would be prudent to treat the mood disorder first, but parents of

children who have ADHD often wish to have the ADHD treated first, because the

response to treatment is quicker.

Inattention and "hyperactive" behavior are not the only problems in children with

ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Many co-

existing conditions require other courses of treatment and should be diagnosed separately

instead of being grouped in the ADHD diagnosis. Some of the associated conditions are:

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Oppositional defiant disorder(35%) and conduct disorder(26%) which both are

characterized by antisocial behaviors such as stubbornness, aggression, frequent

temper tantrums, deceitfulness, lying, or stealing, inevitably linking these comorbid

disorders with antisocial personality disorder(ASPD); about half of those with

hyperactivity and ODD or CD develop ASPD in adulthood.

Borderline personality disorder, which was according to a study on 120 female

psychiatric patients diagnosed and treated for BPD associated with ADHD in 70% of

those cases.

Primary disorder ofvigilance, which is characterized by poor attention and

concentration, as well as difficulties staying awake. These children tend to fidget,

yawn and stretch and appear to be hyperactive in order to remain alert and active.

Mood disorders. Boys diagnosed with the combined subtype have been shown

likely to suffer from a mood disorder.

Bipolar disorder. As many as 25% of children with ADHD have bipolar disorder.

Children with this combination may demonstrate more aggression and behavioral

problems than those with ADHD alone.

Anxiety disorder, which has been found to be common in girls diagnosed with the

inattentive subtype of ADHD.

Obsessive-compulsive disorder. OCD is believed to share a genetic component

with ADHD and shares many of its characteristics.

ADD / ADHD Test & Diagnosis

Tests: Rating Scales and Checklists

Scales and checklists help clinicians obtain information from parents, teachers, and

others about symptoms and functioning in various settings, which is necessary for an

appropriate assessment for ADHD and treatment monitoring. Symptoms must be present

in more than one setting (for example, both at home and in school) to meet DSM-IV

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criteria for the condition. Such instruments are only one component of a comprehensive

evaluation, which includes a medical examination and interviews

According to the American Academy of Child and Adolescent Psychiatry the most

commonly used scales are:

Parent-completed Child Behavior Checklist

Teacher Report Form (TRF) of the Child Behavior Checklist

Conners Parent and Teacher Rating Scales (see below)

ADD-H: Comprehensive Teacher Rating Scale (ACTeRS)

Barkley Home Situations Questionnaire (HSQ) (see below)

Barkley School Situations Questionnaire (SSQ) (see below)

According to the Agency for Healthcare Research and Quality (AHRQ), formerly the

Agency for Health Care Policy and Research, ADHD-specific rating scales are more

accurate in distinguishing between children with and without the diagnosis of ADHD,

than global, nonspecific questionnaires and rating scales that assess a variety of

behavioral conditions.

ADHD Diagnosis

We know through research that a clinically valid diagnosis of ADHD can be reached

through a comprehensive and thorough evaluation done by specially trained professionals

using well-tested diagnostic interview methods. The key elements include a thorough

history covering the presenting symptoms, including ruling out other physical or mental

conditions that may have the same symptoms, possible co morbid conditions, as well as

medical, developmental, school, psychosocial and family history. The criteria fordiagnosis with ADHD specify that symptoms of inattention must have persisted for at

least 6 months to a degree that is maladaptive and inconsistent with the childs

developmental level.

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Proper diagnosis also avoids the possibility that these symptoms are occurring

exclusively during the course of a pervasive developmental disorder, schizophrenia, or

other psychotic disorder and are not better accounted for by another co-morbid condition

or mental disorder (e.g., mood disorder, anxiety disorder, dissociate disorder, or a

personality disorder.) The problems involved with accurate diagnosis of these illnesses

are particularly acute in pediatric primary care settings, where many of these children are

seen, because these evaluations take time and require multiple clinical skills, for

which we have few appropriately trained professionals.

Diagnosis with children: Is it really ADHD?

Not everyone who is overly hyperactive, inattentive, or impulsive has ADHD. Since most

people sometimes blurt out things they didn't mean to say, or jump from one task to

another, or become disorganized and forgetful, how can specialists tell if the problem is

ADHD?

Because everyone shows some of these behaviors at times, the diagnosis requires that

such behavior be demonstrated to a degree that is inappropriate for the person's age. The

diagnostic guidelines also contain specific requirements for determining when the

symptoms indicate ADHD. The behaviors must appear early in life, before age 7, and

continue for at least 6 months. Above all, the behaviors must create a real handicap in at

least two areas of a person's life such as in the schoolroom, on the playground, at home,

in the community, or in social settings. So someone who shows some symptoms but

whose schoolwork or friendships are not impaired by these behaviors would not be

diagnosed with ADHD. Nor would a child who seems overly active on the playground

but functions well elsewhere receive an ADHD diagnosis.

To assess whether a child has ADHD, specialists consider several critical questions: Are

these behaviors excessive, long-term, and pervasive? That is, do they occur more often

than in other children the same age? Are they a continuous problem, not just a response

to a temporary situation? Do the behaviors occur in several settings or only in one

specific place like the playground or in the schoolroom? The person's pattern of behavior

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is compared against a set of criteria and characteristics of the disorder as listed in the

DSM-IV-TR.

DiagnosisChildren

Some parents see signs of inattention, hyperactivity, and impulsivity in their toddler long

before the child enters school. The child may lose interest in playing a game or watching

a TV show, or may run around completely out of control. But because children mature at

different rates and are very different in personality, temperament, and energy levels, it's

useful to get an expert's opinion of whether the behavior is appropriate for the child's age.

Parents can ask their child's pediatrician, or a child psychologist or psychiatrist, to assess

whether their toddler has an attention deficit hyperactivity disorder or is, more likely at

this age, just immature or unusually exuberant.

ADHD may be suspected by a parent or caretaker or may go unnoticed until the child

runs into problems at school. Given that ADHD tends to affect functioning most strongly

in school, sometimes the teacher is the first to recognize that a child is hyperactive or

inattentive and may point it out to the parents and/or consult with the school

psychologist. Because teachers work with many children, they come to know how

"average" children behave in learning situations that require attention and self-control.

However, teachers sometimes fail to notice the needs of children who may be more

inattentive and passive yet who are quiet and cooperative, such as those with the

predominantly inattentive form of ADHD.

Diagnosing ADHD in Adults:

Many adults have been living with Adult Attention-Deficit/Hyperactivity Disorder (Adult

ADHD) and dont recognize it. Why? Because its symptoms are often mistaken for a

stressful life, typically, adults with ADHD are unaware that they have this disorderthey

often just feel that it's impossible to get organized, to stick to a job, to keep an

appointment. The everyday tasks of getting up, getting dressed and ready for the day's

work, getting to work on time, and being productive on the job can be major challenges

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for the ADHD adult.Diagnosing an adult with ADHD is not easy. Many times, when a

child is diagnosed with the disorder, a parent will recognize that he or she has many of

the same symptoms the child has and, for the first time, will begin to understand some of

the traits that have given him or her trouble for yearsdistractibility, impulsivity,

restlessness. Other adults will seek professional help for depression or anxiety and will

find out that the root cause of some of their emotional problems is ADHD. They may

have a history of school failures or problems at work. Often they have been involved in

frequent automobile accidents.To be diagnosed with ADHD, an adult must have

childhood-onset, persistent, and current symptoms. The accuracy of the diagnosis of

adult ADHD is of utmost importance and should be made by a clinician with expertise in

the area of attention dysfunction. For an accurate diagnosis, a history of the patient's

childhood behavior, together with an interview with his life partner, a parent, close

friend, or other close associate, will be needed. A physical examination and

psychological tests should also be given. Co morbidity with other conditions may exist

such as specific learning disabilities, anxiety, or affective disorders.A correct diagnosis

of ADHD can bring a sense of relief. The individual has brought into adulthood many

negative perceptions of himself that may have led to low esteem. Now he can begin to

understand why he has some of his problems and can begin to face them.

The following ADD / ADHD Adult Self Report Scale (ASRS) questionnaire can be used

as a starting point to help you recognize the signs/symptoms of Adult ADHD but is not

meant to replace consultation with a trained healthcare professional. An accurate

diagnosis can only be made through a clinical evaluation. Regardless of the questionnaire

results, if you have concerns about diagnosis and treatment of Adult ADHD, please

discuss your concerns with your physician. (This Adult Self-Report Scale (ASRS)

Screener is intended for people aged 18 years or older.) Are you living with Adult

ADHD? The questions below can help you find outADD / ADHD Adult Self Report

Scale (ASRS) Checklist

The 6-question Adult Self-Report Scale (ASRS) Screener below is a subset of the WHO's

18-question Adult ADHD Self-Report Scale (Adult ASRS) Symptom Checklist

.

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Circle the number that best describes how

you have felt and conducted yourself over the

past 6 months. 0 1 2 3 4

Never Rarely Sometimes OftenVery

OftenScore

1. How often do you have difficulty getting

things in order when you have to do a task that

requires organization?

0 1 2 3 4

2. When you have a task that requires a lot of

thought, how often do you avoid or delay

getting started?

0 1 2 3 4

3. How often are you distracted by activity or

noise around you?0 1 2 3 4

4. How often do you leave your seat in meetings

or other situations in which you are expected to

remain seated?

0 1 2 3 4

5. How often do you feel restless or fidgety? 0 1 2 3 4

6. How often do you have difficulty waiting

your turnin situations when turn taking is

required?

0 1 2 3 4

Total

A score of 11 points or higher indicates that your symptoms may be consistent with

Adult ADHD. It may be beneficial for you to talk with your healthcare provider about an

evaluation.

Adult Self-Report Scale (ASRS) Screener COPYRIGHT 2003 World Health

Organization (WHO). Reprinted with permission of WHO. All rights reserved. This

Adult Self-Report Scale (ASRS) Screener is intended for people aged 18 years or older.

Coaching helps clarify the challenges

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Currently, there is no standardized testing that can clearly and accurately identify the

diagnosis of ADHD. We do know that a clinically valid diagnosis of ADHD can be

reached through a comprehensive and thorough evaluation done by specially trained

professionals using well-tested diagnostic interview methods. We also know these

evaluations take time and require multiple clinical skills, for which we have few

appropriately trained professionals. When we do find well-trained professionals who

know how to conduct a comprehensive evaluation, well-trained coaches can be

instrumental in helping their clients identify patterns and situations where their impairing

challenges of ADHD will tend to manifest.

Individuals seeking a proper diagnosis of ADHD who can accurately communicate how

and where their challenges exist are providing a well trained diagnostician with a crucialand essential information that can dramatically improve the chances of the correct

diagnosis of ADHD and the co-morbid or co-occurring conditions that are part of the

diagnosis in a majority of clinical cases. conditions that shadow. The coach works with

their client to insure that their description and explanation of their challenges are accurate

and concise so that any clinician will understand the impairments that are holding them

back.

Physicians and clinicians have reported back to us that working with clients to clearly

identify their patients impairing has been extremely helpful in correctly identifying the

ADHD and co morbid conditions Although coaches DO NOT DIAGNOSE their skills

and knowledge in questioning and other coaching skills can extremely helpful in

identifying the challenges and the accurately and concisely sharing that with the

clinician. This can be the difference between an accurate diagnosis that leads to proper

treatment and a dramatic improvement in the quality of their life.

Education is the Key and Foundation for Accurate Diagnosis &

Treatment

If you dont understand how you or your loved ones specific impairing challenges

prevent progress in your lives, then a diagnostician will have a difficult time determining

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an accurate diagnosis. Their diagnosis is only as good as what you tell them. Your

understanding of how and when your ADHD barriers manifest is essential information

that you must clearly convey.

To significantly improve your chances for an accurate diagnosis, the Academy has

created a proven program called Simply ADHD. We want to give you a

comprehensive, foundational understanding of ADHD in clear, simple, non-medical

language.

In this program, you will learn to identify how and when your specific ADHD challenges

appear in your life. We know, from many years of experience, the simple, unique models

and tools we have developed will dramatically improve your understanding,

communication, and relationships with those you live and work with every day...

This powerful knowledge can provide you with a strong foundation for a clear and

correct description of your ADHD traits. This is one of the most important elements for

the identification of an accurate diagnosis, crucial to your positive self development and

growth. Ultimately, it can improve the quality of an ADHD persons life. The Simply

ADHD program is a major focus of the Academys global mission to empower every

individual with ADHD to dramatically improve the quality of their lives.

Management:

Attention-deficit hyperactivity disorder management refers to the treatment options

available to people with attention-deficit/hyperactivity disorder(ADHD).

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There are several effective and clinically proven options to treat people with ADHD.

Combined medical management and behavioral treatment is the most effective ADHD

management strategy, followed by medication alone, and then behavioral treatment. .

The most common stimulant medications

are methylphenidate (Ritalin), dextroamphetamine (Dexedrine), and mixed amphetamine

salts (Adderall). Atomoxetine (Strattera) is currently the only non-stimulant drug

approved for the treatment of ADHD. Other medications which may be prescribed off-

label include certain antidepressants such as tricyclic antidepressants, SNRIs orMAOIs.

The presence ofcomorbid (relating to two diseases that occur together,e.g. depression and ADHD) disorders make finding the right treatment and diagnosis

much more costly and time consuming.

Effective treatments

A variety of psychotherapeutic andbehavior modification approaches to manage ADHD

are employed bypsychologists andpsychiatrists. These includepsychotherapy and

working memory therapy. Improving the surrounding home and school environmentwithparent management training and classroom management can improve the behavior

of children with ADHD. Specialized ADHD coaches provide services and strategies to

improve functioning, like time management or organizational suggestions. Self control

training programs have shown to have limited effectiveness. Behaviorally based self

control does better than cognitive self control training, A recent meta-analysis found that

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the use ofbehavior modification for ADHD resulted in effect sizes in between group

studies (.83), pre-post studies (.70), within group studies (2.64), and single subject

studies (3.78) indicating behavioral treatments are highly effective.

Experimental and alternative treatments include nutritional supplements, specialized

diets, and biofeedback.

A 2006 meta-analysis of ADHD research concluded that there was a shortage of data

regarding ADHD drugs' potential adverse effects, with very few studies assessing the

safety or efficacy of treatments beyond four months, and no randomized controlled trials

assessing for periods of usage longer than two years. Treatment of preschool children is

not recommended. The FDA found that a large number of the controlled trials required

subjects who were known to respond to stimulants or who had no history of intolerance

to stimulants, and this limits assumed generalizability of the trials' results.

Several studies have found growth and weight suppression for stimulants. Compared to

the behavior modification group at 8 years of the government-funded MTA study, the

stimulant group had higher level of reported substance abuse.

Psychotherapeutic approaches

There are a variety of psychotherapeutic approaches employed by psychologists and

psychiatrists; the one used depends on the patient and the patient's symptoms. The

approaches include psychotherapy, cognitive-behavior therapy, support groups, parent

training, meditation, and social skills training. If psychotherapy fails to bring

improvement medications can be considered as an add-on or alternative.

Psychotherapy

Psychotherapy is another option, with or without medication, that has been shown to be

effective.

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Parent Education and Classroom Management

Improving the surrounding home and school environment can improve the behavior of

children with ADHD. Parents of children with ADHD often show similar deficits

themselves, and thus may not be able to sufficiently help the child with his or her

difficulties. Improving the parents' understanding of the child's behavior and teaching

them strategies to improve functioning and communication and discourage unwanted

behavior has measurable affect on the children with ADHD. The different educational

interventions for the parents are jointly called Parent Management Training. Techniques

include operant conditioning: a consistent application of rewards for meeting goals and

good behavior (positive reinforcement) and punishments such as time-outs or revocation

or privileges for failing to meet goals or poor behavior. Classroom management is similarto parent management training; educators learn about ADHD and techniques to improve

behavior applied to a classroom setting. Strategies utilized include increased structuring

of classroom activities, daily feedback, and token economy.

Working Memory Training

Many of the problems shown by children with ADHD can be traced back to deficits

in working memory (or short-term memory). By training and improving this memorysome of the other symptoms may diminish as well. In a study by Klingberg et al., a

computerized training program has shown good results in working memory, even if the

generalized effect to behavioural symptoms was not as clear.

Coaching

ADHD Coaching is a specialized type of life coaching that uses specific techniques

geared toward working with the unique brain wiring of individuals with attention-deficit/hyperactivity disorder. Professional coaching is not a substitute for traditional,

multimodal treatment for ADHD such as medication, diet, exercise, and therapy.

Medications

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FDA-approved medicines

Adderall 25 mg XR. Adderall XR is one of the medications used to treat ADHD.

Stimulants are the most effective medications available for the treatment of ADHD. Fivedifferent formulations of stimulants have been approved by the FDA for the treatment of

ADHD: three derived from amphetamine and two derived

from methylphenidate. Atomoxetine is the only non-controlled, non-stimulantFood and

Drug Administration (FDA) approved drug for the treatment of ADHD. There are no

differences in effectiveness between medications used for ADHD.

Short term clinical trials have shown medications to be effective for treating ADHD, but

the trials usually use exclusion criteria, meaning knowledge on medications for ADHD is

based on a small subset of the typical patients seen in clinical practice. They have not

been found to improve school performance and data is lacking on long term effectiveness

and the severity of side effects. This class of medicines is generally regarded as one

unit; however, they affect the brain differently. Some investigations are dedicated to

finding the similarities of children who respond to a specific medicine. The behavioural

response to stimulants in children is similar regardless of whether they have ADHD or

not.

Stimulant medication is an effective treatment forAdult Attention-deficit hyperactivity

disorderalthough the response rate may be lower for adults than children. Some

physicians may recommend antidepressant drugs as the first line treatment instead of

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stimulants although antidepressants have lower treatment effect sizes than stimulant

medication.

Amphetamine based medications:

Three different medicines derived from amphetamine are used in ADHD treatment. Their

trade names are Adderall(a mixture of 72% dextroamphetamine and

28% levoamphetamine), Dexedrine (pure dextroamphetamine),

and Desoxyn(pure dextromethamphetamine). The differences in these three

Amphetamine based medications' active compounds and mixture ratios results in each

medications' slightly different activities.

Levoamphetamine and dextroamphetamine

This mirror difference is enough to cause the two compounds to be metabolized

differently. Adderall begins to work before dextroamphetamine because of

levoamphetamine.

Levoamphetamine also provides Adderall with a longer clinical effect than

dextroamphetamine. However, the brains preference for dextroamphetamine over

levoamphetamine shows that the clinical value of Adderall is, for the most part, due to

dextroamphetamine. A few children with ADHD and comorbid disorders have helpful

responses to levoamphetamine.

Dextromethamphetamine

The body metabolizes dextromethamphetamine into dextroamphetamine (in addition to

less important chemicals). A quarter of dextromethamphetamine will ultimately become

dextroamphetamine.After comparing only the common ground between

dextroamphetamine and dextromethamphetamine, the latter is said to be the stronger

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stimulant. In theoryand in practicea larger dose of dextroamphetamine is needed to

achieve dextromethamphetamines clinical potency. In fact, when dextroamphetamine

and methylphenidate are unhelpful, some doctors may prescribe

dextromethamphetamine. Although more rarely prescribed, anecdotal reports suggest

dextromethamphetamine is very helpful in cases where the other two are ineffective, or

cause limiting side effects.

Methylphenidate based medications

Methylphenidate

There are two different medicines derived from methylphenidate: Ritalin, which is half

dextrothreomethylphenidate and half levothreomethylphenidate, andFocalin, which is

pure dextrothreomethylphenidate. Dextrothreomethylphenidate has a higher

pharmacological activity than its mirror levo-form or enantiomer.

Levothreomethylphenidate has much weaker activity than the dextro isomer, and so for

instance ifDaytrana (Ritalin in transdermal patch form) is used, then the

levothreomethylphenidate comprising half of the administered dose, accounts for only

around one thirteenth of the total clinical effect.

Controlled release of drugs

Doctors may prescribe a controlled release pharmaceutical so that patients only have to

take medication in the morning, or at a time more convenient for the patient. This is

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especially helpful for children who do not like taking their medication in the middle of

the school day. Several controlled release methods are used in the FDA approved

medications for ADHD. Each way provided makes the FDA drugs pharmaceutically

different.

Multiple beads

Adderall and Dexedrine Spansules are examples of pharmaceuticals that use a system of

two beads to achieve a controlled release. The beads are contained in a gelatin capsule

that quickly dissolves in water, thus releasing the beads. The two different types

ofbeads dissolve at different rates, thus extending the effects of the amphetamines. The

company that markets Adderall is developing a new version of Adderall with three

different kinds of beads that would be effective for up to 16 hours.

Osmosis

The only ADHD medication that currently utilizes osmotic pressure to achieve a

controlled release of medicine isConcerta.

A tablet of Concerta is actually a coated capsule. The coating is a mix of

methylphenidate hydrochloride andbinders such as lactose,povidone, and carnauba wax.

Under that coating is a hollow filled capsule made of a semipermeable rigid membrane.

The actual capsule is insoluble in water, but some of the ingredients that fill the capsule

are water-soluble and others react in special ways with water. At one end of the capsule

there is a laser drilled small hole, big enough for methylphenidate particles to pass

through. The capsule's volume is partitioned into three sections. At the end closest to the

hole is the first partition, which is a mixture containing a small concentration of

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methylphenidate. In the middle is the second partition is a different mixture that contains

a higher concentration of methylphenidate. Occupying the third of the capsules volume

that is furthest away from the small hole is triacetin, cellulose

acetate, hypromellose,polyethylene glycol and polyethylene oxides.

Once swallowed, the capsule's shell quickly disintegrates and the methylphenidate that

was contained in the shell is released. When water sweeps through the semipermeable

membrane, the third partition that is furthest away from the capsule's hole will grow

because the hypromellose absorbs water and swells up and the polyethylene glycol will

increase the osmotic pressure. This partition will slowly push the contents of the other

two partitions out the small hole, starting with the lower concentrations of

methylphenidate, once the lower concentration of methylphenidate has mostly left thecapsule the higher concentration of methylphenidate will begin to be pushed out of the

capsule's hole. The capsule will be pharmacologically inactive once all the

methylphenidate is expelled.

Transdermal

This is a patch applied to the skin that allows the drug to diffuse through the skin layers

and enter the bloodstream. Unlike oral drugs, it may be removed and replacedconveniently, so it is flexible around the patient's schedule.

Daytranais the brand name of a transdermal patch which is essentially the same

formulation as Ritalin. Daytrana is applied to the skin in the morning and the drug is

evenly absorbed throughout the day, the patient should expect to feel the effects of the

methylphenidate until two hours after the patch was removed, so patients should expect

to take the patch off a few hours before bedtime. The collaborators that developed

Daytrana are developing a transdermal patch version of dextroamphetamine and have

completed phase 1 FDA human studies. This medicinal patch is code named SPD483

(a.k.a., ATS; Amphetamine Transdermal System; Amphetamine patch).

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Prodrug

Aprodrug is a compound which is itself inactive, but when metabolized becomes

pharmacologically active. Prodrugs are usually designed to improve

oralbioavailability as the chemical properties of the active compound may cause it to be

poorly absorbed from the gastrointestinal tract. Lisdexamfetamine (Sold asVyvanse) is a

prodrug of dextroamphetamine. Vyvanse is a gelatin capsule that quickly dissolves once

swallowed releasing lisdexamfetamine dimesylate.

Non stimulants

Atomoxetine (Strattera) is a non-stimulant drug approved for the treatment of attention-

deficit hyperactivity disorder (ADHD). It is less effective than stimulants for ADHD, is

associated with individual cases of liver damage, carries an FDA black boxwarning regarding suicidal idealization, and controlled studies show increases in heart

rate, decreases of body weight, decreased appetite and treatment-emergent nausea.

Certain antidepressants such as tricyclic antidepressants, SNRIs orMAOIs are sometimes

prescribed and are also effective in the treatment of ADHD.

Non FDA approved medications

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Off-label medications

Some medications used to treat ADHD are prescribed off-label, outside the scope of their

FDA-approved indications for various reasons. The Food and Drug Administration

(FDA) requires numerous clinical trials to prove a potential drug's safety and efficacy in

treating ADHD. The drugs below have not been through these tests, so the efficacy is

unproven (however these drugs have been licensed for other indications, so have been

proven to be safe in those populations), however proper dosage and usage instructions

are not as well characterized.

Amantadine (Symmetrel) an antiviral drug and dopamine agonist. There have been

reports of low-dose amantadine having been successfully used off-label to treat ADHD.

Amineptine (Survector/Maneon) a tricyclic antidepressant now illegal in many

countries for being thought to have a small potential for abuse. It is still legal in some

parts of the EU, such as Spain and Italy; it is no longer available in the U.S., Canada,

France or the UK.

Benzphetamine (Didrex) a less powerful stimulant. It has little psychoactive effects

until the liver metabolizes it into amphetamine and methamphetamine. Since this acts as

a sustained release mechanism, it has lower abuse potential and is schedule 3.

Bupropion (Wellbutrin) is classified as an antidepressant. It is the most common of off-

label prescription for ADHD. It inhibits the reuptake of norepinephrine, and to a lesser

extent, dopamine, in neuronal synapses, and has little or no effect on serotonergic re-

uptake. Bupropion is not a controlled substance. It is commonly prescribed as a timed

release formulation to decrease the risk of side effects. Bupropion is not particularly

known for its stimulant properties because at high doses it tends to cause seizures in alarge portion of the population.

Clonidine Initially developed as a treatment for high blood pressure, low doses in

evenings and/or afternoons are sometimes used in conjunction with stimulants to help

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with sleep and because Clonidine sometimes helps moderate impulsive and oppositional

behavior and may reduce tics. It may be more useful for comorbid Tourette syndrome.

Milnacipran, an anti-depressant drug, is currently being investigated for potential to

alleviate the symptoms of ADHD in adults.

Modafinil (Provigil/Alertec/Sparlon) In the U.S., it is currently off-label pending

decision by the FDA on August 22, 2006. It was originally pending marketing on-label as

Alertec but denied for a reported incidence ofStevens-Johnson Syndrome.

Pemoline (Cylert) a stimulant used with great success until the late 1980s when it was

discovered that this medication could cause liver damage. In March 2005, the makers of

Cylert announced that it would discontinue the medication's production. It is no longer

available in the United States.

Reboxetine (Edronax) is a selective norepinephrine reuptake inhibitorwhich is mainly

used as an antidepressant. Studies outside the USA have found it to be an effective

treatment for ADHD, and it is prescribed off-label for this purpose in Israel and some

European countries, however reboxetine has never been approved by the FDA in the

United States.

Selegiline an MAOI currently being investigated for ADHD.

Emsam is a version of Selegiline delivered via transdermal patch.

Tricyclic anti-depressants are also occasionally prescribed, but they seem to only treat the

hyperactive part of the condition. There is research on the selective serotonin reuptake

enhancerclass of medications (SSREs); currently, the only one available

is tianeptine (trade name Stablon); this is an atypical tricyclic anti-depressant which is

inconclusive in its efficacy and hence not approved.Tianeptine is not available in North

America.

Experimental and alternative medicine treatments

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Dietary supplements and specialized diets are sometimes used by people with ADHD

with the intent to mitigate some or all of the symptoms. For example,Omega-

3 supplementation (seal, fish or krill oil) may reduce ADHD symptoms for a subgroup of

children and adolescents with ADHD "characterized by inattention and

associated neurodevelopmental disorders." Although vitamin or mineral supplements

(micronutrients) may help children diagnosed with particular deficiencies, there is no

evidence that they are helpful for all children with ADHD. Furthermore, megadoses of

vitamins, which can be toxic, must be avoided. In the United States, no dietary

supplement has been approved for the treatment for ADHD by the FDA. There is

however a pilot study done which shows thatphosphatidyl serine (PS) can help against

ADHD.

Some people report short-term positive results using medical cannabis for treating

ADHD and doctor David Bearman supported this treatment. However,long-term effects

of cannabis use include substance dependence,drug tolerance, increase risk

forschizophrenia, bipolar disorders, and major depression.

EEG biofeedback is a treatment strategy used for children, adolescents and adults with

ADHD. The human brain emits electrical energy which is measured with electrodes on

the brain. Biofeedback alerts the patient when beta waves are present. This theory

believes that those with ADHD can train themselves to decrease ADHD symptoms.

There is a distinct split in the scientific community about the effectiveness of the

treatment. A number of studies indicate the scientific evidence has been increasing in

recent years for the effectiveness of EEG biofeedback for the treatment of ADHD.

According to a 2007 review, with effectiveness of the treatment was demonstrated to be

equivalent to that of stimulant medication. The review noted, improvements are seen at

the behavioral and neuropsychological level with the symptoms of inattention,

hyperactivity and impulsivity showing significant decreases after treatment. There are no

known side effects from EEG biofeedback therapy. There are methodological limitations

and weaknesses in study designs however. In a 2005 review, Loo and Barkley stated that

problems including lack of blinding such as placebo control and randomisation are

significant limitations to the studies into EEG biofeedback and make definitive

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conclusions impossible to make. As a result more robust clinical studies have been

strongly recommended. A German review in 2004 found that EEG biofeedback, also

sometimes referred to as neurofeedback, is more effective than previously thought in

treating attention deficiency, impulsivity and hyperactivity; short-term effects match

those of stimulant treatment and a persistent normalization of EEG parameters is found

which is not found after treatment with stimulants. There are no known side effects from

biofeedback therapy although research into biofeedback has been limited and further

research has been recommended. An American review the following year also

emphasized the benefits of this method. Similar findings were reported in a study by

another German team in 2004.

Aerobic fitness may improve cognitive functioning and neural organization related toexecutive control during pre-adolescent development, though more studies are needed in

this area. One study suggests that athletic performance in boys with ADHD may increase

peer acceptance when accompanied by fewer negative behaviors.

Aerobic fitness

Aerobic fitness may improve cognitive functioning and neural organization related to

executive control during pre-adolescent development, though more studies are needed inthis area. One study suggests that athletic performance in boys with ADHD may increase

peer acceptance when accompanied by fewer negative behaviors.

Biofeedback

EEG biofeedback, also sometimes referred to as neurofeedback, is effective in

treating attention,impulsivity and hyperactivity. There are no known side effects from

biofeedback therapy although research into biofeedback has been limited and furtherresearch has been recommended. One 2009 study concluded "that NF may be considered

as a clinically effective module in the treatment of children with ADHD

Dietary supplements

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There are indications that children with ADHD are metabolically different from others.

Zinc- Although the role of zinc in ADHD has not be elucidated, "numerous controlled

studies report cross-sectional evidence of lower zinc tissue levels.

Omega-3 fatty acids - Some studies suggest that a lack ofomega-3 fatty acids is

associated with certain ADHD symptoms. and it has therefore been suggested that diet

modification may play a role in the management of ADHD. People with ADHD were

found to have significantly lower plasma phospholipids and erythrocytes omega-3 fatty

acids. Their intake ofsaturated fat was found to be 30% higher than in controls, while the

intake of many other nutrients was not different. In support of the idea that it is not the

intake of essential fatty acids that causes low tissue levels, a preliminary study showed

that exhaled ethane, a marker of omega-3 fatty acidsperoxidation, was higher in children

with ADHD relative to controls. Researchers from CSIRO, Australia's national science

agency, showed polyunsaturated fatty acids to provide "medium t

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