ADHD Treatment FAQs
Imagine everything around you constantly changing. The feeling of boredom occurs easily and even though you want to, you are simply unable to concentrate on the things you need to complete. Your mind is constantly distracted with the buzz of things happening around you, driving you carelessly from one activity to the next. Your thoughts envelope your mind, distracting you from participating in any important task. Even someone speaking to you goes unnoticed.
For a lot of people, this feeling of helplessness is what it feels like to suffer from Attention Deficit Hyperactivity Disorder (ADHD). These people may not be able to sit in one place for a long time, make long term plans, finish important tasks, or be completely aware of what’s happening around them. Their family, friends and colleagues find them to be confused and disorganized. On some days, they behave completely normal, misleading others to believe that they can actually control their behavior. This can cause severe strain in their relationships with others, disrupt their social life, and make them lose their own sense of worth. ADHD, previously known as hyperkinesis or minimal brain dysfunction, is a type of mental disorder that is commonly found in children. ADHD affects around 3-5% of all children, two thirds of more boys than girls.
Nearly 2 million American children suffer from this disorder. ADHD carries on with the person into their teenage years and adulthood, causing the person to become an emotional wreck of unfulfilled ambitions and dreams. If you thought that there is nothing you can do about this, you’re wrong. There is help to tackle this condition. Extensive research has enabled scientist to identify this disorder in children, teenagers and adults and treat it accordingly. Modern science has developed a number of treatments, therapies that can help change a person’s behavior, and educational opportunities to help people with ADHD become more focused, develop their self-esteem, and improve their behavior to be more productive.
Hyperactivity: Hyperactive people constantly seem to be busy with something or the other. They are unable to sit in one place and they speak incessantly and move around all the time. Sitting through an entire lecture can seem to be an impossible thing to do. Children that are hyperactive are often seen wandering around in the room or fidgeting with things. You may find them tapping their pencil on the desk, trying to reach out to everything around them and constantly shake their legs. Teenagers and adults who are hyperactive may feel extremely restless at most times. They attempt to carry out several tasks at once, juggling multiple things at one time.
Impulsive: Impulsive people act without thinking as they are not able to control their reactions to situations. This causes them to blurt out things or pass inappropriate comments without considering someone else’s feelings. Because of their over impulsive behavior, they may be extremely impatient while waiting in a queue or waiting for their turn to arrive in a game. An impulsive child may grab another child’s toy or throw things around when they’re upset.
Distractibility: Individuals with distractibility issues generally have problems concentrating and difficulty completing tasks. For ADHD patients, this symptoms is the most common complaint and is also the most easily treatable. Thankfully there is medication specifically for ADHD patients who are unable to complete homework, school or work projects because they are easily distracted and have difficulty focusing on one task at a time. After beginning Treatment, patients no longer have a hard time focusing on tasks and being distracted, which resolves the most common complaint.
People who are hyperactive or impulsive may not necessarily suffer from an attention disorder. Everyone tends to blurt out an opinion, juggle multiple things at one time, forget important tasks, and be disorganized at some time or the other in our lives.
So how do specialists really tell if a person has ADHD? In order to find out if a person is suffering from ADHD; specialists have to take into account a number of critical questions: Do these behaviors exist in excess and are they pervasive? Do other people who are of the same age behave in an identical manner? Are these behaviors constant or are they temporary? What kind of settings do these behaviors occur in? Specialists assess the person’s behavioral patterns against these and a number of other criteria to be sure of ADHD. You can have a look at these criteria in a diagnostic reference book known as the DSM (Diagnostic and Statistical Manual of Mental Disorders).
As per the DSM, three basic behavioral patterns give an indication of ADHD. A person with ADHD may be endlessly inattentive, over impulsive and hyperactive. They may shows signs of either one of these behaviors or all three of them.
The DSM states the following signs of inattentiveness:
•Getting easily distracted by various sounds and figures.
•Unable to pay attention to tasks and making silly mistakes.
•Unable to adhere to instructions and follow them completely.
•Losing stuff like pencils, toys, colors, books and other needed things to complete a task.
Hyperactivity and Impulsivity include the following signs:-
•Restlessness, fidgeting with your hands and legs, and twisting your body from side to side due to discomfort.
•Getting up and leaving when you are required to sit down.
•Interrupting people while they speak and blurting out opinions.
•Unable to patiently wait in line or wait for your turn in a game.
As everyone shows these signs at some point in their lives, the DSM has detailed guidelines that can be used to determine if a person has ADHD. A person should show these behaviors before the age of 7 and they should last for a minimum of 6 months. Children with ADHD should display these behaviors more often and excessively than other children of the same age. These behaviors should cripple at least two important areas such as home, work, school or the social life of a person.
If two or more areas are not affected, the person may not be diagnosed with ADHD.
O.C. ADHD (Attention Deficit Hyperactive Disorder) Doctor – Get Treatment Now
Causes ADHD has severe effects on a child’s performance in school and his social life. Parents of these children are most certainly frustrated with their child’s underperformance and exhausted with countering it.
Because ADHD is genetic, it occurs in early childhood and develops along with the developing brain of a child. Signs of depression, learning disabilities, lack of sleep, and other behavioral problems may often be mixed with signs of ADHD or even be confused with Attention disorder. Children that show symptoms of ADHD or other behavioral issues need to be carefully evaluated in order to fully understand the different causes of their behavior. Attention Deficit Disorder (ADD) is diagnosed very frequently in childhood.
This disorder affects around 3 to 5 percent of school going children and is found more frequently in boys than in girls. Children suffering from ADHD may also suffer for one or more developmental and behavioral issue.
Understandably, one of the first questions parents ask when they learn their child has an attention disorder is “Why? What went wrong?”
Health professionals stress that since no one knows what causes ADHD, it doesn’t help parents to look backward to search for possible reasons. There are too many possibilities to pin down the cause with certainty. It is far more important for the family to move forward in finding ways to get the right help.
Scientists, however, do need to study causes in an effort to identify better ways to treat, and perhaps some day, prevent ADHD. They are finding more and more evidence that ADHD does not stem from home environment, but from biological causes. When you think about it, there is no clear relationship between home life and ADHD. Not all children from unstable or dysfunctional homes have ADHD. And not all children with ADHD come from dysfunctional families. Knowing this can remove a huge burden of guilt from parents who might blame themselves for their child’s behavior.
Over the last decades, scientists have come up with possible theories about what causes ADHD. Some of these theories have led to dead ends, some to exciting new avenues of investigation.
One disappointing theory was that all attention disorders and learning disabilities were caused by minor head injuries or undetectable damage to the brain, perhaps from early infection or complications at birth. Based on this theory, for many years both disorders were called “minimal brain damage” or “minimal brain dysfunction.” Although certain types of head injury can explain some cases of attention disorder, the theory was rejected because it could explain only a very small number of cases. Not everyone with ADHD or LD has a history of head trauma or birth complications.
Another theory was that refined sugar and food additives make children hyperactive and inattentive. As a result, parents were encouraged to stop serving children foods containing artificial flavorings, preservatives, and sugars. However, this theory, too, came under question. In 1982, the National Institutes of Health (NIH), the Federal agency responsible for biomedical research, held a major scientific conference to discuss the issue. After studying the data, the scientists concluded that the restricted diet only seemed to help about 5 percent of children with ADHD, mostly either young children or children with food allergies.
ADHD Is Not Usually Caused by:
* too much TV
* food allergies
* excess sugar
* poor home life
* poor schools
In recent years, as new tools and techniques for studying the brain have been developed, scientists have been able to test more theories about what causes ADHD.
Using one such technique, NIMH scientists demonstrated a link between a person’s ability to pay continued attention and the level of activity in the brain. Adult subjects were asked to learn a list of words. As they did, scientists used a PET (positron emission tomography) scanner to observe the brain at work. The researchers measured the level of glucose used by the areas of the brain that inhibit impulses and control attention. Glucose is the brain’s main source of energy, so measuring how much is used is a good indicator of the brain’s activity level. The investigators found important differences between people who have ADHD and those who don’t. In people with ADHD, the brain areas that control attention used less glucose, indicating that they were less active. It appears from this research that a lower level of activity in some parts of the brain may cause inattention.
The brain scans at the beginning of this article dramatize the difference between an adult with Attention deficit Hyperactivity Disorder (right) and an adult free of the disease (left).
One of the difficulties in diagnosing ADHD is that it is often accompanied by other problems. For example, many children with ADHD also have a specific learning disability (LD), which means they have trouble mastering language or certain academic skills, typically reading and math. ADHD is not in itself a specific learning disability. But because it can interfere with concentration and attention, ADHD can make it doubly hard for a child with LD to do well in school.
A very small proportion of people with ADHD have a rare disorder called Tourette’s syndrome. People with Tourette’s have tics and other movements like eye blinks or facial twitches that they cannot control. Others may grimace, shrug, sniff, or bark out words. Fortunately, these behaviors can be controlled with medication. Researchers at NIMH and elsewhere are involved in evaluating the safety and effectiveness of treatment for people who have both Tourette’s syndrome and ADHD.
More serious, nearly half of all children with ADHD–mostly boys–tend to have another condition, called oppositional defiant disorder. Like Mark, who punched playmates for jostling him, these children may overreact or lash out when they feel bad about themselves. They may be stubborn, have outbursts of temper, or act belligerent or defiant. Sometimes this progresses to more serious conduct disorders. Children with this combination of problems are at risk of getting in trouble at school, and even with the police. They may take unsafe risks and break laws–they may steal, set fires, destroy property, and drive recklessly. It’s important that children with these conditions receive help before the behaviors lead to more serious problems.
At some point, many children with ADHD–mostly younger children and boys–experience other emotional disorders. About one-fourth feel anxious. They feel tremendous worry, tension, or uneasiness, even when there’s nothing to fear. Because the feelings are scarier, stronger, and more frequent than normal fears, they can affect the child’s thinking and behavior. Others experience depression. Depression goes beyond ordinary sadness–people may feel so “down” that they feel hopeless and unable to deal with everyday tasks. Depression can disrupt sleep, appetite, and the ability to think.
Because emotional disorders and attention disorders so often go hand in hand, every child who has ADHD should be checked for accompanying anxiety and depression. Anxiety and depression can be treated, and helping children handle such strong, painful feelings will help them cope with and overcome the effects of ADHD.
Of course, not all children with ADHD have an additional disorder. Nor do all people with learning disabilities, Tourette’s syndrome, oppositional defiant disorder, conduct disorder, anxiety, or depression have ADHD. But when they do occur together, the combination of problems can seriously complicate a person’s life. For this reason, it’s important to watch for other disorders in children who have ADHD.
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Even though most people don’t outgrow ADHD, people do learn to adapt and live fulfilling lives. Many with ADD/ADHD are making good lives for themselves–not by being cured, but by developing their personal strengths. With effective combination of medicine, new skills, and emotional support, people with ADHD can develop ways to control their attention and minimize their disruptive behaviors. For example, they may find that by structuring tasks and controlling their environment, they can achieve personal goals. They may also learn to channel their excess energy into sports and other high energy activities. Many can identify career options that build on their strengths and abilities.
As they grow up, with appropriate help from parents and clinicians, children with ADHD become better able to suppress their hyperactivity and to channel it into more socially acceptable behaviors, like physical exercise or fidgeting. And although we know that half of all children with ADHD will still show signs of the problem into adulthood, we also know that the medications and therapy that help children also work for adults.
All people with ADHD have natural talents and abilities that they can draw on to create fine lives and careers for themselves. In fact, many people with ADHD even feel that their patterns of behavior give them unique, often unrecognized, advantages. People with ADHD tend to be outgoing and ready for action. Because of their drive for excitement and stimulation, many become successful in business, sports, construction, and public speaking. Because of their ability to think about many things at once, many have won acclaim as artists and inventors. Many choose work that gives them freedom to move around and release excess energy. But some find ways to be effective in quieter, more sedentary careers. One patient, a computer programmer, found that she thinks best when she wears headphones to reduce distracting noises. Like entrepreneurs with ADHD, some people strive to increase their organizational skills. Others who own their own business find it useful to hire support staff to provide day-to-day management.
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You only pay a consultation fee if you are prescribed medication.
Because our physicians have multiple specialties, we are able to treat coexisting disorders at One Care all in one facility. ADHD is often accompanied by anxiety, mood disorders, substance abuse, depression, or insomnia and our physicians are able to help you with any and all of these issues.
As many as two thirds of children with ADHD have at least one other coexisting condition with less in adulthood. The constant motion and fidgetiness, interrupting and blurting out, difficulty waiting in lines or sitting in restaurants, and need for constant reminders may overshadow these other disorders. But just as untreated ADHD can leave lasting scars, so too can other untreated disorders cause unnecessary suffering in individuals with ADHD and their families. Any disorder can coexist with ADHD, but certain disorders seem to occur more commonly with ADHD.
How are These Coexisting Conditions Identified?
As the diagnosis of ADHD is considered, the clinician or mental health professional must also determine whether there are any other psychiatric disorders affecting the child that could be responsible for presenting symptoms. Often, the symptoms of ADHD may overlap with other disorders. The challenge for the clinician is to discern whether a symptom belongs to ADHD, to a different disorder, or to both disorders at the same time. For some children, the overlap of symptoms among the various disorders makes multiple diagnoses necessary.
By conducting a complete evaluation, a clinician or mental health professional familiar with ADHD and other psychiatric disorders will be able to diagnose both the ADHD and related conditions. Interviews and questionnaires are often used to obtain information about symptoms from the patient, the patient’s family, and his or her teachers to screen for these other disorders.
Which Conditions most Commonly Coexist with ADHD?
ADHD may coexist with one or more disorders. The most common disorders to occur with ADHD are (1) disruptive behavior disorders; (2) mood disorders; (3) anxiety disorders; (4) tics and Tourette Syndrome; and (5) learning disabilities.
Disruptive Behavior Disorders (Oppositional-Defiant Disorder and Conduct Disorder)
About 40 percent of individuals with ADHD have oppositional defiant disorder (ODD). Among individuals with ADHD, conduct disorder (CD) is also common, occurring in 25 percent of children, 45-50 percent of adolescents and 20-25 percent of adults. ODD involves a pattern of arguing with multiple adults, losing one’s temper, refusing to follow rules, blaming others, deliberately annoying others, and being angry, resentful, spiteful, and vindictive.
CD is associated with efforts to break rules without getting caught. Such children may be aggressive to people or animals, destroy property, lie or steal things from others, run away, skip school, or break curfews. CD is often described as delinquency and children who have ADHD and conduct disorder may have lives that are more difficult than those of children with ADHD alone. Academically, students with both ADHD and CD are twice as likely to have difficulty reading as other ADHD children. Children with both ADHD and CD, but not other children with ADHD, are at greater risk for social and emotional failure. Studies now suggest that ADHD and CD may be a particular subtype of ADHD, since multiple family members often have both of these disorders together.
Treatment of the person with ADHD and ODD/CD requires efforts to discourage delinquent behaviors so that the person will increasingly choose pro-social behaviors. ODD and CD usually require strong, clear structure with reinforcement of appropriate behaviors as well as a positive behavior management plan to extinguish antisocial behaviors.
Medication remains important. Research has shown that ADHD and CD students treated with stimulant medicines are not only more attentive, but also less antisocial and aggressive. In addition, medication combinations, such as a psychostimulant with an antidepressant, appear to be very effective for these patients.
Some children, in addition to being hyperactive, impulsive, and/or inattentive, may also seem to always be in a bad mood. They may cry daily, out of the blue, for no reason, and they may frequently be irritable with others for no apparent reason. Both sad, depressive moods and persisting elevated or irritable moods (mania) occur with ADHD more than would be expected by chance.
The most careful studies suggest that between 10-30 percent of children with ADHD, and 47 percent of adults with ADHD, also have depression. Typically, ADHD occurs first and depression occurs later. Both environmental and genetic factors may contribute.
Environmentally, as children with ADHD get older, they may feel left out. Too often they are forgotten on birthday party lists, playdates, and sleepovers. These children may not be invited to play at other children’s homes because of past difficulties with accidents or may not be chosen to be on sports teams or to participate in games. This takes a heavy toll on the child’s self-esteem. As these episodes pile up, the child with ADHD can become discouraged and about one in four may become clinically depressed. While all children have bad days where they feel down, depressed children may be down or irritable most days. Children with ADHD and depression may also withdraw from others, stop doing things they once enjoyed, have trouble sleeping or sleep the day away, lose their appetite, criticize themselves excessively (“I never do anything right!”), and talk about dying (“I wish I were dead”). Fortunately, ADHD by itself is not associated with increased risk of suicidal behavior. Current studies suggest that both ADHD and depression may share a common underlying genetic link, since families with ADHD also seem to have more members with depression than would be expected by chance.
Treatment of children with ADHD and depression involves minimizing environmental traumas and different medication regimens. To minimize the child with ADHD’s difficulty in playing with others, parents and teachers can arrange small group play experiences (sometimes just two people). In addition, it is vital that the parent monitor the school setting. Even children with carefully constructed educational plans may continue to struggle if the plan is inadequate. A number of studies have shown that certain antidepressant medications improve ADHD alone, or with depression. The antidepressant desipramine (Norpramin) has improved both ADHD and ADHD and depression. Researchers have also found that stimulants (such as Ritalin) can be combined safely with antidepressants such as fluoxetine (Prozac) — these children not only feel better but also function better at school. Newer antidepressants such as bupropion (Wellbutrin) and venlafaxine (Effexor) have been found effective in some individuals with ADHD alone and may additionally benefit those individuals with both ADHD and depression.
Up to 20 percent of individuals with ADHD also may manifest bipolar disorder. This condition involves periods of abnormally elevated mood contrasted by episodes of clinical depression. Adults with mania may have long (days to weeks) episodes of being ridiculously happy, and even believe they have special powers or receive messages from God, the radio, or celebrities. With this expansive mood, they may also talk incessantly and rapidly, go days without sleeping, and engage in tasks that ultimately get them into trouble. While manic, they may go on spending sprees which get them into debt, become hypersexual, or contact people at all hours of the night.
In younger people, mania may show up differently. Children may have moods that change very rapidly, seemingly for no reason, be pervasively irritable, exhibit unpremeditated aggression, and sometimes hear voices or see things the rest of us don’t. ADHD is much more common than mania, and while many children with mania may first exhibit ADHD symptoms, very few children with ADHD will go on to develop mania. The combination of ADHD and mania often leads to severe difficulty functioning. The overlap of mania and ADHD is being actively studied. As patients with ADHD-mania are followed over time, it will become clearer what their symptoms look like in adulthood.
From a treatment standpoint, mood must be stabilized on medications before treatment for ADHD is likely to be successful. Patients with ADHD-mania now are treated with mood stabilizers such as lithium, valproate (Depakote), or carbamazepine (Tegretol). Because these agents usually do not improve the ADHD symptoms, stimulants or antidepressants are often added to improve the ADHD symptoms.
Up to 30 percent of children and 25-40 percent of adults with ADHD will also have an anxiety disorder. Anxiety disorders are often not apparent, and research has shown that half of the children who describe prominent anxiety symptoms are not described by their parents as anxious. As with depression, the child’s internal feelings may not stand out to parents or teachers. Patients with anxiety disorders often worry excessively about a number of things (school, work, etc.), and may feel edgy, stressed out or tired, tense, and have trouble getting restful sleep. A small number of patients may report brief episodes of severe anxiety (panic attacks), which intensify over about 10 minutes with complaints of pounding heart, sweating, shaking, choking, difficulty breathing, nausea or stomach pain, dizziness, and fears of going crazy or dying. These episodes may occur for no reason, and sometimes awaken patients. Students with ADHD and anxiety report more school, family, and social/peer problems than student who only have ADHD. Students with ADHD accompanied by anxiety are less likely to appear hyperactive and disruptive, but instead appear more slowed down or inefficient. Genetic research thus far suggests that ADHD and anxiety are separate disorders inherited independently of each other.
Treatment of ADHD and anxiety requires attention to precipitating stressors, and training in methods of contending with fear-provoking circumstances. Relaxation techniques and alternative ways to think through stressful situations may be helpful. ADHD and anxiety appear less responsive to conventional ADHD medication treatments. Specifically, children with ADHD and anxiety only showed a 30 percent response to methylphenidate (Ritalin), versus a 70-80 percent response observed in ADHD-only children. Moreover, at least one study has shown that children with ADHD and anxiety are more sensitive to negative side effects of stimulant medications. Accordingly, alternative medication regimens may be necessary. Tricyclic antidepressants (e.g., desipramine [Norpramin], nortriptyline [Pamelor], imipramine [Tofranil]), benzodiazepines (lorazapam [Ativan], clonazepam [Klonopin], alprazolam [Xanax], etc.) and more recently buspirone (BusPar) may benefit these patients.
Tics and Tourette Syndrome
Only about seven percent of those with ADHD have tics or Tourette Syndrome, but 60 percent of those with Tourette Syndrome have ADHD. Tics (sudden, rapid, recurrent, involuntary movements or vocalizations) or Tourette Syndrome (both movements and vocalizations) can occur with ADHD in two ways. First, mannerisms or movements such as excessive eye blinking or throat clearing often occur between the ages of 10-12 years. When children are nervous or tired, these tics may appear worse or more conspicuous. These temporary tics usually go away gradually over one-to-two years, and are just as likely to happen in children with ADHD as others. Tourette Syndrome is a much rarer, but more severe tic disorder, where patients may make noises (e.g., barking a word or sound) and movements (e.g., repetitive flinching or eye blinking) on an almost daily basis for years. Tourette Syndrome often includes
ADHD, although the opposite is not true.
Tics can also become more noticeable when patients are treated with stimulants or — much less likely –bupropion. While these medicines no longer appear to cause tics, they may unmask or exaggerate tics. Accordingly, sometimes lowering the dose can decrease the tics. Other medicines such as ortriptyline (Pamelor or Aventyl), clonidine (Catapres), or guanfacine (Tenex) may be used to decrease tics while treating ADHD.
Individuals with ADHD frequently have difficulty learning in school. Depending on how learning disorders are defined, up to 50 percent of children with ADHD have a co-existing learning disorder. Individuals with learning disabilities may have a specific problem reading or calculating, but they are not less intelligent than their peers are. Research indicates that students with both ADHD and reading disorder (dyslexia) are no more anxious, hyperactive, or aggressive than student with ADHD only. However, the learning disorder does impact school performance, which may subsequently impact family and peer relationships.
Treatment requires careful attention to the student’s unique strengths and weaknesses. If academic difficulties occur despite beneficial treatment (with psychosocial interventions and medication), then it is necessary to pursue an educational evaluation that assesses learning disabilities. Usually this requires that family members contact the school principal, teacher, or guidance department to initiate the process, which culminates with devising — when necessary — an individual educational plan (IEP) or Section 504 plan for the student. The IEP is reviewed at least annually by school personnel to ensure that educational planning is helping the student make academic progress. Medications do not specifically improve learning disorders, but may improve ADHD symptoms so that learning can accelerate.
What about Substance Abuse?
Recent work suggests that youths with ADHD are at increased risk for very early cigarette use, followed by alcohol and then drug abuse. Cigarette smoking is more common in adolescents with ADHD, and adults with ADHD have elevated rates of smoking and report particular difficulty in quitting. Youths with ADHD are twice as likely to become addicted to nicotine as individuals without ADHD..
As documented by current research, cocaine and stimulant abuse is not more common among individuals with ADHD who were previously treated with stimulants: growing up taking stimulant medicines does not lead to substance abuse as these children become teenagers and adults. Indeed, those adolescents with ADHD prescribed stimulant medication are less likely to subsequently use illegal drugs than are those not prescribed medication.