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ADHD
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Attention deficit hyperactivity disorder (ADHD)



Related terms
Background
Treatment
Author information
Bibliography
Causes

Related Terms
  • ADD, ADHD, attention deficit disorder, Conners' Rating Scale, hyperkinetic disorder, hyperkinetic syndrome.

Background
  • Attention deficit hyperactivity disorder (ADHD) is classified as a psychiatric disorder characterized by a continual pattern of inattention, distractibility, impulsivity, and hyperactivity.
  • Beginning in childhood, ADHD is one of the most commonly diagnosed psychiatric disorders in children and adolescents. ADHD becomes apparent in some children in the preschool and early school years.
  • ADHD is thought to affect about 9.2% of boys and 2.9% of girls who are of school age.
  • While it is estimated that about 4.4% of adults also suffer from ADHD, the condition often goes unrecognized in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults.
  • Adults with ADHD are diagnosed under the same criteria, including the stipulation that their symptoms must have been present prior to the age of seven.
  • ADHD is divided into three subtypes based on symptoms including inattentive type, hyperactive-impulsive type, and combined type with both inattention and hyperactivity-impulsiveness.
  • The most common ADHD subtype is the combined type; females are more likely to have the inattentive type.

Treatment
  • Family therapy: Family therapy can help parents and siblings deal with the stress of living with a child who has ADHD.
  • Behavioral therapy (BT): BT helps individuals with ADHD develop more effective ways to work on immediate issues. Practical assistance may be offered such as helping organize school tasks and studying for school, or assisting the individual with powerful emotional issues. Anger control is an example of BT.
  • Psychotherapy: Psychotherapists work to help people with ADHD to live as functioning members of society, increasing self-esteem and dealing with other psychological issues. Psychotherapy alone, however, does not address the symptoms or underlying causes of the disorder. Upsetting thoughts and feelings are verbalized, along with exploration of self-defeating patterns of behavior. Individuals with ADHD can learn alternative ways to handle their emotions.
  • Social skills training: Social relationships are studied with a therapist to help the individual with ADHD develop and maintain social relationships, like waiting for a turn, sharing toys, asking for help, or responding to teasing. Social skills training helps the child to develop better ways to play and work with other children, and provides the adult with better social skills.
  • Support groups: Support groups help individuals with ADHD and parents to connect with other people who have similar problems and concerns. Meetings occur on a regular basis (usually weekly) to share frustrations and successes and to hear lectures from experts on ADHD, obtain referrals to qualified specialists and information about what works.
  • Parenting skills training: Parents face special obstacles when raising a child with ADHD, and often feel frustrated and like there is no help. Parenting skills training is offered by therapists or in special classes, and can give parents tools and techniques for managing their child's behavior. Time outs, reward systems, and organization are just a few of the skills taught.
  • Stimulants: The most frequently prescribed medications for ADHD are stimulants, which work by stimulating the areas of the brain responsible for focus, attention, and impulse control. Stimulant drugs include Methylphenidate (Ritalin®, Metadate®, Focalin®, Concerta®, Daytrana® - a topical methylphenidate patch), amphetamine, mixed salts (Adderall®, Adderall XR®), dextroamphetamine (Dexedrine®), modafinil (Provigil®), methamphetamine (Desoxyn®), and the recently approved lisdexamfetamine (Vyvanse®).
  • Non-stimulants:
  • Atomoxetine (Strattera®) is a norepinephrine reuptake inhibitor and helps regulate brain function. Atmoxetine is usually taken once or twice a day, depending on the individual, every day, and takes up to 6 weeks to begin working fully.
  • Amantadine (Symmetrel®) is used to increase dopamine in the brain. Reports suggest that low-dose amantadine has been successfully used off label to treat ADHD.
  • Antidepressant medications may be used off label for ADHD, including serotonin reuptake inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs, including selegiline (Emsam®)), and bupropion (Wellbutrin®).

Author information
  • This information has been edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Bibliography
  1. American Psychiatric Association. .
  2. National Alliance on Mental Health. .
  3. National Institute of Mental Health. .
  4. National Institutes of Health. .
  5. Natural Standard: The Authority on Integrative Medicine. .

Causes
  • The exact cause of ADHD remains unknown. Most of the causes have been reported to be dysfunction in the brain and nervous system.
  • Altered brain function: Dopamine is a brain neurochemical necessary for proper function. Research has found that individuals with ADHD may have a deficiency of dopamine. Also, individuals with ADHD may have decreased blood flow to the brain.
  • Thyroid disorders: Thyroid abnormalities have been associated with ADHD and other childhood psychiatric disorders.
  • Head injuries: Head trauma in childhood may cause neurological problems leading to the development of ADHD.
  • Drugs: Hyperactivity may be caused by high or repeated doses of caffeine or stimulants.
  • Genetics: People with family histories of ADHD have an increased risk of developing this disorder. This is because genetics has been linked to many cases of ADHD. Scientists are studying several genes that may be involved in ADHD.
  • Because people with ADHD generally have lower levels of the brain chemical dopamine, researchers are interested in learning more about the genes involved in dopamine regulation. Strong evidence suggests that the dopamine D4 receptor (DRD4) gene is involved in ADHD. A specific variation in this gene may increase a person's risk of developing ADHD by 13-19%. In a meta-analysis, researchers found that some variations dramatically increased the risk of ADHD, while other variants may have a protective effect. Other research suggests that variants of the dopamine D5 receptor (DRD5) gene may significantly increase the risk of ADHD. Yet, one variation of DRD5 may help prevent ADHD.
  • Researchers are also studying the dopamine transporter (DAT1, also known as SLC6A3) gene mainly because it provides instructions for making the dopamine transporter protein. This protein binds to dopamine, removing it from the tiny space between nerve cells (called the synaptic cleft) and deposits it to nearby cells. Some variations in the DAT1 gene have been linked to ADHD, although evidence of this association is not as strong as the DRD4 and DRD5 genes.
  • Some studies have focused on the dopamine beta-hydroxylase gene (DBH) gene. This gene provides instructions for making the dopamine beta-hydroxylase protein which breaks down dopamine into norepinephrine, thereby affecting the total level of dopamine in the brain. Studies in this area have produced conflicting results, and it is unclear if variations of the DBH gene play a role in ADHD.
  • Variations in the serotonin transporter (SLC6A4) gene have also been studied in relation to ADHD. However, the role of SLC6A4 in ADHD remains unclear.
  • The synaptosomal-associated protein 25 (SNAP-25) gene may also play a role in ADHD. In animal studies, mice with a particular variation in the (SNAP-25) gene exhibited hyperactive behavior and other signs of ADHD. However, research in this area has been conflicting.

Copyright © 2011 Natural Standard (www.naturalstandard.com)


The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.



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