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Neuropsychological
functioning of adults with attention deficit hyperactivity disorder.
J Clin Exp Neuropsychol 2000 Feb;22(1):115-24
The neuropsychological functioning of adults with Attention Deficit Hyperactivity Disorder (ADHD) was compared to that of healthy controls and individuals with mild psychiatric disorders including attentional complaints. Thirty adults in each group were examined on the Conners' Continuous Performance Test (CPT) and measures of attention, executive function, psychomotor speed, and arithmetic skills. The ADHD group performed lower than healthy controls on most measures. However when compared to the psychiatric group, the performances of the ADHD group were not significantly lower on any of the measures. Do executive function deficits differentiate between adolescents with ADHD and oppositional defiant/conduct disorder? A neuropsychological study using the Six Elements Test and Hayling Sentence Completion Test J Abnorm Child Psychol 2000 Oct;28(5):403-14
Two neuropsychological measures of executive functions--Six Elements Tests (SET) and Hayling Sentence Completion Test (HSCT)-were administered to 110 adolescents, aged 12-15 years. Participants comprised four groups: Attention Deficit Hyperactivity Disorder (ADHD) only (n = 35). ADHD and Oppositional Defiant Disorder/Conduct Disorder (ODD/CD) (n = 38), ODD/CD only (n = 11), and a normal community control group (n = 26). Results indicated that adolescents with ADHD performed significantly worse on both the SET and HSCT than those without ADHD, whether or not they also had ODD/CD. The adolescents with ADHD and with comorbid ADHD and ODD/CD were significantly more impaired in their ability to generate strategies and to monitor their ongoing behavior compared with age-matched controls and adolescents with ODD/CD only. It is argued that among adolescents with clinically significant levels of externalizing behavior problems, executive function deficits are specific to those with ADHD. The findings support the sensitivity of these two relatively new tests of executive functions and their ecological validity in tapping into everyday situations, which are potentially problematic for individuals with ADHD. Executive functions and developmental psychopathology. J Child Psychol Psychiatry 1996 Jan;37(1):51-87
In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS). Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research. Quantitative EEG and Auditory Event-Related Potentials in the Evaluation of Attention-Deficit/Hyperactivity Disorder: Effects of Methylphenidate and Implications for Neurofeedback Training J. F. Lubar, M. O. Swartwood, J.
N. Swartwood, D. L. Timmermann Neurophysiological correlates of Attention Deficit Disorder with and without Hyperactivity (ADD/HD) and effects of methylphenidate are explored using electroencephalographic (EEG) and auditory eventrelated potentials (ERPs). In the first of four studies, a database of ADD/HD individuals of varying ages and matched adolescent/adult controls is presented. Study 2 compares controls and age-matched children with ADD, and children with ADHD on and off methylphenidate. Study 3 examines habituation of the auditory ERPs of controls and children with ADHD both on and off methylphenidate. The relationship between successful neurofeedback training and EEG changes is presented in Study 4. Overall, these studies support a neurologic basis for ADD/HD and raise questions regarding the role of methylphenidate in modulating cortical processing. http://www.snr-jnt.org/NFBArch/Reprints/jl-jpa.htm Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder. J Neuropsychiatry Clin Neurosci 1994
Summer;6(3):245-9 Neuropsychiatric and neuropsychological evaluations were performed in a pilot study of adolescents with DSM-III-R disruptive behavior disorders, including conduct disorder (CD) and attention-deficit hyperactivity disorder (ADHD). The following comparisons were made: 1) CD comorbid with ADHD vs. CD only; 2) all subjects with ADHD vs. all non-ADHD; and 3) all subjects with CD vs. all non-CD. The CD + ADHD group had increased left-sided soft signs compared with the CD group. CD + ADHD subjects significantly underperformed CD subjects on several executive functioning measures, with no differences on Verbal IQ subtests. Results are discrepant with previous findings of deficient verbal functioning in delinquent populations. Establishing an EEG Norm-Base for ADD v. non-ADD Review of a journal article by Troy Janzen, Ken Graap, Stephan Stephanson, Wilma Marshall, and George Fitzsimmons, "Differences in Baseline EEG Measures for ADD and Normally Achieving Preadolescent Males" Biofeedback and Self-Regulation, Vol. 20, No. 1, 1995, pp. 65-82. Three well known tests (WISC-R, WRMT-R, WRAT-R) were administered to all subjects prior to the main part of the study, a series of cognitive tests performed while connected to a 19 lead EEG cap. Findings: The most consistent finding was that ADD subjects have significantly higher theta amplitudes (p < .05) for all sites at both baseline and while performing cognitive tasks. There were also differences in the ratios of theta to beta and theta to SMR for baseline and all tasks at all sites, but the differences were significant only for some tasks at the parietal sites. The raw beta and SMR amplitudes themselves were not significantly different between the two groups. The authors conclude that although the number of subjects was small, there were significant differences that could be observed. These findings form a starter set of data for additional efforts. http://www.snr-jnt.org/NFBArch/Abstracts/na_blt2.htm
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Attentional
difficulties in hyperactive and conduct-disordered children: a processing
deficit.
J Child Psychol Psychiatry 1994 Oct;35(7):1229-45 A random population sample of 1479 Chinese boys from Hong Kong was screened and diagnosed in a two-stage epidemiological study. Four groups, age 7-8, were distinguished: (1) a pure hyperactive group (HA), (2) a mixed hyperactive/conduct-disordered group (HA+CD), (3) a pure conduct-disordered group (CD), and (4) a normal control group (N). On a visual search task, only the HA children showed a specific processing deficit in performance. This confirms the diagnostic value of such a deficit for hyperactivity, differentiating it from conduct disorder. The failure to find a similar deficit in the HA+CD group raises questions concerning the clinical identity of these children. Each group showed a performance decrement over time in the visual search task but the decrement did not differ between the four groups. This observation is not congruent with the reports of a short attention span in hyperactive children; explanations of this apparent contradiction are considered. Naming Speed Performance and Stimulant Effects Indicate Effortful, Semantic Processing Deficits in Attention-Deficit/Hyperactivity Disorder. Author/s: Rosemary Tannock Issue:
June, 2000 This study investigated rapid automatized naming and effects of stimulant medication in school-age children with attention-deficit/hyperactivity disorder (ADHD) with and without concurrent reading disorder (RD). Two ADHD groups (67 ADHD only; 21 ADHD + RD) and a control group of 27 healthy age-matched peers were compared on four variables: color naming speed, letter naming speed, phonologic decoding, and arithmetic computation. Discriminant function analysis (DFA) was conducted to predict group membership. The four variables loaded onto two discriminant functions with good specificity: phonologic decoding, letter naming speed, and arithmetic defined the first function; color naming speed defined the second function. Both ADHD groups were significantly slower in color naming than controls, but did not differ from one another. DFA correctly classified 96% of the control group, 91% of ADHD + RD, and 82% of ADHD only. A subset of children in the ADHD groups participated subsequently in an acute, randomized, place bo-controlled, crossover trial with three single doses (10, 25, 20 mg) of methylphenidate. Methylphenidate selectively improved color-naming speed but had no effect on the speed of naming letters or digits. These findings challenge the tenet that naming speed deficits are specific to RD and implicate naming speed deficits associated with effortful semantic processing in ADHD, which are improved but not normalized by stimulant medication. Task Switching and Attention Deficit Hyperactivity Disorder. Author/s: Nicholas J. Cepeda Issue: June, 2000 The main goal of the present set of studies was to examine the efficiency of executive control processes and, more specifically, the control processes involved in task set inhibition and preparation to perform a new task in attention deficit hyperactivity disorder (ADHD) and non-ADHD children. This was accomplished by having ADHD children, both on and off medication, and non-ADHD children perform the task-switching paradigm, which involves the performance of two simple tasks. In nonswitch trials, an individual task is performed repeatedly for a number of trials. In switch trials, subjects must rapidly and accurately switch from one task to the other, either in a predictable or unpredictable sequence. Switch costs are calculated by subtracting performance on the nonswitch trials from performance on the switch trials. These costs are assumed to reflect the executive control processes required for the coordination of multiple tasks. ADHD children showed substantially larger switch costs than non-ADHD children. However, when on medication, the ADHD children's switch performance was equivalent to control children. In addition, medication was observed to improve the ADHD children's ability to inhibit inappropriate responses. These data are discussed in terms of models of ADHD and cognition.
Confirmation of an Inhibitory Control Deficit in Attention-Deficit/Hyperactivity Disorder.Author/s: Russell Schachar Issue: June, 2000 The objective of this study was to determine whether deficient inhibitory control distinguishes children with a diagnosis of attention-deficit/hyperactivity (ADHD) disorder, conduct disorder (CD), and comorbid ADHD + CD from normally developing children. Participants were rigorously diagnosed children (age 7 to 12 years) with ADHD (N = 72), CD (N = 13) or ADHD + CD (N = 47) and 33 control children (NC). We studied inhibitory control using the stop-signal paradigm, a laboratory task that assessed the ability to inhibit an ongoing action. The ADHD group had significantly impaired inhibitory control compared to NC, CD, and ADHD + CD children. These results indicate that children with ADHD have deficient inhibition as measured in the stop-signal paradigm and that ADHD occurring in the presence of ADHD + CD may represent a phenocopy of CD rather than a variant of ADHD. |
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Structural Neurology and Attention Deficit Hyperactivity Disorder ADD ADHD ADHD PET Scan Brain scan images produced
by positron emision tomography (PET) show differences between an adult
with Attention deficit Hyperactivity Disorder (ADHD) (right) and an adult
free of the disease (left). Source: Alan Zametkin, M.D.
Brain Scan Found Effective in Diagnosing Attention Disorder New York Times Syndicate -
December 16, 1999 Brain scans have identified a clear-cut chemical abnormality in people with attention deficit-hyperactivity disorder, a problem that makes life difficult for an estimated 3 to 5 percent of US schoolchildren, scientists say.. It could be a first step toward a long-sought objective test for ADHD, say researchers at Harvard Medical School and Massachusetts General Hospital.
Brain Differences in Attention Deficit Disorder Scientists have strong new evidence that attention deficit disorder (ADD)--a condition in which children are hyperactive and have difficulty concentrating--stems from an abnormality in the brain. According to a report in today's Proceedings of the National Academy of Sciences, children with ADD have elevated nerve firing in a brain region involved in motor activity. In addition, the researchers found, Ritalin--the drug most commonly prescribed for the disorder--triggers a surprisingly different biochemical response in the brains of children with ADD than in those without the condition.
Researchers Identify Key Area of Brain Implicated in Children with Attention Deficit Hyperactivity Disorder March 28, 2000 BELMONT, Mass., March 28 (AScribe News) -- Researchers at McLean Hospital, using a new brain imaging technique they developed, have identified a key area of the brain that is underactive in children with attention deficit hyperactivity disorder (ADHD). The technique, a new form of functional magnetic resonance imaging (fMRI), also enabled the researchers to show how Ritalin restored function in ADHD children who were demonstrably hyperactive
Review of Neuroimaging Studies of Child and Adolescent Psychiatric Disorders From the Past 10 Years.(Statistical Data Included) Author/s: Robert L. Hendren ABSTRACT Objectives: To review recent neuroimaging studies of serious emotional disorders in youth and identify problems and promise of neuroimaging in clinical practice. Method: Published reports from refereed journals are briefly described, critiqued, and synthesized into a summary of the findings to date. Results: Childhood-onset schizophrenia shows progressive ventricular enlargement, reduction in total brain and thalamus volume, changes in temporal lobe structures, and reductions in frontal metabolism. Autistic disorder is associated with cerebellar changes, greater total brain and lateral ventricle volume, and asymmetry. The prefrontal cortex and the basal ganglia are consistently reported as abnormal in attention-deficit/hyperactivity disorder. Patients with anorexia nervosa show enlarged CSF spaces and reductions in gray and white matter that are only partially reversible with weight recovery. Conclusions: Results from neuroimaging studies of childhood-onset psychiatric disorders suggest consistency in the structures found to be abnormal, but inconsistencies in the nature of these abnormalities. Although neuroimaging technology holds great promise for neurodevelopmental research, it is not yet a diagnostic instrument. J. Am. Acad. Child Adolesc. Psychiatry 2000, 39(7):815-828.
Subtle Brain Circuit Abnormalities Confirmed in ADHD EMBARGOED FOR RELEASE: JULY 15, 1996 Subtle structural abnormalities in the brain circuit that inhibits thoughts have been confirmed in the first comprehensive brain imaging study of Attention Deficit Hyperactivity Disorder (ADHD). Difficulty staying mentally focused is a primary symptom of ADHD, which affects about 5 percent of school age children. Magnetic Resonance Imaging (MRI) scans of 57 boys with ADHD, aged 5-18, also revealed that their brains were more symmetrical than those of 55 age-matched controls. F. Xavier Castellanos, M.D., of the National Institute of Mental Health and colleagues report on their findings in the July issue of the Archives of General Psychiatry. Three structures in the affected circuit on the right side of the brain -- prefrontal cortex, caudate nucleus and globus pallidus -- were smaller than normal in the boys with ADHD, when examined as a group. The prefrontal cortex, located in the frontal lobe just behind the forehead, is believed to serve as the brain's command center. The caudate nucleus and globus pallidus, located near the middle of the brain, translate the commands into action. "If the prefrontal cortex is the steering wheel, the caudate and globus are the accelerator and brakes," explained Castellanos. "And it's this braking or inhibitory function that is likely impaired in ADHD." ADHD is thought to be rooted in an inability to inhibit thoughts. Finding smaller right hemisphere brain structures responsible for such "executive" functions strengthens support for this hypothesis. The NIMH researchers also found that the entire right cerebral hemispheres in boys with ADHD were, on average, 5.2% smaller than those of controls... more
Using MRI to Examine Brain-Behavior Relationships in Males With Attention Deficit Disorder With Hyperactivity. Author/s: Margaret Semrud-Clikeman ABSTRACT Objective: The relationship between neuropsychological measures of inhibition and sustained attention and structural brain differences in the regions of the caudate and the frontal region was examined in males with attention deficit disorder with hyperactivity (ADD/H). Method: Ten males with ADD/H (aged 8-17) and 11 male controls (aged 9-18) participated in a neuropsychological evaluation and had a magnetic resonance imaging scan. Results: As had been reported previously by these authors, the children with ADD/H were found to have reversed asymmetry of the head of the caudate, smaller volume of the left caudate head, and smaller volume of the white matter of the right frontal lobe. Children with ADD/H were found to score more poorly on measures of inhibition and sustained attention but not on measures of IQ, achievement, or motor speed. Comparison of neuropsychological measures and brain structure measures indicated a significant relationship between reversed caudate asymmetry and measures of inhibition and e xternalizing behavior; i.e., children with reversed caudate asymmetry performed more poorly on measures of inhibition regardless of group membership. Poorer performance on sustained attention tasks was related to smaller volume of the right-hemispheric white matter. Conclusions: There is emerging evidence that compromised brain morphology of selected regions is related to behavioral measures of inhibition and attention. J. Am. Acad. Child Adolesc. Psychiatry, 2000, 39(4):477-484. Key Words: magnetic resonance imaging, attention-deficit hyperactivity disorder, neuropsychology, assessment.
Atypical Frontal Brain Activation in ADHD: Preschool and Elementary School Boys and Girls.(Statistical Data Included) Author/s: Lioba Baving Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder that significantly hampers psychosocial adaptation (e.g., Biederman et al., 1996; Tannock, 1998). Several findings point to the involvement of a right-sided frontostriatal dysfunction in ADHD symptoms. An alerting network for maintaining a vigilant state is assumed to be localized in the right frontal lobe (Posner and Petersen, 1990). This hypothesis is supported by the fact that the development of attention in normal children correlated with magnetic resonance imaging (MRI)-derived morphometric measures of the anterior cingulate, particularly the right (Casey et al., 1992). Adults and children with focal, especially frontal, right-hemispheric lesions display behavior problems comparable with those in children with ADHD, such as inattention, defective response inhibition, and impersistence (Heilman et al., 1991). Findings of structural neuroimaging studies underscore the assumption of a right frontal deficit in ADHD. Using MRI, abnormal - though markedly diverging - findings in several brain regions (e.g., basal ganglia, corpus callosum) were reported in children with ADHD (Filipek, 1999; Tannock, 1998), but all studies examining the frontal region found the right anterior frontal cortex to be smaller than in nonADHD children (Casey et al., 1997; Castellanos et al., 1996; Filipek et al., 1997; Hynd et al., 1990). Casey et al. (1997) correlated performance of ADHD children and control children in 3 response inhibition tasks with MRI-based anatomical measures of the prefrontal cortex and the basal ganglia. Significant negative correlations between task performance and volume of the prefrontal cortex and caudate nuclei emerged, predominantly in the right hemisphere, suggesting that the right frontostriatal circuitry is intimately involved in response inhibition.
Genetics and Attention Deficit Hyperactivity Disorder ADD ADHD New genetic link to ADHD NEW YORK, Sep 15 (Reuters Health) - Researchers have found a gene alteration that may contribute to attention deficit hyperactivity disorder (ADHD) in some children. The risk levels associated with the new alteration, in the dopamine receptor gene DRD4, are similar to those linked to a previously identified variant of DRD4, the researchers note.
The role of genetic factors in conduct disorder based on studies of Tourette syndrome and attention-deficit hyperactivity disorder probands and their relatives. J Dev Behav Pediatr 1995 Jun;16(3):142-57 Comings DE Department of Medical Genetics, City of Hope Medical Center, Duarte, California 91010, USA. To examine the role of genetic factors in oppositional defiant disorder (ODD) and conduct disorder (CD), 38 variables relating to the relevant DSM-III-R criteria, as well as other angry and aggressive behaviors, were examined in 1177 Tourette syndrome (TS) and attention-deficit hyperactivity disorder (ADHD) probands, their first-degree relatives, and controls. Two techniques were used: (1) a genetic loading technique comparing the frequency of symptoms in groups with progressively less genetic loading for Gts and ADHD genes, and (2) comparison of the frequency of symptoms in relatives with, versus relatives without, TS or ADHD. When significant, the latter rules out ascertainment bias and inappropriate controls. For TS, the results were significant with most p values less than 10(-8). The same trends were seen in the smaller number of ADHD families. A polygenic model is proposed in which TS and ADHD alone represent lesser degrees of genetic loading and expression, and TS + CD not equal to ADHD represents a higher degree of genetic loading and expression of genes common to all three disorders. These studies emphasize the important role of genetic factors in ODD and CD. The therapeutic implications are discussed.
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Genetics Fact Sheets: National Institute of Mental Health Attention-Deficit Hyperactivity Disorder Phenotype:Attention-deficit hyperactivity disorder (ADHD) has its onset in childhood and is characterized by developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Epidemiology: In a large sample from the U.S. population, the prevalence of ADHD (male: female ratio) in school-age children was 6.7 percent (5.1:1)[2]. Depending on the use of adaptive functioning ratings to define definite maladjustment, prevalence estimates of 6.6 percent and 9.5 percent Family Studies: Several studies demonstrate that ADHD aggregates in families [13-15]. The rates in probands' sibs in three older studies [16-18] ranged from 17 percent to 41 percent, with respective rates in controls' sibs ranging from zero to 8 percent [16, 17]. Rates of childhood ADHD in parents of hyperactive probands in several older studies ranged from 15 percent to 44 percent for fathers and 4 percent to 38 percent for mothers [19-22], although one study found no evidence of an increased rate of childhood ADHD in parents of ADHD probands Twin Studies: Two small twin studies found that 4 of 4 [34] and 3 of 3 [35] MZ twins were concordant for ADHD. A larger twin study [33] reported respective MZ and dizygotic (DZ) probandwise concordance rates of 51 percent and 33 percent, with a heritability estimate of 64 percent. Adoption Studies: Increased rates of hyperactivity or a history of hyperactivity have been found among both adopted-away sibs of children with ADHD [43] and the biological parents of hyperactive boys compared with controls [21, 44, 45]. Mode of Inheritance: Deutsch and colleagues found limited evidence in a small sample [46] for an incompletely penetrant autosomal dominant single major locus transmission. A segregation analysis of a different data set [25] also resulted in statistical evidence -- including estimates of transmission parameters that were not significantly different from Mendelian expectations -- for an incompletely penetrant dominant or additive autosomal single major locus [47]. Low penetrance estimates predicted that only 46 percent of boys and 31 percent of girls with the ADHD gene would develop the disorder. Molecular Genetic Studies: A population-based association study reported evidence of an association between ADHD and an allele at the dopamine D2 receptor gene on 11q (p = 0.0003) [48], but this finding has not been replicated and was most likely an artifact of population stratification. The Tranmission Disequilibrium Test (TDT) [49] was used in a family-based association study to identify an association between ADHD and a specific allele at the dopamine transporter locus on 5p (p = 0.006) [50]. Another population-based association study found an association between ADHD and an allele at the dopamine D4 receptor on 11p (p = 0.01) [51].
Adoptive and Biological Families of Children and Adolescents With ADHD. Author/s: Susan Sprich ABSTRACT Objective: Using an adoption study design, the authors addressed the issue of genetics in attention-deficit hyperactivity disorder (ADHD). Method: This study examined the rates of ADHD and associated disorders in the first-degree adoptive relatives of 25 adopted probands with ADHD and compared them with those of the first-degree biological relatives of 101 nonadopted probands with ADHD and 50 nonadopted, non-ADHD control probands. Results: Six percent of the adoptive parents of adopted ADHD probands had ADHD compared with 18% of the biological parents of nonadopted ADHD probands and 3% of the biological parents of the control probands. Conclusion: Results of this study lend support to the hypothesis that ADHD has a genetic component. J. Am. Acad. Child Adolesc. Psychiatry, 2000, 39(11):1432-1437. Key Words: adoption, attention-deficit hyperactivity disorder, family study.
Etiology of Inattention and Hyperactivity/impulsivity in a Community Sample of Twins with Learning Difficulties. Author/s: Erik G. Willcutt Erik G. Willcutt [1,3] Bruce F. Pennington [2] John C. DeFries [1] A community sample of 373 8 to 18 year-old twin pairs in which at least one twin in each pair exhibited a history of learning difficulties was utilized to examine the etiology of inattention and hyperactivity/impulsivity (hyp/imp). Symptoms of attention-deficit/hyperactivity disorder (ADHD) were assessed by the DSM-III Diagnostic Interview for Children and Adolescents. Inattention and hyp/imp composite scores were created based on results of a factor analysis. Results indicated that extreme ADHD scores were almost entirely attributable to genetic influences across several increasingly extreme diagnostic cutoff scores. Extreme inattention scores were also highly heritable whether or not the proband exhibited extreme hyp/imp. In contrast, the heritability of extreme hyp/imp increased as a linear function of the number of inattention symptoms exhibited by the proband. This finding suggests that extreme hyp/imp may be attributable to different etiological influences in individuals with and without extreme inatten tion. If this result can be replicated in other samples, it would provide evidence that the hyp/imp symptoms exhibited by individuals with Combined Type ADHD and Predominantly Hyp/Imp Type ADHD may be attributable to different etiological influences.
Genetics of Childhood Disorders: XX. ADHD, Part 4: Is ADHD Genetically Heterogeneous? Author/s: Stephen V. Faraone Reviews of the literature leave no doubt that genes influence the etiology of attention-deficit/hyperactivity disorder (ADHD) (Faraone et al., 1998). Notably, twin studies show the heritability of ADHD to be about 0.80, indicating that the effect of genes is substantial. These genetic epidemiological studies have motivated molecular genetic studies of ADHD that have produced intriguing but conflicting results (Faraone and Biederman, 1998). Researchers have focused on genes in dopamine pathways because animal models, theoretical considerations, and the effectiveness of stimulant treatment implicate dopaminergic dysfunction in the pathophysiology of the disorder. Two genes that have been intensively studied are the dopamine transporter gene (DAT) and the dopamine D4 receptor gene (DRD4). Some studies of these genes strongly suggest that they influence susceptibility to ADHD. There are, however, several negative studies for each gene. The inconsistent results from molecular genetic studies could mean that rather than being a unitary disorder, ADHD comprises several disorders having different genetic and nongenetic etiologies.
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Medical Treatment Issues and Attention Deficit Hyperactivity Disorder ADD ADHD Psychiatrists Say Schools Steer Parents To Over Medicate Kids New York Times Syndicate WASHINGTON - Psychiatric leaders warned Congress Friday that too many educators are urging parents of problem children to give them prescription drugs rather than address their real problems at home or school. Dr. Peter R. Breggin, director of the International Center for the Study of Psychiatry and Psychology, a nonprofit research group in Bethesda, Md., said school officials are pressing parents to give such children stimulant drugs such as Ritalin, Concerta, Metadate, Dexedrine and Adderall. "Teachers, school psychologists and administrators commonly make dire threats about their inability to teach children without medicating them,'' Breggin told a panel of the House Committee on Education and the Workforce.
Reduction of (3H)-imipramine binding sites on platelets of conduct-disordered children. Neuropsychopharmacology 1987 Dec;1(1):55-62 Stoff DM, Pollock L, Vitiello B, Behar D, Bridger WH Medical College of Pennsylvania, Eastern Pennsylvania Psychiatric Institute, Department of Psychiatry, Philadelphia. Binding characteristics of tritiated imipramine on blood platelets were determined in daytime hospitalized prepubertal children who had mixed diagnoses of conduct disorder (CD) plus attention deficit disorder hyperactivity (ADDH) and in inpatient adolescents who had a history of aggressive behavior. The number of (3H)-imipramine maximal binding sites (Bmax) was significantly lower in the prepubertal patient group of CD plus ADDH; the dissociation constant (Kd) was not significantly different. There were significant negative correlations between Bmax and the Externalizing or Aggressive factors of the Child Behavior Checklist when the CD plus ADDH prepubertal patients were combined with their matched controls and within the adolescent inpatient group. We propose that a decreased platelet imipramine binding Bmax value, as an index of disturbed presynaptic serotonergic activity, is not specific to depression and may be used as a biologic marker for the lack of behavioral constraint in heterogeneous. populations of psychiatric patients.
Cerebrospinal fluid monoamine metabolites, aggression, and impulsivity in disruptive behavior disorders of children and adolescents. Arch Gen Psychiatry 1990 May;47(5):419-26 Kruesi MJ, Rapoport JL, Hamburger S, Hibbs E, Potter WZ, Lenane M, Brown GL National Institute of Mental Health, Child Psychiatry Branch, Bethesda, MD 20892. Cerebrospinal fluid levels of 5-hydroxyindoleacetic acid, a metabolite of serotonin, were measured in relation to aggression, impulsivity, and social functioning in 29 children and adolescents with disruptive behavior disorders. The cerebrospinal fluid 5-hydroxyindoleacetic acid level was low compared with that of age-, sex-, and race-matched patients with obsessive-compulsive disorder. Within the disruptive group, significant negative correlations with age-corrected 5-hydroxyindoleacetic acid level were seen for the child's report of aggression toward people and the expressed emotionality of the child toward his or her mother; other correlations of age-corrected 5-hydroxyindoleacetic acid level with measures of aggression were in the expected negative direction but did not reach statistical significance. Impulsivity per se and socioenvironmental factors were not significantly related to cerebrospinal fluid 5-hydroxyindoleacetic acid concentration.
Treatment Services for Children With ADHD: A National Perspective.(attention deficit hyperactivity disorder)(Statistical Data Included) Author/s: Kimberly Hoagwood ABSTRACT Objective: To summarize knowledge on treatment services for children and adolescents with attention-deficit hyperactivity disorder (ADHD), trends in services from 1989 to 1996, types of services provided, service mix, and barriers to care. Method: A review of the literature and analyses from 2 national surveys of physician practices are presented. Results: Major shifts have occurred in stimulant prescriptions since 1989, with prescriptions now comprising three fourths of all visits to physicians by children with ADHD. Between 1989 and 1996, related services, such as health counseling, for children with ADHD increased 10-fold, and diagnostic services increased 3-fold. Provision of psychotherapy, however, decreased from 40% of pediatric visits to only 25% in the same time frame. Follow-up care also decreased from more than 90% of visits to only 75%. Family practitioners were more likely than either pediatricians or psychiatrists to prescribe stimulants and less likely to use diagnostic services, provide mental health counseling, or recommend follow-up care. About 50% of children with identified ADHD seen in real-world practice settings receive care that corresponds to guidelines of the American Academy of Child and Adolescent Psychiatry. Physicians reported significant barriers to service provision for these children, including lack of pediatric specialists, insurance obstacles, and lengthy waiting lists. Conclusions: The trends in treatment services and physician variations in service delivery point to major gaps between the research base and clinical practice. Clinical variations may reflect training differences, unevenness in the availability of specialists and location of services, and changes in health care incentives. J. Am. Acad. Child Adolesc. Psychiatry 2000, 39(2):198-206. Key Words: services, treatments, attention-deficit hyperactivity disorder.
Association of the Dopamine Transporter Gene (DAT1) With Poor Methylphenidate Response. Author/s: Bertrand G. Winsberg ABSTRACT Objective: This study attempted to relate the alleles of the [D.sub.2] (DRD2), [D.sub.4] (DRD4), and dopamine transporter (DAT1) genes to the behavioral outcome of methylphenidate therapy. Method: African-American children with attention-deficit hyperactivity disorder were treated with methylphenidate in doses not in excess of 60 mg/day. The dosage was increased until behavioral change was achieved, using a decrement in scores of less than or equal to 1 on a commonly used rating scale or until the maximum tolerated dose was achieved. Blood samples were obtained at that point, and genotypes for polymorphism at the respective genes were identified. Results: Genotypes were then tested by [X.sup.2] to assess the significance of any association with drug response. Only the dopamine transporter gene was found to be significant. Homozygosity of the 10-repeat allele was found to characterize nonresponse to methylphenidate therapy (p = .008). Conclusions: While the results suggest that alleles of the dopamine transpor ter gene play a role in methyiphenidate response, replication in additional studies is needed. J. Am. Acad. Child Adolesc. Psychiatry 1999, 38(12):1474-1 477. KeyWords: attention-deficit hyperactivity disorder, drug response, dopamine transporter, molecular genetics. http://www.findarticles.com/cf_
Do typical clinical doses of methylphenidate cause tics in children treated for attention-deficit hyperactivity disorder? Author/s: Samule F. Law Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood, affecting up to 6.0% of school-age children. Methylphenidate (MPH) is the drug treatment of choice for ADHD in North America: 75% of cases are treated with this medication (Barkley, 1990; Jacobvitz et al., 1990; Safer and Krager, 1988). Although MPH has been widely prescribed for several decades, there is persistent concern about the potential for MPH to precipitate tics (Bradley, 1950; Shapiro and Shapiro, 1981; Weiss et al., 1971) or Tourette's disorder (Erenberg et al., 1985; Golden, 1974; Lowe et al., 1982), both in subjects with preexisting tics and in those without. By comparison, an emerging body of literature (Gadow et al., 1995a,b; Gadow and Sverd, 1990; Konkol et al., 1990; Sverd et al., 1989) has asserted that MPH may be a safe and effective treatment, even for children with ADHD and Tourette's disorder.
The Association of ADHD and Creativity Cramond, B. 1995 The National Research Center on the Gifted and Talented. http://borntoexplore.org/adhd.htm
National Institutes of Health Consensus Development Conference Statement: Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder (ADHD). Issue: Feb, 2000 ABSTRACT Attention-deficit/hyperactivity disorder (ADHO) is a commonly diagnosed behavioral disorder of childhood that represents a costly major public health problem. Despite progress, ADHD and its treatment have remained controversial, especially the use of psychostimulants for both short- and long-term treatment. Although an independent diagnostic test for ADHD does not exist, there is evidence supporting the validity of the disorder. Studies (primarily short-term, approximately 3 months), including randomized clinical trials, have established the efficacy of stimulants and psychosocial treatments for alleviating the symptoms of ADHD and associated aggressiveness and have indicated that stimulants are more effective than psychosocial therapies in treating these symptoms. Because of the lack of consistent improvement beyond the core symptoms and the paucity of long-term studies (beyond 14 months), there is a need for longer-term studies with drugs and behavioral modalities and their combination. Although trials are under way, conclusive recommendations concerning treatment for the long term cannot be made at present. There are wide variations in the use of psychostimulants across communities and physicians, suggesting no consensus regarding which ADHD patients should be treated with psychostimulants, and thus the need for improved assessment, treatment, and follow-up. Furthermore, the lack of insurance coverage, preventing the appropriate diagnosis and treatment of ADHD, and the lack of integration with educational services are substantial barriers and represent considerable long-term costs for society. Finally, after years of clinical research and experience with ADHD, knowledge about the cause or causes of ADHD remain largely speculative. Consequently, there are no documented strategies for the prevention of ADHD, J. Am. Acad. Child Adolesc. Psychiatry, 2000, 39(2):182-193. Key Words: attention-deficit/hyperactivity disorder, diagnosis, treatment, psychostimulants, risks, barriers.
Behavioral Issues and Attention Deficit Hyperactivity Disorder ADD ADHD Behavioral and neuropsychological correlates of hyperactivity and inattention in Brazilian school children. Brito GN, Pereira CC, Santos-Morales TR Dev Med Child Neurol 1999 Nov;41(11):732-9 Departamento de Pediatria, Instituto Fernandes Figueira, Fundacao Oswaldo Cruz, Brazil. ccsgnob@vm.uff.br Attempts at subtyping attention-deficit-hyperactivity disorder (ADHD) along the hyperactivity dimension are considered controversial. This study addresses this issue by dividing a non-clinical sample of Brazilian children (mean age, 9.4 years; SD, 2.9), who were attending a mainstream school in the Greater Rio de Janeiro area, into four behavioral domain groups (normal [NO, N=324], hyperactive/impulsive [HI, N=17], inattentive [IA, N=48], and combined [C, N=13]) on the basis of teacher ratings on an ADHD scale. The groups did not differ in intellectual level as determined by the Human Figure Drawing test. Comparisons were made between groups along the factorial dimensions extracted from the Composite Teacher Rating Scale, academic performance and neuropsychological measures were then performed. Our data showed that IA and C children are less independent and more prone to socialization problems than NO children, and that HI and C children are less anxious and fearful than IA children. Furthermore, the groups differed in academic and neuropsychological performance. The results could be considered consistent with the hypothesis that ADD with hyperactivity (ADD/+) and ADD without hyperactivity (ADD/-) represent singular nosological entities.
Clinical correlates of ADHD in females: findings from a large group of girls ascertained from pediatric and psychiatric referral sources.(attention-deficit hyperactivity disorder) Author/s: Joseph Biederman Attention-deficit hyperactivity disorder (ADHD) is a common, heterogeneous disorder, conservatively estimated to affect 3% to 5% of school-age children (Anderson et al., 1987; Bird et al., 1988; Shaffer et al., 1996). Although ADHD is more prevalent in boys than in girls, little doubt exists that it is also an important cause of psychiatric disability in girls. While the exact prevalence of the disorder in females remains unclear, it may not be minor. Assuming a conservative male-female ratio of 5:1 and a combined prevalence rate of only 3%, the sex-specific prevalence of ADHD in females could be 1%, which would indicate that at least 1 million girls and women in the United States may be affected with ADHD (Arnold, 1995, 1996).
Diagnostic Issues and Attention Deficit Hyperactivity Disorder ADD ADHD Clinical utility of the test of variables of attention (TOVA) in the diagnosis of attention-deficit/hyperactivity disorder Journal of Clinical Psychology Volume 54, Issue 4, 1998. Pages: 461-476 Published Online: 6 Dec 1998 Ability of the Test of Variables of Attention (TOVA) to distinguish between referred children with attention-deficit/hyperactivity disorder (ADHD) and other (OTHER) clinical diagnoses were studied. The ADHD group differed from the OTHER group on TOVA variables and most measures from the Revised Conners Teacher Rating Scale (RCTRS) and ADD-H Comprehensive Teacher's Rating Scale (ACTeRS). The criteria of any one TOVA variable > 1.5 standard deviations from age and sex adjusted means correctly identified 80% of the sample with attention deficit disorders and 72% of the sample without attention deficit disorder. Cases misclassified by teacher ratings were often correctly classified by the TOVA and conversely. The TOVA makes a unique and important contribution to diagnostic evaluations. (c) 1998 John Wiley & Sons, Inc. J Clin Psychol 54: 461-476, 1998. http://www3.interscience.wiley.com/cgi-bin/abstract/31228/START
Brain Scan Found Effective in Diagnosing Attention Disorder New York Times Syndicate - December 16, 1999 RICHARD SALTUS Brain scans have identified a clear-cut chemical abnormality in people with attention deficit-hyperactivity disorder, a problem that makes life difficult for an estimated 3 to 5 percent of US schoolchildren, scientists say.. It could be a first step toward a long-sought objective test for ADHD, say researchers at Harvard Medical School and Massachusetts General Hospital. http://neuroscience.about.com/
Effects of reward and response cost on response inhibition in AD/HD, disruptive, anxious, and normal children. Author/s: Jaap Oosterlaan Attention deficit/hyperactivity disorder (AD/HD) has been conceptualized as a disorder which arises from a deficit in the capability for response inhibition (e.g., Barkley, 1994, 1997; Douglas, 1989; Newman & Wallace, 1993; Pennington & Ozonoff, 1996; Quay, 1988a, 1988b, 1997; Wender, 1972). That is, a failure to suppress inappropriate responding has been postulated to underlie the inattentive, hyperactive, and impulsive behavior that characterizes AD/HD. Recently, however, the primacy of the response inhibition deficit has been called into question (e.g., Sonuga-Barke, 1995). That is, the possibility exists that the impairment in response inhibition in fact is only one aspect of a more general dysfunction. For example, it has been suggested that poor response inhibition originates from a frontal lobe deficit (Barkley et al., 1992; Pennington & Ozonoff, 1996; Shue & Douglas, 1992) or a lag in the development of the cognitive functions (Barkley, 1997; Barkley et al., 1992; Shue & Douglas, 1992). In the present study, we examine the possibility that poor response inhibition in AD/HD children actually is one of the many manifestations of a disinclination to invest effort, or stated differently, reflects a motivational deficit. Different lines of research seem to converge in indicating that AD/HD children do not have the same motivational set as normal children. One line of research, aimed at localizing possible deficits in the information processing system, suggests that AD/HD children do not expend the effort necessary to perform optimally (see for reviews, Sergeant & Van der Meere, 1990a, 1990b, 1994; Van der Meere, 1996). A second line of research suggests that the performance of AD/HD children seems to rely more strongly on the presence of contingencies than the performance of normal children (e.g., Douglas, 1985, 1989; Haenlein & Caul, 1987; Newman & Wallace, 1993; Quay, 1988a, 1988b, 1997; Wender, 1972).
Reformulating Attention-Deficit/Hyperactivity Disorder According to Signal Detection Theory. Author/s: Victor Lewis Mota ABSTRACT Objective: The current diagnostic algorithm for attention-deficit/hyperactivity disorder (ADHD) is not highly predictive of impairment and yields low interrater agreement. The objective of this study was to enhance the diagnostic accuracy of ADHD by identifying the symptoms that are associated with impairment. Method: Semistructured interviews and impairment rating scales were administered to parents and teachers of 218 children. Combinations of ADHD symptoms were examined according to a receiver operating characteristic (ROC) based procedure to create diagnostic algorithms that predict impairment. Results: In comparison with the DSM-IV, the ROC-based algorithms were 2 to 3 times more efficient in discriminating impaired from nonimpaired children. Parent and teacher agreement was also 3 times higher. Conclusions: Limiting the diagnosis to symptoms that predict impairment can increase the validity of the ADHD diagnosis. Results also support the use of ROC analyses in developing better diagnostic algorithms. J. Am. Acad. Child Adolesc. Psychiatry, 2000, 39(9):1144-1151. Key Words: attention-deficit/hyperactivity disorder, diagnostic efficiency, receiver operating characteristic.
Nutritional Issues in Attention Deficit Hyperactivity Disorder ADD ADHD Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management. Author/s: Parris M. Kidd Abstract Attention Deficit/Hyperactivity Disorder (ADHD) is the most common behavioral disorder in children. ADHD is characterized by attention deficit, impulsivity, and sometimes overactivity ("hyperactivity"). The diagnosis is empirical, with no objective confirmation available to date from laboratory measures. ADHD begins in childhood and often persists into adulthood. The exact etiology is unknown; genetics plays a role, but major etiologic contributors also include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants. Thyroid hypofunction may be a common denominator linking toxic insults with ADHD symptomatologies. Abnormalities in the frontostriatal brain circuitry and possible hypofunctioning of dopaminergic pathways are apparent in ADHD, and are consistent with the benefits obtained in some instances by the use of methylphenidate (Ritalin[R]) and other potent psychostimulants. Mounting controversy over the widespread use of methylphenidate and possible life-threatening effects from its long-term use make it imperative that alternative modalities be implemented for ADHD management. Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine (PS) can ameliorate ADHD symptoms. When individually managed with supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and other features of a wholistic/integrative program of management, the ADHD subject can lead a normal and productive life. (Altern Med Rev 2000;5(5):402-428)
Essential fatty acid metabolism in boys with attention deficit-hyperactivity disorder. Burgess, JR, et al. American Journal of Clinical Nutrition 1995; 62;761-68. Attention-deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism.
Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Burgess, JR, et al. American Journal of Clinical Nutrition 2000,Vol. 71, No. 1, 327-330. Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. We reported previously that a subgroup of ADHD subjects reporting many symptoms indicative of EFA deficiency (L-ADHD) had significantly lower proportions of plasma arachidonic acid and docosahexaenoic acid than did ADHD subjects with few such symptoms or control subjects. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n-3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n-3 fatty acids. The reasons for the lower proportions of long-chain polyunsaturated fatty acids (LCPUFAs) in these children are not clear; however, factors involving fatty acid intake, conversion of EFAs to LCPUFA products, and enhanced metabolism are discussed.
Dietary Polyunsaturated Polyunsaturated Fatty Acids and Depression: When Cholesterol Does Not Satisfy. Hibbeln, J.R., and N. Salem, Jr. American Journal of Clinical Nutrition 62 (1995): 1-9. Epidemiological studies in various countries and in the United States in the last century suggest that decreased n-3 fatty acid consumption correlates with increasing rates of depression. This is consistent with a well-established positive correlation between depression and coronary artery disease. Long-chain n-3 polyunsaturate deficiency may also contribute to depressive symptoms in alcoholism, multiple sclerosis, and post-partum depression. We postulate that adequate long-chain polyunsaturated fatty acids, particularly docosahexaenoic acid, may reduce the development of depression just as n-3 polyunsaturated fatty acids may reduce coronary artery disease.
Dark adaptation, motor skills, docosahexaenoic acid, and dyslexia. Stordy, Jacqueline Americal Journal of Clinical Nutrition, 71 (2000): 323-326. Dyslexia is a widespread condition characterized by difficulty with learning and movement skills. It is frequently comorbid with dyspraxia (developmental coordination disorder), the chief characteristic of which is impaired movement skills, indicating that there may be some common biological basis to the conditions. Visual and central processing deficits have been found. The long-chain polyunsaturated fatty acids (LCPUFAs) are important components of retinal and brain membranes. In the preliminary studies reported here, dark adaptation was shown to be impaired in 10 dyslexic young adults when compared with a similar control group (P < 0.05, repeated-measures analysis of variance); dark adaptation improved in 5 dyslexia patients after supplementation with a docosahexaenoic acid (DHA)rich fish oil for 1 mo (P < 0.05, paired t test on final rod threshold); and movement skills in a group of 15 dyspraxic children improved after 4 mo of supplementation with a mixture of high-DHA fish oil, evening primrose oil, and thyme oil (P < 0.007 for manual dexterity, P < 0.02 for ball skills, and P < 0.03 for static and dynamic balance; paired t tests).
Mineral Deficiencies and Behavior David, from England, wrote: I am following your work with great interest as I am trying to get more information about the subject of ADD / ADHD for a friend of mine who was put in charge of such a child at school. She was given no training for this work nor was she given any backup. She was relieved to find that she was not the only one with this problem! Although the child has finally been moved to another specialized school, it is likely that she will meet the problem again and so I am forwarding any relevant information to her that I can find. Best regards, and carry on the good work, David From "Sunday Times", July 1997 London, UK Zinc diet reduces violence in youths -- Steve Connor, Science Correspondent Scientists have discovered a link between violent behaviour and a chemical imbalance in the body that can be treated by diet. It raises the possibility of treating antisocial individuals with special nutrition. Studies carried out on 135 males aged between 3 and 20 with a history of violence have found that such individuals are much more likely to have high levels of copper and low levels of zinc compared with non-violent people. Scientists believe such minerals influence behaviour because the body uses them to make chemical transmitters in the brain." The article goes on to refer to the work of Dr. William Walsh of the Health Research Institute in Naperville, Illinois. Further, "preliminary experiments have shown that altering the diet of violent males can improve their behaviour". "It usually takes two to three months to overcome the copper-zinc imbalance." "Copper and zinc tend to be concentrated in the hippocampus of the brain and the hippocampus is known to be associated with stress control". "Zinc deficiencies in juvenile offenders were also found in an unpublished study in Britain, said Dr. Neil Ward, a senior lecturer in analytical chemistry at Surrey University. "We think that it is a direct result of exposure to heavy metal toxins such as cadmium and lead which prevent the absorption of zinc. The people we studied had a poor diet with excessive amounts of sugar and alcohol, which is also known to reduce zinc absorption," Ward said." "Stephen Schoenthaler, a leading authority at California State Institute on the role of diet in criminal behaviour, said Walsh's conclusions were plausible. "He is more right than wrong..."
02/August/1997 "Sunday Telegraph", London, U.K. Test Offers Cure for Violent Children by Victoria Macdonald, Health Correspondent (With reference to Attention Deficit Hyperactivity Disorder information) CHILDREN who are aggressive, violent and disruptive at home and school are showing marked improvements after taking a simple £11 laboratory test that can show they are suffering from a chemical imbalance. The urine test detects kryptopyrrole, a by-product of pyroluria, which means the body is depleted of zinc and vitamin B6. These are needed to control mood and behaviour. By identifying the condition, children are able to be given supplements to correct the metabolic imbalance. The Hyperactive Children's Support Group, based in Chichester, is pressing for wider use of the test because it fears disruptive children are being written off as "incurably bad". Sally Bunday, founder of the group, said: "Some of these children are on their last chance at school or have been expelled, or have already been in trouble with the police. All have shown some improvement and in a few cases it has been a remarkable improvement." The test is carried out at the Bio Lab Medical Unit in London. Based on studies carried out in Victoria, Canada, by Dr Abraham Hoffer, a psychiatrist and specialist in schizophrenia, it is then decided what level of supplements to give the child. Tommy Giovannelli, now aged 10, had been expelled from one school by six and was being threatened with a second expulsion at eight. His father, Nick, said Tommy was unable to concentrate, would throw tantrums for no apparent reason and would smash objects in the classroom. It was by chance that Mr. Giovannelli heard about the hyperactive children's group and from them learned of the test. Tommy was found to have zinc levels 55 per cent below normal. Within weeks of giving him supplements and removing all additives from his diet, his behaviour had changed beyond recognition. At Baverstock School in Birmingham, six children have now been given the test. Barbara Parkes, a specialist in teaching dyslexics, said: "I am convinced that the behaviour of large numbers of young offenders is due to poor diet." Andrew, a pupil at Baverstock School, could not concentrate, would beat people up and would talk manically throughout lessons. When the test result came back it showed he had a very high imbalance. Now Andrew has shown a dramatic improvement. "He even asked for extra work for the school holidays," Mrs Parkes said."
OUR COMMENTS ON THE ARTICLES About two years ago I ran hair sample tests on 10 ADD kids to see what I'd find. According to the norms of the lab that did the testing, none of the kids were within the normal ranges. However, none of the kids were alike. Some were high in heavy metals, some were not. Some were low in certain minerals, some were not. I could not discern patterns. However, there was one thing that did stick out. Every child whose parents smoked was very high in Cadmium (a toxic heavy metal) levels. Is this a cause for alarm? I have no idea. But it was interesting to note, and I did ask the parents to stop smoking. Someday when I'm rich and don't have to work for a living, I will take about 100 ADD ADHD kids and get hair samples done and see what we get. Maybe someone out there has already done it?
As time goes on I am becoming more and convinced that nutritional supplements can play a significant role in the treatment of ADD ADHD and other behavior disorders. No, I don't think that they are the ONLY or the BEST treatment options. I believe that many elements need to be looked at in treatment, including Moral Training, Parenting Classes, Family Counseling, Medications, EEG Biofeedback Training, and Nutritional Interventions. We have seen the ATTEND and EXTRESS products make significant contributions to the lives of children with ADHD and ADD. They are products that you should strongly consider.
An extensive list of other research studies involving Creative/Gifted aspects of ADD ADHD children, and an extensive list of studies involving Nutrition and ADD ADHD can be found at Born to Explore, the Other Side of ADD http://borntoexplore.org/studies.htm |
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Disclaimer: The information on Attention Deficit Hyperactivity Disorder presented here in the ADD Information Library is for educational purposes only. It is not intended to replace the expert and professional advice of your physician, psychologist, or therapist. Always seek help from qualified professionals in the field of attention deficit disorder. Always consult your physician.
