What Is Attention Deficit Disorder?

What Is Attention Deficit Hyperactivity Disorder - ADD or ADHD?

Attention Deficit Hyperactivity Disorder, often called ADD or ADHD, is a diagnostic label that we give to children and adults who have significant problems in four main areas of their lives:

• Inattention,
• Impulsivity,
• Hyperactivity,
• and Boredom.

Attention Deficit Hyperactivity Disorder is a neurologically based disorder.

This position has become controversial as many would like to dismiss the diagnosis of Attention Deficit Hyperactivity Disorder altogether saying that there is no evidence of neurological differences, or that there are no medical tests to diagnose ADD ADHD, or that the diagnostic criteria is too broad.

But there is an overwhelming amount of research to support the statement that, indeed, Attention Deficit Hyperactivity Disorder is a neurologically based condition. We discuss this in great detail in the neurology of the ADHD brain and offer plenty of ADHD research information.

ADHD is not the result of "bad parenting" or obnoxious, willful defiance on the part of the child.

Yes, a child may be willfully defiant whether he has Attention Deficit Hyperactivity Disorder or not.

Defiance, rebelliousness, and selfishness are more often "moral" issues than neurological issues. We make no excuses for "immoral," "selfish," or "destructive" behaviors, whether from individuals with ADD ADHD or not.

It may be true that the child or teen's parents may need further or more in-depth training on parenting defiant children. We are constantly amazed at how many young parents today themselves grew up in homes where their own parents were gone all day. We now see "grown up latch key kids" trying to parent as best as they can, but without having had the benefit of growing up with good parental role models. This is a problem that can be solved with some training. But it is not Attention Deficit Hyperactivity Disorder.

Neurologically based Attention Deficit Hyperactivity Disorder is what we explore here at the ADD ADHD Information Library.

Defining Terms: "Attention Deficit Hyperactivity Disorder"

Attention Deficit Hyperactivity Disorder is a medical condition, caused by genetic factors that result in certain neurological differences.

ADHD is one of the most common childhood behavior disorders. It is seen in about 5% of all children and teenagers. Children with ADHD have impaired functioning in a variety of settings, including at home, in school, and in relationships with peers. If untreated, ADHD children can have long-term adverse effects into adolescence and adulthood. About 3% of the population has "adult adhd."

Attention Deficit Hyperactivity Disorder comes in a variety of types.

We have our own way of describing the different types of ADHD that is easy for both parents and children to understand.

In the American Psychiatric Association's DSM IV manual, the different types of ADHD all fall under the main category of Attention Deficit Hyperactivity Disorder (ADHD). The main category is then subdivided into

• ADHD Inattentive Type
• ADHD Impulsive-Hyperactive Type
• ADHD Combined Type

In the recent past the terms attention deficit disorder "with hyperactivity" or "without hyperactivity" were also commonly used. Attention Deficit Hyperactivity Disorder comes in various forms, and truly, no two ADD ADHD kids are exactly alike.

General Description of Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder might affect one, two, or several areas of the brain, resulting in the different "styles" or "profiles" of children (and adults) with ADD ADHD. These different profiles impact performance in these four areas:

• Inattention, which is a problem with losing focus and not being good at paying attention to the right thing at the right time
• Impulsivity, which is a problem with a lack of impulse control, or a lack of self-control
• Hyperactivity, which is a problem with over-activity or motor restlessness - always "on the go"
• Finally, a problem which is not yet an "official" problem found in the diagnostic manuals, but ought to be: being easily bored, especially if the task is not interesting, or is only somewhat interesting

A few other important characteristics of this disorder are:

1) That it is SEEN IN MOST SITUATIONS, not just at school, or just in the home. When the problem is seen only at home, we then would wonder if perhaps the child is depressed, or if the child is just being non-compliant with the parents;

2) That the problems are apparent BEFORE the AGE OF SEVEN (7).

Since Attention Deficit Hyperactivity Disorder is thought to be a neurologically based disorder, we would expect that outside of acquiring its symptoms from a head injury, the individual with Attention Deficit Hyperactivity Disorder would have been born with the disorder. Even though the disorder might not become much of a problem until the second or third grade when the school work becomes more demanding, one would expect that at least some of the symptoms were noted before the age of seven.

ADHD: a Real Mental Health Problem

Is ADHD Real?

Yes, it is a REAL mental health problem - it really is an attention deficit disorder.

There are lots of objections to ADHD made below, and they are in BOLD. And my answers follow.

At best it was a dialogue, at worst a debate of sorts. In 2000 I was homebound with pneumonia when someone brought me a copy of the Journal of Biblical Counseling with an article by Ed Welch on ADD ADHD. Since I am both a Pastor, and a Family Therapist, they wanted my opinion on the article.

My opinions are clear below. Please use this response to the article as a teaching tool - a tool that I hope will both sharpen critical thinking skills, and lay out sufficient evidence for Attention Deficit Disorder to stand as a valid medical problem in the minds of those who wish it were not so...

To: David Powlison, Editor. Journal of Biblical Counseling

RE: What You Should Know About Attention Deficit Disorder by Edward T. Welch

Dear Sir,

It was with some interest that I read the article What You Should Know About Attention Deficit Disorder by Edward Welch after having it handed to me by a member of our church.

There were elements of the article that were insightful, helpful, and needed to be said in a public forum, especially the discussion of the moral and spiritual dimensions of behavior. For this part of the article I applaud Mr. Welch.

However, Mr. Welch's discussion on the physiological and biological aspects of ADD ADHD was lacking to the point of being misleading to the readers. I am sure that Mr. Welch had no intention of misleading any readers, as that would hardly reflect the "biblical guidelines with which to understand ADD" that he seeks to communicate.

Therefore, for the sake of clarifying some details, may I present the following evidence. Perhaps in the near future you would run an article that would present some of this information to your readers, so that they have an accurate understanding of the disorder.

"As with everything we read and hear, Christians should assimilate this information with biblical discernment. The material on ADD is often interesting and helpful, but it is not Scriptural. Therefore, it can be prone to unbiblical assumptions and errors." - p 58

This is true. Yet it would be better placed in the context that all Truth is from God, and that there is extensive research data, objective research data, which seeks to discover Truth. Though this data can be incorrectly interpreted and wrongly used, valid research data describes the objective functioning of a system, person, brain, or whatever is being studied.

"Other books use a biological approach, claiming that brain functioning explains every behavior." - p 58

I might say that I have read several books on the biological realities of ADD ADHD, and brain functioning in general, and none of them have claimed "that brain functioning explains every behavior."

They do, however, point out the differences in both structure and function of a brain with ADD ADHD, or other disorders, vs. brains without these disorders. It is misleading to suggest that "books (using) a biological approach" make such a claim. Perhaps one or two do, but I am not familiar with any at all.

"In other words, their attention is inconsistent rather than universally poor." - 59

This is a fair description, although a better description would be that their attention is "inflexible."

People with neurological difficulties, whether ADHD, head injuries, autism, fetal alcohol syndrome, forms of depression, or dementias, have varying degrees of neurological inflexibility .

Neurological flexibility is a sign of a healthy brain.

It is the ability to move attention from "global" forms of attention to "specific" forms of attention at will, in a fraction of a second. These various types of attention are objective and observable (with PETS, SPECTs, EEGs, QEEGs, and other technologies). People with ADD have difficulty moving from specific to global, or global to specific, styles of attention.

It should be noted that inflexibility of attention is a marker of a neurological problem, though by itself is not diagnostic of any specific problem.

"First, ADHD is not a precisely circumscribed set of symptoms. The ever-present "often" in the diagnostic criteria betrays the loose boundaries of ADD, and it explains why Americans use the diagnosis so frequently. Almost anyone can squeeze into the parameters - at least on certain days." - p 59

This statement is also potentially misleading to the readers .

"The ever-present 'often' in the diagnostic criteria." is very similar to the "ever present" "nearly every day" in the diagnostic criteria for Depression.

The "often" is simply a realistic description of life for individuals with ADHD. It is not "always" as with a structural head injury. It is "often" because it is the result of neurological mechanisms being "often" under-aroused and "often" under-performing.

". . . and it explains why Americans use the diagnosis so frequently."

Studies show that about 5% of the population has ADHD. Over-diagnosis, if there is any, is not due to the diagnostic criteria, but rather to a lack of a comprehensive diagnostic work-ups by most physicians. Many physicians are simply lazy or too rushed to make a careful diagnosis.

"Almost anyone can squeeze into the parameters - at least on certain days."

This is misleading to the readers, and simply not true.

Remember, the DSM-IV also includes these important, and highly discriminating, criteria:

• Six or more symptoms of Inattention, having lasted at least six months , to a degree that is maladaptive ;
• Six or more symptoms of Impulsivity-Hyperactivity, having lasted at least six months , to a degree that is maladaptive ;
• Symptoms of the disorder were present before the age of seven ;
• Impairment is present in a variety of settings ; and
• There is clear evidence of clinically significant impairment in social, academic, or occupational functioning.

The reality is that barely anyone can "squeeze into these parameters." But about 5% of the population does.

It is careless to suggest that "anyone. at least on certain days" can meet the diagnostic criteria. It also conveys a negative picture of those who do actually suffer with the condition.

Would you publish a statement that read, "Almost anyone can squeeze into the parameters of Alzheimer's - at least on certain days?" I would certainly hope not, and yet it is published in connection with ADHD. This is disappointing.

"Second, ADHD is a description of behavior, not an explanation . It tries to describe symptoms rather than explain the causes of those symptoms." - 59

Again misleading, and out of context.

The authors of the DSM-IV themselves point out that they make no attempts to describe the etiology of any of the 300 or more diagnostic categories ranging from Alzheimer's to Trichotillomania.

It is not the purpose of the diagnostic criteria to explain the cause of a disorder, only to categorize the disorder in a realistic manner so that it can (1) be treated successfully, and (2) be researched effectively.

It is from the research that we find the explanation of the causes of ADHD, not from the diagnostic criteria. It is also disappointing that no research in the field was noted, as it would have been helpful to your readers. This leads to the next quote from Mr. Welch:

"The reason it is important to distinguish between description and explanation is that the ADHD literature typically does not distinguish between them. Most discussions about ADHD assume that the list of descriptions is equivalent to establishing a medical diagnosis."

The point is that the purpose of the diagnostic criteria is to establish a medical diagnosis. And the purpose of the diagnosis is for successful treatment and efficient research.

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADHD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are unsupported by evidence."

There are, in fact, biological causes for the behaviors. We cite just a few examples of the research below.

But what are these "behaviors" that we are talking about? The "behaviors" of the diagnostic criteria. We are not talking about behaviors with a moral basis such as hitting your sister. We are talking about the specific behaviors of the DSM-IV diagnostic criteria for ADHD.

"Although there are dozens of biological theories to explain ADHD, there are presently no physical markers for it;."

Just because there are dozens of theories, most of which will prove to be wrong and go away, does not mean that one (or more) of the theories are not accurate descriptions of reality. In fact, research shows that there are several "physical markers" of ADHD.

Here are a few articles, both from peer reviewed journals and from the media discussing peer reviewed journal articles, that might be of interest to your readers. They are just 15 studies or articles about the various biological underpinnings of ADHD.

It is certainly not a comprehensive list, as there have probably been more than 200 similar studies published in the past ten years alone. These are just the studies that I looked up last weekend for another project and already had in my word processor:

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/science/neuroscience/library/pr/blpr991216...

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
Clark C, Prior M, Kinsella GJ
School of Psychological Science, La Trobe University, Victoria, Australia.
[Record supplied by publisher]

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
Pennington BF, Ozonoff S
Department of Psychology, University of Denver, CO 80208, USA.

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.

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.
http://neuroscience.about.com/science/neuroscience/gi/dynamic/offsite.ht...

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.

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.

Neuropsychiatric and neuropsychological findings in conduct disorder and attention-deficit hyperactivity disorder.

J Neuropsychiatry Clin Neurosci 1994 Summer;6(3):245-9
Aronowitz B, Liebowitz M, Hollander E, Fazzini E, Durlach-Misteli C, Frenkel M, Mosovich S, Garfinkel R, Saoud J, DelBene D, et al
Department of Psychiatry, New York State Psychiatric Institute, New York.

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.

NIMH: Genetics Fact Sheets: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].

http://www.nimh.nih.gov/research/genetics.htm#gen12a

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
University of Tennessee

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 AD/HD and raise questions regarding the role of methylphenidate in modulating cortical processing.

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.

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.
Section on Clinical Brain Imaging, Laboratory of Cerebral Metabolism
Division of Intramural Research Programs, NIMH, 1990
http://www.nimh.nih.gov/publicat/adhdbrain.cfm

Attentional difficulties in hyperactive and conduct-disordered children: a processing deficit.

J Child Psychol Psychiatry 1994 Oct;35(7):1229-45
Leung PW, Connolly KJ
Department of Psychology, Chinese University of Hong Kong, Shatin, New Territories.

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.

Researchers Identify Key Area of Brain Implicated in Children with Attention Deficit Hyperactivity Disorder

March 28, 2000 McLean Hospital AScribe Newswire

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

http://neuroscience.about.com/science/neuroscience/library/pr/blpr000328...

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.

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.
http://onhealth.webmd.com/family/briefs/wire/item,100745.asp

Neuropsychological deficits in adolescent-onset schizophrenia compared with attention deficit hyperactivity disorder.

Am J Psychiatry 1999 Aug;156(8):1216-22
Oie M, Rund BR
National Centre for Child and Adolescent Psychiatry, University of Oslo, Norway.

OBJECTIVE: Impaired neuropsychological performance involving abstraction-flexibility, memory, motor function, and attention has frequently been reported in schizophrenia as well as in attention deficit hyperactivity disorder (ADHD).

This study represents an attempt to compare groups of adolescents with schizophrenia and ADHD on a comprehensive neuropsychological test battery. Such a comparison affords the opportunity to ascertain differences in the degree, profile, and specificity of impairments.

Neuropsychological functioning of adults with attention deficit hyperactivity disorder.

J Clin Exp Neuropsychol 2000 Feb;22(1):115-24
Walker AJ, Shores EA, Trollor JN, Lee T, Sachdev PS
Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, Australia.

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.
http://mentalhelp.net/adhd/research/

As you can see, these studies focus on different issues, though most examine either executive functions, or the locations of the brain involved in executive functions, attention, or memory.

It would be hard to conclude that because there are several neurological differences in the brains of ADHD individuals vs. non-ADHD individuals, that somehow that equated to there being no neurological differences.

Once again.

"The popular assumption is that there is an underlying biological cause for the behaviors, but the assumption is unfounded. Although there are dozens of biological theories to explain ADD, there are presently no physical markers for it; there are no medical tests that detect its presence. Food additives, birth and delivery problems, inner ear problems, and brain differences are only a few of the theories that are. unsupported by evidence."

". . . there are presently no physical markers for it;"

As shown above, this statement is not supported by research.

There are many physical markers for it. One just needs a fMRI, SPECT scan, QEEG, or PET scan, to see them.

I have personally performed hundreds of EEGs and some QEEGs, and can attest first hand to the differences in brainwave patterns of ADD ADHD individuals vs. non-ADD ADHD subjects.

". . . there are no medical tests that detect its presence."

This is also misleading to the readers.

Many, if not most, biologically based medical conditions are diagnosed by the observation and experience of a trained clinician or physician. Many medical conditions have no "medical tests" that detect its presence.

For example, I am presently house-bound recovering from pneumonia which has nearly killed me.

Until July, 2000, there were no "medical tests" that detect the presence of pneumonia. Just last summer a urine test was approved by the FDA which is between 75% and 80% accurate in diagnosing pneumonia. There are no blood tests, or other forms of "medical tests" to diagnose it.

My pneumonia was diagnosed solely on the observation and experience of the physician, after another physician the day before examined me and told me I had the flu.

The doctor who made the life-saving diagnosis listened to my breathing and coughing. He observed and interpreted a chest x-ray. Then he made a judgment, a diagnosis, based on observation and experience (not on empirical, objective results from any medical tests), and began treatment.

The x-ray, my coughing, etc., gave him evidence of a condition only. He had no "medical tests" (he did not try the new urine test) to tell him if I had viral pneumonia, bacterial pneumonia, or mycoplasmic pneumonia. Yet based on observation and experience he started a course of treatment. The treatment involved the use of powerful medications, and the treatment has so far been beneficial.

The fact that there are no blood tests - "medical tests" - to diagnose pneumonia is hardly evidence that I am not suffering from a medical condition.

ADHD is also diagnosed by clinicians through observation and experience.

The clinician would rely on developmental, family, academic, and genetic histories, behavioral rating scales, and objective testing. There are tests, psychological and neurocognitive tests, that are extremely helpful in making a diagnosis, such as continuous performance tests and other tests of executive functions.

There aren't any blood or urine tests - "medical tests" - as Mr. Welch would say. But that does not invalidate the biological basis for the condition.

"There are some medical problems that can provoke ADD symptoms. For example, thyroid problems can affect energy level, and hearing or visual impairments can make paying attention difficult."

Yes, these are true. But they describe thyroid problems, and hearing or visual problems, completely separate medical conditions which happen to share some symptoms with ADHD. They do not cause Attention Deficit Hyperactivity Disorder. Depression and anxiety can cause symptoms that look like ADD, but they are not ADD. A head injury can cause symptoms that look like ADD, but a head injury is not ADD.

The neurological problems that cause ADHD are the cause of ADHD. Mr. Welch is simply unwilling to admit that there is a neurological, biological, physiological basis for a very real condition called ADHD. His position, however, is not supported by the reality presented in the research.

"That a stimulant drug would help some children focus seems paradoxical. You would expect that children would be even more physically and mentally excitable when taking it."

First, the effects of Ritalin, or any stimulant including caffeine, are not "paradoxical" in ADHD individuals. They are predictable. And they are effective.

Two significant contributors to ADHD are a lack of dopamine, or an effective lack of dopamine, in the frontal lobes, and a restriction of blood flow in the frontal lobes. Research supports this.

Stimulants, from caffeine to Ritalin, are known to do two things well: increase blood flow, and increase dopamine levels in the brain. Therefore it is not paradoxical at all. One would expect that stimulants would increase performance for individuals with this condition, and they do in about 75% to 80% of the cases.

"One thing, however, is clear. Ritalin does not treat any known chemical deficiency in a child's brain."

What research supports this position? Why is this "clear?"

Ritalin does in fact "treat known chemical (deficiencies) in a child's brain."

It does in fact increase the utilization of dopamine. This is similar to other medications, such as antidepressants, used treat other known brain chemical deficiencies such as a lack of seratonin.

While it is true that stimulants to not "fix" the condition, this does not take away from its usefulness. Insulin does not "fix" diabetes either. But in the short-term stimulants, like Insulin, works to "normalize" or at least "improve" the situation. To say that stimulants "are not a cure" is true. Insulin is not a "cure" either. But both are helpful.

Thank you for your time in considering this perspective.

Sincerely,

Douglas L. Cowan, Psy.D., M.S.

What is NOT ADHD

There are a lot of situations that can look like attention deficit hyperactivity disorder in children or teens, but is NOT ADHD.

A Careful Diagnostic Exam for ADHD is Needed

This is why a careful ADHD diagnostic evaluation is so important. A physician, or mental health professional, must spend quality, and quantity, time to rule out other conditions that can look like ADHD. This conditions include:

• Pervasive Developmental Disorder or PDD
• Asperger's Disorder
• Tourette's Disorder (Tourette's Syndrome) or Tic Disorder
• Mental Retardation
• Schizophrenia, or other Psychotic Disorder
• Bipolar Disorder or Manic Depression
• Depression or other Mood Disorders
• Anxiety Disorder
• Oppositional Defiant Disorder
• Conduct Disorder
• Fetal Alcohol Syndrome (prenatal exposure to alcohol)
• In Utero (prenatal) Drug Exposure
• Brain damage at birth
• Head Injury or Brain Trauma
• Mercury, Copper, Nickel or Other Heavy Metal Toxicity from Dental Work such as fillings or braces
• Specific Learning Disability or Disabilities
• Laziness
• Disobedience

Each one of the items on this list should be ruled out by diagnostic evaluation for ADHD.

ADD vs ADHD

It can be a bit confusing, but the "difference between ADD and ADHD" is really just a matter of terms.

Difference Between ADD and ADHD

Once the American Psychiatric Association's diagnostic manual (DSM 3) referred to the disorder as either "Attention Deficit Disorder - with hyperactivity" or "Attention Deficit Disorder - without hyperactivity." This is how the two terms "ADD" (without hyperactivity) or "ADHD" (with hyperactivity) were formed.

Way back in 1994 the APA came out with the new manual (DSM 4) that changed the category to "Attention Deficit/Hyperactivity Disorder" and then described three sub-categories:

• Attention Deficit/Hyperactivity Disorder, Predominantly Inattentive Type
• Attention Deficit/Hyperactivity Disorder, Predominantly Hyperactive-Impulsive Type
• Attention Deficit/Hyperactivity Disorder, Combined Type

At this point the term "ADD" was really obsolete, but it was part of the cultural vocabulary.

On the internet it is very difficult to use the term "ADD" as it looks like a word used in mathematics, or on forms to insert an item. "ADD Child" might mean a child with attention disorder, or that you should have another baby, or that there is a list that you should add another name to.

So on the internet today the most common term is "ADHD" and for the sake of the good ol' days we refer often to "ADD ADHD".

Causes of ADHD

What Causes Attention Deficit Hyperactivity Disorder ?

The most recent models describing Attention Deficit Hyperactivity Disorder suggest that several areas of the brain may be affected by the disorder. These include the

• frontal lobes
• inhibitory mechanisms of the cortex
• limbic system
• reticular activating system

Each of these areas of the brain is associated with various functions, or qualities, or abilities.

Causes of ADHD

Watch this video: The CAUSES OF ADHD

From Medical News Today (used by permission) this video explores what ADHD really means, and how many children and adults may have it. What are the supposed causes and symptoms of ADHD? How is it diagnosed? Join our panel of experts as they address these questions and more.

Neurological Causes of ADHD

The frontal lobes help us to pay attention to tasks, focus concentration, make good decisions, plan ahead, learn and remember what we have learned, and behave appropriately for the situation.

The inhibitory mechanisms of the cortex keep us from being hyperactive, from saying things out of turn, and from getting mad at inappropriate times, for examples. They help us to "inhibit" our behaviors.

It has been said that 70% of the brain is there to inhibit the other 30%.

When the inhibitory mechanisms of the brain aren't working as hard as they ought to, then we can see results of what are sometimes called "dis-inhibition disorders" such as impulsive behaviors, quick temper, poor decision making, hyperactivity, and so on.

The limbic system is the base of our emotions and our highly vigilant look-out tower. If over-activated, a person might have wide mood swings, or quick temper outbursts. He might also be "over-aroused," quick to startle, touching everything around him, hyper-vigilant.

A normally functioning limbic system would provide for normal emotional changes, normal levels of energy, normal sleep routines, and normal levels of coping with stress. A dysfunctional limbic system results in problems with those areas.

Different Types of ADHD

The Attention Deficit Hyperactivity Disorder might affect one, two, or all three of these areas, resulting in several different "styles" or "profiles" of children (and adults) with ADD ADHD.

Daniel Amen, a medical doctor using SPECT scans, has identified six different types of ADHD, each with its own set of problems, and each different from the other "types."

Dr. Amen is a scientist, but we are story-tellers.

In our office we also described different "types" of ADHD, but instead of using advanced SPECT technology, we used Winnie the Pooh stories to describe the different types.

• Pooh is inattentive, with his head in the clouds
• Tigger is hyperactive, and "bouncy"
• Eeyore is depressed, as are about 25% of children with ADHD
• Piglet is anxious and easily startled
• Rabbit is rigid and inflexible, and wants his way

Here provide more detail on the Neurology of Attention Deficit Hyperactivity Disorder - ADD ADHD.

ADHD Myths

Myths About ADHD

View the ADHD MYTHS Video from Medical News Today

There's been a lot of talk in recent years about attention deficit hyperactivity disorder, also known as ADHD. And with all the talk has come a lot of misinformation. Is this a real disease? If so, what are the causes? And how is it diagnosed? Join our panel as they help us separate fact from fiction.

Our Favorite ADHD Myths

Here are the Top 10 "ADHD Myths" that are popular on the internet or on talk radio. Follow the links below for our discussion on each of these "ADHD myths."

• ADHD does not really exist at all. It was created by psychiatrists, or drug companies, or psychologists, or the media, to create more business.
• ADHD does not really exist at all. It was created by psychiatrists, or drug companies, or psychologists, or bad parents, to create an excuse for children who act like "brats."

Here is a long reply to an article that maintained that ADHD was not a real mental health or medical condition. About 10 significant arguments are examined and rebutted with facts. Check it out!

• Psychiatrists are all evil. Therefore if they say there is such as thing as ADHD, they must be wrong, and ADHD must be evil.

Here is a rebuttal to the Church of Scientology, since they are behind most of the push for these myths.

• ADHD does not really exist at all. It is just a sign of exceptional intelligence, or exceptional creativity that is misunderstood by teachers, parents, doctors, and researchers.
• Children who can concentrate on things that they enjoy, like video games or television, cannot possibly have ADHD.
• Medication is horrible, terrible, sinful, dangerous, awful, and it turns anyone who uses it into a lifeless zombie or drug addict.
• Medication is the only treatment options that works. "If the treatment doesn't have side-effects, it can't possibly work."
• The only nation in the world that uses Medication for ADHD is the United States.
• ADHD is over diagnosed, and over treated by doctors.
• Here's your medication. There's nothing to worry about. ADHD medications are absolutely safe.
• Drug companies aren't in it for the money, they just care about kids with ADHD.

Here we have rewritten the "ADHD myths" into statements of facts.

Drug Exposed Babies or Fetal Alcohol Syndrome vs. ADHD

Prevalence of Drug Exposed Children or Fetal Alcohol Syndrome vs. ADHD

A recent study by the National Institute of Drug Abuse reported the following:

• 5.5% of women REPORTED using illicit drugs while they were pregnant;
• 18.8% REPORTED using alcohol;
• 20.4% REPORTED using tobacco while pregnant.

This compares to about a 5% rate in the population for a genetically based Attention Deficit Disorder in children and teens.

5% ADHD vs 10% Brain Damaged Due to Mother's Drugs or Alcohol Use

In our rural California county it is reported that 10% of all children born in the county were exposed to drugs or alcohol in utero by their mothers.

There are no known "safe levels" of drug, alcohol, or tobacco use while pregnant. The use of drugs or alcohol are especially dangerous to the developing baby and can often cause neurological problems.

When these children enter school, they often display:

• problems with paying attention,
• poor impulse control, a lack of self-control,
• temper outbursts, little control of temper once it begins,
• learning disabilities, problems in school,
• behavior problems and social problems.

Head Injuries Result from FAS or Drug Exposure

These children are often misdiagnosed as having a genetically based Attention Deficit Hyperactivity Disorder, but what they really suffer from are structural brain injuries thanks to their mother's past behaviors.

They will also respond to treatment more poorly than will a child with ADHD. Parents must have very realistic expectations for treatment with either medications, diet, attend, or therapy when the problem is a structural head injury rather than ADHD.

Any of these treatments can help to optimize brain performance, which is always helpful, but won't give the "day and night improvements" that an ADHD child might receive.

Of course there are many things that can cause head injuries in babies. And these head injuries may look a lot like attention deficit hyperactivity disorder later in childhood. Some of these head injuries are caused by events completely our of our control, like accidents. But many of these problems are completely within the control of the mother while she is pregnant with her child, and this is tragic.

Prevalence of ADHD

ADHD Prevalence: How Many People Have ADHD?

Attention Deficit Hyperactivity Disorder - "ADD" or "ADHD" - affects about five percent (5%) of the children in the United States, and about three percent (3%) of all adults in the USA.

How Big of a Problem is Attention Deficit Hyperactivity Disorder?

About 35% of all children referred to mental health clinics are referred for Attention Deficit Hyperactivity Disorder, or ADHD. It is one of the most prevalent of all childhood psychiatric disorders.

You may see published estimates stating that Attention Deficit Hyperactivity Disorder may effect as many as 10% to 25% of children in America, but these numbers are not really supported by research data, and are probably inflated for the purpose of trying to sell something.

The 5% number is a solid number supported by research. The National Institute of Mental Health is estimating 7% of children with ADHD. Even at 5% each classroom in America will have one or two (2) ADHD kids in the class. So it is a very real, and very significant problem across America.

Why Does It Seem That There Are More Children With Attention Deficit Hyperactivity Disorder Than Before?

Even though the percentage of people with Attention Deficit Hyperactivity Disorder is likely the same as in the past, here are three likely reasons why it seems that "there is more ADHD" than ever before:

• You are more aware of problems like this as a parent than you were as a child. You have grown up now;
• The news and entertainment media have talked about Attention Deficit Hyperactivity Disorder a lot more than in the past, raising your awareness level;
• Children who were Drug Exposed in utero, or Fetal Alcohol Syndrome children have many of the same problems as children with Attention Deficit Hyperactivity Disorder, and are often misdiagnosed by physicians as being ADD ADHD.

Drug Exposed Babies or Fetal Alcohol Syndrome vs. ADHD

A recent study by the National Institute of Drug Abuse reported the following:

• 5.5% of women REPORTED using illicit drugs while they were pregnant;
• 18.8% REPORTED using alcohol;
• 20.4% REPORTED using tobacco while pregnant.

  And tobacco use during pregnancy increases the risk of ADHD in children. A study published in the June 15, 2007 issue of Biological Psychiatry presents new evidence that in utero exposure to smoking is associated with attention deficit/hyperactivity disorder (ADHD) problems in genetically susceptible children.

  Rosalind Neuman, Ph.D., one of the study's authors, explains the findings: "When genetic factors are combined with prenatal cigarette smoke exposure, the ADHD risk rises very significantly - 3 to 9 fold."

  John H. Krystal, M.D. adds, "These data highlight a new risk of maternal smoking, increasing the risk for ADHD in their children. ADHD, in turn, increases the risk for substance abuse. Thus, it appears that in utero exposure to nicotine may help to perpetuate a cycle across generations that links addiction and behavioral problems."

  The article is "Prenatal Smoking Exposure and Dopaminergic Genotypes Interact to Cause a Severe Subtype" by Rosalind J. Neuman, Elizabeth Lobos, Wendy Reich, Cynthia A. Henderson, Ling-Wei Sun and Richard D. Todd. All authors are from the Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri. The article appears in Biological Psychiatry, Volume 61, Issue 12 (June 15, 2007), published by Elsevier.

In our rural California county it is estimated that 10% of all children born in the county were exposed to drugs or alcohol in utero by their mothers.

There are no known "safe levels" of drug, alcohol, or tobacco use while pregnant. The use of drugs or alcohol are especially dangerous to the developing baby and can often cause neurological problems. When these children enter school, they often display problems with attention, impulse control, temper, learning, and behavior. They are often misdiagnosed as having a genetically based Attention Deficit Hyperactivity Disorder.

What they really suffer from are structural brain injuries thanks to their mother's past behaviors.

"Attention" and ADHD

Defining "Attention" in ADHD

When we talk about attention, we are talking about two different kinds of abilities:

• The ability to focus on a specific task put in front of us to do, such as school work, and
• the ability to pay attention in a more global sense to the world around us, for example the buzz of the lights overhead, and the touch of the clothes on your skin, and the children playing outside of the classroom.

These are two different kinds of attention.

Paying Attention

One good definition of "Paying Attention" is - “Sustaining and selecting to the right cue.”

One part of that definition is that the child has to pick the right thing to pay attention to. That's the “selecting” part of the definition.

A better word might be "Filtering." The brain is supposed to filter out distractions, or stimuli which compete for our attention, but might not be important at that moment.

Many children with attention problems pay attention to everything in the world around them equally, such as giving equal time to the touch of the clothes on their skin, the buzz of the lights overhead, the kids outside the classroom, and the math worksheet in front of them. This, of course, is a problem if he needs to be paying attention to only the math worksheet or the teacher.

Boring School Work

Many Children with Attention Disorders have trouble concentrating on the specific task in front of them, especially if they are working on something like school work or chores that are only moderately interesting, or not interesting at all.

ADHD kids have to be very motivated, very excited, very interested in what they're doing in order to pay attention.

Now, you might be thinking, "This is not my kid. I have a kid who could play Nintendo, and be so focused that the house could burn down around him, and he'd never notice."

Well, that could be. A lot of these kids could do just exactly that.

Nintendo is interesting, its challenging, and its fun. Kids get immediate feedback, they could play Nintendo for hours.

But just put a math worksheet in front of them and see how different it is. They have a terrible time paying attention to something that's not interesting or that's not motivating, which accounts for about 85% of school work, and about 100% of chores.

Lack of Flexibility with Attention

Part of the problem with Attention Deficit Hyperactivity Disorder – ADHD - is a lack of FLEXIBILITY with attention.

A person without ADHD has the ability to shift from attention that is focused on a specific task at hand to the kind of attention that is global many times in just a few seconds.

Whenever he wants, someone without ADHD can shift from reading a book, to scanning the room to know where our kids are and what they are doing, and then very quickly returning to focus on reading.

Without ADHD we have Flexibility in our ability to Focus. We can shift from specific focus to global focus at will and very quickly.

Individuals with ADHD do not have this same Flexibility of focus.

Those with Attention Deficit Hyperactivity Disorder – ADHD – have a very difficult time shifting from a global focus, such as they might have at recess or lunch break, to a specific focus that would be required when they return to the classroom to study math and work on the math worksheet in front of them.

This is why kids with Attention Deficit Hyperactivity Disorder – ADHD – could play Nintendo, be really focused on that task, and not notice the house burning down around them.

"Hyperactivity" and ADHD

What is “Hyperactivity”?

If you have a child who is hyperactive, you need no explanation. He's the one running across the ceiling. But for the rest of you, this is what we mean.

These are kids that act as if they are driven by a motor.

They "go." You wind them up in the morning and they "go" until they're finally exhausted, and then they go to sleep, maybe.

Some of these sleep pretty well during the night, and some of them hardly need sleep at all. Three hours of sleep and they're up and ready to go.

Each child is different, each child is unique.

Remember that there are several different types of Attention Deficit Hyperactivity Disorder – ADHD.

Hyperactivity Defined

One definition of hyperactivity is "high levels of non-goal directed motor activity."

A child with high levels of motor activity that is always directed at a goal may not be clinically hyperactive. He may be a future professional athlete or rocket scientist.

It's the kid who bounces from one activity to another, in a manner inappropriate for their age, which is our concern.

Hyperactivity is often thought of as the child being “over aroused.”

There is a part of your brain that is constantly scanning the environment to see if there are any changes in that environment.

If anything has changed, then that part of the brain asks the question, “Is this new thing in the environment good or bad? Is it something good to eat, or is it going to eat me? How should I feel about this new thing? Should I like it, or be afraid or it?”

In many ADHD kids who are hyperactive this part of the brain is overly sensitive, and the kids are seen as being easily startled or scared, overreacting to things, touching everything around them, and being very edgy.

They never seem to be able to just relax.

Some of these kids also have a very quick temper, a short fuse. They are sometimes explosive. They often lose friends because of their intensity and temper, and they often seem to run over people like a tornado.

But as we have said, a lot of ADHD kids are not hyperactive. And the kids who are not hyperactive tend to be girls, and they tend to sit in the back of the classroom and just quietly get C's and D's when everyone knows they should be getting A's and B's.

These kids with ADHD without hyperactivity are the one's being labeled as "lazy" and at the parent conferences the parents are told, "He or she could do better if they'd just try harder."

"Impulsivity" and ADHD

IMPULSIVITY

Impulsivity is found in two areas:

• Behavioral Impulsivity - the things that you do
• Cognitive Impulsivity - the way that you think and make choices



Behavioral Impulsivity

ADHD individuals with behavioral impulsivity don't stop and think first before they act.

No matter how many times you tell this kid, "stop and think first," the next time the situation comes up, he may well do the same impulsive thing again.

Children with ADHD often aren't learning from their past mistakes. Their learning threshold is very high, and if you don't excite them, or motivate them enough to get them above that learning threshold, they don't learn, and they make the same the same mistake again and again.

ADHD children with behavioral impulsivity often:

• act without thinking first,
• cut in line,
• can't wait their turn in line or in a game,
• blurt out answers in class,
• speak when they're supposed to be quiet,
• may show aggressive behaviors,
• are often a little too loud,
• sometimes fight,
• often have poor social skills, which of course is the death socially for teenagers with ADHD,
• impulsively say the wrong thing at the wrong time.

They can get one date, but they can't get the second date because they might impulsively blurt out something and then say, "Why did I say that?" The other teens are asking, "Who is this guy?" and often begin to avoid him.

Also, sometimes these kids fail to learn those subtle social cues that everybody else has learned, and so they're socially awkward and often don't know why.



Cognitive Impulsivity

Cognitive impulsivity means that they guess a lot.

Guessing is their problem solving method of choice. Cognitively impulsive ADHD kids will make a multiple number of guesses in a short period of time.

On a matching task, or if you give them multiple choices orally, you'll see them guess for the right answer very quickly, "it's this one, no, its this one, no, wait, its this one," until finally you step in and, when he guesses right, you'll say, "That's it!"

Of course this just reinforces his guessing.

These cognitively impulsive ADHD kids have very limited problem solving strategies.

They don't stop and look and the problem and then say, "Well, I could do it this way first, then do that, then I'll be done." They don't approach problem solving that way. They usually just guess and let trial and error take its course.

Being Fast is NOT a Problem

Now remember, being fast is not a problem. Some have pointed out that “being fast and accurate is good." It's fast and inaccurate that is a problem.

ADHD

ADHD and ADD are the common abbreviations for Attention Deficit Hyperactivity Disorder.
Attention Deficit Hyperactivity Disorder is one of the most common of all Childhood Behavior Disorders, and impacts from 5% to 7% of children and teenagers, and about 3% of all adults.

Characterized by inattention, impulsivity, and perhaps hyperactivity, we have found that there are several different types of ADHD. Each type has a different symptom profile, and each type requires a different treatment strategy for the most effective treatment. Learn about the different types of ADHD and specific treatment strategies for each type of ADHD.

There are a number of effective ADHD medications available today, including those made from methylphenidate, better known as Ritalin. ADHD medications are discussed in this section.

Great alternatives to ADHD medication are also available, including Attend, which is manufactured and sold by VAXA International, EEG Biofeedback training, and our ADHD diet recommendations. These ADHD alternative treatments can be used along with medications, or in many cases can be used instead of ADHD medications.

ADHD is a neurological condition with a genetic basis and we discuss the neurology of ADHD. There are also many conditions that look like ADHD, but are not. A good assessment for ADHD will take “differential diagnoses” into account.

Treatment options and treatment planning for ADHD are considered and discussed.

Articles specific to ADHD children and ADHD teenagers are available, as are articles specific to parents of ADHD children and teens. We also provide sections on reader’s ADHD questions and our answers, and Dr. Cowan’s thoughts (blog) on recent headlines on ADHD..

ADHD and IQ

ADHD is Not Related to IQ or Intelligence

Attention Deficit Hyperactivity Disorder is not related to I.Q.

Some parents are convinced that if their child has ADD ADHD it means that they are retarded. They see their child's poor performance in school or at home and just assume that the child is not very smart.

On the other hand, other parents say, "I've heard that AD/HD kids are really very, very bright. I think my child must have AD/HD," as if they wanted to wear a button that said, "My child is smarter than your child because he has AD/HD."

Well, that's ridiculous.

Some Attention Deficit Hyperactivity Disorder kids are below average I.Q., and some are even retarded.

Some AD/HD kids are above average I.Q., and some are even quite brilliant.

Most Kids are Average

But the awful truth for a parent to hear is that MOST kids are AVERAGE I.Q.

That's why they call it "average."

And most Attention Deficit Hyperactivity Disorder kids have average I.Q. as well. They just have a real tough time in the classroom setting.

In fact, if you think about it, the classroom setting is probably the worst possible setting for these kids. There are a lot of distractions, they are told to sit still, don't move, don't talk, to pay attention to boring worksheets, and keep on task until the work is finished. None of these things come easily to Attention Deficit Hyperactivity Disorder kids.

It is true that most ADHD kids will score poorly on certain of the IQ test's sub-tests, especially those that have to do with short-term memory or focused attention. And these specific deficits will pull down the over all IQ scores. But take those predictably poor areas of performance away and the great majority of AD/HD kids will be "average."

ADHD and the ADA

Recently the staff at the ADHD Information Library was asked if children with ADHD were protected under the American with Disabilities Act of 1990. This parent wrote that if in fact ADHD was included in the Disabilities Act, then perhaps her child was “being discriminated against."

The answer to the question is somewhat long and complicated. So we will begin with writing that while someone with ADHD may qualify for protection under the Americans with Disabilities Act, not everyone with the diagnosis of ADHD will qualify. And that may include you or your child.

Certainly parents want the very best for their children. And people tend to want everything that they feel that they are “entitled” to from the government. But sometimes we can expect too much from our public agencies, and sometimes we look to the wrong places for help. So let's examine the issue in detail.

The ADA and ADHD

The Americans with Disabilities Act was established by Congress in 1990. The purpose of the Act is to end discrimination against persons with disabilities when it comes to housing, education, public transportation, recreation, health services, voting, and access to public services. It also aims to provide equal employment opportunities for people with disabilities.

The ADA was written to offer protections to individuals with disabilities, not individuals with any particular diagnosis. The Americans with Disabilities Act seeks to protect individuals with significant impairments in function.

Since Congress enacted the ADA courts have had several challenges in defining the scope of the Act.

• What exactly is a disability?
• Who would be defined as having a disability?
• Is having a diagnosis the same as having a disability?

These are some of the questions that the courts have had to wrestle with, not to mention the questions related to how schools, work places, public transportation agencies, and more, are to implement the Act in daily operations with both employees and customers.

By the way, it is estimated that the population of the United States is over 300 million persons. And it is estimate that about 19% of persons have some type of long-lasting condition or disability. That would be somewhere near 60 million persons. This includes about 3.5% with a sensory disability involving sight or hearing, about 8% with a condition that limits basic physical activities such as walking or lifting. It also includes millions of people with mental, emotional, or cognitive impairments. See the details in the Census 2000 Brief titled, "Disability Status 2000" at http://www.census.gov/prod/2003pubs/c2kbr-17.pdf

So, to the Question: Is Attention Deficit Hyperactivity – ADHD – included in the ADA?

The answer is “Yes, No, or Maybe.”

The ADA defines “disability” as a physical or mental impairment that substantially limits
one or more “major life activities,” such as walking, seeing, hearing, or learning. Having a
diagnosed impairment, such as ADHD, does not necessarily mean that an individual is disabled within the meaning of the ADA.

The ADA does provide for "mental" conditions or mental illnesses, and potentially ADHD fits in this category. But as with physical impairments, the diagnosis of a mental illness or mental impairment such as ADHD is not sufficient by itself to qualify for protection under ADA. Again, having a “diagnosis” is not the same as having a “disability.”

ADHD ADA Court Cases

We are not lawyers, and our readers probably are not either, but it is interesting to look at some of the recent court cases regarding the ADA that directly related to children or adults with Attention Deficit Hyperactivity Disorder.

These two cases seem to expand the definition of “major life activities” to include concentration and cognitive functions:

• Brown v. Cox Medical Centers (8th Cir. 2002), where reportedly the court stated that the "ability to perform cognitive functions" is a major life activity;
• Gagliardo v. Connaught Laboratories, Inc. (3d Cir. 2002), where reportedly the court held that "concentrating and remembering (more generally, cognitive function)" are major life activities.
But the courts have placed limitations on the scope of the Act as well, and have not just tried to accommodate everyone with ADHD. The court has its limits, and they have ruled that the ADA has its limits.

For example Knapp v. City of Columbus (2006 U.S. App. LEXIS 17081) is the story of three firefighters with ADHD who wanted the City to make accommodations for them in their jobs. The U.S. Court of Appeals for the Sixth Circuit declined to extend ADA coverage to three firefighters who had Attention Deficit Hyperactivity Disorder.

Three firefighters had claimed that ADHD substantially limited their ability to learn, so the City should make accommodations for them. But the court held that the firefighters failed to establish that their ADHD met the standards to qualify as a disability under the ADA.

A very important limitation of Act involved a ruling from an earlier Supreme Court case with Toyota in 2002 which the Sixth Circuit Court used in this case with the firefighters. The Sixth Circuit applied the U.S. Supreme Court’s test in Toyota Motor Mfg., Kentucky, Inc. v. Williams, 534 U.S. 184 (2002).

Under the Toyota Motor ruling the courts must consider whether the person making the claim is unable to perform the variety of tasks central to most people’s daily lives, not whether the claimant is unable to perform the tasks associated with his or her specific job.

When applying this test, the Sixth Circuit wrote that when a person who is seeking protection or accommodations under the ADA can fully compensate for an impairment through medication, personal practice, or an alteration of behavior, a “disability,” as defined by the Disabilities Act, does not exist.

In other words, if a child, teen, or adult with ADHD can “get the task done” or “get the job done” by using medications, applying behavioral management techniques, receiving counseling, using biofeedback, using Attend, or other treatment interventions, then they do not have a disability that is protected under the ADA.

In this court case, all three firefighters testified that taking Ritalin controlled their symptoms, and that they were able to fulfill their family and work obligations. Thus, an ADA disability was not found.

So, it would follow that if you, or your child, could function pretty well at work or in school when taking medication or Attend, or using some other treatment, no disability as defined under the ADA would exist – at least according to the 6th Circuit Court.

Also, it seems that as a result of this ruling, employers under the Sixth Circuit do not need to make accommodations for employees with ADHD under these conditions:

1. When the disorder has not been shown to substantially impair their ability to perform tasks central to daily life;
2. When the ADHD symptoms can be improved by medication or other treatments.

Here is a pretty good list from a major university of the conditions that must be met for ADHD to qualify for coverage and protection under the American with Disabilities Act of 1990:

• The ADHD must cause significant impact or limitation in a major life activity or function;
• The individual must be regarded as having a disability;
• The individual must have a record of having been viewed as being disabled;
• The applicant must also be able to perform the essential job functions with or without accommodations to qualify as an individual with a disability under the meaning of the Act.

To establish that an individual is covered under the ADA, documentation must indicate that a specific disability exists and that the identified disability substantially limits one or more major life activities. Documentation must also support the accommodations requested.

1. The evaluation must be conducted by a qualified professional, such as psychologist, neuropsychologist, psychiatrist, or other medical doctor who has had comprehensive training in the differential diagnosis of ADHD and direct experience with an adult ADHD population. The name, title, and professional credentials of the evaluator should be clearly stated. All reports should be on letterhead, typed, dated, signed and otherwise legible.
2. Documentation must be current. The diagnostic evaluation must adequately address the individual’s current level of functioning and need for accommodations. In most cases, the evaluation must have been completed in the last three years. A school plan, such as an Individualized Education Plan (IEP) or 504 Plan, is insufficient documentation for a university, but can be included for consideration as part of a more comprehensive evaluative report.

Documentation necessary to substantiate the diagnosis must be comprehensive and include:

• Evidence of early impairment. Historical information must be presented to demonstrate symptoms in childhood which manifested in more than one setting.
• Evidence of current impairment, which may include presenting attentional symptoms and/or ongoing impulsive/hyperactive behaviors that significantly impair functioning in two or more settings. In addition, the diagnostic interview should include information from, but not limited to, the following sources: developmental history, family history, academic history, medical history, and prior psycho-educational test reports.
• Alternative diagnoses or explanations should be ruled out. The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD.
• Relevant testing information must be provided and all data must reflect a diagnosis of ADHD and a resultant substantial limitation to learning.
• Documentation must include a specific diagnosis. The diagnosis must include specific criteria based on the DSM-IV, including evidence of impairment during childhood, presentation of symptoms for at least the past six months, and clear evidence of significant impairment in two or more settings. The diagnostician should use direct language in the diagnosis of ADHD, avoiding the use of such terms as “suggests,” “is indicative of,” or “attentional problems.”
• An interpretive summary must be provided that demonstrates that alternative explanations have been ruled out and that explains how the presence of ADHD was determined, the effects of any mitigating measures (such as medication), the substantial limitation to learning caused by the ADHD, and the rationale for specific accommodations.

Obviously, dealing with government regulations with their specific definitions can be very frustrating and difficult. It would be important to have realistic expectations in regards to the American with Disabilities Act and ADHD.

We would recommend getting legal advice from an attorney who specializes in educational law, or has expertise in the Americans with Disabilities Act, to learn more about how the ADA may apply in a specific case to a particular individual with ADHD.

ADHD Impacts Learning and School

ADHD in School

Can you imagine the most difficult environment for a child who had difficulty sitting still, difficulty paying attention, and who loved to talk to other children?

Imagine that this child had to go into this environment every day, and was expected to perform in this environment at the same level as children who didn't have attention problems.

Problems in the Classroom

When you think about it, it is the classroom setting that is this difficult setting for these kids. There are a lot of distractions, yet they are told to sit still, don't move, don't talk, and to pay attention to boring worksheets, and keep on task until the work is finished. None of these things come easily to Attention Deficit Hyperactivity Disorder kids. But day by day, off to school they go.

Often the Attention Deficit Hyperactivity Disorder child has special educational needs, though not always. Most Attention Deficit Hyperactivity Disorder kids can be successful in the regular classroom with some help.

As many as 30% of those with ADHD also have a specific learning disability that can make reading, writing, or learning math, very difficult.

We tend to see Lower academic achievement for I.Q. If they ought to be A students, they're getting C's instead. If they ought to be B students, they're getting D's instead.

Many Attention Deficit Hyperactivity Disorder kids "hit a wall" in school as the school year progresses. Every week they just get a little farther and farther behind, until they're so far behind that it's impossible to catch up.

They lose their homework assignments, even after they have spent hours working on them. And they study hard for tests only to perform poorly the next day. They just slip farther and farther behind with each passing week.

Third Grade

ADHD is most often recognized and referred for treatment in third grade.

This is when kids most often hit the "academic wall." In third grade they are expected to do more and more work on their own, and they are given more homework to do as well.

Seventh Grade

We also see many referrals in seventh grade, or when the child leaves Elementary School for Junior High School, with several classes and several teachers. Many Attention Deficit Hyperactivity Disorder kids who found ways to compensate in Elementary School are totally lost in Junior High School.

ADHD in 9% of Children According to New Study

ADHD in Children Estimated at 9%

A new study reports some attention getting numbers. The first is that about 9% of children in the United States have attention deficit hyperactivity disorder – ADHD. The second number is that only about 1/3 of them are getting medical treatment.

There have been a number of similar studies done through the years, but this study is considered important because it used the most modern diagnostic criteria for ADHD today, the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition.

The ADHD Information Library has written and maintained for years that about 5% of children in the US had ADHD, and that it has been both “over-diagnosed” and “under-diagnosed.”

Over-diagnosed in the sense that often the medical evaluations leading to a diagnosis don’t consider the differential diagnoses that need to be ruled out before diagnosing ADHD, such as fetal alcohol syndrome, head injuries, tourette’s syndrome, bipolar disorder, and more (see http://newideas.net/adhd/differential-diagnosis ).

Our concern is that this study may have fallen into the same trap. Simply reporting that 9% of children meet the DSM-IV criteria for ADHD is not the same as 9% of the kids having ADHD. Rather, many children who meet the criteria for ADHD actually have some other disorder.

And we have reported that ADHD is under-diagnosed in the sense that only about 1/3 of the kids who actually have ADHD ever get treatment. This study confirms that estimate.

"There is a perception that ADHD is overdiagnosed and overtreated," said lead researcher Dr. Tanya E. Froehlich, from Cincinnati Children's Medical Center. "But our study shows that for those who meet the criteria for ADHD, the opposite problem -- underdiagnosis and undertreatment -- seems to be occurring."

The researchers found that some 2.4 million children between the ages of 8 and 15 meet the medical definition of ADHD, but an estimated 1.2 million children haven't been diagnosed or treated, Froehlich said, adding that "girls were more likely to be undiagnosed."

The researchers studies the data on 3,082 children who participated in the National Health and Nutrition Examination Survey. Using interviews, the researchers were able to establish whether a child met the criteria for ADHD. They also used data from doctors and the numbers of ADHD medications being used to establish diagnosis and treatment patterns, according to the report.

The researchers found that of the 8.7 percent of children who met the criteria for ADHD, only 47.9 percent had been diagnosed with the condition and only 32 percent were treated consistently with medications.

Froehlich said more needs to be done to identify and treat children with ADHD. "It's not a trivial disorder," she said. "It can have an impact on the child and the family if it is not diagnosed and addressed. We need to redouble our efforts to help doctors spot the symptoms of ADHD and make an accurate diagnosis."

September 2007 issue of Archives of Pediatrics & Adolescent Medicine.

Adult ADHD New National Survey Published

It is important to remember that many, or most, children with ADHD will never really “out-grow” the problems that ADHD brings. We have discussed this in detail in our reporting on ADHD and Depression in females, and in other articles through the years.

This week another reminder of this was published in a national survey of 1,007 adults with ADHD. The survey looked at how adults with ADHD cope at home, at work, and in relationships with others. The survey was published just in time for the 2008 Chadd Conference, and the 2008 ADHD National Awareness Day.

What the survey found was that, of those adults with ADHD:

• 75% reported that ADHD strongly impacted their ability to stay focused to a task long enough to complete it;
• 70% reported that ADHD strongly impacted their ability to focus on what others were saying;
• 65% reported that ADHD strongly impacted their responsibilities at home;
• 60% reported that ADHD strongly impacted their ability to stay seated through a business meeting, or to organized projects, or follow through with projects until they are completed;
• 57% reported that ADHD strongly impacted their relationships with their families and friends;
• 56% reported that ADHD strongly impacted their ability to advance in their work place or career;
• 47% reported that ADHD caused them to have to work harder than others just to accomplish the same amount of work as those without ADHD;

The survey group was asked about what they would like to accomplish, or treatment goals:

• 50% reported that they would like to get their house organized, and 28% reported that they needed to get their personal finances more organized;
• 38% reported that they needed to get their moodiness under control, and 26% wanted to improve their relationships with others;
• 36% felt that their ADHD symptoms were still not under control, and many report feeling depressed thinking about how hard it is to be an adult with ADHD.

The study was headed up by two big names in the ADHD community: Ed (Ned) Hallowell, M.D., who has written important books such as “Driven to Distraction,” and Natalie Knochenhauer, who as a mother of ADHD children has become an important advocate in the Philadelphia area.

The study was funded by McNeill Pediatrics, which, by the way, markets CONCERTA (methylphenidate HCI) for the treatment of ADHD in adults, as well as in children. Hallowell and Knochenhauer are both paid consultants for McNeill Pediatrics. So there is an element of this study that is designed to market CONCERTA to those adults who are not receiving any treatment, feel that their ADHD is not under control, and etc.

But this study should be more than that.

• IF conservatively 5% of the children in the USA have ADHD, and
• IF conservatively 50% of the children in the USA will “out-grow” their ADHD symptoms by the age of 20 or so, and
• IF there are approximately 300 million people in the USA,
• THEN there are conservatively 7,500,000 adults in the USA alone dealing with “adult ADHD.” And if 38% of them feel that their ADHD is not under control, or are depressed by their ADHD, and so on, well that’s a lot of people suffering from ADHD even into adulthood (38% of 7.5 million adults with ADHD is 2,850,000 adults who feel it is out of control or feel depressed because of their ADHD).

If you are an adult with ADHD, and you are feeling that you can’t get ahead at work because of it, or you can’t get organized, or motivated, or get your moods under control, there is help for you.

Yes, medications like Concerta can help. Stimulant medications can help to increase time on task, focus to boring tasks, and so on. Consider medications as a treatment option and talk to your doctor about it.

We also like people to try the combination of an ADHD diet (including high protein, low carbohydrate breakfasts and some caffeine), with ATTEND, Extress or Deprex (for mood stabilization) and Memorin for memory improvement. See the Different Types of ADHD for specific treatment strategies.

With either of the approaches above, counseling or coaching for ADHD as well as for skills and strategies to improve relationships and work performance are essential.

Why Does It Seem That There Are More Children With ADHD Than Ever Before?

ADHD Symptoms Resulting From Drug Use, Cigarette Smoking, and Alcohol Use

Even though the percentage of people with Attention Deficit Hyperactivity Disorder is likely the same as in the past, about 5% to 7% of the population, there are reasons why it seems that "there is more ADHD" than ever before:

• You are more aware of problems like ADHD as a parent than you were as a child. You have grown up now and you are more concerned about these issues since you have your own children.
• The news and entertainment media have talked about Attention Deficit Hyperactivity Disorder a lot more than in the past, raising your awareness level.
• A recent study by the National Institute of Drug Abuse reported the following:

5.5% of women REPORTED using illicit drugs while they were pregnant;

18.8% REPORTED using alcohol,

20.4% REPORTED using tobacco while pregnant.

Children who were Drug Exposed in utero, or Fetal Alcohol Syndrome children, have many of the same problems as children with Attention Deficit Hyperactivity Disorder, and are often misdiagnosed by physicians as being ADD ADHD.

In our rural area of California it is estimated that 10% of all children born in our county were exposed to drugs or alcohol by their mothers during pregnancy.

There are no known "safe levels" of drug, alcohol, or tobacco use while pregnant. The use of drugs or alcohol are especially dangerous to the developing baby and can often cause neurological problems.

When these children enter school, they often display problems with attention, impulse control, temper, learning, and behavior. They are often misdiagnosed as having a genetically based Attention Deficit Hyperactivity Disorder.

However, rather than having a genetically based Attention Deficit Disorder (ADHD) what they really suffer from are structural head injuries due to their mother's past behaviors.

There are also increased risks of these neurological problems from chemical toxins, mercury poisoning, and other environmental toxins.

Mineral Deficiencies in ADHD

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 a 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."

Minerals and Metals vs ADHD: Our Comments

A few 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? Yes!

Heavy metals such as mercury, lead, cadmium, and nickel are very toxic to the human body (toxic to any form of life) and can pass the blood- brain barrier and be terrible neuro-toxins.

No child, especially not ADHD children, should be exposed to these toxic metals.

And yet without knowing, most parents have these toxic metals actually placed into the mouths of our children in the form of dental work: mercury-amalgam fillings are 50% mercury, and also contain copper and nickel; and braces for our children are often made of these toxic heavy metals as well.

These are bad for all of us.

And as time goes on I am becoming more and convinced that nutritional supplements can play a significant role in the treatment of 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, as well as Nutritional Interventions.

We have seen ATTEND and EXTRESS make significant contributions to the lives of children with ADHD. They are products that you should strongly consider using.

We also strongly encourage the use of Essential Fatty Acid supplements, provided that they are mercury free. These can include certain fish oils, primrose oil, or flax seed oils.

ADD Attention Deficit Disorder

What Is Attention Deficit Hyperactivity Disorder - ADD or ADHD?

Please see our new page: ADHD

Attention Deficit Hyperactivity Disorder, often called ADD or ADHD, is a diagnostic label that we give to children and adults who have significant problems in four main areas of their lives:

* Inattention,
* Impulsivity,
* Hyperactivity,
* Boredom.

Attention Deficit Hyperactivity Disorder is a neurologically based disorder.

This position has become controversial as many would like to dismiss the diagnosis of Attention Deficit Hyperactivity Disorder altogether saying that there is no evidence of neurological differences, or that there are no medical tests to diagnose ADD ADHD, or that the diagnostic criteria is too broad.

For now we will simply report that there is a tremendous amount of research to support the statement that, indeed, Attention Deficit Hyperactivity Disorder is a neurologically based condition.

Attention Deficit Hyperactivity Disorder is not the result of "bad parenting" or obnoxious, willful defiance on the part of the child.

Yes, a child may be willfully defiant whether he has Attention Deficit Hyperactivity Disorder or not. Defiance, rebelliousness, and selfishness are "moral" issues, not neurological issues. We make no excuses for "immoral," "selfish," or "destructive" behaviors, whether from individuals with ADD ADHD or not.

It may also be true that the parents may need further training. We are constantly amazed at how many young parents today grew up in homes where their parents were gone all day. We now see "grown up latch key kids" trying to parent as best as they can, but without having had the benefit of growing up with good parental role models. This is a problem as well. But it is not Attention Deficit Hyperactivity Disorder. It is Attention Deficit Hyperactivity Disorder that we will be exploring here at the ADD Information Library.

Defining Terms: Attention Deficit Hyperactivity Disorder

Attention Deficit Hyperactivity Disorder is a medical condition, caused by genetic factors that result in certain neurological differences.

Attention Deficit Hyperactivity Disorder comes in various forms. Today they all fall under the category of Attention Deficit Hyperactivity Disorder (ADHD), and then the main category is subdivided into ADHD Inattentive Type, or ADHD Impulsive-Hyperactive Type, or ADHD Combined Type. In the recent past the terms attention deficit disorder "with" or "without" hyperactivity were also commonly used. Attention Deficit Hyperactivity Disorder comes in various forms, and truly, no two ADD or ADHD kids are exactly alike.