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ADD and ADHD:  More Information, Help and Support

 


 

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Attention Deficit Disorder describes the characteristics of inattention, impulsivity and hyperactivity that may be present in some children and adults.

 

 

Although health professionals often state that ADD/ADHD is a brain-based biological disorder caused by a brain chemical imbalance, there is simply no reliable test to prove this -- no physical or chemical abnormality validates ADHD as a medical disease. 

 

Since there can be no diagnosis without a disease, what is there?

 

There is a description of behaviors -- symptoms -- that health professionals use as a checklist in deciding whether your child has an attentional disorder.

 

However, symptoms do not necessarily mean there is a disease. To determine disease, there must be an objective test (such as blood text, X-rays, CAT scans, etc.).  There is no independent valid objective test for ADD/ADHD.  Instead health professionals rely on:

  • a list of behaviors (primarily, inattention, hyperactivity, impulsivity, academic underachievement, or behavior problems),

  • diagnostic interviews,

  • anecdotal information from family and school staff.

 

ADD/ADHD behaviors are found in the The Diagnostic and Statistical Manual of Mental Health Disorders, Fourth Edition, Text Revision that forms the accepted guidelines for what are considered to be 'mental illnesses', or as they are more recently referred to, 'mental disorders'.  This reference text is the "bible" of the mental health industry.  ADD was added to the DSM-IV in 1980 and ADHD in 1987.  Read the American Academy of Pediatrics' guidelines for diagnosing ADHD.

 

 

Before accepting a diagnosis of ADD or ADHD, parents should rule out other conditions that show similar symptoms.

  • Allergies and sensitivities to food (dairy, grains, peanuts, food dye) and the environment (grass, pollen, animal dander), can affect behavior.

  • Exposure to toxins can cause hyperactivity, attention deficits, irritability, and learning problems. Children are more vulnerable to toxins than adults. Toxins include pesticides, gasoline fumes, herbicides, disinfectants, furniture polishes, air fresheners, synthetic rugs and carpets, and beds made of synthetic materials and/or dust-laden homes.

  • Mild to high lead levels, even in the absence of clinical lead poisoning, is the leading cause of toxin-induced hyperactivity. Research shows that children with even mildly elevated lead levels suffer from reduced IQs, attention deficits, and poor school performance.

  • Fluoride is a toxic chemical that has been linked with increased lead absorption, learning disabilities, attention disorders, hyperactivity, behavior problems, mottled teeth, decreased fertility, bone loss, and decreased I.Q.  Fluoride is found in most toothpastes and has been added to many area water supplies.

  • High mercury levels can be caused by mercury amalgam dental fillings.  When children grind their teeth, they are at risk for high mercury levels in the body.  Another cause is from eating large amounts of cold-water fish such as tuna and salmon.

  • Thousands of children each year are exposed to toxic levels and poisoned by carbon monoxide each year. Sources of this gas include heaters and other gas appliances, such as fireplaces, dryers, and water heaters.

  • Hearing and vision problems may cause ADD/ADHD behavior if a child can't see or hear properly -- especially in educational settings.

  • Children who are experiencing emotional stress (such as being bullied at school, divorce or death in family, abuse) most often display ADHD behavior.  Emotionally-stressed children can experience sleeping problems, sadness, and they develop physical symptoms, especially if they think those symptoms will keep them home from school. Often they can't concentrate in class, partly because they are worried and partly because they are suffering from sleep deprivation.

  • When dealing with spirited children, the problem usually does not lie with the child but with society's perception of what normal childhood behavior is. Many normal children, according to some people, display ADHD behavior not because they are hyperactive or lack sufficient attention spans but because the person forming the opinion has unrealistic standards of how a child should behave.

  • Gifted children often display ADHD behavior because most of the time they are bored with school and what other kids their age are doing.  Behaviors associated with giftedness are poor attention, boredom, daydreaming, low tolerance for persistence on tasks that seem irrelevant, power struggles, and high activity level.  They may need less sleep compared to other children, and they may question rules, customs, and traditions.  If your child scores above average on IQ tests, aces exams, has no trouble with homework, has no apparent learning disabilities, and primarily exhibits his or her problems mostly at school, seeking a more challenging class or school may help.

  • Spoiled and undisciplined children are sometimes labeled as ADHD because of their defiant and acting-out behavior. Children need structure and consistent rules to learn self-discipline. Labeling undisciplined kids as ADHD gives them an excuse for their misbehavior so that they do not learn to be responsible for their own behavior.

  • One of the main reasons why a child acts out and throws temper tantrums when they have a problem is because of their lack of understanding a problem and lack of expressing how they feel. This is one reason why any emotional or medical problem can cause acting-out behavior in children.

  • Fetal alcohol syndrome (FAS) describes the damage done to children's brains and bodies when their mothers drink heavily during pregnancy.  It is the leading form of mental retardation today. Prenatal alcohol impairment, however, also comes in a milder form called fetal alcohol effects (FAE). Children with FAE often don't look disabled, and they tend to score in the low-normal or even normal range of intelligence, but their mal-developed brains cause them to exhibit a wide range of behavior problems, including hyperactivity, attention problems, learning disorders, and ethical problems such as stealing, lying, and cheating.

  • Learning Style or Learning Disabilities are often the cause of inattention and acting-out behavior.  Children with a diagnosis of ADHD are typically kinesthetic learners and have difficulty with sitting at a desk doing pencil-and-paper work.  When children think of themselves as 'stupid', 'lazy', or 'slow' and are seen as such, they often will be disruptive in school (e.g., class clown, bullying others).

  • CAPD (Central Auditory processing Disorder) will sometimes occur in children who have had a history of ear infections and/or PE tubes.  Symptoms include distractibility, inability to follow a set of verbal instructions, and 'spacing out'.

  • Sensory Integration Dysfunction is thought to be the inefficient neurological processing of information received through the senses, causing problems with learning, development, and behavior. These children are over-sensitive or under-sensitive dealing in touch, taste, smell, sound, or sight.

  • Tourette syndrome is a rare but disruptive condition. It involves multiple tics (small, repetitive muscle movements), usually facial tics with grimacing and blinking. Tics may also occur in the shoulders and arms. This is usually accompanied by loud vocalizations, which may include grunts or noises, or uncontrollable (compulsive) use of obscenities or short phrases. The tics are worse during emotional stress and are absent during sleep. The cause is unknown. It occurs most often in boys, and may begin around age 7 or 8 or not until the child is in his or her late teens or early twenties. It may, at times, run in families. This disorder can be mistaken for not being able to sit still or impulsive behavior.

  • Infestations of Candida albicans (yeast infection) cause hyperactivity in children.  Most children who do suffer from Candida infestations have some underlying problem frequently an immune disorder, or a disorder affecting carbohydrate metabolism that alters blood sugar levels.  Candida infestations are now thought to be a common condition throughout the population.

  • Intestinal parasites rob the body of needed nutrients which in turn affects behavior.

  • Streptococcus bacteria, better known as 'strep', can cause rheumatic fever and a movement disorder known as Sydenham's chorea if left untreated. Recurrent infections can also lead to a group of symptoms collectively known as PANDAS (Pediatric autoimmune neuropsychiatric disorders). Some symptoms of PANDAS include obsessive-compulsive behavior, Tourette syndrome, hyperactivity, cognitive problems, and fidgeting.

  • Hypoglycemia (low blood sugar) can stem from thyroid disorders, liver or pancreatic problems, adrenal gland abnormalities, or insufficient diet.

  • Hyper or hypothyroidism is an imbalance in metabolism that occurs from an overproduction or underproduction of thyroid hormones. This imbalance may cause a variety of behaviors and may affect all body functions.

  • Some mild forms of genetic disorders can go unnoticed in children and display some of the same symptoms of ADHD.  Mild forms of Turner's syndrome, sickle-cell anemia, and Fragile X syndrome are some examples.  Almost any genetic disorder can cause hyperactivity or other behavior problems, even if the disorder isn't normally linked to such problems. Many genetic diseases disrupt brain functions directly, through a variety of paths. A simple blood test can rule out genetic disorders.

  • A commonly overlooked cause of ADHD behavior is the absence seizure. During an absence seizure, the brain's normal activity shuts down. The child stares blankly, sometimes rotates his eyes upward, and occasionally blinks or jerks repetitively, he drops objects from his hand, and there may be some mild involuntary movements known as automatisms. The attack lasts for a few seconds and then it is over as rapidly as it begins. If these attacks occur dozens of times each day, they can interfere with a child's school performance and be confused by parents and teachers with daydreaming.

  • Post-traumatic subclinical seizure disorder causes episodic temper explosions. These fits of temper come out of the blue for no reason.  Some of these seizures can be too subtle to detect without a twenty-four-hour electroencephalogram (EEG).

  • Temporal lobe seizures can cause inappropriate behavior. That's why conducting brain scans is a must when trying to figure out behavior problems.

  • Head injuries, such as post-concussion syndrome, have symptoms that include irritability, mood swings, memory problems, depression, and sleeping problems.

  • Some spinal problems can cause ADHD behavior because, if the spine is not connected to the brain properly, nerves from the spinal cord can give the brain all of signals at once making a child rambunctious and full of energy.

  • Some drugs (both prescription and illegal) can cause the brain to atrophy, leading to disturbed cognition and behavior.  If your child routinely takes prescription or over-the-counter medications for asthma, hay fever, allergies, headaches, or any other condition, consider the possibility that the drugs are causing or contributing to behavior problems.

  • Intentionally or unintentionally sniffing materials such as modeling glue or other household products.

 

Other possible causes of ADHD behavior are:

  • Malnutrition or improper diet

  • B-vitamin deficiency

  • Iron deficiency

  • Lack of exercise

  • Lack of sleep

  • Viral or bacterial infections

  • Early-onset diabetes

  • Heart disease

  • Brain cysts

  • Early-stage brain tumors

 

Medication Concerns

 

Although no chemical imbalance has ever been proven, health professionals prescribe psychostimulant medication (such as Ritalin, Strattera, Adderall) as the primary treatment in correcting the 'chemical imbalance'.  In 2000, more than 19 million prescriptions for ADHD drugs were filled, a 72% increase since 1995.

 

However, with the known side effects of these drugs and without knowledge or evidence of long-term results on growth and development, is medication really the best option?

 

Parents should know that the psychostimulants normally prescribed for ADD/ADHD help all people -- with or without an ADD/ADHD diagnosis -- to focus attention more easily, depending on the dose.

 

However, these drugs are not without serious risk.  Between the years of 1990-2000, over 569 children were hospitalized, 38 of them were life-threatening hospitalizations, and 186 died from Ritalin.

 

It is well known that psychostimulants have abuse potential.  Very high doses of psychostimulants, particularly of amphetamines, may cause central nervous system damage, cardiovascular damage, and hypertension.  In addition, high doses have been associated with compulsive behaviors and, in certain vulnerable individuals, movement disorders.  There is a rare percentage of children and adults treated at high doses who have hallucinogenic responses.  Drugs used for ADHD other than psychostimulants have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion at high doses can cause seizures, and pemoline is associated with liver damage. -- Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, National Institute of Health

 

Many parents do not realize that if their child takes Ritalin or other psychostimulant medication past the age of 12, according to the 1999 Military Recruitment Manual, that child may not join the Army, Air Force, Navy, Marines, Coast Guard, or National Guard until after a doctor has signed a paper stating that the person has been off the medication for four years.

 

Also, if a child uses Ritalin or other psychostimulant medication, the state or federal government cannot hire him or her if the job involves state secrets or national security, because that child is a Class 2 drug user.

 

If a child uses Ritalin or other psychostimulant medication, some insurance companies will turn down that child for being a Class 2 drug user, and may even turn down the entire family.  Other health insurance companies will raise rates and write in a pre-existing condition clause, excluding some coverage for the ADD/ADHD child.

Psychostimulant medication are drugs that are commonly abused.  Some unprescribed users of Adderall, an amphetamine, and methylphenidate, more widely known as Ritalin, are adults.  But experts say many are young people, as young as 11, who get the drugs from peers being treated for ADD.  Users often crush the pills and snort them to get a cocaine-like rush, as these drugs and cocaine have more similarities than differences.

 

Students who take ADD/ADHD medication are often asked to sell or trade their drugs, and many know students who have given away or sold their medication.

 

According to the Substance Abuse and Mental Health Services Administration, a study of students in Wisconsin and Minnesota showed 34% of ADHD youth, ages 11-18, report being approached to sell or trade their medicines, such as Ritalin.

 

There are so many concerns surrounding the diagnosis and treatment of ADD/ADHD that parents must be knowledgeable and cautious.  It is usually the school that approaches parents to have an assessment for ADD/ADHD and parents often feel pressured in having the traditional drug treatment to 'correct' their child's behavior.

 

 

What should parents do if the school identifies a child with potentially having ADD/ADHD?

  • Have the school put their concerns and directions in writing.  Hold them accountable.

  • If the school tells you that your child needs medication to control his or her behavior, remind them that medical help does not necessarily mean taking medication.

  • If you are told to sign a release for your child's medical records, ask to see that law in writing.

  • Whenever you have a school conference or go before a school review board, record that meeting on a tape recorder.  The recorder should be in plain sight.  If you are told that the meeting is confidential, remember that confidentiality is your child's right -- not the school's right.

  • Children who have an ADD/ADHD diagnosis normally have an above-average IQ.  Ask the school why it is so difficult for them to teach the smartest kids in school.

  • The federal government allots over $2 billion to local school systems under the Individual Development Assistance Act of 1985.  Ask the school officials how much money their school and school system gets when a child is coded as needing special education services.

  • Find out what percentage of students in the school system are taking ADD/ADHD medication.  The average number is between 3-5%.



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