A. D. H. D. (Attention
Deficit Hyperactivity
Disorder)
and A. D. D. (Attention
Deficit
Disorder).
by
Dr. Sayeed Ahmad D. I. Hom. (London)
Dr. Helen Likierman and Dr. Valerie Muter describe the subject Article in a greater detail as follows, which is of immense value:
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) and attention deficit disorder (ADD) refer to a range of problem behaviors associated with poor attention span. These may include impulsiveness, restlessness and hyperactivity, as well as inattentiveness, and often prevent children from learning and socialising well. ADHD is sometimes referred to as hyperkinetic disorder.
What are the symptoms of ADHD?
Attention difficulties
A child must have exhibited at least six of the following symptoms for at least six months to an extent that is unusual for their age and level of intelligence.
" Fails to pay close attention to detail or makes careless errors during work or play.
" Fails to finish tasks or sustain attention in play activities.
" Seems not to listen to what is said to him or her.
" Fails to follow through instructions or to finish homework or chores (not because of confrontational behaviors or failure to understand instructions).
" Disorganized about tasks and activities.
" Avoids tasks like homework that require sustained mental effort.
" Loses things necessary for certain tasks or activities, such as pencils, books or toys.
" Easily distracted.
" Forgetful in the course of daily activities.
Hyperactivity
A child must have exhibited at least three of the following symptoms for at least six months to an extent that is unusual for their age and level of intelligence.
" Runs around or excessively climbs over things. (In adolescents or adults only feelings of restlessness may occur.)
" Unduly noisy in playing, or has difficulty in engaging in quiet leisure activities.
" Leaves seat in classroom or in other situations where remaining seated is expected.
" Fidgets with hands or feet or squirms on seat.
Impulsivity
At least one of the following symptoms must have persisted at least for six months to an extent that is unusual for their age and level of intelligence.
" Blurts out answers before the questions have been completed.
" Fails to wait in lines or await turns in games or group situations.
" Interrupts or intrudes on others, e. g. butts into others conversations or games.
" Talks excessively without appropriate response to social restraint.
Pervasiveness of attention difficulties and hyperactivity
For a diagnosis or description of ADHD a child would be expected to show the above difficulties in more than one setting, eg at school and at home.
Sometimes problems are not shown 'at home' but are very evident when a child goes to a hospital department. This can happen when parents do not realize that their child's behavior is out of the normal range (perhaps because they have no other children, or they have other children who behave similarly). It may also be because the problems are mild, or because the family has handled the attention lack at home in such a way that it is not evident there is a major problem, or because the child is very young. In those cases it is quite reasonable for parents not to consider that their child has an attention deficit problem.
Who is affected by ADHD?
About 1.7 per cent of the UK population, mostly children, have ADD or ADHD. Boys are more likely to be affected.
What else could it be?
" Grand mal or petit mal epileptic seizures can cause a child to become drowsy, impairing their attention. Epilepsy can also cause unusual behavior and lead to abnormal perceptions.
" Hearing problems such as deafness or glue ear can make it hard for a child to follow instructions and make them appear inattentive.
" Reading problems, making it hard to complete tasks or follow instructions.
" Obsessive compulsive disorder leads to people following strange rituals that preoccupy their thoughts and distract their attention.
" Tourette's syndrome involves repetitive, involuntary jerking movements of the body and sudden outbursts of noise or swearing.
" Autism and Asperger's syndrome often lead to difficulties in understanding and using language.
" Prolonged periods of insufficient sleep, causing poor concentration.
NB: Many children may be very active or be easily distracted or have difficulty concentrating. If these behaviors are relatively mild, they should not be considered a disorder.
What other difficulties can occur alongside ADHD?
ADHD often occurs alongside other difficulties and is not the sole cause of problem behavior. Children may exhibit temper tantrums, sleep disorders, and be clumsy. Other behavioral problems that occur with ADHD include:
" confrontational defiant behavior, which occurs in 60 per cent of children. The child loses their temper, argues and refuses to comply with adults and deliberately annoys others.
" conduct disorders occur in at least 25 per cent of children. The child may be destructive or show deceitful behavior such as lying, breaking rules and stealing.
" specific learning difficulties, including dyslexia, occur in 25-30 per cent of children.
" severe clinical depression occurs in 33 per cent of children.
" anxiety disorders occur in 30 per cent of children.
What causes ADHD?
Biological factors
" The child's temperament, as this contributes to their attitude and personality.
" Studies of twins suggest a genetic link to ADHD. In 80-90 per cent of identical twins where one has ADHD so does the other. Recent research also suggests there is a greater chance of inheriting the condition from male relatives such as grandfathers and uncles.
" Brain injuries due to birth trauma or pre-birth problems. The brain structures believed to be linked to the development of ADHD are vulnerable to hypoxic damage during birth. The damage is caused by inadequate oxygen reaching parts of the brain while blood flow is reduced.
Environmental factors
" Family stress.
" Educational difficulties.
How is ADHD diagnosed?
ADHD requires a medical diagnosis by a doctor, usually a child or adolescent psychiatrist, a pediatrician or pediatrics neurologist or a GP.
It will often be appropriate for other professionals such as psychologists, speech therapists, teachers and health visitors to contribute their observations to the assessment of a child with possible ADHD. There is no single diagnostic test for ADHD so different sorts of information needs to be gathered, such as the following:
History of symptoms
The precise nature of the difficulties, when they were first noticed, in what situations they occur, factors that exacerbate or relieve them.
Medical history
Risk factors that could predispose the child to ADHD include difficulties and risks in pregnancy and during birth, for example if the mother was in poor health, very young or drank alcohol or smoked or had an extended or complicated labor.
Several medical conditions are known to be associated with ADHD. These include fragile-X syndrome, fetal alcohol syndrome, G6PD deficiency, phenylketonuria and generalized resistance to thyroid hormone.
Accidents, operations and chronic medical conditions such as epilepsy, asthma and heart, liver and kidney disorders all need to be taken in to account. Also of possible relevance is any medication the child is taking, as well as any adverse reactions they have had to medication in the past.
Past psychiatric history
Enquiring about any mental health problems the child has had can help rule out depression or anxiety being behind the symptoms.
Educational history
This means the level of their ability and what specific difficulties they have, how they function within their peer group and get on with teachers, and any behaviour difficulties such as suspensions or exclusions. A more detailed evaluation of the child's learning by a psychologist may be necessary.
Evaluation of the child's temperament and personality
The child's temperament and personality, those of other family members and the nature of relationships within the family may need to be assessed. This will include discussion of the methods used by the parents to manage the child's behaviour and how successful they have been. Although this seems intrusive, the assessor will remain neutral and parents should not feel the disorder is 'their fault'.
Family history
The mental and physical health of the child's parents and other family members can be relevant, particularly regarding the incidence of ADHD or depression.
Social assessment
The family's social circumstances, such as housing, poverty, and social support may all have an impact on the child's behavior.
What treatment is available for ADHD?
Treatment depends on a child's exact diagnosis. It should take into account any specific difficulties and those strengths that may aid their improvement.
It is not easy to live or cope with a child with ADHD. Both parents and teachers can follow general guidelines to manage a child's problematic behavior but they may need specialist support and advice, e. g. from a psychologist.
Management techniques for parents and teachers
" Create a daily routine for the child, eg homework schedules, bedtime and mealtime routines.
" Be specific in your instructions to the child and make clear and reasonable requests, eg instead of telling the child to 'behave' suggest 'play quietly with your Lego for 10 minutes'.
" Set clear and easily understood boundaries, eg how much TV they may watch, and that rudeness is unacceptable.
" Be consistent in the handling and managing of the child.
" Remove disturbing or disruptive elements from their daily routine. For example, remove siblings from the room when they are doing homework or turn off the TV.
" Plan structured program aimed at gradually lengthening the child's concentration span and ability to focus on tasks.
" Communicate with the child on a one-to-one basis and avoid addressing other children at the same time.
" Use rewards (eg. stickers, tokens or even money) consistently and frequently to reinforce appropriate behavior such as listening to adults and concentrating.
" Use sanctions (eg. loss of privileges, being sent to their room) for unacceptable behavior or 'overstepping' of boundaries.
" Discuss your child with their school or nursery and see if you can work together.
Medication
Behavioral management techniques such as those above are always important, and for mild attention deficit problems they are the treatment of choice. US research suggests that medication is the best treatment for true ADHD. The most common and effective medications are amphetamine-like stimulants, mainly Ritalin and Dexedrine. If there are coexisting conditions then these may also require medication.
Ritalin reduces hyperactivity and impulsiveness and helps to focus a child's attention. They become less aggressive, seem to comply with requests, and become less forgetful. Many parents say their child's behavior has vastly improved as a result of Ritalin.
However, there is growing concern about the use of Ritalin to treat ADHD. Like amphetamines, Ritalin is classified as a class A drug. Many parents and professionals are worried about alleged side effects, including damage to the cardiovascular and nervous systems. Ritalin's manufacturers recommend that it is only used to treat children aged six years and over. If symptoms don't improve after a month's trial it should be discontinued. The manufacturers also recommend that even if Ritalin is effective it should discontinued periodically to assess the child's condition. You should discuss any concerns with your child's doctors, and they may alter the dose prescribed.
Psychological treatments
In addition to the management techniques described, other forms of psychological treatment might include anxiety management, cognitive therapy, individual psychotherapy and social skills training.
Educational management
This includes individual, or group, learning support for coexisting learning difficulties and educational underachievement.
Diet
Research suggests that diet is not a significant factor in ADHD for most children. Some children have particular food allergies that need investigation. Dietary changes need to be supervised by a doctor and nutritionist. In this approach all foods suspected of causing behavioral problems are removed from the diet then gradually reintroduced while the child's behavior is monitored by the psychologist.
What is the likely outcome?
Many children simply outgrow ADHD. About half of those affected appear to function normally by young adulthood, but a significant number will have problems that persist into adult life. These may take the form of depression, irritability, antisocial behavior and attention problems.
Remarks:
I have also come across with an Article regarding Amphetamine, which is also reproduced as under :
When is amphetamine
not an amphetamine?
By: Steve Baldwin PhD
Professor of Psychology in the School of Social Sciences
University of Teesside (01 November 2000)
As the 'beat generation' of the 1950s was replaced by the jazz clubs of the 1960s, teenagers and young adults were exposed to a new social phenomenon: 'uppers' and 'downers'. Both in Western Europe and North America, the widespread availability of prescription drugs such as amphetamines (uppers) and barbiturates (downers) produced a new dimension to leisure and recreation activities. For the first time, powerful drug preparations were widely available to teenagers and young adults at low cost.
By the end of the 1960s, other substances such as marijuana and LSD had flooded the UK illegal drug market. Meantime, government concern about the addictive properties of amphetamines had produced powerful legislation to restrict their use to specific health problems and user groups. The toxic (although highly rewarding) properties of amphetamines had confirmed the potential for very rapid addiction in adults. The results of forty years of amphetamine research with laboratory animals have since confirmed the toxic, addictive and potentially dangerous properties on mammals, including humans.
And yet, today, amphetamines are frequently given to children in the guise of Methylphenidate. The drug is often seen as the treatment for attention deficit hyperactivity disorder. In the 1960s psychiatric experimentation with difficult-to-treat childhood conditions produced a climate where novel drug treatments were introduced without much attention to toxic risk or adverse consequences from side- effects. Powerful drugs such as lithium, carbamazine and amphetamines were given to small groups of children without the benefit of scientific evidence collected from proper trials or controlled studies. This work was funded by the drug industry, aimed to establish a market for their new products. Many individual practitioners claimed success from very limited results taken from only a few children and teenagers. Methylphenidate (MPH), a member of the amphetamine family, was subsequently heavily promoted by drug companies and given to many minors diagnosed with problems of hyperactivity.
At the beginning of the 1990s in the UK, the manufacturers of MPH launched a massive new publicity and advertising campaign, directed at psychiatrists, pediatricians and educators. The industrial aim was to establish MPH as a front-line treatment for childhood hyper-arousal problems such as attention deficit hyperactivity disorder (ADHD). This campaign was so successful that prescriptions for MPH multiplied by a factor of fifteen between 1994 and 1997. More than 114 000 prescriptions were made for MPH between January and September 1999. In the USA, aggressive marketing, combined with a 'magic bullet' culture, created a climate where an estimated 1:7 schoolchildren currently take MPH every day. In a spectacular conjuring trick, the drug manufacturers created a 'solution' for hyperactivity with a stimulant.
Several laboratory research studies consistently showed the powerful yet toxic effects of amphetamine on the mammalian central nervous system: narrowing of focus (i. e. only being able to do one behavior), emotional and behavioral blunting (i. e. lack of expression), restricted activity, and behavioral suppression. These findings have been accepted without reservation by government health departments worldwide.
Amphetamine is considered to be harmful to adults because of its potential to produce very rapid addiction (i. e. requiring more of the drug to create the same effect). Like other drugs that act directly on the central nervous system (CNS) such as cocaine and heroin, in large doses amphetamines can produce a toxic state ('amphetamine psychosis') with terrifying consequences. In the extreme, amphetamine psychosis can produce the so-called 'schizophrenic episode' with a split from reality. There is an ongoing debate about whether or not the toxic consequences of amphetamine addiction are reversible. Whatever the dangers for adults, the risks for psychological and physical harm are multiplied for children and teenagers.
The known dangers of amphetamine abuse are so extreme that government health departments in every developed economy in the world have restricted their availability. Most governments impose very strict controls over the availability of amphetamines ('speed') with severe penalties for unlicensed drug trafficking. In Singapore, for example, trafficking in amphetamines is punishable with the death penalty. Moreover, amphetamine misuse by minors is considered a major public health problem in countries where regulation of the supply has broken down because of lax enforcement policies. In the UK, 'folk devils' and moral panic have recently been resurrected because of public concern about illicit drug use by 'bored teenagers'.
In summary, the public health orthodoxy in the UK states that amphetamines should be restricted from children and teenagers, due to their powerful effects on the CNS. Hence amphetamines have been classified as a Class A controlled substance, with very strict regulations and restrictions imposed on storage, prescription and consumption.
In the UK in the 1960s, 1970s and 1980s, many new drug products were launched on the consumer market with very limited information about their side-effects and toxic consequences. Frequently, information about negative side-effects was minimised, or not reported at all. Often drug products initially marketed as 'safe and effective' were later proved to be unsafe, ineffective and dangerous. Recent examples include Valium, Librium, Thalidomide and Mandrax. In each case, serious and irreversible side-effects were identified soon after concentrated blitz advertising had established a mass market of hundreds of thousands of consumers for these new products. Tens of thousands of children were born with disfigurement and irreversible physical limb deformities before Thalidomide was eventually withdrawn.
In the UK there has been considerable debate about the appropriateness of giving amphetamines to very young children (especially when government health policy prohibits the use of 'speed' by youngsters). The proponents of MPH include powerful adult authority figures that exert considerable pressure on parents to medicate their son or daughter. Lobby groups for the prescription of MPH to minors include psychiatrists, pediatricians, educational psychologists, educators, head teachers and some parent support groups. Many groups openly admit to receiving funds directly or indirectly from the pharmaceutical industry to support their activities. So-called 'medical science' journals that publish results of MPH studies are funded by drug companies.
Opponents of MPH prescription to children indicate the known side-effects of MPH when prescribed to minors. These include (but are not limited to):
" aggressive/violent behavior
" suicidal behavior
" self-destructive behavior
" self-mutilating behavior
" tics
" stereotyped behavior
" repetitive behavior
" head aches
" stomach aches
" vomiting
" cardiac problems
" motor problems
" visual disturbance
" appetite loss
" sleep disturbance
" growth retardation
" 'zombie-like' appearance
Many information bulletins about MPH minimize these known facts, or omit details altogether. A recent survey of 65 parents referred into a treatment clinic found that none of them had been informed about side-effects. Moreover, none of them had been informed that MPH was addictive, or even that it was an amphetamine. No parents had been offered any non-drug treatment alternatives. Many prescriptions had been written for children as young as 3, 4 or 5, even though the drug manufacturer instructions prohibit use of MPH for children younger than 6. Also, parents mistakenly attributed drug side-effects to the supposed 'underlying biological condition' of ADHD.
There are 230 other psychological and social therapies for children that do not involve drugging with amphetamines. These therapies include (but are not limited to): psychotherapy, behavior therapy, behavior modification, counseling and family therapy. Irresponsible prescribing behavior is impossible to justify. In four health districts in the UK, GPs have been advised not to write repeat prescriptions for MPH.
There is considerable public concern in the UK about the marketing and prescription of MPH. A class action is in progress by parents whose children have allegedly been harmed by MPH. In the USA a similar class action by parents has cited fraud, conspiracy and collusion by the manufacturers of MPH and 'parent support groups' (many of whom are funded directly by the drug companies to distribute pro-medication literature amongst parents).
In 1998 the USA federal government National Institutes of Health (NIH) held a national Consensus Conference about ADHD, with thirty-one independent scientists. The NIH reported that ADHD is not the result of a biological brain dysfunction. Rather, they concluded that "there are no data to indicate that ADHD is due to a brain malfunction" and "after years of clinical research and experience with ADHD, our knowledge about the cause or causes of ADHD remains speculative". As ADHD is not a biological condition, drugging children and teenagers with amphetamines (too strong medicine) will not help. Instead, parents need support and appropriate professional advice to choose one of the 230 available effective psychological and social therapies.
Suggestion:
I would like to suggest that for such patients who are suffering from the abovementioned diseases), a well qualified classical homoeopath should be consulted for the safe and better treatment to avoid the side effects of the allopathic drugs.
REFERENCE:
NetDoctor UK.
Copyright with Dr. Sayeed Ahmad 2004
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