Attention-deficit hyperactivity disorder
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Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by significant problems with attention, hyperactivity, or impulsivity. ADHD is one of the most common childhood disorders and frequently continues through adolescence and into adulthood.[1] In the US, approximately 11% of children 4-17 years old[2] and about 4.4% of adults[3] are diagnosed with ADHD. ADHD diagnosis rates vary based on the specific criteria used for diagnosis, so these figures are not exact and may vary by a few percent. Although ADHD's diagnoses are disproportionately male, evidence suggests that ADHD is often overlooked and subsequently underdiagnosed in females due to differences in how ADHD symptoms present themselves.[4][5][6] Despite public perceptions that ADHD is overdiagnosed, evidence suggests that there is no systemic issue of overdiagnosis.[7] However, there may well be small-scale (regional) cases of both overdiagnosis and underdiagnosis. Although the number of people diagnosed by ADHD has risen in recent decades, research suggests that the actual prevalence of the disorder has not increased in the past three decades.[8] ADHD is not a mental disorder and there is evidence of physical changes in the brains of people with ADHD.[9]
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[edit] Symptoms and diagnostic criteria
Under the DSM-5's guidelines for diagnosis, ADHD is separated into the primarily inattentive presentation (ADHD-PI), the primarily hyperactive/impulsive presentation (ADHD-H), and the combined type presentation (ADHD-C). Diagnosis requires a certain number of symptoms of either inattention or hyperactivity listed in the DSM to be present for at least six months. Additionally, diagnosis requires that the symptoms are impairing, are not consistent with the patients's developmental level, are present in multiple settings, and were present prior to age 12. Symptoms of inattention include paying poor attention to details, making careless mistakes, difficulty with sustained attention, being easily distracted, being unable to follow through on tasks, difficulty with organization, avoiding or disliking sustained mental effort, losing things, and forgetfulness. Symptoms of hyperactivity/impulsivity include fidgeting, restlessness, an inability to stay seated, an inability to play quietly, excessive talking, having trouble waiting, and interrupting people. Although most people will experience one or more of these symptoms in their lifetime, it is important to note that a diagnosis of ADHD is only made if all of the DSM criteria is met (and the symptoms listed in the DSM are more specific than the ones listed here).
[edit] Causes
Brain imaging studies have revealed that patients with ADHD have delayed brain maturation rates, especially in areas associated with thinking, paying attention, and planning.[10] Many have speculated that genes have a large part to play, researchers are also looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD.[11] There are cases where the patient only suffers from an attention problem, which is called ADHD Inattentive-type (ADHD-I) or Attention Deficit Disorder (ADD). These children have real difficulty in school, not because they do not understand the lessons, but because they have an inability to focus on a subject. This is why these children were often called "underachievers" in the past. Recently however, there has been research to show that there is an dopaminergic transportation issue (1a). This is directly related to an iron deficiency in certain parts of the brain.[citation needed] Dopamine enhancing drugs are often prescribed as a matter of course for many sufferers of this condition.
[edit] Treatments
ADHD is commonly treated with stimulants such as methylphenidate (Ritalin/Concerta), amphetamine salts (Adderall), and dextroamphetamine (Vyvanse/Dexedrine/Dextrostat). In rare cases, methamphetamine (Desoxyn) may be used as a treatment. There are also non-stimulant medications for ADHD, such as atomoxetine (Strattera), guanfacine (Intuniv/Tenex), and clonidine (Kapvay). Antidepressants and blood pressure medication are also used to treat some cases of ADHD. Everyone responds differently to different medications at different doses, so it often takes a while to find a medication that works. Although stimulant medications tend to be the preferred treatment due to their strong and immediate effects (75-90% of patients respond well to stimulant medications[12][13]), they do have side effects, and a potential for misuse and abuse exists. The most common side effects of stimulant medications include insomnia, reduced appetite/weight loss, headaches, stomach aches, mood changes, dry mouth, and an increase in heart rate/blood pressure, but there are many other common side effects, far too many to list here. Although a detailed discussion of how ADHD medications work is far beyond the scope of this article, their primary function is to increase levels of dopamine and norepinephrine by inhibiting reuptake or increasing release of those neurotransmitters. Unfortunately, stimulant medications are frequently misused and abused[14] in order to pull all nighters, function with little sleep, study for exams[15], or even just for the euphoria that larger doses can provide. When abused, they are usually taken at much larger doses than those prescribed for the treatment of ADHD, sometimes by snorting or injecting ground-up pills. This can lead to serious health complications and severe side effects such as psychosis, addiction, and sudden death, especially at higher doses.[16] Because of this, the stimulant medications commonly used to treat ADHD are classified as controlled substances.[17] When prescribed by a doctor (and taken as prescribed), stimulants are considered a safe and effective treatment for ADHD.
The stimulants used to treat ADHD can benefit everyone to some extent, which has led to some people questioning the validity of treating ADHD, and others to call for unrestricted access to stimulants for everyone.[18][19][20] However, prescribing medication requires a risk-benefit analysis. Patients with ADHD benefit drastically from ADHD medication and have a legitimate medical need for the medication. People who do not have ADHD will not benefit as drastically from medication, and do not have a legitimate medical need for the medication. Therefore, the benefit outweighs the risks only in the case of patients with ADHD. In addition, it is unclear how much these stimulants can actually benefit people who don't have ADHD.[21][22] Research on stimulants and arousal theory suggests that too much activation or arousal has negative effects on cognition, which supports the hypothesis that stimulants benefit people with ADHD far more than people with no attention issues.[23]
There are a great number of myths and controversy around ADHD medications. Doctors are often criticized for prescribing potent psychostimulants to children. Although these stimulants have a long record of safety, they do carry risks, and people tend to ignore how much untreated ADHD can impair a child's life. Some people believe that ADHD is not a real disorder and that medications are used to turn kids into obedient zombies. The evidence that ADHD is a real disorder is robust[24], and it's quite simply absurd to claim that these stimulants are turning kids into zombies. Others believe that ADHD can be easily overcome without drugs. While it's true that some people with ADHD do not require medication, especially those with a less severe presentation, that does not mean that everyone with ADHD can get by without medication. Many people believe that ADHD medication is overprescribed to varying degrees, but the evidence does not support the view that ADHD medication is systemically oversubscribed.[25] Even more blame ADHD on poor parenting, poor discipline, sugar, not enough exercise, too much TV, not enough reading, western society, school, not enough time in "nature", bad teachers, boring curriculum, or laziness. All of those "causes" are ridiculous and lack supporting evidence. Some people believe that ADHD can be cured via diet, exercise, fish oil, supplements, nootropics, etc. While there is some limited evidence to support these "cures", they are nowhere near as effective as medication and will do little for most people with ADHD.
There is some evidence that ADHD medication can have short term effects on growth in children, but new research suggests that stimulant medication does not have an effect on adult height or growth rate.[26] ADHD treatment reduces the rate of substance abuse by 31%.[27]
[edit] Adult ADHD
Though most commonly thought of as a children's disorder, about 4% of American adults suffer from ADHD. [28] If left untreated, Adults with ADHD may have difficulty retaining a job, maintaining relationships, managing finances, or managing similar responsibilities requiring organization and focus. In particular, ADHD adults may find that the Americans with Disabilities Act does little to protect them in the workplace, since organization and time management can be argued to be essential duties of almost any job. Untreated or undiagnosed ADHD adults sometimes attempt to self-medicate using caffeine or other stimulants[citation needed].
[edit] Pseudoscience
Because the actual cause of ADHD remains elusive to medical science (although the general consensus is that genes play a large role)[29], that leaves plenty of room for quack doctors to speculate all the livelong day on what causes it and offer up their own advice on how to treat it.
- Joseph Mercola - states ADHD is over-diagnosed because of Big Pharma, speculates that anything from food additives, wheat gluten,[30] high-fructose corn syrup, vaccines, and/or water fluoridation causes ADHD. Suggests that ADHD can be treated nutritionally by cutting out sweeteners and processed foods.[31]
- NaturalNews - says ADHD is a scam of Big Pharma and psychiatry,[32] speculates that mercury from vaccines,[33] common non-organic pesticides,[34] and anesthesia cause ADHD.[35] States that homeopathic cures work better than Ritalin[36] and that eating organic food treats it.[37]
- Infowars - says prescribing kids ADHD drugs is "chemical warfare"[38] and mass murder[39] and Big Pharma is intentionally diagnosing kids for increased profits.[40]
- Conservapedia - states that methamphetamine is prescribed for ADHD (true, under the brand name Desoxyn, but relegated to extremely rare and treatment-resistant cases and subject to heavy monitoring and intense scrutiny; Ritalin and Adderall are far more common) and attempts to correlate methamphetamine with homosexuality.[41]
- Scientology - has always opposed psychiatry and its proponents believe all psychological conditions are scams, including ADHD.[42]
- Not to mention the ever-so prevalent idea that those with ADHD should just get over their issues and learn to focus and be happy like everyone else by using the amazing self-control that they apparently have by the standards of others.
[edit] References
- ↑ [Neuropsychological impairments in adult attention deficit hyperactivity disorder: a literature review.]
- ↑ Key Findings: Trends in the Parent-Report of Health Care Provider-Diagnosis and Medication Treatment for ADHD: United States, 2003—2011
- ↑ The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication.
- ↑ A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis.
- ↑ [Structural and functional neuroanatomy of attention-deficit hyperactivity disorder (ADHD).]
- ↑ Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis.
- ↑ Evaluating the Evidence For and Against the Overdiagnosis of ADHD
- ↑ ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis.
- ↑ The neurobiological basis of ADHD.
- ↑ "Attention Deficit Hyperactivity Disorder". National Institute of Mental Health. Archived from the original on 22 February 2014. http://web.archive.org/web/20140222020243/http://www.nimh.nih.gov/health/publications/attention-deficit-hyperactivity-disorder/index.shtml?utm_source=REFERENCES_R7. Retrieved 22 February 2014.
- ↑ "Attention Deficit Hyperactivity Disorder (ADHD, ADD)?". National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml. Retrieved 22 February 2014.
- ↑ ADHD Medications, An Overview
- ↑ Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study.
- ↑ The potential for misuse and abuse of medications in ADHD: a review.
- ↑ Risky Rise of the Good-Grade Pill
- ↑ Prescription stimulants in individuals with and without attention deficit hyperactivity disorder: misuse, cognitive impact, and adverse effects.
- ↑ DEA-published Controlled Substances List
- ↑ Attention Disorder or Not, Pills to Help in School
- ↑ Should Ritalin Be Distributed to Everyone Taking the SATs?
- ↑ Towards responsible use of cognitive-enhancing drugs by the healthy
- ↑ Objective and subjective cognitive enhancing effects of mixed amphetamine salts in healthy people
- ↑ Are prescription stimulants "smart pills"? The epidemiology and cognitive neuroscience of prescription stimulant use by normal healthy individuals.
- ↑ Psychostimulants and cognition: a continuum of behavioral and cognitive activation.
- ↑ International Consensus Statement on ADHD
- ↑ Are stimulants overprescribed? Treatment of ADHD in four U.S. communities.
- ↑ ADHD, stimulant treatment, and growth: a longitudinal study.
- ↑ Stimulant ADHD medication and risk for substance abuse.
- ↑ "Adult ADHD (Attention Deficit/Hyperactive Disorder)". Anxiety and Depression Association of American. http://www.adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/adult-adhd. Retrieved 01 June 2014.
- ↑ Collingwood, Jane (2010). "The Genetics of ADHD". PsychCentral. http://psychcentral.com/lib/the-genetics-of-adhd/0003789.
- ↑ Mercola (2 November 2011). "Child Have ADHD? Stop Feeding Them Bread". Infowars. http://www.infowars.com/child-have-adhd-stop-feeding-them-bread/. Retrieved 22 February 2014.
- ↑ "Why do One in Ten Kids in the U.S. Have ADHD?". Natural Health Articles. 27 November 2010. http://articles.mercola.com/sites/articles/archive/2010/11/27/why-do-one-in-ten-kids-in-the-us-have-adhd.aspx. Retrieved 22 February 2014.
- ↑ Landsman, Jonathan (16 May 2013). "The ADHD scam that exposes a lack of science within the psychiatric industry". Natural health news. http://www.naturalnews.com/040355_ADHD_scam_psychiatry.html. Retrieved 22 February 2014.
- ↑ Huff, Ethan (21 November 2012). "Medical evidence shows that pregnant mothers exposed to mercury in vaccines are more likely to have children with ADHD". Natural health news. http://www.naturalnews.com/038037_pregnancy_vaccines_ADHD.html. Retrieved 22 February 2014.
- ↑ Heller, Sharon (6 March 2012). "Common pesticides double children's risk of ADHD". Natural health news. http://www.naturalnews.com/035156_pesticides_children_ADHD.html. Retrieved 22 February 2014.
- ↑ Smith, Peter (2 February 2012). "Anesthesia may cause ADHD and Brain Damage". Natural health news. http://www.naturalnews.com/034884_anesthesia_ADHD_brain_damage.html. Retrieved 22 February 2014.
- ↑ Bardot, JB (26 July 2012). "Protect your child from the dangers of Ritalin - Four Homeopathic remedies to treat ADHD and ADD". Natural health news. http://www.naturalnews.com/036593_Ritalin_homeopathic_remedies_ADHD.html. Retrieved 22 February 2014.
- ↑ Benson, Jonathan (16 January 2012). "Instead of drugs and behavioral therapy for ADHD, try changing diet instead". Natural health news. http://www.naturalnews.com/034660_ADHD_diet_symptoms.html. Retrieved 22 February 2014.
- ↑ Rappoport, Jon (12 October 2012). "Bombshell: Mind-control Engineers Now Drugging Children for “Social Justice”". Infowars. http://www.infowars.com/bombshell-mind-control-engineers-now-drugging-children-for-social-justice/. Retrieved 22 February 2014.
- ↑ Melton, Melissa (10 January 2013). "What Are Mass Murder Pills?". Infowars. http://www.infowars.com/what-are-mass-murder-pills/. Retrieved 22 February 2014.
- ↑ Garber, Lisa (26 November 2010). "Younger Kids 50% More Likely to get ADHD Drugs than Older Peers". Infowars. http://www.infowars.com/younger-kids-50-more-likely-to-get-adhd-drugs-than-older-peers/. Retrieved 22 February 2014.
- ↑ Dsherman (7 May 2013). "Methamphetamine". Conservapedia. http://www.conservapedia.com/index.php?title=Methamphetamine&oldid=1051095. Retrieved 18 March 2014.
- ↑ Mieszkowski, Katherine (2 July 2005). "Scientology’s war on psychiatry". Salon.com. http://www.salon.com/2005/07/01/sci_psy/. Retrieved 22 February 2014.
[edit] Further reading
- "RSNA Press Release: MRI Technique Reveals Low Brain Iron in ADHD Patients". RSNA Press Release. 2 December 2013. http://www2.rsna.org/timssnet/Media/pressreleases/pr_target.cfm?id=703. Retrieved 18 March 2014.