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ADHD: The Great Debate

Dr. Karol M.D Article by: Dr. Karol M.D
Date: Sep 23, 2014 · Posted in: Children's Health, Mental Health
ADHD: The Great Debate

Perhaps the most controversial of all developmental childhood disorders is Attention Deficit Hyperactivity Disorder, or ADHD.

The first bone of contention is that ADHD has recently been labeled as vastly over diagnosed.
Another assertion is that traditional medications for this condition are members of the amphetamine family, with the potential for addiction and drug abuse. There have been no strong studies showing the long-term effects of these drugs. These medications can lead to the development of mania and delusional disorders, especially in children genetically predisposed to these conditions.

Finally, many medical experts see this condition as a normal variant of children’s behavior between the ages of 6 and 12: a period in child’s live when symptoms of ADHD usually begin and the exclusive age range during which ADHD can be diagnosed. Children of these ages are very often very active and hyper, something that limits their attention span. Thus, it is argued by some that ADHD is just the upper level of normal hyperactive behavior in children.

Diagnosing ADHD

However there is a fine line between normal hyperactive behavior and behavior that is disruptive to one’s self and others. And there is an extreme of this type behavior that should be looked at seriously. ADHD presents with inattention, hyperactivity, impulsivity and disruptive behavior. It also causes problems in relationships and in social life in general. In order for the diagnosis to be made, the symptoms must begin between the ages of 6 and 12. They must be present for more than 6 months and must trigger problems in social and academic life. Other symptoms are: difficulty managing anger, as well as delays in language and motor development.

As mentioned above, it is very easy to over diagnose this condition in children, especially among older adults who see the very active and inattentive behavior of children as something abnormal. But there is no doubt that the condition exists when the symptoms mentioned above become very disruptive.

ADHD Stats

ADHD is found in between 1 and 7% of the general population; depending on which diagnostic criteria are being used. Some 30-50% of children with ADHD continue the symptoms into adulthood. Two thirds of all individuals also have other co-existing conditions. The most common ones are: anxiety disorder, bi-polar disorder, anti-social personality disorder, conduct disorder, depression, substance abuse, obsessive compulsive disorder and insomnia. The condition is also 3 times more common in boys than in girls. Finally, less than 5% of children with ADHD go on to complete college degrees, whereas the statistic for the general population is 28%.

Understanding the Disorder

The cause of the condition is not entirely understood. But children with ADHD have smaller portions of the prefrontal cortex and the parietal cortex of their brains. The pre-frontal cortex is responsible for moderating social behavior and for planning and executing behavior in general. The parietal cortex is responsible for executing planned movements of the body. It is also believed that children with ADHD have abnormal levels of the neurotransmitters dopamine and norepinephrine (as well as to a lesser extent glutamate, serotonin and acetylcholine). This is precisely the reason why the most commonly- prescribed medications for ADHD increase norepinephrine and/or dopamine in the brain. They do this by causing the release of more norepinephrine between nerve cells (like amphetamine or Ritalin) or inhibiting the reuptake of norepinephrine back to the nerve cell that has released it in the first place (like Atomoxetin or Bupropion). This has the effect of leaving norepinephrine between nerve cells for longer periods of time, thus enhancing its action. Other less common medications act at norepinephrine receptors directly. Some examples of these are Guenfecine and Clonidine. The problem with these meds, as mentioned previously, is that they can cause mania (extreme uninhibited hyperactivity) as well as delusional disorders including auditory and/or visual hallucinations. They can also increase blood pressure, something that can have dire consequences later in life.

The Bright Side

There is a flip side to the story however: prevention. ADHD has been shown to have both a genetic and an environmental contribution. The genetic one we cannot change (at least not yet). However, the environmental factors can be curtailed to minimize the risk of developing symptoms — and even to treat the symptoms once they develop. For example, it has been shown that ADHD is linked to some toxic exposures and infections during pregnancy and childhood. Tobacco, alcohol, lead, organophosphates (as in insecticides), artificial dye exposure and preservative exposure during pregnancy have been linked to ADHD in children—so it makes sense to stay away from such exposure during pregnancy. It is also very important to undergo all recommended vaccinations during pregnancy and childhood. Yes, I know some of you may point to the recent controversies around vaccinations, i.e., that they may cause some conditions such as autism. But the fact remains that not being vaccinated poses a much more serious risk to one’s health from infections then the purported link with autism (if it even exists — it is unverified to date).

Another very important point is some linkage to the deficiencies of zinc, iron, magnesium, iodine and omega-3 fatty acids. This is where dietary supplements come in. Considering the common diet these days among children in this age group, this is not surprising. Fast food, chips, candy, sugar-laden soft drinks, pizza etc., are foods with very little nutritional value, so deficiencies of vital minerals and vitamins abound. This is especially detrimental during this developmental period when children undergo rapid growth spurts. Omega-3 fatty acids (which can be found in fish oils, for example), contribute to the prevention of ADHD and have also been shown to mitigate the symptoms of ADHD in children who have already developed them.

In short, ADHD is largely misdiagnosed. However, there is a proportion of children in whom the severity of symptoms causes a detrimental impact on their social and academic life. This can inhibit their development and career success in the future. In such cases, medications as well as counseling, behavior modification and lifestyle changes can be implemented. Of equal importance is prevention through proper vaccination, healthy diet and supplements as well as a stable, peaceful and nurturing home & school environment.

See you next time.

Dr. Karol, MD