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Denise Lin, M.D.: Classic ADHD Symptoms in Children, Adults

Treatments are available to help minimize the effects of the disorder

A recent study by the Centers for Disease Control and Prevention estimates that 10 percent of American children suffer from attention deficit hyperactivity disorder, or ADHD. Previous research has shown that 65 percent of children with ADHD continue to be impaired as adults.

Medical scientists divide ADHD into three diagnostic categories: inattentive type, hyperactive/impulsive type and combined type. The types of symptoms are often grouped into categories also, and children manifest ADHD a bit differently than adults.

Here is a classic example of a child with ADHD, combined type:

As a baby, he was very active and didn’t sleep for long periods. He didn’t start walking until 15 months of age, and he seemed a little clumsier than his peers. What he lacked in coordination he seemed to make up for in fearlessness and energy. He was always on the move, and spent his time playing active and sometimes risky games that involved climbing, jumping, throwing and running. He frequently sported bruises and had suffered a few broken bones.

He didn’t seem to listen to his parents or follow instructions very well. He couldn’t resist trying to involve his baby sister in his games that would usually end up with her crying and him getting in trouble. He lost things, broke things and left messes in his wake. His parents were often angry and exasperated with him, and he was regularly punished — although this didn’t seem to improve his behavior.

When he started school, he was frequently in trouble for getting out of his chair, talking out of turn, being silly, interrupting and bothering the other children. He resisted doing homework and often lost his pencils and books.

Of course, there are many healthy, active kids who don’t have ADHD. It is when these behaviors are repeatedly disruptive and the child can’t seem to behave differently even when he or she tries that the possibility of ADHD arises.

Here is an example of an adult with ADHD, inattentive type:

A 32-year-old woman who works as a waitress comes into my office complaining of depression and a “short fuse.” She had been a quiet child who struggled to keep up with her school work. Her teachers often told her parents that she was intelligent but didn’t work up to her potential.

After high school, she started college with the hope of becoming a nurse, but dropped out at age 20 when she married and started a family. Her marriage ended in divorce a few years later when her husband had an affair. She tried enrolling in college classes several times but never completed them. When she tried to study, she found that even though her eyes were moving over the words, she was not really paying attention, and so she had to read everything over several times. She would inevitably get behind and become frustrated and drop the class.

In my office, she was tearful, self-critical and focused on her failures. She was bored and unhappy in her job as a waitress and was struggling with the stress of being a single parent.

The inattentive type of ADHD is often overlooked by teachers and parents, but as you can see in the example, it is can be just as impairing as the hyperactive type.

Some people with ADHD demonstrate impairment of the higher brain functions known as “executive functions.” Executive functions include the ability to make complex plans, prioritize, organize information, remember details, multitask, maintain self-discipline and meet deadlines.

Life is difficult for children and adults with ADHD. Often they have grown up hearing they are lazy or bad in spite of their best efforts. By adulthood they may have experienced multiple failures in school and work. It is not surprising that low self-esteem, low mood or depression, and substance abuse tend to co-occur with ADHD.

The ADHD brain needs greater levels of stimulation to function well, so people with ADHD become easily bored and impatient, and they tend to make poor, snap decisions about work and relationships. Their relationships may suffer from their inability to listen carefully and to impulsively do or say damaging things. ADHD patients are more likely to smoke, abuse alcohol and drugs, and are more likely to have car and other accidents. ADHD is a risk factor for criminality and incarceration.

Research on twins and families has shown that ADHD is highly heritable. Someone with a first-degree relative with ADHD has a four to 10 times greater chance of having it themselves. Scientists have located several genes that are implicated in the inheritance of ADHD, suggesting several variations of this disorder.

There are some environmental factors that increase the risk of having ADHD. A pregnant woman who smokes, drinks alcohol, takes certain drugs, has a high level of stress, has high blood pressure or has a premature delivery increases the risk of her baby having ADHD. Some studies suggest that certain environmental toxins and poor diets also may be contributing factors.

Specialized brain imaging studies of people with ADHD demonstrate that the prefrontal and the premotor areas of the frontal lobe exhibit diminished blood flow and decreased use of glucose. This means that these brain areas are underactive in people who have ADHD. When the appropriate medications are administered, these brain areas become more active. The neurotransmitters dopamine and norepinephrine play a key role in attention and impulsivity, and medications that increase the release of these chemical messengers are the mainstay of medical treatment for ADHD.

The diagnosis of ADHD is usually made with a careful clinical assessment by a mental health professional or pediatrician, along with collateral information from family and teachers. There are a number of useful tests that provide information that can help with the diagnosis. However, we don’t have a perfect test that we can rely on to rule in or rule out the diagnosis of ADHD.

The ideal management of childhood ADHD is comprehensive plan that involves the parents, the school, behavioral therapy and a child psychiatrist. It is also helpful to review the child’s diet. Eliminating food dyes and foods that cause extreme swings in blood sugar can be helpful components of the treatment plan. If this condition is caught early and treated appropriately, the child has a much greater chance at leading a productive and happy life.

First-line medications for ADHD include psychostimulants such as Ritalin, Concerta, Focalin, Adderall, Vyvanse and Dexedrine. Second-line medications include Strattera and Provigil or Nuvigil. Other medications that are helpful for ADHD include guanfacine, clonidine and the antidepressant Wellbutrin. Some of these are not approved by the Food and Drug Administration for ADHD but have solid evidence supporting their usefulness nonetheless.

For the brain to function at its best, it requires adequate levels of all the nutrients. I recommend a diet that is low in fast foods, processed foods, sugar and starch, and high in fresh vegetables, fruits, fiber and proteins. I often recommend a daily dose of omega 3 fatty acids, 20 mg of zinc and, if indicated, a high-quality multimineral/multivitamin formula to my ADHD patients.

Click here for more information from the the CDC Web site.

Denise Lin, M.D., is a board-certified psychiatrist who runs Advanced Psychiatric Care, her private practice at 123 W. Padre St., Suite A, in Santa Barbara. She can be reached at 805.845.2323, or click here for more information.

 
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