Introduction
Approximately 3 to 6 percent of the population constitutes people with attention deficit hyperactivity disorder (AD/HD). This figure may be controversial, as some experts believe that this condition is overdiagnosed, while others believe it is underdiagnosed. Some health professionals still believe that AD/HD is a made-up condition that is used as an excuse for bad behavior; fortunately, this isn’t what most believe (Strong & Flanigan 2005, pp. 1).
While AD/HD is generally diagnosed in children, this disability has been found to continue into adulthood with many people. Adults who struggle with AD/HD experience higher divorce rates, poorer driving records, lower academic and vocational achievement, higher rates of emotional struggles, and a higher incidence of sexually transmitted diseases (Ramsey and Rostain 2007). People with AD/HD are usually noted as having trouble focusing and sitting still. However, there are more symptoms of this complex disorder, and I will be discussing these in this article. I will discuss possible causes, such as genetics and brain activity, and various treatments used to treat AD/HD.
Symptoms
Attention Problems
The two main symptoms of AD/HD are inability to pay attention and hyperactivity/impulsivity. Some with the disorder may have more trouble paying attention than hyperactivity, while others will be the opposite. Some will have both symptoms quite prominently. These symptoms can be broken down into more specific problems. First, I will discuss the symptoms related to the inability to pay attention. AD/HD is often associated with a lack of concentration, such as when trying to do tasks such as reading, homework, or other activities that require focus.
Interestingly, people with AD/HD may be able to have a high degree of focus on one thing and struggle with something else. Similarly, times of focus may vary. An example would be someone being able to focus on a project at one time, but concentration becomes complicated when they return to the project. Those with AD/HD may struggle with filtering out their surroundings and become easily distracted. The classic example is a student looking out the window during class and zoning out on what the teacher says.
Forgetfulness is another symptom of AD/HD, and therefore, misplacing things may be a struggle. Being late for appointments and other significant events may be another thing that they struggle with. Procrastination may be a struggle for someone with AD/HD. This is because he may start a project, then become distracted by another project, and continue this process, and get behind on everything he is trying to do. This symptom is also related to difficulty with organizational skills. Carelessness is another trait, such as making mistakes by overlooking details. For example, a job requiring workers to move fast yet pay attention to details may be difficult for someone with AD/HD (Strong and Flanigan 2005, pp 32-34).
Hyperactivity/Impulsiveness
Now, let’s take a look at the symptoms that are related to the hyperactive/impulsive aspect of AD/HD. One example would be the student who blurts out an answer to a question that the teacher asks or the adult who finishes sentences for other people. Similarly, a person with AD/HD may tend to interrupt others in the middle of a conversation. Thrill-seeking and risk-taking, such as driving fast or some other activity that helps get the adrenaline flowing, may be a behavior that those with AD/HD take part in.
Impatience may be a prominent trait present in those who struggle with AD/HD. Perhaps impatience at a stoplight will be more frustrating for this person as compared to someone without the disorder. A person with AD/HD may want things immediately and may be more at risk of impulsive spending or running up the credit card. Sitting still can be a difficulty, as a person with AD/HD may often feel edgy and want to get up and do something rather than sit still. This person may tend to seem usually to be restless (Strong and Flanigan 2005, pp 34-37).
Inhibitory Control in Adults
One study was done to compare the inhibitory control of adults with AD/HD to those without it. One study was done to test the intentional inhibition of distracting information. In this test, participants were asked to look at a specific part of a computer screen, and when a distraction was presented, they were to delay attention to that distraction. In this test, it was found that AD/HD adults showed a lower ability in the intentional inhibition of distracting information. It is thought that the reason for this is connected to the functioning of the frontal eye fields. Automatic inhibition of distracting information was also tested; however, the differences between adults with AD/HD and those without were not significantly different (Roberts et al.).
Other Symptoms Derived from AD/HD
AD/HD may lead to other symptoms such as boredom, low self-esteem, insomnia, learned helplessness, excessive worry, frustration, and even substance abuse (Strong and Flanigan 2005, pp 38-40).
Possible Causes of AD/HD
Genetics
There are many possible causes of AD/HD that have been looked into. First, genetics plays a role in AD/HD. One study showed that 81% of the time, if one identical twin has it, the other will have it, yet this is the case with only 29% of paternal twins. Other studies have shown that when it comes to AD/HD, children will resemble their biological parents more than their adoptive parents. AD/HD is likely connected with the dopamine D2 receptor. Some researchers suggest that DAT1 and DRD4 are behind this disorder, and one study indicated that the DRD4 7R gene may be associated with certain AD/HD symptoms, such as impulsivity (Strong and Flanigan 2005, pp 24-25).
Brain Size and Shape
The role of the brain’s size and shape has been looked into, but there seems to be a lot of conflicting data. There is a possibility that the corpus callosum plays a role because it appears to be different in size for those with AD/HD when compared to those without it and perhaps even operates differently. It is also possible that the basal ganglia may be asymmetrical in people with AD/HD. One study done by Alan Zemetkin used a PET scan to measure brain activity and found that adults with AD/HD had a decrease in activity in the frontal lobe, while those without AD/HD showed an increase.
Another study by Dr. Joel Lubar found that there is an increase in theta waves in the frontal area when a person with AD/HD tries to concentrate. Dr. Daniel G. Amen found that there is an increase in the limbic system in people with AD/HD, which may be one of the root causes of AD/HD. There was also more activity found in the parietal lobe in those with AD/HD (Strong and Flanigan 2005, pp 25-27).
Neurotransmitters
There is evidence to suggest that neurotransmitters play a role in AD/HD. The two neurotransmitters that seem to play a role are dopamine and norepinephrine. Since norepinephrine is associated with agitation and even fight or flight response, too much of it is associated with AD/HD as it may play a role in hyperactivity. Those with a high level of dopamine activity may be able to handle repetitive tasks without being bored. However, those with AD/HD often are easily bored, indicating that they have lower dopamine levels (Strong and Flanigan 2005, pp 27-28).
Brain Activity
In one study, a task-switching task was assigned to fifteen men diagnosed with AD/HD and a control group of 14 men. All participants were adults, so this experiment would pertain more to those with adult AD/HD rather than childhood AD/HD. The findings in this study reveal that there was no difference in executive control problems when it comes to behavior. However, the areas of the brain differed between the experimental group and the control group. The AD/HD group showed higher activity in the dorsal anterior cingulate cortex (dACC), middle temporal gyrus, precuneus, lingual gyrus, precentral gyrus, and insula while the experimental group showed more activity in the putamen, posterior cingulate gyrus, medial frontal gyrus, thalamus, orbitofrontal cortex, and postcentral gyrus. The finding of an increase in activity in dACC is rather interesting.
This area has to do with negative feedback, error responses, and the detection of conflicting information. It has been suggested that those with AD/HD may engage in a stronger activation of the dACC in order to attempt to pay better attention to the conflicting information during a task-switching exercise. Thus, they would perform just as well as the control group. Overall, the AD/HD participants showed more activation in the executive attention system and less activity in the alerting system. This study confirmed that people with AD/HD show different activations in brain areas than those without this disorder (Dibbets et al. 2010).
Treatments
Methylphenidate (Ritalin)
A study was done on the effects of methylphenidate (MPH; Ritalin) on children 7 years old with AD/HD. This study was done to see how this drug affects academic, behavioral, and social functioning and what doses should be used. This study did end up with various results indicating that MPH is only beneficial for some children and not others. Findings also suggest a negative correlation between social engagement and dosage increase. In fact, one child showed such a decrease in social activity that this problem outweighed the benefits of a reduction in disruptive behavior.
There seemed to be no correlation between dosage amount and disruptive behavior and academic performance. This study also found that the effects of MPH were more short-lived for academic performance as compared to reducing disruptive behavior. This study supports that MPH acts in various ways from individual to individual. There is no straightforward answer on how effective MPH will be for various people (Northup et al. 2001).
Other Medications
Several other medications can be used to treat those with AD/HD and I will discuss a few of them here. One of the first medications used for AD/HD is known as Dexedrine. This drug works as a norepinephrine and dopamine agonist. A similar drug called Adderall may be used to treat AD/HD. However, this drug seems to focus more on working on the norepinephrine-containing neurons than Dexedrine. Cylert is a medication that is a dopamine agonist only. However, it holds a high risk for liver damage, so it should be used with caution. While the medications I have mentioned so far are all stimulants, other classes of medications can be used that I will briefly describe. First, there are monoamine oxidase inhibitors (MAOIs), which help prevent the breakdown of norepinephrine, dopamine, and serotonin. Some of these medications include nardil, parnate, and eldepril.
Selective serotonin reuptake inhibitors (SSRIs) help to slow the reuptake of serotonin from synapses. These medications may help to reduce certain impulsive or aggressive behaviors associated with AD/HD. Prozac, Paxil, and Zoloft all fall under this category. Sometimes serotonin/norepinephrine reuptake inhibitors such as Effexor are used along with a stimulant in helping with the symptoms of AD/HD. Tricyclic antidepressants can affect dopamine, serotonin, and norepinephrine to various degrees, and medications such as Tofranil, Nortriptyline, and others may be used for their positive effects on AD/HD. Other medications may be used to treat various aspects that might come with AD/HD, such as antidepressants, antihypertensives, and anticonvulsants (Strong and Flanigan 2005, pp 112-117).
Psychosocial Treatment
When it comes to psychosocial treatment, it seems that cognitive-behavior therapy is the preferred therapy. This may be due to this method’s use of developing skills where there are deficits and helping to elevate self-esteem and organizational techniques and other areas people with AD/HD struggle with. It is often agreed upon that one of the first things that needs to be done when one is diagnosed with AD/HD is to educate the client about it. Having the client understand what his symptoms mean and possible causes may help the client to understand himself better and will pave the way to furthering the therapy process. Hopefully, this process will help motivate the client to want to make the necessary changes to help alleviate the symptoms of AD/HD.
Another essential element in psychosocial treatment is for the therapist to remain direct, active, and focused and not let the session drift off. A warm therapist/client relationship may be beneficial as many who struggle with AD/HD also struggle with feelings of guilt and failure, and feeling like a failure in therapy may cause the client to give up too soon. Since people with AD/HD may struggle with negative self-thoughts, cognitive modification may need to be used to help alleviate feelings of low self-esteem. This may not deal directly with the AD/HD itself but will help with feelings due to the struggle with AD/HD. AD/HD coaching is also used to help adults with this disability overcome challenging obstacles and boost the confidence of the individual. Coaching is best used alongside CBT, as it doesn’t work as heavily with the complex systems of cognition and behavior as CBT does (Ramsey and Rostain 2007).
Diet
Diet may play a role in helping with AD/HD symptoms. Foods containing essential fatty acids, such as Omega-6 and Omega-3, may be beneficial in helping with AD/HD. This would include foods such as fruits, grains, raw nuts, raw seeds, fish, and avocados, among other foods. A person should get two to four times as much Omega-6s in their diet when compared to Omega-3s; however, most people are deficient in Omega-3s. A supplement or seeking out grass-fed meat may help to establish a better ratio between the two. Sugary foods may also counter the effects of these essential fatty acids, so a low-sugar diet may be helpful.
Simple carbohydrates such as pasta, white rice, alcohol, simple sugars, and potatoes trigger high amounts of insulin, which may help to produce certain symptoms that are associated with AD/HD, such as tiredness and inability to concentrate, so it might be helpful to cut down on these foods. Instead, complex carbohydrates such as whole-wheat products, beans, brown rice, etc, should be consumed. The amino acids that make up good-quality proteins, such as lean meats, are used to support neurotransmitters, so those who struggle with AD/HD should eat these. Another reason why following the above recommendations for eating is that it helps keep a healthy yeast balance in the digestive system.
For instance, if there is an overabundance of yeast called candida albicans when compared to other yeasts known as bifidobacteria bifidum and lactobacillus acidophilus, foggy thinking may be a symptom. Another thing that people with AD/HD may want to look for is the possibility of food allergies. Sometimes, certain food allergies, such as gluten sensitivity, may cause a person to feel more cloudy-minded after eating foods with gluten in them. Sometimes, it may be good to go on a restrictive diet, only eating foods that people are generally not allergic to, and slowly start adding other foods to the diet and record which foods seem to cause a negative reaction (Strong and Flanigan 2005, pp. 153-159).
Natural Supplements
Some believe that natural supplements may be beneficial for those with AD/HD. A few studies have been done testing 2-Dimethylaminoethanol (DMAE) and there were significant improvements in AD/HD compared to a placebo. Zinc has shown some benefits in helping with AD/HD; however, the effects are rather modest. In one study, 28% of those using zinc improved, but about 20% of the placebo also improved (Bratman 2007). Some researchers have suggested that calcium and magnesium may help to reduce symptoms of AD/HD as they help the body absorb B vitamins. Vinpocetine may be helpful because it works as a dopamine agonist and increases blood flow in the frontal cortex. Other supplements, such as melatonin or valerian root, may help one get better sleep and improve concentration during waking hours (Strong and Flanigan 2005, pp. 164-168).
Rebalance therapies may be helpful in helping decrease the symptoms of AD/HD. Acupuncture is a Traditional Chinese Medicine system that is used to balance the Qi in the body. It is thought that any disruptions of the Qi in the body result in illness. A professional acupuncturist will look for this disruption in those with AD/HD and work on getting the flow of the Qi to run smoothly through the person and, therefore, reducing AD/HD. Some believe that manipulation therapy, such as chiropractic work, osteopathy, and CranioSacral Therapy, can help alleviate some of the symptoms of therapy by correcting the flow of cerebrospinal fluid. These therapies also help properly align the bones, which may improve neurological problems (Strong and Flanigan 2005, pp. 189-195).
Neurofeedback
There is evidence that supports that the use of neurofeedback training may be an effective treatment for AD/HD. The point of this training is to teach a person to be able to change brave wave patterns at will. A professional will use a brain imaging system to view the patient’s brain and see which parts of the brain are active. The patient may be instructed to do various activities on a computer, such as playing a video game or something similar.
The professional will work on improving brain waves in parts of the brain that are typically low in activity for those with AD/HD, which may include the prefrontal cortex. This process may take up to 50 sessions (usually at least 20), and evidence supports that the effects are lasting even after sessions have ceased. Side effects seem to be rare, as there may be some anxiety, insomnia, and fatigue that can result, but usually wear off soon after. One of the major downfalls of this method is the cost, as it isn’t typically covered by insurance companies (Strong and Flanigan 2005, pp. 176-179).
Conclusion
AD/HD is a rather complex disorder that may be difficult to diagnose and difficult to treat. While there are some patterns that seem to emerge with those with the disorder, the disorder also can be rather individualistic. Certain treatments may be beneficial for some people, while the same treatment may not help others, such as the use of Ritalin. While I have listed several treatment ideas, there are other possibilities that someone with AD/HD may want to look into that I have not listed. Hopefully, as technology and the availability to obtain information increases, there will be a continued improvement in helping those who have been diagnosed with AD/HD.
Further Reading:
Books
ADHD 2.0 by Dr. Edward Hallowell & Dr. John Ratey
The ADHD Effect on Marriage by Melissa Orlov
Delivered From Distraction by Dr. Edward M. Hallowell & Dr. John J. Ratey
Driven to Distraction by Dr. Edward M. Hallowell & Dr. John J. Ratey.
The Explosive Child by Dr. Ross W. Greene
The Mindfulness Prescription for Adult ADHD by Dr. Lidia Zylowska
Smart but Scattered by Peg Dawson & Richard Guare
Taking Charge of ADHD by Russell Barkley
What Your ADHD Child Wishes You Know by Dr. Sharon Saline
Women with ADHD by Sari Solden
You Mean I’m Not Lazy, Stupid or Crazy?! by Kate Kelly & Peggy Ramundo
Online
Attention Deficit / Hyperactive Disorder Articles
The Best Online Resources For ADHD We Tried and Tested
References
Bratman, Steven M.D. (2007) – Collin’s Alternative Health Guide. HarperCollins Publishers. New York, NY.
Dibbets, Pauline; Evers, Elisabeth A. T.; Hurks, Petra P. M.; Bakker, Katja; Jolles, Jelle; Differential brain activation patterns in adult attention-deficit Hyperactivity Disorder (ADHD) associated with task switching. Neuropsychology, Vol 24(4), Jul, 2010. pp. 413-423.
Northup, John; Gulley, Veronica; Edwards, Stephanie; Fountain, Laura; The Effects of Mythelphenidate in the Classroom: What Dosage for Which Children for Which Problems. School Psychology Quarterly, Vol 16(3), Fal, 2001. pp. 303-323.
Ramsay, J. Russell; Rostain, Anthony L.; Psychosocial Treatments for Attention-Deficit/Hyperactivity Disorder in Adults: Current Evidence and Future Directions. Professional Psychology: Research and Practice, Vol 38(4), Aug, 2007. pp. 338-346.
Roberts, Walter; Fillmore, Mark T.; Milich, Richard; Separating Automatic and Intentional Inhibitory mechanism of attention in adults with attention deficit/Hyperactivity disorder. Journal of Abnormal Psychology, Vol 120(1), Feb, 2011. pp. 223-233.
Strong, Jeff; Flanagan, Michael O MD (2005); AD/HD for Dummies. Wiley Publishing, Inc. Indianapolis, Indiana.