children with ADHD are metabolically different from others, [38][39][40] and it has therefore been suggested that diet modification may play a role in the management of ADHD. Perhaps the best known of the dietary alternatives is the Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets.[41] In the 1980s vitamin B6 was promoted as a helpful remedy for children with learning difficulties including inattentiveness. Later, zinc and multivitamins have been promoted as cures, and currently the addition of certain fatty acids such as omega-3 has been proposed as beneficial.[42] [43]
It is claimed by some ADHD patients that commonly available mild stimulants such as caffeine and theobromine have similar effects to the more powerful drugs commonly used in treating the disorder. Herbal supplements such as ginkgo biloba are also sometimes cited. There is some empirical data suggesting caffeine can improve the function of children suffering from ADHD.[44] [45]
[edit]
Coaching
Main article: ADD Coaching
ADD Coaching is a program where coaches work with ADHD individuals to help them prioritize, organize, and develop life skills. Coaching is aimed at helping clients to be more realistic in setting goals for themselves by learning about their individual challenges and gifts, and emphasizes spending more time in areas of strength, while minimizing time spent dealing with areas of difficulty.
[edit]
Other alternatives
Neurofeedback is a proposed ADHD remedy which involves teaching children to control their brain waves by the use of video-game technology. A thorough review by Sandra Loo and Russell Barkley of the research done on this in Developmental Neuropsychology 2005 concluded that neurofeedback does not have adequate support from appropriately conducted scientific studies to support it as an intervention at this time.[46]
Audio-visual entrainment uses light and sound stimulation to guide and change brainwave patterns.[47] While safe for most, it cannot be used by those suffering from photosensitive epilepsy due to the risk of triggering a seizure.
Cerebellar stimulation assumes that by improving the patient’s cerebellar function, many ADHD symptoms can be reduced or even eliminated permanently. As noted above, several studies have shown that the cerebellums of children with ADHD are notably smaller than their non-ADHD counterparts. Several programs of balance, coordination, eye and sensory exercises that specifically involve the functions of the cerebellum are used to treat ADHD, Asperger's syndrome, and many learning difficulties such as dyslexia and dyspraxia. Most prominent are the DORE program,[48] the Learning Breakthrough Program, and the Brain Gym. No substantial body of research exists to support these treatment approaches.
[edit]
Controversy
Main article: Controversy about ADHD
The ADHD diagnosis is controversial and has been questioned by some professionals, adults diagnosed with ADHD, and parents of diagnosed children. They point out the positive traits that people with ADHD have, such as "hyperfocusing." Others believe ADHD is a divergent or normal-variant human behavior, and use the term neurodiversity to describe it, emphasizing that there are an immense number of variations in genetics which could favor a greater or lesser ability to concentrate and/or to remain calm under varying circumstances.[49]
[edit]
Skepticism towards ADHD as a diagnosis
The number of people diagnosed with ADHD in the U.S. and UK has grown dramatically over a short period of time. Critics of the diagnosis, such as Dan P. Hallahan and James M. Kauffman in their book Exceptional Learners: Introduction to Special Education, have argued that this increase is due to the ADHD diagnostic criteria being sufficiently general or vague to allow virtually anybody with persistent unwanted behaviors to be classified as having ADHD of one type or another, and that the symptoms are not supported by sufficient empirical data.[50] Additionally, a recent study by Adam Rafalovich has found that many doctors are no more confident in the diagnosis and treatment of ADHD than are many parents.[51] Another source of skepticism is that most people with ADHD have no difficulties concentrating when they are doing something that interests them, whether it is educational or entertainment.[52] However, these objections have been rejected by the American Psychiatric Association, the American Psychological Association, the American Medical Association, the American Academy of Pediatrics and the U.S. Surgeon General.[53]
Another argument which has been offered against the diagnosis is that the behavior of putative ADHD sufferers is the "natural" way for children to behave in a situation which does not engage them. It has never been a simple task to teach children how to behave in a "grown up" fashion, and therefore great amounts of time and energy have traditonally been spent by parents and educators trying to inspire, cajole, threaten, lecture, bribe (and every other imaginable strategy) in the service of teaching a child how to gain self control, act with consideration for others, and do tasks that are not fun. In other words, it is argued, a child who is not successfully taught how to behave, obey the rules and stay on task will display all of the symptoms of ADHD. Those who place emphasis on the parental role in ADHD claim that while neurological impairments, or innate tendencies, can be a factor in the ability to stay focused on tasks being demanded, the "nature" (or biological) aspects of the nature vs.nurture controversy have been greatly exaggerated. They claim millions of children being diagnosed with this condition have nothing physically wrong with their brains. [54]
A believer that ADHD is a biological condition, Xavier Castellanos M.D., then head of ADHD research at the National Institute of Mental Health, (NIMH), [55] has also expressed reservations about the extent of available biological information about that condition in an interview on Frontline in 2000:
Frontline: "How does ADHD work on the brain? What do we know about it?"
Castellanos: "We don't yet know what's going on in ADHD..."
Frontline: "Give me one true fact about ADHD."
Castellanos "The posterior inferior vermis of the cerebellum is smaller in ADHD. I think that that is a true fact. It's taken about five years to convince myself that that's the case. That's about as much as I know--that I'm confident about..."
[edit]
Parental role
Many clinicians believe that attachments and relationships with caregivers and other features of a child's environment have profound effects on attentional and self-regulatory capacities. An editorial in a special editon of Clinical Psychology in 2004 stated that "our impression from spending time with young people, their families and indeed colleagues from other disciplines is that a medical diagnosis and medication is not enough":
"In our clinical experience, without exception, we are finding that the same conduct typically labelled ADHD is shown by children in the context of violence and abuse, impaired parental attachments and other experiences of emotional trauma."[56]
While no compelling evidence has been offered that parenting methods can cause ADHD in otherwise normal children a sizable minority of clinicians believe this is the case. A different perspective holds that while evidence shows that parents of ADHD children experience more stress and give more commands,[57] further research has suggested that such parenting behavior is in large part a reaction to the child's ADHD and related disruptive and oppositional behavior, and to a minor extent the result of the parent's own ADHD.[58]
[edit]
Positive aspects
Although ADHD is considered a disorder, some view it in a neutral or positive light. Rather than assuming that ADHD is inherently negative, some argue that ADHD is simply a different method of learning as opposed to an inferior one. "While the A students are learning the details of photosynthesis, the ADHD kids are staring out the window and pondering if it still works on a cloudy day" (Underwood). The aspects of ADHD which are generally viewed negatively can be a potential source of strength, such as willingness to take risks. "Impulsivity isn't always bad. Instead of dithering over a decision, they're willing to take risks" (Underwood). Both a proponent and an example of this point is JetBlue Airways founder David Neeleman. He considers ADHD one of his greatest assets and refuses to take medication. [59][60] There has been little serious research into either the intellectual advantages it can provide, or into conditions which might be necessary for taking advantage of ADHD traits.
Many professional counselors emphasize to persons diagnosed with ADHD and their families the perspective that the condition does not necessarily block, and may even facilitate, great accomplishments. Most frequently cited as potentially useful is the mental state of hyperfocus. Lists of famous persons either diagnosed with ADHD or suspected (but not necessarily known to have had ADHD) are numerous, such as Albert Einstein and Thomas Edison, but currently lack scientific proof because ADHD was not a documented medical condition until its appearance in the DSM-III in 1980.
[edit]
History
There is considerable evidence to suggest that ADHD is not a recent phenomenon.
493 BC, the great physician-scientist Hippocrates described a condition that seems to be compatible with what we now know as ADHD. He described patients who had "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression". Hippocrates attributed this condition to an "overbalance of fire over water”. His remedy for this "overbalance" was "barley rather than wheat bread, fish rather than meat, water drinks, and many natural and diverse physical activities."[61]
1845. ADHD was alluded to by Dr. Heinrich Hoffmann, a physician who wrote books on medicine and psychiatry. Dr. Hoffman was also a poet who became interested in writing for children when he couldn't find suitable materials to read to his 3-year-old son. The result was a book of poems, complete with illustrations, about children and their undesirable behaviours. "Die Geschichte vom Zappel-Philipp" (The Story of Fidgety Philip) in Der Struwwelpeter was a description of a little boy who could be interpreted as having attention deficit hyperactivity disorder.[62] Alternatively, it may be seen as merely a moral fable to amuse young children at the same time as encouraging them to behave properly.
1902 – The English pediatrician George Still, in a series of lectures to the Royal College of Physicians in England, described a condition which some have claimed is analogous to ADHD. Still described a group of children with significant behavioral problems, caused, he believed, by an innate genetic dysfunction and not by poor child rearing or environment.[63]. Analysis of Still's descriptions by Palmer and Finger indicated that the qualities Still described are not "considered primary symptoms of ADHD".[64]
The 1918–1919 influenza pandemic left many survivors with encephalitis, affecting their neurological functions. Some of these exhibited immediate behavioral problems which correspond to ADD. This caused many to believe that the condition was the result of injury rather than genetics.
1937 – Dr. Bradley in Providence RI reported that a group of children with behavioral problems improved after being treated with stimulant medication.[65]
1957 – The stimulant methylphenidate (Ritalin) became available. It remains one of the most widely prescribed medications for ADHD in its various forms (Ritalin, Focalin, Concerta, Metadate, and Methylin).
1960 – Stella Chess described "Hyperactive Child Syndrome", introducing the concept of hyperactivity not being caused by brain damage.[66]
By 1966, following observations that the condition existed without any objectively observed pathological disorder or injury, researchers changed the terminology from Minimal Brain Damage to Minimal Brain Dysfunction.[67]
1973 – Dr Ben F. Feingold, Chief of Allergy at Kaiser Permanente Medical Center in San Francisco, claimed that hyperactivity was increasing in proportion to the level of food additives.
1975 – Pemoline (Cylert) is approved by the FDA for use in the treatment of ADHD. While an effective agent for managing the symptoms, the development of liver failure in at least 14 cases over the next 27 years would result in the manufacturer withdrawing this medication from the market.
1980 – The name Attention Deficit Disorder (ADD) was first introduced in DSM-III, the 1980 edition.
1987 – The DSM-IIIR was released changing the diagnosis to "Undifferentiated Attention Deficit Disorder." [68]
1994 – DSM-IV described three groupings within ADHD, which can be simplified as: mainly inattentive; mainly hyperactive-impulsive; and both in combination.
1996 – ADHD accounted for at least 40% of child psychiatry references.[69]
1999 – New delivery systems for medications are invented that eliminate the need for multiple doses across the day or taking medication at school. These new systems include pellets of medication coated with various time-release substances to permit medications to dissolve hourly across an 8–12 hour period (Medadate CD, Adderall XR, Focalin XR) and an osmotic pump that extrudes a liquid methylphenidate sludge across an 8–12 hour period after ingestion (Concerta).
1999 – The largest study of treatment for ADHD in history is published in the American Journal of Psychiatry. Known as the Multimodal Treatment Study of ADHD (MTA Study), it involved more than 570 ADHD children at 6 sites in the United States and Canada randomly assigned to 4 treatment groups. Results generally showed that medication alone was more effective than psychosocial treatments alone, but that their combination was beneficial for some subsets of ADHD children beyond the improvement achieved only by medication. More than 40 studies have subsequently been published from this massive dataset.
2001 – The International Consensus Statement on ADHD is published and signed by more than 80 of the world's leading experts on ADHD to counteract periodic media misrepresentation that ADHD is a real disorder and that medications are justified as a treatment for the disorder. In 2005, another 100 European experts on ADHD added their signatures to this historic document certifying the validity of ADHD as a valid mental disorder.
2003 – Atomoxetine, the first new medication for ADHD in 25 years, receives FDA approval for use in children, teens, and adults with ADHD.
2006-09-24 20:51:31
·
answer #10
·
answered by Linda 7
·
0⤊
2⤋