Attention Deficit Hyperactivity
Disorder
Inappropriate behavior, including
poor attention skills, impulsivity, and
hyperactivity
Attention Deficit Hyperactivity Disorder
Here are some Facts
• Behavioral disorder emerges before the age of
seven
• Symptoms include inattentive, impulsive and
hyperactive behaviors
• ADHD is not a reflection of a child's intelligence
nor caused by poor parenting
• ADHD is more common in people who have a
close relative with the condition
• Twice as many boys are diagnosed with ADHD as
girls
What Is The Difference Between ADD
and ADHD
• The current Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) outlines the diagnostic
criteria for mental conditions.
• Although the terms ADD and ADHD are used
interchangeably, ADHD is the official name used by the
American Psychiatric Association, and it encompasses
hyperactive, impulsive, and/or inattentive behaviors.
• ADD is the older term thus in some older literature you
will find this term as a synonym for ADHD
TYPES OF ADHD
• Combined Type (Inattentive/Hyperactive/Impulsive).
Children with this type of ADHD show all three
symptoms. This is the most common form of ADHD.
• Hyperactive/Impulsive Type. Children show both
hyperactive and impulsive behavior, but are able to pay
attention.
• Inattentive Type. Formerly known as attention deficit
disorder (ADD), these children are not overly active.
They do not disrupt the classroom or other activities,
so their symptoms might not be noticed.
Attention Deficit Hyperactivity
Disorder: Prevalence
• Affects children, adolescents and adults
• The National Institute of Mental Health
(NIMH) estimates that 5 million children in the
United States have ADHD – that is about 5% of
all children!
• Studies show that up to 70% of children with
ADHD continue to have symptoms as adults
Attention Deficit Hyperactivity Disorder:
In Children
• Childhood ADHD is diagnosed after a child has shown
six or more specific symptoms of inactivity and/or
hyperactivity on a regular basis for more than six
months in more than two settings.
• There is no single test for ADHD
• Diagnosis is based on questionnaires
Attention Deficit Hyperactivity Disorder:
In Children
• A doctor can diagnose ADHD with the help of
standard guidelines.
• The diagnosis of ADHD involves the gathering of
information from several sources, including school,
caregivers, and parents.
• The doctor will consider how a child's behavior
compares with that of other children the same age.
Attention Deficit Hyperactivity Disorder:
In Teens
• Typically diagnosed in childhood, ADHD still affects
many teens.
• The symptoms -- inattention, impulsivity, and
hyperactivity - are intrusive, which means they
interrupt and seriously interfere with a teen's life.
• During teen years, especially as the hormonal
changes of adolescence are going on, symptoms of
ADHD may intensify.
Attention Deficit Hyperactivity Disorder:
In Teens
• It's not uncommon for teens with ADHD to forget
assignments, misplace textbooks, and become easily
bored with their daily class work.
• Teens may become inattentive, or excessively
attentive -- not waiting for their turn before blurting
out answers.
Attention Deficit Hyperactivity Disorder:
In Teens
• Teens with ADHD may also be fidgety and have a
difficult time sitting still in class.
• The lack of attention to what they're doing often
leads to poor performance on tests and being
rejected from sports teams, extracurricular activities,
and peer groups.
Attention Deficit Hyperactivity Disorder:
In Teens
• Teens with ADHD are more likely to be heavy
alcoholic drinkers than teens without ADHD.
• In clinical studies, researchers confirmed that teens
with ADHD were twice as likely to have abused
alcohol within the past 6 months.
Attention Deficit Hyperactivity Disorder:
In Teens
• They also found that teens with ADHD were likely to
abuse drugs and three times more likely to abuse
drugs other than marijuana.
• Getting proper treatment for ADHD in teens may cut
the risk of later alcohol and drug abuse.
Attention Deficit Hyperactivity Disorder:
In Adults
• It is now known that these symptoms continue into
adulthood for about 70% of children with ADHD.
• That translates into 4% of the US adult population, or
8 million adults.
• Few adults are identified or treated for adult ADHD.
Attention Deficit Hyperactivity Disorder:
In Adults
• Adults with ADHD may have difficulty following
directions, remembering information, concentrating,
organizing tasks or completing work within time
limits.
• If these difficulties are not managed appropriately,
they can cause associated behavioral, emotional,
social, vocational and academic problems.
Attention Deficit Hyperactivity Disorder:
In Adults
• The following behaviors and problems may stem directly
from ADHD or may be the result of related adjustment
difficulties:
– Chronic lateness and forgetfulness.
– Anxiety.
– Low self-esteem.
– Employment problems.
– Difficulty controlling anger.
– Impulsiveness.
Attention Deficit Hyperactivity Disorder:
In Adults
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Substance abuse or addiction.
Poor organization skills.
Procrastination.
Low frustration tolerance.
Chronic boredom.
Difficulty concentrating when reading.
Mood swings.
Depression.
– Relationship problems.
Attention Deficit Hyperactivity Disorder:
Adults - Interesting Facts
• Adults with ADHD are more likely to:
– Change employers frequently and perform poorly.
– Have had fewer occupational achievements
– Have a lower socioeconomic status.
– Have driving violations such as: be cited for speeding;
have their licenses suspended; and be involved in
more crashes
Attention Deficit Hyperactivity Disorder:
Adults - Interesting Facts
• Adults with ADHD are more likely to:
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Use illegal substances more frequently.
Smoke cigarettes.
Self-report psychological maladjustment more often
Have more marital problems and multiple marriages.
Have higher incidence of separation and divorce.
• Much of this functional impairment diminishes with
remission of the disorder and can be mitigated by
appropriate treatment.
Common Conditions That Coexist With
ADHD
COMORBIDITY
Learning Disorders
Anxiety & Depression
Bipolar Disorder
Oppositional Defiance Disorder
Conduct Disorder
Tourette’s Syndrome
Substance Abuse
Obsessive Compulsive Disorder
Intermittent Explosive Disorder
Panic Disorder
Specific Phobia
CHILDREN
ADOLESCENT
X
X
X
X
X
X
X
X
X
X
X
X
X
X
ADULT
X
X
X
X
X
X
X
Attention Deficit Hyperactivity
Disorder
The Medical Approach
Cocaine or Ritalin?
• Euphoria, confidence and wellbeing, loss of
appetite, a feeling of increased alertness and
energy, excitability, restlessness, aggression,
nervousness, increased blood pressure, heart
rate and respiration, a rise in body temperature,
dilated pupils, and rapid body movements,
psychological dependence and death.
Cocaine or Ritalin?
• Increase blood pressure, heart rate
respirations and temperature, appetite
suppression, weight loss, growth retardation,
facial tics, muscle twitching, CNS stimulation,
euphoria, irritability and agitation, psychotic
episodes, violent behavior, heart arrhythmias
and palpations, high blood pressure,
psychological dependence and death
Medication for ADHD
• A class of drugs called psychostimulants or stimulants have
been used to effectively treat
ADHD for years.
• They work by increasing the
production of two
neurotransmitters – dopamine
and norepinephrine
Medication for ADHD
• Stimulants
– Work by increasing dopamine output from basal ganglia and
increase activity in the prefrontal cortex and temporal lobes
• Adderall
• Ritalin (SR)
• Dexedrine
• Tricyclic Antidepressants
– Increase norepinephrine, dopamine, serotonin used when
depression and bed-wetting are also symptoms
• Imipramine (Tofranil)
• SSRI
– Increase serotonin availability used when excessive worrying,
over focus, or temper problems are also symptoms
• Effexor
Medication for ADHD
• These medicines help users to focus their thoughts and
ignore distractions.
• Stimulant medications are effective in 70% to 80% of
patients.
• However there are short and long term effects related to
these drugs
Medication for ADHD
• Stimulant drugs to treat ADHD include:
– Adderall and Adderall XR
– Concerta
– Dexedrine
– Focalin and Focalin XR
– Metadate CD and Metadate ER
– Methylin
– Ritalin, Ritalin LA
– Vyvanse
– Desoxyn
Side Effects of ADHD Drugs
• ADHD drugs sometimes have side effects
• The most common side effects of ADHD drugs
include:
– Decreased appetite/weight loss
– Sleep problems
– Headaches
– Jitteriness
– Social withdrawal
– Stomach aches
Side Effects of ADHD Drugs
• Rarely, medications for ADHD can cause more serious
side effects.
• For instance, some stimulants are associated with an
increased risk of cardiovascular problems and
sudden death.
• They may also exacerbate psychiatric conditions like
depression or anxiety.
Stimulant Safety Concerns
Effect On The Developing Brain
• The long-term impact of ADD / ADHD medication on
the youthful, developing brain is not yet known.
• Some researchers are concerned that the use of
drugs such as Ritalin in children and teens might
interfere with normal brain development.
Stimulant Safety Concerns
Heart Related Problems
• ADHD stimulant medications have been found to
cause sudden death in children and adults with heart
conditions.
• The American Heart Association recommends that all
individuals, including children, have a cardiac
evaluation prior to starting a stimulant.
• An electrocardiogram is recommended if the person
has a history of heart problems.
Stimulant Safety Concerns
Psychiatric Problems
• Stimulants for ADD / ADHD can trigger or exacerbate
symptoms of hostility, aggression, anxiety,
depression, and paranoia.
•
• People with a personal or family history of suicide,
depression, or bipolar disorder are at a particularly
high risk, and should be carefully monitored when
taking stimulants.
Stimulant Safety Concerns
Potential for Abuse
• Stimulant abuse is a growing problem.
• College students take them for a boost when
cramming for exams or pulling all-nighters.
• Others abuse stimulant meds for their weight-loss
properties.
• Children taking stimulants should not be sharing the
pills or selling them.
Stimulant Contraindications
• ADD / ADHD stimulants are not recommended for
those with:
– Any type of heart defect or diseases
– High blood pressure
– Hyperthyroidism
– Glaucoma
– High levels of anxiety
– A history of drug abuse
Ritalin and Violence
• 1997 a 14 year old boy opened fire at a prayer
meeting killing 3 teenagers and seriously wounding 5
others
• 1998 two boys, 11 and 14 years old shot 15 people
killing 5 and wounding 10 others
• 1998 a 15 year old boy murdered his parents and
then 2 students at his high school plus wounded 22
others…
Sugar
• High consumption of sugar leads to insulin spike
which takes too much glucose from the blood
causing hypoglycemia
• Due to the hypoglycemic state, adrenaline is
released which causes the fight or flight energy
surge
• This agitation, irritability and shakiness from the
adrenaline could be falsely labeled as ADHD
• Could also be caused from not eating often
enough and not enough protein
Sugar Studies
• Yale study where adults and children were fed
a comparable amount of sugar based on
percentage of body weight.
• Blood glucose and blood adrenaline levels
were measured every half hour for five hours
• Adrenaline levels in children were 10 times
higher than normal up to 5 hours later
Journal of Pediatrics, Jones, Tini, Borg 1995
School Lunch
• Lunches were changed from processed foods and sugars as
well as eliminating BHT and BHA to fruits vegetables, whole
grains and proteins in 803 public schools and 9 juvenile
correctional facilities
• After 4 years the academic performance in the schools rose
16% and learning disabilities fell 40% in the public schools
• In the juvenile correction facilities violent and non-violent
anti-social behavior fell 48%
Schoenthaler, et al. "The Impact of a Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public
Schools," International Journal of Biosocial Research, VoL 8(2): 185. 196, 1986
Chiropractic and ADHD Study
• Improvement Attention in Patients Undergoing
Network Spinal Analysis, Pauli, 2010, Journal of
Vertebral Subluxation Study
• 9 adults (4 men, 5 women) diagnosed with ADHD, were
analyzed for attention using TOVA tests (Test of
Variable Attention) before the treatment began, 30
days into treatment and at conclusion of treatment (8
weeks)
• After 8 weeks of chiropractic care, those who work in
the study group experienced a substantial
improvement within their TOVA scores in addition to a
normalizing of their ADHD symptoms
Chiropractic and ADHD Retrospective
Study
• 4 males age 9-13 medically diagnosed with ADHD
through parent/teacher questionnaires were
treated using chiropractic manipulative therapy
for 5 months.
• At the conclusion of treatment the questionnaires
were administered to parents and teachers.
• All 4 patients showed improvement in ADHD
symptoms such as, hyperactivity, impulsivity, and
inattentiveness, as well as behavioral, social, or
emotional difficulties
Cervical Kyphosis is a Possible Link
to ADHD
• 5 year old medically diagnosed with ADHD and treated with
Ritalin and Aderall for 3 years received 35 Chiropractic
adjustments over the course of 8 weeks.
• Cervical lordosis was measured before and after treatment
• A change from 12 degrees to 32 degrees cervical lordosis was
observed as well as resolution of facial tics and improvement
in behavior.
• “Additionally, the medical doctor concluded that the
reduction in symptoms was significant enough to discontinue
the medication.”
JMPT, 2004, Harrison, Bastecki, Haas