A. D.
H. D. (Attention
Deficit
Hyperactivity
Disorder)
and A. D. D. (Attention
Deficit
Disorder).
Dr. Sayeed Ahmad D.
I. Hom. (London)
Dr. Helen Likierman and Dr. Valerie Muter describe
the subject Article in a greater detail as follows, which is of immense
value:
What is ADHD?
Attention deficit hyperactivity disorder (ADHD) and
attention deficit disorder (ADD) refer to a range of problem behaviours
associated with poor attention span. These may include impulsiveness,
restlessness and hyperactivity, as well as inattentiveness, and often
prevent children from learning and socialising well. ADHD is sometimes
referred to as hyperkinetic disorder.
What are the symptoms of ADHD?
Attention difficulties
A child must have exhibited at least six of the
following symptoms for at least six months to an extent that is unusual
for their age and level of intelligence.” Fails to pay close attention to detail or
makes careless errors during work or play.
” Fails to finish tasks or sustain attention in play activities.
” Seems not to listen to what is said to him or her.
” Fails to follow through instructions or to finish homework or
chores (not because of confrontational behaviour or failure to
understand instructions).
” Disorganised about tasks and activities.
” Avoids tasks like homework that require sustained mental
effort.
” Loses things necessary for certain tasks or activities, such as
pencils, books or toys.
” Easily distracted.
” Forgetful in the course of daily activities.
Hyperactivity
A child must have exhibited at least three of the
following symptoms for at least six months to an extent that is unusual
for their age and level of intelligence.” Runs around or excessively climbs over
things. (In adolescents or adults only feelings of restlessness may
occur.)
” Unduly noisy in playing, or has difficulty in engaging in quiet
leisure activities.
” Leaves seat in classroom or in other situations where remaining
seated is expected.
” Fidgets with hands or feet or squirms on seat.
Impulsivity
At least one of the following symptoms must have
persisted at least for six months to an extent that is unusual for their
age and level of intelligence.” Blurts out answers before the questions have
been completed.
” Fails to wait in lines or await turns in games or group
situations.
” Interrupts or intrudes on others, e. g. butts into others
conversations or games.
” Talks excessively without appropriate response to social
restraint.
Pervasiveness of attention difficulties and
hyperactivityFor a diagnosis or description of ADHD a child would
be expected to show the above difficulties in more than one setting, eg
at school and at home.Sometimes problems are not shown ‘at home’ but are
very evident when a child goes to a hospital department. This can happen
when parents do not realise that their child’s behaviour is out of the
normal range (perhaps because they have no other children, or they have
other children who behave similarly). It may also be because the
problems are mild, or because the family has handled the attention lack
at home in such a way that it is not evident there is a major problem,
or because the child is very young. In those cases it is quite
reasonable for parents not to consider that their child has an attention
deficit problem.
Who is affected by ADHD?
About 1.7 per cent of the UK population, mostly
children, have ADD or ADHD. Boys are more likely to be affected.What else could it be?
” Grand mal or petit mal epileptic seizures
can cause a child to become drowsy, impairing their attention.
Epilepsy can also cause unusual behaviour and lead to abnormal
perceptions.
” Hearing problems such as deafness or glue ear can make it hard
for a child to follow instructions and make them appear inattentive.
” Reading problems, making it hard to complete tasks or follow
instructions.
” Obsessive compulsive disorder leads to people following strange
rituals that preoccupy their thoughts and distract their attention.
” Tourette’s syndrome involves repetitive, involuntary jerking
movements of the body and sudden outbursts of noise or swearing.
” Autism and Asperger’s syndrome often lead to difficulties in
understanding and using language.
” Prolonged periods of insufficient sleep, causing poor
concentration.NB: Many children may be very active or be easily
distracted or have difficulty concentrating. If these behaviours are
relatively mild, they should not be considered a disorder.
What other difficulties can occur alongside ADHD?
ADHD often occurs alongside other difficulties and is
not the sole cause of problem behaviour. Children may exhibit temper
tantrums, sleep disorders, and be clumsy. Other behavioural problems
that occur with ADHD include:” confrontational defiant behaviour, which
occurs in 60 per cent of children. The child loses their temper,
argues and refuses to comply with adults and deliberately annoys
others.
” conduct disorders occur in at least 25 per cent of children.
The child may be destructive or show deceitful behaviour such as
lying, breaking rules and stealing.
” specific learning difficulties, including dyslexia, occur in
25-30 per cent of children.
” severe clinical depression occurs in 33 per cent of children.
” anxiety disorders occur in 30 per cent of children.
What causes ADHD?
Biological factors
” The child’s temperament, as this contributes
to their attitude and personality.” Studies of twins suggest a genetic link to
ADHD. In 80-90 per cent of identical twins where one has ADHD so does
the other. Recent research also suggests there is a greater chance of
inheriting the condition from male relatives such as grandfathers and
uncles.” Brain injuries due to birth trauma or
pre-birth problems. The brain structures believed to be linked to the
development of ADHD are vulnerable to hypoxic damage during birth. The
damage is caused by inadequate oxygen reaching parts of the brain while
blood flow is reduced.
Environmental factors
” Family stress.
” Educational difficulties.
How is ADHD diagnosed?
ADHD requires a medical diagnosis by a doctor,
usually a child or adolescent psychiatrist, a pædiatrician or
pædiatric neurologist or a GP.It will often be appropriate for other professionals
such as psychologists, speech therapists, teachers and health visitors
to contribute their observations to the assessment of a child with
possible ADHD. There is no single diagnostic test for ADHD so different
sorts of information needs to be gathered, such as the following:
History of symptoms
The precise nature of the difficulties, when they
were first noticed, in what situations they occur, factors that
exacerbate or relieve them.
Medical history
Risk factors that could predispose the child to ADHD
include difficulties and risks in pregnancy and during birth, for
example if the mother was in poor health, very young or drank alcohol or
smoked or had an extended or complicated labour.Several medical conditions are known to be associated
with ADHD. These include fragile-X syndrome, fetal alcohol syndrome,
G6PD deficiency, phenylketonuria and generalised resistance to thyroid
hormone.Accidents, operations and chronic medical conditions
such as epilepsy, asthma and heart, liver and kidney disorders all need
to be taken in to account. Also of possible relevance is any medication
the child is taking, as well as any adverse reactions they have had to
medication in the past.
Past psychiatric history
Enquiring about any mental health problems the child
has had can help rule out depression or anxiety being behind the
symptoms.
Educational history
This means the level of their ability and what
specific difficulties they have, how they function within their peer
group and get on with teachers, and any behaviour difficulties such as
suspensions or exclusions. A more detailed evaluation of the child’s
learning by a psychologist may be necessary.Evaluation of the child’s temperament and personality
The child’s temperament and personality, those of
other family members and the nature of relationships within the family
may need to be assessed. This will include discussion of the methods
used by the parents to manage the child’s behaviour and how successful
they have been. Although this seems intrusive, the assessor will remain
neutral and parents should not feel the disorder is ‘their fault’.
Family history
The mental and physical health of the child’s parents
and other family members can be relevant, particularly regarding the
incidence of ADHD or depression.
Social assessment
The family’s social circumstances, such as housing,
poverty, and social support may all have an impact on the child’s
behaviour.
What treatment is available for ADHD?
Treatment depends on a child’s exact diagnosis. It
should take into account any specific difficulties and those strengths
that may aid their improvement.It is not easy to live or cope with a child with
ADHD. Both parents and teachers can follow general guidelines to manage
a child’s problematic behaviour but they may need specialist support and
advice, e. g. from a psychologist.Management techniques for parents and teachers
” Create a daily routine for the child, eg
homework schedules, bedtime and mealtime routines.” Be specific in your instructions to the child
and make clear and reasonable requests, eg instead of telling the child
to ‘behave’ suggest ‘play quietly with your Lego for 10 minutes’.” Set clear and easily understood boundaries, eg
how much TV they may watch, and that rudeness is unacceptable.” Be consistent in the handling and managing of
the child.” Remove disturbing or disruptive elements from
their daily routine. For example, remove siblings from the room when
they are doing homework or turn off the TV.” Plan structured programmes aimed at gradually
lengthening the child’s concentration span and ability to focus on
tasks.” Communicate with the child on a one-to-one
basis and avoid addressing other children at the same time.” Use rewards (eg stickers, tokens or even
money) consistently and frequently to reinforce appropriate behaviour
such as listening to adults and concentrating.” Use sanctions (eg loss of privileges, being
sent to their room) for unacceptable behaviour or ‘overstepping’ of
boundaries.” Discuss your child with their school or
nursery and see if you can work together.
Medication
Behavioural management techniques such as those above
are always important, and for mild attention deficit problems they are
the treatment of choice. US research suggests that medication is the
best treatment for true ADHD. The most common and effective medications
are amphetamine-like stimulants, mainly Ritalin and Dexedrine. If there
are coexisting conditions then these may also require medication.Ritalin reduces hyperactivity and impulsiveness and
helps to focus a child’s attention. They become less aggressive, seem to
comply with requests, and become less forgetful. Many parents say their
child’s behaviour has vastly improved as a result of Ritalin.However, there is growing concern about the use of
Ritalin to treat ADHD. Like amphetamines, Ritalin is classified as a
class A drug. Many parents and professionals are worried about alleged
side effects, including damage to the cardiovascular and nervous
systems. Ritalin’s manufacturers recommend that it is only used to treat
children aged six years and over. If symptoms don’t improve after a
month’s trial it should be discontinued. The manufacturers also
recommend that even if Ritalin is effective it should discontinued
periodically to assess the child’s condition. You should discuss any
concerns with your child’s doctors, and they may alter the dose
prescribed.
Psychological treatments
In addition to the management techniques described,
other forms of psychological treatment might include anxiety management,
cognitive therapy, individual psychotherapy and social skills training.
Educational management
This includes individual, or group, learning support
for coexisting learning difficulties and educational underachievement.
Diet
Research suggests that diet is not a significant
factor in ADHD for most children. Some children have particular food
allergies that need investigation. Dietary changes need to be supervised
by a doctor and nutritionist. In this approach all foods suspected of
causing behavioural problems are removed from the diet then gradually
reintroduced while the child’s behaviour is monitored by the
psychologist.
What is the likely outcome?
Many children simply outgrow ADHD. About half of
those affected appear to function normally by young adulthood, but a
significant number will have problems that persist into adult life.
These may take the form of depression, irritability, antisocial
behaviour and attention problems.
Remarks:
I have also come across with an Article regarding
Amphetamine, which is also reproduced as under :When is
amphetamine not an amphetamine?
By: Steve Baldwin PhD
Professor of Psychology in the School of Social Sciences
University of Teesside (01 November 2000)
As the ‘beat generation’ of the 1950s was replaced by
the jazz clubs of the 1960s, teenagers and young adults were exposed to
a new social phenomenon: ‘uppers’ and ‘downers’. Both in Western Europe
and North America, the widespread availability of prescription drugs
such as amphetamines (uppers) and barbiturates (downers) produced a new
dimension to leisure and recreation activities. For the first time,
powerful drug preparations were widely available to teenagers and young
adults at low cost.By the end of the 1960s, other substances such as
marijuana and LSD had flooded the UK illegal drug market. Meantime,
government concern about the addictive properties of amphetamines had
produced powerful legislation to restrict their use to specific health
problems and user groups. The toxic (although highly rewarding)
properties of amphetamines had confirmed the potential for very rapid
addiction in adults. The results of forty years of amphetamine research
with laboratory animals have since confirmed the toxic, addictive and
potentially dangerous properties on mammals, including humans.And yet, today, amphetamines are frequently given to
children in the guise of Methylphenidate. The drug is often seen as the
treatment for attention deficit hyperactivity disorder. In the 1960s
psychiatric experimentation with difficult-to-treat childhood conditions
produced a climate where novel drug treatments were introduced without
much attention to toxic risk or adverse consequences from side- effects.
Powerful drugs such as lithium, carbamazine and amphetamines were given
to small groups of children without the benefit of scientific evidence
collected from proper trials or controlled studies. This work was funded
by the drug industry, aimed to establish a market for their new
products. Many individual practitioners claimed success from very
limited results taken from only a few children and teenagers.
Methylphenidate (MPH), a member of the amphetamine family, was
subsequently heavily promoted by drug companies and given to many minors
diagnosed with problems of hyperactivity.At the beginning of the 1990s in the UK, the
manufacturers of MPH launched a massive new publicity and advertising
campaign, directed at psychiatrists, pædiatricians and educators. The
industrial aim was to establish MPH as a front-line treatment for
childhood hyper-arousal problems such as attention deficit hyperactivity
disorder (ADHD). This campaign was so successful that prescriptions for
MPH multiplied by a factor of fifteen between 1994 and 1997. More than
114 000 prescriptions were made for MPH between January and September
1999. In the USA, aggressive marketing, combined with a ‘magic bullet’
culture, created a climate where an estimated 1:7 schoolchildren
currently take MPH every day. In a spectacular conjuring trick, the drug
manufacturers created a ‘solution’ for hyperactivity with a stimulant.Several laboratory research studies consistently
showed the powerful yet toxic effects of amphetamine on the mammalian
central nervous system: narrowing of focus (i. e. only being able to do
one behaviour), emotional and behavioural blunting (i. e. lack of
expression), restricted activity, and behavioural suppression. These
findings have been accepted without reservation by government health
departments worldwide.Amphetamine is considered to be harmful to adults
because of its potential to produce very rapid addiction (i. e.
requiring more of the drug to create the same effect). Like other drugs
that act directly on the central nervous system (CNS) such as cocaine
and heroin, in large doses amphetamines can produce a toxic state
(‘amphetamine psychosis’) with terrifying consequences. In the extreme,
amphetamine psychosis can produce the so-called ‘schizophrenic episode’
with a split from reality. There is an ongoing debate about whether or
not the toxic consequences of amphetamine addiction are reversible.
Whatever the dangers for adults, the risks for psychological and
physical harm are multiplied for children and teenagers.The known dangers of amphetamine abuse are so extreme
that government health departments in every developed economy in the
world have restricted their availability. Most governments impose very
strict controls over the availability of amphetamines (‘speed’) with
severe penalties for unlicensed drug trafficking. In Singapore, for
example, trafficking in amphetamines is punishable with the death
penalty. Moreover, amphetamine misuse by minors is considered a major
public health problem in countries where regulation of the supply has
broken down because of lax enforcement policies. In the UK, ‘folk
devils’ and moral panic have recently been resurrected because of public
concern about illicit drug use by ‘bored teenagers’.In summary, the public health orthodoxy in the UK
states that amphetamines should be restricted from children and
teenagers, due to their powerful effects on the CNS. Hence amphetamines
have been classified as a Class A controlled substance, with very strict
regulations and restrictions imposed on storage, prescription and
consumption.In the UK in the 1960s, 1970s and 1980s, many new
drug products were launched on the consumer market with very limited
information about their side-effects and toxic consequences. Frequently,
information about negative side-effects was minimised, or not reported
at all. Often drug products initially marketed as ‘safe and effective’
were later proved to be unsafe, ineffective and dangerous. Recent
examples include Valium, Librium, Thalidomide and Mandrax. In each case,
serious and irreversible side-effects were identified soon after
concentrated blitz advertising had established a mass market of hundreds
of thousands of consumers for these new products. Tens of thousands of
children were born with disfigurement and irreversible physical limb
deformities before Thalidomide was eventually withdrawn.In the UK there has been considerable debate about
the appropriateness of giving amphetamines to very young children
(especially when government health policy prohibits the use of ‘speed’
by youngsters). The proponents of MPH include powerful adult authority
figures that exert considerable pressure on parents to medicate their
son or daughter. Lobby groups for the prescription of MPH to minors
include psychiatrists, pædiatricians, educational psychologists,
educators, head teachers and some parent support groups. Many groups
openly admit to receiving funds directly or indirectly from the
pharmaceutical industry to support their activities. So-called ‘medical
science’ journals that publish results of MPH studies are funded by drug
companies.
Opponents
of MPH
prescription to children indicate the known side-effects of MPH when
prescribed to minors. These include (but are not limited to):” aggressive/violent behaviour
” suicidal behaviour
” self-destructive behaviour
” self-mutilating behaviour
” tics
” stereotyped behaviour
” repetitive behaviour
” head aches
” stomach aches
” vomiting
” cardiac problems
” motor problems
” visual disturbance
” appetite loss
” sleep disturbance
” growth retardation
” ‘zombie-like’ appearanceMany information bulletins about MPH minimise these
known facts, or omit details altogether. A recent survey of 65 parents
referred into a treatment clinic found that none of them had been
informed about side-effects. Moreover, none of them had been informed
that MPH was addictive, or even that it was an amphetamine. No parents
had been offered any non-drug treatment alternatives. Many prescriptions
had been written for children as young as 3, 4 or 5, even though the
drug manufacturer instructions prohibit use of MPH for children younger
than 6. Also, parents mistakenly attributed drug side-effects to the
supposed ‘underlying biological condition’ of ADHD.There are 230 other psychological and social
therapies for children that do not involve drugging with amphetamines.
These therapies include (but are not limited to): psychotherapy,
behaviour therapy, behaviour modification, counseling and family
therapy. Irresponsible prescribing behaviour is impossible to justify.
In four health districts in the UK, GPs have been advised not to write
repeat prescriptions for MPH.There is considerable public concern in the UK about
the marketing and prescription of MPH. A class action is in progress by
parents whose children have allegedly been harmed by MPH. In the USA a
similar class action by parents has cited fraud, conspiracy and
collusion by the manufacturers of MPH and ‘parent support groups’ (many
of whom are funded directly by the drug companies to distribute
pro-medication literature amongst parents).In 1998 the USA federal government National
Institutes of Health (NIH) held a national Consensus Conference about
ADHD, with thirty-one independent scientists. The NIH reported that ADHD
is not the result of a biological brain dysfunction. Rather, they
concluded that “…there are no data to indicate that ADHD is due
to a brain malfunction” and “…after years of clinical
research and experience with ADHD, our knowledge about the cause or
causes of ADHD remains speculative”. As ADHD is not a biological
condition, drugging children and teenagers with amphetamines (too strong
medicine) will not help. Instead, parents need support and appropriate
professional advice to choose one of the 230 available effective
psychological and social therapies.
Suggestion:
I would like to suggest that for such patients who
are suffering from the abovementioned disease(s), a well qualified
classical homœopath should be consulted for the safe and better
treatment to avoid the side effects of the allopathic drugs.
REFERENCE
:
NetDoctor UK.
Copyright © Dr. Sayeed Ahmad
2004