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Attention Deficit Disorder

Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD)
(adapted from The University of Maryland Medical Center)

Neurofeedback is now being used with the most difficult children in the custody of the State of California. It is being used in a Federal penitentiary, and in the California prison system. It is being used in the Minnesota school systems and elsewhere. There are some 8,000 or more professionals providing Neurofeedback to ADHD kids around the US. Probably some 100,000 children per year are being helped. This is only a fraction of those who are on stimulant medication, but then the effect of Neurofeedback is cumulative. Next year, it will be another 100,000, and within a decade most children will no longer be on stimulants.
Siegfried Othmer, PhD

Attention deficit/hyperactivity disorder (ADHD) is the most commonly diagnosed behavioral disorder of childhood, estimated to affect between 3% and 5% of school-aged children. The core symptoms of ADHD include inattention, hyperactivity, and impulsivity. Although many people occasionally have difficulty sitting still, paying attention, or controlling impulsive behavior, these behaviors are so persistent in people with ADHD that they interfere with daily life. Generally, these symptoms appear before the age of 7 years and cause significant functional problems at home, in school, and in various social settings. One- to two-thirds of all children with ADHD (somewhere between 1% and 6% of the general population) continue to exhibit ADHD symptoms into adult life. Diagnosis is difficult (usually requiring more than one visit) but essential, as early treatment can substantially alter the course of a child's educational and social development.

Signs and Symptoms
  • failing to pay close attention to details
  • making careless mistakes
  • the inability to sustain attention during tasks
  • not listening when spoken to
  • problems following through on instructions
  • failure to complete tasks
  • difficulty organizing tasks
  • disliking work
  • losing items
  • being easily distracted
  • being forgetful
  • Some individuals with ADD have a hyperactive component to their disorder which causes impulsive behavior.
  • The symptoms of hyperactivity can include
  • fidgeting or squirming
  • the inability to stay seated
  • difficulty being quiet
  • talking excessively
  • blurting out answers
  • difficulty waiting for your turn
  • interrupting frequently

If you notice several symptoms of inattention or hyperactivity in an individual they might be suffering from ADD or ADHD. This diagnosis can seem scary, but be assured there are treatments that can reduce or eliminate the symptoms. At The Montreal Neurofeedback Clinic, we can give you an accurate diagnosis and effective treatment plan.

A person is considered to have ADHD if he or she demonstrates symptoms of inattention, hyperactivity, and impulsivity for at least 6 months in at least two settings (such as at home and in school). The signs and symptoms listed below are typically seen in children with ADHD and usually appear before age seven. (In order to diagnose ADHD in adults, psychiatrists must determine how the adult patient behaved as a child.)

Symptoms of Inattention:Child fails to pay close attention to details or makes careless mistakes, has difficulty sustaining attention in tasks or play activities, does not seem to listen when spoken to directly, does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace , has difficulty organizing tasks and activities, avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort, loses things necessary for tasks or activities Is easily distracted by extraneous stimuli Is forgetful in daily activities

Symptoms of Hyperactivity and Impulsivity:Child fidgets with hands or feet or squirms in seat, leaves seat in situations where remaining seated is expected, runs or climbs excessively in inappropriate situations (in adolescents or adults, may be limited to subjective feelings of restlessness), has difficulty playing or engaging in leisure activities quietly, acts as if "driven by a motor", talks excessively, blurts out answers before questions are completed, has difficulty awaiting turn Interrupts or intrudes on others

Causes
Like most complex neurobehavioral disorders, the cause of ADHD is unknown. Genetic factors as well as those affecting brain development during prenatal and postnatal life are likely involved. Brain scans have revealed a number of differences in the brains of ADHD children compared to those of non-ADHD children. For example, many children with ADHD tend to have altered brain activity in the prefrontal cortex, a region thought to be the brain's command center. Irregularities in this area may impair an individual's ability to control impulsive and hyperactive behaviors. Researchers also believe that hyperactive behavior in children results from excessive slow-wave (or theta) activity in certain regions of the brain. Other studies indicate that ADHD may be caused by abnormally low levels of dopamine, a neurotransmitter involved with mental and emotional functioning.

Risk Factors
Heredity: children with ADHD usually have at least one first-degree relative who also has ADHD and one-third of all fathers who had ADHD in their youth have children with ADHD Gender: ADHD is four to nine times more common in boys than in girls (some experts believe that the disorder is underdiagnosed in girls, however) Prenatal and early postnatal health: maternal drug, alcohol, and cigarette use; exposure of the fetus to toxins, including lead and polychlorinated biphenyls (PCBs); nutritional deficiencies and imbalances, learning disabilities, communication disorders, and tic disorders such as Tourette's syndrome, other behavioral disorders, particularly those that involve excessive aggression (such as oppositional defiant or conduct disorder), nutritional factors (controversial): allergies or intolerances to food, food coloring, or additives (see Nutrition and Dietary Supplements)

Diagnosis
The names and symptoms for ADHD have changed frequently since the turn of the century. What is now referred to as ADHD has been described in the past as Minimal Brain Dysfunction, Hyperkinetic Reaction of Childhood, and Attention Deficit Disorder (ADD) With or Without Hyperactivity. The name ADHD was adopted in 1987 by the third revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).

Diagnosis is largely dependent on specific observed behaviors. The first step in establishing the diagnosis of ADHD is to determine whether the individual meets the diagnostic criteria as defined in the DSM-IV. The DSM-IV's symptomatic criteria were developed for children; there are no specific criteria for ADHD in adults. In these cases, physicians will often determine the psychiatric status of the adult patient as a child and make a retroactive diagnosis of childhood ADHD. Since most of the characteristic behaviors of childhood ADHD occur at home and in the school setting, parents and teachers play an important role in providing information to establish the diagnosis.

DSM-IV Diagnostic Criteria: Either (1) or (2) 1. Six (or more) symptoms of inattention that persist for at least 6 months to a maladaptive degree inconsistent with the child's developmental level 2.Six (or more) symptoms of hyperactivity-impulsivity that persist for at least 6 months to a maladaptive degree inconsistent with the child's developmental level Some inattentive or hyperactive-impulsive symptoms that caused impairment were present before the age of 7 years Some impairment from symptoms present in two or more settings (such as at school/work and home) Clear evidence of significant impairment in functioning Symptoms not secondary to another psychological disorder (such as mood disorder, anxiety disorder)

Although most children with ADHD have symptoms of both inattention and hyperactivity-impulsivity, some tend to demonstrate symptoms from one cluster or the other. These specific subtypes of ADHD are based on the predominant symptom pattern exhibited for the past 6 months: ADHD, Combined Type: if both A1 and A2 criteria are met ADHD, Predominantly Inattentive Type: if A1 is met but A2 is not ADHD, Predominantly Hyperactive-Impulsive Type: if A2 is met but A1 is not

Preventive Care
There are no targeted prevention programs for ADHD. Nevertheless, the following steps may be taken to help reduce the risk of neurobehavioral disorders including ADHD: Minimizing exposures to potential neurotoxins (such as lead, heavy metals, pesticides, herbicides) in the environment Screening children for high levels of lead in the blood and treating this immediately Obtaining comprehensive healthcare during and immediately following pregnancy Addressing psychosocial stressors in the lives of all children

Treatment Approach
Despite the effectiveness of stimulant medications, multiple strategies are required to effectively manage ADHD over the long-term. A combination of prescription drugs and lifestyle changes, including behavioral therapies, is proving to be the best option for many children. Currently, the most accepted treatments include individual and family education, behavioral therapy, school remediation, and social skills training. Although nutritional management (such as elimination diets and high-dose vitamin supplementation) is among the most frequently explored alternative therapy among parents, relatively few studies support its effectiveness for ADHD. A growing number of studies suggest an association between essential fatty acid (EFA) deficiencies and hyperactivity in children, yet intervention studies using EFAs to treat behavioral problems have reported varying results. Preliminary evidence also indicates that homeopathy and mind/body techniques, particularly biofeedback, may significantly improve behavior among children with ADHD.



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