ADD/ADHD

Attention deficit disorder (ADD), formerly known as attention deficit/hyper-activity disorder (ADHD), is one of the most common mental disorders among children today. It is estimated that approximately 3 percent to 5 percent of all children (two to three times as many boys are affected than girls) or nearly 2 million American children (which correlates to one child in each classroom in the United States) have ADHD according to the National Institute of Mental Health.¹ ADHD does not only affect children, as symptoms can progress into adulthood as well.

The specific causes of ADHD are currently unknown, with several factors being responsible in different people. No solitary causative factor has been identified as being responsible for the different behavior patterns observed in ADHD. ADHD is only diagnosed by certain characteristic behavior patterns that are observed over time; no other clear physical signs can be seen. Common behavioral pattern categories in ADHD include inattention, impulsivity, and hyper-activity.

• Inattention: This is marked by difficulty in keeping the mind focused on any one subject and a short attention span. People with ADHD often become bored after only a few minutes at work on a subject, and placing focused attention on new or unfamiliar topics can be challenging.

• Impulsivity: This is marked by an inability to refrain from immediate reactions, making it difficult to wait and first think before speaking or acting.

• Hyperactivity: This is marked by constant perpetual motion; staying in one place and sitting still can be difficult. Adults may feel quite restless and may start several projects and have a difficult time finishing them.

Diagnosis of ADHD is based upon an analysis of the person’s behavioral patterns, which are compared to established criteria. These criteria are defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The manual outlines the three previously mentioned behavior patterns, and people may display varying amounts of each pattern or only one. Because nearly everyone displays some of these symptoms at some time in their life, certain criteria, including age of onset (early in life, before age seven), duration of symptoms (continuous for at least six months), frequency (occurring more often in themselves than others of similar age), and most importantly, behavior(s), must occur in at least two different areas of the person’s life, namely, school, home, work, or social settings.

A recent report issued by the Centers for Disease Control and Prevention claimed that nearly 1.6 million elementary school–aged children have a diagnosis of ADHD, and a national survey revealed that the parents of 7 percent of children ages 6–11 years old were told by a healthcare professional that their child had ADHD.² The report also included the following demographic information: boys are nearly three times as likely to have ADHD than girls; white children are twice as likely than Hispanic and black children to have a diagnosis of ADHD; children with health insurance are diagnosed with ADHD more often than children without health insurance; and children with ADHD use more healthcare services, including mental health services, than those without ADHD. This report went on to propose that ADHD is probably overdiagnosed in those with regular access and may be underdiagnosed in those with limited healthcare access.

A common neurodevelopmental disorder, ADHD results in impaired educational processes, social growth, and adaptation that lead to increasing rates of behavioral difficulty, depression, school dropouts, and substance abuse,³ which have lead to the mass prescription of stimulant psychotropic medications in children affected with this disorder. With no fully established biological causes recognized, ADHD does display prominent heritability. Mainstream treatment focuses on the use of mainly stimulant drugs, and because of the perceived relative success of these drugs in alleviating ADHD symptoms, many studies have focused mainly on genes that are responsible for the development and regulation of brain neurotransmitter systems, specifically that of dopamine, wherein the physiologic basis for the action of these drugs exists.

Genetic factors do play a role in the genesis of ADHD; estimates of herita-bility are greater than those of nearly every other child and adolescent psychiatric disorder and first-degree relatives have increased rates of ADHD, including conduct and affective disorders as well as substance abuse and dependency. Additionally, the subtypes of ADHD (impulsivity, hyperactivity, inattention) do not correlate with that of additional family members, leading researchers to conclude that nongenetic factors are responsible for intrafamialial variability.⁴ Factors other than genetics have been implicated in the development of ADHD prior to birth. Prenatal exposure to nicotine and psychosocial adversity have been identified as risk factors for ADHD; a review of the studies in ADHD literature exploring the relationship between prenatal exposure to these factors and the risk of developing ADHD revealed that smoking (specifically nicotine exposure) and exposure to psychosocial stress during pregnancy indicated greater and modest risk, respectively, in contributing to the development of ADHD.⁵ Other causes/contributors of ADHD that have been implicated in the literature include food sensitivities and allergies, food additive intolerance, imbalance and deficiency of nutrients, environmental toxicity (including heavy metal poisoning, thyroid irregularities, and other toxic pollutants).