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Attention Deficit/Hyperactivity Disorder (ADHD)

Attention Deficit / Hyperactivity Disorder

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ADD Aspergers Anxiety Psychologist Counseling Testing Dallas

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Dr. R Says...

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ADD Aspergers Anxiety Psychologist

 

2:30

Some people have argued ADHD is merely a social construct with the division between “normal”

2:35

and “abnormal” completely arbitrary. By using real-life impairment resulting from

2:39

the symptoms, the diagnosis can be made less subjective and arbitrary.

2:43

ADHD is identified and diagnosed by its symptoms. It is generally agreed that these symptoms

2:48

result from one or more neurological deficiencies, but the specific deficiencies and the best

2:52

way to treat them are areas of hot debate and active research. The primary theories

2:57

are: (1) dopamine deficiencies, (2) low arousal to external stimuli, and (3) working memory

3:02

deficits. Dopamine is a neurotransmitter that controls

3:05

the flow of information coming from other parts of the brain. By emphasizing important

3:10

stimuli and suppressing others, it functions like a traffic light for incoming information.

3:14

Hypodopaminergia has also been implicated as a possible cause for deficits in executive

3:19

functioning which is responsible for planning, initiating and inhibiting actions, and selecting

3:24

relevant sensory data. The high effectiveness of stimulants with dopaminergic effects as

3:28

treatment for ADHD in double-blind controlled trials has supported this theory for over

3:33

30 years. According to the low arousal theory, people

3:36

with ADHD react less to external stimuli than people without the disorder. In order to maintain

3:42

the level of mental arousal necessary to be focused and attentive, a person with ADHD

3:46

will try to generate additional stimulation by walking around, fidgeting, talking, or

3:50

bouncing in their chair. This theory has been supported twofold: first, by the effectiveness

3:55

of stimulants independent of dopaminergic effects. Both methylphenidate and caffeine

4:00

have proven effective in low doses at increasing mental arousal and decreasing hyperactive

4:04

and inattentive behavior. Additionally, the use of bright colors to emphasize tasks has

4:09

been shown to be highly effective at drawing and maintaining attention towards the current

4:13

task and increasing overall performance, even when the added color had no relation to the

4:17

specific task. Recent studies have shown a statistically

4:20

significant correlation between demands on working memory and hyperactive behavior. An

4:25

extension of the low arousal theory, the working memory model suggests that hyperactive behavior

4:29

is a direct result of increased demands on working memory, and that the hyperactive behavior

4:33

consistently ceases immediately following a decrease in working memory demand.

4:38

In addition to the uncertainty about which deficits cause ADHD, the causes for the proposed

4:43

deficits are unknown and also under active research. Current theories can be separated

4:47

into two basic categories: environmental and genetic. Research studies have shown that

4:53

ADHD may be caused by toxins introduced during pregnancy and early development, such as alcohol,

4:57

tobacco, lead, and certain insecticides. Premature birth and certain artificial food colorings

5:02

have also been correlated with ADHD. In the genetic category, multiple twin studies have

5:08

indicated that the disease is highly heritable and that genetics are a factor in 75% of all

5:13

cases. In a recent study of over 30,000 patients, subjects with ADHD were significantly more

5:19

likely than controls to have large, rare chromosomal structure abnormalities that have previously

5:24

been associated with other neurodevelopmental disorders including intellectual disability,

5:29

schizophrenia, and autism. Although it is safe to assume that genes play a role in ADHD

5:34

and its heritability, ADHD is best understood as the result of a complex interaction of

5:39

genetic and environmental factors that are not yet clearly understood.

5:43

Although some DSM-IV recognized disorders can be maintained through external influences

5:47

or behavioral patterns, given that symptoms of ADHD are caused by neurological differences,

5:52

ADHD is considered to be an incurable, but manageable, disorder.

5:56

As a result of the wide variety of possible deficiencies and resulting symptoms, treatment

6:01

for ADHD is usually planned on a very individualized basis to address the patient’s specific

6:07

symptoms and deficiencies. The most effective and most commonly used treatment plan is a

6:11

combination of medication and behavioral therapy. The most commonly used medications for treatment

6:17

of ADHD are stimulants with dopaminergic effects, such as methylphenidate and dextroamphetamine,

6:22

commonly known as Ritalin and Adderall, respectively. These drugs are believed to reduce ADHD symptoms

6:27

by increasing dopamine thereby allowing the brain to self-regulate incoming stimuli. Another

6:33

recently released medication is atomoxetine, marketed as Strattera, which is a selective

6:38

norepinephrine reuptake inhibitor. Originally intended as an antidepressant, atomoxetine

6:44

has been highly effective at treating ADHD without the withdrawal and abuse risks associated

6:49

with stimulants. In addition to medication, most psychologists

6:52

recommend behavioral therapy to provide special attention to areas where people with ADHD

6:57

generally struggle. These include organization and management of time, tasks, and distractions.

7:02

The most commonly taught skills are using a calendar and task list, breaking down overwhelming

7:07

tasks into smaller steps, and writing down distractions for later instead of acting on

7:12

them write away. In addition to therapy for the patient, education is generally recommended

7:17

for parents and teachers who will be working with the patient. This generally involves

7:21

instruction about ADHD and suggests certain techniques like highlighting that have proven

7:25

to be very effective when teaching people with ADHD. In addition to these basic skills,

7:30

therapy sessions are usually specifically tailored to a patient’s needs.

7:34

Due to the high incidence rate of ADHD and enhanced creativity, some have chosen to regard

7:39

ADHD as a “difference” rather than a “disorder.” They argue that perceived impairment is due

7:45

to the strict academic mold posed in the modern education system: students with ADHD think

7:50

and learn differently from the way they are taught and tested, resulting in significant

7:54

academic difficulties. This also explains the perception that children grow out of their

7:59

ADHD or it just goes away when they complete their formal education: instead of ADHD going

8:04

away, the release from a specific learning and knowledge application process allows the

8:08

child to learn and work in a way that their ADHD symptoms do not cause impairment. Some

8:13

have even extended this farther to claim that ADHD is a gift because an inability to focus

8:18

solely on a single idea can enable thinking outside the box and result in new and unique

8:23

solutions to a problem. While it is difficult to say anything definitive

8:27

about ADHD due to the many uncertainties about the neurological and underlying causes, research

8:32

and debate over ADHD will likely continue for many years as scientists continue to learn

8:37

more about the true final frontier: the human brain.

 
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