Out of the three most commonly used medications for ADHD, Ritalin, or methylphenidate (MPH), is prescribed for more than 70 percent of patients according to one public health conference: http://bit.ly/5VxUJ1. Although in many patients the disorder may result from the lack of brain stimulation, the medical profession leans toward treating the biochemical theory of ADHD – hence, the use of medications that affect the level of dopamine in the brain.
Dopamine is the main neurotransmitter in the “pleasure center” of the brain – a network of nerve cells or neurons that motivates much of human behavior. The “pleasure center” reinforces people’s drives to eat, drink, and procreate and is responsible for addiction. For example, when a person tastes ice cream, the sensors of the tongue signal the brain that it feels something, and a neuron fires in the taste center of the brain. Dopamine from one neuron is released into the space between it and another neuron. The second neuron, in turn, sends the signal to third neuron by the same process. Through this complicated network of signaling, the brain lets the person know that an experience is pleasurable and is worth paying attention to.
Dopamine is recycled by dopamine transporters—proteins that are embedded in the membrane of the initial neuron. When molecules of dopamine are floating around in the synapse (or gap between neurons), any that come in contact with the transporters are sucked back into the initial neuron. A recent study (Lancet, 1999; 354:2132-2133) showed that ADHD patients have more dopamine transporters than people without the disorder. This means that dopamine is not given enough time to reach the second neuron and instead is taken back into the first neuron’s membrane. As a result, an inadequate number of dopamine molecules reach the second neuron so it won’t send a signal. MPH (Ritalin) is called a reuptake inhibitor. It blocks dopamine transporters and allows dopamine to reach the second neuron and create a signal, improving children’s ability to focus. http://www.jama.amaassn.org/issues/v286n8/fpdf/jmn0822.pdf
But Ritalin is not a cure for ADHD. The medication neither corrects the disorder nor addresses the patient’s individual problems. Eighty percent of hyperactive children have ADHD features in adolescence, and up to 65 percent maintain them in adulthood.(http://www.aacap.org/clinical/adhdsum.htm) Medications merely control the symptoms of hyperactivity/ impulsivity and even aggression.
Effects associated with moderate doses of stimulants are decreased appetite and insomnia. Negative effects on growth rate are possible, but ultimate height appears not to be affected. Very high doses of psychostimulants, such as Ritalin, may cause central nervous system damage, cardiovascular damage, hypertension, compulsive behaviors, and, in certain vulnerable individuals, movement disorders. A rare percentage of children and adults treated at high doses have hallucinogenic responses. An animal study of Ritalin has produced a “weak signal” that the drug may potentially cause cancer. Other drugs used for ADHD have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion can cause seizures, and pemoline (Cylert) is associated with liver damage.
Stimulant therapy is not recommended in patients with a history of tics or Tourette’s disorder, the presence of a thought disorder, significant resistance to such medications in the patient or family, or insufficient severity of the symptoms or dysfunction.
Ritalin’s chemical properties cause the most serious concerns about its use. MPH is a schedule II narcotic that belongs in the amphetamine family of stimulants and is regulated by the Drug Enforcement Agency (DEA) as a controlled substance. Chronic exposure to stimulants during development may change the way the brain reacts to environmental challenges, including stressful events and pharmacological agents. Another concern is that long-term stimulant administration in children may alter the way the brain reacts to further exposure to stimulants or other drugs with potential for abuse.
A recent study showed that MPH is not a weak stimulant, as had been thought, but is a more potent transporter inhibitor than cocaine. A typical dose given to children (0.5mg/kg) blocked 70 percent of dopamine transporters, while cocaine blocks only 50 percent. People who took MPH displayed high levels of extracellular dopamine—just as people using cocaine did. http://www.jama.amaassn.org/issues/v286n8/fpdf/jmn0822.pdf The only difference between the MPH and the cocaine effect on the brain is in the way it is administered: MPH taken orally raises dopamine in about an hour, whereas inhaled or injected cocaine hits the brain in seconds.
In 1999, approximately 9 million Americans used prescription drugs for non-medical purposes—to get high, to have fun, to get a lift, or to calm down. Ritalin abuse has been reported among middle and high school students. Some used it to suppress appetite or to stay awake while studying. The DEA lists Ritalin as a “drug of concern” and reports that some abusers have dissolved the tablets in water and injected the mixture, which can block small blood vessels and damage the lungs and retina of the eye. More
When a child’s behavior or academic performance starts troubling teachers, they usually make the preliminary ADHD diagnosis and report it to the parents. The parents then take the child to a general practitioner or a pediatrician who makes the final diagnosis and prescribes a stimulant medication, typically Ritalin. The problem with this scenario is that the people involved aren’t the right ones to be making the diagnosis. Before placing a child on medications and pinning him or her with a diagnosis of ADHD, first get a second opinion from a healthcare professional that specializes in this disorder, such as a psychiatrist, psychologist, or doctor specializing in neurology and/or in ADHD specifically
But even for a qualified specialist, ADHD is not always easy to diagnose. ADHD belongs to a spectrum of neurological disorders. The spectrum goes from attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) through learning disabilities, obsessive-compulsive disorder (OCD), and Tourette’s syndrome, to pervasive developmental disorders and autism. The neurological mechanisms involved in all the disorders are very similar. Besides, there is increased co-morbidity among these syndromes, meaning that a child can have multiple disorders. For example, 50 percent of the ADHD patients will have OCD, and 50 percent of patients with Tourette’s syndrome will have ADHD. Early-onset mania or bipolar mixed state may be particularly difficult to distinguish from ADHD, or may also be co-morbid.
On the other hand, some children may be at the high end of the normal range of activity, or have difficult temperaments. Poor attention may also be caused by impaired vision or hearing, seizures, head trauma, acute or chronic medical illness, poor nutrition, insufficient sleep, anxiety disorders or realistic fears, depression, or the sequelae of abuse or neglect. Various drugs (including phenobarbitol) may interfere with attention.
Similar symptomatology and co-morbidity of conditions increase the possibility of misdiagnosis. ADHD is not a learning disability, but it can affect the ability to progress in society and the ability to learn. Many children are misdiagnosed with ADHD because they have learning disabilities or language problems. Some children may simply have difficulty learning certain subjects, but schools often push to diagnose the child with ADHD. There have always been children who learn at different speeds, but it almost seems easier to put a diagnosis of ADHD on the child and deal with the learning difficulties in that way.
Communication with the child and his/her parents is the key to a correct diagnosis. We need to understand the frustrations the child has. Is he/she too active? Bored? Do they have dyslexia or a different learning pattern? It can be a behavior problem, problems at home, or frustrations with the teacher’s style. If the child is a visual learner, and the teacher is not teaching towards that learning style, the problem may be the child is not being taught in a way he can learn. As adults, if we went to a conference where the speakers taught in a way we can’t learn, we would be frustrated and would start to misbehave—we’d leave or chat to the person sitting next to us. The same thing applies to children.
The traditional way of diagnosing ADHD seems to follow a cookie-cutter principle. The very diagnosis of ADHD is based on the questionnaire laid out in the DSM-IV5 or other diagnostic manuals. If the child’s parents or teachers identify as positive six out of nine criteria for inattention, or six out of nine criteria for hyperactivity and impulsivity, the child leaves the doctor’s office with a drug prescription and a new personality label. The patient is basically at the mercy of the medical doctor’s clinical experience—and 60 percent of doctors agree that there aren’t enough properly qualified ADHD diagnosticians, according to a Canadian survey performed in 1999.
Therefore, if your child has been diagnoses with ADHD, please make a point of seeing a specialist to confirm the diagnosis and other possible contributing syndromes the child may have. More
ADHD has been diagnosed in approximately 8 million children in the United States. As a result, there is a whole generation of children growing up on stimulants and other medication. How will all of this affect their adult life is a question that has no answer at this time. In order to clarify this condition for parents, in my next four blog posts, I’m going to cover, what ADHD is, what occurs in the brain to cause it, it’s diagnosis, and treatment options.
True ADHD is characterized by behavioral problems in reacting to an average, every-day situation. The diagnosis is based on the history of displaying three types of behavior:
- An inability to perform everyday tasks, or distractibility
- An impairment in the ability to control impulses, or impulsivity
- Restlessness, or hyperactivity
In reality, everyone displays those behaviors at times, so to classify for ADHD, those behaviors have to be excessive, occur before the age of seven, last for at least six months, and cause a problem in a social environment, such as at school or home, at work or in a marriage. If the school is the only place where the child is acting up, the parents should see if there are problems with the school before pursuing a medical diagnosis.
Every person with ADHD will display a combination of the three behavioral aspects. ADHD is broken into subtypes—with predominant or non-dominant aspects depending on the individual – such as predominant inattention or predominant hyperactivity. The range of symptoms will vary from one patient to another and may include inability to concentrate and irritability, as well as confrontational, defiant, and oppositional behaviors.
Non-verbal communication and interaction with people is a major problem for people with ADHD. They don’t pick up body messages and don’t understand personal space. It’s hard for them to get jokes and the context of speech. They understand what you say, but not how you say it. As a result, they often have difficulty making friends and being in social situations, which leads to aggression and frustration.
The reason ADHD cannot be considered just a psychological problem is its functional presentations. There are motor signs—tics, tremors, and balance or postural problems. Soft neurological signs, such as sensory integration deficits—unusual sensitivity to touch, movement, sights, or sounds—are also present in ADHD children.
But how is the inability to focus and sit still connected with postural problems and sensory integration? Research shows that the link is in the brain. ADHD is caused by a problem with the reticular activating system—the attention center of the brain. Its other functions include vision, hearing, and preservation of older genetic traits. By using a PET (positron emission tomography) scan, researchers can observe the metabolic areas of the brain and compare the brain structures in non-ADHD and ADHD individuals. In patients with ADHD, certain areas of the brain, such as the cerebellum, the frontal lobes, or the right or left hemisphere, are under-functioning. Under-functioning may be caused by two factors: the level of stimulation of the brain or the biochemical substrates to the brain. More
One of my patients came into the office a month or so ago excited at how well her child with ADHD has been doing under chiropractic care. She thanked me for talking to her about this months earlier because a new study was recently released by The American Journal of Psychiatry that supports the claims that stimulant drugs usually prescribed for ADHD could increase the risk of sudden unexplained death in children. This particular patient saw this while watching the CBS Early Show that particular morning, and the M.D. on the show recommended Chiropractic care and nutritional counseling instead of the medications. More
Doctors of chiropractic offer a non-drug and non-invasive treatment alternative for ADHD patients that targets the underlying problems,
not just symptoms. “Motor activity—especially development of the postural muscles—is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that’s what’s happening in ADHD patients,” says Dr. Melillo of the American Chiropractic Association. So if you have a child who has been diagnosed with ADHD, there are safer alternatives to taking Ritalin and some of the other medications.