Question of the Week

October 31, 2005



"ADHD stands for attention deficit hyperactivity disorder. ADHD used to be known as attention deficit disorder, or ADD. In 1994, it was renamed ADHD. The term ADD is still used, though, to describe a type of ADHD that doesn't involve hyperactivity. ... People with ADHD have differences in the parts of their brains that control attention and activity. This means that they may have trouble focusing on certain tasks and subjects, or they may seem 'wired,' act impulsively, and get into trouble. ... Of course, it's normal for everyone to zone out in a boring class, jump into a conversation, or leave their homework on the kitchen table once in a while. But people with ADHD have so much trouble staying focused and controlling their behavior that it affects their emotions and how well they do in school or other areas of their lives. ...

Over the years, there are many theories for how to treat and/ or prevent ADD, ADHD, and other behavioral disorders. "Dr. Stephen D. Lockey, Sr. of the Mayo Clinic was an early advocate of using a non-salicylate and no-tartrazine (Yellow No.5) diet to treat urticaria (hives). His dietary recommendations were provided to physicians for their patients as early as 1948.
* He was aware of the cross-sensitivity between aspirin and tartrazine shown in the early German and other studies. He also was aware of the adverse physical and even behavioral effects of both BHA and BHT...
* Unfortunately, Dr. Lockey's recommendations were often ignored. One possible reason may be that his diet format is almost exclusively negative. It is a long listing of what should not be eaten, and it is quite formidable. Another possible reason may be that physicians had discovered Ritalin - a magic bullet - which is easier and quicker than a life-style change."

By building on the theories of those who came before, doctors over the years have tried to find and do what works to make their patients better. In some cases the course of action they have found has been to write a prescription. In other cases, the course of action has been to help patients make life-style changes.

"Most of Dr. Feingold's early experience with using the diet for hyperactivity was clinical -- helping children who had not responded to any other treatment -- what he called 'the failures of the medical community.' A significant percentage of these children underwent dramatic improvement on the diet.
* In his presentation to the American Medical Association (AMA) in 1973, Dr. Feingold called for researchers to do the basic research required to find out why this diet worked. He called for the government to be involved because he knew it would be expensive and take many years. He, himself, was a clinician -- he felt it was his job to get the patient well, not to find out why it worked."

Whether it is writing a prescription, asking patients to remove certain things from their diets, or asking patients to add certain things to their diets, doctors are still trying to find what is proven to work best.

"Specific nutrient deficiencies have been described in children with ADHD including zinc, magnesium, calcium, and essential fatty acids. In addition, children with ADHD have been noted to behave and concentrate better in some studies when the ratio of protein compared with carbohydrate in their diets was increased, however, this was anecdotal information noted from studies designed to study other factors, so its not clear if the increased protein is actually the cause of the improved behavior. ... [T]his initial study was designed to determine 1) whether or not children with ADHD have different patterns of nutrient intake compared with children in the same family and children in families without a child with ADHD, 2) if the described nutrient deficiencies are due to decreased intake, and 3) whether there is an increased occurrence of carbohydrate craving, based on parents' perceptions, eating patterns, and actual intake, among children (or certain subgroups of children) with ADHD. The information gained from this study will be used to design additional studies to test causative hypotheses and intervention strategies."

Unfortunately, what works best for one patient, may not work best for the next, so the search continues. Dozens of clinical trials searching for possible causes and treatments for ADD and ADHD are seeking participants. Theories, anecdotal information, and new medications are all currently being tested.

Sometimes the testing finds something that seems to help with no adverse side effects.

"BOSTON, Oct 3, 2005 (UPI via COMTEX) -- A Boston scientist says an extended-release stimulant for attention-deficit hyperactivity disorder is effective for two years with no side effects. A multi-institutional research team reports finding treatment with Concerta, a once-daily form of the drug methylphenidate, successfully controlled ADHD symptoms in more than 200 children. Dr. Timothy Wilens of Massachusetts General Hospital lead author of the study said there had been concerns whether stimulant medications used to treat ADHD continued to be effective, whether patients build up tolerance, or whether the drugs might have adverse effects on cardiovascular health or growth. 'We haven't seen any clinically meaningful problems with height and weight or any cardiovascular difficulties in this study, which also is the first to evaluate this kind of daylong treatment in a large group of children.'"

Sometimes the testing finds causes for concern with medications that were previously found to be safe.

"The Food and Drug Administration (FDA) today is issuing a Public Health Advisory to alert physicians of reports of suicidal thinking in children and adolescents associated with Strattera, a drug approved to treat attention deficit hyperactivity disorder (ADHD). ... FDA is advising health care providers and caregivers that children and adolescents being treated with Strattera should be closely monitored for clinical worsening, as well as agitation, irritability, suicidal thinking or behaviors, and unusual changes in behavior, especially during the initial few months of therapy or when the dose is changed (either increased or decreased). Patients and caregivers who have concerns or questions about these symptoms should contact their healthcare provider. ... Today's actions follow a review and analysis of 11 clinical trials conducted in children with ADHD and one trial in children with enuresis (bedwetting) that identified an increased risk of suicidal thinking for Strattera."

There are those who feel that eliminating or adding certain things from a person's diet will help these behavioral issues. There are those that think changing the entire diet is too difficult and/ or next to impossible with the busy schedules that most people have in the 21st century. There are those who think medication is the key. There are those who are concerned about the effects of too much medication, or the wrong kind of medication, for those with ADD or ADHD. Then there are those who have found help and hope someplace else entirely...

"Kids with attention deficit hyperactive disorder (ADHD) should spend some quality after-school hours and weekend time outdoors enjoying nature, say researchers at the University of Illinois at Urbana-Champaign. The payoff for this 'treatment' of children 5 to 18 years old, who participated in a nationwide study, was a significant reduction of symptoms. ... 'Overall, our findings indicate that exposure to ordinary natural settings in the course of common after-school and weekend activities may be widely effective in reducing attention deficit symptoms in children.'"

Questions of the Week:
If you do not have an ADD or ADHD diagnosis, and do not have symptoms where you or anyone else would suspect that you might have either condition, how and/ or why could the information gained from all this research be useful to you? If you do have some trouble with possible ADD or ADHD symptoms, but do not have a diagnosis, how might you be able to work with your health care professional and use the results of current research to help yourself function better as you go about your daily activities? Whether or not you feel the need for an official diagnosis, what information about various treatment options should you bring with you (and/ or have enough knowledge about to be able to discuss) when consulting with a health dprofessional?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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