Stripping Away the Myths Surrounding ADHD
By Holly VanScoy, HealthDay Reporter
FRIDAY, July 30 (HealthDayNews) -- Sugar doesn't usually cause it and neither do head injuries nor lax parenting. About a third of the individuals diagnosed have never been overactive; it's not confined to children. And the stimulant medications prescribed to treat it probably aren't turning millions of kids into drug addicts or endangering their health.
In fact, the myths and misunderstandings surrounding Attention Deficit Hyperactivity Disorder (ADHD) are among the most difficult aspects of this serious and often lifelong disorder for mental health professionals to manage.
According to Dr. Hugh Bases, a developmental pediatrician and associate professor at Hackensack University Medical Center in New Jersey, there's even confusing variation in the diagnostic terminology.
"Many parents, the media and even some professionals refer to ADHD as 'ADD' or Attention Deficit Disorder, even though the official, medical diagnosis is Attention Deficit Hyperactivity Disorder," Bases said. "Over time, the two terms have become interchangeable."
Further complicating matters, there are three subtypes of the disorder, characterized as "Predominantly Inattentive Type," "Predominantly Hyperactive-Impulsive Type," and "Combined Type." Although hyperactive children garner most of the media attention, the subtypes are about equally represented in children and adults.
One aspect of ADHD is not subject to misunderstanding: The number of individuals -- particularly children -- receiving treatment has skyrocketed over the past two decades. This had led some parents, educators and public officials to question whether the label of ADHD is being too zealously applied to normally active youngsters who simply need more structure or discipline, not medical care.
Richard Macur Brousil, director of child and adolescent behavioral health at Mt. Sinai Hospital in Chicago, and other experts readily debunk that notion.
"As mental health professionals' understanding of child development has grown, we've learned that much of what was once thought of as 'bad behavior' in youngsters is not under their control," he explained. "We can now identify many qualitative and quantitative differences between children who are simply active and those who are overactive or have difficulty concentrating. In ADHD, the symptoms are serious and interfere with a child's ability to function at home, in school or with their friends. Untreated, up to 75 percent of those affected will experience these symptoms and their consequences into adulthood."
Although the causes of ADHD remain unknown, there's ample evidence that it is biologically based, with strong genetic components. Recent studies supported by the National Institute of Mental Health (NIMH), for example, suggest that glucose activity in neurotransmitters within the brain may play a role. And if one person in a family is diagnosed, the chance that another member of the family will have the disorder is significantly higher.
Fortunately for children and adults with ADHD, there are a range of treatments that have proved effective in symptom management. These include -- for children -- parent education and support, school accommodations, individual and group therapies and medication. Most research shows it takes all of these, working together, to restore order to the life of an ADHD child.
Dr. Peter Della Bella, associate medical director and chief of psychiatry for Premiere HealthCare in New York City, is among the professionals who believe recent concerns about overuse of medication -- especially stimulants -- in ADHD children are misplaced.
"The recent uproar about the number of children being prescribed stimulants for hyperactivity is based on the fallacy that stimulants are harmful," Della Bella said. "In fact, several decades of using stimulants for ADHD in youngsters have demonstrated that they are the least harmful and most effective medications available. All of the others that are currently so highly touted may, in fact, have catastrophic consequences."
As with any potent medication that must be taken for an extended period, Della Bella asserts that one of the most important aspects of using stimulants -- including Ritalin (methylphenidate), Adderall (amphetamine mixed salts), Dexedrine (dextroamphetamine), Desoxyn (methamphetamine) or Cylert (pemoline) -- is prescribing and dispensing the correct dosage.
"Many of the horror stories with stimulants come from settings where children are started on doses that are too high for them," he said. "When experienced child psychiatrists initiate stimulant therapy in ADHD, we start with low doses and check the child's symptoms frequently. If they don't experience symptom relief, we increase the dose until the child is taking the lowest amount that provides effective relief."
Della Bella noted the relatively new non-stimulant Strattera (atomoxetine) can also be effective for children who don't respond well to a stimulant. But it's not the initial medication of choice for ADHD, he said.
"The upside of atomoxetine is that when it works, it works all of the time, unlike stimulants which may wear off," he said. "The down side is that it's a new medication whose long-term effects on the normal development of children just isn't known yet, unlike the stimulants, whose long-term use is known to be extremely safe, with no long-term side effects."
The nonprofit organization Children and Adults With Attention-Deficit/Hyperactivity Disorder (www.chadd.org ) has more information on ADHD.
SOURCES: Richard Macur Brousil, Psy.D., director, child and adolescent behavioral health, Mt. Sinai Hospital, Chicago; Hugh Bases, M.D., assistant professor, pediatrics, UMDNJ, Hackensack, N.J.; Peter Della Bella, M.D., associate medical director and chief, psychiatry, Premiere HealthCare, New York City
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