ADHD What is it? What can I do? June 22, 2013 Joseph L. Flint, MD Delavan Pediatrics

Transcription

1 ADHD What is it? What can I do? June 22, 2013 Joseph L. Flint, MD Delavan Pediatrics

2

3 Common Questions What is ADHD? Is it real? Isn't it over-diagnosed? What are my options? Will my child be a zombie? How long do we treat?

4 What is ADHD? ADD vs. ADHD Attention Deficit Hyperactivity Disorder Is it real? YES and NO It is a classification of symptoms It does not give a reason or cause

5 Typical Symptoms poor focusing easily distracted fidgety hyperactive talks non-stop impulsive

6 Traditional Classification 3 Basic Subtypes: 1. Primarily Inattentive 2. Primarily Hyperactive 3. Combined Subtype

7 Dr Amen's 6 Types of ADD Type 1. Classic ADD (ADHD) -- inattentive, distractible, disorganized, hyperactive, restless, and impulsive. Type 2. Inattentive ADD -- inattentive and easily distracted, but not hyperactive; sluggish, slow moving, low motivation, and often described as space cadets, daydreamers, couch potatoes. Type 3. Overfocused ADD - inattentive, trouble shifting attention, frequently get stuck in loops of negative thoughts or behaviors, obsessive, excessive worrying, inflexible, frequent oppositional and argumentative behavior. May or may not be hyperactive.

8 Dr Amen's 6 Types of ADD Type 4. Temporal Lobe ADD - inattentive, irritable, quick temper, aggressive, dark thoughts, mood instability, and severe impulsivity. May or may not be hyperactive. Type 5. Limbic ADD - inattentive, chronic low grade depression, negativity, "glass half empty syndrome," low energy, and frequent feelings of hopelessness and worthlessness. May or may not be hyperactive. Type 6. Ring of Fire ADD - inattentive, extreme distractibility, angry, irritable, overly sensitive to noise, light, clothes and touch; often inflexible, cyclic moodiness, hyperverbal, and opposition. May or may not be hyperactive

9 How is it diagnosed? There is NO blood test It is subjective based on observations Observations can be skewed by an individual's own bias whether it be a parent, teacher, or doctor Rating scales help with the diagnosis but should not be used entirely to make the diagnosis Evaluate for other conditions these must be ruled out first Symptoms must be present in more than one environment ex: home and school

10 Rating Scales Vanderbilt NICHQ Parent and Teacher Scales Conners' Rating Scale The rating scales are not perfect some can be manipulated

11 Could it be something else? Immaturity Family or home stresses Parenting issues Teacher/School issues Learning disability Seasonal allergies Food allergies/sensitivities Poor nutrition Mood disorder Thyroid disorder Sleep disorder Other chronic illness (seizure, headaches, other) Maternal drug exposure

12 Home Issues Family and household stresses can contribute to troubles in school and at home Parenting deficiencies how we were parented affects how we parent Household environment that is not conducive to learning Inconsistent expectations

13

14 School Issues Class size Teacher deficiencies (personality, teaching style, discipline, etc.) Learning disabilities Bullies Friends Advanced students can also be labeled as ADHD

15

16 Medical Conditions Thyroid Disorders Hyperthyroidism: hyperactivity, impulsivity, anxiety Hypothyroidism: inattention, depression Seizure Disorder Migraines/Headaches Other chronic illness

17 Allergies The potential role for allergies or sensitivities cannot be overlooked or overstated Exposure to allergens can have a profound effect on a child's behavior Look for associated signs/symptoms: dark circles under eyes, nasal congestion, recurrent headaches, eczema/dry skin, hives Dr. Block video

18 Common Food Sensitivities Milk Wheat Eggs Nuts Food dyes MSG Nitrates Aspartame Sugar Caffeine Chocolate

19 Food Allergies Testing can look for IgE antibodies (true allergies) Some specialized testing is available for IgG antibodies (many food sensitivities) Best way to diagnose: Elimination diets Example: the Feingold diet Eliminate likely offenders for at least 2-3 weeks (until symptoms improve) then slowly reintroduce one item at a time until symptoms return

20 Gut Instinct Serotonin is made in the gut and has activity in the brain Stimulants release serotonin SSRI anti-depressants keep serotonin around longer Serotonin is a precursor to melatonin therefore a deficiency in serotonin can explain sleep problems in children with ADHD symptoms Intestinal problems resulting from inflammation, yeast overgrowth, or other imbalance can affect serotonin production

21

22 Treatment Options Prescription medication: stimulants and nonstimulants Natural/Homeopathic supplements Dietary changes Treating the underlying chronic medical condition Other treatments

23 Medications Stimulants Methylphenidate: Ritalin, Concerta, Focalin, Quillivant Amphetamines: Adderall, Vyvanse, Dexedrine Non-Stimulants Strattera Intuniv

24 Medication Side Effects Headache Abdominal pain Insomnia Decreased appetite Jitteriness Irritability Mood changes (side effect vs. comorbidity)

25 Natural Supplements Synaptol ( Attend ( Focus Formula ( Bright Spark ( Listol (

26 Other Supplements Magnesium Omega 3 fatty acids Probiotics to restore gut balance Garlic (allicin) to treat underlying fungal infection

27 Other Treatments Chiropractic manipulation Mitchell Family Chiropractic (Bloomington, IL) Small Miracles Chiropractic (Atlanta, IL) Dr. Kurt Ehling (Morton, IL) Biofeedback ( Counseling and behavioral therapy

28 Resources Block Center for ADHD ( Feingold ( ADHD Solution ( Taking Charge of ADHD by Russell Barkley The Biology of Behavior (

29 Summary ADHD only describes symptoms Identify the cause and correct early ADHD medications will not fix other problems Use stimulants only when absolutely necessary