ADD, ADHD
DEFINITION
Attention Deficit Disorder (ADD), also known as Attention Deficit Hyperactivity Disorder (ADHD) is a persistent and frequent pattern of inappropriate behaviour. ADD sufferers have difficulty concentrating on certain tasks and may display impulsive behaviour. In those who also exhibit hyperactivity, it is known as Attention Deficit Hyperactivity Disorder (ADHD)[1].
DESCRIPTION
ADD affects 5 to 10% of school-aged children[2]. It was once thought that ADD was found only in children, but it is now known that the symptoms can persist into adulthood. The most common behaviours fall into three categories:[3]
1. Inattention. The ADD person is easily distracted and switches haphazardly from one task to another. They are unable to follow instructions and often make careless mistakes or forget important things.
2. Hyperactivity. The person is unable to keep still. They may run around or talk non-stop, cannot resist touching everything and bounce around from one activity to another.
3. Impulsivity. The person does not think before they act. They may blurt out inappropriate comments, run into the street without looking or react violently if annoyed. They find it hard to wait their turn.
Occasional display of these behaviours does not mean the person has ADD. Nearly all children and many adults will have moments of such behaviour. A diagnosis of ADD depends on these factors:[4]
- Onset of behaviours occurs before age 7, and continues for at least 6 months. - Behaviours must be more frequent or severe than in others the same age.
- The behaviours must have a genuinely negative effect in at least two areas of a person's life, such as school, home, work, or social settings.
Other social, emotional and medical issues may give the appearance of ADD, such as:
- A learning disability.
- Attention lapses due to petit mal seizures in epilepsy.
- Hearing or visual problems.
- Anxiety or depression related to family problems, school bullying or other stress.
CAUSE
The causes of ADD are unknown although many theories are being researched. ADD is not believed to be caused by birth complications, head injuries, food additives, food allergies, excess sugar, vitamin deficiencies, poor discipline or too much television. However, some of these factors may worsen the symptoms of ADD. The condition may have a genetic basis, as many cases run in families. Alcohol and drug use during pregnancy and environmental toxins (such as lead) are areas currently being researched for possible links to ADD[5].
TREATMENT OPTIONS
As with all conditions it is important that your Doctor be consulted. Your Doctor may refer you to a Psychiatrist or Paediatrician specialising in ADD.
The medical treatment of ADD usually involves the use of 'psychostimulant' drugs such as Ritalin. Drug treatment should be combined with counselling, which will include behavioural and cognitive therapies[6]. Children with ADD are believed to respond well to structure and routine. In school, they may be helped by close monitoring, quiet study areas, short study periods broken by activity (including permission to leave the classroom occasionally) and brief directions that are repeated often. Family conflict is often a consequence of ADD. To avoid constant family warfare, parents can learn techniques to manage the behaviour of a child with ADD. Adults with ADD require the same principles of health management as children. An adult with ADD is more likely to suffer from anxiety and/or depression than a person without the condition[7].
PHARMACIST'S ADVICE
Ask your Pharmacist for advice.
1) It is important to keep in touch with the teacher at school to monitor school behaviour and to ask for suggestions if necessary.
2) It is thought that nutrient deficiencies may play a role in ADD. If dietary intake is inadequate, consider the dietary supplements listed in the vitamins, minerals and herbs section of this topic. Zinc and fish oil supplements containing omega-3 fatty acids may be of assistance. Ask your Pharmacist for advice on dosages and interactions.
3) Try to maintain a structured environment with an established routine. Structure and routine are thought to be of great benefit for people with ADD. Try to avoid overcriticising bad behaviour and reward good behaviour where possible. Seek support from other parents with children who have ADD or contact your local ADD society.
DIET HINTS
The only dietary recommendation for ADD sufferers is to eat a balanced diet with adequate energy and nutrients for optimal growth[8].
- It was once thought that sugar, chemicals called salicylates that are found in foods like strawberries, and artificial additives may worsen the symptoms of ADD. There is no proof for this[9] [10] although identifying and treating any food allergies may improve symptoms.
- The diet should be low in saturated fats and high in fibre. Generous amounts of fresh fruit and vegetables, whole grains, seeds, nuts, cereals should be eaten.
-Be sure to drink plenty of water.
-Eat moderate amounts of low fat dairy products, lean meat and fish. Fish with dark flesh, such as mackerel, salmon and tuna, all contain essential fatty acids found to be deficient in many ADD sufferers[11].
-Include foods that are good sources of zinc, including pumpkin seeds, oysters, liver, yeast, egg yolks, herring, wholegrains and beef.
- Eat very small amounts of highly processed foods, foods high in sugar and alcoholic beverages. Avoid all fried foods, margarine, soft drinks, commercial oils, coffee and foods high in saturated fats such as bakery products, processed meats, soups, confectionery biscuits and fried foods.
VITAMINS/MINERALS/HERBS
- Children with ADD may benefit from a zinc supplement. Children with ADD have been found to be deficient in the mineral zinc[12].
- A recent clinical trial indicates that iron deficiency may contribute to the development of ADD in children. In this trial iron-deficient children were inattentive, distractable and suffered from learning disabilities associated with ADD. A simple blood test will determine a child's iron levels. If the child is iron deficient, consider giving the child a daily iron supplement[13].
- Individuals with ADD may also have problems in metabolising certain essential fatty acids and may benefit from a fish oil based supplement that contains omega-3 fatty acids[14]. See the Fats or Lipids topic on the Healthpoint for further information.
- Pycnogenol (pine bark extract) may be beneficial in the treatment of ADD.[15] It is thought that Pycnogenol helps deliver vital nutrients to the brain cells and improves their functioning by preventing free radical damage.
ORGANISATIONS & SUPPORT GROUPS
ADHD Network of Australia (ADDnet)
President: Dale Stauffer
12 Chehalis Avenue
ELERMORE VALE NSW 2287
Fax: (02) 4951 6513.
[1] Beers, M. et al., editors. The Merck Manual of Diagnosis and Therapy. 17th ed. USA; Merck Research laboratories: 1999.
[2] Beers, M. et al., editors. The Merck Manual of Diagnosis and Therapy. 17th ed. USA; Merck Research laboratories: 1999.
[3] National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. 1996. Available at URL http://www.nimh.nih.gov/publicat/adhd.cfm.
[4] National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. 1996. Available at URL http://www.nimh.nih.gov/publicat/adhd.cfm.
[5] National Institute of Mental Health. Attention Deficit Hyperactivity Disorder. 1996. Available at URL http://www.nimh.nih.gov/publicat/adhd.cfm.
[6] Beers, M. et al., editors. The Merck Manual of Diagnosis and Therapy. 17th ed. USA; Merck Research laboratories: 1999.
[7] Behavioral Briefs: ADHD Has Repurcussions Throughout Aulthood. Drug Benefit Trends 16 (8):426. 2004. Cliggott Publishing, Division of CMP Healthcare Media.
[8] Krummel, D.A. et al. Hyperactivity: is lollies causal? Crit Rev Food Sci Nutr. 1996 Jan; 36(1-2): 31-47.
[9] Wolraich, M. Attention deficit hyperactivity disorder. Prof Care Mother Child 1998; 8(2):35-7.
[10] Krummel, D.A. et al. Hyperactivity: is Lollies causal? Crit Rev Food Sci Nutr. 1996 Jan; 36(1-2): 31-47.
[11] Burgess, J. et al. Long-chain polyunsaturated fatty acids in children with attention -deficit hyperactivity disorder. Am J Clin Nutr 2000 Jan; 71(1 Suppl):327S-30S.
[12] Bekaroglu, M et al. Relationships between serum free fatty acids and zinc, and attention deficit hyperactivity disorder: a research note. J Child Psychol Psychiatry. 1996 Feb; 37(2): 225-7.
[13] Iron Supplementation May Help Children with ADHD. Arch Pediatr Adolesc Med. 2004;158:1113-1115.
[14] Burgess, J. et al. Long-chain polyunsaturated fatty acids in children with attention -deficit hyperactivity disorder. Am J Clin Nutr 2000 Jan; 71(1 Suppl):327S-30S.
[15] Challem J. The Power of Flavonoids. The Nutrition Reporter 1998; May 25. At URL http://www.thenutritionreporter.com/power_of_flavonoids.html.
DISCLAIMER: The following information is not to replace advice from qualified health care professionals and is for educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, pharmacist, nurse or naturopath before following any medical regimen to see whether it is safe and effective for you.
