Attention Deficit Hyperactivity Disorder (ADHD)

ADHD has no single identified cause. Scientists believe that there are a few variables that influence the risk of ADHD, which include:

• Genetics;
• Exposure to stress during pregnancy, or childhood;
• Early social interactions;
• Environmental toxins.

ADHD is found to be inherited genetically. 

Genetic variations are associated with ADHD like the regulation of dopamine, the chemical messenger used by brain cells. Dopamine is important in ADHD, as it is used to treat this disorder by increasing the levels in the brain, which in turn treats the symptoms of ADHD.

• Environmental toxins; such as polychlorinated biphenyls, pesticides, and lead are linked but not proven to be the cause of ADHD.
• External factors such as negative child-parent interactions, and poor early social contact have been noted to contribute to the condition.
• Some risk factors in the womb, but are not causative to ADHD include smoking during pregnancy, premature birth, low birth weight, maternal stress.

Traumatic brain injuries have been linked to cause ADHD. 20-50% of children who suffer from a traumatic brain injury develop the same symptoms as ADHD patients and is termed as secondary form ADHD.

• A lack of certain nutrients such as, zinc, magnesium and polyunsaturated fatty acids are linked to ADHD. 
• Lack of Omega – 3 and 6 are linked to people with ADHD as well as lower levels of magnesium and zinc.
• High levels of artificial coloring and additives in food intake, are connected to increased activity in children and may increase the risk of ADHD.
• Excessive sugar intake.

It has been observed that 30% of people with ADHD suffer from sleep apnoea.

Sleep apnoea and restless leg syndrome resemble symptoms of ADHD in children and adults. It’s important that someone is not misdiagnosed with ADHD which actually suffers from a sleep disorder with the same symptoms. Medication used to treat ADHD may also be the cause of some of the sleeping disorder symptoms. Although it is not set in stone that this is the cause, it must be monitored while the medication is administered, to prevent changes in sleep patterns.

The Physician must be consulted before any changes in medication and dosages are made. The drugs have to be monitored carefully to prevent other implications and concerns and to ensure the patient gets the best results. 

Persistent symptoms of inattention hyperactivity and impulsiveness can effect a person’s quality of life.

Symptoms of Inattention:

• Careless mistakes during school work;
• Difficulty staying focused;
• Difficulty in paying attention and listening when spoken to;
• Difficult to organize and finish tasks;
• Often losing toys, tools and books used for activities;
• Easily distracted; and
• Forgetfulness during daily activities and tasks.

Symptoms of Hyperactivity:

• Fidgeting with hands or feet;
• Leaving your seat when asked to remain seated;
• Running/climbing in inappropriate situations;
• Difficulty in working/playing quietly;
• “on the go” all the time;
• Talking a lot (excessive). 

Symptoms of Impulsiveness:

• Blurting answers out before the question is finished;
• Difficult to wait your turn;
• Interrupting or intruding on others conversations/play; and
• Many children struggle academically and socially, they also show symptoms like depression, anxiety and substance abuse.

There is no test for ADHD, but other conditions have to be taken into consideration, such as anxiety and learning disabilities, which may have similar symptoms.

• Conventional treatment – This involves both medication and psychological support.
• Stimulants - There are several brain stimulants available. These drugs change the levels of signalling by neurotransmitters in the brain.
• Methylphenidate – Most common medication used to treat ADHD. Comes in different forms, (capsules, tablet and a patch) which also vary in dosage. This is better absorbed and more chemically active in the brain.

The side effects are heart problems, growth suppression, as well as oxidative stress.

Oxidative stress is a metabolic process where reactive molecules damage cells and tissues. It is also a contributing factor for ageing. Children are more susceptible to oxidative stress than adults. Oxidative stress can also contribute to the development of psychiatric disorders, which include ADHD. Methylphenidate is most commonly prescribed by doctors without fully understanding the long term developmental effects it can have on children and the impact it can have on the brain health in later life.

1. It’s a combination of amphetamine and dextroamphetamine, which is also commonly prescribed, and some people respond better to these alternatives with ADHD. 
2. Lisdexamphetamine is a new addition to treat ADHD, and is approved to use for children and adults.
3. It’s a “prodrug” which means that it only becomes active once ingested, which in turn gives the drug a smoother effect throughout the day with less side effects. 
4. It may also prevent addiction and abuse.

• The side effects can be mild to severe.
• Adverse effects include headaches, insomnia, decreased appetite, rapid heart rate, abdominal pain and growth suppression.
• These stimulants should not be used by people with hypertension, heart or vascular disease, hyperthyroidism, glaucoma, psychosis, or when taking monoamine oxidase inhibitors, prescribed for depression.
• These have a potential for abuse and effects the addiction –related pathways in the brain, so would not suit people with a substance abuse or addiction problem.
• This could worsen the ticks in people with Tourette’s syndrome, and may cause ticks where some had none previously.
• May cause mania or psychosis in people who show signs of bipolar or schizophrenia.
• Rare cases have resulted in death, the reason why a full cardiovascular screen should be done before taking these stimulants.

• This is an effective alternative for some patients, with less side effects, like tics and sleep disorders, with an increased risk of suicidal thinking in children and adults. These patients should be well monitored when starting on these medications.
• Only a few are approved by the FDA.
• Atomoxetine – inhibits the re-uptake of the neurotransmitter norepinephrine. Others are clonidine, guanfacine, which counter the effects of the nervous system.
• Antidepressants are not FDA approved for ADHD, but have some good results in treating the disorder.

By using a FDA approved device that monitors brain waves, it can assist doctors in diagnosing ADHD in children and adults.

This is a non-invasive test that takes 15-20 min which uses sensors on the scalp of the person to monitor their brainwaves. ADHD patients have a higher theta/beta brainwave that can only be detected by this test, However more evidence is needed to believe that this is really a sufficient test to diagnose ADHD.

• New drugs are being tested for the treatment of ADHD which target the neurotransmitters, acetylcholine, which involves learning.
• Big improvement in cognition, memory, attention and emotional responses in adults were found when taking this drug.
• Although these drugs are still in development, they could be an effective drug for ADHD in the future.

• Specific dietary changes can alter the symptoms of ADHD dramatically.
• Food colouring results in hyperactivity in children, however when removed from die diet it remarkably improves the behaviour when food items lack these additives.
• Children who are sensitive to food colouring tend to also be sensitive to foods such as milk, eggs, wheat, and soy.
• Children should avoid food high in sugar, which can help to prevent hypoglycaemia symptoms, which can be the same as ADHD symptoms in some children.
• Children that eat a healthy balanced breakfast with proteins, vitamins and minerals found in whole grains, concentrate better during the morning hours at school.

1. Neurofeedback – Is a technique that measures the brain activity in real time: This aims to change the threshold that triggers brain activity which is impaired in people with ADHD. This has the best results shown for inattention, impulsivity and some benefits for hyperactivity.
2. Cognitive behavioural therapy– Uses behavioural skill training and interventions which targets the dysfunctional patterns of thought and improves functional performance. This is particularly effective in adolescence.
3. Physical activity – Exercise has a positive impact on ADHD symptoms in children and adults.
4. Exercise helps reduce the anxiety and impulsive symptoms, cognitive symptoms in children shows an improvement after only 20 min of exercise.
5. Yoga will also help in reducing symptoms.

• By taking supplements with free fatty acids and excluding artificial food colouring from the diet, it is shown to significantly reduce the symptoms of ADHD.
• Children with ADHD have low levels of omega-3 in their blood and high levels of omega-6.
• Hyperactivity and inattention are linked to a deficiency in omega-3.
• Insufficient omega-3 levels also show symptoms of opposition behaviour and emotional instability, antisocial traits, and lack of emotional processing. 

• Phosphatidylserine forms a big component of cell membranes, and is a very important brain nutrient.
• Its functions in the brain are to support cell membrane fluidity and influence neurotransmitter systems beneficially.
• Patients who have been using the supplement showed a great improvement in inattention, impulsivity and short term memory, with no negative side effects.

• This nutrient is a natural derivative of L-Carnitine, and has a key role in the metabolism of fatty acids and cellular energy.
• It has been shown to improve symptoms of ADHD like inattentiveness in children as well as hyperactivity and social behavior.

• Vitamin B6 and Magnesium – Vitamin B6 aids in the production of serotonin, and by using this as a supplement will increase serotonin levels and improve hyperactivity in ADHD. Magnesium deficiencies are common in people with ADHD, but by taking a magnesium supplement it will help to reduce hyperactivity too.
• Zinc and Iron – Both of these menirals help with dopamine production, and a lack of these minerals could have an adverse effect on ADHD. Deficiencies may cause sleep disorders, like restless leg syndrome.

• Gingko balboa and Ginseng – Taking these supplements have been noted to improve a range of symptoms such as social and impulsivity problems, as well as anxiety and attentional symptoms.
• Pycnogenol - Used for ADHD for its antioxidant and vasodilator properties. It has been proven to help with ADHD symptoms such as decrease in hyperactivity, improvement in attention, increase in visual and motor coordination, as well as oxidative stress in children.

• Multivitamin/multi-nutrient formula
• Whey protein
• Fish oil
• Phosphatidylserine
• Phosphatidylcholine
• Acetyl-L-Carnitine
• Vitamin B6
• Magnesium
• Zinc
• Iron
• Probiotics
• Gingko Biloba
• Ginseng
• Pycnogenal

• Omega score
• Vitamin B6
• Zinc
• Iron and total Iron-building Capacity
• RBC Magnesium