(Diagnosis requires the presence of at least 11 of the following)

• Inability to complete tasks
• Difficulty focusing
• Distractibility
• Stress Intolerance
• Frequent forgetfulness
• Atypical response to psychoactive drugs
• Antisocial personality disorder
• Blurting out answers before the question is asked
• Difficulty awaiting turn
• Interrupting or intruding on others
• Inattention Deficit
• Driven to Distraction
• Sense of Under achievement
• Difficulty getting organized
• Intolerance of boredom
• Often creative and highly intelligent
• Increase number of projects going on at the same time
• Trouble following "proper procedures"
• Tendency to worry needlessly
• Sense of insecurity
• Problems with self-esteem
• Inaccurate self-observation
• Family History of substance abuse, ADHD, or depression

Additionally, symptoms of ADHD can be found in cases of learning disabilities, language disorders and mental retardation. Thus co morbidity raises the questions as to whether the presence of another disorder alters the likelihood of a positive drug response? Family histories of the first degree relatives find increased rates of ADHD, poly-substance dependence, antisocial personality disorder, depression and anxiety disorders. Additionally, there is a 25% concordance rate for ADHD exists among the pro bands' first-degree relatives (Weiss and Hechtman 1986). Children with ADHD are at an increased risk of having antisocial behavior, depression and poly-substance abuse problems occurring when they are adults.

ADHD problems persist into adulthood in approximately 11-50% of the patients. Adults with ADHD are usually self-sufficient, but they have poorer academic performance, poorer job performance, and lower socioeconomic status than siblings. They have frequent divorces, job changes, change of residence, and car accidents. Most report a high level of subjective distress (79%) and interpersonal problems.

Treatment

Various abnormal neurochemical findings for ADHD have been reported. A decrease in norepinephrine's major metabolite, MHPG, has been argued to support norepinephrine deficiency hypothesis, whereas low levels of dopamine's major metabolite, homovanillic acid (HVA) are postulated to support a dopamine deficiency hypothesis (Cohen et al 1977).

In other words, we have not figured out exactly what causes ADD but we do know how to treat it medically. Additionally, an excess of platelet MAO has been observed. Young et al (1980) demonstrated an age-related decrease in MAO in the platelets of normal children. However, the decrease in MAO activity was not observed in children with ADHD. The brain maps of ADHD children show a focus of delta activity located in the frontal lobe which may relate to a decrease in glucose metabolism in this area. (Zametkin et al 1990).

While CNS stimulant medications currently are the drugs of choice, tricyclic antidepressants (TCA's) are also useful. Stimulants such as Dexedrine, Ritalin, Adderall, (norepinephrine or dopamine agonists) have been shown to help the symptoms of ADHD. Patients, teachers, and clinicians rate 75% of children with ADHD to be improved on stimulants, compared to 18% of placebo-treated children (Green 1992). Approximately 20-25% of those who respond poorly to one medication will respond positively to another (Dulcan 1990). Importantly, the psychopharmacology literature provides no agreement about how much improvement is required for a child to qualify as a "clinical responder."

Stimulants tend to decrease physical activity, particularly during times when children are expected to be less active such as during school. They decrease vocalization and noise and disruptive activity, and improve handwriting. Stimulants improve compliance with adults' commands, improve attention span and short-term memory and reduce distractibility and impulsivity. The studies reviewed in this section include those that were double-blind controlled studies that investigated the efficacy of stimulants, antidepressants, and clonidine in the treatment of ADHD. Dopamine agonists such as L-DOPA, permax, amantadine are not effective.

Dosing for ADHD

Stimulants:

• Amphetamines-Dexedrine 5mg. to 15mg. a day
• Ritalin* 10mg bid
• Cylert (pemoline) 18.75mg. and titrate upwards*

TCA's:

• Desipramine 10-25mg. qhs. up to 5mg/kg/day immediate effect but side effects of dry mouth, tiredness, headaches)

Other:

• Wellbutrin (bupropion - good response, better than stimulants)
• Clonidine
• MAOI's

*Methylphenidate (Ritalinreg.), dextroamphetamine, and pemoline appear equally effective in treating ADHD. The 3 psychostimulants were found to more effective than caffeine and placebo. The usual starting dose of pemoline (Cylert) is 37.5 mg each morning. The dose is titrated upward at a rate of 18.75 mg/wk to a maximum dose of 112.5 mg/day. The average child generally requires a dose between 56.25 - 75 mg/day. The slower onset of action of pemoline is more likely a function of the slow titration period recommended by the manufacturer. Thus some clinicians increase the dose every 3rd day to speed up the process.

Some of my patients have used a product called Restores+ for ADD symptoms and they have claimed excellent results. Restores+ is a phenylalanine ( a precursor of dopamine in the diet) containing compound and is apparently totally safe and has no side effects.

Restores+ may completely reverse some chidrens' ADD by correcting their deficiency or it may only improve their symptoms as long as they use it. Most of the ADHD treatments involve amphetamines or "Speed, a dopamine like agent which does help sufferers feel better since they have a deficiency, but they may get addicted quickly."

Restores+ can enhance normal brain function through nutrition and reduces stress damage on the brain. See their website at: http://www.quest4health.com for more information or call the distributor: at 1-800-737-8161. Use the order # 550887117.

There are several other phenylalanine derivatives, over the counter OTC. The medications I use in my practice to treat ADD are all Rx: Wellbutrin, a dopamine stimulator and/or Dexedrine spansules or Adderall, aphetamines used as appetite suppressants. In some cases intense behavior modification works to improve ADHD symptoms.

Co-morbid Conditions (or associated diseases)

• Excessive caffeine use-three or more cups per day of strong coffee contains more than 500mg of caffeine
• Thyroid disorders-generalized resistance to thyroid hormone
• OCD-obsessive compulsive disorders-counting, hoarding, washing, gambling, sexual compulsions, shopping, locking
• Substance Abuse-rarely marijuana or downers-sleep meds, barbituates or Valium; more often, Cocaine, crack, speed or EtOH (ethanol) abuse-25%