If ADHD medications like Ritalin are chemically similar to substances like cocaine and amphetamines, does that mean they are addictive? Technically, the answer is no.  Although both Ritalin (methylphenidate) and cocaine stimulate the production of dopamine, Ritalin takes longer to metabolize while cocaine works instantly. For pleasure-seeking recreational users who want the immediate gratification of stimulants, this makes all the difference in the world.  The effects of cocaine wear off faster than Ritalin, causing the user to crave for more drugs to sustain the high. Based on this major difference, experts conclude that ADHD medications metabolize too slowly to be habit-forming – as long as kids and teens take their pills as instructed by their doctor, that is.

But as it turns out, not all teens that use ADHD medications take them as prescribed.  In fact, many of them might not even have ADHD. According to a new study published in the journal Pediatrics, the number of teens who overdosed on ADHD medications rose 76% over the last seven years.

Researchers looked at data gathered by American Association of Poison Control Centers, which was based on calls from 13- to 19-year olds between the years 1998 and 2005. Throughout this time, nationwide calls for ADHD drug misuse increased from 330 to 581 yearly.  Around 42% of affected teens experienced moderate to severe side-effects such as aggression, seizures, personality changes, and psychosis. Most had to be rushed to the hospital for emergency treatment, while four of these cases resulted in death.

Indeed, abuse of Ritalin and other prescription drugs is a phenomenon college guidance counselors struggle with every year.  From the point of view of a teenager, the short-term side effects of ADHD medications are very desirable. Not only does Ritalin suppress appetite and cause weight loss; the drugs help students stay up all night while they frantically finish papers or study for exams. It’s common practice for teens to crush the tablets and snort the medicine as though it were cocaine; this makes the methylphenidate metabolize faster. Unfortunately, ADHD medications do have a strong potential for abuse if they are taken this way.

The study’s authors did not have information as to whether the abusers were diagnosed with ADHD or not. However, anecdotal evidence and previous research suggests that many of these teens did not have ADHD. According to a study by the University of Miami, students who were prescribed ADHD medications were least enthusiastic about taking them. On the other hand, non-prescribed students were more eager to use these drugs, which can be obtained from ADHD peers who are more than happy to sell or trade extra pills. It’s not uncommon for teens without ADHD to fake the symptoms so that they can obtain a prescription from a doctor.

Even though there are only hundreds of overdose cases compared to the millions of children who take Ritalin and other stimulants, the rising numbers are consistent and reflect a major increase in teenage substance abuse problems.  If your child or teen is taking medications for ADHD, make sure that you’re aware of where the pills are stored, how many there are, and who has access to these drugs.  Better yet, keep them in a place where your child can’t sneak them out.  Watch out for signs of abuse, which include difficulty focusing and increased agitation. You may also want to consider trying a non-medical approach to manage ADHD, especially if your child no longer shows improvements after years of taking medication.

The first day of school is just a few weeks’ away and like many parents, you’re probably looking for ways to help your ADHD child excel academically (or at the very least, meet the passing grade).  One of the biggest challenges parents face is keeping their kids attentive and focused long enough to get their homework done.  The average child often puts up a real struggle when it comes to schoolwork, but the symptoms of ADHD magnify the homework wars tenfold. Not only do they have problems with self-control, but their forgetful tendencies may keep them from taking note of the assignment and bringing home the things they need. Fortunately, researchers just developed a system that can reduce homework problems by half. At least, that’s what a new study just discovered.

Researchers from Monmouth University in New Jersey were able to address the homework issues ADHD kids face with a new system.  This was tested on 39 children between the ages 6 – 10, with the help of their teachers. All children were boys, had ADHD combined type, and had problems getting homework done.  They were then randomly assigned to a treatment group that implemented the homework system, and a comparison group with no interventions.

Those in the treatment group kept a homework notebook where they had to write all their assignments. They had to show this to their teacher before going home each day. As soon as they got home, they were allowed an hour of rest before settling down to accomplish the homework in a quiet place. The boys were not allowed to play video games or watch TV until they were done with the day’s work. As a consequence for forgetting to bring home the homework notebook or forgetting to bring the day’s assignments, the boys could not use the computer or watch TV for a day. In two to three weeks, the researchers evaluated the groups and noticed a dramatic improvement in the treatment group.  The boys who followed the system experienced at least a 50% reduction in homework problems, compared to the control group.

The homework system sounds easy enough to implement, especially if you can get your child’s teacher to cooperate with you.  Even if the teacher does not help, you can still use the homework system by implementing a study time and keeping your child away from distractions until everything is done. Perhaps the toughest challenge is making sure that parents follow through with the consequences.  But if you already have a good behavior management program in place, then you should not have a problem enforcing rules and motivating your child to get homework done on a daily basis.

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It’s difficult to quantify what the most effective ADHD treatment is. Because a child experiences more problems than hyperactivity, impulsivity, and inattention, it’s not uncommon for parents to use more than one method to treat ADHD.   But which of these treatments have the most impact?  According to a new survey from Consumer Reports, stimulants are the most effective ADHD treatment for kids, but parents still think it’s not enough.  In fact, the survey notes that kids who tried alternative treatments besides medication did better than kids who were on medication only. As for the most effective non-medical treatment for ADHD, it turns out that sending children to a school better equipped to deal with ADHD made all the difference.

Consumer Reports spoke to 934 parents of children with ADHD and asked them about various topics, from the impact of ADHD medications to the effects of alternative treatments like behavior therapy and diets.  It was discovered that 84% of parents medicated their children at some point, and that 67% of them reported that the stimulants were helpful.  What’s surprising is that not all of the parents were satisfied with the effects of medication, even those who reported that they reduced hyperactivity and inattention.  Only 52% of parents believed that if they could do it all over again, they would medicate their children, whereas 44% also wished there was another way to treat ADHD.  It’s likely that these findings were due to the various side effects of stimulants, which were reported by 84% of parents.

As for treatments beyond medication, 45% of parents discovered that switching their kids to a school that can handle ADHD helped their children “a lot.” Hiring a tutor also worked for the 37% of parents who did so, as did providing a structured schedule of activities.

Diet and nutrition is another approach some families had success with. 17% of families found that adding multivitamins and supplements helped “a lot”, while fish oil supplements got very satisfied marks from 12% of families that tried them.  It looks like these parents might have found validation from the recent study that demonstrates the impact of Western diet on ADHD.  Fast food and junk food not only contain high concentrations of sodium, fat, and refined sugar; they drain the body’s nutrient stores when they get converted into energy.

Although there is no single ADHD treatment that is universally effective, natural remedies and alternative treatments are always worth looking into.  Medication will make it easier for a child to behave and learn because he or she is not as distracted, but popping a pill everyday is like applying band-aid to a wound. It won’t make the disorder get any worse, but it won’t treat the root of the problem either.  At the end of the day, ADHD is a complex condition that requires various treatment methods if you want your child to overcome the disorder for good.  As to what these treatment methods are, it depends on the possible causes of the disorder, what your child needs, and what your overall treatment goals are.

As for narrowing down these treatments, Consumer Reports suggests that parents keep all copies of test results, psychological records, and other medical records related to their child’s ADHD.  It also helps to make a list of every professional who treated your child, the treatment strategies you have tried, and your child’s responses to each. That way, you’ll have an easier time figuring out the next step when you seek a new professional for your child.

We’ve long suspected that the typical Western diet might be the reason why so many children are diagnosed with ADHD today.  The brain requires a healthy number of nutrients, essential fatty acids, and amino acids to release and regulate neurotransmitters (brain chemicals responsible for mood, attention, concentration, and impulse control).  Although these nutrients can be obtained from a healthy diet of fruits and vegetables, the typical Western diet has little room for such healthy options.  Why? This type of diet prioritizes the convenience of cooking rather than nutritional value. Unfortunately, these fast food meals are high in fat, refined sugar, and sodium, and offer few nutrients in return. Can such a diet be responsible for the increase of ADHD epidemic among children and teens today?

An exciting new study from Perth’s Telethon Institute for Child Health Research may have just confirmed the link between ADHD and Western-style diets.  This study, which was published in the Journal of Attention Disorders, examined the dietary habits of 1,800 adolescents from the Raine Study, an ongoing long-term health research project. The Raine Study has been tracking the health and diet of these kids since they were born in the late 80s and early 90s.

The diets of the adolescents were classified into two groups. The “Healthy diet” group is characterized by high intakes of fresh vegetables and fruits, fish, and whole grains. This diet tends to be higher in fiber, folate, and omega-3 essential fatty acids.  The “Western-style diet” is characterized by fast food takeout, fried food, refined foods, and processed foods. This diet is higher in total fat, saturated fat, sodium, and refined sugar.  The dietary patterns were then compared to whether the individual received an ADHD diagnoses before the age of 14. In this study, 115 adolescents were diagnosed with ADHD – 24 girls and 91 boys.

After adjusting the data for other social influences, it seems that those in the Western diet group had double the risk of having an ADHD diagnosis compared to those who ate healthier foods. Lead researcher Dr. Wendy Oddy says, “When we looked at specific foods, having an ADHD diagnosis was associated with a diet high in takeaway foods, processed meats, red meat, high fat dairy products and confectionery.”  She also pointed out that the typical Western diet does not provide the essential micronutrients required for proper brain function, especially for tasks like concentration and attention. Not to mention that Western diets contain more artificial additives, flavors, and food dyes, which have been linked to the onset of ADHD in the past. Finally, Dr. Oddy suggests that impulsivity, a hallmark symptom of ADHD, may also lead to poor dietary choices like quick snacks.

Although the study was not able to determine a causal relationship (e.g. researchers are not sure if a poor diet leads to ADHD or if ADHD leads to poor dietary choices), there is definitely a link between ADHD and the typical Western diet.  Here’s a little experiment you can try: remove junk food, processed food, fast food, and fried food from your child’s diet for a week. Replace these with lots of green leafy vegetables, fresh fruits, and non-processed meats.  Are there any noticeable improvements in behavior and overall symptoms?

When we think of possible ADHD natural treatments for children, tonsil removal is hardly the first thing that comes to mind. After all, ADHD is caused by the interaction between genetics and the environment. What does removing tonsils have to do with reducing hyperactivity, impulsivity, and inattention?  The answer is more surprising than you think.

Tonsils (two clumps of tissue on both sides of the throat) and adenoids (a single clump of tissue behind the nose) are made up of lymphoid tissue, the same kind of tissue found in the gastrointestinal tract and the tongue’s base. This lymphoid tissue is made up of lymphocytes, which works with the immune system to produce antibodies – a type of protein that fight against germs and bacteria.  Antibody production is normally considered a good thing, but tonsils and adenoids are not designed to handle the sheer amount of viral infections children are exposed to.    And kids get exposed to at least five kinds of germs once school starts.

Normally, tonsils and adenoids swell when they prepare to neutralize germs. Once they’ve done their job, the tissue should shrink back to their normal size. In many cases, however, tonsils and/or the adenoids fail to do so and become large enough to impede breathing. The tissue blockage can be especially problematic at bedtime, when they block the air passages during sleep and cause snoring and overall poor sleep as a result. This interruption of the air flow during sleep is called sleep apnea, which literally means “without breathing”.  This is because the trachea’s entrance is completely blocked, cutting off the air flow to the lungs.

Lack of restful sleep produces daytime sleepiness in adults, but not in children – they become more hyperactive and inattentive as a result.  A study of the sleep habits of 5- and 7-year olds discovered that children with mild ADHD are more likely to snore than the general population. They also discovered that children who snore have lower scores on tests of attention, overall intelligence, and language ability than children without.

Hyperactive and aggressive children with enlarged tonsils seemed to benefit from getting their tonsils and/or adenoids removed via surgery (also called an adenotonsillectomy). After the procedure, they became noticeably more calm and behaved, especially when other treatment options failed to achieve these results.  Researchers from the University of Michigan observed that children who had their tonsils and adenoids removed had behavioral problems and sleep problems before their surgery. When their behavioral test scores were compared to another group of children with unrelated surgery, the researchers noted very little difference between the two groups.  Of the twenty-two children with ADHD from the adenotonsillectomy group, 11 no longer met the diagnostic criteria of the disorder one year after surgery.

This is why a comprehensive physical exam is an important component of the ADHD evaluation process. Detecting enlarged tonsils and adenoids at this stage can immediately narrow down your treatment options and get to the root of your child’s hyperactive symptoms.  If you notice that your hyperactive child snores during sleep or keeps getting up in the middle of the night, this is also a good time to get him or her checked for enlarged tonsils.

We’ve discussed how squirming, fidgeting, and moving around can actually improve the focus of kids with ADHD, but were you aware that hyperactivity can also boost working memory? Although hyperactive behavior is normally associated with restlessness and boredom, a new study by Mark Rapport and colleagues in the Journal of Abnormal Child Psychology suggests a link between fidgeting and improved memory.   Unlike previous research on the subject, which used  flawed methodology like subjective ratings from parents, Rapport’s study used objective methods for measuring hyperactivity and its impact on working memory.

The study required the participation of 12 boys with ADHD and 11 boys without; all were between the ages of 8 and 12.  Each participant engaged in the control activity and the experiment activity. The control activity required children to make drawings of anything they like using Microsoft Paint – a task that requires little working memory.  The experiment activity involved playing two memory games. In the first game, the boys were shown a random series of numbers and a capital letter for 800 milliseconds. The boys were then asked to recite the numbers and letter. The second game involved nine squares. In each round, red and black dots appeared on random places on the square for 800 milliseconds at a time. At the end of the round, the boys had to identify the position of the dots in the order they appeared.

Throughout both activities, each participant wore an actigraph – a watch-like device that measures intensity of movements and acceleration. The actigraph was worn on both ankles and the wrist of the nondominant hand. As the boys accomplished both tasks, the actigraphs took samples of their movement 16 times per second.

In both tasks, boys with ADHD were more physically active than those without. However, both groups displayed a two-fold increase in hyperactivity when they performed memory tasks (relative to their activity level when using Microsoft Paint).  They swiveled around in their chairs and fidgeted more in general.  The researchers suggest that hyperactive behavior might be necessary to stimulate central executive processing, and becomes excessive when children try to compensate for under-arousal. More research is needed to see if increased physical activity also improves performance quality. Of course, girls with ADHD should be included in future studies as well.

So if your child fidgets often while doing homework and other tasks that need focus, let him be. Provided that the actions aren’t destructive, hyperactive behavior can actually improve the concentration and working memory of kids with ADHD.

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Are you tired of punishing your ADHD child for impulses that he or she cannot control? Most parents who have impulsive ADHD children are often at their wits’ end. Children with ADHD hyperactive/impulsive type are not only unable to learn from past mistakes; their tendency to act before they think often gets them into trouble or places themselves and others in dangerous situations.  Besides natural ADHD treatments like neurofeedback, what else can you do to teach their child control their impulsivity?

Some parents have been able to curb their children’s impulses with a simple game called Remote Control Impulse Control.  This card game aims to reduce impulsivity in children (grades 1 to 9) by imparting skills based on remote control symbols:

STOP what you’re doing and consider alternative actions
REWIND and learn from old mistakes
FAST FORWARD and consider the possible consequences before acting

During the game, the players pick a card and read out the true-to-life situation printed on it, which is based on case studies of actual impulsive children. For instance, one card reads, “You see yourself in the bathroom mirror and notice that a few strands of hair seem unruly. You have the impulse to cut them off.” Then, every player should to choose between one of the three impulse control strategies mentioned above.  If you choose “stop”, you should say what you would do instead of the impulsive behavior (e.g. get a haircut at the barbershop). If you choose “rewind”, you should share a similar impulse you gave into in the past, what happened afterwards, and what you learned from the experience (e.g. you cut a bald spot and had to have your head shaved completely, thus teaching you never to cut unruly hairs by yourself). If the “fast forward” option is picked, you should describe what might happen if the impulse is carried out.  Every player can take turns sharing their impulse control strategy and talk about how they might respond in any given situation.

Aside from better impulse control, the game aims to teach kids to learn from old mistakes, anticipate consequences, think before acting, work cooperatively with others, and improve problem-solving skills.  It’s also a great way for the kids to bond with the family. Together with other ADHD treatments, practicing these impulse control skills in a fun way may help your child make better choices in real life situations.

The Remote Control Impulse Control game can be purchased at Amazon and Toys R Us. Have you ever tried this game? How has it helped your child?

Natural treatment for ADHD is now going to the dogs, in a manner of speaking. Child and adolescent psychiatrists in some parts of Europe, the United States, and Australia have been trying animal assisted therapy (AAT) on children with ADHD. This innovative approach makes use of furry, four-legged friends to help children manage their ADHD symptoms, and it is proving to be just as effective as more traditional treatments.

What is animal-assisted therapy?

Animals have been used for therapeutic purposes since the 1700s, but only recently did the therapeutic process become more streamlined and organized. Animal-assisted involves far more than just petting and socializing with animals.  Like conventional therapy, AAT interactions are individualized, goal-oriented treatments directed by a qualified professional. What makes it different is the presence of animals, which serve as teaching aids and help the child warm up to the therapist and the therapeutic process.

At the start of therapy, the therapist interviews the child and family and takes note of his or her social, emotional, cognitive, and physical state. This helps him or her choose the right techniques to achieve certain therapy goals.  During each session, the child gets to interact with an animal under the therapist’s supervision, who takes note of any improvements or unusual responses.

How can animal-assisted therapy help kids with ADHD?

AAT can address the emotional, behavioral, and social components of ADHD.  Let’s say that an ADHD child is going through a parent’s divorce and has been throwing tantrums as a result.  Having an animal around will make it easier for the therapist to divine the problem and the next best step to take.  For instance, the child can be asked to tell the rabbit what happened and how he or she feels.  Most children feel comfortable with opening up to animals and telling them things they would not reveal to an adult or a stranger. In terms of healing troubled emotions, the goals of AAT are the same as any therapy, except the techniques involve the comforting presence of animals.

AAT sessions can also be done in groups, which is helpful in addressing behavioral symptoms and teaching kids how to socialize. It is not uncommon for children in group therapy to learn to wait their turn, control their impulses, and become more patient.   As for children who feel uncomfortable with human emotions or physical contact, therapists observe that they become more affectionate with dogs and other domestic animals.  However, it is not yet certain if they can apply these learned behaviors during human interactions.

Who can benefit from animal-assisted therapy?

Most kids love animals, but not all can benefit from animal-assisted therapy.  For children with a phobia for certain animals, this approach will prove to be more traumatizing than therapeutic. Children with allergies to animal fur may also experience discomfort during sessions.  And as with all therapeutic approaches, there are just some children who cannot be helped by AAT.

If, on the other hand, your child enjoys playing with furry friends and little critters, AAT may teach him or her to keep ADHD symptoms under control.   You can find an animal-assisted therapist by visiting deltasociety.org.

Although it’s not the most affordable of therapies available, neurofeedback is one of the most promising and interesting natural treatments for ADHD.  Basically, the goal of neurofeedback is to “train” a child to change the way his brain works, so that he can function as if he doesn’t have ADHD. In other words, neurofeedback teaches a brain how to not have ADHD.  Sounds fascinating, doesn’t it? Neurofeedback treatments are non-invasive and safe for children to take, especially if they have problems maintaining their focus and ignoring irrelevant stimuli. We have an article in the Article Library that explains how this mechanism works.

Neurofeedback is also one of the most well-studied alternative treatments for ADHD.  A German study published in the Journal of Child Psychology was able to address some limitations in previous research of neurofeedback and ADHD. The study authors discovered that children who received neurofeedback treatments had fewer inattentive and hyperactive-impulsive symptoms than those in the control group.

More recently, a paper published in the Journal of Neuropathy found evidence of neurofeedback as a “safe and efficacious treatment in the intervention for ADHD.” The paper reviewed over 40 studies that used various neurofeedback techniques for ADHD and compared to control groups, including placebo treatments and stimulant medications.  Most of the research evaluated attention span, impulse control, and hyperactivity symptoms.  According to the review, neurofeedback is most effective at treating poor attention span and impulse control issues.

Current research is evaluating the effectiveness of neurofeedback for related disorders like anxiety, autism, insomnia, and substance abuse. So far, the results seem promising.

So if your child is afflicted by predominantly inattentive ADHD, he or she might have a good chance of overcoming the symptoms with the help of neurofeedback. To find a neurofeedback provider in your area, visit eeginfo.com.

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Children who do not respond to stimulants for ADHD are sometimes given “off-label” prescriptions for other drugs to help them cope with the symptoms. “Off-label” use is when a drug is prescribed for a disorder other than what is approved by the Food and Drug Administration (FDA). This is a fairly common practice in Western psychiatry; for instance, until the ADHD drug Intuniv was approved by the FDA, some children were prescribed anti-hypertensive medications when stimulants failed them. Today we are going to talk about Abilify, an anti-psychotic drug approved to treat schizophrenia, bipolar disorder, depression, and irritability associated with autism. Abilify is sometimes used off-label for ADHD.

What is Abilify?

Abilify (generic name aripiprazole) was approved by the FDA in 2002 to treat symptoms of psychosis, including social withdrawal, blunted affect, inability to experience pleasure, and hallucinations in people with schizophrenia.  It is thought that these effects are due to Abilify’s complex effects on dopamine and serotonin receptors.  Essentially, Abilify is a “partial agonist” of dopamine receptors – it reduces excess dopamine activity, which is thought to cause delusions, hallucinations, and other symptoms of psychosis and schizophrenia.  It can also increase dopamine activities in areas where it is deficit, and balance out levels of serotonin on the brain.

How can Abilify treat ADHD?

The drug is thought to benefit children and adults with ADHD because of its positive effects on symptoms of bipolar disorder. These symptoms include impulsivity, irritability, and racing thoughts, which are also the hallmark symptoms of ADHD. However, researchers are still investigating Abilify as an ADHD treatment.  One study, which was completed in May 2009, concluded that “No significant treatment effect in ADHD symptoms was observed.”

What are the side effects of Abilify?

Like medications for ADHD, Abilify has side effects that may actually aggravate the symptoms of the disorder. The pharmaceutical website states that Abilify may cause akathisia (restlessness or the need to move), fatigue, constipation, or insomnia. Although Abilify is said to have a low rate of significant weight gain in adults, parents of children who took the drug reported excessive weight gain due to overeating. Although their ADHD symptoms did improve, parents eventually discontinued the use of medication for fear that the excessive eating caused by the drug will lead to serious health complications in the long run.

Severe side effects include an increased risk for neuroleptic malignant syndrome (NMS), a potentially fatal condition that is sometimes associated with the use of antipsychotic drugs like aripiprazole. Symptoms of NMS include irregular blood pressure, myoglobinuria (presence of myoglobin in the urine due to muscle destruction), excessive sweating, acute renal failure, and irregular heartbeat.

Another syndrome related to aripiprazole use is tardive dyskinesia. “Dyskinesia” is a condition characterized by involuntary, repetitive, and purposeless body movements, where as “tardive” means a “slow or belated onset.”  Movements associated with tardive dyskinesia include lip smacking, tongue protrusion, rapid eye blinking, and grimacing.  Anyone who develops tardive dyskinesia has a hard time staying still and not moving.  As if this is not bad enough, tardive dyskinesia is thought to be irreversible. The likelihood of developing this syndrome increases throughout the duration of the treatment and the total cumulative dose of the drug.

Since there are virtually no studies on the long-term effects of Abilify, the use of this drug as an off-label treatment might be too risky for children. Although Abilify is said to have fewer side effects than the average anti-psychotic medication, it may too dangerous to take this gamble, especially since children are more vulnerable to the neurological effects of medication.

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