ADD and Ritalin
Attention Deficit Disorder (ADD) is a problem that affects 5% to 10% of all
children. ADD affects more children than any other childhood problems except
asthma. It is estimated to be the largest single cause for first referrals to
child guidance clinics throughout the country, making up as many as 40% of
those cases. Many ADD cases are not diagnosed because the problem most often
does not show in the doctors office.
Current estimates suggest that approximately 50 to 65% of the children with ADD
will have symptoms of the disorder as adolescents and adults. Although ADD has
just recently been discovered and there is still relatively little known about
it. In 1902, George Frederick Still believed the dilemma of the problem child
was linked to a biological defect inherited from an injury at birth and not the
result of the environment. Through 1930-40's stimulant drugs were first used to
successfully treat many behavior problems due in part by Still's hypothesis. In
1960, Stella Chess researched in the field by writing about the
"hyperactive child syndrome." She took Still's hypothesis further
stating that the resulting behavior problems stem from a biological cause,
although it is linked to a genetic inheritance rather then a birth defect from an
injury. Finally, in 1980, the syndrome was named Attention Deficit Disorder,
due in large part to Virginia Douglas's work to find accurate ways to diagnose
it (Hallowell 2).
This is currently how it exists today, with the addition of a new category Attention
Deficit Hyperactivity Disorder and there sub types. Most scientists now believe
that an abnormality in brain chemistry could be to blame for the symptoms of
Attention Deficit Disorder. The frontal lobes of the brain are believed to be
responsible for the regulation of behavior and attention. They receive
information from the lower brain, which regulates arousal and screens incoming
messages from within and outside of the body. The limbic system, which is a
group of related nervous system structures, located in the midbrain and linked
to emotions and feelings then sends the messages to the frontal lobes. Finally,
the frontal lobes are suspected to be the site of working memory, the place
where information about the immediate environment is considered for memory
storage, planning, and future-directed behavior.
Scientist believe the activity in the frontal lobes is depressed in people with
ADD. Studies also show, a decrease in the ability of the Attention Deficit
Disorder brain to use glucose, the body's main source of energy, leading to
slower and less efficient activity. Neurotransmitters provide the connection
between one nerve cell and another. It is also now suspected that people with
Attention Deficit Disorder have a chemical imbalance of a class of
neurotransmitter called catecholamine. Dopamine, helps to form a pathway
between the motor center of the midbrain and the frontal lobes, as well as a
pathway between the limbic system and the frontal lobes. Without enough
dopamine and related catecholamine, such as serotonin and norepinephrine, the
frontal lobes are under stimulated and thus unable to perform their complex
functions efficiently.
Attention Deficit Disorder is primarily considered a genetic disorder. Which is
why it is labeled an axis two in the DSM-IV. Studies show that 20-30% of all
hyperactive children have at least one parent with ADD. However, not all cases
of ADD are genetically linked. Some studies show that smoking, drinking
alcohol, and using drugs during pregnancy, influenced a small percentage of ADD
cases. Exposure to toxins, such as lead, may also alter the brain chemistry and
function. Both of these issues are cause for concern for the at-risk
population.
ADD generally affects males more often than females, in a 3:1 ratio. Because
this disorder effects the brain detection of this condition is difficult. The
accepted test, although today there has been an increase in research into ADD
and subsequently now other tests. The test requires a nine-month observation of
the person, as well as EEGs, MRIs, or a PET scan. During the nine months, the
person has to show a certain number of the classic traits associated with the
disorder. The EEG is used to record the amount of electrical activity that is
happening in the brain. An MRI is an x-ray that shows the brain's anatomy
however it is not a routine assessment. More recently, the way to diagnose ADD
is the use of a PET scan, which measures the amount of activity in the brain.
There are two general categories for those diagnosed with Attention Deficit
Disorder. One is ADHD (Attention Deficit Hyperactivity Disorder); this is the
more prevalent of the two. A person with ADHD will show certain
characteristics. Characteristics like, fidgeting, squirming, difficulty
remaining seated, easily distracted, difficulty awaiting turn, interrupting,
difficulty following directions, sustaining attention, shifting from one
uncompleted task to another, not listening, following multiple directions, and
frequently engaging in dangerous actions. The general diagnosis of ADD, as
opposed to ADHD, has some, but not all of the above characteristics.
There are people who have been diagnosed with ADD whose characteristics are not
hyperactive but the complete opposite, they are under active. This goes against
the general notion that only kids who are hyperactive have ADD. These children
often daydream and are never mentally present anywhere. They constantly drift
off into their own world during classes or conversations. This type is more
prevalent in females with ADD then in males. The underlining issues with these
children are the inability to focus, they are too easily distracted. This form
of ADD is the hardest to diagnose since it seems that these people simply need
to "apply themselves more" or "get their act together."
Attention Deficit Disorder not only affects those afflicted in the classroom
but at home as well. The rest of the families’ daily routine may become a
distraction to those afflicted with ADD. Sometimes a television or radio that
is turned on in another room may become a distraction. What the ADD person
needs is a sound screen. A sound screen is some form of constant noise that
plays in the background, commonly a television or a radio. At first it may seem
like a distraction, but in reality, if the TV or music forms a kind of
"white noise" with an even level of intensity, which actually covers
up discrepant noises that can be a distraction. "The hum of a ceiling fan
or motor can do wonders to soothe and focus you" (Weiss.7).
Getting a family household to function smoothly is challenging for any family,
with or without the presence of ADD. Adults and children suffering from
Attention Deficit Disorder have trouble establishing and maintaining physical
order, coordinating schedules and activities, and accepting and meeting
responsibilities. Parents with children suffering with ADD have to learn how to
deal with the obstacles that they will have while raising their child. Since
ADD is genetically passed through to children the tendency is to have more then
just the child with ADD but the parents too. Not only does the child have a
problem with rules and schedules but also so does the parent.
Adults dealing with ADD often have chronic employment problems, impulsive
spending, and erratic bookkeeping and bill paying. Raising healthy,
well-adjusted children requires patience, sound judgment, good humor, and,
discipline which is difficult for a parent with ADD to do. The presence of ADD
often hinders the development of intimate relationships for a variety of reasons.
Although many adults with ADD enjoy successful, satisfying marriages, the
disorder almost always adds a certain amount of extra tension and pressure to
the union. The non-ADD spouse bears an additional burden of responsibility for
keeping the household running smoothly and meeting the needs of the children,
the spouse with ADD, and, if he or she has time, his or her own priorities.
Raising a child who has ADD can be an exhausting and, at times, frustrating
experience. Parents play a key role in managing the disability. They usually
need specialized training in behavior management and benefit greatly from
parent support groups. Parents often find that approaches to raising that work
well with children who do not have ADD, do not work as well with children who
have ADD. Parents often feel helpless, frustrated and exhausted. Especially if
the child's condition is unknown at the time. It could seem to the parent that
the child is just bad. Too often, family members become angry and withdraw from
each other. If untreated, the situation only worsens. Parent training can be
one of the most important and effective interventions for a child with ADD.
Effective training will teach parents how to apply strategies to manage their
child's behavior and improve their relationship with their child. Without
consistent structure and clearly defined expectations and limits, children with
ADD can become quite confused about the behaviors that are expected of them.
Making and keeping friends is a difficult task for children with ADD. A variety
of behavioral excesses and deficits common to these children get in the way of
friendships. They may talk too much, dominate activities, intrude in others'
games, or quit a game before it’s done. They may be unable to pay attention to
what another child is saying, not respond when someone else tries to initiate
and activity, or exhibit inappropriate behavior.
There is no cure for Attention Deficit Disorder. "Along with increasing
awareness of the problem, a better understanding of its causes and treatment
has developed” ( Wender 3). There is medication for ADD that will only
alleviate the symptoms. The medication will not permanently restore the
chemical imbalance. Approximately 70% of adults with ADD find that their
symptoms significantly improve after they take medication prescribed by their
doctors. The patient is able to concentrate on difficult and time-consuming
tasks, stop impulsive behavior, and time the restless twitches that have been
experienced in the past.
Some ADD patient's psychological and behavioral problems are not solved by
medication alone, and are required more therapy or training. Adult patients
have the burden of the past that often hinders their progress. The patient then
needs help with the relief of disappointment, frustration, and nagging sense of
self-doubt that often weighs upon the ADD patient. Some ADD patients suffer
from low-grade depression or anxiety, others with dependence on alcohol or
drugs, and most with low self-esteem and feelings of helplessness. There are
two types of drugs that work to balance the neurotransmitter and have been
found to be most effective in treating ADD, stimulants and antidepressants.
Stimulants work by increasing the amount of dopamine either produced in the
brain or used by the frontal lobes of the brain. Antidepressants also stimulate
brain activity in the frontal lobes, but they affect the production and use of
other chemicals, usually norepinephrine and serotonin. All the drugs used to
treat ADD have the same goal, to provide the brain with the raw materials it
needs to concentrate over a sustained period of time, control impulses, and
regulate motor activity. The drug or combination of drugs that work best for
the patient depends on the individual’s brain chemistry and constellation of
symptoms. The process of finding the right drug can be tricky for each
individual. The psychologists are not able to accurately predict how any one
individual will respond to various doses or types of Attention Deficit Disorder
medication. However, the drug of choice for Attention Deficit Disorder is
Ritalin. Ritalin (Methylphenidate) is a mild CNS stimulant. In medicine,
Ritalin’s primary use is treatment of Attention Deficit /Hyperactive Disorder
(ADHD). The reason why this drug works so well is not completely understood,
but Ritalin presumably activates the arousal system of the brain stem and the
cortex to produce its stimulant effect. According to the Drug Enforcement
Agency (DEA), prescriptions for Ritalin have increased more than 600% in the
past five years. Ritalin (Methylphenidate) is manufactured by CIBA-Geigy
Corporation. It is supplied in 5 mg., 10 mg., and 20 mg. tablets, and in a
sustained release form, Ritalin SR, in 20 mg. tablets. It is readily
water-soluble and is intended for oral use. It is a Schedule II Controlled
Substance under both the Federal and Vermont Controlled Substance Acts (Bailey
5). As stated before, ADHD is a condition most likely based in an inefficiency
and inadequacy of Dopamine and Norepinephrine hormone availability, typically
occurring when a person with ADHD tries to concentrate. Ritalin improves the
efficiency of the hormones Dopamine and Norepinephrine, increasing the
resources for memory, focus, concentration and attention (Clark 6). Ritalin exhibits
pharmacological activity similar to that of amphetamines. Ritalin’s exact
mechanism of action in the CNS is not fully understood, but the primary sites
of activity appear to be in the cerebral cortex and the subcortical structures
including the thalamus. Ritalin blocks the re-uptake mechanism present in
dopaminergic neurons. As a result, sympathomimetic activity in the central
nervous system and in the peripheral nervous system increases. Ritalin-induced
CNS stimulation produces a decreased sense of fatigue, an increase in motor
activity and mental alertness, mild euphoria, and brighter spirits. In the PNS,
the actions of Ritalin are minimal at therapeutic doses (Clark 2). Ritalin is
the quickest of all oral ADHD stimulant medications in onset of action: it
starts to achieve benefit in 20 - 30 minutes after administration, and is most
effective during the upward ‘slope' and peak serum levels. Ritalin’s effect is
brief: Most people experience 2-3 hours of benefit, but after 3 hours, benefits
drop off rapidly. Some individuals, especially children, may obtain 4 or even 5
hours of positive effect (Clark 1). Attention Deficit Disorder is very
prevalent throughout this country and the world. There is no cure. Those
afflicted with the disorder must learn to compensate for it and live regardless
of its affects. There are drugs and therapy available for those with this
disorder to help them maintain their life. It is very frustrating to live with
ADD or ADHD and even harder to live with it and not know it. Since ADD's
detection is difficult, often the symptoms are likened to some other cause in
an effort to explain the behaviors. This has lead to many misdiagnoses.
However, new studies on ADD and ADHD are in the works and with the Human Genome
Project's completion in 2003 there is hope more light will be shed on this
disorder.
Bibliography
Bibliography Baliey, W.J. Attention Deficit Disorder. 9 May 1997. Online
Internet. 10 November 2000. http://www.execpc.com/~calliope/ Clark, C.G.
Children Who Can’t Pay Attention. 5 October 1998. Online Internet. 10 November
2000. http://www.aacap.org/publications/factsfam/noattent.htm Hallahan, Daniel
& Kuaffman, James. Exceptional Child. 1999. Online Internet. 10 November
2000. http://borntoexplore.org/ Hallowell, Edward M. & Ratley, John J.
Driven to Distraction. 13 April 1997. Online Internet. 10 November 2000.
http://www.livingwithadd.com/ Wender, Pual H. M.D. The Hyperactive Child,
Adolescent, and Adult. 15 November 1998. Online Interent. 10 November 2000.
http://www.attn-deficit-disorder.com/ Weiss, Lynn M.D. Attention Deficit
Disorder in Adults. 4 January 1999. Online Interent. 10 November 2000.
http://www.mentalhealth.com/dis/p20-ch01.html