Monday, 10. May 2010 22:48
Here is the article that one of the group members talked about last meeting that was in the Oregonian.
Putting the attention on attention deficit hyperactivity disorder
By Andy Dworkin, The Oregonian
March 31, 2010, 4:21AM
Faith Cathcart/The OregonianTen-year-old Charles Salber (center) plays with friends Matthew Brown (right) and Michael Brown. Charles has attention deficit disorder, a common but often misunderstood childhood condition that can make it hard to keep friends. Finding the right medicine for Charles made a big difference, said his mother, Laura Kozell: “He’s a very sweet and gentle soul, and you could see that personality come out.”Amid the public attention to attention deficit hyperactivity disorder — including worries that kids are overmedicated with amphetamines — a few facts about the condition get ignored.
While drugs can often treat ADHD, there is no cure. Attention deficit disorder is probably not one disorder, but a spectrum of problems, like autism. And ADHD doesn’t really involve an inability to pay attention, at least not in the way many people define the word.
“There’s different kinds of attention, but the only kind that’s not working in these kids is alertness,” said Joel Nigg, director of the Division of Psychology at Oregon Health & Science University.
Psychologists call the ability to filter out extraneous information — like background chatter at a cocktail party — selection. Another facet of attention, orienting, is the ability to focus on something to the side, like cars in nearby lanes on a freeway. These abilities are usually normal in kids with ADHD, Nigg said.
Alertness is the ability to concentrate on something unexpected, like a driver in the next lane swerving. If a driver is sleepy, they’re less alert and less able to process and respond to the unexpected.
“That’s ADHD all over,” Nigg said. “They’re half a second slower.”
That can make people with the condition seem like they focus on too many things, Nigg said. It can also lead to a host of social and school problems.
Laura Kozell said her 10-year-old son, Charles, seemed perfectly normal as a toddler, touching everything and squirming about. But when he got into kindergarten, his teachers noted that Charles was not growing out of those behaviors. He had problems processing a lot of sensory input, needed to get up and move around a lot and “wasn’t always aware of where his body was,” his mom said — one teacher had to point out to Charles that he was lying splayed on the floor. Sometimes, the inability to deal with sensory inputs or stay still would frustrate Charles, and he would act out in ways that annoy others.
“You can tell him, ‘No, don’t do that,’ and it’s like he just can’t help himself,” Kozell said.
While many kids with ADHD behave like Charles, some do not. Nigg said ADHD is a spectrum of disorders, with some kids mostly impulsive, some mostly inattentive and some mixing both behaviors.
“It’s not one size fits all,” Nigg said. “That’s the main message I give physicians and teachers.”
The condition’s severity also varies a lot. Some people worry that ADHD is overdiagnosed and kids get medicated for normal but rambunctious behavior. But that concern touches the mildest end of the spectrum. Most cases of ADHD are clear problems. In fact, the diagnosis requires that symptoms cause “significant distress or impairment” in school, work or social life.
“The real McCoy is a serious problem,” Nigg said. “The child can’t function. Family life is ruined. The child’s social life is ruined.”
When kids with ADHD grow up, the condition can still cause problems. The disease itself doesn’t necessarily shorten life. But people with ADHD are generally more likely to have car accidents, abuse drugs and have problems finishing school or keeping jobs, according to the National Institutes of Health.
Nigg and other scientists are still trying to figure out the cause of the condition, which may affect 1 in 20 grade-schoolers, more commonly boys. Genetics clearly plays a role, since ADHD can run in families; Kozell said her husband and two brothers have the condition. Studies find parents with certain other conditions, including bipolar disorder, are also more likely to have children with ADHD. The genetic link doesn’t mean the disease is a parent’s fault, Nigg stressed.
“Parents don’t cause it. I think that guilt and fear is a big one,” he said.
Environmental factors also seem to affect ADHD. Some studies suggest moms who drink or smoke while pregnant may be more likely to have kids with ADHD. And Nigg has found evidence linking ADHD to exposure to lead, even at fairly low levels.
“I would never say lead is the cause of ADHD, or even necessarily the most important,” he said. But he’s continuing to study that idea and working on studying images of the brains of ADHD patients, hoping the evidence will point to certain regions of the brain whose size or structure are different in ADHD patients.
One substance that offers clues to the origins of ADHD is amphetamines, a class of drugs used to treat the condition for decades. The stimulants help many ADHD patients rein in impulses and focus on one task. Studies involving stimulants indicate that brain chemicals, including dopamine, and brain regions that influence memory, complex thought and other abilities help cause ADHD.
While stimulants seem to be the most effective treatment for ADHD, they are not a cure, Nigg said. If users stop taking them, their ADHD symptoms return. Other drugs and behavioral treatments also help some ADHD patients, though the behavioral work generally takes a lot of time and commitment, he said.
Kozell said it took years to find the right kind and dose of medicine for Charles. He now takes a long-lasting amphetamine called Vyvanse that has helped him behave less impulsively, she said.
“He’s a very sweet and gentle soul, and you could see that personality come out.”
Kozell said it’s important to tell teachers about your child’s diagnosis, so they know what to look for and can help the child succeed. Her son’s teachers will let him get up and move around in class, when he needs to, perhaps helping hand out papers or sharpen pencils. In the past, Charles also took part in morning “friendship groups” before school, Kozell said, where students who needed the activity would spend 10 or 15 minutes before school playing and moving around.
The family has also adapted to help Charles, giving him a firm schedule, even on weekends and holidays.
“One of the most important things for people with ADHD is that they have a schedule, so they know what’s expected of them and when,” she said.
The Kozells’ experience of taking years to find the right treatments isn’t unusual, Nigg said. Often, family doctors diagnose ADHD, and some kids do well with that diagnosis and the first prescription they get. But since ADHD is a range of conditions and sometimes overlaps with other problems, it can be hard to get the diagnosis or treatment just right in one visit.
“You should be spending several hours (with a doctor) figuring out what kind of ADHD you have,” he said.
Insurance policies often won’t pay for that intensive work, he acknowledged. But if your child seems developmentally “stuck,” not improving with a given treatment or diagnosis, Nigg said it is good to seek further help from a psychologist or psychiatrist.
With good treatment, many ADHD people learn to function well and lead perfectly healthy lives. But up to a fifth will still have ADHD as adults, and two-thirds may have some ADHD symptoms they have to cope with for the rest of their lives.
Given the persistence of ADHD, Kozell said, it’s important to remind people that there are good things about it. She said Charles “can hyper-focus on things that are interesting to him,” for instance, and has a lot of energy, which the family has channeled into gymnastics classes.
“I try to keep in mind the positive aspects of it, because this is not something that’s going to be cured,” Kozell said. “This is the way his brain has developed.”
– Andy Dworkin
Pasted from <http://www.oregonlive.com/health/index.ssf/2010/03/putting_the_attention_on_atten.html>