Attention deficit hyperactivity disorder

May 9, 2012
Dr. A. Ghadi, Instructor
Lebanese international university
Beirut, Lebanon

Dear Dr. Ghadi:

We worked on this project, which is a problem we are facing a lot nowadays
in several countries all around the world. The issue of ADHD is very
dangerous since most parents and teachers do not tend to pay attention that
when kids have some problems it can be that serious.
This report shows the disadvantages of the treatments given to children with
ADHD, with the addition of our recommendation to parents and patients to
be aware of this issue.
We hope you find our report interesting and useful for you and most readers.
If you have any questions or would like us to discuss our recommendations,
we would be more than happy to respond.

Sincerely yours,
Nour N
Rouda F

Attention deficit hyperactivity disorder

2

Attention deficit hyperactivity

disorder

Draft one

Nour N (biochemistry)
Rouda F (pharmacy)

May 9, 2012

Attention deficit hyperactivity disorder

Prepared for

Dr. Ghadi

Table of contents

LIST

OF

ILLUSTRATIONS. 3
ABSTRACT.....
3
INTRODUCTION..
4
Background.
.4
Subtypes
. 4

of

ADHD..

Understanding
problem5

the

Causes
ADHD..7

of

Problem.
8
Purpose.
8
Scope
8
DISCUSSION..9

Attention deficit hyperactivity disorder

Medications
ADHD.9

for

Side
effects
stimulants..10

of

Behavioral
treatment... 11
CONCLUSION
12
RECOMMENDATIONS
13
REFERENCES
14

List of illustrations

Figure 1: percentage of students diagnosed with ADHD in 2007-2008 .. 6

Figure
2:
percentage
of
girls
LD.. 7

and

boys

having

ADHD

and

Figure 3: Common side effects of stimulants for ADD & ADHD... 11

Figure 3: restriction to take ADD / ADHD stimulants 11
Figure
4:
effects
of
drugs. 14

ADHD

Attention deficit hyperactivity disorder

5

Abstract
This report opens with some cases of children who suffer from ADHD of
different symptoms. Then we will highlight about some statistics
concerning this diseases and its coloration with LD. After that, we will
discuss briefly the different kinds or sub types of this disorder.
Additionally, we will discuss the type of drugs used to treat this kind of
disorder and their various harmful side effects on the kids. As for the
conclusion, we will end with some recommendations that advice parents
with ADHD children should be enlightened about the symptoms of this
disorder and be able to recognize this disorder. And that once they
suspect their child having any of the symptoms you should see a
specialized doctor. Also, never hesitate to see several doctors, and to try a
combination of treatments psychological and medical.
.

Introduction

Background
Imagine living in a fast-moving kaleidoscope, where sounds, images, and
thoughts are constantly shifting. Feeling easily bored, yet you cant finish any
task you start. Distracted by unimportant sights and sounds, your mind
drives you from one thought or activity to another. Maybe you are so

Attention deficit hyperactivity disorder

wrapped up in a world of thoughts and images that you cant notice if
6
someone speaks to you. This is how a patient of ADHD feels every day.
Attention deficit hyperactivity disorder is a very serious disease that attacks
children. It affects 3 to 5 percent of all children, perhaps as many as 2 million
American children. Two to three times more boys than girls are affected. On
the average, at least one child in every classroom in the United States needs
help for the disorder. ADHD can continue through adolescence and adulthood. Symptoms
of this disorder include difficulty staying focused and paying attention, difficulty controlling
behavior, and hyperactivity (over-activity).
ADHD has three common subtypes:

Predominantly hyperactive-impulsive
o Several symptoms (6 or more) are the hyperactivity-impulsivity categories.
o Less than 6 symptoms of inattention are present, however inattention may still be
present to a certain degree.

Predominantly inattentive
o Children with this subtype have difficulties getting along with children. They may
sit quietly, but they are not paying attention to what they are doing. Thus, the
child may be overlooked, and parents and teachers may not notice that he or she
has ADHD.

Combined hyperactive-impulsive and inattentive

o Most children have the combined type of ADHD.

Attention deficit hyperactivity disorder

UNDERSTANDING THE PROBLEM
7
Mark:

Mark, age 14, has more energy than most boys his age. But then, he's
always been overly active. Starting at age 3, he was a human tornado,
dashing around and disrupting everything in his path. At home, he darted
from one activity to the next, leaving a trail of toys behind him. At meals, he
upset dishes and chattered nonstop. He was reckless and impulsive, running
into the street with oncoming cars; no matter how many times his mother
explained the danger or scolded him. On the playground, he seemed no
wilder than the other kids. But his tendency to overreact--like socking
playmates simply for bumping into him--had already gotten him into trouble
several times. His parents didn't know what to do. Mark's doting
grandparents reassured them, "Boys will be boys. Don't worry; he'll grow out
of it." But he didn't.
Lisa:

At age 17, Lisa still struggles to pay attention and act appropriately. But this
has always been hard for her. She still gets embarrassed thinking about that
night her parents took her to a restaurant to celebrate her 10th birthday. She
had gotten so distracted by the waitress' bright red hair that her father called
her name three times before she remembered to order. Then before she
could stop herself, she blurted, "Your hair dye looks awful!"
In elementary and junior high school, Lisa was quiet and cooperative but
often seemed to be daydreaming. She was smart, yet couldn't improve her
grades no matter how hard she tried. Several times, she failed exams. Even
though she knew most of the answers, she couldn't keep her mind on the
test. Her parents responded to her low grades by taking away privileges and
scolding, "You're just lazy. You could get better grades if you only tried." One
day, after Lisa had failed yet another exam, the teacher found her sobbing,
"What's wrong with me?"
Henry:

Attention deficit hyperactivity disorder

Although he loves puttering around in his shop, for years Henry has had
8
dozens of unfinished carpentry projects and ideas for new ones he knew he
would never complete. His garage was piled so high with wood, he and his
wife joked about holding a fire sale.
Every
day Henry faced the real frustration of not being able to concentrate long
enough to complete a task. He was fired from his job as stock clerk because
he lost inventory and carelessly filled out forms. Over the years, afraid that
he might be losing his mind, he had seen psychotherapists and tried several
medications, but none ever helped him concentrate. He saw the same lack of
focus in his young son and worried.

Parents and teachers can miss the fact that kids with symptoms of inattention have ADHD since
they are mostly quiet and dont act out. They may quietly, seem to be playing, but they are often
not paying attention to what they are doing. They may get along with others better than those
who have social problems. But children with the inattentive kind of ADHD are not the only ones
whose disorders can be missed. For example, adults may think that children with the hyperactive
and impulsive subtypes just have emotional or disciplinary problems.
It has been shown that Boys (13.2%) were more likely than girls (5.6%) to have ever been
diagnosed with ADHD. And that the rates of ADHD diagnosis increased at a greater rate among
older teens as compared to younger children.

Attention deficit hyperactivity disorder

9

As

of

of 2.7
youth
years
(66.3%
of those
with
a
current

2007,
parents
million
ages
4-17

diagnosis) report
that their child was receiving medication treatment for the disorder. (figure
1)

Also About 5% of children had ADHD without Learning Disability (LD), 5% had
LD without ADHD, and 4% had both conditions. ( figure 2)

Attention deficit hyperactivity disorder

10

Scientists are not sure what causes ADHD. Studies suggest that genes play a large role like many
other illnesses; it probably results from a combination of factors. But on the other hand there are
other factors that may lead to the cause of this disorder.
Genes inherited from our parents, determine who we are. Results from international studies of
twins show that ADHD often runs in families as a hereditary disease. Researchers are looking at
different genes that may make people more likely to develop the disorder. These studies if are
successful, will make us able to detect this disorder and prevent it from developing into a serious
disease that affects the lives of the children and people around them.
Some children with ADHD have thinner brain tissue in the attention related areas of their brains.
As children with this gene grow up, the brain develops to a normal level of thickness. Their
ADHD symptoms also improve.
i.

Environmental factors: Studies suggest a potential link between smoking and alcohol
use during pregnancy and the development of ADHD in children. Moreover, kids who are
exposed to lead in large rates may have a higher risk of developing ADHD.

ii.

Brain injuries: Some children, who had brain injuries, may have some attention
problems and some other ADHD symptoms but only a little percentage of these children
actually develops ADHD disorder.

iii.

Sugar: Studies shows that children who are exposed to high amounts of sugars above the
average are in risk of ADHD, also having sugar substitutes has such as much risk.

Attention deficit hyperactivity disorder

iv.

11

Food additives: Consumption of certain food additives like artificial colors or

preservatives, increase the activity of children which can lead to ADHD over time.

Treatments can relieve many of the symptoms, but it is incurable. With treatment, most people
with ADHD can be successful in school and have productive lives but medications and drugs that
are used to treat ADHD have severe and dangerous consequences. Researchers are developing
more effective treatments and interventions, and using new tools such as brain imaging, to
understand ADHD and find effective ways to treat and prevent it.
Problem
Medications and drugs are used to treat the symptoms of ADHD (hyperactivity,
inattentiveness, and impulsivity) by giving very high and several doses of drugs for
those children. However these medications have many side effects on children, and are not
always effective. These medications are a short term treatment for some of the symptoms caused
by ADHD, however many cases hold this disorder with them along their teenage years and even
adulthood. Medication wont be helpful after a certain period of time leaving this person more
disturb but what they have.
Purpose
The purpose of this report is to show that ADHD can be treated without the usage of drugs. Just
depending on some therapies and a specific life style those children could be treated without the
massive side effects of the drugs usually used.
Scope
This report explores some statistics about the number of patients having ADHD, and also
discusses all the subtypes of this disease and the various ways to cure them. Most importantly it
emphasizes on a treatment free of drugs, since it's much healthier for the kids.

Discussion

Attention deficit hyperactivity disorder

On the other hand, things dont have to be this way. There are other ways to help these patients.
12
Evidence
shown that behavioral therapy, having a healthy diet, exercising and sleeping well,
along with making other smart lifestyle choices can help you or your child effectively manage
the symptoms of ADHD. Whether youre the parent or the patient, its important to learn the
facts about medication for ADHD so you can make an informed decision about whats best for
you or your child.
The very first step in choosing the best medications for you, is actually acknowledging what
these medication can and cant do. What symptoms are they able to treat and which they cant
treat? What side effect does it have on the patient whether psychological or physical or
emotional?
Even though patients respond to medications and start improving, that doesnt mean they are
magical and they can solve everything. On the contrary, these patients still struggles a lot.
Forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization,
distractibility, and relationship difficulties will always be there. Thats why its so important to
also make lifestyle changes that include regular exercise, a healthy diet, and sufficient sleep.
In addition, medications are for life, since once they are stopped all the symptoms will be
attacking the patient again. Also it is very important to know the selectivity of medications since
not all patients respond similarly to the drugs; some may have dramatic improvements while
others may not experience any improvement at all. So it is essential to always be updated with a
specialized doctor to maintain the best life style that can be provided.
The other treatments for ADHD are the stimulants. They are most common treatments and have
the longest track record and they have a lot of researchers and results to back up. The stimulant
class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.
Stimulants work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter
associated with motivation, pleasure, attention, and movement. For ADHD patients, stimulant
medications boost concentration and focus while reducing hyperactive and impulsive behaviors.
The long-acting versions of ADHD medication are often preferred, since people with ADHD
who have no one to watch for them often have trouble remembering to take their pills. Taking
just one dose a day is much easier and more convenient.

Common side effects of stimulants for ADD & ADHD:

Attention deficit hyperactivity disorder

13

Feeling restless and jittery

Difficulty sleeping
Loss of appetite
Headaches
Upset stomach

Irritability, mood swings

Depression
Dizziness
Racing heartbeat
Tics

Figure 3: Common side effects of stimulants for ADD & ADHD

Other side effects:
i.

Effect on the developing brain: Some researchers are concerned that the use of drugs
such as Ritalin in children and teens might interfere with normal brain development.

ii.

Heart-related problems: ADHD stimulant medications have been found to cause sudden
death in children and adults with heart conditions. The American Heart Association
recommends that all individuals, including children, have a cardiac evaluation prior to
starting a stimulant.

iii.

Psychiatric problems: Stimulants for ADHD can trigger or exacerbate symptoms of

hostility, aggression, anxiety, depression, and paranoia. People with a personal or family
history of suicide, depression, or bipolar disorder are at a particularly high risk, and
should be carefully monitored when taking stimulants.

iv.

Potential for abuse: Stimulant abuse is a growing problem, particularly among teens and
young adults. College students take them for a boost when cramming for exams or
pulling all-nighters. Others abuse stimulant meds for their weight-loss properties. If your
child is taking stimulants, make sure he or she isnt sharing the pills or selling them.

ADD / ADHD stimulants are not recommended for those with:

Any type of heart defect or diseases

Glaucoma

High blood pressure

High levels of anxiety

Hyperthyroidism
A history of drug abuse
Figure 3: restriction to take ADD / ADHD stimulants.

Attention deficit hyperactivity disorder

Another type of medications which is not stimulating is Strattera, typical
14
antidepressants, and certain blood pressure medications. In most cases, nonstimulant medications are considered when stimulants havent worked or
have caused intolerable side effects. Strattera, also known by its generic
name atomoxetine, is the only non-stimulant medication approved by the
FDA. Unlike stimulants, Strattera boosts the levels of norepinephrine, a
different brain chemical. Strattera is longer-acting than the stimulant
drugs .Since it has some antidepressant properties, its also a top choice for
those with co-existing anxiety or depression. Another plus is that it doesnt
exacerbate tics or Tourettes syndrome. Unfortunately, Strattera doesnt
appear to be as effective as the stimulant medications for treating symptoms
of hyperactivity.
Recently, after lots of research it has been concluded that the best way to
treat ADHD is combination of treatments like for example medications and
therapy along with providing the best life styles and healthy environment.
Dr. William Pelham, an expert in behavioral treatments for children with
ADHD, describes five categories of behavioral treatment:
A. cognitive-behavioral interventions
B. clinical behavior therapy
C. direct contingency management
D. intensive, packaged behavioral treatments
E. combined behavioral and pharmacological treatments

Attention deficit hyperactivity disorder

The main aim of this study is to help patients by teaching self-control
15
through verbal self-instructions, problem-solving strategies, cognitive
Effects on Social Behavior

reduced off-task behavior in classroom

decreased anger, better self-control
improved participation in organized sports (i.e., baseball)
reduced bossy behavior with peers
reduced verbal and physical aggression with peers
reduced non-compliant, defiant and oppositional behavior
modeling, self-monitoring, self-evaluation, self-reinforcement and other
strategies.

Figure 4: effects of ADHD drugs.

Cognitive Effects
reduced distractibility
decreased impulsivity

Attention deficit hyperactivity disorder

16

increased work production

increased accuracy of work

Conclusion
As a conclusion, medications are not always the best way to treat ADHD all
drugs and treatments are never free of side effects. Thats why the best way
to treat this disorder is to combine therapy with medications and best life
styles.
This issue is very common and wide known; the number of children affected
with this disorder is increasing more and more, especially knowing that this
disease is heredity related. These children deserve having normal and
peaceful lives. Knowing that these kids already suffer from insecurities and
they are secluded from their social lives.

Recommendations

Attention deficit hyperactivity disorder

1. Parents with ADHD children should be enlightened about the symptoms

17

of this disorder and be able to recognize this disorder.

2. Once you suspect your child having any of the symptoms you should
see a specialized doctor.
3. Once your kid is diagnosed with ADHD you should think rationally and
chose the best medications.
4. Dont hesitate to see several doctors and try a combination of
treatments psychological and medical.
5. Try to reduce all the risks that may lead to development of ADHD.
6. Spend more time with your kid to notice any abnormal actions.

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Attention deficit hyperactivity disorder

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