Understanding ADHD

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Understanding ADHD

• Stevan Cordas DO MPH

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History

• 1960 minimal brain dysfunction.
• 1968 Hyperkinetic reaction of childhood.
• 1980 attention deficit disorder with or without
  hyperactivity.
• 1987 ADHD.
• 1994, 2001 ADHD with three subtypes.

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Some Tests for ADHD

• At least 6 symptoms of inattentiveness or 6
  symptoms of hyperactivity lasting at least 6
  months and starting before age 7. DSM iv
• Conners adult ADHD rating scale
• Wender Utah rating scale
• Adult symptom inventory

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What Is ADHD

• It is a developmental disorder.
• It has a genetic basis.
• It is characterized by hyperactivity,
  inattention, and impulsivity.
• Frontal portion of brain is often smaller than
  normal. This area acts by inhibiting this
  behavior through neurohormones.

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Incidence

• 5 (one out of twenty) children.
• 30 to 70 of these cases persist into adulthood.
  Often have ADHD children.
• Most common psychiatric disorder of childhood.
• Often misdiagnosed as an anxiety disorder, manic
  state, or personality disorder.

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Hyperactivity

• An aimless restlessness.
• Talks incessantly.
• Always on the go.
• Fidgets.
• Cant cant play quietly.
• Often lessens in the adult.

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Inattentiveness

• Not a global inability to focus per se, but
  rather the inability to sustain, shift, and
  establish attention to particular tasks the
  individual finds boring but are nonetheless
  essential to functioning.
• Attention deficits often worsen in the adult ADHD.

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Impulsiveness

• Inability to determine when and how actions
  should be expressed and sequenced, and continued
  environmental dependency where circumstances
  control action, rather than the other way around.
  Poor time management

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Comorbidities Childhood ADHD

• Conduct and education performance problems.
• Comorbidities common. Oppositional-defiant
  behavior (40) and disruptive conduct or
  behavioral disorders (20).
• Antisocial behavior, if present continues into
  adulthood.

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Adolescent ADHD

• What appeared as hyperactivity in the younger
  child emerges as restlessness in the adolescent.
  Poor organizational skills make high school and
  college years difficult for the adolescent and
  young adult with ADHD.

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Adolescent ADHD

• Impairment follows and manifests as lower grades,
  more school suspensions, and higher college
  drop-out rates. Furthermore, higher rates of
  illegal substance and alcohol use in adults with
  ADHD appear to have their beginnings in the
  adolescent years.

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Adult ADHD

• Has been validated in recent years.
• Decrease in prefrontal lobe, the basal ganglia
  and frontal cortical thalamic striatal pathway.
• A dopamine transporter gene and two receptor
  genes D4 and D2 are correlated with ADHD.

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Adult ADHD

• Feels overwhelmed.
• Inner restlessness.
• Talks incessantly.
• Changes jobs impulsively.
• Irritable quick to anger.
• Doesnt enjoy being quiet.
• Easily distracted.

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Comorbidities in the Adult With ADHD

• 75 of adults have at least one comorbidity.
• 40 smoke.
• 3 fold alcohol use.
• 4 fold marihuana and cocaine use.

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Treatment

• Methphenidate Ritalin, Concentra.
• Dextroamphetamine Dexadrine.
• Mixed amphetamines Adderall XR.
• Selective norepinephrine reuptake inhibitor
  Atomoxitine (Strattera) first nonstimulant
  approved by the FDA not schedule II.

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Treatment

• Drugs help about 70.
• They use Wellbutrin or other antidepressants in
  more resistant cases.
• New Hinz method is our preferred method.
• Often baseline neurotransmitter urine tests show
  major catecholamine hyperexcretion.

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Treatment Hinz Method

• Rule out lead poisoning, parasites, learning
  disorders, Aspergers syndrome and confirm
  diagnosis of ADHD.
• Start special patented amino acid blend for
  children 1A, or Neuroreplete plus Cystreplete
  (special cysteine blend) and a copper free
  vitamin. Gradually build up the amino acid levels
  to rebuild the catechols.

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Hinz Method

• A stepwise method of adding neurotransmitter
  precursors. These are amino acids (5 - hydroxy
  tryptophan and tyrosine with essential cofactors
  in aggressive doses.
• This method is checked by measuring Serotonin,
  epinephrine, dopamine and norepinephrine levels
  in the urine.

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Treatment Hinz Method

• This method also rebuilds the Serotonin system at
  the same time.
• This method rebuilds the methylation products
  such as glutathione and same as well as 41 other
  enzymes simultaneously.
• With this method it is important to wean off
  psychotropic drugs.
• Psychological counseling may be required when
  indicated.

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Allergies and ADHD

• Not a higher amount of allergies in this
  population that in controls (25).
• Some evidence that certain additives influence
  nerve conduction.
• Sensitive children and adults are often worse
  after ingesting certain foods.
• Some foods can create sensitization without being
  allergic LEAP test .

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Summary

• ADHD is common.
• Found in adults as well as children.
• New medical as well as natural treatments are
  available.
• Treatments will reduce substance abuse, divorce
  rates, college drop out rates.