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Herbal medicine is one of many natural treatment options used for treating a range of conditions, including Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD). This is part of a growing trend as people look for natural alternatives to medication with fewer side effects.

ADD is a behavioural disorder, though to be caused by a chemical imbalance in the brain. Sufferers struggle to deal with an excess of visual or auditory stimulation, and often leads to a range of learning difficulties.

ADD is predominantly observed in children, but some patients are also liable to suffer the condition into adulthood. Recent research has demonstrated that some people have one element of the condition - either hyperactivity or attention deficit - whilst others have both elements. ADD has traditionally been treated with medication, including drugs like Ritalin; which controversially has been linked with insomnia and a lack of creativity in patients. Modern treatment typically utilises medication in conjunction with other approaches, including alterations to diet and exercise.

What is Herbal Medicine?

Herbal medicine is an ancient tradition of healing using plants or elements of plants; including the flowers, stems, leaves and roots. These are typically used fresh, preserved or in the form of a remedy to heal a wide range of conditions. Some of the most well known proponents of herbal medicine are Traditional Chinese Medicine (TCM) practitioners, as well as the Ayurvedic healing tradition of India.

How Can Herbal Medicine Help ADD?

Herbal remedies are commonly used for ADD due to their sedative or anxiolytic properties as well as their role in enhancing memory and cognition. Consultation with an herbalist will typically involve a holistic assessment of the patient, including information on their medical history and any medication currently being taken. Traditional herbal treatments for ADD that may be prescribed by a herbalist include:

Ginkgo biloba: valued for its ability to promote enhanced blood flow in the brain, and its promising effects on adult cognition, concentration, and memory, making it useful for treating ADD.

Kava: thought to have anxiolytic, sedative, and muscle relaxant properties without adverse effects on cognitive function or mental acuity. Trials have suggested that kava is helpful for managing anxiety and tension.

Valerian: and

Adequate levels of Vitamin D are also thought to be beneficial for ADD sufferers, which essentially involves ensuring one receives sufficient exposure to the sun.

Find out about other effecitve natural ADD treatments .

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herbal medicine and attention deficit disorder (add)

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article: Herbal Medicine and Attention Deficit Disorder (ADD)

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Herbal Medicine is one of many natural treatment options used for treating a range of conditions, including Attention Deficit Disorder (ADD)

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New research into ADHD is changing our understanding of how it affects people and, most tellingly, whom it affects. JOHN McCRONE reports.

People think and operate in wildly different ways. But some live just a few extra steps beyond normal. For them life is a continual struggle with being out of synch with others. New research indicates that the sluggish, passive and disorganised fall under the same ADHD umbrella as the classic hyperactive types.

Day-dreamy, inattentive, unmotivated, disorganised? You could have sluggish cognitive tempo disorder (SCT). It is not that you are simply slack and lazy. It is a problem with your brain. A problem with which you were born. And just to confuse you, it is a newly recognised variant of hyperactivity, or attention deficit hyperactivity disorder (ADHD).

The excellent news is that psychiatrists are considering adding SCT to the next update of the bible of their trade, the Diagnostic Statistical Manual Revised. So how long before the drugs companies can legitimately peddle amphetamines to give sluggard minds everywhere a healthy kickstart?

Too slow, too fast. Well, what is normal anyway? What decides whether these brain differences are a defect of an individual, a condition to be treated medically, or of the societies within which they are supposed to fit? A big question has been growing bigger because, as SCT shows, the definition of ADHD has been spreading. Hyperactivity was once thought to be a condition affecting only young boys. The “busy” eight to 12 year olds who could not control themselves and were liable to do stupid things such as act up in class or jump off the garage roof.

The worst cases could be calmed using the stimulant drug, methylphenidate - better known by its tradenames such as Ritalin, Rubifen and Concerta. Or put them on a special diet, take them off fizzy drinks and additives, said some. It was a phase, so give them time and they would grow out of it.

However, over the past decade there has been another revolution in the research, say psychologists such as Canterbury University associate professor Julia Rucklidge. It has been proven that girls may be equally prone to ADHD, though it shows up somewhat differently in them than as straight-out hyper behaviour.

Even more surprisingly - although perhaps not if you felt it was a fact about a person’s brain-processing style - in two- thirds of cases ADHD is a condition that does not just disappear with age. All that happens is the ADHD becomes encrusted with other issues, the life problems it causes such as substance abuse, anxiety, and relationship break-ups, so that clinicians find it harder to recognise the underlying complaint.

So what is society to do if there is more ADHD about? Dish out strong pills to grown-ups too?

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Rosemary Murphy overviews the various treatments for ADHD, including medication, drug free options, and diet.

MEDICAL HELP : PROS AND CONS
Medication: Ritalin
Once your child has gone through a full assessment process with a paediatrician, and has received a formal diagnosis it is most likely that a trial of Ritalin, Concerta or other stimulant medication will be offered. In simple terms, these drugs appear to improve the effectiveness of dopamine which is one of the main neuro transmitters in the brain and is related to feelings of reward and happiness. Ritalin appears to increase the flow of information to the attention centres of the brain, stimulating attention.

If your child's symptoms are severe you will most likely see a dramatic improvement in school performance once they have adapted to the medication and are on the correct dosage.

Side effects
However there will also be side effects from this medication which will need to be taken into account. These may include loss of appetite, difficulty going to sleep at night, jitteriness, lethargy and inactivity. A rebound effect immediately after the daily dose has worn off often occurs, when the child's symptoms are even more severe than usual for a brief period of time. Most children also do not take the medication after school or on the weekends, so that symptoms experienced at home remain the same.

The long term effects of these stimulant drugs on the brain are also not known.

There has been some media commentary in recent years about ADHD being over- diagnosed in the USA, and also regarding possible over- use of Ritalin and similar stimulant medicines to control the behaviour of these children. Many parents are now seeking alternative ways to help their children without resorting to drug therapy.

DRUG FREE OPTIONS

There are several other options open to parents which are drug free and well worth exploring. There is also exciting work being done in many parts of the world by a number of professionals to pinpoint the underlying causes of ADHD and similar disorders. The following suggestions have arisen out of this research and address underlying causes, rather than just suppressing the symptoms with drug therapy.

DEVELOPMENTAL DELAY SYNDROME

Dr Robin Pauc, neurologist and author of "Is That my Child?", states that most learning difficulties including ADHD are caused by an underlying developmental delay which occurs at four months of life. At this stage a second -wave of nerve cell generation should occur, where spindle cells form in the pre frontal cortex, the front of the brain.

Dr Pauc states that the pre frontal cortex is implicated in the guiding of attention, memory, the ability to plan, social skills, impulse control and the ability to delay gratification. A delay in this crucial phase of brain development can result in ADD, ADHD, Dyspraxia, Dyslexia, Tourette's syndrome and OCD.

Dr Pauc says that current medical treatments such as Ritalin manage the symptoms but do not treat the causes. He suggests that parents find a practitioner who can do a neuro developmental assessment to look at these underlying areas and design a movement therapy programme a programme for the child to correct this delay.

Ref: "Is That my Child?" by Dr Robin Pauc, 2006: Virgin Books, Chatham, Kent, Great Britain.

DEVELOPMENTAL DELAY ASSESSMENT AND THERAPY
EXTRA LESSON™
The Extra Lesson™ is an international, one to one intervention programme and is available in many centres in New Zealand and Australia. The Extra Lesson™ assessment focuses on the neuro developmental status of the child, looking at areas which should have been resolved in the first few months of life but are still present as lingering immaturities. These include retained primitive reflexes which should be suppressed by 4 months of age. It also looks at other developmental markers which should be established in early childhood, before the child starts school. These include spatial orientation, body awareness, visual perceptual skills, balance and gross and fine motor skills.

Of these, the retained primitive reflexes are perhaps the most useful marker for diagnosis of a mild, developmental delay.

Retained Primitive Reflexes

Most ADHD children have a cluster of retained primitive reflexes which are controlled by the primitive part of the brain. These are reflexes babies are born with to assist them to become upright in the first year of life. They should be suppressed by 4 months of age. These are mostly stimulated by head movements or touch, and when triggered cause very small but compelling automatic, movements. When a number of retained primitive reflexes are present together these movements are amplified and can result in hyperactivity.

For example, the Asymmetrical Tonic Neck reflex (ATNR) causes poor posture and frequent movement while seated, with a tendency to sit with one leg up on the chair and one leg extended, or sit with the elbow on the desk while propping the head up with the hand. A retained ATNR also interferes with the development of a mature grip, necessary for neat hand writing and other fine motor skills.

The Spinal Gallant reflex is often seen in ADHD children. This is triggered by touch to the lower spine. This touch causes an automatic twitch of the spine to the side and contributes to restlessness, particularly while seated.

The Moro reflex is the primitive startle reflex present in newborns designed to summon help when danger is imminent. When retained past 4 months of age it causes distractibility and sometimes the fight or flight response (lash out or run) when triggered.

All of the primitive reflexes (and there are several others) interfere with focus, concentration and higher cognitive functioning as they are controlled by the primitive past of the brain responsible for survival. When a matter of survival arises to the primitive brain's attention, it does not matter what is on the board or what 2+3 equals. The current concept or process being learned goes "out the window" and is not stored in the memory of the child. Learning under these circumstances is inconsistent, there one day and gone the next.

Neuro Developmental Therapy

Primitive reflexes and retained midlines etc can be removed through a programme of neuro developmental therapy. If the reflexes are very severe they will be picked up by GPs during wellness checks or other medical consultations. In these cases referral for therapy is often made at this time to the hospital where an occupational therapist (OT) trained in neuro developmental therapy will offer a reflex suppression programme. However in milder cases these can go unnoticed and are not considered medically significant. They are however educationally significant.

The Early Childhood Development agency in your area might also have OT services and parents can self refer for assessment of children under the age of 7. Again only the most severe cases are treated and OTs in these centres have limited funding and in general no therapy space available.

Extra Lesson™ practitioners offer weekly one to one movement therapy sessions for each child. A daily programme of neuro-developmental exercises is prescribed for each child according to their individual needs and carried out at home by the parents. The programme follows the developmental sequence of early childhood movement patterns which should have removed the reflexes in the first place. Extra Lesson is unfortunately not in general funded by the government except for some cases of children in the High Complex Needs category. Some schools offer a subsidy for Extra Lesson™ so it is worth asking at your local school.

These are a growing number of Extra Lesson practitioners working in NZ, some in schools and some in private practice. They are professionals( usually teachers, counsellors, occupational therapists or physiotherapists) who have taken additional post graduate training and are registered thorough the Australian Extra Lesson Association.

For more information on Extra Lesson™ see www.extralesson.com and www.developlearning.co.nz

For a referral to a registered Extra Lesson Practitioner near you email info@developlearning.co.nz. or www.extralesson.com and click on practitioners in NZ.

For more information on the effect of retained reflexes on learning see

" Reflexes, Learning and Behaviour: A Window Into the Child's Mind by Sally Goddard,2005, Fern Ridge Press, Oregon, USA.

DIETARY TREATMENT

Dr Pauc is one of a number of doctors in this field who also suggest dietary changes to support the child's neurological system. Many children are suffering from an underlying nutritional deficiency and are not consuming the nutrients which will allow them to overcome this neuro developmental delay and develop a strong and health brain.

He believes that in addition to an underlying developmental delay, many children with ADHD, Dyslexia, ADD, OCD and Tourette's also have a sugar addiction, which plays havoc with their blood sugar levels.

He also notes that these children are greatly affected by the many additives we find in our food today.

His 5 step nutritional diet plan includes the following:

1. Reducing or eliminating all foods with E numbered food additives and colourings.

2. Avoiding all foods containing artificial sweeteners.

3. Reducing the amount of carbohydrates consumed. These include sugar, sugar containing foods (such as soft drinks, sweets, candy bars and sugar laden breakfast cereals) and refined or white floor foods( bread, biscuits, muffins etc),

4. Adding omega 3 and omega 6 to the diet together with zinc which assists in the manufacture of neuro transmitters together improve brain function.

5. Eating foods which improve brain function. These foods include:

protein rich breakfast such as eggs and bacon, or oatmeal porridge and whole grain toast

fruit for snacks (avoid snack foods which contain additives- read the labels and only buy those with wholesome ingredient)

plenty of fresh vegetables together with protein for dinner

omega 3 rich foods such as salmon, tuna, sardines, and other oily fish

Dr Pauc urges parents to seek out a developmental assessment, make the necessary dietary changes and address the underlying causes before their children reach adolescence.

Useful Resources

For more information on dietary treatment and Dr Pauc's recommendations see: "Is That my Child?" by Dr Robin Pauc, 2006: Virgin Books, Chatham, Kent, Great Britain.

Further excellent information on this subject can also be found in the book

"Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies" by Kenneth Bock, M.D. and Cameron Stauth, 2007: Random House, New York.

Rosemary Murphy is a trained teacher with a particular passion for helping children overcome learning difficulties. She is a graduate of the Extra Lesson™ post graduate training programme and is a Registered Extra Lesson Practitioner. She is also an Integrated Listening System Professional, a certified provider for The Listening Program®. Rosemary runs the Developmental Learning Centre

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Rosemary Murphy overviews the various treatments for ADHD, including medication, drug free options, and diet.

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Research shows that what you feed your body has a direct correlation to how your brain functions. Diet and nutrition impact cognition, attention, sleep, and mood. According to the Harvard Health Blog, studies show that people who eat "clean" or "whole" diets high in vegetables, fruits, unprocessed grains, and lean meats, are more likely to experience better emotional health and 25 to 35 percent less likely to experience mood disorders.

Can a clean, natural diet help combat symptoms of ADHD? Adults and parents of children with ADHD are finding that, while whole foods may not be a cure-all, diet changes can make a big difference for some patients. Nutrition and ADHD go hand-in-hand.

Poor diet and eating habits do not cause ADHD. And when it comes to controlling impulsivity, inattention, and other symptoms, there is no substitute for medication and behavioral therapy, which are clearly the most effective approaches - and the only ones recommended by the American Academy of Pediatrics.

Still, adults and parents of children with attention deficit have long reported a connection between the kinds of foods they eat and their behavior and symptoms. Now, science is beginning to add credence to those observations.

Research shows that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. Which may explain why Fruity Pebbles are one of the worst breakfasts for your child.

In essence, the better you want your brain to perform, the more unprocessed foods, proteins, vegetables, and fruits you should eat.

Two studies show a relationship between diet and ADHD symptoms. One, published in Pediatrics in 2010, concluded that pesticides, specifically organophosphates, found on fruits and vegetables may be linked to ADHD. The higher the levels of the compounds detected in a child's urine, the more likely he or she is to be diagnosed with ADHD. (The answer? Eat organic, suggest the study's authors.) Another study, published in the Journal of Attention Disorders in 2010, showed that a Western diet - processed meats, fast foods, high-fat dairy products, and sugary foods - doubled the risk of having an ADHD diagnosis, compared with a healthier diet.

Nutrition affects the ADHD brain in three ways.

1. Brain cells, like other cells in the body, need proper nutrition to carry out their functions.

2. The myelin sheath, which covers the axons of brain cells, as insulation covers electrical wires, needs the right levels of nutrients to speed transmission of the electrical signals between brain cells.

3. Neurotransmitters - dopamine, serotonin, and norepinephrine - are also dependent on diet for proper functioning.

If the right nutrients aren't accessible to the brain, its circuits misfire. Read on to find out what nutrients an ADHD brain needs to function well.

What to Eat

Carbs and ADHD Brain Power

Carbs affect brain function and mood. The rate at which sugar from a particular food enters brain cells, and other cells of the body, is called the "glycemic index" (GI). Foods with a high glycemic index stimulate the pancreas to secrete high levels of insulin, which causes sugar to empty quickly from the blood into the cells. Insulin regulates the ups and downs of blood sugar, and the rollercoaster behavior that sometimes goes with them. Low-glycemic foods deliver a steady supply of sugar, helping a person with ADHD control behavior and improve performance

Foods with the best brain sugars include:

Fruits: grapefruit, apples, cherries, oranges, and grapes. Fruits have a lower GI than do fruit juices, because fiber in fruit slows the absorption of fruit sugar. A whole apple is more brain-friendly than apple juice; a whole orange better than orange juice. Please note that the acid in oranges, grapefruits, and their juices interrupts the absorption of short-acting stimulant ADHD medications and should be avoided when taking these prescriptions.

Cereals and grains: oatmeal, bran, higher-fiber cereals and pastas also have a low GI. Corn flakes and sugarcoated breakfast cereals have higher GIs, and should be avoided.

Vegetables and legumes: legumes, such as soybeans, kidney beans, and lentils have the lowest GI of any food.

Dairy products: Milk and yogurt have low GIs, slightly higher than legumes, but lower than fruits. Plain yogurt has a lower GI than yogurt with fruit preserves or sugar added.

Protein and ADHD Brain Power

The brain makes a variety of chemical messengers, or neurotransmitters, to regulate wakefulness and sleep. Studies by Massachusetts Institute of Technology neuroscientist Richard Wurtman Ph.D., and others have shown that protein triggers alertness-inducing neurotransmitters, while carbohydrates trigger drowsiness.

These findings support the popular belief that people with ADHD do better after eating a protein-rich breakfast and lunch. Yet child psychologist Vincent J. Monastra, Ph.D., head of an ADHD clinic in New York says that, of the 500 children a year he evaluates for ADHD, less than 5 percent are eating the government-recommended amounts of protein at breakfast and lunch. In addition to boosting alertness, says Monastra, a protein-rich breakfast seems to reduce the likelihood that ADHD medication will cause irritability or restlessness.

Proteins affect brain performance by providing the amino acids from which neurotransmitters are made. Neurotransmitters are biochemical messengers that carry signals from one brain cell to another. The better you feed these messengers, the more efficiently and accurately they deliver the goods, allowing your child to be alert at school or you to be more on top of things at work.

Two amino acids, tryptophan and tyrosine, are important building blocks of neurotransmitters. These amino acids influence the four top neurotransmitters - serotonin, which is made from the amino acid tryptophan, as well as dopamine, epinephrine, and norepinephrine, which are made from the amino acid tyrosine. Tryptophan is an essential amino acid. The body does not make it; it must be supplied by the diet. The body can make tyrosine if there is not enough in the diet.

"Because the body makes brain-awakening neurotransmitters when you eat protein, start your day with a breakfast that includes protein," says Laura Stevens, M.S., a nutritionist at Purdue University and author of 12 Effective Ways to Help Your ADD/ADHD Child. "Also look for ways to slip in lean protein during the day, as well."

"Protein helps keep blood sugar levels steady, and prevents the mental declines that come from eating a meal containing too many simple carbs," says Ned Hallowell, M.D., author of Driven to Distraction.

If your family's idea of breakfast is toast, sugary cereals, or doughnuts, don't panic. You don't need to eat a plate of eggs and bacon every morning to meet your daily protein requirements. "We're not talking about a ton of food," says Monastra, author of Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach.

Depending on their age, children need between 24 to 30 grams of protein a day. Adults need 45 to 70 grams. You can get 7 grams in a cup of milk or soy milk, one egg, or an ounce of cheese or meat.

5 Balanced Breakfasts

A nutrition-packed breakfast should contain a balance of complex carbohydrates and protein.

Think grains, plus dairy, plus fruits. For example:
1. Granola cereal, yogurt, sliced apple
2. Scrambled eggs, whole-grain toast, orange
3. Veggie omelet, bran muffin, fresh fruit with yogurt
4. Whole-grain pancakes or waffles topped with berries and/or yogurt, milk
5. Low-fat cheese melted on wholegrain toast, pear

Fat, Fish Oil, and ADHD Brain Power

"Fats make up 60 percent of the brain and the nerves that run every system in the body," says William Sears, M.D., an associate clinical professor of pediatrics at the University of California, Irvine, School of Medicine. "The better the fat in the diet, the better the brain will function."

Most important to brain function are the two essential fatty acids found in fish oil: linoleic (or omega 6) and alpha linolenic (or omega 3). These are the prime structural components of brain cell membranes, and an important part of the enzymes that allow cell membranes to transport nutrients in and out of cells. Western diets contain too many omega-6 fatty acids and too few of the omega 3s, which are found in cold-water fish (primarily salmon and tuna), soybeans, walnuts, wheat germ, pumpkin seeds, and eggs. Flaxseed and canola oils are good sources of omega 3s.

"Individuals with ADHD who have low levels of omega 3s will show the biggest improvement in mental focus and cognitive function when they add more of these healthy fats to their diet," says Richard Brown, M.D., associate clinical professor of psychiatry at Columbia University College of Physicians and Surgeons.

Vitamins and ADHD Brain Power

Studies indicate that children in grade school whose diets are supplemented with appropriate vitamins and minerals scored higher on intelligence tests than did those who took no supplements. This is encouraging news, but it comes with an important caveat: Genetic abnormalities such as MTHFR can make some supplements difficult, even dangerous. For this reason and others, you should always consult with your physician before introducing a new vitamin or supplement to your or your child's diet. Even the seemingly innocuous vitamin B can cause serious side effects in certain individuals.

Here are some specific vitamins and minerals that affect behavior and learning in children and adults:

Vitamin C is required by the brain to make neurotransmitters. In fact, the brain has a special vitamin c "pump," which draws extra vitamin c out of the blood into the brain.

Vitamin B6 deficiency causes irritability and fatigue. Adequate levels of the vitamin increase the brain's levels of the neurotransmitter dopamine, increasing alertness.

Iron is also necessary for making dopamine. One small study showed ferritin levels (a measure of iron stores) to be low in 84 percent of children with ADHD, compared to 18 percent of a control group. Low iron levels correlate with severe ADHD.

Zinc regulates the neurotransmitter dopamine, and may make methylphenidate more effective by improving the brain's response to dopamine. Low levels of this mineral correlate with inattention.

More of these nutrients is not necessarily better, and sometimes problematic. Studies using megavitamin therapy in children with ADHD showed no effect.

What Not to Eat

Food Sensitivities and Elimination Diets

Studies show that sensitivities to certain foods may worsen symptoms of ADHD in children.

When placed on a special elimination diet excluding foods that trigger unwanted behavior, as many as 30 percent of toddlers and preschoolers benefit, says Eugene Arnold, M.D., author of A Family's Guide to Attention-Deficit Hyperactivity Disorder and professor emeritus of psychiatry at Ohio State University. He says that such a diet does not seem to have any effect on adults with ADHD.

On an elimination diet, you start by eating only foods unlikely to cause reactions:

Then you restore other foods, one at a time, to see whether they cause a reaction.

If nothing happens in two weeks - if you see no difference in your child's behavior - stop the experiment. If you notice an improvement, reintroduce one excluded food each day and watch what happens. If the child has a bad response to the food - if he becomes more fidgety or has trouble sleeping, for example - eliminate it again. If it's a food your child really likes, try reintroducing it again a year or so later. When not repeatedly exposed to a trigger food, children often outgrow sensitivities.

If you'd like to try the diet with your children at home, Dr. Arnold recommends consulting a registered dietician ( go to eatright.org).

The Feingold Diet

In the 1970s, Benjamin Feingold M.D., a pediatrician and allergist at Kaiser Permanente Medical Center in San Francisco, introduced an eating plan that he said could help alleviate symptoms of ADHD. The Feingold Diet forbids artificial food colors, flavorings, sweeteners, and preservatives, as well as salicylates, naturally occurring compounds found in some fruits and vegetables.

Studies failed to uphold Feingold's claims when he first made them, and most ADHD experts still dismiss the Feingold diet as ineffective. Yet some recent research suggests that the Feingold diet may be beneficial to the small percent of children with ADHD who seem sensitive to chemicals in food.

One study, published in the December 2004 issue of the Journal of Developmental and Behavioral Pediatrics, analyzed 15 previously published studies and concluded that artificial food colors can lead to hyperactivity, irritability, and insomnia in some kids with ADHD.

Many parents say they use the Feingold Diet despite a lack of clear scientific evidence because, quite simply, it works for their families. Marilee Jones of Oakdale, Connecticut, put her son, now 17, on the Feingold Diet when he was a toddler. Prior to the diet, he was hyperactive and had dark circles under his eyes from not sleeping. "We put him on the diet, and everything changed. He became a normal 18-month-old," says Jones, who now works for the Feingold Association.

Even now, says Jones, her son notices that if he strays too far from the diet and, say, indulges in a soft drink with artificial food coloring, his personality changes.

The Sugar Debate

Most parents of children with ADHD - 84 percent of 302 parents in one 2003 study - believe that sugar has a negative effect on their kids' behavior. And many adults with ADHD are convinced that sugar worsens their symptoms as well.

But medical experts still tend to discount any link between behavior and sugar or artificial sweeteners. As evidence, they point to a pair of studies that appeared in the New England Journal of Medicine . "Effects of Diets High in Sucrose or Aspartame on the Behavior and Cognitive Performance of Children" (February 3, 1994) found that "even when intake exceeds typical dietary levels, neither dietary sucrose nor aspartame affects children's behavior or cognitive function." A similar study, "The Effect of Sugar on Behavior or Cognition in Children" (November 22, 1995), reached much the same conclusion - though the possibility that sugar may have a mild effect on certain children "cannot be ruled out," according to the study's authors.

In any case, sugar carries loads of calories and has no real nutritional value. People who eat lots of sweets may be missing out on essential nutrients that might keep them calm and focused. Since ADHD medications tend to blunt the appetite, it's important to make every calorie count.

The most recent review of all the studies on diet and ADHD, concluded and published in 2014, found mixed outcomes, which proves the science is still shaky in this area. They found that parents often reported behavior changes with artificial food colorants and additives, but teachers and clinical tests didn't report the same level of change. They could conclude that artificial colors do react adversely with ADHD symptoms in some children. The studies on sugar and artificial colors had negligible results as well, thwarting the theory that sugar and artificial sweeteners cause ADHD symptoms. And all studies on the effect of elimination diets on ADHD symptoms that they looked at found statistically significant ADHD symptom reduction when the children were given a narrow diet of foods unlikely to cause reactions.

What you or your child with ADHD eats is very important, and can have an impact on ADHD symptoms.

1 MD, Eva Selhub. "Nutritional Psychiatry: Your Brain on Food." Harvard Health Blog. Harvard Health Publications, 17 Nov. 2015.
2 Bouchard, M. F., D. C. Bellinger, R. O. Wright, and M. G. Weisskopf. "Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides." Pediatrics, vol. 125, no. 6, 2010.
3 Amber L. Howard, Monique Robinson, Grant J. Smith, Gina L. Ambrosini, Jan P. Piek, and Wendy H. Oddy. "ADHD Is Associated With a 'Western' Dietary Pattern in Adolescents." Journal of Attention Disorders, 2010; DOI: 10.1177/1087054710365990
4 Wurtman, Richard J. "Nutrients That Modify Brain Function." Scientific American, vol. 246, no. 4, 1982, pp. 50-59., doi:10.1038/scientificamerican0482-50.
5 Schoenthaler, Stephen J., et al. "The Effect of Vitamin-Mineral Supplementation on the Intelligence of American Schoolchildren: A Randomized, Double-Blind Placebo-Controlled Trial." The Journal of Alternative and Complementary Medicine, vol. 6, no. 1, 2000, pp. 19-29., doi:10.1089/acm.2000.6.19.
6 Konofal, Eric, Michel Lecendreux, Isabelle Arnulf, and Marie-Christine Mouren. "Iron Deficiency in Children With Attention-Deficit/Hyperactivity Disorder." Archives of Pediatrics & Adolescent Medicine, vol. 158, no. 12, 2004, pp. 1113.
7 Akhondzadeh, Shahin. "Zinc Sulfate as an Adjunct to Methylphenidate for the Treatment of Attention Deficit Hyperactivity Disorder in Children: A Double Blind and Randomized Trial." BMC Psychiatry, vol. 4, no. 9, 2004, doi:10.1186/isrctn64132371.
8 Haslam, Robert, et al. "Effects of Megavitamin Therapy on Children with Attention Deficit Disorders." Pediatrics, vol. 74, no. 1, July 1984, pp. 103-111.
9 Pelsser, Lidy M. J., et al. "A Randomised Controlled Trial Into the Effects of Food on ADHD." European Child & Adolescent Psychiatry, vol. 18, no. 1, 2008, pp. 12-19., doi:10.1007/s00787-008-0695-7.
10 Schab, David W., and Nhi-Ha T. Trinh. "Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes? A Meta-Analysis of Double-Blind Placebo-Controlled Trials." Journal of Developmental & Behavioral Pediatrics, vol. 25, no. 6, 2004, pp. 423-34.
11 Dosreis, Susan, et al. "Parental Perceptions and Satisfaction with Stimulant Medication for Attention-Deficit Hyperactivity Disorder." Journal of Developmental & Behavioral Pediatrics, vol. 24, no. 3, 2003, pp. 155-162., doi:10.1097/00004703-200306000-00004.
12 Wolraich, Mark L., et al. "Effects of Diets High in Sucrose or Aspartame on The Behavior and Cognitive Performance of Children." New England Journal of Medicine, vol. 330, no. 5, Mar. 1994, pp. 301-307., doi:10.1056/nejm199402033300501.
13 Wolraich, M L, et al. "The Effect of Sugar on Behavior or Cognition in Children." JAMA, vol. 274, no. 20, Nov. 1995, pp. 1617-1621.
14 Nigg, Joel T., and Kathleen Holton. "Restriction and Elimination Diets in ADHD Treatment." Child and Adolescent Psychiatric Clinics of North America, vol. 23, no. 4, 2014, pp. 937-953., doi:10.1016/j.chc.2014.05.010.

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Studies show that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. Which may explain why Fruity Pebbles are so awful for your child with ADHD. Read on for more trigger foods, and for healthier alternatives.

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This medication is used to treat attention deficit hyperactivity disorder - ADHD. It works by changing the amounts of certain natural substances in the brain. Methylphenidate belongs to a class of drugs known as stimulants. It can help increase your ability to pay attention, stay focused on an activity, and control behavior problems. It may also help you to organize your tasks and improve listening skills.This medication is also used to treat a certain sleep disorder ( narcolepsy).

How to use Ritalin

Read the Medication Guide provided by your pharmacist before you start taking methylphenidate and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth as directed by your doctor, usually 2 or 3 times a day. This medication is best taken 30 to 45 minutes before a meal. However, if you have stomach upset, you may take this medication with or after a meal or snack. Taking this medication late in the day may cause trouble sleeping ( insomnia).

Take this medication regularly to get the most benefit from it. To help you remember, take it at the same times each day.

The dosage is based on your medical condition and response to treatment. Your doctor may direct you to gradually increase or decrease your dose. Also, if you have used it for a long time, do not suddenly stop using this drug without consulting your doctor.

If you suddenly stop using this medication, you may have withdrawal symptoms (such as depression, suicidal thoughts, or other mental/mood changes). To help prevent withdrawal, your doctor may lower your dose slowly. Withdrawal is more likely if you have used methylphenidate for a long time or in high doses. Tell your doctor or pharmacist right away if you have withdrawal.

When used for a long time, this medication may not work as well. Talk with your doctor if this medication stops working well.

Though it helps many people, this medication may sometimes cause addiction. This risk may be higher if you have a substance use disorder (such as overuse of or addiction to drugs/alcohol). Take this medication exactly as prescribed to lower the risk of addiction. Ask your doctor or pharmacist for more details.

Tell your doctor if your condition does not improve or if it worsens.

Side Effects

Nervousness, trouble sleeping, loss of appetite, weight loss, dizziness, nausea, vomiting, or headache may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.

Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

This medication may raise your blood pressure. Check your blood pressure regularly and tell your doctor if the results are high.

Tell your doctor right away if you have any serious side effects, including: signs of blood flow problems in the fingers or toes (such as coldness, numbness, pain, or skin color changes), unusual wounds on the fingers or toes, fast/pounding/irregular heartbeat, mental/mood/behavior changes (such as agitation, aggression, mood swings, abnormal thoughts, thoughts of suicide), uncontrolled muscle movements (such as twitching, shaking), sudden outbursts of words/sounds that are hard to control, vision changes (such as blurred vision).

Get medical help right away if you have any very serious side effects, including: fainting, seizure, symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), symptoms of a stroke (such as weakness on one side of the body, trouble speaking, sudden vision changes, confusion).

Rarely, males (including young boys and teens) may have a painful or prolonged erection lasting 4 or more hours while using this medication. Caregivers/parents should also be watchful for this serious side effect in boys. If a painful or prolonged erection occurs, stop using this drug and get medical help right away, or permanent problems could occur. Ask your doctor or pharmacist for more details.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/ tongue/throat), severe dizziness, trouble breathing.

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

In the US -

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Your doctor may monitor you for a while after the medication is stopped, especially if you have taken this drug for a long time or in high doses. (See also How to Use section.

Precautions

See also Warning section.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: high blood pressure, blood circulation problems (such as Raynaud's disease), glaucoma, heart problems (such as irregular heartbeat, heart failure, previous heart attack, problems with heart structure), family history of heart problems (such as sudden cardiac death, irregular heartbeat), mental/mood conditions (especially anxiety, tension, agitation), personal/family history of mental/ mood disorders (such as bipolar disorder, depression, psychosis, suicidal thoughts), personal/family history of uncontrolled muscle movements (motor tics, Tourette's syndrome), overactive thyroid ( hyperthyroidism), seizure disorder.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

If used for a long time, this drug may affect a child's growth rate, weight, and final adult height. To reduce the risk, the doctor may recommend briefly stopping the medication from time to time. Check the child's weight and height regularly, and consult your doctor or pharmacist for more details.

During pregnancy, methylphenidate should be used only when clearly needed. Discuss the risks and benefits with your doctor.

This medication passes into breast milk. Consult your doctor before breastfeeding.

Interactions

Taking MAO inhibitors with this medication may cause a serious (possibly fatal) drug interaction. Avoid taking MAO inhibitors ( isocarboxazid, linezolid, metaxalone, methylene blue, moclobemide, phenelzine, procarbazine, rasagiline, safinamide, selegiline, tranylcypromine) during treatment with this medication. Most MAO inhibitors should also not be taken for two weeks before treatment with this medication. Ask your doctor when to start or stop taking this medication.

Methylphenidate is very similar to dexmethylphenidate. Do not use medications containing dexmethylphenidate while using methylphenidate.

This medication may interfere with certain medical/lab tests (such as brain scan for Parkinson's disease), possibly causing false test results. Make sure lab personnel and all your doctors know you use this drug.

Does Ritalin interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: vomiting, agitation, confusion, sweating, flushing, muscle twitching, hallucinations, seizures, loss of consciousness.

Do not share this medication with others. Sharing it is against the law.

Lab and/or medical tests (such as blood pressure, complete blood count, height/ weight monitoring in children) may be done while you are taking this medication. Keep all medical and lab appointments. Consult your doctor for more details.

There are different brands and forms of this medication available. Not all have the same effects. Do not change brands or forms without consulting your doctor or pharmacist.

If you miss a dose, take it as soon as you remember. If it is near bedtime or near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Different brands of this medication have different storage needs. Check the product package for instructions on how to store your brand, or ask your pharmacist. Do not store in the bathroom. Keep all medications away from children and pets.

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Are you currently using Ritalin?

This survey is being conducted by the WebMD marketing sciences department.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

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Ritalin Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing - WebMD

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Find patient medical information for Ritalin oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.

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What are prescription stimulants?

Prescription stimulants are medicines generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy-uncontrollable episodes of deep sleep. They increase alertness, attention, and energy.

What are common prescription stimulants?

dextroamphetamine (Dexedrine®)

dextroamphetamine/amphetamine combination product (Adderall®)

methylphenidate (Ritalin®, Concerta®).

Popular slang terms for prescription stimulants include Speed, Uppers, and Vitamin R.

Do Prescription Stimulants Make You Smarter?

Some people take prescription stimulants to try to improve mental performance. Teens and college students sometimes misuse them to try to get better grades, and older adults misuse them to try to improve their memory. Taking prescription stimulants for reasons other than treating ADHD or narcolepsy could lead to harmful health effects, such as addiction, heart problems, or psychosis.

How do people use and misuse prescription stimulants?

Most prescription stimulants come in tablet, capsule, or liquid form, which a person takes by mouth. Misuse of a prescription stimulant means:

taking medicine in a way or dose other than prescribed

taking someone else's medicine

taking medicine only for the effect it causes-to get high

When misusing a prescription stimulant, people can swallow the medicine in its normal form. Alternatively, they can crush tablets or open the capsules, dissolve the powder in water, and inject the liquid into a vein. Some can also snort or smoke the powder.

How do prescription stimulants affect the brain and body?

Prescription stimulants increase the activity of the brain chemicals dopamine and norepinephrine. Dopamine affects feelings of pleasure. Norepinephrine affects blood vessels, blood pressure and heart rate, blood sugar, and breathing.

Short-Term Effects

People who use prescription stimulants report feeling a "rush" (euphoria) along with the following:

increased blood pressure and heart rate

increased breathing

decreased blood flow

increased blood sugar

opened-up breathing passages

At high doses, prescription stimulants can lead to a dangerously high body temperature, an irregular heartbeat, heart failure, and seizures.

What are the other health effects of prescription stimulants?

Repeated misuse of prescription stimulants, even within a short period, can cause psychosis, anger, or paranoia. If the drug is injected, it is important to note that sharing drug injection equipment and having impaired judgment from drug misuse can increase the risk of contracting infectious diseases such as HIV and hepatitis.

Risk of Later Substance Use

Some people may be concerned about later substance misuse in children and teens who've been prescribed stimulant drugs to treat ADHD. Studies so far have not shown a difference in later substance use in young people with ADHD treated with prescription stimulants compared with those who didn't receive such treatment. This suggests that treatment with ADHD medication does not positively or negatively affect a person's risk of developing problem use.

Can a person overdose on prescription stimulants?

Yes, a person can overdose on prescription stimulants. An overdose occurs when the person uses enough of the drug to produce a life-threatening reaction or death (read more on our Intentional vs. Unintentional Overdose Deaths webpage).

When people overdose on a prescription stimulant, they most commonly experience several different symptoms, including restlessness, tremors, overactive reflexes, rapid breathing, confusion, aggression, hallucinations, panic states, abnormally increased fever, muscle pains and weakness.

They also may have heart problems, including an irregular heartbeat leading to a heart attack, nerve problems that can lead to a seizure, abnormally high or low blood pressure, and circulation failure. Stomach issues may include nausea, vomiting, diarrhea, and abdominal cramps. In addition, an overdose can result in convulsions, coma, and fatal poisoning.

How can a prescription stimulant overdose be treated?

Because prescription stimulant overdose often leads to a heart attack or seizure, the most important step to take is to call 911 so a person who has overdosed can receive immediate medical attention. First responders and emergency room doctors try to treat the overdose with the intent of restoring blood flow to the heart and stopping the seizure with care or with medications if necessary.

Can prescription stimulant use lead to substance use disorder and addiction?

Yes, misuse of prescription stimulants can lead to a substance use disorder (SUD), which takes the form of addiction in severe cases. Long-term use of stimulants, even as prescribed by a doctor, can cause a person to develop a tolerance, which means that he or she needs higher and/or more frequent doses of the drug to get the desired effects. An SUD develops when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home. Concerns about use should be discussed with a health care provider.

If a person develops an SUD and stops use of the prescription stimulant, he or she can experience withdrawal. Withdrawal symptoms can include:

Points to Remember

Prescription stimulants are medicines used to treat ADHD and narcolepsy.

Most prescription stimulants come in tablet, capsule, or liquid form, which a person takes by mouth. When misusing a prescription stimulant, a person can swallow, snort, smoke, or inject the drug.

Prescription stimulants increase the activity of the brain chemicals dopamine and norepinephrine.

Prescription stimulants increase alertness, attention, and energy. Their misuse, including overdose, can also lead to psychosis, anger, paranoia, heart, nerve, and stomach problems. These issues could lead to a heart attack or seizures.

Prescription stimulant misuse can lead to a substance use disorder, which takes the form of addiction in severe cases, even when used as prescribed by a doctor.

Withdrawal symptoms include fatigue, depression, and sleep problems. Concerns about use should be discussed with a health care provider.

Behavioral therapies can be effective in helping people stop prescription stimulant misuse, including cognitive-behavioral therapy and contingency management.

How can people get treatment for prescription stimulant addiction?

Behavioral therapies, including cognitive-behavioral therapy and contingency management (motivational incentives), can be effective in helping to treat people with prescription stimulant addiction. Cognitive-behavioral therapy helps modify the patient's drug-use expectations and behaviors, and it can effectively manage triggers and stress. Contingency management provides vouchers or small cash rewards for positive behaviors such as staying drug-free. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.

Learn More

For more information about prescription stimulants, see our:

This publication is available for your use and may be reproduced in its entirety without permission from the NIDA. Citation of the source is appreciated, using the following language: Source: National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services.

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Prescription stimulants are medicines generally used to treat attention-deficit hyperactivity disorder (ADHD) and narcolepsy-uncontrollable episodes of deep sleep. They increase alertness, attention, and energy. dextroamphetamine (Dexedrine®) dextroamphetamine/amphetamine combination product (Adderall®) methylphenidate (Ritalin®, Concerta®). Popular slang terms for prescription stimulants include Speed, Uppers, and Vitamin R.

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Joseph M. Carver, Ph.D., Clinical Psychologist
Portsmouth, Ohio 45662
(740) 353 - 1548

http://www.drjoecarver.com/index.html
email: jmcarver@adelphia.net

Introduction
Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder in children. This handout has been developed to educate parents regarding the causes, symptoms, and issues associated with Attention-Deficit Hyperactivity Disorder (ADHD). Designed as an overview, years of experience with ADHD children and adults has prompted the identification of several patterns of behavior described in this handout. Information in the handout has been obtained from several sources - professional experience, books, parent/student interviews, and internet websites. This handout is not a substitute for professional evaluation or assessment of ADHD in children and is placed on the internet as a resource for those interested in Attention-Deficit Hyperactivity Disorder (ADHD).

Causes of Attention-Deficit Hyperactivity Disorder (ADHD)
Attention-Deficit Hyperactivity Disorder (ADHD) has been clinically researched for over thirty-five years. Various labels have been utilized to reflect two basic themes - the predominant symptom of hyperactivity and the clinical assumption that ADHD is related to a neurological dysfunction. Thus, early labels such as "Hyperkinetic Reaction in Childhood", "Minimal Brain Damage", and "Minimal Brain Dysfunction" were used to describe the condition. As research accumulated and better neurological assessment equipment surfaced, professionals began to understand the complex nature of Attention-Deficit Hyperactivity Disorder (ADHD), its' symptoms, and how it can be treated.

Attention-Deficit Hyperactivity Disorder (ADHD) is caused by neurological rather than parental, social, or emotional causes. The cause of Attention-Deficit Hyperactivity Disorder (ADHD) has been linked with the brain's chemical system, not it's structure. Thus, Attention-Deficit Hyperactivity Disorder (ADHD) is a problem with brain chemistry - not brain damage or injury.

The brain uses multiple chemical substances for operation, regulation, and communication. These chemicals, called "neurotransmitters", serve various functions in the brain. Three neurotransmitters have been linked to behavioral and emotional conditions: Dopamine, Serotonin, and Norepinephrine. If we imagine using a "dipstick", like the dipstick used to check oil/transmission fluid levels in our automobile, we might be able to check the neurotransmitter levels in our brain, finding which neurotransmitters are low, within the normal range, or high. Low levels of Serotonin, for example, are linked with clinical depression and for that reason, modern antidepressant medication increases the availability of the Serotonin neurotransmitter in the brain.

Attention-Deficit Hyperactivity Disorder (ADHD) appears related to two neurotransmitters - Dopamine and Norepinephrine. Neurotransmitters are used by the brain to stimulate or repress stimulation in brain cells. To pay proper attention, the brain must be adequately stimulated. To have proper control of our impulses, areas of the brain must be adequately controlled, repressed, or slowed down. In ADHD children, both systems of stimulation and repression are not working correctly. Some studies suggest that ADHD Children/Adults may have only ten to twenty-five percent of these two neurotransmitters found in the normal brain.

Inattention and distractibility appear to be related to low levels of Norepinephrine. ADHD Children/Adults can't judge which things in their environment are important and which should be ignored. ADHD Children/Adults often feel the flight path of a fly in the room is as important as the teacher's algebra lesson. To the ADHD Child/Adult, everything on the desk is equally interesting and worthy of attention. Low levels of Norepinephrine also make it very difficult for ADHD Children/Adults to sustain their focus on a task, plan ahead, and understand such concepts as sequence and time.

The impulse and behavior problems found in Attention-Deficit Hyperactivity Disorder (ADHD) appear related to low levels of Dopamine in the brain. When dopamine levels are normal, we can repress the urge to do or say something in public, grab something interesting on a desk, blurt out our opinion, or touch/poke someone who has just walked within our physical range. Low levels of dopamine in the brain makes control of impulsive behavior almost impossible in the ADHD Child/Adult.

In treatment, medications effective with ADHD Children/Adults are those which alter levels of Dopamine and Norepinephrine. Stimulate medications (Ritalin) are known to increase the production of these two neurotransmitters - boosting their levels into the normal range and producing increased attention and decreased impulsivity. Other medications with similar actions, such as antidepressant medications, can also be of use in the treatment of ADHD Children/Adults.

The many symptoms and behaviors found in ADHD Children/Adults are linked to the various levels of these two neurotransmitters. ADHD is diagnosed in children and adults by recognizing the patterns and symptoms found in the condition. This paper will explore the symptoms associated with Attention-Deficit Hyperactivity Disorder (ADHD).

Diagnosis of Attention-Deficit Hyperactivity Disorder (ADHD)

The essential features of Attention-Deficit Hyperactivity Disorder (ADHD), as described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (1994), is the presence of developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity. Individuals with the disorder generally display some disturbance in each of these areas, but to varying degrees.

The following is a list of symptoms commonly associated with Attention-Deficit Hyperactivity Disorder (ADHD) based on the 1994 Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV):

These symptoms are related to inattention...

Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities. ADHD Children/Adults children are famous for skipped math problems, milk cartons on the kitchen table, etc.

Often has difficulty sustaining attention in tasks or play activities. A two-minute timed task is often interrupted by glancing about the room.

Often does not seem to listen when spoken to directly. As described, ADHD Children/Adults are often considered to have hearing problems or difficulties in auditory processing due to their inability to hear or respond to comments.

Often does not follow through on instructions and fails to finish schoolwork, chores, or duties. ADHD Children/Adults quit games half-way through, half-clean their room, or wander off in the middle of projects. Homework is often partially finished or even if finished, the ADHD student forgets to turn it in.

Often has difficulty organizing tasks and activities. Many tasks/activities require planning and organization. An adult might gather four tools for a project in one trip. The ADHD individual must retrieve one tool at a time, failing to see the big picture and the equipment that might be needed.

Often avoids, dislikes, or is reluctant to engage in tasks that require sustained effort. Homework and schoolwork are often an ordeal for the ADHD Child and his/her parents. What should normally take 30 minutes requires three hours and after the ordeal, both student and parent are exhausted and traumatized.

Often loses things necessary for tasks or activities. ADHD Children misplace pencils, notebooks, and other needed equipment. They forget lunch money or inform you 20 minutes before bedtime that they need a large poster board for a project the next day.

If often easily distracted by extraneous stimuli. Noises, conversation, flying birds, movements by others - almost anything can draw the attention of ADHD Children from their task at hand.

If often forgetful in daily activities.

These symptoms are related to hyperactivity...

Often fidgets with hands or feet or squirms in seat. ADHD Children look much like a running motor with a rough idle. If we imagine a video recording of the ADHD Children, their body is almost constantly in movement, importantly, purposeless movement.

Often leaves seat in classroom or in other situations in which remaining seated is expected. Depending upon the severity of the hyperactivity, ADHD Children have difficulty remaining seated in school, church, family gatherings, etc. In school, ADHD Children are known to "pop up" from their seat, as though gravity was suddenly canceled in their area.

Often runs about or climbs excessively in situations in which it is inappropriate. Younger ADHD children are climbers, runners, bouncers, tumblers, and jumpers. As the ADHD Child matures, he/she may report an internal sensation of a "running motor" or restlessness. Hyperactivity in ADHD adolescents can also take the form of finger drumming, restless legs, excessive humming/singing/whistling, and even object-drumming. ADHD teens often turn kitchen canisters and tables into drum sets.

Often has difficulty playing or engaging in leisure activities quietly. As the excitement builds in an ADHD Child, so increases the voice and physical activity. When playing video games, ADHD Children often shout, yell, and physically act their participation.

Often "On the go" or acts as if "driven by a motor".

Often talks excessively. ADHD Children and Adults talk and question excessively. Questions are often totally unrelated to the task at hand. ADHD in adults often produces the "fast talker" we find in certain occupations.

These symptoms are related to impulsivity...

Often blurts out answers before questions have been completed. Labeled "disruptive" in the classroom setting, ADHD Children fail to raise their hand or await proper acknowledgment before speaking in group situations.

Often has difficulty awaiting turn. If we study the actual location where ADHD Children have difficulty, it's often when they are waiting - the cafeteria line, riding on the bus, in line before recess, etc. During such times, ADHD Children can't control their urge to physically touch/poke or irritate others.

Often interrupts or intrudes on others. ADHD Children butt into conversations, interrupt adults, interrupt games, and demand responses to questions when the parent/teacher is already engaged. ADHD Children have few "social graces" for this reason.

Neurology and ADHD
The ADD Medical Treatment Center of Santa Clara Valley list absolute indications and suggestive indications of the underlying neurological basis for Attention-Deficit Hyperactivity Disorder (ADHD).

Absolute Indicators of ADHD Neurology

Hyperactivity/Fidgetiness

Impulsivity (hyperactivity of the mind)

Unexplained inattention for "boring" activities

Primary nocturnal enuresis (bed-wetting)
(48% of ADHD children have bed-wetting)

Episodic Explosiveness or Emotional Outbursts

Strongly Suggestive Indicators of ADHD Neurology

Waking slowly, not snapping awake, or being
excessively grouchy (91% of ADHD cases)

Difficulty falling asleep at night (73%)

Unexplained irritability and rapid frustration

Unexplained negativity with or without depression

Verbal and/or spatial dyslexia (number, letter,
and often word reversals)

Manifestations of the disorder usually appear in most situations, including at home, in school, at work, and in social situations, but to varying degrees. Some people, however, show signs of the disorder in only one setting, such as at home or at school. Symptoms typically worsen in situations requiring sustained attention, such as listening to a teacher in a classroom, attending meetings, or doing class assignments or chores at home. Signs of the disorder may be minimal or absent when the person is receiving frequent reinforcement or very strict control, or is in a novel setting or a one-to-one situation (e.g., being examined in the clinician's office, or interacting with a videogame).

Attention-Deficit Hyperactivity Disorder (ADHD) in younger children is often readily identified by the presence of hyperkinesis or "hyperactivity". Rapid, purposeless, and nonstop movements are often found. These youngsters can seldom watch a thirty-minute television/VCR program due to their short attention span and hyperactivity.

In older children, above the age of twelve, the rapid body movements become less obvious although they can still be observed. Rather than running around the room or class, the older ADHD child exhibits leg shaking, drumming fingers, squirming, glancing about the room, and poor impulse control. The older ADHD child remains inattentive and will have difficulty with harder classes and frequently forgets homework.

Attention-Deficit Hyperactivity Disorder (ADHD) can persist into adulthood. The adult version of Attention-Deficit Hyperactivity Disorder (ADHD) contains rapid speech, poor judgment, poor impulse control, quick temper, and poor sustained effort. The adult "fast talker" frequently wears out friends with their hyperactive pace and talkativeness.

ADHD Behavioral Patterns

The following patterns have been found in Attention-Deficit Hyperactivity Disorder (ADHD) children and adults. The patterns are identified through a combination of professional research and twenty-seven years of clinical experience with ADHD.

Difficulty Understanding Sequence
Life moves in a series of sequences, one event connected to another and to another as our activities continue. ADHD children/adults have difficulty with understanding sequences, creating a variety of problems. For example, if you have an appointment in your hometown, you anticipate the amount of time needed to prepare, drive to the office, park the car, and register - perhaps 60 minutes. For ADHD Johnny, the short attention span makes understanding sequences very difficult. Getting ready for school is a nightmare as ADHD children don't understand that time is involved in every activity. They somehow figure you can get out of bed at 7:45 am, shower, eat breakfast, brush their teeth, gather their books, and get dressed -all before the bus arrives at 8:00 am.

The inability to understand sequences is the cause for the amazing ability of ADHD children/adults to always get caught when doing something wrong. ADHD children/adults are unable to be "sneaky" due to this trait. As a parent, you can watch the ADHD child grab a cola from the refrigerator and sit in the next room to watch television. You walk in, notice the cola is spilled, and question them about the spill - to which they reply "I didn't do it!" ADHD children can't figure out how you know the sequence of events that allows adults to figure out who did what. They can't project sequence forward or backward.

This inability to understand sequence and time creates many problems for the ADHD teenager. Told to be home at 7:00 pm, the ADHD teenager leaves at 6:00 pm to visit a friend. They walk to the local video store where they meet a friend with a new game. They follow the friend home to check out the game. A contest follows and the friend's mother provides soda and snacks so the ADHD teenager doesn't get hungry. Eventually, the friend's family bluntly tells the ADHD teenager to go home - it's 10:00 pm! Upon returning home, the ADHD teenager is at a loss to explain why he's three hours late, didn't call, and was rude to stay too long at the friend's home. Despite grounding, the same behavior is repeated within a few days.

"I don't know"
When confronted with a misbehavior and asked "Why did you do that?", the number one response from an ADHD child is "I don't know!" This response is a combination of two behaviors in ADHD children, the lack of sequence understanding and the presence of tangential behavior. In geometry, a tangent is the single point at which two separate objects touch. Due to a short attention span, ADHD children jump from one activity to another, the two activities often linked together by a glance. If asked to clean the top of their desk, they wipe a bit, examine the lamp, read a comic, staple a few things, pull tape from the dispenser, and reprogram the phone - one behavior leading to another as they look around the desk. Asked why the desk isn't cleaned off or why the phone is now reprogrammed to call only video stores - "I don't know" is the reply. ADHD children can't remember the sequence of events that ended with a reprogrammed phone. It's not unusual to send an ADHD student to the garage for a hammer, finding him/her 45 minutes later in the process of disassembling the lawn mower. Asked why - "I don't know!"

Hyperfocus and Outbursts
ADHD Children have very low levels of attention, focus, and concentration. Normal concentration/attention allows us to listen to conversation or watch a television program with extra attention to spare - to monitor the environment, listen for the oven buzzer or others in the house. ADHD Children may only have half the concentration of non-ADHD individuals. For this reason, if they intensely focus on a television program or play a computer game, they have no extra attention with which to monitor their environment. When playing a game, they don't hear calls for lunch because all 50% of their attention is on the game.

Both research and clinical experience tells us that ADHD Children can exhibit a type of "hyperfocus" - intense concentration and single-minded focus when the activity is very interesting. This situation is most often found when ADHD Children play computer games. ADHD Children may have an amazing ability to hyperfocus on a computer game, one of the few things that moves fast enough to maintain their attention, unlike homework or routine chores.

The hyperfocus found in ADHD Children is not a normal type of concentration or focus. Remembering the neurochemical aspects of Attention-Deficit Hyperactivity Disorder (ADHD), hyperfocus requires the child to use the maximum attention and sustained concentration available. For parents and teachers, imagine trying to thread a needle, in low light, while sitting in a row boat in the ocean - the waves tossing and rolling all the time. The amount of concentration required to thread that needle makes us anxious, tense, and irritable - as if somebody were asking us questions while we were trying to thread that needle. This is way ADHD Johnny is so fidgety while trying to listen to your conversation or correction.

In ADHD Children, hyperfocus allows them to participate in computer games or watch high-action movies - but at a cost. The amount of energy being used makes them very irritable. If a parent interrupts the computer game or movie with a question, a call for lunch, or a request - the ADHD Children is likely to explode in a burst of verbal or physical aggression. His or her concentration has been broken and that neurochemical activity spills out into the room, or is directed at the interrupting source. It's not uncommon for ADHD Children, upon losing a computer game, to throw controllers or objects, stomp, scream, or behave in a way that tells us they are very upset. As a parent or teacher, we are shocked at their overreaction to such a minor situation. To see it from the viewpoint of an ADHD Children - imaging trying to thread that needle for 30 minutes - then accidentally dropping the needle overboard. We'd have a few choice words or a bit of behavior problem as well.

Dealing with hyperfocus requires patience and a minimal reaction to their overreaction. Interrupting ADHD Children who are hyperfocusing will always bring an inappropriate reaction, typically a verbal outburst. Parents are advised to not focus on their overreaction but remain on the topic. For example, interrupting ADHD Johnny's videogame to ask for help in the kitchen is likely to prompt a loud reaction such as "Why do I have to help! Sally never does anything! It's always me!" and so on for about five minutes. After the outburst, the parent might address the comments superficially but stick to the request as in "If you think I treat you unfairly, we can get together in an hour after lunch and discuss it. But right now, I need you to help me set the table."

"I think my child is possessed!" - Neurochemical Excitability
Of all Attention-Deficit Hyperactivity Disorder (ADHD) behaviors that bring ADHD Children to the attention of professionals, severe behavioral outbursts must be ranked in the top three complaints. One parent described the wild look in her son's eyes, the aggressiveness, kicking holes in the wall, and the physically threatening behavior with the summary "I think my child is possessed!" ADHD Children are normally more aggressive, pushy, argumentative and talkative. When upset, as when confronted or in a heated discussion, their neurochemical system explodes in a burst of energy and aggression that is far in excess to the situation.

Let's review what happens in a routine discussion or argument, as if it were being videotaped. If adults are in a discussion, the issue is first reviewed. If a disagreement is present, both sides present their opinion, normally at first, then more aggressively. As the discussion continues, we notice signs of neurochemical excitement - loud voice, an aggressive or resistive posture, name calling, references to past arguments, and often what I call the "adrenalin finger" - that pointed forefinger shaken at the other person. In healthy adults, as the neurochemical excitement increases, there is a sense that the discussion or argument is getting out of hand. Often a truce is offered as "We don't need to be yelling at each other. Let's take a break, get a cup of coffee, and talk about this later."

ADHD Children are already more excited and excitable than most children and adults. When upset or angry, the neurochemical excitement of anger or distress is added to the already-present high level of aggression and excitability. Imagine being very angry or upset, then suddenly receiving an injection of stimulants. At that point, you'd be out of control, talking and yelling nonstop, posturing, and physically aggressive. The upset ADHD Child rapidly goes from "hyper" to out of control. Parents often find that normal "rough-housing" with the child or between siblings, prompts the ADHD child to become very aggressive and unable to settle down after the event.

Signs of neurochemical excitement and outburst:

- Verbally loud, threatening, screaming, and talking excessively. In psychiatry, we use the term "pressured speech" to describe an aggressive, nonstop talking that is difficult to interrupt. The ADHD Children are almost totally unreasonable at this point.

- Physical aggression is strong. The neurochemical excitement becomes so strong at times that arms wave, feet stomp, objects are thrown, furniture/walls are hit, and the ADHD Child closes the physical range and may be intimidating or "in your face". Repeated cautions to calm down have no effect.

- Aggressive pursuit is often present. Recognizing that the situation is out of control, a parent typically offers a truce or attempts to disengage from the argument. The enraged ADHD Child suddenly can't break off their attack. If you walk away, they pursue you - following the parent through the house - still yelling, intimidating, and hitting the walls as they go.

- A major component of an Attention-Deficit Hyperactivity Disorder (ADHD) is impulsivity, acting before thinking. ADHD Children have difficulty understanding consequences of their behavior, a component related to their problems understanding sequences. For this reason, enraged ADHD Children can be very dangerous and threaten or engage in high-risk behavior. They may destroy their favorite possessions, run out the door, strike at parents/teachers, curse, or threaten suicide. Amazingly, all those behaviors can surface simply because you've asked the ADHD Child to take out the garbage.

- Normal parenting techniques used for discipline or behavior are totally ineffective during these episodes. After the outburst is over and the ADHD Child does settle down, they are always remorseful and apologetic but the parents are traumatized.

Dealing with this excessive chemical reaction involves several components.

Address the ADHD Child in a calm manner. A loud voice will only increase their reaction to being interrupted or addressed.

Expect a verbal reaction. Attention-Deficit Hyperactivity Disorder (ADHD) children have "quick-draw mouth" - a verbal reaction and reflex anytime they are addressed or interrupted. I often encourage parents of ADHD children to become deaf for ninety seconds after asking the ADHD child a question. A simple comment such as "Jimmy, can you take your glass into the kitchen for me" produces an aggressive "Why!? Jennifer leaves her glass in here all the time! I'm not the only one with an empty glass around here! You never tell Dad to take his glass to the kitchen! He can do anything!" Expect an overreaction to your comments or requests.

Don't take the verbal reaction personally. Parental focus on the ADHD Child's overreaction will often prompt an emotional and behavioral explosion. When the comments include such gems as "I wish I didn't live here!" or "Jennifer is the favorite around here!", the natural tendency is to defend yourself or address the comments. Addressing their reaction only side-tracts the original discussion and raises their agitation.

Ignore the reaction and stay on your original topic. Often a comment such as "I'm sure there are times you don't like our family rules. If you want to talk about that, we can get together after you take your glass into the kitchen."

When are ADHD Children Identified
ADHD Children are often diagnosed as being "hyperactive type" or "inattentive type" - or the combined version. There is difference in identification with these two types. The obviously hyperactive child is often identified within the first week of kindergarten or first grade. Parents arrive at a professional office with a note from the school principal, often demanding that the child be seen by a psychologist or pediatrician. These hyperactive children have been running around the room for three days at that point.

The inattentive type of Attention-Deficit Hyperactivity Disorder (ADHD) is more difficult to detect. The inattentive child is often labeled a "dreamer", "immature", "in a world of his/her own", or parents are told the child should be held back. As all six year old children are somewhat flighty at times, the inattentive child is typically advanced in school with the understanding that they will probably mature as they age. For this reason, inattentive ADHD Children often aren't identified until they are discovered to be one or two grades behind (see Academic Problems).

Academic Problems
ADHD Children typically have many academic problems. Despite being intelligent, academic performance is often below grade level. The best way to visualize the difficulty is to image an automobile with a Rolls Royce engine (the IQ/ability) and a go-cart transmission (attention/concentration system). The power of the engine is not getting to the wheels due to a difference in the transmission capability. Engine performance is only as powerful and efficient as the transmission system. If a child's intellectual ability (IQ) is measured at 115 and his/her concentration "IQ" is 75 - academic performance will most likely be at the "75" level - with hyperfocus bursts of sheer genius at times. In this situation we find very bright children often performing one or two grades behind despite amazing abilities to reprogram the school computers.

Without treatment, ADHD Children rapidly lose ground in school. Imagine an ADHD Child with only 75% concentration. For each grade completed, he/she retains 75% despite the IQ level. After four grades in school, the ADHD Child has retained only three grades and is now one grade behind. At this point, the child begins failing and lacks the foundation to understand some more complex math concepts.

Attitude Problems
Parents often asked about the risks involved in both medication treatment and not treating Attention-Deficit Hyperactivity Disorder (ADHD). Untreated ADHD Children can experience academic failure and behavior problems but more importantly, they often sustain damage to their self-confidence and self-esteem. Years of untreated ADHD gradually wear down the self-esteem of the child, creating a commonly found "ADHD attitude".

The "ADHD attitude" forms as a direct result of lots of adult attention. ADHD Children receives lots of attention but when we monitor that attention with a camcorder, we find that the attention received is about 90% negative. Adults are constantly attending to the ADHD Child with comments like "don't touch that", "sit still please", "stop that singing/drumming/moving", or "leave your sister alone". The ADHD Child finds the same type of attention at school, the teacher commenting "sit down", "please pay attention", "your work is too sloppy", and "leave your neighbor alone". As time passes, the student develops a negative view of himself or herself. Comments we often hear from hyperactive youngsters are "I can't do anything right", "they're always on my case", "they never say anything to my sister", or "no matter what I do I get into trouble." ADHD Children often describe themselves as "stupid" or a troublemaker. Personality development can be permanently altered or damaged by the presence of an ADHD attitude. With proper treatment of the hyperactivity, this self-view can gradually change to a more positive self-image. If the change does not appear in time, counseling in this area might be needed. One child recently treated at the office, when asked how his school situation had changed since medication treatment, replied "Now I got three friends!" It's important to remember that untreated ADHD often prevents the ADHD Children from obtaining and keeping friends. Like an octopus, the hyperactive student is constantly touching, hitting, poking, slapping, and irritating anyone who enters their body zone/range. For that reason, other students keep their physical distance from the hyperactive octopus.

Parents of ADHD Children: Issues
Parents of ADHD Children often develop difficulties of their own due to the constant supervision and effort required by the ADHD son or daughter. Commonly encountered parental issues:

"I can't take it anymore!" Many parents arrive exhausted and overwhelmed by the constant stress involved in rearing ADHD Children. Single parents are particularly vulnerable to being gradually overwhelmed by the night and day coping required with ADHD Children. At times, parents may require treatment for stress, anxiety, or depressive reactions.

"They say he's all boy." As the infant grows and the symptoms of ADHD surface, parents begin to question the activity level of their child. As they compare their child with other children, they ask the opinions of relatives, friends, and others. Initially, parents are often told "He's just all boy". While many later stick to their original assessment as "all boy", you'll notice that nobody volunteers to baby-sit that "all boy" child.

"We're both crying by the time homework is over!" Homework time, labeled "homework hell" by some parents of ADHD children, is often so stressful that both child and parent are traumatized by the experience. If the child is receiving medication treatment, it is not unusual for the child to experience a period of "emotional instability" after school, as the school-time medication loses effectiveness. Homework during that time would involving crying, yelling, temper tantrums, frustration, etc.

"I must be a bad parent!" With ADHD Children, normal parental discipline and educational techniques don't work. Your neighbor offers "I did this (technique) and Billy hasn't repeated it since!" If your child has ADHD, use of that technique will have little or no effect. After trying various recommendations and reading parenting books, and still nothing works, parents become demoralized and feel they are at fault. In reality, a completely different approach is often needed for ADHD Children.

"Dealing with this is ruining our marriage!" Selecting a coping style to deal with ADHD Children often places parents at odds. One parent may come from the "All he needs is a good spanking" school of discipline (totally ineffective by the way) and the other desires to protect and understand the condition. Parents also argue over issues of medication, who does homework, and who deals with the school. Parents of ADHD Children often receive daily notes from teachers/principals - the record at my office being 37 discipline slips in a two week period. When the marriage is troubled in this manner, marital counseling and support is often needed.

Treatment of Attention-Deficit Hyperactivity Disorder (ADHD)
Treatment of ADHD often involves a multidisciplinary approach and includes physicians, therapists, educators, and families. Children and adults with mild ADHD may require minimal professional intervention while severe ADHD may require multiple medications and professional interventions.

Medication Medication for Attention-Deficit Hyperactivity Disorder (ADHD) has been the treatment of choice for many years. Three groups of medications have been utilized: stimulants, antidepressants, and tranquilizers. Stimulants have the best track record, working very well in 65 - 75 percent of cases. Children with the inattentive type of ADHD frequently require a low dose to obtain a favorable response. Antidepressants can be of help, especially when bed-wetting is also part of the ADHD symptom picture. Tranquilizers have been used although typically in special cases, as when the ADHD features are related to neurological damage or head trauma.

Counseling for ADHD Counseling can help both the ADHD child and his family understand and cope with the disorder. Cognitive approaches often assist the ADHD student with developing coping skills and decreasing impulsivity. Counseling often focuses on self-control, respecting others, and decreasing negative self-concept that often accompanies ADHD.

Home/Classroom Management Techniques A variety of home and classroom management techniques are found in ADHD research and literature. Recommendations abound and several are listed in this paper. Clinical experience also provides "tricks of the trade" that are shared via the internet or in literature. Perhaps one of the best discovered by this author deals with the "withdrawals" experienced by some ADHD children after school, as the Ritalin medication leaves the system and the child becomes grouchy and hypersensitive. One pediatrician recommends a 12 oz. Mountain Dew which serves to "flatten out" the angle of the withdrawal. Thousands of internet sites are devoted to Attention-Deficit Hyperactivity Disorder (ADHD) and offer these and other suggestions for family and school management.

Discipline and Home Management Recommendations
The following two sections offer a program of discipline helpful in Attention-Deficit Hyperactivity Disorder (ADHD) children as well as a list of home management suggestions. The "Highway Patrol Approach" has been outlined by this author while the home management suggestions have been available in the public domain for many years.

The Highway Patrol Approach to Discipline

The Highway Patrol Approach uses the discipline and correction methods of the adult world with children. The Highway Patrol Approach is strictly business, not emotional or reactive, and corrects behavior through punishment (the fine) and bringing attention to the incorrect behavior. If you are speeding on the highway and are pulled over by the Highway Patrol, after viewing your license and registration, the conversation goes something like this:

Highway Patrol: "Mr. Jones you were clocked going 65 in a 55 mile per hour zone." He has just told you the incorrect behavior.

Highway Patrol: "The fine for speeding in this state is $85.00. Please sign this ticket." The officer has informed you of the punishment for that offense.

Highway Patrol: "Have a nice day." The officer remains polite and businesslike. He does not ask why you were speeding. He does not try to make you understand the reason for speeding laws in that state. He does not insult you with "How can you be so stupid!" or "Where did you get this junker of an automobile?"

The Highway Patrol Approach thus involves three steps:

Step 1: Identify the offense or incorrect behavior.

Step 2: Inform the offender of the punishment/fine.

Step 3: Remain polite and business-like.

When used with children, the Highway Patrol Approach is effective in reducing anger, hostility, and incorrect behavior. The fine for speeding won't bankrupt anyone, will sting the pocketbook, but is not unbearable - nor is it easy to ignore. This approach has been found the most effective in maintaining adult behavior.

When we use this same approach with children, it decreases the anxiety and anger often associated with parental discipline in both the children and the parents. By identifying the incorrect behavior, providing an appropriate fine or punishment, and maintaining a calm, business-like interaction, we decrease the misbehavior while continuing our good relationship with the child. An example:

Parent: "Jimmy, you shoved your brother and you know we don't allow shoving and hitting in this family. I want you to go to your room for 15 minutes. When your time is up you can join the rest of us and watch television. We'll see you in 15 minutes."

Variations in the Highway Patrol Approach That Create Misbehavior
The Highway Patrol Approach, like parental discipline, could be altered in a way that accidentally creates increased bad behavior. Some variations in parental behavior:

Excessive Fines The punishment/fine must always focus on correction - not excessive punishment. If you are audited by the Internal Revenue Service (IRS), their opening line goes something like "This is not a punishment. This audit is simply to insure compliance."

If a new law passes in your state that makes the fine for speeding $10,000.00 - the majority of adults would lie, try to evade arrest, or do anything in their power to avoid getting that ticket for speeding. Nobody tries to avoid an $85.00 fine unless they have an outstanding warrant for another crime.

With children, excessive punishment ("You're grounded for six months!!") almost forces children to lie and cover-up mistakes and offenses. If the punishment is short-and-sweet, designed only to "insure compliance" with the rules/regulations, the child feels no need to lie.

Unpredictable Fines Another law is passed in your state that allows the arresting officer to create his/her own fine - anything from giving you $5,000.00 to beating or shooting you on the spot. If arrested, unpredictable fines prompt the offender to manipulate - trying to get the lowest fine possible. When parental discipline is unpredictable, ignoring offenses sometimes while excessive punishment at other times, a very manipulative child is created. Unpredictable fines produce behaviors such as "sweet talking", crying spells, lying, attempts to influence ("I've got a relative that's in law enforcement!"), and even threats ("My next door neighbor is an attorney!"). Consistency in fines avoids manipulation in both law enforcement and parental discipline.

Canceled Fines If you are stopped for speeding and fined $85.00, then receive notice in the mail that your fine was canceled, you are more likely to continue speeding. If children are punished - then "bailed out" by the parents - they are likely to continue the incorrect behavior as they never suffer the consequences of their behavior. Children that are frequently rescued from the logical consequences of their misbehavior gain the feeling that rules don't apply to them. As time passes, their misbehavior often increases in severity to the point that a rescue isn't possible. The offender is then shocked that they will actually be punished. This situation is often found in teenagers who are frequently given probation or no punishment for offenses as a minor (under 18 years of age), then are shocked when sentenced to six months incarceration for an offense after turning 18 years of age.

Harassing Officer You are fined for speeding while driving to work on Monday. For the next four days, that same Highway Patrol officer stops your car to remind you that you are a speeder, lecturing you with each stop. You develop resentment and bitterness, feeling you are being harassed after already paying for the original offense. This also happens when we continue to remind our children of their mistakes, a situation which creates resentment.

Insulting Officer Almost all children and adults can accept their mistakes and punishment - if the punishment is appropriate for the crime/offense. However, imagine your reaction if you are stopped for speeding and during the process of giving you a ticket for speeding the Highway Patrolman offers comments such as "You're pretty stupid to be going this fast in this worthless automobile. You're probably the worst driver I've seen in months. Your parents obviously didn't raise you right! At this rate, you'll not have a license in six months. Did you get your license out of a gumball machine?"

In this situation, insults are more harmful than the actual punishment. When disciplining children, parents are often angry or upset, creating the temptation to "jab" at the child with insults. A child may learn from his or her mistake and accept an appropriate punishment, but insults continue to hurt long after the punishment is over. Insulting a child creates psychological damage that decreases their self-esteem. Imagine working at a business where your supervisor tells you how ignorant you are each time you make a mistake. You would lose your motivation to work, forget any plans for advancement or success, and develop resentment toward the supervisor and business. Children in trouble often offer comments like "My Dad thinks I'm stupid anyway. My Mom says I can't do anything right!" The idea is to correct - not insult.

The Angry Officer Imagine your reaction when pulled over for speeding, you look in the rear view mirror, and the officer is cursing, angry in appearance, and walking toward your automobile as though he's going to rip the door off your vehicle. Your anxiety level increases and when he asks questions your voice is mumbling, hesitant, and shaky. You are terrified that his anger may come in your direction and for that reason, you "clam up", fearful of making any type of response.

When disciplining children, it's important that we provide our discipline, structure, and interaction without anger and hostility. Being terrified of a parent is not a form of respect - it's a form of intimidation in which violence is respected, not the individual/parent. Discipline provided by an angry parent, often ranging in form from yelling and screaming to physical threats, sends a strong message to children that verbal and/or physical violence and aggression is acceptable - as long as there's a reason and you're upset. Parents who use the yell-and-scream method produce children who yell and scream. As time passes, everyone in the home yells and screams so much that the home is totally out of control by the time the children are teenagers. Those teenagers then mature to yell and scream at their sweethearts, spouses, and eventually their children.

Our best bet, don't discipline your children when you're angry or upset. Remember, it's business - not personal. In all interpersonal interactions, from disciplining children to a professional boxing match, the winner is the individual who maintains control - not the most aggressive or angry.

Summary: Both children and adults learn from mistakes. Corrective action should increase compliance with the established laws and rules of behavior - not harshly punish or intimidate the offender. As in the adult legal system, punishments are designed to fit the crime and discipline is conducted in a business manner. As children misbehave and make mistakes, our job as parents is to guide them in the correct direction. Guiding just about anything is done with a series of small corrections, not intenseshoves or overcorrections.

Home Management Recommendations

Be firm. Establish clear ground rules when the child is young and keep these rules (with whatever needed amendments) on into adolescence. As the child improves in judgment, give him more leeway.

Do not flood the child with petty time-consuming decisions; for example, what dress to wear, what shirt, etc. If he dawdles and shows indecision, them make these decisions for him.

Whenever possible, do consider his opinion in some larger matters; for example, to go to Jimmy's birthday party, to go fishing with friend, etc. If there is no real reason to deny the child, then allow him the option of "yes" or "no." However, many ADHD youngsters will need time to picture the situation and think it through before deciding.

Do not haggle or negotiate or wheedle about small things: an extra TV program, whether or not a helping of a new food is accepted, etc. A decision, even if it's in error, is better than haggling. Have faith in yourself.

Give the child chores by all means: setting the table for supper, helping serve at table; clearing the dishes, making the bed, etc. Boys as well as girls should do these chores. Parents must share their duties and chores with their ADHD child for the child's good. Such activities build self-discipline and a sense of responsibility. Select one or two chores and many calm reminders to get these chores done. Withholding a desired privilege for a short time may be necessary if the child fails to do the chore assigned.

Be prepared to accept the absentmindedness of most ADHD children. These youngsters need to be reminded again and again but without the escalation of irritation when directions or reminders need to be given over and over. When you have to repeat a direction say it each time as though it were the first time. These children are not being willful and stubborn when they can't remember; at this point in time, they just can't keep the many things we expect them to remember at the forefront of consciousness.

Be alert to the ADHD youngsters' absentmindedness in regard to care of tools and other implements, toys, etc. Note where you see the child lay the kitchen shears, saw, hammer, etc. Check later and if the object is still there, give a calm reminder to put it away properly.

Short lists of tasks are excellent to help a child remember. A list is impersonal and reduces irritations and the child will gain satisfaction as he checks off tasks completed.

Many ADHD youngsters seem to "never hear" or to ignore parents' directions and commands. Often these children do not process multiple requests quickly or accurately. Therefore, it helps if the parents first make sure they have the child's attention before making a request. After they've stated their wish in simple, clear, one-concept commands, the child should be asked to repeat what was said. Speaking at a slower rate of speed to the child often is helpful too.

Since many children with ADHD are disorganized, they may sometimes have difficulty relating an event in proper sequence. Family members often need to quietly ask, "Who, what, where, and when" to get the necessary information. Again, a calm, uncritical and not-irritable manner should be the rule.

A common characteristic of many ADHD children is their difficulty in waiting their turn, e.g., in playing a game or when participating in a conversation. Some interruptions when adults are talking may be allowed, for the youngster is impulsive. However, having permitted some infractions of good manners, parents should correct the child sharply if he/she persists in interrupting - send him from the table or discipline him in a similar fashion if he should continue with this behavior.

Do not permit the ADHD child to be unduly loud and noisy in a public place. Do something about it quickly, then and there, even if it is embarrassing for all concerned. Saying "Just wait 'til I get you home" will not help the child and will only make parents feel frustrated.

Routines are helpful for all children and seem to be particularly needed by the ADHD child: a regular time for meals, homework, TV, getting up and going to bed. Each family should find the schedule that suits it best.

In the majority of instances, parents should not try to tutor their own child. It is helpful to a youngster who has problems in reading to have someone in the family read material aloud for content purposes. But to "teach" a child spelling or reading words, or to drill him/her on the concepts of mathematics, is usually unsuccessful. More is lost because of the strained relationships which often result than is gained in improved skills.

Punishment should be: Designed to fit the child and to vary with the offense. The cardinal rule is to "punish behavior and not the child. Generally, physical punishment should be avoided because other forms of discipline (short periods of isolation or withholding privileged activities) focus more on the behavior of the child and less on the child's self-concept. Realistically, however, some physical punishment is likely, and care should be taken to be sure that it is not too severe or prolonged.

Punishment should be of short duration. It must clear the air; the parent should not continue to accuse and grumble, but the child may be allowed to grumble a bit.

Help other members of the family recognize and understand the ADHD youngster's differences. This child can't help being impulsive, loud, forgetful, clumsy, etc. The siblings' patience with their brother or sister who has these problems will be of great assistance to him.

Parents themselves need to come to terms with their child's deficits and strengths. The child with ADHD has a handicap with which he will often need help for many years. Goals should be those that challenge but do not extend beyond his capabilities. If parents can accept their child's assets and liabilities, the child can then begin to accept himself. The siblings' patience with their brother or sister who has these problems will be of great assistance to him/her.

As Attention-Deficit Hyperactivity Disorder (ADHD) involves the neurochemical system, we can expect the child/student to become more excited and "out of control" in certain situations. The more people in a room, the more excited the ADHD child becomes. The more noise or activity in the environment - the more rowdy and talkative. Be prepared for more excited and rowdy behavior in situations in which there is more action or normal excitement - as around the holidays or birthdays.

Children with Attention-Deficit Hyperactivity Disorder (ADHD) have a "quick-draw mouth". Almost any request for performance or activity, taking out the garbage, doing homework, or picking up something - will be met with a quick-draw, fast verbal response. The response is usually a complaint, whine, or other negative comment as in "Why do I have to do it!?" Parents of Attention-Deficit Hyperactivity Disorder (ADHD) children are advised to become deaf for at least 90 seconds after each request of the child - ignoring that verbal reflex they possess. Remember: as Attention-Deficit Hyperactivity Disorder (ADHD) is a neurochemical condition - the longer we discuss something with the ADHD child - the higher his/her excitement becomes. A general rule: All requests are short and their quick-draw response is ignored. Responding to their quick-draw response only prolongs the excitement and makes the child more rowdy or disruptive.

Conclusions

Attention-Deficit Hyperactivity Disorder (ADHD) is a common childhood, adolescent, and even adult condition. ADHD is typically treated with a combination of medications, home management methods, and school techniques. This handout is provided to increase knowledge and understanding of Attention-Deficit Hyperactivity Disorder (ADHD). Other information regarding the medical treatment, educational techniques, and management of ADHD is available in your professional community, local resources, and on the Internet. I hope this handout has been helpful.

Joseph M. Carver, Ph.D.
Clinical Psychologist

Joseph M. Carver, Ph.D., Clinical Psychologist

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Good for conclusion - about combined medication

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ADHD & Ritalin: The Pros, Cons And Natural Alternatives

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Set your child free from learning & behavioural difficulties at the Developmental Learning Centre. Check out our blog on ritalin pros & cons for ADHD today!

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Attention Deficit Hyperactivity Disorder (ADHD) - Southern Cross NZ

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ADHD is a developmental disorder characterised by hyperactivity, inattention, and impulsivity and affects 2-5% of school age children in NZ. Symptoms, diagnosis, treatment.

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Information & Articles About Natural ADHD Treatment

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Integrative medicine combines complementary and alternative medicine (CAM) practices with conventional medicine.

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Chinese Herbs Effective for ADHD - ProgressiveHealth.com

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There are numerous medications and treatment options for children and adults with ADHD. Chinese herbs have been used to treat ADHD in children for thousands of years. Find out more about this unconventional treatment method and its effectiveness below.

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Overview:

Parents and professionals faced with the challenging task of treating ADD and ADHD in children commonly face an unfortunate situation in which behavior problems at home and/or school have placed yet another pressure to opt for medication as the primary treatment.

There is little doubt that the majority of these 'medicated' children will have benefits in their attention span, behavior, and other components of their disorder. And yet, the benefits of medication come with built-in risks from misdiagnosis, side effects, abuse, and unforeseen long-term complications.

Although complementary and alternative therapies have shown promise in treating ADD and ADHD, the task of matching the patient to the most appropriate of these therapies remains elusive to many parents who have explored the options, as well as professionals. Many treating physicians are waiting for better studies, and conventional standards, to help establish appropriate treatment protocols.

This article will explore the potential of herbal medicine as a component of a complementary treatment plan for ADD /ADHD (please see our complete list of other treatments for ADHD).

[ Return to "Quick-Index" for Herbal Medicine & Treatments for ADHD]

Herbal Treatments & the Alarming Increased Medical Use of Stimulants:

The use of herbal medicine in the treatment of ADHD is of high interest to the many families and professionals looking for alternatives to drug therapy. This interest has no doubt heightened in recent years due to problematic and near epidemic-proportion use of stimulants in children. The following review of an alarming trend to medicate ever-increasing numbers of school- and pre-school age children will help serve to emphasize the need for greater research into natural alternative treatments.

Conventional pharmaceutical treatment for ADD/ADHD commonly includes methylphenidate (Ritalin) or amphetamine (primarily Adderall and Dexedrine). Both of the substances are powerful stimulants that have been in the Drug Enforcement Administration's (DEA) Schedule II of the Controlled Substances Act (CSA) since 1971. Schedule II of the CSA contains those substances that have the highest abuse potential and dependence profile of all drugs that have medical utility.

According to the DEA's own records, the production of methylphenidate by the drug manufacturers in this country has increased by more than 500 percent since 1991. The production of amphetamine has increased by over 2,000 percent in the same nine-year period of time. More than 50 percent of the methylphenidate and amphetamine prescriptions are written by pediatritions.

Their data indicate that the number precriptions written for ADHD has increased by a factor of 5 since 1991. In 1998 alone, over 4,000 prescriptions for methylphenidate were written for children 2 years of age or less. (It should be noted that this drug is not approved for use in children under six years of age because safety and efficacy has not been established.)

The use of these medications varies widely from one region and community to another, with some regions identifying up to 20% of the student population receiving stimulants for ADHD.

For a complete text of the information that has been summarized immediately above, please see the "Statement of Terrance Woodworth, Deputy Director, Office of Diversion Control, Drug Enforcement Administration: Before the Committee on Education and the Workforce Subcommittee on Early Childhood, Youth and Families".

Related Links:

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Why are Stimulants Useful in ADD and ADHD?:

There appear to be biological differences in the brains of children appropriately diagnosed with ADD and ADHD. Although diagnosis appears to be fraught with problematic issues for professionals, there does seem to be a general agreement that stimulants will generate significant improvements in many symptom-parameters of ADD/ADHD patients.

A less well known fact is that these stimulants tend to improve most everyone's performance, child or adult - ADHD or not. The potential for the abuse of stimulants is not a new issue. A drug abuse problem now includes college kids, who are, for example, abusing Ritalin to help them in their studies. What may be specific to the ADHD patient however, is their apparent difficulty in achieving and maintaining the type of brain activity normally associated with alert, focused, states of concentrated analytical learning.

This difference can be demonstrated in brain-maps using quantitative electroencephalographic (QEEG) measurements of brain wave activity in the various lobes of the brain. In the frontal lobe, where focused, analytical thinking occurs, ADD/ADHD patients tend to produce an abnormally high amount of alpha-, and/or theta- waves (normally associated with dreamy, eyes-closed states,) and less beta-waves (associated with focused, analytical thinking).

When given an 'eyes-open' challenge involving focused mental calculation or reading, most people will produce less alpha (or theta), and more beta wave. This state of brain functioning appears to be necessary for optimal focused attention and linear problem-solving. When given the same challenge, patients with ADHD appear to be unable to make the appropriate shift into this focused type of brain functioning. Stimulant drugs and EEG Biofeedback Therapy have been shown to bring brain wave activity, reflected in EEG and brain-map data, closer to normal. The patient often experiences a dramatic improvement in the ability to focus thought and pay attention for longer periods of time.

Specific changes in brain function associated with ADD and ADHD have been reported in the literature (see study below). Diminished perfusion (blood flow) and cortical activity are associated with ADHD. Herbal, nutritional and pharmaceutical interventions may be designed to improve such functional parameters of the condition.

RELATED STUDIES:

Herbal medicines have demonstrated effectivenss in their ability to improve blood perfusion to the brain and learning capacity. (See references to specific herbals below, notably Ginkgo and Bacopa). Studies such as the one above may provide indicators and possible mechanisms for herbal therapeutics.

RELATED STUDIES:

As demonstrated in the above study, the effectiveness of stimulant therapy, including indications for specific medication, could be predicted based on QEEG determinations.

It may be important to keep such biological implications in mind when using herbal remedies, because any medication with exclusively sedative or hypnotic actions may fail to produce the desired effects. The effects of herbal medicines in ADHD remains somewhat speculative, especially since practitioners rarely rely on the herbal treatment alone, and very few studies have been published on the prevailing herbal formulas. Research into functional and biological effects of herbal medicine is greatly needed and will help to clarify some of the questions about their appropriate use in ADHD.

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The Use of Herbal Stimulants in ADD/ADHD:

Caffeine, as found in coffee and other herbal stimulants has been proposed as an alternative to stimulant drugs in the treatment of ADD/ADHD. Although herbal practitioners rarely use caffeine or caffeine-containing herbs alone, many of the most popular formulas do contain stimulating components.

The benefit of caffeine stimulation has been addressed in several studies in this population. In general, these studies have demonstrated significant benefits with the administration of caffeine to children with ADD/ADHD. The benefits however have not been without side effects, and have failed to match or exceed those derived from the conventional stimulant medication regimes.

RELATED STUDIES:

It has even been suggested that many ADHD children who go into remission as adults may have learned to self-medicate with regular coffee consumption. In such cases, elimination of caffeine from their diet may actually unmask the underlying ADHD condition. (Dalby JT)

RELATED STUDIES:

The following studies comparing caffeine therapy to Ritalin (methylphenidate) showed similar benefits using low-dose caffeine, and even better results when the two stimulants were combined. It may be important to note that the benefits of caffeine were negated using higher doses.

RELATED STUDIES:

Responses to Methylphenidate and Varied Doses of Caffeine in Children with Attention Deficit Disorder

Garfinkel BD, Webster CD, Sloman L
Can J Psychiatry 1981 Oct;26(6):395-401

Six children with the diagnosis of Attention Deficit Disorder were treated as day hospital patients, using different stimulant medication. They were studied in a double-blind crossover experiment in which they received caffeine in low dose or in a high dose. Methylphenidate was added to both dosages, as well as administered alone.

Results indicated that caffeine in low dosage when added to methylphenidate was superior to all other treatment conditions. Caffeine in low dosage could not be differentiated from 10 mg of methylphenidate.

High dosage caffeine was not different from placebo or no-drug conditions. This study offers evidence to support a curvilinear pattern of dose-response for caffeine, in attenuating the behavioural manifestations of this syndrome.

Individual Responses to Methylphenidate and Caffeine in Children with Minimal Brain Dysfunction

Garfinkel BD, Webster CD, Sloman L
Can Med Assoc J 1975 Oct 18;113(8):729-32

Eight children with minimal brain dysfunction were studied for their individual responses to two stimulant medications - methylphenidate hydrochloride and caffeine citrate. Four types of behavioural responses were observed in the double-blind crossover experiment: four children responded favourably to both psychostimulants, one responded to methylphenidate alone and two responded to the placebo. The behaviour of one child deteriorated while he was taking methylphenidate and caffeine.

In general, methylphenidate was superior to caffeine in diminishing hyperactive and aggressive behaviour. It is apparent that such stimulantmedication exerts... therapeutic effects... and would therefore be useful as one aspect of a complete treatment program for children with this syndrome.

In the following study caffeine failed to show significant benefits compared to conventional stimulant drugs. Herbalists have maintained that use of isolated active ingredients from medicinal plants (in this case, caffeine) risks loss of synergistic benefits of the whole plant or herb.

NEGATIVE CAFFEINE STUDIES:

Caffeine Versus Methylphenidate and D-Amphetamine in Minimal Brain Dysfunction: a Double-Blind Comparison

Huestis RD, Arnold LE, Smeltzer DJ
Am J Psychiatry 1975 Aug;132(8):868-70

The authors compared the efficacy of caffeine, methylphenidate, and d-amphetamine in children with minimal brain dysfunction using a double-blind crossover design.

The slight improvement with caffeine was not significantly better than placebo. Both prescription drugs resulted in significant improvement and were significantly superior to caffeine.

The authors suggest that the discrepancy between these results and an earlier, more optimistic report may stem from the use in this study of pure caffeine rather than whole coffee.

[Editor's note: At the time of some of these earlier studies, the terms "Attention Deficit Disorder (ADD)" or "Attention-Deficit/Hyperactivity Disorder (ADHD)" had not been included in the DSM. The term "Minimal Brain Dysfunction" was one of the diagnostic distinctions that we have now come to describe as ADD (DSM-III) or one of the forms of ADHD (DSM-IV)].

Other studies on caffeine therapy for ADHD have also failed to show clear benefits compared to stimulant drugs or even placebo. (Arnold, LE) (Garfinkel, BD).

Considering the failure of caffeine to demonstrate consistent and reliable benefits, combined with the incidence of caffeine-related side-effects, alternative and herbal practitioners are more likely to recommend herbal formulas designed to provide mild stimulating effects along with other indicated and synergistic actions.

Several herbal formulas that have been used to treat ADHD will be discussed below.

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Other (Caffeine-free) Herbal Stimulants, Brain Antioxidants, and Nerve Tonics:

Studies on the physiological effects of herbs point to potential benefits for several brain, neurological , and performance parameters. Many of these benefits may well extend to ADHD patinets. Several herbal remedies for the nervous system are known for their stimulating effects. Frances Brinker, ND, classifies this category of herbs as 'alertness enhancers', due to their documented effects on nervous system function (Brinker): None of the following herbs contain caffeine.

Ginkgo (Ginkgo biloba)

Ginkgo leaves are remarkable for their ability of their ginkgolide and flavone glycoside-containing extracts to increase local blood flow to brain, bringing greater oxygenation to the tissues, while acting as a neural antoixidant. Ginkgo also improvies brain glucose metabolism, and positively affects levels of amine neurotransmitter substances in the brain. These benefits become more pronounced after prolonged use.
For more information, please see the Alternative Medicine Review, Monograph: Ginko Biloba

Brahmi (Bacopa monniera)

This Ayurvedic herb has a long history of use as a cognitive enhancer. Research shows that it the protects brain from free radical damage even better than the cognitive-enhancing drug deprenyl (Battacharya), while stimulating improved learning and cognitive function (Kidd).

Siberian Ginseng (Eleutherococcus senticosis)

Adaptogenic; helps to modulate stress reactions by normalizing physiological function. The extract stimulates brain activity and causes a more economical release of body energy which results in increased work output. It contains a mixture of eleutherosides A-E, including syriingin (B) and syringaresinol diglucoside (E), which have been shown to diminish stress-caused reductions of strength and memory retrieval. It also benefits growth rates.

The anti-stress effect seems to derive from its antioxidant and steroid metabolism activity on the hypothalamus-pituitary-adrenal endocrine function. It improves adaptation to dimished blood flow to the brain. Siberian ginseng also produces an increase of amine nerve transmitter substances in the brain and adrenal gland.

Gotu Kola (Centella asiatica, also Hydrocotyle asiatica)

These herbs are not to be confused with the caffeine-containg Kola nut. Their triterpenoid glycosides - asiaticoside, madecassoside, and brahmoside - reduce adrenal corticosterone blood levels during stress. They have also been found to be useful for cognitive and nervous disorders and vascular problems of the brain.

Green Oats (Avena sativa)

The fresh green seeds have been used as a mild antispasmotic and nourishing nerve tonic. Its tonic effects are not immediatly stimulating as with caffeine, but are cummulative and resotorative over time with continued use.

Various combinations of sedative and stimulating herbs have been widely used in naturopathic and herbal practice as one aspect of treatment for ADHD. The following herbal formula is similar to many of those being recommended for the treatment of ADHD. It includes both stimulant and sedative herbs. In this study it was used to test effectiveness in the treatment of adult adjustment disorder with anxiety. The formula demonstrated significant benefits in the treatment of anxiety, an interesting finding in that it made use of stimulant herbs.

RELATED STUDIES:

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Herbal Formulas for ADHD:

Herbal tonics and nervines designed for the treatment ADHD are used frequently in the practice of herbal medicine. The herbal formulas presented here reflect both the medical literature, when available, and popular usage, based on the experience and recommendations of authorities in the field.

Chinese Herbs and the Treatment of ADHD:

In the system of traditional Chinese medicine, herbal formulas are used in synergistic combination to nourish and balance the systems of the body. The philosophy of 'restoring balance' lends itself in particular to ADD/ADHD, in which the affected individual suffers from multiple biochemical, neurological, and behavioral symptoms for which there is no clear-cut etiology.

Chinese herbal preparations are traditionally compounded for the individual patient, based on their particular symptom picture.

A chinese herbal formula, called Tiaoshen Liquor, was used to treat children with hyperactivity. Results were very favorable, as summarized below. The authors offered a probable mechanism, based on previous animal studies, suggesting that the improvements noted could be due to improved cholinergic neurotransmitter function, as well as increased tolerance to brain oxygenation problems.

RELATED STUDIES:

Additional evidence of neurotransmitter stimulation with herbs was demonstrated in this study of Chinese herbal treatment of ADHD.

RELATED STUDIES:

In the following study a Chinese herbal formula was compared to a western medicine approach (Ritalin) in a side-by-side clinical trial. The herbal formula performed as well as Ritalin in this trial, with fewer side-effects.

RELATED STUDIES:

Regarding the availability of Chinese herbs, the Chinese herbal formulas tested in the above mentioned studies were not 'traditional' Chinese patent formulas, and therefore would be difficult to reproduce or purchase commercially. It is nevertheless encouraging that several different formulas based on Traditional Chinese herbal system have all demonstrated effectiveness in ADHD.

Although more research is necessary to confirm these findings and generalize them to other herbal formulas, similar Chinese herbal formulas are available or may be compounded by knowledgeable health practitioners.

The following Chinese herbal formulas have been recommended for ADHD by master Chinese herbalists, and are based on available herbal products that are generally recognized as safe.

Recommended Chinese Herbal Formulas:

Dr. Yong Deng, OMD, L Ac, Department Chair of Oriental Medicine at Southwest College of Naturopathic Medicine, has recommended the following formula for the treatment of ADHD with Chinese herbs:

This formula may be used alone or in combination with other herbs or formulas as may be prescribed by a trained practitioner of Chinese herbal medicine.

Formulas are generally available through licensed practitioners, and may be prescribed as herbal decoctions, or in convenient tablets and fluid extracts. Problems with taste may be overcome by adding the extract to a honey or syrup base, or by mixing with fruit juices.

For information on obtaining the Calm Dragon Formula, please contact K'an Herbs at 800-543-5233. Although K'an Herbs does not sell to the public, they can direct you to a professional practitioner who can provide you these products.

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Other Commonly Recommended Herbal Formulas for ADHD:

Herbal treatment for ADHD is varied amongst western herbal practitioners, who commonly recommend dietary changes and nutritional supplements along with combination herbal formulas. Although the effectiveness of the herbal formulas have yet to be evaluated in clinical trials, a review of prevailing recommendations based on authoritative sources reveals some interesting similarities in treatment strategies.

What follows is a sampling of expert recommendations. Note that many formulas contain both relaxing and stimulating components along with synergistic nervines.

Sharol Tilgner, N.D. (Author of: Herbal Medicine from the Heart of the Earth):
The following formula has been recommended for AD/HD. Marketed as ' Liquid Serenity', Dr. Tilgner refers to this as 'antidepressive formula' in her book.

For more information on the availability of this product, please contact:

Wise Woman Herbals
PO Box 279
Creswell, Oregon, 97426
(800) 532-5219

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David Winston, Herbalist AHG & Ethnobotanist (Author of: Herbal Therapeutics: Specific Indications for Herbs and Herbal Formulas):

Focus Formula:

Components of This Formula:
A gentle, yet useful formula for children with hyperactive behavior and attention deficit disorder (ADHD/ADD). Also indicated for general irritability, poor concentration, and restless sleep patterns. Adults can use this formula for poor concentration and restlessness.

Oats, Lemon Balm, and Scullcap are 'nerve tonics' that nourish and normalize the nervous system.

Hawthorne strengthens the heart and circulatory system and in Chinese medicine calms the Shen (Mind).

Ginkgo increases vascular circulation to the brain, improving memory and concentration.

Use 10 -20 drops of the tincture 2 -4 times per day taken in warm milk or chamomile/lemon balm tea. Let the tea sit for 5-10 minutes to evaporate the alcohol.

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Mary Bove, N.D. (Author of: An Encyclopedia of Natural Healing for Children and Infants):

The following formula - Compounded Melissa ~ A Children's Hyperactivity Compound (same as ' Melissa Supreme' ) - has been recommended for ADHD by herbalist, Mary Bove, N.D.:

Components:
This compound contains both nervine and tonic principles which both relax and restore stimulating balance to the functions of the brain and nrevous system. It quiets down the agitation and over-excitability of the nervous system without causing drowsiness.

Authors claim this compound is effective in the treatment of childrens hyperactivity, anxiety, nervous sensitivity, excitability, and attention deficit disorders. As a restorative tonic, this compound may be taken during the daytime to reduce hyperactivity and at bedtime to promote restful sleep. The compound may also be used by adults who exhibit similar difficulties, excessive mental chatter and nervous mental irritation.

Add 20-30 drops of the extract to water or juice and take 3-4 times per day between meals. For best results take the fomula over an extended period of several months or longer.

For more information on the availability of this product, please see Gaia Herbs.

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Herb-Drug Interactions:

Herbal remedies are generally well-tolerated and safe when used according to informed practice guidelines. It is important, nevertheless, that parents, patients and professionals who employ herbal therapies be aware of the potential for side-effects and drug interactions.

The use of tonic and stimulating herbs for ADHD may potentiate the effects of stimulant medication causing side-effects, or necessitate a reduction in the effective dose. The list below includes some common precautions (Brinker):

Coffee (caffeine) :

Possible contraindications (aggravated by excessive dosing):

High-grade inflammation Restless insomnia Heart palpitations Anxiety states

Drug interactions (aggravated by excessive dosing):

Ephedrine (drug, or herbal ephedra: ma huang) with excessive caffeine may cause:
weight loss agitation tremors insomnia

Monoamine oxidase inhibitors (MAOIs):
may cause hypertensive crisis (when combined with excessive caffeine)

Ginseng :

Drug interactions :

Phenelzine:
Concurrent use of phenelzine has resulted in manic-like symptoms

Kava-Kava :

Possible contraindication :

Endogenous depression (due to its sedative activities)

Drug interactions :

Sedatives, Tranquilizers:
May potentiate CNS depressant action

Ma Huang :

Possible contraindications :

Anorrhexia (due to its appetite suppressing effects)Insomnia Suicidal tendencies (may aggravate anxiety, tension, and apprehension)High blood pressure Diabetes (due to its hyperglycemic effects)

Drug interactions :

Coffee, tea, stimulants (caffeine, methylxanthines, theophylline):
potentiates stimulating effects may accelerate undesired weight loss and loss of appetite
Monoamine oxidase inhibitors (MAOIs):
toxicity in combination wait two weeks after discontinuing MAOI drugs before considering Ma Huang

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Precautions about Discontinuing Stimulant Drugs:

Physicians frequently advise against discontinuing Ritalin and other amphetamines abruptly. Withdrawal may cause aggravation of ADHD symptoms, including depression, irritabilty, exhaution, hyperactivity, excitability, psychosis, and suicidal feelings. It is commonly recommended that the medication dose be gradually reduced over the course of several weeks (Breggin).

When embarking on a treatment that incorporates or substitutes herbal medicine it is advised that parents and patients consult with professionals knowledgeable in these approaches as well as in the management of aggravations during the weaning process.

In his book, Talking Back to Ritalin, Peter Breggin reminds us that it may be normal for a child to exhibit heightened behavioral symptoms during the withdrawal phase.

Use of herbal, nutritional and other complementary therapies may help reduce these risks. It is important to provide a child with a sensitive network of support.

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Finding a Practitioner Familiar with Herbal Therapies:

Although a number of medical doctors are being educated in alternative therapies and hospitals are opening centers for complementary and integrative medicine at a rapid rate, it still may be difficult for you to find a physician or licensed professional who is familiar with herbal treatments for ADHD or Traditional Chinese Medicine.

Here are a few resources that may assist you in your search:

Find a Naturopathic Physician:

Use this search engine to locate an N.D. near you. Physicians in this database are members of the American Association of Naturopathic Physicians.

Practitioner Reference Guide:

This is a listing from the Institute for Traditional Medicine of practitioners who practice Chinese medicine and prescribe herbs as part of their practice. It is also a very good resource on Traditional Chinese Medicine and how to choose a practitioner.

Find an Integrative Medicine Practitioner Near You:

This multifaceted search resource allows you to search for practitioners from a great number of alternative therapies. The practitioners' list currently available is provided by American WholeHealth Networks, which is continually expanding their database. At this time [07/20/00], they have a limited directory and may not have a listing for a therapist in your area, but you might want to keep checking for updates and additions

If you have a comprehensive resource list or search engine for practitioners of alternative medicine and wish to have your site included on this page, please write to our Webmaster.

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Summary:

There is a great need to explore alternative treatments for ADHD. As the use of Ritalin and amphetamine in children have increased to alarming proportions, parents and professionals alike are searching for effective alternatives to stimulant drugs. Herbal medicines may offer a safe alternative, especially in combination with complementary therapies.

Although more research is necessary to confirm the implied benefits of commercially available herbal formulas, there are at least a few clinical trials of herbs and herbal extracts, notably Chinese herbal formulas, that have shown promising results in this arena.

References:

Arnold LE, Christopher J, Huestis R, Smeltzer DJ; Methylphenidate vs Dextroamphetamine vs Caffeine in Minimal Brain Dysfunction: Controlled Comparison by Placebo Washout Design with Bayes' Aanalysis. Arch Gen Psychiatry 1978 Apr;35(4):463-73

Amen DG, Carmichael BD; High-Resolution Brain SPECT Imaging in ADHD. Ann Clin Psychiatry 1997 Jun;9(2):81-6

Bhattacharya SK, Bhattacharya A, Kumar A, Ghosal S; Antioxidant Activity of Bacopa monniera in Rat Frontal Cortex, Striatum, and Hippocampus. Phytother Res 2000 May;14(3):174-9

Bove, Mary; An Encyclopedia of Natural Healing for Children and Infants; 1996, Keats Pub

Breggin, Peter;Talking Back to Ritalin; Common Courage Pr; 1998

Brinker, F; Formulas For Healthful Living; Eclectic Medical Publications, 1995; pp 115-18

Brinker, F; Herb Contraindications And Drug Interactions, Second Edition ; Eclectic Medical Publications, 1998

Chabot RJ, Merkin H, Wood LM, Davenport TL, Serfontein G; Sensitivity and Specificity of QEEG in Children with Attention Deficit or Specific Developmental Learning Disorders.Clin Electroencephalogr 1996 Jan;27(1):26-34

Dalby JT; Will Population Decreases in Caffeine Consumption Unveil Attention Deficit Disorders in Adults? Med Hypotheses 1985 Oct;18(2):163-7

Garfinkel BD, Webster CD, Sloman L; Individual Responses to Methylphenidate and Caffeine in Children with Minimal Brain Dysfunction. Can Med Assoc J 1975 Oct 18;113(8):729-32

Garfinkel BD, Webster CD, Sloman L; Responses to Methylphenidate and Varied Doses of Caffeine in Children with Attention Deficit Disorder. Can J Psychiatry 1981 Oct;26(6):395-401

Huestis RD, Arnold LE, Smeltzer DJ; Caffeine Versus Methylphenidate and D-Amphetamine in Minimal Brain Dysfunction: a Double-Blind Comparison. Am J Psychiatry 1975 Aug;132(8):868-70

Kidd PM; A Review of Nutrients and Botanicals in the Integrative Management of Cognitive Dysfunction. Altern Med Rev. 1999 Jun;4(3):144-61. Review.

Schechter MD, Timmons GD; Objectively Measured Hyperactivity - II: Caffeine and Amphetamine Effects. J Clin Pharmacol 1985 May-Jun;25(4):276-80

Sun Y, Wang Y, Qu X, Wang J, Fang J, Zhang L; Clinical Observation and Treatment of Hyperkinesia in Children by Traditional Chinese Medicine. J Tradit Chin Med 1994 Jun;14(2):105-9

Tilgner, S; Herbal Medicine from the Heart of the Earth; 1999; Wise Acres Press; pp 216-17.

Wang LH, Li CS, Li GZ; Clinical and Experimental Studies on Tiaoshen Liquor for Infantile Hyperkinetic Syndrome. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 1995 Jun;15(6):337-

Winston, David; Herbal Therapeutics, Specific Indications for Herbs and Herbal Formulas, 6th ed.; Herbal Therapeutics Library; 1999; pp14-15

Woodworth, T (DEA rep) ; Committee on Educ and Workforce, 106th Congress, 2nd session; Sub-committee on early Childhood, Youth, and Families Hearings, "Ritalin Use Among Youth: Examining the Issues and Concerns" May 16, 2000

Zhang H, Huang J; Preliminary Study of Traditional Chinese Medicine Treatment of Minimal Brain Dysfunction: Analysis of 100 Cases. Chung Hsi I Chieh Ho Tsa Chih 1990 May;10(5):278-9, 260

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Treatments for Children with ADHD: Herbal Medicine & Chinese Herbs

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A complete review of herbal therapies for ADHD. Traditional Chinese Medicine and herbs as an alternative for stimulant drug treatments - including Ritalin - for children with attention deficit hyperactivity disorder or ADD.

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Attention deficit hyperactivity disorder is a common neurodevelopmental disorder. Children with ADHD may be more active and more easily distracted than others.
There are both strengths and challenges associated with ADHD. For example, children with ADHD may be creative thinkers with high motivation for activities that are interesting to them, but their difficulties with attention and planning may make it hard for them to begin or complete schoolwork and chores. Their behaviour may also be affected if they have trouble regulating their emotions or if they often act without thinking.

Diagnosis and treatment can help support children with ADHD to develop strategies, expand on personal strengths and learn specific skills for navigating these challenges.

Of course, all kids (especially younger ones) act in a busy, distracted and energetic way at times, particularly when they're anxious or excited. But the difference with ADHD is that symptoms are present over a longer period of time and occur most of the time. They affect the child's ability to function socially, at school, and at home.

In the past, we used the term ADD (attention deficit disorder) to describe children who had extreme attention challengers but were not hyperactive. ADD is now called "inattentive ADHD" and children with this condition may seem to be often lost in a daydream. In a classroom, these children are in danger of being overlooked, because the children who have hyperactivity within ADHD cannot fail to get noticed.

It is important to support children with ADHD to develop their self-esteem. Some children with ADHD experience negative comments from teachers or family/whānau regarding their behaviour or school achievement. This can make them feel "not good enough". Adults can encourage children with ADHD by acknowledging and celebrating their unique talents, skills and efforts.

With proper treatment and support, kids with ADHD can learn to successfully live with and manage their symptoms.

Boys are about three times more likely than girls to be diagnosed with ADHD. Experts now believe this is because girls tend to display less of the "disruptive" signs of ADHD, not because they are less likely to have ADHD, meaning they are in danger of being overlooked and missing out on important support.

ADHD often occurs with other childhood mental health conditions. These may exist alongside or develop as a result of ADHD. For example, some children with ADHD have conduct disorder or experience anxiety or depression.

Learning difficulties that are not recognised or taken notice of present a risk for mental health problems, as they affect progress at school and self-esteem. Likewise, without support in emotional regulation and problem-solving skills, children with ADHD can find interacting with peers difficult, which is another risk factor for mental health challenges.

For teenagers, ADHD and its associated challenges are serious if untreated because they can put young people at risk for accidents, drug or alcohol abuse problems, or suicidal thoughts and behaviours. Providing ongoing support and treatment options can increase the safety of young people with ADHD and provide strategies for managing any mental health challenges.

Even though a lot of research into ADHD has gone on around the world, the exact cause is still unknown. What is known is that ADHD is not caused by poor parenting, too much sugar or vaccines.

There is thought to be a genetic element to most ADHD; that is, it runs in families. Studies have shown that brothers or sisters of children with ADHD are two to three times are likely to have it as well.

Studies of brain scans show that children with ADHD seem to have brain circuits that are wired a little differently from other people. This means they have trouble using executive functioning skills: attention, working memory, time management, organisation, planning, initiating tasks and self-monitoring.

Research into children with ADHD has also found irregularities in their levels of dopamine and norepinephrine, chemicals in the brain that influence mood. This can make it very difficult for a child with ADHD to complete a task that they find less stimulating, such as a project that takes a long time and isn't of great personal interest to them.

Likewise, these differences in brain chemistry might mean highly stimulating activities like social media, gaming, risky behaviour and arguments can be more appealing to children with ADHD.

Understanding these physical differences can help adults to support children with ADHD through learning tasks and personal challenges, at home and school.

Signs to look for (symptoms)

A child with ADHD will have some or all of the following signs:

As babies and infants:

being colicky, restless, and hard-to-cuddle babies and poor sleepers

crawling or walking earlier than other children

having lots of energy and being constantly on the go - they seem unable to sit still even if they are enjoying doing something

having a short attention span and not following through what they set out to do.

At school:

tuning out or appearing to daydream, especially when being given instructions

talking a lot, interrupting others and being unable to wait for their turn

having trouble with the work and often giving the impression they have not heard the teacher's instructions

having trouble starting a task on their own or completing one without regular one-on-one support

frequently calling out in class or a group and being known as the 'class clown'

doing dangerous and impulsive things, like jumping from heights or running out onto the road without looking out for traffic

acting before they think

being easily upset

getting angry and "exploding" quite easily

finding it hard to make and keep friends, usually because they are seen as bossy.

It's important that children with ADHD get support early in life, and throughout each life stage, so they can learn to manage their ADHD and develop the skills and confidence they will need to lead a successful adult life.

There is no single medication, intervention or strategy that can make ADHD "disappear", but ADHD behaviours/symptoms can be reduced and managed well by providing ongoing support that works well for the individual child.

If you believe your child has ADHD, the first step is for them to be assessed by a specialist. You can ask your GP for a referral to a specialist under the public health system, which will be free of charge but may mean waiting some time for an appointment, or you can contact a private specialist directly, which will incur a cost but may mean you can get an assessment sooner.

If your child is diagnosed with ADHD, the specialist will then work with you to create a treatment plan. ADHD is a complicated condition, generally best managed by a mixed treatment programme, which may include the following components:

Stimulants are the main kind of medication used in the treatment of ADHD. These are used to help your child concentrate better, be less impulsive, feel calmer and be able to learn and practise new skills. In fact, the same medications are used for both children and adults.

It's important that the progress of a child on medication for ADHD is checked and the treatment reviewed regularly with your doctor.

If your child is prescribed medication you are entitled to know:

the names of the medicines

what symptoms they are supposed to treat

how long it will be before they take effect

how long the child will have to take them for and what their side effects are (short and long term).

Talking therapies and counselling

These are talk-based therapies which look at the child or young person's thinking, behaviour, relationships and environment.

For ADHD, these treatments include behaviour management and social skills training to help support your child at home and at school. It's important that children are encouraged to develop and learn coping behaviours and skills, and parents and teachers play a key role to help them learn and practise these new skills.

Family counselling can also play an important part in helping everyone in the family understand the condition and support the child, providing the counsellor has good knowledge of ADHD. Check this with the counsellor before starting.

Any therapy/counselling should be provided to children, adolescents and their families/whānau in a manner that is respectful of them, and with which they feel comfortable and free to ask questions. It should be consistent with and incorporate their cultural beliefs and practices.

Other strategies to support a child with ADHD

Complementary therapies

Health and healing practices are varied and differ according to how people view illness. Any health-related practice that increases your child's sense of wellbeing or wellness is likely to be of benefit.

The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and which may be used to complement and support it.

Complementary therapies can include using a number of herbal and other medicinal preparations to treat particular conditions.

When considering taking any supplement, herbal or medicinal preparation, consult a doctor to make sure it is safe and will not react with other medication.

Ways to support a child with ADHD at home

For family/whānau of someone with ADHD, the following strategies are useful:

Make sure there are everyday routines in the home. Most children respond to predictability and structure. Routines help the child to know what the rules are around getting up, showering, mealtimes, homework, going to bed and playing. If a child has to navigate this themselves, it increases the demands placed on them, which can be overwhelming for someone with ADHD. Setting up clear structure can help by creating one routine, rather than several tasks to remember. To support this, your child may need a reminder list or picture chart for some things.

Give instructions clearly and one at a time, so your child knows exactly what's expected. It will be less time-consuming in the long run to look your child in the eye when you ask them to do something and check they have heard and understood the request by asking them to repeat what you've said. Instructions such as "please put these toys in your room" (a specific request) will work better than "tidy your room" (a general and, to the child, confusing request).

Teach and encourage your child to insert a pause before acting. The act of stopping and breathing first will help your child to pause and think things through before acting. Consider what will work best for your child in teaching and practising this. For example, if your child likes cars, they could practise holding a small toy car in their pocket, slowly feeling the sides and wheels of it as they pause and breathe.

Encourage your child to talk about their life - the good things and the not so good. You may be able to help them with a problem, and it's important to keep the communication going. Build trust with your child by remaining calm and empathetic when discussing challenges. Problem-solve together and model useful conversations and strategies to use. On topics your child has more experience and confidence in, gradually step back so they can learn to problem-solve more independently, with support from you.

Build on your child's strengths. Find something your child does well, is interested in or enjoys doing. It is vitally important for them to experience success. This may mean the whole family/whānau takes up rollerblading! Physical activities that can be done in short bursts may work out better than organised sports for the child with ADHD.

Be positive about any successes, even if they don't complete a task. It is better for a child's self-esteem if you say that you noticed how hard they tried to do something, rather than to comment on how they didn't do it properly or finish it.

If your child raises one of their challenges with you, assure them that everyone has things they find easier and harder. (You can point to examples of this in yourself to normalise and model acceptance of this.) Ask them if they would like more support in those areas, and problem-solve together how you can help them learn more in this area.

Take care of yourself and other relationships. At times, a child with ADHD demands more time and attention, and siblings can feel resentful or left out. Try and make sure that their needs are met and use all the help you can get from extended family/whānau and community for babysitting, time-out, or having fun. Consider your own wellbeing, and create a self-care plan that supports your mental health. Marriages can be put under a lot of stress, so it may be helpful to consult a counsellor or family therapist to work out the best ways of living with a child with ADHD, keeping your partnership healthy and the rest of the family/whānau happy.

Ways to support a child with ADHD at school

It's best to keep up with your child's school programme and inform the teacher of any changes in behaviour or treatment. A home-to-school notebook is a good idea, in addition to meetings to create solutions to any current challenges. It's important that the school understands your child's strengths, interests, goals and areas for support. Some teachers know quite a lot about ADHD − others don't, so as a parent you may have to help with the teacher's education!

Talk to the school about getting assistance from the Ministry of Education's Learning Support Service for help with your child's classroom behaviour and learning needs.

The following strategies can be useful to support children with ADHD in school:

have the child sit in an area with as little distractions as possible - not beside a busy window or at the back of the classroom

use lists, reminders and predictable schedules

break tasks, information and instructions into small chunks

provide close support with each new task, gradually stepping back so the child can become more and more independent

set short, realistic time frames for how long the child is expected to focus for, and extend this time gradually where appropriate

include the child's personal interests in the curriculum as much as possible

include "doing" activities like play-based activities and field-based learning

provide lots of opportunities for physical exercise

if required, create a behavioural management programme with clear rules, goals and supports.

As a parent or caregiver, you are your child's best advocate at school and in dealing with health professionals, because you know your child best. Help teachers and health professionals understand your child, so the best solution can be worked out for them. Don't forget, too, that children themselves are often able to tell adults what is most helpful to them.

Thanks to Kiera Mintoft-Jones, educational psychologist, for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.

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Learn about ADHD, signs to look for, how your doctor determines if your child has ADHD and treatment options.

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Western Medicine and Ayurvedic Philosophies and the Use of Stimulants to Treat ADHD Western Treatment cont. Children with mild cases of ADHD can benefit from behavioral therapy Children should try to stick to a routine, stay organized, and limit distractions Parents should reward good behavior and use discipline techniques effectively So what do we think?