Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are neurodevelopmental disorders, affecting both children and adults, are typically associated with challenges in maintaining attention, hyperactivity, and impulsive behavior.
However, the narrative around ADD and ADHD is predominantly shaped by conventional medicine, often overlooking the potential benefits of a holistic, alternative approach to understanding and managing these conditions.
In this new series of articles we’ll be diving deep into this subject. Then stems from seeing several adults friends recently diagnosed with these issues, and in several cases getting on medications that really did help them. As is typical, throughout this series I’ll cover the conventional outlook and treatment as well as the holistic outlook and alternatives, and herbs that may be helpful.
Buckle in, this will be a comprehensive ride through the territory.
ADD and ADHD Symptoms and Diagnosis
Attention Deficit Disorder (ADD) and Attention Deficit Hyperactivity Disorder (ADHD) are neurodevelopmental disorders characterized by a range of behavioral symptoms.
ADHD is the official diagnosis, which can be divided into three subtypes: predominantly inattentive, predominantly hyperactive-impulsive, and combined.
- The inattentive type of ADHD, formerly known as ADD, is often used to describe those who have trouble focusing but aren’t necessarily hyperactive or impulsive.
- Hyperactive-impulsive ADHD obviously includes symptoms of excessive energy and impulsive actions.
- The combined type exhibits a mix of both inattentiveness and hyperactivity/impulsivity.
However, these symptoms can vary significantly from person to person. Plus, how these symptoms manifest can vary greatly. For example, inattention might look like forgetfulness in daily activities, while hyperactivity might be evident in constant fidgeting or an inability to remain seated.
Signs of inattention may include challenges with:
- Paying close attention to details or making seemingly careless mistakes at work or during other activities
- Sustaining attention for long tasks, such as preparing reports, completing forms, or reviewing lengthy papers
- Listening closely when spoken to directly
- Following instructions and finishing duties in the workplace
- Organizing tasks and activities and managing time
- Engaging in tasks that require sustained attention
- Losing things such as keys, wallets, and phones
- Being easily distracted by unrelated thoughts or stimuli
- Being forgetful in daily activities, such as paying bills, keeping appointments, or returning calls
Signs of hyperactivity and impulsivity may include:
- Experiencing extreme restlessness, difficulty sitting still for extended periods, and/or wearing others out with one’s activity
- Fidgeting with or tapping hands or feet or squirming in seat
- Being unable to engage quietly in leisure activities
- Talking excessively
- Answering questions before they are asked completely
- Having difficulty waiting one’s turn, such as when waiting in line
- Interrupting or intruding on others
Diagnosis is usually based on a detailed history of the individual’s behavior across different settings and may involve input from others. Note that it is based completely on symptoms with no sort of physiological testing involved.
Prevalence and Demographics
ADHD symptoms typically emerge in early childhood, often by the age of 7. However, diagnosis can occur at any age, and symptoms can persist into adulthood.
Historically, ADHD has been diagnosed more frequently in boys than in girls, partly due to the overt nature of hyperactivity symptoms often seen in boys. However, girls with the disorder, often presenting more inattentive symptoms, may be underdiagnosed.
The global rate of ADHD is said to be 2.2% of people in 2017. As covered here, some countries have a lot more diagnosed than others.
The increase in diagnosis is occurring. In the USA, the following numbers were reported:
Exploring Daniel Amen’s Perspectives on ADD/ADHD
Dr. Daniel Amen is a well-known psychiatrist and brain disorder specialist who has contributed significantly to the understanding of ADD/ADHD through his books and research. His unique approach to categorizing ADD/ADHD into distinct types is particularly notable. He Amen emphasizes that ADD/ADHD is not a one-size-fits-all disorder and that understanding its different types is crucial for effective treatment. He identifies several distinct types of ADD/ADHD in his work, each with its own set of symptoms and characteristics.
- Classic ADD: Characterized by the core symptoms of inattentiveness, distractibility, hyperactivity, and impulsivity. This type is what most people typically associate with ADHD.
- Inattentive ADD: Individuals with this type are not hyperactive or impulsive but struggle with sustaining attention. They may appear daydreamy and easily distracted.
- Overfocused ADD: Here, individuals have trouble shifting attention and tend to get stuck in negative thought patterns or behaviors. They may show symptoms of excessive worry and difficulty coping with change.
- Temporal Lobe ADD: This type is associated with issues in the temporal lobes of the brain, leading to symptoms like quick temper, aggression, and sometimes memory problems.
- Limbic ADD: Characterized by moodiness and low energy. Individuals with Limbic ADD often appear chronically sad or have a negative mindset.
- Ring of Fire ADD: Described as a more severe form of ADD, it involves multiple areas of the brain. Symptoms can include extreme distractibility, aggression, and hypersensitivity to noise, light, or touch.
- Anxious ADD: Individuals with this type experience high levels of anxiety and tension alongside typical ADD symptoms. They are often overwhelmed by physical or emotional stress.
By categorizing ADD/ADHD into these types, Dr. Amen argues for more personalized treatment approaches. For instance, treatments for Classic ADD might focus on stimulating underactive brain regions, whereas Overfocused ADD might be treated with strategies to reduce excessive mental activity.
For those seeking a deeper understanding of ADD/ADHD and its management, exploring Amen’s types may provide valuable insights and guidance. Again, you can see his book Healing ADD Revised Edition: The Breakthrough Program that Allows You to See and Heal the 7 Types of ADD.
Conventional Understanding and Treatment of ADHD
In conventional medicine, ADHD is often viewed as a disorder of brain function related to the regulation of a particular set of neurotransmitters, namely dopamine and norepinephrine. The focus is largely on the neurobiological underpinnings, with less emphasis on environmental or holistic factors.
As with most diseases in conventional understanding, a large genetic component is attributed to ADHD. The research includes twin and family studies, heritability and several genes implicated in its development. Many of these genes are involved in the dopaminergic system, which is crucial in regulating attention and behavior. For example, variants of the DRD4 gene (dopamine receptor D4) and the DAT1 gene (dopamine transporter) have been consistently associated with ADHD in multiple studies.
Research also focuses on gene-environment interactions, investigating how genetic predispositions might interact with environmental factors such as prenatal exposures, early life adversity, or educational experiences to influence the risk of developing ADHD. (More on environmental factors to be discussed in the next article.)
Whether due to genetics, environment or other factors, ADHD is attributed to imbalances in brain chemistry, particularly in neurotransmitter systems, that are causative of symptoms.
Common ADHD Medications and Their Side Effects
The most frequently prescribed medications for ADHD are stimulants, notably methylphenidate (commonly known by brand names like Ritalin or Concerta) and amphetamine-based stimulants (such as Adderall).
These medications work by increasing the levels of dopamine and norepinephrine in the brain, neurotransmitters that play key roles in attention and concentration. By enhancing these neurotransmitters, stimulant medications help improve the core symptoms of ADHD, such as inattention, hyperactivity, and impulsivity. They are known for their quick onset of action and effectiveness in improving focus, organizational skills, and impulse control.
While these medications are effective for many individuals with ADHD, they can have side effects. These include sleep disturbances (such as insomnia), decreased appetite leading to weight loss, headaches, stomachaches, and potential cardiovascular effects like increased heart rate and blood pressure. Psychological side effects can include mood swings, increased anxiety, and in rare cases, symptoms resembling paranoia.
There is also consideration regarding the long-term use of stimulant medications, including the potential for dependency. This necessitates careful monitoring by healthcare providers.
Non-stimulant medications like atomoxetine (Strattera) offer an alternative for managing ADHD, particularly in cases where stimulant medications are not effective, are contraindicated, or cause intolerable side effects. They are also used when there is a concern about the misuse or abuse of stimulant medications. Atomoxetine works differently from stimulants. It primarily increases levels of norepinephrine and, to a lesser extent, dopamine in the brain, but it does so in a more gradual and steady way compared to stimulants.
The side effects of non-stimulant medications can differ from those of stimulants. They include fatigue, nausea, decreased appetite, and in some cases, mood changes like irritability or depression. Atomoxetine also carries a warning about the potential increase in suicidal thinking, especially in children and adolescents, which requires close monitoring.
Behavioral Therapies in Conventional Treatment
Cognitive-Behavioral Therapy, or CBT, is a common non-pharmacological treatment for ADHD, focusing on changing negative patterns of thinking and behavior.
Research indicates that while CBT doesn’t necessarily reduce the core symptoms of ADHD, such as inattention, it significantly helps with the emotional and psychological challenges that often accompany ADHD, like low self-esteem and anxiety.
Other behavioral interventions include techniques like behavior modification, organizational skills training, social skills training, often used in children to help manage symptoms in school and at home. For children, educating parents and doing family therapy is also used.
Many experts agree that a combination of medication and behavioral therapies is often the most effective approach, highlighting the need for comprehensive, individualized treatment plans.
In this first article in this series, we have explored the conventional understanding and treatment of ADD/ADHD, focusing on the medical perspective, common medications, their side effects, and behavioral therapies. While these treatments are effective for many, the varying responses to medication and the complexity of the disorder necessitate a broader look at alternative and complementary approaches, which we will discuss in the following article.