ATTENTION DEFICIT DISORDER

actually this is my english writing yesterday semester, but i think this information is important to you know. lets read it..

WHAT IS ADD?

Attention-deficit disorder (ADD) is a developmental disorder usually diagnosed in childhood disorder characterized by the individual attention and impulsive behavior.

 To be able to diagnose this disorder, patients must show the existence of one or more interference in daily activities, including interpersonal relationships, education, employment, cognitive function and adaptation.

 It could be a new ADD diagnosed in adulthood, but the symptoms have been since childhood, typically before age 7 years.

The diagnosis of ADD should not be made quickly. It should include information from a variety of significant adults in the child's life including the parents, teachers, physician, and psychologist who specializes in the field, as well as input from the child. It may also be helpful to have a learning specialist involved since ADD children frequently have special education needs such as giftedness or difficulty in math. As research continues, some specialists are encouraging people to think of ADD not as a disorder, but simply as a different style of learning which, when supported, can enhance the student's innate abilities.

It is not unusual for ADD children with high intellectual abilities to go undiagnosed until middle school or junior high since they have learned how to compensate enough to "get by" in elementary school (Goldstein, 1992). When a student is diagnosed later in life, research shows that elementary teachers’ reports had often attributed these students’ inattention and inconsistencies to boredom, laziness, or behavior problems. However, the increased demands of secondary school make it difficult for even the brightest student to keep up both academically and socially. An accurate evaluation with appropriate support becomes essential for these students to help them fulfill their potential and increase their self-esteem, which may have already been damaged by behavior problems or poor social relationships.

But, until now not clear what factors can cause the emergence of ADD, although more research is done in the field of neurology and genetics seem to show a little bright spot. Many researchers suspect genetic and biological factors as the cause of ADD, although the environment in which children grow and also help determine the specific child's behavior.

Studies on brain images show which parts of the brains of children with ADD who do not work and cause malfunction of that part is not yet known, but may be related to multiple gene mutations. In addition to genetic factors, there are several factors that are often said to have contributed in the emergence of ADD, including: premature birth, alcohol consumption and tobacco (cigarettes) during pregnancy, exposure to high levels of lead in, and brain damage before birth. Several more parties claim that food additives, sugar, yeast, and the pattern of care that can come up with ADD dry, but this is less an opinion supported by facts and accurate data (Barkley, 1998; NIMH, 1999).

          Attention Deficit Disorder children will have a number of challenges to face as they try to cope with time management skills and self-control. If they are not treated at all for ADD, they are likely to carry it into adulthood and if they are treated with ADD psychostimulants, as the majority are, they are not going to be cured and there is still a risk of substance abuse

EPIDEMIOLOGY OF ADD

In various epidemiological studies had been done, found prevalence rates ranging from 3-11%. Figures for the prevalence of ADD in Central Jakarta is 4.2%. Based on research Saputro D (2004) using the instrument of Diagnostic and Statistical Manual for Mental Disorders IV (DSM-IV) found figures of 2.2% for hyperactive and impulsive type, a mixture of 5.3% for hyperactive-impulsive type and inatensi, and 3.15% for ADD inatensi type. More common in males, the ratio of male: female 3:1 to 5:1. In Unitated Stated 3-5% in people with ADD under the age of 19, as 2% and as high as 14% among school aged children. The frequency of the diagnosis differs between male children (10%) and female children (4%) in the United States

 Nevertheless the number of cases that came to seek treatment is generally still very low due to the knowledge and awareness of parents, teachers and surrounding communities are still very low.

SYMPTOMS OF ADD

Symptoms are typically seen early in a child’s life, often when he or she enters a school setting. In order to meet the diagnostic criteria for ADD symptoms must be more excessive than what would be appropriate for an individual’s age and developmental level. Problematic behaviors associated with ADD may continue into adolescence and adulthood.

There are main symptoms and common symptoms in ADD. Included in the main symptoms are Inattention and Problem of Cognition. This is mostly characteristic of children with ADD. This inattention can give effect to intelegent and make problem of cognitive.

INATTENTION AND COGNITIVE PROBLEM

Individuals who are inattentive have difficulty staying focused and attending to mundane tasks. They are easily distracted by irrelevant sights and sounds, shift from one activity to another, and seem to get bored easily. They may appear forgetful and even spacey or confused as if “in a fog.” Organizing and completing tasks is often extremely difficult, as is sorting out what information is relevant versus irrelevant. An individual with inattentive symptoms may have great difficulty keeping up with items, frequently losing things and living life in a disorganized way. Time management is also often an issue. Inattentive behaviors are sometimes overlooked because they are often harder to identify and less disruptive than hyperactive and impulsive symptoms. An individual with the predominately inattentive type of ADHD may even appear sluggish, lethargic and slow to respond and process information.

Inattention and cognitive problem may not become apparent until a child enters the challenging environment of school. In adults, symptoms of inattention may manifest in work or in social situations. Symptoms including inattention are easily distracted by irrelevant stimuli and frequently interrupting ongoing tasks to attend to trivial noises or events that are usually ignored by others, inability to sustain attention on tasks or activities, frequent shifts from one uncompleted activity to another, disorganized work habits.

Symptoms including cognitive problems are difficulty paying attention to details and tendency to make careless mistakes in school or other activities; producing work that is often messy and careless, difficulty finishing schoolwork or paperwork or performing tasks that require concentration.

PROBLEM SOCIAL AND ANXIETY

Meanwhile for the other symptoms are Problem social and anxiety & depression. Children with ADD, are very vulnerable to social problems, their attention is often diverted to different things, so that they can not focus in a social activity with people. They will usually forgetfulness in daily activities for example forgetting to bring lunch, frequently switch from conversation, not listening to others, not keeping one's mind on conversations, and not following details or rules of activities in social situations

Anxiety & Depression very common for anxiety and/or depression to be mistaken for ADD, especially when children are involved.  Both conditions have a very dramatic impact on the ability to concentrate and on a person's memory.  A depressed person not only has trouble with concentration and is forgetful, but may be too demoralized to do much about it.  An anxious person may blank out in mid-sentence and worry a great deal about their failures. Both conditions affect sleep.  An anxious person may have trouble falling asleep, being too keyed up. A depressed person might sleep too much, or perhaps wake up too early.  Some researchers believe that if the condition is chronic, the brain may change permanently, affecting functions such as memory and the ability to learn.]

Anxiety and depression often occur together and some people may have some level of one or the other most of their lives, if not treated.  Anxiety and depression can also be induced by life experiences, especially in susceptible people.   A child who is being shunned and teased by all his classmates is a prime candidate.   A battered woman is another. 

Technically, if ADD symptoms are caused by anxiety or depression, the condition should not be classified as ADD.  In reality, there is not usually enough detective work done to rule out depression or anxiety.  Moreover, ADD may be viewed as the CAUSE of the anxiety or depression.  You may have read that most people with ADD suffer from anxiety and depression. 

It is important to rule out anxiety and depression before being treated with stimulant medications because these medications can make both conditions worse, especially anxiety.  In fact, stimulants alone can induce anxiety.   If anxiety and depression are a major piece of the puzzle, then it is probably safer to start with medications such as the SSRs (Paxil, Prozac, Zoloft, etc.).

If anxiety and depression have been caused by some sort of 'real world' situation, then by all means have the situation corrected if at all possible. Don't substitute medications.  Parents should be alert to school problems -- some children are hesitant to tell adults about trouble they are having with peers.  If there are serious problems, then by all means pull the child from school.  Try another school if possible or homeschool.  I have seen kids who were almost suicidal change overnight, without medications, after they were removed from a bad situation at school.

Anxiety often causes the following problems:

1.    restlessness or feeling keyed up

2.    being easily fatigued

3.    difficulty concentrating or mind going blank

4.    irritability

5.    muscle tension

6.    sleep disturbance (difficulty falling or staying asleep, or restless unsatisfying sleep)

Again, do not take stimulants if anxiety is your problem!   In fact, be sure to cut back or eliminate caffeine, decongestants and any other type of stimulant you may be exposed to.  Caffeine alone can induce not only anxiety, but panic attacks in people.  Leave it alone! Reactive hypoglycemia can also cause anxiety as blood sugar levels fall.  If you suffer from "sugar crashes", a change in diet may be warranted.

Depression may cause any of the following:

1.    depressed mood

2.    irritability

3.    sleep problems (too much sleep or insomnia)

4.    difficulty concentrating, inability to think or make decisions

5.    loss of all interest and pleasure

6.    appetite or weight changes

7.    fatigue

8.    self reproach

MEDICAL TREATMENT THERAPY

We can give treatment therapy for ADD kids or adult with 3 ways, medication therapy, behavior therapy, and nitrition and diet therapy.

MEDICATION THERAPY

Medication can help reduce the symptoms of hyperactivity, inattentiveness, and impulsivity in both children and adults with ADD.

Stimulants are the most common type of medication prescribed for attention deficit disorder. They have the longest track record for treating ADD and the most research to back up their effectiveness. The stimulant class of medication includes widely used drugs such as Ritalin, Adderall, and Dexedrine.

Stimulants are believed to work by increasing dopamine levels in the brain. Dopamine is a neurotransmitter associated with motivation, pleasure, attention, and movement.

For many people with ADD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors.

Stimulants for ADD come in both short and long-acting dosages. Short-acting stimulants peak after several hours, and must be taken 2-3 times a day. Long-acting or extended-release stimulants last 8-12 hours, and are usually taken just once a day.

The long-acting versions of ADD medication are often preferred, since people with ADD often have trouble remembering to take their pills. Taking just one dose a day is much easier and more convenient.

Stimulant medications may also cause personality changes. Some people become withdrawn, listless, rigid, or less spontaneous and talkative. Others develop obsessive-compulsive symptoms.

Many individuals take stimulants with few side effects. Others experience mild problems and some are unable to tolerate stimulants. Often we can treat annoying side effects so the individual can continue to take the stimulant.

• Reduced appetite

This effect may be worse in the very young. It may improve after several weeks or months. If it continues to be problematic, one may reduce the dose; or time a short-acting stimulant to wear off before mealtimes. In some cases we resign ourselves to a eating a large breakfast and supper along with a small lunch.

• Headache

If this does not improve with time, we may reduce the dose or switch to another stimulant.

• Jittery feeling:

Eliminate caffeine or other stimulant-type medications. A small dose of a beta-blocker (a type of blood pressure medication) can block tremor or jitters.

• Gastrointestinal upset

 Take the medication with meals or eat smaller, more frequent meals.

• Anxiety

If an individual is anxious, the stimulants can exacerbate the symptoms. The treatment of this side effect is similar to that of depression.

• Blood glucose changes

Individuals with diabetes mellitus or borderline glucose tolerance may experience a rise in blood sugar. Such individuals can often take stimulants but may need closer monitoring.

• Increased blood pressure

Stimulants may cause small increases in blood pressure or pulse. This is usually not significant at normal doses in most people. Individuals on very high doses of stimulants or individuals at risk for blood pressure problems should be monitored more closely. Some adults may opt to continue the stimulant and add a blood pressure medication

• Psychosis or paranoia

These are rare side effects. They may occur in an individual who is already predisposed to a psychotic reaction. They may also occur when someone takes an overdose of the stimulant. It is important to screen for and treat certain other psychiatric disorders prior to starting a stimulant

ADD stimulants are not recommended for those with:

• Any type of heart defect or diseases
• High blood pressure
• Hyperthyroidism
• Glaucoma
• High levels of anxiety
• A history of drug abuse

ADD medication may help improve the ability to concentrate, control impulses, plan ahead, and follow through with tasks. However, it isn’t a magic pill that will fix all of you or your child’s problems. Even when the medication is working, a child with ADD might still struggle with forgetfulness, emotional problems, and social awkwardness, or an adult with disorganization, distractibility, and relationship difficulties.

It’s also important to understand that medication doesn’t cure ADD. It can relieve symptoms while it’s being taken, but once medication stops, those symptoms come back. Also, ADD medication works better for some than for others. Some people experience dramatic improvement while other experience only modest gains.

Because each person responds differently and unpredictably to medication for ADD, its use should always be personalized to the individual and closely monitored by a doctor. When medication for ADD is less carefully monitored, it is less effective and more risky.

BEHAVIOR THERAPY

Despite the well documented benefits of stimulant medication for treating ADD, medication is no panacea and some children with ADD should not receive it. There are several reasons for this. First, although medication helps the majority of children with ADD, as many as 20% derive no real benefit from medication. Second, some children experience side effects that prevent them from receiving medication on an extended basis. Third, many children who benefit from medication still have difficulties with primary ADD symptoms or associated problems which must be targeted via other means. Fourth, some children with ADD can have their symptoms managed effectively without medication (this is most likely to be true, however, when symptoms are relatively mild.) In addition to these reasons, some children have extremely strong objections to taking medication - this may be more likely to occur with teenagers. In these circumstances, trying to force medication on a child can create more problems than it solves. F or all these reasons, other treatments are often necessary - some would say always necessary - to effectively treat ADD.

An important non-medical approach used in treating children with ADD is known as behavior therapy or behavior management. Behavior therapy is based on several simple and sensible notions about what leads children to behave in socially appropriate ways. One reason is that children generally want to please their parents and feel good about themselves when their parent is proud of them. When the relationship between parent and child is basically positive, this is a very important source of motivation. A second reason that children behave appropriately is to obtain positive consequences for doing so (i.e. privileges or rewards). Finally, children will behave appropriately to avoid the negative consequences that follow inappropriate behavior.

Behavior therapy typically begins with the analysis of a trained therapist. The therapist analyzes the behaviors of the patient that cause stress, reduce the patient's quality of life, or otherwise have a negative impact on the life of the patient. Once this analysis is complete, the therapist chooses appropriate treatment techniques.

Treatments can include such techniques as assertiveness training, desensitization, environment modification, and relaxation training. The therapist may also use exposure and response prevention to work towards controlling the patient's actions. Other commonly used techniques include positive reinforcement, modeling, and social skills training.

In some cases, paradoxical intention techniques may be used in behavior therapy. This type of technique involves encouraging the patient to continue adverse behaviors temporarily. Therapists who use this technique report that it is useful in identifying and removing a wide range of undesirable behaviors.

The goal of behavior therapy, therefore, is to increase the frequency of desirable behavior by increasing the child's interest in pleasing parents and by providing positive consequences when the child behaves. Inappropriate behavior is reduced by consistently providing negative consequences when such behavior occurs. This is a simplified, but not unreasonable view, of what behavior therapy is all about.

NUTRITION AND DIET THERAPY

People labeled ADD are often unusually sensitive to diet and nutrition.  For example, they may metabolize fats and carbohydrates differently than other people, or may react to food additives when others are fine.  Popular processed foods are just full of unhealthy or non-nutritional ingredients. Unfortunately, the health care system in the U.S. (or most other countries) is not set up to identify nutritional deficiencies or allergies that might be affecting you or your child.  Physicians who do not keep up with new studies are likely to discount the role of nutrition, health insurance companies could care less, and even your local public school is likely to circumvent your efforts in addressing nutrition. 

Especially overlooked is the role of nutrition and allergies with regard to adult ADD, depression and anxiety.  Most of the studies involve children. But there is no magic moment where nutrition suddenly doesn't matter.   On the contrary, adults have to deal with potential deterioration of brain function related to aging.  For example, women's estrogen levels begin dropping in their mid-thirties, which impacts the brain, and damage from free-radicals slowly tears apart the brain of older folks who don't consume lots of antioxidants.

In one study, average adult and ADD children were fed a drink containing glucose, a simple sugar that is absorbed immediately into the bloodstream. All carbohydrates, including complex carbohydrates like whole wheat, are broken down into glucose.  Both sets of children experienced a sharp increase in blood sugar. Both sets also experienced a sharp increase in blood insulin levels, and then a corresponding drop in blood sugar levels. This decrease in insulin normally triggers an increase in the hormones epinephrine and Norepinephrine, which increase glucose entry into the brain to compensate for the drop in blood sugar.  In the ADD children, the expected rise in these two hormones was only 50% that of the average children (Journal of Pediatric Research, Oct. 1995).

Norepinephrine is a "fight or flight" neurotransmitter that increases alertness and the flow if information between brain cells.  The ADHD kids weren't getting as much of this neurotransmitter in their brain because of their response to blood sugar. Moreover, Norepinephrine is a precursor of dopamine, the primary neurotransmitter implicated in ADD.  And one of the most commonly cited proofs used to demonstrate ADD is a brain defect are pictures showing reduced glucose metabolism in the brain.  It's possible that such pictures are not showing some kind of permanent neurological defect that requires medication, but rather a simple manifestation of reactive hypoglycemia that can be mitigated with dietary changes. 

Some studies have also shown a strong relationship between fatty acid deficiencies and ADD, learning disorders, and behavior problems. Interestingly, fatty acid deficiencies have also been linked to reactive hypoglycemia, described in the previous paragraph, as well as allergies and asthma, also associated with ADD.

Dietary changes frequently recommended include:

• Provide fatty acid supplements (as in fish oil, flax oil, DHA/EPA supplements, primrose oil, Efalex, or Focus).
• Adjust the types of fats your family eats (good fats are olive oil, fish oil, canola oil and flax oil; reduce all others). This is also excellent for your heart and reduces the risk of cancer.
• Ban or sharply limit trans-fats (man-made hydrogenated oils which can be incorporated into your brain structure).  These fats are also worse for your heart than saturated fats and are potential carcinogens.  They will be banned within 10 years because they are so bad, yet processed foods are just full of them.
• The top food culprits producing causes of ADD symptom are : sugar, chocolate, eggs, milk, wheat, colors/additivies/flavor, and corn. So reduce it.
• Avoid food additives and highly processed foods
• Supplement with a high quality multivitamin that contains trace minerals and  other supplements, especially calcium, magnesium, zinc, and B vitamins.

In order to stabilize blood sugar, reduce the amount of sugar, grains, pasta, and breads people with ADD eats and increase the amount of fruits and vegetables.  Avoid large meals and fasting. Frequent small meals and snacks are much better.  Balance your calories with each meal: 40% carbohydrates, 30% lean protein and 30% good fats.

Vegetarian diets are NOT recommended for people with ADD. Vegetarians have significantly lower levels of essential fatty acids in their blood.  They also eat a higher percentage of carbohydrates and a lower percentage of protein than is recommended to stabilized blood sugar.  While I applaud the goal of vegetarians and I was once almost a vegetarian myself, the reality is that the human race evolved eating meat to nourish its oversized brains.   There are also theories about ADDers and people of Type O blood having a metabolic system closer to that of our past hunter/gatherer ancestors and having a greater need for protein in their diet.   Many of the foods eaten by vegetarians, even whole wheat and beans, are broken down into sugars fairly rapidly.

i wish this article can make you understand about ADD. and now don't be affraid if you have ADD. ADD can be treat. okay :)