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Pay Attention: New Controversy in how Attention Deficit Hyperactivity Disorder is defined and its effects on the method of treatment

There are many theories concerning the nature of ADHD, but currently the two biggest schools of thought are that ADHD is a disease that can be grown out of and cured, or ADHD is a genetic difference that must be coped with. The later school has been gaining far more momentum recently, and with that has come not only changes in the way ADHD is thought of, but also in its treatment. It’s important to note that ADHD is divided into three groups: primarily hyperactive-impulsive, primarily inattentive, and combined. (“Recommendations”) Symptoms can range from quite slight to extremely severe. “The available evidence points towards involvement of multiple factors involving inheritance, amounts of neurotransmitters in specific brain areas, and deficits in specific neurocircuits. In addition to genetics, environmental and psychosocial factors also contribute to brain development, and the complexities of self-image, personality, character, and compensatory styles can influence individual manifestations of symptomatology.” (“Recommendations) ADHD is different for every patient, presenting different problems, and therefore requiring different treatments. While stimulants have been shown to help children with ADHD pay attention and retain information in class, it should be noted that these stimulants can actually decrease some of the cognitive functions of adult sufferers. “A review of neuropsychological studies indicates that, although response latencies are reduced, performance of ADHD adults on tests of ‘distractibility’ and ‘planning’ is also not consistently improved by stimulants. Studies in non-ADHD adults suggest that stimulants do not promote acquisition of new information, might improve retention of previously acquired information, and facilitate memory consolidation, but may actually impair performance of tasks that require adaptation, flexibility and planning.” (“Cognitive Effects”) In addition to these medicines’ failure to help adult patients, newer studies have shown that stimulant medications don’t do any kind of long term good. When the patient stops taking them, the symptoms of the disorder reappear just as they had before the medicine was introduced into their system. (“Is Anyone Normal”) In fact, in some patients, stimulants like methylphenidate can cause headaches, insomnia, and loss of appetite, and can also have negative effects on the cardiovascular system.(“Recommendations”) Scientists barely understand how these stimulants work within the brain. Basically these medicines may help patients gain an edge in some areas, but they do not solve all the complications. Even worse, these medications are being over prescribed to misdiagnosed patients who, while having ADHD-like symptoms, may be suffering from other problems that are simply brushed under the rug, such as bipolar disorder or borderline personality disorder. “Looser diagnostic criteria are one of several factors that have driven the number of “disordered” children to record highs. Children need a diagnosis to get access to special school services. Parents with difficult children are desperate for hope. And harried family doctors want to help. Eighty per cent of all psychiatric medication is prescribed by them, although they may spend only a few minutes with a patient and have little psychiatric expertise.” (“Is Anybody Normal”)

Those of the “disease” camp often use the rhetoric that if drugs can help a patient’s symptoms, then they have a disease which must be cured. However, just because a patient’s symptoms are helped by medication does not make their condition a disease, especially not one to be eradicated. Many benefits, such as more mental adaptability, have been exhibited by ADHD patients. (“Prenatal Stress”)

“In our evolutionary history it is possible that some increase in these characteristics in some individuals was adaptive in a stressful environment, and that this type of fetal programming prepared the child or group for the environment in which they were going to find themselves.” (“Prenatal Stress”) If benefits go along with drawbacks, is it really fair to call it a disease at all? For that matter, since ADHD is often diagnosed based on societal norms, such as difficulty sitting still for an amount of time deemed “reasonable”, rather than true measurable data, the idea of ADHD being more of a symptom of slightly extreme human individuality is far more likely. (“Difference”)

The ambiguity of ADHD and the problems associated with stimulants are forcing patients and doctors to look for better options. Some are turning to non-stimulant drugs to mitigate symptoms without causing the side effects associated with stimulant medication. “Intuniv is a new, extended-release formulation of the high-blood pressure medication guanfacine (sold for hypertension under the brand name Tenex) that can be used alone or along with stimulant medications in children ages 6 to 17.” (“Intuniv”) This new therapy is not a perfect solution, however, because it is still often used in conjunction with stimulants and is slightly more expensive than stimulants. (Cruz)

EEG-neurofeedback has also gained prominence as a promising treatment. In EEG-neurofeedback training, the patient’s brain activity is monitored and shown to them, with the goal of trying to self-control and regulate the brainwaves. This has shown some limited success, but more testing is needed. (Lansbergen) Once the right treatment is found for these patients however, the outlook grows brighter. “Although there is no simple cure for ADHD, some treatments do relieve symptoms effectively. Standard therapies include educational approaches as well as psychological or behavioral modifications with or without medication. A diagnosis of ADHD can provoke anxiety, and symptoms can be a challenge for parents and children alike. However, treatment can make a difference, and most children with ADHD grow up to be vibrant, active, and successful adults.”(Cruz)

Works Cited

“Annual Research Review: Prenatal Stress and the Origins of Psychopathology: An Evolutionary Perspective.” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 11 Apr. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/21250994>.

Cruz, Martin P. “Guanfacine Extended-Release Tablets (Intuniv), a Nonstimulant Selective Alpha2A-Adrenergic Receptor Agonist For Attention-Deficit/Hyperactivity Disorder.” Www.ncbi.nlm.nih.gov. US National Library of Medicine, Aug. 2010. Web. 10 Apr. 2013.

“A Difference Doesn't Have to Be a Deficit;.” LexisNexis Acedemic. N.p., 2 July 2011. Web. 10 Apr. 2013. <http://www.lexisnexis.com.ezproxy.umw.edu/lnacui2api/results/docview/docview.do?docLinkInd=true&risb=21_T17138736282&format=GNBFI&sort=BOOLEAN&startDocNo=1&resultsUrlKey=29_T17138736274&cisb=22_T17138736284&treeMax=true&treeWidth=0&csi=8286&docNo=23>.

“Intuniv: New Nonstimulant Medication for ADHD?” Intuniv (Guanfacine): New Medication for ADHD from Shire. N.p., n.d. Web. 11 Apr. 2013. <http://www.additudemag.com/q&a/ask_the_add_medical_expert/6968.html>.

“Is Anybody Normal Any More?” LexisNexis Academic. N.p., 5 May 2012. Web. 10 Apr. 2013. <http://www.lexisnexis.com.ezproxy.umw.edu/lnacui2api/results/docview/docview.do?docLinkInd=true&risb=21_T17138736282&format=GNBFI&sort=BOOLEAN&startDocNo=1&resultsUrlKey=29_T17138736274&cisb=22_T17138736284&treeMax=true&treeWidth=0&csi=303830&docNo=12>.

Lansbergen, M. M., M. Van Dongen-Boomsma, J. K. Buitelaar, and D. Slaats-Willemse. “Abstract.” National Center for Biotechnology Information. U.S. National Library of Medicine, 17 Dec. 2010. Web. 11 Apr. 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051071/>.

“Recommendations.” Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 10 Jan. 2013. Web. 11 Apr. 2013. <http://www.cdc.gov/ncbddd/adhd/guidelines.html>.

“What Are the Cognitive Effects of Stimulant Medications? Emphasis on Adults with Attention-deficit/hyperactivity Disorder (ADHD).” National Center for Biotechnology Information. U.S. National Library of Medicine, n.d. Web. 11 Apr. 2013. <http://www.ncbi.nlm.nih.gov/pubmed/20381522>.

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