ADD/ADHD

Description

• Attention Deficit Disorder and Attention Deficit/Hyperactivity Disorder are not well understood and have been difficult to define. The American Psychiatric Association describes ADD/ADHD as "a disease of infancy and childhood characterized by developmentally inappropriate inattention, impulsiveness, and hyperactivity." Affected children typically have problems in school because of their inability to persist with tasks or to organize their work. They do not appear to listen or to hear what is said, and are unable to sit still. The activity is haphazard and not goal-directed. Some children display the inattention component without hyperactivity.
• These disorders are far more common in boys than in girls, and half of all cases occur before age four.¹
• Symptoms are grouped into inattention and  hyperactivity-impulsivity categories. Diagnosis of attention-deficit hyperactivity disorder is based on the person demonstrating at least six symptoms from one or both of these categories. ²

Causes

• Although the causes are not clear, dopamine, a brain neurotransmitter, is thought to play a role in attention deficit hyperactivity disorder. People with ADHD may have malfunctioning D4 dopamine receptors. ³

Types

• A patient with symptoms mainly from the inattention category is classified as predominantly inattentive type.
• A patient with mainly hyperactivity-impulsivity symptoms is diagnosed as a predominantly hyperactive-impulsive type.
• Someone with at least six symptoms from both groups has combined-type attention-deficit hyperactivity disorder. This is the most common type. ⁴

At Risk

• It is thought that children are born with this disorder. It affects boys more than girls.⁵
• Complications during pregnancy, delivery and infancy are positively correlated with incidence of ADD/ADHD.⁶
• There may be a genetic element to this disorder. Diagnosing and treating family members may be helpful. ^7,8

Prevention and Management

General:

• Because pregnancy, delivery and infancy complications may lead to higher incidence of ADD and ADHD, good prenatal care, including healthy behavior by the mother, is important. ⁹

Nutritional Influences:

• Contrary to popular belief, sugar does not seem to increase hyperactivity in children. ¹⁰
• Some researchers believe that essential fatty acid deficiency may play a role in ADD/ADHD in some children. ¹¹

Additional Information

• http://members.aol.com/addcenter/page1.htm
• http://www.cpgs.com/add/

Abstracts

Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995 Oct;62(4):761-768. Attention-deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism. The present study found that 53 subjects with ADHD had significantly lower concentrations of key fatty acids in the plasma polar lipids (20:4n-6, 20:5n-3, and 22:6n-3) and in red blood cell total lipids (20:4n-6 and 22:4n-6) than did the 43 control subjects. Also, a subgroup of 21 subjects with ADHD exhibiting many symptoms of essential fatty acid (EFA) deficiency had significantly lower plasma concentrations of 20:4n-6 and 22:6n-3 than did 32 subjects with ADHD with few EFA-deficiency symptoms. The data are discussed with respect to cause, but the precise reason for lower fatty acid concentrations in some children with ADHD isnot clear.

 LaHoste GJ, Swanson JM, Wigal SB, Glabe C, Wigal T, King N, Kennedy JL. Dopamine D4 receptor gene polymorphism is associated with attention deficit hyperactivity disorder. Mol Psychiatry 1996 May;1(2):121-4. Dopamine is believed to play a major role in the manifestation of attention deficit hyperactivity disorder (ADHD), which affects 3-6% of school-age children and shows evidence of familiarity. The dopamine D4 receptor, which is preferentially distributed in cortical and limbic regions of the brain, is currently of major interest because of the high degree of functionally relevant variability in its gene (DRD4), and the association of this gene with Novelty Seeking behavior. We examined the variability in the length of a region of DRD4 that contains a 48-bp repeat sequence in children with ADHD and controls matched for ethnicity. ADHD children differed from controls in that the 7-fold repeat form of DRD4 occurred significantly more frequently than in the control sample. This form of the receptor has previously been shown to mediate a blunted intracellular response to dopamine. Although ADHD is likely to be multifactorial in its etiology and its heritability is likely to be polygenetic, the present findings suggest that polymorphic variation in the gene encoding the D4 dopamine receptor may be a contributing factor in the expression of symptoms associated with ADHD.

References

¹ Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, Lipp SR, Burgess JR. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995 Oct;62(4):761-768.
² Diseases. Springhouse (PA):Springhouse Corporation; 1993 p 50.
³ LaHoste G. Dopamine DR receptor gene polymorphism is associated with attention deficit hyperactivity disorder. Mol Psychiatry 1996 May;1(2):83-4.
⁴ Diseases. 2nd ed. Springhouse (PA):Springhouse Corporation; 1993. p 898.
⁵ Milberger S. Pregnancy, delivery and infancy complications and attention deficit hyperactivity disorder: issues of gene-environment interaction. Biol Psychiatry 1997 Jan 1;41(1):65-75.
⁶ Hechtman L. Families of Children with attention deficit hyperactivity disorder: a review. Can J Psychiatry 1996 Aug;41(6):350-60
⁷ Comings D. Genetic aspects of childhood behavioral disorders. Child Psychiatry Hum Dev 1997 Spring;27(3):139-50.
⁸ Milberger S. Pregnancy, delivery and infancy complications and attention deficit hyperactivity disorder: issues of gene-environment interaction. Biol Psychiatry 1997 Jan 1;41(1):65-75.
⁹ Kanarek R. Does sucrose or aspartame cause hyperactivity in children? Nutr Rev 1994 May;52(5):173-5.