Friday, May 29, 2009

Attention Deficit Hyperactivity Disorder part 3

Before I talk about treatments for ADHD I want to talk a little bit about the causes of this disorder. Basically we do not know a lot. We do know that ADHD has a heritable component, that it does run in families. We know that those infants with low birth weight (which is a nonspecific marker for problems in fetal development) have a higher incidence of ADHD. However most children with low birth weights do not develop ADHD and most children with ADHD did not have low birth rates. One environmental cause is the use of alcohol in pregnancy. There may be but I do not know whether or not there is any association with use of tobacco. But overall we do not know enough about the causes of this disorder.

Well how about treatment? This is an area where there is controversy. There is no controversy within the medical field about the benefits of ADHD medications. Evidence demonstrates their effectiveness. But there is some controversy in our society as a whole about the whole idea of using medications that affect the brain in children and adolescents. One thing I think people need to keep in mind is that the brain is an organ of the human body. In fact it is our most complicated organ. We know that disease states can affect every other organ. It only stands to reason that there can be problems with the brain itself. Yet very few people would take the position that we should not treat other organs but for some reason people put the brain in a separate category as if there can be no disorder in this particular part of our body. There is no question that children with this disorder suffer greatly and that their families suffer as well. I think it is extremely arrogant for those who oppose medication treatment for ADHD to want to make these medications unavailable.

What about psychosocial interventions? Wouldn't there be effectiveness in this approach? It only makes sense that there would be behavioral interventions that make a difference. However numerous studies have shown the same thing. Behavioral and psychosocial interventions are very effective, but only in those who are on medication treatment. Psychosocial and behavioral interventions in the absence of medication treatment are no more effective than no intervention at all. This only make sense when one considers that ADHD is a brain disorder. This is no different than in other areas of medicine and in disorders of other body organs. Exercise and proper diet as well as the cessation of smoking are very helpful in the treatment of coronary artery disease but the vessels must be clear by medical interventions before these behavioral approaches will work. Behavioral interventions and lifestyle changes are very useful in treatment of diabetes but the blood glucose levels must be brought down to normal to have these interventions make a significant difference. So disorders of the brain like ADHD are no different in this respect from other body organ problems.

In my next post I will discuss specific treatments and we will review not only medications but also effective psychosocial and behavioral treatments.

Thought for the day

We need to be empathetic and not critical and judgmental with parents whose children have emotional or behavioral problems.

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