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Hjernetrening for å behandle ADHD-symptomer

January 20, 2010

Syk – eller bare annerledes?

November 21, 2009

Tre bevist effektive, alternative behandlingsformer

January 7, 2009

ADDitude Mag er et amerikansk blad som ofte virker å være positive til bruk av medisin. Det betyr ikke at de ikke har interessante artikler og -forfattere. Artikkelen under er et eksempel. Håkon.

Improve focus and regulate mood with these proven alternative ADHD treatments.

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Brain Training

New evidence suggests that alternative ADHD treatments like meditation and sharpening working memory can improve attention and focus in both adults and children.

The ability to pay careful attention isn’t important only for students and air-traffic controllers. Researchers are finding that attention is crucial to a host of other, sometimes surprising, life skills: the ability to sort through conflicting evidence, to connect more deeply with other people, and even to develop a conscience.

But for all that, attention remains one of the most poorly understood human faculties. Neither a subject nor a skill, precisely, attention is often seen as a fixed, possibly inborn, faculty that cannot be taught. Now scientists are rapidly rewriting that notion. Fresh advances in neuro-imaging and genetics have powered decades of research, leading to a much clearer picture of attention. Many scientists have come to see attention as an organ system, like circulation or digestion, with its own anatomy, circuitry, and chemistry. Building upon this new understanding, researchers are discovering that skills of focus can be bolstered with practice in both children and adults, including those with attention-deficit disorders. In just five days of computer-based training, the brains of six-year-olds begin to act like those of adults on a crucial measure of attention, one study found. Another study suggested that boosting short-term memory seems to improve children’s ability to stay on task.

We do not yet know how long these gains last, or the best methods for developing attention. But the demand is clear: Dozens of schools nationwide are already incorporating some kind of attention training into their curricula. And as this new arena of research helps overturn long-standing assumptions about the malleability of this essential human faculty, it offers intriguing possibilities for a world of overload.

‘If you have good attentional control, you can do more than just pay attention to someone speaking at a lecture, you can control your cognitive processes, control your emotions, better articulate your actions,’ says Amir Raz, Ph.D., a cognitive neuroscientist at McGill University, who is a leading attention researcher. ‘You can enjoy and gain an edge in life.’

How We Pay Attention
Recently, scientists have used advances in genetics and imaging technologies to map brain activity to formulate more detailed theories of what, exactly, attention is. It has been compared to a filter, a mental spotlight, and a tool for allocating our cognitive resources. Increasingly, however, attention is viewed as a complex system comprising three networks, or types of attention: focus, awareness, and ‘executive’ attention, which governs planning and higher-order decision-making. According to this model, first proposed by University of Oregon neuroscientist Michael I. Posner, Ph.D., the three attentional networks are independent, yet work closely together.

Armed with an improved sense of how attention works, Posner and others have begun researching whether attention can be trained. And their findings are intriguing. After years of research into how attention networks develop, Posner and colleague Mary K. Rothbart, Ph.D., began experimenting a few years ago with training children’s attention. They targeted children six and under, since executive attention develops rapidly between ages four and seven. Inspired by computer-learning work with monkeys, Posner and Rothbart created a five-day computer-based program to strengthen executive-attention skills, such as working memory, self-control, planning, and observation.

After the training, Posner and Rothbart reported that six-year-olds showed a pattern of activity in the anterior cingulate – a banana-shaped brain region that is ground zero for executive attention – similar to that of adults, along with slightly higher scores on IQ tests and a marked gain in executive attention. The children who were the most inattentive gained the most from the program. The results were published in the Proceedings of the National Academy of Sciences, and have since been replicated in similar experiments by Spanish researchers. ‘We thought this was a long shot,’ says Posner. ‘Now I’ve changed my mind.’ Though small-scale, the results, from his lab and others, have been so remarkable that he and Rothbart are now calling on educators at conferences, and in their book, Educating the Human Brain, to consider teaching attention in preschool.

Improving Executive Attention
A parallel line of investigation is based on the close link between attention and memory. Working memory is the short-term cognitive storehouse that helps us recall a phone number or the image of a landscape; this type of memory is integral to executive attention. Tapping into this link, cognitive neuroscientist Torkel Klingberg, M.D., Ph.D., of Sweden’s Karolinska Institute, devised software to improve executive attention by training working memory in children and teens with attention-deficit hyperactivity disorder.

Using a training program he calls RoboMemo, Klingberg has helped children improve their working memory and complex reasoning skills, according to studies published in the Journal of the American Academy of Child and Adolescent Psychiatry, among other publications. This appears to pay off in attention, as well: The children were also reported to be less impulsive and inattentive by their parents, although their teachers largely did not report such improvements.

A different line of research investigates the attention-boosting potential of something very different: the 2,500-year-old tradition of meditation. With a long history but little scientific data on its effects, meditation has begun to intrigue neuroscientists in labs around the country, who are measuring the success of meditative practices that boost focus and awareness.

Lidia Zylowska, M.D., assistant clinical professor in psychiatry at UCLA, co-founded the university’s Mindful Awareness Research Center, and is a pioneer in the study of meditation’s impact on human focus and attention.

In one study, Zylowska and colleagues reported that eight weeks of mindfulness meditation – a technique designed to improve attention and well-being largely by focusing on breathing – boosted powers of focus and self-control in 24 adults and eight teens with ADHD. The work was published in May in the Journal of Attention Disorders.

Focus in the Classroom
If focus skills can be groomed, as research has begun to hint, the important next question is whether, and how, attention should be integrated into education. Will attention become a 21st-century ‘discipline,’ a skill taught by parents, educators, even employers? Already some educators are showing interest in attention training, mostly through the practice of meditation. Susan Kaiser Greenland, a former corporate lawyer who started the nonprofit InnerKids Foundation, in 2001, to teach meditation practices in schools, says demand outstrips her staffing. The Santa Monica-based firm works with children, ages four to 12. But with the field of attention training still in its infancy, scientists don’t know whether any current teaching brings long-lasting gains – or, for that matter, which practices work best. ‘Part of the problem in today’s society is that people are looking for extremely quick fixes. People are looking to lose 20 pounds before the wedding next week,’ says Raz. ‘But attention training is a slow process.’

Nonetheless, with global use of ADHD medicines tripling since the early 1990s, and evidence mounting that attention can be strengthened, researchers are permitting themselves cautious excitement at the prospect that attention training could work. ‘Attention is such a basic skill that children need, and to be able to impact that skill, to teach them how to redirect their attention and how to become more aware of themselves, their bodies, emotions, and thoughts – it’s an exciting thing,’ says Zylowska. ‘It’s also critical.’

Maggie Jackson (maggie-jackson.com) is the author of Distracted: The Erosion of Attention and the Coming Dark Age (Prometheus Books). The full version of this article originally appeared in The Boston Globe.

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Diet Matters

The right foods and supplements can sharpen focus and regulate mood.

Doctors and ADD experts rarely talk with parents about managing their child’s ADD symptoms through diet. This is a mistake, says Ned Hallowell, M.D., author of Delivered from Distraction, because the quality of a child’s diet determines how effectively his brain operates. Poor nutrition can cause a child to become distracted, impulsive, and restless. ‘The treatment of ADD must include diet as an essential component of a proper regimen,’ says Hallowell. Here are tips on improving ADD symptoms by improving diet:

Beef Up Your Protein Levels
It is more difficult for a child to pay attention or regulate mood when he’s not getting enough protein, says Vincent J. Monastra, Ph.D., author of Parenting Children with ADHD: 10 Lessons That Medicine Cannot Teach. Foods rich in protein are used to make neurotransmitters, the chemicals released by our brain cells to communicate with each other. Protein can also prevent surges in blood sugar, which increases hyperactivity. ‘Because the body makes brain-awakening neurotransmitters when you eat protein, it’s a good idea to start your day with a breakfast that includes it,’ says Monastra. Common protein sources include beef, pork, poultry, fish, eggs, beans, nuts, and dairy products.
Take Omega-3 Fatty Acids
Found in cold-water, fatty fish, such as sardines, tuna, and salmon, omega-3s are believed to be important in brain and nerve cell function. Omega-3s increase the level of dopamine in the brain. While omega-3 fatty acids seem to improve anyone’s mental focus, the compounds may be especially helpful to those with ADHD. One study, done in 2003, showed that omega-3s tend to break down more readily in the bodies of patients with ADHD than in those without the condition. Another study, from 2004, suggested that ADD children were more likely to have low blood levels of omega-3 fatty acids than those with no symptoms. Hallowell, founder of the Hallowell Centers for ADHD, recommends that his patients take omega-3 supplements, and notes that ‘it seems to help with mental focus, not hyperactivity or impulsivity.’

Mind Your Minerals
Deficiencies of several minerals – zinc, iron, and magnesium – can worsen symptoms of inattention, impulsivity, and hyperactivity. Zinc is involved in the regulation of dopamine, a neurotransmitter that helps control mood. One study showed that zinc combined with ADD medication – methylphenidate, specifically – improved symptoms of hyperactivity and impulsivity. Zinc is found in beef, turkey, chicken, pork, lamb, oysters, and beans.

Magnesium is involved in hundreds of enzyme activities. ‘Among the substances that are developed from magnesium are the myelin sheath that surrounds the brain cells and the neurotransmitters involved in attention and concentration,’ says Monastra. Magnesium is found in meats, nuts, soybeans, and spinach.

The latest research suggests that low levels of iron can worsen ADHD symptoms in children with the condition. A 2004 study found that 84 percent of children with ADHD had significantly lower levels of iron, compared with 18 percent of kids without the condition. Iron plays an important role in the brain, affecting production of the key neurotransmitter, dopamine. If you suspect your child has low levels of iron, talk with your doctor about testing him. Diet, not supplements, is the safest way to increase your child’s iron levels.

Balance Your Diet
Hallowell encourages parents of ADD children to visualize their plates when preparing a meal. Half of the plate, he recommends, should be filled with fruits and vegetables, one-fourth with a protein, and one-fourth with carbohydrates. This combination will control swings in behavior caused by hunger or a shortfall of a particular nutrient. In addition to the balanced plate, Hallowell advocates eating several servings of whole grains each day, to prevent blood-sugar levels from spiking and later plummeting, and cutting back on foods that contain dyes and excess sugar. Several studies have suggested that artificial food coloring and sugar may increase hyperactivity in children with ADHD.

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The Calming Benefits of Nature

A daily dose of greenery, from a walk in the woods or by playing in a room full of plants, may reduce ADHD symptoms in adults and children.

As many parents and teachers well know, children diagnosed with ADHD have trouble paying attention, listening, following directions, and focusing on tasks. They may also be aggressive, antisocial, and susceptible to academic failure. From looking at high-tech images of the brain, some scientists report that ADHD children show altered levels of some neurotransmitters and slight shrinking in the part of the cerebral cortex that governs attention and impulse control. But scientists are not clear whether those differences indicate a cause for the disorder, which could be due to a genetic defect, or simply a manifestation of another cause or causes.

In ongoing studies by the Human-Environment Research Laboratory at the University of Illinois, researchers have discovered tantalizing evidence for a new view of the syndrome. In a 2004 study published in the American Journal of Public Health, the laboratory found that children as young as five showed a significant reduction in ADHD symptoms when they engaged with nature.

Parents and guardians were asked to identify after-school or weekend activities that left their children functioning particularly well or poorly. The study measured responses to two types of activities: those in green landscapes – such as grassy backyards, parks, and farmland – and those in indoor or paved recreation areas. The researchers designed the study to account for any effects of physical exercise, so they could measure only the influence of green settings. They also factored out age, gender, family income, geographic region, size of community, and the severity of diagnosis.

In 54 of 56 cases, outdoor activities in more natural settings led to a greater reduction in ADHD symptoms than activities in less natural areas. The only instances when symptoms worsened occurred in the artificial environments. In a related experiment, the laboratory found that children could focus on specific tasks better in green settings.

Going Green
Other researchers have found that engagement with nature buffers life stresses, which otherwise could aggravate ADHD. Although most of their studies focus on adults, an increasing number gauge the impact of green settings on children. A 2003 Cornell University study reported that the more nature a child encountered at home – including exposure to indoor plants and window views of natural settings – the less he or she was affected by negative stresses.

A 2003 study by researchers at the New York State College of Human Ecology reached similar conclusions. Nancy Wells, Ph.D., the lead researcher, said that exposure to nature resulted in ‘profound differences’ in children’s attention capacities and that ‘green spaces may enable children to think more clearly and cope more effectively with life stress.’ That, in turn, could strengthen a child’s attention and potentially decrease the symptoms of ADHD.

It’s not clear why exposure to nature would have such an apparently powerful influence on brain functions related to attention. One theory is that the experience simply engages a child mentally and physically in a ‘natural’ way, consistent with how humans have evolved. In an earlier hunting and gathering or agricultural society – which is to say, during most of humankind’s history – young people were more likely to engage in physically demanding, mentally relaxing activities that immersed most of their sensory receptors: climbing, hunting small animals, baling hay, splashing in the swimming hole.

As recently as the 1950s, most U.S. youngsters still had some kind of agricultural connection. Even in towns or cities, kids played ball in sandlots or spent hours building forts in tangled and wild ‘vacant’ lots. Their unregimented play was steeped in nature. That kind of exposure to nature has faded dramatically in recent decades, but our need for nature – possibly physiological – has not. ‘Neurologically, human beings haven’t caught up with today’s over-stimulating environment,’ says Michael Gurian, a family therapist and author of The Wonder of Boys. ‘The brain is strong and flexible, so 70 to 80 percent of kids adapt fairly well. But the rest don’t.’

Rethinking Attention
If ADHD has something to do with a lack of nature, the neurological mechanics could be explained by the attention-restoration theory developed by Stephen and Rachel Kaplan, husband-and-wife environmental psychologists at the University of Michigan.

In the early 1970s, the Kaplans studied the impact of a range of activities and found that too much directed attention (this could include computer tasks, homework, studying for a test) leads to what they call ‘directed-attention fatigue,’ marked by impulsive behavior, agitation, irritation, and inability to concentrate. Directed-attention fatigue occurs because neural inhibitory mechanisms become overstressed by blocking competing stimuli. Subsequent research, including more than 100 studies linking exposure to nature to stress reduction, has supported the Kaplans’ theory – and the salutary influence of what they called ‘the restorative environment.’

The University of Illinois team, while not questioning the effectiveness of current ADHD treatment methods, has suggested that nature therapy could be a third option, in conjunction with prescription medications and behavioral therapy. They recount how one parent began taking her son to the local park for 30 minutes each morning before school, which she had indicated reduced his ADHD symptoms. ‘Come to think of it,’ she told the researchers, ‘I have noticed his attitude toward going to school has been better, and his schoolwork has been better this past week.’ Another parent of a boy with attention-deficit symptoms began engaging him regularly in outdoor activities, with similar results.

Nature Deficit: The Cause of ADD?
If a greener environment can play a role in managing ADHD, few, if any, studies have explicitly examined whether the converse is also true: that ADHD may be a set of symptoms initiated or aggravated by lack of exposure to nature. By this line of thinking, many children may benefit from medications, but the real disorder lies in the society that has disengaged children from nature and imposed on them an artificial environment for which they have not evolved. Viewed from this angle, children and adults alike would suffer from what might be called nature-deficit disorder, not in a clinical sense, but as a condition caused by the cumulative human costs of alienation from nature, including diminished use of the senses, attention difficulties, and higher rates of physical and emotional illnesses.

If that’s the real ailment, a walk in the woods would be the ideal treatment: It’s not stigmatizing, has no serious side effects, and it’s free. But such reliance on greenery would underscore the need to scale back industrialism, redesign cities, and expand access to nature – which can’t be encapsulated in a pill, but could be equally powerful medicine.

Richard Louv has written for The New York Times and the Christian Science Monitor, and is a longtime columnist for the San Diego Union-Tribune. He is the author of seven books, including Last Child in the Woods: Saving Our Children from Nature-Deficit Disorder (Algonquin Books), from which this piece was adapted with permission. For more information about the book, go to thefuturesedge.com.

Nytt kosthold mot atferdsvansker

January 5, 2009

Barn med atferdsproblemer kan få et bedre liv ved å legge om kostholdet. Det mener spesialpedagog Magne Nødland. Sammen med forsker Ann Mari Knivsberg ved Lesesenteret og Karl-Ludvig Reichelt ved Rikshospitalet har han gjennomført et forskningsprosjekt der 23 barn med ADHD-atferd kuttet ut alle melkeprodukter i ett år.

Grunnstønad ved glutenintoleranse uten cøliaki

January 5, 2009

Feiler det deg noe? Ernæringsforslag fra Bjarte

January 5, 2009

Historien til Bjarte Aasland

January 5, 2009

Jeg har gjort meg en del tanker rundt min erfaring, og jeg er av den oppfatning at en ubalanse slik den jeg har erfart, har vidtrekkende konsekvenser, familiært, sosialt og økonomisk. Derfor er det meget interessant å sette fokus på lidelsen og sette den inn i større sammenhenger, slik at folk blir oppmerksomme på hvor stor betydning feil mat kan ha. Derfor ønsker jeg å dele min historie med andre slik at det kanskje kan inspirere, informere og hjelpe andre til en bedre hverdag for seg eller sine.

Jeg har så lenge jeg kan huske vært opptatt av kosthold, ernæring og trening. Har generelt hatt et sunt kosthold og bedrevet regelmessig trening. Selv trodde jeg at jeg tålte all mat, og har ikke lagt noen restriksjoner på meg selv i så måte. Fra rundt midten av tiåret (2004- 2005) merket jeg noe var i ferd med å utvikle seg. Jeg følte meg ofte oppblåst, energiløs, sløv og tung i hodet. Opplevde en tidligere ukjent anspenthet, pustebesvær og angst, selv i helt trygge omgivelser. Men jeg tilskrev det livssituasjonen min, og skyldte på familielivet, arbeidssituasjonen, alder, etc. I tillegg kunne jeg merke et redusert kognitivt funksjonsnivå, spesielt knyttet til redusert tale-og språkopplevelse, oppmerksomhet, orienteringsevne, hukommelse, nylæring, initiativ, etc. Lidelsen viste seg også i form av nærmest anfall av melankoli og tristhet, kognitiv svik, en lammende og nummen fornemmelse i og rundt hals og struperegion. Det sistnevnte fenomen har jeg forøvrig sett beskrevet i vitnesbyrd fra andre i PIF-nytt som €lang i ansiktet€. Uansett, ennå falt ikke mistanken på ernæring.

Lidelsen medførte at jeg var i en tilstand og atmosføre preget av å komme gjennom dagene, en navnløs, iskald, totalomfattende livsangst og flukt som sakte men sikkert gikk over til å bli en normaltilstand..Det meste rundt meg , både situasjoner, personer og hendelser var skremmende og noe jeg måtte forholde meg til med stadig større vansker. Da er man kun opptatt av og dominert av sin egen uro, angst og smerte. I et slikt klima er det ikke plass til varme, nærhet, toleranse, forståelse, empati, velvilje eller€¦ kjærlighet

Vanskelighetene med å mestre livet forsterket seg, og det kulminerte med samlivsbrudd i 2006, med påfølgende utflytting til leilighet og et liv alene.

Etter tips fra en kamerat holdt jeg meg unna hvete noen dager etter påske 2007, da merket jeg en viss bedring og forstod at jeg var i ferd med å trykke på de riktige knappene. Jeg gikk helt i kjelleren, det eneste som stod i hodet på meg var å finne ut hva jeg led av og hvordan jeg kunne bli frisk. Og jeg brukte mye tid og ressurser på å identifisere denne fienden, og dermed få innsikt i hvilke våpen jeg skulle bruke for å bekjempe og uskadeliggjøre den.

Leste på internett og andre kilder, prøvde og feilet ved å eksperimenterte med mat, levde en nærmest asosial, vegetativ tilværelse. Mistanken gikk til hjerneskade, Alzheimer, jeg hadde samtaler med min tannlegeonkel om kvikksølvforgiftning og bestilte MR-scan av hjernen. Så, endelig, etter flere konsultasjoner i løpet av 2007 , blod-og urinprøver og vurdering av prøveresultat, både hos fastlege, homeopat, Neurozym og Balder-klinikken i Oslo ble bildet tydeligere. Etter hvert har jeg fått kartlagt hva jeg lider av – hveteallergi, intoleranse mot gluten, øl-og bakegjær og kumelk.

Det var først i november 2007 at det løsnet for alvor, og helsen forbedret seg dramatisk i løpet av kort tid. Fra da av startet jeg en nærmest puristisk praksis angående mat, og spiste kun HELT ren mat, og inntok en homeopatisk basert måltidserstatter og næringsjuice som inneholder større konsentrasjoner av stoffer alle har bruk for. I løpet av få dager våknet jeg fra de mentalt døde, og til et nytt liv, i løpet av uker hadde det nye, forhøyede funksjonsnivået etablert seg. Man kan trygt snakke om før og etter. Sjelden har begrepet hatt større relevans. Det var en opplevelse hinsides det jeg trodde var mulig. Og som i viktighet og omfang kan sidestilles med det å bli far, ingen annen erfaring, hendelse, innsikt, periode i mitt liv, lærdom eller annet har hatt tilnærmelsesvis samme betydning som denne, noengang!

Ifjor var jeg så langt nede at jeg i fremtiden så for meg et uverdig liv med sterke begrensninger. Jeg vurderte flere ganger å gå til legen å få €krykker€, i form av farmasøytisk medisin, da primært mot depresjon og ADHD-symptom (antidepressiva, ritalin, etc). Og i mine svarteste stunder, da alt opplevdes håpløst, var jeg veldig nær å ringe for å bestille time.Jeg hadde også bestilt time for utredning for ADHD., som da naturlig nok etter november 2007 ble kansellert

Nå har jeg et mentalt, følelsesmessig og kroppslig funksjonsnivå og velvære jeg aldri har erfart tidligere. Bedre enn NOEN gang før , og bedre enn jeg trodde var mulig å få det, så raskt og i en alder av 42 år. Jeg har i praksis ikke spist ett kornprodukt/gjærprodukt på snart ett år, og omtrent ikke melkeprodukt på like lang tid. Og har aldri hatt det tilnærmelsesvis bedre.

Det dramatisk forbedrede funksjonsnivået, først og fremst mentalt og kognitivt, men også fysisk, er permanent og i stadig utvikling, takket være riktig ernæring og diett.

Jeg er trygg, rolig, behersket, sterk og kontrollert. Blodsukkeret er stabilt , og jeg er fokusert og konsentrert.

Jeg vil nevne ett aspekt som jeg synes er veldig interessant. Jeg har store deler av livet vært litt stam, nesten uhørlig, en såkalt skjult stammer. Og har hatt et problematisk forhold til mitt språk og min tale. Som nevnt forverret dette seg de siste årene. Tidlig ifjor var jeg på en ukes behandling i Statped Vest i Bergen for mitt angivelige stammeproblem. I dag nærmest ler jeg av det hele, når jeg erfarer hvor mye lidelsen har innvirket på tale-og språkopplevelsen min. Nå er talen tilnærmelsesvis helt flytende, naturlig, uhemmet og rolig.

Først og fremst fordi sentralnervesystemet som jo former tanker, refleksjoner, bokstaver og ord til setninger, fungerer slik det skal. Da kan man forestille seg at det er flere der ute med samme lidelse som går til logoped og andre behandlingstilbud. Erkjennelsen etter den innsikten lidelseshistorikken har gitt meg, sier meg at man må ha et funksjonsnivå i bunn før man går til behandling, enten det nå er for mentale, språklige eller fysiske plager. Og da står ernæring helt sentralt.

Ett annet viktig moment er det jeg har nevnte tidligere, med barndom og oppveksvilkår. Nå ser jeg at jeg feilaktig de siste årene har lagt mye av skylda mi på en begrensende barndom og perifer far, men erkjenner nå at angst, tvang, uro og dysfunksjon i mitt tilfelle i all hovedsak kom av ting jeg spiste som kroppen ikke håndterte, og som plaget den, først og fremst mentalt, med angst, ADHD-symptom og tvang som resultat. I seg selv en erkjennelse med perspektiver langt utover en selv.

Jeg er i bedre form i dag enn noen gang i mitt liv, og jeg har trent mer eller mindre jevnlig 2-5 ganger i uken i over 30 år, helt siden jeg begynte med uorganisert idrett som 8-10 åring. Jeg har mye mer energi, overskudd og kraft enn noen gang, og kroppen responderer mye bedre på trening. I mai 2007 falt jeg på rulleski og slo skulderen stygt, den ble gradvis bedre, men forble vond utover høsten 2007. Det var først etter at jeg fant nøkkelen til mitt helbred i november 2007 at helningskurven skjøt i været i løpet av få uker, og nå kjenner jeg ingenting til skaden. Jeg har hvilepuls på under 50. Mitt sanseapparat er forsterket, min finmotorikk forbedret, og jeg har dramatisk forsterket opplevelse av og evner i tale, musikk og språk. Nå er jeg fritatt for uro, rastløshet, tvang, angst, adhd-symptom, symptomer som blir forbundet med autisme og schizofreni og depresjon. Endelig er livet godt! Så sterkt kan det sies. Når jeg NÃ… opplever fravær av disse symptomene, erkjenner jeg at jeg har hatt det så lenge jeg kan huske, men plagene ble forsterket de siste årene. Og som nevnt innledningsvis kan konsekvensene både individuelt og i ytterste konsekvens samfunnsmessig være store. Personlig har jeg i ettertid erkjent at sykdommen har vært den direkte årsak til eller bidratt til forsterket destruktiv atferd, oppførsel og handlinger, og vært en sterkt begrensende faktor i mitt liv. Ukritisk pengebruk, redusert evne til sosial interaksjon, ineffektivitet og dårlig utnyttelse av ens potensiale er viktigst i så henseende.

Og vitnesbyrd fra NPIF-medlemmer på nett og i medlemsblad forteller meg at vi er flere som har likelydende erfaringer, både mentalt, somatisk og sosialt.

Opplevelsen er ubeskrivelig, takknemligheten og gleden kjenner ingen grenser, ikke sjelden gråter jeg av ren lykke over å ha det så godt. Jeg kunne i dag €med god grunn€ vært fylt av et osean av bitterhet over at ingen, verken hjem, helsevesen eller skole tok tak i dette på mine vegne for 30 år siden. Men tro meg, gleden over det høye funksjonsnivået fortrenger all bitterhet over at ingen har visst om eller tatt tak i dette på mine vegne for lenge siden.

Daglig tar jeg meg i å reflektere over og erfare hvor mye bedre jeg mestrer hverdagslivets oppgaver og plikter, funksjoner, situasjoner og møte med mennesker. Man rekker så mye mer, utfører oppgaver så mye enklere, har mer ro og orden. Selve opplevelsen av tid og det å være i tiden, har endret seg på grunn av dette. For man ser at man har kapasitet til mye mer, når man er frisk, uten unødig angst for oppgaver, situasjoner, personer eller handlingar. Med et sentralnervesystem som virker slik det skal og et mentalt og kognitivt funksjonsnivå de fleste andre tar for gitt, er mulighetene uendelige.

Det har vært et paradigmeskifte, en øyeåpner av rang, og min erfaring har dramatisk endret min virkelighetsoppfatning på flere områder. Først og fremst når det gjelder ernæringsterapi og ortomolekylær medisin, og dens enorme potensiale. Men også den generelle inkompetansen, kunnskapsløsheten, tvilen og skepsisen hos den tradisjonelle legestanden og i skolemedisinen om ernæringsterapiens potensiale. Jeg ble frisk mer på tross av enn på grunn av fastlegen min.

Mitt kosthold er i dag basert på fire prinsipper:

Unngå å spise det kroppen ikke håndterer (matallergi-matintoleranse)

Få i seg større mengder av det alle har godt av (vitaminer, mineraler, sporstoffer, aminosyrer, enzymer etc).

Endre energibalansen til mer sakte karbohydrater og mer protein og fett.

Spise så ren volum-mat som mulig.

Ernæring er uhyre viktig for velvære og funksjonsnivå. Vi tar det som en selvfølge at vi skal puste ren og ubearbeidet luft. Likevel tenker vi ofte ikke over at maten vi putter i oss er bearbeidet og behandlet. Hvorfor ikke være snill med kroppen vår og gi den ren mat også?

Det er mitt utgangspunkt, lager maten fra grunnen av og spiser så ren og ubearbeidet mat som mulig, i praksis tilnærmet steinalderkost med høyt innslag av belgfrukter. Mennesket er genetisk uforandret de siste fleire ti-talls tusen år, og har dermed utviklet oss og levd i samhandling med omgivelsene og de rammebetingelser de satte, angående kosthold etc. De siste 50-100 årene har matvareindustrien presentert oss for så mange nye forbindelser, fargestoffer, konserveringsmiddel, behandlingsmåter etc, at det er ikke det minste rart at en del av oss reagerer. Det er etter min oppfatning det største ufrivillige ernæringpolitiske eksperiment noensinne, og fremstår nærmest som et institusjonalisert statlig og sosialt overgrep. Men man trenger heldigvis ikke å underkaste seg det. Bare så synd at ernæringsinformasjonen til befolkningen gjennom media, skoleverk, statlige institusjoner og profesjoner er så unyansert, forvirrende, usystematisk og fragmentert. Det er ikke lett å orientere seg i den informasjonsjungelen for den alminnelige borger.

Jeg føler meg priviligert som har fått ta del i, og nyte godt av mulighetene ernæringsterapi gir. Det er en virkelighet få mennesker utenfor profesjonsmiljøene vet finnes, noen flere har intellektuell kapasitet til å ane eksisterer, men som sørgelig få tar konsekvensene av.

Majoriteten av befolkningen i den “moderne” vestlige sivilisasjon pådrar seg nemlig sakte men sikkert plager, ubalanser og unødvendig tidlig død som følge av uheldig kosthold og livsstil. Men det skjer så sakte at man tror man lever….

Min erfaring har perspektiver langt utover meg selv, og jeg har allerede rådgitt, bistått og ansporet flere mennesker til å reflektere over sin egen og andres ernærings-og diettsituasjon i lys av plager de har av forskjellig karakter. Flere av disse har gitt tilbakemelding om at de grunnprinsippene jeg anvender, som egentlig er veldig enkle og greie, virker veldig positivt.

Jeg har kjempet en hard og vond kamp, og vært gjennom mitt livs mørke. Hadde det ikke vært for mine tre barn og min kamerat som rådet meg til å forsøke hvetefri diett som en begynnelse, vet jeg ikke om jeg hadde klart å holde ut. Jeg kan med stolthet og ydmykhet si at kampen er kronet med hell, uten bruk av ett eneste farmasøytisk produkt. Helbredet har gjort meg til et bedre menneske, smerten er borte, fordi man er fritatt for angsten og uroen.

Dermed har man evne og forutsetning, og naturligvis ØNSKER å nyte livet og samværet med andre mennesker, i stedet for å være opptatt av sin egen smerte og kamp.

Jeg håper at jeg med dette vitnesbyrdet kan sette i gang konstruktive prosesser hos de som leser det. Og dermed kanskje hjelpe andre til et bedre liv. Da er gleden uendelig, og man utøver i praksis det dobbelte kjærlighetsbud. Og hva er mer meningsfylt enn det?

Mvh

Bjarte Aasland
Mjugbakken 7
4048 Hafrsfjord

Bjarte Aasland er 42 år gammel, bosatt i Stavanger og medlem i

NPIF.

Brev fra din kjære kone – som ikke har ADHD

June 17, 2008

Tanker og handlinger er ikke like tilfredsstillende: Det er mulig at du tenker mye på meg, men når du er borte i din egen verden eller er distrahert av noe, så er det ikke mulig for meg å vite det. For meg føles det som om du nesten aldri tenker på meg. Det gjør meg trist. I fremtiden, kan du bruke noen sekunder på å vise meg ved handling, ikke tanker, at du tenker på meg? Et lite kyss, et “Jeg elsker deg” eller andre handlinger vil bety mye for meg.

Jeg liker ikke å være en masekjerring, men vet ikke om en mer effektiv måte å få oppmerksomhet fra deg på: Mennesker med ADD er ofte tilfreds med å være i sin egen verden. Det er greit en del av tiden, men hvis jeg ønsket å være fullstendig ignorert så hadde jeg ikke giftet meg. I løpet av årene så har jeg lært at den enkleste (merk deg at jeg ikke sier “beste”) måten å få oppmerksomhet fra deg på er å gå helt opp i ansiktet ditt og mase eller kjefte. Jeg er sikker på at du ikke liker dette, og det gjør ikke jeg heller. La meg stoppe dette mønsteret ved å vise meg et tegn vi kan være enige om. Når jeg virkelig trenger din oppmerksomhet, så kan jeg bruke dette tegnet og du går med på å slutte med hva-nå-du-holder-på-med og følger med på det jeg sier. Jeg lover at jeg ikke skal misbruke dette – og vi kommer til å få det så mye bedre!

Jeg elsker deg masse, men lurer på om du elsker meg: Mennesker uten ADD trenger positive, fysiske bekreftelser. Jeg vil gjerne tro at du elsker meg, men når du blir distrahert av stort sett alt unntat meg, så er det vanskelig å tro at jeg er høyt prioritert. Hvorfor skulle en bil, en datamaskin eller et spill være viktigere enn meg? Uansett hvor mye jeg forsøker å ikke ta det personlig, så hender det at jeg ikke får det til. Jeg trenger tid, hver uke, hvor du bare fokuserer på meg – ingenting annet. Gjennom dette vil du vise meg at du elsker meg, og vil få meg til å føle meg bedre og mer lykkelig. La oss sette oss ned nå og sette av tid på timeplanene våre til hverandre-tid.

Jeg vil gjerne vise deg min kjærlighet, men sinnet mitt kommer i veien: Jeg elsker deg. Masse. Jeg ser for meg en fremtid hvor du har jobbet med noen av ADD-symptomene dine – og jeg har jobbet med mine negative reaksjoner til dem – slik at vi kan ha det gøy sammen igjen. Men vi må jobbe sammen om dette, ikke slåss mot hverandre. Det er for mye sinne og frustrasjon på begge sider akkurat nå. Kan vi jobbe sammen? Vær så snill?

Jeg jobber virkelig hardt med forholdet vårt, men av og til kjenner jeg på fortvilelse fordi det ikke virker som om du også gjør det: Jeg ber deg ikke om å møte meg nøyaktig på midten, men av og til fortviler jeg fordi vi aldri møtes i det hele tatt! Jeg trenger oppmerksomhet, og en form for oppmerksomhet er at du tar mine behov såpass alvorlig at du gjør en innsats i min retning. Dette går tilbake til “tanker og handlinger er ikke det samme”-konseptet. Jeg vil være lykkelig rundt deg (og du ønsker at jeg skal være lykkelig – alt er så mye enklere da!) men det er vanskelig å alltid forsøke uten å se gjensidig handling. Kan vi bli enige om en ting som du vil jobbe med for meg og sette opp en plan for hvordan det skal skje? Da vil jeg føle meg mer lykkelig, som vil gjøre meg mer lykkelig, som vil være til gjensidig glede.

Vi har begge våre sterke og svake sider: Du tenker kanskje at alt jeg gjør er å fortelle deg hva du gjør feil, og at dette betyr at jeg tror jeg er perfekt. Jeg beklager at jeg maser, og jeg tror ikke at jeg er perfekt (masingen er bevis på det!). La oss annerkjenne at vi begger er mennesker, og dermed ikke er perfekte, og sette opp en plan for å få gjort tingene en eller begge av oss ikke er så gode til. Løsninger kan være å bytte på hvem som gjør en ting, eller å leie andre til å gjøre det.

Jeg beklager at jeg er sint: Jeg hater å føle meg sint hele tiden. Det begynner virkelig å få meg til å mislike meg selv, faktisk. Jeg forstår hvorfor jeg føler meg sint – forholdet vårt går ikke den retningen jeg trodde det skulle gå. Du er sikkert sint på grunn av dette, også. Jeg vil gjerne jobbe meg gjennom sinnet mitt – og å få deg til å innrømme og jobbe med – ditt. Dette innebærer atferdsendring hos oss begge, og kanskje profesjonell hjelp, men la oss gjøre det til et felles mål å jobbe med det for vår (ikke-sinte og potensielt fantastiske) fremtid. Et skritt i riktig retning vil være for meg å lære å akseptere mitt tidligere sinne, tilgi meg selv, og gå videre. Er det noe du også kan gjøre?

Jeg vil ha det gøy! Hva skjedde med dagene hvor vi elsket å være sammen hele tiden? Livet vårt er for seriøst og sint akkurat nå. La oss sette av tid til å gjøre noe morsomt sammen (og skaffe en barnevakt hvis vi trenger det). Jo sprøere og jo lengre borte fra hverdagen, jo bedre!

Jeg vil at du skal ville ha meg: Vi har problemer nå, som kanskje påvirker sexlivet vårt, men jeg savner virkelig dagene da sex var gøy, opphissende, og jeg følte meg elsket og trygg med deg. Jeg vil at du skal ville ha meg seksuelt. Når vi har kvittet oss med noe av sinnet, og jeg er mer sikker på at du kan vise at du elsker meg, kan vi sammen finne tilbake til det vi hadde? Det vil jeg virkelig. Kanskje kan vi starte med små kjærtegn – eller kanskje vi bare skal ha fantastisk sex – akkurat nå!

Oversatt av Håkon Rian Ueland

Hentet fra ADHDmarriage.com

Dr. Hallowells tale om ADHD og læringsproblemer

June 3, 2008

Eagle Hill Graduation Talk
June 1, 2008
Edward M. Hallowell, M.D.
(Used with permission from the author).

http://www.drhallowell.com/

When Alan Carney, my classmate at Exeter, told me that he had suggested to Mr. McDonald that I be your graduation speaker this year, I was thrilled. Why would I be thrilled, you might wonder. Why would I be thrilled to give up a Sunday morning with my wife, Sue, and our 3 phenomenal kids? Why would I be thrilled to drive all by myself many miles to the west? Why would I be thrilled to speak to an audience whose chief desire for this talk is that it end quickly?

I’ll tell you why I was thrilled. I was thrilled because I knew I would be able to divulge a great secret in this talk, and I love divulging secrets. Who doesn’t? As Samuel Johnson said, “The chief reason for divulging a secret is the vanity of being known to have been trusted with it in the first place.”

So what is this secret I am going to divulge to you? I can see you wondering. I can almost hear you thinking, What’s up with this guy? What kind of secret could he possibly have?

Well, the secret relates to your school, Eagle Hill, and to this day, your graduation. You believe that you have attended the Eagle Hill School, a school that describes itself on its website as a school for students with learning disabilities. You believe that P.J. McDonald, your good-natured head, is indeed that, a good-natured head of school named P.J. McDonald. You believe that you will graduate from this school today having mastered the prescribed curriculum so that you are now ready to attend college and take your place alongside students who do not have learning disabilities.

The secret is that this is all a ruse. The secret is that Eagle Hill is a covert operation, code name, Eagle Hill. The true mission of Eagle Hill is to find and train the most interesting, talented, gifted, unusual, tenacious, humorous, creative, hard-working, out-of-the-box future innovators and leaders that can be found among kids of or near high school age.

Believing that it might cause these students to develop a swelled head were they told of the true mission of the school, it was decided years ago to disguise what happens here as the treatment of learning disabilities. This would encourage you all to work all the harder, not that you need all that much of such encouragement, and it would also help in fund-raising, as donors prefer to give to people in need.

But now, I can let you in on the secret. Having both ADD and dyslexia myself, I am a member of the secret society you all belong to, the society of the magnificently-minded.

I don’t know any of you personally, but I can tell you about you. Let me describe you to you, and let’s see if I’m right. I’ll bet there is someone in this class who can make just about anyone, anywhere laugh. I’ll bet there is a master trickster. I’ll bet there is one person in this class who could make a fortune as a con artist but instead is heading toward a career in show business. I’ll bet you have an amazing mathematician who comes up with incredible solutions to problems without having any idea how he did it. I’ll bet you have someone who could make even the shyest person on this planet feel comfortable in conversation. I’ll bet you have a superb writer, a superb artist, and a superb singer. I’ll bet you have a magician, a chef, and a potter. I’ll bet at least one of you can hit the cover off a golf ball and another one of you who someday will design a better golf ball. I’ll bet there are more than a few of you who haven’t a clue what you will do when you get to that age when you’re supposed to “do” something. Don’t worry! You’ll know it when you find it and you will surprise not only the world, but yourselves as well.

You see, this is the great secret, secret even, maybe, from each of you. You are beautifully, magnificently, and so very variously talented. You do not fit the mold, thank God. In fact, God depends upon you to keep changing the mold. Others in this world, the ones who plod ordinarily along, living with attention surplus disorder or the other disabilities of normalcy, sometimes don’t understand you. Sometimes they place misleading labels on you, like LD or ADD. But, believe me, they rely on you. The world relies on you.

How so? Well, let me tell you about a couple of members of our society, the society of the magnificently-minded. I went to high school with one of them. He was a few years ahead of me. Our high school, Exeter, was another covert operation. Only it was even more covert than Eagle Hill, but Exeter itself didn’t realize how many of the magnificently-minded it was helping develop their special talents. One of them, this fellow I want to tell you about, thought he was stupid while he was at Exeter. It took him 5 years to get through the 4 year curriculum. He rarely got a grade above a C or a D. The only reason they let him stay was that he was a faculty member’s son. Finally, he graduated, but barely. His name? John Irving. He is now one of the world’s most famous novelists, and probably Exeter’s best known alum.

How about another? This guy couldn’t stand school at all. But his family valued education, so he stayed with it as long as he could. Finally, he could take it no longer, and he dropped out of college. Others told him he was disabled and slow, but he knew better. He knew he had talent. To make a wonderfully long story short, he went on to become one of the greatest innovators in the aviation industry, the creator of, among other things, the electronic ticket. His name is David Neeleman, and he is the founder of JetBlue Airlines. Hs says his ADD is the key to his success.

One more. This woman used to be so ashamed of her organizational problems that she would not let friends come to her house or into her room. She had a terrible time with certain academic subjects, but, she too knew part of her mind was magnificent. She never gave up on herself or on pursuing the vision she had. Vision was indeed her gift. She is now a Pulitzer-prize winning photo journalist and a New York Times best-selling author several times over. Her name is Sharon Wohlmuth.

I could tell you hundreds of other stories about members of our society. But you want me to end soon. I understand.

But before I end and before you leave, I want to be sure you’re in on the secret. You are not disabled. Just the opposite. You are magnificently-minded. You are the innovators, the ones who can make people laugh and cry, the ones who will dream up new stuff and the ones who will make the new stuff sell. You’re the ones get knocked down a hundred times but get up a hundred and one. You’re the ones who find new ways to new destinations and new ways to bring others along.

One of you, probably one of the ones who hasn’t heard a word of this talk, will come up with a stand-up comedy routine that will bring down the house. Another of you, probably one of the ones who almost missed this morning’s ceremony for a comedy of reasons, will one day discover a new medical procedure accidentally on purpose. Another of you, probably all of you, will be the most fantastic, playful, devoted, hopelessly-in-love parents the world has ever seen.

The mention of parents leads me to the one suggestion I have for you graduates. Take a moment today, perhaps on the way home, maybe after you get home, but certainly before you go to bed to say two words to your parent or parents or whoever it is who changed your diapers, worried over you year after year, gave you birthday cakes and occasional reprimands, stayed up late when you were sick, took you to doctor’s appointments, ball games, museums, dances, and parties, reminded you to kiss grandma and to look a person in the eye when you shook hands, take a moment to say to that person or those people, the one or ones who made the smart decision for you to come to this covert operation of a school and paid the money as well, take a moment and say two words. You know the words. Thank you. You have no idea how happy it will make these simple people. We parents are so very simple. We love you insanely. Indeed, the day you were born we entered into a permanent state of psychosis, falling madly in love with you. Seeing you grow, seeing you find and develop the secrets in your magnificent minds, watching you come to like life and like yourselves, this is reward enough for us. As I said, we’re simple. But, if you would say thank you, and really mean it, well, then you would see us glow. Just watch. After you say those two words, just stand back and watch. You’ll see it. The glow. Probably some tears, too. It’ll make you laugh.

The rest? Well, now that you’ve lived in this magical kingdom for a while, your mission becomes to share with the less-enlightened rest of the world all the wonders you’ve discovered. Don’t worry. This will come naturally to you. One of the great qualities of the society of the magnificently-minded is that once they have spent time in a place like this, they-you- become irrepressible, unstoppable, and undefeatable.

As you listen to my words, if in fact you are listening, I hope you feel as good about yourselves and about life as you ought to. You are magnificent. The world will open up to you more and more as you go. The magnificently-minded are what the ordinary world calls “late bloomers.” That is to say, your most unusual and spectacular achievements lie years away. These years of work-and it takes a lot of work to develop magnificent minds-will pay off big time later on in time. Trust me. I know. I’ve been there myself and I am in the business of helping develop magnificent minds.

You deserve tremendous credit now for your hard work. People with ordinary minds do not have to work as hard as you. Learning is easier for them. Sometimes you might have wished you could have been born like them. That’s understandable. But, I am here to tell you, you are the lucky ones. What you have can’t be bought or taught. You have to be born with a mind like yours, a magnificent mind. Each of you has a special talent. It just takes work to develop it. It is one of the paradoxes of life that the most talented people almost invariably face the most formidable challenges. I guess God wants people to pay a price for talent. But you all have paid the price. There is still more to pay, more work ahead, but I bet one of the great discoveries you’ve made here is that you can actually like the work, because work can be play. Indeed, that’s what a great career truly is. It’s finding some form of play that someone is willing to pay you to do. And believe me, you all are uniquely equipped to find some such play. Your problem will likely be in choosing which of many to pursue.

So revel in your differences. Exult in who you are. Tough as it may have been, it is worth it to be you. And this world really needs the real you, not some altered version being forced to fit an old mold.

So, be glad. The world is now your oyster. And if you don’t like oysters, it’s your pizza, your hot dog, your Eggs a la Russe or whatever you especially adore. This covert operation, code name Eagle Hill, has turned you all into special agents of goodness, creativity, positive energy, and joy. Wherever you go, you’ll carry these great qualities with you, loving life and helping others to love life, as you so delightfully live it according to the dictates of your own magnificent minds and hearts.

One last secret. I can now reveal to you the true identity of your good-natured head. Mr. McDonald, good old P.J., is in fact the direct descendant of Albus Dumbledore, head of the Hogwarts School. Because the good folks who support schools do not like to think of their Heads as being wizards or masters of magic, P.J. passes himself off as the affable, normal man you know and love. But underneath, his genius hovers over this place, connecting you all to the legion of predecessors who have developed the talents of special, magnificently-minded youth since the dawn of time. Welcome to their midst.

I know you all will thrive and surprise. I send you off, be it on broomsticks or in Volvo’s, with my heartfelt wishes for everlasting good will, good luck, and joy.

Farmakologisk behandling

April 12, 2008

Pharmaceutical Treatments for ADHD – Medications for Attention-Deficit/Hyperactivity Disorder

Overview:

Psychostimulants constitute the major pharmacological treatment of ADHD. Theoretically, these stimulants cause more blood flow to areas of the frontal lobe that are important for attention.

Many clinicians treating ADHD believe that greater harm–emotionally and socially–occurs to untreated ADHD patients than could possibly come from the side effects of the medications. Not everyone agrees, however, and many parents are concerned about the side effects of medications. Nor does medication work for every child. Nevertheless, the usefulness of psychostimulants in the treatment of ADHD has been established and is the standard of care in mainstream medicine.

There are many styles for the use of medication in ADHD. Some clinicians increase the medicine’s dose until the desired effect is achieved or too many undesirable side effects, such as jitteriness, stomach aches or headaches occur and do not subside after several weeks. Some clinicians use other medications to treat the side effects of the psychostimulants, an approach that becomes even more problematic for parents already concerned about the consequences or long-term effects of medication use. For example, Zantac or Pepto-Bismo can be used to help patients who experience stomach ache from using psychostimulants.

If psychostimulants are not effective or sufficiently effective, the second line therapy consists of anti-depressants, such as imipramine, desipramine, nortriptyline, bupropion, or venlafaxine. Clonidine is a third-line medication. Another approach when none of these three classes of medications work, is to combine classes and give multiple drugs.

If the first psychostimulant medication does not help, Thomas Phelan, Ph.D., suggests that all patients try a second or even a third stimulant. Individuals may respond quite differently to each one. For instance, he might start with Ritalin, noting the best result the patient achieves and at what dose. He then has the patient try dexedrine or Adderall or Cylert , again observing the best result at what dose. After this, he and the patient jointly decide which medicine at what dose is best for long-term usage. He believes that patients may be “treated” for ADHD, but without comparisons among medications, the patients will not know which one works best.

Dr. Phelan emphasizes that patients need a clinician who is aware of what changes medicines can bring about in a patient’s ability to function and who knows that ADHD is not a disorder in which one medicine or one dosing schedule suits all. Patients need to watch for changes in functioning when on medicine. Sometimes another person in the patient’s life needs to note these changes.

First-line therapy: Psychostimulants:Psychostimulants are controlled substances that calm persons with ADHD rather than stimulate them. While we know that ADHD affected persons have neurochemical correlates these have not been accurately determined. However, it has been asserted that the dopamine and norepinephrine circuits are affected in ADHD.

Methylphenidate HCL (Ritalin) and sustained-release preparations (Ritalin-SR, Concerta, Metadate CD):

Ritalin is said to affect as much as a 70% improvement in those affected with ADHD. Ritalin is supposed to induce hyperperfusion [increase blood supply] to the frontal lobes of the brain. Of all the ADHD medications, Ritalin is the most inconsistently absorbed. Some adults and children absorb as much as 80-90% of the medication, whereas others only absorb 30-40% of a medication dose. Methylphenidate is derived from the same family as cocaine and increases blood flow to the basal ganglia and decreases flow to frontal and motoric regions. The basal ganglia are involved in the control of movement. Parkinson’s disease, for example, is caused by a degeneration of certain neurons located in the mid-brain that send axons to parts of the basal ganglia. Cerebral studies in persons with ADHD have shown cerebral hypoperfusion in the frontal lobe and decreased blood flow to the caudate nucleus. The amygdala, considered by some anatomists to be part of the basal ganglia, is located within the temporal lobe near its rostral tip. The side effects of Methylphenidate include facial tics and a delay in the onset of action.

Some important facts to remember about Ritalin & Methylphenidate:

1. Its onset of action is rapid: 20-30 minutes.
2. It has the shortest duration of action of 2-4 hours. Many children only benefit for 3 hours from medication.
3. There may be a significant “rebound” when the medication wears off, constituted by over-agitation and/or anxiety.

Summary Drug Monograph: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Clinical Pharmacology:The mode of action of Methylphenidate hydrochloride in man is not completely understood, but methylphenidate presumably activates the brain stem arousal system and cortex to produce its stimulant effect. There is neither specific evidence which clearly establishes the mechanism whereby methylphenidate produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system. Methylphenidate hydrochloride in extended-release tablets is more slowly but as extensively absorbed as in the regular tablets. Bioavailability of the MD Pharmaceutical Inc. methylphenidate hydrochloride extended-release tablet was compared to a sustained release reference product and an immediate-release product. The extent of absorption for the three products was similar, and the rate of absorption of the two sustained-release products was not statistically different. Dosage and Aministration:Children (6 years and over): Methylphenidate hydrochloride should be initiated in small doses, with gradual weekly increments. Daily dosage above 60 mg is not recommended. If improvement is not observed after appropriate dosage adjustment over a one-month period, the drug should be discontinued. Tablets: Start with 5 mg twice daily (before breakfast and lunch) with gradual increments of 5 to 10 mg weekly. Extended-Release Tablets: Methylphenidale hydrochloride extended-release tablets have a duration of action of approximately 8 hours. Therefore, the extended-release tablets may be used in place of the immediate-release tablets when the 8-hour dosage of methylphenidate hydrochloride extended-release tablets corresponds to the titrated 8-hour dosage of the immediate-release tablets. Methylphenidate hydrochloride extended-release tablets must be swallowed whole and never crushed or chewed. If paradoxical aggravation of symptoms or other adverse effects occur, reduce dosage, or, if necessary, discontinue the drug. Methylphenidate should be periodically discontinued to assess the child’s condition. Improvement may be sustained when the drug is either temporarily or permanently discontinued. Drug treatment should not and need not be indefinite and usually may be discontinued after puberty. Warnings:Methylphenidate should not be used in children under six years, since safety and efficacy in this age group have not been established. Sufficient data on safety and efficacy of long-term use of methylphenidate hydrochloride in children are not yet available. Although a causal relationship has not been established, suppression of growth ( i.e., weight gain, and/or height) has been reported with the long-term use of stimulants in children. Therefore, patients requiring long-term therapy should be carefully monitored. Methylphenidate should not be used for severe depression of either exogenous or endogenous origin. Clinical experience suggests that in psychotic children, administration of methylphenidate may exacerbate symptoms of behavior disturbance and thought disorder. Methylphenidals should not be used for the prevention or treatment of normal fatigue states. There is some clinical evidence that methylphenidate may lower the convulsive threshold in patients with prior history of seizures, with prior EEG abnormalities in absence of seizures, a.d. very rarely, in absence of history of seizures and no prior EEG evidence of seizures. Safe concomitant use of anticonvulsants and methylphenidate has not been established. In the presence of seizures, the drug should be discontinued. Use cautiously in patients with hypertension. Blood pressure should be monitored at appropriate intervals in all patients taking methylphenidate, especially those with hypertension. Symptoms of visual disturbances have been encountered in rare cases. Difficulties with accommodation and blurring of vision have been reported. Drug Interactions:Methylphenidate may decrease the hypotensive effect of guanethidine. Use cautiously with pressor agents and MAO inhibitors. Human pharmacologic studies have shown that methylphenidate may inhibit the metabolism of coumarin anticoagulants, anticonvulsants (phenobarbital, phenytoin, primidone), phenylbutazone, and tricyclic anti-depressants (imipramine, clomipramnine, desipramine). Downward dosage adjustments of these drugs may be required when given concomitantly with methylphenidate. Precautions: Patients with an element of agitation may react adversely; discontinue therapy if necessary. Periodic C.C. differential, and platelet counts are advised during prolonged therapy. Drug treatment is not indicated in all cases of this behavioral syndrome and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe methylphenidate should depend on the physician’s assessment of the chronicity and severity of the child’s symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. When these symptoms are associated with acute stress reactions, treatment with methylphenidate is usually not indicated. Long-term effects of methylphenidate in children have not been well established. Adverse Reactions:Nervousness and insomnia are the most common adverse reactions but are usually controlled by reducing dosage and omitting the drug in the afternoon or evening. Other reactions indude hypersensitivity (including skin rash, urticaria, fever, arthralgia, exfoliative dermatitis, erythema multiforme with histopathological findings of necrotizing vasculitis, and thrombocytopenic purpura); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; drowsiness; blood pressure and pulse changes, both up and down; tachycardia; angina; cardiac arrhythmia; abdominal pain; weight loss during prolonged therapy. There have been rare reports of Tourette’s syndrome. Toxic psychosis has been reported. Although a definite causal relationship has not been established, the following have been reported in patients taking this drug: instances of abnormal liver function, ranging from transaminase elevation to hepatic coma; isolated cases of cerebral arteritis and/or occlusion; leukopenia and/or anemia; transient depressed mood; a few instances of scalp hair loss. In children, loss of appetite, abdominal pain, weight loss during prolonged therapy,insomnia, and tachycardia may occur more frequently; however, any of the other adverse reactions listed above may also occur.

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Adderall:

Adderall is made by Richwood Pharmaceuticals, and was previously known as ‘Obetral’. The dosage of Adderall is roughly equivalent to a comparable dose of Dexedrine. Adderall tablets consist of equal amounts of Amphetamine and Dextroamphetamine, with both short and long-acting preparations. The therapeutic effect is apparently more subtle and smooth than other preparations and the length of action is 6-9 hours.

Important points to note when prescribing or taking Adderall:

1. It provides therapeutic cover for a full school or working day.
2. Adderall has been used for ‘impulse-control.’
3. Adderall has a distinct anorexic effect and therefore management of diet, especially in children, is essential.
4. Because Adderall has a slow onset of action and a sloped drop-off of action, anxiety induced at the onset of action and rebound at drop-off is reduced over other stimulants

Summary Drug Monograph: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Clinical Pharmacology:Amphetamines are non-catecholamine sympathomimetic amines with CNS stimulant activity. Peripheral actions include elevation of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulant action. There is neither specific evidence which clearly establishes the mechanism whereby amphetamine produces mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system. Dosage and Aministration:Regard less of indication, amphetamines should be administered at the lowest effective dosage and dosage should be individually adjusted. Late evening doses should be avoided because of the resulting insomnia. Attention Deficit Disorder with Hyperactivity; Not recommended for children under 3 years of age. In children from 3 to 5 years of age, start with 2.5 mg daily; daily dosage may be raised in increments of 2.5 mg at weekly intervals until oplimal response is obtained. In children 6 years of age and older, start with 5 mg once or twice daily; daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Give first dose on awakening; additional doses (1 or 2) at intervals of 4 to 6 hours Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy. Warnings:Clinical experience suggests that in psychotic children, administration of amphetamine may exacerbate symptoms of behavior disturbance and thought disorder. Data are inadequate to determine whether chronic administration of amphetamine may be associated with growth inhibition; therefore, growth should be monitored during treatment. Drug Interactions:Acidifying agents – Gastrointestinal acidifying agents (guanethidine,reserpine, glutamic acid HCl,ascorbic acid, fruit juices, etc.) lower absorption of amphetamines. Urinary acidifying agents -(ammonium chloride, sodium acid phosphate, etc.) Increase the concentration of the ionized species of the amphetamine. Primary excretion – Both Groups of agents lower blood levels and efficacy of amphetamines. Adrenergic blockers – Adrenergic blockers are inhibited by amphetamines. Alkalinizing agents -Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.)increase absorption of amphetamines. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups of agents increase blood levels and therefore potentate the actions of amphetamines. Antidepressants, tricyclic – Amphetamines may enhance the activity of tricyclic or sympathomimetic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated. MAO inhibitors – M.O. antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings, this can cause headaches and other signs of hypertensive crisis. A variety of neurological toxic effects and malignant hyperpyrexia can occur, sometimes with fatal results. Antihistamines – Amphetamines may counteract the sedative effect of antihistamines. Antihypertensives – Amphetamines may antagonize the hypotensive effects of antihypertensives. Chlorpromazine – Chlorpromazine blocks dopamine and norepinephrine receptors, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning. Ethosuximide – Amphetamines may delay intestinal absorption of ethosuximide. Haloperidol – Haloperidol blocks dopamine receptors, thus inhibiting the central stimulant effects of amphetamines. Lithium carbonate – The anorectic and stimulatory effects of amphetamines may be inhibited by lithium carbonate. Meperidine – Amphetamines pone the analgesic effect of meperidine. Methenamine therapy – Urinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy. Norepinephrine – Amphetamines enhance the adrenergic effect of norepinephrine. Phenobarbital – Amphetamines may delay intestinal absorption of phenobarbital; co-administration of phenobarbital may produce a synergistic anticonvulsant action. Phenytoin – Amphetamines may delay intestinal absorption of phenytoin; co-administration of phenytoin may produce a synergistic anticonvulsant action. Propoxyphene – In cases of propoxyphene overdose, amphetamine CNS stimulation is potentiated and fatal convulsions can occur. Veratrum alkaloids – Amphetamines inhibit the hypotensive effect of veratrum alkaloids. Precautions: Caution is to be exercised in prescribing amphetamines for patients with even mild hypertension. The least amount feasible should be prescribed or dispensed at one time in order to minimize the possibility of over dosage. Amphetamines may impair the ability of the patient to engage in potentially hazardous activities s.c. as operating machinery or vehicles; the patient should therefore be cautioned accordingly. Adverse Reactions:Cardiovascular: Palpitations, tachycardia, elevation of blood pressure There have been isolated reports of cardiomyopathy associated with chronic amphetamine use. Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness. dizziness, insomnia, euphoria. dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonictics and Tourette’s syndrome. Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects when amphetamines are used for other than the anorectic effect. Allergic: Urticaria. Endocrine: Impotence. Changes in libido.

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Dextroamphetamine saccharate/Dextroamphetamine sulfate (Dexedrine):

Dexedrine is one of the better known stimulant medications and is second only to Ritalin in the treatment of ADHD. The generic equivalent of Dexedrine is Dextroamphetamine Sulfate. Because the PDR continues to list Dexedrine under “Diet Control” medications, some insurance companies will not cover Dexedrine for the treatment of ADHD.

Important things to bear in mind when prescribing or taking Dexedrine:

1. The onset of action is 30 minutes, slower than Ritalin.
2. The coverage provided by Dexedrine is 3 1/2 to 4 1/2 hours; about an hour longer than Ritalin, especially with adult administration.
3. Dexedrine purportedly has a “smoother” onset of action and “drop-off” than Ritalin. It is usually almost completely absorbed and therefore one does not usually see the variation in onset of action that one sees with the use of Ritalin.
4. Dexedrine 5mg is about equivalent to 10mg of Ritalin. In other words it is about twice as potent as Ritalin.
5. Ingestion of Vitamin C and Dexedrine simultaneously, e.g., taking medication with orange juice, may significantly reduce Dexedrine absorption.
6. Because Dexedrine in the SR form is long acting, it is very useful for Middle and High school students who forget to take their second or third dose. Dexedrine, however, has the potential side effect of reduced appetite.

Summary Drug Monograph: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Clinical Pharmacology:Amphetamines are non-catecholamine, sympathomimetic amines with CNS stimulant activity. Peripheral actions include elevations of systolic and diastolic blood pressures and weak bronchodilator and respiratory stimulant action. There is neither specific evidence which clearly establishes the mechanism whereby amphetamines produce mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system. Dexedrine (dextroamphetamine sulfate) Spansule capsules are formulated to release the active drug substance in vivo in a more gradual fashion than the standard formulation, as demonstrated by blood levels. The formulation has not been shown superior in effectiveness over the same dosage of the standard, noncontrolled-release formulations given in divided doses. Dosage and Aministration:Attention Deficit Disorder with Hyperactivity : Not recommended for pediatric patients under 3 years of age. In pediatric patients from 3 to 5 years of age, start with 2.5 mg daily, by tablet daily dosage may be raised in increments of 2.5 mg at weekly intervals until optimal response is obtained. In pediatric patients 6 years of age and older, start with 5 mg once or twice daily, daily dosage may be raised in increments of 5 mg at weekly intervals until optimal response is obtained. Only in rare cases will it be necessary to exceed a total of 40 mg per day. Spansule capsules may be used for once-a-day dosage wherever appropriate. With tablets, give first dose on awakening additional doses (1 or 2) at intervals of 4 to 6 hours. Where possible drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy. Warnings:Amphetamines have a high potential for abuse. Admimistration of Amphetamines for prolonged periods of time may lead to drug dependence and should be avoided. Particular attention should be paid to patients obtaining Amphetamines for nontherapeutic use or distribution to others. Contraindications: Advanced arteriosclerosis, symptomatic cardiovascular disease, moderate to severe hypertension, hyperthyroidism, known hypersensitivity or idiosyncrasy to the sympathomimetic amines, glaucoma. Agitated states. Patients with a history of drug abuse. During or within 14 days following the administration of monoamine oxidase inhibitors (hypertensive crises may result). Drug Interactions:Acidifying Agents: Gastrointestinal acidifying agents (guanethidine, reserpine, glutamic acid HCl, ascorbic acid, fruit juices, etc.) lower absorption of amphetamines, Urinary acidifying agents (ammonium chloride, sodium acid phosphate, etc.) increase the concentration of the ionized species of the amphetamine molecule, thereby increasing urinary excretion. Both groups of agents lower blood levels and efficacy of amphetamines. Adrenergic Blockers: Adrenergic blockers are inhibited by amphetamines. Alkalinizing Agents: Gastrointestinal alkalinizing agents (sodium bicarbonate, etc.) increase absorption of amphetamines. Urinary alkalinizing agents (acetazolamide, some thiazides) increase the concentration of the non-ionized species of the amphetamine molecule, thereby decreasing urinary excretion. Both groups by agents increase blood levels and therefore potentiate the action of amphetamines. Antidepressants tricyclic: Amphetamines may enhance the activity of tricyclic or sympathometic agents; d-amphetamine with desipramine or protriptyline and possibly other tricyclics cause striking and sustained increases in the concentration of d-amphetamine in the brain; cardiovascular effects can be potentiated. MAO Inhibitors: MAOI antidepressants, as well as a metabolite of furazolidone, slow amphetamine metabolism. This slowing potentiates amphetamines, increasing their effect on the release of norepinephrine and other monoamines from adrenergic nerve endings; this can cause headaches and other signs of hypertensive crisis. A variety of neurological toxic effects and malignant hyperpyrexia can occur, sometimes with fatal results. Antihistamines:Amphetamines may counteract the sedative effect of antihistamines. Antihypertensives: Amphetamines may antagonize the hypotensive effects of antihypertensives. Chlorpromazine: Chlorpromazine blocks dopamine and norepinephrine reuptake, thus inhibiting the central stimulant effects of amphetamines, and can be used to treat amphetamine poisoning. Ethosuximide: Amphetamines may delay intestinal absorption of ethosuximide. Haloperidol: Haloperidol blocks dopamine and norepinephrins reuptake, thus inhibiting the central stimulant effects of amphetamines. Lithium Carbonate: The stimulatory effects of amphetamines may be inhibited by lithium carbonate. Meperidine: Amphetamines potentiate the analgesic effect of meperidine. Methenamine Therapy: Urinary excretion of amphetamines is increased, and efficacy is reduced, by acidifying agents used in methenamine therapy. Norepinephrine: Amphetamines enhance the adrenergic effect of norepinephrine. Phenobarbital: Amphetamines may delay administration of phenobarbital and may produce an intestinal absorption of phenobarbital; coadministration of phenobarbital may produce a co-synergistic anticonvulsant action. Phenytoin: Amphetamines may delay intestinal absorption of phenytoin; co-administration of phenytoin may produce a synergistic anticonvulsant action. Propoxyphene: In cases of propoxyphene overdosage, amphetamine CNS stimulation is potentiated and fatal convulsions can occur. Veratrum Alkaloids: Amphetamines inhibit the hypotensive effect of veratrum alkaloids. Precautions: Long-term effects of amphetamines in pediatric patients have not been well established. Amphetamines are not recommended for use in pediatric patients under 3 years of age with Attention Deficit Disorder with Hyperactivity. Clinical experience suggests that in psychotic children, administration of amphetamines may exacerbate symptoms of behavior disturbance and thought disorder. Amphetamines have been reported to exacerbate motor and phonic tics and Tourette’s syndrome. Therefore, clinical evaluation for tics and Tourette’s syndrome in children and their families should precede use of stimulant medications. Data are inadequate to determine whether chronic administration of amphetamines may be associated with growth inhibition; therefore growth should be monitored during treatment. Drug treatment is not indicated in all cases of Attention Deficit Disorder with Hyperactivity and should be considered only in light of the complete history and evaluation of the child. The decision to prescribe amphetamines should depend on the physician’s assessment of the chronicity and severity of the child’s symptoms and their appropriateness for his/her age. Prescription should not depend solely on the presence of one or more of the behavioral characteristics. When these symptoms are associated with acute stress reactions treatment with amphetamines is usually not indicated. Adverse Reactions:Cardiovascular: Palpitations, tachycardia, elevation of blood pressure. There have been isolated reports of cardiomyopathy associated with chronic amphetamine use. Central Nervous System: Psychotic episodes at recommended doses (rare), overstimulation, restlessness, dizziness, insomnia, euphoria, dyskinesia, dysphoria, tremor, headache, exacerbation of motor and phonic tics and Tourette’s syndrome. Gastrointestinal: Dryness of the mouth, unpleasant taste, diarrhea, constipation, other gastrointestinal disturbances. Anorexia and weight loss may occur as undesirable effects. Allergic: Urticaria. Endocrine: Impotence, changes in libido.

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Methamphetamine HCL (Desoxyn):

Desoxyn is rarely used in the treatment of ADHD. There is no generic available. Desoxyn is made by Abbott and the dosage is comparable to Dexedrine. However, Desoxyn is about 2-3 times more expensive than Dexedrine.

Important points to remember when prescribing or taking Desoxyn:

1. Desoxyn is apparently effective for the Inattentive form of ADHD.
2. Onset of action is 20-30 minutes, lasting 3 to 4 hours where the drop-off in effect is more similar to Dexedrine than Ritalin.
3. Desoxyn is contraindicated in patients with glaucoma.

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Pemoline (Cylert) for ADHD:

Cylert ranks third in sales for the treatment of ADHD. Cylert is manufactured by Abbott; no generic is available. Unlike other stimulant medications Cylert has an onset of action of about an hour and must be taken for 1-2 weeks before improvement occurs. It is recommended that the dosage of this medication be increased in increments of 18.75mg every 2-3 days over several weeks. Cylert is more expensive than Ritalin or Dexedrine.

Important points about Cylert:

1. Liver enzyme changes have occasionally been noted on patients taking Cylert. Baseline liver enzymes are recommended with follow ups at 3-6 months.
2. Persons using alcohol are at higher risk with this medication. Patients with either liver or kidney compromise should not take this medication.
3. SSRI’s affect the use of Cylert due to their effects on the liver P450 isoenzymes.
4. Cylert is a useful alternative for patients with cardiovascular disease as it has no effect on this system.
5. Cylert may cause insomnia, appetite suppression, and tics.

Summary Drug Monograph: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Clinical Pharmacology:Cylert (pemoline) has a pharmacological activity similar to that of other known central nervous system stimulants; however, it has minimal sympathomimetic effects. Although studies indicate that pemoline may act in animals through dopaminergic mechanisms, the exact mechanism and site of action of the drug in man is not known. There is neither specific evidence which clearly establishes the mechanism whereby Cylert produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system. Pemoline is rapidly absorbed from the gastrointestinal tract, Approximately 50% is bound to plasma proteins. The serum half-life of pemoline is approximately 12 hours. Peak serum levels of the drug occur within 2 to 4 hours after ingestion of a single dose. Multiple dose studies in adults at several dose levels indicate that steady state is reached in approximately 2 to 3 days. In animals given radiolabeled pemoline, the drug was widely and uniformly distributed throughout the tissues, including the brain. Pemoline is metabolized by the liver. Metabolites of pemoline include pemoline conjugate, pemoline dione, mandelic acid, and unidentified polar compounds. Cylert is excreted primarily by the kidneys with approximately 50% excretedunchanged and only minor fractions present as metabolites. Cylert (pemoline) has a gradual onset of action. Using the recommended schedule of dosage titration, significant clinical benefit may not be evident until the third or fourth week of drug administration. Dosage and Aministration:Cylert (pemoline) is administered as a single oral dose each morning. The recommended starting dose is 37.5 mg/day. This daily dose should be gradually increased by 18.75 mg at one week intervals until the desired clinical response is obtained. The effective daily dose for most patients will range from 56.25 to 75 mg. The maximum recommended daily dose of pemoline is 112.5 mg. Clinical improvement with Cylert is gradual. Using the recommended schedule of dosage titration, significant benefit may not be evident until the third or fourth week of drug administration. Where possible, drug administration should be interrupted occasionally to determine if there is a recurrence of behavioral symptoms sufficient to require continued therapy. ufficient to require continued therapy. Warnings:Because of its association with life threatening hepatic failure, Cylert should not ordinarily be considered as first line drug therapy for ADHD. Since Cylerts’s marketing in 1975, 13 cases of acute hepatic failure have been reported to the FDA. While the absolute number of reported cases is not large. the rate of reporting ranges from 4 to 17 times the rate expected in the general population. This estimate may be conservative because of under reporting and because the long latency between initiation of Cylert treatment and the occurrence of hepatic failure may limit recognition of the association. If only a portion of actual cases were recognized and reported, the risk could be substantially higher. Of the 13 cases reported as of May 1996, 11 resulted in death or liver transplantation, usually within four weeks of the onset of signs and symptoms of liver failure. The ear-liest onset of hepatic abnormalities occurred six months after initiation of Cylert. Although some reports described dark urine and nonspecific prodromal symptoms (e.g., anorexia, malaise, and gastrointestinal symp-toms), in other reports it was not clear if any prodromal symptoms preceded the onset of jaundice. It is also not clear if the recom-mended baseline and periodic liver function testing are predictive of these instances of acute liver failure. Cylert should be dis-continued if clinically significant hepatic dysfunction is observed during its use. Drug Interactions:The interaction of Cylert (pemoline) with other drugs has not been studied in humans. Patients who are receiving Cylert concurrently with other drugs, especially drugs with CNS activity, should be monitored carefully. Decreased seizure threshold has been reported in patients receiving Cylert concomitantly with antiepileptic medications. Precautions: Clinical experience suggests that in psychotic children administration of Cylert may exacerbate symptoms of behavior disturbance and thought disorder. Cylert should be administered with caution to patients with significantly impaired renal function. Since Cylert’s market introduction. there have been reports of elevated liver enzymes associated with its use. Many of these patients had this increase detected several months after starting Cylert. Most patients were asymptomatic, with the increase in liver enzymes returning to normal after Cylert was discontinued. Liver function tests should be performed prior to and periodically during therapy with Cylert. Treatment with Ctlert should be initiated only in individual without liver disease and with normal baseline liver function tests. The relationship, if any, between reversible elevations in liver function tests and the occurrence of life threatening hepatic failure in patients on long-term therapy with Cylert is not known. Liver function testing may not predict the onset of acute liver failure. Nonetheless, Cylert should be discontinued if clinically significant liver function test abnormalities are revealed at any time during therapy with this drug Adverse Reactions:The following are adverse reactions in decreasing order of severity within each category associated with Cylert: Hepatic: There have been reports of hepatic dysfunction, ranging from asymptomatic reversible increases in liver enzymes to hepatitis, jaundice and life- threatening hepatic failure, in patients taking Cylert. Hematopoietic: There have been isolated reports of aplastic anemia. Central Nervous System: The following CNS effects have been reported with the use of Cylert: convulsive seizures: literature reports indicate that Cylert may precipitate attacks of Gilles de la Tourette syndrome; hallucinations; dyskinetic movements of the tongue, lips, face and extremities: abnorrnal oculomotor function including nystagmus and oculogyric crisis; mild depression; dizziness; increased irritability; headache; and drowsiness. Insomnia is the most frequently reported side effect of Cylert, it usually occurs early in therapy prior to an optimum therapeutic response. In the majority of cases it is transient in nature or responds to a reduction in dosage. Gastrointestinal: Anorexia and weight loss may occur during the first weeks of therapy. In the majority of cases it is transient in nature; weight gain usually resumes within three to six months. Nausea and stomach ache have also been reported. Miscellaneous: Suppression of growth has been reported with the long- term use of stimulants in children. Skin rash has been reported with Cylert. Mild adverse reactions appearing early during the course of treatment with Cylert often remit with continuing therapy. If adverse reactions are of a significant or protracted nature, dosage should be reduced or the drug discontinued.

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Second-line Therapy – When Stimulants Cannot Be Used:

Antidepressant Medications and ADHD:

Anti-depressant medication is often prescribed for persons with ADHD who cannot tolerate or show no signs of improvement on stimulants, or for those who have mood sequealae. Dosage levels, while there are guidelines, are essentially determined on a case to case basis. Because ADHD persons are often poor self observers it may be helpful to enlist a person with whom the ADHD person is close in order to note any improvement or deterioration in behavior following medication changes.

It should be strongly emphasized that treatment of ADHD with anti-depressants does not necessarily imply that the patient is depressed. Antidepressants are often used to enhance the control of the patient’s symptoms, rather than as treatment of primary depression.

Some clinician feel that the SSRI’s have superior benefits, especially with children, for the mooded aspects of ADHD because they cause less side-effects than older generation anti-depressants such as the tricyclics (Imipramine, Nortriptyline, Amitryptyline, Desipramine). Desipramine has become less prescribed due to some unexplained sudden deaths which appeared to be related to heart conduction patterns.

Zoloft, Paxil, and Prozac, are the three most widely prescribed SSRI medications. Bupropion HCL (Wellbutrin) can also be a good second-line treatment. Links for drug monographs for antidepressant medications used for ADHD can be found at the end of this section.

In order to assess the effectiveness of medication any therapy it is important to ask whether an improvement has been noted in the following signs:

Inattentiveness and academic underachievement

Fidgeting and hyperactivity

Behavioral or verbal impulsivity (interrupting others, blurting out, acting before thinking)

Difficulty falling asleep at night

Trouble waking up (not getting out of bed) in the morning

Excessive irritability with-out cause and/or easy frustration

Bedwetting or primary nocturnal enuresis

Dyslexia with spatial or verbal reversals

Episodic explosiveness, emotional outbursts, or temper tantrums

Unexplained and persistent emotional negativity

If your medication does not help with any or all of these symptoms then either an increased dosage is required or a change, elimination or addition of a medication may be necessary.

Summary Drug Monographs - Selected Antidepressant Medications Used for ADHD: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Imipramine HCL (Tofranil, Janimine ) Desipramine HCL (Norpramine, Pertofrane) Amitrtriptyline (Elavil) Nortriptyline (Pamelor) Bupropion HCL (Wellbutrin) Sertraline HCL (Zoloft) Paroxetine HCL (Paxil) Fluoxetine HCL (Prozac)

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The Use of Busiprone (BuSpar) in Treating ADHD:

Busiprone (BuSpar) is a relatively new anti-anxiety medication which shows some promise in treating ADHD when psychostimulant medications are not effective or their side effects cannot be tolerated. It can also “potentiate” benefits of the serotonergic antidepressants. The side-effects of Busoprone are often better tolerated than those of other medications used for ADHD. It should always be remembered, that for reasons still not fully understood, every individual responds differently and uniquely to a specific medication. The effective administration of a specific medication for any psycho-neurological condition will still – and most likely will for quite some time – remain an art, rather than a science.

For adults with ADHD, it has been noted that women with ADHD often report especially severe PMS, and their spouses and children may be very troubled by their exceptional irritability and impatience during this time of the month. Medications such as BuSpar are often extremely effective in relieving PMS symptoms.

RELATED STUDIES:

Transdermal Patch Formulation of Anti-Anxiety Medication Holds Promise For Treating Hyperactive Children C. Keith Conners, Ph.D., Professor of Medical Psychology Duke University Medical Center Administration through a skin patch developed by Sano Corporation of a widely used anti-anxiety medication may provide a safe and effective treatment alternative for children with attention deficit hyperactivity disorder (ADHD), according to the results of a pilot study presented at a National Institute of Mental Health conference by Duke University researchers. The drug buspirone (BuSpar) was administered to a group of 32 children with ADHD using a new transdermal (through the skin) delivery technology. The transdermal buspirone patch is not yet commercially available and will require completion of current trials as well as the necessary FDA review and approvals. Following the eight-week, open-label study, 70-80% of patients treated were rated by parents and teachers as “much improved or very much improved,” according to study-leader C. Keith Conners, Ph.D., Professor of Medical Psychology at Duke University Medical Center. “The treatment was well liked by parents and well tolerated by the patients in the study – important considerations in evaluating prospective therapies for ADHD,” said Dr. Conners. He noted that the results of transdermal buspirone evaluated in the phase II trial suggest that the therapy may offer several benefits for treatment of ADHD in children. Unlike oral medications that must be taken repeatedly at home and school, the transdermal patch is applied once each morning, relieving children and their caregivers of the daily responsibility and stigma of pill-taking. Oral medications are frequently metabolized in the liver. In the drugs currently used to treat hyperactivity and attention deficit disorder this so-called “first-pass metabolism” releases active drug components erratically, creating fluctuations which increase the risk of inconsistent control of symptoms. “The main difference is that oral drugs’ side effects are associated with their peak level in thebloodstream, which is higher than their therapeutic level,” Dr. Conners noted. “If you can reduce these peak levels, you can avoid a lot of adverse effects.” He said that this may help account for the tolerability of the transdermal buspirone noted in the study. The study looked at boys and girls aged 8-12 years who were physically healthy and had been diagnosed with ADHD. Two eight-child groups wore low- dose skin patches measuring either 2.5 cm2 or 5 cm2. Two high-dose groups of eight children began the treatment period with skin patches measuring 10 cm2 or 20 cm2. Patches were replaced daily. The high-dose skin patches were increased in size every 10 days. According to Dr. Conners, the study demonstrated a relationship between dose and effect. That is, the two high-dose groups showed improvement in terms of clinical global impairment ratings by parents and teachers, while the low-dose groups showed less improvement. He characterized the side effect profile as mild and well tolerated. The adverse effects reported were mild or moderate in severity and included insomnia (15.6%), reaction at the site of the patch (12.5%), headache (9.4%), and increased activity level (9.4%). There was one severe headache. The next steps in evaluating the therapy will be the analysis of placebo- controlled efficacy studies currently underway.

For a complete drug monograph of Busiprone HCL (BuSpar), please click here.

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Clonidine (Catapres), Another Alternative to Stimulants for Treating ADHD:

Clonidine (Catapres), another alternative to stimulants for treating ADHD, has been receiving widespread anectdotal support from parents with ADHD children, and is now considered a reasonable and increasingly popular pharmaecuetical treatment for ADHD. It seems to work best in decreasing hyperactivity, but does not always improve distractibility (as stimulants do). Some physicians have found benefits in using this medication with children who have ADHD and conduct problems.

Clonidine can be useful in alleviating the hyperactivity and fidgetiness of ADHD, without having any clear affect on the attentional part. It is often used in conjunction with methylphenidate, which helps the learning and attentiveness. Methylphenidate in higher doses, ie, those necessary to control the hyperactivity in some kids, will begin to have a negative effect on learning. Thus the combination, which enables specific treatment of attention with one drug and activity with another. Clonidine may be used with Group One or Two medications to increase their effectiveness.

Warnings: Only 10 children total have been studied in double blind placebo controlled clonidine trials. Possible sudden death may be related to clonidine/stimulant combination.

Robert Renichel and Charles Popper have a review, in the Journal of Child and Adolescent Psychopharmacology, of cases of sudden death in children taking the combination of clonidine and methylphenidate. This came in response to a July, 1995, National Public Radio news piece about three deaths in children being treated with the combination. Their conclusion was that none of the fatalities support the conclusion that the combination played any role in the children’s deaths.

The most common presenting symptom of clonidine poisoning in children is lethargy. Other toxic effects include bradycardia; early transient hypertension followed by hypotension; respiratory depression and apnea; miosis; and hypothermia.

Among the 285 clonidine toxicity cases among children reported to the Kentucky poison center since 1990, 55% involved the child’s own medication; 106 cases were the result of therapeutic error, usually a double dose. A common scenario was for one parent to dose their child and then the second parent to unknowingly give the child a second dose, he said. Ninety-nine children were 1-3 years old, the most common age range for accidental poisonings; 81 children were 7-10 years old, most of whom took their own medication in excess.

For a complete drug monograph of Clonidine HCL (Catapres), please click here.

[Return to "Quick-Index" for Pharmaceutical Treatments for ADHD - Medications]

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Other Medications For Selected Symptoms Of ADHD & Accompanying Disorders:

Carbamazepine (Tegretol)

Clomipramine HCL (Anafranil)

Guanfacine HCL (Tenex)

Lithium Carbonate (Eskalith, Lithobisd, Lithonate, etc.)

Molindone HCL (Moban)

Propanolol HCL (Inderal)

Thioridazine HCL (Mellaril)

Trazodone HCL (Desyrel)

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Mood Stabilizers (for ADHD with Mood and Behavior Problems) : Lithium, Carbemazepine (Tegretol), and Valproic Acid (Depakote) have been used when mood disorders co-exist with ADHD. One frequently sees bipolar patients with supposed comorbid ADHD or diagnosed solely with ADDH. This is becoming increasingly common in adults as well as kids thanks to the popularity of the ADHD diagnosis. The problem is that just about all bipolar patients have a disorder of attention. To differentiate between the two, it is sometimes helpful to look for symptoms that are seen in bipolar disorders but not usually in ADHD, for example:

racing thoughts

not needing to sleep or hypersomnia

changes in energy parallel to the above

tangential thinking

overspending, overcommitting

grandiosity

grandiose thrill seeking (eg, jumping off of high places)

psychosis.

When ADHD and Bipolar Disorder are comorbid, starting treatment with a stimulant in these patients will often exacerbate the hyperactivity, flatten affect, and greatly decrease appetite. Some doctors start instead with either clonidine or guanfacine plus one of the following mood stabilizers: lithium, carbamazepine, valproic acid, or lamotrigine.

Once the patient is stable on therapeutic doses, a stimulant can be added if ADHD symptoms remain; if necessary, an antidepressant is sometimes added as well.

The boundary between persistent hypomania and ADHD is unclear. The usual practice is to treat such cases with stimulants before puberty and with mood-stabilizing agents in adulthood.

Summary Drug Monographs - Selected Medications Mentioned in this Section: (Provided courtesy of and copyright by: RxList – The Internet Drug Index) Lithium Carbonate (Eskalith, Lithobisd, Lithonate, etc.) Divalproex Sodium / Sodium Valproate + Valproic Acid (Depakote ) Carbamazepine (Tegretol) Lamotrigine (Lamictal) Guanfacine HCL (Tenex) Clonidine (Catapres)

[Return to "Quick-Index" for Pharmaceutical Treatments for ADHD - Medications]

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Innovative Pharmacological Agents for Attention-Deficit/Hyperactivty Disorder:

Dimephosphonum:

Professor Vadim G. Malyshev, Head of the Department of Pathology, Ulyanovsk State University, Russia, is studying the biological properties of new phosphorous-containing drugs, synthesized at the Kazan State Institute of Organic and Physical Chemistry. He reports that one of these agents, Dimephosphonum, produces a normalizing effect on the functioning of the nervous system, mechanisms of blood circulation control, the tonicity of vessels, and on the acid-base state in acidosis of different aetiology and membrane functions of tissues. When locally applied, he reports that dimephosphonum exhibits an antiseptic, antiphlogistic, and antiallergenic effect, increasing the protective barrier of the skin and the mucous membrane functions, thus contributing to the healing of wounds.

Dimephosphonum produced a normalizing effect on

1. Brain functioning in stroke due to:
   
   1. Vertebral and carotid artery lesions (initial manifestations, transient ischemic attacks, ischemic and haemorrhagic insults, post insult complications, discirculatory encephalopathy, myelopathy and radiculopathy)
      
   2. Arterial hypertension
      
   3. Vasomotor dystonia

   

2. In neurosurgical trauma in the course of cranial and spinal operations;
   
3. In craniocerebral injuries (concussion and contusion of brain);
   
4. In Meniere’s syndrome and disease.
   
5. In vegetative dysfunction.

Malyshev reports that dimephosphonum is more effective than sermionum and pyracetam in correction of cerebral vessel reactivity. For more information email him at cik@pop.ul.ru, or write him at 2-21 pr Sozidately, Ulyanovsk 432059, Russia. Telephone and fax numbers are 7 (8422) 217.992.

[Return to "Quick-Index" for Pharmaceutical Treatments for ADHD - Medications]

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Points About the Outcome of Any Therapy: In monitoring treatments for ADHD, measurable improvements include attention span, concentration, memory, mood, task completion, motor coordination. Behaviors that may decrease include daydreaming, hyperactivity, immature behavior, anger, defiance, oppositional behavior, and impulsivity.

In order to assess the effectiveness of any therapy for ADHD it is important to ask whether an improvement has been noted in the following signs:

Inattentiveness and academic underachievement

Fidgeting and hyperactivity

Behavioral or verbal impulsivity (interrupting others, blurting out, acting before thinking)

Difficulty falling asleep at night

Trouble waking up (not getting out of bed) in the morning

Excessive irritability with-out cause and/or easy frustration

Bedwetting or primary nocturnal enuresis

Dyslexia with spatial or verbal reversals

Episodic explosiveness, emotional outbursts, or temper tantrums

Unexplained and persistent emotional negativity

If your medication does not help with any or all of these symptoms then either an increased dosage is required or a change, elimination or addition of a medication may be necessary.

The following information is excerpted from a National Institute of Mental Health (NIMH) leaflet regarding “Treatment For Attention Deficit Hyperactivity Disorder (ADHD)”:

For decades, medications have been used to treat the symptoms of ADHD (Attention Deficit Hyperactivity Disorder). For many people, these medicines dramatically reduce their hyperactivity and improve their ability to focus, work, and learn. The medications may also improve physical coordination, such as handwriting and ability in sports. Recent research by the National Institute of Mental Health (NIMH) suggests that these medicines may also help children with an accompanying conduct disorder to control their impulsive, destructive behaviors. Unfortunately, when people see such immediate improvement, they often think medication is all that’s needed. But these medicines don’t cure the disorder, they only temporarily control the symptoms. Although the drugs help people pay better attention and complete their work, they can’t increase knowledge or improve academic skills. The drugs alone can’t help people feel better about themselves or cope with problems. These require other kinds of treatment and support. For lasting improvement, numerous clinicians recommend that medications should be used along with treatments that aid in these other areas. There are no quick cures. Many experts believe that the most significant, long-lasting gains appear when medication is combined with behavioral therapy, emotional counseling, and practical support. Some studies suggest that the combination of medicine and therapy may be more effective than drugs alone. NIMH is conducting a large study to check this. Use Of Stimulant DrugsStimulant drugs, such as Ritalin, Cylert, and Dexedrine, when used with medical supervision, are usually considered quite safe. Although they can be addictive to teenagers and adults if misused, these medications are not addictive in children. Sometimes, a child’s ADHD symptoms seem to worsen, leading parents to wonder why. They can be assured that a drug that helps rarely stops working. However, they should work with the doctor to check that the child is getting the right dosage. They also need to know that new or exaggerated behaviors may also crop up when a child is under stress. The challenges that all children face, like changing schools or entering puberty, may be even more stressful for a child with ADHD. Some doctors recommend that children be taken off a medication now and then to see if the child still needs it. They recommend temporarily stopping the drug during school breaks and summer vacations, when focused attention and calm behavior are usually not as crucial. These “drug holidays” work well if the child can still participate at camp or other activities without medication. Children on medications should have regular checkups. Parents should also talk regularly with the child’s teachers and doctor about how the child is doing. This is especially important when a medication is first started, re-started, or when the dosage is changed. The Medication DebateAs useful as these drugs are, Ritalin and the other stimulants have sparked a great deal of controversy. Most doctors feel the potential side effects should be carefully weighed against the benefits before prescribing the drugs. While on these medications, some children may lose weight, have less appetite, and temporarily grow more slowly. Others may have problems falling asleep. Some doctors believe that stimulants may also make the symptoms of Tourette’s syndrome worse, although recent research suggests this may not be true. Other doctors say if they carefully watch the child’s height, weight, and overall development, the benefits of medication far outweigh the potential side effects. Side effects that do occur can often be handled by reducing the dosage. It’s natural for parents to be concerned about whether taking a medicine is in their child’s best interests. Parents need to be clear about the benefits and potential risks of using these drugs. Another debate is whether Ritalin and other stimulant drugs are prescribed unnecessarily for too many children. Remember that many things, including anxiety, depression, allergies, seizures, or problems with the home or school environment can make children seem overactive, impulsive, or inattentive. Critics argue that many children who do not have a true attention disorder are medicated as a way to control their disruptive behaviors. Medication & Self-EsteemWhen a child’s schoolwork and behavior improve soon after starting medication, the child, parents, and teachers tend to applaud the drug for causing the sudden change. But these changes are actually the child’s own strengths and natural abilities coming out from behind a cloud. Giving credit to the medication can make the child feel incompetent. The medication only makes these changes possible. The child must supply the effort and ability. To help children feel good about themselves, parents and teachers need to praise the child, not the drug. It’s also important to help children and teenagers feel comfortable about a medication they must take every day. They may feel that because they take medicine they are different from their classmates or that there’s something seriously wrong with them. Parents and teachers can help children view the medication in a positive way.

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List of Articles & Information on Pharmaceutical Treatments for ADHD – Medications:

Schools’ Backing of Behavior Drugs Comes Under Fire: New York Times, 8/19/01 – Some of Ritalin’s competitors are breaking with 30-year-old international marketing restrictions to advertise ["Concerta" and "Metadate CD"] directly to parents, selling the idea that drugs may be the answer to their children’s problems in school. At the same time, state legislatures are moving to prevent schools from recommending or requiring that parents put their children on medication.



Ritalin Information from the Parkinson’s Information Exchange



Methylphenidate in Children with Hyperactivity [Wessex Institute for Health Research and Development Report]



DEA Warns of Ritalin Abuse: Students Using Ritalin Like Cocaine



Attention Deficit Hyperactivity Disorder Medication Information [Child Development Institute]



Dr. Bob’s Psychopharmacology Tips: Adderal

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What others in the field think of Pharmaceutical Treatments for ADHD – Medications:

Harvard University: Study Points to More Targeted Use of Ritalin: Drug Not Effective For All

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