1 The Comparison of ADHD Treatments “Attention-deficit hyperactivity disorder (ADHD) is a prevalent and debilitating disorder diagnosed on the basis of persistent and developmentally-inappropriate levels of overactivity, inattention and impulsivity” (Gail Tripp and Jeffery R. Wickens, 2009, p.579). “The diagnostic criteria for ADHD include descriptions of 9 symptoms in each of two domains (inattention and hyperactivity/impulsivity). Not all symptoms have to be present for the diagnosis to be made: it is sufficient to have 6 of 9 in either domain, or both domains in the case of combined type…the number different combinations of 6 drawn from 9 is 504” (Tripp and Wickens, 2009, p.579). This means that there are five hundred and four different possible ways to be diagnosed with ADHD. “Attention deficit hyperactivity disorder is one of the most common childhood neuropsychiatric disorders, and it often persists into adulthood”(Kerstin Konrad, and Simon B Eickhoff, 2010, p.904). Although ADHD is such a common disorder, not much is known about its origin or what it really goes on in the brain. Gail Tripp and Jeffery R. Wickens discuss the neurotransmitter system, theorizing a correlation to ADHD. “Executive functions may be defined as “neurocognitive processes that maintain an appropriate problem-solving set to attain a latter goal””(Tripp and Wickens, 2009, p.581). “There is good evidence of impairment in a variety of executive function measures amongst groups of children with ADHD. The most reliable being response inhibition, vigilance, working memory, and planning” (Tripp and Wickens, 2009, p.581) “There is also a large deficit in motivation in children with ADHD. Children with ADHD have an altered response to reinforcement, suggesting a deficiency in dopamine absorption. They are less able to delay gratification, and exhibit failure to respond to discipline” (Tripp and Wickens, 2009). “Children with ADHD respond more impulsively to reinforcements, consistently choosing small immediate reinforcement over larger delayed 2 The Comparison of ADHD Treatments reinforcement”(Tripp and Wickens, 2009). People with ADHD are always seeking stimulation. They are extremely impulsive. ADHD is particularly debilitating in a classroom setting, as the afflicted child cannot maintain focus, and is constantly distracting other students, therefore disrupting not only their own education, but the education of those students around them as well. Luckily there are some treatment options. While there are a few non-medication or alternative forms of treatment for ADHD, ultimately stimulant medication is more effective (except in a few extreme cases) therefore stimulant medication should be the first choice in ADHD treatment. When I say alternative treatments I am referring to the possibility of any type of treatment that is not a stimulant drug. One type of treatment I have come across is biofeedback. EEG biofeedback uses auditory and visual stimulation to try and condition the brain into a more effective way of functioning. First it records the condition of the brain and the rate at which the brain waves emit and then compares them to normal (normal meaning a brain not suffering from ADHD) brain waves and tries to change the afflicted brains waves to that of a more efficient sort. In brains suffering from ADHD common brain wave alterations could be “increased theta wave rhythms (associated with drowsiness), decreased fast sensorimotor rhythm (SMR, inversely associated with movement), and decreased beta rhythm (associated with attention and memory process)” (Neal L. Rojas and Eugenia Chan, p. 116, 2005). These brain wave patterns will result in a decreased attention span, memory issues (ex. You can tell someone with ADHD something important and even if you stress how important it is, within 5 minutes they can completely forget you said anything at all), there will be an increase in a drowsy like state due to the theta wave, and decreased movement control. 3 The Comparison of ADHD Treatments “Theta/beta biofeedback aims to reduce theta waves associated with drowsiness or dreaming at 4-6 Hz, while increasing beta waves associated with wakefulness at 16-20 Hz.” (Neal L. Rojas and Eugenia Chan, 2005, 117). EEG biofeedback treatment is based on the theory that children with hyperactivity “could decrease their muscle treatment and become more still with enhanced SMR activity”(Neal L. Rojas and Eugenia Chan, 2005, p. 117). I know this sounds awesome but due to the lack of reliable studies done for this treatment, it cannot be seen as a reliable treatment for ADHD. Neal and Eugenia, 2005, talk about the possible use of diet as a treatment strategy for ADHD. According to them, diet modification is popular among parents because it makes them feel more in control about their child’s disease. However, there are nutritional issues to the ADHD diet as in an attempt to help, so many different types of foods are eliminated. Also, there isn’t adequate research to support using diet as the only treatment for ADHD. It may work great when paired with other treatments however. Yoga might also be an alternative treatment for ADHD. “yoga is an extremely varied exercise… which seeks to alter the body’s physiology”(Neal and Eugenia, 2005). “Yoga participants significantly improved…in Hyperactivity, Anxious/Shy…”(Neal and Eugenia, 2005). Although these seems to be a great improvement, but all the patients were treated with yoga in addition to already being “stabilized on medications”(Neal and Eugina, 2005). Yoga treatment has only been tested one documented time, so there is nothing to compare the results to, making this an unreliable form of treatment. 4 The Comparison of ADHD Treatments Although there are many alternative forms of treatment, many of them only work if they are paired with stimulant medications. Other treatments are highly controversial and aren’t proven to work. The only proven treatment for ADHD is stimulant medication. No one has yet to prove exactly how these type of drugs help, however, because no one has been able to prove exactly what ADHD is, what exactly is going on inside the brain, or how it is caused. Some people are born with it, while others can acquire it from a brain injury, or head trauma. Even though there is no exact answer, there are many theories as to how stimulant medication works and the effects it has on the brain. On theory discussed by Gail and Jeffery, 2009, is that ADHD is actually caused by a malfunction in the dopamine system in the brain. Where in normal children the dopamine system learns to reward itself when a child stays on task,(ex. Sitting in their chair all class, doing all their homework, or listening to someone else) in an ADHD brain the dopamine system can’t reward itself in the same way. It can’t stay on task because it can’t reward itself for staying on task. An ADHD brain can only reward itself for immediate things. That is where the hyperactivity comes in. The ADHD brain is always seeking the next “reward” even though it does so in unconventional ways. Instead of seeking a “good job”, it seeks a reaction. Usually scaring someone so they scream. Gail and Jeffery theorized that the ADHD medication stimulates the dopamine receptor, allowing the child with ADHD to receive the mental “reward” of sitting still, of staying on task, ect.. Thus, ultimately, the ADHD brain becomes calmer, more focused, and more functional. There some concerns, for example the controversies of giving young child a drug, or possible side effects the drug might cause. The most common drug for the treatment of ADHD is methylphenidate, or Ritalin. Methylphenidate is a central nervous system stimulant. Common side effects that may occur 5 The Comparison of ADHD Treatments are nausea, insomnia, anxiety, loss of appetite, vomiting, increased heart rate, increased blood pressure, agitation, nervousness, and possibly psychosis (Eni Willams, PharmD, PHD, www.rxlist.com/ritalin-side-effects-drug-center.htm). I have been taking methylphenidate since I was in kindergarten, and the only side effect I ever experienced was loss of appetite. The medication wore off by dinner however, so the only meal I occasionally skipped was lunch. Alice Charach, Abel Ickowicz, and Russell Schachar conducted a study in 2004 about the use of stimulant medication over a five year time span. They state that “more than 1.5 million children in the United States take stimulant medication, most commonly methylphenidate”(559). During this study only 15% of the original number of participants dropped out do to side effects of methylphenidate (Alice Charach, Abel Ickowicz, and Russell Schachar, 2004). This means that 85% of the participants did not experience any dramatic negative side effects. Alice, Abel and Russell summarize that although stimulant medication may have its methodological shortcomings, the current study shows that children with ADHD continue to reap benefit and continue to experience adverse effects from long term use of stimulants (at least five years). Even children who experience significant symptoms still receive therapeutic results when consistently taking stimulant medication over several years (566). Based on my research, due to the fact that alternative treatments are ultimately less effective and less reliable that stimulant medication, I believe that stimulant medication is the best treatment for ADHD and should be the first choice in treating anyone with ADHD.