ADD,+ADHD,+Attention+Expansion+Advantage

See also Attention Deficit Hyperactivity Disorder (ADHD)

Incidence/Prevalence:
6.8% prevalence among school-aged children ages 6-12 years based on systematic review of 14 studies prevalences ranged from 4.2% to 26% pooled prevalence estimates were 6.8% using DSM-III criteria, 10.3% using DSM-III-R criteria, and 6.8% in single study using DSM-IV criteria prevalence 3 times higher for boys (9.2% vs. 3%) than girls, but did not vary with age Reference - AHRQ evidence-based review (Evid Rep Technol Assess (Summ) 1999 Nov;(11):i-viii, 1-341)
 * 1) 1 behavioral disorder of school-age children

methylphenidate (e.g. Ritalin 1 mg/kg/day in divided doses) reduces core symptoms of ADHD superior to non-drug treatments improved outcomes when added to behavioral interventions may disrupt sleep and appetite long-acting formulations (Metadate CD or Metadate ER twice daily, Concerta or Ritalin LA once daily Also - Dexedrine, Adderall) http://www.ritalindeath.com/

Diet:
elimination of certain substances (e.g. food dyes and preservatives) not proven to be effective Feingold diet (elimination of certain foods and synthetic chemicals) has received widespread support despite lack of controlled clinical trials studies of food dyes in children with ADHD have had inconsistent results oligoantigenic diet associated with limited behavioral improvement in crossover trial; 49 children with hyperactive/disruptive behavior disorder randomized to oligoantigenic diet vs. control diet in crossover fashion while in inpatient unit, 12 children (24%) showed significant behavioral improvement in 2 behavior ratings during diet relative to control diet conditions, methylphenidate used in 36 children yielded more responders (44%) than diet (Eur Child Adolesc Psychiatry 1997 Jun;6(2):88) Reference - Altern Ther Health Med 2002 Jan-Feb;8(1):68, commentary can be found in Altern Ther Health Med 2002 May-Jun:8(3):18 food additives might promote hyperactivity in children, but evidence limited and inconsistent sugar challenges have not shown evidence of behavior problems in 12 double-blind placebo-controlled trials (Crit Rev Food Sci Nutr 1996 Jan;36(1-2):31) (* further peer review in progress) essential fatty acid supplementation for 4 weeks had little or no benefit in randomized placebo-controlled crossover trial of 31 children with marked inattention and overactivity (J Abnorm Child Psychol 1987 Mar;15(1):75 in Altern Ther Health Med 2002 Jan-Feb;8(1):68) Growth inhibited with stimulants No change DHA

Nutritional Factors
 *  Sensitivities to food additives
 *  Food intolerances
 *  Sugar and reactive hypoglycemia
 *  Heavy metal toxicity
 *  Environmental illness
 *  Maternal hypothyroidism and an abnormal
 * thyroid responsiveness
 *  Essential fatty acid deficiencies and other
 * nutrients
 *  Gut and liver dysfunction

He Huan Pi (Albizzia)- tablet to dampen the allergic response. Andrographis tablet to increase immune vigilance. Bacopa tablet to positively modify behavioral and cognition difficulties. Bacopa to improve cognition and concentration. Rosemarinus as a choleretic, antioxidant and memory enhancer. Withania [Ashwaghanda] as an adaptogen and general tonic. [improves cognition, comprehension] Gymnema to improve his glucose tolerance. [deters sugar cravings] Schizandra as an adaptogen and supporter of liver detoxification.
 * Aust J Med Herbalism 20(3) 2008 91: Attention deficit hyperactivity disorder - Rob Santich:**

Andrographis extract 2.0 g Ocimum tenuiflorum extract 500 mg Echinacea purpurea root extract 300 mg Echinacea angustifolia root extract 200 mg 3 tablets daily

Matricaria recutita, Filipendula ulmaria, Silybum marianum, Citrus reticulata (Chen Pi), Albizia lebbek, Scutellaria baicalensis
 * Food allergy and intolerance**

Euphrasia officinalis, Solidago virgaurea, Hydrastis canadensis, Echinacea spp, Andrographis paniculata
 * Upper respiratory allergy (hayfever)**

Curcuma longa, Ginkgo biloba, Adhatoda vasica, Scutellaria baicalensis, Grindelia camporum, immune modulators
 * Lower respiratory allergy (asthma)**

Hydrastis Canadensis, Calendula officinalis
 * Heal leaky gut**

Silybum marianum, Crataegus oxycantha, Allium sativum
 * Chelate heavy metals**

Flaws: If the spirit is healthy, then it is calm, there is no fidgeting. Hyperactivity, on the other hand, is described as the heart spirit stirring restlessly; clinically there is inability to sit peacefully or fidgeting. According to Chinese medical theory, there are three basic mechanisms that may result in pédiatric hyperactivity: either 1) the spirit is insufficiently constructed and nourished, 2) some sort of heat evils are harassing the spirit, or 3) some sort of evil qi, such as phlegm turbidity or blood stasis, is blocking the orifices of the heart. Insufficient nourishment and construction may be due to a congenital insufficiency (as in the case of Down's syndrome) or may be due to improper diet.

Heat evils may be 1) inherited from the parents at conception, 2) engendered during gestation due to the mother's diet and emotions, 3) caused by improper diet after birth, 4) caused by frustration, anger, and other emotional excesses, 5) caused by too much stimulation (such as violent TV and video games), and 6) caused by the external contraction of beat evils (possibly via inoculations). Phlegm turbidity is caused by improper diet and too little exercise, bile blood stasis is the result of either prolonged mental-emotional stress or traumatic injury (including injury during delivery).

If there is insufficient qi and blood to nourish and construct the spirit mind, there are some heat evils harassing the heart spirit making it disquieted, or there is some evil qi blocking the heart orifices, thus misting and confounding the heart spirit. There is also an inability to remember. This is also mostly due to insufficient nourishment and construction of the heart spirit. The Chinese Medical Treatment of ADHD and ADD

In most cases of ADHD and ADD involve some sort of evil heat. The main types of evil heat present in this condition are depressive heat, phlegm heat, and vacuity heat. Therefore, clearing heat is almost always some part of the Chinese medical treatment plan for ADHD/ADD. ADHD/ADD Due to Vacuity Heat "The Treatment of 36 Cases of Pédiatric ADHD (Attention Deficit Hyperactivity Disorder) by Integrated Chinese-Western Medicine" by Yang Hong (Fu Han Zhong Yi Yao [Fujian Chinese Medicine & Medicitials]. August, 2005:34).

//-There were 56 patients in this two-wing comparison study, including 38 males and 18 females. All patients were between the ages of five and 11 years old, and the course of disease was from six months to three years in length. The disease appeared before the age of seven years old in all patients. The individual patient IQ ranged between 85-11 7 points. These participants were randomly divided into two groups.//

//The treatment group (who received both Chinese and Western medicine) included 36 patients: 24 males and 12 females.// //In this group, the average age was six years, and the course of disease was between eight months and three years in length, with an average duration of 1.8 years.// //The average IQ of these children was 95. The comparison group (who only received Western medicine) included 20 patients: 14 males and six females.// //In this group, the average age was five years and eight months old, and the course of disease was between six months and 2.7 years in length, with an average duration of 1.65 years.// //The average IQ of these children was 90. Thus, there were no significant statistical differences between these two groups.//

//The treatment group took five milligrams of methylphenidate (Ritalin®) two times per day in the morning and evening.// //[Note: In clinical practice, the usual dosage for this medication ranges from 0.3-0.8mg/kg depending upon body weight.// //Prescribing physicians usually begin with a dosage of 0.3 mg/kg (i.e., a 5-lOmg pill in the morning) and, based on the response to treatment, may add a second late morning or early afternoon dose.// //This dose may then be increased by five milligrams per week until either the desired beneficial effect or undesirable side effects occur.] In addition to Ritalin, the treatment group was administered://

//Chinese herbal medicine. The formula used was Liu Wei Di Huang Tang hie Gan Mai Da Zao Tang (Six Flavors - Rehmannia Decoction plus Licorice, Wheat, & Red Date Decoction):// //Shu Di Huang (cooked Radix Rehmanniae), 12 grams// //Shan Zhu Yu (Fructus Corni), 9 grams// //Dan Pi (Cortex Moutan), 6 grams// //Shan Yao {Radix Dioscoreae), 12 grams// //Fu Ling (Poria), 10 grams// //Ze Xie (Rhizoma Alismatis), 6 grams// //Da Zao (Fructus Jujubae), 6 grams// //Xiao Mai (Fructus Tritici), 30 grams// //Gan Cao (Radix Glycyrrhizae), 3 grams//

//One packet of this medicine was taken per day by adding 600 milliliters of water to the above and boiled until the fluid was reduced to 200 milliliters.// //The resulting liquid was divided into two doses and taken in the morning and evening.// //The comparison group took Ritalin at the same dosage and intervals as the treatment group.// //In both groups, one course of treatment equaled one month, and all patients in the study continued treatment for three courses (i.e., three months).//

//Study Outcomes:// //Cure meant that the patient's concentration, focus, and mood had stabilized and that his or her grades in school had improved substantially. Improvement meant that the child's movement was less and he or she could sit for a longer period of time and concentration, focus, and school grades had also improved.// //No improvement meant that there was no difference in the child's health from before to after treatment. Based on these criteria, 26 cases in the treatment group were cured, eight cases improved, and two cases did not improve. Therefore, the cure rate for this group was 72.2%, and the total amelioration rate was 94.47%.// //In the comparison group, 12 cases were cured, four cases improved, and four cases did not improve. Thus the cure rate for this group was 60%, and the total amelioration rate was 80%.//

//Follow-up visits six months later showed that symptoms had reappeared in 70%. (14/20 cases) of the patients in the comparison group, while symptoms reappeared in only13.9% (5/36 cases) of the patients in the treatment group. In addition, only eight children in the treatment group - TOWNSEND LETTER - APRIL 2008 151//

Chinese Medicine, ADHD & ADD had side effects (which included poor appetite and slight difficulty sleeping), whereas, in the comparison group, 12 cases (60%) had side effects that had a tendency to be more severe than the treatment group and included decreased appetite, insomnia, abdominal pain, and rapid heartbeat.

-A child's body belongs to pure yang. In children, yang is often in surplus and yin is often insufficient. Due to these tendencies, it is easy to see how children manifest signs of yang stirring having a surplus and yin tranquility being insufficient. Attention deficit hyperactivity disorder easily develops, because yin cannot control yang and yang qi stirring frenetically results in the heart spirit not being settled, therefore causing the child's attention span to be lax. To address these disease mechanisms, the doctor in this article used Liu Wei Di Huang Tang to enrich yin and supplement the kidneys, combined with Gan Mai Da Zao Tang to nourish the heart and quiet the spirit.

[Readers should note that Liu Wei Di Huang Wan has been in constant use in Chinese medicine since the Song dynasty (approximately 1,200 years) and was created by the greatest premodern Chinese medical pediatrician, Qian Yi, while Can Mai Da Zao Tang is five hundred years older still (approximately 1,700 years) and was created by the greatest of all premodern Chinese herbalists, Zhang Zhong-jing.]

When Chinese herbal medicine is combined with the proper diet and lifestyle modifications to address the underlying causes of these conditions. Properly prescribed Chinese herbal medicine is without side effects and can also reduce the dosage and the side effects of Western Pharmaceuticals at the same time as making those drugs clinically even more effective. It is logical, that TCM would be included as a choice of treatment and/or complement to modern Western psychiatry for the treatment of these conditions.

Restless Syndrome In Children
Hyperactive children making it hard for them to learn or contain their emotions.

3 main causes again in Chinese Medicine:
-Congenital Liver / Kidney Deficiency (ie-emotional during pregnancy) -Trauma during birth or childhood (shaking, dropping, scaring child) is a possible cause for Attention Deficit Disorder. -The Main TCM mechanism for Attention Deficit Disorder (ADD) is the disharmony of Yin and Yang with dysfunctional Heart, Liver, Spleen or Kidney.

This gives them the lack of concentration which is most prominent when first starting school when they can not control their emotions or stay seated for long periods of time.

Spleen Xu, liver hyperactivity
Uncontrollable fidgeting, emotional tension, easy anger, poor sleep, fatigue, diminished appetite, easily developing diarrhea in response to emotional stress And Chai Hu, Gou Teng, Dang Gui, Chuan Xiang, Bai Zhu, Fu Ling, (and Gan Cao) Neuroplus, Dopatone
 * Tongue:** thin white fur
 * Pulse:** Wiry
 * Herbal Treatment:** Gui Zhi Tang and Yi Gan San: Gui Zhi, Bai Shao, Gan Cao, Sheng Jiang, Da Zao
 * Dietary Recommendations:** can add “Becalmed”– 5HTP, Magnesium, Calcium, B6, folate, phenylalanine, Glutamine, Fish oil

Heart/ Spleen insufficiency
sallow yellow, or pale complexion, pale nails, lips, fatigue, insomnia, palpitations, SOB, poor appetite, poor memory, child is in their own world, lack of concentration, dreamers, quiet, suttle movement, light sleeper, spontaneous sweat, night sweat, picky eater (autistic) Sleep walking – Gou Teng, Long Chi, - Dens Draconis and Zhen Zhu Mu – Margarita Impaired memory: Yuan Zi, Long Gu, Shi Chang Pu, Bacopa, Rhodiola
 * Tongue:** Pale & puffy
 * Pulse:** Thin and Weak
 * Herbal Treatment:** Gan Mai Da ZaoTang Plus Gui Pi Tang : Tai Zi Shen, Fu Shen, Bai Zhu, Dang Gui, Huang Qi, Yuan Zhi, Suan Zao Ren, Shi Chang Pu, Wu Wei Zi, Da Zao, Fu Xiao Mai, Gan cao
 * Modifications:**

Kidney yin deficiency with Liver Yang Rising
Hyperactivity, easy getting angry, hard to concentrate, insomnia, restlessness, malar flush, five hearts hot, possible night sweating, dry mouth or thirst, loud Or - Qi Ju Di Huang Wan + Long Gu, Mu Li (calm spirit herbs)
 * Tongue:** red with thin scanty coat.
 * Pulse:** Rapid
 * Herbal Treatment:** Zuo Gui Yin Jia Jian: Shu Di Huang, Du Zhong – Eucommia, Shan Zhu Yu – cornus, Gou Qi Zi – Lyciium fruit, Shan Yao – Dioscorea, Niu Xi – Achyranthis, Tu Si Zi – Cuscuta, Sang Ji Sheng – Loranthus, Lu Jiao Jiao – Cornus, Gelatinum Plastrii Testudinis – Gui Ban Jiao

Phlegm Heat Disturbing heart
Easy anger, restless, possible nausea, chest fullness and oppression, poor sleeping thirst, scanty urine and constipation [Ban Xia, Chen Pi, Zhu Ru, Zhi Shi, Fu Ling, Zhi Gan Cao, Da Zao, Huang Lian]
 * Tongue:** Red w/ greasy coat
 * Pulse:** thin and Pale
 * Acupucnture Treatment:** H7, PC6, Liv3, St36, Bl15, Bl20, St40, Sp6, Bl23, L14, Sp10
 * Herbal Treatment:** Huang Lian Wen Dan Tang

Heart And Kidney Deficiency
slow mental reactions, poor memory, lack of concentration, enuresis, many dreams, dark complexion
 * Herbal Treatment:** Kong Sheng Zhen Zhong Dan: or choose from above formula and add Chi Shao, Dan Shen, Hong Hua

So far over 10 genes have been suspected to be involved in the manifestation of ADHD, and many of these genes center around dopamine receptors or dopamine transporting molecules. Also, there seems to be no one gene which guarantees ADHD, but rather certain genes have been identified as denoting susceptibility to ADHD. Some of the genes may increase dopamine receptors in certain parts of the brain which may have the effect of depleting dopamine--which, as you will see, is an important player in ADHD. Dopamine and Norepinephrine ADHD was found to be the result of a deficiency of a specific neurotransmitter -- here, norepinephrine. Like all neurotransmitters, norepinephrine is synthesized within the brain; however norepinephrine synthesis requires dopamine as an intermediate step. Specifically, the basic building block of each norepinephrine molecule is dopa; this molecule is converted into dopamine, which is then converted into norepinephrine. This is the normal process. Theoretically, if this dopa-to-norepinephrine synthesis is altered (say by certain genes), low levels of norepinephrine and ADHD-like symptoms could occur. Conversely, drugs which provide extra levels of norepinephrine relieve the symptoms of ADHD.

Its likely that the full spectrum of ADHD symptoms is not solely attributed to the prefrontal cortex, but rather entire pathways which interact together. These pathways do include the frontal/prefrontal areas (attention, impulse control) but also the limbic system (regulates emotions), the basal ganglia (this is the brain's "router," directing information), and the reticular activating system (affects attention and impulses, motivation). Since these areas communicate with each other, its likely that neurochemical problems in one area may affect others.
 * See [|apex] product dopatone**

Drugs for ADHD
Ritalin and many other popular ADHD drugs (ie, Adderal) are stimulants: they make the brain produce more norepinephrine, relieving the symptoms of ADHD for as long as the drug is in the person's system. About 4 million Americans are currently on Ritalin or a similar stimulant, and about 70% of those diagnosed with ADHD respond to this class of drug. Like any drug, there are costs and benefits to treatment which should be weighed with a health provider. According to the graph below, the United States and Canada have seen sharp increases in Ritalin prescriptions over the past few years.

Environmental Effects?
Interestingly, the mystery of ADHD doesn't end with genes and neurotransmitters, as there is a well-documented environmental effect. For example, babies born prematurely face a significantly greater risk of developing ADHD than full-term babies (socioeconomic status was controlled for). Infants born at "34 to 36 weeks' gestation had a 70% greater risk of developing ADHD. And babies born before 34 weeks were nearly three times as likely to develop the disorder as those born at term." However one theory states that premature babies are a higher risk for hypoxia in the womb, which in animal models led to increased dopamine receptors in the brain. More dopamine receptors would, in turn, mean less norepinephrine in the brain as the required substrate (dopamine) would have a higher likelihood of being bound or degraded before it could be synthesized into norepinephrine.

It is thought that the stimulants actually reduce the pleasurable effect that the drug elicits from the brain, making drug-seeking behavior and addiction more unlikely. Another explanation is that the stimulant conveys improved impulse control which reduces the likelihood of partaking in risky behaviors like drug abuse, and increases the likelihood of performing well in school and developing positive social skills which would deter drug abuse.
 * One last mention**: an interesting study conducted at Chicago Medical School suggests that children diagnosed with ADHD who do receive Ritalin have a reduced likelihood of developing a drug or alcohol problem in adulthood.