ADHD – A Disease of Modern Times?

Attention Deficit Hyperactivity Disorder (ADHD), is a neurobehavioral condition that has risen to epidemic proportions in recent times. The symptoms include inattentiveness, hyperactivity and impulsive behavior.

Psychologist Enrico Gnaulati, of Pasadena, California, claims that ADHD is now “as prevalent as the common cold.”

The causes may not be known, but one thing is certain, the condition is running rife through the children of Western society.

“So many kids have trouble these days,” says long-time ADHD researcher L. Alan Sroufe, professor emeritus at the University of Wisconsin at Madison. “I doubt it’s a change in our genetic pool. Something else is going on.”

The disorder seems to be most prevalent in areas of specific geographic, ethnic and cultural peculiarities; for example, in the predominantly "blue" state of California, ADHD is relatively uncommon, yet North Carolina, a typically "red" state, the condition is widespread, with the state’s children being 2.5 times more likely to be diagnosed.

The most typical ADHD sufferer is likely to be a middle class teenage boy, with up to 30 per cent of teenage boys in North Carolina having confirmed symptoms; however diagnoses in other categories, such as pre-schoolers, girls and adults, are steadily rising. Across the whole of the US, one in ten children have been tested and diagnosed with the condition.

Richard Scheffler, a health economist at the University of California at Berkeley and co-author of a new book entitled The ADHD Explosion, says "It’s getting scary."

Scheffler and his colleague and co-author Stephen P. Hinshaw, a psychologist at Berkeley, have examined the causes behind the rapid rise in diagnosis rates across the country.

They examined demographics, health care policies, cultural values and other potential factors, before happening upon a school policy that Scheffler calls “the closest thing to a silver bullet.”

Incentive laws introduced in US schools to increase productivity and raise test scores are thought to be a factor in the high diagnosis rates in North Carolina, which was one of the first states to introduce them. The laws, which include accountability processes, and punishment/reward tactics for missing or exceeding targets, provide an incentive to highlight and support children who are under-performing.

This fact could explain the increase in diagnoses, but does not give a reason for the development of the condition. Is there a physiological reason, or could it be a mental health disorder created by a unique set of social or cultural factors?

The rate of diagnosis certainly varies from country to country, but this could be due to detection rates rather than prevalence of the condition. It has been found that the brains of those suffering from ADHD are actually different to non-sufferers. They appear to be slightly smaller, and short on the receptors required to activate the neurotransmitter dopamine. Beyond these limited observations, there is no way of conclusively diagnosing the disorder using a brain scan, so ADHD is generally diagnosed by checking a list of nine symptoms of inattentive behavior compiled by the Diagnostic and Statistical Manual of Mental Disorders, or DSM, from the American Psychiatric Association.

The DSM dictates that a sufferer should display the symptoms consistently in more than one type of environment.ADHD can also be mistaken for other health issues. A new book by Richard Saul, entitled ADHD Does Not Exist, lists 25 conditions that can appear to manifest as ADHD, including sleep deprivation, immaturity, particularly in boys who are often a year or more behind girls in basic self-regulation.

Other often-mistaken causes for inattentive behavior can be due to simple vision and hearing issues.

“Until you get glasses, it’s very hard to understand what [the teacher] is speaking about if you can’t see the board,” says Saul. “Same with hearing.”

Other conditions misdiagnosed as ADHD range from bipolar disorder to Tourette’s syndrome, but, despite the unequivocal title of his book, Saul admits that 20 per cent of those diagnosed are “neurochemical distractible impulsive,” and do have genuine ADHD.

A new study has provided some evidence that the onset of ADHD could be triggered by the use of a particular drug during pregnancy. Research by Liew et al into the effects of Acetaminophen (Tylenol) has recently been published in the journal JAMA Pediatrics. The study, which followed over 64,000 families in the Danish National Birth Cohort, found evidence to suggest that prenatal use of the drug could double the risk of behavioral disorders in children. Post-natal diagnoses of the hyperkinetic disorder (HKD), a severe form of ADHD, were recorded, and the number of prescriptions for ADHD medications (e.g. Ritalin).

Though there is not yet sufficient evidence for public recommendations to be made regarding the use of the drug, the findings appeared to reveal that Acetaminophen was strongly linked to an increased risk of ADHD diagnosis in the first seven years of life which was 30% greater than in those who had not taken the drug.

“When women reported having used acetaminophen for 20 or more weeks during pregnancy, the risk for HKD diagnosis in children almost doubled,” stated the paper.

Based on these results, the authors suggest that pregnant women should be aware of the risk and seek to discuss it with their physician. Acetaminophen can cross the placenta and travel to the fetus, potentially affecting the development of its delicate nervous system. The drug is a known endocrine (hormone) disrupter, being previously linked to cases of undescended testes in male infants.

The study authors propose that it’s “possible that acetaminophen may interrupt brain development by interfering with maternal hormones or via neurotoxicity such as the induction of oxidative stress that can cause neuronal death.”

The study does not provide definitive proof that ADHD is caused solely by Acetaminophen, merely a correlation between its use and incidences of the condition. Other genetic and environmental factors could also be influencing the results, so further research is required, but it would be sensible for pregnant women to avoid taking Acetaminophen until more is known.

As far as other causes for the development of ADHD, nutritional factors are also thought to be significant. Studies shown that those with ADHD may be deficient in some vitamins, minerals, and omega-3 fatty acids. Symptoms were found to improve when patients improved their diets and took specific vitamin and mineral supplements.
Scientists have cited food additives, refined sugars, food allergies and impaired fatty acid metabolism as factors that could have adverse effects on behavior. A diet high in processed foods and soft drinks may lead to peaks and troughs in blood sugar, triggering periods of hyperactivity.

A review of research on adults revealed that “adequate levels of glucose in the blood facilitate attention control.” The researchers stated that “Acts of self-control deplete relatively large amounts of glucose. Self-control failures are more likely when glucose is low. Restoring glucose to a sufficient level typically improves self-control.”

Specifically for ADHD, there is some evidence for a role in increasing the intake of omega-3 fatty acids, found in oily fish (such as salmon, herring, mackerel, anchovies and sardines), flaxseeds and linseeds.

Dr. Natalie Sinn of the University of South Australia in Adelaide says that “the current evidence supports nutritional and dietary influences on behavior and learning in children, with the strongest support to date reported for omega-3 fatty acids.”

The cause of the disorder may well be multi-factorial, but its place in our society is unfortunately becoming increasingly well-established, and more research needs to be conducted in order to prevent it from escalating further. The prospect of a new generation of children with established mental health disorders must be a huge concern for us all. Share your experiences with us here at Unknown Country – subscribe today to leave your valuable comments