ADD/ADHD Attention Hyperactivity Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


The incidence of Attention Deficit and Hyperactivity Disorders, or at least the diagnosis and prescription of pharmaceutical amphetamines to treat ADHD, has risen dramatically in the United States in the last two decades. Many of the patients that seek medical help with this problem are adults, although most of the attention in the press concerns the problem with children. A study published in 2010 from Northwestern University in Chicogo, Illinois, showed that between 2000 and 2010, the number of patients under 18 years of age that were given a diagnosis of ADHD rose 66 percent, from 6.2 million to 10.4 million, and in 2013, the U.S. Centers for Disease Control and Prevention (CDC) reported that by 2012, nearly 20 percent of high school age boys in the United States and 11 percent of children overall had received a medical diagnosis of ADHD, and most were prescribed amphetamine drugs called psychostimulants. IMS Health, a leading source of healthcare statistics, released a report in 2013 that showed that sales of prescription stimulants to treat ADHD more than quintupled in 10 years. In 2014, an analysis of about 15 million privately insured people under 65 found that adults taking psychostimulant amphetamine medications legally prescribed for ADHD, such as Adderall, Concerta and Stattera, rose from an estimated 1.7 million Americans in 2008 to 2.6 million in 2012 (Express Scripts Lab; J. Austerman, DJ Muzina). The cost per prescription averaged $142.86, driving up health care costs considerably, which is reflected in the cost of everyone's insurance, and government spending. A dramatic rise in use occurred among women age 26 to 34, and is believed to be driven by use of these drugs as appetite suppressants, mimicking a practice seen with prescribed amphetamines in the 1960s. Experts believe that there is no possibility that such dramatic rise in prescription of these amphetamine medications is purely due to the actual rise in incidence of ADHD.

Many adult patients are still affected at work and at home with problems of cognitive focus and related problems despite having taken medications for ADD/ADHD when they were young, and a growing sense of alarm has occurred, as medical doctors and public health experts realize that psychostimulants do not cure ADHD, merely providing a stimulant to increase mental focus, and in fact these amphetamine psychostimulants are now considered a popular drug of abuse, as a study aid during testing, to accomodate more intense work schedules, as an appetite suppressant in weight loss, and even for recreational use. Complementary Medicine provides a less problematic treatment protocol to actually address the underlying pathophysiology of ADHD, improving brain health and function, rather than just masking the problem with psychostimulant amphetamines. For those with actual ADHD, integrating Complementary Medicine would allow a shorter course of pharmacological therapy to be used, with less chance of addiction and long-term negative health consequences. There is much research concerning the use of Complementary Medicine to correct the underlying health problems in ADHD, and treatment protocols useful to restore normal brain function and health. Extensive research in this field has produced much clinically relevant information concerning nutrient and herbal therapy, dietary changes, clearing of environmental toxins and heavy metals, as well as proof that acupuncture is itself an effective potential neurostimulant. Studies utilizing functional MRI have proven that the correct acupuncture stimulation does increase activity in specific centers of the brain. Many patients are now investigating and utilizing these advances in Complementary Medicine to insure a greater chance of success in treatment of ADHD and neurodegeneration.

In a December 15, 2013 interview with the New York Times, Dr. Keith Connors M.D. and professor of psychology at Duke University, responded to the absurd rise in diagnoses and prescriptions for ADHD in the last 10 years: “The numbers make it look like an epidemic. Well, it's not. It's preposterous. This is a concoction to justify the giving out of medication at unprecedented and unjustifiable levels." Problems with addiction to these stimulant drugs, drug dependency and addiction, and profound contributions to the rising costs of healthcare and thus costs of insurance and government health spending, the most significant contributor to our federal deficit, seem to have been overlooked for the sake of profits. As a great percentage of our population becomes addicted to stimulant drugs, the hidden side effects of long term use are also emerging.

The CDC, or Center for Disease Control, in 2003, stated that prevalence of ADHD in school-aged children ranged from 2-18 percent in various community samples, but by 2013 these numbers had grown dramatically, rising 53 percent in a decade, to at least 11 percent of all school-age children in the U.S. The U.S. CDC also notes that substantial health risks might be associated with medication, and a proposed change in the definition of ADHD by the American Psychiatric Association may substantially increase the number of prescriptions of pyschostimulants to children. These health risks include psychosis with long-term use, as well as increased risk of future drug addiction, and short-term side effects include high incidence of nervousness and insomnia. Cardiovascular risks with long-term use, especially in adults, is also a concern, with studies demonstrating increased risk of myocardial infarction (MI), TIAs, and sudden death syndrome with arrhythmias. The medication typically prescribed is an amphetamine, Methylphenidate, commonly known by the trade names Ritalin, Attenta, Methylin, Equasim, Rubifen, or Concerta, and it works by increasing the neuroinhibitor dopamine in the brain. The original name for ADHD disorder in the 1960s was Minimal Brain Dysfunction, which reflects recent findings that ADHD is indeed a neurodegenerative disorder. While Methylphenidate may relieve some of the hyperactivity and attention deficit symptoms, it does not actually reverse the neurodegeneration that we see in this disorder. There are few quality clinical trials to evaluate the long-term effects of these stimulants, and studies on animals suggest that long-term use could adversely affect the dopaminergic system in the brain and produce eventual adverse effects on brain development in many patients. Complementary Medicine offers a more thorough approach to this neurodegenerative health problem that could help the ADHD patient to reverse neurodegeneration and reduce dependancy on symptom-relieving medication and its risks and side effects.

In a March 1, 2013 article in the New York Times, entitled A.D.H.D. Seen in 11% of U.S. Children as Diagnoses Rise, the director of the U.S. Centers for Disease Control and Prevention (CDC), Dr. Thomas R. Frieden, was quoted: “The right medications for A.D.H.D. given to the right people, can make a huge difference. Unfortunately, misuse appears to be growing at an alarming rate." Since there are no objective tests for a diagnosis of AHDH, the diagnosis is made by exclusion, yet few patients are investigated for other causes of symptomatic behavior, and a simple short exam is usually all that is needed to obtain a psychostimulant prescription. Often the repeated visits to the prescribing doctor and prescription renewals are not covered by the insurance or government health program, and sales of these psychostimulants have more than doubled from 2007 to 2012, from $4 billion to $9 billion, according to a report by IMS Health, cited in this NY Times article. Dr. James Swanson, a professor of psychiatry at Florida International University, and one of the premier ADHD researchers in the U.S., was quoted: “If we start treating children who do not have the disorder with stimulants, a certain percentage are going to have problems that are predictable - some of them are going to end up with abuse and dependence. And with all those pills around, how much of that actually goes to friends? Some studies have said it's about 30 percent." A leading voice in the field of child psychiatry, and a proponent of amphetamine psycostimulant medication for children, Dr. Ned Hallowell, stated in this article that his advice in the past, that Adderall and other stimulants were “safer than aspirin", now generates regret. He was quoted as saying that he “won't be saying that again... That we have kids out there getting these drugs to use them as mental steroids - that's dangerous, and I hate to think I have a hand in creating that problem."

L. Alan Stroufe, professor emeritus of psychology at the University of Minnesota's Institute of Child Development, quoted in a January 29, 2012 article in the New York Times entitled Ritalin Gone Wrong.

“To date, no study has found any long-term benefit of attention-deficit medication on academic performance, peer relationships or behavior problems, the very things we would most want to improve. Until recently, most studies of these drugs had not been properly randomized and some of them had other methodological flaws. But in 2009, findings were published from a well-controlled study that had been going on for more than a decade, and the results were very clear...At first this study suggested that medication, or medication plus therapy (cognitive-behavioral), produced the best results. However, after three years, these effects had faded, and by eight years there was no evidence that medication produced any academic or behavioral benefits."

A number of studies have demonstrated that even with pharmacological treatment of childhood ADHD, with temporary improvement, 30-50 percent of all clinically diagnosed cases persist into adulthood. A growing chorus of experts are now convinced that a holistic non-pharmacological treatment protocol is absolutely necessary to treat childhood ADHD and to reduce the potential adverse effects of psychostimulant use. The emergence of strong association between childhood ADHD and overweight conditions are also a cause of alarm. It is believed that a variety of factors explain this association, including psychosocial stress, diet and lack of daily physical activity, and even the medications themselves that are prescribed to treat ADHD, especially with multiple medications used. Clearly, amphetamines and psych drugs will not address these health concerns.

A rising alarm is now heard regarding the combinations of medications widely prescribed to children with a diagnosis of ADHD. A 2014 study at the University of Melbourne and The Royal Children's Hospital, Parkville, Australia, found that in a randomized sample of 252 children treated for ADHD, that 22 percent of these patients were prescribed sleep medications. These researchers noted that use of sleep medications in children has been associated with onset of prescription of ADHD medication, as well as the onset of “combined-type" ADHD, and that a number of other health problems later in life (co-morbidities) were also associated with use of these sleep medications (PMID: 24684977). Combined-type ADHD refers to syndromes with significant symptoms of inattention, hyperactivity, and impulsivity, with equal severity of these classic symptoms. In addition to this problem, current ADHD guidelines now list 6 types of ADHD, recommending additional prescription of SSNRI antidepressants, antiseizure medications such as Neurontin, and antipsychotic medications such as Abilify or Seroquel, to the drug cocktail. The growing body of scientific study concerning warnings that such combinations of drugs lead to other health problems with chronic use, and a significant increased overall mortality risk in the future, is largely ignored, as well as the obvious problems with prescribing such harsh medications with long-term adverse health effects to children. On the other hand, these same prescribing doctors continue to warn parents that trying to integrate any Complementary Medicine into the treatment protocol is dangerous, with no actual proof of harm. Increasingly, intelligent parents, and intelligent patients taking these medications as adults, are beginning to understand the fallacies of this medical advice and protocol. The key to successful integration of Complementary Medicine into the treatment strategy begins with patient education and understanding.

By 2015, with the American Civil Liberties Union (ACLU) filing a lawsuit in Kentucky to finally highlight a growing problem with abuse of many children with ADHD prescribed amphatemine pschostimulants and antipsychotic medications, but still presenting what are termed Disruptive Behavior Disorders, Oppositional Defiant Disorders, and Conduct Disorders, the actual problem of this growing trend of heavily medicating children for unwanted behavior in school, finally was coming to a head. The case that surfaced involved a school official who took a phone video of the repeated restraint with handcuffs of an 8 year old boy and 9 year old girl by a school 'resource officer', who was heard saying "you don't get to swing at me like that" in the video as the children cried. An article in the New York Times of August 4, 2015, stated that experts say that the use of handcuffs on these children is no longer uncommon. The U.S. federal Department of Education reports that 12 percent of the student population now have such disabilities, and that 75 percent of these children diagnosed with ADHD and other disabilities have been subjected to physical restraints! In 2014, a judge in New Mexico upheld the use of handcuff restraints on a 7 year old with diagnosed with autism. The U.S. CDC reports that 11 percent of children age 4-17 had been diagnosed with ADHD by 2011, showing that almost all of the 12 percent of young students with disabilities have ADHD and related behavioral disorders. The states with the highest prevalence were in the South and Midwest, and the lowest prevalence was in California and Nevada, Idaho, Utah and Colorado. The protocol of just increasing medication to these children, especially the fifth of all children now diagnosed with ADHD and Disruptive Behavior Disorders, is finally emerging as a crisis. Finally, increasing use of cognitive and behavioral therapy is being recommended, but there is still a consistent reliance on a cocktail of pyschostimulants, antipsychotics, and antidepressants, as well as anti-anxiety and sleep medications. By 2015, the U.S. Centers for Disease Control and Prevention (CDC) stated that most children diagnosed with ADHD and Disruptive Behavior Disorders were receiving treatment, but that the problem could be that they weren't receiving a combination of intensive cognitive and behavioral therapy combined with a drug cocktail. The search for answers to this sudden explosion of such disorders in our children is going very slow, and is not seriously looking for systemic answers.

The American Psychological Association reported in 2012 that the use of second-generation anti-psychotics nearly tripled from 1995 to 2008 in the United States, increasing to more than 16 million prescriptions per year by 2012, largely driven by massive advertising and monetary incentives to prescribing medical doctors, and laws that prevented denial of these type of drugs. Brand names such as Abilify, Seroquel, Serentil, Latuda, Zyprexa and Lullan imply that these are safe and gentle, but a host of FDA warnings, especially for use by children, imply otherwise. In 2008, an FDA alert notified healthcare professionals that both conventional and atypical antipyschotic drugs are associated with an increased risk of death from a variety of causes, implying that these drugs adversely affect a number of systems in the body. While the studies validating this warning concerned elderly patients, such effects are obviously not limited to the elderly. Prior studies showed that atypical, or second generation, antipsychotics often cause metabolic changes and obesity, and increase risks for developing diabetes and Metabolic Syndrome. Clinical trials showed that side effects over time of restlessness, rigidity and muscle spasm were not uncommon, as well as episodes of rapid heart beat, blurred vision, dizziness, drowsiness, and skin and eye sensitivity to sunlight, and that long-term use may lead to tardive dyskinesia, a brain dysfunction responsible for nocturnal bruxism (teeth grinding), restless leg syndrome, and other disorders. Clinical trials also noted that dependency and addiction occur, as stopping anti-psychotic drugs often results in rebound effects and relapses of symptoms. By 2014, studies showed that almost half of full-time college students at many prestigious universities abused combinations of prescription drugs and alcohol, with about a quarter of these students now meeting the requirements for a diagnosis of substance abuse or drug dependence. Amphetamine psychostimulants and atypical antipsychotic drugs were at the top of the list of abused prescription drugs, and for many this drug dependency started early in life with a prescription of an ADHD drug, or by obtaining the drugs from friends who were prescribed them. These alarming facts did not lead to the decrease in prescriptions of combinations of amphetamine psychostimulants and atypical antipsychotic drugs to children, though, but a large increase from 2010 to 2014.

By 2014, a report from experts at the University of Florida School of Medicine, Department of Psychiatry, in Gainesville, Florida, U.S.A. noted that "of adults presenting with a substance abuse disorder (SUD), 20% to 30% have concurrent ADHD, and 20% to 40% of adults with ADHD have a history of SUD (substance abuse disoder).....As many as 30% of individuals with ADHD are estimated to either have secondary side effects (of medication) or are not responsive to stimulant medication." This report was particularly alarming, and was not an isolated report. Standard medicine and the pharmaceutical industry appears to have contributed heavily to addiction and substance abuse, again, yet we again see little public uproar or concern. The good news is that these experts recommended "we also consider the benefits of non-stimulant medication and alternative treatment modalities, which include diet, herbal medications, iron supplementation, and neurofeedback. With the goals of improving treatment of patients with ADHD and SUD prevention, we encourage further work in both genetic diagnosis and novel treatment approaches" (PMID: 24393762). Whether we shall soon see patients integrating these "new" treatment protocols is still in question.

In 2012, a study at the University of Illinois, published in the Journal of Pediatrics, found that a 20-minute period of aerobic exercise significantly improved symptoms of ADHD in children, with measurable improvement in mental focus and neurocognitive function, as well as inhibitory control. This randomized controlled study of children diagnosed with ADHD compared to those without this diagnosis found that measurable effects of event-related brain potentials showed that children with ADHD and lower P3 amplitude when focused on reading showed greater improvement on this neurocognitive focus after exercise than controls. Healthy therapeutic regimens incorporating such exercise may provide significant benefit and a reversal of this neurological dysfunction. Instead, many school systems have cut funding for physical education while spending much money on pharmacological assessment and treatment for ADHD. A protocol with a healthy diet, improved exercise activity, a reduction in environmental toxins, and Complementary Medicine may achieve our goals of both reducing symptoms and restoring a healthy nervous system. Psychostimulants often do nothing toward this goal, and present the risk of future drug addiction.

The Trouble with Definitively Diagnosing ADHD

The criteria for diagnosis of ADHD, in the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders), presents a complicated scenario for the diagnosis of ADHD, dependent both on careful evaluation of cognition and behavior, and on accurate subjective reporting of these problems. The criteria for inattention are the confirmation of 6 or more of common cognitive and behavioral patterns, many of which could be attributed to other health problems, or be part of an emotional reactive pattern. These symptoms also need to persist for at least 6 months in these DSM guidelines. The array of symptoms include careless mistakes in schoolwork, difficulty in sustained attention in tasks, not seeming to listen to parents or teachers when directly spoken to, failure to finish homework or chores, difficulty organizing tasks or activities, reluctance to do homework, persistent losing of tools to do homework, being easily distracted by extraneous stimuli, and being forgetful in daily activities. Few of us can honestly say that when we were children, we did not engage in these tactics to some extent to avoid household chores or schoolwork, and most of these "symptoms" of ADHD are perceived in a subjective manner by parents and teachers, and are not objectively measured. In addition, most adults may perceive that the world is more complex for children today than when they grew up, and more complex social games evidently occur in this setting as children test the limits of their world, the rules, the constraints, and their own personal power as they grow out of the position of a dependent child to an independent person. Most parents of children diagnosed with ADHD will admit that the prescribing doctor did not spend a lot of time diagnosing the problem as well, and that 6 or more of these symptoms did not consistently occur for longer than 6 months. In addition, most parents will admit that the prescribing doctor did not refer the child to careful evaluation with an expert in child behavior and psychology, who could perhaps distinguish between common behavioral actions of a child, and an actual disease with ADHD, but only if they spent the time to truly get to know the child individually. All of this proper diagnostic procedure would cost too much, and not be readily approved by the insurer. Instead, a quick evaluation and discussion often leads to too easy prescription of the amphetamine. When the amphetamine prescription does not work, there is rarely a discussion that perhaps the child has been misdiagnosed, and that other tactics and therapies need to be tried. Instead, when the ADHD amphetamine does not work well, other psychoactive prescriptions are added. All of this has occurred without the common sense alarm bells sounding that this could be harmful for a young child, and most prescribing doctors assure that parents that there are no concerns in this regard. Current scientific study and research is proving otherwise.

The criteria for diagnosis of hyperactivity are just as unclear. Once again, 6 or more of common symptoms of hyperactivity, that could be attributed to other causes, are needed for the DSM diagnosis. This does not mean that 6 of these common behaviors in children in total for inattention and hyperactivity need to be seen, but 6 or more or these inattentive behaviors plus 6 or more of these hyperactive behaviors, all of which could be attributed to normal childhood tactics, often conscious learned tactics to get out of doing homework or childhood chores, or behaviors related to overconsumption of sugars and simple carbohydrates, and food additives. Increasingly, research reveals that excess stimulation by watching television and/or using computers, electronic games, pads, and smart phones also cause these behaviors. The behavioral symptoms that need careful evaluation in hyperactivity include fidgeting or squirming, frequently getting out of one's assigned seat, running about excessively, showing difficult in playing quietly or being quiet when told, often “on the go", often talking excessively, often blurting out answers before a question is completed, often finding it difficult to wait for his or her turn in group activities, and often interrupting adults. Now, honestly, most adults would be hard-pressed to say that they never engaged in these common activities when they were a child, and that they did not frequently receive messages from their parents and teachers to stop these behaviors when they became annoying. As children, we learn behavioral limits by being scolded, which has always been a common practice. Now the common practice is apparently prescribing a drug cocktail. So far, as a society, we have not yet become alarmed to this growing practice. Once again, many experts and researchers around the world are starting to voice shrill alarm at this situation, and concerns that the prescription of these drugs are not benign, and will lead to numerous health problems in the future, including addictive personalities, anxiety and depressive mood disorders, poor sleep quality and insomnia, physical hyperactivity disorders such as bruxism and restless leg syndrome, increased allergic and immune-related disorders, increased neurohormonal disorders, obesity and diabetes, and now even increased risk of overall mortality. Surely, there is a great need to spend the time and money to properly and assuredly diagnose these children before prescribing a problematic drug regimen. Pretending that a lack of significant immediate side effects means that the long-term health outcomes are safe is not logical, and more and more research is proving otherwise.

It could be that we should be examining the behavior of the adults in this obvious overprescription of pharmaceutical amphetamines to treat common problems in child-rearing and teaching children. In many cases, it could be the parents and teachers that need to improve their skills in managing children, not a disease of the children requiring medications with questionable long-term benefit and a growing list of risks and adverse effects. Could we be developing a societal disorder where taking a pill is the obvious answer to most problems, instead of a society that learns and adapts to changing behaviors in children and responds in a manner that helps our children and ourselves as well. Could this attitude that a pill can easily solve all behavioral and cognitive problems also carry over to ourselves in adulthood, and keep us from adapting to our own problems with positive learning and changes, and instead just take pills for all our problems. There is no doubt that these medications, like antidepressants and anti-anxiety medications, and anti-psychotic medications, are useful when necessary, but must we give in to an attitude that we can use medications and overuse them without negative consequences? This may be great for pharmaceutical profits, but is it good for human civilization?