lederr

Taking Charge of Adult ADHD-R. Barkley

In ADHD, Brain studies, School Psychology on Wednesday, 12 September 2012 at 06:38

Here is some general information regarding ADHD in adults.  For an incredibly informative and helpful read, please look to Russell Barkley’s book “Taking Charge of Adult ADHD.”  I highly recommend it for anyone who wants to know more about ADHD, has been diagnosed with ADHD (child or adult), or treats those with ADHD.

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What the research shows about the causes of ADHD: Studies of twins and families have made it abundantly clear that genetic factors are the major causes of ADHD. If a child has ADHD, nearly one out of three siblings will also have ADHD. A study done at UCLA examined 256 parents of children with ADHD and found that 55% of these families had at least one parent affected by the disorder. An estimated 75–80% of variation in the severity of ADHD traits is the result of genetic factors, and some studies place this figure at over 90%—higher than the genetic contribution to personality traits, intelligence, and other mental disorders such as anxiety and depression and nearly the same as the genetic contribution to individual differences in height. Several recent studies have scanned the entire human genome searching for genes that carry the risk of ADHD and have found at least 20 to 25 sites on chromosomes to be associated with ADHD. It is therefore likely that ADHD arises from a combination of multiple risk genes, with each contributing a small likelihood of risk for the disorder. The more risk genes you inherit, the greater the number and severity of ADHD symptoms, and so the greater the probability you will be impaired by and diagnosed with the disorder. A very small number of cases are caused by early-development (often prenatal) neurological injury, such as alcohol and tobacco exposure during pregnancy, premature delivery, especially with minor brain hemorrhaging, early lead poisoning, stroke, and frank brain trauma, to name just a few. The frontal lobes, basal ganglia, cerebellum, and anterior cingulate cortex are 3–5% smaller in people with ADHD than in others of the same age and substantially less active. Studies show that the brains of those with ADHD react to events more slowly than the brains of those without ADHD. People with ADHD have less blood flow to the right frontal region of the brain than those who don’t have ADHD, and severity of symptoms increases the more blood flow is reduced.

What the research says about popular myths regarding the causes of ADHD: Available evidence suggests that sugar plays no role in the disorder and that fewer than 1 in 20 preschool children with ADHD may have their symptoms worsened by additives and preservatives. No compelling evidence exists to support the claim that ADHD results from watching too much TV or playing too many video games as a child, other than that people growing up with ADHD may be more likely to watch television or play video games. Little evidence has emerged that child-rearing practices can cause ADHD. There is no question that families with children having ADHD show more conflict and stress than other families. But researchers found that this was largely due to the impact of the child’s ADHD in disrupting family functioning and also to the likelihood that the parent also had ADHD.

PREPARE BY KNOWING WHAT TO EXPECT AND WHAT TO TAKE ALONG Here are the typical elements in a diagnostic evaluation:  Collection of rating scales and referral information before or during the evaluation  An interview with you  A review of previous records that may document your impairments  Psychological testing to rule out general cognitive delay or learning disabilities  Interviews with others who know you well to corroborate your reports  A general medical examination when medication might be part of your treatment or coexisting medical conditions need to be evaluated (if your physician hasn’t already done this) What you can take along to facilitate these steps:  Any records you have or can collect in advance from schools you attended and physicians and mental health professionals you’ve seen, any driving and criminal records, and any other documentation of problems that could be related to ADHD or another disorder  The names of a few people who know you well and whom you trust to speak honestly and objectively with the evaluators  Results of a medical exam if you’ve already had one from your physician  A list of family members with mental disorders you know about  A description of impairments during childhood and adolescence, as well as more recent ones

Here’s how the anti-ADHD medications work neurogenetically: Brain imaging, EEGs, and a variety of other testing methods have shown that the brains of those with ADHD are different from those of others in several important ways: Certain regions of the brain are different structurally, mainly being smaller than in those without ADHD: the right prefrontal region, associated with attention and inhibition; the striatal region, associated with pursuing pleasurable or rewarding behavior; the anterior cingulate cortex, which helps you govern or self-regulate your emotional reactions; and the cerebellum, associated with the timing and timeliness of your actions, among other executive functions. People with ADHD have less electrical activity in the brain, particularly in these regions, meaning they don’t react to stimulation in these regions as much as others. Children and adolescents with ADHD also have less metabolic activity in the frontal regions. The brains of those with ADHD seem to be deficient in or show excessive reuptake of norepinephrine and dopamine. Other neurochemicals may also be involved. Scientists believe the structural abnormalities in the ADHD brain underlie the development of the disorder: this is the genetic legacy that causes ADHD to appear in the descendants of those who have ADHD. We don’t know how to restore a typical structure to these brains. We do, however, know how to correct the neurochemical imbalance found in those with ADHD, at least temporarily: medication. When the neurotransmitters dopamine and norepinephrine are not available in the same measure as they are in typical adults, the messages these chemicals are supposed to send don’t get through as they should. Without the help of these neurotransmitters, the brain does not respond to stimulation (any input, like an event or an idea or an emotion) the way it should. Impulse control doesn’t kick in when it should. Memories of the past and visions of the future aren’t triggered to keep you mentally on track. And even when they are, they cannot be sustained for very long, leading you to forget what it is you were planning on doing. The motor-control brakes don’t keep you from fidgeting with restlessness. This is why ADHD medications work (though some operate on other neurochemicals). By causing nerve cells to express more of these neurochemicals, or by keeping the nerve cells from pulling them back in once they’ve been released, they increase communication between nerve cells in regions of the brain linked to ADHD. The two basic categories of drugs approved by the U.S. Food and Drug Administration for use with adults who have ADHD—stimulants and a few nonstimulants—boost your mind’s ability to respond to whatever is going on in your day.

Reference:

Barkley, Russell A. (2011-04-04). Taking Charge of Adult ADHD.  Guilford Press. Kindle Edition.

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