ADHD Brain Changes Appear to Persist Into Adulthood

THURSDAY, Nov. 10 (HealthDay News) — Adults who were diagnosed with attention-deficit hyperactivity disorder (ADHD) as children have less gray matter in certain areas of their brains as adults than people who didn’t have ADHD in their youth, researchers say.

“The majority of individuals with ADHD improve in adulthood, but it was still somewhat disappointing to see that even with improvement, there continue to be challenges for those with ADHD,” said the study’s lead author, Dr. F. Xavier Castellanos, a professor of child and adolescent psychiatry at New York University Langone Medical Center in New York City.

Castellanos and his team also found a trend toward even more significant brain changes in people who continued to have ADHD symptoms as adults.

Results of the study are published in the November issue of the Archives of General Psychiatry.

ADHD is a common childhood disorder, according to the U.S. National Institute of Mental Health. Symptoms include an inability to pay attention or focus, being easily distracted, becoming quickly bored, daydreaming a lot and hyperactive behavior.

Previous research has found reduced brain volume in children with ADHD, and those reductions are especially pronounced in areas of the brain that help regulate attention and emotion, according to background information in the study.

The current study included boys who had participated in an ongoing study that began in the 1970s. At that time, the study consisted of 207 white boys between the ages of 6 and 12 and 178 age-matched boys who didn’t have ADHD to serve as the control group.

Castellanos’s research included 59 of the study volunteers who’d had ADHD in their childhood and 80 who had not. Their average age was 41. Of the 59 with ADHD, 17 continued to have symptoms of ADHD as adults, according to the study.

The study volunteers underwent magnetic resonance imaging (MRIs) in 2002 and were interviewed about their current symptoms and medication use.

The researchers found that the outer layer of the brain (the cortex) was significantly thinner in people who’d had ADHD when they were young compared to those who hadn’t had the disorder. These changes were seen in people who continued to have ADHD symptoms and in those who didn’t. However, Castellanos said there was a consistent trend for those who still had symptoms to have an even thinner cortex.

The areas most affected by thinning are regions involved in “top-down control of attention and the regulation of attention,” said Castellanos. For example, he explained, the amount of attention you give a task is a complex calculation of what’s going on around you; how much noise there is; if something else is moving in the room and so forth. If you hear a loud noise, you’re at least momentarily distracted unless you can rationally explain the noise away, such as if you’re having construction done. If you can rationally explain the noise away, you can get back to work without further distraction. But, this process doesn’t work as well for people with ADHD.

“To me, these kinds of studies are exciting because they get to the real neurobiology of ADHD,” said Dr. Sara Hamel, a behavioral/developmental pediatrician at Children’s Hospital of Pittsburgh. Hamel said some people still see ADHD as a weakness in personality or as caused by bad parenting, but this study and others like it show that “ADHD is a physiologic phenomenon and a real neurological deficit.”

Both experts said that it’s important for people to realize that ADHD can be a lifelong condition, and if symptoms persist into adulthood, they shouldn’t be ignored.

“It’s not your fault. It’s something different in the way you’re wired, and it’s probably inherited,” explained Hamel. She recommended both medications and behavioral therapy for people with ADHD.

Castellanos pointed out that almost all of the people in his study had taken stimulant medications for their ADHD, and yet the changes in the brain volume persisted into adulthood. That means that while medications can help control the symptoms of ADHD on a day to day basis, they’re not likely having any impact on the underlying cause of the disease.

More information

To read more about attention-deficit hyperactivity disorder in adults, visit the U.S. National Institute of Mental Health.

Understanding Attention Deficit Disorder Symptoms

 It took over two years for our son to be diagnosed with ADHD at 8 years old, and this really isn’t unusual for young children.  Many schools officials, teachers and even doctors have been reluctant to pursue the testing process because of special education budgeting issues and an apparent inclination to believe the behavior is the result of “immaturity” (social or otherwise) or poor parenting.  Once a diagnosis is made, there are many options to consider and the decisions must take into account behaviors at home  as well as school.

Article by Michelle Bery

Attention Deficit Disorder can be defined in three ways – inattentiveness, hyperactivity, and a combination of both. New and better treatments for Attention Deficit Disorder are being developed every day. But prior to treatment is the obvious step of diagnosis – which can be the most difficult stage. Learning to understand Attention Deficit Disorder symptoms is the first line of defense in tackling this difficult condition.

Attention Deficit Disorder symptoms manifest themselves differently in every person. One sufferer may demonstrate the inability to concentrate on simple tasks, listen to straightforward directions, or focus long enough to complete a project; these are considered symptoms of classic Attention Deficit Disorder.

Others present with excessive hyperactivity – the inability to sit still, wait their turn, organize their thoughts, or control impulsive behavior; these are considered signs of Attention Deficit Hyperactive Disorder. In some cases, sufferers may actually demonstrate a combination of behaviors.

When making an Attention Deficit Disorder diagnosis, medical professionals will look for at least eight out of a possible fourteen Attention Deficit Disorder symptoms to be present. The medical community’s accepted guidelines on Attention Deficit Disorder symptoms acts as a checklist for determining prevailing behaviors.

When a significant number of Attention Deficit Disorder symptoms are present, a diagnosis of Attention Deficit Disorder is made. Only then can you begin appropriate treatment – including therapy and effective medication.

If you are unsure whether to consult a doctor regarding behavioral concerns, do your own preliminary research on Attention Deficit Disorder symptoms. The Internet is a vast resource for finding signs and symptoms that may be attributed to Attention Deficit Disorder. There is no substitute for a doctor’s intervention; so if your research yields startling results regarding a pattern of behavior then make an appointment with a medical professional right away.

While there is no cure for Attention Deficit Disorder, Attention Deficit Disorder symptoms can be successfully managed with appropriate and consistent treatment.

For easy to understand, in depth information about attention deficit disorder visit our ezGuide 2 Attention Deficit Disorder.


Understanding Attention Deficit Disorder Symptoms


Attention-Deficit/Hyperactivity Disorder – Neuropsychological Testing

Attention-Deficit/Hyperactivity Disorder – ADHD – is found not only in children or adolescents, but often continues into adulthood, where it can change form – often times with less hyperactivity, but similar difficulties with inattention, disorganization, and added risks.

Experts estimate that as many as 50% of children with ADHD continue to have some form of the diagnosis into adulthood.

There are two sets of ADHD symptoms – inattentive, and hyperactive-impulsive. These symptoms are found in varying degrees within the three basic subtypes of the disorder: ADHD Predominantly Inattentive Type, ADHD Predominantly Hyperactive-Impulsive Type (which is typically found only in young children), and ADHD Combined Type. This last, “combined” type is very common, including in adults. These are the adults who often feel restless, even if they don’t outwardly fidget. They can be impulsive, acting without thinking. And of course, they typically have marked inattention and other cognitive symptoms – difficulty with focusing, remembering things, organizing and completing tasks, and long-range task planning.

Studies have suggested that frontal brain circuits – those involved in focus, and self-control – are disrupted in ADHD. Studies have also indicated that proper levels of norepinephrine and dopamine – chemicals regulating brain stimulation – are lacking in individuals with ADHD. However, individuals with ADHD should not be discouraged. We also know from studies of the brain that it has a remarkable ability to make new connections, improve its circuitries, and actually change its own chemistry, by changing thought and behavior patterns.

The first approach to managing ADHD should be a formal evaluation. Evaluation should include a careful interview with the individual in question, and with those who know them best (such as family members, etc.).

Evaluation should also include forms filled out by all key persons involved – self-report forms, and, when available, observer forms (usually filled out by family members).

It is very important to specify which ADHD symptoms are most troublesome, for a particular individual. Is there more trouble with simple focus, shifting focus or multi-tasking, planning or organizing tasks, finishing tasks, or restlessness interrupting attention? Once we’ve answered these questions, we can develop the right recommendations and supports for each client.

In our view, it is also helpful to do additional neuropsychological testing for ADHD, wherein we measure an individual’s actual attention, memory ability, etc. Attention and memory patterns are very important. Some individuals focus and learn best when they can do hands-on activities, where their eyes, ears and hands are working together. Some individuals focus and learn best with small chunks of information, frequently repeated. Some are best able to focus on the first thing they are told, some on the last thing. Some individuals can learn average overall amounts of new information, but should be more consistent when they learn. Optimally, a person is always adding to their knowledge base, holding onto each piece of new information and building on it. Strong or weak attention/memory patterns are best detected by neuropsychological testing, and this information on patterns is used to guide supports.

It is important to note that attention is the gateway mental ability, the basis for everything we do mentally, and in action. If you can’t focus, you will not learn and remember properly, or perform at your best, in any context. That is why improving attention is so important, for kids and adults with ADHD.

By: Jeffrey J Gaines

Staggering New Statistics About ADHD

ADHD News Blog
Tuesday October 11th – 3:07pm

Celebrate ADHD Awareness Week

PHILADELPHIA, October 11, 2011 – New survey results reveal that Attention-Deficit/Hyperactivity Disorder (ADHD) impacts aspects of work and school for adults and children living with the condition. The survey also shows that many people with ADHD have been diagnosed with, or suspect presence of, other health conditions including anxiety, depression and sleep disorders.

ADHD, which affects more than 13 million Americans, is a genetic, neurobiological disorder that results in challenges with attention, hyperactivity and impulsivity.

The ADHD Awareness Coalition conducted the survey with the goal of increasing awareness and understanding of the disorder during ADHD Awareness Week, observed on October 16-22. They add that people with ADHD can live fulfilling lives with proper management of ADHD symptoms. Facts about ADHD, survey details and awareness week activities are available at

“The theme for ADHD Awareness Week this year is ‘Get the Facts,’ because our goal is to ensure that every person in America understands that ADHD is a real brain disorder with real consequences,” said Ruth Hughes, CEO of Children and Adults with Attention-Deficit/Hyperactivity Disorder CHADD, a member of the ADHD Awareness Coalition. “We know that undiagnosed and/or untreated ADHD can have a tremendous negative impact on individuals with the disorder, as well as their families, friends and colleagues. The purpose of ADHD Awareness Week has always been to help the public and policy makers understand that the key to improving the lives of those individuals is education and awareness.”

Workplace and School Impact

The survey covered many areas of life impacted by ADHD including employment among adults and satisfaction with school in children, as reported by parents.

More than half (60 percent) of adults with ADHD surveyed said they had lost or changed a job and attributed the job loss to their ADHD symptoms. More than 36 percent reported having 4 or more jobs in the past 10 years, and 6.5 percent responded they have had 10 or more jobs within the past 10 years. According to the ADHD Awareness Coalition, finding the right career and asking for some minor accommodations on the job can be the keys to achieving success in the workplace.

Of parents with a child or children with ADHD, 44 percent reported their child to be dissatisfied with their school life, with responses ranging from extremely dissatisfied to slightly dissatisfied, and 41 percent reported dissatisfaction with their social life using the same range of dissatisfaction.

After receiving appropriate treatment, most children with ADHD experience a dramatic turnaround and are able to focus and children with hyperactivity or impulsivity are able to pay attention in classroom lessons, according to the ADHD Awareness Coalition.

Associated Conditions

The survey also explored the incidence of co-occurring conditions and found that parents of children with ADHD reported additional diagnoses such as anxiety (29 percent), depression (19 percent) and sleep disorders (14 percent). Parents of children with ADHD who have not been diagnosed with a co-occurring condition reported they suspect their child may have anxiety (35 percent), depression (15 percent) or a sleep disorder (38 percent).

Of the adults with ADHD surveyed, 28 percent reported also being diagnosed with a sleep disorder and an additional 43 percent believe they may have a sleep disorder as reported in survey responses. Surrounding yourself with people who understand that ADHD is a real disability and finding the right treatment plan can help an individual manage the day-to-day challenges that come with an ADHD diagnosis, in addition to associated conditions affecting many adults and children with ADHD.

According to the ADHD Awareness Coalition, with appropriate treatment, children are able to succeed and overcome obstacles from ADHD and associated conditions. As they feel less frustrated by their ADHD symptoms and become more confident in their ability to succeed at home and at school, most of these children gradually overcome sadness, anxiety, or other emotional problems they may have been experiencing.

The survey also indicated that many adults and children use exercise as a mechanism to manage symptoms, with more than 40 percent of adults and children currently engaging in exercise and 50 percent of adults and 39 percent of children reporting they have used exercise at some point to manage symptoms.

“In addition to exercise, there are many options for managing ADHD. A total treatment plan may include a combination of medical treatment, behavior modification and/or coaching to dramatically improve the quality of life for children and adults living with ADHD. Developing a personal treatment plan helps individuals manage their symptoms and succeed at work and school and sustain meaningful relationships with family,” said Sarah D. Wright, of the ADHD Coaches Organization (ACO), a member of the ADHD Awareness Coalition.

More information about ADHD Awareness Week and supporting organizations is available at

About the Survey

Survey results are not scientific. Voluntary responses were provided by 2,598 adult participants who identified themselves as someone with ADHD or as a parent of a child or children with ADHD. Not all participants answered all questions.

About ADHD

More than more than 13 million children and adults are living with Attention-Deficit/Hyperactivity Disorder (ADHD) in the United States. Abundant scientific research has led major mainstream medical, psychological, and educational organizations in the U.S. to conclude that ADHD is a real neurological disorder. The American Medical Association, American Academy of Pediatrics, National Institute of Mental Health, Centers for Disease Control and Prevention, American Psychiatric Association, American Academy of Child Adolescent Psychiatry, and the U.S. Department of Education, among others, recognize ADHD as a legitimate diagnosis.

Research shows that ADHD is the result of an imbalance of neurotransmitters in the brain. Its primary symptoms are inattention, impulsiveness, and, sometimes, hyperactivity. ADHD is included in the American Psychiatric Association’s Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR) which provides criteria for diagnosing the condition.

About the Coalition

The ADHD Awareness Coalition is made up of five organizations collaborating to promote awareness of ADHD and provide support for individuals and families affected by the disorder.

Next Blog
ew AAP Guideline: ADHD Evaluation Can Begin at Age 4

ADHD Awareness Week 2011: October 16-22

Filed Under:

Myths About ADHD
Comorbid Conditions with ADD
ADHD Sleep Advice
Focus at Work


Is it ADHD/ADD or Are We Just Overloaded?

So is attention deficit hyperactivity disorder (ADD/ADHD) a real thing, or is it just a byproduct of the times we live in? We have over-committed, over-scheduled and overextended ourselves. We have to answer our emails right now. We have to check Facebook as soon as we wake up in the morning. Television shows have quick edits and short sound bites, and we have 800 channels to choose from. Have we been conditioned to be an ADHD/ADD society?

Not exactly.

While overscheduling ourselves and constantly looking at our Blackberrys and iPhones can cause us to be distracted and inattentive, it doesn’t really qualify as ADD/ADHD. Being overextended can mimic ADD/ADHD symptoms, but there is a big difference between having some symptoms and qualifying for a diagnosis.

Symptoms of ADD/ADHD include:

  • Difficulty following multi-step directions
  • Not listening
  • Disorganization
  • Interrupting others
  • Distractibility
  • Difficulty following through on tasks/projects
  • Losing items often
  • Acting before thinking

Now, you may say to yourself, “Are you kidding me? I had all those symptoms today before breakfast.” I believe you. Sure, all of us lose our keys from time to time. And we may lose them even more so when we are supposed to be in five different places at once. But here is the difference between being “overloaded” and having ADD/ADHD:

The big difference is the intensity, frequency and duration of symptoms.

    • How severe are the symptoms? Are they impairing your day-to-day functioning?
    • How often do the symptoms occur? Is it just when you are overloaded? Or is it all the time? How many symptoms do you experience on a daily basis?
    • How long do these symptoms last? Do they seem to turn off and on, or do they never really seem to go away?
    • Have other people in your family had the same difficulties as you?


If you have ADHD/ADD, you most likely:

  • Have had symptoms like distraction and fidgeting since childhood.
  • Have problems with organization, even when you aren’t over-scheduled.
  • Have ADHD symptoms that affect all aspects of your life — home, school, work and social.
  • Had comments on your school report cards such as, “doesn’t work to potential,” “runs in hallways,” “does not stay at desk,” “has difficulty keeping friends,” “looks out the window during class time,” “difficulty managing time” or “messy desk.”
  • Have had symptoms that were always there — you can’t remember a time when you didn’t have difficulty with focus, disorganization, not following through on things, etc.
  • Have had impairment in your day-to-day functioning due to these symptoms — you have had difficulty in your relationships, you may have been fired from jobs, you may just feel like you have never worked to your potential.
  • Have one or more family members who had lifetime difficulties with focus and distraction.

If you have ADD/ADHD, being over-scheduled and overextended just makes your symptoms (and functioning) worse. But being over-scheduled and overextended does not cause the symptoms outright.

Then why has it become more prevalent? Well, it really hasn’t; ADD/ADHD has been around a long time, way before the technological age.

ADD/ADHD is a biological and genetic disorder. There have been several genes linked to ADD/ADHD, and children with ADHD have genetic variations not found in children without ADHD (Elia et al. 2010; Guan et al. 2009). And if you have ADD, there is a 75 percent chance that you inherited the genes from at least one of your parents (Rietveld et al. 2004).

So while it is best to get some downtime from your Blackberry, iPhone, iPad, what-have-you, they are not causing you to have ADD/ADHD. Your overuse may just be mimicking the symptoms of ADD/ADHD.

The important thing to look at is how long you’ve been having difficulties with distractibility and inattention. Equally important (if not more so) is asking your family about its medical history, including any relatives that had symptoms of ADD/ADHD, bipolar disorder, anxiety and depression. Knowing that information can unlock many doors in determining whether you have electronics-induced ADD/ADHD or the real thing.

If you feel that your symptoms of inattention, distractibility and disorganization have caused you impairment in your day-to-day living, it’s worth talking about it with a doctor. There is treatment available if you do meet the diagnostic criteria for ADD/ADHD.

And for everyone, ADHD/ADD or not, it’s important to “unplug” on a regular basis.


Books by this author

Adult ADD: A Guide for the Newly Diagnosed

10 Simple Solutions to Adult ADD: How to Overcome Chronic Distraction and Accomplish Your Goals


Follow Stephanie Sarkis, Ph.D. on Twitter:

ADHD Awareness Week: Resources to Help

October 16 through October 22 has been designated as ADHD Awareness week. It is a time, not only to spread the word and help other’s better understand ADHD, but for you to become more aware of your own symptoms, to focus on how ADHD has stopped you from reaching your goals and how ADHD enhances your life. It is a time to use your new awareness to take steps to improve your life and be more involved in your medical care.

This week, in recognition of ADHD Awareness Week, I have compiled resources to help you begin the next part of your journey.


Online Events:

The ADHD Awareness Expo is a free online resource hosted by ADHD Coach Tara McGillicuddy and Dr. Rory Stern. According to the website, there will be experts sharing tips and strategies through online videos and you can connect with others in chat rooms and forums. You do need to register for the event, which will be going on throughout the week. Click on the above link to register.


The Attention Deficit Disorder Association (ADDA) is offering several free webinars on October 19 beginning at 7:00 P.M. with ADHD 101. Additional webinars include Treatment Options, Practical Strategies and Everything You Wanted to Know About ADHD but Forgot to Ask.


Sharing Basic Information About ADHD:

Do you know someone that wants to know more about ADHD? The following articles explain some basic information. They might be great to share with your child’s teachers, your friends, your relatives, to help them better understand what you and/or your child experience each day.

How ADHD Affects the Daily Life of a Child – While most of us know the main symptoms of ADHD – impulsiveness, inattention and hyperactivity – do you know how each of those symptoms really show up? In this article, we explain why children forget to hand in assignments, why raising a child with ADHD can be exhausting and much more.

How ADHD Symptoms Manifest in Adults – Even though children and adults share the same main symptoms, they may appear differently. This article explores some of the common behaviors in adults with ADHD.

10 ADHD Myths – Expert Terry Matlen debunks 10 common myths about ADHD.


Understanding the Symptoms of ADHD:

Hyperactivity – Hyperactivity is considered to be one of the main symptoms of ADHD. Learn about the common characteristics of hyperactivity in children and adults.

Inattention – Learn more about the characteristics of, and treatment for, inattention in both children and adults.

Impulsiveness  – Impulsiveness is one of the major symptoms of ADHD. Both children and adults can struggle with controlling impulsive behaviors.


Being Involved in Your Medical Care:

We are partners in our health care. Although our doctors may provide expert advice about ADHD treatments, we need to be involved in every aspect of our care. We need to be knowledgeable about our symptoms and how we react to treatments.


Organization Strategies for ADHD

People with attention deficit hyperactivity disorder (ADHD) face extra challenges getting and staying organized. The symptoms of ADHD include restlessness, lack of concentration, inability to focus and impulsivity. Many adults with ADHD are gifted but the ADHD interferes with their ability to achieve goals.

Adults with ADHD might not have been given useful tips for managing their ADHD while at school. But there are many organizational tools available that can help people with ADHD to focus on and succeed in activities at work and at home.

Planning ahead, deciding on priorities and setting goals can all help to get where you want to be. Time management reduces the sense of chaos and complexity in your life. Getting support from friends, workmates and family can also be essential, as some things cannot be dealt with on your own.

A good place to start is goal setting. Take the time each day to set specific goals and determine what you want to achieve. Try to find the middle ground between aiming too high and not high enough, bearing in mind your abilities and enthusiasm. When choosing a goal, it’s useful to think along these lines: is the goal challenging, valuable, specific, and measurable, and does it have a specific deadline?

Writing down the goal will make it official and will add to your sense of commitment to it. Decide where to begin, and make a detailed step-by-step plan of the major tasks needed to achieve the goal. Keep deadlines realistic to avoid disappointment.

When things get busy, ADHD symptoms can lead a person to lose perspective. On a daily level, to-do lists can help organize your schedule according to the importance of each activity. Use stars, arrows, numbers, or letters or devise your own system. Prioritize daily activities into urgent, important, and nonessential. Allow some margin for unpredictable interruptions and delays. Plan to maximize your sense of accomplishment while creating space for relaxation too.

Color-coding files, reminders and schedules can be particularly useful as many people with ADHD are visually oriented. Take advantage of this by making things memorable and attention-grabbing with color.

Poor time management can reduce your productivity. Underestimating the time it will take to complete tasks can throw off your schedule for the rest of the day. However, this is difficult for many people with ADHD, who have particular problems giving themselves enough time. If you are in the habit of pushing yourself too hard because of unrealistic expectations and standards, ask yourself the following questions: Do I have enough time to do the things I enjoy? Am I constantly rushing and often late? Do I often cancel enjoyable activities because I’m too busy? Do I feel there are not enough hours in the day? Do I get frustrated and impatient?

This will highlight your need to consider how you allocate time and whether it is working for you. If you are not happy with the amount of time you spend on any one area, think of ways to reallocate your time and achieve a new balance.

Notice how and where you work best, and let yourself work under whatever conditions are ideal for you. Make lists when you feel overwhelmed, as things will seem more organized on paper. Simply by writing the list, you will feel you have already begun to conquer it.

To keep track of your daily tasks, you can use Post-it notes, diaries, calendars, personal or electronic organizers and appointment books. Time is often lost due to disorganized filing systems, lack of an ‘in-tray’ system, or keeping unnecessary copies of paperwork. You need systems for filing and making appointments. Ensure that computer data is backed up regularly.

Keep a notepad in your car, by your bed, and in your jacket. You never know when a good idea will hit you, or when the inevitable cascade of ‘off-topic’ thoughts will arise. It’s also OK to multitask. People with ADHD often need to be doing several things at once in order to be productive.

Disorganization caused by family and children is an emotional issue. Relationships are potential minefields of pressure and anxiety. With children, your daily routine changes, your sleep is disturbed, and new pressures arise. For a person with ADHD, the challenges can be enormous. Staying calm and collected all the time is an impossible goal. Small hassles can add up and pressure can build until you are ready to burst.

Ways to reduce the strain include adjusting your priorities, including standards of order and neatness. Don’t take on unnecessary duties and responsibilities. If you’re doing your best, don’t feel guilty (easier said than done!) Accept any help that’s offered. If you can afford it, consider paying someone to help with the cleaning, shopping or laundry, especially at busy times. Take advice from people whose opinion you trust, and get specific advice on problems.

Plan ahead. Get as much ready for the following day as possible, and give yourself extra time to leave the house. Anticipate and prepare for problems before they occur; you can’t be expected to remember everything. Build up your resources: support network, emergency funds, and your own energy. Finally, don’t put impossible pressure on yourself.


Scientifically Reviewed
Last reviewed: By John M. Grohol, Psy.D. on 2 Feb 2011
Published on All rights reserved.


ADHD: The role of diet and sleep

I recently had a guest post published on the CNN news blog, The Charts, entitled Calming your child’s ADHD symptoms. The subject clearly needs a fresh look, given the startling statistic from a recent CDC report that diagnosis of ADHD was up by 29{4f6aab00077e9ca07d0267f1e2c90ddebbd6efe6937fd47967aa92739e3edbbe} from 2000 to 2009, and evidence that medication use for ADHD increased at an average yearly rate of 3.4{4f6aab00077e9ca07d0267f1e2c90ddebbd6efe6937fd47967aa92739e3edbbe} from 1996 to 2008.

In a nutshell, I describe ADHD as a problem of regulation of emotion, behavior and attention. I offer three points of approach. The first is to address family relationships. This is because children learn self-regulation in context of relationships with primary caregivers, and family conflict is clearly associated with increased risk for ADHD. Second, I recommend involving kids in activities that promote self-regulation including, but not limited to, horseback riding, swimming, martial arts and drumming. And last I recommend careful use of medication when a child’s symptoms interfere with learning and social relationships.

A number of people commented that I had not addressed the issues of diet or sleep, both of which have been associated with symptoms of inattention and hyperactivity. I gave some careful thought to why I had not included these issues among the top three. The reason is that, in my experience, problems around sleep and diet are usually embedded in problems in relationships (the major exception is obstructive sleep apnea, a sometimes overlooked condition that can cause of hyperactivity in children. This topic is well covered in a recent post by an ENT specialist on the blog KevinMD.)

For example, I took care of one teenage girl with symptoms of inattention who met diagnostic criteria for ADHD. I learned that up until her thirteenth birthday, her mother lay in bed with her every night until she fell asleep. Then on the day of her birthday, her mother decided that her daughter was too old for this habit, and abruptly stopped, insisting that she fall asleep on her own. Not surprisingly, her brain and body had no idea how to fall asleep independently, so she was staying up until two or three o’clock every morning, sneaking her laptop into bed with her.

Many children with a range of behavior problems crave sweets. Parents describe constant battles around food choices. It is likely that these problems have complex causes: sweets may be used to reduce stress, and food is a place where children can exert absolute control by simply closing their mouths.

Certainly it is important for growth, development, and learning that children eat a healthy diet. Ideally they should have three meals a day with sufficient fresh fruits, vegetables, and protein and a minimum of processed foods. However, if all attention in management of ADHD is focused on diet, to the exclusion of relationships, then the intervention is off the mark. In addition, evidence for more specific food restrictions, such as dairy, wheat or food dyes, is more anecdotal, and some of these diets can be quite restrictive.

Similarly, getting enough sleep is essential to healthy brain function and regulation of behavior, emotions and attention. But, with the exception of obstructive sleep apnea, most sleep problems develop in the context of relationships. In my work with the teenager I describe above, we needed to understand what about family relationships, between mother and father as well as between mother and daughter, led to this problematic situation. Only then could we could begin to solve the “sleep problem.” Many children I see with a diagnosis of ADHD have been engaging in battles with their parents for years around sleep, but almost always in the setting of a range of conflicts within the family.

My answer to those who question the omission of sleep and diet from my discussion of ADHD is that yes, these issues are important. In my CNN piece I describe inattention, impulsivity and hyperactivity as symptoms, and urge parents and clinicians who treat ADHD to not simply treat symptoms, but rather to address the underlying cause. Similarly, problems with sleep and diet are often symptoms of problems in relationships. Many parents describe being overwhelmed by the volume of information coming at them about this complex entity known as ADHD. I believe both parents and professional would do well to be open to a variety of ideas while maintaining a focus on supporting relationships and repairing disruptions in relationships.



Dr. Claudia GoldDr. Claudia M. Gold is a pediatrician and author of “Keeping Your Child in Mind: Overcoming Defiance, Tantrums and Other Everyday Behavior Problems by Seeing the World Through Your Child’s Eyes.”