I am not a sports fanatic, my husband is one. That’s why, during the Beijing Olympics, he kept a mental record of the events he wanted to see from the live television coverage. In particular, my husband was eager to watch Michael Phelps bring into realization his dream of getting 8 gold medals in the swimming competition. I wasn’t interested with Michael Phelps then, not until my husband mentioned to me that this amazing athlete was diagnosed with Attention Deficit Hyperactivity Disorder or ADHD when he was 9. This ignited my interest, and I started watching Phelps realize his very dream of breaking the Olympic record which he actually did.

In my practice, I was fortunate to see one case of ADHD. An eight-year old boy was brought in by his mother for consult due to his cough. Beforehand, I was alarmed by the mother that her child has ADHD. I could not ask him about his cough because he kept moving around the emergency room, touching things on my table, then on to the nurse’ deck, the emergency cart. He kept talking excessively to anybody in the room. When I’m about to examine his chest, he grabbed my stethoscope and placed it on his ears and pretended to examine me instead. Not long after, he got my pen and started writing on my prescription pad. His mother told me that his son often fidgets with hands. In school he often leaves his seat in the classroom, does not seem to listen when spoken to, does not like engaging in activities that require sustained mental work and has difficulty waiting for his turn. He is often on the go as if driven by a motor engine because even in the late evening or early dawn, she said, his son would oftentimes go outside the house without notice and the whole family goes out to look for him.

Sources say that bout 3% to 5 % of all children and possibly as many as 2 million American children are estimated to be affected by ADHD. The term attention deficit in ADHD is a misnomer since persons with ADHD are not actually deprived of attention. Instead they have difficulty regulating their attention. They have difficulty limiting their attention to irrelevant stimuli in the same way that they can not focus their attention to the more relevant ones. In other words, they have little focus because they pay too much attention to a lot of things. Since they can’t stay focused to almost anything, their education, psychological development, relationships and family life is greatly affected. Other symptoms of ADHD include impulsiveness (acting quickly without thinking), and hyperactivity (always moving around, cannot sit still). This condition often continues into adolescence and adulthood.

Neuropsychological studies suggested an imbalance of neurotransmitters (catecholamines like dopamine and norepinephrine) in the brain which lead to development of this condition. Dopamine is a chemical in the brain which affects pleasure, movement, and attention in an individual. The impulsiveness in ADHD can be explained by the low levels of dopamine of the brain in these individuals, while distractibility and inattention seems to be related to low levels of norepinephrine. MRI studies of the brain of ADHD patients strongly support decreased activation of the frontal lobe of the brain which is responsible for executive function, attention, and exercising inhibition.

For several years now, symptoms of ADHD have been treated with oral stimulants like Methylphenidate (a chemical cousin of amphetamine) and Dexamphetamine. Perhaps you might be wondering why a stimulant is given to treat this hyperactivity disorder. Researchers have been asking this same question for years, and only recently did they begin to shed light on its explanation. This drug can increase the low dopamine and norepinephrine levels in the brain of individuals with ADHD. Hence, this drug has a paradoxical effect since even though it is a stimulant, it has the ability to decrease hyperactive behavior and increase ability to focus when given at low doses. However, like all medications, these drugs are not free of side effects. Children may have insomnia, less appetite, weight loss and slow growth while on medication.

Two years ago, the Food and drug Administration (FDA) has approved the Methylphenidate Transdermal System (MTS). This is in a form of an adhesive patch that can be worn based on the patient’s need. Unlike oral preparations, this offers a better opportunity for treatment individualization.

Other suggested managements of ADHD include neurotherapy, a computer-based technique wherein patients are taught to restore self-regulation in the brain by retraining brainwave patterns; incorporation of Omega 3- essential fatty acid in the diet; and counseling for ADHD patients as well as the families involved.

ADHD in a child may make him less able to do some things in life, but it doesn’t make him any lesser as an individual. This has been proven true by Michael Phelps himself with the crucial help of his mother who in so many ways tried to bring out the best in him.

References:

1) Bethesda, MD (2006). Lifting the Curtain on How Ritalin Packs its 1-2 Punch.
http://www.the-aps.org/press/journal/06/11.htm
2) Susan Louisa Montauk, MD (2008). Attention Deficit Hyperactivity Disorder.
http://www.emedicine.com/ped/TOPIC177.HTM
3) Marcia L. Buck, Pharm.D., FCCP; Kristi N. Hofer, Pharm.D.; Michelle W. McCarthy, Pharm.D. New Treatment Options for Attention-Deficit/Hyperactivity Disorder (ADHD): Part I. Transdermal Methylphenidate and Lisdexamfetamine
http://www.medscape.com/viewarticle/578746
4) Jacques Duff (2005). ADHD Treatment. Behavioural Neurotherapy Clinic
http://www.adhd.com.au/ADHD_Treatment.htm
5) NIDA InfoFacts: Stimulant ADHD Medications – Methylphenidate and
Amphetamines. National Institute on Drug Abuse.
http://www.nida.nih.gov/Infofacts/ADHD.html
6) Attention-deficit hyperactivity disorder. Wikipedia.
http://en.wikipedia.org/wiki/Attention-deficit_hyperactivity_disorder
7) Joseph M. Carver, Ph.D. Attention-Deficit Hyperactivity Disorder (ADHD)
http://www.drjoecarver.com/clients/49355/File/Attention-
Deficit%20Hyperactivity%20Disorder%20(ADHD).html