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Research on ADD

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ADD research overview

If you explore papers reporting research on Attention Deficit Disorder, you will notice that it often is not actually called ADD. It is mostly described as a subtype of the more commonly known Attention Deficit Hyperactivity Disorder, ADHD, but without the hyperactivity. It is often referred to as the inattentive type, or ADHD predominantly inattentive, sometimes abbreviated as ADHD-I (where the I stands for inattentive) [1-3].

DSM-V
There is a guide, commonly used by psychologists and psychiatrists called the Diagnostic and statistical manual of mental disorders, abbreviated as DSM. In the current version, the DSM-IV [4] that appeared in 1994, it states that there are three different types of ADHD: hyperactive, inattentive and combined.

There is however a high probability that in the next edition (DSM-V) ADD will be on its own, because there are convincing studies that show that the inattentive type has a different origin: from a neurological perspective there is a clear difference and there are considerable differences in the effectiveness of treatments [1, 5-7].

Causes
We can distinguish a line of research that focuses on mapping the processes that are essential for ADD and finding possible causes. It is generally agreed upon that genetic factors are of influence [6, 8]. But also other factors are found to be relevant, like life style, brain injuries and exposure to certain chemicals [9-12].

There is also research that observes factors like age and gender. It is found that generally, symptoms are becoming less prominent when people with ADD are older [13, 14], but there is still much discussion on  the relationship with gender [14].

Treatments
Many research projects focus on the effectiveness of different methods of treatment, like coaching, diets or different forms of medication. An often reoccurring find is that there is much variation between subjects: what works for one person, does not work for another. This is not only the case for different forms of therapy and coping strategies, but also for forms of medication, like Ritalin. Moreover, there are many differences on the effectiveness between ADHD subtypes [15, 16].

A complicating factor is comorbidity. People symptoms of ADD, may also show symptoms of other disorders and conditions, like different forms of autism, CD DBD and ODD. This does not only complicate the diagnosis, it also impacts the effects of treatments [3, 17-21].

Alternatives
Recently there is also some research on the effectiveness of medication that a less drastic impact than strong drugs like Ritalin and Adderall that are often prescribed.  Examples are Citicoline (also called CDP Choline) [22, 23]  and Ginkgo biloba [24]. Both are commonly available as diatary supplements and appear to have a positive effect without obvious negative side effects.

Some research focuses on the effectiveness of (specially developed) games [25] and screen agents. An example of the latter is a screen personality that has been developed in Thessalonika as a studying aid [26]. The preliminary results are encouraging, but no large scale experiments have been reported yet.

A type of gaming that has repeatedly shown to be very effective in the treatment of ADD is neurofeedback [27, 28]. It concerns a game set up in which the player controls a car with brain signals. This activity stimulates the brain part that is known to be less active with ADD subjects.

This overview shows that there is not one common approach to ADD. Partly this is due to the fact that there is still some uncertainty about what causes ADD and how it should be categorized. But also a reoccurring pattern is that of individual differences, sometimes in symptoms, but especially in the effectives of treatment methods. This demands flexibility, an up to date knowledge and a certain skill from those who need to find the right treatment.  

June 3, 2011

References

  1. Grizenko, N., M. Paci, and R. Joober, Is the Inattentive Subtype of ADHD Different From the Combined/Hyperactive Subtype? Journal of Attention Disorders, 2010. 13(6): p. 649.
  2.  Schmitz, M., H. Ludwig, and L.A. Rohde, Do Hyperactive Symptoms Matter in ADHD-I Restricted Phenotype? Journal of Clinical Child & Adolescent Psychology, 2010. 39(6): p. 741-748.
  3. Valo, S. and R. Tannock, Diagnostic instability of DSM–IV ADHD subtypes: Effects of informant source, instrumentation, and methods for combining symptom reports. Journal of Clinical Child & Adolescent Psychology, 2010. 39(6): p. 749-760.
  4. Association, A.P. and A.P.A.T.F.o. DSM-IV., Diagnostic and statistical manual of mental disorders: DSM-IV-TR2000: Amer Psychiatric Pub Inc.
  5. Adams, Z.W., R. Milich, and M.T. Fillmore, A Case for the Return of Attention-Deficit Disorder in DSM-5. The ADHD Report, 2010. 18(3): p. 1-6.
  6. Diamond, A., Attention-deficit disorder (attention-deficit/hyperactivity disorder without hyperactivity): A neurobiologically and behaviorally distinct disorder from attention-deficit/hyperactivity disorder (with hyperactivity). Development and Psychopathology, 2005. 17(03): p. 807-825.
  7. Carr, L., J. Henderson, and J.T. Nigg, Cognitive control and attentional selection in adolescents with ADHD versus ADD. Journal of Clinical Child & Adolescent Psychology, 2010. 39(6): p. 726-740.
  8. Pheula, G.F., L.A. Rohde, and M. Schmitz, Are family variables associated with ADHD, inattentive type? A case–control study in schools. European child & adolescent psychiatry, 2011: p. 1-9.
  9. Botting, N., et al., Attention deficit hyperactivity disorders and other psychiatric outcomes in very low birthweight children at 12 years. Journal of Child Psychology and Psychiatry, 1997. 38(8): p. 931-941.
  10. Aguiar, A., P.A. Eubig, and S.L. Schantz, Attention deficit/hyperactivity disorder: a focused overview for children’s environmental health researchers. Environmental health perspectives, 2010. 118(12): p. 1646.
  11. Nigg, J.T., et al., Confirmation and extension of association of blood lead with attention deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population typical exposure levels. Journal of Child Psychology and Psychiatry, 2010. 51(1): p. 58-65.
  12. Cho, S.C., et al., Effect of environmental exposure to lead and tobacco smoke on inattentive and hyperactive symptoms and neurocognitive performance in children. Journal of Child Psychology and Psychiatry, 2010. 51(9): p. 1050-1057.
  13. Ramelli, G.P., et al., Age-dependent presentation in children with attention deficit hyperactivity disorder. World Journal of Pediatrics, 2010. 6(1): p. 90-90.
  14. Ramtekkar, U.P., et al., Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. Journal of the American Academy of Child & Adolescent Psychiatry, 2010. 49(3): p. 217-228. e3.
  15. Langford, S. and D. Moher, How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis. CMAJ, 2001. 165(11): p. 1475-88.
  16. Roessner, V., et al., Methylphenidate normalizes elevated dopamine transporter densities in an animal model of the attention-deficit/hyperactivity disorder combined type, but not to the same extent in one of the attention-deficit/hyperactivity disorder inattentive type. Neuroscience, 2010. 167(4): p. 1183-1191.
  17. Genro, J.P., et al., Attention-deficit/hyperactivity disorder and the dopaminergic hypotheses. Expert review of neurotherapeutics, 2010. 10(4): p. 587-601.
  18. Faraone, S.V. and S.J. Glatt, A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes. The Journal of clinical psychiatry, 2010. 71(6): p. 754.
  19. Puffenberger, S.S., The Efficacy of Working Memory Training for Children and Adolescents with Attention-Deficit/Hyperactivity Disorder-Combined type compared to Children and Adolescents with Attention-Deficit/Hyperactivity Disorder-Primarily Inattentive type, 2011, The Ohio State University.
  20. Semrud-Clikeman, M., et al., Executive Functioning in Children with Asperger Syndrome, ADHD-Combined Type, ADHD-Predominately Inattentive Type, and Controls. Journal of autism and developmental disorders, 2010: p. 1-11.
  21. Meltzer, H., et al., Mental health of children and adolescents in Great Britain. International Review of Psychiatry, 2003. 15(1-2): p. 185-187.
  22. Saver, J.L., Citicoline: update on a promising and widely available agent for neuroprotection and neurorepair. Rev Neurol Dis, 2008. 5(4): p. 167-77.
  23. Silveri, M., et al., Citicoline enhances frontal lobe bioenergetics as measured by phosphorus magnetic resonance spectroscopy. NMR in Biomedicine, 2008. 21(10): p. 1066-1075.
  24. Niederhofer, H., Ginkgo biloba treating patients with attention deficit disorder. Phytotherapy Research, 2010. 24(1): p. 26-27.
  25. Kwan, G., Issues: Pay attention! Can custom–made video games help kids with attention deficit disorder. Berkeley Medical Journal, 2002.
  26. Chatzara, K., C. Karagiannidis, and D. Stamatis. An Intelligent Emotional Agent for Students with Attention Deficit Disorder. 2010. IEEE.
  27. Lévesque, J., M. Beauregard, and B. Mensour, Effect of neurofeedback training on the neural substrates of selective attention in children with attention-deficit/hyperactivity disorder: A functional magnetic resonance imaging study. Neuroscience Letters, 2006. 394(3): p. 216-221.
  28. Lubar, J.F., Neurofeedback for the management of attention deficit disorders. Biofeedback: A practitioner’s guide, 2003: p. 409-437.


 

 

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