Is the ADHD Brain Damaged?

Posted by on February 14th, 2005 | Comments off

This will be a long post as it seems that researchers can find numerous parts of the ADHD brain that seem dysfunctional. A major flaw in virtually all of this research is that they use very small groups that cannot depict the vast spectrum brain variability among the human species. This published research confuses many people as it seems the brains of those with ADHD are smaller, have damage in the basal ganglia, putamen, frontal lobes, cerebellum, and brain stem. This amounts to little more than neophrenology.

Small Brains

“It’s strong support for a very strong biological contribution to what causes ADHD.” Dr. Judith Rapoport, National Institute of Mental Health

(AP) Hyperactive children and teens have slightly smaller brains than those without the disorder, a study shows.

Exactly why this is so is not clear, but the researchers said the smaller brain volume does not appear to be related to the use of hyperactivity drugs such as Ritalin, as some parents had feared.

The finding could be reassuring to parents in another respect as well: It suggests that hyperactivity is biological in origin, not a product of bad parenting.

The researchers said it appears that that the brains of hyperactive children develop at a normal pace but never entirely catch up in size with the brains of other youngsters. However, they said that people with smaller brains are not necessarily less intelligent.

The findings were reported in Wednesday’s Journal of the American Medical Association.

Other studies also have suggested biological differences in the brains of people with attention deficit hyperactivity disorder.

“It’s strong support for a very strong biological contribution to what causes ADHD,” said one of the researchers, Dr. Judith Rapoport, chief of child psychiatry at the National Institute of Mental Health in Bethesda, Md.

The 10-year study used MRIs to look at 152 patients ages 5 to 18 who had the disorder, and 139 people in about the same age range who did not. It also compared patients who were on medication and those who were not.

The study found the disorder is associated with about a 3 percent to 4 percent decrease in volume throughout the brain. The smaller their brains, the greater their symptoms.

“The first thought people have is that this is a product of bad parenting” or that it is environmental, said Dr. Daniel Coury, a professor of clinical pediatrics at the Ohio State University College of Medicine who was not involved in the research. “Having clear biological findings that this is something beyond the control of parents or the child themselves helps to remove that stigma.”

Dr. Bennett Leventhal, professor of psychiatry and pediatrics at the University of Chicago, said the findings regarding the effects of medication “should be reassuring to parents that you can treat your kids and not hurt their brains.”

The research was conducted between 1991 and 2001 at the National Institute of Mental Health, which funded it.

ADHD is one of the most common childhood psychiatric disorders. Its symptoms include short attention span, impulsive behavior, difficulty focusing and fidgetiness. The American Academy of Pediatrics estimates 4 percent to 12 percent of school-age children are affected.

Bad Basal Ganglia

Reading and attention disorders both seem to stem from the same primitive part of the brain that governs thinking and muscle control, Yale researchers have found.

A study of 27 people ages 18 to 24 revealed that participants with attention deficit and hyperactivity disorder, and those with reading disorders, displayed low activity in their basal ganglia.

The study, which was published in the November issue of the American Journal of Psychiatry, is the first to use sophisticated functional magnetic resonance imaging to identify the neural circuits involved with ADHD.

When both groups were given the drug methyl-phenidate (brand name Ritalin) activity in the basal ganglia was normal, said Keith Shafritz, lead author.

Shafritz performed the work as a Yale graduate student and is now a research associate at the Duke University Medical Center.

Shafritz said the results suggest that Ritalin does not produce a unique effect in people with ADHD and that ADHD and reading disorders are in some way equivalent.

Nationally about 5 percent of children have reading disorders, characterized by reading at a lower level than expected.

About 3 to 5 percent of children show symptoms of ADHD. These include inattention, impulsiveness, and hyperactivity.

Participants were placed in a functional magnetic resonance imaging unit where they saw and heard a mixture of real and nonsense words.

The normal control group was about 80 percent accurate. People with ADHD and people with reading disorders both scored about 70 percent, Shafritz said.

Basal ganglia activity was higher in the control group.

When participants with ADHD or reading disorders were given methylphenidate and repeated the test their basal ganglia function rose to normal levels.

Shafritz said the basal ganglion is an inhibitory organ that can also activate areas of the brain. The neurotransmitter dopamine regulates the basal ganglion.

Ritalin apparently increases the inhibitory effect, dropping people with ADHD to a calmer and more attentive state.

The drug blocks the dopamine transporter, a system that clears away dopamine. With the transporter turned down dopamine accumulates.

“One driving question was, ‘Were the effects of Ritalin on the brain unique to kids with ADHD?’” Shafritz said. “The results suggest that Ritalin has similar effects in ADHD and other conditions. The idea that Ritalin is acting in a certain way in ADHD appears not to be the case.”

“The study also suggests that ADHD brains are not that different from everyone else’s brains,” Shafritz said.

Shafritz said the study was not designed to measure classroom behavior or reading skills. Also, medical ethics prevented giving Ritalin to the control group.

Bad Putamen

An inverse index of regional cerebral blood flow, T2 relaxometry (an fMRI procedure), was used to indirectly assess blood volume in the striatum (caudate and putamen) of boys ages 6 to 12 in steady-state conditions (Teicher et al., 2000). Boys with ADHD had higher T2 relaxation times bilaterally in the putamen than controls. Relaxation times strongly correlated with both the individual’s capacity to sit still and error performance on an attentional task. Daily treatment with methylphenidate significantly changed T2 relaxation times in the putamen of boys with ADHD, although the magnitude and direction of the effect was strongly dependent on unmedicated baseline activity.

Bad Frontal Lobes

Investigators at UCLA used magnetic resonance imaging (MRI) to compare the brains of 27 children with ADHD to those of 46 children without the disorder. They found that the region of the brain associated with attention and impulse control, located on the bottom of the frontal lobes of the brain, was smaller in the ADHD kids than in the other children.

“We would expect that the abnormalities would be in this region, and this is what we found,” lead investigator Elizabeth Sowell, PhD, tells WebMD.

The researchers also found that children with ADHD had larger areas of the outer layers of the brain.

Previous research has indicated that the differences were limited to the right side of the brain, but Sowell and colleagues found that they occurred on both sides.

Bad Cerebellum

Symptoms of ADHD in adults may include reading difficulties, poor concentration, clumsiness, and low self-esteem. Our research has shown that a medical condition we refer to as Cerebellar Developmental Delay (CDD) is a likely culprit of ADHD in adults. In CDD, the cerebellum is under-developed and not able to process information going to and coming from the cerebrum (often known as the “thinking brain”) efficiently. DORE has developed specific exercises that stimulate the cerebellum, thus allowing it to process information faster.

Bad Brain Stem and Other Parts

U.S. researchers reported brain scans of children with attention deficit hyperactivity disorder show anatomical abnormalities beyond a chemical imbalance.

The study by North Shore-Long Island Jewish Health Center was presented at the annual meeting of the Radiological Society of North America.

A second study by the same authors showed stimulant medications prescribed to balance brain chemistry appear to normalize some of these brain irregularities.

“We found abnormality of the fiber pathways in the frontal cortex, basal ganglia, brain stem and cerebellum,” said lead author Manzar Ashtari.

“These areas are involved in the processes that regulate attention, impulsive behavior, motor activity and inhibition – the key symptoms in ADHD children.”

The study used diffusion tensor imaging to compare 18 children with diagnosed ADHD with 15 control children to evaluate the brain’s white-matter fiber development. Researchers found differences in the brain fiber pathways that transmit and receive information among brain areas.

Bad Reticular Formation

Usefulness of QEEG neurometrics in a clinical setting.

Chabot and colleagues found that generalized or focal theta/alpha excess was present in 76.2% of their sample of ADD, ADHD, and children with attentional problems. These theta and alpha excess children can be divided into two distinct neurophysiological subgroups .

The first and most common group consisting of 46.4% of the sample was characterised by theta and/or alpha excess, mostly at frontal and/or central regions with normal alpha mean frequency.

Excessively high output of thalamocortical alpha generators can result from (a) overactivation of the thalamus. The primary dopamine pathways originate in the substantia nigra in the brainstem and innervate the caudate nucleus and putamen and are largely responsible for sensorimotor integration. Down-regulation of nigrostriatal dopaminergic neurons results in overstimulation of the midbrain reticular formation and the production of excess alpha (b) underactivation of the prefrontal cortex resulting from disinhibition from nucleus reticularis.

Bad Cerebrum

The authors report a study to compare regional brain volumes at initial scan and their change over time in medicated and previously unmedicated male and female patients with ADHD and healthy controls. The case-control study was conducted from 1991-2001 at the National Institute of Mental Health, Bethesda, Md, of 152 children and adolescents with ADHD (age range, 5-18 years) and 139 age- and sex-matched controls (age range, 4.5-19 years) recruited from the local community, who contributed 544 anatomic magnetic resonance images. Using completely automated methods, the main outcome measures were initial volumes and prospective age-related changes of total cerebrum, cerebellum, gray and white matter for the 4 major lobes, and caudate nucleus of the brain were compared in patients and controls.

Summary

It’s both significant and tragic to note that one can use a search engine and type in ‘ADHD’ and virtually any particular portion of the brain and find clinically controlled research that indicates related brain damage or abnormality.

Brain scans and QEEG are relatively nascent technologies that are currently more art than science when used to determine the source of ADHD. Obviously, the publishing of data on small groups may assist researchers in garnering grant funds. It may even help them retain their position at university in a publish or perish world. However, publishing of such data is not only unethical, it is also highly misleading if it does not explicitly define itself as highly preliminary. Even then it is questionable.

Publication of this neophrenology allows media to portray ADHD individuals as irreparably brain damaged which is both harmful and flagrantly untrue.

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Disorder? A Dubious Diagnosis

Posted by on February 10th, 2005 | Comments off

Ten years ago, PBS ran the documentary- ATTENTION DEFICIT DISORDER- A DUBIOUS DIAGNOSIS?. The case was made that the epidemic of Attention Deficit Disorder affecting mostly white, middle class boys is to a large extent man-made, one result of a long-term, unpublicized financial relationship between the company that makes the most widely known A.D.D. medication and the nation’s largest “A.D.D. Support Group.”

No question that A.D.D. is spreading, along with the use of powerful psychostimulants. The number of children being medicated-now an estimated 2,000,000-seems to be doubling every two years.

In preparing our documentary, we heard time and again that Ritalin is “all over the schools.” Recovering drug addicts told us that Ritalin was becoming what’s called a “gateway drug,” the first drug a child tries. And addicts told us that some teenagers snort Ritalin for a quick, cheap (but dangerous) high.

Viewer reaction to the the broadcast of the ADHD diagnosis television show was generally positive.

“And did I ever tell you that ADD: A Dubious Diagnosis probably saved my son’s life? His pediatrician gave me a copy and I think it was her way of saying that perhaps you might want to reconsider accepting the diagnosis. Watching this video was undoubtedly the most pivotal point that revealed/exposed to me the collusion that’s fueling the ADHD epidemic in the US. It really changed the course of our lives in an very positive way. Thanks a million for making it.”

“It is refreshing to see someone with an objective viewpoint weigh in on this issue. The very idea that we would condone giving children drugs that can damage the brain of a child before the brain has even developed is in my opinion insane.”

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Adult ADHD Life Strategies

Posted by on November 12th, 2004 | Comments off

ADHD Strategies for School & Work

Diffused attention during the learning process greatly decreases the amount of information that can be transferred from short-term memory to long-term. When questioning an ADHD student about the material just presented during a lesson, typically he’ll recall bits and pieces of the material presented, but seldom a holistic perspective. Other areas of life are affected including everything from personal interactions to work or school.

School

Diffused attention also makes reading a challenge as the student must read a passage two to four times before he can gain fundamental meaning from the text. Academic work becomes tiring and tedious. Children often claim homework is ‘boring’ after failing to be successful at simple assignments they are highly capable of accomplishing in short order if their attention were not diffused. Equating boredom with academic work is usually the result of lack of success and an assignment that is not highly stimulating.

Social Interactions

Socially, diffused attention causes an inability to perceive social cues. A look of disapproval, a simple shake of the head meaning NO, and other social cues are overlooked. For adults, this can cause conflict between workers or embarrassing situations at social gatherings. For a child, peers tend to shy away from kids who cannot recognize social cues. ADHD kids are labeled as nuisances and are often excluded from parties, etc. ADHD kids also discern themselves from their peer which results in reduced self-esteem.

Adults

 Typical symptoms of ADHD such as hyperactivity, poor organizational skills, distractibility, impulsivity, etc., often are challenges for the adult in the workplace. A recent article in WebMD.com reports that Joseph Biederman, MD, professor of psychiatry at Harvard Medical School, has surveyed ADHD adults and found that the incomes of households with an ADHD member are substantially lower than households without an ADHD member. Biederman calculates that households with an ADHD member have incomes that are $10,791 lower for high school graduates and $4,334 lower for college graduates. This extrapolates to an annual revenue loss of close to $77 billion in the US.

Biederman reports that an adult with ADHD has greater difficulty keeping a job due to lack of organizational and social skills. In fact, he thinks the disorder may actually make it more difficult to get an appropriate education to obtain a job that offers a higher pay scale. Lost days at work due to ADHD also provide a negative financial impact. “About 50% of the people with ADHD who had jobs in the survey said they lost work directly related to their ADHD symptoms,” says Biederman. “The symptoms of ADHD are very difficult for employers to deal with.”

However, there are strategies that can be employed to maximize function, skill, and satisfaction in the workplace.

Know your strengths and weaknesses

It is important to realize that many ADHD adults have successful careers. Edison, Mozart, and even Einstein may have had AD/HD.  Success seems to be linked to employing good coping strategies once you’ve discovered your strengths and know your weaknesses. Once you become aware of your specific set of challenges, it will become easier for you to plan a strategy. Therefore, consider your unique characteristics as you design your strategies. Below is a checklist describing many of the symptoms typically associated with ADHD. Strategies for coping are listed below each symptom.

Distractibility – people walking by your desk, or talking near you, distract you from your work

  • Try to place yourself in the least distracting environment. This may be a private office or cubicle with little foot travel by other office workers. You may retreat to a conference room if possible.
  • Maintain a memo pad to keep ideas and assignments from slipping away if you become distracted. Use the memo pad to jot down notes when you receive a phone call.
  • Come in early or do your work when others are not in the office.
  • Don’t multi-task. Set a goal to finish your current task before starting another.
  • Background noise, sometimes known as “white noise” can be effective. Special white noise CDs, audio tapes, or earphones are available for this purpose. Simple classical or new age music may also help.

Poor Memory – you can’t recall dates, names, or appointments.

  • First and foremost, buy a day planner and use it religiously to keep track of your schedule and upcoming tasks.
  • Many freeware and commercial computer programs are available that automate scheduling and task reminders.
  • Make use of pocket recorders. Current recorders no longer need audio tapes as they record on microchips. These are effective for personal reminders or note taking at meetings.
  • Write checklists and set reasonable goals for projects.

Poor Organization – you can’t seem to finish projects on time or you fail to keep good records.

  • If possible, find a job that does not require long-term task management.
  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
  • Reward yourself when you reach a goal.
  • Use an automated computer scheduler to set meeting times. These usually come with an alarm. Set it alert you five to ten minutes before each meeting.
  • Allow adequate time between meetings or projects to you do not overload or overbook your schedule.
  • Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set goals and reward you as you achieve your goals.

Impulsivity – you respond, at times, without thinking of consequences, sometimes your respond with outbursts

  • Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
  • From this feedback, develop strategies to be used when you become frustrated.
  • Yoga and some martial arts classes may prove effective in teaching relaxation and concentration skills. A meditation class may be effective, too.

Procrastination – you put things off until the last minute sometimes frustrating or angering colleagues

  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer. Reward yourself when you reach a goal.
  • Use an automated computer scheduler to set meeting times. These usually come with an alarm.
  • Partner with a co-worker who has good organizational skills. This person may act as your coach. The coach will help set project goals and reward you as you achieve your goals.

Hyperactivity – you find it very difficult to sit still during meetings or at your desk o Maximize your personal time like breaks, lunch, etc. to exercise and burn off some energy. This can include walking around the block or trips up and down the stairwell.

  • Break up your day to include trips to the mailroom, photocopier, fax, and restroom. o Bring a notepad to meetings and take copious notes.
  • A rubber band or paperclip in your free hand can provide stimulation while you take notes.

Daydreaming – when you find something boring you block out the stimuli and think of something more fun.

  • Remember, if you have a job you truly enjoy, you’ll find you’ll daydream less. o A job with challenging responsibilities will provide less opportunity for daydreaming than a job shuffling papers.
  • Set goals for your current task by breaking it into a series of manageable tasks. Mark the deadline for each mini-task with a timer. Computer programs are available for this or you may use a simple kitchen timer.
  • Reward yourself when you reach a goal.

Avoiding details – details like paperwork bore you and you find them virtually impossible to finish o Rule number one; if you can get someone else to do it properly (like an office assistant), let them handle paperwork.

  • Make filing more fun by color coding folders and using catchy labels. o Personalize your filing (sensibly) by using fun labels and folders – possibly color coded.
  • For paperwork that requires immediate attention have your filing system close at hand, perhaps directly on your desk

Poor social skills – your interactions with your colleagues are marked by your interruptions, blunt comments, or poor listening skills.

  • Have a trusted co-worker provide constructive feedback about your interactions with other staff. This co-worker may also act as a personal coach to role-play appropriate responses to common office dynamics.
  • Pay particular attention to social cues and work on them with a personal coach to develop awareness and appropriate response.
  • From this feedback, develop strategies to be used when you become frustrated.
  • Learn to pick up on social cues more readily. Some adults with ADHD have a hard time picking up nonverbal cues that they are angering a co-worker or supervisor.

Summary

A person with ADHD must develop skills and strategies that will enable him/her to function optimally in the workplace. Should skills and strategies fail, it may be necessary to switch careers after careful assessment of your work attributes and skills.

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ADHD: An Interest and Motivation Deficit?

Posted by on November 5th, 2004 | Comments off

Dr. Russell Barkley also proposes that ADHD is related more to lost interest and motivation rather than with an inability to pay attention or concentrate. He contends that students lose interest quickly because they are not motivated.

ADHD is Directly Related to the Level of Stimulation

If one has ever watched an ADHD child play commercial video games like Sony Play Station or Xbox, it becomes obvious that ADHD is not only a matter of motivation or interest, but is directly related to level of stimulation.  Video games are intrinsically motivating because they offer the viewer a heightened state of arousal, stimulation, and response. ADHD people do not have trouble maintaining focus on a three-ring circus. Motivation is a secondary consideration at best. It is a fact that persons with ADHD frequently cannot attend to low-level stimuli like homework or balancing a checkbook. ADHD people know that balancing a checkbook or doing well on homework are quite essential to their personal wellbeing. They are typically quite motivated to perform these tasks, but they cannot. Their diffused attention pulls them away from the task unless they are redirected by an outside stimulus/agency. People with ADD/HD can pay attention but usually shift attention from task to task, never staying with or completing a current task. It may also take a much higher level stimulation to shift out of inattentiveness or to maintain attention for longer periods.

Curriculum Modification Only A Short-term Intervention

Agreeing that ADHD is a misnomer, Barkley contends that curriculum should be made more motivating and interesting to students.  This is not only an over simplification of the problem, but also a fundamentally flawed perspective. Curriculum modification is a standard practice of teachers who encounter students with ADHD. It is a sensible short-term intervention just as are incorporating a behavioral shaping program, token reinforcement, and placing the student closer to the teacher. But these are only short-term solutions as they tend only to change the student’s environment.  They do not change the student.

ADHD Leads To A Negative Self-Image

This being so, when an ADHD student repeatedly fails to successfully perform homework, class assignments, or tests, their self-image declines. They perceive themselves as unable to control their behaviors and begin to believe they are victims of an unfair world. Because they believe that they cannot control their behaviors and thus are not personally responsible for negative behaviors, they deem other’s negative reactions as excessively harsh, discriminatory, or unfair.  Complaints of this nature are seldom assigned to just one person or group; they will be directed to everyone.  A natural reaction to the perception of victimization is anger.  Anger may cause outbursts, defiance, and even hitting as solutions to even the most minor conflicts. This type of behavior may cause the individual to become a social outcast.  This in turn serves to reinforce his perceptions of unfairness and rejection.  Sometimes, rather than fight or deny the negative responses to his behaviors, he may elect to agree with his critics.  He may label himself ’stupid,’ ‘lazy,’ ‘bad,’ etc.  This frequently leads to a feeling of worthlessness and may result in an I don’t care or I don’t care what you think attitude. 

ADHD and Learned Behaviors

All of the aforementioned perceptions and behaviors are learned. They are indeed compensations which produce a disastrous cycle that destroys self-esteem, decreases opportunities for friendships, and lowers academic performance.  It is quite evident that modifying the environment is only a short-term solution that must be tempered with cognitive skill building. 

ADHD And Cognitive Skill Building

Cognitive skill building includes increasing organizational skills, short-term memory skills, visual tracking, time on-task, and discriminatory processing (filtering) skills, all of which are loosely termed executive functions by psychologists and educationalists. Psychologists and research scientists have long known that executive functions can be improved through training. But the true question must be put: why do we consider ADHD a disorder that cannot be improved? Diffused attention can be improved thus improving subordinate deficits. Society will only become aware of this through a paradigm shift.

“Cognitive exercises, including computer-assisted strategies, have been used to improve neuropsychological processes, predominately attention, memory, and executive skills. Both randomized controlled studies and case reports have documented the success of these interventions using intermediate outcome measures.” –Rehabilitation of persons with traumatic brain injury, NIH Consensus Statement, 1998 Oct. 26-28;16(1):1-41.

Training Works For ADHD

It has been repeatedly demonstrated that provided the correct challenge, executive functions can be increased which would promote successes in the workplace and at school. It is founded in current cutting edge research in neuroplasticity and the human genome project. However, this is cutting edge, and the dinosaurs that rule the ADHD domain will not likely embrace it in their lifetimes.

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What’s the mystery behind ADHD?

Posted by on November 1st, 2004 | Comments off

Attention-deficit hyperactivity disorder (ADHD) is currently defined as a neurological disorder (brain disorder) that affects both children and adults. It is characterized by symptoms of inattention, impulsivity, and hyperactivity.

According to the National Mental Health Association, “ADHD is the most common psychiatric condition affecting children, estimates in prevalence in childhood range from 5 – 10%.” The ratio of ADHD boys to girls treated in clinical settings is 3:1.

Attention Deficit/Hyperactivity Disorder in Girls May Often Go Undiagnosed

Girls are often overlooked as they do not frequently display hyperactivity or behavioral problems. Girls are 2.5 times more likely to be diagnosed with a learning disability, more than 16 times more likely to have repeated a grade in school, and almost 10 times as likely to have been placed in a special class at school (Joseph Biederman, M.D., “Clinical Correlates of Attention Deficit Hyperactivity Disorder in Females: Findings from a Large Group of Pediatrically and Psychiatrically Referred Girls,” Journal of the American Academy of Child and Adolescent Psychiatry, August 1999, p. 966-975).

U.S. Is The World Leader In ADHD Drug Consumption

Most estimates indicate the United States has less than fifty percent of the ADHD population in the developed world. Yet, the US is the world leader in ADHD drug consumption at 90%. Conversely, Europe, which does not readily accept ADHD as a true disorder, labels only 1% of its child population as ‘hyperkinetic.’

Diffused Attention vs Attention Deficit

The mystery of AD/HD begins because the label, attention-deficit/hyperactivity disorder, is a misnomer of sorts. People with the disorder do not have a deficit of attention, but they do have diffused attention; attention that is fleeting and can be sustained only for short periods before moving to another stimulus.

A Difficult Diagnosis

ADHD is an umbrella category that frequently engenders controversy. This may be attributable to the fact that everyone periodically exhibits the characteristics used to diagnose ADHD. These may include general problems with attention such as frequent distractibility, difficultly being organized or keeping track of things, making careless mistakes, and failing to complete tasks, etc. Common characteristics of hyperactivity can include excessive talking, constant fidgeting, or constantly being on the go as if driven by a motor. Since most everyone exhibits these characteristics, the ADHD diagnosis is dependent upon the frequency that the characteristics are exhibited. Typically the diagnosis is determined by analysis of parent and teacher rating scales (behavioral checklists) and a patient interview.

ADHD Can Be Easily Mistaken For Other Problems

Thus, the diagnosis is quite subjective (Bird 2002) and can be easily mistaken for other problems like learning disabilities, unidentified mood disorders, or parenting problems. By labeling such problems as due to ADHD, many children are given a quick fix via medication.

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