Thirteen Years Later
A lot has happened in the world of ADD/ADHD over the last thirteen years since I first wrote Healing ADD. It is now being diagnosed much more frequently. Statistics from the Centers for Disease Control report that nearly one in five high school–age boys and 11 percent of school-age children overall have received a medical diagnosis of ADD. The figures showed that an estimated 6.4 million children between the ages of 6 to 17 had received an ADD diagnosis at some point in their lives, a 16 percent increase since 2007 and a 41 percent increase in the past decade.
The frenetic pace of the world is seemingly making it even more common. Children and adults are not just obsessed with smart phones, tablets, and video games, they are often using two or three of these devices at the same time! There are new medications and non-medication options to help ameliorate the symptoms of ADD. The long-term outcome of having untreated ADD is becoming clearer, and it is not good news. Untreated ADD increases the risk of depression, drug abuse, obesity, smoking, Type 2 diabetes, and Alzheimer’s disease. We are also learning more about how diet and exercise can impact ADD. In a replicated study from Europe, 70 percent of ADD children showed greater than a 50 percent reduction of symptoms on an elimination diet, which means that food intake can make ADD symptoms better or worse. In another study, exercise significantly enhanced executive function in ADD children. Taking PE out of schools to save money may actually be costing our society much more in the long run in terms of lost learning and productivity.
In addition, our brain SPECT imaging database has grown from about 10,000 scans in 2001 to over 85,000 scans at the end of 2013, making our experience with both ADD and SPECT much more robust. Looking at the brains of tens of thousands of ADD individuals has taught us many valuable lessons, especially on the variability of ADD in the brain and in clinical practice. Subtyping ADD into six types was the major breakthrough I discussed in Healing ADD. In this version I have added a new type based on our brain imaging work and clinical experience: Anxious ADD. I have also included more information on the impact of toxic exposure as one of the potential causes of ADD. Additionally, we have discovered that the cerebellum at the back bottom part of the brain is more involved in ADD than anyone knew. The cerebellum is involved with coordination, potentially explaining why physical exercise can be helpful in lessening the symptoms of ADD.
In our clinical practice at Amen Clinics, using natural treatments has become much more common as a first line therapy. We are definitely not opposed to medication and there are many examples throughout the book where medication has been helpful, even lifesaving. But we are opposed to the indiscriminate use of medication, which we are seeing even more commonly in the new patients who come to our clinics. One child who came to our Reston, Virginia, office was on seventeen medications! I will discuss new natural treatment options for each of the ADD types.
In addition, our own method for evaluating and treating psychiatric illnesses in general and ADD in particular has evolved. The traditional way most psychiatrists make diagnoses and decide on treatment is based on symptom clusters found in the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM). If you have six out of nine of these symptoms without any clear medical issues, then you are given a specific diagnosis, such as ADD or ADHD. Symptom clusters drive diagnosis and subsequent treatment.
However, it is becoming clearer that this method of symptom-based diagnosis has outcomes that are not very impressive. According to Tom Insel, Director of the National Institutes for Mental Health, “For the antidepressants . . . the rate of response continues to be slow and low. In the largest effectiveness study to date, with more than four thousand patients with major depressive disorder in primary care and community settings, only 31 percent were in remission after 14 weeks of optimal treatment. In most double-blind trials of antidepressants, the placebo response rate hovers around 30 percent . . . The unfortunate reality is that current medications help too few people to get better and very few people to get well.”
In the 1990s the largest, longest, and most expensive treatment study on ADHD was undertaken at six sites in the United States, involving many of America’s most prominent ADHD researchers. It was called the Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. The trial included 579 ADHD children who were given fourteen months of intensive medication management (MM), behavior therapy (BT), combined MM/BT, or a referral to a local physician (community care—CC) in which the families may or may not have actually followed through and received any treatment. Follow-up assessments were then conducted at approximately two, three, six, and eight years. For the children in the active treatment group the researchers took a “spare-no-expense” approach to ensure that the children received optimal versions of MM or BT. A conservative cost estimate for the fourteen months of MM was $4,150, $11,430 for BT, and $16,980 for the combined MM/BT. Despite the best care:
Given the findings from this study, the evidence is clear that the gold-standard, commonly recognized, “evidence-based” treatments fail to result in sustained benefit for the vast majority of ADHD children who receive them. In fact, new brain imaging research suggests that using stimulants alone may actually be making the situation worse for many. Gene-Jack Wang and colleagues at the Brookhaven National Laboratory found that treatment with Ritalin over a year increased the dopamine transporters (proteins that help clear dopamine, the neurotransmitter that helps us focus) out of the brain’s synapses, meaning that there is less dopamine to do its work. Taking the stimulant seems to increase the need for it.
Our treatment outcomes at six months show high levels of improvement at 75 percent for very complicated patients, and an increased quality of life in 85 percent. Mental health treatment clearly needs a makeover. In this version of Healing ADD I will clearly outline the method we use at the Amen Clinics for evaluating and treating patients and give you many tools you can use in your own life to effectively manage and even thrive with ADD.