User:Devon Cosgrove/sandbox

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Main article: Attention deficit hyperactivity disorder


Management[edit]

The management of ADHD typically involves counseling or the use of medication either alone or in combination. ((While treatment may improve long-term outcomes, it has not show to only diminish its effects)).[1] Medications used include stimulants, atomoxetine, alpha-2 adrenergic receptor agonists, and sometimes antidepressants.[2][3] ADHD stimulants also improve persistence and task performance in children with ADHD.[4][5] In those who have trouble focusing on long-term rewards, a large amount of positive reinforcement improves task performance (Gaskins?).[5] In the classroom

There is good evidence for the use of behavioral therapies in ADHD and they are the recommended first line treatment in those who have mild symptoms or are preschool-aged.[6][7] Psychological therapies used include: psychoeducational input, behavior therapy, cognitive behavioral therapy (CBT), interpersonal psychotherapy, family therapy, school-based interventions, social skills training, behavioral peer intervention, organization training,[8] parent management training,[9] and neurofeedback.[10] Parent training may improve a number of behavioral problems including oppositional and noncompliant behaviours.[11] It is unclear if neurofeedback is useful.[12]

There is little high quality research on the effectiveness of family therapy for ADHD, but the evidence that exists shows that it is similar to community care and better than a placebo ((Australian review).[13] Several ADHD specific support groups exist as informational sources and may help families cope with ADHD.[14]

(((( studies within the last decade may suggest that ADHD can initially be diagnosed as depression and other mood disorders before being understood to be ADHD.)) ((Seeking counseling for help in)) social skills, behavioral modification, ((critical thinking)) and medication may have some limited beneficial effects to the individual. ((Should troubling behavior and feelings arise, it is important that family, friends and counselors help the individual to seek help. It has been found to be a)) important factor in reducing later psychological problems, such as major depression, criminality, school failure, and substance abuse disorders is formation of friendships with people who are not involved in delinquent activities.[15] (have sources dateing to 2010 so what is different about source in 2005?)

((needs it own section heading))

Regular physical exercise, particularly aerobic exercise, is an effective add-on treatment for ADHD in children and adults, particularly when combined with stimulant medication, although the best intensity and type of aerobic exercise for improving symptoms are not currently known.[16][17][18] In particular, the long-term effects of regular aerobic exercise in ADHD individuals (can) include better behavior and motor abilities, improved executive functions (including attention, inhibitory control, and planning, among other cognitive domains),((long sentence)) faster information processing speed, and better memory.[16][17][18] Parent-teacher ratings of behavioral and socio-emotional outcomes in response to regular aerobic exercise include: better overall function, reduced ADHD symptoms, better self-esteem, reduced levels of anxiety and depression, fewer somatic complaints, better academic and classroom behavior, and improved social behavior.[16] Exercising while on stimulant medication ??augments?? the effect of stimulant medication on executive function.[16] It is believed It has been demonstrated and perceived that these short-term effects of exercise are mediated by an increased abundance of synaptic dopamine and norepinephrine in the brain.[16]

Medication[edit]

(image ritalin is promoting the drug brand)

A picture of a Ritalin packet
Methylphenidate (Ritalin) 10 mg tablets

Stimulant medications are the pharmaceutical treatment of choice.[19][20] (2009) (2011) They have at least some effect on symptoms in the short term in about 80% of people.[21](2013 is not enough for this statement to be credited tit could advance since then greatly - 2018) Methylphenidate appears to improve symptoms as reported by teachers and parents.[22] (( Methylphenidate is a specific compound use in Ritalin. it does not mention others like phenethylamine used is drugs like Adderall. Lisdexamfetamine in Vyvanse. Dextroamphetamine used in Concerta. It is pushing Ritalin)) Stimulants may also reduce the risk of unintentional injuries in children with ADHD.[23] (feels out of place)

There are a number of non-stimulant medications, such as atomoxetine, bupropion, guanfacine, and clonidine that may be used as alternatives, or added to stimulant therapy.[19][24] ((The recent no good studies comparing the various medications have found to be poor determinants)); however, they ((can)) appear more or less equal with in respect to side effects.[25] Stimulants appear to improve academic performance while atomoxetine does not.[26] (2013) Atomoxetine, due to its lack of addiction liability, may be preferred in those who are at risk of recreational or compulsive stimulant use. ((liability what to what?))[27](2010) There is little evidence on the effects of medication on social behaviors. (will find evidence to show this has changed)) [25] As of June 2015, the long-term effects of ADHD medication have yet to be fully determined.[28][29] Magnetic resonance imaging studies suggest that long-term treatment with amphetamine ((randomly pulls in word amphetamine in this category with no prior statement of it)) or methylphenidate decreases abnormalities in brain structure and function found in subjects with ADHD.[30][31][32]

Guidelines on when to use medications vary by country, with the United Kingdom's National Institute for Health and Care Excellence recommending use for children only in severe cases, though for adults medication is a first-line treatment. (made two sentences) While most United States guidelines recommend medications in most age groups.[33] Medications are not recommended for preschool children.((Why?))[9][34] Underdosing of stimulants may ((can)) occur and result in a lack of response or later loss of effectiveness.[35] This is particularly common in adolescents and adults as approved dosing is based on school-aged children, causing some practitioners to use weight based or benefit based off-label dosing instead.[36][37][38] ((could add about periods and male school children dosing typically applied based on the source I have))

While stimulants and atomoxetine((?)) are usually safe, there are side-effects and contraindications to their use.(give more examples then just one)[19] A large overdose on ADHD stimulants is commonly associated with symptoms such as stimulant psychosis and mania;[39] although very rare,(.) at therapeutic doses these events(example) appear to occur in approximately 0.1% of individuals within the first several weeks after starting amphetamine or methylphenidate therapy.[39][40][41] Administration of an antipsychotic medication has been found to effectively resolve ((help to treat)) the symptoms of acute amphetamine psychosis.[39] Regular monitoring has been recommended in those on long-term treatment.[42] Stimulant therapy should be stopped periodically to assess continuing need for medication, decrease possible growth delay, and reduce tolerance.[43][44] Long-term misuse of stimulant medications at doses above the normal dose, in the therapeutic range for ADHD treatment, is associated with addiction and dependence.[45][46] Untreated ADHD, however, is also associated with elevated risk of substance use disorders and conduct disorders.[45] The use of stimulants appears to either reduce this risk or have no effect on it.[27][28][45]((2008)) The safety of these medications in pregnancy is unclear.[47] ((2006))

Attention Deficit Hyperactivity Disorder[edit]

My Additions:

Neurofeedback (have to check biofeedback or biofeedback)[edit]

Neurofeedback is the recording of brainwaves which interprets them and turns it into biofeedback, a process where an individual learns to take control of their brainwave patterns in the hopes of having that individual control their brain states. {cite} The idea of Neurofeedback has been around since the1970’s. Since then, research into the field has improved, especially in regards to how it affects individuals with ADD/ADHD. Neurofeedback seeks to isolate four different brainwave patterns: Beta, Alpha, Theta, and Delta to lessen or improve the areas related to controlling attention, behavior, and or emotions. Over the course of as many as 40-50 sessions go on average an upwards of 40 to 60 minutes the individual will be asked to do a series of tasks that will be performed through their brainwaves. Tasks include listen to audio tones, play a video game or read via a screen, are trying to encourage the brain to manage it's thoughts. After Neurofeedback therapy, individuals IQ has been recorded to increase by 9-12 points

When the process of Neurofeedback treatment starts, electrodes are expected to be placed on the scalp and earlobes in the hopes of determining and evaluating the patterns that are coming from the brain.

EEG is considered a non invasive treatment since it uses a tiny electromagnetic signal, rather than a direct voltage or current (change word) applied to the patient. In order to recondition and retrain the brain wave patterns, it is required to understand that specific brainwaves are often linked to problems in consecration, memory, controlling impulses and moods, hyperactivity. ( not sure how to segway) Beta waves are often the smaller faster brain waves associated with intellectual activity and outwardly focused concentration. Alpha waves are much larger and slower and connected to the brains relaxation and disengaged behaviors. Theta waves influence mental inefficiency, creating a "spacy" state in individuals. Lastly Delta waves are the slowest high amplitude waves out of the four, and are the waves that are equated with learning disabilities and are experienced when asleep. When focusing on ADD/ADHD patients brainwaves, most technicians tend to see excessively slow brain waves as a common occurrence.

Those who adopt this method often find it more important than treating the widely accepted practice of treating the “chemical imbalance” with medication. 80% of clients who use Neurofeedback as a treatment, can substantially improve the symptoms of ADD. Some on the side effects patients may feel once they begin treatment is tiredness, lack of focus, anxious, headaches, difficulty falling asleep or agitation and irritability. However, most of these side effects often pass as treatments continue. These changes are often maintain comparable improvements in attention and concentration in juxtaposition to taking Ritalin. Long-term safety of the medications used in the treatment of ADD/ADHA treatment, evidence from studies, often lacks the information on the effect that drug treatment improves academic performance or risky behaviors on long term basis, in adolescents or adults. After only three months on Ritalin, 100% of children experience chromosomal aberrations which could increase cancer risk, not unlike adult methamphetamine users (cite). Not yet taught in most medical schools or psychology graduate programs, it is considered of the utmost importance to seek treatment with highly trained professionals, rather then seek at-home treatment. If self treatment is improperly applied, it maybe more detrimental to the patient then helpful.

(should I include) families where member had ADHS / cost of health care / averaged $1,288 per year higher / comparison ADD was not present /combined with indirect costs would be $5,542

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    In particular, adolescents and adults are vulnerable to underdosing, and are thus at potential risk of failing to receive adequate dosage levels. As with all therapeutic agents, the efficacy and safety of stimulant medications should always guide prescribing behavior: careful dosage titration of the selected stimulant product should help to ensure that each patient with ADHD receives an adequate dose, so that the clinical benefits of therapy can be fully attained.
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    About 5–15% of the users who develop an amphetamine psychosis fail to recover completely (Hofmann 1983) ...
    Findings from one trial indicate use of antipsychotic medications effectively resolves symptoms of acute amphetamine psychosis.
  40. ^ "Adderall XR Prescribing Information" (PDF). United States Food and Drug Administration. Shire US Inc. December 2013. Archived (PDF) from the original on 30 December 2013. Retrieved 30 December 2013. Treatment-emergent psychotic or manic symptoms, e.g., hallucinations, delusional thinking, or mania in children and adolescents without prior history of psychotic illness or mania can be caused by stimulants at usual doses. ... In a pooled analysis of multiple short-term, placebo controlled studies, such symptoms occurred in about 0.1% (4 patients with events out of 3482 exposed to methylphenidate or amphetamine for several weeks at usual doses) of stimulant-treated patients compared to 0 in placebo-treated patients.
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  44. ^ Ibrahim, Kinda; Donyai, Parastou (2015). "Drug Holidays From ADHD Medication: International Experience Over the Past Four Decades". Journal of Attention Disorders. 19 (7): 551–568. doi:10.1177/1087054714548035. ISSN 1557-1246. PMID 25253684. S2CID 19949563. Archived (PDF) from the original on 30 June 2016.
  45. ^ a b c Malenka, RC; Nestler, EJ; Hyman, SE (2009). Sydor, A; Brown, RY (eds.). Molecular Neuropharmacology: A Foundation for Clinical Neuroscience (2nd ed.). New York: McGraw-Hill Medical. pp. 323, 368. ISBN 978-0-07-148127-4. supervised use of stimulants at therapeutic doses may decrease risk of experimentation with drugs to self-medicate symptoms. Second, untreated ADHD may lead to school failure, peer rejection, and subsequent association with deviant peer groups that encourage drug misuse. ... amphetamines and methylphenidate are used in low doses to treat attention deficit hyperactivity disorder and in higher doses to treat narcolepsy (Chapter 12). Despite their clinical uses, these drugs are strongly reinforcing, and their long-term use at high doses is linked with potential addiction
  46. ^ Oregon Health & Science University (2009). "Black box warnings of ADHD drugs approved by the US Food and Drug Administration". Portland, Oregon: United States National Library of Medicine. Archived from the original on 8 September 2017. Retrieved 17 January 2014.
  47. ^ Ashton H, Gallagher P, Moore B (September 2006). "The adult psychiatrist's dilemma: psychostimulant use in attention deficit/hyperactivity disorder". J. Psychopharmacol. (Oxford). 20 (5): 602–610. doi:10.1177/0269881106061710. PMID 16478756. S2CID 32073083. Archived from the original on 15 August 2009.
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