Contrary to popular belief, at least 60% of children with ADHD continue to exhibit features of the disorder during adulthood. Poor adjustment and performance can have an erosive effect on self-esteem, leading to clinically significant anxiety or depression, or both, which are often the presenting features of adult ADHD in the primary care setting.
There was a high rate of psychiatric comorbidity in ADHD adults: 38% had a mood disorder, 47% had an anxiety disorder, 15% had a substance-use disorder, and nearly 20% had an impulse-control disorder. Candidate gene selection is based on the hypothesis that deficient dopamine availability contributes to ADHD. No one gene or its protein derivatives has been found to have a consistent relation with ADHD, which suggests that like most psychiatric disorders, ADHD is the consequence of polygenetic influences. At least six symptoms of inattention or at least six symptoms of hyperactivity or impulsivity have persisted for at least 6 months and occur often enough to be maladaptive and inconsistent with developmental level. Symptoms do not occur exclusively during course of a pervasive developmental disorder, schizophrenia, or psychotic disorder. Symptoms might not be observable when the patient is in highly structured or novel settings, engages in interesting activity, receives one-on-one attention or supervision, or is in a situation with frequent rewards for appropriate behavior.
Symptoms typically worsen in situations that are unstructured, minimally supervised, or boring or that require sustained attention or mental effort.
In adolescents (or adults), symptoms include restlessness (rather than hyperactivity, as seen in children), impaired academic performance, low self esteem, poor peer relations, and erratic work record.
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Determining whether the patient fulfilled these criteria depends almost exclusively on the patient's knowledge of his or her childhood behavior and school performance. The difficulty of diagnosing ADHD in adults results largely from the nonspecificity of this behavior-symptom complex. Virtually any type of distress, regardless of the cause, can interfere with normal attention. Accurate diagnosis of these disorders and determining whether they are comorbid or secondary to ADHD have important implications for treatment selection and prognosis.
Baseline measures of weight, heart rate, and blood pressure should be obtained before starting stimulant or nonstimulant medication. The standard of care for adults has evolved largely from studies in children, and the medications used in adults are the same as those used in children and adolescents with ADHD (Table 3).
Central nervous system (CNS) stimulants such as dextroamphetamine, methyphenidate, and dexmethylphenidate are the drugs of choice for ADHD in both children and adults. The dosage of medication must be individualized by increasing gradually to maximal benefit while avoiding side effects. Stimulant side effects are typically dose related and include nausea, headache, jitteriness, tics, high blood pressure, and high heart rate. It is reasonable to expect that timely and effective treatment should reduce the risk of psychosocial morbidity associated with ADHD. If the extensive psychosocial morbidity of ADHD can be prevented, then it stands to reason that it should be identified and treated as early as possible. The challenge for the prescribing physician is to keep stimulant medications out of the hands of persons prone to drug or alcohol addiction. CNS stimulants do not cause a clinically significant reduction in seizure threshold and therefore can be used safely in patients with epilepsy. All CNS stimulant drugs are listed as class C and should therefore be avoided if possible during pregnancy. At least 60% of children with ADHD continue to exhibit clinically significant features of the disorder as adults. Undiagnosed or untreated ADHD is associated with significant morbidity, including higher-than-expected rates of maladaptive behavior, family problems including divorce, problematic employment, substance abuse, motor vehicle accidents, and secondary mood and anxiety disorders. The primary treatment for adult ADHD is a methylphenidate- or amphetamine-based compound supplemented when necessary with structured, skills-based cognitive-behavioral therapy.
Below are copies of a few rating scales which may be of help to use to monitor your child to see how things are working with any treatment options you are using including medication, these are for use either at home or school.
Neurofeedback for ADHD + ADDNeurofeedback, also called EEG biofeedback or neurotherapy, is a research proven way to help you improve your brain function through intensive brain training exercises. Research on neurofeedback for ADHD + ADDThere is a solid body of research showing that neurofeedback is an effective treatment for ADHD and ADD. A statistical study of all the existing research was published in a neurology journal in 2009. Attention deficit disorder is associated with decreased activity in attention networks in the brain, especially in the front part of the brain – the frontal lobe. Neurofeedback is often especially helpful with the difficulties with frustration, irritability, anger, anxiety, and mood that very often accompany ADHD. After 20 sessions of neurofeedback, my husband and I see the improvement first-hand in day to day situations! Curiously enough, the afternoon I found out by telephone that I had passed the exam, I was at the NeuroDevelopment Center undergoing training. We tested Evan’s attention using a computerized test before he started neurofeedback and after 20 sessions. We will use well-established psychological tests to measure your symptoms before and after twenty neurofeedback sessions.
Our treatment outcome data show that 70% - 80% of neurofeedback clients show significant improvement after their first twenty sessions.
Neuro Development Center has been recognized as one of the top Providence Psychology practices.
ADHD symptoms can be caused by anxiety, depression, sleep disorders, and even some medical conditions. The prestigious American Academy of Pediatrics recently reviewed scientific evidence about nonmedical treatments for ADHD. The symptoms of ADHD and ADD can have other causes – anxiety, depression, sleep disorders, and even some medical conditions. It makes sense that neurofeedback is safe when we remember that the process is simply one of learning or training. Common comorbidities complicate the array of signs and symptoms that ADHD adults can present with.

Despite having clinically significant ADHD, many adults do not fulfill the threshold of six or more criteria defined for children and adolescents. Most adults with ADHD recall some evidence of problems related to either inattention or hyperactivity during childhood.
Compounding the lack of specificity, many adults with long-standing undiagnosed and untreated ADHD develop secondary mood, anxiety, or substance-use disorders, alone or in combination, that become the focus of clinical attention and obscure detection of the more fundamental problem with attention. Therefore, the feature that distinguishes ADHD from other causes of inattention is a lifelong pattern of the behavior-symptom complex. Successful treatment of a comorbid disorder reduces symptom burden, but it does not affect the symptoms and behavior of ADHD.
Other nonstimulant agents whose mechanism of action in ADHD is not fully understood include bupropion and imipramine. Clinical effects are felt within 15 to 30 minutes of oral administration, and peak blood levels are achieved within approximately 2 hours. The World Health Organization (WHO) Adult Self-Report Screener (ASRS) for Adult Attention Deficit Disorder (ADD) includes six questions rated on a scale from 0 to 4 (0 = never, 1 = rarely, 2 = sometimes, 3 = often, 4 = very often).
Geriatric-age patients with a diagnosis of ADHD can benefit considerably from appropriate treatment. Nonpharmacologic therapies or nonstimulant medications should be tried first in such patients. Andrew Adesman, Chief of Developmental & Behavioral Pediatrics at the Steven and Alexandra Cohen Children's Medical Center of New York (CCMCNY), part of the North Shore-LIJ Health System. We know from many studies that the brain is capable of enormous change and reorganization through practice. At that time, more than 10 controlled studies had been completed.  The results showed a significant benefit of neurofeedback for attention, impulsivity, and hyperactivity when compared to control groups who received computerized attention exercises, group therapy, muscle activity biofeedback, and being placed on a wait list. Several studies have shown increased frontal lobe activity after neurofeedback, documenting that neurofeedback is addressing the core problem in ADHD, not just temporarily reducing the symptoms.
Her symptoms, as reported by her teacher and her parents, were quite severe and her learning at school quite impaired. Within 5 sessions, however, I began noticing subtle differences in the way I approached test questions.
His scores before neurofeedback placed him in the 3rd %ile for both auditory and visual attention.
They placed neurofeedback in the top tier has having "Best Support" in scientific research for treatment of ADHD without medication. If you don't, we will continue to provide treatment, without charge, for another twenty sessions. Two-thirds of kids with ADHD have other difficulties as well: learning disabilities, anxiety, behavior or mood problems. We will take the time necessary to understand the problem completely with specialized ADD and ADHD testing.
If you don’t, we will continue to provide treatment, without charge, for another twenty sessions. When you are doing neurofeedback, you are just seeing your own brain activity and getting hints when it is headed in the direction of improved functioning. Abnormal mood, vocational and interpersonal problems, and substance abuse are often the problems that patients present with when the underlying primary diagnosis is ADHD. This points to the fundamental problem of employing a descriptive nosology to define clinical disorders. Trouble sitting still, frequent fighting, temper outbursts, tendency to daydream, or suboptimal school performance is typical. Although neuroimaging and genetic testing offer attractive diagnostic potential, they are not sufficiently specific or sensitive for routine clinical use. On the other hand, successful treatment of ADHD can result in improvement of secondary anxiety, depression, or substance abuse.
Adding life-skills coaching or cognitive-behavioral therapy, or both, in either individual or group settings can further improve outcome, but by themselves they are generally insufficient.
Treatment of such patients should involve close collaboration with an internist or cardiologist.
Patients with baseline tachyarrhythmia, hypertension, or structural heart disease are at high risk for stimulant-induced aggravation of these abnormalities.
Older patients are more likely, however, to have coexisting cardiovascular abnormalities that warrant careful monitoring during treatment with stimulant medication. If these are ineffective, however, and the fully informed patient desires a trial of stimulant medication, it should be prescribed with careful monitoring in conjunction with the supervision of a cardiologist or internist to minimize the risk of adverse outcome. Although he has willingly taken his medication when it is put out for him, he doesn’t think to take it on his own.
That’s why it is crucial to begin your path forward with a careful, specialized ADHD test and assessment. If your pediatrician is not aware of this rating, contact us and provide us with his or her contact information. Two-thirds of kids with ADHD have other problems as well: with learning, anxiety, mood, behavior, or even family circumstances or stressors.
NDC outcome data show that 70% – 80% of neurofeedback clients show significant improvement after their first twenty sessions.
Future editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will struggle with this dilemma until the pathophysiologic mechanisms of specific psychiatric disorders such as ADHD are better understood. Those with clinically significant ADHD who report successful school performance may have compensated with higher-than-average intellectual strengths, had an insufficiently challenging curriculum, or simply do not remember accurately. Certain disorders that are commonly associated with or have features that can mimic ADHD are listed in Table 2.
The nonstimulant atomoxetine can cause increases in heart rate and blood pressure, but it is far less likely to do so than stimulants are.
The Wender Utah Rating Scale (WURS) was originally used as a research instrument and validated as a screener subsequently. Effective treatment of ADHD should reduce the risk of substance abuse, especially when substance abuse is secondary to ADHD.

You learn to alter your brain activity the same way you learn every other skill – through feedback and practice.
The prestigious American Academy of Pediatrics recently reviewed research on non-medical treatments for ADHD. We measure brain function with a quantitative EEG brain map,  so that you can see the reason for your difficulties. When she was done, her parents and teacher repeated the Conners ADHD symptom rating scale which had been done before she started. I began to read faster and discriminate more effectively between more and less important information, as presented in the often lengthy test questions. For many individuals, these difficulties in childhood continue in adult life ( on the actual page of my site, i want the size to of the text so that is ends precisely in three lines, with the third line having only two words, adult life.”)! Even when medications help, they do not solve the core problem in ADHD – reduced activity in the brain’s attention networks. We will be delighted to send your pediatrician this AAP document and other summaries of the research. The nonstimulants work more gradually and can take days to weeks to achieve a full therapeutic effect. A score of 46 or more obtained from adding the ratings on items 3-7, 9-12, 15-17, 20, 21, 24-29, 40, 41, 51, 56, and 59 is highly predictive of a diagnosis of ADHD. For persons with ADHD and comorbid substance abuse or dependence, the treatment of choice includes a nonstimulant agent such as atomoxetine, buproprion, or imipramine. That is why people with attention deficit disorder may need to continue to take the medications every day, probably for the rest of their lives.  But most people do not continue medication long term.
What is new in neurofeedback is that you are guided by a form of feedback that was previously not available to you.
This image shows the problem for one of our clients – reduced activity (shown in red) in frontal attention centers. Incidents which would have angered or frustrated him before neurofeedback, now seem to have very little negative effect. I also noticed a greater ease with which I approached my daily test preparation.Throughout the 6 week therapy, Dr. Then we will discuss the whole range of ADD and ADHD treatment options to find the solution that is right for you and your family. In our comprehensive neuropsychological ADD and ADHD testing at Family Life Solutions we will evaluate all of these important areas and get to the bottom of it. Effects such as difficulty falling asleep, inattention, irritability, sadness, restlessness, and headaches have been reported. Published questionnaires can be used to capture the necessary information and can assist with (but not confirm) the diagnosis (Box 2). A blanket policy of refusal to prescribe CNS stimulants to patients with a history of drug abuse, however, is ill advised.
Once we see the source of the problem in the brain, we target that area for change with neurofeedback brain training. This allows you to reshape your brain, not just mask your symptoms. His whole personality has “lightened up,” and he is actually able to laugh at himself! In looking at his report card for the last marking period I was truly amazed; all his grades were good, but in two courses he liked the least, he went from a 70 to an 80, and a 75 to a 95! As the graphs here show, Lee showed huge and very consistent improvements in attention, hyperactivity, and other common symptoms of ADHD. Hirshberg made adjustments in the treatment protocol based on my personal reports and continually honed the training to maximize my ability to learn, and convey what I had learned, effectively.
My effort had paid off, but it had also been sharpened by a very special type of therapy, one that is not yet part of medical curricula. Thanks to the neurodevelopment center I am now free to move ahead in my professional, and personal, development.
Even though you understand this, there may be times when you find yourself frustrated, angry, then guilty. The we will work with you to develop a carefully individualized treatment plan with practical workable solutions. A focused assessment like this is much shorter and can usually be scheduled and completed with very little delay. However, these effects are usually gone the next day, and it is almost always possible to make adjustments in how the training is done so that they do not recur. Ultimately, however, the clinician must rely on the patient's veracity and accuracy of recall.
In all cases, substance abuse must be stabilized first, and ADHD treatment can be initiated as soon as the substance abuse is stabilized. Often parents disagree on how to handle the challenges associated with raising a child with ADHD. In order to know which assessment is necessary, we ask that you take about 45 minutes to complete and an online survey. These ADHD treatments harness the power of neuroplasticity to reshape brain attention networks.
Your answers to these questions will allow us to decide which type of assessment is best for you and your child.
Still sweet and happy, she was now much better able to learn in school.Jeff's Med School BluesI arrived desperate.
Research has shown that these treatments result in brain change and lasting improvement in symptoms. In 20 neurofeedback sessions, with feedback every half second, you get 72,000 chances to learn. Four times I had failed Step 1 of the United States Medical Licensing Exam, the exam that students take after completing the first two years of medical school. While my mentors both in the classroom and on the hospital floors reassured me that I knew enough to pass, I kept failing.
A trusted friend and nationally recognized neuroscientist recommended neurofeedback, saying he had seen Dr.

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