What You Should Know About ADHD Treatment

ADHD has seemingly become more and more common in recent years. But what is it, really, and what do we need to know about ADHD treatment?

What is ADHD?

The condition known as Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder (commonly referred to as ADD or ADHD), is a neurodevelopmental disorder and a mental disorder that afflicts children, adolescents, and adults. It is categorized as such by the American Psychiatric Association in its Diagnostic Statistical Manual (DSM-5).

The DSM-5 explains that “Individuals with ADHD may present with both inattention and hyperactivity/impulsivity, or one symptom pattern may predominate… Three presentations of ADHD are commonly referred to – combined-type, inattentive-type, and hyperactive/impulsive-type… The appropriate presentation of ADHD should be indicated based on the predominant symptom pattern for the last six months.”

The ADHD Institute’s definition of the disorder is: “A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, has symptoms presenting in two or more settings (e.g. at home, school, or work; with friends or relatives; in other activities), and negatively impacts directly on social, academic, or occupational functioning. Several symptoms must have been present before age 12 years.”

The National Institute of Mental Health (NIMH) describes ADHD as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.”

Types of ADHD

According to the NIMH, there are three types of ADHD:

• Inattention: drifting off task, lacking perseverance, inability to focus, and being disorganized, but not maliciously or out of a failure to understand.
• Hyperactivity: constant moving around, even in situations where stillness is required; excessive fidgeting, tapping, or talking; often seen in adults who are restless and exhaust others with their constant activity.
• Impulsivity: acting quickly (and possibly making risky choices) based on how one is feeling at any given time, without prior consideration; desire for instant gratification; possibly being socially intrusive or interrupting a lot, or making important decisions rashly, without the consequences in view.

Symptoms of ADHD

According to the National Resource Center (CHADD), each type demonstrates specific symptoms:

ADHD predominantly inattentive presentation:

• Lacks attention to detail, often making careless mistakes
• Has problems maintaining focus
• Seems to not listen
• Has difficulty following instructions
• Tends to be unorganized
• Dislikes tasks that require persistent mental work
• Often loses items
• Is distracted easily
• Exhibits forgetfulness in everyday activities

ADHD predominantly hyperactive-impulsive presentation

• Fidgets and squirms, especially when expected to sit still
• Has trouble staying seated
• In children: excessive running or climbing
• In adults: excessive restlessness
• Has trouble participating in quiet activities
• Behaves as though driven by an engine
• Talks immoderately
• Answers quickly before a question is finished
• Has trouble taking turns or waiting
• Frequently interrupts others or intrudes on the

ADHD combined presentation:

• The individual fits the description of both the other two types.

According to the Mayo Clinic’s website, ADHD “is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior … children with ADHD also may struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age [but] some people never completely outgrow their ADHD symptoms.”

The Mayo Clinic explains the struggles children who have ADHD often experience on a daily basis:

• They have a hard time in school, often leading to struggles to get good grades and being judged by their teachers and peers.
• They often experience or cause accidents or injuries at a higher rate than their non-ADHD peers.
• They frequently have low self-esteem.
• They have a higher likelihood of experiencing interpersonal problems with other children and adults.
• They are at a higher risk for substance abuse and delinquency.

Other conditions are often correlated with ADHD. The Mayo Clinic relates ADHD to:

• Learning disabilities, especially those that involve problems with comprehension and communication
• Anxiety disorders, including overwhelming worry and apprehension
• Depression
• Disruptive Mood Dysregulation Disorder (DMDD), seen in irritability and a lack of capacity to handle disappointment
• Oppositional Defiant Disorder (ODD), characterized by negative behavior patterns, defiance, and hostility toward those in authority
• Conduct disorder, which manifests itself in stealing, fighting, bringing harm to people or animals, destruction of other people’s property, along with other antisocial behavior
• Bipolar disorder, including both mania and depression
• Tourette’s syndrome, a neurological disorder marked by repetitive tics of the muscles or vocal chords

Causes of ADHD

According to CHADD and the NIMH, no definitive causes for ADHD have been found, even though scientific research has been done. There are, however, several factors that are believed to contribute to the development of ADHD:

• Genes
• Smoking, drinking, or using drugs during pregnancy
• Being exposed to toxins in the environment (e.g. – high levels of lead), during pregnancy or in early childhood
• Excessive intake of refined sugar
• Low birth weight
• Injuries to the brain

CHADD also reports that over 20 genetic studies have shown that ADHD tends to run in families. This demonstrates a strong likelihood that ADHD is genetically based. CHADD also says that “the complexity of ADHD [is probably] the result of multiple interacting genes.”

There are also environmental factors that are commonly linked to ADHD, including:

• Exposure to environmental toxins, such as high levels of lead or pesticides, during the early years
• Premature birth or low birth weight
• Brain injury

Although no studies have demonstrated a clear causal connection between the next factors and ADHD, CHADD says that they can make symptoms worse in many children:

• Excessive television watching
• Eating refined sugars
• Stress in the family (poverty, family conflict)
• Traumatic experiences

Although there have been varying hypotheses about what causes ADHD, most experts agree that at its fundamental level, the disorder originates from a chemical imbalance in the brain.

ADHD is seen as a medical problem, and professionals emphasize that it is not believed to be caused by bad parenting, moral failure, problems at home, bad teaching, or social problems. Lacking evidence-based proof, ADHD is believed to be a genetic, neurological mental disorder.

Treatment for ADHD

Encouragingly, there are several treatments that help people with ADHD to limit their symptoms and function better on a daily basis. These treatments include medication, psychotherapy, education, or any combination of these.

There are various recommended medications as well as a variety of therapies that can be employed, including:

• Behavior therapy: This helps parents and teachers learn how to employ strategies to change behavior in order to deal with difficult ADHD situations. These strategies can include timeouts and systems of rewards.
• Psychotherapy: Older children who suffer from ADHD can benefit from talking about their issues, inappropriate patterns of behavior, and possible ways to handle their symptoms.
• Training for parents: This educates parents on how to constructively deal with their ADHD child’s behavior.
• Family therapy: This can be beneficial for both the parents and the brothers and sisters of the ADHD individual.
• Training in social skills: This is a way for a child with ADHD to learn to function appropriately in social settings.

The Mayo Clinic also discusses alternative treatment modalities:

• Yoga or relaxation techniques can teach children how to relax and become more disciplined, which can, in turn, help them to take better control of their symptoms.
• Modified diets often eliminate foods which are suspected to make ADHD symptoms worse, like sugar, wheat, milk, or eggs, and possibly even various food dyes and other types of additives. Although no research has definitively linked diet and ADHD, there is anecdotal evidence to suggest that dietary changes can influence symptoms. Caffeine, a stimulant, should not be given to children who have been diagnosed with ADHD.
• Vitamin or mineral supplements are not proven to reduce ADHD symptoms, and “megadoses” that go beyond the recommended Daily Value (DV) can be dangerous. Instead, a variety of healthy foods is the best way to get the needed vitamins and minerals.
• Herbal supplements are not proven to remedy ADHD, and in some cases may have harmful effects. These require a great deal more research to determine levels of effectiveness.
• Proprietary formulations are products created from vitamins, micronutrients, etc. and marketed as potential treatment options for children with ADHD. They have had little to no testing and do not fall under the oversight of the FDA. They can be ineffective or even harmful, and like the herbal supplements, need scientific studies done to determine whether they are effective or not.
• Essential fatty acids are being researched to discover their potential to improve ADHD symptoms. These fats include omega-3 oils and are vital for proper brain function.
• Neurofeedback* training, also known as electroencephalographic (EEG) biofeedback. This method makes use of a brainwave pattern monitor while a child is directed to focus on a specific task, with the goal of keeping their brain wave patterns active in the front of the brain. This, in turn, should improve their symptoms. This method requires more research to determine its level of effectiveness.
• Exercise not only has health benefits, but it may positively impact the behavior of ADHD children when used in conjunction with other treatments.

*According to CHADD, a new training known as “neurofeedback” is “a computer-assisted therapy that measures brain activity via electrodes placed on the scalp, with activity then visualized on a monitor. This allows a person to learn how to control brain activity in response to the computerized feedback. Over a gradual learning process, the brain is rewarded for changing its activity to more appropriate patterns.”

This process, as described by Dr. Van Der Kolk, is meant to reconfigure neural pathways to allow for greater focus and concentration, while reducing impulsive behavior

What Every Christian Needs to Know About ADHD  Treatment

The Medicalization of ADHD

The medicalization of ADHD is widespread. According to estimates from CHADD, in the U.S., children ages 4-17 have a 1 in 10 chance of being given a positive diagnosis of ADHD. 15 out of every 100 children in the 1^st through 5^th grades have received an ADHD diagnosis.

Many people are worried by these numbers and feel that the APA may not be correct in considering ADHD to be a neurobehavioral disease. Many people are concerned that kids are being handed off so quickly to medical practitioners to receive a diagnosis and treatment.

Since ADHD is such a common diagnosis right now, it may be too easy to jump to the conclusion that a child with behavior problems needs medicine and brain rewiring. Families and schools are being overrun with this medicalization approach, and kids receiving psychiatric referrals is becoming routine.

This approach has its dissenters, including Dr. Leon Eisenberg, who is considered by many to be the patriarch of ADHD research. He passed away in 2009 at age 87, and in his last interview, he spoke of ADHD as a fictional diagnosis based on a group of common behavioral symptoms.

It is evident that this set of issues seems too vague to be boiled down to a single medical diagnosis. And oftentimes a child who is labeled as ADHD is not helped so much as stigmatized.

Kati Li describes for The Journal for the Scientific Study of Religion how children’s behavior has, over time, come to be seen as a medical issue. She believes that “by diagnosing kids with ADHD, biological factors have come to override what used to be considered moral problems under the jurisdiction of the family.”

She further reminds her readers that medicalizing ADHD is a way to make kids less responsible for poor behavior. Instead, deviance is viewed as a disease or a disorder, taking responsibility away from parents to discipline, socialize, and protect their children.

Medication

Both Christians and non-Christians are concerned by the issue of medicating children diagnosed with ADHD. Jeremy Martin, in his book ADHD: Beyond the Meds, warns that “In many cases, drugs used to treat ADHD are gateway drugs for other drugs, both legal and illegal.”

Some of the most commonly prescribed ADHD medications closely resemble amphetamines (speed), which shares the same category as cocaine. In fact, it’s often obtained in order to use recreationally.

Martin’s second concern involves the effectiveness of ADHD drugs; oftentimes they don’t reduce behavioral symptoms.

He’s also concerned by the side effects, including addiction, nervousness, anxiety, insomnia, decreased appetite, headache, stomachache, nausea, dizziness, and heart palpitations.

Anthony Martignetti is another voice in the movement that is wary of psychiatric medication. His proposed alternative solution is “talk therapy.” He lists three reasons why medicine has become such a quick fix intervention for behavior problems:

1. Discipline is seen as harmful: Parents have erroneously been taught by society that discipline, accountability that is appropriate for the child’s age, and clear boundaries are forms of child abuse.  Failure to implement these things, however, creates generations of children who are undisciplined, do not understand boundaries, do not respect parental authority, and “who act and appear to be what we would have referred to in another time as ‘spoiled brats.’”
2. Parents are tired and guilty: They feel like they don’t give their kids enough of their energy or attention; they’re also too tired to enforce boundaries or give needed instruction.
3. Society has changed: Behavior such as aggression, competition, roughhousing, or any other types of “acting out” are now seen as pathological and detrimental.

Religious Considerations

Kati Li’s study showed that both Catholics and conservative Protestants were offended by the medicalization of ADHD. Inherent in conservative Protestantism is the belief that the Bible is God’s infallible Word, and that mankind is by nature sinful and rebellious against God’s law. This leads them to discourage sinful behaviors that are also, incidentally, health risks, such as substance abuse, pre- or extramarital sex, etc.

Evangelicals believe that our physical bodies are temples of the Holy Spirit and should be pure instruments for worship. Evangelicalism rejects secular psychiatry in favor of a biblical worldview and its approach to treating ADHD. For all these reasons, evangelicals are reluctant to consider ADHD as a medical disease.

Both Catholics and evangelicals recognize the spiritual implications of ADHD. Quite a number of the symptoms are addressed in Scripture and can be studied in detail, including:

• “attentiveness” (Proverbs 6:6-8, 6:20-21, 7:24, 12:11, 24:27; Colossians 3:23; James 1:19; Deuteronomy 6:6-8; 1 Peter 1:12-15)
• “self-control” (Galatians 5:23, 2 Peter 1:6, 1 Corinthians 9:27, Proverbs 10:19, 25:28, Matthew 12:36, Philippians 4:8)
• “impulsivity” (Proverbs 18:13, 21:5, James 1:2-4, 1:19, Galatians 5:22)

Some related topics:

• In Philippians 2:3-4, we read of orienting our lives around serving others.
• In Romans 12:2, Ephesians 4:23, and Philippians 4:8, we learn to control our thoughts.
• In 1 Corinthians 14:40, we can see the necessity of having structure and order in our lives.
• In 2 Timothy 3:10-11, we see the importance of having examples of “proper behavior.”
• In 2 Timothy 3:16, we read that the teachings of the Bible are of vital use.

One conservative Christian resource is The Pursuit of Godly Seed. It contains biblical principles related to child rearing and Christian living in the home and can provide possible solutions for ADHD behaviors.

It outlines the consequences that occur when children are not valued, cared for, and accepted, and gives help and instructions for nurturing, protecting, teaching, disciplining, and guiding them.

According to the author, children can be exasperated by the behavior of their parents, and this can draw them away from God instead of into closer relationship with him.

The book lists five of the most destructive ways this can happen:

1. Lukewarm or nominal Christianity at home
2. Being physically abused out of uncontrolled anger
3. Watching their parents divorce and remarry
4. Experiencing verbal abuse
5. Being the victim of sexual abuse

Although this book does not mention ADHD, it is reasonable to connect destructive parenting with behavioral problems in children.

Conclusion

Christians should not simply take the diagnosis of ADHD at face value and medical and treatment as a foregone conclusion. Dr. Eisenberg, who as we’ve mentioned was the “discoverer” of ADHD, said himself that “ADHD is a prime example of a fictitious disease.”

This fictitious disease gave Eisenberg a luxurious lifestyle, thanks to sales of pharmaceuticals for treatment. According to Psychiatric News, Eisenberg received the “Ruane Prize for Child and Adolescent Psychiatry Research and . . . was a leader in child psychiatry for more than 40 years through his work in pharmacological trials, research, teaching, and social policy and for his theories of autism and social medicine.”

This is a cautionary tale about blindly accepting a medicalized diagnosis for behavior problems. The medical industry, under the pretense of giving help to children, undermines parental roles and interferes with children’s healthy upbringing. Parents then resort to medical solutions to correct a brain disease that may not even exist, subjecting their children to treatments that may be both unnecessary and dangerous.

Children who are impulsive and struggle with focus don’t need medicine; they need their parents to love, guide, and discipline them. They need the Gospel, and the goal of being a blessing, just as they were created to be.