Attention deficit hyperactivity disorder

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Attention DeficitHyperactivity Disorder

Although this disorder is known to occur in various cultures (DSM-IV, 1994, p. 81), variations in the prevalence of the disorder have been reported. These variations have been explained in terms of two hypotheses (Barkley, 1990). The first hypothesis states that the relatively high rate of Attention-Deficit-Hyperactivity Disorder (ADHD) in developing countries (e.g., the United States) in comparison with underdeveloping countries (e.g., Caribbean, Central American, and South American countries) is a result of increase in the cultural tempo in developing countries, which leads to increases in environmental stimulation and significant increases in impulsivity, inattention, and overactivity among individuals exposed to that cultural tempo. The second hypothesis states that the presence of symptoms suggesting ADHD is a function of consistent versus inconsistent expectations in the demands made and standards set for child behavior and development (Barkley, 1990, p. 16). Consistent cultures...

Attentiondeficit Hyperactivity Disorder

In 1990, Arnold et al observed that boys aged 6-12 years with ADHD with a higher baseline hair zinc level had better responses to amphetamine therapy than children with mild zinc deficiency. At the time it was suggested that children responding poorly to drug therapy and presenting with mild zinc deficiency would require zinc supplementation instead of amphetamine treatment to address the condition. Since then, numerous controlled studies have identified that children with ADHD have lower zinc tissue levels (serum, red cells, hair, urine, nails) than normal children (Arnold 2005). It is not certain why this occurs, but may result from not sitting at the kitchen table long enough to consume a balanced diet, picky eating, stimulant-related appetite suppression, malabsorption or biochemical changes. Two double-blind studies have investigated whether oral zinc supplementation has a beneficial effect in ADHD, producing promising results. One randomised study involving 400 Turkish children...

Attention deficit disorder

Attention deficit disorder (hyperkinetic syndrome) is characterized by restlessness, impulsiveness, inability to concentrate, and short attention span. It is more common in boys. There is often a history of birth trauma or other cerebral insult in early life. Aggressive behaviour, low intelligence, epilepsy, minor motor abnormalities, and minor EEG changes are sometimes present. Food additives, as in coloured sweets or drinks, may exacerbate the symptoms.

Recommended dosage

Methylphenidate is usually administered in two or three separate doses each day, preferably 45 minutes before a meal. For children suffering from ADHD, the initial recommended dosage is 5 mg twice daily before breakfast and lunch, increased by 5-10 mg per week to a maximum of 60 mg per day. The average total dosage is 20-30 mg per day, although 10-60 mg is not uncommon. For narcolepsy in adults, the recommended dose is 5-20 mg two to three times a day, 30-45 minutes before meals.

Causes and symptoms

100 of the identical twins with the predisposing genes would develop the disorder. However, because the results show only a relationship, or a correlation, between genetics and cocaine use among twins, these results indicate that other factors must be at work, as well.) Studies have also shown that disorders like attention-deficit hyper-activity disorder (ADHD), conduct disorder, and antisocial personality disorder all have genetic components, and since patients who abuse cocaine have a high incidence of these diagnoses, they may also be genetically predisposed to abusing cocaine.

DSMIV and Dsmivtr The Diagnostic and Statistical Manual

A further break in tradition is exemplified by the dropping of the diagnostic category known as inadequate personality disorder from DSM-III and DSM-IV. In contrast to the traditional categories that have been deleted, however, recent interest and research in several areas have resulted in new inclusions. For example, both the borderline personality disorder and the narcissistic personality disorder have been added as discretely recognized diagnostic entities starting with DSM-III and continuing in DSM-IV. Similarly, the section on psychosexual dysfunctions has been greatly expanded in response to current interest and treatment approaches in this area. The diagnosis of minimal brain damage is reclassified in DSM-IV as an attention-deficit hyperactivity disorder based on insufficient evidence of positive underlying neurological trauma.

Multimethod Assessment And Construct Validation

Example, we use the attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperac-tivity impulsivity (HI), and oppositional defiant disorder (ODD) constructs. We first discuss how the CFA procedures can estimate the convergent and discriminant validity of the individual symptom ratings on a rating scale, thereby allowing the selection of items with good convergent and discriminant validity. We then describe how the procedures can estimate the convergent and discriminant validity of the summary scores for the ADHD-IN, ADHD-HI, and ODD measures. In these examples, we outline the ideal results necessary to establish strong convergent and discriminant validity for the measures. We then outline the less-than-ideal results (i.e., strong method effects) and the complexities that such results create for judging the validity of measures. Although our example focuses on ADHD-IN, ADHD-HI, and ODD, it is meant to provide a general framework for estimating the validity of measures...

Use Of Cfa To Model A Multitrait By Multimethod Matrix

For our example with ADHD-IN, ADHD-HI, and ODD, let us assume the use of multiple sources (mothers, fathers, teachers, and teachers' aides) rather than multiple methods. Later in the chapter we discuss the complexities associated with using multiple methods (e.g., interviews, rating scales, direct observations) to measure multiple traits. Let us also assume that each source completes the same ADHD-IN, ADHD-HI, and ODD rating scale. Here the mothers and fathers are instructed to rate the children's behavior in the home, while the teachers and aides are instructed to rate the children's behavior in the classroom. Because our example uses multiple sources and a single method (same rating scale), we refer to this example as a multitrait by multisource matrix to make a distinction between sources and methods, although the more common name is multitrait by multimethod (Campbell & Fiske, 1959).

Multitrait by Multisource Matrix

Figure 27.1 shows the model with individual symptom ratings. This model involves three latent trait factors (ADHD-IN, ADHD-HI, and ODD) and four latent source factors (mothers, fathers, teachers, and aides). The model contains 104 manifest variables. This involves 26 manifest variables (symptom ratings) for mothers, 26 for fathers, 26 for teachers, and 26 for aides (each source rates the occurrence of the nine ADHD-IN, nine ADHD-HI, and eight ODD symptoms). Our purpose with this example is to demonstrate how CFA procedures can be used to estimate the convergent and discriminant validity of the individual symptom ratings.

In9 In1 In9 Hi1 His Hi1 Hi9 Hi1 Hi9 Hi1 Hi9

Heuristic representation of a multitrait by multisource model for the attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity impulsivity (HI), and oppositional defiant disorder (ODD) symptom ratings (26 symptom ratings per source nine ADHD-IN symptoms, nine ADHD-HI symptoms, and eight ODD symptoms). FIGURE 27.1. Heuristic representation of a multitrait by multisource model for the attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity impulsivity (HI), and oppositional defiant disorder (ODD) symptom ratings (26 symptom ratings per source nine ADHD-IN symptoms, nine ADHD-HI symptoms, and eight ODD symptoms).

Individual Symptoms Problematic Outcomes

In contrast to the preceding outcomes, let us assume that each symptom rating contained more source than trait variance. In the traditional view, such a result would indicate that the symptom ratings contained mostly bias, thus indicating that the ADHD-IN, ADHD-HI, and ODD symptom ratings have no construct validity. The alternative view would argue that the strong source effects could indicate that each source has a valid, but different, By having two sources in each situation (mothers and fathers for the home situation and teachers and aides for the school situation), it is possible to further investigate the reason for each symptom rating containing more source than trait variance. To do this, it is necessary to perform two separate CFAs. The first analysis would use CFA to model a multitrait (ADHD-IN, ADHD-HI, and ODD) by multisource matrix where the two sources are teachers and teachers' aides. The second analysis would use CFA to model a multitrait by multi-source matrix where...

Summary and Integration

ADHD has a strong biological basis, and for many children, it is an inherited condition. However, the specific cause of the disorder is not known. ADHD is probably the result of a complex pattern of interacting influences. We are just beginning to understand the complex causal pathways through which biological risk factors, family relationships, and broader system influences interact to shape the development and outcome of ADHD over time (Hinshaw, 1994 Taylor, 1999). Although data do not yet permit a comprehensive causal model, a possible developmental pathway for ADHD that highlights several known causal influences and outcomes is shown in Figure 2.1. Findings generally suggest that inherited variants of genes related to the transmission of dopamine and serotonin lead to structural and functional abnormalities in the frontal lobes and basal ganglia regions of the brain. Altered neurological function causes changes in psychological function involving a failure of children to...

Latent Trait Effects Problematic Outcomes

Behavioral observations of ADHD-IN, ADHD-HI, and ODD symptoms in the home and classroom situations would help clarify the meaning of trait and source effects. Let us assume that the separate situation analyses yielded stronger trait than source effects for the ADHD-IN, ADHD-HI, and ODD measures. If the ADHD-IN, ADHD-HI, and ODD trait factors for the classroom analysis showed convergent and discriminant correlations with the ADHD-IN, ADHD-HI, and ODD observational measures, and the convergent correlations of each trait with its corresponding direct observation measure were larger than the correlations of the teacher and aide source correlations with the three direct observation dimensions, then such findings would indicate that the trait effects (systematic variance across the teacher and aide sources) reflect the reality of the behavior observations in a specific manner. If similar results occurred for the mother and father ratings, then our understanding of the mother, father,...

Complexities Of Multitrait By Multimethod By Multisource Analyses

For our examples, we intentionally used four sources rather than multiple methods. The use of multiple methods such as interviews, rating scales, and direct observations would at first glance appear to represent an ideal multitrait (ADHD-IN, ADHD-HI, and ODD) by multimethod (interview, rating scale, and direct observations) matrix. Unfortunately, this type of matrix often contains a number of confounds that can make the interpretation of the results difficult (Burns, 1980 Cone, 1979). A third complexity with multiple methods concerns the possibility that the content of the trait may be specific to the method. For example, the content of the diagnostic interview may be slightly different from the rating scale with both these methods having different content than the observational measure. Although such content differences across methods are at times appropriate because different methods have different goals (e.g., diagnosis versus treatment outcome evaluation), content differences can...

Instruments of Measurement

Several different instruments are often offered as measures of the same construct (e.g., the many parent and teacher rating scales of ADHD and ODD). If only a single instrument is used in a multitrait by multisource study, then the construct validity results are limited to the specific instrument (e.g., the generalizability of the Child Behavior Checklist constructs across parent and teacher sources rather than the generalizability of the constructs across sources). The use of multiple instruments within the same method of measurement can begin to address this issue. However, a problem can occur when instruments are simply selected because they share the same title without a careful considera

Methods of Measurement

The more common methods of measurement in clinical psychology include interviews, rating scales, standardized tests, self-monitoring, behavioral observation, and psychophysiological procedures. These methods can be designed to provide specific information on the facets, modes, and dimensions of the particular problem for multiple sources in multiple settings across multiple occasions. The development of interviews, rating scales, observational systems, and self-monitoring procedures with similar facets, modes, and dimensions for conceptually related constructs (e.g., anxiety and depression ADHD and ODD) would facilitate research on such constructs. Such highly specific measures would also allow better clinical decisions about individual clients (e.g., Haynes & O'Brien, 2000, chaps. 6 and 7).

Internalizing Disorders Anxiety Disorders

Figure 2.1 A possible developmental pathway for attention-deficit hyperactivity disorder. Figure 2.1 A possible developmental pathway for attention-deficit hyperactivity disorder. unhappiness or wide swings in mood from sadness to elation. The two most common mood disorders in childhood are major depressive disorder (MDD) and dysthymic disorder (DD APA, 2000). MDD and DD are related many children with DD eventually develop MDD, and some children may experience both disorders (Lewinsohn, Rohde, Seeley, & Hops, 1991). A third mood disorder, bipolar disorder, is rare in children, although there is growing interest in this problem in young people (Carlson, Bromet, & Sievers, 2000 Geller & Luby, 1997). In the sections to follow, we limit our discussion to anxiety disorders, highlighting many of the same features that we covered for ADHD. Once again, issues that we raise in discussing anxiety disorders have relevance for other childhood disorders as well. Anxiety disorders are among most...

Latent Trait Effects Outcomes Required for Construct Validity

In the first example (Figure 27.1), the manifest variables were the individual symptom ratings. More typically, however, these procedures use summary scores as manifest variables (e.g., the summary score for the nine ADHD-IN, nine ADHD-HI, and eight ODD symptoms for the four sources), the focus of our second example. Figure 27.2 shows the model for the summary scores. This model involves three latent trait factors (ADHD-IN, ADHD-HI, and ODD) and four latent FIGURE 27.2. Heuristic representation of a multitrait by multisource model for the attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity impulsivity (HI), and oppositional defiant disorder (ODD) measures across a 3-month interval. FIGURE 27.2. Heuristic representation of a multitrait by multisource model for the attention-deficit hyperactivity disorder (ADHD)-inattention (IN), ADHD-hyperactivity impulsivity (HI), and oppositional defiant disorder (ODD) measures across a 3-month interval. There are six...

Mouse Models With Reduced Gsk3 Activity

These GSK-3P heterozygous knockout mice were used by Beaulieu et al. and O'Brian et al. in two recent studies. In the first study Beaulieu et al. demonstrated in dopamine transporter knockout mice that this monoamin-ergic neurotransmitter implicated in multiple brain disorders such as Parkinson's disease, schizophrenia, or attention deficit hyperactivity disorder 42 can exert its behavioral effects by acting on a lithium-sensitive signaling cascade involving Akt PKB and GSK-3 43 . In this study increased dopamine neurotransmission arising either from administration of amphetamine or from the lack of dopamine transporter resulted in inactivation of Akt and concomitant activation of GSK-3a and GSK-3P. These biochemical changes were effectively reversed by the administration of the GSK-3 inhibitor lithium. The GSK-3P heterozygous knockout mice reproduced the effect of lithium in behavioral tests, thus establishing this cascade as an important mediator of dopamine action in vivo.

Pharmacological Treatment of the Paraphilias

It has been hypothesized that for a subset of individuals, paraphilias may be secondary to obsessive-compulsive related disorders, for which the SSRIs have been found to be effective. A study comparing the effectiveness of the SSRI flu-voxamine to the heterocyclic desipramine in the treatment of exhibitionism found that fluvoxamine effectively reduced the paraphilic urges and behavior, whereas desipramine was associated with relapse (147). A study comparing the effectiveness of fluvoxamine, fluoxetine, and sertraline in paraphilics found all three effective in reducing the severity of fantasies and no significant differences in overall efficacy (138). Kafka and Hennen reported on the successful use of psychostimulants in combination with SSRIs in the treatment of individuals with paraphilias and comorbid adult symptoms of ADHD (148).

Symptoms and Subtypes

The main attention deficit in ADHD appears to be one of sustained attention (Douglas, 1999). When presented with an uninteresting or repetitive task, the performance of a child with ADHD deteriorates over time compared to that of other children. However, findings are not always consistent and may depend on the definitions and tasks used to assess this construct (Hinshaw, 1994). Symptoms of hyperactivity and behavioral impulsivity are best viewed as a single dimension of behavior called hyperactivity-impulsivity (Lahey et al., 1988). The strong link between hyperactivity and behavioral The three core features of ADHD inattention, hyperac-tivity, and impulsivity are complex processes. The current view is that hyperactivity-impulsivity is an essential feature of ADHD. In contrast to inattention, it distinguishes children with ADHD from those with other disorders and from normal children (Halperin, Matier, Bedi, Sharma, & Newcorn, 1992). As such, impulsivity-hyperactivity appears to be a...

Neurological Effects

Aggressive behaviour The DHA component of fish oils has been used to reduce aggressive behaviour in children and adolescents. One placebo-controlled study of 42 college students showed that DHA supplementation (1.5-1.8 g day) prevented an increase in aggression toward others at times of mental stress (Hamazaki et al 1996) however, another placebo-controlled trial found that DHA supplementation had no effect on aggressive behaviour under non-stressful conditions (Hamazaki et al 1998). Attention-deficit hyperactivity disorder It has been reported that many children with ADHD have EFA deficiency (mainly n-3 FA) with a high correlation between severity of symptoms and severity of deficiency (Yehuda et al 2005). Deficiency may be due to insufficient dietary intake or inefficient conversion of EFA to longer chain fatty acids. Several studies have investigated the effects of supplemental fatty acids to children with ADHD with mixed results however, interpretation of findings is difficult...

Prerequisite Psychometric Conditions

Items for the given construct Haynes, Richard, & Kubany, 1995). Second, the distributional characteristics of measures from each item must be reasonable (e.g., skewness and kurtosis are within reasonable limits). Third, the ADHD-1N, ADHD-HI, and ODD measures on the scale must have good internal consistency. And finally, the scale must have demonstrated good structural validity for each source (i.e., separate CFA studies with mothers, fathers, teachers, and aides show the items on the ADHD-IN, ADHD-HI, and ODD measures to have the expected structural properties). Such outcomes represent the major prerequisite conditions for the use of CFA to model multitrait by multisource matrices.

Commonly Occurring Disorders

Indian and Native youth and adults are at high risk for or have a high prevalence of the following mental retardation, speech impediments, learning disabilities, developmental disabilities, Attention Deficit Hyperactivity Disorder, Conduct Disorder, psychoactive substance abuse and dependence, depression, simple phobias, social phobias, separation anxiety, overanxious disorder, obsessive-compulsive disorder, and posttraumatic stress disorder (Manson et al., 1997 Manson & Brenneman, 1995 Manson, Walker, & Kivlahan, 1987). In addition, American Indian and Alaska Native youth experience high rates of Fetal Alcohol Effects or Fetal Alcohol Syndrome, otitis media, which can contribute to language and speech delays (McShane, 1982), suicide (Blum, Harmon, Harris, Bergeisen, & Resnick, 1992), and child abuse and neglect (Manson et al., 1997).

Legal status and availability

Injectable amphetamines are class A, and oral amphetamines class B drugs. They used to be widely prescribed for depression (in the 1950s and 1960s) and for obesity (until quite recently). They are stimulants, and are thus related to cocaine (see below). They are now only licensed for treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents as part of a comprehensive treatment programme, and for narcolepsy or obstructive sleep apnoea syndrome. Inappropriate private prescription by 'slimming clinics' still occurs occasionally, and patients sometimes get supplies over the Internet. Easy chemical synthesis also makes for continued widespread availability.

Behavior modification

Behavior modification is used to treat a variety of problems in both adults and children. Behavior modification has been successfully used to treat obsessive-compulsive disorder (OCD), attention-deficit hyperactiv-ity disorder (ADHD), phobias, enuresis (bed-wetting), generalized anxiety disorder, and separation anxiety disorder, among others.

Speed Issues in Visualization Systems

FIGURE 21 3D visualization of lesion-deficit associations. The development of ADHD (attention deficit hyperactivity disorder) was studied using a voxel-based approach for a spatial statistical technique (Fisher's exact test) applied to a population of children involved in frontal lobe injury. Higher intensity (left image) shows higher confidence of association in those regions. Right image shows the associated regions in a color-mapped 3D Talairach atlas registered to the volume. See also Plate 117. (Images courtesy of V. Megalooikonomou, C. Davatzikos, E. H. Herskovits, M. Solaiyappan.) FIGURE 21 3D visualization of lesion-deficit associations. The development of ADHD (attention deficit hyperactivity disorder) was studied using a voxel-based approach for a spatial statistical technique (Fisher's exact test) applied to a population of children involved in frontal lobe injury. Higher intensity (left image) shows higher confidence of association in those regions. Right image shows the...

Individual Symptoms Outcomes Required for Construct Validity

Four outcomes are required for the individual symptom ratings to have strong construct validity. First, each symptom rating in Figure 27.1 must have a substantial loading on the appropriate trait factor (i.e., each ADHD-IN symptom rating has a substantial loading on ADHD-IN trait, each ADHD-HI symptom rating has a substantial loading on the ADHD-HI trait, and each ODD symptom rating has a substantial loading on the ODD trait). Such outcomes would provide support for the convergent Second, for the symptom ratings to demonstrate discriminant validity (i.e., more trait than source variance), each symptom rating is required to have a much stronger loading on the appropriate trait factor than on its respective source factor (i.e., each ADHD-IN symptom rating has a stronger loading on the ADHD-IN trait factor than on its source factor each ADHD-HI symptom rating has a stronger loading on the ADHD-HI trait factor than on its source factor and each ODD symptom rating has a stronger loading on...

Difficulties In Distinguishing Psychopathology From Culturerelated Conditions

Second, assuming that clinicians agree that it is important to consider the impact of cultural variables upon the assessment of multicultural groups, a crucial question would be Why such variables are not currently emphasized by clinicians in their clinical practices At least two answers may be proposed (Paniagua, 1998). First, current standard clinical ratings such as the Minnesota Multiphasic Personality Inventory, the Child Behavior Checklist, the Zung Depression Scale, and the Schedule of Affective Disorders and Schizophrenia (Rut-ter, Tuma, & Lann, 1988) and diagnostic instruments such as the DSM-IV (1994) do not require an assessment of cultural variables that might lead to the identification of culture-bound syndromes (e.g., Table I) or disorders associated with specific cultural contexts (e.g., ADHD, Anorexia Nervosa, etc.). Thus, in clinical practice one would not be concerned with the fact that a given mental health practitioner does not include a screening of cultural...

Treatment And Prevention Of Deficiency

Iodine deficiency is accepted as the most common cause of brain damage worldwide, with IDD affecting 740 million people (Higdon 2003). Although it is well accepted that severe deficiency is responsible, evidence is now emerging that mild deficiency during pregnancy is also important and can have subtle effects on brain development, lowering intellectual functioning and inducing psychomotor deficits in early childhood. Preliminary data are also emerging to suggest an association between iodine deficiency hypothyroidism of pregnancy and the incidence of ADHD in the offspring however, this still requires confirmation in larger studies (Soldin et al 2002, Vermiglio et al 2004).

Health Problems 28 Understanding Disorders Of Childhood

AN OVERVIEW 30 EXTERNALIZING DISORDERS ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD) 32 Symptoms and Subtypes 32 Epidemiology 33 Developmental Course 33 Accompanying Disorders and Symptoms 34 Associated Features 34 Causes 35 We begin with a discussion of the significance of children's mental health problems and the role of multiple interacting influences in shaping adaptive and maladaptive patterns of behavior. Next we provide a brief overview of disorders of childhood and adolescence and related conditions as defined by current diagnostic systems (American Psychiatric Association APA, 2000). We then consider two common categories of problems in children and adolescents externalizing disorders (disruptive behavior disorders attention-deficit hyperactivity disorder, ADHD), and internalizing disorders (mood disorders, anxiety disorders). We illustrate current issues and approaches to child and adolescent disorders by focusing on ADHD and anxiety disorders as examples. In doing so we...

Glossary And Abbreviations

Active constituents - Chemical components that exhibit pharmacological activity and contribute to the agent's overall therapeutic effects. Acute - Beginning abruptly sharp and intense subsiding after a short period. Adaptogen - Innocuous agent, non-specifically increasing resistance to physical, chemical, environmental, emotional or biological factors ('stressors') and having a normalising effect independent of the nature of the pathological state. ADHD - attention deficit hyperactivity disorder ADI - Acceptable Daily Intake


Therapy that addresses both psychological and social issues (called psychosocial therapy), usually combined with medications, is the treatment approach of choice to alleviate ADHD symptoms. For children who do not respond well to stimulant therapy, and for children who clearly suffer from depression as well as ADHD, tricyclic antidepressants (a group of drugs used to treat depression) may be recommended. Examples of these antidepressants include desipramine (Norpramin, Pertofane) and amitriptyline (Elavil). Reported side effects of these drugs include persistent dry mouth, sedation, disorientation, and cardiac arrhythmia (an abnormal heart rate), particularly with desipramine. Other medications prescribed for ADHD therapy include buproprion (Wellbutrin), an antidepres-sant fluoxetine (Prozac), an SSRI antidepressant (a group of medications used to treat depression by directing the flow of a neurotransmitter called serotonin) and carbamazepine (Tegretol, Atretol), an antiseizure drug....


Clonidine tablets and patches are approved by the United States Food and Drug Administration (FDA) for the treatment of high blood pressure. However, clonidine has been found to be useful in the treatment of alcohol, opiate, and nicotine withdrawal syndromes, attention-deficit hyperactivity disorder (ADHD), and Tourette's syndrome, one of the tic disorders. Several studies of treatment for smoking cessation showed patients treated with clonidine had decreased nicotine craving. Clonidine skin patches appear to be more effective than tablets in this condition. Both dermal patches and tablets are effective in the treatment of Tourette's syndrome and ADHD.

Personality Factors

The social and biological influences contribute to risks involving the child's temperament and cognitive competence. These include, for example, impulsiveness, hyper-activity, attention deficits, emotional lability, verbal problems and below-average intelligence (Farrington, 1998 Hawkins et al., 1998 Lipsey and Derzon, 1998). Deficits in executive brain functions impact on abstract thinking, planning, goal-directed behaviour and self-control (Moffitt and Henry, 1991). Again, one should not overemphasize one single risk factor. For example, even the syndrome shows only a moderate correlation with later criminality (Loeber and Stouthamer-Loeber, 1998). The personality dispositions may also have a different impact on various delinquent pathways. Frick (1998), for example, distinguishes between two causal pathways of antisocial development. The first results primarily from poor parental socialization and low intelligence. The second is mainly due to callous, unemotional, and other traits...

Executive function

Executive function deficits are associated with a number of psychiatric and developmental disorders, including obsessive-compulsive disorder, Tourette's syndrome, depression, schizophrenia, attention-deficit hyperactivity disorder, and autism. Executive function deficits also appear to play a role in antisocial behavior. Chronic heavy users of drugs and alcohol show impairments on tests of executive function. Some of these deficits appear to result from heavy substance use, but there is also evidence suggesting that problems with executive functions may contribute to the development of substance use disorders.

Closing Comments

Taking Charge of ADHD The Complete Authoritative Guide for Parents. New York Guilford. Barkley, R. (1999). Attention Deficit Hyperactivity Disorder A Handbook for Diagnosis and Treatment (2nd edn). New York. Guilford. Braswell, L. & Bloomquist, M. (1991). Cognitive Behavioural Therapy for ADHD Children Child, Family and School Interventions. New York Guilford.

Bruce F Pennington

Fragile X syndrome, PKU, William's syndrome, and other neurogenetic disorders. Examples of the second strategy are genetic studies of attention deficit hyperactivity disorder (ADHD), autism, dyslexia, developmental speech and language disorders, schizophrenia, Tourette's syndrome, and other psychiatric disorders. Because the details of most of the discoveries using each strategy are described elsewhere, we will not review specific discoveries except in an illustrative way. Instead, this chapter focuses on methods and the general implications of what has already been discovered for developmental cognitive neuroscience. The backward strategy, exemplified by recent work on the neuropsychology and genetics of dyslexia and ADHD, usually has the advantage of greater prevalence and larger samples. But given the ubiquitous problems of etiological heterogeneity and phenocopies (the same phenotype is produced by environmental causes), it is almost certain that not all the individuals in these...


Kafka and Prentky conducted a study of lifetime comorbid nonsexual diagnoses in males with paraphilias and paraphilia-related disorders (26). Almost 72 had a lifetime prevalence of a mood disorder, with dysthymic disorder occurring most frequently. Interestingly, there were no significant differences in comorbidity patterns between men with paraphilias and men with paraphi-lia-related disorders, with the exception of retrospectively diagnosed childhood ADHD, which was identified in 50 of the paraphilia group but in only 17 of the paraphilia-related group. Similar comorbidity patterns were found in a later study (27).

Of Cities

Depression affects up to 2.5 of children and 8.3 of adolescents in the U.S. at any given time. Lifetime prevalence for adolescents has been estimated at 15 to 20 , mirroring the rate seen in adults. Although in childhood the rates of depression are approximately the same for girls and boys, by adolescence girls are twice as likely as boys to develop depression (Lagges and Dunn, 2003). Children with depression are at risk for several other psychiatric disorders. Before the onset of depression, children may develop ADHD, oppositional defiant disorder, or conduct disorder, while adolescents are at increased risk for developing anxiety disorders after the onset of depression (Lagges and Dunn, 2003). Depressed adolescents are also at an increased risk for suicidal behavior and substance abuse (Birmaher, et al., 1998 Weissman, et al., 1999). More than 90 of children and adolescents who committed suicide had a history of a psychological disorder before their death. The most common disorder...

Before Intervention

Leagues (1998), who examined patterns of brain activity in children with and without ADHD on ritalin during performance of the go no-go task (Casey et al., 1997b) described previously. Overall, Vaidya showed improved behavioral performance and an increase in prefrontal activity for healthy children on ritalin and for children with ADHD on ritalin. Significant changes in basal ganglia activity were observed for the ADHD children when on ritalin. Specifically, the pattern of activity in this region for children with ADHD on ritalin was almost identical to the pattern observed in the healthy children off ritalin, suggesting normalization of activity in the basal ganglia with medication. This chapter has provided illustrations of the utility and promise of structural and functional MRI and how these techniques can be used to map changes in the human brain as a function of development. For example, a number of regional changes have been reported in the developing human brain, particularly...


Amoxapine is used primarily to treat depression and to treat the combination of symptoms of anxiety and depression. Like most antidepressants of this chemical and pharmacological class, amoxapine has also been used in limited numbers of patients to treat panic disorder, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, enuresis (bed-wetting), eating disorders such as bulimia nervosa, cocaine dependency, and the depressive phase of bipolar (manic-depressive) disorder. It has also been used to support smoking cessation programs.

Clinical Overview

Individuals with WBS usually have mild mental retardation, with an average intelligence quotient (IQ) of between 55 and 60, although there is a wide range of recorded values. The most striking aspect of the WBS phenotype is the distinct behavioral profile, which encompasses a unique combination of both friendliness and anxiety (11,14). It is characterized by impaired cognition, hyperreactivity, sensory integration dysfunction, delayed expressive and receptive language skills, and multiple developmental motor disabilities affecting balance, strength, coordination, and motor planning (12). In addition, approx 70 of WBS individuals suffer from attention deficit and hyperactivity disorder and there is a high incidence of anxiety and simple phobias (12,15,16).

Bias and Base Rates

As for epidemiological notions, examiners may be consciously or inadvertently influenced in the conclusions they draw by how they view the nature and incidence of various conditions. Those who believe that borderline personality disorder is widespread are likely to diagnose this condition more frequently than those who think this diagnostic category lacks precision and is used too frequently. Those who believe that attention-deficit hyperactivity disorder (ADHD) occurs mainly in boys, and adolescent anorexia mainly in girls, are relatively unlikely to diagnose ADHD in girls and anorexia in boys. In all such instances of possible influence derived from demographic, environmental, and epidemiological expectations, the challenge for assessment psychologists is to recognize their personal biases and prevent them as much as possible from exerting inappropriate influence on the conclusions and recommendations they derive from their assessment data. On the other hand, the previous examples...


Desipramine is known principally as an antidepressant drug used to promote recovery of depressed patients. It also has therapeutic uses in panic disorder, pain management, attention-deficit hyperactivity disorder (ADHD), sleep attacks (narcolepsy and cataplexy), binge eating (bulimia), and in cocaine craving in the treatment of addiction.

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