ADHD stands for 'Attention Deficient Hyperactivity Disorder' and is a complex diagnosis based on markers of inattention, hyperactivity and impulsiveness through the DSM-V criteria for ADHD (DSM stands for diagnostic statistic manual for mental health disorders). While these symptoms have been documented as early as 1902, the contemporary concept of ADHD is relatively new, can be seen in a few different ways.
WHAT DO WE KNOW?
1. There are marked differences in dopamine production, transmission and availability.
We know individuals with ADHD have fewer dopamine receptors, smaller volume and less reactivity in structures involved in the dopamine pathway. These individuals have:
-->Alterations in reward sensitivity and reward processing
-->They may be able to plan an approach, but difficulty actually doing it if it's not intrinsically motivating
-->They seek external sources of dopamine (think addiction picture here)
-->They have difficulty with delayed gratitude (they respond better with an immediate rewards).
2. Executive function effected in an ADHD brain
We know individuals with ADHD have impacts on:
Working memory: holding information while mentally working on it (this can be seen as constantly misplacing things, carelessness and lack of attention to detail).
Mental time travel: predicting outcomes and consequences, time blindness/ loosing track of time (this also be seen as inability to prioritise or inability to deal with stress).
Attentional regulation: controlling, switching, and directing attentional focus (this can be shown as mood swings, irritability, quick temper and poor organisational skills).
Inhibitory control: impulse control (an example is an ADHD individual blurting out responses and often interrupting others, addiction, extreme impatience and starting a new task before finishing the first one).
3. Gender bias
Currently our boys are twice as likely to receive an ADHD diagnosis by the time they are 10 than girls.
4. ADHD is associated with many co-morbidities
We know that many ADHD individuals have other presenting symptoms including: sleep disturbances, addiction, hormone imbalance, complex childhood trauma, various mental health fitness levels, acquired brain injury, other neurodivergence, learning and processing issues, situational/life stage factors, and/or other health issues.
5. ADHD functional impacts.
We know there are many factors that play a role in the severity of ADHD individuals including: neurodivergence, their environment (or more importantly how they 'fit' in their environment), their mental health, their life stage (how many women are getting an ADHD diagnosis after becoming a mother?), level of support, coping strategies and intellectual ability, and general health.
6. There is an in-fluctuation of women being diagnosed
We know women (or assigned females at birth- AFAB) are commonly being diagnosed at a later stage of their life as they commonly 'internalise' their presentation (all while un-doing the people pleasing behaviour that has been taught from a very young age!). We also know women are commonly being diagnosed at transitional times in their lives: teenager, becoming a mother, perimenopause (which raises the question is it true ADHD or is it a hormonal change; life stage change or a combination of them all?).
7. There is a high hereditary disposition
It is currently estimated there is a 70-80% likelihood of ADHD in a symptomatic individual if a family member has already received a diagnosis.
8. Adults with ADHD present much differently to kids
Adults have learnt to control their hyperactivity, however many still show signs of fidgeting or excessive talking. Addiction is a common co-morbidity amongst adults with ADHD as well as emotional dys-regulation (often seeking external sources of dopamine to 'regulate their emotions'). Being hyper-focused is another common trait among adult individuals with ADHD (many leaders in their field attributing their ADHD diagnosis to their success!!). More often than not, adults individual with ADHD have learnt to suppress their symptoms (and with this anxiety yield its ugly head with a common trait of not feeling like they are enough).
9. We still don't know a lot!
Most studies have been done on rats and men, and women studies are still quite under-researched.
HOW TO GET DIAGNOSED THROUGH THE WESTERN MEDICINE MODEL
Medical model includes:
Currently General practitioners (GP's) will flag ADHD if they come to their office with:
1. Cognitive, behavioural and/or emotional dysreguation
2. Experiencing the co-morbidities (as listed above)
3. Have a diagnosis of Autism
4. There is a family history of ADHD
So here is how it usually goes. You suspect you or your child may have ADHD tendencies, you go to the GP who will refer to a psychiatrist/ psychologist (or paediatrician for our little ones). You often wait months on end to get an appointment, sometimes spending thousands of dollars. You reach a diagnosis, to which you are given a choice to a few different medications (which is really a matter of choosing a short acting, long acting, or intermediate acting release drug essentially based on trial and error). If you are successful, you may find ultimate relief and gain more mental clarity- a clarity you have never thought was possible. However you are completely reliant on the drug, and once you feel relief, you can't function without it.
But what happens next? We know there are many side effects of stimulant medications (and non-stimulant medications- note these are given if there are other underlying health conditions). We also know there is a direct link to reduced blood flow to the brain and brain shrinkage with long term use of methylphenidate. So why are we prescribing these medications so freely without any thought or justification of other markers like diet, exercise, sleep quality and detoxification?
OTHER CONSIDERATIONS BASED ON PHYSIOLOGY
As a nutritionist specialising in ADHD, we treat ADHD symptoms of hyperactivity, impulsivity and inattention as just that- symptoms to an underlying root cause!
We know there are direct links to ADHD and systemic inflammation/neuro-inflammation, gut dysbiosis, sleep disturbances, hormone imbalances, thyroid disorders, adrenal fatigue and increased toxic load.
THE GUT AND ITS RELATION TO ADHD
We know the gut microbiome can influence dopamine levels in the frontal striatum and prefrontal cortex. Furthermore, more than half of your dopamine is made in the gut.
We know the microbiome influences tryptophan metabolism--> which is a pre-cursor to serotonin and melatonin (therefore if we heal the gut, we optimise sleep).
We know the microbiome can also affect production of GABA which upregulates dopamine activity.
We know imbalances in the gut (such as bacterial overgrowths) can also cause an up regulation in the stress response which down regulates gut function, causing a drop in secretion of acid and enzymes; all slowing gastric emptying. Therefore managing stress to heal and optimise the gut function, to optimise neurotransmitter production and usability is paramount.
HOW DO WE KNOW WHICH PILLARS OF HEALTH NEED ADDRESSING TO SUPPORT YOUR ADHD SYMPTOMS?
Well, we assess. An assessment to look for nutrient deficiencies and altered mechanism of actions in the body can include:
--> Extensive questionnaire of all signs and symptoms and how they marry up to the systems of your body.
--> Blood tests to assess liver function, thyroid function, adrenal function, iron, zinc, zinc/copper ratio, vitamin D, inflammation, infection, immunity, homocysteine, tick/vector borne illness.
--> Comprehensive stool tests to assess gut function, microbiome, auto immune disorders, systemic inflammation.
--> Urine tests to assess organic acid metabolism (what's going on, at a cellular level) + heavy metal toxicity.
--> Mould (house) assessment test kits (to rule out mould exposure).
--> Hormonal non-invasive markers like basal temperature to assess progesterone, and T4.
HOW DO WE TREAT?
--> With diet
--> With practitioner grade nutraceuticals
--> With specific lifestyle tools
--> With Exercise
--> With environmental changes
You are, and always will be in control on of your health.
If you are interested in a 'new' effective way to treat ADHD, or looking for extra support, working co-currently with your medication, head to www.goodnessgraciousnutrition.com.au to book both face-to-face or tele health.
References:
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Nasrallah, HA et al 1986. 'Cortical atrophy in young adults with a history of hyperactivity in childhood' Psychiatry Research, Vol 17, Issue 3 pp, 241-246.