What Is Attention Deficit Hyperactivity Disorder?

Attention Deficit Hyperactivity Disorder is a medical condition. It is caused by genetic factors that result in certain neurological differences. Attention Deficit Hyperactivity Disorder comes in various forms, and there are five or six different types of ADHD.

In the DSM-IV Diagnostic manual, each of these forms, or "types" of ADHD falls under the diagnostic category of Attention Deficit Hyperactivity Disorder (ADHD). The main category is then subdivided into ADHD Inattentive Type, or ADHD Impulsive-Hyperactive Type, or ADHD Combined Type. In the recent past, the terms attention deficit disorder "with" or "without" hyperactivity were also commonly used. Attention Deficit Hyperactivity Disorder comes in various forms, and truly, no two ADD or ADHD kids are exactly alike.

Attention Deficit Hyperactivity Disorder might affect one, two, or several areas of the brain, resulting in several different "styles" or "profiles" of children (and adults) with ADD ADHD.

These different profiles impact performance in these four areas:

First, problems with Attention.
Second, problems with a lack of Impulse Control.
Third, problems with Over-activity or motor restlessness,
Fourth, a problem which is not yet an "official" problem found in the diagnostic manuals, but ought to be: being easily Bored.

A few other important characteristics of this disorder are:

1) That it is SEEN IN MOST SITUATIONS, not just at school, or just in the home. When the problem is seen only at home, we then would wonder if perhaps the child is depressed, or if the child is just being non-compliant with the parents;

2) That the problems are apparent BEFORE the AGE OF SEVEN (7). Since Attention Deficit Hyperactivity Disorder is thought to be a neurologically based disorder, we would expect that, outside of acquiring its symptoms from a head injury, the individual with Attention Deficit Hyperactivity Disorder would have been born with the disorder. Even though the disorder might not become much of a problem until the second or third grade when the school work becomes more demanding, one would expect that at least some of the symptoms were noted before the age of seven.

About one of twenty people, children and adults, have Attention Deficit Hyperactivity Disorder. It is a significant problem for these people, and for their families. Learn more about the different types of ADHD at and visit the ADHD Information Library's family of web sites.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

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Intro to Being an ADHD Parent

In my fifteen years of private practice working with children with ADHD, one of the common concerns that I observed by parents was the fear that they had done something, or failed to do something, that caused their child's ADHD. I guess it is normal to blame yourself when your child is having problems.

However, it is important for parents to know that Attention Deficit Hyperactivity Disorder is not the result of "bad parenting" or obnoxious, willful defiance on the part of the child. Attention Deficit Hyperactivity Disorder is a medical condition, caused by genetic factors that result in certain neurological differences.

Yes, a child may be willfully defiant whether he has Attention Deficit Hyperactivity Disorder or not. But defiance, rebelliousness, and selfishness are usually "moral" issues, not neurological issues. Make no excuses for "immoral," "selfish," or "destructive" behaviors, whether from individuals with ADD ADHD or not. Parents need to step up and correct these behavior problems whether a child has ADHD or not.
 
It may also be true that the parents may need further training. We are constantly amazed at how many young parents today grew up in homes where their parents were gone all day. We now see "grown up latch key kids" trying to parent as best as they can, but without having had the benefit of growing up with good parental role models. This is a problem in any family, but especially when there is a child in the home who is inattentive, impulsive, and possibly hyperactive.

Parents should consider becoming a part of a parenting class offered by a local therapist, or a local church. These classes can be a good investment of your time. More information about Attention Deficit Disorder is available at the ADHD Information Library.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

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Attention Deficit Hyperactivity Disorder: Neurologically Based

Attention Deficit Hyperactivity Disorder is a neurologically based disorder.

This position has become controversial as many would like to dismiss the diagnosis of Attention Deficit Hyperactivity Disorder altogether saying that there is no evidence of neurological differences, or that there are no medical tests to diagnose ADD ADHD, or that the diagnostic criteria is too broad. But the fact of the matter is that there are measurable neurological differences, and there are several good tests available to physicians and psychologists, available to diagnose the disorder.

For now we will simply report that there is a tremendous amount of research to support the statement that, indeed, Attention Deficit Hyperactivity Disorder is a neurologically based condition. Much of this information is available at the ADHD Information Library for parents to read over.

Attention Deficit Hyperactivity Disorder, often called ADD or ADHD, is a diagnostic label that we give to children and adults who have significant problems in four main areas of their lives:

Inattention -- people with ADHD are often easily distracted, and have trouble focusing on a task that is only moderately interesting.
Impulsivity -- about 50% of those with ADHD are impulsive, they do or say things without thinking about the consequences first.
Hyperactivity -- about 50% of those with ADHD are hyperactive. This means that they have excessive motor activity that is not directed toward any goal.
Boredom -- people with ADHD are easily bored with mundane activities, like cleaning rooms or doing homework. Tasks must be exciting to capture attention.

Talk to your pediatrician or family practice physician if you think that your child has some of these problems. You can learn more about Attention Deficit Disorder at the ADD ADHD Information Library of NewIdeas.net.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

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New Treatment for Chronic Depression

Vagus Nerve Stimulation for Chronic Treatment-Resistant Depression

About Vagus Nerve Stimulation

VNS is not brain surgery, although it is a treatment that affects the function of the brain. Vagus Nerve Stimulation uses specific stimulation of the vagus nerve to send stimulation to specific parts of the brain that are involved in mood. It is not like Electro-Convulsive Therapy (ECT), a treatment that involves stimulation of the entire brain and induces convulsions in patients. In fact, patients may not even feel the stimulation from VNS since the vagus nerve does not have the type of nerves that carry pain signals. Nor does VNS interfere with drugs, and patients having Vagus Nerve Stimulation can continue taking their other drugs without worrying about side effects or interactions between drugs.

On June 15th, the FDA's Neurological Advisory Panel recommended APPROVAL of the vagus nerve stimulator as a treatment for chronic depression.

What is the Vagus Nerve ?

Vagus means "wandering" in Latin, and is the perfect description for the vagus nerve, the longest nerve in the body. It averages almost two feet in length and "wanders" throughout the upper body. The vagus nerve starts in the brain, goes down the neck and into the body where if affects the vocal cords, the acid content of the stomach, the heart, the lungs, and other organs. In the brain it projects to areas believed to be responsible for seizures, mood, appetite, memory and anxiety (note 3). However, the vagus nerve cord does not have many pain nerves, so stimulation of the vagus nerve is not painful, although some patients may feel some sensation when electrical pulses are generated.

The History of Vagus Nerve Stimulation
Vagus Nerve Stimulation has been used to treat epilepsy patients for years; the first human clinical trial was in 1988,(note 1) and the FDA approved VNS therapy for epilepsy in 1997 (note 2). So far over 22,000 people worldwide have had VNS therapy (note 3), and it has proven to be a safe and effective treatment for epilepsy. These patients have reported minimal side effects, which have tended to decrease over time. The efficacy of the treatment has also been shown to increase with longer treatment time (note 1).

When Vagus Nerve Stimulation was first approved for epilepsy, some patients reported an improvement in mood. Researchers decided to design a study specifically to measure changes in a patient's mood and depression due to stimulation of the vagus nerve. In 1999, scientists began the first open label (no placebo group) study for depression with 60 patients. This first study found that there was indeed an improvement in mood for depressed patients. Based on this study, a more detailed and thorough study was designed to determine if Vagus Nerve Stimulation would be a safe, tolerable and effective treatment for chronic depression.

The recently completed one-year, double blind, placebo controlled trial had 235 patients from 21 participating hospitals in the United States, and showed clinically significant improvements due to treatment compared to baseline (note 2). The acute (short-term) phase lasted three months, during which half of the patients received stimulation (treatment group) and half did not (control group). The long-term phase of the study lasted an additional 9 months (for one year total treatment) of stimulation. The HRSD-24 (24 item clinician-rated Hamilton Rating Scale for Depression) improvements observed over the first year were highly significant. The results of this long-term, pivotal study were submitted to FDA in October 2003; the FDA's decision on the use of Vagus Nerve Stimulation for depression is not anticipated before October 2004 (note 2). Of note, Vagus Nerve Stimulation therapy was approved for use in patients with treatment resistant depression in the European Union in March 2001, and in Canada in April 2001 (note 2) .

How Does Vagus Nerve Stimulation Therapy work ?

The Pulse Generator (battery) delivers a small amount of electrical current to the vagus nerve intermittently (30 seconds on and five minutes off ) (note 3) 24 hours a day, 7 days a week for up to 10 years. The stimulation is delivered automatically, so the patient does not have to do anything. Because there is nothing to remember, compliance is assured. The stimulation is not supposed to be uncomfortable, and some patients do not even feel the stimulation. A nurse at the doctor's office can adjust the level of stimulation (amount of electricity delivered) if the patient ever feels uncomfortable. In the study currently being reviewed by the FDA, researchers noted several similarities between epileptic and depressed patients (note 4).

One of the most important similarities is that Vagus Nerve Stimulation treatment efficacy improves over time. The longer the patient receives stimulation, the better the results. In addition, both populations of patients share the following:

· Assured adherence to treatment regimen
· Safety of the procedure
· Safety of the therapy
· High continuation rates
· No drug interactions

What is the surgery like?

Vagus Nerve Stimulation is NOT brain surgery, even though it is an invasive surgical procedure that changes the function of the brain. The stimulator is a pacemaker-like device that generates electrical pulses (Pulse Generator); it is implanted under the skin in the left chest through a small incision. While this may sound like a serious or dangerous procedure, it is not. The FDA has approved the use, and confirmed the safety of this procedure, and 22,000 patients have received the implant to treat epilepsy. The Vagus Nerve Stimulation surgery involves two small incisions, one in the chest and one at the lowest part of the neck. At no time is the brain physically manipulated by the surgeon.

The surgery to implant the NCP System takes 45 minutes to two hours. Local, regional or general anesthesia (putting the patient to sleep) is used during the surgery; the doctor and anesthetist determine which type of anesthesia is best for each patient. Most Vagus Nerve Stimulation patients will have outpatient surgery, (note 3) but some patients may need to stay in the hospital overnight, and in that case they will need a family member or companion to take them home from the hospital.

What Happens After the Vagus Nerve Stimulation Surgery?

Most Vagus Nerve Stimulation patients go home the same day or the next day. You will feel some minor stiffness/soreness around the area of the implant for a few days. Your doctor may prescribe a minor pain medication such as Tylenol with codeine. A week later your surgeon will probably want to check the scars and a nurse can program/change the settings on the stimulator in the doctor's office.

Is the Vagus Nerve Stimulation Surgery final?

The Vagus Nerve Stimulator can be turned off or removed (explanted) at any time if the patient feels that it is not helping, or in the unlikely event that the patient can't tolerate the stimulation. The device can be completely turned off in less than 30 seconds in the doctor's office, all it takes is for a nurse to hold a programmable wand over the skin above the Pulse Generator. Explantation (removal) of the Vagus Nerve Stimulation device is also possible, however, less than one half of one percent of the 22,000 patients have elected to have the device removed. As for implantation, the surgery to remove the device is a very simple procedure. Only the Pulse Generator is taken out of the body; attempting to remove the electrode from around the vagus nerve could cause damage, and is not recommended.

References

1. Pharmacoresistant Epilepsy and VNS Therapy. September 24, 2003 presentation by J.W. Wheless, MD. The University of Texas Health Science Center, Houston TX, USA.

2. Form 10-Q for Cyberonics Inc, September 4, 2003.

3. Vagus Nerve Stimulation Therapy Mechanisms of Action. September 24, 2003 presentation by M.S. George, MD. Medical University of South Carolina, Charleston, SC, USA.

4. The Investigation of Vagus Nerve Stimulation Therapy in Treatment-Resistant Depression. September 24, 2003 presentation by R.L. Rudolph, MD. Cyberonics, Inc.

Charles Donovan was a patient in the FDA investigational trial for vagus nerve stimulation and depression. He testified to the Panel at the Advisory Meeting on June 15th. After 25 years of chronic depression, vagus nerve stimulation completely cured his chronic depression. The author is so grateful and humbled by this remarkable device. Learn more at his website: www.VagusNerveStimulator.com

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The Patients Guide to Vagus Nerve Stimulation and Depression

INTRODUCTION

Everybody has a story. My story is the one I know best and can write about. It is not a memoir of chemical dependency or self-abuse. Those subjects have been written about many times. This is a story of my winning battle against depression and the vagus nerve stimulation treatment that saved my life by bringing me Out of the Black Hole. And, this is the first book to be published about winning the battle with a medical implant procedure called VNS Therapy?.

Personally, I don't believe the stigma associated with depression has changed one bit in the past century, so I was apprehensive about sharing my story. After all, I had spent the majority of my life hiding my depression from family, friends, and business associates--and now I was writing a tell-all book.

I wrote the main part of this book as if I were having a conversation with my closest friend who was looking for guidance with his or her debilitating chronic depression. I discuss the misery I experienced, the seemingly unending search for answers, the vagus nerve implant procedure itself, and my subsequent recovery from the grip of depression. The last part, the appendices, contains technical information about depression; the VNS Therapy System?; and Cyberonics, the manufacturer of the vagus nerve stimulator.
I hope my journey and the treatment I chose helps readers with their depression treatment plans; especially when they consider whether or not to undergo vagus nerve stimulation therapy. When I decided to participate in the investigational trial there wasn't any information available to me. I just signed an eleven-page consent agreement and hoped for the best.

On June 15, 2004, the FDA's Medical Device Advisory Panel recommended approval of vagus nerve stimulation as an adjunctive long-term treatment for chronic depression. Cyberonics, the manufacturer of the VNS Therapy System?, is in the process of providing the FDA additional information required for the FDA to render a final decision consistent with the Panel's recommendation. Currently VNS Therapy for the treatment of chronic depression is available in Canada and Europe.

I also wrote Out of the Black Hole: The Patient's Guide to Vagus Nerve Stimulation and Depression for the loved ones of people who suffer from depression. When a patient reaches the severe, chronic level of this disease, often it is their family members who are making the medical decisions. At the other extreme, the family members may be in the dark about what is going on between the doctor and the patient, or they don't trust the information that they're receiving from their loved ones. One thing is for certain, the lack of knowledge about this disease and not knowing the best way to help and interact with the suffering loved one complicates everything.
.

I have been fortunate throughout my life because I have always had access to the best medical care available (for any illness), and I have a close and supportive family. I don't know how people survive severe depression if they don't have access to good doctors, the latest pharmaceutical drugs, psychologists, psychiatrists, and a strong support group. Many depressed patients have none of the above, yet they still endure. Their stories, in many ways, are more remarkable than mine.

Senator Hillary Rodham Clinton wrote a book titledIt Takes a Village. It's about how we can shape our society into the kind of village that enables children to grow into able, caring, resilient adults; physically, intellectually, emotionally, and spiritually. If my family wrote a similar book about the past ten years of my life, it would be titled It Took Heaven and Earth. So, I've also written this book for them. Let's get started.

Visit www.VagusNerveStimulator.com for more information on the book.

Charles Donovan was a patient in the clinical trial for the investigation of vagus nerve stimulation as a treatment for chronic depression.

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Depression in Teenagers: Now What Can We Do?

No doubt you have seen the recent news headlines about a federal panel that recommended to the FDA that anti-depressant medications carry the strongest possible warning label for use in children and teenagers. This recommendation to the FDA shook the medical community, especially those who work with depressed young people. The biggest problem from the treatment community's point of view was not the recommendation for the warning label, but the way that the media protrayed the panel's recommendation.

The panel reported that 2% to 4% of children and teens who were given anti-depressants for the treatment of depression became suicidal, that is they had suicidal thoughts, or made suicidal attempts of one kind or another. None of the 4,000 children and teens studied committed suicide.

What the media did not report well is the fact that 15% of children and teens with depression who receive no treatment will commit suicide. These 15% will not just think about it, but will actually kill themselves.

So what are we to do? If the media had their way it seems that no teens with depression would receive anti-depressants. As a result the suicide rate for those who could be using the medication would rise from nearly zero percent to about fifteen percent. But at least we wouldn't have to be concerned about evil medications.

Look, I understand that there actually are young people, even adults, who have become suicidal only after beginning treatment with an anti-depressant. Some have in fact gone on to take their own lives. This is absolutely tragic. But so is the fact that untreated depression is potentially a fatal disease. Fifteen out of one hundred young people with depression take their own lives. They should be allowed to receive a treatment that will lower the suicide rate dramatically, and without any stigma attached to it by the media.

Recently we had a patient brought to our counseling center named John (not his real name). John was rebellious, angry, withdrawn, and in trouble often, and yet he was diagnosed and treated for depression.

When we think of someone who is depressed, we usually picture a sad, tearful, lonesome person. But teenagers with depression don't look like adults with depression. Current studies show that there are about as many teenagers who are depressed as there are adults that are depressed. However, depression is exhibited far differently by teenagers than by adults. Teenagers do not commonly display gloom, self-depreciation, or talk about feeling hopeless like adults do.

Teenagers with Major Depression are described in diagnostic manuals as often becoming negative and antisocial. Feelings of wanting to leave home, or of not being understoodand approved of increase. The teen often changes, and becomes more restless, grouchy, or aggressive. A reluctance to cooperate in family ventures, and withdrawal from social activities, with retreat to one's room are frequent. School difficulties are likely as concentration is affected. Sometimes there is inattention to personal appearance and increased emotionality. Often there is an increased sensitivity to rejection in love relationships as well.

Teenage boys will often become aggressive, agitated, and get into trouble at home, at school, or with the law. Teenage girls will sometimes become preoccupied with themes of death or dying, and become decreasing concerned about how they look. Suicidal thoughts are common. Some studies suggest that 500,000 teens attempt suicide each year, and 5000 are successful. Increased use of alcohol or other drugs is common, along with other forms of "self-destructive behaviors." Poor self-esteem is common with teenagers, but especially with those who are depressed.

Parents are often confused and frustrated when their teens begin to act like this. Sometimes parents become stern disciplinarians, or even put the teen down, which only serves to increase feelings of guilt and depression. Other times, parents feel helpless, and stand by waiting for adulthood to arrive. Of course neither course is the right one to take. If you know of a teen whose behaviors have changed to look like what has been described above, let the parents know that there is help available, and encourage the family to seek help from a professional. With proper diagnosis and treatment a depressed teen, or adult, can be greatly helped.

If someone close to you is suffering from depression, first please understand that depression is a very emotionally painful condition. For some people with depression it turns into a "terminal illness" due to suicide. Please take the situation seriously.

1) Get a medical evaluation. Symptoms of depression can be the result of a wide assortment of illnesses, including thyroid problems, viral infections, and other factors.

2) Deprex is an amino acid and homeopathic medicine for the treatment of depression that we have seen work well with our patients. It may be worth trying as long as the situation is "stable" and there is no suicidal thinking on the part of the depressed person.

3) Medications such as Prozac can be very helpful for more difficult cases. Consult your doctor. These medications are often prescribed by Family Practice Doctors, but in most cases ought to be monitored by Psychiatrists.

4) Increase intake of Protein somewhat. Use a protein powder supplement, just like a weight lifter.

5) Exercise daily. Just get out and walk for about 15 minutes.

6) Seek out counseling from someone who is good at treating depression. This can do a world of good for you. However, always use great wisdom and common sense when choosing a therapist. Some are good, and some are not, so choose wisely.

Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.

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Chronic Fatigue Syndrome And Depression Are Not The Same Thing!

Chronic Fatigue Syndrome And Depression Are Not The Same Thing!

Chronic Fatigue Syndrome is a very misunderstood illness and this is perhaps why there are so many myths about it. Perhaps the most common myth about Chronic Fatigue Syndrome is that it is effectively a mental condition, and another name for depression.

But these two conditions are very different!

And when you label a condition incorrectly it can cause no end of problems when trying to diagnose and treat it. So it's extremely important to make the distinction between Chronic Fatigue Syndrome and depression - because they are completely different illnesses.

For one, depression can be a symptom of Chronic Fatigue Syndrome, but there are many Chronic Fatigue Syndrome sufferers out there who do not suffer from depression at all.

Second, research has shown that Chronic Fatigue Syndrome sufferers have an abnormality in their 'deep sleep' brainwave patterns. In contrast, depression sufferers do not have this abnormality.

In addition, depression sufferers tend to feel tired all the time, whereas Chronic Fatigue Syndrome sufferers' exhaustion increases notably after mental or physical exertion.

There are also symptoms of Chronic Fatigue Syndrome that are not shared by depression sufferers. Nasty flu-like symptoms, headaches, reversal of sleeping patterns, painful muscles and joints, Restless Legs Syndrome, and an increase in colds and viruses all are just a few symptoms that can play a part in Chronic Fatigue Syndrome.

These are just a few of the differences between Chronic Fatigue Syndrome and depression!

Another myth about Chronic Fatigue Syndrome is that all Chronic Fatigue Syndrome sufferers need to do is to 'pull themselves together' - and they'd be cured...

... if only it were that simple!

Chronic Fatigue Syndrome is actually a bio-physical condition and was (finally) accepted as such by the UK government in 2001. But no cure has yet been found.

Unfortunately there are still many people out there (including some medical professionals) who still think that the condition is 'all in the sufferer's head'.

It is because of this misunderstanding that the Chronic Fatigue Syndrome community has fought so hard against Chronic Fatigue Syndrome being wrongly labelled as a mental illness. And it is perhaps because of this battle that depression amongst Chronic Fatigue Syndrome sufferers has often sadly been overlooked...

Yet for many, depression can be a very real symptom of Chronic Fatigue Syndrome. If you suffer from depression as a Chronic Fatigue Syndrome sufferer, then it's vital that you take it very seriously and that you try to address it as soon as possible.

If you don't deal with your depression, you are unlikely to be able to recover from any chronic illness...

...and recovering from Chronic Fatigue Syndrome is no exception.

It is possible to recover from Chronic Fatigue Syndrome. So if you do experience depression as a symptom of your Chronic Fatigue Syndrome, make it a priority to deal with it. Only that way can you get yourself on the road to recovery.

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Claire Williams is editor of sleepydust.net and has suffered from Post Viral Fatigue Syndrome/ Chronic Fatigue Syndrome since 1995.

She created 'sleepydust.net' to help Chronic Fatigue Syndrome and Fibromyalgia sufferers to deal with the condition - from handling their money worries, to recovering from their illness....

http://www.sleepydust.net

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