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Holistic physician and pediatrician, Dr. Vivian DeNise at Patients Medical gives information on how to tell if a patient needs to be evaluated for ADD or ADHD, tests to find the "root cause" of the symptoms, and natural treatment options for both children and adults living with ADD or ADHD.
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Natural Treatment Options for Your Child with ADD/ADHDVivian F. DeNise,DO Integrative PediatricianPatients Medical
Patients Medical
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Physicians collaborate to approach each patient holistically.
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Founder, Dr. Warren Levinbegan practicing his ground-breaking
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Introducing our speakers:
Vivian DeNise, DOIntegrative Pediatrics
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Completed her medical degree at New York College of Osteopathic Medicine
Residency in Pediatrics Certifications in Integrative
Medicine with the American Academy of Anti-Aging Medicine (A4M)
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Specialties include Behavioral Concerns Hormonal Imbalances Nutritional Imbalances Gastro-Intestinal Problems Detoxification And many more!
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ADD and ADHD Allergies Anxiety Asperger’s Syndrome Asthma Autism Celiac Disease Chronic fatigue Chronic pain Depression Fibromyalgia Headache & migraine Immune dysfunction Irritable Bowel Syndrome Stress disorders Weight gain Weight loss
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Natural Treatment Options for Your Child with ADD/ADHD
What Is ADHD?
Attention deficit hyperactivity disorder, is a variable neurobehavioral condition
generally characterized by inattentiveness and/or hyperactivity
and impulsivity.
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Symptoms
DSM-IV Criteria for ADHD
Either A or B:Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is inappropriate for developmental level:
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Symptoms
Inattention Often does not give close attention to details or makes careless
mistakes in schoolwork, work, or other activities. Often has trouble keeping attention on tasks or play activities. Often does not seem to listen when spoken to directly. Often does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
Often has trouble organizing activities. Often avoids, dislikes, or doesn't want to do things that take a lot
of mental effort for a long period of time (such as schoolwork or homework).
Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).
Is often easily distracted. Is often forgetful in daily activities.
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Symptoms
Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:
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Symptoms
Hyperactivity Often fidgets with hands or feet or squirms in
seat when sitting still is expected. Often gets up from seat when remaining in seat
is expected. Often excessively runs about or climbs when
and where it is not appropriate (adolescents or adults may feel very restless).
Often has trouble playing or doing leisure activities quietly.
Is often "on the go" or often acts as if "driven by a motor".
Often talks excessively. www.patientsmedical.com
Symptoms
ImpulsivityOften blurts out answers before questions have
been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g.,
butts into conversations or games).
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Symptoms and Diagnosis
II. Some symptoms that cause impairment were present before age 7 years.
III. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home).
IV. There must be clear evidence of clinically significant impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).
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Types of ADHD
ADHD, Inattentive Subtype: Diagnosis is confirmed if the criteria of Category 1 have applied for six months or longer, but not those of Category 2.
ADHD, Hyperactive-Impulsive Subtype: Diagnosis is confirmed if the criteria of Category 2 have applied for six months or longer, but not those of Category 1.
ADHD, Combined Subtype: Diagnosis is confirmed if the criteria of both Category 1 and Category 2 have applied for six months or longer. This is referred to as Mixed Subtype.
ADHD Not Otherwise Specified: Diagnosis is confirmed in this subtype if children do not meet the certain the classic criteria of the three types, but still have certain qualities and characteristics of ADHD.
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Dr. Daniel Amen’s 6 Brain Types of ADD/ADHD
Classic PFC/CB- Dopamine Inattentive PFC/CB- DopamineOver-focused-AC/PFC-Dopamine/
SerotoninLimbic-Limbic/PFC-(NE)/DopamineTemporal Lobe-
TLs/PFC-Dopamine/GabaRing of Fire-Gaba/Dopamine
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Criteria Common To All Types
Short attention span for routine tasks
DistractibilityOrganizational
problemsDifficulty with
follow throughPoor internal
supervision www.patientsmedical.com
Over-Focused ADD
Trouble shifting attention, looks like they cannot pay attention
Worrier Tends to hold grudges Gets stuck on thought
patterns or behavior patterns Upset if things don’t go
they’re way Often
argumentative/oppositional
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Temporal Lobe ADD
Emotional instabilityMemory problemsPeriodic anxiety Illusions/shadowsFrequent headachesToo sensitive to othersExternal or Internal aggression
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Limbic ADD
Sad, moody, irritable
Many negative thoughts
Low motivation/ finds little pleasure
Sleep/appetite problems
Social isolation www.patientsmedical.com
Ring of Fire ADD
Too many thoughtsOften very hyperHyper-verbalOppositionalAggressiveHypersensitive to light, sound, taste,
touchMoodinessCyclical behavioral changes *may be
bipolar equivalent www.patientsmedical.com
Facts
The American Psychiatric Association states in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) that 3%-7% of school-aged children have ADHD. However, studies have estimated higher rates in community samples.
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Facts
Recent data from surveys of parents indicate that: Approximately 9.5% or 5.4 million children 4-17 years of
age have ever been diagnosed with ADHD, as of 2007.
The percentage of children with a parent-reported ADHD diagnosis increased by 22% between 2003 and 2007.
Rates of ADHD diagnosis increased an average of 3% per year from 1997 to 2006 and an average of 5.5% per year from 2003 to 2007.
Boys (13.2%) were more likely than girls (5.6%) to have ever been diagnosed with ADHD.
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Facts
• Rates of ADHD diagnosis increased at a greater rate among older teens as compared to younger children.
• The highest rates of parent-reported ADHD diagnosis were noted among children covered by Medicaid and multiracial children.
• Prevalence of parent-reported ADHD diagnosis varied substantially by state, from a low of 5.6% in Nevada to a high of 15.6% in North Carolina.
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The Effects of AD/HD
Attention Deficit/Hyperactivity is a serious public health problem because of the large estimated prevalence of the disorder, significant impairment in the areas of school performance and socialization, the chronic nature of the disorder.
Using a prevalence rate of 5%, the annual societal ‘‘cost of illness’’ for ADHD is estimated to be between $36 and $52 billion, in 2005 dollars. It is estimated to be between $12,005 and $17,458 annually per individual.
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ADD is not only a “minor” disorder
35% never finish high school
43% of untreated boys with ADHD are arrested
Up to 50% of the prison population has ADD/LD
52% of ADD adults abuse substances
75% have interpersonal problems
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Co-existing Conditions of AD/HD
Two thirds of children with AD/HD have at least one other coexisting conditions
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Disruptive Behavioral Disorders
Oppositional defiant disorder (ODD)-40%
Conduct disorder (CD)-25% of children, 45-50% of adolescents and 20-25% of adults
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Mood Disorders
Depression 10-30% of children with
AD/HD 47% of adults with AD/HD
Mania/Bipolar Disorder 20% of individuals with AD/HD
Anxiety 30% of children with AD/HD 25-40% of adults with
AD/HD
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Tics and Tourette Syndrome
Only about 7% of those with AD/HD60% of those with Tourette
Syndrome have AD/HD
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Learning Disabilities
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50% of children with AD/HD have a co-existing learning disorder.
Sleep Disorders
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25%-50% of parents of children with AD/HD report that their children suffer from a sleep problem, especially problems with falling asleep and staying asleep. This includes greater activity during sleep restless legs/periodic leg movements
during sleep (PLMS) unstable sleep patterns greater sleepiness than other children
during the daytime
Sleep Disorders cont.
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Researchers speculate that AD/HD is associated with hypo-arousal rather than hyper-arousal.
The coping mechanism of hyperactivity may be to counteract the daytime sleepiness.
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Treatment by Traditional Medicine
Treatment By Traditional Medicine
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Give cautiously to patients with a history of drug dependence or
alcoholism. Chronic abusive use may lead to marked tolerance and
psychological dependence with varying degrees of abnormal behavior.
Careful supervision required during withdrawal from abusive use.
Black Box Warning for Ritalin
Treatment By Traditional Medicine
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High potential for abuse; avoid prolonged use. Misuse of
amphetamine may cause sudden death and serious cardiovascular
adverse events.
Black Box Warning for Adderal
Treatment By Traditional Medicine
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Caution with history of drug dependence or alcoholism. Marked tolerance and
psychological dependence with varying degrees of abnormal behavior may occur with
chronic abusive use. Careful supervision is necessary during withdrawal from abusive use
to avoid severe depression.
Black Box Warning for Concerta
ADHD Medications
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Many medications used to treat ADHD aim to restore chemical balance.
Medication Neurotransmitters Affected
Ritalin® Dopamine
Strattera® Norepinephrine
Concerta® Epineprhine
Adderall® PEA
The Integrative Approach
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Neurotransmitter ImbalanceVitamin DeficiencyMineral DeficiencyHeavy Metal IntoxicationAllergiesFood additivesThyroid DisordersSleep DisordersPandas Syndrome
The brain is the master controller
of nervous system, using chemicals
called neurotransmitters
to “talk” with itself.
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The Brain
The Brain
The brain uses neurotransmitters to maintain focus & concentration
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Imbalances in brain
chemistry can lead
to inattentive and hyperactive behaviors.
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Neurotransmitters are the chemical messengers of the nervous system
Serotonin
Dopamine
GABA
Glutamate
Epinephrine
Norepinephrine
Histamine
PEA
Types of Neurotransmitters
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ExcitatoryGlutamateNeorepinephrineEpinephrineDopamineHistamineAspartic AcidPEA
InhibitoryGABAGlycineSerotoninTaurine
Excitatory
Inhibitory
Epinephrine
Dopamine
Norepinephrine
Glutamate
Taurine
Serotonin
Gaba
Dopamine
Responsible for feelings of pleasure and satisfactionmuscle controlmuscle functionGI issues
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Limit video games
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Epinephrine
Important for motivation, energy, and mental focus. Also, known as adrenaline.
Primarily made in the adrenal glands.
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Glutamate
Necessary for learning and memory
One of the most common neurotransmitters in the brain
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Norepinephrine
Important for mental focus, emotional stability and endocrine function.
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GABA
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The Primary neurotransmitter in the brain necessary to feel calm and relaxed.
Glutamine
Glutamate
B6
GABA
Serotonin
Plays an important role in mood, sleep and appetite
Tryptophan 5-HTP B6 Serotonin
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Major contributors to neurotransmitter imbalance
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High levels of stress
Poor dietary habits
Toxins
Lack of sleep
Major contributors to neurotransmitter imbalance
Chronic stress leads to imbalances in brain chemistry Busy schedules Emotional trauma Personal issues
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MSG
MSG Symptoms Complex
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Symptoms can be:• Numbness• Tingling• Facial pressure or
tightness• Headache• Nausea• Rapid Heartbeat• Drowsiness• Chest pain• Difficulty breathing
What Contains MSG?
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Flavorings such as natural chicken flavoring
Stock Seasonings Soy Sauce Broth Cornstarch Pectin Bouillion Barley Malt
Often contains MSG or creates MSG during processing
Glutamate Monopotassium
Glutamate Textured Protein Hydrolyzed protein Yeast Nutrient Calcium Caseinate Gelatin Glutamic Acid
Always contains MSG
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Vitamin Deficiency
Vitamin CVitamin B6, B12
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Vitamin C
Reduces harmful oxidantsBalances levels of dopamineHelps balance phenylalanine and
tyrosine
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Mineral Deficiency
ZincCopper IronMagnesium
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Major contributors to neurotransmitter imbalance
Toxins: environmental, occupational, and recreational poisons can disrupt proper communication in the brain
Heavy Metals: Lead and Mercury Sources of Mercury:
Eating fish or shellfish Dental work such as Mercury amalgams Breathing contaminated vapors or skin contact
with: antiseptics, bactericides, batteries, cosmetics, fabric softeners, floor wax and polish, paints, tattoo inks, perfumes, etc.
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Major contributors to neurotransmitter imbalance cont.
Poor sleeping habits An inadequate amount of
sleep, or having a poor or irregular sleeping schedule can lead to poor brain function and a lack of concentration.
Exhibited by up to 50% of children in the United States.
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Major contributors to neurotransmitter imbalance cont.
Sleep deprivation adds up over time, so an hour less per night is like a full night without sleep by the end of the week. Among other things, sleep deprivation can lead to:
decreased attentiveness decreased short-term memory inconsistent performance delayed response time generally bad tempers, problems in school,
stimulant use, and driving accidents (more than half of "asleep-at-the-wheel" car accidents are caused by teens).
A careful history physical
First and Foremost
Vitamin Deficienci
es
Mineral Deficienci
es
AllergiesHeavy Metals
Thyroid Disorders
Contributing Factors to ADHD
What Can Be Done
Feed Your Brain Lean protein Complex carbohydrates Decrease simple sugars Decrease bad fat not all fat Omega 3 Fatty Acids
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What Can Be Done
Lifestyle Changes Head injuries matter Avoid toxic substances Get enough sleep Manage stress Exercise Limit video games
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What Can Be Done cont.
Omega 3 Probiotics Vitamin C Vitamin B complex L theanine Phosphatidylserine L-tyrosine Gaba
5 HTP DL phenylalanine SAMe
Supplements that can help
Q and A with the Doctor
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