Source: ADDitude Magazine
An expert on ADHD and learning disabilities talks about the biology behind attention deficit disorder and why it's sometimes so difficult to diagnose and treat ADHD symptoms in children.
by Larry Silver, M.D.
In my 40 years as a child and adolescent psychiatrist, I have treated thousands of youngsters. With some children, I am able to make a quick evaluation about attention deficit hyperactivity disorder (ADHD) and outline a course of treatment. With others — more often than I care to admit — I have to tell parents that it's not clear what is wrong. It's not that I lack the expertise or diagnostic skills. It's just that psychiatry isn't quite as far along as other medical specialties.
A pediatrician can do a throat culture and tell at once whether a child needs an antibiotic; appropriate treatment follows the diagnosis. In contrast, psychiatrists are often required to initiate a specific treatment and worry about clarifying the diagnosis later on. As I often tell parents, we must "put out the fire and blow the smoke away" before we can figure out what started the fire.
If a child is having problems in school, he may have attention deficit disorder (ADD ADHD), but it's also possible that he has a learning disability. Or depression. Or anxiety. Sometimes what looks like ADHD is the result of family tensions.
If ADHD seems to be even a part of such a "mixed clinical picture," I typically prescribe medication. If this solves the problem, terrific. But in many cases, another intervention is needed to address persistent academic, emotional, or family problems. Only weeks or months after treatment has been initiated will the full clinical picture become clear.
I understand parents' concern about medicating their children. My clinical knowledge notwithstanding, I agonized over whether my granddaughter, who has ADHD, should be on meds. (Ultimately, we decided she should.) I have found, however, that parents often feel better about ADHD meds when they understand a bit about neurotransmitters, the remarkable compounds that govern brain function.
How neurotransmitters work
Before I tell you about these special brain chemicals, let me explain a bit about brain anatomy.
There are millions of cells, or neurons, densely packed into various regions of the brain. Each region is responsible for a particular function. Some regions interact with our outside world, interpreting vision, hearing, and other sensory inputs to help us figure out what to do and say. Other regions interact with our internal world — our body — in order to regulate the function of our organs.
For the various regions to do their jobs, they must be linked to one another with extensive "wiring." Of course, there aren't really wires in the brain. Rather, there are myriad "pathways," or neural circuits, that carry information from one brain region to another.
Information is transmitted along these pathways via the action of neurotransmitters (scientists have identified 50 different ones, and there may be as many as 200). Each neuron produces tiny quantities of a specific neurotransmitter, which is released into the microscopic space that exists between neurons (called a synapse), stimulating the next cell in the pathway — and no others.
How does a specific neurotransmitter know precisely which neuron to attach to, when there are so many other neurons nearby? Each neurotransmitter has a unique molecular structure — a "key," if you will — that is able to attach only to a neuron with the corresponding receptor site, or “lock.” When the key finds the neuron bearing the right lock, the neurotransmitter binds to and stimulates that neuron.
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