Many therapies have been developed for the treatment of ADHD, ADD and PDD-NOS. The most commonly used and accepted is the use of medication with methylphenidate (Ritalin). This medication is also prescribed for narcolepsy (sleeping sickness). Is this the best solution? What does new scientific research say and what are the new recommendations? Or is there perhaps another approach possible? Methylphenidate is a substance registered in the 1960s. This substance belongs to a group that also includes ephedrine, caffeine, methafmethamine (the MA part of XTCs MDMA) and amphetamine (speed). It is a so-called adrenaline-like substance and has a stimulating effect on the central nervous system (including the brain). Taking methylphenidate prevents the reuptake of the hormones dopamine and norepinephrine. Dopamine release to the presynaptic neurons increases.Two major variants are known:

• Group 1: Tablets under the names: Ritalin, Medikinet and Methylphenidate. The effect starts after one to two hours and lasts about three to six hours.
• Group 2: Are extended-release tablets and capsules: Concert, Equasym XL and Medikinet CR. The effect starts after one to two hours. Tablets from this extended-release group remain active for approximately twelve hours. The extended-release capsules last approximately eight hours. [1]

Side effects:

1. Headache.
2. Difficulty falling asleep, insomnia and restlessness.
3. Nervousness.
4. Decreased appetite resulting in weight loss. This causes shortages of nutrients that are important for the brain: fatty acids and amino acids.
5. Dizziness.
6. Abdominal pain, nausea and vomiting.
7. Palpitations, accelerated heart rate and increased blood pressure.
8. More easily irritated, more quickly out of balance.
9. Concentration reduction
10. Altered judgment.
11. Certain psychological and neurological conditions can worsen. In particular tics, (Tourette’s syndrome), epilepsy, severe mental confusion and severe anxiety disorders.
12. Cold hands and feet due to narrowing of the blood vessels.
13. Hypersensitivity reactions: rash, itching or joint pain
14. Growth retardation in puberty.
15. Blurred vision and pupil dilation. Glaucoma (increased intraocular pressure) is one contraindication.
16. Dry mouth, cavities in teeth develop faster.
17. Hyperactivity.
18. Loss of spontaneity.
19. Urge to speak and euphoric, manic feeling (extreme feeling of happiness).
20. Movement disorders, chewing movements and teeth grinding.
21. Drowsiness.
22. Reduction of libido, erectile dysfunction.
23. Blurred vision, double vision, dry eyes.
24. Muscle or joint pain
25. Long-term use may cause severe depression and/or mental confusion.
26. Severe disturbance of bodily functions. In particular, an increase in sympathetic activity. This is noticeable by unexplained fever, very stiff muscles, drowsiness, palpitations and severe sweating.
27. Increased risk of cardiac arrhythmias.
28. Sudden dizziness or loss of consciousness for a short time.
29. Breast development in men. [1]

Usage and costs

In the period from 2005 to 2011, the increase in prescriptions rose from 70,000 to 200,000. More than 1 million Dutch people now use methylphenidate. 5% of young people between the ages of 11 and 20 are daily users. [2]The increase in percentage terms is the largest in the age group of 20-60 year olds. [2]The personal contribution that users pay in 2011 amounted to 25,600,000. The number of daily doses reimbursed in the period from 2005 to 2011 increased from 1,700,000 to 4,700,000. This is a total increase in healthcare costs for this medicine alone of 22%.

Risks

Research between a group of 370 ADHD diagnosed children and a group of 740 non-ADHD diagnosed children (the so-called control group) showed that lower reading skills were observed in the first group. Children from this group also sat down on average 3 times more often. The chance of dropping out of school without a diploma was 2.7 times higher in this study. [3]Biederman reported in 2007 that the development of eating disorders (anorexia nervosa and bulimia nervosa) was 3.6 higher among girls with ADHD.[4]

Research

After the Durham study, which showed that the use of a combination of omega 6 and omega 3 fatty acids had beneficial effects on ADHD and related disorders, a follow-up study was conducted. Cochrane Review reported that omega 3 from fish oil did not provide any demonstrable improvement. The reason is that the EPA and DHA of such products are derivatives. The body can produce EPA and DHA as needed if sufficient non-oxidized omega 3 is present. Adding EPA and DHA is not necessary. However, most omega 3 capsules contain EPA and/or DHA and not the necessary non-oxidized omega 3 fatty acid. However, this is not always stated on the packaging. [5]In 2008, Johnson conducted a double-blind placebo controlled study using a combination of fish oil and evening primrose oil. The 75 children were between the ages of 8 and 18 years. The results were positive. After 6 months it turned out that 50% of the users of the fatty acid combination observed an improvement of 25%. This is analogous to what drug studies of the effectiveness of methylphenidate showed. After six months, the score of users with ADHD had improved by 36%. Under the ADD this was 58%. [6]Barragan-Perez then investigated the effects even further. A group of 90 ADHD-diagnosed children aged 6 to 12 years were divided into 3 groups:

1. The first group only received the combination of omega 3 and 6.
2. The second group only received the medication with methylphenidate.
3. The third group received the fatty acid combination in addition to the medication with methylphenidate.

In this study it is clear that EPA and DHA were chosen together with GLA. All are derivatives of omega 3 or 6. The ratio EPA:DHA:GLA was 9:3:1. The dose was 792 mg per day.Several testing models were used for the evaluation :

1. DMS-IV.
2. ADHD-RS-VE score.
3. ADHD (CEAL) for Latin America (the study was in Mexico).
4. Clinical Global Impression Score (this is used to measure general well-being).

The doses were taken for 1 year. After 1 year there was an evaluation and the improvement among all groups showed that 75% of the children suffered 50% less from the symptoms. It was striking that the symptoms of ADD were reduced equally in the first two groups.The score on ADHD was lower in the first group. In the combination group (group 3) there was no greater difference in reduction of symptoms than in the other two groups. However, it turned out that this group suffered much less side effects than the group that only used methylphenidate. In the methylphenidate group, the number of side effects was high:

1. Fears
2. Lack of appetite
3. Weight loss

As a result, the score on the general well-being measurement was lower than that of the combination group where these side effects were nil.The conjecture of Professor Peskin and Dr. Habib is that using non-oxidized fatty acids from omega 3 and 6 will give much better results. [5] However, no research has yet been done into this .

Brain and fatty acids

Methylphenidate is only indicated as an aid for ADHD, ADD and PDD-NOS. It doesn’t solve the real cause. The cause lies in an increased distance between the neocortical and other brain areas. As a result, intelligence is normal to higher, but the impulses cannot be processed quickly enough.The brain consists of 60% fats. The majority of these are probably essential fatty acids (EFA). These EFA are the basic fatty acids that the body cannot produce itself, but consume through food. However, foods containing high EFA spoil quickly. The EFA attract oxygen. The food industry is destroying this EFA, which means that products have a longer shelf life. However, this has major consequences for the body. The oxidized fatty acids are absorbed by the body, but repel oxygen. The direct cause of cancer (http://science.infonu.nl/onderzoek/102468-de-primaire-oorzaak-van-kanker-celademhaling.html)These oxidized fatty acids are not of much use to the brain. Blood tests show that 40% of children with ADD are deficient in these essential fatty acids [8].ADD and ADHD are more common among men. According to Medical Hypotheses [9], men would need more essential fatty acids than women. There could be an explanation for this, although it has not been confirmed.Essential fatty acids ensure, among other things, that the endocrine system becomes more balanced.

Misdiagnosis

The diagnosis of ADHD or ADD is not easy to make. There are at least 50 physical conditions that cause exactly the same symptoms as ADHD/ADD. These include nutritional deficiencies (EFA), allergies and toxic substances. [10]When the correct ratio of essential fatty acids is consumed, the body is able to produce the necessary GLA, EPA and DHA.

Essential fatty acids

Research shows that supplementing the EFA:

1. The processing of impulses in the brain increases.
2. There is more concentration.
3. Memory improved.
4. There is more clarity of mind.

The ratio between essential, non-oxidized omega 3 and omega 6 is between 1:1 and 1:2. The fatty acids must be cold-pressed and cleanly processed.