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Does VAXA's "Attend" really treat AD/HD?
"Attend" by VAXA is a nutraceutical formula used to treat ADD (Attention Deficit Disorder) and ADHD (Attention Deficit Hyperactivity Disorder). ADHD technically refers to the involvement of hyperactivity absent in ADD, however, most physicians usually refer to ADD and ADHD interchangeably. In order to understand the purpose of "Attend" one must first know about AD/HD.
Since AD/HD results from a biological imbalance, the disorder might affect one, two, or several areas of the brain, resulting in several different "styles" or "profiles" of individuals with the condition (http://www.newideas.net). To be diagnosed with AD/HD, individuals must display at least six of the following signs of inattention and at least six of the following signs of hyperactive-impulsivity:
1. fails to give close attention to details or makes careless mistakes in schoolwork, work or other activities
2. experiences difficulty sustaining attention in tasks or play activities
3. does not seem to listen when spoken to directly
4. 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)
5. has difficulty organizing tasks and activities
6. avoids, dislikes or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
7. loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)
8. easily distracted by extraneous stimuli
9. forgetful in daily activities
1. fidgets with hands or feet or squirms in seat
2. leaves seat in classroom or in other situations in which remaining seated is expected
3. runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
4. has difficulty playing or engaging in leisure activities quietly
5. often "on the go" or acts as "driven by a motor"
6. talks excessively
7. blurts out answers before questions have been completed
8. has difficulty awaiting turn
9. interrupts or intrudes on others (http://www.chadd.org)
AD/HD is considered the most commonly diagnosed psychiatric disorder among school-aged children for it affects approximately 3-5% of adolescents in America (http://www.pslgroup.com/dg/2088ca.htm). Although AD/HD is more commonly diagnosed in children, many adults also suffer from the condition. The criteria for diagnosing the disorder in children and adults is similar.
In order for a child to be diagnosed with AD/HD, symptoms that cause impairment must be present from before age seven and should have lasted more than six months. The symptoms should be apparent in two or more settings, such as school, home, or social situations. Other psychological factors, including depression, adjustment problems, family stress, or abuse must be ruled out. It is also imperative to investigate other possible medical problems that may contribute to AD/HD-like behavior, such as lead poisoning or severe anemia (http://add.about.com).
Adults are diagnosed for AD/HD based on their performance at home and work. When possible, their parents are asked to rate the individual's behavior as a child. A spouse or roommate can also help evaluate current behaviors. For the most part, adults are generally asked to describe their own experiences. A common symptom adults describe is a sense of frustration and bewilderment. Since individuals with AD/HD are often intelligent, they usually report feeling frustrated that they are not living up to their potential. Many also feel restless and are easily bored. Some say they need to seek novelty and excitement to help "channel the whirlwind in their minds." Although it may be impossible to document when these behaviors first started, most adults with AD/HD can give examples of being inattentive, impulsive, overly active, impatient, and disorganized most of their lives (http://www.nimh.nih.gov/publicat/adhd.cfm#adhd6).
Students with AD/HD have a greater likelihood of grade retention, dropping out of school, academic underachievement, and social and emotional adjustment difficulties, unless they receive adequate and appropriate treatment. This is probably because AD/HD makes children vulnerable to failure in two important areas for developmental mastery - school performance and social relations. Untreated AD/HD may lead to poor self-esteem and poor social adjustment.
AD/HD is a specific neurological difference for which there is no cure; Treatments only relieve the symptoms of the condition (http://www.vaxa.com). If taken regularly, "Attend" relieves the symptoms of AD/HD by supporting the body's natural ability to calm and reduce stress and frustration. The formula helps individuals focus their attention and improve concentration to allow smooth, balanced information processing. "Attend" also helps to flush toxins and plaque and free radicals from brain pathways to increase flow of nutrients, oxygen and energy to the brain (http://www.vaxa.com).
What is the rationale? That is how is "Attend" supposed to achieve its purposes? How does it supposedly work?
One must first learn the
possible causes of AD/HD, in order to understand how "Attend" actually works.
Medical experts are still divided as to the primary cause of AD/HD. While there
is no single gene or neurotransmitter that causes the disorder, studies involving glucose have
found that individuals with AD/HD have decreased activity in the regions of the brain
responsible for regulating their impulses, memory, and planning ability (http://add.about.com).
Glucose in the brain is thought to inhibit impulses and control attention. Since glucose is the
brain's main source of energy, measuring how much is used serves as a good indicator of the
brain's activity level. Scientists have found important differences in glucose levels between
people who have AD/HD and those who do not have the disorder. In a study of patients with
AD/HD, researchers found that the brain areas that control attention used less glucose, indicating
that they were less active. It appears from research that a lower level of glucose and, therefore a
lower level of activity, in some parts of the brain may cause inattention
(http://www.nimh.nih.gov/publicat/adhd.cfm#adhd6). But scientists, however, are uncertain
about what causes AD/HD individuals to have lower levels of glucose in the brain.
"Attend's" all-natural nutraceutical formula supposedly achieves it purposes by helping to support the function of the Central Nervous System and addressing the specific dietary and neurochemical deficiencies which occur within AD/HD individuals. It is formulated to supply the essential building materials for the entire neural network. "Attend" is designed to complement the body's natural calming and balancing agents with specific micro-nutritionals (Lithium bromatum and Lithium carbonicum) and neurotransmitters (eg. GABA, DLPA and other neural buffers) which help to target, direct and smoothly focus attention. "Attend" also supplies the essential framework of lipids and fatty acids, natural hormones and neural growth and synchronization factors crucial for neural and glial cell generation so as to meet the demands of increased neural stimulus or "traffic" through the Reticular Activating System. Additionally, "Attend" supplies important catecholamine precursors (such as catechol, phospholipids and naturally occurring trans- and cis-cloramide, a naturally conjugated form of L-dopa) to dopamine, acetylcholine and norepinephrine, the three most important neurotransmitters within the brain. The natural hormone pregnenolone is included in "Attend" to aid in memory retention. Pregnenolone helps memory because it is directly related to neural genesis, growth, and reconfiguration for it enables gene activation and allows the multiplication, development and "connectivity" of neural cells. Other supporting minerals within "Attend" help feed and strengthen the small capillaries in new neural growth sites to prevent damage to the expanding neural network and protect neural patterns (http://www.vaxa.com).
What are the causes of AD/HD in relationship to Attend's treatment approach?
To evaluate the effectiveness of "Attend," we first must consider VAXA's treatment approach in relationship to what they believe is the cause of AD/HD. The theory of AD/HD given by VAXA is only their theory; it is not the only explanation for AD/HD. Therefore, we must look upon other theories about the etiology of the disorder when assessing the effectiveness of "Attend."
Although its etiology remains unknown, data from family-genetic, twin, and adoption studies as well as segregation analysis suggest a genetic origin for some forms of the disorder. However, other etiologies are also likely such as psychological adversity, perinatal insults, and perhaps other yet unknown biological causes.
There are inconsistencies in findings regarding the underlying psychological mechanisms responsible for AD/HD. Currently neuro-psychological models of AD/HD tend to be driven by the search for a single underlying mechanism that could provide the basis for a "grand theory" of AD/HD. These accounts attempt to explain AD/HD by reference to psychological dysfunction caused by impairments in specific brain modules. Even those theorists, who have rejected the modular accounts of dysfunction proposed by the neuro-psychological model, tend to search for grand theories that explain the etymology of the condition. The various, multi-faceted symptoms that characterize AD/HD-like behavior and its uncertain aetiology, however, make achieving the sort of theoretical unity, or "grand theory," about the causes of AD/HD quite unlikely. Edmund J.S. Sonuga-Barke's study (2000), explores two neuro-psychological models that attempt to explain the causes of AD/HD. He concludes that AD/HD may be caused by a dual-pathway model that incorporates both models:
•A recent meta-analysis shows the association of AD/HD with deficient inhibitory controls in the brain. This model asserts that inhibitory dysfunctions cause cognitive and behavioral
dysregulations (of thought and action) that produce AD/HD symptoms.
• The second model views AD/HD as a motivational style. This model is based on the assumption that AD/HD behaviors are expressions of an underlying motivational style rather than the result of dysfunctioning regulatory systems. According to this hypothesis AD/HD children are motivated to escape or avoid delay. Their inattentive, overactive and impulsive behaviors, therefore, represent expressions of what is called "delay aversion." The model predicts that when AD/HD children are faced with a choice between immediacy and delay, they will choose immediacy. When no choice is available they will act on their environment by displaying inattentive or hyperactive behavior in order to reduce their perception of time during the delay. According to this model, AD/HD symptoms can result from a shortened "delay of reward gradient." This means that AD/HD children discount the value of future events at a higher rate than other children. This, in turn, leads to a preference for immediacy, which results in a distinctive AD/HD symptom -impulsive behavior. The motivational style model claims that some symptoms of inattention that characterize AD/HD, such as difficultly organizing tasks, managing time and working memory, arise as secondary effects of delay aversion.
Some scientists consider AD/HD a biological disorder that is linked to or caused by other genetic disorders because a variety of chromosomal abnormalities are typically associated with an increased susceptibility to behavioral and cognitive problems in children. Among the suspected etiology of AD/HD is the theory that the disorder is caused by and/or linked to other disorders that stem from genetic aberrations. A recent study (Bastain et al., 2002) examined 100 AD/HD children that have an IQ above 80 in order to see if AD/HD patients have chromosomal abnormalities that are associated with Velocardiofacial syndrome (VCFS) and fragile X syndrome. The researchers sought to investigate the correlation between these two genetic disorders which are characterized by physical anomalies and AD/HD because several studies have found AD/HD to occur at a higher than expected rate among children with VCFS and fragile X syndrome. The scientists conducted tests on the AD/HD children to see if they possessed chromosomal abnormalities that diagnose an individual with either VCFS or fragile X syndrome. The results of the test failed to identify any children with VCFS or fragile X syndrome. The investigation demonstrated that children with AD/HD and average IQ do not display elevated rates of cytogenetic (chromosomal) abnormalities associated with the condition; thus AD/HD may not be caused by chromosomal abnormalities and may not be linked to other disorders which stem from genetic aberrations (Bastain et al., 2002).
Other scientific research, however, suggests that genetic predisposition causes AD/HD. AD/HD can possibly be attributed to multiple gene aberrations because many studies demonstrate that heritability for the disorder is over 50% (Arnold). Although scientists hypothesize that the condition results from many gene aberrations, only two specific dopamine gene abnormalities have been identified to be linked to AD/HD - the dopamine transporter gene (DAT1) and the dopamine receptor gene (DRD4). Scientists identify that genetic predisposition does not account for all AD/HD conditions; there are sporadic cases without family history that result from things such as toxins, early brain insult and maternal deprivation. Moreover, even genetically predisposed cases can be aggravated or improved by other risk or environmental factors (Arnold).
Scientific evidence shows that dietary imbalances may also cause AD/HD. Some scientists hypothesize that a variety of allergenic foods, such as milk, soy, nuts, wheat, and fish, and food additives contribute to the behavioral symptoms that characterize the condition; these symptoms include alterations in mood, attitude, and sleep as well as the typical behaviors associated with AD/HD, such as hyperactivity, inattention, and impulsivity (Baumgaertel).
The theory that dietary imbalances and subtle deficiencies in certain vitamins and minerals cause AD/HD, correlates with Attend's treatment approach. The makers of "Attend" claim that their formula naturally addresses the "specific dietary...deficiencies which are thought to occur within the population of Attention Deficited individuals" (http://www.vaxa.com). Research shows that early nutritional deprivation has been associated with long-term effects on cognition, behavior, and learning. In addition, iron deficiency has identified effects on attention and cognition (Baumgaertel). The section below further evaluates Attend's treatment approach in relation to the "extra" vitamins and minerals that the formula contains and if these "extra" components in a patient's diet effectively treat the disorder.
Is there any scientific evidence that shows that the ingredients contained in "Attend" actually treat AD/HD?
There is not an abundant amount of research that examines each specific ingredient contained in "Attend" and its effects on the brain and how it treats AD/HD. Research shows, however, that an adequate diet is a necessary requirement for growth and development (Baumgaertel). Following this notion, the makers of "Attend" assert that the vitamins and minerals in their formula supply the "essential building materials for the entire neural network." VAXA's claim may be supported by an experiment conducted on adolescent schoolchildren. The controlled study proved that supplementation with a standard multivitamin and mineral preparation given through a school year has significant positive effects on performance IQ (Baumgaertel). After considering this study, one might conclude that "Attend," which is in a sense can be considered a multivitamin, can also enhance performance IQ. But on the other hand, although VAXA discloses a list of ingredients contained in "Attend," the company does not reveal how much of each ingredient is in the formula. Therefore, "Attend" may be considered a multivitamin or the formula may contain an exorbitant amount of vitamins. If this is the case, a dose of too many vitamins, or megavitamins, may actually be harmful to one's health. Research in megavitamin therapy disproves the effectiveness of vitamins and minerals as a treatment for AD/HD. Haslam conducted a double-blind, placebo-controlled study which showed that children did not show any behavior improvements while on megavitamins. In fact, the children demonstrated 25% more disruptive behavior on megavitamins than on placebo. Haslam's experiment illuminated the serious toxic effects which are a critical side effect from taking megavitamins; forty-two percent of the research participants had elevations of liver enzymes. Haslam's experiment demonstrated that "megavitamins are of little benefit in the treatment of AD/HD and actually may cause harm" (Baumgaertel). The study also revealed that it is possible to experience harmful side effects, even from a natural supplement. The evidence from Haslam's research contrasts statements made on VAXA's website. VAXA explicitly states on their website that their treatment is "all natural, no side effects, no drugs and guaranteed!" (http://www.vaxa.com).
"Attend" is formulated to supposedly complement the body's natural calming and balancing agents with specific micro-nutritionals, such as Lithium bromatum and Lithium carbonicum. Baumgaertel notes that AD/HD adolescents may have an increased risk for micro-nutritional deficiency because they are likely to have erratic eating habits. There has not been consistent evidence, however, that shows that micro-nutrient deficiency enhances AD/HD symptoms.
In addition to the "extra" vitamins and minerals contained in "Attend," the formula also includes an ingredient called pyridoxine, which is actually Vitamin B6. Pyridoxine is necessary for neurotransmitter synthesis and normal brain development. Baumgaertel reviewed a double-blind study that compared pyridoxine with methylphenidate (a stimulant medication used to treat AD/HD) and placebo in hyperactive adolescents. The study "found a nonsignificant trend in favor of pyridoxine, with behavioral improvements on doses between 10 and 15 mg" (Baumgaertel). The results of the study are not very accurate and valid, however, because a replication of the study with larger cohorts has not been performed. Additionally, the evidence fails to justify routine supplementation of pyridoxine beyond the recommended daily allowance in AD/HD adolescents unless a pyridoxine deficiency is formally documented (Baumgaertel).
VAXA's formula also contains the two essential fatty acids (EFAs), linoleic acid and linolenic acid, which are important in neuronal functioning and brain development. Baumgaertel reviews the relationship between EFAs and AD/HD by examining an epidemiologic study that revealed a higher rate of nonspecific physical symptoms typical of EFA deficiency (such as skin conditions and increased thirst) in hyperactive adolescents. The researchers found lower plasma levels of EFAs in hyperactive males compared with controls. In this study, however, the cause of the lower EFA levels was unknown and a direct link was not established between decreased EFA levels and AD/HD behavior. Baumgaertel notes that the researchers did suggest that dietary supplementation of EFAs may be useful in treating AD/HD children as long as the intervention is specific and based on individual fatty acid profiles. Baumgaertel concludes that "it is still unclear whether EFA supplementation improves behavior; additional investigation is ongoing."
DMAE (dimethylaminoethanol), or deanol, is also an ingredient in "Attend." DMAE is often contained in many other over-the-counter AD/HD remedies. In a double-blind, placebo-controlled study of adolescents with AD/HD, DMAE proved to be as effective as methylphenidate (a common stimulant AD/HD medication) in treating target behaviors. Baumgaertel claims that further research is needed to properly evaluate the effectiveness of DMAE in the treatment of AD/HD.
Gingko biloba is an ancient remedy that contains pharmacologically active substances with membrane stabilizing, antioxidant, and nootropic properties that facilitate learning and memory. Although gingko supposedly helps learning and memory by enhancing neurotransmission, there is no scientific evidence that supports this assertion. Gingko is frequently contained in many herbal remedies for AD/HD, however, this ingredient has not been studied systematically and "reports of effectiveness are anecdotal" (Baumgaertel). It is important to realize that herbal ingredients, such as gingko biloba and gotu kola in "Attend", typically vary in the amount of active substrate they contain, so it is often difficult to evaluate their effectiveness.
VAXA's website claims that "Attend" contains essential amino acids that "promote the
production of various neurotransmitters and enzymes critically needed in brain metabolism
allowing smooth, balanced cognition and fluid transition from thought to disciplined action"
(http://www.vaxa.com). But, according to a controlled study (Spencer, Biederman, Wilens,
Harding, O'Donnell, Griffin, 1995) amino acids for the treatment of AD/HD only provided
benefits that did not last beyond 2-3 months. Short-term benefits were suspected to be the
result of tolerance that develops. The fact that the benefits were not sustained over time shows
that consumption of essential amino acids contained in "Attend" may not be as effective and
long-lasting as VAXA promises. The study also showed that some amino acids may have side
effects. One adult participant in the study who took L-Tyrosine (which is contained in "Attend")
became irritable and angry (Arnold).
VAXA stipulates that the natural hormone pregnenolone is included in "Attend" to aid in memory retention and to help neural growth and reconfiguration which allows growth and "connectivity" of neural cells and, in turn, enables learning to proceed with less frustration (http://www.vaxa.com)bbib1. A recent study (Strous, Spivak, Yoran-Hegesh, Maayan, Averbuch, Kotler, Mester, Weizman, 2001) shows that higher levels of pregnenolone decrease the severity of AD/HD symptoms. The study examined the relationship between pregnenolone and AD/HD symptoms by measuring levels of DHEA (dehydroepiandrosterone) in the blood of AD/HD males; researchers used DHEA blood levels to determine this relationship because DHEA's principal precursor is pregnonolone. The experiment found that subjects with higher DHEA blood levels displayed fewer hyperactive symptoms. Further research (Strous, Spivak, Yoran-Hegesh, Maayan, Averbuch, Kotler, Mester, Weizman, 2001) shows that DHEA, and therefore pregnenolone, may exert positive effects in AD/HD patients by improving neurotransmission at specific receptors. Evidently, this scientific research supports VAXA's claim about what pregnenolone does and how higher levels of the substance reduce the severity of AD/HD symptoms.
What claims are made about the effectiveness of this treatment?
In order to evaluate the effectiveness of "Attend," we must first examine other available treatments:
Psychostimulants (such as methylphenidate, dextroamphetamine, and pemoline) are the most widely used treatments for the management of AD/HD-related symptoms. Between 70-80% of children with AD/HD respond positively to psychostimulant medications. However, many stimulants, such as Adderall, Concerta, and Ritalin, cause unfavorable side effects. Common side effects from psychostimulants include irritability, difficulty going to sleep, nausea, depression, moodiness, the "rebound effect" when the medication wears off, and temporary tics (http://add.about.com). Often, psychostimulant medication is most effective in adolescents when it is combined with a behavior modification program that may include academic help for the child and parenting strategies.
Behavior therapy alone may be used as a single form of treatment. The therapy teaches individuals to be more patient, to better handle anger and frustration and to curb impulsivity. Behavior therapy, however, has not proven to be effective as a stand alone treatment; it is most beneficial used with psychostimulants.
An alternative form of treatment is Neurofeedback. Neurofeedback trains AD/HD patients to control their brain waves. Unlike other forms of treatment, the effects of Neurofeedback are supposedly permanent because once the patient learns how to control his brain waves, the results last indefinitely (http://healthpsych.psy.vanderbilt.edu/HealthPsych/neuro_ADD.htm).
"Attend" may be a favorable AD/HD treatment compared to other choices. Unlike stimulant medications, "Attend" is a natural supplement that allegedly has no side effects. VAXA encourages AD/HD patients to take "Attend" instead of participating in Neurofeedback training because the use of the formula, over the same length of time, allegedly accomplishes "about the same results," but for far less money (http://www.vaxa.com).
VAXA asserts that the greatest effect from "Attend" should occur from four to six months of continued use, but patients should notice the benefits of the treatment within three to four months. VAXA suggests that patients who are trying to "get off of" psychostimulants should take "Attend" and continue taking psychostimulants until they wean their way off the prescription medication. The goal is to reduce or completely eliminate use of stimulants or other medications over a six month period of time.
What evidence does VAXA offer in support of their claims?
VAXA provides no well-controlled, valid studies that endorse their specific claims. The only scientific evidence in support of the exact formula contained in "Attend" is presented on VAXA's website.
According to clinical trials, which VAXA considers "pilot" studies, results showed that when used for a period of 30 days, with no other interventions in place, 70% of the subjects made "statistically significant" improvements as measured by the computerized performance test known as the TOVA (Test of Variables of Attention). As measured by the TOVA, 30% of the subjects jumped from "out of the normal ranges" to "within normal ranges" of performance. This jump in performance is supposedly comparable to having the "perfect" dose of Ritalin in their systems at a 1.5 hour interval. As measured by parent ratings, 80% of the subjects showed improvement in behavior and academic performance (http://www.vaxa.com).
The evidence offered in the clinical trial is rather vague. The experiment does not articulate exactly what comprises a "statistically significant" improvement. Additionally, the "parent ratings" are unreliable because the parents did not use a precise formula, scale, or test to measure and evaluate the children's improvements.
Who is presenting this information, and why are they presenting it?
There is no scientific information about "Attend" specifically. The only reliable information that can be gathered about "Attend" is by researching each particular ingredient contained in the formula and investigating VAXA's treatment approach in relation to other treatment approaches. Information about "Attend" itself is only listed on VAXA's website. VAXA is presenting the information in order to sell their product. The information found on the site is aimed at persuading consumers to buy their product; thus, the information may not be completely true. In fact, since medical researchers have not yet reached a consensus on the specific cause of AD/HD, VAXA's stipulation on what exactly causes the condition may be false. If the information that VAXA provides on the cause of AD/HD is false, then their remedy to treat the disorder could possibly be ineffective.
Testimonials, the weakest form of evidence, present information about the effectiveness of "Attend." Since there are so many AD/HD treatments on the market today, many treatments are marketed with emotional hype, which make claims that are not realistic. Some marketing often appears insidiously scientific and logically sound, however, the product might not be biologically sound; other marketing may be factually accurate yet its overall message may be misleading. Moreover, the rationale for using many alternative therapies is based on traditional uses or purported mechanisms of action rather than on scientific data. Because AD/HD affects one, two, or several parts of the brain, no two individuals diagnosed with AD/HD are the same. Just because a product works for one patient, or even some patients, does not mean that it will work for all individuals, or even most patients. Having success with just one out of a few patients is probably sufficient enough to build big marketing programs complete with testimonials from satisfied parents and patients. Big marketing programs present a huge problem, especially when paired with statements which would lead a parent to believe that the product will work for anyone and everyone, and if for some reason it does not it is probably because the parent or child is not trying hard enough or has some other serious problem.
Because medical experts have not yet reached a consensus on the true cause of AD/HD, much controversy surrounds the debate of what treatments prove most effective. The one thing that is for sure is that the form of treatment that is most effective is unique to each AD/HD individual.
When one is thinking about taking "Attend," it is important to remember that the FDA does not regulate nutritional supplements. The consistency, purity, potency, and safety of natural remedies can vary among manufacturers and even within the same lot produced by a single manufacturer. Contamination by pesticides, heavy metals, and other products may also occur at any time during the manufacturing process. Also, it is difficult to assess how safe a natural supplement is because many of the ingredients in natural supplements are often listed under other names. For example, in "Attend," VAXA lists the ingredient "caffeinum," which really stands for caffeine. VAXA's website provides a list of all the ingredients contained in "Attend" and gives you a description of each ingredient through a link within the website. Upon a careful investigation, however, many of the links do not provide information. For example, when I clicked on the link that should provide a description of the ingredient "DHA (Decosahexaenoic Acid)" the link brought up a window that said "Sorry but this ingredient is under construction. Please check back later. Thank you."
After scrutinizing VAXA's claims about "Attend" and investigating scientific evidence
about AD/HD in relation to VAXA's treatment approach, I have found that the effectiveness of
"Attend" is debatable. Certainly more research must be conducted to find the true etiology of
the disorder. Once scientists reach a consensus about the cause(s) of AD/HD, it will become
easier to assess the effectiveness of "Attend," as well as other treatment approaches.
Additionally, even without knowing the exact etiology of AD/HD, more scientific studies must
be carried out in order to find what AD/HD remedies are safe and effective.
Arnold, Eugene. "Alternative Treatments for Adults with Attention-Deficit Hyperactivity Disorder (ADHD)." Ann NY Acad Sci 931 (2001): 310-341.
Bastain, Theresa, et al. "Cytogenetic Abnormalities in Attention-Deficit/Hyperactivity Disorder." Journal of the American Academy of Child and Adolescent Psychiatry 2002 July;41(7): 806-810.
Baumgaertel, Anna. "Alternative and Controversial Treatments for Attention- deficit/hyperactivity disorder." Pediatric Clinics of North America 1999 Oct;46(5): 977- 992.
Sonuga-Barke, Edmund. "Psychological Heterogeneity in AD/HD-A Dual Pathway Model of Behaviour and Cognition." Behavioural Brain Research 10 Mar. 2002: 29-36.
Spencer, Thomas, Joseph Biederman, Timothy Wilens, Margaret Harding, Deborah O'Donnell, and Susan Griffin. "Pharmacotherapy of Attention-Deficit Hyperactivity Disorder Across the Life Cycle." Journal of the American Academy of Child and Adolescent Psychiatry 1996 April;(35): 409-432.
Strous, Rael, Baruch Spivak, Rony Yoran-Hegesh, Rachel Maayan, Elena Averbuch, Moshe Kotler, Roberto Mester, and Abraham Weitzman. "Analysis of Neurosteroid Levels in Attention Deficit Hyperactivity Disorder." International Journal of Neuropsychopharmacology 4 (2001): 259-264.
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