Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Homoeopathy, Durban University of Technology, 2009. / INTRODUCTION The aim of this study was to evaluate the efficacy of homoeopathic simillimum in the treatment of attention-deficit/hyperactivity disorder (AD/HD) in schoolgoing children aged 6-11 years. AD/HD affects approximately 3-5% of children worldwide. It is thus a highly prevalent childhood disorder characterised by hyperactivity, impulsivity and restlessness. There are 3 subtypes of the condition, namely combined type, predominantly inattentive type and predominantly hyperactive-impulsive type (DSM-IV-TR, 2000 pg 90). OBJECTIVE The objective of the study was to determine the efficacy of homoeopathic simillimum in the treatment of this disorder, and thus promote homoeopathy as a safe alternative to conventional AD/HD treatments. METHODOLOGY The study was conducted as a double-blind placebo-controlled study. The sample group consisted of 30 participants. There was an experimental group of 16, which was compared to a placebo control group of 14. Participants were recruited from the greater Durban area. They had to satisfy clear inclusion and exclusion criteria. Participants and parents/guardians were required to attend 3 consultations with the researcher at The Homoeopathic Day Clinic over a 2-month period. The ADHD Rating Scale-IV Home and School Versions (Appendices B and C) had to be completed by the participant’s parent/guardian and teacher respectively. One was filled in at the initial consultation to serve as a baseline reading, and thereafter, every month. Remedies were dispensed at the first 2 consultations and these remedies were decided upon after thorough case-taking, use of Radar 9.0 Homoeopathic Software and discussion with 1 of 2 selected clinicians. Those on placebo were given free treatment at the end of the study. RESULTS Statistical analysis was conducted on the ADHD Rating Scales-IV Home and School Versions (Appendices B and C), completed by the parent/guardian and teacher respectively. Improvement was based on a decrease in the rating scale score. On analysis, the results (Table 4.8, 4.9 and 4.10) showed no statistically significant effect of treatment (i.e. no difference between treatment and placebo group), but across the whole trial and within each group (particularly the treatment group) subjects had significant reductions in symptoms (i.e. the reductions in symptoms were large enough that there was less than 5% chance that they were random fluctuations/effects). This was seen in both the treatment and placebo groups, as indicated by Table 4.11, 4.12 and 4.13, but more significant reductions were seen in the treatment group, indicated by Table 4.14. As discussed in Chapter 5, this by no means rules out the efficacy of homoeopathic simillimum for the treatment of AD/HD. CONCLUSIONS A large number of parents, teachers and doctors are seeking a safe, effective way to treat this highly prevalent disorder (Soreff & Chang, 2008) and, although the study did not satisfy the hypothesis that homoeopathic simillimum is an effective treatment for AD/HD in schoolgoing children, it did aid in creating awareness of the use of homoeopathy as a treatment option for this condition and highlighted the need for more extensive research to be undertaken for this treatment option. It is the researcher’s opinion that larger, longer duration studies, employing quantitative analysis, as well as qualitative analysis would yield more significant results.

Dissertation submitted in partial compliance with the requirements for a Masters Degree in Technology: Homoeopathy, Durban University of Technology, 2009. / INTRODUCTION The aim of this study was to evaluate the efficacy of homoeopathic simillimum in the treatment of attention-deficit/hyperactivity disorder (AD/HD) in schoolgoing children aged 6-11 years. AD/HD affects approximately 3-5% of children worldwide. It is thus a highly prevalent childhood disorder characterised by hyperactivity, impulsivity and restlessness. There are 3 subtypes of the condition, namely combined type, predominantly inattentive type and predominantly hyperactive-impulsive type (DSM-IV-TR, 2000 pg 90). OBJECTIVE The objective of the study was to determine the efficacy of homoeopathic simillimum in the treatment of this disorder, and thus promote homoeopathy as a safe alternative to conventional AD/HD treatments. METHODOLOGY The study was conducted as a double-blind placebo-controlled study. The sample group consisted of 30 participants. There was an experimental group of 16, which was compared to a placebo control group of 14. Participants were recruited from the greater Durban area. They had to satisfy clear inclusion and exclusion criteria. Participants and parents/guardians were required to attend 3 consultations with the researcher at The Homoeopathic Day Clinic over a 2-month period. The ADHD Rating Scale-IV Home and School Versions (Appendices B and C) had to be completed by the participant’s parent/guardian and teacher respectively. One was filled in at the initial consultation to serve as a baseline reading, and thereafter, every month. Remedies were dispensed at the first 2 consultations and these remedies were decided upon after thorough case-taking, use of Radar 9.0 Homoeopathic Software and discussion with 1 of 2 selected clinicians. Those on placebo were given free treatment at the end of the study. RESULTS Statistical analysis was conducted on the ADHD Rating Scales-IV Home and School Versions (Appendices B and C), completed by the parent/guardian and teacher respectively. Improvement was based on a decrease in the rating scale score. On analysis, the results (Table 4.8, 4.9 and 4.10) showed no statistically significant effect of treatment (i.e. no difference between treatment and placebo group), but across the whole trial and within each group (particularly the treatment group) subjects had significant reductions in symptoms (i.e. the reductions in symptoms were large enough that there was less than 5% chance that they were random fluctuations/effects). This was seen in both the treatment and placebo groups, as indicated by Table 4.11, 4.12 and 4.13, but more significant reductions were seen in the treatment group, indicated by Table 4.14. As discussed in Chapter 5, this by no means rules out the efficacy of homoeopathic simillimum for the treatment of AD/HD. CONCLUSIONS A large number of parents, teachers and doctors are seeking a safe, effective way to treat this highly prevalent disorder (Soreff & Chang, 2008) and, although the study did not satisfy the hypothesis that homoeopathic simillimum is an effective treatment for AD/HD in schoolgoing children, it did aid in creating awareness of the use of homoeopathy as a treatment option for this condition and highlighted the need for more extensive research to be undertaken for this treatment option. It is the researcher’s opinion that larger, longer duration studies, employing quantitative analysis, as well as qualitative analysis would yield more significant results. / M

Sammanfattning Syfte: Syftet med studien var att beskriva arbetsterapeuters kliniska resonemang samt erfarenheter av interventioner för att främja delaktighet i aktivitet hos barn med ADHD. Metod: Studien var baserad på en kvalitativ ansats med semistrukturerade intervjuer för att undersöka arbetsterapeuternas kliniska resonemang och erfarenheter. Sex arbetsterapeuter från olika regioner i Sverige deltog i studien. En kvalitativ innehållsanalys användes för att undersöka erfarenheter av interventioner vilka därefter analyserades deduktivt för att identifiera kliniska resonmang. Resultat: Resultatet redovisades i ett övergripande tema; Att möta barnet och familjen i den aktuella situationen med tre kategorier; Hela familjen som klient, Kartläggning av aktivitetsutförande för en lyckad intervention och Resonemang kring yrkesetiska aspekter. Resultatet visade att klientcentrering var kärnan i deltagarnas kliniska resonemang där empati, samarbete och kommunikation var viktiga aspekter att resonera kring. Deltagarnas erfarenhet var att det mest betydelsefulla för att främja delaktighet i aktivitet hos barn med ADHD var inlärning av strategier för att hantera barnets begränsningar i vardagen. Utöver det var olika former av kognitivt stöd vanligt förekommande interventioner. Slutsats: Studien har bidragit till ökad insikt i arbetsterapeuters erfarenhet av interventioner i arbetet med barn med ADHD samt en ökad förståelse för arbetsterapeuters kliniska resonemang.

Basic criteria for determination of Attention Deficit Hyperactivity Disorder (ADHD) include hyperactivity, impulsivity, and distractibility. Four scales of the Personality Inventory for Children have been found to be useful in the diagnosis of ADHD. Impulsivity and distractibility can affect scores on the Hand Movements, Number Recall, Word Order, Spatial Memory, Arithmetic, Riddles, and Matrix Analogies subtests of the Kaufman Assessment Battery for Children. Subjects were 100 children, aged six through 13 who were referred for psychological assessment. The purpose of this study was to determine if there was a correlation between scores on the four scales of the PIC and the designated subtest scores on the KABC. Four correlations were significant, but of low magnitude.

Background. Numerous clinical trials demonstrate the efficacy of medication and behavioral treatment for Attention-Deficit/Hyperactivity Disorder (ADHD) in children, but provision of behavioral treatment for ADHD is limited in community clinics and only the pharmacological treatment is the standard care for children with ADHD. The current study evaluated the treatment effectiveness of combining psychosocial treatment to methylphenidate and to compare this combined treatment with medication alone in treating ADHD in children of a community mental health center in Hong Kong. Psychosocial treatment consisted of parent training and child intervention. The treatment group for children was a 24-week problem solving, anger coping, and social skills training program. Parent training consisted of 18 weekly sessions, highlighting parenting as an integration of elements of cognition, emotion, and behavior, as well as introducing effective parenting techniques based on social learning principles. Method. A group of 146 consecutive child patients with ADHD symptoms attending Yaumatei Child Psychiatric Center were invited for screening their eligibility of participating in this study. A randomized group comparison design was used with two treatment conditions (medication-only; combined medication and psychosocial treatment) and four assessment time points. Ninety eligible child-parent dyads were randomly allocated to the combined treatment condition or medication-only condition. Treatment outcomes were assessed in multiple domains at pre-intervention and post-intervention, and at 6-month and 12-month follow-ups. Data was analyzed through intent-to-treat mixed-effects regression model. / Conclusions. The combined treatment condition not only yielded significantly greater benefits than the medication-only condition on primary ADHD symptoms, but also other advantages in terms of conduct problem and adaptive functioning outcomes. / Results. Regarding ADHD symptoms, children in combined treatment condition showed significantly greater improvement than those given medication alone at post-treatment assessment. Combined treatment also proved better than medication alone in several other domains, such as oppositional behavior, a child's performance on computerized test, parenting behavior, and parental accurate knowledge of ADHD. Parental treatment-related attributions were also found to be changing over the course of treatment. Follow-up assessments revealed that children in the combined treatment condition maintained greater reduction in oppositional behavior one year after the completion of psychosocial treatment. / So Yuk-chi. / "May 2005." / Adviser: Patrick W. L. Leung. / Source: Dissertation Abstracts International, Volume: 67-07, Section: B, page: 4119. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 222-247). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract in English and Chinese. / School code: 1307.

Attention-deficit hyperactivity disorder (ADHD) is a common neuropsychiatric disorder with onset at preschool age Approximately 5-10% of school-aged children worldwide have ADHD. Psychostimulants are the most common treatments for ADHD, although the precise etiology and pathological mechanisms underlying ADHD are poorly understood. Animal models could help to elucidate and further the understanding of this disorder. Among the major rodent models of ADHD of the genetic and neurotoxin-exposed animal models, the spontaneously hypertensive rats (SHR) are more extensively studied. Nevertheless, the mechanism of ADHD is complex and the evidence of SHR model for ADHD has been conflicting. Objective. In this work, we combined behavioral, neurochemical, neuroimaging, pharmacological and molecular studies to examine SHR as an animal model of ADHD. At the same time, the results of our studies could help us to explore the potential mechanism of ADHD. Material and methods. We compared the locomotor activity, attention, inhibition, learning and memory of juvenile male SHR with those of age- and gender-matched genetic control Wistar-Kyoto rats (WKY) by using the open field test, Morris water maze and prepulse inhibition test. We employed magnetic resonance imaging (MRI) to measure potential morphological differences between different brain areas of SHR and WKY, and the functional MRI (fMRI) for functional differences in these brain areas. We also measured dopamine concentration and dopamine related genes expression in the different dopamine pathways by using enzyme-linked immunosorbent assay (ELISA) to measure the dopamine concentration and by using real time PCR to assay genes expression. We examined SHR responses to D-amphetamine (D-AMP), which is psychostimulant. These included locomotor activity and inhibition ability during D-AMP treatment, expression of dopamine related genes after D-AMP treatment measured by real time PCR and c-fos protein after repeated treatment of D-AMP by the Western Blotting. Results . Hyperactivity, impulsivity and attention deficit were observed in SHR. Decreased brain volume in caudate-putamen and vermis cerebelli in SHR were demarcated using MRI. Functional MRI (fMRI) and altered c-fos expression indicated plasticity changes of the prefrontal cortex (PFC) in SHR. Dopamine content was found to decrease in mesocortical and mesolimbic dopamine pathways, but increased in the striatum. Dopamine D4 receptors gene and protein expression were decreased in the PFC in SHR. We also found that the expression of the synaptosomal-associated protein 25 (SNAP-25) gene was initially lower in the PFC but higher in the striatum in SHR. However, this disparity of SNAP-25 in the PFC vanished after repeated treatment of D-AMP between SHR and WKY. Conclusions. In the present study, we demonstrated that SHR could be established as an ADHD model by completing complex assessments of face validity, construct validity and prediction validity. We suggested that the "synaptogenesis hypotheses" might contribute to the abnormal release of dopamine and dysfunction of PFC and the striatum in SEER. In conclusion, our results have provided further new information relevant to the understanding of ADHD in human via the analysis of the SHR model. / Li, Qi. / Adviser: David Yen. / Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 1375. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 108-125). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese. / School code: 1307.

Studiens syfte har varit att undersöka upplevelsen och betydelsen av att få en ADHD-diagnos hos unga kvinnor. Studien har haft en kvalitativ ansats och består av intervjuer med tre kvinnor i åldrarna 24 till 30 år som alla har fått sin diagnos efter tjugo års ålder. Utskrifterna från dessa intervjuer har meningskoncentrerats och har analyserats utifrån känsla av sammanhang, diagnossociologiska tankeströmningar och medikaliseringsbegreppet. De två forskningsfrågor som studien har ämnat besvara har varit dels hur de intervjuade kvinnorna har upplevt att få en ADHD-diagnos och dels vilken betydelse ADHD-diagnosen har haft för de intervjuade kvinnorna. Resultatet visar att kvinnorna i studien upplevde det som mestadels positivt att få en ADHD-diagnos och att diagnosen har ökat deras känsla av sammanhang avseende framför allt begriplighet och hanterbarhet men även avseende meningsfullhet. Att få en diagnos har enligt mina informanter inneburit att de förstår sig själva bättre och att de också har fått en större förståelse från andra. Diagnosen har också fungerat som en förklaringsmodell för ens eget beteende. Förutom att egna beteenden har omdefinierats till att förstås utifrån en medicinsk förklaringsmodell har diagnosen även inneburit att kvinnorna fått tillgång till hjälp och hjälpmedel som exempelvis receptbelagda läkemedel. Det har också underlättat utvecklingen av strategier för att klara av vardagen genom att antingen ”ADHD-säkra” eller använda diagnosen som en felsökningsmanual. Slutligen visar studien, som dess titel skvallrar om, på en alternativ bild av att ha en ADHD-diagnos än den som vanligtvis förmedlas i samhället, där kvinnorna ser på ADHD mer som en uppsättning personlighetsdrag som förvisso kan innebära vissa svårigheter i vardagen men som också för många goda saker med sig så som kreativitet, initiativrikedom och en förmåga att se möjligheter där andra ser problem. / The purpose of this study was to examine the experience and the meaning of being diagnosed with ADHD in young women. The study had a qualitative approach and consists of interviews with three women aged 24 to 30 whom all received their diagnosis after the age of 20. The transcripts from the interviews have been processed through meaning condensation and then content analysis, focusing on sense of coherence, sociology of diagnosis and medicalization. The study aims to answer two questions – how the interviewed women experienced being diagnosed with ADHD and what meaning the diagnosis had for the interviewed women. The results shows that the women in this study mainly had positive experiences of being diagnosed with ADHD and that the diagnosis increased their sense of coherence mainly in regards of comprehensibility and manageability but also regarding meaningfulness. Getting an ADHD-diagnosis has, according to the interviewed women, led to a greater understanding of themselves and also to a more understanding approach from others. The diagnosis has also been used as an explanation model for their own behavior. In addition to own behaviors being redefined to be understood in a medicinal explanation model, the diagnosis has also meant that the women has gained access to help and aids like, for instance, prescription drugs. It has also facilitated the development of strategies for managing everyday life through either “ADHD-securing” and using the diagnosis as a manual for troubleshooting.  Finally, this study shows an alternative picture of having an ADHD-diagnosis that differs from the picture that is usually conveyed in society, where the women in this study perceive ADHD more as a set of personality traits that indeed may cause difficulties in their everyday life but also brings a lot of good things with it, such as creativity, an ability to take initiatives and an ability to see possibilities where others see problems.

Attetion Deficit Hyperactivity Disorder, ADHD, är den vanligaste barnpsykiatriska diagnosen.Syftet med denna studie var att beskriva hur skolsköterskan erfar skolsituationen för elevermed ADHD-diagnos. Fyra till sex procent av alla elever i skolan har denna diagnos (ADHD).Skolsköterskan har i sin dagliga kontakt med elever möjlighet att tidigt upptäcka och även tillviss del förhindra utvecklandet av komplikationer. Orsaken till ADHD består främst avgenetiska anlag men sociala faktorer finns och de påverkar hur svår utvecklingen blir.Metoden var en kvalitativ innehållsanalys med induktiv ansats beskriven av Lundman ochHällgren Graneheim. Datainsamlingen gjordes genom intervjuer med sex skolsköterskor. Urdatamaterialet framträdde temat Att förväntas vara som andra, men inte kunna med treunderteman. Resultaten kan användas till att öka förståelsen för elever med ADHD och derasskolsituation. Förhoppningsvis kan insikten om problemets svårighetsgrad öka motivationenatt förbättra situationen i skolan för alla elever och vuxna. Det finns många saker sompåverkar situationen för elever med ADHD, med rätt resurser och förutsättningar gesmöjlighet att påverka elevens utveckling i positiv riktning. / Attention Deficit Hyperactivity Disorder, ADHD, is today the most common psychiatricdiagnosis among children. The purpose of this study was to describe school nurses̛experiences of the school situation of pupils with ADHD. Four to six percent of all schoolpupils have been diagnosed with this illness. Due to her daily contact with school children,the school nurse has the opportunity to assist in early detection of ADHD, and can to someextent even prevent the development of possible complications. Genetic predisposition is theprimary cause of ADHD but social factors affect the severity of its development. The methodin this study was qualitative content analysis with an inductive approach described byLundman och Hällgren Graneheim. The data collection was made through interviews with sixschool nurses. Based on the analysis, the theme; Expected to be like the others, but also notbeing able, emerged with three subthemes. The results can be used to increase theunderstanding of pupils with ADHD in their school situation. Hopefully, awareness of theproblem severity increases motivation to improve the situation in schools for all studentsand adults. There are many things that affect the situation for children with ADHD. With theright resources and conditions the opportunity to influence students' development in apositive direction occurs.

The purpose of this study was to determine school psychologists' current level of knowledge about Attention-deficit/hyperactivity disorder (ADHD), their training and comfort level with that training, their roles and practices in assessing, diagnosing, and treating children and adolescents with ADHD, and their attitudes toward the disorder and those with it. An original survey (see Appendix B) developed for this purpose was distributed to 700 systematically selected members of the National Association of School Psychology (NASP) who were currently practicing in the public schools. A total of 406 usable surveys were returned for a final response rate of 58%.Overall school psychologists are confident in their abilities to deliver services (consultation, assessment, and intervention) to students with ADHD. Respondents underestimated the rate of comorbidity of ADHD with other psychiatric disorders but overestimated the percentage of students with ADHD who also have a learning disability. Respondents most often mentioned diagnosis or identification of the disorder as their goal for assessment of possible ADHD. However, in their rankings of specific goals, respondents ranked the development of appropriate interventions as more important than the diagnosis of the disorder. The most often used standardized tests for ADHD referrals are questionnaires (for parents, teachers, and students) and drawings. Most (57%) school psychologists agreed that they do not determine the diagnosis of ADHD, but rather refer to a medical doctor. A Specific Learning Disability is the most often used special education category for students with ADHD who qualify, followed somewhat closely by Other Health Impaired, then by Emotionally Handicapped. Only 14 percent of the school psychologists surveyed stated that every student with ADHD who did not qualify for special education was considered for accommodations under Section 504. More respondents (83%) agreed that teachers often press to have their problem students diagnosed with ADHD than agreed that parents often press (55%). The majority of respondents (74%) agreed that ADHD is overdiagnosed. However, there was disagreement as to whether stimulant medications were used more often than necessary to treat ADHD. Implications of these findings for school psychologists and for future research are discussed. / Department of Educational Psychology

The catechol-O-methyltransferase (COMT) gene is the predominant means of dopamine deactivation within the prefrontal cortex (PFC), a brain locus implicated in Attention deficit/hyperactivity disorder (ADHD). Dopamine dysregulation is a significant contributor to the pathophysiology of ADHD and Methylphenidate (MPH), an effective treatment for ADHD, and acts at least in part, through modulation of dopamine levels in the PFC. Thus, we tested the hypothesis that the Catechol-O-Methyltransferase (COMT) Val108/158 Met polymorphism modulates behavioral dimensions relevant for ADHD and/or response of these behavioral dimensions to MPH and/or neuropsychological functions considered relevant for ADHD. No genotype or genotype by treatment interaction effects were observed for behavioral response to MPH. No genotype effects were observed using the family-based approach. Marginal genotype effects were observed between the Met/Met genotype and some but not all aspects of executive functioning. Overall, these results do not support the implication of the COMT Val108/158 Met polymorphism in ADHD, ADHD relevant behaviours or response to methylphenidate, but weakly implicate COMT gene in some aspects of executive functions in children with ADHD. Given that gene effects on behaviours are likely to be very small, a much large sample would be needed in order to establish these results, both negative and positive, with better confidence.