Food dyes and ADHD symptoms have been studied for decades in the quest to create a good ADHD diet plan for those with the disorder.  Thus far, the research conducted has generally been inconclusive.  Although there is a general agreement that some connection between food dyes and ADHD may exist, the nature of this connection is uncertain.

Food Dyes and ADHD

Although research findings are mixed on the impact of food dyes, the research suggesting negative effects is concerning. In fact, The Center for Science in Public Interest is asking the FDA to ban all artificial food dyes.  

When it comes to food dyes impact on specific disorders, those with ADHD might have a distinct intolerance.  In many studies, the dyes in food and ADHD symptoms (specifically hyperactivity) were positively correlated (Diets for ADHD Hyperactive Child and Inattentive Type).  This means as the consumption of food dyes increase, the severity of ADHD symptoms does as well. Although research is mixed, if you have concerns about the dyes in food and ADHD symptoms of either yourself or your child, there are ways to decrease the consumption of these additives.

Dyes in Food and ADHD: What to Look Out For

Some studies identify specific additives and colorants to look out for when it comes to food dyes and ADHD.

• Blue No. 1 – this additive is often disguised in ingredients labels under the name “brilliant blue.” While it may sound harmless, in terms of food dyes and ADHD, blue no. 1 can have the same negative effects, including increased hyperactivity and decreased attention and focus.
• Blue No. 2 - this food coloring is also known at indigotine, and is present in many popular food items such as pop-tarts, M&M’s, and Betty Crocker frostings.
• Red No. 3 – also referred to as carmoisine, the food coloring red no. 3 is often put in candy, gum, and cake icings.
• Red No. 40 – in terms of food dyes and ADHD, red no. 40 (sometimes called allura red), is one of the most discussed.  This may be because this is the most popularly used food dye and thus, it is in many packaged food items (i.e. – Quaker instant oatmeal, Fruit Loops, Frito-Lay chips, etc.). And although the FDA has approved this food dye, it has, at times, been banned in Australia and much of Europe, due to health concerns. Many studies have been done on this food dye and ADHD symptoms.  Red no. 40 has been linked to increased nervousness and decreased ability to concentrate.
• Yellow No. 5 – the second most commonly used food dye in America, yellow no. 5 (also called tartrazine) is linked to increased hyperactivity.  Be sure to check for this additive when considering the impact of food additives and ADHD.
• Yellow No. 6 – on many ingredient labels, yellow no. 6 is referred to as sunset yellow.  This is another common food dye found in things like fruit roll-ups, gelatin desserts, and instant puddings.
• Green No. 3 – this food coloring, although rarely used anymore, can still be found in some candies, pudding, ice cream, and beverages.
• Sodium Benzoate – found in pickles, fruit juices, and carbonated drinks, sodium benzoate is a food preservative, is used to stop the growth of microorganisms.

article references

In-depth information on the causes and risk factors of Alzheimer's Disease.

Alzheimer's Causes

The causes of Alzheimer's disease (AD) are not entirely known but are thought to include genetics and environmental factors. New research indicates that free radicals (highly reactive molecules that can cause oxidation, or damage to cells) may play a role in the development of AD.

A gene for the protein epsilon apolipoprotein (Apo E)—especially Apo E3 and Apo E4 varieties—is thought to accelerate the formation of abnormal deposits (called plaques) in the brain and increase the risk for AD. Reports indicate that between 50% and 90% of those with the Apo E4 gene develop AD. However, even people without inherited genes for the disease can get AD.

Scientists also believe the environment may play a part in Alzheimer's disease because people in different regions of the world have widely varying risks of developing the disease. For example, people living in Japan and West Africa have much less risk for AD than Japanese and Africans living in the United States.

People with Alzheimer's disease have abnormal deposits, or plaques, in their brain tissue. These plaques contain beta amyloid, a protein that releases free radicals, or highly reactive molecules that can cause damage to cells through a process called oxidation. These free radicals are believed to lower levels of acetylcholine (a brain chemical that helps transmit impulses in the nervous system) and damage brain tissue, bringing on the symptoms of AD.

Although not confirmed by scientific studies, other factors that have been speculated to contribute to the development of AD include infections (such as herpesvirus type 1), exposure to metal ions (such as aluminum, mercury, zinc, copper, and iron), or prolonged exposure to electromagnetic fields.

Alzheimer's Risk Factors

The causes and risk factors contributing to the development of Alzheimer's disease are not entirely clear. The following all appear to have an association with AD to varying degrees.

• Family history of Alzheimer's disease
• Older age—20% to 40% of people with AD are older than 85
• Female gender—while women tend to develop AD more than men, this may be related to the tendency for women to live longer
• Americans are more likely to get AD than Asians or Native Americans
• Long-term high blood pressure
• History of head trauma—one or more serious blows to the head may put a person at an increased risk
• Down Syndrome
• Elevated levels of homocysteine (a body chemical that contributes to chronic illnesses such as heart disease, depression, and AD)
• Aluminum or mercury poisoning
• Prolonged exposure to electromagnetic fields

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Alzheimer's Preventive Care

• Consuming a low-fat, low-calorie diet may reduce the risk for Alzheimer's.
• Higher intake of fatty, cold-water fish (such as tuna, salmon, and mackerel) has been associated with a lower risk of dementia. This may be due to the high level of omega-3 fatty acids found in such fish. Eating fish at least two to three times per week provides a healthy amount of omega-3 fatty acids.
• Reducing intake of linoleic acid (found in margarine, butter, and dairy products) may prevent cognitive decline.
• Antioxidants, such as vitamins A, E, and C (found in darkly colored fruits and vegetables) may help prevent damage caused by free radicals.
• Maintaining normal blood pressure levels may reduce the risk of AD.
• Hormone-replacement therapy in postmenopausal women may decrease the production of chemicals that cause AD, stimulate the growth of brain cells, and improve blood flow in the brain. However, the role of hormones in the prevention of AD is still controversial.
• Some studies suggest that certain medications may prevent AD, including "statin" drugs (such as pravastatin or lovastatin, used to lower cholesterol) and nonsteroidal anti-inflammatories (NSAIDs), with the exception of aspirin. More research is necessary, however, to determine how effective these medications are in reducing the risk of the disease.
• Keeping mentally and socially active may help delay the onset or slow the progression of AD.

Food for ADHD. For your child with ADHD, what he or she eats can make a big difference in ADHD symptom management.

Food, for ADHD children, can greatly impact their mental, physical and behavioral health.  Of course, diet and nutrition are central to any person’s overall health and well-being.  Yet for a child with inattention and/or hyperactivity, a diet that consists of specific food for ADHD symptom management can have a significant impact (Best Diet for Your ADHD Child).  In order to do this, you must be aware of which foods are helpful, and which foods are not, in terms of your child’s ADHD.

Healthy Food for ADHD

Although there are not any foods found to actually cure (or cause) ADHD, there are certain choices, when it comes to food for ADHD children, that can be much more beneficial than others.

• Healthy carbs – carbohydrates provide energy to the body, brain, and nervous system.  But many of us choose unhealthy carbs that lack fiber, vitamins, and minerals. Some healthy carbohydrate options are walnuts, whole-wheat pasta and bread, lentils, and brown rice.
• Organic fruits and vegetables – although organic fruits and vegetables do not necessarily have more nutritional value than their non-organic counterparts, they are free from pesticides, which have been linked to increased ADHD symptoms. Buying organic can be expensive, so if you cannot afford to do so, wash the fruits and vegetables that you do buy very well.
• Healthy fats – we all need a certain amount of fat for our brain to function. Thus, choosing healthy fats is an essential part of using food for ADHD symptom management.  Try using olive, coconut or safflower oil when cooking for your child. Also, incorporating avocado into recipes is an easy way to provide your child with a healthy fat.
• Protein – protein is a central aspect of healthy brain function. Protein promotes the production of neurotransmitters in the brain, which induce alertness and focus.  Protein also helps maintain steady blood sugar levels. Depending on your child’s age, aim for somewhere between 24 to 30 grams of protein per day.

Foods to Avoid: Unhealthy Foods for ADHD Child

• Trans and hydrogenated fats – unhealthy for anyone, trans and hydrogenated fats are particularly unhelpful in terms of food for ADHD children.  This is because hydrogenated oils and fats interfere with nerve functioning in the brain. Surprisingly, many food items that say “zero trans fat” still contain it. Manufacturers are able to label foods as such, as long as they have less than .5 grams of trans/hydrogenated fats. Be sure to check the ingredients to be certain about what you are purchasing.
• Saturated fats – the western diet is full of saturated fats (which are found in many meats, dairy, and poultry).  Choosing unprocessed, lean meats and poultry, and low-fat dairy products is a good way to monitor your child’s saturated fat consumption.
• Artificial additives – these come in the form of artificial colorants, dyes, sweeteners, and preservatives. These chemicals can cause hyperactivity in children who are not diagnosed with ADHD, so it is not surprising they are considered unhelpful in terms of children with ADHD (Food Dyes and ADHD: Do Food Dyes Cause Hyperactivity?).
• Sugar – it may be impossible to eliminate all sugar from your child’s diet, but monitoring his or her sugar intake is important (ADHD and Sugar: How Sugar Affects Your ADHD Child’s Behavior). Limit sugary sodas, juices, and desserts and encourage healthier choices by having other accessible options.

article references

Pregnant women with ADHD, after consultation with their doctor, may consider SSRI antidepressants and antihypertensives to control some of the ADHD symptoms.

While the stimulants remain the most effective treatment for AD/HD, other medications that are approved for use during pregnancy might also be considered to address either associated symptoms such as the anxiety and depression or for the AD/HD itself. Further investigation may need to be done, but here is some of what we know now.

• The antihypertensives (Clonidine and Tenex) are second line treatments for AD/HD and are no longer considered a risk during pregnancy as a result of studies that have shown no significant association between exposure during pregnancy and defects or behavior changes in infants.
• The SSRI antidepressants also have been studied and have a large database on pregnancy exposure.
• After considerable monitoring, Prozac, Luvox, Paxil, and are considered to have no increased risk of major malformations in the infant when used within recommended dosage levels during the pregnancy. There was also no increased risk of miscarriage, stillbirth, or premature delivery noted.
• Wellbutrin does not yet have enough data, but has been labeled a Category B as a result of studies done in rabbits. A pregnancy database to monitor its safety was established in 1997 to further investigate its safety in humans and currently contains almost 400 mother-infant cases. The registry may be found here. There is there is some concern about its use during pregnancy and a potential for congenital heart defects.

Regarding stimulants for ADHD, there have been no well-controlled human studies of stimulants during pregnancy. Animal studies show adverse effects. Studies of women addicted to amphetamines have shown higher rates of low birth rate and pregnancy complications. Another study found that children of women exposed to Dexedrine had a higher incidence of heart defects at three-year follow-up. A study of 48 women exposed to methylphenidate (Ritalin) during pregnancy found higher rates of premature birth, growth retardation, and symptoms of withdrawal in the infants.

As of August 2006, WebMd ADHD medical expert, Richard Sogn, MD, warns that all medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.

Remember, this information should not be considered a substitute for medical advise and a pregnant women should always discuss such information with her treating physician.

Source:
CHADD website

Detailed information on sleep problems in Alzheimer's patients and how to treat sleep problems associated with Alzheimer's Disease.

The nature of sleep changes in Alzheimer's

Scientists do not completely understand why sleep disturbances occur in people with dementia. Sleep disturbances associated with Alzheimer's disease include increased frequency and duration of awakenings, decrease in both dreaming and nondreaming stages of sleep, and daytime napping. Similar changes occur in the sleep of older people who do not have dementia, but these changes occur more frequently and tend to be more severe in people with Alzheimer's disease.

Some people with Alzheimer's disease sleep too much while others have difficulty getting enough sleep. When people with Alzheimer's cannot sleep, they may wander during the night, be unable to lie still, or yell or call out, disrupting the rest of their caregivers. Some studies have shown that sleep disturbances are associated with increased impairment of memory and ability to function in people with Alzheimer's. There is also evidence that sleep disturbances may be worse in more severely affected patients. However, a few studies have reported that sleep disruption may also occur in people with less severe impairment.

Coexisting conditions may intensify sleep problems for older adults with Alzheimer's. Two conditions in which involuntary movements interfere with sleep are periodic limb movement and restless leg syndrome. Other common conditions that disrupt sleep include nightmares and sleep apnea, an abnormal breathing pattern in which people briefly stop breathing many times a night. Depression in a person with dementia may further worsen sleep difficulties

Shifts in the sleep-wake cycle of people with Alzheimer's can be severe. Experts estimate that in the later stages of the disease, affected individuals spend approximately 40 percent of their time in bed awake and a significant proportion of their daytime hours asleep. This increased daytime sleep consists almost exclusively of light sleep that compensates poorly for the loss of deep, restful nighttime sleep. In extreme cases, people with dementia may experience complete reversal of the usual daytime wakefulness/nighttime sleep pattern.

Treatment of Alzheimer sleep problems

Although widely used medications can temporarily improve the sleep disturbances of older adults, a number of studies have found that prescription drugs do not improve overall ratings of sleep quality in older people, whether they are living in their homes or in residential care. Thus, the treatment benefits of using sleep medications in individuals with dementia may not outweigh the potential risks. To improve sleep in these individuals, the U.S. National Institutes of Health (NIH) has encouraged use of the nondrug measures described below rather than medication therapy unless the sleep disturbance is clearly related to a treatable medical condition. It is important that the person experiencing sleep problems be professionally assessed for medical or psychiatric causes for the sleep disturbance before applying any drug or nondrug interventions.

Nondrug treatments

A variety of nondrug treatments for insomnia have been shown to be effective in older adults. These treatments, which aim at improving sleep routine and the sleeping environment and reducing daytime sleep, are widely recommended for use in people with Alzheimer's disease. To create an inviting sleeping environment and promote rest for a person with Alzheimer's:

• Maintain regular times for going to bed and arising.
• Establish a comfortable, secure sleeping environment. Attend to temperature and provide nightlights and/or security objects.
• Discourage staying in bed while awake; use the bedroom only for sleep.
• If the person awakens, discourage watching television.
• Establish regular meal times.
• Avoid alcohol, caffeine and nicotine.
• Avoid excessive evening fluid intake and empty the bladder before retiring.
• Avoid daytime naps if the person is having trouble sleeping at night.
• Treat any pain symptoms.
• Seek morning sunlight exposure.
• Engage in regular daily exercise, but no later than four hours before bedtime.
• If the person is taking cholinesterase inhibitors (tacrine, donepezil, rivastigmine or galantamine), avoid nighttime dosing.
• Administer drugs such as selegiline that may have a stimulating effect no later than six to eight hours before bedtime.

Sleep Medications for Alzheimer's Patients

Drug therapy should be considered only after a nondrug approach has failed and reversible medical or environmental causes have been ruled out. For those people who do require medication, it is imperative to "begin low and go slow." The risks of sleep-inducing medications for older people who are cognitively impaired are considerable. These include increased risk for falls and fractures, increased confusion, and decline in the ability to care for oneself. If sleep medications are used, an attempt should be made to discontinue them after a regular sleep pattern has been established.

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The table below lists some of the many different types of medications that can temporarily assist in sleep. The list includes drugs prescribed chiefly for sleep as well as some whose primary use is in treating psychiatric illnesses or behavioral symptoms. Although little is known about the safety and effectiveness of medications for treating chronic sleep disturbances in Alzheimer's, all of these medications are commonly prescribed to treat insomnia and disruptive nighttime behaviors in Alzheimer's disease. All of the medications listed here are available by prescription only and must be used under a physician's supervision. The medication recommended by a physician often reflects the type of behavioral symptoms accompanying the sleep problems.

Some medications commonly used in the treatment of insomnia and nighttime behavioral disturbances in Alzheimer's disease

Drug category	Examples (generic names)	The recommended dose in milligrams/day	Potential adverse effects
Tricyclic antidepressants	Nortriptyline	10 -75	Dizziness, dry mouth, constipation, trouble urinating
	Trazodone	25-75	Dizziness, especially when standing or rising
Benzodiazepines	Lorazepam	0.5 - 2	Lethargy, confusion, unsteadiness
	Oxazepam	10 - 30	Dependence
	Temazepam	15 - 30	Confusion, unsteadiness
Nonbenzodiazepines	Zolpidem	5 - 10	Sedation, confusion
	Zaleplon	5 - 10	Sedation, amnesia
	Chloral hydrate	500 - 1,000	Sedation, nausea
"Classical" antipsychotics	Haloperidol	0.5 - 1.5	Parkinson-like symptoms*
"Atypical" antipsychotics	Risperidone	1 - 6	Dizziness, especially when standing or rising; nausea*
	Olanzapine	5 - 10	Sedation*
	Quetiapine	12.5 - 100	Sedation; dizziness, especially when standing or rising*
* Recent studies have linked use of antipsychotic drugs in older adults with dementia to a slightly increased risk of death. The risks and benefits of using these drugs should be carefully evaluated.

This fact sheet is prepared in consultation with the Alzheimer's Association Clinical Issues and Interventions Work Group. The information provided does not represent an endorsement of any medication or nondrug sleep intervention by the Alzheimer's Association.

Source: Sleep changes in Alzheimer's disease fact sheet, Alzheimer's Association, 2005.

Should a pregnant woman with ADHD take stimulant medication like Ritalin, Adderall XR or Concerta? There is no clear cut answer, but there are risks to the fetus that should be considered.

With more and more women being diagnosed and treated for AD/HD, the question of safe use of stimulant medications during pregnancy has become more critical. In general, stimulants (either the amphetamines like Adderall or methyphenidate like Concerta, Ritalin LA and Metadate CD) are all considered "Category C" teratogens. That means that they should only be used when the risk to the mother outweighs the risk to the fetus.

To date, the effects of stimulants during pregnancy have only been studied in animals, where defects were seen in the offspring when the mothers were given very high doses of the stimulants. The doses of stimulants given to animals for these studies have been 41x and 12x the usual human dose. The literature contains individual case reports of women who have taken stimulants during their pregnancy and, clinically, there have been many other women who have taken stimulants and have had normal babies.

The important questions for a woman who is being treated for AD/HD and who is thinking about getting pregnant or who recently learned that she is pregnant are the following:

• Should she discontinue stimulants prior to becoming pregnant?
• Should she continue stimulants after her first 3 months?
• Should she discontinue medication during the entire pregnancy?
• What are the risks both to the mother and the baby if her AD/HD goes untreated?

Each woman needs to decide the answers to these questions for herself after considering all of the available information and discussing the issue with both the child's father and her physician. The problems with the stimulants have to do with cardiac defects, which usually occur because of problems during the formation stages of each organ system during the first trimester. To date, there are no large-scale studies to provide us with answers.

As for breastfeeding while taking stimulant medication, as of August 2006, WebMd ADHD medical expert, Richard Sogn, MD, warns that all medications are excreted into breast milk, exposing them to the infant. Amphetamines are concentrated in breast milk which causes concern about typical side effects of stimulant medications as well as withdrawal symptoms. There is no information about methylphenidate during nursing. There is too little information available about atomoxetine and modafanil to recommend their use during breastfeeding.

While we have tried to answer your question by providing information, this information should not be considered a substitute for medical advise and a women should always discuss such information with her treating physician.

Source:
CHADD website

ADHD in girls and women can look very different from ADHD in boys and men. Girls and women with ADHD often have very different challenges.

Knowledge of ADHD in women at this time is extremely limited as few studies have been conducted on this population(1,2). Women have only recently begun to be diagnosed and treated for ADHD, and today, most of what we know about this population is based on the clinical experience of mental health professionals who have specialized in treating women.

Information includes:

• common symptoms and patterns of ADHD in adult women
• treatment of ADHD in adult women
• strategies for daily living

Impact of ADHD in Women

Females with ADHD are often overlooked when they are young girls(3,4), the reasons for which remain unclear, and are not diagnosed until they are adults. Frequently, a woman comes to recognize her own ADHD after one of her children has received a diagnosis. As she learns more about ADHD, she begins to see many similar patterns in herself.

Some women seek treatment for ADHD because their lives are out of control -- their finances may be in chaos; their paperwork and record-keeping are often poorly managed; they may struggle unsuccessfully to keep up with the demands of their jobs; and they may feel even less able to keep up with the daily tasks of meals, laundry, and life management(5). Other women are more successful in hiding their ADHD, struggling valiantly to keep up with increasingly difficult demands by working into the night and spending their free time trying to "get organized." But whether a woman's life is clearly in chaos or whether she is able to hide her struggles, she often describes herself as feeling overwhelmed and exhausted (6).

While research in women continues to lag behind that in adult males with ADHD, many clinicians are finding significant concerns and co-existing conditions in women with ADHD. Compulsive overeating, alcohol abuse, and chronic sleep deprivation may be present in women with AD/HD(7,8,9).

Women with ADHD often experience dysphoria (unpleasant mood), major depression and anxiety disorders, with rates of depressive and anxiety disorders similar to those in men with ADHD(10). However, women with AD/HD appear to experience more psychological distress and have lower self-image than men with AD/HD(11,12).

Compared to women without ADHD, women diagnosed with ADHD in adulthood are more likely to have depressive symptoms, are more stressed and anxious, have more external locus of control (tendency to attribute success and difficulties to external factors such as chance), have lower self-esteem, and are engaged more in coping strategies that are emotion-oriented (use self-protective measures to reduce stress) than task-oriented (take action to solve problems)(2).

Studies show that ADHD in a family member causes stress for the entire family(13). However, stress levels may be higher for women than men because they bear more responsibility for home and children. In addition, recent research suggests that husbands of women with ADHD are less tolerant of their spouse's ADHD patterns than wives of men with AD/HD(14). Chronic stress takes its toll on women with ADHD, affecting them both physically and psychologically. Women who suffer chronic stress like that associated with AD/HD are more at risk for diseases related to chronic stress such as fibromyalgia(15).

Thus, it is becoming increasingly clear that the lack of appropriate identification and treatment of ADHD in women is a significant public health concern.

Challenge Women with ADHD Face in Receiving Appropriate Treatment

ADHD is a condition that affects multiple aspects of mood, cognitive abilities, behaviors, and daily life. Effective treatment for ADHD in adult women may involve a multimodal approach that includes medication, psychotherapy, stress management, as well as AD/HD coaching and/or professional organizing.

Even those women fortunate enough to receive an accurate ADHD diagnosis often face the subsequent challenge of finding a professional who can provide appropriate treatment. There are very few clinicians experienced in treating adult ADHD, and even fewer who are familiar with the unique issues faced by women with ADHD. As a result, most clinicians use standard psychotherapeutic approaches. Although these approaches can be helpful in providing insight into emotional and interpersonal issues, they do not help a woman with ADHD learn to better manage her ADHD on a daily basis or learn strategies to lead a more productive and satisfying life.

ADHD-focused therapies are being developed to address a broad range of issues including self-esteem, interpersonal and family issues, daily health habits, daily stress level, and life management skills. Such interventions are often referred to as "neurocognitive psychotherapy," which combines cognitive behavior therapy with cognitive rehabilitation techniques(5,16). Cognitive behavior therapy focuses on the psychological issues of ADHD (for example, self-esteem, self-acceptance, self-blame) while the cognitive rehabilitation approach focuses on life management skills for improving cognitive functions (remembering, reasoning, understanding, problem-solving, evaluating, and using judgment), learning compensatory strategies, and restructuring the environment.

Medication Management in Women with ADHD

Medication issues are often more complicated for women with ADHD than for men. Any medication approach needs to take into consideration all aspects of the woman's life, including the treatment of co-existing conditions. Women with ADHD are more likely to suffer from co-existing anxiety and/or depression as well as a range of other conditions including learning disabilities(17,18,19). Since alcohol and drug use disorders are common in women with ADHD, and may be present at an early age, a careful history of substance use is important(20).

Medication may be further complicated by hormone fluctuations across the menstrual cycle and across the lifespan (e.g., puberty, perimenopause, and menopause) with an increase in ADHD symptoms whenever estrogen levels fall(21). In some cases, hormone replacement may need to be integrated into the medication regimen used to treat ADHD.

For more information on medication management in adults with ADHD, see the fact sheet on the medical treatment of ADHD in adults.

Other ADHD Treatment Approaches

Women with ADHD may benefit from one or more of the following treatment approaches:

1. Parent training. In most families, the primary parent is the mother. Mothers are expected to be the household and family manager -- roles that require focus, organization, and planning, as well as the ability to juggle multiple responsibilities. ADHD, however, typically interferes with these abilities, making the job of mother much more difficult for women with ADHD.

   Furthermore, because ADHD is hereditary, a woman with ADHD is more likely than a woman without the disorder to have a child with ADHD, further increasing her parenting challenges. Women may need training in parenting and household management geared toward adults with ADHD. The evidence-based parent management programs found to be effective in children with ADHD are also recommended for parents with ADHD 22,23. However, recent research on these parent training approaches has indicated that parent training may be less effective if the mother has high levels of AD/HD symptoms24. Thus, it may be necessary to incorporate adult AD/HD life management strategies into parent training programs for mothers with AD/HD.

2. Group therapy. Social problems for females with AD/HD develop early and appear to increase with age. Women with AD/HD have greater self-esteem problems than men with AD/HD, and often feel shame when comparing themselves to women without AD/HD11. Because many women with AD/HD feel shame and rejection, psychotherapy groups specifically designed for women with AD/HD may provide a therapeutic experience -- a place where they can feel understood and accepted by other women and a safe place to begin their journey toward accepting themselves more and learning to better manage their lives.

3. AD/HD coaching. AD/HD coaching, a new profession, has developed in response to the need among some adults with AD/HD for structure, support and focus. Coaching often takes place by telephone or e-mail. For more information on coaching, read the information and resource sheet entitled, "Coaching and AD/HD in Adults."

4. Professional organizing. As contemporary lives have become increasingly complicated, the organizer profession has grown to meet the demand. Women with AD/HD typically struggle with very high levels of disorganization in many areas of their lives. For some women, they are able to maintain organization at work, but at the expense of an organized home. For others, disorganization is widespread, which increases the challenges and difficulties of AD/HD. A professional organizer can provide hands-on assistance in sorting, discarding, filing, and storing items in a home or office, helping to set up systems that are easier to maintain. For more information on organization, see the information and resource sheet entitled, "Organizing the Home and Office."

5. Career guidance. Just as women with AD/HD may need specific guidance as a parent with AD/HD, they may also greatly benefit from career guidance, which can help them take advantage of their strengths and minimize the impact of AD/HD on workplace performance. Many professional and office jobs involve the very tasks and responsibilities that are most challenging for a person with AD/HD, including paying attention to detail, scheduling, paperwork, and maintaining an organized workspace. Sometimes a career or job change is necessary to reduce the intense daily stress often experienced in the workplace by most individuals with AD/HD. A career counselor who is familiar with AD/HD can provide very valuable guidance. For more information, consult the information and resource sheet on workplace issues.

Ways that Women with ADHD Can Help Themselves

It is helpful for a women with AD/HD to work initially with a professional to develop better life and stress management strategies. However, developing strategies that can be used at home, without the guidance of a therapist, coach or organizer, is critical to reducing the impact of AD/HD. A woman with AD/HD would benefit from the following strategies(13):

• Understand and accept your AD/HD challenges instead of judging and blaming yourself.
• Identify the sources of stress in your daily life and systematically make life changes to lower your stress level.
• Simplify your life.
• Seek structure and support from family and friends.
• Get expert parenting advice.
• Create an AD/HD-friendly family that cooperates and supports one another.
• Schedule daily time outs for yourself.
• Develop healthy self-care habits, such as getting adequate sleep and exercise and having good nutrition.
• Focus on the things you love.

Summary
Individuals with AD/HD have different needs and challenges, depending on their gender, age and environment. Unrecognized and untreated, AD/HD may have substantial mental health and education implications(1). It is important that women with AD/HD receive an accurate diagnosis that addresses both symptoms and other important issues with functioning and impairment, which will help determine appropriate treatment and strategies for the individual woman with AD/HD.
Internet Resources
The National Center for Gender Issues and AD/HD

References

1. Biederman, J., Faraone, S.V., Spencer, T., Wilens, T., Mick, E., & Lapey, K.S. (1994). Gender differences in a sample of adults with attention deficit hyperactivity disorder. Psychiatry Research, 53, 13-29.

2. Rucklidge, J.J., & Kaplan, B.J. (1997). Psychological functioning of women identified in adulthood with Attention-Deficit/Hyperactivity Disorder. Journal of Attention Disorders, 2, 167-176.

3. Biederman, J., Mick, E., Faraone, S.V., Braaten, E., Doyle, A., Spencer, T., Wilens, T.E., Frazier, E., & Johnson, M.A. (2002). Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatry clinic. American Journal of Psychiatry, 159, 36-42.

4. Gaub, M., & Carlson, C.L. (1997). Gender differences in ADHD: A meta-analysis and critical review. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1036-1045.

5. Nadeau, K. (2002). Psychotherapy for women with AD/HD. In K. Nadeau & P. Quinn (Eds.), Understanding Women with AD/HD (pp. 104-123). Silver Spring, MD: Advantage Books.

6. Solden, S. (1995). Women with attention deficit disorder: Embracing disorganization at home and in the workplace. Grass Valley, CA: Underwood Books.

7. Dodson, W.M. (2002). Sleep disorders. In P. Quinn & K. Nadeau (Eds.), Gender issues and AD/HD: Research, diagnosis, and treatment (pp. 353?364). Silver Spring, MD: Advantage Books.

8. Fleming, J., & Levy, L. (2002). Eating disorders. In P. Quinn & K. Nadeau (Eds.), Gender issues and AD/HD: Research, diagnosis, and treatment (pp. 411-426). Silver Spring, MD: Advantage Books.

9. Richardson, W. (2002). Addictions. In P. Quinn & K. Nadeau (Eds.), Gender issues and AD/HD: Research, diagnosis, and treatment (pp. 394?410). Silver Spring, MD: Advantage Books.

10. Stein, M.A., Sandoval, R., Szumowski, E., Roizen, N., Reinecke, M.A., Blondis, T.A., & Klein, Z. (1995). Psychometric characteristics of the Wender Utah Rating Scale (WURS): Reliability and factor structure for men and women. Psychopharmacology Bulletin, 31, 425-433.

11. Arcia, E., & Conners, C.K. (1998). Gender differences in ADHD?. Journal of Developmental and Behavioral Pediatrics, 19, 77-83.

12. Katz, L.J., Goldstein, G., & Geckle, M. (1998). Neuropsychological and personality differences between men and women with ADHD. Journal of Attention Disorders, 2, 239-247.

13. Nadeau, K.G. & Quinn, P.O. (Eds.). (2002). Understanding women with AD/HD. Silver Spring, MD: Advantage Books.

14. Robin, A.L., & Payson, E. (2002). The impact of AD/HD on marriage. The ADHD Report, 10(3), 9-11,14.
15. Rodin, G.C., & Lithman, J.R. (2002). Fibromyalgia in women with AD/HD. In Nadeau, K.G. & Quinn, P.O. (Eds.), Understanding Women with AD/HD. Silver Spring, MD: Advantage Books.

16. Young, J. (2002). Depression and anxiety. In Nadeau, K.G. & Quinn, P.O. (Eds.), Understanding Women with AD/HD. Silver Spring, MD: Advantage Books.

17. Biederman, J. (1998). Attention-deficit/hyperactivity disorder: a life-span perspective. Journal of Clinical Psychiatry, 59(Suppl. 7), 4-16.

18. Biederman, J., Faraone, S.V., Spencer, T., Wilens, T., Norman, D., Lapey, K.A., Mick, E., Lehman, B.K., & Doyle, A. (1993). Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. American Journal of Psychiatry, 150, 1792-1798.

19. Biederman, J., Faraone, S.V., Mick, E., Williamson, S., Wilens, T.E., Spencer, T.J., Weber, W., Jetton, J., Kraus, I., Pert, J., & Zallen, B. (1999). Clinical correlates of ADHD in females: Findings from a large group of girls ascertained from pediatric and psychiatric referral sources. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 966-975.

20. Wilens, T.E., Spencer, T.J., & Biederman, J. (1995.) Are attention-deficit hyperactivity disorder and the psychoactive substance use disorders really related?. Harvard Review of Psychiatry, 3, 160-162.

21. Quinn, P. (2002). Hormonal fluctuations and the influence of estrogen in the treatment of women with ADHD In P. Quinn & K. Nadeau (Eds.), Gender issues and AD/HD: Research, diagnosis, and treatment (pp. 183-199). Silver Spring, MD: Advantage Books.

22. Anastopoulos, A.D., & Farley, S.E. (2003). A cognitive-behavioral training program for parents of children with Attention-Deficit/Hyperactivity Disorder. In A.E. Kazdin & J. R. Weisz (Eds.), Evidence-based psychotherapies for children and adolescents (pp. 187-203). New York: Guilford Publications.

23. Robin, A.L. (1998). ADHD in adolescents: Diagnosis and treatment. New York: Guilford Press.

24. Sonuga-Barke, E.J.S., Daley, D., & Thompson, M. (2002). Does maternal AD/HD reduce the effectiveness of parent training for pre-school children's ADHD? Journal of the American Academy of Child and Adolescent Psychiatry, 41, 696-702.

This information & resource sheet was developed for the National Resource Center on AD/HD under CDC grant R04/CCR321831-01-1 by the Attention Deficit Disorder Association. It was approved by CHADD's Professional Advisory Board in February 2004. Permission is hereby granted to reproduce this document in its entirety as long as the NRC name, contact information, and logo are included.

Understanding, assessing and treating hallucinations associated with Alzheimer's Disease.

When Alzheimer's Patients have Hallucinations

First, it's important to understand the difference between hallucinations and delusions. A delusion is defined as a false idea, sometimes originating in a misinterpretation of a situation. For example, when individuals with dementia have a delusion, they think that family members are stealing from them or that the police are following them.

A hallucination, in contrast, is a false perception of objects or events, and is sensory in nature. When individuals with Alzheimer's have a hallucination, they see, hear, smell, taste or even feel something that isn't really there.

Hallucinations are caused by changes within the brain that result from the disease. Hallucinations are visual and auditory. Individuals may see the face of a former friend in a curtain or may see insects crawling on their hand. In other cases, they may hear people talking to them and may even talk to the imagined person.

Hallucinations can be frightening. On some occasions, individuals may see threatening images or just ordinary pictures of people, situations or objects from the past. Some ideas for handling hallucinations are outlined in this fact sheet.

Obtaining medical guidance

Ask a physician to evaluate the person to determine if medication is needed or might be causing the hallucinations. In some cases, hallucinations are caused by schizophrenia, a disease different from Alzheimer's.

Have the person's eyesight or hearing checked. Also make sure the person wears his or her glasses or hearing aid on a regular basis.

• The physician can look for physical problems, such as kidney or bladder infections, dehydration, intense pain, or alcohol or drug abuse. These are conditions that might cause hallucinations. If the physician prescribes a medication, watch for such symptoms as oversedation, increased confusion, tremors or tics.

Assess and evaluate

Assess the situation and determine whether or not the hallucination is a problem for you or for the individual.Managing Behavioral and Psychiatric Symptoms

• Is the hallucination upsetting to the person?
• Is it leading him or her to do something dangerous?
• Does the sight of an unfamiliar face cause him or her to become frightened? If so, react calmly and quickly with reassuring words and comforting touching. Respond with caution.

Be cautious and conservative in responding to the person's hallucinations. If the hallucination doesn't cause problems for you, the person or other family members, you may want to ignore it.

• • Don't argue with the person about what he or she sees or hears. Unless the behavior becomes dangerous, you might not need to intervene.

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Offer reassurance

Reassure the person with kind words and a gentle touch. For example, you might want to say: "Don't worry. I'm here. I'll protect you. I'll take care of you," or "I know you're worried. Would you like me to hold your hand and walk with you for awhile?"

• Gentle patting may turn the person's attention toward you and reduce the hallucination.
• Look for reasons or feelings behind the hallucination and try to find out what the hallucination means to the individual. For example, you might want to respond with words such as these: "It sounds as if you're worried" or "I know this is frightening for you."

Use distractions

Suggest that the person come with you on a walk or sit next to you in another room. Frightening hallucinations often subside in well-lit areas where other people are present.

• You might also try to turn the person's attention to other activities, such as listening to music, conversation, drawing, looking at photos or pictures, or counting coins.

Respond honestly

Keep in mind that the person may sometimes ask you about the hallucination. For example, "Do you see him?" You may want to answer with words such as these: "I know that you see something, but I don't see it." In this way, you're not denying what the person sees or hears or getting involved in an argument.

Assess the reality of the situation

Ask the person to point to the area where he or she sees or hears something. Glare from a window may look like snow to the person, and dark squares on tiled floor may look like dangerous holes.

Modify the environment

• If the person looks at the kitchen curtains and sees a face, you may be able to remove, change or close the curtains.
• Check the environment for noises that might be misinterpreted, for lighting that casts shadows, or for glare, reflections, or distortions from the surfaces of floors, walls and furniture.
• If the person insists that he or she sees a strange person in the mirror, you may want to cover up the mirror or take it down. It's also possible that the person doesn't recognize his or her own reflection.
• On other occasions, you may want to turn on more lights and make the room brighter.

Remember that hallucinations are very real to the individual with the disease. You can ease feelings of fear by using words that are calm, gentle and reassuring.

Sources:

• Peter V. Rabins, MD, geriatric psychiastrist and associate professor of psychiatry at the Johns Hopkins University School of Medicine, Baltimore, MD.

• David L. Carroll. When Your Loved One Has Alzheimer's. New York: Harper and Row, 1989.

• Nancy L. Mace and Peter V. Rabins, M.D. The 36-Hour Day. Baltimore. The Johns Hopkins University Press, 1991.

• Lisa P. Gwyther. Care of Alzheimer's Patients: A Manual For Nursing Home Staff. Washington, D.C.: American Health Care Association, and ADRDA, 1985.

Many with Alzheimer's suffer with depression. Learn about diagnosis and treatment of depression in Alzheimer's patients.

According to experts, clinically significant depression occurs in about 20 to 40 percent of people with Alzheimer's disease. Treatment of depression in Alzheimer's disease can improve sense of well-being, quality of life, and individual function, even in the presence of ongoing decline in memory and thinking. There are many potentially effective non-drug and drug therapies available and the benefits of treatment justify the cost.

Features of depression in Alzheimer's disease

Identifying depression in Alzheimer's disease can be difficult. There is no single test or questionnaire to detect the condition and diagnosis requires careful evaluation of a variety of possible symptoms. Dementia itself can lead to certain symptoms commonly associated with depression, including apathy, loss of interest in activities and hobbies, and social withdrawal and isolation. The cognitive impairment experienced by people with Alzheimer's often makes it difficult for them to articulate their sadness, hopelessness, guilt and other feelings associated with depression.

Although depression in Alzheimer's is often similar in its severity and duration to the disorder in people without dementia, in some cases it may be less severe, not last as long, or not recur as often. Depressive symptoms in Alzheimer's may come and go, in contrast to memory and thinking problems that worsen steadily over time. People with Alzheimer's and depression may be less likely to talk openly about wanting to kill themselves, and they are less likely to attempt suicide than depressed individuals without dementia. Men and women with Alzheimer's experience depression with about equal frequency.

Diagnosis and proposed diagnostic criteria for "depression of Alzheimer's disease"

The first step in diagnosis is a thorough professional evaluation. Side effects of medications or an unrecognized medical condition can sometimes produce symptoms of depression. Key elements of the evaluation will include a review of the person's medical history, a physical and mental examination, and interviews with family members who know the person well. Because of the complexities involved in diagnosing depression in someone with Alzheimer's, it may be helpful to consult a geriatric psychiatrist who specializes in recognizing and treating depression in older adults.

A group of investigators with extensive experience in studying and treating both late life depression and dementia, working under the sponsorship of the U.S. National Institute of Mental Health, has proposed diagnostic criteria for a specific disorder called "depression of Alzheimer's disease." These criteria are designed to provide a consistent basis for research as well as to aid in identifying people with Alzheimer's who are also depressed. Although the criteria are similar to general diagnostic standards for major depression, they reduce emphasis on verbal expression and include irritability and social isolation. To meet these criteria, someone must have, in addition to an Alzheimer diagnosis, a change in functioning characterized by three or more of the following symptoms during the same two-week period. The symptoms must include at least one of the first two on the list — depressed mood or decreased pleasure in usual activities.

• Significantly depressed mood — sad, hopeless, discouraged, tearful
• Decreased positive feelings or reduced pleasure in response to social contacts and usual activities
• Social isolation or withdrawal
• Disruption in appetite that is not related to another medical condition
• Disruption in sleep
• Agitation or slowed behavior
• Irritability
• Fatigue or loss of energy
• Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
• Recurrent thoughts of death, suicide plans or a suicide attempt

Treating depression in Alzheimer's disease

The most common treatment for depression in Alzheimer's involves a combination of medicine, support and gradual reconnection of the person to activities and people he or she finds pleasurable. Simply telling the person with Alzheimer's to "cheer up," "snap out of it," or "try harder" is seldom helpful. Depressed people with or without Alzheimer's are rarely able to make themselves better by sheer will or without lots of support, reassurance and professional help. The following sections suggest non-drug strategies and medications that often prove helpful in treating depression in Alzheimer's.

Alzheimer's Non-drug approaches

• Schedule a predictable daily routine, taking advantage of the person's best time of day to undertake difficult tasks, such as bathing
• Make a list of activities, people or places that the person enjoys now and schedule these things more frequently
• Help the person exercise regularly, particularly in the morning
• Acknowledge the person's frustration or sadness, while continuing to express hope that he or she will feel better soon
• Celebrate small successes and occasions
• Find ways that the person can contribute to family life and be sure to recognize his or her contributions. At the same time, provide reassurance that the person is loved, respected and appreciated as part of the family, and not just for what she or he can do now
• Nurture the person with offers of favorite foods or soothing or inspirational activities
• Reassure the person that he or she will not be abandoned
• Consider supportive psychotherapy and/or a support group, especially an early-stage group for people with Alzheimer's who are aware of their diagnosis and prefer to take an active role in seeking help or helping others

Alzheimer's antidepressant approaches

Physicians often prescribe antidepressants for treatment of depressive symptoms in Alzheimer's. The most commonly used medications are in a class of drugs called selective serotonin reuptake inhibitors (SSRIs). These include;

• Citalopram (Celexa®)
• paroxetine (Paxil®)
• fluoxetine (Prozac®)

Physicians may also prescribe antidepressants that inhibit the reuptake of brain chemicals other than serotonin, including;

• venlafaxine (sold as Effexor® and Effexor-SR®)
• mirtazapine (Remeron®)
• Bupropion (Wellbutrin®)

Antidepressants in a class called the tricyclics, which includes Nortriptyline (Pamelor®) and desipramine (Norpramine®), are no longer used as first-choice treatments but are sometimes used when individuals do not benefit from other medications.

Sources:

• The proposed diagnostic criteria for "depression of Alzheimer's disease" are described in: Olin, J.T.; Schneider, L.S.; Katz, I.R.; et al. "Provisional Diagnostic Criteria for Depression of Alzheimer's Disease." American Journal of Geriatric Psychiatry 2002; 10: 125 - 128. On pages 129 - 141 following the article, there is a commentary by the authors discussing rationale and background for the criteria.
• Alzheimer's Association

Learn about behavioral and psychiatric symptoms of Alzheimer's disease; how they are diagnosed and drug and non-drug treatments.

What are the behavioral and psychiatric symptoms of Alzheimer's disease?

When Alzheimer's disrupts memory, language, thinking, and reasoning, these effects are referred to as "cognitive symptoms" of the disease. The term "behavioral and psychiatric symptoms" describes a large group of additional symptoms that occur to at least some degree in many individuals with Alzheimer's. In the early stages of the disease, people may experience personality changes such as irritability, anxiety or depression. In later stages, other symptoms may occur, including sleep disturbances; agitation (physical or verbal aggression, general emotional distress, restlessness, pacing, shredding paper or tissues, yelling); delusions (firmly held belief in things that are not real); or hallucinations (seeing, hearing or feeling things that are not there).

Many individuals with Alzheimer's and their families find behavioral and psychiatric symptoms to be the most challenging and distressing effects of the disease. These symptoms are often a determining factor in a family's decision to place a loved one in residential care. They also often have an enormous impact on care and quality of life for individuals living in long-term care facilities.

Evaluation of behavioral and psychiatric symptoms

The chief underlying cause of behavioral and psychiatric symptoms is the progressive deterioration of brain cells in Alzheimer's disease. However, a number of potentially correctable medical conditions, drug side effects and environmental influences may also be important contributing factors. Successful treatment depends on recognizing which symptoms the person is experiencing, making a careful assessment, and identifying possible causes. With proper treatment and intervention, significant reduction or stabilization of symptoms can often be achieved.

Behavioral and psychiatric symptoms may reflect an underlying medical condition that causes pain or contributes to difficulty making sense out of the world. Anyone experiencing behavioral symptoms should receive a thorough medical evaluation, especially when symptoms appear suddenly. Examples of treatable conditions that may trigger behavioral symptoms include infections of the ear, sinuses, urinary or respiratory tracts; constipation; and uncorrected problems with hearing or vision.

Side effects of prescription medication are another common contributing factor to behavioral symptoms. Side effects are especially likely to occur when individuals are taking multiple medications for several health conditions, creating a potential for drug interactions.

Situations that may play a role in behavioral symptoms include moving to a new residence or nursing home; other changes in the environment or caregiver arrangements; misperceived threats; or fear and fatigue resulting from trying to make sense out of an increasingly confusing world.

Non-drug treatments for Alzheimer's

The two major types of treatment for behavioral and psychiatric symptoms are non-drug interventions and prescription medications. Non-drug interventions should be tried first. In general, steps to developing non-drug alzheimer's management strategies include

1. identifying the symptom
2. understanding its cause
3. adapting the caregiving environment to remedy the situation

Correctly identifying what has triggered behavior can often help in selecting the best intervention. Often the trigger is some sort of change in the person's environment, such as change in caregiver or in living arrangements; travel; admission to a hospital; presence of houseguests; or being asked to bathe or change clothing.

A key principle of intervention is redirecting the person's attention, rather than arguing or being confrontational. Additional strategies include the following:

• simplify the environment, tasks and routines
• allow adequate rest between stimulating events
• use labels to cue or remind the person
• equip doors and gates with safety locks
• remove guns
• use lighting to reduce confusion and restlessness at night

Alzheimer's Medications to treat behavioral symptoms
Medications can be effective in some situations, but they must be used carefully and are most effective when combined with non-drug approaches. Medications should target specific symptoms so their effect can be monitored. In general, it is best to start with a low dose of a single drug. People with dementia are susceptible to serious side effects, including a slightly increased risk of death from antipsychotic medications. Risk and potential benefits of a drug should be carefully analyzed for any individual. Examples of medications commonly used to treat behavioral and psychiatric symptoms include the following:

• Antidepressant medications for low mood and irritability: citalopram (Celexa); fluoxetine (Prozac); paroxetine (Paxil); and .
• Anti-anxiety drugs for anxiety, restlessness, or verbally disruptive behavior and resistance: lorazepam (Ativan) and oxazepam (Serax).
• Antipsychotic medications for hallucinations, delusions, aggression, agitation and uncooperativeness: aripiprazole (Abilify); clozapine (Clozaril); olanzapine (Zyprexa); quetiapine (Seroquel); risperidone (Risperdal); and ziprasidone (Geodon).

Although antipsychotics are among the most frequently used medications for treating agitation, some physicians may prescribe an anticonvulsant/mood stabilizer, such as carbamazepine (Tegretol ) or divalproex (Depakote ) for hostility or aggression.

Sedative medications, which are used to treat sleep problems, may cause incontinence, instability, falls or increased agitation. These drugs must be used with caution, and caregivers need to be aware of the possible side effects.

Helpful hints during an episode of agitation

Do:

• Back off and ask permission
• use calm, positive statements
• reassure
• slow down
• add light
• offer guided choices between two options
• focus on pleasant events
• offer simple exercise options, or limit stimulation

Say:

• May I help you?
• Do you have time to help me?Managing Behavioral and Psychiatric Symptoms
• You're safe here.
• Everything is under control.
• I apologize.
• I'm sorry that you are upset.
• I know it's hard.
• I will stay with you until you feel better.

Do not:

• Raise voice
• show alarm or offense
• corner, crowd, restrain, demand, force or confront
• rush or criticize
• ignore
• argue, reason, or explain
• shame or condescend
• make sudden movements out of the person's view

Helpful hints to prevent agitation

• Create a calm environment: remove stressors, triggers or danger; move person to a safer or quieter place; change expectations; offer security object, rest or privacy; limit caffeine use; provide opportunity for exercise; develop soothing rituals; and use gentle reminders.
• Avoid environmental triggers: noise, glare, insecure space, and too much background distraction, including television.
• Monitor personal comfort: check for pain, hunger, thirst, constipation, full bladder, fatigue, infections and skin irritation; ensure a comfortable temperature; be sensitive to fears and frustration with expressing what is wanted.

Sources:

• Manju T. Beier, Pharm.D., FASCP, Treatment Strategies for the Behavioral Symptoms of Alzheimer's Disease, Pharmacotherapy. 2007;27(3):399-411
• Alzheimer's Association