ADHD - Attention Deficit Hyperactivity Syndrome
ADHD (or ADD without the hyperactivity) is becoming one of the most common ‘diagnoses’ that parents will hear from a paediatrician. But long before their child (most commonly a boy) receives this label, they will have known that childish unruliness and indiscipline has spilled over into something else.
It usually begins at school, with a note or call from a concerned teacher. You learn that your child is not mixing normally with his peers or is being bullied. He is disruptive, and will not stay in his seat or carry through even simple projects. His grades fall and he may eventually be ‘excluded’ for some incident involving ‘bad behaviour’. Specialists are involved and then comes the inevitable conclusion - little Johnny/Jenny is ‘suffering from’ ADHD, and drugs will be prescribed.
Is ADHD a disease or a mental illness?
Actually it is neither. ‘Attention Deficit Hyperactivity Disorder’ is just a label for a syndrome, or set of functional problems. By handing out such labels and prescribing drugs, a certain brand of ‘health practitioner’ tends to feel that their job is done. The problem has been ‘identified’ and the ‘remedy’ has been administered.
But the fact is that far from fixing the problem, such unthinking ‘treatment’ (which is largely fostered by the makers of the drugs concerned) is at the very best just masking some symptoms - and at a potentially high cost to the child concerned. (For example, it has recently been discovered that although the effectiveness of Ritalin wears off over a period of years, the child’s growth can be stunted as a result of taking the drug.) And this leaves aside the moral question of anyone’s right to keep another individual, adult or child, drugged up to the eyeballs for extended periods in an attempt to modify their behaviour.
If we take a closer look, there are actually three different behaviour sets which are commonly lumped together and labelled ADD or ADHD. These are:
(1) Predominately inattentive (ADD)
(2) Predominately hyperactive/impulsive
(3) Combined
With the Predominately Inattentive type of ADHD, the child may fail to pay attention to details and have difficulty sustaining attention on a task or activity. They are often perceived by teachers as not listening when spoken to directly, and may seem to occupy a ‘world of their own’.
The group describes as predominately hyperactive/ impulsive tend to be restless and unable to stay still. They fidget or squirm in their seat, or get up and move about during lessons. They are often impatient, will interrupt others, and may be generally disruptive. An estimated 40% of boys with ADHD also have an abnormal tendency toward physical violence, which in this context is labelled Oppositional Defiant Disorder. ODD is characterized by negative, hostile, and defiant behaviour.
And just for good measure, there is ‘Combined’ ADHD, where the child may show most of the behaviours listed above.
A detailed list of criteria for the diagnosis if ADHD is presented on Wikepedia.
ADHD affects an estimated 2,000,000 American children, and a similar proportion in most developed countries, although the US is well ahead in the wholesale prescription of stimulants to try to control the condition.
Researchers have found that children diagnosed with ADHD (and who have been able to sit still long enough to take the lengthy IQ tests!) tend to have higher than average IQs. But at least 25% of children with ADHD also suffer some type of communication or learning disability, so this label is clearly not describing one ‘syndrome’, but several.
So is this disorder ‘real’, or something dreamed up by teachers, social workers and child specialists to describe kids who, because they are bright, become ‘difficult’ when things don’t happen quickly enough for them? Or children who because of poor communication skills or lack of self control suffer from frustration and so express themselves physically? Or is the whole things just another symptom of poor parenting, lack of discipline and general decline in standards?
The fact is that the behavioural problems associated with ADHD are real, and growing. If you have a child who has been diagnosed with the disorder, you may have a real medical condition to deal with - but NOT by drugging your child into ‘normality’!
What causes ADHD?
Because ‘ADHD’ is such a broad-brush label for any extremely inattentive or disruptive behaviour pattern, it is little surprise that researchers have not found any one specific cause for the condition, only a number of ‘contributory factors’. Each child diagnosed with ADHD will probably have a different set of problems, with different causes.
However, studies have been done that show that there are certain genetic or biological factors that predispose toward ADHD, and there are also very strong nutritional and environmental links. ADHD can also be found to co-occur with other disorders, and can sometimes be associated with trauma such as low birth weight or brain injury.
Recent research showed that in many children diagnosed as having ADHD, a certain part of the brain (a region in the front called the prefrontal cortex) matured approximately three years later than normal. This area of the brain is responsible for focusing attention and suppressing inappropriate thoughts and actions — functions that appear to be damaged in people with ADHD. The same research also found that another part of the brain called the motor cortex (responsible for controlling movement in the body) often matured faster in kids with ADHD. Together, such abnormalities could explain much ADHD behaviour.
But while these bits and pieces of research may tell us the immediate reasons for the behavioural problems, they do not reveal the root cause - the reason why anything from 5-8% of school age children show symptoms of the condition, which often persist into adulthood, with or without drug treatment (60%).
Can ADHD be treated?
It is obviously quite difficult to find any particular treatment that can be useful across the ADHD spectrum, when it is becoming clear that behavioural problems that have been labelled 'ADHD' seem to stem from a variety of root causes. The following have been found help for some children, although it must be stressed that experimentation is necessary to find out what helps, and what does not.
Physical exercise
Children are designed to run about and blow off steam! While some will adapt to being tied to a desk and 'taught at' for a large part of the day, some will not - and will express the frustration of being restricted in this way through behaviour it has been found convenient to label as 'mild' ADHD. There may be nothing wrong at all that a couple of hours of sporting activity at lunchtime or in the evening could not fix. Unfortunately it can be easy to be persuaded by specialists who think along well worn grooves that there is a medical problem, when there may not be one at all.
Behavioural therapy
Various forms of behavioural modification may be used to limit difficult behaviour. Most focus on providing a sense of self-worth and achievement. In order to be successful, a well-designed plan of activity and reward needs to be adhered to carefully by all adults involved - no small task. The aim of such training is to help you get the child out of negative patterns of behaviour and to help him or her to learn new, more positive ones. Basically, to learn greater self control through a modified environment that provides immediate reward for 'positive' changes, and discourages repeated disruptive behaviours. Rewards are attention, praise and tokens of achievement (stars, reward points, etc.), and opportunities to indulge in favourite activities such as games. Poor behaviour is similarly greeted with a cessation of attention, etc. This is essentially classic Pavlovian 'Carrot and stick' applied methodically within a controlled environment.
Educational techniques
Behavioural therapy could and should be extended into the school environment through 'learning support' schemes, although availability of suitably trained teachers or teaching assistants may preclude this. For these methods to be effective, parents and teachers need to work together to teach self-control and improve self-esteem and academic achievement. In addition to normal classroom teaching, a teacher or teaching assistant will need to provide extra attention, encouragement and assistance, and break teaching tasks down into smaller tasks that lie within the attention span of the child. If successful, the scope of the sub-tasks can be increased gradually.
Psychological tools
Psychotherapy can be used to address some of problems of ADHD, especially in older children and young adults. For example, Cognitive Behavioural Therapy (CBT) can improve self-esteem, while so called 'family therapy' can help to improve interpersonal relationships within the family unit. Hypnosis and meditation training have also been found to be very helpful, and a relatively recent technology called 'brainwave entrainment' using acoustic stimuli has been found to be particularly helpful. Hypnosis and entrainment audio recordings can be found online at some specialist web sites such as MindWaves. Other forms of psychological treatment might include anxiety management, individual psychotherapy and social skills training.
Drugs
The stimulant drugs Ritalin, Dexedrine, Adderall, and Siler are the standard medical answer to a diagnosis of ADHD. While many children do respond to these drugs in the short term, they are not a solution for the problem. The effectiveness of such drugs tends to fall off quite rapidly, and it is becoming apparent that there are long-term problems with them. So at best these drugs should be viewed as a short term ‘patch’ that can be used to allow a window in which behavioral and psychological tools can be tried, and other potentially contributing factors can be assessed.
Diet
Research suggests that diet (especially early diet) may be contributory to, or even a cause of, the brain abnormalities that many ADHD children exhibit. In very young children, certain food colours such as 'Sunset Yellow' can be very clearly associated with ADHD-like symptoms, and several other food additives have also been implicated (see below). Dietary changes designed to identify nutritional problems need to be supervised by a specialist in this area. Normally, all foods suspected of causing behavioural problems are removed from the diet then gradually reintroduced while the child's behaviour is monitored by the psychologist.
The following dietary factors seem to be involved in ADHD behaviours:
Sugar
Dietary studies consistently show that hyperactive children tend to eat more sugar than other children, and reducing sugar intake (in particular, glucose in the form of refined sugar) has been found to reduce dysfunctional behaviour by up to 50% in some ADHD groups (young offenders). Contributing factors are genetic (abnormal glucose metabolism) and environmental (very poor diet). Abnormal glucose tolerance has been found in a very high proportion of ADHD children (about 75%). If sugar intake is to be reduced, this should be done gradually, or adverse withrawal symptoms including headaches, irritability or mental lassitude can result.
Omega 3 and omega 6 essential oils
The diets of children in the US and UK in particular, but also in many other Western countries, are strikingly poor in these fats. This is particularly the case in lower socioeconomic groups. Yet these essential oils are absolutely essential for brain development and function, and some researchers believe that diets insufficient in them can result in structural and functional abnormalities of the brain which may result in ADHD behaviour.
If this is indeed the case, then by the time ADHD is diagnosed, much of the damage will already have been done. However, there is empirical evidence that increasing intake of omega 3 and 6 fats may be very helpful, reducing symptoms such as anxiety, short attention spans, and general behavioural problems.
There may well be a direct connection between the fact that boys have a higher requirement during their development than girls for omega 3 fats in particular, and the higher incidence of ADHD in boys. However, this simple picture is complicated by other issues such as the ability to absorb omega 3 and 6 fats and to metabolise them properly, and also by other dietary factors such as the presence of salicylates in some foods (wheat and dairy products) that can inhibit uptake.
Research carried out at Oxford University using the omega 3 and omega 6 fish oil supplements in a double-blind trial involving children with ADHD symptoms and specific learning difficulties showed marked improvements in those children receiving supplements within 3 months.
Vitamins and minerals
Children diagnosed as ADHD are often deficient in certain vitamins and minerals, and respond very well to supplemntation. Of particular importance in this context are deficiencies in vitamins and minerals needed to metabolise omega 3 and 6 fats (vitamins B3, B6, C, biotin, zinc and magnesium). Zinc deficiency in particular has been found to be common in children with ADHD.
Recent research carried out at the University of Surrey has found a corelation between ADHD and exposure to multiple courses of antibiotics in early childhood. The research showed that where children had been prescribed three or more such courses before the age of three, thier blood levels of zinc, calcium, chromium and selenium were significantly below average. It is likely that such antibiotic treatments may cause disruption of the normal development of a beneficial gut flora in these children, with consequent effects on nutrient absorbtion and overall health. Where an infant has been exposed to antibiotics, a course of 'probiotic' treatments may therefore be beneficial, in addition to direct supplementation.
Food allergies
In some groups of ADHD children, hidden food allergies may be contributory, possibly causative. While strong 'type 1' allergic reactions to certain foods such as eggs, shellfish, peanuts are generally noted early on, lower-level 'type 2' reactions may be much more subtle in their effects, and so may go undetected.
An American study found that hyperactive children are far more likely to have 'hidden' food allergies than other children. The study of 7 to 10 year olds diagnosed as ADHD showed that more than half tested positive for food allergies (most commonly wheat, corn, yeast, milk, soya, peanuts and eggs) compared to less than 8% of non-ADHD children. Children with ADHD/hyperactivity may also have a sensitivity to additives and preservatives, and an investigation by the privately funded Hyperactive Children’s Support Group found that abnormally large percentages of children with ADHD reacted badly to food colourings, flavourings, MSG, chocolate and even to oranges.
A significant proportion of ADHD children may therefore benefit from a program designed to identify and eliminate eliminating foods that trigger the behavioural problems.
From: Deena Kotlewski, MA, LCPC
Dear Parent,
Like you, I have kids I worried about when they were younger - Are they eating the
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