GENERAL

The Controversy of, and Holistic Therapies for ADHD

As a school psychologist who started his career over 30 years ago as a secondary science teacher I have always relied on research and data to support my beliefs. And when I explored the nature vs nurture (genetics vs environment) debate as it applies to mental illness I have found (based on research and data) that over 75 percent of mental illness is due to environmental factors, not genetics. This is what I believe and found to be the case with ADHD (if the “disorder” exists at all!).

Attention-Deficit/Hyperactivity Disorder (ADHD) is considered the most common childhood neurobehavioral disorder of school-aged children today. And, it is the most controversial disorder also. Controversial when we check beyond mainstream traditional Western (allopathic) diagnosis and treatment. As a school psychologist with over thirty years’ experience working with students and families from the pre-kindergarten age through grade twelve, I have rarely seen “proper” diagnosis of the disorder. What I have seen are children “drugged” in order to “do better in school.” This current trend in medicating and labeling our children can have lifelong negative effects!

Today there are many physicians, psychiatrists and psychologists that question whether such a disorder even exists. And, they refuse to recommend psycho-stimulate medication for the “disorder’s” symptoms, but seek alternative therapies.

According to the DSM-IV, children with ADHD display problematic behaviors at home and 80% are believed to display academic performance problems. Estimates range between four to twelve percent of school children have the disorder. Children that are diagnosed with ADHD usually are put on psycho-stimulate medication with what seems to be little concern of short-term or long-term side effects.

Of the five million children today with ADHD over three million take Ritalin (methylphenidate) with sometimes only cursory medical/professional diagnosis of the disorder. The medical community appears to be more concern with controlling the student’s behavior with drugs rather than trying to determine a cause of the condition. However, there are a number of theories today that address the cause and treatment of the condition’s symptoms without the use of potentially harmful medications.

Diagnosis of ADHD

The American Academy of Pediatrics (AAP) calls ADHD the most common childhood neurobehavioral disorder. Not surprisingly, the AAP questions the possible over-diagnosis of ADHD.

In their May, 2000 issue of Pediatrics the AAP calls for stricter guidelines for primary care physicians diagnosing ADHD in children age six to twelve years-old. These guidelines include: using the DSM-IV criteria, with symptoms being present in two or more settings, the symptoms adversely affecting the child’s academic or social functioning for at least six months, the assessment should include information from parents as well as classroom teachers or other school professionals, and the evaluation of ADHD should also include an assessment for co-existing conditions such as learning or language problems.

The AAP appears to be concerned that far too many physicians will place a child on psycho-stimulate medication with little or no assessment of the condition. Often they speak only to the parents or give the child a quick in-office physical before writing a prescription for Ritalin.

The National Association of School Psychologists (NASP) in their text, Best Practices in School Psychology (1995), outlines specific criteria children must meet in order to be diagnosed with ADHD. This criteria not only includes DSM-IV guidelines but meets federal requirements for evaluating a child to qualify for educational services under the Individuals with Disabilities Education Act (IDEA).

Therefore, school psychologists are often faced with the task of reconciling confused communication among parents (who believe something is not right with their child), school personnel (who have strict federal guidelines in order service students with special needs) and medical personnel (that label children ADHD and prescribe medications without any testing).

Have I seen this kind of “correct” diagnosis for ADHD? Rarely, if ever! What usually happens is that a parent brings their child to the family physician, stating that the child is having trouble paying attention in school and the physician gives an on-the-spot diagnosis of ADHD, and writes a script for a trial of an ADHD medication.

Causes of ADHD

The medical community appears to down play any one deciding factor that would cause ADHD, and would rather list several factors that may contribute to the condition. Dr. K. S. Berger, in his book, The Developing Person Through the Life Span (1998) states that current research lists factors such as genetics, prenatal damage from teratogens, or postnatal damage, such as from lead poisoning or head trauma as the cause of ADHD.

Russell Barkley, Ph.D. author of several books on ADHD such as Taking Charge of ADHD, (1995) cites recent research indicating that the areas of the brain in children with ADHD are reduced in size when compared with children without the disorder. Possible causes for the reduction could be polygenetic in nature. Specifically genes that dictate the way the brain uses a neurotransmitter called the dopamine receptor are thought to be mutated in children with ADHD. Other theories include prenatal alcohol consumption, fatty acid deficiency, faulty glucose metabolism, and thyroid abnormalities as possible causes of ADHD.

David Stein, Ph.D. questions if ADHD is a medical disorder at all. He states that there is little scientific evidence to support that it is a medical condition. Dr. Stein suggests that the environment a child is brought up in is the primary reason for ADHD behavior. In his book, Ritalin Is Not The Answer (1999), he contends lack of discipline in the home or in the classroom is the main cause of ADHD. He believes by setting consistent boundaries with behavior control interventions, adhd childsymptoms can be eliminated.

Sugar appears to be highly controversial regarding its effect on children and the possibility of it causing ADHD. Depending on which study you read, you can be thoroughly confused as to its relation to children’s behavior. Dr. William Crook, a pediatrician whom had been treating hyperactive children for twenty-five years, reports in a five year study, where he interview parents of 182 hyperactive children and found the great majority of the children were adversely affected by their diet. He found their hyperactivity was definitely related to specific foods they consumed, the worst offender being sugar.

Another study by the New York Institute of Child Development in New York City involved 265 hyperactive children. They found that 74 percent of the children had an inability to properly digest and assimilate sugar and other refined carbohydrates. A study conducted by the National Institute of Mental Health showed that the rate at which the brain uses glucose, its main energy source, is lower with subjects with ADHD than with subjects without ADHD.

Mary Block, M.D., in her book, No More Ritalin, Treating ADHD Without Drugs (1996) explains how reactive hypoglycemia and adrenaline levels are related. Dr. Block states when we have too little glucose in our body (blood sugar) the body releases a backup reserve called epinephrine or adrenaline. Adrenaline is a hormone that gives the body an energy surge. The body goes into hypoglycemia (low blood sugar) by either not eating enough or paradoxically by eating too much sugar. People with reactive hypoglycemia may have a metabolism problem that causes the over secretion of adrenaline. Dr. Block cites a Yale study that tested the effects of sugar on blood glucose and adrenaline levels. The study showed the adrenaline levels of children were ten times higher than normal up to five hours after ingesting the sugar. She explains that many studies that show a poor relationship between sugar intake and behavior are usually flawed and poorly conducted. She also makes the point if any medical professionals questions the effect sugar has on behavior they should talk to a parent or teacher around Halloween.

In the 1970’s Ben Feingold, M.D., developed one of the first natural approaches to treating hyperactivity. He was a pediatrician who taught at Northwestern University and a pioneer in the fields of allergy and immunology. He also served as Chief of Allergies at the Kaiser Permanente Medical Center in San Francisco.

According to Dr. Feingold many hyperactive children are sensitive to naturally occurring salicylates and phenolic compounds. Salicylates are used as food preservatives and in the production of aspirin. Dr. Feingold determined that food additives induce hyperactivity after researching over 1,200 cases where additives were linked to behavior disorders. Dr. Feingold believes that salicylates, artificial colors, and artificial flavors in the diet are responsible for hyperactivity in children.

Dr. Weintraub reports as far back as 1940 there have been reports of sensitivities to food dyes, aspirin, and naturally occurring salicylate substances found in fruits and vegetables. Dr. Weintraub cites other studies in support of Dr. Feingold’s theory. A study published in Lancet (1985) found that 82 percent of a large group of hyperactive children responded positively to a hypoallergenic elimination diet. While on the diet many of the children’s behavior became normal. The most commonly provoking substances were artificial food colors and preservatives.

Dr. Carl Pfeiffer M.D. recommends a natural diet for hyperactive children based on the belief that food additives, artificial colors, flavors and preservatives causes hyperactivity. Another study in support of Dr. Feingold’s theories, was a study of 76 hyperactive children. When placed on a restricted diet devoid of additives 62 of the children improved and 21 realized normal behavior.

Dr. Weintraub discusses a recent study conducted at the Royal Children’s Hospital, University of Melbourne, Australia of 200 hyperactive children. In a six week trial, the children were placed on a diet free of all synthetic foods. The parents of 150 children reported significant behavioral improvements, however, they noted when artificial colors were added back into their diets their behavior worsened. The more food coloring they consumed, the longer the undesirable behavior lasted.

A 1994 study at the North Shore Hospital-Cornell Medical Center found that by eliminating reactive foods such as those with food additives and artificial colors the ADHD symptoms of irritability, restlessness, sleep disturbances and other negative behaviors were reduced.

By using PET scans of the brain scientists are able to visually observe the amount of glucose certain areas of the brain uses. In examining the brains of people with ADHD, there are certain areas of the brain that show decreased use of glucose and diminished brain metabolism. Scientists are currently searching for the cause of this decreased glucose metabolism in people with ADHD.

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