ATTENTION DEFICIT / HYPERACTIVITY DISORDER

Attention deficit / hyperactivity disorder (ADHD) is the most commonly diagnosed neuro-biologically-based developmental and behavioural disorder of childhood, estimated to affect between 3% and 5% of school-aged children. Although many people occasionally have difficulty sitting still, paying attention, or controlling impulsive behaviour, these behaviours are so persistent in people with ADHD that they interfere with daily life.

Generally, these symptoms appear before the age of 7 years and cause significant functional problems at home, in school, and in various social settings. One to two-thirds of all children with ADHD (somewhere between 1% and 6% of the general population) continue to exhibit ADHD symptoms into adult life.

ADHD SIGNS AND SYMPTOMS

A person is considered to have ADHD if he or she demonstrates symptoms of inattention, hyperactivity, and impulsivity for at least 6 months in at least two settings (home and in school). In order to diagnose ADHD in adults, healthcare providers must determine how the adult patient behaved as a child.

ADHD CHARACTERISTICS

• Physically Hyperactive
• Impulsive & Intrusive
• Rebellious & Bossy
• Irritation
• Show Off/Egotistical
• Attracts friends but doesn’t easily bond
• More prone toward Oppositional Defiant Disorder or Conduct Disorders

SYMPTOMS OF INATTENTION

• Fails to pay close attention to details or makes careless mistakes
• Has difficulty sustaining attention in tasks or play activities
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace
• Have difficulty organizing tasks and activities
• Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort
• Loses things necessary for tasks or activities
• Is easily distracted by extraneous stimuli
• Is forgetful in daily activities

SYMPTOMS OF HYPERACTIVITY AND IMPULSIVITY

• Fidgets with hands or feet or squirms in seat
• Leaves seat in situations where remaining seated is expected
• Runs or climbs excessively in inappropriate situations (in adolescents or adults, may be limited to subjective feelings of restlessness)
• Has difficulty playing or engaging in leisure activities quietly
• Acts as if "driven by a motor"
• Talks excessively
• Blurts out answers before questions are completed
• Has difficulty awaiting turn
• Interrupts or intrudes on others

SUBTYPES OF THE DISORDER

Most kids exhibit one or more of the subtypes:

• Combined Type -- multiple symptoms of inattention, impulsivity, and hyperactivity
• Predominantly Inattentive Type -- multiple symptoms of inattention with few, if any, of hyperactivity-impulsivity
• Predominantly Hyperactive-Impulsive Type -- multiple symptoms of hyperactivity-impulsivity with few, if any, of inattention

CAUSES

• Genetic factors as well as those affecting brain developments during prenatal and postnatal life
• Irregular brain activity
• Excessive slow - wave activity in certain regions of the brain
• Low levels of neurotransmitters involved with mental and emotional functioning

RISK FACTORS

• Heredity - at least one first-degree relative who also has ADHD and one-third of all fathers who had ADHD in their youth have children with ADHD
• Gender - ADHD is more common in boys than in girls (10:1)
• Prenatal and early postnatal health - maternal drug, alcohol, and cigarette use; exposure of the fetus to toxins, including lead and polychlorinated biphenyls (PCBs); nutritional deficiencies and imbalances, prenatal trauma
• Learning disabilities, communication disorders, and tic disorders such as Tourette's syndrome
• Nutritional factors allergies or intolerances to food, food coloring, or additives, diets high in sugar and refined carbohydrates, low protein diet

DIAGNOSIS

1. Diagnosis is largely dependent on specific observed behaviours and is made using the diagnostic criteria as defined in the DSM-IV - Diagnostic and Statistical Manual of Mental Disorders. Parents and teachers play an important role in providing information to establish the diagnosis since most behaviours occur at home or at school.


2. Hair analysis (to test for heavy metals and minerals).


3. Blood testing (to test for nutritional deficiencies and food allergies / sensitivities).

TREATMENT OPTIONS FOR ADHD

It is important to have a thorough discussion with your healthcare provider regarding the benefits of different options for ADHD treatment:

1. Allopathic / Conventional Treatment Approach
2. The Naturopathic Approach To ADHD

1. ALLOPATHIC / CONVENTIONAL TREATMENT APPROACH

Multiple strategies are required to effectively manage ADHD over the long-term. Lifestyle changes, including behavioural therapies, are proving to be the best option for many children. Currently, the most accepted treatments include individual and family education, behavioural therapy, school remediation, and social skills training.

LIFESTYLE CHANGES

There are two basic ways to manage hyperactive children: change the child's environment or change the child's behavior. The former can be accomplished by actively modifying a child's social and family interactions, a process that usually begins with parental training. The latter involves stimulant medication.

Notably, a recent study sponsored by the National Institute of Mental Health (NIMH) indicated that a comprehensive treatment regimen that combines medication with intensive behavioural interventions (such as parental training) is among the most effective treatments for elementary school children with ADHD. Adults with ADHD may benefit from a variety of behavioural interventions including cognitive remediation, couple therapy, and family therapy.

2. THE NATUROPATHIC APPROACH TO ADHD

The naturopathic approach to ADHD involves first identifying the root cause of the symptoms. This is accomplished by collecting the clinical and family history of the child, and then checking blood and hair specimens to identify any abnormalities that are present physiologically. Once all the information has been collected, an individual treatment plan* is created specific for the child, which may entail the use of various natural therapies such as nutrition and dietary supplements, lifestyle changes, botanical and Traditional Chinese medicine and homeopathy.

Nutrition and Dietary Supplements

The Feingold Program - based upon an elimination diet is composed of two stages:

• Stage 1 - Initial period during which two groups of foods are eliminated - foods that contain synthetic (artificial colors and flavours), foods contain antioxidants and the second group of foods that contains natural salicylates
• Stage 2 - After a favourable response has been observed for 4 - 6 weeks, the foods in the second group may be carefully reintroduced and tested one at a time. The foods in the first groups are generally not reintroduced

According to Benjamin Feingold, a practicing allergist’s observations, eliminating all of these substances dramatically improved ADHD symptoms in 50% of children, and reintroducing them one at a time caused the symptoms to recur. Elimination diets, however, should only be used under the guidance and direction of a registered naturopath because of the potential risk of malnourishment

Sugar and Artificial Sweeteners

How sugar influences ADHD is one of those controversial areas in medicine. There are two sides to the debate. On one side, there is the official medical establishment that claims numerous scientific studies show that children do not react to sugar and that sugar does not play a role in ADHD. On the other side, there are all the mothers who have personally witnessed that when they give their children sugar, within a few minutes, their children are bouncing off the walls. So, the question is with whom does the truth lie.

A study in Yale by Girardi suggested that sugar ingestion triggered certain metabolic abnormalities in ADHD children causing reactive hypoglycemia, and suggested that children with ADHD have a general impairment of hormone regulation with sugar metabolism, and sugar may accentuate this defect.

There is another effect of eating refined sugar. Table sugar is a nutrient vacuum. It provides no nutritional benefit other than calories, but it requires a lot of other nutrients to process it. It depletes the child's nutritional base. That means that if a child's ADHD is caused or exacerbated by the lack of certain nutrients, having a high sugar meal may drain these nutrients and push him into a nutrient deficiency state.

Dietary supplements

A well-balanced diet rich in micronutrients is essential for normal brain development, particular in young children. In fact, many children with nutrient deficiencies have significant cognitive and behavioural problems. Children with ADHD tend to have irregular eating habits and are therefore at slightly increased risk for becoming mildly deficient in certain nutrients.

Magnesium

Symptoms of magnesium deficiency include irritability, excessive fidgeting, anxiety, restlessness, learning difficulties, decreased attention span, and mental confusion. In one study of 116 children with ADHD, 95% were magnesium deficient. In a separate study, 75 magnesium-deficient children with ADHD were randomly assigned to receive magnesium supplements in addition to standard treatment or standard treatment alone for 6 months. Those who received magnesium demonstrated a significant improvement in behaviour, whereas the control group exhibited worsening behaviour.

Vitamin B6

Adequate levels of vitamin B6 (pyridoxine) are required for normal brain development and are essential for the synthesis of essential brain chemicals including serotonin and other neurotransmitters. A preliminary study found that pyridoxine was slightly more effective than the most commonly used prescribed stimulants in improving behaviour among hyperactive children.

Iron

Iron deficiency is common among children and adolescents, particularly in lower socioeconomic groups where it affects half of all infants. Normal levels of iron in the blood are necessary for optimal brain function. Symptoms of iron deficiency include decreased attention span, arousal, decreased voluntary activity and social responsiveness. Since iron can be toxic in children who are not deficient, it may be important to first confirm an iron deficiency before supplementing with iron. If iron levels are low, a healthcare provider can determine whether replacement is needed.

Zinc

Zinc regulates the activity of neurotransmitters, fatty acids, and melatonin, all of which are related to the biolog of behaviour. Tartrazine (artificial yellow food coloring decreases may decrease zinc levels in the body. Two separate studies found that children with ADHD have significantly lower blood zinc levels than children without ADHD. Another study indicated that ADHD children with mild zinc deficiency may be less likely to improve from a commonly prescribed stimulant than children with adequate zinc levels.

Essential Fatty Acids

Fatty acids play a key role in normal brain function. Since the body cannot synthesize essential fatty acids (EFA), they must be provided in the diet. There are two major types of EFAs: omega-3 fatty acids (found in cold-water fish such as salmon, mackerel, halibut, and herring) and omega-6 fatty acids (found in commonly used cooking oils, such as sunflower oil, safflower oil, corn oil, and soybean oil).

Omega-3 fatty acids are highly concentrated in the brain and appear to play a particularly important role in cognitive and behavioural function. Specific enzymes convert EFAs (such as alpha linolenic acid [ALA]) into other substances known as long-chain polyunsaturated fatty acids (PUFAs). PUFAs, including eicosapentaenoic acid (EPA) and docosahexaenoic (DHA), are also essential for normal brain function.

Some researchers believe that individuals with ADHD may have difficulty converting EFAs to PUFAs and may be deficient in both of these substances. In a recent study, researchers reported the following findings in hyperactive boys compared to boys of the same age who were not hyperactive:

• Lower blood levels of PUFAs and omega-3 fatty acids


• More allergies and other health problems associated with EFA deficiencies


• Less likelihood of having been breastfed (breast milk contains PUFAs)

Another study found that boys with lower levels of omega-3 fatty acids had more learning and behavioural problems (such as temper tantrums and sleep disturbances) than boys with normal omega-3 fatty acid levels.

Massage and Physical Therapy

Relaxation and massage techniques have been shown to reduce anxiety and activity levels in children and adolescents with a variety of psychiatric illnesses.

Mind / Body Medicine

Mind/body techniques such as hypnotherapy, progressive relaxation, and biofeedback are particularly well suited to children and adolescents. Children tend to readily accept hypnotic suggestion and the visual process of biofeedback works well for children of this generation because many are accustomed to computerized graphics. Through these techniques, children are often able to learn coping skills that will stay with them for the rest of their lives. These treatments allow children to gain a sense of control and mastery, increase self-esteem, and decrease stress.

To be most effective for ADHD, however, these mind/body techniques should be incorporated into an overall comprehensive treatment plan that is tailored to the particular individual.

Other Considerations - Pregnancy

To prevent ADHD in their unborn children, pregnant women should obtain high quality prenatal medical care, abstain from cigarette, alcohol, and drug use, and should avoid exposure to toxic substances, including lead.

Prognosis and Complications

As many as half of all children with ADHD who receive appropriate treatment learn to control symptoms and function well in adulthood, while the remaining continue to exhibit symptoms of inattention and impulsivity throughout life. As many as 50% to 80% of those who do not seek treatment for ADHD may demonstrate delinquent and antisocial behaviour into adulthood. In most cases, ADHD can be effectively managed throughout life, particularly when multiple treatment strategies are combined.

Please ask your doctor or naturopath before starting on any supplements. Its is better to first identify the cause and then treat it with the right remedies, even though those mentioned above have minimal side effects.

* DISCLAIMER: The information on this article is the property of Dr. Sushma Shah, Naturopathic Doctor, and is not intended to treat, diagnose or cure any diseases or promote any services or products mentioned on the website.