All Posts tagged ADHD

Natural Treatment of ADHD, Part 4

ADHD can often be successfully treated naturally to the point where the need for medication may be significantly decreased or even eliminated.  Research has shown that improvements can be made with ADHD through diet, nutrition and chiropractic care.  The Center for Science in the Public Interest (a division of the U.S. Dept. of Health and Human Services) has published a report, “Diet, ADHD, and Behavior”, that reviews studies on the effect of diet on behavior (including ADHD) and touches on side effects of the stimulant drugs that have been used to treat behavior disorders in millions of children.  CSPI’s report reviews more than 20 controlled studies of diet and behavior. Most of the studies found that food dyes and, in some cases, other additives and foods provoked symptoms of ADHD or other behavior problems in some children.  They recommend the first avenue of treatment should be the elimination of foods with dyes and additives from a child with ADHD’s diet.  They recommend this be done before any medication is prescribed due to the side effects of the medications as well as Ritalin being a “possible human carcinogen”.  Therefore, if your child is properly diagnosed with ADHD, your first step in treatment should be to change their diet to organic foods with as few food dyes, additives, and preservatives as possible.

Food sensitivities and allergies are starting to be more widely looked at in terms of the treatment of ADHD patients.  In the research of diet and its connection to ADHD, nutritionists commonly find the elimination of foods such as oranges, chocolate, corn, wheat, eggs and milk, may work to improve a child’s mental functioning and, thereby, alleviate, to some degree, the symptoms associated with ADHD.  During an allergic reaction, or food sensitivity reaction, the body releases a chemical known as histamine. Histamine, in physiological terms, works to increase the removal of blood serum from around the brain tissue, thereby reducing adequate blood flow to the tiny capillaries which nourish the brain. When this reaction of histamine occurs within the body, the brain becomes unbalanced and the first indications of complication, from a psychological aspect, involve loss of memory, attention and cognitive function.  Using a diary or journal to log the activities and foods of your child, over a 30 day period, will often provide insight into the natural culprits which may be creating more complex ADHD symptoms; being mindful that food sensitivities, generally, take several hours to appear following consumption. Once the foods are identified, steps can be taken to remove those exposures from the child’s diet and, thereby, remedy the symptoms of ADHD.

Another area that’s getting a lot of research lately is Omega-3 fatty acid supplementation. Dr Basant Puri, a consultant and senior lecturer at Hammersmith Hospital has been using sophisticated imaging techniques to study the role of fatty acids in brain function. He says he has unearthed a wealth of evidence about how supplementation with specific fatty acids can not only help those with ADD/ADHD (attention deficit/ hyperactivity disorder), but also dyslexia and dyspraxia.  “In clinical trials we have seen significant improvements in ADHD symptoms in children administered with fatty acid supplements,” he said.   Typically those who get a benefit enjoy improved attention and concentration, a reduction in anxiety and impulsivity and generally an improvement in self esteem.   Fatty acids are important for the brain growth of all children and particularly so for those with learning conditions.   Dr. Puri recommends that the best results have come from supplementation with a combination of marine and botanical oils rich in a specific fatty acid called Eicosapentaenoic Acid or EPA.   Similarly, a Purdue University study showed that kids low in Omega-3 essential fatty acids are significantly more likely to be hyperactive, have learning disorders, and to display behavioral problems.  Your brain is more than 60% structural fat, just as your muscles are made of protein and your bones are made of calcium. But it’s not just any fat that our brains are made of – it has to be Omega-3 fats, and the typical American diet is low in these types of fats.  We eat man-made trans-fats and excessive amounts of saturated fats and vegetable oils high in Omega-6 fatty acids, all of which interfere which our body’s attempt to utilize the tiny amount of Omega-3 fats that it gets.

Because ADHD can be caused by both biochemical imbalances and brain under-stimulation, chiropractic care is often needed to help stimulate the nervous system and restore normal brain stimulation.  Research has shown not only that the developing brain relies on normal structural integrity and joint movement, but that complex neurochemical communication and pathways involved in helping us to “feel good” are tied into spinal biomechanics.  Children’s nervous systems need the constant stimulation of movement in order to develop and function properly. Abnormal position or movement of the spinal vertebra can develop and this can lead to nerve interference. It is this interference that chiropractors correct.  In the October 2004 issue of the peer-reviewed research publication, the Journal of Manipulative and Physiological Therapeutics (JMPT), a case study shows a child with ADHD who was helped with chiropractic care.  The case study was of a 5 year old boy who had been diagnosed with ADHD at the age of 2.  The child’s pediatrician prescribed Ritalin, Adderall, and Haldol for 3 years.  After 27 visits to a chiropractor, “The patient experienced significant reduction in symptoms. Additionally, the medical doctor concluded that the reduction in symptoms was significant enough to discontinue the medication.”  This case study can be found at the following link:

So, if you do have a child with ADHD, there are a number of alternatives that you can try before using medications that have numerous side effects and may possibly be carcinogenic.  I hope this series was helpful for you, and if you have any questions or comments, please post them or contact me directly.


Medical Treatment of ADHD, Part 3

pillsOut of the three most commonly used medications for ADHD, Ritalin, or methylphenidate (MPH), is prescribed for more than 70 percent of patients according to one public health conference:  Although in many patients the disorder may result from the lack of brain stimulation, the medical profession leans toward treating the biochemical theory of ADHD – hence, the use of medications that affect the level of dopamine in the brain.

Dopamine is the main neurotransmitter in the “pleasure center” of the brain – a network of nerve cells or neurons that motivates much of human behavior. The “pleasure center” reinforces people’s drives to eat, drink, and procreate and is responsible for addiction.  For example, when a person tastes ice cream, the sensors of the tongue signal the brain that it feels something, and a neuron fires in the taste center of the brain.  Dopamine from one neuron is released into the space between it and another neuron.  The second neuron, in turn, sends the signal to third neuron by the same process.  Through this complicated network of signaling, the brain lets the person know that an experience is pleasurable and is worth paying attention to.

Dopamine is recycled by dopamine transporters—proteins that are embedded in the membrane of the initial neuron.  When molecules of dopamine are floating around in the synapse (or gap between neurons), any that come in contact with the transporters are sucked back into the initial neuron.  A recent study (Lancet, 1999; 354:2132-2133) showed that ADHD patients have more dopamine transporters than people without the disorder.  This means that dopamine is not given enough time to reach the second neuron and instead is taken back into the first neuron’s membrane. As a result, an inadequate number of dopamine molecules reach the second neuron so it won’t send a signal.  MPH (Ritalin) is called a reuptake inhibitor.  It blocks dopamine transporters and allows dopamine to reach the second neuron and create a signal, improving children’s ability to focus.

But Ritalin is not a cure for ADHD. The medication neither corrects the disorder nor addresses the patient’s individual problems. Eighty percent of hyperactive children have ADHD features in adolescence, and up to 65 percent maintain them in adulthood.(  Medications merely control the symptoms of hyperactivity/ impulsivity and even aggression.

Side Effects

Effects associated with moderate doses of stimulants are decreased appetite and insomnia.  Negative effects on growth rate are possible, but ultimate height appears not to be affected.  Very high doses of psychostimulants, such as Ritalin, may cause central nervous system damage, cardiovascular damage, hypertension, compulsive behaviors, and, in certain vulnerable individuals, movement disorders.  A rare percentage of children and adults treated at high doses have hallucinogenic responses.  An animal study of Ritalin has produced a “weak signal” that the drug may potentially cause cancer.  Other drugs used for ADHD have their own adverse reactions: tricyclic antidepressants may induce cardiac arrhythmias, bupropion can cause seizures, and pemoline (Cylert) is associated with liver damage.

Stimulant therapy is not recommended in patients with a history of tics or Tourette’s disorder, the presence of a thought disorder, significant resistance to such medications in the patient or family, or insufficient severity of the symptoms or dysfunction.

Ritalin’s chemical properties cause the most serious concerns about its use. MPH is a schedule II narcotic that belongs in the amphetamine family of stimulants and is regulated by the Drug Enforcement Agency (DEA) as a controlled substance.  Chronic exposure to stimulants during development may change the way the brain reacts to environmental challenges, including stressful events and pharmacological agents.  Another concern is that long-term stimulant administration in children may alter the way the brain reacts to further exposure to stimulants or other drugs with potential for abuse.

A recent study showed that MPH is not a weak stimulant, as had been thought, but is a more potent transporter inhibitor than cocaine. A typical dose given to children (0.5mg/kg) blocked 70 percent of dopamine transporters, while cocaine blocks only 50 percent. People who took MPH displayed high levels of extracellular dopamine—just as people using cocaine did.  The only difference between the MPH and the cocaine effect on the brain is in the way it is administered: MPH taken orally raises dopamine in about an hour, whereas inhaled or injected cocaine hits the brain in seconds.

In 1999, approximately 9 million Americans used prescription drugs for non-medical purposes—to get high, to have fun, to get a lift, or to calm down.  Ritalin abuse has been reported among middle and high school students. Some used it to suppress appetite or to stay awake while studying. The DEA lists Ritalin as a “drug of concern” and reports that some abusers have dissolved the tablets in water and injected the mixture, which can block small blood vessels and damage the lungs and retina of the eye.


Diagnosis of ADHD, Part 2

medical-doctorWhen a child’s behavior or academic performance starts troubling teachers, they usually make the preliminary ADHD diagnosis and report it to the parents.  The parents then take the child to a general practitioner or a pediatrician who makes the final diagnosis and prescribes a stimulant medication, typically Ritalin.  The problem with this scenario is that the people involved aren’t the right ones to be making the diagnosis.  Before placing a child on medications and pinning him or her with a diagnosis of ADHD, first get a second opinion from a healthcare professional that specializes in this disorder, such as a psychiatrist, psychologist, or doctor specializing in neurology and/or in ADHD specifically

But even for a qualified specialist, ADHD is not always easy to diagnose. ADHD belongs to a spectrum of neurological disorders.  The spectrum goes from attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) through learning disabilities, obsessive-compulsive disorder (OCD), and Tourette’s syndrome, to pervasive developmental disorders and autism. The neurological mechanisms involved in all the disorders are very similar.  Besides, there is increased co-morbidity among these syndromes, meaning that a child can have multiple disorders.  For example, 50 percent of the ADHD patients will have OCD, and 50 percent of patients with Tourette’s syndrome will have ADHD.  Early-onset mania or bipolar mixed state may be particularly difficult to distinguish from ADHD, or may also be co-morbid.

On the other hand, some children may be at the high end of the normal range of activity, or have difficult temperaments. Poor attention may also be caused by impaired vision or hearing, seizures, head trauma, acute or chronic medical illness, poor nutrition, insufficient sleep, anxiety disorders or realistic fears, depression, or the sequelae of abuse or neglect. Various drugs (including phenobarbitol) may interfere with attention.

Similar symptomatology and co-morbidity of conditions increase the possibility of misdiagnosis.  ADHD is not a learning disability, but it can affect the ability to progress in society and the ability to learn. Many children are misdiagnosed with ADHD because they have learning disabilities or language problems.  Some children may simply have difficulty learning certain subjects, but schools often push to diagnose the child with ADHD.  There have always been children who learn at different speeds, but it almost seems easier to put a diagnosis of ADHD on the child and deal with the learning difficulties in that way.

Communication with the child and his/her parents is the key to a correct diagnosis.  We need to understand the frustrations the child has.  Is he/she too active?  Bored?  Do they have dyslexia or a different learning pattern?  It can be a behavior problem, problems at home, or frustrations with the teacher’s style. If the child is a visual learner, and the teacher is not teaching towards that learning style, the problem may be the child is not being taught in a way he can learn.  As adults, if we went to a conference where the speakers taught in a way we can’t learn, we would be frustrated and would start to misbehave—we’d leave or chat to the person sitting next to us.  The same thing applies to children.

The traditional way of diagnosing ADHD seems to follow a cookie-cutter principle. The very diagnosis of ADHD is based on the questionnaire laid out in the DSM-IV5 or other diagnostic manuals.  If the child’s parents or teachers identify as positive six out of nine criteria for inattention, or six out of nine criteria for hyperactivity and impulsivity, the child leaves the doctor’s office with a drug prescription and a new personality label.  The patient is basically at the mercy of the medical doctor’s clinical experience—and 60 percent of doctors agree that there aren’t enough properly qualified ADHD diagnosticians, according to a Canadian survey performed in 1999.

Therefore, if your child has been diagnoses with ADHD, please make a point of seeing a specialist to confirm the diagnosis and other possible contributing syndromes the child may have.


What is ADHD?

girl-flyingADHD has been diagnosed in approximately 8 million children in the United States.  As a result, there is a whole generation of children growing up on stimulants and other medication.  How will all of this affect their adult life is a question that has no answer at this time. In order to clarify this condition for parents, in my next four blog posts, I’m going to cover, what ADHD is, what occurs in the brain to cause it, it’s diagnosis, and treatment options.

True ADHD is characterized by behavioral problems in reacting to an average, every-day situation.  The diagnosis is based on the history of displaying three types of behavior:

  1. An inability to perform everyday tasks, or distractibility
  2. An impairment in the ability to control impulses, or impulsivity
  3. Restlessness, or hyperactivity

In reality, everyone displays those behaviors at times, so to classify for ADHD, those behaviors have to be excessive, occur before the age of seven, last for at least six months, and cause a problem in a social environment, such as at school or home, at work or in a marriage.  If the school is the only place where the child is acting up, the parents should see if there are problems with the school before pursuing a medical diagnosis.

Every person with ADHD will display a combination of the three behavioral aspects.  ADHD is broken into subtypes—with predominant or non-dominant aspects depending on the individual – such as predominant inattention or predominant hyperactivity.  The range of symptoms will vary from one patient to another and may include inability to concentrate and irritability, as well as confrontational, defiant, and oppositional behaviors.

Non-verbal communication and interaction with people is a major problem for people with ADHD. They don’t pick up body messages and don’t understand personal space. It’s hard for them to get jokes and the context of speech. They understand what you say, but not how you say it. As a result, they often have difficulty making friends and being in social situations, which leads to aggression and frustration.

The reason ADHD cannot be considered just a psychological problem is its functional presentations.  There are motor signs—tics, tremors, and balance or postural problems. Soft neurological signs, such as sensory integration deficits—unusual sensitivity to touch, movement, sights, or sounds—are also present in ADHD children.

But how is the inability to focus and sit still connected with postural problems and sensory integration?  Research shows that the link is in the brain.  ADHD is caused by a problem with the reticular activating system—the attention center of the brain. Its other functions include vision, hearing, and preservation of older genetic traits.  By using a PET (positron emission tomography) scan, researchers can observe the metabolic areas of the brain and compare the brain structures in non-ADHD and ADHD individuals.  In patients with ADHD, certain areas of the brain, such as the cerebellum, the frontal lobes, or the right or left hemisphere, are under-functioning. Under-functioning may be caused by two factors:  the level of stimulation of the brain or the biochemical substrates to the brain.


A Child With ADHD, What’s a Parent To Do?

One of my patients came into the office a month or so ago excited at how well her child with ADHD has been doing under chiropractic care.  She thanked me for talking to her about this months earlier because a new study was recently released by The American Journal of Psychiatry that supports the claims that stimulant drugs usually prescribed for ADHD could increase the risk of sudden unexplained death in children. This particular patient saw this while watching the CBS Early Show that particular morning, and the M.D. on the show recommended Chiropractic care and nutritional counseling instead of the medications.
Doctors of chiropractic offer a non-drug and non-invasive treatment alternative for ADHD patients that targets the underlying problems,
not just symptoms. “Motor activity—especially development of the postural muscles—is the baseline function of brain activity. Anything affecting postural muscles will influence brain development. Musculoskeletal imbalance will create imbalance of brain activity, and one part of the brain will develop faster than the other, and that’s what’s happening in ADHD patients,” says Dr. Melillo of the American Chiropractic Association. So if you have a child who has been diagnosed with ADHD, there are safer alternatives to taking Ritalin and some of the other medications.