The incidence of Attention Deficit Hyperactivity Disorder, commonly called ADHD or ADD, has exploded -- a relatively uncommon syndrome has become a household word. Three to seven percent of the children in the United States, over 4 million of them, are being diagnosed with this "disease," and 2.5 million are being treated with Ritalin or some other long-term medication. This is a 1,600 percent increase since the 1970s! It sometimes seems that every time we turn around, another child has been diagnosed with ADHD and placed on pharmaceutical medication, which the child is expected to take throughout childhood and even for life. Worse yet, there is very little solid research concerning the long-term benefits or side effects of these medicines.
What is going on here? Have millions of our children become so hyperactive and unable to focus that they are incapable of succeeding at school or dealing with the demands of normal life? Or are we creating an illness where there is none, calling normal variations in temperament and personality a "disease" that requires the intervention of long term, and extremely profitable, pharmaceutical medication?
Furthermore, for those children who really are having difficulties, can we go back to basics? Can we find more natural, less invasive and less dangerous methods for healing these children and enabling them to succeed and thrive without the necessity of pharmaceutical treatment?
As an integrative pediatrician who has helped hundreds of children diagnosed with ADHD over the past 20 years, I offer these practical points to consider:
1. ADHD is often grossly and carelessly misdiagnosed and overdiagnosed. All too often a teacher complaint and a 10-minute talk with a pediatrician results in an ill-considered diagnosis and an indefinite prescription for psychostimulant medication. This hurried process can miss both simple explanations (a gifted child who is bored, a poor fit between student and teacher, parents without adequate time and resources to motivate an intense and difficult child), or more serious problems like anxiety, depression, dyslexia and other learning disabilities.
2. If a child really is having significant attention issues, nutrition, and not medication, is the place to start. Many children begin the day with pop-tarts, Lucky Charms, and similar junk food. We might as well pour table sugar down their throats and send them off to learn. I have seen many children whose attention problems were fixed simply by providing them with a good breakfast and a decent lunch (often hard to obtain at your typical school).
3. In addition to the basics of nutrition, many children have real food allergies or sensitivities. Several research studies have shown, for instance that artificial colors and flavors can make normal children hyperactive and hyperactive children worse. Think about that the next time you see a child downing a huge bottle of bright purple Gatorade. For some kids, even such basic foods as milk and wheat can be triggers for hyperactive behavior.
4. Omega-3 fatty acids, found in fish oil, have been shown in multiple research studies to have significant and sometimes dramatic positive results in children with ADHD. These studies have shown that ADHD children are usually even more deficient in these crucial fats than are most people in our country, and that a daily fish oil supplement can result in dramatic improvement.
5. Recent research has shown that deficiencies of such basic minerals as iron, zinc and magnesium can contribute to ADHD symptoms, and adding simple supplements of these minerals can help improve those symptoms. Levels of these nutrients can be easily checked by your doctor, but very few do so.
By the way, why don't most doctors know and tell you about this? It is because all too many physicians get their information from pharmaceutical representatives and from conferences sponsored by pharmaceutical companies. These companies have no interest in letting anyone know about cheap and simple nonpharmaceutical treatments. It is also a sad fact that most of the "experts" who write articles in prestigious journals about the "correct" treatment for ADHD receive significant financial support from these same companies.
6. Let's not forgot the important role of good parenting in fixing what may look like ADHD. Unfortunately, many have little time for proper parenting. Imagine working or single parents picking their child up at six o'clock, after seven hours in school and three hours in aftercare, then having to rush home and trying to find time to make a decent meal and supervise homework. Is it any wonder everyone is overstressed and kids can't concentrate? Most kids are resilient and will get by, but for the child who may have a harder time concentrating in the first place, this could put him or her over the edge. It's no wonder a simple pill looks like an easy alternative.
7. ADHD has also been linked to too many hours of TV watching and video game playing. These may seriously impair children's ability for sustained attention and focus.
8. Finally, are our schools part of the problem? Caring and hardworking teachers are being given larger classes, less time to teach, and forced by "No Child Left Behind" to teach only for standardized tests. Entire schools are judged by their student's performance on these tests. Again, encouraging parents to place their children on medication can become an all too easy solution.
There are some children with severe ADHD who truly need medication, but many more who are misdiagnosed or have mild symptoms. Let's do better evaluations, and begin with basic, simple and safe interventions before exposing children to what might be a lifetime of powerful medications with long-term effects that are not really known.
For more details and information on natural, safe, effective therapies, see my book "ADHD Without Drugs: A Guide to the Natural Care of Children," with a foreword by Andrew Weil, M.D. It's filled with information that parents, educators and other health professionals can understand and put into immediate practical use.
Art Markman, Ph.D.: How Beneficial Are ADHD Medications Really?
Stephanie Sarkis, Ph.D.: Is it ADHD/ADD or Are We Just Overloaded?
Susan Weissman: Child Food Allergies: What Causes Them?
Dan Brown: HBO's Journey Into Dyslexia Is Excellent
I volunteered at the Center for Integrative Medicine at the U of Arizona for ten years and saw amazing results (which is why I stayed) usually with much reduced side effects.
My plea is to begin with the thin edge of the wedge––start with nutrition. Then look for a doctor who understands an integrative approach to medicine, and abides by his oath to "Do No Harm."
The clear good sense of his argument is typical of the integrative approach: do what works and question fads by subjecting them to scientific scrutiny. I ope a great many pediatricians will read his book, which is a welcome addition to the literature.
As a former elementary school principal, I am quite aware that attention difficulties are just the tip of the iceberg. ADHD children can't filter out distractions, finish tasks on-time, use their memory optimally, etc. A pill doesn't teach these skills.
My wife and I opted to use cognitive training for our son, Alex. We used Play Attention (www.playattention.com) and ADHD Nanny (www.adhdnanny.com). We've been very successful with these approaches. We also changed our parenting skills with great success.
It's just important to know that medicine teaches nothing. Parents and teachers must actively participate to help change a child's life.
I agree that comprehensive evaluation is required in order to come to the conclusion of ADD or ADHD. In my child's case he was monitored by the school nurse, had two hour-long evaluations by a psychologist, multiple written evaluations filled out by myself and his teacher, then finally an evaluation by a psychiatrist before starting him on medication. Now that he has attended school with the aid of medication, he genuinely prefers not to go without it... and we did try.
Do 2.5 million kids really need medication? Maybe not. But I fought with a teacher then an entire school administration over not holding my child back in school because they had the same attitude as the author; perhaps the child is lacking proper guidance at home. Articles such as this only fuel that belief. Perhaps if the author ever had to fight our fight, he might chosen a different approach.
Frei, H, Everts R, von Ammon K, Kaufmann F, Walther D, Hsu-Schmitz SF, Collenberg M, Fuhrer K, Hassink R, Steinlin M, Thurneysen A. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. Eur J Pediatr., July 27,2005164:758-767.
Frei, H, and Thurneysen, A. “Treatment for Hyperactive Children: Homeopathy and Methylphenidate Compared in a Family Setting,” British Homeopathic Journal, October 2001,90:183-188.
Frei, H, von Ammon, K, Thurneysen, A. Treatment of Hyperactive Children: Increased Efficiency Through Modifications of Homeopathic Diagnostic Procedure. Homeopathy, July 2006,95,163-170.
In addition to these controlled clinical trials are a larger number of pediatricians and other health and medical care professionals who have used homeopathic medicines successfully in providing minor and major health care improvements. "First, do no harm" is an obvious FIRST step...and homeopathy provides a safe and often effective treatment...
As a nutritionist, I've seen HUGE changes in chronic disease states by going back to healthy eating. Feeding kids a bowl of chocolate-coated sugar bomb cereal and a microwaved pop tart is part of the problem. Most kid's foods are absolutely horrible! It's hard to find foods without heaps of refined sugar and very high amounts of Omega-6.
Yes, Omega-3 pills help a lot. But that's not the only solution.
Parents have to go back to feeding their kids whole foods, grains, veggies and grass-fed animal products. Anything with soy and corn oil should be eliminated - these oils are too rich in Omega-6, which compete with crucial Omega-3 absorption.
Google Susan Allport and check out her work on Omega-6 and how too much of this "evil twin" of Omega-3 can hurt you. It's eye-opening.
I know what I'm suggesting is hard. Popping a pill is easy. Start with cutting out soda, candy and cookies. Then eliminate foods with corn and soy oils - switch to olive or canola. Those are baby steps.
Trust me, it's worth it.