Attention Deficit Hyperactivity Disorder (ADHD) is a complicated name for a complicated condition that is affecting more and more children. What do you do if your child is one of them?
Four-year-old Dale* is the ‘difficult’ child in the family. He’s always in trouble, both at home and at his preschool, where he is frequently separated from the other children because he is disruptive and aggressive. For a long time his parents tried to justify his behaviour: he’s the middle child; he’s had repeated ear and throat infections; he was the one most upset by moving house recently. But these things don’t account for his consistently worrying symptoms: Dale is unnaturally restless and easily distracted. He can’t finish tasks, he doesn’t listen to instructions or obey rules. He can be sweet and loving one minute and throw a spectacular temper tantrum the next. Dale’s parents recently acknowledged that their child needs help, but they are overwhelmed by the confusing array of disorders he could be suffering from. Does he have learning difficulties, ADD, ADHD, Autism or Asperger’s Syndrome? On the advice of Dale’s teacher they have made appointments with an educational psychologist and a paediatrician. The long road to diagnosing what’s wrong with their son has begun.
When is it ADHD?
ADHD is one of the conditions on the Autism spectrum, which encompasses a range of disorders from profound disability to high-functioning savant ability at the Asperger’s end of the scale. There is a degree of overlapping between the disorders; for example, 40% of children diagnosed with Asperger’s Syndrome also meet the criteria for ADHD, which has three defining characteristics: inattention, hyperactivity and impulsivity.
However, a child with ADHD may not exhibit all of these symptoms. A multi-disciplinary team at the Behavioural Neurotherapy Clinic in Doncaster, UK, describes the subtypes of the disorder as mainly inattentive (the child is forgetful and distracted), mainly impulsive and hyperactive (the child fidgets, walks around in class, talks incessantly, has trouble taking turns) and a form that combines these symptoms. The condition first occurs before the age of seven and should be noticeable in different settings (at home, at school and in public) for a period of at least six months. It should be severe enough to have affected family life and the child’s ability to function normally at school and in social situations.
A diagnosis of ADHD is made only when physical and emotional explanations have been ruled out. Illness, food intolerance or a reaction to medication will affect a child’s behaviour, as will trauma and depression. It is important to eliminate these factors before labelling strange behaviour ‘ADHD’ as the drugs used to control the disorder can make undiagnosed physical and emotional conditions worse.
Despite all these checks and balances, ADHD is still very difficult to pinpoint as it so often goes hand in hand with other disabilities. There may be learning difficulties, particularly in language, reading and maths. Also, because they experience so much rejection, these children frequently suffer from a great deal of worry and anxiety; they may have low self-esteem, weight issues and sleep disturbances. Emotional distress as a result of the ADHD then adds to the child’s problems.
What causes it?
‘Over the last 20 years, ADHD has increased by over 400% to become the most prevalent childhood neurological disorder in South Africa,’ says Hannah Kaye, a nutritional therapist and Defeat Autism Now! (DAN!) clinician who practises in Johannesburg and Cape Town. ‘It’s not something you can diagnose by running a test; it’s a number of symptoms that occur in a particular combination.’
There is some debate as to whether it is a psychiatric or a neurological problem. Qualitative EEG brain scanning technology that uses colour gradations can pick up the differences between ADHD and learning difficulties. According to the Doncaster group, an ADHD brain produces too many theta waves and not enough beta waves – an imbalance that neurotherapy can help to correct.
But there are other possible causes for ADHD. It has been linked to lead toxicity and also to bacterial imbalances in the gut. A study by the University of Pittsburg School of Medicine found a connection between childhood abdominal pain and the development later in life of anxiety, depression and migraine. In a similar study, the Mount Sinai Medical Department of Psychiatry in New York found that 70 – 90% of patients with irritable bowel or leaky gut syndrome also suffered from anxiety and depression. As the bacterial balance in the gut was restored, symptoms of anxiety, irritability and temper decreased.
Just as there is no single definition for ADHD, it is also not possible to identify a single cause. But the rapid rise of the disorder suggests that we should pay attention to modern-day environmental and nutritional factors that might be contributing to its prevalence.
What are the treatment options?
Drugs such as Ritalin stimulate the brain’s production of dopamine, which is thought to be low in ADHD. Some children do better on medication – it stabilises them and enables them to cope at school – but other children don’t react well. As with most drugs, there are side effects: growth, sleep and appetite can be affected and the gut can be irritated, which makes it all the more crucial to establish the health of the digestive tract early on. While improving mood and behaviour, the medication could aggravate undiagnosed digestive problems.
Conduct disorders can’t only be treated with drugs, say the Doncaster team. Short-term stimulant drug therapy has its place, but metabolic causes, brainwave abnormalities and behavioural issues must also be addressed. Nutritional supplementation (particularly Omega 3 essential fatty acids) and neurotherapy support the brain, after which cognitive behaviour therapy can help the child to control his actions.
‘As you’d expect, there is no one-size-fits-all solution for ADHD,’ says Hannah Kaye, ‘and treatment also depends on the route the parents want to take. They are stressed and exhausted so it’s natural that they would want a diagnosis and a quick fix. Medication can help, but it manages the symptoms of the disorder without necessarily addressing its causes, which is why I favour a biomedical approach. The family history is considered; blood, stool and allergy tests are done. The aim is to reduce environmental toxins; treat fungal, viral, bacterial or parasitic infections and make dietary changes that will support the child’s overall health. Without the right nutrients, the body can’t protect itself.’
Navigating the minefield
Unfortunately, ADHD goes hand in hand with food fads and fussy eating. ‘I can appreciate that the last thing parents want to deal with at the end of the day is a fight about food,’ says Kaye. ‘All the same, a diet high in carbohydrates and sugar is going to make things worse.’
Eczema, ear infections and tummy aches indicate allergies or imbalances that need investigation. One option is to try a strict elimination diet to identify what the child is sensitive to. ‘The most common culprits are gluten, soy, caffeine, corn and sugar’, says Kaye, ‘but some children are also affected by a natural compound found in apples, which comes as depressing news to parents who rely on the trusty apple to deliver a daily dose of vitamins.’
There are several diet plans that have been found to be helpful in managing ADHD, but you have to experiment to find the one that is right for your child. It takes time, money and commitment, but with professional help it’s possible to find a nutritional programme that works. Generally, it involves a significant reduction of sugar (including fruit) and the introduction of good quality protein and lots of vegetables.
Good nutrition is the basis for good health and can only benefit the ADHD child, but the chances are that it will take the expertise of several health practitioners to tailor a treatment plan that is really effective for you child. An accurate diagnosis is the first essential, and for that an educational psychologist, psychiatrist or paediatrician should be consulted. Thereafter, a nutritional therapist and occupational therapist can offer practical advice for managing the condition.
ADHD takes a toll on family life, on the parents’ relationship, energy and resources. So it is important to find a support group with whom you can share information and encouragement. If it is left untreated, ADHD sufferers can be drawn into antisocial or dangerous activities and substance abuse. But with the right help, they can live productive, creative, satisfying lives.
This article was published in Reality Magazine