Attention Deficit Disorder

DESCRIPTION

A pattern of behaviour in children characterized by short attention spans and impulsivity, with or without hyperactivity, attention deficit disorder (ADD) is implicated in learning disorders and estimated to affect 5–10% of school-aged children with incidence substantially greater in boys than girls (10 : 1). Over two million American school-aged boys take the drug methyl-phenidate (Ritalin) for ADD. Onset is usually by 3 years of age, but diagnosis is generally not made until later when the child is in school.

Three separate attention deficit disorders exist:

• Hyperactivity (attention deficit disorder with hyperactivity) – signs of inattention, impulsiveness, and hyperactivity inappropriate for the child’s age
• Learning disability (attention deficit disorder without hyperactivity) – developmentally inappropriate brief attention span and poor concentration for the child’s age
• ADD, residual type (in individuals 18 years old or older) – a continuation of the process of ADD into adulthood.

 

FREQUENT SIGNS AND SYMPTOMS

Characteristics of ADD with hyperactivity in order of frequency

• Hyperactivity (squirms in seat, fidgets with hands or feet, unable to stay seated when required to do so, difficulty waiting turn in lines and games, difficulty playing quietly)
• Perceptual motor impairment
• Emotional instability
• General coordination deficit
• Disorders of attention (short attention span, easily distracted, lack of perseverance, failure to finish things, shifts from one uncompleted project to another, not listening, poor concentration)
• Impulsiveness (action before thought, abrupt shifts in activity, poor organizing, jumping up in class, talks excessively, blurts out answers before a question is finished, interrupts or intrudes on others, often engages in dangerous activities without considering consequences)
• Disorders of memory and thinking (difficulty following instructions, doesn’t appear to listen, frequently
  loses items necessary for tasks)
• Specific learning disabilities
• Disorders of speech and hearing
• Equivocal neurological signs and electroencephalographic irregularities

Characteristics of ADD without hyperactivity

• Frequent ear infections (otitis media)
• Moderate to severe hearing loss
• Impaired speech and language development
• Lowered general intelligence scores
• Learning difficulties

CAUSES

Although ADD with hyperactivity and ADD without hyperactivity (learning disabilities) are discussed separately, the factors discussed under one may be equally relevant to, and should be considered in treatment of, the other.

ADD with hyperactivity

• Food additives:
• Some 5,000 additives are used in the US including anticaking agents (e.g., calcium silicate), antioxidants (e.g., BHT, BHA), bleaching agents (e.g., benzoyl peroxide), colourings (e.g., artificial azo dye derivatives, particularly the yellow dye tartrazine), flavourings (emulsifiers, mineral salts), preservatives (e.g., benzoates, nitrates, sulphites), thickeners, and vegetable gums.
• Each person in the US is estimated to consume 3.5–4.5 kg (8–10 lb) of food additives per year with daily per capita consumption averaging 13–15 g. For the US population, total annual consumption of artificial food colours alone is approximately 45 million kg (100 million lb).
• Based on his experience with over 1,200 cases in which food additives were linked to learning and behaviour disorders, Benjamin Feingold MD has proposed that food additives are a major cause in hyperactivity. According to Feingold, many hyperactive children – perhaps 40–50% – are sensitive to artificial food colours, flavours, and preservatives and to naturally occurring salicylates and phenolic compounds.
• Although Feingold’s hypothesis has been hotly debated, the published studies yield some clear conclusions. Virtually every study has demonstrated that some hyperactive children consistently react with behavioural problems when challenged by specific food additives, and their responses are reproducible under double-blind conditions.
• Studies evaluating Feingold’s hypothesis in the US (funded by the Nutrition Foundation, an organization supported by the major food manufacturers – Coca Cola, Nabisco, General Foods, etc. – which would suffer economically if food additives were found harmful) have been largely negative, while studies in Australia and Canada have been supportive. The use of artificial food additives has been significantly restricted in other countries because of the possibility of harmful effects.
• Sucrose (sugar) consumption:
• Destructive–aggressive and restless behaviour has been found to significantly correlate with the amount of sucrose consumed.
• A high percentage – 74% of 261 hyperactive children in a recent study – has been shown to have abnormal glucose tolerance curves exhibiting hypoglycemia, which would promote hyperactivity via increased adrenaline secretion.
• Refined carbohydrate consumption appears to be the major factor in promoting reactive hypoglycemia, i.e., hypoglycemia resulting from a rapid elevation in blood sugar for 1–2 hours followed by a severe drop in blood sugar levels.
• Food allergies:
• While artificial colourings and preservatives have been the most common substances causing hyperactivity in studies, no child has been found to be sensitive to these alone. Food allergies or sensitivities can also cause psychological symptoms. A number of studies have demonstrated that to effectively heal ADD, both food additives and allergens must be eliminated from the diet.
• In a double-blind study of 26 hyperactive children, 19 responded well when both food additives and allergens were eliminated, and in a larger study of 185 children with hyperkinetic syndrome, 116 improved. In a retrospective study, 86% of hyperactive children were found to have elevated levels of eosinophils, white blood cells that are linked to allergies.

Learning disabilities (ADD without hyperactivity)

Three factors appear to be particularly relevant to learning disabilities.

• Otitis media (ear infections):
• Current and recurrent ear infections have been reported to be twice as common in learning disabled children as non-learning-disabled children.
• Children with moderate to severe hearing loss tend to have impaired speech and language development, lowered general intelligence scores, and learning disabilities.
• Nutrient deficiency: low levels of nutrients in the diet prevent the brain from functioning properly, and poor nutritional status may be most harmful earlier in life, during physical, mental and social development. Even a subclinical deficiency of virtually any nutrient can result in hampered nerve cell function and impaired mental performance.
• Iron deficiency, the most common nutrient deficiency in American children, is associated with markedly decreased attentiveness; less complex or purposeful, narrower attention span; decreased persistence; and decreased voluntary activity – all of which are usually responsive to supplementation.
• Several clinical studies have demonstrated that nutritional supplementation can significantly improve mental function in school-age children.
• Nutrients especially important to proper brain and nervous system function include thiamin, niacin, vitamin B6, vitamin B12, copper, iodine, iron, magnesium, manganese, potassium, and zinc.
• Heavy metals:
• Numerous studies have demonstrated a strong relationship between childhood learning disabilities (and other disorders including criminal behaviour) and body stores of heavy metals, particularly lead.
• Learning disabilities are frequently characterized by a pattern of high levels of mercury, cadmium, lead, copper, and manganese as determined by hair analysis.

RISK INCREASES WITH

• Ear infections: frequent ear infections and antibiotic use are associated with greater likelihood of developing ADD.
• A nutrient-poor diet composed largely of additive and sugar-laden (processed) foods.
• Exposure to heavy metals: common sources – in addition to environmental contamination of air, water and food crops due to industrial processes and leaded gasoline – include lead from pesticide sprays,  cooking utensils, the solder in tin cans; cadmium and lead from cigarette smoke; mercury from dental fillings, contaminated fish, and cosmetics; and aluminium from antacids, antiperspirants, cookware and aluminium foil.
• History: a family history of ADD.

PREVENTIVE MEASURES

• Avoid processed foods: the debilitating load of sugars, refined carbohydrates, trans fats and food  additives that these foods contain contributes to ADD in children – and to elevated cholesterol levels, blood pressure, and a significantly increased risk for obesity and diabetes in adults.
• Provide a health-promoting diet rich in whole, unprocessed, preferably organic foods, especially plant foods (fruits, vegetables, whole grains, beans, nuts and seeds), and cold-water fish.
• Eat organic produce: both for maximum nutrient density and minimal pesticides, herbicides, fungicides and waxes, choose organic produce whenever possible. If organic produce is not readily available, try to buy local in-season produce. Soak the produce in a mild solution of additive-free soap or pure castille soap from the health food store. All-natural, biodegradable cleansers are also available at most health food stores. Simply spray the produce with the cleanser, gently scrub, then rinse off.
• Minimize exposure to heavy metals: this is another reason to choose organic produce. Don’t smoke or allow your child to be around smokers. Avoid being outside when smog levels are high. If pesticide use is necessary, sprinkle boric acid – a non-allergenic, relatively safe insecticide – in all potentially infested areas. Use waxed paper, glass, ceramic or steel containers for storage and serving. Avoid canned foods; purchase fresh or frozen foods or dried beans.

Expected outcomes

Identification and elimination of clear causative factors, such as food allergies or sensitivities to food additives, will often bring about dramatic improvements within the first 2 weeks of treatment in many cases. However, in cases where food allergies/sensitivities do not appear to be the primary factors, improvements will be more subtle and gradual.

 
TREATMENT

Screening for heavy metal toxicity
Hair mineral analysis and EDTA challenge should be used to screen for heavy metal toxicity as these tests
illustrate long-term burden versus blood measurements; the latter reflect only recent exposure and do not accurately evaluate heavy metal concentration in the brain.

 
Diet

• Eliminate all refined sugars and as many food additives as possible by providing a diet composed from whole, unprocessed, preferably organic foods prepared at home. When in control of food preparation, consumption can be monitored accurately.
• To identify and eliminate food allergens, the most sensible and least expensive method is a 4-week program of the oligoantigenic diet (oligo ??from the Greek oligos meaning little??plus antigenic ??allergy-provoking – in other words, a diet containing the least amount of potentially allergenic foods).
• The oligoantigenic diet consists of lamb, chicken, potatoes, rice, banana, apple, cabbage-family vegetables, a multiple vitamin, and 3 g q.d. of calcium gluconate.
• After 4 weeks on the oligoantigenic diet, reintroduce suspected problem foods (full servings at least once a day, one food introduced per week). If symptoms recur or worsen upon reintroduction/challenge, the food should be removed from the diet.
• If no improvement occurs on the oligoantigenic diet, the child may be reacting to something else in the diet or environment, and further testing for allergens or heavy metals may be indicated.
• To help chelate heavy metals, increase consumption of foods high in sulfur such as garlic, onions, and eggs, provided your child is not allergic to these foods. In addition, water-soluble fibers (e.g., guar gum, oat bran, pectin, and psyllium seed) bind toxins in the gut and help promote their excretion.

Nutritional supplements

• A high-potency children’s general multivitamin and mineral supplement – with special care used to ensure the child is not allergic to any of the product’s constituents.
• Should a child be found to have heavy metal toxicity, the following minerals and vitamins are of  particular importance in combating heavy metal poisoning: calcium, magnesium, zinc, iron, copper, and chromium; vitamin C and B-complex vitamins. The sulphur containing amino acids (methionine, cysteine, and taurine) may also be prescribed.

Botanical medicines

• Silymarin: a special extract from Silybum marianum (milk thistle), silymarin contains a group of  flavonoid compounds that exert powerful beneficial effects in protecting the liver from damage and enhancing detoxification processes:
• Silymarin is an antioxidant many times more potent than vitamin E and vitamin C.
• Silymarin prevents the depletion of glutathione, perhaps the most important detoxification enzymein the liver. Glutathione has primary responsibility for the elimination of fat-soluble toxins, a group that includes not only heavy metals, but also many of the toxins from pesticides, gasoline and cigarette smoke. The higher its glutathione levels, the greater the liver’s capacity to detoxify harmful chemicals.
• Dosage: 70–210 mg t.i.d.

Drug–herb interaction cautions

None.

 
Physical medicine

• Help the child at home by providing a structured environment, well-defined behaviour limits and consistent use of parenting techniques. Professional counselling for parents and child may be helpful.
• Behaviour and cognitive therapies involve the child with self-monitoring, role playing and self-recording, focusing on strategies that alter the undesired behaviour.
• Stay in close contact with the child’s teacher. Arrange for extra lessons or tutoring if needed.

ICIM Medics Approach

If you feel that this article relates to a family member or friend then please make an appointment to see Dr. Finbar Magee.  http://icimmedics.com/our-team/

This article is not meant to be used for treatment but for information purposes only. If you feel that this approach is appropriate please contact ICIM Medics on 045 844 819 or www.icim.ie e-mail : info@icim.ie  where an appointments can be arranged for you.

Tags: Attention Deficit Disorder, Attention Span, Hyperactivity, Ritalin