Dr Frances Pitsilis - What is ADHD?

ADHD affects 3-5% of children globally and is short for Attention Deficit and Hyperactivity Disorder. The condition can start before age 7 and its main constituents consist of inattention, hyperactivity and impulsivity. Sufferers can have one, some or all of these problems.

The ratio of boys/girls affected is 4/1 and many are given Ritalin®.

Around 30-50% of children develop into adults with the condition.There is controversy around its diagnosis and treatment.

Symptoms of ADHD:

Predominantly inattentive type symptoms:

• Be easily distracted, miss details, forget things, and frequently switch from one activity to another.
• Have difficulty maintaining focus on one task.
• Have difficulty focusing attention on organising and completing a task or learning something new or trouble completing or turning in homework assignments, often losing things (e.g. pencils, toys, assignments) needed to complete tasks or activities.
• Not seem to listen when spoken to.
• Daydream, become easily confused, and move slowly.
• Have difficulty processing information as quickly and accurately as others.
• Struggle to follow instructions.

Predominantly hyperactive-impulsive type symptoms:

• Fidget and squirm in their seats.
• Talk nonstop.
• Dash around, touching or playing with everything.
• Be constantly in motion.
• Have difficulty doing quiet tasks or activities.

Manifestations of impulsivity:

• Be very impatient.
• Blurt out inappropriate comments.
• Show their emotions without restraint.
• Act without regard for consequences.
• Can’t wait for things or waiting their turn.

Distinguishing between normal kid behaviour and A-D-H-D?

Because there is a spectrum of behavior, it may be difficult to draw a line between where normal behaviour ends and abnormal behaviour starts.

I would look at performance at school, relationships with others, and the ability to get on with others and lead a normal life at home, school or work.

Diagnosis OF ADHD.

Diagnosis should be made using specific criteria (DSM V) and is usually done by a paediatrician or psychiatrist.

Associations between autism, A-D-H-D and other behaviour disorders.

Some consider that there are associations between the following disorders because of biochemical overlaps.

Tourettes Syndrome, Dyslexia/learning disabilities, some Behavioural problems, Obsessive compulsive disorder, Bipolar Disorder, some cases of Depression and Anxiety, some cases of Schizophrenia.

Behavioural problems – Oppositional defiant disorder, temper tantrums, personality disorders.

All of these conditions are genetically inherited and 75% of them run in families – one person develops one and another may have one of the others in the spectrum. This is why some call them the Autistic spectrum disorders.

Why are these conditions seemingly being diagnosed a lot more now?

That these conditions seem to be diagnosed more often now has been discussed. It is controversial and speculative and there are many theories.  Are we better at diagnosing these conditions?

Some think that those with ADHD and the associated disorders may be increasing because of new environmental factors in modern times that now are “ pushing over” those with some biochemical imbalances that used to get away with it – these people are the “Canaries in the coalmine”.

Some research has suggested that the changed environmental factors can include diet, gut flora, chemical/pesticide exposure.

Treatment for ADHD:

• Diagnose early - parents and teachers to be on the lookout.
• Use experts.
• Exclude any biochemical abnormalities and treat any health problems.
• Behavioural, educational and psychological therapies are said to be the most effective treatments.
• Look at medication when needed for aggression, hyperactivity. 

One medical review stated that although 70% of children receive medications, the benefits do not outweigh the risks. Nevertheless, we all know of children (and adults) that are on Methylphenidate (Ritalin®) who seem to benefit. SSRI's (like Prozac®) and other drugs can be used too.

How Does Ritalin work?

Its been called a psychostimulant drug because it increases neurotransmitters in the brain. It does this by reducing the re-uptake of Noradrenaline and Dopamine (and a little serotonin).

But this actually means it will calm the person because when these neurotransmitters are depleted, agitation and anxiety is caused.

Natural treatments that could work alongside a conventional approach.

This is called the Biomedical Approach – controversial in some peoples view. I would suggest that it could be added into the conventional approach:

• Find a doctor with an interest in this.*
• Designed to help the brain work better biochemically by correcting any imbalances that contribute to the problems.
• Gluten/dairy free diet.
• Correct specific vitamin, mineral, omega 6 and omega 3 deficiencies.

Specific deficiencies that are thought to require correction.

Its important to work with a doctor who has an interest in this approach.

• Low Vitamin B6 and Zinc.
• Magnesium and Vitamin B12 is also useful.
• Often, antioxidants like vitamin C are added in to help reduce oxidative stress on the body.
• Cod liver oil is useful - contains Vitamins D and A.
• Omega 6’s.
• Probiotics and correction of gut flora.
• Melatonin drops can be used in children who can’t sleep.

Advice to parents

Each child is an individual - treatment must be tailored.

Get support! From: Family, Teachers, friends, family doctor, support groups.

Biomedical resources

The following organisations run conferences for parents and train doctors:

• http://mindd.org/
• www.biobalance.org.au
• Also, Google “Autism doctor”.

References:

1. Braun, L., & Cohen, M.  Herbs & Natural Supplements. An evidence based guide, 3rd Edition. Churchhill Livingstone: Australia.
2. Douglas, R. M., Hemila, H., D'Souza, R., Chalker, E. B., Treacy, B. (2004). Vitamin C for preventing and treating the common cold. The Cochrane Database of Systematic Reviews, 4, Art. No.: CD000980.pub2. doi: 10.1002/14651858.CD000980.pub2.
3. Hromek, K. (2010). Injectable nutrients, 1st Edition. KAM Publishing: Australia.
4. Van Straten, M., Josling, P. (2002). Preventing the Common Coldwith a Vitamin C Supplement: A double-blind, placebo-controlled survey. Advances in Therapy, 19(3), 151-159.