ADHD: The classroom epidemic

Drugs are not the only option for Attention Deficit Hyperactive Disorder. Natural therapies can offer children--and parents--relief.

Justin Hill-Smith of Dallas, was a happy, easygoing child who was always on the go--running, climbing and jumping around. But from the time he was 3, it was obvious to his mother, Deborah, that when he was "wound up," it was hard to get his attention or to get him to mind. Deborah assumed this was normal behavior for a boy Justin's age. At 4, Justin was enrolled in a Montessori pre-school program. Deborah felt that Justin would do well in his new school because he liked to be kept busy, and he was a quick learner. When one of Justin's teachers called, Deborah was genuinely shocked by what she heard.

The teacher asked Deborah to take Justin out of the school and not to bring him back until he was on Ritalin--a stimulant drug that is a controlled substance in the same class as morphine and often prescribed for children with attention deficit hyperactive disorder (ADHD). The school told Deborah to take her son to a psychiatrist for a comprehensive evaluation to confirm that Justin had ADHD.

The child psychiatrist who evaluated Justin was an expert in the treatment of childhood hyperactivity. After a lengthy workup, he concluded that the school was correct in identifying the boy as an ADHD child. Deborah reluctantly accepted the diagnosis, noticing that even in the doctor's office Justin touched, handled and almost took apart everything within reach.

Justin and Deborah left the doctor's office with a prescription for Ritalin and an understanding that ADHD was a central nervous system disorder for which there was no one simple treatment. Because only 20 percent of ADHD children outgrow the need for medication, Justin would probably be on Ritalin and possibly, antidepressants, anti-seizure drugs and tranquilizers, for the rest of his life. Behavior training would be necessary to help Justin change some of his impulsive actions such as running around wildly or using beds as trampolines, and he would need to be schooled in a special educational environment for the learning disabled.

Deborah quit her job so she could provide home schooling for Justin. But after two months on the new regimen, Justin was still bouncing off walls and racing through the house. The doctor increased the dosage of Ritalin, but there wasn't much improvement so Deborah, frustrated with the conventional approach to her son's problems, started reading everything she could get her hands on about ADHD. Among the many things she found out was that Ritalin was not recommended for children under 6 years of age. Justin was given it at 4. Deborah also discovered that there are some physicians who believe that childhood hyperactivity is caused by food allergies, not neurological problems. According to these physicians, once the offending foods are removed from the diet, the hyperactivity diminishes.

A member of Deborah's home-schooling support group suggested she see a local osteopathic physician who treats children for hyperactivity without drugs. Mary Ann Block, D.O., who practices in Hurst, Texas and is the author of No More Ritalin (Kensington, 1996), says her medical education started when her daughter, Michelle, experienced a chronic illness that was caused by food allergies. Doctor after doctor prescribed drugs for Michelle, who kept getting sicker. Block finally found an osteopathic physician who was a good medical detective and believed that drugs should be the last resort, especially when the drugs only treat symptoms and have serious side effects. Under the osteopath's care, Michelle was restored to health, but the healing journey was so difficult and stressful that, that at the age of 39, Block decided to go to medical school herself. "I went out of self-defense and in defense of my daughter," says Block adding, "but no one should have to go to medical school just to be able to care for his or her child."

Justin Hill-Smith's mother was more fortunate. Instead of going to medical school, she made use of Block's medical services. After treatment by Block with a combination of diet, behavioral training and osteopathic manipulation, Justin, now 11, is drug-free and symptom-free. In fact, he is now in a college prep program and doing very well.

Justin and Michelle are like 4 and a half million other children in the United States, between 4 and 11 years old, who are being referred by their teachers to psychiatrists and neurologists for the treatment of the behavioral and learning disorders collectively known as ADHD. Believed to be caused by a deficiency of norepinephrine, a chemical messenger needed by the brain to inhibit muscle activity and impulsive behavior, between 3 percent and 6 percent of children in the United States are believed to suffer from ADHD, a condition much more common here than in Europe. ADHD's defining symptoms include: either behaviors labeled inattention, the so-called quiet symptoms of ADHD (such as making frequent, careless mistakes, failing to pay attention to details, not listening when spoken to, difficulty organizing tasks, lack of follow-through, losing things, forgetfulness and easy distractibility) or hyperactivity and impulsivity, the two types of behaviors most often identified with ADHD. This grab bag of behaviors includes the more disruptive, least) easily managed ADHD symptoms that are ten times more common in boys. Behaviors include fidgeting, squirming, running and climbing instead of sitting, talking incessantly, blurting out answers before a question is framed, difficulty awaiting turn and butting in on others.

According to Larry Silver, M.D., author of Attention Deficit Hyperactive Disorder: A Clinical Guide to Diagnosis and Treatment (American Psychiatric Press, 1992), ADHD is often diagnosed at school because a child has trouble reading or difficulties concentrating. "But other conditions, such as depression or anxiety, are much more often the cause" says Silver, implying that many cases called ADHD may actually be caused by other psychological problems, not ADHD. "If the behavioral problems are not chronic and pervasive, occurring both at school and home, they're probably not ADHD," cautions Silver, who adds that children who really have ADHD need the medication Ritalin to function normally, in the same way that diabetics need insulin.

However, critics such as the national grass-roots organization, Parents Against Ritalin (PAR), based in Claremore, Okla., disagree, saying insulin is an essential chemical made in the body that is a necessity for everybody's health. Ritalin, on the other hand, is a synthetic drug with which we have limited human experience and several reasons for caution, such as drug dependence and serious adverse drug reactions.

Even the United Nations is worried about Ritalin being passed out as freely as candy in the United States. In a 1995 report, the International Narcotics Control Board (INCB) of the United Nations noted the huge increase in use of Ritalin by children with ADHD in the United States, five times more than in the rest of the world. The report warned that if present trends continue, as many as 8 million American children could be taking Ritalin by the year 2000.

Contrary to the INCB, Silver doesn't believe that Ritalin is overprescribed. Although some children are probably misdiagnosed, Silver speculates that as many as half the children who have ADHD have yet to be identified, and most of the 1 percent of adults who have the disorder don't know it. However, Ronald L. Hoffman, M.D., a specialist in environmental medicine from New York City, author of The Natural Approach to Attention Deficit Disorder (ADD): Drug-Free Ways to Treat the Roots of this Childhood Epidemic (Keats, 1997), asks the question, is ADHD (ADD is the old name for the condition) on the rise because our awareness of them is increasing or because we are trying to treat a multitude of different behaviorial problems simplistically with a pharmaceutical?

ACCORDING TO Hoffman, what Ritalin does to ADHD children is to temporarily slow them down and give them the appearance of behaving normally, but it does not address the underlying cause of their problem. In addition, Ritalin doesn't work for everybody--some children show little or no improvement on the drug and many troublesome side effects. As far as Hoffman's concerned, the widespread prescribing of Ritalin for young children is an unprecedented experiment with their children's health. "It's become expedient to address a complex behavior problem with a one-size-fits-all drug," says Hoffman.

Why the almost 400 percent rise in children medicated for ADHD in just four years? PAR, the grassroots advocacy group, offers five reasons:

Lack of parental discipline. The pill is an easier option than dealing with the common challenges of child-rearing.

Pressure from the school system. Teachers who are asked to do more with less may seek relief from disruptive students the easy way--with a pill.

Inadequate medical evaluations. A recent report in the Archives of Pediatric and Adolescent Medicine showed that half the pediatricians surveyed send children home with prescriptions after spending less than an hour evaluating them.

Misdiagnosis of condition. Some children with behavioral difficulties other than ADHD are being given Ritalin.

Multimillion dollar drug. PAR points out that ADHD is big business--sales of Ritalin are approaching $400 million annually, more than double the revenues in 1990. The booming sales are attributed to pressure put on doctors and teachers by the marketers of the drug through ads and sponsored educational activities.

The benefits of drug alternatives for children with ADHD have been debated for decades. Although PAR supports many natural alternatives, Children and Adults with Attention Deficit Disorder (CHAADD), which is partially funded by Ciba-Geigy, the drug company that makes Ritalin, considers these treatments controversial, unproven or ineffective. In fact, the organization's promotional literature warns parents to be wary of investing time, money and their child's best interests in "unproven, questionable treatments."

For parents who are convinced that their child suffers from ADHD and are dissatisfied with Ritalin, alternative therapies deserve close inspection. Some of the most promising include:

Homeopathic remedies are extreme dilutions of plant, mineral and sometimes, animal substances that are based on the principle of "like curing like." Prescriptions are in microdoses, and there are no adverse side effects. Homeopathic doctors attempt to find the one remedy that fits the entire symptom picture shown by the patient.

On an initial visit to a homeopathic doctor, the patient is carefully interviewed and observed to identify his or her unique pattern of symptoms. In the case of an ADHD child, this may mean talking to the parents and watching the child wander around the exam room, fidget or even make noises and trash the place. The pains, quirks and emotional and mental states of the child are considered important clues to the symptom picture. The homeopathic physician prescribes a specific remedy in a tincture or tiny pills to be used over a period of days or weeks. Usually, the patient returns in five to eight weeks to be evaluated. If the patient improves, the prescription is continued, if not, it is changed. Once the child is functioning more normally, follow-up visits two to four times a year are all that are needed to monitor progress.

While there are no case-control studies evaluating this treatment approach, two physicians, Judyth Reichenberg-Ullman, N.D., and Robert Ullman, N.D, have described their work with over 900 ADHD children in a recent book, Ritalin-Free Kids (Prima, 1996). The Ullmans claim a 70 percent cure rate using classic homeopathic methods with ADHD children who remain in their care for at least one year. Conventional medicine, which doesn't believe there is a cure, offers symptoms control through continued medication. Many of the Ullmans' patients have been on Ritalin and other drugs for as long as five years before coming to them. Once their course of homeopathic treatment is successfully completed, all medications for ADHD can be eliminated.

Food Allergy Therapy
A WHOLE-FOODS diet, high in protein, complex carbohydrates, vitamins and minerals, is best for ADHD children, according to Donald J. Brown, N.D., a naturopath who teaches herbal medicine at Bastyr University in Bothell, Wash. Food allergies have been debated as a possible explanation for hyperactivity and attention deficit disorder since 1922, but the best-known food allergy and hyperactivity hypothesis was developed by Ben Feingold, M.D., in 1973. Feingold proposed that salicylates can negatively affect the behavior of some children. Salicylates are found in artificial colors and flavors, aspirin, grapes, tomatoes, green and red bell peppers and many other foods. Feingold found that by removing all salicylate-containing foods from a child's diet, hyperactive behavior improved. Feingold Associations formed across the country to aid parents in adopting the difficult, restrictive Feingold diet, a diet which they claimed helped half of all children diagnosed as hyperactive. Although debate about the value of dietary changes for hyperactivity has raged for decades, many parents swear by it. PAR modeled their diet suggestions after the Feingold (hypoallergenic) diet.

The diet basics according to PAR are:

Reduce sweets and simple sugar intake

Remove all white substances from the diet (white sugar, white flour and milk)

Eliminate food sources of common food allergies including milk, wheat, chocolate, oranges, yeast, food additives and food dyes.

In addition, PAR emphasizes adding generous amounts of these wholesome, nourishing foods to the diet:

Fresh vegetable soups rich in minerals

Whole grains, such as brown rice, millet and whole oats, which are rich in B vitamins, calcium and magnesium

Raw vegetables and salads rich in vitamins and minerals

Fresh fruits that serve as a cleansing agent, ridding the body of toxins and helping children withdraw from processed sugar (the fructose in fruit reduces the urge to binge on sugar).

New research is beginning to back up the Feingold diet. A study in the Annols of Allergy (May, 1994) showed that children on a diet free of dairy, wheat, corn, soy, citrus, eggs, chocolate, peanuts, artificial colors and preservatives for two weeks experienced considerably less hyperactivity, but the symptoms returned when they resumed their normal diets.

Another study in The Lancet (May 9, 1992) reported that a majority of ADHD children (116 out of 185) put on a hypoallergenic diet supplemented by calcium, magnesium and zinc as well as vitamins responded favorably, with fewer ADHD symptoms.

For a highly readable review of recent studies that support the Feingold hypothesis and older studies that don't, send for: Why Can't My Child Behave? by Jane Hersey (Pear Tree Press, 1996, P.O. Box 30146, Alexandria, VA 22313).

Osteopaths are believers in holistic health care. They treat the body as an integrated whole instead of merely looking at specific symptoms or illnesses. Block uses osteopathic manipulation as well as diet, herbs and behavioral approaches to help ADHD children. Osteopathic manipulative therapy adjusts the body mechanically in order to allow the nervous system to function more smoothly. It is said to be particularly valuable for children with ADHD who have suffered head and neck trauma.

Block, the osteopath who treated Justin Hill-Smith, has treated over 700 ADHD kids using a multifaceted treatment plan. She tests for allergies, learning disorders, hypoglycemia (low blood sugar) and yeast infections. Once she identifies sources of the problem, she works with patients on dietary changes, allergy desensitization, manipulative therapy and behavior modification. Block believes that the norepinephrine deficiency cited as the cause of ADHD is actually a result of the syndrome. There is no physiological basis for the diagnosis of ADHD so it doesn't make sense to name it, says Block.

Medicinal Herbs
Some children and adults with ADHD are depressed, restless and, at times, low in energy. They may have memory and concentration problems due to reduced blood flow to certain areas of the brain, and they may not sleep well. Brown suggests these herbs are particularly helpful to people with ADHD, but cautions that adult dosages may need to be cut in half for children. Check out the correct level for your child with a naturopath or professional herbalist:

For Alleviating depression. St. John's wort extract; 300 (milligrams) mg., three times daily. It is a mild ant depressant and increases norepinephrine levels in the brain.

For increased memory and mental acuity: Ginkgo biloba; 240 mg. in pill or powder form, divided into two or three doses per day. This herb increases blood flow to the brain.

For energy and endurance. Siberian ginseng (Eleutherococcus senticosus); 300 mg. to 400 mg. in two or three daily doses. (In tincture, 8 milliliters [ml.] to 10 ml. in two to three divided doses). Use for four to six weeks, stop for one to two weeks, then, resume.

For liver cleansing. Milk thistle is useful in counteracting the effect of drugs, yeast infections and toxic byproducts resulting from food allergies: Milk thistle extract of 420 ma. is recommended, divided into three doses. Milk thistle is particularly valuable for protecting the liver when taking prescription antidepressants, which is sometimes part of the ADHD treatment plan.

For insomnia. Valerian root extract; 300 mg. to 500 mg., one hour before bedtime. Combine with passionflower, lemon balm and skullcap. Consult with an herbalist to determine the right amount of each. Valerian is a mild central nervous system sedative that helps children get to sleep faster and enjoy deeper sleep.

For calming. Chamomile extract; two to three ml. of liquid extract in warm water before bed. Or, if the child is allergic to ragweed (related to chamomile, botanically), use other mild herbal sedatives such as skullcap and passionflower.

Herbs have helped many people manage ADHD, says Debra Jones, founder of PAR. However, she cautions that not all herbs and herbal sources are created equal, so it's important to educate yourself and seek professional help in deciding which herbs and what amounts and sources to use. Just as prescription medications don't work the same for everyone, neither do herbs because everybody's system is different.

What can you expect from herbs? Bear in mind that they will not cure a child with ADHD. All they can do is provide the body with the nourishment needed for balance and proper functioning. By balancing the child's body, however, he or she usually feels better and behaves more appropriately.

Recent studies suggest that ADHD children may face even greater hurdles as adults. They are at higher risk for depression, alcoholism and antisocial behavior. Therefore, early intervention and successful treatment is not only crucial to a child's ability to learn but to their success in life. Nonetheless, questions about conventional treatments remain. Are millions of children suffering from what is classified as a psychiatric illness (with all the negative social connotations that such a diagnosis carries), requiring mind-numbing medications, or are we simply dosing children to make their behavior conform to that of their classmates?

Andrew Weil, M.D., the Tucson, Ariz., alternative medicine guru, believes that while Ritalin is appropriate in some cases, it is greatly overprescribed and that good alternative treatments are available. If you suspect that your child or you have ADHD, get a good diagnostic workup that rules out other causes such as depression, allergies, hearing or vision impairments, says Weil, cautioning that conventional drug treatments for these maladies are themselves controversial.

Block says there is no such thing as ADHD, just a dysfunctional educational system. "I believe education must change so all children entering school are on a level playing field. Before they get to school, they should be eating organic, whole food, low in sugar and additives and taught to overcome any learning difficulties they might have. In the classroom, children's talents, strengths and abilities should be celebrated rather than all the focus placed on limitations, which is the case now."

A support group dedicated to non-drug alternatives: ADD Action Group P.O. Box 1440 Ansonia Station New York, NY 10023 (212) 769-2457

American Academy of Environmental Medicine P.O. Box CN1001-80001 10 E. Randolph St. New Hope, PA 18938 (216) 862-4644

The Block Center 1721 Cimarron Trail, Suite 4 Hurst, Texas 76064 (817) 280-9933 (888)-DRBLOCK

CHAADD (Children and Adults with Attention Deficit Disorders) 499 Northwest 70th Ave., Suite 101 Plantation, FL 33317 (954) 587-3700

Feingold Association of the United States P.O. Box 6550 Alexandria, VA 22306 (703) 768-FAUS

Homeopathic Academy of Naturopathic Physicians (HANP) P.O. Box 69565 Portland, OR 97201 (603) 795-0679

For information on the ADHD/Food Allergy Connection Immuno Laboratories, Inc. 1620 West Oakland Park Blvd. Ft. Lauderdale, FL 33311 (800) 231-9197 or (954) 486-4500

Parents Against Ritalin (PAR) National Headquarters 225 S. Brady Claremore, OK 74017 (800) 469-6929 or (918) 342-5125


PHOTO (COLOR): Hyperactivity diminishes and impulsivity




Luise Light is the health editor of Vegetarian Times.

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