ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioural disorder that arises in childhood and may continue into the teen years and adulthood. Children and adults with ADHD may appear inattentive or distracted, hyperactive, and/or impulsive (act without thinking). These symptoms affect the way they interact with the world, negatively impacting their ability to function, concentrate, and excel in school or at work, and affect their efforts to form strong personal relationships. Because the symptoms of ADHD are disruptive and difficult to deal with for other people, children and adults with ADHD are often unfairly judged and suffer from low-self-esteem as a result. Children with ADHD are more likely to have a learning disorder and develop a behavioural disorder. Teens and adults with ADHD are at greater risk for self-destructive behaviours.
ADHD is the most commonly diagnosed mental health problem among children. It is estimated that up to 6 percent of Canadian children show symptoms of ADHD, with males outnumbering females three to one. (Boys tend to be more hyperactive while girls tend to be more inattentive.) Children with ADHD begin to show signs of their condition before the age of four, but it is often not diagnosed until the school years when their inability to conform to school expectations and achieve academic standards becomes apparent.
There has been a great deal of research on ADHD, but the actual cause is not known. There are many misconceptions about the disorder. It does not result from poor parenting skills or low income status. It is thought that ADHD may result from structural changes in the brain, alterations in neurotransmitter levels, and environmental and dietary factors.
Brain scans of some people with ADHD have shown smaller basal ganglia and reduced frontal lobe activity. Basal ganglia, or nerve clusters, are involved in routine behaviours, and the frontal lobes are involved in planning and organizing, attention, impulse control, and inhibition of responses to sensory stimulation.
It is thought that those with ADHD may have low levels of neurotransmitters (chemical messengers) such as dopamine and norepinephrine. Dopamine is involved in controlling emotions and reactions, concentrating, reasoning, and coordinating movement. An abnormally low level of dopamine can cause the three primary symptoms of ADHD: inattention, impulsiveness, and hyperactivity.
SIGNS & SYMPTOMS
The hallmark symptoms of ADHD, whether in children or adults, are hyperactivity, impulsiveness, and inattention. Children may be diagnosed with ADHD if they exhibit significant and disabling symptoms at home and at school for at least six months. Not all children with ADHD are hyperactive or impulsive but may have disabling inattentive-ness or easy distractibility. Girls are more likely to suffer from the primarily inattentive form of the disorder (often referred to as ADD) and are often never diagnosed. Many adults with ADHD were never properly diagnosed as children and they often suffer serious problems in their life if they don’t obtain proper treatment.
Signs of hyperactivity:
• Cannot play independently or quietly
• Cannot sit still or fidgets when sitting
• Restless, jittery, and always moving
• Talks excessively in a loud voice
Signs of impulsiveness:
• Frequently interrupts and blurts out responses
• Impatient, cannot tolerate waiting or line-ups, becomes agitated
• Unable to control impulses, and acts before thinking (such as crossing the street without looking, making rude comments, or exhibiting dangerous or inappropriate behaviour)
• May not be able to control frustration and anger
Signs of inattentiveness:
• Cannot focus or concentrate; easily distracted
• Does not pay attention to what he or she has been told
• Has a hard time finishing large or involved tasks without frequent reminders to stay on task
• Is not well organized; may appear forgetful or careless
• May appear to daydream and not listen
The above symptoms mean a child with ADHD may have difficulty developing healthy social skills and friendships. Other symptoms may include mild to severe sleeping and eating problems.
LOOKING FOR ADHD IN ADULTS
The symptoms of hyperactivity, impulsiveness, and inattentiveness are present in adults, but may be more difficult to identify. Here are some of the criteria that doctors use when diagnosing ADHD in adults:
A childhood history of ADHD
Anger and stress management issues
Difficulty having strong personal relationships, or frequently has negative interactions with people and co-workers
Difficulty in controlling impulsive behaviour (reckless driving, drug and alcohol abuse, other addictions, frequent job changes, financial problems)
Difficulty in relaxing; is restless
Inability to focus on tasks, and cannot make deadlines or complete assigned work
Forgetful about daily activities (failure to make appointments and commitments)
RISK FACTORS
• Heredity: There are known genes associated with ADHD; having a parent with ADHD triples your risk of developing the disorder; identical twins are both likely to be affected.
• History of antibiotic use
• Illness or infection (Strep, ear infections)
• Imbalance of neurotransmitters
• Infant or childhood exposure to environmental toxins: preservatives, food additives, heavy metals (lead and mercury)
• Infants who experience brain trauma during pregnancy, delivery, or after birth are at greater risk of ADHD.
• Maternal smoking, drug or alcohol use, or exposure to toxins
• Poor nutrition during childhood
• Poor nutrition of mother during pregnancy
ENVIRONMENTAL TOXINS AND ADHD
Preschool children exposed to certain environmental toxins, particularly lead and PCBs, are at increased risk of developmental and behavioural problems, many of which are similar to those found in children diagnosed with ADHD. Exposure to lead, which is found mainly in paint and pipes in older buildings, has been linked to disruptive and even violent behaviour and to a short attention span. Exposure to PCBs in infancy may also increase a child’s risk of developing ADHD.
DOCTOR’S ORDERS
There is no definitive way to diagnose ADHD. If a child exhibits symptoms of ADHD, the parents, caregivers, and teachers involved with the child will be asked to fill out a variety of questionnaires regarding the child’s behaviour. A complete physical examination is also done to rule out other conditions. In some cases, a psychological assessment is done.
The typical medical approach to the management of ADHD is the use of psycho-stimulant drugs, which boost levels of neurotransmitters (dopamine) in the brain. Although these drugs help relieve symptoms in some children, they don’t cure ADHD and they can cause troubling side effects, such as difficulty falling or staying asleep, loss of appetite and weight, and upset stomach. Some children develop jerky muscle movements, such as grimaces or twitches (tics). These drugs may also cause reduced growth rate in children and may negatively impact brain development.
The most commonly prescribed medications for treating ADHD include:
• Dextroamphetamine/amphetamine (Adderall]
• Dextroamphetamine (Dexedrine]
• Methylphenidate (Ritalin or Concerta]
Atomoxetine (Strattera) is a non-stimulant medication for ADHD that is believed to provide the brain with a steady supply of norepinephrine.
Sometimes children with ADHD are prescribed antidepressants if they do not respond to stimulants. These drugs also cause a variety of unpleasant side effects such as sleeping problems, dry mouth, irregular heartbeat, and changes in appetite. The younger the child, the more susceptible he or she is to the side effects.
Counselling and family and school support are other key parts of treatment. It can be demanding and frustrating for parents dealing with a child with ADHD and equally difficult for the child. A holistic strategy that incorporates counselling along with nutritional and lifestyle strategies, patience, and perseverance are essential. Drug therapy should be considered only as a last resort.
Dietary Recommendations
A nutritious, whole foods diet is essential for the management of ADHD. Some individuals with ADHD have food allergies or sensitivities that can cause inflammation in the gut and worsening of ADHD symptoms. The most common allergens are wheat, yeast, dairy, corn, soy, and food additives (preservatives, dyes and chemicals). To determine potential food allergies, consider an Elimination Diet as outlined in Appendix D.
Foods to include:
• Cultured dairy, such as yogurt and kefir, contains beneficial bacteria that support intestinal health, immune function, and aid in the elimination of toxins.
• Eat fresh organic fruits and vegetables as tolerated, and whole grains (brown rice, whole oats, millet, amaranth, and quinoa).
• Ensure adequate protein intake. Choose free-range poultry, wild fish, beans, and legumes.
• Include healthy fats such as extra-virgin olive oil, hemp oil, orflaxseed oil. Coconut oil is suitable for cooking. Use ghee (clarified butter) instead of regular butter or margarine.
• Medicinal food blends, such as Learning Factors (by Natural Factors), contain a blend of essential nutrients and protein to help support proper brain function and overall health.
Foods to avoid:
• Fast foods, processed foods, and junk foods, such as hot dogs, burgers, french fries, snack cakes, cookies, sugary breakfast cereals, which are high in sugar, refined starch, saturated and trans fats, and preservatives and are also low in nutritional value.
• Read labels and avoid foods that contain ingredients such as additives, flavour enhancers (MSG), artificial sweeteners (aspartame, saccharin), colourings, dyes, and preservatives such as nitrates, sodium benzoate, sulfites, BHA, and BHT. If you have trouble reading or pronouncing an ingredient, chances are you should avoid that food.
Lifestyle Suggestions
Here are some suggestions for helping children with ADHD both at home and at school:
At home:
• Provide support, patience, and love. Children with ADHD exhibit behaviour that can be trying. Despite this, they need as much positive feedback as possible as they work toward correcting these problems.
• Provide structure and realistic expectations. Children with ADHD need to know what’s expected of them and they need these expectations to be enforced. Be consistent.
• As your child develops better coping mechanisms and social skills, he or she will be better able to cope with demanding situations. Until then, avoid triggers for bad behaviour such as line-ups, restaurants, etc.
• Avoid overstimulation or keep stimulating activities to under two hours.
• Provide support at home for organizing personal belongings. Keep bins clearly labelled, and a white board with the weekly agenda in plain sight.
• Make physical activity a priority and limit their TV, video game, and computer times to less than two hours per day.
• Keep any discussions clear and brief.
At school:
• Discuss your child’s ADHD with school administration and all teachers or aides who interact with your child. If the school or teacher is unresponsive, do not give up.
• Be assertive. You are your child’s best advocate. Don’t be shy to ask the school for what your child needs such as reading or writing aids or occupational therapy.
• Create a personal learning program suited to your child. School boards call these programs by different names, but they describe what accommodations your child warrants in the classroom, and also typically function to enable the school to apply for financial support for resources and teaching aids.
• Have your child sit close to the front of the class or teacher’s desk, beside model students and away from distractions.
• Have the teacher give your child responsibilities in the classroom, which allow him or her to move around with purpose.
• Break large tasks down into manageable assignments. Have a daily agenda and create clear expectations and consequences for classroom behaviour.
Top Recommended Supplements
There are many supplements that can provide nutritional support to children with ADHD. These supplements may be taken in conjunction with prescription medications, but always discuss any supplements with your doctor or pharmacist before giving to a child on medication.
Essential fatty acids: Essential for proper brain development and function; deficiency is common in children with ADHD. The omega-3 fatty acids EPA and DHA (from fish oil) are particularly important for brain function and the proper release of dopamine. Some studies have also shown benefits with evening primrose or borage oil supplements, which provide GLA (an omega-6 fatty acid). Typical dosage: 600 mg EPA and 175 mg DHA. If borage or evening primrose oil is added the typical daily dosage is enough to supply 60 mg GLA.
Multivitamin and mineral formula: Children with ADHD may be deficient in certain nutrients, which can hamper proper brain function and affect behaviour. In particular, the B-vitamins, vitamin C, magnesium, selenium, iron, and zinc are necessary for the brain and nervous system and production of neurotransmitters. Choose a product that is free of chemical additives and dyes.
Probiotics: Beneficial bacteria that support intestinal health, aid digestion of nutrients and elimination of toxins, and support immune function. Children with ADHD may be depleted in beneficial bacteria and have overgrowth of the fungus Candida albicans, which can affect behaviour and cognitive function. Dosage: For children over four, give a product that provides at least 10-20 billion live cells daily. Use half that amount for those under age four. Probiotic supplements are available in capsules, chewable tablets, and powders. Many require refrigeration, except Kyo-Dophilus.
Complementary Supplements
American ginseng: Has antioxidant properties, supports immune function, improves resistance to stress, and supports cognitive function (learning, attention, and memory). One study looked at the effects of a product called AD-fX that contains American ginseng extract (HT-1001) providing no less than 15 percent ginsenosides along with an extract of Ginkgo biloba containing 24 percent flavone glycosides and 4 percent total terpenelactones in a group of 36 children with ADHD. This formulation was found to improve behaviour in at least three parameters of ADHD symptoms in 85 percent of human subjects tested (Journal of Psychiatry & Neuroscience, 2001: 26(3); 221-228). Dosage (AD-fX): For adults and children seven years and older, one to two capsules twice daily for two months, then one capsule twice daily thereafter.
L-theanine: An amino acid present in green tea that can reduce anxiety, improve concentration and sleep quality and stabilize mood. It is widely used in Japan and Europe for the treatment of ADHD and gaining popularity in North America. Typical dosage: 200 mg two to three times daily for children eight years, and half this dosage for children as young as four years.
RESEARCH HIGHLIGHT
In association with the University of British Columbia, Dr. Michael R. Lyon, MD, author of Is Your Child’s Brain Starving?, recently completed a double-blind, randomized study on the use of L-theanine (branded ingredient Suntheanine) for 100 boys with ADHD ages eight to 12. The objective of this study was to measure the potential benefits of L-theanine on behaviour, cognitive performance, and sleep quality. This study found that 200 mg of L-theanine chewable tablets twice daily improved sleep quality, reduced hyperactive behaviours and improved short-term memory function.
FINAL THOUGHTS
To improve the management of ADHD, consider the following:
1. Encourage a healthful diet of organic vegetables and whole grains, free-range poultry, wild fish, beans, healthy oils, and cultured dairy.
2. Avoid or minimize fast foods, processed foods, junk foods, preservatives, and other chemicals.
3. Counselling and school support can help both the family and child.
4. Consider supplements of essential fatty acids, multivitamin/minerals, and probiotics.
5. Give a child with ADHD patience, support, and love.
