Attention Deficit Disorder and Hyperactivity

confident-kidThe right diet and supplements can make a huge difference, and even make drugs unnecessary, for kids with ADD and ADHD.

Food,while nourishing, can also energise or subdue, comfort or agitate. A growing body of evidence implicates diet in the commonly diagnosed attention deficit disorder (ADD). Simple meal modification may eliminate the need for the frightening array of drugs being prescribed to control children. Diet can mean the difference between a normal childhood and years of difficult behaviour or behaviour-modifying drugs.

Attention deficit disorder is the fastest-growing childhood disorder in Australia. A corresponding condition is called attention deficit hyperactivity disorder (ADHD), or ADD with hyperactivity. A third category is the combination of these two. For purposes of clarity inthis article, I will use ADD to designate the inattentive type and ADHD for the hyperactive-impulsive and combined types.

In America, by January 1998, about 4 million children – an astounding 10 percent ofthe entire school-age population – were diagnosed with either ADD orADHD. In some areas of the country, about half the children in schools are labeled “victims” of these mysterious, mentally disabling disorders. More alarming, 13 million adults suffer from ADD or ADHD,bringing the total to 17 million Americans struggling with these conditions. These burgeoning numbers worry some government experts,including those at both the National Institute of Mental Health (NIMH)and the Drug Enforcement Agency (DEA) in Washington, D.C., who wonder if ADD and ADHD are being overdiagnosed and patients overmedicated.

Gene Haislip, a former deputy assistant administrator at DEA, is concerned about the proliferation of attention deficit diagnoses. “With the exception of AIDS, there are few examples of such rapid spread of a serious condition in recent years,” he says. And Haislip wonders, “Why are we rushing to feed stimulants (such as methylphenidate in the formof Ritalin) to children?”

There are people who carelessly apply the labels ADD and ADHD to a variety of behaviours as if they were designer disabilities, but both are valid psychiatric disorders with serious consequences, most notably the use of powerful drugs to control symptoms.

The inattentive ADD child is often more difficult to diagnose because inattentive behaviour is not as obvious as hyperactivity. Nevertheless, the inability to get started or finish tasks jeopardises the child’s functioning both at home and at school.The inattentive ADD individual procrastinates and rarely completes anything. This kind of ADD is most likely to persist into adulthood, affecting a person’s ability to succeed in a career or relationships.

The hyperactive or impulsive youngster attracts attention by constantly disturbing others. Children with this kind of ADHD can pay attention.In fact, they engage themselves for hours in taks that interest them. Adults with hyperactive or impulsive behaviours are always on the go and constantly in motion, but they get things done. However, they tend to be impatient and quick to fly off the handle.

Some children have a combination of ADD (inattentive) and ADHD (hyperactive-impulsive). These children have the most difficulty succeeding, and their self-esteem takes a constant beating. Children and adolescents with combined ADHD are often unpopular because they don’t wait their turn and frequently interrupt conversations. They lack responsibility, do not follow instructions, are often clumsy and awkward, and are likely to have learning disabilities. These individuals do not readily accept change and can become agitated when their schedule is upset, because they do not adapt well.

To qualify as any type of ADHD, the behaviour must have occurred beforethe age of 7 and in a persistent and disabling pattern for at least six months. In other words, the child must have great difficulty ¬†functioning in school and/or home. According to John Ratey, M.D., a Boston psychiatrist specialising in ADHD, “The behaviour must beserious enough to be disabling.” The DSM-IV criteria seem clear, andthe conditions qualifying as ADHD behaviours are specific, yet many individuals are prescribed medication without being properly evaluated- leading many people to question what constitutes an accurate ADHDdiagnosis.

A diagnosis should be accepted only after a thorough evaluation by a team of professionals who specialise in the disorder.Psychologists, psychiatrists and social workers with special training are qualified. Neurologists, paediatricians and general practitioners are not qualified, even legally, to independently diagnose the condition. Paediatricians, internists, and general practitioners should, however, rule out medical conditions that may account for the symptoms.

Because there are no laboratory tests to identify the disorder, ADHD must be diagnosed from medical history in addition to parent, teacher and pshychiatric observations. There are tests to  measure ADHD behaviour, including the ability of the patient to concentrate and process information. Not surprisingly, ADHD children often have trouble with abstraction. Many think in complete pictures rather than being able to isolate pieces of information and re-organisethem into complete ideas.

In the 1990s, however, brain imaging techniques such as positron-emission tomography (PET) have provided clues to the causes of ADHD. PET scans have been used to characterise abnormalities, such as impaired glucose metabolism, seen in ADHD patients. Since a child’s brain uses up to a half of his or her daily caloric intake for energy needs, reduced glucose availability limits brain function dramatically. Scientists at NIMH, for example, have provided vital information on glucose processing in the ADHD brain, so appropriate nutritional programs can be designed to alleviate ADHD symptoms throughout life. ADHD has several causes, including nutrition and food sensitivities, genetic predisposition, neurotransmitter imbalances and environmental factors, but the emphasis of this article is nutritional influences.

Diet’s Far-Reaching Effects

Studies are racking up evidence linking diet to both health and behavior-including ADD and ADHD. In addition, several studies show that American children and adolescents aren’t eating balanced, high-quality diets.

Startling evidence of the prevalence of poor-quality diets was revealed in the U.S. Department of Agriculture (USDA) dietary survey of 3,300 U.S. children and adolescents. The survey showed that less than 1 percent meet the recommended daily requirements for the five food groups. A whopping 16 percent do not meet any of the requirements.

In 1994, Australian researchers Katherine Rowe,M.D., and Kenneth Rowe, Ph.D., found that 55 percent of the children who responded favorably to elimination of all food dyes and additives subsequently reacted when fed a single dye such as tartrazine or yellow dye No. 5 at various dose levels. The behavioral changes noted were irritability, restlessness and sleep disturbances. A year later, Marvin Boris, M.D., and Francine Mandel, Ph.D., evaluated 26 ADHD children and found that 73 percent (19) responded favorably to a multiple-item  elimination diet. If a child reacted to an item, it was withdrawn and subsequently challenged to confirm the reaction. All 19 children reacted to many foods, dyes and preservatives.

N.L. Girardi,M.D., and colleagues at Yale University School of Medicine in New Haven, Conn., studied differences in the response to sugar in 17 ADHDand 11 normal children. After an all-night fast, the children drank a glucose beverage containing eight times the sugar the brain uses in one hour.

The normal response to a sugar onslaught is an out pouring of insulin, which quickly reins in rising blood sugar levels. The adrenal glands release norepinephrine and epinephrine-catecholamine hormones-to counterbalance a rapid drop in glucose caused by high insulin levels.

Both groups of children were given a battery of tests three hours after their sugary meal to measure cognitive performance. Results showed ADHD children had released only half the amount of catecholamines as the normal children. ADHD children’s PET scans showed markedly reduced brain activity caused by insufficient glucose for processing information. Not surprisingly, their test scores were much worse than those of the children who did not have ADHD.

Sugar did not affect the ADHD children uniformly, however. Many became increasingly hyperactive during the three- to five-hour period following the glucose breakfast. The research teams concluded that the children were jumping around in an unconscious biochemical attempt to get their adrenal glands to pump more epinephrine and norepinephrineinto their brains.

There still exists considerable controversy regarding sugar’s effect on hyperactive behaviour, largely because testing protocols are not standardised. Therefore, children tested under different conditions do not respond the same. For example, the response to sugar is greatest when it is given first thing in the morning on an empty stomach. The effects are dampened when it is eaten later in the day or after a meal containing protein.

OtherADHD children in the Girardi study became calm after the sugar surge; their bodies locked onto another of sugar’s effects-carbohydrates, especially sugar, raise serotonin levels in the brain, which causes drowsiness. Protein, on the other hand, raises catecholamine levels and is arousing. Parents can test their child’s reaction to sugary foods first thing in the morning and after a protein-containing meal to determine the child’s response. In most cases, it is best to feed the child some protein, complex carbohydrates and eliminate simple sugars for breakfast. Emphasis should also be placed on protein foods for breakfast and lunch and complex carbohydrates for dinner. Adjust snacks based on when they are to be eaten.

By customising the diet and supplementing with missing nutrients, the faulty communication in a child’s or an adult’s brain can be repaired and behaviour modified.This process begins with understanding how the body uses food and what effects protein, carbohydrates and fats have on the brain and behavior.