Thursday, June 18, 2009

ADHD- A different perspective

News recently (see link 1) that the FDA has advised parents not to stop giving their children ADHD drugs yet despite a government backed study showing a six fold increase in deaths in children on medication compared to those not on medication. In the same week a cold remedy was pulled off shelves (link 2) due to it affecting the sense of smell.
Let me be up front on this. I do not believe that attention issues in children (or adults) are caused by a lack of amphetamine like stimulant medication in the blood stream. Lets examine the facts .
There are children who display behaviors, which are consistent with some of the diagnostic criteria for ADHD. This presents a genuine management issue for the child, their parents and often the school as well. There has been a significant increase in the number of children (and more recently adults) who are being diagnosed ADHD or similar over the last 20 years.
So what has led to this increase in diagnosis and, what can be done to manage the problem? The diagnosis of ADHD is based on fulfilling certain criteria and is completely subjective. There is no scan or blood test to detect the condition. Certain behaviours may be acceptable in certain circumstances but not others. For example, grabbing a person and throwing them to the ground is acceptable on some sports fields but not in the street. The behaviour is the same but the context is different. Answering questions early is rewarded on TV quiz shows with buzzers but is one of the diagnostic criteria for ADHD in a classroom setting.

The issue then is how we look at behaviours may have changed more over the last 20 years than the behaviours themselves. Furthermore, children are not actually designed to sit still for long periods of time. Boys in particular need to be running around to use up pent up energy. The number of avenues for them to do this has decreased. Fewer children walk or ride to school and they are less likely to run around in a park after school. They still have the same amount of energy to burn up as their predecessors. Bottle up this energy and it may well come out where you don’t want it.

Another significant change has been the teaching methods for literacy. The whole of language approach, which has become almost a religion in certain education circles does not serve the interest of all children and particularly not a large number of boys who will learn literacy in a phonetic manner. Guess what happens to a child sitting in a classroom if they are not able to keep up or understand the lesson. They will get bored and they will misbehave.

By creating circumstances that don’t necessarily suit children and restricting their outlets for letting off steam behavioural issues can be created. However, these are behavioural issues and do not necessarily constitute a medical illness which requires a drug treatment.

Another big issue with children these days is their nutritional status. There is a growing view that children are often overfed but malnourished. This paradox comes about because whilst they are consuming increasing amounts of food, they are not getting the nutrients that they need and in particular, not the essential fatty acids, vitamins and minerals. Furthermore, their bodies may be exposed to a variety of preservatives and toxins, which their young bodies are even less designed to cope with than adult bodies.

We need to look at the child in their total environment, look at what their genuine needs are and consider what expectations are placed on them. Not all children will be brilliant scholars and it is ridiculous to expect them to be so. This is not to say that doing your best in school is not important, but many extremely successful people did not score brilliantly in school exams. One of the justifications for use of medication is that it improves academic performance. This argument would not be acceptable in a sporting environment.

Ensuring that simple things like vision and hearing have been checked is important. Ensuring that children do have the opportunity to be active and are encouraged to be so is critical. Allowing children to have a variety of interests and be on the move is also important. Simple dietary changes like cutting down on processed and packaged foods, minimizing food colorings and additives and ensuring adequate intake of key minerals, vitamins and essential fatty acids is critical. The study in link 3 shows that children eating a Mediterranean type diet (lots of fruit and veg) had less behavioral issues than those eating a “typical” western diet of processed grains. This may mean saying no to demands for soft drinks and other packaged foods. Parents need to be aware that saying no is quite ok.

It is likely that in 20 years time, people will look back in horror at the medicalisation of behavior that we have seen over the last two decades and in particular, the over medicalising of childrens behavior where we have repackaged behavioral phenomenon and labeled it a disease and provided a drug treatment. By that time we will hopefully be catering to the genuine needs of our children rather than seeking to force them to fit a narrow definition of “normality” and labeling them as diseased when they don’t.




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