Hyperactivity is a descriptive term that refers to restless, distractible children who have a knack for disrupting order at home and at school. For the most part these are normal children, more often boys than girls. From my vantage, humans in general are hyperactive creatures who wander all over the planet, cannot sit still and are easily distracted. In my view the judgment that a child is hyperactive is usually a a problem owned by a parent or a teacher and not problem owned by a child. This is not to argue that children by nature are pleasant, cooperative and sociable, since this is seldom the case. It is to argue that children, like adults come with different sizes, shapes, colors and personalities. Some children are more social and adapt better to classrooms. Girls have an advantage over boys, but not all girls. Some girls have male minds and some boys have female minds. Body size and gender can be misleading.
"Hyperactive" behavior and attention deficits are often connected so that the term attention deficit hyperactivity disorder (ADHD) has been popular. Let us discard the idea of a disorder or disease that must be treated with drugs. Let us understand that normal boys and some girls tend to be hyperactive and when they are enclosed and constrained, they can be disruptive of an adult sense of order. Often bright, energetic children are diagnosed when they do not adapt well to rigid classroom protocols. The trend toward drugging children so that they can attend school is to be deplored.
I believe that bad food and bad air are the two most correctable causes of extreme behavior and learning problems in children. I believe that food chemistry and delayed patterns of food allergy play an important role in causing learning and behavioral problems in children. Whenever children are sick or influenced by food and/or airborne chemicals, their brain function is compromised and symptoms include disturbances of sensing, feeling, remembering and acting. Their learning is impaired and their behavior may be disturbed. The intention of compassionate biological management is to restore orderly, normal functioning of the child by careful revision of environmental conditions and food intake.
Ritalin and Amphetamines
In the US, a FDA advisory committee heard testimony indicating that 2.5 million children take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States. The use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. The popularity of the diagnosis, Adult ADHD is relatively recent leading to at least 1.5 million adults who take stimulants on a daily basis, with 10 percent of users older than 50 years of age. Drug-related events reviewed by the committee included 25 cases of sudden death in children or adults that included myocardial infarction, stroke, and serious heart arrhythmias. The committee concluded: “We rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon and decisively. “
Professor Sroufe wrote: “Three million children in the USA take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage of drugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning. But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled? In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder. As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs. Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth. Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.”
A highly regarded Cochrane Review showed that there is only very low-quality evidence to support the use of methylphenidate (Ritalin, Concerta, other brands) in children with attention deficit hyperactivity disorder (ADHD) leading the reviewers to urge more caution when prescribing stimulants. Storebø and Zwi stated: "We should view the average reduction in symptom scores attributable to treatment with a high degree of caution," they add. "Clinicians need to weigh what we now believe to be an uncertain degree of benefit against the many adverse events that are known to be associated with methylphenidate, such as appetite suppression and sleep difficulties. The general perception of methylphenidate as an effective drug for all children with ADHD seems out of step with the new evidence. This new information from our review should challenge the mindset of clinicians because there is more uncertainty to factor in to balancing the benefits and risks of these medications." (Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD) Cochrane Database of Systematic Reviews. November 25 2015.)
I found that some "hyperactive" children were not well. Children who are not well have physical symptoms that are linked to learning and behavioral symptoms. They may display mood swings, inappropriate anger and sometimes are violent. Their schoolwork suffers from inattention, disorganization, poor memory, and behavior disruptive of orderly classrooms. ADHD may improve as children age, but some have a long-term handicap, limited by a combination of physical illness, poor achievement, low self-esteem, and antisocial behavior.
Several theories were advanced to explain ADHD. The theory of "minimal brain damage or dysfunction" had many advocates. The child is viewed as having a fixed disability, manifesting a structural problem of brain, acquired during prenatal development or at birth. Language disability or dyslexia has also been attributed to a fixed circuitry problem in the brain that impairs encoding and decoding of language symbols. These brain-damage theories ignore the living, dynamic properties of the brain; they seem to view the brain as a simple appliance or computer that comes hardwired to behave in a certain way.
But what about the daily input of molecular substances to the brain? Can improper food-body-brain interactions, sustained by habitual food choices, produce the patterns of dysfunction commonly observed?
Caffeine is a problem. Hirsch reported a 252% increase in ADHD scores (using the Connor’s scale) when children drank less than one can of caffeinated colas. Coca cola contains 44 mg per 12 oz can and Pepsi Cola 38 mg per can. High caffeine drinks such as Jolt and Red Bull are available in supermarkets and may be consumed by children.
"Sugar" is often blamed for hyperactivity. Parents often observe that children's' behavior deteriorates after eating sugar-containing foods, such as chocolate chip cookies, cake, jello, kool-aid, pop, strawberry ice cream, or chocolate bars. While high sugar diets are never desirable, other ingredients in high sugar foods can also create major problems. Other food ingredients have been identified as the culprits in children's behavioral problems such as food dyes, mono sodium glutamate and aromatic substances. Amines in fruits, for example, are neuroactive chemicals that produce behavioral changes when given alone. Nutmeg is known to contain hallucinogenic substances, and cinnamon often triggers hyperactivity and/or headaches. Several naturally occurring polyphenolic compounds have been studied for their effects on behavior. Gardner advanced the hypothesis that the whole range of aromatic compounds in the food supply are chemically active in the brain.
The Food Allergy Explanation of ADHD
Many physicians have described diet revision treatment for children's' behavioral and learning problems. Egger remarked: "A role for food allergy in the hyperkinetic syndrome has been postulated since early this century." ADHD can be seen as a symptom of a food-driven hypersensitivity disease. Many children with ADHD will have symptoms and signs of delayed pattern food allergy. We are not talking about common allergy, diagnosed by skin tests. We are talking about delayed patterns of food allergy that cannot be detected by tests. The "normal" foods that cause delayed food allergy effects are milk, wheat, eggs, soya, beef, pork, chicken, and corn.
Psychopharmacology & Hyperactivity
The most researched neurochemical approach to hyperactivity is based on a drug-neurotransmitter model of brain function. The dopamine system is involved in reward-seeking behavior, sexual behavior, control of movement, regulation of pituitary-hormone secretion, and memory functions. A model of schizophrenia postulates increased or unregulated dopamine circuits and drugs which block dopamine activity reduce the schizophrenic syndrome. An interesting neurochemical relationship between hyperactivity and schizophrenia has been postulated, where the two conditions seem to have opposite features.
ADHD may be attributed to dopamine deficiency. Dopamine synthesis slowly increases as children grow and may not reach full capacity until late teens. This is one of the built-in maturation lags which prevents some children from assuming adult-like behavior in their early life. Dopamine in young animals exerts a protective influence against hyperactivity. Since schizophrenia is associated with increased dopaminergic activity and is improved by dopamine-blocking agents, there is a reciprocal relationship between psychosis and hyperactivity.
Nutritional strategies may attempt to modify the amino acid profile of the diet to encourage dopamine synthesis by augmenting intake of phenylalanine and tyrosine and supplying extra cofactor, Vitamin.B6 (pyridoxine). A more direct drug approach is to utilize molecules that stimulate dopamine circuits or act as dopamine agonists - options have included pemoline, L-dopa, bromocriptine, amantadine, and lergotrile.
Ritalin and amphetamines increase dopaminergic activity and decrease hyperactivity while they increase stereotypy. Ritalin has become the "drug of choice" for children with ADHD. Ritalin therapy poses many risks, some obvious and others concealed. Any child treated with Ritalin is moved from the hyperactivity end of the spectrum toward a schizophrenia-like state. The most obvious Ritalin effect is appetite suppression and retarded growth. Some parents complain that their Ritalin-treated child acts like a "zombie". They describe emotional blunting and detachment from family and friends, a mild schizophrenic attribute. Children on higher doses and chronic use may manifest paranoid features - withdrawal, anger, restless, suspicious behavior.
Adults who abuse amphetamines regularly develop a psychotic state with paranoid features. Ritalin may also produce disruption of movement control in a few unlucky children. Facial and head tics may appear, and, in the Tourette's syndrome progress to peculiar grunting and respiratory tics, associated with compulsive behaviors, manifesting stereotypy. No drug which works on the dopamine system is free of long term toxicity on the motor system.
Studies on the effects of long term Ritalin use show the mixed results expected from a symptomatic drug therapy which does nothing to remove the underlying cause of the disorder. In all drug-related studies of ADHD, there is no consideration of dietary variables, nor any thought that the learning and behavior problems are just symptoms of a more pervasive illness. The reviewers of drug studies discover that ADHD continues through adolescence into adult experience. The names for the disorder change as patients age and accumulate social and interpersonal problems.
Hechtman reviewed the outcome of children treated with Ritalin. She stated: "Thus, stimulant treatment in childhood does not seem to secure a positive adolescent outcome for the hyperactive. However, studies that have combined stimulants with other multimodal interventions... do suggest more positive outcomes."
I propose a multimodal therapy which repairs the attention deficit disorder with effective, diet revision therapy; repairs academic deficits by appropriate remedial education; repairs lost self-esteem by family and child counseling; and maintains normal functioning by supporting the family effort to sustain proper diet, learning and social opportunities. A brief review of these concepts follows.
The Physical Symptoms
I created a profile of children who were not well and were not doing well in school. The most common symptoms were allergic shiners (dark circles under the eyes) and stuffy nose. These kids tended to have histories of nose congestion, recurrent middle-ear infections, and sleep disturbances, starting in infancy. Some had more specific allergic problems such as eczema, hives, and asthma but most have non-specific symptoms that do not fit the familiar patterns of allergy. Digestive disturbances were common. Some had headaches and many had leg pains at night. Often parents stated that the child had recurring colds or flus and were prescribed antibiotics too frequently. Preschool infants with food problems tended to fussy eating with strong food preferences and refusal to eat many healthy foods. These children frustrated their mothers who eventually accepted their idiosyncratic eating patterns. Children with food allergy typically became eating specialists - compulsively eating a small number of "favorite" foods and refusing the rest. Vegetable foods were the first foods refused, often in favor of compulsive eating of fruit juices, dairy or wheat products.
When you see a four year girl in her pink dress with bows in her hair, allergic shiners and stuffy nose, screaming and writhing in the aisle of the supermarket because her mother will not let her keep the bag of candy she just snitched from the shelf, you can predict years of difficulty for this child and her parents unless they are successful in controlling her food supply. Their success is doubtful for many reasons - even if they are highly motivated and well informed, the little girl in the pink dress will not comply willingly and will show every behavior of a committed food addict for years to come.
Proper Diet Revision
Symptoms often cleared dramatically when food selection was changed. The details of a successful food plan varied from individual to individual. The most globally successful diet revision in all these illnesses involved complete diet revision.
Consideration is given to
Brief Note on Delayed Pattern Food Allergy
I am referring to delayed food allergy, not the more obvious immediate food allergic reactions. Delayed patterns of food allergy are not so obvious and generally go unrecognized. Allergy skin tests do not show this problem nor do blood tests for antibodies such as RAST or ELIZA. Delayed patterns of food allergy are responsible for causing specific diseases such as asthma and eczema and also common but ill-defined illness patterns in children.
See Dr. Gislason's Blog Drugging Children.