Counseling Sheet

Agatha M. Thrash, M.D.
‍Preventive Medicine‍

Mirna Vergara
‍Healthcare Provider Intern

Attention deficit hyperactivity disorder (ADHD) is a behavioral disturbance usually starting before the age of 7, lasting at least 6 months, and in some cases persisting to some degree into adult life. Intelligence is usually normal or superior, but the victims have symptoms which are observed by third parties who may label the child with attention deficit disorder (ADD) or ADHD. These children may talk excessively, interrupt and intrude upon others, and have difficulty in playing quietly. They tend to leave tasks unfinished, and shift prematurely from one subject to another. Once the symptoms get well developed, they usually tend to remain constant for that individual, not usually getting much worse.

Approximately 25-30% of childhood ADHD cases will persist into adulthood.1 Males have traditionally had higher rates of ADHD, but the number of ADHD diagnoses among adults aged 18 - 64 years increased between 2007 - 2012, predominantly among women, thus decreasing the difference between male and female ADHD cases.2‍

There is a widespread epidemic of hyperactivity and learning disability syndromes which plague our society. A 5-minute observation of the child is not adequate to make a good assessment. Children of a wide variety of diseases, symptoms, and disorders are lumped together under the labels of attention deficit disorder, learning disabilities, or ADHD. Yet, ADD appears to be caused by multiple factors operating at once, one of which is believed by some researchers to be failure of the mother to have peace and happiness during pregnancy.

Dr. Thomas Armstrong, a psychologist who has written several books on children, one called The Myth of the ADD Child, believes ADD is being vastly over-diagnosed, and Ritalin greatly over-prescribed. He states that there are children who are distractible and hyperactive or impulsive, but his question is "What accounts for it?" He believes ADD is far too simplistic. Children get labeled ADD even though they represent a large group of children who have complex social problems at home and school, and emotional, psychological, and educational hurdles which have caused their unacceptable behavioral expressions.

Another study showed that the stereotype that boys are more likely to manifest ADHD influenced psychologists to over-diagnose ADHD in boys.3‍

Dr. Thomas believes there are some children who have physical disease as the basis for their behavioral problems, and it is far more likely the children generally diagnosed as ADD have health-based or lifestyle problems which can be treated without medication.

Many others agree with Dr. Armstrong, such as Dr. Julie B. Schweitzer of Emory University. She believes that ADD and ADHD have a biological rather than a psychiatric base. She has discovered differences in blood flow in specific brain regions in ADHD sufferers, compared to normal children.

Neuroimaging has shown that there are abnormal brain networks in relation to cognition, attention, emotion and sensorimotor functions in ADHD sufferers. Dopamine and norepinephrine in four functional regions of the brain are not produced in normal levels. Genetic studies also show that 60 to 75% of ADHD manifestations can be accounted for by heredity, which along with environmental factors, can increase susceptibility to ADHD.4‍

Physicians are not trained to look for alternatives either in diagnosing or treating these youngsters without drugs. For physicians and even some parents, treating ADHD with medication may be the preferred approach, and an increasingly common one. Data from parents' reports in the US indicate that 69% of children diagnosed with ADHD aged 4-17 years currently receive medication - medication that is possibly being prescribed to children who, in reality, do not fulfill ADHD criteria, but whose parents wish to help them improve in their academics.5‍

Treatment‍

The first phase of treatment is proper diagnosis. Try to make a more specific assessment of the child than the catch-all of ADHD and get the most appropriate label on his behavior.

While the medication may work to calm the child, or any child, the problem could be deeper, but since no one looks for it, family conflicts remain uninvestigated, moral and social issues are unaddressed, the child continues to watch hours of TV daily, or the school makes no changes, and the child grows up with a sort of band-aid therapy - Ritalin. As soon as the psychostimulants wear off, the symptoms will come back or the behavioral problem will express itself in some other equally unacceptable behavior.

Many of these children are highly creative who have very different ways of thinking, and need correction and training rather than a powerful, mind-altering drug. Medication treatment for children between 3 to 5.5 years of age with ADHD has shown less success and more side-effects.6 Try to get some adult the youngster will respect and love to take an interest in him (we use the pronoun him since about 75% or more are males) and be with him several hours each week.

TV is almost always injurious to these youngsters. We recommend the television actually be removed from the home. Even occasional watching is sufficient to increase the difficulty he has in controlling himself. Virtually all TV has been found by Dr. Wilhelm Raab and others to cause the production of stress hormones by the adrenals. Give a one-year TV moratorium and you will very likely never return to TV watching.

The child should be homeschooled and not sent away to school until the child is coping well - usually that means adulthood. The homeschooled child will do much better socially, as young children cannot be expected to understand illness, especially one having to do with the nerves, which is difficult even for adults. Children can be very cruel in their ostracism and unkind remarks which may be made very innocently, but cut very deeply. The outcome will be much better eventually for the homeschooled child, and the child's cooperation is more likely.

The child needs training at the right time in books, but for those with a nervous system problem such as ADHD, never before age eight. Without saying the child is slow or delayed, quietly change his curriculum to minimize scholastics and maximize practical arts. Present topics such as sewing, cooking, carpentry, gardening, horticulture, biologic field trips, or rock gathering expeditions. Train slowly and painstakingly, and try to get the child to become proficient in something. The brain develops at different rates in different children.

Not every child learns best sitting quietly at a desk with a work sheet. Some may need, to in order to learn, to build things, work on projects, and go on field trips. Confined to a desk they become fidgety. A wise parent, teacher, or counselor is alert to this matter and directs the child to a schooling situation best suited to his needs. Unquestionably a home school is the very best school for these children. They will exhibit night and day differences in a homeschool, as compared to any group school. It may be challenging. Tutors for special instruction such as music, typing, domestic arts, and computers may be needed for a period to get the child and mother started.If there is no option but a group school, at any rate the child must not start to school before age eight. His nervous system is not mature enough yet, and school almost always makes him worse. Other children disrespect him, and teachers consider him a nuisance. He comes to believe this is what he is like - unloved, disrespected, unable to make friends, and a failure in scholarship. Often, nothing is farther from the truth with good management. He may be endearing, brilliant, and a loyal friend.

One reason for the popularity of the ADD diagnosis is that with it nobody is to blame, and no further time or effort needs to be taken with the situation. We can relax and try to cope personally. If the child becomes much more docile, starts listening and behaving, then everybody is absolved of any responsibility to get at the root of the difficulty and his true problem festers and boils under the surface to break out elsewhere. The child gets labeled with a psychiatric disorder. In 2016, around six million American children 2 to 17 years of age have been diagnosed with ADHD.

People who have difficulty visualizing verbal instructions (either spoken or written) are often labeled ADD. Dr. Schweitzer says those labeled with ADHD should be taught first to visualize verbal instructions before responding. Persons taking Ritalin show more normal blood flow in the brain in the visual association cortex. In our opinion, this does not mean the child needs the drug, but much more probably needs time to mature that part of the brain. The immature child cannot visualize what he cannot see. If "book learning" is forced on the unready mind, it will result in the child's becoming cemented in the self-evaluation that he is not good with books; maybe not as intelligent as others. This is regrettable if he only needs 2-4 years more maturation in that area.

Test the child with a wide variety of foods for sensitivity. Milk and dairy products are most frequently involved; up to 60% or more of all food sensitivities. You must read labels as the very sensitive child may require only a teaspoonful per week to keep him in a reaction. These foods are followed by coffee, tea, colas, and chocolate. Next come citrus fruits and juices; then meat, fish, veal, lamb, eggs, and seafood; then wheat, apples, strawberries, and bananas. Get a list from an allergist or get our book Food Allergies Made Simple.

We had one 12 year-old girl who had never passed a single test in school, nor made a single grade, but no teacher would hold her back a second year because they could not tolerate her. When she was 13 years old her mother brought her to me after she had been expelled from the third school, and had exhausted her options. I recommended our typical diet for hyperactive children. She was allowed to watch no TV, and her grandmother took the summer off to work with her. They walked alone in woods and fields several hours each day. They did housework together, cooked together, and occasionally drove to some special place such as a museum. Within 3 months, she was a transformed little girl. She started making good grades, became a well-behaved young lady, and eventually got married and holds down a responsible job. In her case the problem was food sensitivities, physical inactivity, an unstructured home life, and irritation from schoolmates.

In appendix B of our book "Natural Remedies" we have a list of foods high in naturally occurring salicylates. You should remove those for a test period of three months to see if you can gain some benefit from their removal from the diet. Improvement is not always as dramatic as the one above, but if any help can be found, it should be obtained for these children, as many are highly intelligent and can be very productive.

One study showed very definitely that ADD could be benefited greatly by exercise. Get the child into sports which do not require involvement of other children. Being around other children, whether at school or in the neighborhood, will usually be found to have an adverse effect. Many sports are appropriate - backpacking, canoeing, gardening, bicycling, spelunking, exploring, swimming, etc. The child needs adult companionship. Some of our most famous Americans were reared in a homeschool without any or many other children around. Abraham Lincoln and Benjamin Franklin are examples.

Another support for the biologic base for much ADD or ADHD, rather than psychiatric-base, is that of a thyroid problem. In a study of 11 children and adolescents aged 7 to 15 where it was found that these children either were obese or had subclinical (does not manifest symptoms) hypothyroidism or both. And another of 277 children with ADHD at the University of Chicago found the commonness of thyroid abnormalities high in comparison to the normal population.8

Doctors treating children with ADD and ADHD should consider a complete physical workup on the child in an effort to identify physical problems which may be at the root of the disorder.

Altering the diet may be helpful in normalizing the thyroid function. See our counseling sheet on Thyroid Disease for more information on this subject.

Visual defects, hearing loss, emotional or social disorders (depression, anxiety, child abuse, split home, etc.), and mental retardation may be confounding factors in making a diagnosis. Prevalence of a lifetime of depression and anxiety was found to be higher in women and substance abuse higher in men.9 This condition can often persist into adulthood and is a risk factor also for negative outcomes, including educational underachievement, difficulties with employment and relationships, and criminality.6 Each of these has specific things to be done. Study the child and do not make the mistake of neglecting to supply the appropriate remedy when one is available.

There is an herb which one should try called licorice. It is available as the root powder. Take one tablespoon of the powder for an adult in a quart of water, and one teaspoon of the powder for a child in a pint of water. Boil it very gently for about 20 minutes, strain if desired, and drink the amount over a period of one day. Make it fresh daily. If one seems to get some benefit from it, double the dosage of the powder used. On the long-term basis (more than a year) there is the possibility of getting mineral imbalances from it, revealed by feeling weak and faint, but if it helps it is worth the trial - merely watch for the side effects. Licorice has been used for generations to make candy and chewing tobacco. It is quite nontoxic, except on a long-term, heavy use basis (1-3 years of 4 tablespoons or more a day) in which case imbalances in minerals have been reported.

Zinc was shown to improve ADHD symptoms reducing hyperactivity and impulsivity but not the inattention.10‍

For many years mothers have observed that sugar and foods containing sugar as one of the ingredients, and various chemical sweeteners and coloring agents have a drastic effect on their children. Physicians have noticed that patients in all ages may respond adversely to these articles of diet.

"The truly sugar sensitive individual may have a family history of alcoholism, sugar craving, overweight, diabetes, or all four. This happens so frequently that it suggests a strong genetically determined idiosyncrasy," says Dr. Derrick Lonsdale, writing in Townsend Letter for Doctors, June 1994, page 609. Interestingly, sugar has a strong influence on the mesolimbic dopamine system, also known as the reward pathway, reinforcing dependence, whether the sugar is infused into the stomach or directly into the circulation.11 He suggests that repeated exposure to sugar or other sweet articles in diet affects the limbic system in the brain, which causes somewhat of a similar reaction as addiction to drugs.

Omit all sugar, honey, malt, syrups, and molasses, as well as all sugar substitutes.

Regularity in all things is essential. The parent or caregiver must discipline herself in order to be an appropriate guide for the child.

A five year old girl, called very "hyper," was taken into a foster home where she had a simple diet and a well structured program of eating on time, going to bed on time, and living with a calm family in a quiet country setting with no TV. Within less than a month people could not believe it was the same little girl. Unfortunately, she went back to her mother, where she ate what she wanted, when she wanted, went to bed late, and watched TV a lot. In no time she lost what she had gained. We cannot overemphasize attention to details of family government. There are multiple benefits. If you are kind and careful, your child's mind will translate your carefulness to mean, "They care enough about me to make rules. I must be a worthwhile person. I must try to live up to their expectations."

Another woman in her early 40s was diagnosed with chronic depression at the age of 23, after a series of events in her life caused her to go downhill. In elementary school there were no complaints about her behavior other than being shy and quiet. During high school she switched schools constantly. She started different careers but always changed until finally settling into nursing school. She was also forgetful, struggled with organization and finishing tasks, and was easily distracted. At the early signs of depression and anxiety, prescriptions of fluoxetine (Prozac) and quetiapine (Seroquel) were given, later moving on to other mood-stabilizing medications as the previous ones did not have any effect. Panic attacks, impulsivity, anger crises and depersonalization later manifested. Many mental health specialists were consulted in a period of 3 years concluding with ADHD (inattentive subtype) and Borderline personality disorder (BPD). Lifetime medication was strongly advised. After being at Uchee Pines for a whole year, changing to a complete plant-based diet, getting exercise, regularity in sleep and schedules, spending time in nature and learning to trust solely in God as Creator and Jesus as her Savior, she is no longer in need of medication and lives a purposeful life.

Questionnaire for Adult Attention Deficit Disorder (AADD)

Use the following scale to score each of the 10 statements:

A lot of the time = 10 points
Often = 7 points
Seldom = 5 points
Almost never = 0 points

1. I often lose my train of thought, forget what I'm doing, and tune out what people are saying to me.
2. I have changed jobs frequently because I:
   -Have been fired for inefficiency (10 points)
   -Have been fired for arguing (7 points)
   -Get bored and quit (5 points)
   -Keep returning to school (3 points).
3. I talk too fast and too much. I skip from topic to topic too quickly for others to follow in conversation.
4. I start a task, get distracted, and never seem to finish.
5. I can't focus on one aspect of my life. My thoughts run wild; it's hard to concentrate.
6. I constantly argue with my spouse/parent over my messiness.
7. Keeping track of time is a problem. I'm late or early to meetings and appointments.
8. I've been told I could have accomplished more if I had applied myself.
9. I have an addictive personality, craving more and more, whether its food, alcohol, clothes, or attention.
10. I'm creative and smart, but can't focus energy in the right direction.

How to figure your score:

0 - 20  You are just a bit forgetful. No AADD crisis.
20 - 60  You are showing a few signs of AADD. Learn to make lists and follow them.
60 - 100  You probably have AADD. 

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References:

1. Barbaresi, W. J., Weaver, A. L., Voigt, R. G., Killian, J. M., & Katusic, S. K. (2015). Comparing Methods to Determine Persistence of Childhood ADHD Into Adulthood: A Prospective, Population-Based Study. Journal of Attention Disorders, 22(6), 571-580.
2. London, A. S., & Landes, S. D. (2019). Cohort Change in the Prevalence of ADHD Among U.S. Adults: Evidence of a Gender-Specific Historical Period Effect. Journal of Attention Disorders, 108705471985568
3. Fresson, M., Meulemans, T., Dardenne, B., & Geurten, M. (2018). Overdiagnosis of ADHD in boys: Stereotype impact on neuropsychological assessment. Applied Neuropsychology: Child, 1-15.
4. Cortese, S. (2012). The neurobiology and genetics of Attention-Deficit/Hyperactivity Disorder (ADHD): What every clinician should know. European Journal of Paediatric Neurology, 16(5), 422-433.
5. Davidovitch, M., Koren, G., Fund, N., Shrem, M., & Porath, A. (2017). Challenges in defining the rates of ADHD diagnosis and treatment: trends over the last decade. BMC Pediatrics, 17(1)
6. Sayal, K., Prasad, V., Daley, D., Ford, T., & Coghill, D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet Psychiatry, 5(2), 175-186.
7. Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of Clinical Child & Adolescent Psychology, 47(2), 199-212.
8. G'l et al; The possible relationship between thyroid dysfunctions, weight gain, and attention deficit/hyperactivity disorder (ADHD) among children and adolescents: A consultation-liaison psychiatry sample with pediatric endocrinology; Gulhane Med J 2018;60: 136-138
9. Hesson, J., & Fowler, K. (2015). Prevalence and Correlates of Self-Reported ADD/ADHD in a Large National Sample of Canadian Adults. Journal of Attention Disorders, 22(2), 191-200.
10. Sood, Deppti MD; Klein, Susan MD; Is zinc supplementation an effective natural alternative to the treatment of ADHD?; Evidence-Based Practice: May 2018-Vol 21-Issue 5-p E7
11. De Jong, J. W., Vanderschuren, L. J., & Adan, R. A. (2016). The mesolimbic system and eating addiction: what sugar does and does not do. Current Opinion in Behavioral Sciences, 9, 118-125.

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Updated March 25, 2020‍‍