Counseling Sheet

Agatha M. Thrash, M.D.
Preventive Medicine

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Hyperkinetic children have become common in our society. We should make a persistent search for every factor in the environment that could lead to a hyperactive child. Minimal brain dysfunction and hyperactivity have both achieved quite a lot of popularity during the past several years. Along with the various shades of brain damage which are obvious, there are certainly many individuals who have unmeasurable but definitely present deficits in their mental function. The delicate nuances of mental functioning cannot be measured—such things as ambition, zeal, tenderness, compassion, the social graces, honesty, heterosexuality, and many other functions of the brain. The subtle deficiencies are so small that there are no changes of the electroencephalogram. While it is true that some hyperkinetic children show immature reflexes, poor motor coordination cannot be demonstrated. Many factors in the environment have been implicated as possible sources of the problem, from methods of obstetrical delivery to the level of lead in the drinking water.

Since personality disorders are associated with hyperactivity, it can be expected that certain psychometric tests would reveal a higher risk of alcoholism, sociopathic behavior, hysteria, and other adulthood disorders. It is a fact that these personality disorders are more frequently found in adults who were hyperactive children. Let us examine some of the underlying environmental conditions.

In the home, there is often inconsistent discipline from the parents or guardians. Children do not know whether an action will be followed by approval or disapproval. Alcoholism in any adult member of the household compounds the problem. Since alcohol in the blood of the mother damages an unborn child, it could be expected that the unborn child might develop pancreatic problems, resulting in metabolic disorders. It has been shown through biochemical studies that 70% of hyperactive children have an abnormal glucose tolerance curve.

Dr. Benjamin Feingold, a California pediatrician, has reported dramatic results with a diet that eliminates harmful habits and all synthetic food colorings and flavorings, all sweets, and many other "junk foods." The Feingold diet would be good for everyone. Most children recognize that they feel better on the diet than off, and even request to stay on it, much to mother's surprise.

It is a new thing to understand that there is a dietary toxicology that affects behavior! Many of the hyperactive children studied had finicky eating habits, being unwilling to eat vegetables and fruits, and took mainly milk, cheese, boxed cereals, crackers, and white bread. In the treatment, all artificial flavors, coloring agents, and natural salicylates were eliminated. The last group is found in almonds, apples, apricots, berries, cherries, currents, nectarines, oranges, peaches, tomatoes, and cucumbers. It still seems strange to the American parent that foods can adversely affect the central nervous system.

There are often significant factors in the child's background, beginning even before he is born and carrying through the early childhood years: prematurity; difficult, hasty, or precipitous labor; blood incompatibility; adoption; tip-toe walking; or ambidexterity after age seven. The likelihood of a learning disability is as follows: With one or two of these historical factors, he is suspect. With three it is strong evidence, and with four or more it is almost certain that he will have a learning disability. It has also been found that iron deficiency anemia can cause defective production of brain hormones, which could lead to hyperactivity or other misbehavior.

If a woman smokes during her pregnancy, her child will have a greater likelihood of being hyperactive. A child is three times more likely to be hyperactive if her mother smoked 23 cigarettes or more per day during her pregnancy than if she smoked none.

Lead in food and drinking water has been implicated in hyperactivity. If a sample of water going into a home yields 2,000 micrograms per liter of lead, there is more mental retardation than if the level is below 800 micrograms. Even a mild degree of lead poisoning in rats produces a decrease in brain dopamine, one of the brain hormones needed for transmission of a nerve impulse. In one study, hyperactive children had higher blood and urine levels of lead than did controls.

Factors that have contributed to the great change in the psychological climate of the family are as follows: dislocations and disruptions; earlier and more immature marriages; easy divorce; decline of religion; widespread female employment; mechanization; emphasis on materialism and money instead of learning to work; the great overuse of TV, movies, comic books, even the daily papers; population explosions; pampering and family indulgence, especially where they replace true love for children. Hyperactive children are more likely to become juvenile delinquents. Whether the environmental factors that contribute to the hyperactivity or the physical problems are the greatest precipitating factors has not yet been determined.

The treatment is a very delicate matter. Prevention of the hyperactive state is much better than cure. Nevertheless, if at any time the parent recognizes hyperactivity, a strong effort should be put forth to have good discipline ("few rules, but strictly enforced"), a solid ego identification with someone of the same sex as the patient, preferably the father or the mother, and a good relationship to the parent of the opposite sex. Boys outnumber girls by a ratio of 6 to 1. Crisis periods often occur at age 5, 8, and again at about age 17.

Growth suppression occurs with some of the drugs to treat hyperactivity. It is usually best to leave off drugs, allow a child first to reach some maturity, and later try to catch up in academic matters. Hyperactive children are usually immature in their personality and mental development. As they grow older, there is a gradual reduction in anti-social behavior. The child should be started to school late, as schooling greatly compounds the neurological problems. Placing a child in a grade level he barely qualifies for in terms of age frequently leads to trouble; I recommend that children not start to school until they are eight or ten years of age, particularly if they are hyperactive. Little boys are much more vulnerable because they mature less rapidly. The mother should be the only teacher until the child starts to school, and she should not be ambitious about the academic training. She should concentrate on developing such skills as cooking, housekeeping, yard work, taking care of the car, etc. The child should always work right along beside the mother, not being sent off to work alone.

• Rich rewards will come from learning some fundamental principles and faithfully following a few basic suggestions on this common disorder. The child should be treated vigorously to promote long-range benefits.
• Hyperactivity in children is a common childhood disorder, involving from 3-10% of school children in this country. It is a modern society disease, developing from features in our lifestyle.
• Stimulant drugs are often given for this disorder, but need not be used if a proper program for the child is instituted. Often the treatment is worse for the child than the illness, since under the influence of the drugs the personality is altered, many becoming compulsive goody-goodies, sensitive to discipline, incapable of proper use of the mind, and become strangers to their parents.
• Hyperactive children may be growth-retarded. A large percentage of hyperactive children have a low blood sugar level, below 65.
• In addition to hyperactivity, many of the children are found to have anemia, impaired achievement, and defective breakdown of stress hormones in the body. These all indicate a multiple system disorder, not just neuromuscular, just digestive, or just central nervous system, as many have supposed.
• Family problems are never to be discussed in the hearing of children.
• Fathers are needed by children as well as mothers, especially beginning at about age five. Fathers should give some of their leisure hours to their sons.
• Do not place the child in unfamiliar surroundings at night. He should go to bed in his own bed every night. Have no other persons in his bed. Spend-the-night parties are fashionable, but are unhealthful both physically as well as socially. Plan some other type of social activity.
• He should not be expected to do activities that are beyond his years such as learning to read, being responsible for a younger child, etc. Schooling should be delayed until physical maturity indicates that he is able to concentrate for long periods, usually about 8-10 years of age for these special children. To start them earlier usually results in unhappiness for all, and in the child's forming a mental image of himself as a poor achiever, slow learner, and unliked by others.
• Factors now known to be related to the development of hyperactivity are as follows:
• Iron deficiency anemia.
• Other factors of malnutrition, especially overnutrition, or selective overfeeding of certain nutrients such as white flour and white rice products, boxed cereals, sweet food or drink, and too-rich foods. Oils and margarine are also rich foods, which imbalance the diet. Use of lard (often found in homogenized peanut butter, bread, and crackers).
• Certain food colorings, especially Red II dye, a common dye used in many red foods from wieners to suckers. Many food additives, including flavorings, enrichers, and preservatives. Vitamin and mineral supplements are stimulating to some.
• The overuse of sweets begins in the hospital nursery with sugar water. Breast feeding and water between times is all the baby needs for the first six months. Since certain children are sensitive to eggs and milk, it is worth a strict trial of six weeks without either of these or any of their products. Read food labels carefully. Similarly, since meats have stimulating guanine and other purine substances in them, during the same six week period, eliminate all flesh foods from the diet. Supply the place of animal products with plenty of greens, whole grains, and legumes (beans, peas, and peanuts).
• Stomach irritants, such as pepper, spices, baking soda, and baking powder products, caffeine containing drinks, chocolate, and any foods that "disagree" with the child (milk is a common offender).
• Inadequate external controls in the parental environment, reflected by such things as eating between meals, temper flare-ups, no set pattern of life.
• TV, comics, radio, stereo, and competitive games.
• Noisy home environment and city living.
• Improper clothing of the child is a cause of discomfort and hyperactivity. The arms and legs, feet, hands, and ears should always be warm. There should be no patches of cold skin anywhere on the body except the face. Tight bands must be avoided. If a band leaves a mark on the skin it is too tight. There should not be more layers of clothing on the trunk than on the extremities. Similarly, the child should not be overclothed. When the temperature rises, the clothing should be adjusted. Multiple layers of thinner garments are better than one or two thick garments.
• Inconsistent discipline and unwise supervision lead to poor personal control. Have few rules for the child, but strictly enforce them.
• Disarray and clutter confuse children and lead to poor performance. Keep everything the child's eye rests upon neat and orderly.
• An irregular schedule upsets the natural biologic time-clock. Have set times for all major events: bedtime and arising time, exercise time, mealtime, bathtime, storytime, etc. Irregularity may seem a small thing to the parents, but takes a great toll on the child's nervous system.