Your 4 year old needs Ritalin Part II

Yesterday I wrote about how the American Academy of Pediatrics has changed the guidelines about how young (and old) a child could be diagnosed with ADHD. The new guidelines say that a child as young as 4 and as old as 18 may now be diagnosed with ADHD.

They went on to say that Ritalin and other drugs are good choices for treatment even for the youngest patients. To me this sounds like a terrible idea.

So what are some effective alternatives?

First and foremost, we must look at a child’s diet.  A healthy diet is a big key to helping a child regulate his brain function.  The problem in ADHD is that circuits in the brain that are responsible for attention, focus and other executive functions are under active.  That is precisely why most of the medications that exist are stimulants.  These stimulants speed up the processing in these brain regions and allow the child to function more normally.  The problem is that they carry serious side effect profiles, some of them very dangerous.

So where, exactly, does diet fit into this? Good question. First, each and every child must begin the day with breakfast. Food provides the fuel that the brain uses to do its job!  If there isn’t enough of the right kind of fuel, the child’s brain cannot function as well as it should.

And what is the right kind of food? Each child should begin the day with a source of protein and a little healthy sugar in the form of fruit.  This will provide ample amounts of fuel so your child can make it until his next meal at lunch.  Do not allow a child to eat sugary cereals or pop tarts or to skip breakfast.  Those types of fuel (or lack thereof) only set the child up for a crash in blood sugar which deprives the brain of the vital energy it needs.

The rest of the day should be roughly the same.  Be sure that your child eats protein and a fruit or vegetable every time he eats. Steer them away from sugary snacks and drinks.  They have a negative impact on brain function.

Balancing Neurotransmitters

A natural program to balance neurotransmitters in the brain is important. Neurotransmitters are specialized proteins that each nerve in the brain uses to communicate with its neighbors. The balance of them is important.  In ADHD the focus has been on the neurotransmitters called dopamine and norepineprhine.  Others, however, may play a role and include GABA, glutamate, PEA and serotonin to name a few.

The levels of these neurotransmitters in the brain is important.  Levels that are too high or too low can cause the brain to function less than optimally.  In my office we measure these neurotransmitters in a urine test and have found them very helpful clinically.  If we find levels that are low, we can supplement to raise them.  For example, dopamine is raised by increasing dietary levels of tyrosine (or its derivatives) and serotonin is raised by increasing dietary levels of tryptophan (or its derivatives).  The process is relatively simple, but it is very effective. Through this process we are able to rebalance the neurotransmitter system and see improvements in behavior and attention.

Reprogram the brain

This sounds very much like something out of a science fiction movie, but it is all based in neurology.  In ADHD the brain is wired incorrectly.  The circuits that we want to work are not efficient enough to produce balanced brain function.  To change this we must provide a program of neurologic rehabilitation.  It can be done many ways, but in our office we use a combination of home exercises that include eye exercises, balance exercises, light and sound therapy and proprioceptive feedback with an in-offfice therapy called interactive metronome or IM.

IM was developed in the early 1990s and is used to help children with learning and developmental disorders as well as adult neuro rehabilitation patients. IM is a neuro-motor assessment & treatment tool used in therapy to improve the neurological processes of motor planning and sequencing.

The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tone heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions. A patented auditory-visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.

Over the course of the treatment, patients learn to:

• Focus and attend for longer periods of time
• Increase physical endurance and stamina
• Filter out internal and external distractions
• Improve ability to monitor mental and physical actions as they are occurring
• Progressively improve coordinated performance.

I’ve used this program with many children and adults in my office and it works exceptionally well.  It is a great option for patients who have been diagnosed with ADHD and other learning disorders.

There are many options for parents with children with ADHD.  Medications are of course one of them, but there is no permanent benefit to taking them.  As a matter of fact, 50% of children who take medications will still need them as adults.  Rewiring the brain, dietary changes and rebalancing neurotransmitters has lasting and permanent effects.  In my opinion, it’s the best way to go.

Your 4 year old needs Ritalin

Unfortunately, your child’s pediatrician might agree.  The American Academy of Pediatrics recently changed the age at which children could be diagnosed with ADHD.  Now children as young as 4 and as old as 18 can be diagnosed with attention deficit hyperactivity disorder.  This diagnosis now also includes the old diagnosis of ADD, a term that is no longer used.

This change has led to fears that with more diagnoses there will be more drug therapies applied and perhaps some of these will be diagnosed incorrectly.  To me, these sound like legitimate fears.

The first problem I have is that the drugs approved for treating ADHD are dangerous and pose serious risks.  On top of that, they have only been approved to be used in children 6 and over.  No one has studied these medications on children younger.  This is a major problem. We cannot possibly know what these powerful stimulants can do to a developing brain.  These stimulants are, after all, a derivative of methamphetamine (basically speed!).

The guidelines are quick to point out that while Ritalin is an effective option, it should only be used once behavior modification has been tried unsuccessfully. The problem with that is I find many pediatricians are already too quick to write a prescription and move on to the next patient.  In a health care environment where most physicians are strapped for time as it is, they are unlikely to take the time to describe how to implement a program of behavioral modification and are much more likely to recommend something quick and easy like Ritalin.

A child that is just 4 years old is still developing.  Their brain is malleable and easily changed.  On one hand this is a good thing.  It means changes in their home life, behavioral modifications and therapeutic exercises have a great chance of working.  On the other hand it means the potential for negative change associated with medications is greater as well.

I see many children in my office for neurobehavioral disorders like ADHD.  I find I can recognize the hard signs in a 4 year of ADHD like breakdown in gait patterns, breakdown in eye movements or the persistence of primitive reflexes.  These are easily corrected with a program of brain rehabilitation and does not require dangerous stimulants.

These guidelines seem to be a way to open a new market for pharmaceutical sales.  As a matter of fact, the chairman of the committee who recommended the new guidelines, physician Mark Wolraich, is a periodic consultant to Eli Lilly,  Shire Plc, and other pharmaceutical companies. Eli Lilly and Shire hold exclusive U.S. patents for atomoxetine (brand name Strattera) and guanfacine (brand name INTUNIV), respectively, both of which the report recommends for treating ADHD in adolescents.

Parents should not be fooled by these recent recommendations.  Parents should seek drug-free alternatives for their children if they believe that they have ADHD. We just don’t know what these medications can do to a young brain.

Sidney Crosby’s got a new weapon

Dr. Carrick and Sidney Crosby seated at a press conference.

If you follow the NHL at all, you know who Sidney Crosby is.  He is arguably the best hockey player in the world.  He is the face of the National Hockey league. He is not playing hockey at the moment.

At the beginning of this year, Crosby was leading the NHL in scoring.  His team was playing well and was expected to make a deep run into the playoffs. Then two hits sidelined his season and possibly his career.  These hits, which came just days apart from one another caused Crosby to have two concussions which he had a very difficult time recovering from.

His symptoms were so debilitating that he couldn’t watch TV, drive a car or even shop at the grocery store. He had post-concussive syndrome with a unique component.  His vestibular system was affected.

The vestibular system is basically our balance center.  It allows us to stay balanced in earth’s gravitational field.  It tells the muscles of our neck, back and eyes how to respond to changes in position without conscious intervention.  This is important because if we needed to think about staying balanced every time we changed position, we wouldn’t think about much else!  Without our vestibular system, you and I could not walk, run or play. And we definitely could not skate at the level Sidney Crosby is accustomed to!

Sidney Crosby’s progress was moving exceptionally slow.  It was so slow that people in the media began to question whether he would ever play hockey again. He had been seeing some of the most prominent neurologists and concussion experts in the world with little to show for it. Then, a chiropractor who works with many professional sports teams recommended that he go see Dr. Ted Carrick.

Dr. Carrick is a chiropractic neurologist and head of the Carrick Institute.  In addition to being a chiropractic neurologist, he has a Ph.D in neurology.  His focus is to help people functionally rehabilitate their brains when there has been injury.  The results he has achieved with Crosby are quite amazing.

What do I mean, functionally rehabilitate? The brain has many, many functions.  It is very powerful.  Even small changes in the way the brain processes, interprets and executes function can cause symptoms.  Despite this fact, when people have concussions they are told time is the only thing that can heal the brain.  They are given no advice on how to rehabilitate their brain.  We understand rehabilitation when someone sprains an ankle or tears and ACL.  Those patients are given aggressive rehab programs to strengthen and heal their ankle or knee.  Why wouldn’t we do this for someone with a brain injury?

This is what Dr. Carrick has done for Sidney Crosby and it is also what we do here in our clinic.  We use the same techniques that Dr. Carrick is using on Crosby to help patients in our office every day.  As a matter of fact, I have studied under Dr. Carrick and seen him lecture on these brilliant techniques many times.  It is quite amazing.

So what exactly do we do? We use many different therapies designed to re-educate the brain and help it to more efficiently process the information it receives.  If the information is processed correctly it can respond appropriately and that is when we begin to see symptoms of many brain disorders improve.  The types of therapies vary depending on what and where the problem lies in the brian.  But they range from eye exercises to sound and light therapy to balance exercises to general brain games.  The list really is endless.

Dr. Carrick is hopeful the Crosby will begin playing shortly.  The progress that Crosby has made with Dr. Carrick is astonishing, but it’s not a miracle, it’s neurology.  I’m glad this type of rehabilitation is getting a little mainstream media coverage.  In my opinion, it’s just the tip of the iceberg!