Tag Archives: ADHD

Your 4 year old needs Ritalin Part II

Ritalin Methylphenidat

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.

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Your 4 year old needs Ritalin

Picture taken by myself of my Adderall prescri...

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.

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Food Dyes Pose Serious Risk to Children and Adults

All of these foods contain artificial food dyes

Food dyes are an interesting subject.  Health groups have been calling for their removal from the market for years because of links to allergies, hyperactivity in children and cancer.  The food industry uses them for one sole purpose – to make food look more appealing.  That’s it.  We’re not even talking about flavor enhancers here (which have their own set of problems). Food dyes don’t make food taste better and have no nutritional value to them whatsoever.  They are nothing more than chemicals used to make us think our food is going to taste better.

Now the Center for Science in the Public Interest (CSPI) is calling for the removal of several of these dyes.  They say the three most widely used dyes, Red 40, Yellow 5, and Yellow 6, are contaminated with known carcinogens.  They also say that another dye, Red 3, has been known by the government for years to be a carcinogen yet it remains in our food supply.

Let’s take a look at some things that might open your eyes:

  • Every year about 15 million pounds of eight synthetic dyes end up in our food.
  • Per capita consumption of dyes has increased five-fold since 1955.
  • Children consume more dye per unit of body weight than adults and they are much more susceptible to their effects.
  • The FDA did not consider the risk to children when making their ‘acceptable level’ guidelines.
  • Most safety studies conducted on dyes were conducted or commissioned by food dye manufacturers.
  • Most of these studies lasted less than two years so long term affects could not be assessed.
  • The amount of artificial chemical allowed in any given dye is based on usage from 1990 and usage has increased by 50% since then.

The Center for Science in the Public Interest is claiming that the FDA is not upholding the law for the following reasons:

  • Red 3 and Citrus Red 2 should be banned under the Delaney amendment, because they caused cancer in rats (some uses were banned in 1990), as should Red 40, Yellow 5, and Yellow 6, which are tainted with cancer-causing contaminants.
  • Evidence suggests, though does not prove, that Blue 1, Blue 2, Green 3, Red 40, and Yellow 6 cause cancer in animals. There certainly is not “convincing evidence” of safety.
  • Dyed foods should be considered adulterated under the law, because the dyes make a food “appear better or of greater value than it is”—typically by masking the absence of fruit, vegetable, or other more costly ingredient.

Click here for a summary of studies on food dyes

There are 9 dyes currently approved for use in the United States.  Many previous dyes have been banned because they have caused adverse affects in laboratory animals.  In fact, the British government had asked manufactures, as of last December 31st,  to completely phase out use of dyes and the European Union is requiring that every food containing dye come with warnings.  Below is a summary of each dye and its potential problems.  This list is from the CSPI.

  • Blue 1 was not found to be toxic in key rat and mouse studies, but an unpublished study suggested the possibility that Blue 1 caused kidney tumors in mice, and a preliminary in vitro study raised questions about possible effects on nerve cells. Blue 1 may not cause cancer, but confirmatory studies should be conducted. The dye can cause hypersensitivity reactions.
  • Blue 2 cannot be considered safe given the statistically significant incidence of tumors, particularly brain gliomas, in male rats. It should not be used in foods.
  • Citrus Red 2, which is permitted only for coloring the skins of oranges not used for processing, is toxic to rodents at modest levels and caused tumors of the urinary bladder and possibly other organs. The dye poses minimal human risk, because it is only used at minuscule levels and only on orange peels, but it still has no place in the food supply.
  • Green 3 caused significant increases in bladder and testes tumors in male rats. Though the Food and Drug Administration (FDA) considers it safe, this little-used dye must remain suspect until further testing is conducted.
  • Orange B is approved for use only in sausage casings, but has not been used for many years. Limited industry testing did not reveal any problems.
  • Red 3 was recognized in 1990 by the FDA as a thyroid carcinogen in animals and is banned in cosmetics and externally applied drugs. All uses of Red 3 lakes (combinations of dyes and salts that are insoluble and used in low-moisture foods) are also banned. However, the FDA still permits Red 3 in ingested drugs and foods, with about 200,000 pounds of the dye being used annually. The FDA needs to revoke that approval.
  • Red 40, the most-widely used dye, may accelerate the appearance of immune-system tumors in mice. The dye causes hypersensitivity (allergy-like) reactions in a small number of consumers and might trigger hyperactivity in children. Considering the safety questions and its non-essentiality, Red 40 should be excluded from foods unless and until new tests clearly demonstrate its safety.
  • Yellow 5 was not carcinogenic in rats, but was not adequately tested in mice. It may be contaminated with several cancer-causing chemicals. In addition, Yellow 5 causes sometimes-severe hypersensitivity reactions in a small number of people and might trigger hyperactivity and other behavioral effects in children. Posing some risks, while serving no nutritional or safety purpose, Yellow 5 should not be allowed in foods.
  • Yellow 6 caused adrenal tumors in animals, though that is disputed by industry and the FDA. It may be contaminated with cancer-causing chemicals and occasionally causes severe hypersensitivity reactions. Yellow 6 adds an unnecessary risk to the food supply.

I always encourage my patients to eat as naturally as possible and this is one of the main reasons.  These chemicals, basically derived from petroleum, are clearly not as safe as the food manufacturers would like you to think they are.  While not all of these dyes pose a serious threat, why risk it?  You can bet that if you buy a packaged food and it is brilliantly colored, it has one or more of these dyes in it.  That is also problematic as these dyes have been studied alone and not it combination with one another.  No one knows what the safety of these dyes are when consumed with other dyes.

Natural Alternatives

There are options for food coloring out there.  Many natural colors exist that work just as well as the synthetics and are known to be safe.  I’ve listed some below for your reference.

  • Caramel coloring made from caramelized sugar, used in cola products and also in cosmetics.
  • Annatto a reddish-orange dye made from the seed of the Achiote. (Some are allergic to this one.)
  • A green dye made from chlorella algae.
  • Cochineal a red dye derived from the cochineal insect, Dactylopius coccus.
  • Betanin extracted from beets.
  • Turmeric (curcuminoids)
  • Saffron (carotenoids)
  • Paprika
  • Elderberry juice
  • Pandan Pandanus amaryllifolius, a green food coloring
  • Butterfly pea Clitoria ternatea, a blue food dye

I see many children in my practice that struggle with attention and hyperactivity.  Those symptoms are often alleviated by removing all artificial sweeteners and dyes from the diets of these children.  In terms of overall health, stick on the edges of the grocery store.  Skip the middle aisle where all of the processed junk is kept.  That is what will contain the dyes you want to avoid.

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Pesticides and your child’s health

I am going to take a one day break from my series on solving childhood obesity to mention this study that I just read about.  The study shows that children exposed to small amounts of pesticides have a significantly higher risk of developing ADHD.

In my last blog I spoke about controlling chemical exposures to limit obesity in children.  This study reveals yet another reason you should be wary of what goes in your child’s mouth.  The study looked at pesticides that are used on fruits and vegetables to improve the yield of a crop.  Sure, the pesticides work because they stop insect infestation but at what cost.

The pesticides are in a class of compounds called organophosphates.  These organophosphates are neurotoxins (toxic to the nervous system).  They act by inactivating an enzyme called acetylcholinesterase (A-see-tal-kole-in-es-ter-ace).  By inactivating this enzyme in an insect they die.  The problem?  Humans also need this enzyme to function.

In the human brain the neurotransmitter acetylcholine (A-see-tal-kole-een) is used for many things.  It is essential for learning and memory.  Acetylcholinesterase is also present in the brain.  It is designed to breakdown excess acetycholine.  By inactivating this key enzyme you may have too much neurotransmitter causing detrimental side effects.

This recent study isn’t the first to link organophosphates to ADHD, but it is the first to look at exposure to the general population.  Other studies have looked at farming communities and workers.

Researchers measured the levels of pesticide byproducts in the urine of 1,139 children from across the United States. Children with above-average levels of one common byproduct had roughly twice the odds of getting a diagnosis of ADHD, according to the study, which appears in the journal Pediatrics.

Where is the exposure coming from?  The EPA has banned most organophosphates from general lawn and garden use so the exposure is likely our fruit and vegetable supply.  That’s a scary thought because these are supposed to be our healthiest options.

Detectable levels of pesticides are present in a large number of fruits and vegetables sold in the U.S., according to a 2008 report from the U.S. Department of Agriculture cited in the study. In a representative sample of produce tested by the agency, 28 percent of frozen blueberries, 20 percent of celery, and 25 percent of strawberries contained traces of one type of organophosphate. Other types of organophosphates were found in 27 percent of green beans, 17 percent of peaches, and 8 percent of broccoli.

Nearly 95% of the children studied had detectable levels of organophosphate metabolites in their urine.  The children with the most had the highest rates of ADHD.

I always encourage my patients to eat organic or at the very least buy local.  Organic is best because it ensures that there is very little, if any, pesticide residue on your fruit or vegetable.  Buying local is also good because studies have shown that local produce also has less pesticide on it.

In my practice I see children with ADHD very frequently and our first step is always to clean up the diet and go as organic as possible.  In general parents are receptive to this which is good.  Most of the time, however, they get very little support from their family doctor or their child’s pediatrician.  In general I find, pediatricians don’t believe diet or chemical exposure has anything to do with ADHD.  It’s nice to finally have a study that will be published in their own trade journal that proves it does matter what a child eats.

The authors of the study suggest washing and peeling fruits and vegetables before you eat them.  I agree with the washing advice but don’t suggest you peel anything.  The skins of fruits and veggies is where some of the best nutrients are.  They are important to consume.  My advice is to buy organic and still wash the fruit or vegetable.  This will significantly reduce your risk of consuming organophosphates.

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How to get better brain function!

In the study of neurology, there are many theories and formulas that can be applied in order to better help our understanding of how we as humans experience the world around us.  Scientists, researchers and other doctors break them down, analyze them and apply them to different areas of the brain, mostly for academic value.  That is extremely valuable, especially for me as a functional neurologist.  While helpful for me, this is usually not the case for many of you.  One of the most common questions I get is “How can I better understand the way my brain functions so I can feel better?”

There is one principle that applies to the entire brain that is very easy to understand and is indispensable for me when considering my treatments.  It is also very simple; input equals output.  That’s it.  And it really is as simple as it sounds.

Our brains are completely dependent upon the input coming in from all around us to generate its output.  Let me give you a simple example of correct input resulting in correct output and then just the opposite.  Picture yourself at a restaurant and you are ordering a wonderful organic, grass-fed New York strip steak.  When you place your order the waiter asks, “How would you like that done?”  You reply, “Medium, please.”  You responded appropriately because the input (the waiter’s question) was interpreted by your brain correctly and it quickly formed the correct output (your response to his question).  But what if the scenario unfolded as follows; the waiter asks the same question, but you hear, “Would you like a bun?”  You might reply, “No thank you,” but of course the waiter would look at you funny because that is not the answer to his question.  The problem in the second scenario is that the input was interpreted incorrectly, so your brain had no choice but to formulate incorrect output.

This is a very simple set of circumstances, but in fact, this is happening millions of times per day in our own brains.  And input comes from everywhere!  Input comes from the outside world in the form of hearing, sight, touch, taste and smell among others.  This is called external input.  Input is also internally generated.  This input comes from within the brain from other circuits that communicate with each other to maintain the high output of the human brain.

Both internally and externally generated input is critical.  In functional neurology, we use a combination of these two inputs to change the way the brain fires.  First we establish where the problem is.  A person might say they have headaches, high blood pressure or depression, all of which could be from aberrant output of the brain.  The symptoms are being caused from this aberrant output, but as illustrated earlier, the brain is actually just responding or interpreting the input it is receiving incorrectly.  Once we discover the part of the brain that is not working correctly, we recommend specific exercises to retrain the brain.

It is through these corrective exercises that we are able to change the input, which changes the output and reduces the symptoms of many conditions.  It is a cutting edge treatment for many conditions and is gaining momentum as research mounts on brain function.

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Vision Therapy For ADHD.

I recently came across an article in the NY Times that speaks of using vision therapy to correct problems in children like learning disabilities and ADHD.  The article explores the divide that exists between what mainstream medical practitioners think and optometrists think when it comes to vision therapy.  Most of the health practitioners who practice vision therapy for leaning disabilities happen to be optometrists.

Behavioral optometry, as it is called when optometrists focus on these types of conditions, is a growing field within optometry.  This is similar to my own chiropractic profession in which regulated subspecialties like neurology, radiology and nutrition have emerged over the last 20 years or so.  Behavioral optometrists use eye exercises to improve conditions such as ADHD, Autism, learning disabilities and even neck pain.

Mainstream medicine, of course, finds this abhorrently offensive because it does not fit into their own paradigm of drug therapy.  To them, everything that can be known is known and anything ‘outside the box’ is without a doubt wrong and probably dangerous.  As a matter of fact, they will often tell you if you seek these treatments the practitioners offering it are ‘quacks’ and are out to steal your money.  This may sound harsh, but it is not an exaggeration.  I have heard it many times from my patients who were unsuccessfully lobbied by their primary care doctors to stop seeing me for their treatments.

Eye exercises along with other modalities is something that we use with regularity to treat children with a range of conditions that includes ADHD, Autism and other learning disabilities.  It is extremely successful.  Many doctors will say that there is no scientific research that shows it works.  Takes this quote for instance.

“It has no validity,” says Marshall Keys, a Rockville, Md., pediatric and adolescent ophthalmologist who is an outspoken critic of vision therapy.

Dr. Keys clearly has not picked up a neurology text in a very long time. The fact that they eyes and the brain act as virtually one entity is well known.  If they eyes do not work properly the brain cannot process information correctly.  If the brain is not working properly it cannot control the eyes.  The connection is easy to understand.  Try this simple demostration:

Stand up and put your feet together and with your eyes open look up at the ceiling and roll your head in several circles.  Now repeat this with your eyes closed.  It was much easier to stand and roll your head in circles with your eyes open wasn’t it?  You felt more stable with your eyes open.  Why?  Because you depend very heavily on your eyes for your sense of balance.  When you close your eyes you rely solely on the information coming from your inner ear and the receptors in the joints of your legs and spine.  Without the input from your eyes, your brain finds it slightly more difficult to process information.  Now extrapolate this to reading, writing, attention, etc.  Is it not easy to see that if you had an issue with your eyes or your brain that these tasks might be difficult to perform?

I do take exception to one thing in behavioral optometry.  They tend to attribute everything to a problem with the eyes.  While this is the case many times, just as many cases are problems in the brain.  I have seen many children with learning disabilities and sometimes the problem is with the eyes and sometimes it’s in the brain.  The treatments, however, are similar.  You must retrain the eyes or the brain.  To do so eye exercises, light therapy, sound therapy, vestibular therapy, cognitive visualization and balance exercises are applied to name a few.  This, when applied correctly and specifically, corrects the underlying issue.  It is really very amazing.

The brain is an amazing environment, but it is not perfect.  It makes mistakes and can under function just like other parts of the body.  When this happens it needs to be rehabilitated.  This rehabilitation is a simple process, but often requires months to be effective.  This is because of the very nature of the brain.  While it is malleable, it resists change.  A perfect example is trying to master a new skill.  You can’t master it overnight.  It takes many hours of repetition before the skill has been mastered.  Rehabilitating the brain is similar.  Exercises must be done over and over again in order to reap the rewards and see benefit in the end.  People are often frustrated at the pace of therapy, but are extremely pleased with the overall results.  You wouldn’t expect to be able to run a marathon after training for a month would you? The brain is very similar to a muscle.  It must be trained and maintained to function at its very best.  When it isn’t working well, training is the only way to fix it.

If you have a child that is having trouble in school have someone who is trained in functional neurology examine them.  A great website with a list of doctors is www.acnb.org.  They have a doctor locator in which you can put your address and zip code in and find all of the doctors within a defined radius.  If you ask your pediatrician for advice, your child will end up on drugs that have dangerous, even lethal side effects with no prospect of producing any permanent benefits.  Functional brain rehabilitation is the only way to permanently change the function of a child’s brain.

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Vital Signs – Study Finds Sharp Increase in Chronic Health Problems in Children – NYTimes.com

Childhood rates of chronic health problems, including obesity, asthma and learning disabilities, have doubled in just 12 years, a new study reports — to 1 in 4 children in 2006, up from 1 in 8 in 1994.

But the findings, which appeared in the Feb. 17 issue of The Journal of the American Medical Association, held a welcome surprise, the researchers said: many chronic conditions resolve themselves during childhood.

While half of the children followed from 2000 through 2006 had a chronic condition at some point during the period, only one-quarter did at the study’s end.

“There is much to be hopeful about,” said the paper’s lead author, Dr. Jeanne Van Cleave, a pediatrician at the Massachusetts General Hospital for Children in Boston. “We’re now wondering what’s going on with those kids, and why a chronic condition resolves in one child while another child may not experience the same thing.”

The study analyzed data from the government’s National Longitudinal Surveys that included three nationally representative groups of children ages 2 through 8. Besides obesity and asthma, the scientists looked at allergies, heart trouble, impaired vision and hearing, and behavior and learning problems like attention deficit hyperactivity disorder.

Though the researchers did not study the reasons for the increases, they suggested several possible factors: improvements in screening and diagnosis that led to more reporting of the chronic conditions; the rise in childhood obesity, which can lead to other problems; and the increasing survival of premature babies and children with cancer and other diseases, who are more likely to have chronic health problems.

via Vital Signs – Study Finds Sharp Increase in Chronic Health Problems in Children – NYTimes.com.

Dr. Court’s Comments:

To me, it is not a surprise that these chronic health conditions are on the rise.  Steadily over the last twenty years children have become more sedentary and diets have become poorer.

This study did not hypothesize why these conditions might be on the rise, but the dangerous combination I mentioned above is as good as any.

The link between diet and obesity is an easy one.  Children are eating more and more processed and refined foods which are loaded with bad carbohydrates and contain very little actual nutrition.  The asthma/diet link is also an easy connection.  Many children consume copious amounts of foods they are allergic to.  Routinely, I place children on elimination diets to rid them of any possible allergies.  The likely culprits are dairy and wheat, but others may exist.

The link between diet and learning disabilities is also there.  Elimination of offending foods often results in better behavior and increased concentration at school.  Also, there must be more activity for these children.  Active children are much less likely to suffer from ADHD and other similar problems.  When I treat children with ADHD I always recommend that they child get into some kind of organized activity.  If they don’t, they end up with too much “screen time.”  That is, they spend too much time in front of the TV or computer.  This is very detrimental to their brain development.

If we want to change this disturbing trend we have to get our children better nutrition and get them active.  Parents must understand that these conditions don’t develop because they are “unlucky” or have “bad” genes.  These are controllable and need to be addressed with corrective measures and not covered up with drugs that only relieve symptoms.

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