Tag Archives: attention deficit hyperactivity disorder

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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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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