Naturopathic Doctors Address ADHD:
Attention Deficit Hyperactivity Disorder (ADHD) is a medical condition where a person has trouble with everyday tasks like sitting still, paying attention and impulse-control. ADHD is very common in the US and has been on the rise since the 1990s, with millions of cases currently diagnosed each year. There is no specific “cure” for ADHD and the common treatment used by pediatricians is to alleviate symptoms using amphetamine drugs like “Adderall”. That said, pediatricians and medical researchers have identified many fixable situations that may give rise to ADHD symptoms. Because Adderall only offers temporary relief for ADHD and comes with serious side effects, the doctors at Terrain Wellness in Portland, Oregon believe it is worthwhile to look for possible underlying causes of ADHD symptoms with a goal of reaching a more permanent, medication-free solution.
Possible Sources of
- Sleep disturbances. Children with chronic upper respiratory infections, enlarged tonsils, undiagnosed asthma and other apneic conditions are at higher risk for having disrupted sleep cycles. Pediatricians may see children who present with behavioral conditions such as ADHD who have other health conditions that to disrupted sleep. Problems at home such as divorce, arguing parents or situations outside the home like bullying at school may also result in disturbed sleep. Whatever the cause, disturbed sleep patterns can result in symptoms like ADHD.
- Retained Reflexes. In some children, infant reflexes don’t integrate into more developed patterns as they grow up, which can result in ADHD-like patterns. For these children, ADHD symptoms can be resolved with modifications like using a standing desk along with pediatric occupational therapy. The Symmetric Tonic Neck Reflex is a hands and knees position that is integrated through crawling. The Asymmetric Tonic Neck Reflex involves one arm outstretched with eyes looking toward outstretched hand while the other arm is bent with the hand close to the head. When these reflexive body positions are not integrated as infants, positions like sitting at a desk reading or writing can trigger patterns in the brain that interfere with attention and learning. Pediatricians and researchers have found that children whose ADHD behaviors disappear when working at a standing-height desk with elbows bent may simply have these reflexes active (Petke, 2014).
- Variant Learning preferences. Catering learning and teaching modalities toward each individual student is always preferable. Many children, especially boys, are more kinesthetic learners. Pediatrics researchers noted that kinesthetic learners immediately improve their reading skills (fluency and accuracy) when walking around the room, rather than sitting still at a desk. Tailoring the learning environment to match a child’s learning style can quickly improve attention and learning (Petke, 2014).
- Food Allergies and Sensitivities. While it may sound strange at first, the foods we eat can have a large impact on ADHD symptoms. Conditions like gastrointestinal problems, eczema or asthma show how certain foods can influence physical patterns in organ systems, leading pediatricians to ask whether certain foods can affect the brain. Studies have shown that ADHD symptoms can be resolved in some children using strict diets that eliminate certain foods that may be the culprit.
- History of Traumatic Brain Injury. Head injuries in professional, collegiate and even high-school sports have captured headlines in recent years. However, brain injuries are also very common in children due to their active lifestyles. Interestingly, pediatricians and researchers note that children who sustain mild Traumatic Brain Injuries with ADHD are more affected than children without ADHD (Bonfield, Lam, Greene 2013). Because of this, many doctors suspect that head trauma may exacerbate ADHD or even be part of the cause.
- Children who are Bored. With classroom sizes becoming larger every year, teachers are often put in the tedious situation of spending more time on discipline rather than teaching. Many gifted learners are under-challenged in school and act out due to being bored with a school curriculum that caters to slower learners. In this way, exceptionally smart children may display ADHD symptoms because they need an environment where they are free to excel.
- Environmental toxins. Toxic substances such as lead, PCBs and pesticides may play a role in ADHD. Mothers who drink alcohol or smoke may place their children at higher risk of ADHD, among other health concerns. Suspect environmental toxins if the child’s ADHD symptoms grow worse at a given time each week or month or if the behavior is linked to a specific activity/location (Petke, 2014). Parents’ occupation and products used around the house may put their children at an increased risk for exposure to toxins linked to ADHD.
- Absence seizures or Tourette’s syndrome. Both of these disorders can exhibit symptoms very similar to ADHD. Absence seizures may appear as if the child is “daydreaming” for 10 seconds or more. These seizures may appear to teachers and caregivers as if the child is being inattentive. In the early stages of Tourette’s Syndrome, twitching and involuntary movements may appear as a child who is fidgety or hyperactive.
The Science of ADHD
Scientific studies have demonstrated a genetic predisposition to developing ADHD. However, there are no brain scans or blood tests to confirm that one has the disorder. ADHD is the extreme end of behavior seen throughout the entire population in varying degrees. Despite a lack of definitive lab scans/lab-tests to confirm ADHD, there are some general features seen in ADHD brains: the right prefrontal cortex, caudate nucleus and globus pallidus are typically smaller. These qualitative brain differences suggest lack of connectivity in key brain regions that modulate attention, stimulus processing, and impulsivity. (Medscape, 2014). ADHD also carries a notable dysfunction in norepinephrine and dopamine pathways. Dopamine is involved in reward, risk taking and mood; whereas norepinephrine governs attention, arousal and mood.
In children with ADHD, doctors and pediatrics researchers suspect that there is a dysfunction in the receptor proteins responsible for the effective utilization of the neurotransmitters, dopamine and norepinephrine. Environmental factors including family trauma, maternal health and low socioeconomic status have also been correlated to ADHD and are considered secondary causes.
How do Pediatricians Diagnose ADHD?
The national Institute of Mental health describes Attention deficit and hyperactivity disorder (ADHD) as one of the most common childhood disorders. They go on to state that ADHD can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior and hyperactivity (NIMH 2014). Doctors, pediatricians and psychiatrists have categorized ADHD into three subtypes:
Types of Attention Deficit Hyperactivity Disorder (ADHD)
- Most symptoms (six or more) are in the hyperactivity-impulsivity categories.
- Fewer than six symptoms of inattention are present, although inattention may still be present to some degree.
Predominantly hyperactive-impulsive ADHD
- The majority of symptoms (six or more) are in the inattention category and fewer than six symptoms of hyperactivity-impulsivity are present.
- Children with this subtype are less likely to act out or have difficulties getting along with other children. They may sit quietly, but they are not paying attention to what they are doing.
Predominantly inattentive ADHD
- Six or more symptoms of inattention and six or more symptoms of hyperactivity-impulsivity are present.
- Most children have the combined type of ADHD. (NIMH 2014).
Combined hyperactive-impulsive and inattentive
Naturopathic ADHD Treatment
As illustrated above, there are numerous possible causes that result in symptoms like ADHD. As such, while there are cases of neurotransmitter imbalance in children with ADHD, it is important to look for any contributing or underlying causes before using stimulant or anti-depressant medications. As naturopathic physicians, we have the privilege to explore and investigate the underlying causes and contributing factors to a disease manifestation. As a licensed primary care physician in Portland, Oregon practicing naturopathic medicine and acupuncture, I take the time to get a thorough history of diet, toxic exposure risk, developmental reflex integration and incidences of injury to help create effective treatments for children with ADHD symptoms without exposing children to the side-effects of psychotropic medications. It is my goal to move treatments for ADHD toward natural solutions to ADHD symptoms whenever possible.
References for ADHD Medical Studies & Pediatric Research:
- National Institute of Mental Health. http://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml Accessed: 10/19/2014.
- Arnold, L. E. (1999). Treatment alternatives for attention-deficit hyperactivity disorder (ADHD). Journal of attention disorders, 3(1), 30-48.
- Petke, Rich. “Is it Really ADHD?” NDNR September 2014. http://ndnr.com/pediatrics/is-it-really-adhd/
- http://www.cdc.gov/ncbddd/adhd/data.html Accessed: 10/29/2014.
- Medscape: “ADHD part 1: Current status, diagnosis and etiology/pathophysiology” http://www.medscape.org/viewarticle/418518 Accessed: 10/29/14
- Pelsser, L. M., Frankena, K., Toorman, J., Savelkoul, H. F., Dubois, A. E., Pereira, R. R., … & Buitelaar, J. K. (2011). Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet, 377(9764), 494-503.
- Bonfield, C. M., Lam, S., Lin, Y., & Greene, S. (2013). The impact of attention deficit hyperactivity disorder on recovery from mild traumatic brain injury: Clinical article. Journal of Neurosurgery: Pediatrics, 12(2), 97-102.