May 10th 2010
Attention Deficit ADHD is is fast becoming an epidemic. Parents wondering what the cause of ADHD and ADD in their child was, often get little practical information. Even attention deficit research is producing conflicting results, as well as conflicting prognoses with regard to effective treatment. Experts with the same qualifications are recommending very different treatments, and even warning against following other treatments. How is a parent with a child diagnosed as having Attention Deficit Hyperactivity Disorder (ADHD), to make a competent judgement on top of the daily stress of having an overactive child?
As tempting as it may be to rely on one opinion on ADHD, it is ultimately the parent's responsibility to choose the right treatment for the child. To follow the advice of a reassuring doctor when one is bewildered and confused is tempting. The trouble is that there are many misunderstandings among doctors of what ADHD or ADD is.
The definitions and diagnosis of ADHD and ADD come from theDSM-IV (Diagnostic and Statistical Manual of Mental Disorders) diagnostic manual. What is described there are collections of behaviors. These behaviour patterns are regarded as symptoms.
There is no laboratory test to diagnose ADHD. There are no biological, physiological, neurological or any other logical assessments that can show somebody has Attention Deficit Hyperactivity Disorder, Attention Deficit Disorder (ADD), Hyperkinetic Disorders or Hyperkinetic Syndrome as it is also called. Even the DSM-IV states this. Unfortunately there are many doctors who regard the DSM-IV manual as an absolute definitive guide to mental health.
The DSM-IV also states regarding the word disorder:
“The problem raised by the term mental disorders has been much clearer than its solution, and, unfortunately, the term persists in the title of DSM-IV because we have not found an appropriate substitute. . . Mental disorders have also been defined by a variety of concepts (e.g., distress, dysfunction, dyscontrol, disadvantage, disability, inflexibility, irrationality, syndromal pattern, etiology and statistical deviation). Each is a useful indicator for a mental disorder, but none is equivalent to the concept, and different situations call for different definitions.”
(Introduction page xxxi)
There are three types of ADHD:
There are three possible causes for attention deficit hyperactivity:
There is a residual group where medication may be necessary, but the more usual causes should be tried first.
The DSM-IV is a categorised list of behavior patterns which may, but do not necessarily indicate a mental condition. The word condition is used here instead of disorder, as it implies a less severe state of health. There are disorders described in the DSM-IV, but most cases of ADHD are not “disorders.”
To get a clearer view, it is helpful to look at the problem from different perspectives. The mainstream consensus is largely pushed by the pharmaceutical industry. New ADHD medications are being developed because the present ones have serious side effects. It costs millions of Dollars to develop a new medicine. The market is worth billions of Dollars. Seminars are held by the various pharmaceutical companies to inform physicians about the ADHD drugs, as well as advertisements in the press and on the Internet. Many doctors have only learned one side of the story. First at medical school where the text book was written by someone from the “medicate only consensus” faction, and then later attending pharmaceutical industry sponsored seminars and conferences.
The Industry funds much of the Attention Deficit Disorder research. These research projects produce results biased towards support of the ADHD drug manufacturers claims. Many of the researchers are in an academic environment where the “chemical imbalance in the brain” is perceived as the main cause of the attention deficit condition. Other researchers are so absorbed with finding the “it's the gene” as the one main cause that they have lost perspective of what attention deficit actually is.
Genes do play many complex roles, predisposing some individuals to be more susceptible to environmental stimuli than their neighbour. But epidemics do not suddenly spring up out of nowhere in one generation, unless the population has been exposed to toxins or nuclear radiation. Since this has not happened across the whole of the United States this line of research looking for THE cause was a failed effort before it started. If there is a cause for this epidemic change in the human genome over a couple of generations, then that should be found first.
The “chemical imbalance in the brain” hypothesis is based on the unsubstantiated assumption that there is nothing beyond the material existence. The consequences of these ideas is that the mind with thoughts and reasoning is nothing more than electrochemical impulses in the brain and chemicals produced on order by the brain.
It is possible to prove something exists, but not that something does not exist. The philosopher Wittgenstein wrote, “You again and again reach the conclusion that the sensation (as in consciousness) itself is a nothing. Not at all. It is not a something, but not a nothing either.”
The debate on mind and matter has been going on for millennia. In short, there is no evidence that the mind and the brain are the same.
What comes first, the thought (realisation) that I am late for an important appointment, or the chemical cocktail injected into my system? Do the chemicals adrenaline and cortisol cause the anxious thoughts, or do the anxious thoughts trigger the adrenaline and cortisol to be pumped into the system.
The debate over ADHD treatments can be brought down to our personal understanding of reality. If I believe that my thoughts and feelings are the result of random impulses in my brain, then medication is the logical answer. If on the other hand, I believe that my thoughts trigger a reaction in my brain, which then produces chemicals, then Cognitive Therapy is the answer.
Since Cognitive Therapy has been shown to be as efficacious or more than medication for a range of mental conditions, this tends to promote the idea that thoughts rule the brain.
This assumption that my mind and my thoughts are formed by the brain impulses means that there is no “me” inside myself. There are only electrochemical impulses. These electrochemical impulses are my thoughts, my beliefs, my self-awareness, my emotions. Who makes the decisions? If my brain impulses control me, then I am merely an illusion, a product of my brain synapses and the idea that “I” have any choice is an illusion as the “real me” does not exist, other than a thought constructed by neuron chemical impulses between synapses.
The next section on the quantum brain is an illustration that we really do not understand the brain.
Quantum physics has shown that at the most fundamental level we can reach with matter, there is something influencing this time-space reality we are in. Quantum physics has laws say it is impossible to investigate this something, as with theHeisenberg's uncertainty principle. In effect, this suggests that we have reached the border, in theoretical quantum physics, beyond which science cannot reach. Yet at the same time know that there is something beyond that border.
Science and philosophy were once integrated. The influence of humanism split the subject into two. Science became hypermaterialistc, rejecting anything that could not be tested with our senses, or through instruments. This is an important point in any discussion on mental health. We tend to become trapped in a humanisticparadigm.
The concept of consciousness and whatconsciousness is has not been answered in a definitive way.
Philosophy and science are being reunited again at the forefront of today's scientific research.
The model of the brain is being expanded through the model of thequantum brain. This is a dynamic and exciting field. The quantum brain model makes the current electrochemical model look archaic. It is like comparing a Ferrari racing car with an oxcart. However there is still the barrier mentioned above, where quantum theory's own laws show that the consciousness is beyond the grasp of science today. We know we are conscious, but understanding that consciousness is not feasible.
There is a constraint in quantum theory between observer and the physical system being observed. This separates the object and the observer. So I cannot observe my consciousness in quantum theory as the observer and the object would be the same.
While Attention Deficit Hyperactivity Disorder exists, misdiagnosis in ADHD related cases is very common. If there is an ADHD epidemic, this may be caused by a misdiagnosis epidemic and defining what is considered normal, with an arbitrary boundary.
Many successful alternative ADHD treatment actually treat the cause, meaning that an ADHD disorder was not there in the first place.
Anyone who is diagnosed as having ADD or ADHD, should be screened for other conditions. Even the DSM-IV has a caveat at the end of the list of diagnostic criteria: “The symptoms are not better accounted for by another mental disorder.”
Many mental disorders have overlapping diagnostic criteria. For example, it is common for people with ADHD or ADD symptoms to be depressed and suffer from anxiety. Anxiety can cause the child to behave hyperactively (ADHD) and depression can be interpreted as inattentiveness (ADD).
The causes are listed in no specific order or categorising. The purpose with this list, which is not definitive, is to encourage the search for the cause, instead of treating the symptom. All these conditions can result in ADHD like symptoms.
There is no ONE cure for ADD and ADHD. There is no ONE cause for ADHD and ADD. Every child and adult is unique. Our metabolisms differ from person to person. Even identical twins, after being exposed to different environments and different experiences, are not the same.
ADHD, Hyperkinetic Syndrome and ADD are controversial conditions. This means that we should deal with it responsibly and with an open mind.
1) Hypoglycemia (Low Blood sugar). ADD like symptoms caused by lack of glucose to the brain.
2) Hyperglycemia. (High blood sugar). ADHD like symptoms.
3)Hyperthyroidism a metabolism imbalance from an overproduction of thyroid hormones. ADHD like symptoms.
4)Hypothyroidism a metabolism imbalance from an underproduction of thyroid hormones. ADD like symptoms.
5) Food preservatives. e.g. sodium benzoate (E211).
6) PANDAS. A cuddly acronym for Paediatric autoimmune neuropsychiatric disorders. Result of strep or Streptococcal infections.
7) Lack of exercise.
8) Food dye allergy. Among suspect food dyes found in sweets and soft drinks are allura red AC (E129), carmoisine, a coal tar derivative (E122), ponceau 4R (E124), quinoline yellow (E104), sunset yellow (E110) and tartrazine (E102). TheAllergy Resource Center has some interesting information and resources on allergies.
10) Gluten allergy or coeliac disease.
11) Casein allergy.
12) Learning disabilities.
13) Low self esteem.
14) Anaemia. (Low haemoglobin).
15) Post concussion syndrome. Mild cases of brain trauma, but with no physical evidence. Child may feel confused and frustrated and act in a hyperactive manner.
16) Hearing problems
17) Eyesight problems.
20) lead poisoning.
21) Spinal Problems. Some spinal problems can cause ADHD like symptoms because if the spine is not connected to the brain properly nerves from the spinal cord can give the brain all of signals at once making a child rambunctious and always on the go.
22) Pesticide poisoning.
23) Gasoline fumes.
24) Household chemicals, such as air fresheners, polish, disinfectants.
27) Specific dust, such asdust mites.
29) CO2 poisoning.
30) Absence seizures. Can be misdiagnosed as the daydreaming, inattentive form of ADD.
32) Viral or bacterial infections
33) Turner's syndrome (TS).
34) Sickle cell anaemia.
35) Fragile X Syndrome.
36) Sleeping disorders.
37) Dyscalculia. Difficulty understanding mathematics.
39) Tactile or kinetic learner. The child needs to use his/her body to learn. A “hands on” learning.
40) Auditory Learner. Has difficulty if most of the information in class is through writing.
41) Visual learner. ADHD behavior from frustration at not understanding a teacher only lecturing.
42) Education not meeting special learning style needs in some pupils. There are seven learning styles.
43) Post-traumatic sub-clinical seizure disorder.
44) Mercury poisoning.
45) Manganese poisoning.
46) Iron deficiency.Iron supplements may help. A study found serum iron levels were abnormal in 84% of children with ADHD and 18% of controls.
47) Magnesium deficiency.
48) B vitamin deficiencies. Especially B-6. Vitamin B-6 is important for neurotransmitters, which affect behavior. The Recommended Dietary Allowance (RDA) figures are an average requirement for an average person, below which a deficiency complications develop. Stress and other factors in an individuals environment determine the lower threshold, not a statistical variable. Some people might need more. We have different metabolisms.
49) Vitamin overdose.
50) Early-onset diabetes. The symptoms include anxiety, aggressive behavior and depression.
51) Heart conditions. This has an effect of starving the brain of oxygen, glucose and other nutrients.
52) Tourette syndrome. Some of the symptoms are similar to the impulsive form of ADHD.
53) Child-like Bi-Polar disorder. Early-Onset Bi-polar should be ruled out before ADHD, as ADHD medication can make the child-like bipolar disorder psychotic. The symptoms are similar to ADHD, with impulsivity, restlessness, distractibility and hyperactivity among other symptoms.
54) Worms. This usually a problem in preschool and kindergarten children.
55)Auditory Processing Disorder (APD). This is a term for a range of problems with the brain that can interfere with processing auditory information. It is not a hearing disability, but a problem processing sound.
56) Sensory Integration Dysfunction. The inability of the brain to correctly process information brought in by the senses. These children are over-sensitive or under-sensitive dealing in touch, taste, smell, sound, or sight.
58) Stimulants, e.g. caffeine in the diet. In some children caffeine causes hyperactivity, while in others it can act as a mild stimulant to treat hyperactivity, instead of powerful drugs such as Ritalin. We all have different metabolisms.
59) Fetal alcohol syndrome (FAS). The damage done to a child's brain when the mother drinks alcohol during pregnancy. Foetal Alcohol Syndrome is the biggest cause of non-genetic mental handicap in the western world and the only one that is 100% preventable.
60) Sniffing solvents like modelling glue, fingernail polish and permanent markers.
61) Medication side effects. Some cough and cold over-the-counter medicines contain pseudoephedrine which can cause hyperactivity. Pain killers and asthma medication can also cause ADHD like symptoms.
62) Bad diet. Skipping breakfast.
63) Allergies: 15 to 20 percent of the world has some type of allergy.
64) Over stimulation sitting in front of the TV and playing videogames together with lack of physical excercise.
65) Neglect by parents.
66) Feelings of rejection.
67) Emotional abuse.
69) Creative child.
70) Gifted child. Hyperactive behaviour is the result of under stimulation and boredom.
71) Bullying at school.
72) Lack of rules at home. Lack of discipline at home.
73) Lack of discipline at school.
74) Chocolate allergy.
75) Lack of communication skills. The behavior is a result of the child's inability to express him or her self.
76) Lack of a vocabulary to describe feeling. Many times being able to put a name to a feeling gives a sense of being in control.
77) Brain tumour.
78) Cysts in the brain.
79) Klinefelter syndrom. Probably the most common genetic disorder in which a male has an extra X chromosome (XXY).
80) Jacob's syndrome also called XYY syndrome, is a rare chromosomal disorder that affects males. It is caused by the presence of an extra Y chromosome. Males normally have one X and one Y chromosome. Males with Jacob's syndrome have one X and two Y chromosomes. The extra Y chromosome has been associated with attention deficit, delayed speech and learning disorders.
81) A normal, lively, healthy child. The DSM-IV criteria are based on teachers' and parents' perceptions of how a child should behave.
82) Monosodium glutamate.
83) zinc deficiency.
84) Aluminium poisoning.
85) Omega 3 fatty acid. This is an essential fatty acids found in fish sardines, mackerel, tuna and salmon. Vegetarian sources are Soya, hemp, flax and pumpkin seeds. Theomega-3 family, play essential roles in the maintenance of energy balance and glucose metabolism.
86) Minimal brain damages from birth trauma and low oxygen levels at birth.
87) Candida Albicans infestation (Yeast Infection). The symptoms are varied and include headaches, inability to concentrate, depression, mood swing, hyperactivity etc. These symptoms often overlap those of food allergies.
88) Mild psychosis.
90)Generalized Anxiety Disorder (GAD).
91) Addison’s disease. Underproduction of cortisol.
92)Cushing’s disease. Overproduction of cortisol.
93)Sleep apnea. A disorder where the sufferer stops breathing many times during their sleep. This causes a bad quality sleep.
96) post-concussion syndrome
97) Post Traumatic Stress Syndrome orPost Traumatic Stress Disorder (PTSD).
98) An inner ear infection.
100) Substance abuse.
101) Speech and Language disorders.
This list of some disorders, emotional traumas, and other conditions, which have signs and symptoms similar to Attention Deficit Hyperactivity Disorder, is intended to show the complexity of diagnosing attention deficit syndrome. A good child psychologist who has experience with treating ADHD children should be consulted before any medicinal treatment is tried. A doctor should be consulted for screening for possible physiological causes of the behaviour.