Arizona Advanced Medicine Clinic

Attention Deficit (Hyperactivity) Disorder – ADD and AD/HD

The American Psychiatric Association gave official recognition to attention deficit disorder (ADD) in 1980. The drug Ritalin® became a household word. Then in 1997 with the epidemic standing somewhere around 500,000 to 700,000 nationwide, the American Psychiatric Association rewrote the diagnostic criteria by adding the term “hyperactivity” to the attention deficit disorder. ADD became AD/HD.[1] Mostly.

ADD differs from AD/HD because there is an absence of hyperactivity. These children are withdrawn, they display what some might describe as the “lights on, but nobody home” type behavior. Usually, people say ADHD when talking about attention deficit disorders.

Three types of ADHD are diagnosed:[2]

  • 80% = combined inattentive, hyperactive, and impulsive
  • 10%-15% = predominantly inattentive
  • 5% = predominantly hyperactive and impulsive

A study released by the Centers for Disease Control in November, 2010, found that 9.5 percent of parents said a doctor or health care provider had told them their child had ADHD. That means nearly one in 10 children aged 4-17 years is diagnosed with ADHD. That is an increase from a 2003 study that found about one in 8 children had been diagnosed with ADHD. The study's lead author, Susanna Visser of the CDC, suggests greater awareness and stepped-up screening efforts as part of the explanation. The study also found that about two-thirds of the children with ADHD are being medicated.[3,4]

Diagnosis comes down to an opinion. There is no physiological process of degeneration or disease that characterizes the disorder. The diagnosis of ADHD is most often made after a doctor or psychiatrist observes behavior and deems the patient has ADHD.

ADHD is characterized by the “inability to marshal and sustain attention, modulate activity level, and moderate impulsive actions.”[5] This results in behavior which is markedly inappropriate to the child's age, and often gets them in serious trouble in school. These children are typically impulsive, often aggressive. They cannot seem to control their level of activity, and they spend three times as long as other children doing their homework. Even at that, they usually require the presence of a parent or other caregiver to enable them to finish their homework at all.

The diagnosis and treatment of ADHD has generated controversy. The DSM-IV (the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders), lists 14 symptoms; the diagnosis of ADHD can be made if a child is found to have 8 of them.ADD2

  1. often fidgets or squirms
  2. has trouble staying in one’s seat
  3. is easily distracted
  4. cannot wait one’s turn
  5. blurts out answers
  6. has trouble following instructions
  7. cannot sustain attention
  8. shifts from one activity to another
  9. does not play quietly
  10. talks excessively
  11. interrupts
  12. cannot listen
  13. loses things
  14. does dangerous things

If you're thinking that sounds like you as a child and some adults you know today, you're not alone.

Research in 2010 suggests that nearly 20 percent of the children in the U.S. are potentially misdiagnosed with attention deficit hyperactivity disorder simply because they are the youngest - and most immature - of their kindergarten class.

Using a sample of nearly 12,000 children, Michigan State University economist Todd Elder examined the difference in ADHD diagnosis and medication rates between the youngest and oldest children in a grade. He found the youngest kindergartners were 60 percent more likely to be diagnosed with ADHD than the oldest children in the same grade. Similarly, when that group of classmates reached the fifth and eighth grades, the youngest were more than twice as likely to be prescribed stimulants.

“If a child is behaving poorly, if he’s inattentive, if he can’t sit still, it may simply be because he’s 5 and the other kids are 6,” said Elder. “There’s a big difference between a 5-year-old and a 6-year-old, and teachers and medical practitioners need to take that into account when evaluating whether children have ADHD.”[7]

pillsStimulant Drugs

Drug therapy is the most common form of allopathic medical treatment for ADHD. Ritalin, Concerta or Adderall are the most popularly prescribed drugs. Focalin, another methylphenidate drug, is the latest. There is little doubt that stimulants help to control behavior in many cases. There is much doubt whether they in fact improve scholastic performance.[8] And concerns about the drugs' side effects are mounting. Prescription drugs for ADHD are almost all stimulants and come with “black box” warnings, meaning they carry significant risk of serious or even life-threatening adverse effects. These drugs have been linked to cardiovascular problems, sudden death and violence. The more common side effects can be so devastating or unpleasant that many kids just don’t want to take them.

Long term, drug therapy may turn out to have been a very costly short term fix.

There is evidence that the use of stimulants increase the risk of substance abuse in later life by over 50%.[9] There is substantial evidence that stimulant drugs increase the risk of hypertension, stroke and cardiovascular disease.[10] Many parents, and even some researchers, are questioning whether the use of stimulant drugs is warranted, given that other therapies are more effective in the long run.[11]

In April 2009, USA Today editorialized that we need more education, less drugs.[12] The paper reported that according to the government’s leading, multiyear study of 579 children[13], the effectiveness of the popular drugs for ADHD can dissipate after 14 months of use. By the six- and eight-year mark, across 30 measures of behavior and academics, children still given medication fared no better than their non-medicated counterparts, despite a 41% increase in the average total daily dose, failing to support continued medication treatment as salutary. The drugs can stunt growth. After three years, medicated children have grown almost an inch less than non-medicated ADHD kids. They also suffer from more muscle tics.

The editors wrote,

“Response to what the study itself calls its “failure to find better outcomes associated with continued medication treatment” has been troubling. Psychiatrists who’ve publicly favored drug over non-drug therapy have downplayed the findings. And the website of Children and Adults with Attention Deficit/Hyperactivity Disorder, a leading ADHD advocacy and support group, buried mention of the study in a blog without noting any findings. Perhaps not coincidentally, 30% of CHADD’s revenue is from drug companies. Such denial risks real harm. It’s time for those with ADHD children in their care to recalibrate their enthusiasm for long-term use of the drugs and to engage in some behavioral modification of their own.”

School officials are prohibited from implying that medication is a requirement for school attendance but teachers, more than parents or doctors, refer children for an ADHD diagnosis. Drugs are the usual consequence. Yet most teachers surveyed are ignorant about many of the drugs’ basic aspects, says a University of Wisconsin-Eau Claire study.[14]

California neurologist Dr. Fred Baughman, author of The ADHD Fraud, How Psychiatry Makes “Patients” Out of Normal Children, spearheads the arguments against the exploding AD/HD diagnosis and increased drug treatment:

adhdbrain“The single, biggest heath care fraud in US history - the representation of attention deficit hyperactivity disorder (AD/HD) to be an actual disease, and the drugging of millions of entirely normal American children, as “treatment,” is spreading like a plague - still. Once children are labeled with AD/HD, they are no longer treated as normal. Once methylphenidate hydrochloride, or any psychiatric drug, courses through their brain and body, they are, for the first time, physically, neurologically, and biologically abnormal.”[15]

Some psychiatrists, including Peter Breggin, worry about the drug therapies too:

“…we abuse our children with drugs rather than making the effort to find better ways to meet their needs. In the end, we are giving out children a very bad lesson - that drugs are the answer to emotional problems. We are encouraging a generation of youngsters to grow up relying on psychiatric drugs rather than on themselves and other human resources.”[16]

We need only look around us at the children today to see that something is clearly amiss.

The U.S. government admits that 1 in 6 children is born today with some kind of brain impairment.[17] By age 3, an increasing number of children exhibit autism and other forms of toxicity related illness such as asthma, diabetes, ADD, and depression.

Getting to The Root Cause

Root causes of the ADHD syndrome may be multiple, including brain processing abnormalities, problems with the entire listening/hearing system, food or environmental allergies, metabolic insufficiencies, or heavy metal toxicity, among other things.

Researchers at the UC Davis Center for Mind and Brain and M.I.N.D. Institute found that two brain areas fail to connect when children with attention deficit hyperactivity disorder attempt a task that measures attention.[18] The researchers measured electrical rhythms from the brains of volunteers. When part of the brain is emitting alpha rhythms, it is disengaged from the rest of the brain and not receiving or processing information optimally. “This is the first time that we have direct evidence that this connectivity is missing in ADHD,” said researcher Ali Mazaheri in 2010.[19]

According to current models of how the brain allocates attention, signals from the frontal cortex - such as the “V” and “A” cues - should alert other parts of the brain, such as the visual processing area at the back of the head, to prepare to pay attention to something. That should be reflected in a drop in alpha wave activity in the visual area. However, children with ADHD showed no such drop in activity, indicating a disconnection between the center of the brain that allocates attention and the visual processing regions. “The brains of the children with ADHD apparently prepare to attend to upcoming stimuli differently than do typically developing children,” Mazaheri concluded.

coloreddyesWe know many cases of AD/HD behavior have been cleared up by making a few extremely important changes in diet. Removing sugar has stopped some children from “bouncing off the walls.” Removing specific foods to which they are sensitive has been the answer for others. Harvard and Columbia researchers recommended that artificial food colorings are one reason for the surge in children's hyperactivity and attention problems. They asked, “Do children's foods really need to be colored with petroleum-based dyes like Red 40 and Yellow 5 when there are plenty of natural dyes available? Are food manufacturer's profits worth the tradeoff in our children's health?”[20]

In 2008, the American Academy of Pediatrics said the 2007 Southampton/McCann Study finally convinced them to reverse their long-standing position on food additives:[21]

“Thus, the overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong.”

“In real life, practitioners faced with hyperactive preschoolers have a reasonable option to offer parents. For the child without a medical, emotional, or environmental etiology of AD/HD behaviors, a trial of a preservative-free, food coloring-free diet is a reasonable intervention.”

Sometimes fish oils correct a fatty acid deficiency and restore normalcy. A 2005 Oxford study of 117 underachieving children found 40% of them made dramatic improvements in reading and spelling when given fish oil supplements high in omega-3 fatty acids.[22]

Australian researchers tracked a group of 1,799 children from their birth in 1989.[23] As young teens, some consumed relatively high amounts of fresh fruit and vegetables, whole grains, and fish. This diet pattern delivered more omega-3 fatty acids, folate (a B vitamin involved in brain health), and fiber. Others consumed a typical "Western" diet pattern - takeout foods, sweets, pastries, and processed, fried, or refined foods. This diet pattern delivered less omega-3s but more total fat, saturated fat, omega-6 fats, refined sugar, and sodium.

Out of the total of 1,799 teens, 91 boys and 24 girls had been diagnosed with ADHD by age 14. After adjusting the results to account for various known social and family influences on ADHD risk, the Aussie team found that the kids who ate the "Western" diet were more than twice as likely to have received an ADHD diagnosis. Omega-3 fatty acids are thought to hold benefits for mental health and optimal brain function.

The chicken or the egg?

It's not always clear which came first - the processing problem or the metabolic insufficiency. For example: Children raised on commercial baby formulas (some are 50 percent corn syrup), likely have been metabolically challenged since their very beginning. They may have lost brain function because they took in more manganese than what is in breast milk. Manganese occurs at very low levels in breast milk, but it is added to infant formula made from cow’s milk and occurs naturally at even higher levels in soy formula. It is dangerous for infants to consume more manganese than they would get from breast milk because infants have no capacity to excrete excess amounts until they are older. The effects of too much manganese include inattention, impulsivity, and hyperaggression.[24] Soy baby formulas do not contain nearly as much protein as breast milk, depriving the developing brain of what it needs. Researchers at Brown Medical School compared premature infants fed with breast milk to those fed formula and found breast fed babies clearly did better on tests of mental development by age 18 months. The more breast milk they consumed, the better they did on the tests. Ingredients in breast milk, particularly fatty acids, seem to help the brain develop properly.[25] Additionally, breast milk builds a strong immune system.

“In some cases, ADHD can be vanquished by eating foods that build strong bodies and learning how to eliminate those foods to which a child is allergic. I call that - the power of the refrigerator. You’ll love the control it gives you.”

Some children are impacted by the high body burden of heavy metals which interfere with the normal developmental processes. Take lead for example: Children with higher exposures to lead are more easily distracted, less organized, and apt to be hyperactive, impulsive, aggressive, and easily frustrated. Sound familiar?

Governmental research reports the average American baby, at birth, has more than 200 chemicals in its body.[26] Even after 9 months of growth in the womb, the infant’s nervous, respiratory, reproductive, and immune systems are not yet fully developed. They are in a dynamic state of growth with cells multiplying and organ systems developing at a rapid rate. Pound for pound, children take in more air, food, and liquids than do adults. For example, carpets are typically made with toxic materials; children tend to make direct contact with carpet with their faces and hands as they play.

Neurotoxin experts Philippe Grandjean and Philip Landrigan reported in 2006 that the widespread use of pesticides, cleaning products, glues and other chemicals that contaminate our air, water, and homes are causing a “silent pandemic” of brain diseases in children. When children reach their “toxic overload” point, out-of-control behaviors can be the result. Medical schools do not train physicians in detoxification procedures, nor does medical school curriculum yet embrace the mounting evidence that environmental toxins cause breakdowns in body systems that cannot be corrected simply by adding a prescription drug - yet another toxic substance.

The Cincinnati Children’s Hospital Medical Center study is the first to examine how genes, toxins and gender interact to shape ADHD. “Our analysis confirms a suspected link between prenatal tobacco exposure and ADHD, and it demonstrates that the greater the level of blood lead, the greater the risk of ADHD, says Bruce Lanphear, MD, director of the Children's Environmental Health Center at Cincinnati Children’s and corresponding author of the study. “These findings underscore the profound behavioral health impact of these prevalent exposures and highlight the need to strengthen public health efforts to reduce prenatal tobacco smoke exposure and childhood lead exposure.” Investigators found approximately 270,000 cases of AD/HD attributable to mothers smoking during pregnancy. Children exposed to tobacco before birth had a 2.5-fold higher risk of ADHD compared to children not so exposed to tobacco. The study is based on data gathered between 1999 and 2002 from a parent or guardian of 4,704 children.[27]

Food sensitivities and heavy metals create inflammation in the GI tract. If we have an inflamed “gut,” we are not able to efficiently process and absorb the nutrients in the food we eat. As some wise person once said: we are not what we eat, we are what we absorb.

It is important to have a strong body biochemistry and metabolism[28], so that the brain processing can be corrected, and will hold fast even under stress.

Lyme Disease and ADHD

There is growing evidence that some children with ADHD symptoms actually have Lyme disease. Lyme’s effect on the brain can appear as increasing anxiety, irritability, chronic depression, cognitive decline and memory loss, and much stronger ADHD tendencies.

Lyme Disease, like its predecessor syphilis, is called “The Great Imitator” since it can affect the entire body in a myriad of ways. It is often misdiagnosed as ADD, ADHD, rheumatoid arthritis, autism, depression, chronic fatigue, multiple sclerosis, and more. The co-infection bartonella has been associated with neuropsychiatric disease.

Most experts agree that the incidence of pediatric neurological dysfunctions, including autism and ADHD, has increased at least four to five times in the last decade. The vast majority of promising evidence connects many of these dysfunctions to the emerging inter-relationship of the neurological and immune systems.

Non-Drug Approach

At the Arizona Center for Advanced Medicine, comprehensive and holistic treatment for ADD and ADHD includes brain processing, food sensitivities, environmental allergies, heavy metal and other toxicities, metabolism, and function of the intestinal (GI) tract, so we can determine the origin of the problems.

brainIt is well known that people with ADHD, depression, head injury, and other forms of brain dysfunction often have a slowing of the activity in the frontal lobes - that area of the brain in charge of executive function: planning ahead, decision-making, judgment, language, and other important cognitive functions. Sometimes an ADHD individual has been robbed of the ability to hear and process specific frequencies, because of chronic ear infections, severe allergies or lots of very loud concerts. The ear becomes unresponsive and must be stimulated, in order to be able to tune into the desired sound. Attention, focus, learning, and language abilities can all be improved by retraining the brain to listen using different frequency sounds, so that whatever is available is working at maximum capacity. This kind of brain dysfunction can be treated without drugs.

Hemoencephalography (HEG) uses light to measure activity in the frontal lobes by measuring the oxygenation in the blood. Oxygenation of blood flowing to the frontal lobes can be increased through a computer-assisted biofeedback mechanism. This can improve all the functions dependent upon frontal lobe activity. This can bring order from chaos in the brain of a child - or an adult - with ADHD. As oxygenation increases, neurons are able to make new connections.

The pieces of the puzzle necessitate a focus on nutrition. In some people, ADHD symptoms can be reversed by eliminating sugar, wheat, corn, and chemical additives from their diets. Parasitic infections are common with ADHD and good homeopathic remedies can correct the problem. Sleep deprivation is another piece of the puzzle that can be addressed through both behavioral and nutritional means, sometimes with specific supplements.

Some children have turned around just by removing specific foods to which they are sensitive and adding omega-3 fish oils to correct a fatty acid deficiency. Others get a big boost with chelation to remove metals which are silently warehoused in brain and bones and gum up the works.

By treating the origins of the dysfunction, and determining if Lyme disease is also a factor, we can avoid the need for dangerous stimulant medication. But most importantly, we give parents a way to restore their child's health naturally and bring forth the person who got lost when the body's functions got confused.

  1. Fred A. Baughman Jr., MD. The ADHD Fraud, How Psychiatry Makes “Patients” Out of Normal Children by. Trafford Publishing, 2006
  2. Rappley, MD. Attention Deficit Hyperactivity Disorder. N Engl J Med 2005;352:165-73.
  3. CDC Weekly Morbidity and Mortality Weekly Report of November 12, 2010
  4. Stobbe, Mike. US Survey: 1 in 10 Kids Has ADHD, Awareness Cited. Associated Press. November 10, 2010
  5. Rappley MD. Attention Deficit-Hyperactivity Disorder. NEJM 2005;352:165-73.
  6. Elder et al. The importance of relative standards in ADHD diagnoses: Evidence based on exact birth dates. Journal of Health Economics, 2010; DOI: 10.1016/j.jhealeco.2010.06.003
  7. Nearly One Million Children in U.S. Potentially Misdiagnosed with ADHD, Study Finds. Science Daily. August 17, 2010
  8. Purdie, N., Hattie, J. and Carroll, A. (2002) 'A Review of the Research on Interventions for Attention-Deficit Hyperactivity Disorder: What Works Best?', Review of Educational Research 72(1): 61-99.
  9. Sales, A. (2000) 'Substance Abuse and Disability', Substance Abuse and Counseling. A Perspective. ERIC document reproduction service, no. 440352. Also Lambert N, Hartsough CS. Prospective study of tobacco smoking and substance dependence among samples of ADHD and non-ADHD subjects. J Learn. Disabil. 1998;31:533-544
  10. Nissen SE. ADHD drugs and cardiovascular risk. NEJM 354;14 (April 6, 2006).
  11. Doggett AM. ADHD and drug therapy: is it still a valid treatment? J Child Health Care 8;1:69-81
  12. Ben O’Brien, USA Today. "Our view on helping hyperactive kids: New findings raise questions about use of ADHD drugs." Accessed April 13, 2009 at http://blogs.usatoday.com/oped/2009/04/our-view-on-helping-hyperactive-kids-new-findings-raise-questions-about-use-of-adhd-drugs.html
  13. Molina B, Hinshaw S et al. MTA at 8 Years: Prospective Follow-up of Children Treated for Combined-Type ADHD in a Multisite Study. Journal of Amer Academy of Child & Adolescent Psychiatry: doi: 10.1097/CHI.0b013e31819c23d0 POST AUTHOR CORRECTIONS, 23 March 2009
  14. Snider VE, Busch,T.et al (2003).Teacher Knowledge of Stimulant Medication and ADHD. Remedial and Special Education, 24(1), 46-56
  15. Fred A. Baughman Jr., MD, presentation to the Parliamentary Assembly, Council of Europe, November 23, 2001, http://www.adhdfraud.com/frameit.asp?src=commentary.htm
  16. Breggin PR. Psychostimulants in treatment of children diagnosed with ADHD: Risks and mechanism of action, International Journal of Risk and Safety in Medicine,1999;12
  17. Canfield RL, et al, Intellectual impairment in children with blood lead concentrations below 10 mcg/dl, New England Journal of Medicine, 348:1517-26, 2003
  18. Ali Mazaheri, Ingrid L.C. Nieuwenhuis, Hanneke van Dijk, Ole Jensen. Prestimulus alpha and mu activity predicts failure to inhibit motor responses. Human Brain Mapping, 2009;
  19. Press Release: Disconnect Between Brain Regions in ADHD. University of California-Davis. January 11, 2010
  20. Do artificial food colorings promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind, placebo-controlled trials, D.W. Schab et al., Journal of Developmental and Behavioral Pediatrics 25(6):423-434, December 2004
  21. ADHD and Food Additives Revisited, AAP Grand Rounds 2008;19;17. Accessed February 2008 at http://www.feingold.org/Research/PDFstudies/AAP08.pdf
  22. The Oxford-Durham study: a randomized, control trial of dietary supplements with faty acids in children with developmental; coordination disorder. A.J. Richardson, P. Montgomery, Pediatrics 115(5):1360-6, May 2005
  23. Al Howard, M Robinson. ADHD Is Associated With a ‘Western’ Dietary Pattern in Adolescents. J Atten Disord. 2010 Jul 14. Also see http://www.ichr.uwa.edu.au/media/1185
  24. Former U.S. Public Health Service director Philip R. Lee, keynote speech February 2003 to the National Institute of Environmental Health Sciences
  25. Betty R. Vohr, et al. Beneficial Effects of Breast Milk in the Neonatal Intensive Care Unit on the Developmental Outcome of Extremely Low Birth Weight Infants at 18 Months of Age, Pediatrics, Jul 2006; 118: e115 – e123. Also, Carla K. Johnson, Infants’ brains developed better with breast milk, The Boston Globe, July 10, 2006
  26. Landrigan PJ, Sonawane B, Drollaer D, Early environmental origins of neurodegenerative disease in later life, Environmental Health Perspectives, 113;9:1230-33, 2005
  27. Cincinnati Children’s Hospital Medical Center, news release of October 5, 2006, Tobacco Smoke and Lead Exposure Linked to One-third of ADHD Cases. Full study published in Environmental Health Perspectives, September 19, 2006. Braun JM, Kahn RS et al. Exposures to Environmental Toxicants and Attention Deficit Hyperactivity Disorder in U.S. Children. EHP 114;12:Dec 2006.
  28. Ferguson SA, Berry KJ. Behavioral effects of prenatal folate deficiency in mice
  29. . Birth Defects Res A Clin Mol Teratol. 2005 pr;73(4):249-52.
Attention Deficit (Hyperactivity) Disorder – ADD and AD/HD
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