ADHD treatment

Rosemary Murphy overviews the various treatments for ADHD, including medication, drug free options, and diet. 

MEDICAL HELP : PROS AND CONS

Medication: Ritalin

Once your child has gone through a full assessment process with a paediatrician, and has received a formal diagnosis it is most likely that a trial of Ritalin, Concerta or other stimulant medication will be offered. In simple terms, these drugs appear to improve the effectiveness of dopamine which is one of the main neuro transmitters in the brain and is related to feelings of reward and happiness. Ritalin appears to increase the flow of information to the attention centres of the brain, stimulating attention.

If your child’s symptoms are severe you will most likely see a dramatic improvement in school performance once they have adapted to the medication and are on the correct dosage.

Side effects
However there will also be side effects from this medication which will need to be taken into account. These may include loss of appetite, difficulty going to sleep at night, jitteriness, lethargy and inactivity. A rebound effect immediately after the daily dose has worn off often occurs, when the child’s symptoms are even more severe than usual for a brief period of time. Most children also do not take the medication after school or on the weekends, so that symptoms experienced at home remain the same.

The long term effects of these stimulant drugs on the brain are also not known.

There has been some media commentary in recent years about ADHD being over- diagnosed in the USA, and also regarding possible over- use of Ritalin and similar stimulant medicines to control the behaviour of these children. Many parents are now seeking alternative ways to help their children without resorting to drug therapy.

DRUG FREE OPTIONS

There are several other options open to parents which are drug free and well worth exploring. There is also exciting work being done in many parts of the world by a number of professionals to pinpoint the underlying causes of ADHD and similar disorders. The following suggestions have arisen out of this research and address underlying causes, rather than just suppressing the symptoms with drug therapy.

DEVELOPMENTAL DELAY SYNDROME

Dr Robin Pauc, neurologist and author of “Is That my Child?”, states that most learning difficulties including ADHD are caused by an underlying developmental delay which occurs at four months of life. At this stage a second –wave of nerve cell generation should occur, where spindle cells form in the pre frontal cortex, the front of the brain.

Dr Pauc states that the pre frontal cortex is implicated in the guiding of attention, memory, the ability to plan, social skills, impulse control and the ability to delay gratification. A delay in this crucial phase of brain development can result in ADD, ADHD, Dyspraxia, Dyslexia, Tourette’s syndrome and OCD.

Dr Pauc says that current medical treatments such as Ritalin manage the symptoms but do not treat the causes. He suggests that parents find a practitioner who can do a neuro developmental assessment to look at these underlying areas and design a movement therapy programme a programme for the child to correct this delay.

Ref: “Is That my Child?” by Dr Robin Pauc, 2006: Virgin Books, Chatham, Kent, Great Britain.

DEVELOPMENTAL DELAY ASSESSMENT AND THERAPY

EXTRA LESSON™

The Extra Lesson™ is an international, one to one intervention programme and is available in many centres in New Zealand and Australia. The Extra Lesson™ assessment focuses on the neuro developmental status of the child, looking at areas which should have been resolved in the first few months of life but are still present as lingering immaturities. These include retained primitive reflexes which should be suppressed by 4 months of age. It also looks at other developmental markers which should be established in early childhood, before the child starts school. These include spatial orientation, body awareness, visual perceptual skills, balance and gross and fine motor skills.

Of these, the retained primitive reflexes are perhaps the most useful marker for diagnosis of a mild, developmental delay.

Retained Primitive Reflexes

Most ADHD children have a cluster of retained primitive reflexes which are controlled by the primitive part of the brain. These are reflexes babies are born with to assist them to become upright in the first year of life. They should be suppressed by 4 months of age. These are mostly stimulated by head movements or touch, and when triggered cause very small but compelling automatic, movements. When a number of retained primitive reflexes are present together these movements are amplified and can result in hyperactivity.

For example, the Asymmetrical Tonic Neck reflex (ATNR) causes poor posture and frequent movement while seated, with a tendency to sit with one leg up on the chair and one leg extended, or sit with the elbow on the desk while propping the head up with the hand. A retained ATNR also interferes with the development of a mature grip, necessary for neat hand writing and other fine motor skills.

The Spinal Gallant reflex is often seen in ADHD children. This is triggered by touch to the lower spine. This touch causes an automatic twitch of the spine to the side and contributes to restlessness, particularly while seated.

The Moro reflex is the primitive startle reflex present in newborns designed to summon help when danger is imminent. When retained past 4 months of age it causes distractibility and sometimes the fight or flight response (lash out or run) when triggered.

All of the primitive reflexes (and there are several others) interfere with focus, concentration and higher cognitive functioning as they are controlled by the primitive past of the brain responsible for survival. When a matter of survival arises to the primitive brain’s attention, it does not matter what is on the board or what 2+3 equals. The current concept or process being learned goes “out the window” and is not stored in the memory of the child. Learning under these circumstances is inconsistent, there one day and gone the next.

Neuro Developmental Therapy

Primitive reflexes and retained midlines etc can be removed through a programme of neuro developmental therapy. If the reflexes are very severe they will be picked up by GPs during wellness checks or other medical consultations. In these cases referral for therapy is often made at this time to the hospital where an occupational therapist (OT) trained in neuro developmental therapy will offer a reflex suppression programme. However in milder cases these can go unnoticed and are not considered medically significant. They are however educationally significant.

The Early Childhood Development agency in your area might also have OT services and parents can self refer for assessment of children under the age of 7. Again only the most severe cases are treated and OTs in these centres have limited funding and in general no therapy space available.

Extra Lesson™ practitioners offer weekly one to one movement therapy sessions for each child. A daily programme of neuro-developmental exercises is prescribed for each child according to their individual needs and carried out at home by the parents. The programme follows the developmental sequence of early childhood movement patterns which should have removed the reflexes in the first place. Extra Lesson is unfortunately not in general funded by the government except for some cases of children in the High Complex Needs category. Some schools offer a subsidy for Extra Lesson™ so it is worth asking at your local school.

These are a growing number of Extra Lesson practitioners working in NZ, some in schools and some in private practice. They are professionals( usually teachers, counsellors, occupational therapists or physiotherapists) who have taken additional post graduate training and are registered thorough the Australian Extra Lesson Association.

For more information on Extra Lesson™ see www.extralesson.com and www.developlearning.co.nz

For a referral to a registered Extra Lesson Practitioner near you email info@developlearning.co.nz. or www.extralesson.com and click on practitioners in NZ.

For more information on the effect of retained reflexes on learning see

“ Reflexes, Learning and Behaviour: A Window Into the Child’s Mind by Sally Goddard,2005, Fern Ridge Press, Oregon, USA.

DIETARY TREATMENT

Dr Pauc is one of a number of doctors in this field who also suggest dietary changes to support the child’s neurological system. Many children are suffering from an underlying nutritional deficiency and are not consuming the nutrients which will allow them to overcome this neuro developmental delay and develop a strong and health brain.

He believes that in addition to an underlying developmental delay, many children with ADHD, Dyslexia, ADD, OCD and Tourette’s also have a sugar addiction, which plays havoc with their blood sugar levels.

He also notes that these children are greatly affected by the many additives we find in our food today.

His 5 step nutritional diet plan includes the following:

1.  Reducing or eliminating all foods with E numbered food additives and colourings.

2.  Avoiding all foods containing artificial sweeteners.

3.  Reducing the amount of carbohydrates consumed. These include sugar, sugar containing foods (such as soft drinks, sweets, candy bars and sugar laden breakfast cereals) and refined or white floor foods( bread, biscuits, muffins etc),

4.  Adding omega 3 and omega 6 to the diet together with zinc which assists in the manufacture of neuro transmitters together improve brain function.

5.  Eating foods which improve brain function. These foods include:

• protein rich breakfast such as eggs and bacon, or oatmeal porridge and whole grain toast
• fruit for snacks (avoid snack foods which contain additives- read the labels and only buy those with wholesome ingredient)
• plenty of fresh vegetables together with protein for dinner
• omega 3 rich foods such as salmon, tuna, sardines, and other oily fish

Dr Pauc urges parents to seek out a developmental assessment, make the necessary dietary changes and address the underlying causes before their children reach adolescence.

Useful Resources

For more information on dietary treatment and Dr Pauc’s recommendations see: “Is That my Child?” by Dr Robin Pauc, 2006: Virgin Books, Chatham, Kent, Great Britain.

Further excellent information on this subject can also be found in the book

“Healing the New Childhood Epidemics: Autism, ADHD, Asthma and Allergies” by Kenneth Bock, M.D. and Cameron Stauth, 2007: Random House, New York.