ADD is attention deficit disorder. It is characterized by a poor or short attention span and impulsiveness inappropriate for the childn’s age, with or without hyperactivity. (With hyperactivity, it is called ADHD.) Hyperactivity is a level of activity and excitement in a child so high that it concerns the parents or caregivers. The diagnosis of ADD usually requires that the child display at least eight of the following symptoms.

• Often fidgets with hands or feet or squirms while sitting (restlessness).
• Has difficulty remaining seated when required to do so.
• Is easily distracted by extraneous stimuli.
• Has difficulty waiting for his or her turn in games or group situations.
• Has difficulty following instructions from others, even if the instructions are understood.
• Has difficulty sustaining attention in tasks or play activities.
• Often shifts from one uncompleted task to another.
• Often talks excessively.
• Often interrupts or intrudes on others.
• Often doesn’t seem to listen to what’s being said.
• Often loses things necessary for tasks or activities at school or at home.
• Often engages in physically dangerous activities without considering possible consequences.

Diagnosis is based on the number, frequency and severity of symptoms. Of course this “diagnosis” depends on the subjective opinion of the observer. The symptoms are not unique to a child with ADD and a child without ADD may have one or more of the symptoms.

What is Ritalin?

Ritalin is methphenidate hydrochloride. It is a central nervous system stimulant used to treat ADD. Side effects of the drug include nervousness and insomnia; hypersensitivity (including skin rash, hives, fever, joint pain, dermatitis,); anorexia; nausea; dizziness; palpitations; headache; dyskinesia; drowsiness; blood pressure and pulse changes, both up and down; angina; cardiac arrhythmia; abdominal pain; and weight loss during prolonged therapy. There have been rare reports of Tourette’s syndrome. Toxic psychosis has been reported. Instances of abnormal liver function, isolated cases of cerebral arteritis and/or occlusion; leukopenia and/or anemia; transient depressed mood; a few instances of scalp hair loss have also been reported.

In children, loss of appetite, abdominal pain, weight loss during prolonged therapy, insomnia, and rapid heart rate may occur more frequently; however, any of the other adverse reactions listed above may also occur.

Suppression of growth has been reported with the long-term use of stimulants in children. Methylphenidate should not be used for severe depression. Methylphenidals should not be used for the prevention or treatment of normal fatigue states. There is some clinical evidence that methylphenidate may lower the convulsive threshold (that is, increase the likelihood of seizures) in patients with prior history of seizures, with prior EEG abnormalities in absence of seizures, and very rarely, in absence of history of seizures and no prior EEG evidence of seizures. Safe concomitant use of anticonvulsants and methylphenidate has not been established. In the presence of seizures, the drug should be discontinued.

Visual disturbances have been encountered in rare cases. Difficulties with accommodation and blurring of vision have been reported. Marked anxiety, tension and agitation are contraindications to methylphenidate hydrochloride, since the drug may aggravate these symptoms.

Clearly the decision to take this drug should not be taken lightly. Unfortunately, many times children are placed on this drug based on their symptoms and without much of a medical examination. There are many reasons for a child to have problems concentrating, and there are even physical reasons for behavioral problems. Before a child is placed on a drug that so drastically affects the nervous system, some of these other health issues should at least be considered.

What Kind of Physical Exam Was Performed?

Too often a diagnosis of ADD or ADHD is handed down without any physical exam or lab work. We are not even talking about “alternative” medicine here, just good old-fashioned traditional medical diagnosis. A few of the medical problems that can cause a child to have poor concentration are as follows:

• Anemia—Anemia can cause symptoms that may be mistaken for ADD. A simple, inexpensive blood test, called a CBC (complete blood count) should be taken.
• Low thyroid function—A child with an underfunctioning thyroid will have symptoms similar to ADD. A simple blood test can rule this out.
• Hypoglycemia—Low blood suger. This is determined with more extensive blood testing.
• Heavy metal toxicity—We have gotten better about screening children for lead. Children are not routinely screened for mercury or cadmium toxicity. Cadmium is found in cigarette smoke.

If a child is labeled with the ADD diagnosis, at the very minimum the doctor should have ruled out the above conditions.

Learning Disabilities

A child may have problems with reading, and the reading problem may not become evident until fourth or fifth grade. Don’t expect teachers or administrators to be well informed about this type of concern. Here is a typical story about a girl who had a reading problem. In the mind of the teachers and administrators everything was fine because her grades were good and her standard test scores were within the normal range. She did, however, become increasingly apprehensive about going to school. The whole thing came to a head in the fourth grade.

Between first and third grades most children learn to read. From fourth grade forward, children read to learn. A dyslexic child will rely on memory to get through school work, and since most students with dyslexia are of above average intelligence, this works for a while. In fourth grade this becomes almost impossible. This is when many students exhibit “symptoms” or behavior problems.

Don’t expect the teachers and administrators to be on top of this. Some are, others are not. When the parents began to suspect that the girl had a reading problem, the folks in the school system told them that she was fine—her scores said so. Her reading scores were just a little below her grade level. They checked everything but her reading. The school psychologist asked her about our family life; the principal watched her from the back of the room to see if he could notice any behavior problems; and they suggested that she just may be trying to get attention.

She had trouble spatially recognizing letters and organizing them into sounds. In other words, the learning strategy that works for most everyone else does not work for her. When the parents discovered how easy it was to diagnose their daughter’s learning problem, they were very annoyed with the school system for missing something so obvious. When she was learning to talk, it was hard to understand her. She would omit syllables from words or she would insert her own syllables that didn’t belong. People joked that the mother was needed to interpret what her daughter was saying.

In preschool she could not rhyme words or tell right from left. In fact, at the age of 10 she had to look at a freckle on her right hand to tell the difference between right and left. This, along with the earlier language problem, were clues to her future reading problem.

In fourth grade she was given practice spelling tests. Not only did she misspell the words, if no one told you, you would have no idea what word she was trying to spell. Usually when a child misspells a word you can tell what that word is. Often when a dyslexic child makes an attempt to spell a word that he or she hasn’t memorized, it is very difficult to tell what the word is.

If you suspect a reading problem, you can contact the International Dyslexia Association. It can provide you with information about testing for dyslexia and other learning problems. The association can also help you find a tutor. The tutor will teach different learning strategies that are more appropriate for the way the child’s brain works.

Children with learning problems may develop behavior problems or simply let their minds wander. They can become poor students, and it is easy for them to get labeled as ADD or ADHD.

Sensory Integration

Children with sensory integration problems do not properly process information from the environment. It can lead to unusual, even bizarre behavior. A simple example would be a child having trouble paying attention in class because he is focused on his uncomfortable shoes. It is hard to give a complete picture of sensory integration problems in this short section. To read more about sensory integration, get a copy of The Out-of-Sync Child by Carol Stock Kranowitz, M.A. The following information is taken from that book. If you know a child who exhibits strange behavior, buy this book.

A child may be oversensitive or undersensitive to a particular stimulus. Inappropriate processing of touch, movement, body position, sight, sound, smell and taste can all affect the behavior of the child.

Touch

Oversensitive: The child avoids touching. He or she may have a fight-or-flight response to getting dirty, textures of clothes or food, or another person’s light touch.

Undersensitive: The child may be unaware of pain, temperature, or how things feel. He or she may wallow in mud, paw through toys purposelessly, chew on objects, rub against walls or furniture and bump into people.

Movement

Oversensitive: The child avoids moving or being unexpectedly moved, and may be anxious when tipped off balance. He or she may avoid running, climbing, sliding or swinging. He or she may feel seasick in cars or elevators.

Undersensitive: The child may crave fast and spinning movement. The child may move constantly, fidget, enjoy getting into upside-down positions and be a daredevil.

Body Position

Oversensitive: The child may be rigid, tense, stiff and uncoordinated. He or she may avoid playground activities that require good body awareness.

Undersensitive: The child may slump or slouch. His or her actions may be clumsy and inaccurate. He or she may bump into objects, stamp feet or twiddle fingers.

Sight

Oversensitive: The child may be overexcited when there is too much to look at and may cover his or her eyes or have poor eye contact. He or she may be inattentive when drawing or doing deskwork, or overreact to bright light. He or she may be hyper-vigilant—on the alert and ever watchful.

Undersensitive: The child may touch everything to learn because vision is not sufficiently coordinated. He or she may miss important cues such as facial expressions, gestures, as well as signposts and written directions.

Sound

Oversensitive: The child may cover ears to close out sounds or voices. He or she may complain about noises, such as vacuum cleaners and blenders.

Undersensitive: The child may ignore voices and have difficulty following verbal directions. The child may not listen well to his or herself and speak in a booming voice. He or she may want the TV or radio to be loud.

Smell

Oversensitive: The child may object to odors, such as a ripe banana, that other children do not notice.

Undersensitive: The child may ignore unpleasant odors like soiled diapers. He or she may sniff food, people or objects.

Taste

Oversensitive: The child may strongly object to certain textures and temperatures of foods. He or she may often gag when eating.

Undersensitive: The child may lick or taste inedible objects like clay and toys. He or she may prefer very spicy or very hot foods.

The Out-of-Sync Child gives examples of the difficulty the children with the various sensory integration problems have. It explains instances of unusual behavior in school and in play. The book gives drug-free strategies for parents. It helps parents to understand their children and gives them ways to help. If you know any child with a behavior problem, difficulty learning, playing or fitting in, buy this book. You will recognize children that you know by the behavior described in this book.

One thing worth noting: Sensory integration problems have been associated with low serotonin levels. Exercise increases serotonin. There are some doctors who think that we are seeing so much ADD (also possibly a serotonin problem) and sensory integration problems because children spend too much time in front of the TV, computers and video games and not enough time playing.

Alternative Therapies

Hypoglycemia, thyroid problems, anemia, learning disabilities and sensory integration problems may all be misdiagnosed as ADD or ADHD. So far, we have only discussed things that should be recognized by a traditional medical doctor (although sensory integration is not yet a recognized diagnosis). The message is that even if you do not believe in alternative therapies, at least do a thorough investigation of the child’s problems before resorting to a mind-altering drug. Too often a drug is prescribed after a short interview, with no exam, no lab work and no investigation into the source of the child’s problem. You do not have to believe in alternative medicine to know that this is not right. Ritalin may affect the behavior of the learning-disabled fifth grader, but not improve grades. Ritalin may have no effect on the child with a sensory integration problem. Sometimes Prozac or heavier drugs are used—this is sad and unnecessary.

Alternative health care may offer some answers for children diagnosed with ADD or ADHD. Ritalin may offer symptomatic control—but no one knows why it works and it certainly does not address the cause. The idea of holistic care is to treat the patient, not the disease.

Nutrition

It seems strange to think of nutrition as “alternative care,” but many doctors see it that way. It is not uncommon to hear, “Vitamins do not cure disease,” from medical doctors. In a sense, they are right. Vitamins do not cure disease, but there is one very important exception. Vitamins cure vitamin deficiency. What constitutes vitamin deficiency is where all the controversy lies.

A recent survey conducted by the National Cancer Institute asked Americans about their diet from the previous day. Only 9% of those asked consumed three or more servings of vegetables or two or more servings of fruit on the previous day. One in nine surveyed had no servings of fruits or vegetables on the previous day.

Clearly, such eating habits create nutrient deficiency. When a diagnosis of ADD or ADHD is handed down it is important to consider the child’s diet. Don’t think of it in an overly simplistic point of view, “He eats sugar, he gets wired.” Think of it as a poor diet creating a health problem.

Essential fatty acids: Packaged food, fried food and junk foods are loaded with hydrogenated oils and partially hydrogenated oils. Cells, especially nerve cells, need oil (fat) for the integrity of the cell membrane. Hydrogenated oils contain trans fats that do not belong in the diet and do not resemble anything in nature. One idea nutritionists have about the cause of ADD is that the trans fats become incorporated into the nerve cells in the brain, making transmission of nerve impulses faulty. The trans fats may also be more permeable to chemical toxins and viruses. The solution is to give the child flax oil or DHA and remove all hydrogenated or partially hydrogenated oil from the diet. Even if the nerve cell theory is not true, this is an excellent suggestion for the health of your child.

Sugar: The New England Journal of Medicine recently published a flawed study that ostensibly disproved the link between hyperactive children and sugar consumption. This subject needs to be more closely examined. Children who eat a lot of sugar are vitamin deficient—especially in B vitamins and in minerals. A large percentage of their food is starch, which is turned to sugar by the body. Lots of parents think that bagels, English muffins, and sugar-free cereals are healthy. What they need to realize is that starch and sugar are essentially the same thing. Starch and sugar deplete B vitamins, vitamin C and minerals. Sugar also stresses the adrenal glands. Some holistic practitioners think that Ritalin mimics the output of the adrenal gland and if you give up sugar and support the adrenals, you will get a better result.

B vitamins: Deficiency in B vitamins causes neurologic symptoms. Traditional medicine only recognizes a thiamine deficiency as beriberi or a niacin deficiency as pellagra. What about subclinical deficiencies? Nervousness, poor concentration, fatigue, depression, poor sleep, forgetfulness and other symptoms can all be caused by not having enough B vitamins. B vitamins are very important for mental function. Eating a lot of sugar and refined carbohydrate depletes B vitamins. One of the most common deficiencies is folic acid. Folic acid is necessary to produce serotonin and norepinephrin (important neurotransmitters, or brain chemicals). Folic acid is found in fresh green produce. How many children get enough green vegetables? We can get a liquid folic acid and a liquid multivitamin that can be placed in juice. Often the results are amazing. Of course nothing replaces a good diet, but that is sometimes difficult to accomplish.

Chemical additives: Read Ruth Winter’s book on chemical additives. You will see that many of them cause poor concentration, fatigue and trouble with the nervous system. Aspartame, sold under the brand name Nutrasweet or Equal found in many sugar-free snacks, creates methanol (a neurotoxin) in the body.

Minerals: ADHD has been linked to zinc/copper imbalance. Trace mineral deficiency has been linked to allergies. Minerals are often the cofactors that enable enzymes to work.

Amino acids: Amino acids are the building blocks of protein. A diet high in junk food, poor digestion and vegetarianism can cause a deficiency of certain amino acids. There are lab tests to determine amino acid status.

Hidden allergies, Candidiasis and heavy metal toxicity: If you have gone to a nutritionist or an alternative health practitioner, you may have heard one or all of these terms. Candida albicans is a yeast that grows in the intestine. A diet high in sugar or heavy use of antibiotics can cause high levels of Candida, which causes nutritional deficiency and toxicity. The chemical toxins from the yeast can cause fatigue, nervousness and poor concentration (among a wide variety of symptoms). Hidden allergies can also be a problem. A favorite food, eaten every day, often is the culprit causing the ADD or ADHD. Great improvement is often achieved by following simple, basic nutritional rules, like those presented earlier in the book.

Chiropractic: Of course chiropractors treat ADD and ADHD; the nervous system is involved, isn’t it? Many times jamming in the upper cervical spine affects the dura (a membrane covering the brain and spinal cord), affecting the entire nervous system. This can happen from the trauma of birth. Chiropractors treat this, often with great success.

Craniosacral therapy: The cranial bones move, much the same way that the gills of a fish move. This movement is vital to the correct function of the central nervous system. Birth trauma, head trauma or jaw dysfunction may interfere with this movement, creating the symptoms of ADD or ADHD. Babies who are born by Cesearean section are often in need of craniosacral therapy. The contractions of the birth canal serve to pump the craniosacral system during birth. Babies born by C-section do not have this benefit. Learn more about craniosacral therapy by going to www.upledger.com.

Many times parents will try nutrition, put their child on a hypoallergenic diet or try some alternative therapy without getting the desired result. Then the parents are frustrated. The point is, all of the pertinent issues must be addressed. Giving a child who has a learning disability a dairy- and wheat-free diet may benefit his or her health, but it will not correct the learning disability. You can give vitamins to a child with sensory integration issues and still not solve the problem. By all means, improve the health and nutrition of your child—there’s a chance that it will improve the ADD. If not, there may be other issues that need to be addressed. The idea is not to treat ADD or ADHD, but rather treat the patient who has the condition. The goal is not merely to get rid of the symptom, but to find the cause and correct it. Health is not merely the absence of disease; health is optimal function.