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ADD/ADHD

An alternative to Ritalin

According to ADHASA, ADHD is believed to affect 10% of the South Africa population, and is prevalent in every ethnic and socio-economic cluster.

According to the Attention Deficit and Hyperactivity Support Group of Southern Africa (ADHASA), ADHD is believed to affect 10% of the South Africa population, and is prevalent in every ethnic and socio-economic cluster.

Imagine what it would be like to realise that your child acts and thinks differently; he says and does whatever comes to mind, and when you have guests, he constantly interrupts while they are talking.

Imagine what it would be like to learn from his teacher that he is ‘rude and disruptive’, not capable of paying attention or following simple instructions in the classroom.

The frightening realisation that your child’s schooling career might be in jeopardy could drive you into the arms of a doctor. And when you take your child there, instead of a comprehensive medical assessment and blood tests, you may end up having a conversation about your child’s behaviour, and, after a few minutes, you could leave with an Attention Deficit-Hyperactivity Disorder (ADHD) diagnosis coupled with a prescription for Ritalin.

Ritalin is a central-nervous-system stimulant effective in treating ADHD symptoms, such as hyperactive behaviour, inability to pay attention and/or impulsivity.

Quick fix

When asked about her thoughts on the use of Ritalin in young children, Delia A Strondl, a registered counsellor and Health24 ADHD expert said: “For those whom it works, it works wonderfully; for those where it doesn’t work it leaves a child in a subdued, often withdrawn state where his/her personality ceases to exist.”

ADHASA supplied Health24 with a study funded by the Food and Drug Administration (FDA) and the National Institute of Mental Health. The study showed that, for some children, the benefits of stimulants may be far outweighed by the risks attached – especially if there is a history of cardiac abnormalities. The results of the Research Project show that there may be a connection between ADHD drugs and sudden death among children which in the USA strikes 1 in 10 000 children. This is regarded as a rare occurrence and no direct link has been suggested. However the research has drawn attention to the potential risks for stimulant medication in children. 

The side effects of the side effects

Strondl said that she agrees that Ritalin is prescribed too readily.  And from the parents she has spoken to, the doctor made the diagnosis, and said the child should be put on Ritalin – end of story.  “For those children where Ritalin does not work, severe side effects are experienced, leading to a multitude of medications to deal with the side effects of the side effects. I believe later in life there is a chance of addiction.  These children have long since forgotten what ‘normal’ feels like, and it is for this reason that they turn to medication or narcotics in search of that ‘normal’ feeling“, told Strondl.

“Too often, doctors do not provide parents with the alternative options such as play therapy, occupational therapy, speech therapy, neurotherapy, biofeedback and physiotherapy or even remedial,” she said.

Children with suspected ADHD should be referred to these kinds of therapies (play, occupational, and reflex, as needed) as well as these support therapies.

   

Diet and healthy eating

Says Heather Picton, an ADD/ ADHD consultant: It is impossible to predict how a child will benefit from a change in diet, but changes are often obvious in improved behaviour, concentration, academic ability, sleep, general health and social interaction.

Parents should avoid all artificial colourants, flavourants and antioxidant preservatives such as purchased cakes, pies, hamburger patties, fish fingers, packet soups and sauces, processed meats and polonies, fruit squashes and fizzy drinks states Picton’s article. “Avoid foods that tend to aggravate ADHD and precipitate symptoms in your child”, she says.

A single protein and complex carbohydrate breakfast will provide three hours of your child’s best concentration. Regular snacks every two to three hours, such as a peanut butter or tuna sandwich, homemade plain white popcorn, plain biltong, cheese or nuts will maintain concentration. Between five and six pm in the evening is usually the most difficult hour of the day. A healthy snack usually helps calm the child, but make sure it’s small enough not to spoil supper, and always avoid sugar on an empty stomach.

“It would be nice to have fruit at hand when the child wants to nibble, but children want sweets,” she says. She suggests that even though it is hard to deny a child sweets, care should be taken in the quantity and the type of sweet given to the child. Suitable sweets would be homemade fudge, and sweets that contain only natural colourants and natural flavourants.

Supplements should also be taken:

Supplementation is very important for raising EFA levels, and high levels may be needed especially in the earlier stages of moving to a healthier eating lifestyle:

  • Omega 3 – Fatty Fish Oil e.g. unflavoured cod liver oil.  Capsules: halibut liver oil, cold pressed salmon oil.  Flaxseed oil contains both the omega 3 and omega 6 series of EFAs
  • Multivitamin and mineral supplement, to assist the metabolism of the Fatty Acids.  These must also be free of synthetic colourants and synthetic flavourants.  Some preparations contain the EFAs, but usually not enough.

Picton comments that other supplements may be required and that these depend upon the child’s unique individual requirements.

Exercise

According to Health24’s DietDoc, Dr Ingrid van Heerden: regular exercise is one of the most therapeutic things an ADHD child needs. Exercise utilises some of the surplus energy your child is bubbling over with, it improves muscle and eye co-ordination, keeps the body healthy, prevents depression, and helps the child with relaxation.

Occupational therapy

Occupational therapy (OT) makes a tremendous difference in the life of your child, according to the British Journal of Occupational Therapy. If your child consistently demonstrates difficulty with writing, cutting, tying laces, handling small objects, and toys, you may need an occupational therapist.

Some children have trouble with gross motor function, such as sitting upright at a desk, or difficulty moving specific joints during an activity. Some need assistance with feeding themselves, while using the toilet, or dressing and undressing during school activities – OT assists with this.

It is also useful for academic performance, especially when the child’s teacher reports problems with copying from the blackboard, recalling what objects look like, large amount of reversals in written work and difficulties copying design. And some therapists are able to help children with overreaction to touch, taste, and smell, visual and hearing.

 

Play Therapy

Susan Garofolo, a play therapist reminds us that play therapy (PT) is the child’s natural medium of self-expression. With the therapeutic use of play, all children are given the chance to express their emotions safely, and naturally, thus enabling the counteractive process to begin whilst working through problems. Through this kind of therapy a child realises that it is okay to receive help. PT allows children to internalise this fostering message and learn healthy self-care skills that lead into later life.

Reflex Therapy

It is a natural remedial technique aimed at incorporating the body, mind and soul. It works with the constant flow of energy, through the meridian system to achieve alteration in the body.  Reflex therapy focuses on the whole person with the aim of normalising the flow of energy through the meridians bringing forth a state of harmony. Reflex therapy is not a basic body massage – it is closely related to acupuncture, without the needles or the sting.

 

Neurotherapy 

According to the Behavioural Neurotherapy Clinic, neurotherapy training has proven effectiveness in reducing seizure activity, helping ADHD seizure patients experience improved attentiveness, focus, concentration and improved classroom motor inactivity. The child could also show decreased oppositional and out-of-seat behaviours and increased co-operation, with a definite improvement in their schoolwork. If applied systematically, without medication, it can be highly effective in helping to remediate ADHD children having difficulties with academic tasks.

ADHASA points out that a healthy lifestyle with adequate exercise, sufficient essential fatty acids, and mainly eating real foods could eliminate many difficulties for children with ADHD. All therapies, natural remedies, diet & supplementation  should be undertaken as a holistic team effort on everyone’s part who is involved with the particular child – each makes up a part of the ‘big picture’.

(Zaakirah Rossier/ October)

Beyond Ritalin

  • Attention deficit-hyperactivity disorder is believed to affect 8-12% of school-aged children worldwide. Yet some experts say it’s over-diagnosed and too often treated with Ritalin.

    Attention deficit-hyperactivity disorder (ADHD) is a complex syndrome believed to affect between 8% and 12% of school-aged children worldwide.However, there’s a school of thought – well argued by psychologist Richard DeGrandpre, author of Ritalin Nation – that the condition is over-diagnosed. And the current gold standard drug in terms of treatment – Ritalin (methylphenidate) – is controversial.

    Ritalin is a central-nervous-system stimulant highly effective in treating symptoms of ADHD, which include hyperactivity, inattention and/or impulsivity. It can have nasty side effects, including insomnia, depression, decreased appetite, headaches, drowsiness, cramps and convulsions. The drug has – rarely, but shockingly – also been cited in cases of psychosis, mania and cardiovascular problems in children.

    There has also been some concern that Ritalin may trigger long-term changes in the brains of young children. In laboratory studies involving young rats, scientists have found changes in the brain areas that control higher executive functioning, addiction and appetite, social relationships and stress. HealthDay reports that these changes gradually disappeared as the rats were taken off the drug.

    While science makes up its mind, many parents are wary of Ritalin. And, of course, there are other approaches to managing ADHD that do present options.

    Health24 caught up with Dr Murray Rushmere, a medical doctor and homeopath from Cape Town, to find out how he treats children who display ADHD symptoms – without using psychotropic drugs.

    A different take on things
    It’s clear Rushmere doesn’t agree with conventional wisdom regarding ADHD: ‘In my opinion, ADHD is almost too broad a series of symptoms to be limited to a single clinical diagnosis with a single treatment,’ he says.

    Instead, he believes the series of symptoms that typically make up the diagnosis often point to multiple causes. ‘These comprise the real illness, so to speak.’

    We don’t know exactly what causes ADHD, but it’s believed that a combination of genetic and environmental factors is at play. Rushmere is certain, however, that the causes differ from individual to individual: ‘If you take 10 people with ADHD, each will have a different story,’ he says. So he believes each child should be treated individually.

    ADHD is often a result of disturbance in the home, Rushmere says, although other factors in the environment also frequently play a role. ‘For some children, the symptoms are reversible if you take some of these factors into account, and find solutions for them.’

    Hasty diagnosis
    Rushmere feels that the ADHD diagnosis is often made hastily, mostly because the symptoms are uncomfortable in a society which prefers uniformity. For example, if a child is disruptive and impulsive in the classroom, it could make him unpopular among teachers and fellow learners. It can also have a negative impact on the child’s academic performance. This would be disturbing to both the child and to his or her parents.

    ‘In this context, it’s easy to see why there’s such an urgency to treat the perceived problem as a condition,’ Rushmere says. ‘We want everyone to do well in the conventional way.’

    As a result, drugs are probably more frequently prescribed than is strictly necessary, he believes. ‘These drugs are generally effective at the level where you want them to be: for example, they will make the child less disruptive and impulsive. So it’s very tempting to go this route.’

    Rushmere agrees that the drug has a place. But he shares the concern that it might affect a child’s long-term direction. Some of the greatest figures in history, including Mozart and Winston Churchill, might have been put on Ritalin if the drug existed in their time, he says. ‘ADHD is often a symptom of sensitivity and intelligence. The question is: would Churchill have gone on to win the Nobel Prize if he was put on Ritalin? The drug brings short-term gains, but how can we be sure that we’re not changing the course of the child? We want them to conform, but are we not curbing their creativity in the process?’

    Treatment: a step-by-step approach
    Rushmere believes that symptoms such as hyperactivity and inattention could be the result of other, possibly reversible causes. To find and treat these causes, he usually goes through the following process:

    1) He first sets out to determine whether the child really experiences hyperactivity, inattention and/or impulsivity.

    2) He then looks at possible problems in the child’s environment. This may include conflict in the home, personal issues, or problems at school. These are addressed first.

    3) Then the child’s diet is assessed. Every child reacts differently to certain foods, but a tendency to hyperactivity and poor concentration is often exacerbated by sugar, as well as certain colourants, flavourants and preservatives. If he thinks these are contributing to the problem, Rushmere advises parents to cut these from the child’s diet. He also often prescribes an omega-3/omega-6 fatty acid supplement.

    4) Where appropriate (for example, if a child has poor muscle tone), Rushmere refers the child to an occupational therapist. Other forms of body work, such as kinesiology, are also sometimes recommended. ‘Where a deep reflex has been blocked due to over-stimulation of the nervous system, kinesiology can help settle it down,’ Rushmere explains. Some patients also respond well to a technique called ‘dry brushing’, where the skin is rubbed with a dry, natural-bristle brush for a few minutes. According to Rushmere, this also settles down the nervous system.

    5) Finally, Rushmere explores homeopathic remedies. ‘The ADHD symptoms are often merely a sign that the child’s constitution is off balance. If you then give them their constitutional remedy, the symptoms of hyperactivity and poor concentration settle.’ He explains that psychotropic drugs suppress symptoms, and don’t treat underlying imbalances. The opposite is true for homeopathy.

    According to researchers from the Children’s Hospital Boston, the initial evidence for some emerging complementary and alternative therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. “But more rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD,” write researchers Neal Rojas and Eugenia Chan in a study extract on Pubmed.gov.

    Rushmere advises concerned parents to seek professional help, but, he says: ‘Also evaluate your own value systems: do you simply want your child to conform? Do a bit of soul-searching,’ he says. ‘Then seek out a homeopath, a kinesiologist and/or an occupational therapist to assist your child. Just make sure the child is treated as an individual.’

    – (Carine van Rooyen, Health24, July 2008)

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