~ Attention Deficit Disorder Diagnosis, Treatments Split Experts, Parents

The State Journal-Register Springfield, IL, 10-13-05

Although it has been decades since the early diagnoses of attention deficit disorder, there still is no cure-all, nor even a basic agreement among professionals of how ADD works. It is no surprise, then, that treatment options from drugs to diet equally raise controversy. Proponents of drug therapy say, for many, chemicals are the most effective, if not the only, solution. Others worry children are being unnecessarily drugged and push for treatments of the problem, not just the symptoms.

In the middle are parents with dozens of questions. The first step is proper diagnosis.

In cases of ADD and ADD with hyperactivity - ADHD - brain activity has been compromised. The connections between cells that transmit information from place to place in the brain don't properly work. Causes and duration vary from person to person, but typical signs of ADD can include the inability to pay attention, sit still, control impulses or a combination. All of these symptoms also may be caused by many other factors, say experts.

According to Glen Aylward, Ph.D., of the Southern Illinois University Medical School in Springfield, four "masqueraders" may produce ADD-like symptoms, or exist in conjunction with ADD. Aylward's partial list includes:
  • Medical, biological issues - response to certain medicines, hearing and vision problems, seizures, sleep apnea.

  • Emotional indicators - anxiety, depression, Tourette's syndrome, autism.

  • Learning and communication problems - verbal problems, expressive language disorder, receptive language disorder.

  • Environmental issues - dysfunctional parent-child interaction, hurried lifestyle, bad teacher-child match.
"It is extremely difficult for a personal care physician to get into these issues in the course of an outpatient visit," says Aylward, who recommends a specialist make a thorough diagnosis.

"It is extremely important to discover not only the correct, but the complete diagnosis, so the doctor doesn't just treat symptoms, but asks why a condition exists. Then the doctor must find the proper sequence of treatment," says neuropsychiatrist Dr. Georgia Davis, who has practiced in Springfield for more than 30 years and maintains a private practice serving children and families.

"So much hinges on this, because using the wrong medications, or in the wrong order, may make the patient worse, not better."

For example, children with ADD and anxiety or obsessive traits can be rigid, reluctant to compromise and perfectionists. Treating some of these children with stimulant medication, Davis says, may make them more obsessive. Caregivers may see them begin to twirl and twist their hair, tear at their cuticles, pick at mosquito bites and blemishes. The mood disorder may need to be treated first.

Recent research has shown there are many forms of ADD, far more than the six recognized forms of years past. Further, each child's personal history and biochemistry have to be evaluated. Many doctors such as Davis are beginning to understand the close interrelation of the body's organs, gastrointestinal and immune systems and the brain. In short, ADD no longer is just a brain problem.

Some of the biggest developments in research have involved nutrition, toxins and immunity.

Davis' research looks closely at these areas. She has found that identifying vitamin and mineral deficiencies and restoring them to proper levels can substantially aid treatment of ADD. She also has found evaluation of infections, immune function, gut function (digestion and elimination) and toxins such as mercury and other heavy metals to be helpful in guiding treatment.

"We in the medical profession must be willing to look at this," she says, and argues for improving diet and lifestyle as well as using appropriate medication and evaluating outcomes. Davis' term for this approach is "evidence-based medicine," or looking at what works.

Aylward does not find support in contemporary medical studies for nutritional modifications but, he says, "there are no likely risks that I know of (to trying)."

According to Davis, a starting point for some is as simple as supplementing the daily diet with a capsule of live, refrigerated probiotics such as the beneficial bacteria lactobacillis and bifidobacterium.

Taken first thing in the morning, this helps boost the immune system, and can help reduce yeast overgrowth. Likewise, making sure the daily diet includes enough essential fatty acids found in nuts, dry beans and cold water fish oils, and amino acids in meat, fish, fowl, egg, and tofu, helps brain function and the immune system.

Some families have discovered food sensitivities, causing either immediate or delayed reactions, contribute to the problem. Two common culprits are gluten, the protein found in most grains, breads and pastas; and casein, the protein in dairy products. Eliminating gluten and casein, as well as more highly processed and refined foods, artificial preservatives, chemical sweeteners and synthetic colors (which usually appear on packaging with a number by them), may help, says Jane Hersey of the Feingold Association of the United States, based in Riverhead, N.Y.

Hersey knows several families that experienced relief from long- term behavior problems by eliminating synthetics. They used the Feingold Diet, with help from the Feingold Association, first developed in 1976.

"Dr. (Ben) Feingold believed there are variations among people," Hersey says, "and some people are more sensitive than others to additives."

Hersey is among the grateful parents who found ways, without drugs, to solve her daughter's ADD problems.

After years of living with a daughter who was calm and delightful one minute, impulsive and out of control the next, Hersey says she and her husband had come to wonder what they were doing wrong as parents. "We never connected the problem to food," she says.

When they rewarded her daughter's good behavior with food, though, it made matters worse, Hersey says.

After eating a certain brand of cookie or brightly colored slurpy drink, the girl's behavior lurched out of control again.

The Herseys learned of the Feingold Diet and decided to try it. It worked. And quickly.

"Normally," Jane Hersey says, "you would expect to see some results in three to seven days. Within 24 hours, we could see a 'Wow!' change. It totally turned her behavior around. She made eye contact. Her conversations made sense. She was a normal, bright, little girl, and I was walking on clouds."

That is, until a few days later when someone gave her daughter something with an additive in it, and her behavior reverted to the tempest the Herseys had come to know.

"But then it was OK," Jane Hersey says. "I knew it wasn't that I was a bad parent, or that she was brain damaged. I knew she was just reacting to something in the food she ate."

The Feingold Diet was an early study area, Davis says. And although most published studies since then show little correlation between diet, behavior, learning and disposition, Davis believes Feingold opened up the medical profession to the possibility that food sensitivities may play a part in certain children's behaviors.

Like Davis, Hersey believes there is a place for medication. "Medication has value," Hersey says, "but we don't believe it should be the first or only option. There are many other ways to treat these problems, and they should be investigated."

Known side effects to brain-altering medication include loss of appetite, weight loss, difficulty sleeping, rebound irritability and hyperactivity, headaches and stomachaches, so as Hersey says, "why not try nutritional changes first?"

Davis also is reexamining the connection between vaccines, mercury and neuropsychological problems. In addition, the vaccine for hepatitis-B is routinely administered to infants shortly after birth when their immune system is not fully developed.

Davis is looking at the possibility that children with a genetic predisposition to ADD, ADHD or autism may be more sensitive to a build-up of certain toxins and heavy metal preservatives that can be injurious to the brain.

In some cases, Davis uses neuroimaging technology to reveal brain structure and function in three dimensions. Pictures reveal which areas of brain function are appropriate, overactive and underactive.

Even if there isn't a quick cure-all for every child suffering with ADD or ADD-like symptoms, she says, parents can be encouraged by the amount of new information coming out.

"Traditional medicine looks at symptoms. The medicine of tomorrow is going to look at the metabolic processes, the biochemistry of the body," Davis says. "Diagnostic studies of yesterday looked at structure. The medicine of tomorrow will use a combination of structure and function."


* To learn more: Springfield neuropsychiatrist Dr. Georgia Davis recommends "Children with Starving Brains" by Jaquelyn McCandless (Bramble Co., Second Edition, $29.95).

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