If you have been part of the ‘3 Steps’ network for a while you will be well aware of the emphasis that I place on a healthy and balanced diet as your first line of defense when it comes to dealing with ADHD. The purpose of this article is to focus on the second factor mentioned above namely physical activity.

Prof Fitzgerald contends that some of the exact same factors that can make ADHD so difficult to manage have been turned into positives by these people. His arguments set me thinking about one of the most overlooked aspects when it comes to discussing ADHD, namely the fact that the condition can also have some very positive outcomes. This week’s article is a continuation of the discussion that I began in response to this. I already focused on the fact that people with ADHD are often noted for their creativity, drive and compassion. These traits are by no means the only positive results that can stem from the correct management of ADHD. Here are some more ‘ADHD Positives’

The proposed new edition of the DSM is attracting widespread criticism as it is felt that the psychiatrists working on it must suffer from a disorder off their own namely “Over Definition Addiction”! Many things that were previously just seen as being part of the scale of normal human behavior are described as disorders in the manual. Whatever you are struggling with, it seems that the new DSM will have a label for you:

One of the most enduring debates in the world of psychology is the one dealing with nature versus nurture. In its essence this debate boils down to the question whether your psychological state (and your thoughts, feelings and behaviors) is primarily determined by your genes (nature) or your environment (nurture). This is obviously not an issue that I will be able to solve in a short article! It is, however, interesting to note how this debate plays out when it comes to ADD/ADHD. I would also like to showcase some research that is bringing the ‘accepted’ wisdom in this area into question.

Up to now the consensus was that ADHD is caused almost exclusively by genetic factors. This is the belief that was very energetically pushed by the major drug companies as it implies that the condition cannot be effectively addressed by changes in the environment of the person dealing with ADHD. Instead, they would have us believe, medication should be used to straighten out the problems caused by nature. Pushing this belief was obviously a very profitable move by the drug companies, as is evidenced by their record profits that they have earned from drugs designed to address attention problems. However, this notion (that ADHD is all down to nature and not nurture) is being challenged by a groundbreaking new study.

The fact that ADD/ADHD can have some positive benefits has once again been highlighted by Prof. Michael Fitzgerald from Trinity College in Dublin. He addressed a recent meeting of the Royal College of Psychiatrists on the subject of ADHD Creativity, Novelty Seeking and Risk. Prof Fitzgerald analyzed the lives of some achievers and believes that it is possible to ‘diagnose’ ADD/ADHD in some of them on the basis of the historical record.

Hardly a week goes by without smoking being named as a risk factor for yet another condition. Smoking has been blamed for problems as diverse as heart failure, erectile dysfunction, high blood pressure and of course a host of lung diseases. Now it seems that ADD/ADHD can be added to this list!

One of the lead researchers, US based Joseph Biederman, pocketed as much as $1.6 million from drug companies between 2000 and 2007 – Presumably enough to convince him to fight their corner! We should all be thankful to the Australian government for blowing the whistle on what is presumably a widespread practice in most Western countries. The content of new draft guidelines (to be used while the process of drafting something more permanent is started from scratch, presumably this time without drug company influence) is also heartening.

While there is no denying the effectiveness of the profit motive as an engine for growth it should also be noted that unfettered capitalism could lead to serious moral and ethical dilemmas as society grapple with the question of where to draw the line between legitimate business activities and those that are detrimental to the public good. In most societies these lines are drawn to protect the vulnerable and to ensure that those with money do not make ill gotten profits from the misfortune and suffering of others. This is why activities like pimping, drug dealing, people smuggling and loan sharking are generally outlawed in most modern economies.

One of the pioneers in determining a historical perspective on ADD/ADHD is Matthew Smith a researcher at the Centre for Medical History at Exeter University, England. In a paper he recently delivered at a medical history conference at Ottowa’s Carleton University, Smith made the following points:

A mistaken ADD/ADHD diagnosis can have consequences that are nothing short of devastating. Any initial diagnosis should therefore be treated with a healthy dose of skepticism and followed up by second and even third opinions. Care should also be taken to ensure that all possible alternative explanations are investigated. Why do I feel so strongly about this? Here are a few reasons:

The process of diagnosing ADD/ADHD is often sloppy and inaccurate. ADD/ADHD has entered into the public consciousness as the number one reason behind attention and behavioral problems (How often have you heard someone being described as being ‘A bit ADD’?). It therefore, sadly, an unchallenged belief among many that this is the first door that should be knocked on whenever a child with problems in these areas is presented to a health professional. This means that diagnosis is often done with improper haste and without the careful weighing of all factors. Hot on the heels of this diagnosis will be the ‘cure’, presented as a panacea that will ‘solve everything’: Heavy doses of psycho-stimulant medication. I shudder to think how many children have been condemned to years of unnecessary ‘treatment’ at the hands of medical professionals and drug companies who, in an ideal world, are supposed to have their best interests at heart. This is a scenario that could easily have been avoided if more care was taken during the initial diagnosis.

The probable underreporting of ADD/ADHD among adults and girls should be addressed as a matter of urgency. Another area that demands our attention is the stark gender imbalance when it comes to ADD/ADHD diagnoses. The gap between boys and girls are so large that it will almost certainly not be closed by more accurate identification of cases among girls. This leaves the question: Are boys simply more prone to the condition than girls? There are many scientists who come to this exact conclusion. Many others point out that this may be partially true but that there are also additional factors that should be taken into account.

I find myself in the second camp and I firmly belief that the one factor that could go a long way towards explaining the over-diagnosis of boys is the modern school system and the way in which it is geared towards the needs of girls. I realize that this is a startling assertion to make but it is one that is supported by the latest research into childhood development.

One of the most serious conditions that are often missed due to overzealous ADD/ADHD diagnoses is bipolar disorder. Bipolar disorder (also called bipolar depression or manic depression) is a serious mental condition. Sufferers experience severe swings between high-energy elevated moods (the ‘manic’ phase) and low-energy depressed stages. Bipolar disorder can have a dramatic impact on the quality of life of a sufferer and requires specialist, often prolonged, medical intervention.

About half of one percent of children suffer from bipolar disorder in various stages of severity. This makes the condition much less prevalent than ADD/ADHD, a condition generally thought to affect 3-4% of children (certainly not the more than 10% that prescription rates in many parts of North America would seem to suggest). There are some cases of co-morbidity (i.e. where both conditions are present). It is far more common, however, for bipolar disorder to be confused with ADD/ADHD. This is a very dangerous situation as the drugs that are used to treat ADD/ADHD are almost guaranteed to increase the severity of the mood swings of patients with bipolar disorder.

It turns out that many of the people who have the most to say about the deficiencies of a nutrition based strategy have a vested interest in continuing the status quo (i.e. drugging people on a massive scale). I suppose that, on one level, you cannot blame them. If you have successfully created a cash cow it is perhaps only natural that you will react with alarm when someone threatens its ability to inflate your profit statement.  We should note, however, that individuals and companies who perpetuate the wholesale profit driven medication of a significant part of an entire generation cannot be relied upon to provide the most accurate and objective information about how best to deal with ADD/ADHD.

The recommendations that form the basis of ‘No Child Left Inside’ are not revolutionary but rather a restatement of ‘back to basics’ principles that we ignore at our peril. The suggestions below may help you to get these foundational principles right:

Analyse your current situation: People living in urban and suburban areas can sometimes go for weeks without any meaningful interaction with nature. Recognising this fact and determining that you will do something about it is the first step towards re-engagement with the natural world. Begin by analysing whether ‘nature deficit disorder’ is indeed a factor in your life. This is normally not too difficult. The challenging part is to develop a strategy to counteract this deficit (if it does indeed exist). Most people would say that any ‘nature deficit’ that may exist can be traced back to 1) Lack of time and 2) Lack of access (real or perceived) to natural environments. Any ‘re-engagement strategy’ should therefore address these areas.

Start with ‘baby steps’: Getting a bit more nature in your life (and that of your children) need not be a monumental undertaking. Most people can dramatically increase their exposure to the natural environment by making just a few simple changes to their lifestyles e.g.:
•    Find a nearby park and see if you cannot include it on your route to/from school/work (while walking or cycling of course). A 10 minute detour along a ‘road less travelled by’ can sometimes make a world of difference!
•    Get a dog! The fact that your new ‘best friend’ will require regular walks will ‘force you’ (in a good way of course!) to get out more.
•    Scout out your local area. Most people live within striking distance of a nature reserve or other natural area. A simple Google search should confirm this fact if you wonder whether it is true in your case!  Moving some of your leisure activities to such areas (e.g. meeting friends at a nature reserve instead of the local coffee shop) is an easy and often inexpensive way to increase your ‘natural exposure’
•    Make nature part of your vacation planning. The most obvious way to do this would be to go on regular camping trips. I recognise that this is not everybody’s cup of tea (or mug of black coffee more likely!) but non-campers can still include visits to National Parks or other natural attractions in their holiday planning without necessarily ‘roughing it’.

Link up with local nature groups: Unless you live in a very small town (in which case lack of exposure to nature is perhaps not such a big problem) you will normally have easy access to groups and activities dedicated to the preservation and appreciation of nature. Many such groups organise fun activities (e.g. ‘night stalks’, nature sleepovers, guided hikes etc.) that will delight and excite even the most dedicated couch potatoes. A list of ‘No Child Left Inside’ coalition members offering environmental education initiatives can be found here.

Combine nature and technology: Many children (especially older ones) will respond to calls for more ‘nature time’ with claims that they have much more ‘exciting’ things to do. One of the best ways to counter this is to introduce them to the sport of Geocaching. Geocaching is the perfect way for combining a love for nature with a passion for modern technology. The object of the game is to find hidden objects (caches) with the aid of a GPS receiver. Participants can find caches to hunt on the internet and can also share their experiences with other users. Those with a competitive streak can even compete with other geocachers by trying to ‘outfind’ them. The fact that the vast majority of geocaches are hidden in natural areas means that you cannot really participate in the sport without getting hefty doses of ‘outside exposure’. Participants will also find levels of ‘real world’ excitement, suspense and skills development that no video game can even come close to matching. Click here for more information about Geocaching.

It must be emphasised that the strategies profiled in this article should not be seen as ‘magic bullets’ that will automatically solve all attention problems. They will, however, go some way towards addressing the ‘nature deficit’ that has such a negative influence on modern life. They may also in the process dramatically improve attention – In the most natural way imaginable!

I think it is fair to say that we are currently living through the biggest ever change in the way of childhood is experienced. If one asked every generation of children, before the present one, its members would have indicated that time spent outdoors was a very important part of daily life. This is simply no longer the case.  The world described by Mark Twain in Huckleberry Finn (or even that of the, much more recent, cartoon characters Calvin and Hobbes) where the majority of play time was spent out of doors must seem strange and unfamiliar to most modern children.

There are many reasons for this profound shift. A significant contributing factor is the perception that we are living in a world that is much more dangerous than the one encountered by our forebears. Many parents respond to this by keeping their kids indoors as far as possible. (Although to think that this will automatically keep your children safe is a fallacy, as the growing tide of Internet initiated abductions confirms) I do not think, however, that safety is the primary reason behind the current reconfiguration of childhood (previous generations of parents also experienced the world as a pretty scary place). The main reason, in my opinion (and this is confirmed by reams of research), is the rapid growth of home-based entertainment systems.

Most modern North American children have access to a vast array of gadgets and gizmos that can open up totally new worlds to them. They can, from the comfort of their own home, chat with friends halfway across the world, conquer virtual kingdoms and draw up musical playlists that reflect their personality. None of this is a bad thing as such, but the net effect is that fewer and fewer children feel the need or urge to explore their immediate surroundings. The results are, to say the least, depressing. The writer Michelle Howard wrote a poignant piece about a piece of land where generations of children from her hometown congregated to share their dreams and their lives. She noted sadly that the paths to this ‘place of meeting’ was overgrown and that the last hearts carved into the trees in order to signify eternal love and devotion dated from years and years ago.

It is easy, when one describes changes like this, to collapse into a kind of pointless nostalgia where the past is elevated to a mythical country where everything was perfect. This is obviously not my intention. I do think, however, that we as a society should be very worried about the experiment in social engineering that we have embarked upon. It would be simplistic to say that the rise in lifestyle related illnesses among young people (e.g. obesity, heart disease and even psychological disorders) is all due to lack of outdoor activity. It would, however, be equally simplistic to deny that any such link exists. This principle also applies when it comes to ADD/ADHD.

Recent studies about the effects of nature on ADD/ADHD symptoms have yielded surprising results. Consider the following:

• A wide-ranging survey asking parents about the effects of different settings on the ADHD symptoms of their children consistently showed that these symptoms were less severe in green settings than indoors.
• An even more surprising insight can be found in the results of an experiment where children with ADD/ADHD were taken for a walk in different outdoor settings (a downtown area, a neighbourhood and a park). The positive influence of this activity on the ADD/ADHD symptoms was directly proportional to the amount of interaction with nature! (With the downtown area scoring lowest and the park the highest)

Could it be that something in our natural make-up predisposes us to paying more attention and feeling more alive in natural settings? There are certainly many people who believe that this is exactly the case. One of them is Richard Loev author of a groundbreaking book called Last Child in the Woods: Saving our Children from Nature-Deficit Disorder. (It should be noted that the title could be a little misleading. Loev does not attribute all cases of ADD/ADHD to a lack of contact with nature, nor does he teach that contact with nature is the only thing that this required to overcome the condition). Loev’s work has led to the growth of a movement called ‘No Child Left Inside’. Although not exclusively focussed on the treatment of ADD/ADHD the principles and methods advocated by this movement could prove invaluable to those struggling with the condition. At its most basic the message is: Make sure that your child has sufficient ‘green time’! Please check back next week for a more detailed and practical summary.

The state of Western Australia covers the entire Western third of the Australian continent, yet contains only about 10% of the Australian population. Its capital, Perth, could at one stage stake a credible claim as the ‘Ritalin capital of the world’ with prescription rates much higher than the US average. It is estimated that by 2003 about 20,000 West Australian children (out of a population of 2.2 million) were taking stimulants to ‘treat’ ADHD. A recent report by the West Australian Health Department puts the figure for 2008 at 5666! This means that the prescription rate was brought down by almost three quarters in the space of five years.

The West Australian experience proves that prescription rates need not be a one-way street, but that they can indeed be turned around leading to better outcomes for children and for society at large. (For example, the reduction in stimulant prescription rates coincided with a significant reduction in amphetamine abuse!) So what can we learn from Western Australia when it comes to tackling the sky-high prescription rates in most North American jurisdictions?

Here are a few factors that contributed significantly to the turnaround:

Citizen activism: The West Australian population is fairly small (only about 2.2 million people). Perth is also a very isolated city, about four hours flying time from the other major Australian population centres. The drugging of 20,000 children in such a relatively small and isolated population attracted widespread attention. The drug companies tried their usual tactics in trying to reassure people that their products were perfectly safe, but there were many people who refused to stop asking questions. The main question that they kept asking was why Western Australia had perhaps the highest stimulant prescription rate in the Western world. This led in 2004 to a full parliamentary enquiry into the issue. This enquiry conducted by the West Australian Parliament was the beginning of the end of high prescription rates in the state. The lesson is clear: In a democracy we have the privilege of bringing issues to the attention of our political leaders and doing so thoughtfully and persistently can sometimes result in radical changes.

Tightening up prescription rules: The enquiry by the West Australian Parliament yielded some surprising and disturbing results. It seemed that only a handful of paediatricians were behind the massive spike in prescription rates. These paediatricians wrote prescriptions under a system called ‘Block Authorisations’ under which: “…a practitioner was able to apply to the (West Australian) Department of Health and be granted blanket approval to treat any number of patients with stimulant medication, without further notifying of changes to individual patient details or dosage.” The rationale behind the system was that people who often worked with a specific kind of medication would be more familiar with it and that it would therefore not be necessary to check the reasons for every prescription. The unintended consequence was that it handed certain doctors (whom the state thought could be trusted) a blank check to write as many stimulant prescriptions as they wanted without being accountable for them. The enquiry made it clear that this trust placed on doctors was abused on a massive scale by some of them. One of the major recommendations of the enquiry was that physicians should be able to account for every single stimulant prescription that they write. Paediatricians would in future have to: “…apply to the (West Australian) Department of Health and obtain a unique Stimulant Prescriber Number (SPN) to initiate stimulant treatment in any patient. The practitioner must provide individual patient details, including age, gender and dose required, thus enabling the collection of data for future analysis of stimulant use in Western Australia.”

Emphasis on a multi-disciplinary approach: The Parliamentary enquiry was very critical of the way in which ADHD was diagnosed and treated. It pointed out that many paediatricians did not bother to look for other possible causes or at alternative methods of treatment. In many cases diagnoses were rushed, leading to only one possible outcome: Medication. As a result of the enquiry physicians will now have to be able to indicate how they went about eliminating other possible causes of inattention before deciding on an ADHD diagnosis. The state is also in the process of setting up two multidisciplinary centres for the treatment of ADHD where alternative treatment methods will be used under the direction of people from several different health-related disciplines. The purpose of the centres will be to reduce the rate of medication even further by first exhausting alternative treatment options before medication is recommended.

The West Australian example clearly shows that rising medication rates need not be a one-way street but that it can be successfully turned around where there is sufficient popular concern and resultant political will. It is true that Western Australia is a unique place with a relatively small and isolated population, but there is no reason why these stunning results cannot be replicated on a larger scale in other jurisdictions.

Click here for more information about the way in which medication rates in Western Australia was lowered.

A central plank of my advice on getting off the blood sugar rollercoaster is the avoidance of high-sugar and high-fat foods. Now it turns out that this advice is not only sensible when it comes to the short term avoidance of blood sugar spikes and the long term avoidance of weight gain. It seems that consumption of junk food could also be harmful in the medium term.

A recent research project at the Southwestern Medical Center of the University of Texas tested the response of lab rats to different kinds of fat. Dr. Deborah Clegg (the lead researcher) reported that palmitic acid (commonly found in butter, cheese, milk and beef) had the effect of ‘convincing’ the brain that the body needs more food, thus effectively suppressing signals that sent the message that the bodies’ needs have been met! It does this through causing the brain to ignore the hormonal signals sent out by leptin and insulin (the usual appetite suppressants).

Dr. Clegg summarises her findings as follows: “What we’ve shown in this study is that someone’s entire brain chemistry can change in a very short period of time. Our findings suggest that when you eat something high in fat, your brain gets ‘hit’ with the fatty acids, and you become resistant to insulin and leptin. Since you’re not being told by the brain to stop eating, you overeat.“

The most astonishing fact about Dr. Clegg’s research is that the results show that the effect of palmitic acid in raising appetite can last for up to three days. This means that the hamburgers, fries and milkshake that you had on Friday could still be making you hungry by Monday!

These findings suggest that the so called blood sugar rollercoaster might be even more powerful (and a great deal more complicated) than first thought. One way to describe it could perhaps be as a moving ‘Hotel California’: Easy to get on to, rather more difficult to stop! This is because the time delayed effect of the palmitic acid will ‘motivate’ you to eat some more fatty food three days down the road, making you hungry for another three days, until you are trapped in a vicious circle of overeating and blood sugar spikes.

I have already made some suggestions on ways in which the blood sugar rollercoaster can be escaped. The research profiled above means that we will perhaps have to add the following to them:

• Be aware of the dangers: Many of us have been exasperated by the way in which we sometimes lapse into unexplainable eating binges. This research suggests that the phenomenon is perhaps not so unexplainable after all! It seems that a binge can easily be set off by just a single high fat meal.
• Be aware of the kind of fat/oil that you eat: An interesting aspect of the research results is that not all oils have this ‘time bomb’ effect. Palmitic acid is found in common types of saturated fat but do not occur at the same levels in oleic fats (e.g. olive oil). It may be worth your while to monitor sources of saturated fats in your diet with a view to radically reduce your intake.
• Break the circle: The best response to a vicious circle is to do your best to break it as quickly as possible. You should therefore carefully monitor your food intake to determine if you are not being taken on an ‘extended roller coaster ride’. If you are, it may be time to take some radical action to get off!

Designing nutrition for optimum brain function is one of the most effective ways of combating ADD/ADHD and is integral to the approach that we follow here at ‘3 Steps ADD’. One of the best ways to do this is to make sure that you do not get onto roller coasters (either for short or long rides!). Following the ‘3 Steps’ can be a powerful tool for helping you to stay off!

This ‘popularization’ of ADD/ADHD in North American culture helps no one. Not the people trying to rationalize their own behavior and certainly not those who are actually affected by the condition. Trivializing the condition can have some very significant negative outcomes including the following:

• Over and Misdiagnosis: We are fast approaching a point where the existence of any behavioral or attention problems will be automatically ascribed to ADD/ADHD unless proven otherwise! This is obviously a very unhealthy situation as it leads to people being unnecessarily medicated and also to potentially serious conditions being missed due to hasty and sloppy misdiagnoses.
• Increased rates of medication: Increasing rates of diagnosis will inevitably lead to more and more people being medicated in an attempt to combat the condition. This is not a hypothetical danger. The increased rate of prescription for ADD/ADHD drugs over the past few decades is nothing short of staggering. This would perhaps not be so much of a problem if the drugs were essentially benign and effective. I am convinced however that they are neither. They do not treat the root causes of the condition and they have some very dangerous side effects.
• Lack of help for true ADD/ADHD cases: The massive rates of ADD/ADHD overdiagnosis in our society are having profound negative effects on those who are actually suffering from the condition. This is because the media paints ADD/ADHD as a very simple problem with a very simple solution (i.e. medication!). This simplistic approach means that the condition is often not addressed properly as people buy the line that band-aid solutions would be sufficient to counter it.

One of the best ways out of the quagmire of ADD/ADHD misdiagnosis would be the application of much more stringent criteria before a conclusion is reached. After such a conclusion is reached care should also be taken to address the condition with a multi facetted and individualised approach. Thankfully it seems as if the day of accurate diagnoses (hopefully with a corresponding decrease in misdiagnoses) is drawing nearer.

During a recent study, conducted at the Brookhaven National Laboratory (a report on the study appears in the current issue of The Journal of the American Medical Association) detailed analyses were performed on the brains of 53 adult ADHD/ADD subjects (who have never received any treatment for the condition) and 43 non-ADD/ADHD subjects. The participants in the study were very carefully screened in order to control for factors unrelated to ADD/ADHD.

Researchers made use of a very advanced scanning method called Positron Emission Topography (PET). They specifically looked at the ways in which the subjects’ brains reacted to dopamine: One of the key regulators of mood and attention. They also measured the level of proteins regulating the transportation and reception of dopamine.

The findings of the study comprehensively disprove the assertion that ADD/ADHD is simply another word for ‘acting out’! Researchers found a consistent correlation between ADD/ADHD symptoms and lower levels of dopamine. ADD/ADHD subjects also had significantly less dopamine transporters and receptors in their brains. The areas where the levels of these proteins were the lowest were the nucleus accumbens and the midbrain. Both of these areas are part of the limbic system, the brain region primarily responsible for emotions, sensations, motivation and reward. Researcher Dr Nora Volkow said: “These deficits in the brain’s reward system may help explain clinical symptoms of ADHD, including inattention and reduced motivation, as well as the propensity for complications such as drug abuse and obesity among ADHD patients.“

The research results are very significant as it confirms something that we have highlighted again and again here at ‘3 Steps ADD’ namely the critical importance of creating the conditions for optimum brain function when battling the effects of ADD/ADHD.

It is one thing to be aware of the fact that certain protein deficiencies can play a significant role in exacerbating the symptoms of ADD/ADHD. It is quite another to do something proactive about it by making sure that your diet contains all the building blocks necessary to battle the condition. Most people go from this realisation to a radical chemical ‘solution’.

Following the 3 Steps will safeguard you from the harmful effects that this ‘solution’ brings with it. You will instead be following a totally natural system that 1) Takes the existence of ADD/ADHD seriously and 2) Brings you into the position where your brain will have a fighting chance to overcome the conditions that keeps it from firing on all cylinders!

Most major drug companies would like us to believe that there is only one possible route that we can take after the diagnosis of ADD/ADHD. This route is the one that always ends in the prescription of powerful drugs with which to ‘manage’ the condition. There is, however, a growing realisation that these drugs are not the miracle cures that parents are so often promised.

Research is pointing to the following very troubling consequences of long term ADD/ADHD drug use:
•    Stunted growth
•    Loss of long term motivation
•    Mood swings (Leading, in very extreme cases, to suicidal thoughts)
•    Substantial risk of abuse and addiction

As if the above were not bad enough it is becoming clear that the effectiveness of these drugs decrease over time.  They are therefore often not much more than temporary ‘band aids’ and do not make any difference to the underlying causes of the condition.  These facts are causing more and more people to ask the question: “Is there not a better way!?” Here at ‘3 Steps ADD’ we have always answered the question with an enthusiastic ‘Yes’. This is, in fact, exactly what the three steps are about: A better, natural, way to cope with and triumph over ADD/ADHD.
Pharmaceutical companies tried very hard over the years to paint those who advocate natural responses to the condition as being part of a lunatic fringe.  This is getting harder and harder to do as modern research is pointing to some real successes with natural approaches. 

The fact that there are a number of treatment options that can produce positive outcomes points to the fact that every person is unique. Different techniques will therefore work for different people. It is also a confirmation of the emerging scientific consensus that ADD/ADHD is not a single unified condition but rather a range of conditions.  It therefore makes perfect sense that different ‘ types’ of ADD/ADHD will have to be treated in different ways.

A major article in a recent issue of US News and World report provides an excellent overview of the different drug-free methods that have proven successful in the management and treatment of ADD/ADHD. This article confirms the philosophy that we have been teaching here at ‘3 Steps ADD’. Many of the methods that are detailed in the article are discussed at length in ‘3 Steps to Conquering ADD-ADHD’ and on this website. They include:

Positive Parenting: ADD/ADHD is a recognised neurological condition. This does not mean, however, that positive behavioural techniques and parental guidance cannot make a difference in addressing the condition. Tried and tested parenting techniques (e.g. setting routines, providing a stimulating and nurturing environment and adapting your interactions with your children according to their personalities) can go some way towards alleviating many of the more challenging aspects of the condition.

Nutrition: I firmly believe that nutrition is one of the most important keys to addressing the growing epidemic of ADD/ADHD. Many are the effects of the condition can be traced back to neurotransmitters in the brain not functioning as they should. Very often this is due to the building blocks needed for these transmitters (i.e. fats, vitamins, minerals etc) not being present in the body. This situation can often be very effectively remedied by following a balanced and carefully worked out anti ADD/ADHD diet.

Sufficient sleep: I have already pointed out in an earlier article that many instances of ADHD misdiagnosis can be traced back to a lack of sleep. Ensuring that a child gets the right amount of sleep appropriate to his/ her developmental stage can therefore be one of the most important things that a parent can do to improve attention.

Exercise: There is growing evidence that aerobic exercise can have a marked positive effect on children’s ability to pay attention. Many people would say that you certainly do not need academic studies to tell you this! Earlier generations were very aware of the positive benefits of physical activity and reaped the benefits in the form of better physical and mental health. In our day and age it is perhaps a bit more difficult to make exercise part of your daily routine but it is a discipline that is certainly well worth pursuing.

Exposure to the natural environment: One of the most interesting and most effective approaches to dealing with ADD/ADHD is to make sure that children are regularly exposed to the natural environment. More research is needed on why this is the case. Perhaps it has something to do with the fact that the natural environment is so effective in stimulating the whole range of our senses. The bottom line is perhaps that we all need to realise that time spent outside should be seen as an essential part of growing up.

The approaches listed above should make it clear that there are many options available for the treatment of ADD/ADHD. These options may perhaps not have the endorsement of ‘Big Pharma’ but that is perhaps exactly the point. None of them involve pumping your kids full of dangerous drugs! I am convinced that natural approaches can work, otherwise I would not have invested so much time and energy into ‘3 Steps ADD’. It is for this reason that I am delighted with the growing willingness to challenge the accepted orthodoxy on how the condition is to be managed.

(Please check back next week when I will discuss some of the other natural methods that was mentioned in the US News and World Report Article)

The study conducted by the Cincinnati Children’s Hospital Medical Center (and published in the September issue of the journal Pediatrics) analysed calls by 13- to 19-year-olds to poison control centers between 1998 and 2005. Its findings make for sobering reading to say the least. During the period under review, calls related to teenage ADHD medication increased by 76%. This figure is roughly in line with the staggering increase in prescription rates for these kinds of drugs.  This fact underlines one of the basic problems with the industrial scale medication of a significant proportion of an entire generation.

The basic laws of economics teach us that an increase in the supply of a given product almost inevitably leads to a corresponding increase in demand.  This principle acquires an especially vicious edge when it comes to the abuse of illicit drugs.  Drug dealers create artificial conditions of abundant supply (by supplying free samples) only to then create conditions of scarcity once the addictive properties of the drugs hooked the client. With psycho-stimulant drugs that can be legally bought (at least if you have a prescription) the dynamic is slightly different.  Abundant supply is created by over-prescription which means that increasing numbers of young people who are curious about the effects of narcotics, or who perhaps had previous experience with drug use, will make use of the opportunity to get a ‘legal’ high. At least some of them will be keen to use ADD/ADHD drugs on a regular basis as their drug of choice.  The fact that these drugs can be more or less legally acquired makes them all the more appealing as they are a) easier to get hold of b) cheaper and c) more socially acceptable.

It is a sad situation when something that is supposedly designed to help struggling young people creates the perfect conditions for exposing large numbers of them to dangerous habit forming drugs. The study referenced above confirms that this is not merely a hypothetical danger but that many teenagers are in fact being harmed on a daily basis.  What is even more troubling is that misuse of the most dangerous ADHD/ADD drugs (i.e. those based on amphetamines) are far outstripping rises in prescription rates. This is especially true in the case of Aderall. Anecdotal evidence for the growth in demand for Aderall as one of the drugs of choice on school and college campuses has long been dismissed as hearsay by drug companies. This report shows that these dismissals were nothing more than PR exercises.

Can we really afford to believe the bland reassurances that ADD/ADHD drugs are the best solution for dealing with attention problems in our society?  I believe that simply taking this on good faith is a dangerous position.  We need an honest debate in our society about the effects of drugging so many people over such a long time with such dangerous chemicals.  During this debate close attention will need to be paid to the role of the big drug companies and especially to the huge profits that they are making from their flagship ADD/ADHD products.

No one expects large pharmaceutical companies to be in the business for purely philanthropic reasons.  We all understand that these companies are businesses first and foremost and that they have shareholders to keep happy.  However, most of us would also expect these companies to refrain from chasing after profits at any cost. Especially if this means promoting products that can actively harm some of the most vulnerable members of society. I believe that many companies have crossed this line.

The issues surrounding addiction are but the tip of the iceberg of what I believe to be the harmful societal impact of ADD/ADHD drugs. I will use next week’s article to discuss the reasons why I believe this to be the case.  In the meantime I urge you to tread carefully by refusing to accept the soothing reassurances about the safety and efficacy of these drugs at face value.  Instead, ask probing questions and do some research.  Your findings will surprise and shock you. See you next week!

Last week’s article

Simply put, provenance is about where something is from.  This is important because production standards and methods differ from place to place and country to country. It is common, for example, to see chemicals that have long been banned in North America due to adverse health effects still being used in other parts of the world.  This is a serious issue for people dealing with the effects of ADD/ADHD.  Many of the symptoms of the condition can be traced back to signals in the brain not being transmitted properly.  This is often due to chemical imbalances.  Anything that can contribute to such imbalances should therefore be avoided at all costs.

So how can you get serious about provenance as an ordinary consumer?  I think one of the keys is to stop seeing food shopping as a health-neutral activity, but to rather view it as a valuable investment in the health and well-being of your family. Some suggestions on how you can ensure that every bite that your family put into their mouths is safe include the following:

Grow your own: Most people would recoil at the very idea of growing their own food, but what can be more natural?  If you have a bit of land it would be quite easy to utilise it to grow some basic foodstuffs.  The fact that you are cultivating the food yourself means that you can control to the finest detail what chemicals and pesticides (if any) are used on it.  Growing your own food will also serve as a wonderful lesson to your family about the value of sustainable food production.

Buy locally: Do your best to source as much as possible of your food from your local area.  Buying locally produced food will not only support the local economy, it will also mean that you will eat food that did not have to travel halfway around the world to get to your table.  This means that no chemicals or refrigeration technology were needed to help it along on each part of a long journey.  Getting hold of locally produced food is perhaps not as difficult as you might imagine.  Most large towns and cities play host to farmers markets these days.  This is where local producers get the opportunity to market their products directly to the public. Visitors to the markets are often pleasantly surprised: Both by the pleasant atmosphere and by the reasonable prices.

Go organic: Foods marketed as organic was produced under strict guidelines governing the use of pesticides, chemicals and harmful production methods.  Buying organic produce is therefore an excellent way to reassure yourself about provenance. Increasing demand for organic products means that going organic is certainly not as expensive as it used to be. If price is a significant consideration you should at the very least consider going organic with certain high-risk foods.  A list of foods where the risk of ingesting pesticide residues are the greatest can be found here.

Update your skills: The farm where something was produced is not the only issue when it comes to provenance.  It is sometimes the case that perfectly healthy food is turned into something altogether more sinister in a factory somewhere.  Mass-produced foods often contain very high levels of oil, salt and harmful chemicals.  Weaning yourself from commercially produced foods by learning to prepare your favourites at home will not only benefit your waistline but also quite possibly your brain!

Always read the label: The importation of food from countries with lower environmental standards is a significant health risk.  It is therefore important that you educate yourself about where your favourite foods come from and about the standards that prevail in that location.  One way of doing so is to spend some time on the website of the United Nations Food and Agriculture Organisation. One of the areas that this arm of the United Nations deals with is pesticide management. Their website contains massive amounts of information about environmental standards and pesticide use in different parts of the world.  Familiarising yourself with some of this information will put you in a much better position the next time that you pick up a piece of foreign fresh produce at your local supermarket.

The steps highlighted above do not represent some kind of silver bullet that will instantly deliver perfect health.  Taken together, however, they should at least place you in a much better position to enjoy food in a way that will not exacerbate the symptoms of ADD /ADHD.

Research on this topic is still in its infancy and it is clear that we might be dealing with a kind of chicken and egg situation. In other words: Are children suffering from ADD/ADHD more likely to become addicted to video games; or is it the case that videogames exacerbate the symptoms of ADD/ADHD? This very important question will only be answered by focused research.  What is clear, however, is that parents of children struggling with ADD/ADHD should at the very least actively monitor their children’s involvement with videogames.

The monitoring and perhaps even control of gaming will not go down too well with most dedicated gamers, especially as many of them view their gaming identity as such an important part of who they are. I am convinced, however, that this will in some cases be unavoidable if you have your children’s best interests at heart.  I suspect that the best way to deal with this issue is not to go in with all guns blazing but to rather attempt to have a rational discussion about the content and possible ‘real-life’ consequences of videogames.

I would strongly recommend that you carefully analyze your child’s video gaming before you attempt to have a discussion about it with him or her.  This does not mean that you should follow them around with a clipboard for a number of days but rather that you take an active interest in what they are playing and how often they do so.  Some of the things that you should pay attention to are:

Content: Modern videogames often have highly complex storylines. These storylines (and related activities) can sometimes be highly questionable from an ethical point of view (e.g. Players are rewarded for killing policemen in the Grand Theft Auto series). This is perhaps enough reason for restricting the playing of some games. From the perspective of a parent dealing with ADD/ADHD there are also several other reasons. Many videogames make use of shock tactics, repetitive actions, lighting, music and sound to create heightened levels of attention and awareness. This kind of adrenaline induced ‘hyper-reality’ will often make it very difficult for a gamer to return to the real world and pay attention to rather more mundane things such as chores and schoolwork. Many concerns in the first area (e.g. questionable ethics and morals) will be pointed out by the rating systems used for games. The second set of concerns (i.e. the creation of a stimulating hyper-reality that will spoil a child for the ‘ordinary’) will not be. It is therefore highly advisable that you do your own research into the kinds of games that your child is playing instead of merely relying on the ratings system. If you would not feel comfortable trying out a game for yourself you should, at the very least, read some reviews on the internet.

Time: You may have gotten used to your son’s position in front of the console as his ‘natural habitat’! However, many parents would be shocked by how many hours some children routinely spend playing videogames. This is obviously very worrying from both a health and a social development point of view. The interesting thing is that most gamers would themselves be rather surprised by the amount of time that they spend playing. Keeping an informal tally and discussing it with your child could help clarify the problem when you do get round to a discussion.

Activity displacement: Every hour spent playing is automatically displacing other activities. Could it be that your child’s playing habits is crowding out activities that could be very beneficial in helping him/her deal with the effects of ADD/ADHD? You can attempt to determine whether this is the case by making a list of things that your children enjoyed before taking up gaming and that they can’t find the time for anymore. Sometimes these activities can be something as basic as sitting down for a balanced ‘ADD/ADHD busting’ meal with the rest of the family!

Carefully investigating the three areas listed above (content, time, and activity displacement) should give you a very clear idea of whether your child’s gaming has strayed from innocent leisure activity to significant contributing factor to ADD/ADHD symptoms. This is obviously a very tough call to make and the resultant discussion is likely to be even tougher! I am convinced however that going through this exercise could be extremely important in helping parents to protect their children from long term harm. Next week we will discuss ways in which you can encourage responsible and healthy gaming habits.

The debate about the role of videogames is a valid and important one. Questions need to be asked about the possible long term impact of the disengagement from the real world that inevitably results from vast amounts of time spent in digital environments.  For those struggling with the symptoms of ADHD the question about possible links between the condition and videogames also needs to be asked.

This subject is obviously guaranteed to generate a spirited debate with people airing very strong opinions on both sides of the argument.  Some would even go as far as to argue that videogames used in moderation can actually improve the symptoms of ADHD.  Personally I am a little wary of such claims, not least because the video gaming industry is pouring vast amounts of money into public relations efforts to try and dispel some of the unease about its products.  A central plank of these efforts is to emphasise some of the supposed positive effects of video games.

One example of the ‘games are good’ trend is the many articles claiming that gaming can improve reaction times by a few hundreds of a second. The problem with many of these ‘benefits’ is that they lack mainstream real-world application. Being able to push a button slightly faster than someone else might be of some use if you are training to be a fighter pilot, but not for much else. (The many hours in front of the console, instead of in front of math and science handbooks, will in any way make moving into a real pilot’s seat highly unlikely!)

If you conclude, based on the comment made above, that I am very worried about the way in which videogames can lead to withdrawal from the real world you would be absolutely correct. In the past I would perhaps have stopped my comments there and avoid making any statements about linkages between ADD/ADHD and gaming. However, a new study by DA Gentile (Pathological video game use among youth 8 to 18: A national study.   Psychological Science, 20, 594-602) means that I can now be a bit bolder with my warnings about excessive gaming and ADD/ADHD.

Gentile’s study was conceived as a way to determine whether some young people are indeed ‘addicted’ (in the clinical sense) to video games and, if this is the case, what the implications would be. The study worked with a randomly selected sample (1178) of American young people. It found that about 8% of the gamers in this group had ‘pathological patterns of play’. Pathological gaming is where gaming activity reaches levels where it significantly impairs schoolwork, relationships, everyday activities etc. All of this may come as no surprise to most people, we are all aware of the way in which some kids lives can get ‘taken over’ by gaming. What is surprising, however, is the direct links that Gentile found between pathological gaming and ADD/ADHD diagnoses. He writes: “Pathological gamers had been playing for more years, played more frequently and for more time, knew more of the video-game rating symbols, received worse grades in school, were more likely to report having trouble paying attention in school, were more than twice as likely to have been diagnosed with an attention-deficit disorder, had more health problems that were likely to have been exacerbated by long hours of playing video games (e.g., hand pain and wrist pain), and were more likely to report having felt “addicted” to games and having friends they thought were “addicted” to games.”

Gentile’s findings, although disturbing, comes as a welcome validation to thousands of parents who are uneasy about the effects of video games on their children (despite the fact that the industry tells them that it is ‘good for them’!). The fact is that about one in ten gamers experience significant ‘real world’ negative fallouts from their near constant immersion in digital environments. There is admittedly a bit of a ‘chicken and egg’ question here namely: “Do ADD/ADHD kids naturally gravitate towards pathological levels of gaming?”; or “Does gaming lead to the development of ADD/ADHD symptoms in some children?”. More research will have to be done on these questions. One fact remains however: There are clear and undeniable links between pathological gaming and ADD/ADHD diagnoses.

The existence of this link should prompt all of us to have the best possible strategies and policies for the way in which gaming in our homes will be managed in place. With next week’s article we will begin to discuss the principles of healthy gaming as well as outline a strategy for how this can be achieved.

I believe that part of the solution lies in the (take a deep breath!) de-commoditization of food. Complex word, simple concept! Commoditization refers to the process where the internal differences and competitive advantages between certain products give way to a mass market where price is the only differentiating factor. A product is thoroughly commoditized when the only question that I ask is ‘How much does it cost?”. Gold, iron ore and copper are classic commodities. Buyers simply do not care where it was mined, or which company is marketing it, as long as the price is right.

Many parts of the food market (e.g. eggs, flour, sugar and milk) have been commoditized for decades. This is reflected in the fact that this is the products where buying decisions are typically the quickest. (When last did you hold a bottle of milk in your hands to study it from all sides!?)  What is really scary, however, is how more and more foods are joining the ranks of the ‘classic commodities’ every year.

Massively improved transports infrastructure, genetic modification, cooling technology, chemical pest control methods and super efficient distribution methods all combine to bring us foods that can often only be distinguished on one level: (you guessed it) price! “Where is the harm in that?” you may ask.

I have already explained in my article on superabundance that the ‘superabundant’ foods are often exactly those that cause the worst health outcomes if taken in excess. This superabundance is made possible by commoditization as it streamlines the delivery of vast amounts of products based on the lowest common denominator. More information about dealing with superabundance can be found here.

Another problem with commoditization that we will all (but especially those dealing with the effects of ADD/ADHD) have to address has already been hinted at above: Provenance. Another of those ‘big word/simple concept’ cases! In nutritional terms ‘provenance’ simply means: “Where something comes from”. The less commoditized a product is, the easier it is to determine provenance. Think of all the ‘Chateau so-and-so’ wine labels, or the well written ‘word pictures’ of where something was produced that you commonly find on high-end products. In a fully commoditized market provenance is virtually impossible to determine. Who knows, or cares, where the lump of sugar that you just threw in your coffee came from!?

Why is provenance important? Simply because where something came from will often determine what effect it is going to have on you. This is true in two ways (the second of which will somewhat expand the classical definition of provenance): 1) Production location can have a huge impact on the final composition of a product. For example, some countries will allow the use of pesticides and chemicals that have long been banned in North America. 2) Production methods can have a huge impact on the final composition of a product. This is not only true when talking about primary production (i.e. farming) but also when it comes to processing. Additives, cooking oils, sugar, fats etc. can all play a part in turning essentially healthy products into disaster zones. You should therefore always ask the following questions: Where was this produced? By whom was it produced?

Giving in to the easy availability of convenient foodstuffs by not asking the questions above is a very risky business as it could lead to exposure to the very factors (e.g. certain additives, High-GI concoctions etc.) that are known to exacerbate the symptoms of ADD/ADH.

My first piece of advice in dealing with the easy availability of food is to make sure that you play close attention to provenance. Doing so will allow you to enjoy the convenience of our modern food culture without being damaged by it. I will devote next week’s article to ways in which anyone dealing with ADD/ADHD can get serious about provenance. See you then!

The problem of misdiagnosis would not have been all that serious if the only thing that diagnosis led to was a renewed focus on the role of lifestyle factors (e.g. diet, sleep patterns, parental discipline) as a means of behaviour modification. The fact is, however, that an ADD/ADHD diagnosis almost invariably leads to a child being placed on powerful medication. It is as if we are sleepwalking into a world where we think that it might just be a good idea to medicate the next generation at levels that previous generations would have found almost impossible to believe.
The sad fact is that most prescriptions are made by professionals who are a) Not adequately trained to make a proper ADD/ADHD diagnosis and b) Under pressure (especially from teachers) to come up with the ‘right’ diagnosis.

Many doctors who immediately prescribe drugs for the treatment of ADD/ADHD justify their actions by saying that they are simply trying to see if it will work. There are two huge problems with this approach. It is firstly highly irresponsible to reach for the ‘nuclear option’ first! In most other areas of medicine physicians will start with the least invasive and dangerous treatment options first. It seems, however, that this piece of common sense good practice does not apply when it comes to children with behavioural issues (that may or may not be due to ADD/ADHD). The second problem is that ADD/ADHD drugs act like ‘steroids for the brain’. They will lift performance regardless of whether a child has ADD/ADHD or not. This is why Adderall is such a hotly traded commodity on college campuses around exam time! The fact that it ‘helps’ is therefore no proof of the existence of ADD/ADHD or an indication (due to the existence of the law of diminishing returns) of long term improvement. The big question is: What price will your child (and society) have to pay for a brief spike in performance?

The answer to the above question is the reason why I am so passionate about alerting people to the existence of non-narcotic solutions. It is my belief that ADD/ADHD medication can be implicated in the epidemic of addiction that is destroying thousands of lives. There have also been several cases in which these drugs were cited as one of the contributing factors to violence and suicide. These outcomes are terrible and reason enough to do your best to keep your child off ADD/ADHD drugs. They could, however, be only a small part of the picture. There is more and more evidence that ADD/ADHD drugs could be one of the leading causes of one of the most pernicious and troubling aspects of modern life: Unmotivated boys and young men

In his excellent book Boys Adrift: The Five Factors Driving the Growing Epidemic of Unmotivated Boys and Underachieving Young Men, Dr. Leonard Sax analyses the problem of young men who are ‘failing to launch’ (i.e. still living with their parents in their late twenties and early thirties). He makes it clear that this is a complex issue that do not lend itself to easy generalisations. He does, however, ask the question whether ADD/ADHD medication could not at least be partially to blame. He points to an experiment where young male rats were given doses of the types of medication commonly used for the treatment of ADD/ADHD. The long term result was that the rats become lazy and unmotivated! This was due to the fact that the drugs damaged a key area of the brain that regulated motivation. Dr. Sachs rightly point out that this experiment has not yet been replicated in humans but as he so brilliantly puts it: “Would you like to volunteer your son for trials?”

The implications of this research are troubling to say the least! Could it be that we are reaping the whirlwind (in the form of thousands of young men failing to realise their potential) because we are, as a society, so prone to reach for the medicine cabinet rather than investigating alternatives. I want to strongly urge you to quit following the crowds and to stand firm on the conviction that it is a fallacy that the solution to everything can be found in a medicine bottle. Especially as the bottles under discussion contain substances that are dangerous in the here and now and could have consequences that will come back to haunt you decades down the line!