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.

“3 Steps” is all about choices.

When it comes to snacking, we have to become smarter.

Many of us don’t think twice about what we are eating as snacks.

I shot this video on my iphone.

It features my 3 year old daughter Mackenzie.

She is talking about one of her favorite snacks…

Wheat Thins with cheese and turkey.

Its subtle, but think about it.

You could have chosen potatoe chips.  Which means saturated fat and no nutritional value.

By adding the turkey to the snack we are “sneaking” in protein.

Once again, its all about choices.

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!

The shifts that we looked at over the past few weeks were: 1) Natural to Artificial 2) Scarce to Superabundant

With this week’s article we will begin to discuss a shift that is perhaps a bit more difficult to pin down than the two mentioned above but that are no less significant. I am referring to the historical perception that food almost always equalled hard work.

Most people, especially those responsible for getting meals to the table, would perhaps unreservedly welcome the fact that this is not always the case anymore. The fact that we do not have to spend days and months cultivating our own food, followed with hours behind the stove to prepare it, has undeniable benefits. Time previously spent in food preparation can now be used for leisure or work in other areas. I am, of course, not advocating a return to the time when the main meal of the day took, on average, four hours to prepare. I am merely asking you to consider what we as a society lost due to the fact that it is now possible to put the words ‘easy’ and ‘fast’ before so much of what we eat. Consider the following:

The cost of ease of access: Modern methods of cultivation and distribution means that we have left the link between cultivation (or hunting!) and consumption far behind. While there was nothing romantic about tilling the fields, previous generations were in no doubt about where their food came from. These days our food can just as easily come from the other side of the world as from a farm in your county (with the former perhaps more likely). Most of us do not spend any time thinking about this fact, aside perhaps from the occasional amused glance at a food label spelling out the name of some obscure third world country. Our forebears couldn’t help thinking about the origins of their food – especially since they had to gather, hunt or cultivate it themselves. Our foods often have much more ‘interesting’ stories but we can afford not to worry too much about where it came from. Or can we? Foods shipped from the other side of the world are a) often grown with the help of pesticides that are banned in North America and b) Preserved with chemicals that could have a marked negative effect on optimum brain function.

The cost of ease of preparation: We spend less and less time preparing for mealtimes. On one level this is perhaps not a bad thing as it frees up time for other activities. We need to realise however that the trend towards ‘food on the fly’ is not without consequences. We need to remember that: a) Faster methods are often much less healthy (think slow cooker vs. deep fryer!) b) ‘Ready meals’ can contain ridiculous amounts of salt and saturated fats c) In some cases ease of preparation is down to the addition of chemicals to aid the cooking process or to act as preservatives.

I think you will agree, after weighing up the cost, that easy does not necessarily translate into good! It is for this reason that I strongly believe that we have to recapture something of the old ways of thinking about food. It is, of course, a bit of a challenge to think about food as ‘difficult’ when you know full well that access and preparation is relatively uncomplicated. Next week’s article will focus on ways in which we can rebuild our lost ‘connection’ with food that will allow us to value it as a precious and life giving gift. I believe it is possible, as I will show, to do so without having to engage in the back breaking work and long hours in front of the stove that used to characterise food cultivation and preparation. See you next week!

This week I would like to briefly focus on the development of Food Mindfulness. This can be described, in this context, as the firm resolve to react to the superabundance around you by putting strategies in place to ensure that you do not overindulge. This kind of mindfulness is necessary because the superabundance around us means that food, and lots of it, is almost always present. It is therefore very easy to ‘eat on autopilot’.

We can keep from autopilot eating by constantly reminding ourselves that “If it is there we will eat it!” It seems that centuries of scarcity have conditioned us humans that if food is available we should make the most of it. Our default response to available food is therefore to eat as much as possible. The amazing extent to which this is true was proven by an ingenious experiment conducted by Cornell University in which moviegoers were served 14 day old popcorn (Many of them described the taste of the popcorn as ‘terrible’ afterwards!). The study found that rather than simply leaving the popcorn alone, the moviegoers ate significant amounts of it: In direct proportion to the amount that they were served! The fact is we will eat even unappetizing food if it is readily available and our consumption of it will be directly related to portion sizes. The problem is made worse by the fact that we are dealing with severe ‘portion inflation’ in our society. Today’s ‘small’ is very often yesterday’s ‘large’! Some possible responses to our built-in ‘If it is there we will eat it’ responses include the following:

Use smaller plates and containers: The popcorn experiment discussed above drove home a simple point. The larger the container in which food is served the more we will eat! A logical response to this would be to simply make use of smaller plates, cups, bowls etc.! This may seem like a rather simplistic way to attempt to manage your food intake but the ‘Bigger plate – bigger meal’ (and vice versa) rule have been proved again and again by research. If you are particularly serious about blood sugar management you can beat this rule by always eating from a side plate.  People may give you a few funny looks in restaurants if you transfer some of your food from the main plate to a smaller plate but in the health benefits will be worth it!

Don’t be swayed by portion sizes and ‘upgrade’ offers: I have already mentioned the huge (literally!) problem of ‘portion inflation’. You would be well advised to be aware of this as you make your food choices and of the fact that choosing a ‘small’ does not mean that you are depriving yourself but rather that you are making sensible food choices: Choices not dependant on other people inviting you to completely overindulge by the benchmarks that they have set. Don’t even get me started on ‘Supersize’ and other upgrade offers! Their only purpose is to make more money for food outlets. Nobody else receives any benefits from them (despite the insistence that you will be getting a ‘good deal’), especially since the long term use of such offers is quite likely to lead you into some pretty serious health issues.

Keep a food diary: One of the best ways of modifying your eating habits is to keep a detailed daily food diary. This technique is especially valuable for those dealing with the impact of ADD/ADHD as it can also help you to determine which foods seem to exacerbate the condition. Here’s how it works: Keep a little book with you and make a note of every single thing that you put into your mouth over a set period (I would recommend at least a month). This will help you to identify negative patterns and habits. It is also very effective in keeping you from overindulging. This may seem like a very tedious thing to do but studies have shown that food diaries have the ability to break even long term destructive habits.

Food superabundance is a daily fact of life, much of our present and future health will depend on how we respond to it. I used a very important word earlier on: Mindfulness. The goal is to get to the point where you make conscious food choices based on what you really need and not on what society tells you to consume.

Recent studies have shown that symptoms associated with fetal overexposure to alcohol are often mistaken for ADD/ADHD.  Fetal Alcohol Spectrum Disorder (FASD) is a serious condition (or perhaps, more correctly, range of conditions) that afflict many children whose mothers used too much alcohol while they were still in utero. The impact that FASD can have on a child’s health and wellbeing can be nothing short of devastating and it is one of the reasons why alcohol is best avoided during pregnancy. Some of the most common effects of FASD include the following:

Stunted growth: Children with FASD tend to show up on the lower percentiles in terms of height and weight.

Skull and facial abnormalities: Some studies suggest a strong link between facial and cranial defects and alcohol overexposure.

Damage to the central nervous system: Perhaps the most serious impact of FASD is the havoc that it wreaks on the central nervous system. This can range from stunted brain growth to the development of serious neurological conditions (e.g. epilepsy and seizure disorders). This damage can also manifest itself in the  form of functional disabilities or development disorders. The most common among these are:
•    Problems with social/adaptive skills
•    Reduced memory capabilities
•    Lack of impulse control, attention, social perception and judgment
•    Sensory problems
•    Difficulty in mastering motor skills

It is obvious that this last list can very easily be mistaken for a description of what medical professionals are looking for when attempting to diagnose ADD/ADHD! This fact has serious consequences for those suffering from FASD. The abovementioned study, conducted by the University of Toronto in conjunction with the Hospital for Sick Children at Surrey Place Center, found that it is likely that many FASD children are not receiving appropriate help and care because of ADD/ADHD misdiagnoses.

The main area of concern that the study (which compared 33 children with FASD, 30 ADHD children and 34 children with no disorders) flagged up was the issue of social interaction. It is suggested that FASD children who are not correctly diagnosed early on are in grave danger of developing serious behavioral problems if the condition is not responded to correctly. One of the authors of the research report, Joanne Rovet, had the following to say about this: “In terms of social cognition and emotional processing, the core deficit in FASD appears to be in understanding and interpreting another’s mental states and emotions. These problems with social cognition and emotion processing may underlie the severe conduct problems seen in children with FASD.  It is imperative that these children receive assistance in social and emotional processing domains, specifically targeting interventions to deal with their unique deficits.”

This study shows, once again, how dangerous the current ‘trigger happy’ attitude to ADD/ADHD diagnosis can be. It also underlines that the problem of misdiagnosis can cut both ways. On the one hand it leads essentially healthy children into a system where they have to have to unnecessarily take dangerous drugs on a daily basis. It also keeps, on the other hand, children who need highly specialized care and treatment (as is the case with FASD) from receiving it because many physicians are almost conditioned not to look beyond the ADD/ADHD label.

If you suspect that FASD could be a factor in your child’s problems you should take heart. Many excellent interventions and treatment methods for the condition exist. It should therefore never be seen as a ‘life sentence’ to a low functioning and problem filled life. The most important thing is to simply get together the courage to take the first step. Many parents of FASD children hesitate to seek help, or to flag up maternal alcohol use during pregnancy as a possible factor, because of the social stigma that is sometimes attached to the condition. I want to urge you however to refuse to allow possible past mistakes to overshadow your child’s future. If you have the courage to seek it you will find that help is available and the condition can be successfully managed in most cases.

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More information about the University of Toronto study can be found here.

More information about FASD, and about managing the condition, can be found here.
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Last week we began our exploration of the issue of ‘Food Superabundance’. I pointed out that the easy availability of food in our society is something that previous generations would have found very hard to even begin to comprehend. It is unfortunately the case that the fact that most North Americans do not have to give a second thought to where the next meal will come from is a decidedly mixed blessing. No one can lament the fact that actual instances of starvation have largely been eliminated. The rising incidence of bad food choices, obesity and food related health problems is a bit more difficult to get excited about however.

It is my opinion that food superabundance has a particularly negative effect on those struggling with the effects of ADD/ADHD as the kinds of food that are the most abundant are often precisely the kinds of food that should be avoided because of their effects on human attention and brain function. So how to best live in this world where it is much easier to be a contented ‘grazer’ than the ‘lean mean hunting machines’ that we were designed to be? Some suggestions (continued over two weeks) for doing so are the following:

Listen to your body: Our bodies have very specific ways of reacting to the oversupply of food. The most obvious sign that you are overindulging is obviously the one that you see as you get on the bathroom scale every morning! The signals that your body are sending goes way beyond weight gain however. The following can sometimes (although not necessarily always) be messages from your body that you should change your eating patterns:

A bad taste in the mouth: This can often be due to the prolonging of the digestive process due to excessive amounts of food.

Heartburn: Heartburn could have many underlying reasons but can in many cases be blamed on overeating.

A heavily coated tongue: A coated tongue can often be nature’s way of signalling the fact that the nutritional system is overcrowded and that intake should be reduced. This is because it is an indication that the tongue has been ‘roped in’ to assist with the dispatch of waste products.

A ‘muddy’ skin: This occurs with ‘big league’ overeating and is a sign that the body has to get rid of so much waste products that it attempts to release some of it through the skin!

Dull eyes: If too much bile is released into the bloodstream it can affect the whites of the eyes, usually by making it dull or giving it a greenish tinge.

It should be emphasised again that all of the symptoms mentioned above can have causes other than overeating. The point is, however, that excessive food intake should at least be considered as an option if you experience any of them.

Avoid the ‘Temples of Superabundance’: One of the most visible results of the food superabundance in our society is the proliferation of ‘fast food’ outlets. It is no secret that many of these establishments work on the principle of the lowest common denominator by offering the largest possible portions at the lowest possible price. This is mostly done at the expense of quality and nutritional value. It does not make sense to ‘rejoice’ in the fact that you got so much food for so little if you have to count the cost in terms of negative nutritional and emotional outcomes afterwards. I realise that going out for ‘fast food’ is almost a ritual in our society but we really need to begin counting the cost of this habit. This is especially true in the case of families who are struggling with the management of ADD/ADHD in one of its members. The average fast food meal could almost have been custom designed to exacerbate ADD/ADHD as it usually contains:

• Highly refined carbohydrates at the top end of the Glycemic Index
• Very high amounts of saturated fats that could seriously impede brain function by limiting the absorption of ‘good’ fats.
• High levels of sugar, guaranteed to shoot blood sugar levels through the roof and set the ‘Blood Sugar Rollercoaster’ rolling.
• High levels of caffeine in soft drinks. This could lead to a worsening of ADD/ADHD symptoms or even to an ADD/ADHD misdiagnosis (Due to sleep deprivation being mistaken for the condition)
• Many different kinds of additives and preservatives that could interfere with natural digestion and absorption processes.

The list above should make it clear that limiting your ‘fast food visits’ to special treats, rather than twice weekly occurrences, can be one of the easiest ways to tune out of some of the more destructive effects of food superabundance.

Please check back next week when I will continue with some more suggestions on how you can live a nutritionally balanced life in a superabundant world. See you then!

Significant new research (published in the Journal of Development & Behavioral Pediatrics) points to the widespread occurrence of the placebo effect when it comes to ADD/ADHD medication. This should perhaps be expected as the effect has been shown to occur with just about any kind of medication imaginable. What makes the findings surprising however is that the placebo effect did not occur in the ADD/ADHD patients themselves but in their caregivers! In other words, the belief that a child is being medicated was sometimes enough for parents or teachers to significantly modify their attitudes to, and expectations of, that child.

The study was conducted by pediatric psychologists from the University of Buffalo and found that, when caregivers believed that children were receiving ADD/ADHD medication (e.g. Ritalin and Adderall) they would view them more favorably and treat them more positively – whether medication was actually involved or not!

The lead author of the review Dr. Daniel A Waschbusch summarized their rather alarming findings as follows: “”The act of administering medication, or thinking a child has received medication, may induce positive expectancies in parents and teachers about the effects of that medication, which may, in turn, influence how parents and teachers evaluate and behave toward children with ADHD. We speculate that the perception that a child is receiving ADHD medication may bring about a shift in attitude in a teacher or caregiver. They may have a more positive view of the child, which could create a better relationship. They may praise the child more, which may induce better behavior.“

The findings of this research project is a damning indictment of the well documented ‘rush to medicate’ whenever there is the slightest suspicion that ADD/ADHD might be involved. The pressure to do so often comes from teachers who explicitly and implicitly signal that little Johnny will have a much tougher time in class if Ritalin is not added to the mix as soon as possible. Parents are often so intimidated by this stance that they meekly accept the ‘recommendation’ to go and see a medical professional that can be relied on to supply the ‘correct’ diagnosis and treatment. This is the exact path that thousands of young people take every year: A path that leads to unnecessary exposure to very dangerous chemicals and an accompanying label classifying the child as ‘difficult’.

The suggestion, implicit in the research quoted above, that positive outcomes can be achieved by some focused attention and high expectations is a rare and welcome nod in the direction of plain old fashioned common sense. As a society we need to be reminded that it is a fallacy to believe that every problem can be solved by medicating it away.

It is my belief that parents should educate and equip themselves to deal with the pressure to ‘diagnose and medicate’ that they will perhaps have to deal with. This preparation should focus at being ready with answers and arguments on both the side effects and the effectiveness of ADD/ADHD medication.

Side Effects: The evidence that ADD/ADHD medication can have some pretty nasty unintended consequences is mounting by the day. Medicines like Ritalin, Strattera and Adderall have been implicated in everything from suicidal thoughts to increased susceptibility to addiction. The fact is that you are dealing with powerful mind-altering chemicals: A fact that should not be obscured by comforting advertising copy and the glib reassurances of those who benefit financially (or otherwise) from their distribution.

Effectiveness: The research quoted above is another nail in the coffin of the ‘defense’ that the perceived dangers of the products are obscured by the fact that they are so effective in improving attention. This is a very difficult assertion to prove when it comes to long term use of products like Ritalin. Could it, further, be the case that all that is really needed are some lifestyle modifications (as suggested in the ‘3 Steps ADD’ Program) and a more positive engagement with the child? If the answer to this question is ‘yes’ (as I believe it is) it would perhaps leave pharmaceutical companies with radically reduced profit margins. This is, however, a negligible price to pay for giving our kids back the privilege of living their lives without unnecessary ‘chemical crutches’!

* The full article, entitled, Are There Placebo Effects in the Medication Treatment of Children With Attention-Deficit Hyperactivity Disorder? Can be found on the website of the Journal of Development & Behavioral Pediatrics

* A shorter discussion of be accessed on Science Daily.

One of the latest physicians to flag up the issue is Dr. Gregory Olmor, director of Pulmonary Medicine and the Sleep Lab at Akron Children’s Hospital (Click here for a video where he discusses his findings). He reminds parents that children need, on average (there will of course be individual variations), the following amounts of sleep:

Teenagers: 9 hours

6 – 12 year olds: 10 hours

Preschoolers: 11 hours

If they don’t get this amount of sleep (as is the case with many kids in our society!) children are likely to become distracted, irritable and impulsive. Sound familiar?

Any parent should, in light of the above, first eliminate sleep deprivation as a possible explanation for ‘ADHD like’ behaviour before going down the path to a full blown diagnosis (with the accompanying pressure to medicate). But how can you ensure that your child gets more, and better, sleep? Here are some practical suggestions:

Establish a strong bedtime routine: This may be difficult to work into your busy schedule but I highly recommend that you make the effort, especially in the case of smaller children. The regular repetition of a bath, followed by a drink, followed by a story (or whatever else you decide on) can be very reassuring and will help the child to make the transition from wakefulness to being ready for sleep.
Keep night time interaction to a minimum: If your child wakes up at night (perhaps due to a nightmare of a bit of anxiety about the dark) you should, of course, move in and reassure and comfort him/her. This is, however, not the time to have a deep discussion about the reasons for the nightmare or the anxiety (Save this for the morning). Settle the child as quickly, and compassionately, as possible and then withdraw to allow him/her to drift back to sleep.
Use a reward chart: If you place something on a reward chart for every night during which there were no call-outs or ‘escapes’ your children will be able to see a visual presentation of their progress. This should reinforce the importance of undisturbed sleep in their minds.
Keep distractions to a minimum: For older kids it may be necessary to have strict rules for the prevention of middle of the night ‘electronic activities’ (e.g. listening to music, watching TV, surfing the web, instant messaging etc.). This will almost certainly be resented at first but could, in time, lead to the establishment of much healthier sleeping patterns.
Encourage physical activity: It does not take a rocket scientist to work out that the more active a person was during the day, the more likely he/she will be to ‘crash’ and sleep through the night. Encouraging your kids to participate in sport will therefore not only aid their physical fitness and motor development, it could also turn them into much better sleepers.
Avoid caffeine close to bedtime: As a stimulant caffeine is famous for its powers to keep people awake. Yet many people think nothing of allowing their children to drink near industrial qualities of the stuff close to bedtime. I am not, in the first instance, referring to the caffeine in coffee (which many parents would take care to avoid) but rather to the huge amounts found in many soft drinks. Drink such as this will hit a child with a double whammy: They will put the child on the ‘blood sugar rollercoaster’ and then make sure that he/she ‘hangs on for the ride’ through being wide awake! It is my opinion that drinks like these should be avoided at any time, but especially close to bedtime.

If none of the above is effective in helping your child to get a better night’s sleep it may be necessary to seek a bit of professional help (with the focus firmly on sleeplessness and not on a possible ADD/ADHD diagnosis). A medical professional focussing on sleep related issues should be able to suggest several techniques, beyond those mentioned above, with which to send your child to dreamland quicker and for longer.

There are obviously several different products on the market that claim to ‘cure’ sleeplessness. I would personally caution against using any of them on your children until you get an independent and knowledgeable medical opinion.

Many people needlessly go down the road to an ADD/ADHD misdiagnosis when all their kids need is a few nights of proper sleep. Make sure that you are not one of them: Look into possible sleep deprivation first. Sweet dreams!