Using ADHD medications has become the modern solution for a child’s behavioral and academic problems. Medicating troubled children has become even easier with the American Academy of Pediatrics’s new ruling last month. They declared that children as young as 4 years old can receive the ADHD diagnosis and get treated with dangerous amphetamines like Ritalin. It just goes to show how drug companies have successfully marketed their “chemical imbalance” theory as the root of childhood behavioral disorders.

However, alternative theories to the causes of ADHD are also becoming widely accepted. One of these is the idea that family stress can be as toxic to children as it is to the parent, triggering troubled behavior and other symptoms that resemble ADHD.

I know of a few family therapists who have been working with this theory for decades. Instead of viewing behavioral issues as a genetic or biochemical issue, family therapists look at a child’s home environment and see how he or she is being nurtured. A family is a very complex social system, and the smallest change can disturb the balance and cause unexpected changes in a child’s behavior.

For instance, a colleague recently had a four-year-old boy in his office because the teacher suspected that he had ADHD. He literally transformed into a different person overnight, from a caring, well-behaved boy to a restless tornado that would hit his friends and refused to listen to his teacher.  When my colleague asked what was wrong, he said he was worried about his father, who starts fights at home and cries all day after losing his job. It’s amazing how young children can be so attuned to the moods of their parents and experience emotional problems because of this.

My colleague then spoke to the child’s parents and requested that they avoid having arguments around their son. In fact, he suggested that they discuss serious issues in the car with the windows rolled up or while their child is at school. Secondly, since the boy seemed worried about his father, my colleague asked him to avoid looking sad in front of his son and tell him two good things that happened in his day. In two weeks, the child’s behavior improved. Although he still displayed moments of aggression, he was for the most part the same sweet boy everyone at school knew. In a little over a month, his aggressive tendencies disappeared and he was his usual cheerful self once more.

What may seem like symptoms of a behavioral disorder may actually be a child’s reaction to his or her family environment.  As parents, we can adapt healthy communication habits to protect young children from family stress. This means arguing when the children aren’t around, avoiding serious financial or political discussions at the dinner table, or telling your child a positive thing or two about your day. An ADHD evaluation should only be considered if the child displays behavioral problems despite a healthy home environment.

A parent recently posed a very interesting question – are sickly children more likely to have ADHD than healthy ones? Before her daughter was diagnosed with ADHD, she had frequent asthma attacks and was prone to ear infections. When she compared notes with a fellow parent who has a son with ADHD, she discovered that the boy also suffers from chronic allergies and experienced upper respiratory tract infections on a regular basis.

Most doctors would say that there is no connection between ADHD and these illnesses; after all, ADHD is a neurological problem while these common childhood illnesses are caused by environmental irritants, genetics, or bacteria. But if you look beyond the superficial symptoms and asses the body as a whole, you’ll find that these health problems are no coincidence.

The traditional medical perspective views the three core problems of ADHD – hyperactivity, impulsivity, and inattention – as the problem that needs to be treated.  Hence, stimulant medications are prescribed in order to address the neurotransmitter deficiency behind these symptoms.  However, ADHD is more than just a problem with brain chemistry and genetics; the onset of the symptoms is also influenced by how our body relates with the environment. While genetics does increase a child’s risk of developing ADHD, what really causes ADHD symptoms are triggers like food allergies, toxins in the environment, and nutritional deficiencies. These are the possible underlying problems behind ADHD.

So what do childhood illnesses have to do with ADHD? A number of studies have demonstrated that children with ADHD experience more than just the three main symptoms. Children with ADHD are 50% more likely to get diagnosed with a different psychiatric disorder like childhood depression, or with learning disorders.  From the medical perspective, these psychiatric disorders are completely unrelated and require different treatment. Our perspective says otherwise. We view ADHD and these related disorders as signs of a more complex underlying cause in the body and mind of the individual.  ADHD symptoms are just the tip of the iceberg; what’s important is discovering what lies beneath the surface so that the body can be healed completely.

In other words, the underlying causes of ADHD also affect the various systems of the body and interfere with their functions.  Hence, children and adults with ADHD are more likely to experience problems that go beyond their brain and their behavior.  This is why stimulant drugs are not the best way to help a child with ADHD. While medication can temporarily suppress the symptoms, it is by no means an adequate treatment for the underlying problems behind the disorder.

Lack of focus, forgetfulness, and hyperactive behavior – children with ADHD put up with a lot of symptoms and discomfort.  But these aren’t the only problems they have to deal with. Research shows that kids with ADHD are also more likely to experience allergies than kids without.  There is no easy explanation for why this happens but we do know that certain allergies, such as an intolerance to artificial food additives, can make the disorder worse for some kids.  Although many allergens cannot be controlled (e.g. high pollen count), it is possible to avoid triggers that aggravate ADHD symptoms.

Find out what foods your child is allergic to

Food allergies are often the primary contributor to ADHD symptoms, but the problem lies in detecting them. Unlike allergies to seafood or chocolate, these allergens do not have immediate reactions. Rather, their effects are delayed because they build up over time, until they spill over and cause a number of symptoms like dermatitis, joint inflammation, mood swings, depression, anxiety, and poor memory.

You can slowly uncover these hidden allergens through an elimination diet, an effective process that eliminates the most common food allergens – citrus fruits, shellfish, wheat, dairy, nuts, caffeine, and artificial additives.  The goal of the elimination diet is to avoid all these possible allergens for at least four days, or until you notice a change in your child’s behavior. For instance, you want to test if your child is allergic to citrus. Citrus fruits, juice, and foods with citrus ingredients are eaten one to three times for one day. Over the next several days, all citrus fruits are eliminated, then slowly added back to the diet.  If your child’s behavior gets worse, or if allergic reactions occur, it is likely that your child is allergic to citrus.  To make it easier to locate the allergen, keep a diary of foods and any reactions your child might have.

Although it takes months to complete an elimination diet, all your efforts will be rewarded when you discover what your child is allergic too.  ADHD children who avoid food allergens experience a significant improvement in their symptoms, and can even function as well as normal children.

No smoking in the house

It’s important for a child with allergies to stay away from tobacco smoke; inhaling smoke increases the amount of allergens in the lungs and nose.  Aside from making the house a smoke-free zone, avoid using candles, incense, a fireplace, or plug-in air fresheners, as these are strong allergens too.

Bathe pets weekly

Pets can be a godsend to children with ADHD, but many kids are allergic to a protein found in animal saliva, urine, or dander.  When a furry animal sheds, the allergen gets carried by invisible air particles, and lands on the lining of your eyes and nose.  A child with allergies will then experience symptoms like watery eyes or sneezing fits. Research suggests that washing your pets weekly will lower the amount of allergens they release into the air.

Get rid of dust mites

Dust mites thrive on dust particles that gather in the house, and their droppings are responsible for many kinds of allergies.  Get rid of dust mites by changing linens twice a month, having your air ducts cleaned regularly, using an air-conditioner to filter out pollen and other allergen material. Additionally, avoid decorating the house with heavy drapes, carpets, and stuffed animals, as these are havens for dust mites.

A medical diagnosis should never view the disorder in terms of black and white, especially with a condition as complex as ADHD.  What I mean by this is that the ADHD diagnosis should not be made after checking a list of symptoms, because there are many similar disorders that are characterized by inattention, hyperactivity, or impulsivity.  Additionally, there are hundreds possible reasons behind your child’s behavior, and if these causes are not treated properly, your child’s problems will continue to persist. A wrong diagnosis is just as harmful as no diagnosis at all. Not only is your child not getting the help needed, but he or she is being treated for a condition that isn’t there and needlessly suffering the side effects of this treatment.

So when should you get a second opinion? Here are a few instances.

The diagnosis was done too quickly

As I said earlier, ADHD is far too complex a disorder to be evaluated based on symptoms alone.  If the doctor took a quick look at your child and prescribed medication without taking into account his or her family history, medical history, or without testing for related disorders, seek a second opinion.

Your child is under the age 6

When a child below the age 6 is given an ADHD diagnosis, by all means seek a second opinion from a different specialist.  ADHD symptoms like hyperactive behavior, short attention spans, or talking too much could simply be signs that your child is acting his or her age. Don’t worry about placing a label for this behavior just yet.  Instead, decide if your child really does have a problem and if he or she needs help. Are these behaviors interfering with family life?  Does your child’s behavior get him or her into trouble at preschool or day care? Are they so severe that your parenting strategies can’t keep your child at bay?

Your child has not had a recent physical exam

Many teachers are quick to assume that children who cannot focus in class or do not answer when called are probably suffering from ADHD.  However, hearing and vision problems can also account for these problematic classroom behaviors. If your child has not had a complete physical exam in the last year or so, obtain one in order to rule out any physical causes for inattention.

Your child shows no symptoms at home

In order for an ADHD diagnosis to be made, the symptoms must appear in two different settings. If a babysitter, teacher, or friend urges you to see a doctor for an ADHD evaluation, take note of the symptoms described and see if your child shows any of these problems at home.  Let’s say the teacher complains about chronic inattention; your child spends the entire day staring out the window, completely oblivious to the lectures going on in the classroom.  Yet you notice that your child has no problem reading quietly by herself or finishing a board game with siblings. It’s likely that ADHD is not the cause of inattention; your child may simply be uninterested in what’s going on inside the classroom.   

At the UnRitalin Solution, we ask the parents about the circumstances surrounding the pregnancy and birth of their child. It may seem unrelated at first, but the answers often yield helpful clues about their child’s ADHD causes and how best to treat their condition. Functional medicine refers to these birth and pregnancy complications as antecedents, factors that increase the risk of ADHD and other disorders. Certain triggers can set these antecedents off and cause full-blown ADHD symptoms to emerge.

One thing I’ve observed among my young ADHD patients is that many of them were born prematurely, came from complicated pregnancies, and/or had low birth weight. These antecedents interfere with the development of the nervous system, especially if the child suffers from complications. Using government health records, a study by Swedish researchers at Stockholm’s Karolinska Institutet found an association between premature birth and ADHD. The more premature the deliver is, the higher the risk for ADHD.

The study was published in Pediatrics’ April 18 issue and can be viewed online. The research team looked at health data of nearly 1.2 million Swedish children born between 1987 and 200, and then contacted them to see if they took ADHD medications between the ages 6 – 19. They observed that the odds of developing ADHD are greater the earlier they were born.

• Children born at 37 to 38 weeks had a 10-20% chance of having ADHD.
• Children born at 33 to 34 weeks had a 40% chance of having ADHD.
• Children born at 29 to 32 weeks had a 60% chance of having ADHD.

These findings highlight two things. One, parents should reconsider getting elective Cesarean surgery, which is becoming popular in Europe because of its convenience and predictability. This type of delivery brings all sorts of neurological, behavioral, and cognitive risks to the child. Secondly, babies who are born premature should receive more attention in neonatal care.

However, the study also emphasizes that premature birth is simply a risk factor. Not every child born early will develop ADHD, especially if he or she receives proper nutrition, exercise, and is not exposed to toxins and cigarette smoke during childhood.

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Is there a smoker in the family? Here’s one more reason to kick the habit.  Researchers from the United States examined nearly 3,000 children, and discovered that those with highest concentrations of cigarette chemicals in their blood were more likely to have mental health issues and behavioral problems. The presence of ADHD symptoms was particularly strong in these kids.

The study, which is published in the April 2011 issue of Archives of Pediatrics and Adolescent Medicine, was done by researchers from the University of Miami’s Miller School of Medicine and involved the participation of 2,901 children between the ages 8 to 15. To measure their exposure to secondhand smoke, they measured blood levels of cotinine, the substance that forms when the nicotine in tobacco breaks down in the body. Teenagers who had the highest levels of cotinine were smokers themselves, and were not included in the final analysis. The children were also interviewed for symptoms of a behavioral or mental disorder.

The results were intriguing. After controlling factors like race and age, it was revealed that boys who had high levels of cotinine were more likely to have symptoms of ADHD, conduct disorder, anxiety, and depression than those with no secondhand smoke exposure. Girls with high levels of cotinine only had symptoms of ADHD and anxiety.

The researchers were unable to explain why exposure to cigarette smoke has this effect on children’s brains, and how the mother’s cigarette smoking during pregnancy relates to current exposure. One thing is for sure though – children must be kept away from secondhand smoke, and parents should quit smoking when able.  Even if you smoke away from your child, the chemicals in the smoke linger in your clothes and hair. When you hug your child, he or she could inhale these chemicals.

Moms-to-be should also quit smoking a year before they plan to conceive. Aside from lowering fertility, the chemicals in cigarette smoke linger in the bloodstream and can be absorbed by the growing fetus. Since an infant in the womb has an under-developed immune system, these chemicals can interfere with the growing nervous system, where it can increase the risk of ADHD, learning disorders, and other psychological problems.

In addition to its effect on ADHD symptoms, secondhand smoke can also contribute to lung and heart problems among children. In fact, it’s the number one culprit behind asthma attacks and symptoms, and can trigger lower respiratory tract infections for children 18 months and younger.  Cigarette smoke also contains hundreds of carcinogens. A study from the American Association for Cancer Research discovered that children exposed to secondhand smoke have 8% of the carcinogens found in their smoking parents.

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In the 1960s, Dr. Benjamin Feingold uncovered a relationship between ADHD and artificial food additives. He observed that upon ingesting foods with these additives, the children’s bodies reacted adversely and became hyperactive and aggressive. Some estimates suggest that the consumption of artificial additives doubled since the 1990s, which can explain the increase behind ADHD cases in recent years.

In response to these findings, Europe’s food manufacturers banned the use of artificial food dyes to protect children. But what is the United States doing? Only recently did their government consider these petroleum-based dyes and their possible connection to ADHD.  Today, their Food and Drug Administration (FDA) is making a big step forward by investigating food dyes and agreeing that elimination diets can help children recover from the disorder.

On March 30, the FDA formed an advisory panel that will look into the relationship between artificial food dyes and hyperactivity in ADHD.   Their findings may require manufacturers to place warning labels on the colored goodies children love, such as gummi bears, sugary cereals, even juice drinks and instant macaroni and cheese.  Right now, there are 8 dyes being used in the United States: Yellow 5 & 6, Citrus Red 2, Red 3, Red 40, Blue 1 & 2, and Green 3. All of these dyes are based on petroleum and have been found by studies to cause hyperactivity, inattention, and impulsivity, as well as allergic reactions like hives.

The FDA panel is made up of scientists, doctors, and consumer representatives. A few days later, they made an 8-6 vote saying it’s too early to place warning labels about the link to hyperactivity. However, food manufacturers are required to list all food colorings in the packaging.

Although the panel believes that matter needs further study, they haven’t made any final decisions on artificial dyes just yet. However, they did agree that diets eliminating artificial dyes reduce behavior problems and help children cope with ADHD. This is a major step forward from the previous government ruling, which declared that there was no relationship between these petroleum-based dyes and ADHD.

If you want to know more about the relationship between food dyes and ADHD, check out our article on food additives and the Feingold diet. You can also learn more at Feingold.org.

Anyone who has ever taught, lived with, or spent time with an ADHD child has noticed that the disorder is more than just the three core symptoms. They are correct in this observation; inattention, hyperactivity, and impulsivity are just the tip of a large iceberg.  What lies underneath its surface?

A diffused attention span

The very name of the condition, attention deficit-hyperactive disorder, is actually a little inaccurate. Children with ADHD don’t have a deficit of attention per se; they just have trouble directing their attention towards the stimuli that matters. I often ask my young ADHD clients what’s going on in the clinic. They could tell me about the bird flying outside the window, the sound of other children waiting outside, a little of what I was explaining to their parents, and the amount of books on the wall. Children with ADHD have a lot of attention. The only problem is that this attention is spread over a wide area of stimuli throughout the day, making it difficult for them to focus on the things that truly matter.

A problem with executive function

The symptoms of ADHD are also signs of an underlying imbalance in the brain’s domains of cognition, or executive functions.  Aside from the inability to direct attention, ADHD also makes it difficult for a child to organize tasks and thoughts, causes problems with short-term and working memory, and controlling emotions or behavior.

A functional disconnection syndrome

Have you ever wondered why children with ADHD tend to experience related problems like anxiety or oppositional defiant disorder? Brain imaging technology has allowed neuroscientists to discover the root cause of many such mental disorders – functional disconnection syndrome, a communication problem between the left and right hemispheres of the brain. For the brain to function properly, both hemispheres have to be in sync and working on the same wavelength; when one hemisphere lags, the brain’s function gets disrupted, and symptoms appear. Western medicine then labels these symptoms and calls them mental disorders.

ADHD needs a comprehensive solution

How can one treatment possibly address all these problem areas? Well, a single treatment isn’t enough. The primary treatment for ADHD is stimulant medications, but drugs cannot correct the problems in these cognitive domains. That’s why many parents see few long-term improvements among medicated children.

There are many treatments designed to address the unique behavioral, mental, and physical problems experienced by children with ADHD. But how do you know which treatment is best for your child? This is where the UnRitalin Solution steps in. The 14 keys organize the many strategies and tools available for ADHD children and create a personalized, comprehensive plan tailored to the needs of each child.  All children are biochemically unique, and each child has different problems lying underneath his own ADHD iceberg. The UnRitalin Solution helps me determine what treatments are the most important for this particular child so that he or she can have long-term recovery from ADHD.

Children age 12 and below need at least 10 hours of sleep each night, especially if they have ADHD.  Studies have shown that when ADHD children don’t get enough sleep, they become more hyperactive, inattentive, and irritable the following day. But what qualifies as “not enough sleep” and how bad do ADHD symptoms get? A new study in the scientific journal Sleep reveals that as little as one less hour of sleep is enough to make the academic performance of ADHD students deteriorate.

The study involved the participation of 43 children with a mean age of 9 years. Eleven of them have ADHD while 32 are controls. After monitoring their baseline sleep for six evenings, the children were asked to remove an hour of sleep by going to bed later for six consecutive nights. An actigraph (a watch-like device) was used to monitor their sleeping hours during the baseline and experiment period.

After the baseline period and the experimental period, the children’s neurobehavioral function was measured using a Continuous Performance Test, a computer-based diagnostic test used to evaluate ADHD. The test takes 15 minutes to complete and involves responding to specific signals. Results revealed that after a mean 34 minutes of nightly sleep loss, the performance of children with ADHD deteriorated by four of six measures in the inattention scale. They also had slower reaction time. While the children without ADHD also had poorer performance, those with the disorder made more mistakes.

It’s worth pointing out that the reduction of sleep done in the study is quite modest compared to the actual sleep deprivation children experience today. The slightest changes in a child’s routine, such as eating dinner later or staying up to study (or play video games), is enough to push sleep back and cause poorer neurobehavioral functioning the following day.

Preventing sleep deprivation is an important part of a holistic ADHD treatment. After all, it takes time to see the effects of long-term solutions for ADHD, and your child needs to deal with the symptoms today.   Here are five solutions to sleep problems, which we talked about a few weeks ago, as well as a few more resources on sleep and ADHD.

Many parents I’ve spoken to make the same observation about their ADHD children’s sleep habits: they have a hard time falling asleep, staying asleep, or waking up in the morning.  When they don’t get enough sleep the previous night, they spend the rest of the day in an ADHD funk with their symptoms in overdrive. These observations are hardly surprising – sleep problems and ADHD are closely related because the regions of the brain responsible for attention also regulate sleep. While there’s not much you can do to change your child’s biology, there are a few things that can be done to help your child get enough sleep.

Establish a bedtime

Doctors recommend that school-age children get at least 10 hours of sleep every night.  Determine your child’s bedtime by subtracting ten hours from the time he or she has to get up at school (e.g. children who have to be up by 7 am should be sound asleep by 9 pm the previous evening).  Enforce this bedtime consistently, even on weekends. Allowing your child to stay up late on Fridays and Saturdays will disrupt the body clock; by Monday, he or she will experience something like jet lag.

Create a bedtime routine

While enforcing a strict bedtime may be enough for the average child, kids with ADHD may need more than this, especially for those who end up tossing and turning well after midnight.  An hour before going to bed, create e a routine filled with calming and relaxing activities.  Read a book, listen to music, or do yoga together. The important thing is that these activities slow your child’s brain down and help ease any anxieties he or she might have about sleeping at night.

Keep the bedroom dark

Darkness is not only the perfect cue for bedtime; it also gets rid of any visual distractions that keep your child from falling asleep. For instance, if your child has no light to read, she’s less likely to stay up reading all night.  If your child is afraid of the dark and needs a light to calm his fears, provide a very dim light and shut it off once your child is asleep.

Use white noise

If the slightest sound stirs your child from sleep, try using white noise – a type of noise made up of different sound frequencies, enabling it to mask disruptive sounds without interrupting a person’s sleep.   White noise is normally emitted by household appliances – the whirring of an electric fan or the hum of an air-conditioner count as white noise.  You can also find white noise in CD recordings or in white noise machines.

Consider melatonin

Is your child still tossing and turning all night? Consider giving a melatonin supplement before bedtime.   Melatonin, a hormone secreted by the pineal gland, is responsible for maintaining our body’s internal clock; studies suggest that children with ADHD may have problems with melatonin secretion. Supplements are available in health food stores – try giving your child a small dose an hour before going to bed to induce sleepiness.