Attention Deficit Hyperactivity Disorder
DEFINITION
Also known as ADHD or AD/HD or ADD this most common of childhood psychiatric disorders is a neurobehavioral and developmental disorder. Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD starting before seven years of age. The symptoms of ADHD can at times be difficult to define because it is hard to draw the line at where normal levels of inattention, hyperactivity, and impulsivity end and clinically significant levels requiring intervention begin. To be diagnosed with ADHD, symptoms must be observed in two different settings for six months or more and to a degree that is greater than other children of the same age.
ADHD is the most commonly studied and diagnosed psychiatric disorder in children, affecting about 3 to 5 percent of children globally and is diagnosed in about 2 to 16 percent of school aged children. It is a chronic disorder with 30 to 50 percent of those individuals diagnosed in childhood continuing to have symptoms into adulthood. Adolescents and adults with ADHD tend to develop coping mechanisms to compensate for some or all of their impairments. It is estimated that 4.7 percent of American adults are estimated to live with ADHD.
ADHD is diagnosed two to four times as frequently in boys as in girls, though studies suggest this discrepancy may be partially due to subjective bias of referring teachers. ADHD management usually involves some combination of medications, behavior modifications, lifestyle changes, and counseling. ADHD symptoms can, at times, be difficult to differentiate from other disorders. This increases the likelihood that the diagnosis of ADHD will be missed in some cases while in others it may be over diagnosed.
Stimulants, such as Ritalin and Adderall, form the core of conventional treatment of ADD/ADHD, and we now consume over %80 of the world’s stimulants.
NON CONVENTIONAL TREATMENTS
The following are the list of some of research based non-conventional treatments modalities which can be incorporated into treatment plans of patients with ADD/ADHD.
I. EEG Biofeedback (AKA Neurofeedback)
In this treatment, modality children receive biofeedback training to modulate their own EEGs. The research available on this method is quite promising, but it takes many sessions and can be quite costly.
II. Vitamins/Minerals
Studies indicate a benefit to non-verbal intelligence/academics with a simple multivitamin and mineral supplement.
III. Essential Fatty Acids (EFAs)
Eicosanoids that are produced from EFAs control the functioning of the pervasive prostaglandin system. These hormone-like substances mediate physiological functions throughout the body.
IV. Other Treatment Considerations
- i. Thyroid hormone resistance: There seems to be a correlation of resistance to thyroid hormone and ADHD. If the child has a positive family history of thyroid disorder or clinical indicators, laboratory evaluation and appropriate treatment are indicated.
- ii. Diet: I consistently recommend that parents clean up their child’s diet by reducing sugar, preservatives, dyes, and caffeine. I always recommend a high protein breakfast and more whole grains. Soda has no place for these kids. These simple changes can often make very significant changes in behavior and attention for challenged children.
Integrative medicine is classically defined as ‘relationship-centered care that focuses on the whole person, making use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing, including evidence-based complementary and alternative medicine.’
Based on this definition, there are four major principals that an integrative practitioner must adhere to:
1- Use the innate healing power of the body to support and facilitate that natural capacity.
2- View and treat the patient as a whole physical/emotional/mental and spiritual member of a community and society. This self-healing power of the body decreases with aging and is at its peak during childhood and adolescence.
3- Implement the necessary lifestyle changes. Lifestyle changes are a cornerstone of this model since the state of our health is the result of interactions between genes and our environment. Diet, physical activity, stress, sleep, rest, fulfilling relationships, work, and school etc. are examples of aspects of lifestyle that are addressed during the development of treatment plans.
4- Fully utilize the critical healing power of the doctor-patient/parents relationship. The importance of the healing relationship between a physician and the patient is a well-known fact which, due to the managed care environment, has taken a back seat in the current western way of therapy.
In other words, pediatric integrative medicine is healing-oriented medicine that focuses on the ‘whole’ individual (body-mind-spirit) as well as all aspects of lifestyle, making use of appropriate therapies, both conventional and alternative. Based on this model, the physician takes the time to listen and understand the parents’ ideas and choices and incorporates their feedback into the treatment plan.
The typical western medicine model of symptomatic treatment of patients is redirected toward preventive care so that symptoms have less of a chance to develop in the first place. The common and overuse of medications especially antibiotics are replaced with prudent use of medications complemented with nutritional therapies, herbs, and supplements.
The field of integrative medicine is rapidly developing and growing, and it is exciting for us pediatricians to be at the forefront of this new field. The limitations posed by the current western model of medicine and the ensuing frustrations have encouraged us to look at human health and illness from a different and more comprehensive perspective. The consumers, too, are demanding a more comprehensive approach to their children’s health. They want to know why more and more of their children are developing asthma and allergies. They are demanding to know why the incidence of ADHD and autism is so high. They want to know why so many unnecessary antibiotics are being prescribed to their children.
The current medicine model as a whole and pediatric medicine, in particular, is at crossroads and needs reinvention. The integrative medicine model is at the forefront of building such an alternative model by creating a more holistic, patient-specific, least invasive approach with the focus on preventive care.
This model, besides conventional medicine, integrates and utilized multiple different healing modalities from a cross-section of therapeutic models some of which may include:
1- Acupuncture
2- Aromatherapy
3- Environmental and body detoxification
4- Exercise medicine
5- Functional medicine
6- Herbal and supplements
7- Homeopathy
8- Massage and Chiropractic therapies
9- Mind-body medicine
10- Naturopathic medicine
11- Nutritional and diet therapy
12- Osteopathic Medicine
Pediatric integrative medicine can address or complement the treatment of many medical conditions that are not adequately addressed by the conventional model such as:
Abdominal Pain
Acne
ADD / ADHD
Allergies
Arthritis
Asthma
Anxiety
Autism
Autoimmune Disorders
Celiac Disease
Colic
Depression
Diabetes
Digestive Issues
Eczema
Ear Infections
Feeding Issues
Food Allergies
Gluten Sensitivities
Growth Disorders
Headache
Inflammatory Bowel Disease (IBD)
Hormonal Imbalance
Irritable Bowel Disease (IBS)
Leaky Gut
Learning Issues
Moody Dysregulation
PANS / PANDAS
Preventive Care
Stress-induced Disorders
Trauma-Related Disorders & PTSD
Thyroid Disorders
School-related performance issues
Infections
Behavioural and Mental Disorder
Integrative medicine is still evolving and promises to usher a new healthcare model that is focused on delivering comprehensive, customized, and most efficient and cost-effective means of healing to our patients. This model seeks not only to treat ailments but to create health and a sense of wellbeing. An integrative pediatrician will be best suited to lead the way in this health revolution.
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