Paediatrics: Focus on ADHD

adhd-boy

Attention Deficit Hyperactivity Disorder, or ADHD (also called ADD or Hyperactivity Syndrome), is a ‘condition’ that seems to be becoming more prevalent in Western society. Increasing numbers of parents are bringing their children for a Cranial Osteopathic opinion and I have a found a few common themes which are worth sharing.

Far from being purely a ‘sign of the times’, ADHD was first described clinically in 1798. The diagnosis is based on the individual being: ‘Impulsive, overactive and/ or inattentive to an extent that is unwarranted for their development and is a significant hindrance to their sociological and educational success’ (British Psychological Society 1996). However, there are other diagnostic criteria commonly used (e.g. WHO, American Paediatric Association) which differ in terms of age of onset, I.Q., impulsivity, etc. Then there are the subtypes (e.g. Hyperkinetic Syndrome). As a result, it is often not entirely clearcut whether or not ADHD is the appropriate diagnosis.

I have seen patients who have been given the ADHD label based on behavioural, psychological, ‘medical’ or sociological features but rarely on a combination of all these. To put this in context, estimations on numbers of people with ADHD in the USA, UK, NZ and Australia vary between 5% percent of the population to 16%, depending on which criteria are used!

Symptoms of ‘inattention’:
 Poor attention or makes frequent careless mistakes
 Difficulty sustaining attention in tasks or play
 Difficulty listening when spoken to
 Difficulty following instructions or completing work
 Difficulty organizing tasks and activities
 Avoids tasks that require sustained mental effort
 Loses things necessary for tasks or activities
 Easily distracted by extraneous stimuli
 Forgetful in daily activities

Symptoms of ‘hyperactivity’:
 Fidgets frequently
 Difficulty staying in seat
 Runs excessively (subjective restlessness in adolescents/adults)
 Difficulty playing quietly
 Acts as though “driven by a motor”
 Talks excessively
 Blurts out answers before questions completed
 Difficulty awaiting turn
 Interrupts /Intrudes on others

Symptoms of ‘impulsivity’:
 Reckless, unthinking, impetuous and disinhibited
 Impatient, interruptive, and fail to wait their turn

Regarding theories of cause, neurological studies have shown some interesting results by looking at the electrical activity in areas of the brain responsible for the basic drives and subconscious arousal. One example is the limbic system. In some individuals with ADHD these areas are UNDER-active, suggesting that the frontal lobes and neo-cortex (which are the highly developed conscious areas responsible for inhibiting behaviours) are not being stimulated enough. This is evidenced by reduced bloodflow to and physical size of the frontal lobes in many patients diagnosed with ADHD. As a result, there is a deficit in inhibitory and regulatory mechanisms. This is the rationale behind treatment with drugs such as Ritalin, a CNS stimulant.

Interestingly, it is also a proposed mechanism behind the action of Osteopathic treatment for ADHD which is also geared toward stimulating these regions via increased bloodflow, cerebro-spinal fluid movement, and improved nerve function.

Genetic studies have identified a gene (called Dopamine D4) which is more prevalent in many ADHD individuals. This gene has been associated with novelty seeking, impulsivity, exploratory behaviour and excessive excitability. Dopamine is one of many neurotransmitters which act to transmit signals across synapses in nerve/ brain tissue. Another, noradrenaline, normally acts in balance with Dopamine to regulate activity in an area of the brain known as the Locus Ceruleus. This area is responsible for maintaining concentration levels and the drug, Clonidine, acts on receptors here to modify ADHD behaviours.

From a functional perspective, many patients with ‘ADHD-tendencies’ have demonstrably low levels of specific amino acids, used to manufacture neurotransmitters. Hence a nutritional approach is often warranted. This also includes looking at levels of essential fatty acids (EFA’s), used by the body in neurological development and maintenance, as well as levels of food additives to which the individual may be intolerant. Both children (with ‘ADHD’) and adults (with concentration problems/ poor memory) often report significant improvement following treatment to address EFA/ amino-acid deficiencies and this improvement can also affect associated conditions such as OCD, anxiety and depression.

The concept of ‘behavioural modification’ is a controversial one but there is no doubt that many individuals, children and adults, are functioning suboptimally because of ADHD-type behaviour patterns that can respond very effectively to an integrated treatment approach.

Interesting stats:

  •  10% of children who watch an average of 2.2 hours TV/day at age 1yr, and/or  3.6 hrs/week at age 3yrs, have attentional problems at age 7yrs
  • A 1-SD increase in number of hrs of TV at age 1yr is associated with a 28% increase in probability of attention problems at age 7yrs

Author:

David Propert, Osteopath at Calmer Clinics (Offering Cranial/ Paediatric Osteopathy)

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