Paediatrics: Focus on ADHD

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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)


LESS CAN BE MORE

lessmore

Current economic woes aside (enough already!) much of the stress experienced in families is actually self-inflicted – due to our overwhelming emphasis on achieving: achieving success at work; achieving success for our children; achieving ownership of all the stuff we want – stuff for the home, stuff for each other, stuff for the children; achieving status; achieving social skills; achieving advantages; achieving achievements!

Those of us who are parents spend huge amounts of time scheduling activities for our children so that they will achieve. Our goal is for them to excel, and own personal fears of under-performance and not being good enough fuel the energy, time and money we put into striving for the ‘perfect life’ for our children. Unfortunately, what we also achieve in this process is instilling a belief in our children that we don’t think they’re good enough.

PARENTING-CALMER-CLINICS

We live in a society where most of the emphasis is placed on having and doing, while little, if any, is placed on being. Sadly this results in children who feel inadequate, only accepted and loved for what they achieve, rather than for who they are. We seem to have forgotten the order in which true and sustained growth and fulfilment occurs; we must first be the unique individuals we are in order to successfully dowhat we have the most potential for, and what we do will lead naturally to what wehave. (In other words, being, doing and having happens in that order.)

There are some key areas where we tend to let achievement oriented parenting (doing and having) take over, resulting in oft-unnecessary stress for both ourselves and our children. In my many years of counselling parents and children, I have found that ask yourself the following questions can be helpful;

How are decisions about education and your children’s future reached?

  • Are you pushing a child to attend a specific school, educational method or direction even though it might not suit that particular child? Do you help your children (I.e. with homework) because you are afraid they might not do a good enough job?
  • Spend some time exploring your values as a parent; what is really important? Explore your motives for helping out and ‘rescuing’ your child. Remember that childhood is not a performance– it is a work in progress.
  • Spend time listening to your children, ask them their opinion about things, what they worry about, and what dreams they have. Really listen to their answers. Have no expectations; discover who your children really are. 
  • Try to eliminate the word ‘should’ from your vocabulary. Appreciate and enjoy your children as they are.

Why does your child participate in extra curricular activities, such as athletics?

  • Are your children playing sports because they love the games – or because they are focused on winning? Do your children have enough time daily to play unsupervised with friends and to spend time with family?
  • Explore your own motives for any tendency you might have to over-schedule your child’s life. What does being a winner or being socially successful mean to you?
  • Consider cutting back on extra-curricular activities and replace at least one with focused time spent with you and/or the whole family; play a board game, go swimming or running, spend time with no specific purpose. Spending time with children without any purpose other than to be together, demonstrates to them that you love them for who they are rather than what for they can achieve.

Shifting the focus generally from doing and having to being, can be a refreshing and de-stressing change for the whole family. Try some of these tips for simplifying your lives and experiencing more being, less doing and having:

  • Don’t answer the phone (and turn off your laptop, iPad, and the TV) when you’re spending focused time with your children.
  • Cut all extra-curricular activities to two days a week.
  • Limit computer games, TV and videos/DVDs to one hour a day, max!
  • Sit down to a family mean once a day if possible, or at the very least 3 days a week, with all technology switched off.
  • Teach your children to spend ‘quiet time’ every day. Show them the pleasure of watching the night sky or being in nature, even if it’s planting some potted herbs.
  • Restrict the purchase of toys and games to special occasions.
  • Have the whole family clean up and give away all you haven’t used for a year.
  • Become aware of trying to change others, and try not to – especially your children and your mate!

By: Jennifer Day

Jennifer Day is a consultant, coach and founder of Applied Emotional Mastery® She specialises in working with parents and leaders, and has written six books, several of which are available at Calmer Clinics, where she also has a practice.

She can be contacted at Jennifer@AppliedEmotionalMastery.com