ADD / ADHD
Treat ADD and ADHD without drugs.
A parent's first encounter with ADHD is usually through the school system. Behavior concerns are brought to a parent's attention by a teacher, usually by the third grade. Generally issues involve distractibility and restlessness during classroom activities.
Dr. Domenick Masiello is a licensed homeopath and osteopath.
The New York office is conveniently located in midtown Manhattan, and is close to many busses, subways and regional transit.
Formally AD/HD is defined in the Diagnostic and Statistical Manual, 4th edition (DSM-IV) as follows:
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through on instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring sustained mental effort
- Loses things
- Is easily distracted
- Is forgetful in daily activities
Hyperactive- Impulsive type
- Fidgets with hands or feet or squirms in chair
- Has difficulty remaining seated
- Runs about or climbs excessively
- Difficulty engaging in activities quietly
- Acts as if driven by motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting or taking turns
- Interrupts or intrudes upon others
- Individual meets both sets of inattention and hyperactive criteria
The first thing I explain to parents is that in medicine, "syndrome" or "disorder" means a collection of symptoms that often occur together but which do not have any known cause linking them. Such is the case with ADHD. There is no blood test, CT scan, or MRI which can tell us the cause of this disorder. We actually don't know if it is one disorder or several disorders that appear the same. ADHD used to be called "minimum brain dysfunction". Generations ago, children exhibiting these behaviors were labeled as "morally defective". Over the years the names have changed and we now screen, diagnose and medicate, however, beyond that not much else has changed.
The behaviors of ADHD are also the same behaviors one sees in childhood allergies. Pediatric allergist Doris Rapp, MD has many video case-studies documenting allergy related behavior changes in school-aged children. Her books are a must read for parents with a child diagnosed with ADHD. Please keep in mind that scratch testing for food allergies is not very useful. Blood testing (RAST) can be better for food allergies, although there is no perfect or complete allergy test. Testing is done only after a history and physical exam. Sometimes an elimination diet is needed to uncover hidden food allergies. ADHD behaviors are also exhibited by children with vision problems. One of the greatest short-comings of our education system is that we do not require proper vision screening. We need to go beyond an eye exam for just visual acuity (eye chart). Children need to be evaluated for visual tracking, fixation, focus change, binocular vision, visualization and visual-motor coordination. In my experience only behavioral optometrists are up to this task. They can perform a complete examination of your child's vision and perceptual skills and design a vision therapy program if needed. I have seen children with convergence insufficiency and restricted visual fields change dramatically after vision therapy. I refer all my patients with an ADHD diagnosis to Joseph Shapiro, OD for a complete eye exam.
Another disorder with a large overlap with ADHD is Sensory Integration Dysfunction. First described by occupational therapist and education psychologist Dr. A. Jean Ayres, children with sensory integration dysfunction have difficulties processing and integrating sensory input such as touch, taste, smell, sight and movement. These difficulties can be expressed as either an oversensitivity or an undersensitivity. Occupational therapists with special certification in Sensory Integration can test for and treat this disorder.
Lastly, some of the behaviors of ADHD are normal to children under the age of seven or eight. Children will grow and develop at different rates and when they encounter a classroom situation, they will stand out as "difficult". Let's face it, the behaviors of ADHD are problematic, in part, because they are not conducive to sitting quietly in a classroom. In this sense this "disorder" or "disease" is culturally relative. This is important because we place such a high premium on school performance as an predictor of success later in life. However, we should also realize that many people who were "poor students" go on to rich, rewarding lives when they can express their creativity in careers that do not rely so much on book learning.
It is difficult to evaluate the many theories of the causation of ADHD without actually knowing what the disorder is! The genetic versus environmental argument will continue indefinitely until we discover some definitive cause. On balance, I must say that there are some facts we know about ADHD. While there are no structural or anatomical abnormalities in the brain of an ADHD patient, there are functional or physiological differences. EEG recordings of ADHD patients often show a decrease in activity in the pre-frontal cortex. This is also true of SPECT scans (single photon emission computed tomography) of the brain. When asked to concentrate on a task the SPECT scan shows a decease in glucose utilization in the pre-frontal region of the brain. This is why a stimulant such as Ritalin would actually calm down a hyperactive child. It increases metabolic activity in the part of the brain need for attention and concentration. This also explains why using brain wave biofeedback to increase brain activity in the prefrontal part of the brain also works with ADHD children. Child psychiatrist and researcher Dr. Daniel G. Amen, MD has performed thousands of these scans on ADHD patients. His recent book describes 6 types of ADD and he notes that some types of ADHD can be made worse by stimulant drugs. Of course this doesn't explain why a child would have an under functioning pre-frontal cortex but its a start.
In conventional medical circles head trauma is viewed as a possible explanation for changes in behavior along with things like stroke and brain tumors. What is not appreciated by the conventional medical world is that many children, despite a "normal" delivery have suffered head trauma. This is also true of children born by c-section after many hours of labor. Cranial osteopaths can diagnose and treat these effects of trauma (strain patterns) in children. These patterns are decreases in the normal range of motion and function of the bones of the cranium and the soft tissue attachments to them. Although there is no specific pattern for ADHD virtually all children I have treated for ADHD have had significant cranial injury. Homeopathy is another modality that has shown great promise in the treatment of ADHD. Remedies are safe, non-toxic and work gradually over time to increase the capacity for attention and decrease restless behavior. With both osteopathy and homeopathy one sees improvement and less reliance on other supportive measures over time.
In summary, ADHD is a description of behavior without a known cause. The behaviors overlap other conditions and a better way to diagnose a child for ADHD would be to have a sensory integration evaluation by a qualified occupational therapist, a complete eye exam by a behavioral optometrist, an evaluation by a child psychologist or child psychiatrist and a consultation with an allergist. In my practice, I integrate homeopathy and osteopathy and favor other non-drug modalities such as biofeedback and vision therapy if indicated. If the ADHD behavior is related to multiple factors such as head trauma and allergies then homeopathy and osteopathy are used to treat both conditions. Stimulant drugs are a last resort not a first choice in my practice. Regardless of the medication selected the proper treatment of this condition involves education, social and emotional support, school, work and social skills training.
Useful References for children's health:
Ayres, A. Jean, Sensory Integration and the Child, Western Psychological Services, 1979
Kranowitz, Carol, Out-of-Sync Child, Berkley Publishing Group, 1998
Rapp, Doris, J., Is This Your Child?, William Morrow and Company, 1991.
Kavner, Richard, S., Your Child's Vision, Simon and Schuster, 1985.
Amen, Daniel, G., Healing ADD, G.P. Putnam, 2001
Ullman, Robert and Reichenberg-Ullman, Judith, Ritalin Free Kids, Prima Publishing, 2000. (homeopathic treatment of ADHD)
Block, Mary, Ann, No More Ritalin, Kennsington Publishing Corp., 1996.
Brief Article on Osteopathy and ADHD from The Osteopathic Center for Children in San Diego