The ADD Epidemic

by Ronald D. Whitmont, M.D.

Attention Deficit Disorder (ADD or ADHD, with hyperactivity) is the most common pediatric psychiatric disorder today. It involves an estimated 10 million children in the U.S. alone (up from 900,000 in 1990). At least two million new diagnoses of ADD/ADHD are made annually. The World Health Organization estimates that between 3?5% of all U.S. schoolchildren are taking a medication for this condition, which is five-fold more than the rest of the world combined.

ADD/ADHD is a term that defines a group of behaviors whose core symptoms include inattention, hyperactivity and impulsivity. There has been tremendous controversy lately regarding the use and overuse of this term and the appropriate intervention to address this behavior.

The definition of ADD/ADHD is derived directly from the Diagnostic and Statistical Manual of Mental Disorders (DSM) that is the handbook and bible of psychiatrists. This manual clearly defines the criteria that must be met before the diagnosis can be made. No one other than a skilled health care professional should apply this term without proper training, since doing so could lead to damaging social stigma and/or serious physical injury (even when applied "appropriately.")

There are medical and physical causes for some behavioral problems that may need to be ruled out before the diagnosis of ADHD can be determined, but there is no known biochemical or physiological cause for ADHD. There is no diagnostic test for ADHD and the determination must be made entirely on the basis of clinical history and the interview process.

There is a good deal of controversy surrounding the use of the term ADHD. Many physicians and health care professionals feel that these diagnoses are over-utilized. The behaviors of inattention, hyperactivity and impulsivity are normal in childhood and the epidemic of ADHD may represent a cultural challenge unique to modern times. Retraining young minds that have been raised with television, video games and the internet (with instant gratification and continual stimulation) may contribute to boredom and inattention when stimuli are withdrawn and replaced by a traditional schoolroom setting.

Many psychologists believe that behaviors like depression and ADHD can represent symptoms of family dynamics that have become overly stressful and difficult for children. Our society imposes a vast array of cultural stresses and the breakdown of the nuclear family unit may undermine a young child's ability to process and integrate these varied emotional stressors. An outlet for this stress may be behavior that runs against societal constraints and social standards.

The treatment of ADHD has polarized the medical community as well as the school systems. The current recommendations supported by the American Academy of Pediatrics calls for managing this syndrome (in the six-year old-and older) with the use of psychotropic medications such as the amphetamine, ritalin. The use of ritalin in all children has increased by an alarming 700% since 1990 and has quadrupled in the age group of two- to six-year-olds (where it is not approved for use by the FDA). This represents about four million children in the U.S. who take this drug. There are at least another 2.5 million children who take antidepressants (a number that recently doubled in preschoolers), and some are treated with a combination of both these drugs.

There are many cases where we have seen dramatic improvement in children who take these drugs, but many simply don't tolerate them due to untoward side effects, including impulsive and violent behavior, insomnia, loss of appetite, weight loss and growth retardation. We have scant information on the safety of these drugs in the older child and absolutely no information regarding their use in the younger child. There is no information on long term effects of these drugs and how they affect brain development in children. We simply don't know what they do in the long run.

In the midst of growing concern over drugs used for these behaviors, the Colorado State Board of Education passed a resolution in 1999 discouraging teachers from recommending behavioral drugs and encouraged them to use discipline and instruction to overcome problem behavior in the classroom. Apparently, the actions taken in Colorado stemmed (at least partly) from the realization that some of the teenagers taking part in the Columbine High School shooting were being treated with these drugs for behavioral problems.

There is good evidence that other modalities may be more efficacious (and safer than drugs) in treating ADHD. Biofeedback has received particular attention recently and a number of studies have found that a form of brainwave biofeedback is helpful in retraining some of the neurocognitive pathways involved in attention and behavior. Treatment may take several sessions, but it appears to be quite effective in the long run.

Individual and family therapy and counseling are effective in allowing for the expression and resolution of stress and conflict in the family. In many cases this approach may help individuals and families address the underlying factors that can predispose to some of these behaviors. The director for the International Center for the Study of Psychiatry and Psychology in Bethesda, Maryland has expressed concern that: "doctors have become too eager to prescribe psychotropic drugs at the expense of conversations among parents, teachers and children to learn why children are acting in antisocial ways."

Homeopathic treatment has been quite effective in gently and naturally altering the behaviors of ADHD. Homeopathic medicines are prescribed on the basis of a bio-psychosocial analysis and have shown promise in addressing these behavioral concerns in a dynamic fashion that stimulates growth and development (in contrast to the highly suppressive action of psychotropic drugs).
Nutritional interventions have been suggested, but there is still only limited data describing the rational use of supplements and vitamins in this area. Certainly, few could question the advantages of a balanced diet in supporting neurological growth and development.

Further research is clearly needed to determine what factors underlie the development of this group of behavioral disorders collectively known as ADD/ADHD. For the moment however, most experts recommend an eclectic approach to the child with these behaviors integrating psychosocial support with school, family and community, aligned with complementary modalities (and drug treatment, when indicated).

Our role as caregivers is to support the child with ADD/ADHD in a process of development and maturation, causing as little (or no) harm whenever possible; ensuring every chance to become an active, gifted, socially responsible future adolescent and adult.