The
ADD/ADHD,
Hyperactive and Impulsive Child:
Causes and Solutions
by
Toni Hager, NDS,
©1999
Today,
children are diagnosed ADD/ADHD, Hyperactive and Impulsive disorder in growing
epidemic proportions.
Is
there a root cause? Is it
genetic, environmental or maybe neurological? What are the solutions?
What are the long-term effects? This
paper will discuss the neurological aspects of ADD/ADHD.
ATTENTION
DEFICIT DISORDER (ADD)
The
label ADD or ADHD refers to children who are experiencing attending problems.
They are unable to "filter" out the extra "stuff".
Many of these children are hyper auditory, which means they hear the
plane 30,000 ft. up, the door slam next door, the hum of electricity in your
appliances or lights, the furnace or air conditioning come on.
Many things we don't
notice, like that flickering light on the ceiling fan, don't bother us, but
will drive the ADD child wild.
One of the reasons he/she doesn't stay in their seat is, unconsciously,
he/she is trying to get away from all the distractions.
It's not they don't have enough
attention; they have too much and don't know where to direct their attention.
|
Is it REALLY ADD or something else?
Alternative
Diagnosis—Maybe its not ADD |
|
Symptoms |
AD/HD
(DSM-IV) |
Sensory
Integration
Dysfunction (Kranowitz) |
Learning-related
Visual Problems
(Berne, Getz) |
Nutrition
Allergies
(Rapp, Sabley, Zimmerman) |
Normal Child
Under age 7 |
|
Inattention
(at least 6 necessary) |
|
Often fails to give close attention to
details or makes careless mistakes |
X |
X |
X |
X |
|
|
Often has difficulty sustaining
attention to tasks or play activity |
X |
X |
X |
X |
X |
|
Often doesn’t listen when spoken to
directly |
X |
X |
X |
X |
|
|
Often doesn’t follow through on
instructions or fails to finish work |
X |
X |
X |
X |
X |
|
Often has difficulty organizing tasks
or activities |
X |
X |
X |
X |
X |
|
Often avoids, dislikes or is reluctant
to engage in tasks requiring sustained mental effort |
X |
X |
X |
X |
X |
|
Often loses things |
X |
X |
X |
X |
X |
|
Often distracted by extraneous stimuli |
x |
x |
x |
x |
x |
|
Often forgets in daily activities
|
X |
X |
X |
X |
|
|
Hyperactive and Impulsive
(at least 6 necessary) |
|
Often fidgets with hands, feet or
squirms in chair |
X |
X |
X |
X |
X |
|
Often has difficulty remaining seated
when required to do so |
X |
X |
X |
X |
X |
|
Often runs or climbs excessively |
X |
X |
|
X |
X |
|
Often has trouble playing quietly |
X |
X |
|
X |
X |
|
Often “on the go” |
X |
X |
|
X |
X |
|
Often blurts out answers to questions
before they are completed |
X |
X |
X |
X |
X |
|
Often has difficulty waiting turns |
X |
X |
X |
X |
X |
|
Often interrupts or intrudes on others |
X |
X |
X |
X |
X |
Essentially,
the label ADD describes symptoms. The
child receives the label based on prolonged occurrences of four or more, of
the possible nine, symptoms before the age of seven.
These
symptoms are:
-
Often
fails to give close attention to details or makes careless mistakes in
schoolwork, work, or other activities;
-
Often
has difficulty sustaining attention in tasks or play activities;
-
Often
does not seem to listen when spoken to directly;
-
Often
does not follow through on instructions and fails to finish
schoolwork, chores, or duties in the workplace (not due to
oppositional behavior or failure to understand instructions);
-
Often
has difficulty organizing tasks and activities;
-
Often
avoids, dislikes, or is reluctant to engage in tasks that require
sustained mental effort ( such as schoolwork or homework);
-
Often
loses things necessary for tasks or activities (e.g., toys, school
assignments, pencils, books, or tools); is often easily distracted by
extraneous stimuli;
-
Is
often forgetful in daily activities;
-
Often
talks excessively.
ATTENTION
DEFICIT HYPERACTIVE DISORDER
The child who is ADD and also
demonstrates these symptoms are identified as ADHD:
-
Excessive activity is the
most visible sign
-
Often
fidgets with hands or feet or squirms in seat;
-
Often
leaves seat in classroom or in other situations in which remaining
seated is expected;
-
Often
runs about or climbs excessively in situations in which it is
inappropriate (in adolescents or adults, may be limited to subjective
feelings of restlessness);
-
Often
has difficulty playing or engaging in leisure activities quietly,
-
Is
often "on the go" or often act as if "driven by a
motor"
When
people think of impulsivity; they most often think about cognitive
impulsivity, which is acting without thinking.
The impulsivity of children with ADD or ADHD is slightly different.
These children act before thinking, because they have difficulty
waiting or delaying gratification. The
impulsivity leads these children to speak out of turn, interrupt others,
and engage in what looks like risk-taking behavior.
The child may run across the street without looking or climb to the
top of very tall trees. Although
such behavior is risky, the child is not really a risk-taker, but simply
has great difficulty controlling impulse.
Often, the child is surprised to discover that he or she has gotten
into a dangerous situation and has no idea of how to get out of it.
Below are some examples:
-
Often
blurts out answers before questions have been completed;
-
Often
has difficulty awaiting turns in games or other activities;
-
Often
interrupts or intrudes on others (e.g., butts into conversations or
games).
-
Many
adults demonstrate these symptoms but were never identified and
diagnosed.
Today,
these adults may have problems in relationships, always feel overwhelmed
or confused, or have trouble getting or holding a job. A high percentage
have drug and/or alcohol problems, never finished high school, or get
arrested by age sixteen. Our
prisons are full of individuals who are ADD/ADHD or Learning Disabled.
Traditional
solutions:
The
popular medical solutions seem to advocate drugging the individual with
amphetamines, which slow down the brain processes.
The two commonly prescribed drugs are Ritalin and Dexedrine.
These drugs affect the chemical make up of the brain (more
specifically, they raise dopamine levels).
This appears to give the person added attention span while in
actuality these drugs serve only to slow the brain function down, thereby
slowing down the learning and processing abilities.
Medications also put a toxic load on the body and can cause severe
damage to the vital organs. Second, so what is going on in the brain to
cause these symptoms?
According
to a report by the NIH (National Institute of Health), there are no
long-term studies of the effects of individuals on medications for more
than eighteen months; and, treatments are inconsistent.
Neurodevelopmental
causes:
The
root causes are in Neurological Dysorganization.
The brain's
job is to receive, process, store and utilize information gathered from
the environment. It gathers information through its three main sensory
channels of vision, auditory and tactile.
Impairments
such as near-sighted, far-sighted, astigmatism, a "lazy"
eye, or convergence problems, obviously effect the quality and quantity of
information the brain receives.
Many
children have a history of ear infections or fluid build-up due to food
sensitivities (see the Allergic Child Article) these hinder development of
normal receptive language (understand language) and expressive language
(spoken language). What they hear is muffled (like listening underwater),
distorted, inconsistent sounds or words, or they only hear certain
frequencies (usually low range). The
child really didn't hear the words or tone of the voice. The receptive
problem makes it difficult to follow directions, attend to what is said,
learn through verbal instruction, utilize phonics, and interact socially.
Expressive problems are reflected in articulation, resonation or phonation
difficulties.
In
the development of tactility, there are two common areas where problems
can occur. The first involves
the ability to appropriately process sensations of light touch, pressure
and pain; the second involves proprioception.
Proprioception is the brain=s
unconscious awareness of where the body is in space. When this stage is
skipped the brain is unlikely to know specifically where the body is, the
individual may bump into things, fidget or squirm around, and to a degree,
engage in physically dangerous activities without considering the
consequences.
To
determine if your child may have a problem with tactility, ask yourself
these questions. Does my child exhibit the above mentioned symptoms?
Does he have a high tolerance for pain (e.g., not knowing where he
got the bruises on his arms or legs after playing)?
Is the individual appropriately ticklish (not ticklish at all or so
ticklish they can=t
stand to be touched)? If your
answers are yes, your child may not have completed all of the
developmental levels dealing with proprioception.
Processing
(both auditory and visual) is another area that is often found to be
underdeveloped. Auditory and
visual processing affects the short-term memory.
This is the brain=s
ability to understand, categorize, and interpret its world.
A
child with low processing appears not to be listening to what is being
said, has difficulty following directions from others, is unable to remain
seated, is easily distracted, has a short attention span, shifts from one
activity to another never completing the previous ones, or loses things
easily. Many are "Driven
crazy" by certain textures, sounds, or tags in their cloths. Many are unable
to control their bladders, overeat or never get hungry, never complain
(the compliant child), and struggle to learn and function with daily life.
The brain is unable to hold together enough information to make sense of
it and react appropriately (see auditory and visual processing article).
Long-term
memory inefficiencies may also be an issue with the ADD/ADHD child.
This is related to a concept known as dominance.
Think
of dominance as the brain's file cabinets. If the child is right handed, then he/she should use the
right eye, ear, hand and foot to take in information as efficiently as
possible. Your stronger eye
or ear isn't necessarily
the dominant one. If for some
reason, he/she uses the opposite eye or ear, then that information is
stored on the opposite side of the brain (wrong file cabinet), sometimes
causing problems recalling that information.
An
alternative to medication is to look at what is causing the impulsivity,
and then eliminate it. Many
times food sensitivity are found to be an issue. Food sensitivities are
generally not as obvious as allergies, so they are often called the hidden
problem. Some times the child
is hyper sensitive to smell or odors.
Researchers
are now saying ADD is genetic or a neurotransmitter problem.
The dopamine levels that Ritalin react to is a neurotransmitter.
The brain utilized neural plasticity, redundancy and the branching
effect. This means another
area of the brain can take over the job of an area not working; and, that
each area of the brain is capable of performing more than one job. The
brain has a need for organized specific input which is provided by the
necessary frequency, intensity, and duration.
Fortunately,
developmental problems can be identified, addressed, and often eliminated.
It is important to remember that the symptoms are not the real problem.
It is essential to look at what is really causing these symptoms.
Once the root causes are identified, they can be addressed, and
eliminated. The way to
address and eliminate the causes is through specific stimulation.
Solution:
CAN
LEARN empowers parents with the knowledge, techniques, and expertise that
enable them to assume primary responsibility for their child's maximum growth and development. CAN
LEARN provides families with individualized home programs that can include
homeschool programs for children with labels like ADD/ADHD, Learning
Disabled, Dyslexic, Dysgraphic, Short-attention Span, Processing Disorder,
normal learner, accelerated, and gifted.
This
solution is obtained by determining the levels of development that have
been missed or underdeveloped. An individualized therapy program is then
written that will stimulate the brain and central nervous system to a
higher level of function. Re-evaluations are done every four months to
adjust and modify the program as the neurological dysorganization is
eliminated.
The
real tragedy is many individuals are attempting to cope with unidentified
neurological dysorganization that does not need to exist.
References:
-
American
Psychiatric Association, 1994, pp. 83-84
-
Jaquith,
J.M., The ADD/ADHD Child, Journal of the National Academy for
Child Development (1996) Vol. 10, No. 2)
-
Is
This Your Child?: Allergies and Your Family
Dr.
Doris Rapp , 2757 Elmwood, Kenmore, NY. 14217