An Epidemic of ADD or a Matter of Overdiagnosis? Does ADD Really Exist?

Thomas Armstrong, Ph.D., in his controversial
book The Myth of the ADD Child, insists that ADD is a diagnosis
aimed at forcing children to behave in a particular, narrowly
defined manners.² He claims that children have different learning
styles, respond to stress in various ways, and that the condition
has been radically overdiagnosed and overtreated. He encourages
a wide variety of nondrug interventions including adjustment of
the classroom setup, more kinesthetic learning, project-based
learning, martial arts classes, visualization, and meditation.

A similar viewpoint is held by Peter
Breggin, M.D., author of Toxic Psychiatry and The War Against
Children. Dr. Breggin, a psychiatrist who refuses to prescribe
Ritalin for his patients diagnosed with ADD, holds a strong belief
that there is no evidence that symptoms associated with ADD constitute
a diagnosis or a mental disorder. He voices strong concerns about
the possibly damaging long-term effects of Ritalin.³

Still a third health professional,
child psychiatrist Dr. Stanley Greenspan, writes in his book The
Challenging Child that a number of attention problems are
due to visual, auditory, motor, and special processing difficulties.
Children with all of these individual difficulties, according
to Dr. Greenspan, are often misdiagnosed with ADD.⁴

As homeopathic physicians, we do
not believe that it is helpful to lump so many people with widely
differing symptoms into one syndrome and treat them all with similar
drugs. Having seen several hundred children with mild to major
behavioral, learning, and attitude problems, we believe that these
children need to be handled as individuals with unique problems
rather than treated stereotypically. We also favor a treatment
approach, homeopathy, that lasts for months or years, not just
a few hours.

What About Neurotransmitters?

Most physicians and mental health
professionals attribute ADD to an imbalance in transmitters within
the brain, often serotonin. Many studies have attempted to correlate
ADD with specific neurotransmitter abnormalities. A group of researchers
from the University of Georgia reviewed these neuroanatomical,
neurochemical, and neurophysiological theories and studies.⁵ They
concluded that although there is evidence of neurological differences
in children diagnosed with ADD,
no definitive mechanism has been found for these differences.
The authors recommended a differential diagnosis of ADD, learning
disability, and conduct disorder. They suggest that it may be
more accurate to view the syndrome as a cluster of various behavioral
deficits, including attention, hyperactivity, and impulsivity,
which share a common response to psychostimulants. In other words,
a neurotransmitter imbalance is an impressive way to explain ADD,
but remains questionable.

One correlation which is clear to
us is the increasingly rapid pace of our highly technological
society and a growing number of children diagnosed with ADD.
We live in an extremely overstimulated society. Children spend
hours playing Nintendo rather than romping through the woods or
playing outside. Many are glued to the television set. Movies
are speedier, scarier, and more violent than ever before. There
is a growing atmosphere of hurriedness, intensity, and urgency.
Many children and teenagers do not leave home without their beepers
for fear of missing something for even a moment. We eat fast,
play fast, and channel-surf. We eat in fast-food restaurants known
to decorate their premises in jangly colors so that their customers
will eat quickly and move on to make space for the next shift.
People look for caffeine and drugs of all kinds to make them go
faster and stay up longer. They buy double espressos to pick them
up more quickly. They use highly caffeinated amphetamine-like
herbs, including ma huang and guarana, that contain seven times
as much caffeine as coffee. Our society places little value on tranquillity, quiet,
solitude, and the simple joy of being in nature.

Biofeedback is one method to induce
deep relaxation by altering brain waves through selective reinforcement.
Some have found biofeedback to be helpful for ADD,
but the need for frequent treatments may put it economically out
of reach for many children and adults.

Is ADD a Dietary Problem?

Parents often tell us that their
child’s behavior is considerably worse the morning after Halloween
or after any sugar binge. Their perceptions have recently been
supported by researchers at the Yale University School of Medicine.
They found that within a few hours after substantial sugar intake,
children release large amounts of adrenaline, which causes them
to experience shakiness, anxiety, excitement, and concentration
problems. Their brain waves also indicated a decreased ability
to focus.⁶

As naturopathic physicians
with considerable training in nutrition, we are appalled that
the per capita intake of sugar is over 130 pounds per year in
this country and that children are the worst fast-food junkies.
Many of the parents of our ADD child patients are very nutritionally
aware and have had their children tested for food and environmental
allergens. Those children we have seen, despite eliminating cow’s
milk, wheat, and other foods from their diets, have not experienced
a consistent and significant improvement in behavior or learning.
Some parents have tried the Feingold dietary approach, which eliminates
foods with natural salicylates, artificial colors,

flavorings, additives, and preservatives.
Yet a review of the literature indicated that the Feingold diet
has helped only a small percentage of children with ADD.⁷ In those
cases where allergies and sensitivities to additives are a major
problem, it is helpful to remove or restrict them. A healthy diet
which emphasizes whole, natural foods is likely to benefit the
health of any child or adult with ADD and is a useful part of
the total treatment plan.

Yet both in examining the scientific
literature concerning diet and ADD and in interviewing parents
of children with ADD, we have found correlations between ADD and
sugar consumption, ingestion of food additives and colorings,
and food allergies, and hypoglycemic and anti-yeast diets, to
affect some children and not others. We have not found that changing
a child’s diet has nearly as consistent, profound, and lasting
impact on behavioral and learning problems as homeopathic treatment.
Dietary approaches undoubtedly do work for some children, but
not for many others. We admit that children who have enjoyed a
great improvement in behavior strictly from dietary change are
not likely to turn up in the office of a homeopath unless their
dietary measures stop working and the parents seek out an alternative
other than dietary intervention.

How true are criticisms like those
of Drs. Armstrong and Breggin that the overdiagnosis of ADD is
a means for teachers and parents to stultify children’s freedom
and individuality? It is true that some teachers are excessively
rigid and wish to run their classrooms like a military academy.

These are the same teachers who bring
the parents of any unruly child in for a conference and put pressure
on them to put their children on stimulant medications. It is
also true that many classrooms have more children than the teacher
can possibly handle, and that some of these children are frighteningly
violent and exhibit an antipathy to learning. However, other teachers
sincerely wish to create more relaxed learning environments in
which imagination and creativity are fostered. They, too, often
find a growing number of restless, disruptive children who find
it next to impossible to concentrate.

Try telling the parent of a child
with full-blown ADD, who has tried every possible learning style
including home schooling, that the diagnosis is all in the mind
of the child’s teacher and that her child just needs a less structured
learning environment. That parent may look at you in disbelief,
insist that her child live with you for a week, and then see what
you think.

Gifted or Hyperactive?

One group of children that may be
included in the diagnostic category of ADD but which has very
specific needs is precocious children with ADD-like symptoms.
If you had an IQ of 150 and a photographic mind, how would you
feel about being in a regular fourth-grade classroom? You would
probably be bored to tears unless your teacher created special
activities and outlets for your unusual intellectual capabilities.
You might tap your pencil on your desk, design paper skyscrapers,
or invent a magical world of dinosaurs. Then when the teacher
called on you . and Hobbes.. . cops! Sounds a lot like Calvin

James Webb and Diane Latimer address
this dilemma: “In the classroom, a gifted child’s perceived
inability to stay on task might be related to boredom, curriculum,
mismatched learning style, or other environmental factors. Gifted
children may spend from onefourth to one-half of their regular
classroom time waiting for others to catch up-even more if they
are in a heterogeneously grouped class.”⁸ They point out
that because a gifted child may demonstrate ADD-like behaviors
in some settings and not others, one classroom teacher may diagnose
her with ADD while the other teachers do not. The authors recommend
individual evaluation followed by appropriate curricular and instructional
changes to account for advanced knowledge, diverse learning styles,
and various types of intelligence. Such individual evaluation
is exactly what homeopathy has to offer.

We have seen many children who are
the spitting image of their parents. They may share one or both
parents’ behavioral and learning styles. We often hear that the
mother or father also had difficulty with reading or concentration,
but was never diagnosed as having ADD and somehow made it through
school. We have seen little boys with the same explosive tempers
and total lack of patience as their type A fathers. We have also
seen many a child whose restlessness and inability to concentrate
ran through all of the siblings in the family. You will see

this phenomenon reflected in some
of our case histories later in the book.

Many experts have documented a hereditary
aspect to ADD. We saw one child whose chief problem was absentmindedness
in spite of intellectual brilliance. All he wanted to do was to
read about atoms and quarks and to contemplate the boundlessness
of the universe. His father was the same way: brilliant, but he
could barely remember to change his socks. His father’s father
was a renowned educator who had had a number of car accidents
because he couldn’t be bothered to keep his car on the road. They
were like carbon copies of each other.

Yet we see other children whose tantrums,
violence, and excessive restlessness seem to come out of nowhere.
They may have very mellow parents who have limited their children’s
exposure to guns, sugar, and violent movies and who have raised
them in a very loving, safe environment-and they still behave
like wildcats.

Even if they have two parents with
ADD and eat sugar all day, some children will develop ADD and
others will not. What can account for this disparity? Homeopaths
believe that the reason some children and adults suffer from ADD
and others do not lies in susceptibility. If you ask the parent
of a child with ADD when he first noticed problem behaviors or
tendencies in his child, he will likely say from infancy or toddlerhood.
Such a child may have been hyperalert and have tendencies to wake
frequently during the night, to be fussy and hard to satisfy,
to run as soon as he could walk, and to climb all over the furniture
as soon as he was mobile. This predisposition

to ADD-like behavior often occurs
at a very tender age. Homeopaths frequently observe that this
predisposition or susceptibility depends on the constitution of
the individual from birth and may even be affected by the state
of the parents prior to conception and during pregnancy.

How is this susceptibility passed
on? Genetically? Homeopaths recognize these common traits among
parents and children and hypothesize that there is some mechanism
which we do not yet understand for these impressions or threads
to be passed on generationally.Researchers at the University of
California, Irvine recently reported finding the first abnormal
gene associated with ADD. The gene controls dopamine receptors
in the brain. Children with a more severe form of ADD have an
abnormality of this gene, causing less sensitivity to dopamine,
a neurotransmitter. Ritalin is known to stimulate dopamine release,
perhaps accounting for the drug’s efficacy.⁹

Most important to the homeopath are
the unique tendencies or predispositions of the individual child
or adult, regardless of what specifically may trigger the susceptibility.
The phenomenon of susceptibility varies from individual to individual
and cannot be stereotyped. But the individual can be carefully
listened to and deeply understood. And from this understanding,
a homeopathic medicine can be matched to the individual which
will shift that susceptibility and bring the person into balance.

Our conclusion, which is not particularly
surprising given that we are homeopaths, is that each child or
adult with ADD is individual. The cause of his ADD is no more
stereotypical than his symptoms. Other than saying that anyone
with ADD must have a predisposition to it, be it hereditary or
environmental, we believe it is fruitless to ascribe all of the
individual ADDs to one causative factor. Even if researchers conclude
that every person with ADD has a deficiency or excess of one specific
neurotransmitter, it is still an observation and not the underlying
cause of the problem.

References

2. Thomas Armstrong, Ph.D., The Myth of the ADD Child (New
York: Dutton, 1995).

3.The Merrow Report, op.cit.

4. Stanley, Greenspan, Ph.D., The Challenging Child (Reading, MA: Addison-Wesley,
1995).

5. C.A. Ricco et al., “Neurological
Basis of Attention Deficit Hyperactivity Disorder,” Exceptional
Children, 60 (1993): 118-124.

6. Journal of Pediatrics, February,
1996 cited in Well BeingJournal, May/June 1996.

7. E.H. Wonder, “The Food Additive-Free Diet in the Treatment of
Behavior Disorders: A Review,” Developmental and Behavioral
Pediatrics 7 (1986):35-42.

8. James T. Webb and Diane Latimer,
“ADHD and Children Who are Gifted,” ERIC Digest,
#E522, 1993.

9. Study Links Gene Abnormality
to Hyperactive Children,” Seattle Times, May 1,1996.