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"She has a remarkable ability to engage in a task. We use her as a model for the other kids, to show them what we want out of the journaling project," said my daughter's nursery school teachers as we sat together on diminutive, paint-splotched furniture. Rather than feeling self-satisfaction at her stellar "performance," my mind wandered to the greater issue at hand here: what is happening to children, how are we being manipulated by industry to interpret it, and how can awareness be raised around better solutions other than ADHD medications for kids.
A candid and uncharacteristically provocative piece entitled the Selling of Attention Deficit Disorder ran in the NY Times, as part of an effort to raise this awareness. The article discusses the making of an epidemic, much as Robert Whitaker, author of Anatomy of an Epidemic and host of Mad in America, has in his efforts to expose the manufacturing of a profit-driven machine into which our children are being fed. The Times article begins with a bird's eye view of the alarming statistics:
Centers for Disease Control and Prevention show that the diagnosis had been made in 15 percent of high school-age children, and that the number of children on medication for the disorder had soared to 3.5 million from 600,000 in 1990.
And goes on to state that,
Behind that growth has been drug company marketing that has stretched the image of classic A.D.H.D. to include relatively normal behavior like carelessness and impatience, and has often overstated the pills' benefits.
This post will focus on ADHD, but Psychiatry is like a blob consuming as much of our population as it can. From 1994 to 2003, for instance, there was an 8,000% increase in children 0-19 treated for Bipolar Disorder. Critics have implicated direct to consumer advertising (only legal in the US and New Zealand) including comics for kids, financial courtship of doctors who claim to be beyond influence, ghost-written, and pharmaceutically funded research, and paid key opinion leaders positioned to dismiss safety concerns. Psychiatric studies funded by pharma are 4x more likely to be published if they are positive, and only 18% of psychiatrists disclose their conflicts of interests when they publish data.
Psychiatry is particularly susceptible to industry corruption because of the highly subjective, non-biological, impressionistic nature of diagnostic criteria. With our "governing body" the American Psychiatric Association heavily funded by pharmaceutical companies, the temptation is all too great to open the diagnostic umbrella to encompass behavioral criteria like "makes careless mistakes" or "often has difficulty waiting his or her turn."
Perhaps we are all susceptible, as a society, to Pharma's courtship; however, because the notion of a popping a pill, and a hyper-simplified diagnostic label of illness allows us to reduce an incredibly complex and multi-etiologic syndrome into the linear "A medication for B disease" model we have come to love in America.
The trouble with psychiatry is that we are using open-label, short-term studies to justify life-long treatments. We have lost all ability to appreciate the natural course of an illness, if we want to call it that, and the realities of long-term efficacy and cumulative burden of side effects. A longitudinal NIMH study, the only one of its kind, demonstrated that after an initial decrease in ADHD symptoms, at three years, there was deterioration in the medicated group, and by six, worse attentional and behavioral symptoms than unmedicated controls, and increased functional impairment. Despite claims that stimulant side effects are "generally mild," data accumulated by psychiatrist Dr. Peter Breggin has demonstrated quite the opposite. He cites studies that demonstrate concerning risks for:
- Motor and vocal tics
- Addiction, withdrawal and rebound
- Growth suppression
- Adverse cardiovascular effects
- Mania, suicidality, psychosis
and explores the premise of creating brain pathology, that Whitaker and others have also expressed grave concern about. He cites a study by Nasrallah et al in which more than 50% of treated young adults experienced PET confirmed brain atrophy, concluding "cortical atrophy may be a long-term adverse effect of this treatment." In rhesus monkeys, Wagner et al demonstrated long-term changes to dopamine levels and receptor density, related to compensatory changes the brain undergoes in the setting of chronic intoxication. Subjects abstinent from stimulants for three years were found to have persistent dopamine-related brain changes on PET scans, related to Parkinsonian pathology.
When we interfere with behavior and brain growth, when we force children to conform to our needs as busy, distracted, and often chronically ill adults, we may be fundamentally compromising their expression of self, as Breggin cites Greenough et al:
Spontaneous or self-generated activities–play, mastery, exploration, novelty seeking, curiosity, and zestful socialization-are central to the growth and development of animals and humans and necessary for the full elaboration of CNS synaptic connections.
I treat many women on the other end of this negligent spectrum of reckless prescribing, when I try to help them taper off of stimulants before pregnancy, and in some cases, am unable to do so because of the dependency and subsequent withdrawal that emerges.
I would like to peel back the layers of this complexity so that we can take a collective glimpse into what may actually be going on with our children (and adults!) and discover what tools parents have at their disposal before they pick up the phone to that psychiatrist.
Here's what I want to tell parents to think about when it comes to underlying drivers of symptoms, drivers that a stimulant – in no way – addresses. This list will focus on toxic exposures, most derived from diet. Amazingly, this review of dietary treatment for ADHD encompasses data establishing efficacy of diets ranging from ketogenic to Feingold, to low sugar, but still claims that, "In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients."
I disagree and would state that dietary modification towards a whole food, high natural fat, no grain diet represents first-line intervention.
- Sugar – Pick up a food product marketed to a child population and you will inevitably see one to four types of sugar listed in the ingredients. From infant formula to endless processed snacks, to sodas and juices, our children are pushed into reactive hypoglycemia and insulin resistance by this onslaught. The behavioral effects of high and low blood sugar, cortisol, and insulin account for energy levels, agitation, and hyperactivity, but there is a more insidious process at work: sugar causes inflammation and suppresses a growth factor in the brain called BDNF. Soda and processed food have been linked to academic errors, inappropriate behavior and violence according to research by David Hemenway. Cumulative, long-term effects of sugar on the brain are fast becoming a leading model for Alzheimer's, confirmation of the brain-based starvation that occurs in the setting of chronic exposure.
- Gluten – Not only an inducer of inflammation and autoimmunity including brain-based autoantibodies, it also contains opiate-like compounds called gliadorphins. Gluten-containing foods are almost always processed for increased insulin provocation and made with genetically-modified vegetable oils. Read more about its brain effects here. Consider eliminating all grains (corn, wheat, rye, millet, barley, oats, etc.) and dairy (a cross-reactant) for one month.
- Genetically modified/Glyphosate-sprayed foods – We now know that the herbicide genetically modified foods are designed to withstand is wreaking havoc on our guts. Our children are vulnerable to this chemical that decimates beneficial bacteria, produces ammonia, binds minerals, interferes with hormone-managing enzymes, and metabolism of other environmental toxins. Responsible Technology has guides to GMO-free shopping; also consider including fermented foods like sauerkraut (even just the juice) and lacto-fermented pickles in your child's diet.
- Food dyes and additives – Banned in Europe, these food additives may be exacerbating cognitive function: Blue #1 and #2 food coloring; Green #3; Orange B; Red #3 and #40; Yellow #5 and #6; and sodium benzoate, a preservative. Relatedly, monosodium glutamate and aspartame are excitotoxins that drive neurochemical changes and behavioral symptoms consistent with attentional impairment and hyperactivity.
- Ultrasound in pregnancy – There is an accumulating body of evidence that implicates ultrasound technology, in its current unstudied application (in frequency and intensity), in the development of abnormal brain structure. I discuss recent data supportive of this concern in a recent blog post entitled Perils of Peaking Into the Womb: Ultrasound Risk.
Vaccination – Neurobehavioral abnormalities stemming acutely or subacutely from vaccine-exposure have been compensated and reported. Putative mechanisms include brain-penetrant additives such as polysorbate 80, and adjuvants such as aluminum and mercury.A primate study done with an unvaccinated control group, concerningly demonstrated delayed acquisition of neurodevelopmental reflexes in the thimerosol (ethylmercury-forming preservative) Hep B vaccinated group (particularly in those with low birth weight and gestational age) relative to the unexposed group, and another rhesus placebo-control (saline) study found that the vaccinated experienced changes in amygdala growth and opiate binding.Studies such as this, along with another one that determined a 9x greater risk for receipt of special educational services in boys receiving the pre-2001 Hep B vaccine series, raise questions about a connection. We are now learning that there may be no "safe dose" of these metals and that a synergy between environmental chemical exposures and multiply administered vaccines may be more dangerous than previously expected.
By no means a gold-standard study, but a much needed vaccinated vs unvaccinated comparison California survey commissioned by Generation Rescue found that: Among more than 9,000 boys age 4-17, the survey found vaccinated boys were two and a half times (155%) more likely to have neurological disorders compared to their unvaccinated peers. Vaccinated boys were 224% more likely to have Attention Deficit Hyperactivity Disorder (ADHD), and 61% more likely to have autism.For older vaccinated boys in the 11-17 age bracket, the results were even more pronounced. Vaccinated boys were 158% more likely to have a neurological disorder, 317% more likely to have ADHD, and 112% more likely to have autism.
7. Deficiencies and nutrient stress
B vitamins: Deficiencies of B vitamins can arise from dietary restriction – for example, lack of B12 in the setting of animal-protein limited diets and from compromised utilization related to genetic variants such as the MTHFR gene and associated methylation defects. Methylation appears to play a highly relevant role in production of neurotransmitters, pruning, myelination, and DNA expression.
Iron: A real Goldilocks mineral, iron is a mineral that is a critical cofactor for neurotransmitter production, vital for brain oxygenation and thyroid hormone utilization. Studies linking iron stores to ADHD have been equivocal, but researchers argue for brain-based assessments such as this MRI study which identified critical deficiencies in the thalamus of those diagnosed with ADHD. Low serum ferritin has been linked to symptoms of ADHD and also to increased dosing of stimulants for effect.
8. Thyroid - Functional thyroid deficiency can result from autoimmune attack of the gland, iodine/nutritional deficiency, or peripheral resistance. Poor access to active thyroid hormone in utero may result from iodine deficiency. Exposure to endocrine disrupting chemicals such as pthalates and bisphenol A may also serve to impair thyroid hormone trafficking resulting in a diagnosis of ADHD in the child. Others recommend looking beyond a standard TSH screening to assess for peripheral resistance and low free hormone levels in these children.
Control for these exposures (try it for a month!), consider benign functional-medicine based interventions, homeopathy, and even neurofeedback, but please consider sparing your child from the relentless cycle of medications begetting medications, long-term inefficacy, and potentially irreversible side effects. Apologies, fines (57.5 million levied against NJ-based pharmaceutical company Shire, maker of blockbuster ADHD drug Adderall), and acknowledgement of pharmaceutical corruption of pediatric health is too little too late. We are going to look back on this era of child drugging with shame and humility, I predict, so I encourage you to begin that discovery process now.