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21 July 2008

Beyond Ritalin

Attention deficit-hyperactivity disorder is believed to affect 8-12% of school-aged children worldwide. Yet some experts say it's over-diagnosed and too often treated with Ritalin.

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Attention deficit-hyperactivity disorder (ADHD) is a complex syndrome believed to affect between 8% and 12% of school-aged children worldwide.

However, there's a school of thought – well argued by psychologist Richard DeGrandpre, author of Ritalin Nation – that the condition is over-diagnosed. And the current gold standard drug in terms of treatment – Ritalin (methylphenidate) – is controversial.

Ritalin is a central-nervous-system stimulant highly effective in treating symptoms of ADHD, which include hyperactivity, inattention and/or impulsivity. It can have nasty side effects, including insomnia, depression, decreased appetite, headaches, drowsiness, cramps and convulsions. The drug has – rarely, but shockingly – also been cited in cases of psychosis, mania and cardiovascular problems in children.

There has also been some concern that Ritalin may trigger long-term changes in the brains of young children. In laboratory studies involving young rats, scientists have found changes in the brain areas that control higher executive functioning, addiction and appetite, social relationships and stress. HealthDay reports that these changes gradually disappeared as the rats were taken off the drug.

While science makes up its mind, many parents are wary of Ritalin. And, of course, there are other approaches to managing ADHD that do present options.

Health24 caught up with Dr Murray Rushmere, a medical doctor and homeopath from Cape Town, to find out how he treats children who display ADHD symptoms – without using psychotropic drugs.

A different take on things
It's clear Rushmere doesn't agree with conventional wisdom regarding ADHD: ‘In my opinion, ADHD is almost too broad a series of symptoms to be limited to a single clinical diagnosis with a single treatment,’ he says.

Instead, he believes the series of symptoms that typically make up the diagnosis often point to multiple causes. ‘These comprise the real illness, so to speak.’

We don't know exactly what causes ADHD, but it's believed that a combination of genetic and environmental factors is at play. Rushmere is certain, however, that the causes differ from individual to individual: ‘If you take 10 people with ADHD, each will have a different story,’ he says. So he believes each child should be treated individually.

ADHD is often a result of disturbance in the home, Rushmere says, although other factors in the environment also frequently play a role. ‘For some children, the symptoms are reversible if you take some of these factors into account, and find solutions for them.’

Hasty diagnosis
Rushmere feels that the ADHD diagnosis is often made hastily, mostly because the symptoms are uncomfortable in a society which prefers uniformity. For example, if a child is disruptive and impulsive in the classroom, it could make him unpopular among teachers and fellow learners. It can also have a negative impact on the child's academic performance. This would be disturbing to both the child and to his or her parents.

‘In this context, it's easy to see why there's such an urgency to treat the perceived problem as a condition,’ Rushmere says. ‘We want everyone to do well in the conventional way.’

As a result, drugs are probably more frequently prescribed than is strictly necessary, he believes. ‘These drugs are generally effective at the level where you want them to be: for example, they will make the child less disruptive and impulsive. So it's very tempting to go this route.’

Rushmere agrees that the drug has a place. But he shares the concern that it might affect a child's long-term direction. Some of the greatest figures in history, including Mozart and Winston Churchill, might have been put on Ritalin if the drug existed in their time, he says. ‘ADHD is often a symptom of sensitivity and intelligence. The question is: would Churchill have gone on to win the Nobel Prize if he was put on Ritalin? The drug brings short-term gains, but how can we be sure that we're not changing the course of the child? We want them to conform, but are we not curbing their creativity in the process?’

Treatment: a step-by-step approach
Rushmere believes that symptoms such as hyperactivity and inattention could be the result of other, possibly reversible causes. To find and treat these causes, he usually goes through the following process:

1) He first sets out to determine whether the child really experiences hyperactivity, inattention and/or impulsivity.

2) He then looks at possible problems in the child's environment. This may include conflict in the home, personal issues, or problems at school. These are addressed first.

3) Then the child's diet is assessed. Every child reacts differently to certain foods, but a tendency to hyperactivity and poor concentration is often exacerbated by sugar, as well as certain colourants, flavourants and preservatives. If he thinks these are contributing to the problem, Rushmere advises parents to cut these from the child's diet. He also often prescribes an omega-3/omega-6 fatty acid supplement.

4) Where appropriate (for example, if a child has poor muscle tone), Rushmere refers the child to an occupational therapist. Other forms of body work, such as kinesiology, are also sometimes recommended. ‘Where a deep reflex has been blocked due to over-stimulation of the nervous system, kinesiology can help settle it down,’ Rushmere explains. Some patients also respond well to a technique called ‘dry brushing’, where the skin is rubbed with a dry, natural-bristle brush for a few minutes. According to Rushmere, this also settles down the nervous system.

5) Finally, Rushmere explores homeopathic remedies. ‘The ADHD symptoms are often merely a sign that the child's constitution is off balance. If you then give them their constitutional remedy, the symptoms of hyperactivity and poor concentration settle.’ He explains that psychotropic drugs suppress symptoms, and don't treat underlying imbalances. The opposite is true for homeopathy.

According to researchers from the Children's Hospital Boston, the initial evidence for some emerging complementary and alternative therapies, such as essential fatty acid supplementation, yoga, massage, homeopathy and green outdoor spaces, suggests potential benefits as part of an overall ADHD treatment plan. "But more rigorously designed studies are needed to evaluate their effectiveness as single therapy for ADHD," write researchers Neal Rojas and Eugenia Chan in a study extract on Pubmed.gov.

Rushmere advises concerned parents to seek professional help, but, he says: ‘Also evaluate your own value systems: do you simply want your child to conform? Do a bit of soul-searching,’ he says. ‘Then seek out a homeopath, a kinesiologist and/or an occupational therapist to assist your child. Just make sure the child is treated as an individual.’

- (Carine van Rooyen, Health24, July 2008)

Read more:
ADHD guide

 
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