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ADD, ADHD, LEARNING DISABILITIES, BEHAVIORAL DISORDERS
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DEFINING
THE PROBLEM
- From 1990-1995
there is a 250% increase in Ritalin (methylphenidate) use in the US.
- By
1997, there is a 700% increase in Ritalin use.
- About
80 percent of the 11 million prescriptions doctors write for
that medication each year treat childhood ADHD.
- The production
of Adderall and Dexedrine, also used to treat ADHD, has risen
2,000 percent in nine years.
- Spending
on ADHD drugs has increased 122% over the past two years.
The increasing
use of stimulant medication to treat ADHD in the United States differs
significantly from practices in the rest of the world. The U.S. produces
and consumes about 85 percent of the world's production of methylphenidate.
This recent
and dramatic increase suggests that disorders which fall into the Attention
Behavioral Continuum (ABC disorders) are not strictly genetic
problems.
A REAL
PROBLEM?
OR SIMPLY
A CONVENIENT VEHICLE FOR DRUG COMPANY PROFIT?
Interviews
with educators provided a resounding Yes. Experienced teachers
report a significant observational change in kids over the last 15 years,
noting a general global decrease in language and cognitive abilities.
Jane Healy,
in her book "Endangered Minds", investigated the
rise of ABC disorders. She found both overdiagnosis and overmedication,
but nevertheless identified this as a real problem that is getting
progressively worse.
She evaluated
standardized test scores for 4th graders, comparing the 1960s to 1980s,
and noted a huge decrease in the difficulty of the tests. Despite
this, scores decreased during this period, and continue to do so,
particularly in measurements of language skills and cognitive abilities.
- In
NYC, there is a 55% increase in Learning Disability diagnoses from 1983-1996.
- California
reported Autism diagnoses increased by 210% from 1987-1998
- other
states have shown 1000% increases.
- In
2000, 1 in 6 kids fall into the ABC spectrum
- 1
in 10 kids have some form of affective disorder.
Surgeon General
Satcher recently called for a complete overhaul in the nation's approach
to child mental health services. Only 1 in 5 ABC kids get any treatment,
mostly medication.
SCIENTIFIC
DATA: WHAT DO WE ACTUALLY KNOW?
ADHD and
most other learning disabilities seem to show
- decreased
activity in frontal lobes and other subcortical structures demonstrated
via PET scans and functional MRI, particularly in boys.
- Stimulant
medication, especially dopamine uptake inhibitors (Ritalin)
seem to improve symptoms, at least temporarily.
- Boys
are affected more than girls, in an 8:1 ratio, some estimates are
much higher.
- High
comorbidity (overlap) of symptoms: 50% of kids with one diagnosis
within the ABC have at least one other ABC diagnosis, and the majority
have more than one.
- Kids
are often on 3-5 different medications as a result.
No obvious
pathology exists in any of these kids.
- However,
the sensorimotor loop involving the prefrontal cortex, basal ganglia,
cerebellum, and thalamus demonstrates both decreased activity
and reduced anatomical size, particularly in the right brain
and the left cerebellum.
- Diagnoses
are typically vague, made with checklists from the DSM 4, involving
parental interviews and vague subjective symptoms. These stand as syndrome
disorders, based on groupings of symptoms only, the vast majority of
which overlap.
Recent thought
places these as a constellation of symptoms on a continuum, the Attention
Behavioral Continuum (ABC), comprising at least all of the
following:
- Attention
Deficit Disorder (ADD)
- Attention
Deficit Hyperactivity Disorder (ADHD)
- Learning
Disability (LD)
- Obsessive
Compulsive Disorder (OCD)
- Tourette's
Syndrome
- Pervasive
Developmental Delay (PDD)
- Asperger's
Syndrome
- Sensory
Integration Disorder (SID)
- Apraxia
and Apraxia of Speech
- Central
Auditory Processing Disorder (CAPD)
- Autism
All of these
are similar in their underlying neurological mechanism, involving the
prefrontal cortex, the basal ganglia, the thalamus and the cerebellum.
Three
typical cases:
- ADD/ADHD:
Boy with good verbal skills, a strong vocabulary, and grade-level math
skills. Met 14 of 18 criteria necessary for diagnosis. Hyperactive,
disorganized, did not listen to parents or teachers.
- Learning
Disability : Girl labeled as nonreader by age 8. Speech and language
delay, difficulty with word calling and retrieval, could not recall
letters or numbers and apply phonics.
- Autism:
Boy diagnosed at age 3. Never acquired language, nonverbal. Exhibits
many self-stimulating activities, hand-flapping and head-rocking. Little
or no eye contact, focuses in small objects or details.
These are
typically seen as 3 completely different disorders, with different genetic
etiologies, but their histories show more similarities than differences.
TYPICAL
EARLY HISTORIES
ABC
kids are predominantly born to mothers with histories of allergies
and/or immune difficulties, often with prenatal exposure to toxins or
pesticides.
They tend
to be breech births, with prenatal or neonatal oxygen deprivation,
cerebral swelling, or other birth injury, but no obvious
brain damage or disorder.
- They typically
manifest with colic or other digestive disorders, and
alternate between chronic constipation and diarrhea, and reflux
or projectile vomiting and pyloric stenosis.
- They tend
to present with allergies, asthma, thrush, yeast infections, and
progressive eczema.
- Most have
had immunization reactions of some kind, and tend to regress
or show significant slowing or stoppage of development at roughly 18
months.
- Often
show sleep disturbances, and regularly have some degree of decreased
muscle tone (hypotonia) and sensory processing difficulty.
YEARS
2-3
- Diet
becomes increasingly limited to wheat and dairy in every
combination. Tend towards hypersensitivity to foods and food textures.
- Manifest
with allergic symptoms, both dietary and environmental.
- Often
show abnormal eye movements, strabismus and nystagmus.
- Abnormal
or delayed crawling, often skip stages of crawling before walking.
- Clumsy,
with floppy or hypotonic movements. Often show toe-in or knock-kneed
gait patterns.
- Common
thread: all have some history of motor, digestive, sensory, and immunological
dysfunction.
- All appear
to be similar problems of varying degrees of severity.
HOW TO
EXPLAIN THE DIFFERENCES
Brain
Hemisphericity: All ABC disorders can be categorized as typically
right or left brain disorders.
Example: Attention
deficits exist for 2 reasons:
- Inability
to pay attention or fixate, which are right brain functions,
or
- lack
of intention, motivation and interest, which are functions of
the left brain.
All ABC disorders
can be categorized in a similar fashion, and which a much greater degree
of specificity than this.
THE GENDER
ISSUE: WHY MORE BOYS THAN GIRLS
Distinct
differences exist between male and female brains, and these are
accentuated in early development.
- Males
are typically right brain dominant, with a larger right frontal lobe.
- As a result,
adult males typically have better right brain skills than women.
Maternal
health is a necessary condition for appropriate fetal brain development.
Maternal hormonal levels during pregnancy (especially estrogen) appear
critical in this process for proper fetal male brain development.
- Females
tend to be better with left brain skills, such as language, calculation,
and so on.
- Females
also tend to have a much greater degree of brain symmetry than
males, with the primary asymmetry being a slightly larger left posterior
temporal lobe for speech and language access.
- As a result,
if they suffer some form of insult early in development, they will be
much more capable to compensate for this injury than will males.
- The male
brain thus appears to be much more susceptible to maternal
stress
than the female brain.
- Physical,
chemical, and emotional stressors all alter the maternal hormone
level, which tends to primarily affect male brain development.
Other than
hormonal influences, early brain development after birth is intimately
tied to the motor system, especially the cerebellum. Boys are more
affected by lack motor development than girls.
The majority
of ABC disorders involve the right brain, and males are much less
able to recover from an early right brain insult than females.
Language
disorders, which are generally more left brain issues, are
more evenly distributed between males and females. Males predominate
here as well, since the female brain in early development tends to
heal more quickly.
WHY THE
SUDDEN RISE OVER THE PAST 15 TO 20 YEARS?
Many teachers interviewed tie the rise in ABC problems to an
- overall
decrease in physical activity in kids.
- Children
in general are becoming much more sedentary.
- The rise
in ABC disorders correlates to the increase in juvenile obesity levels
(currently 24-35% of kid population, compared with only 12% in early
'90s).
Since
the advent of TVs, VCRs and computers, we have seen an increase
in anxiety and affective disorders that mirror the ADD increase. This
represents the adult manifestation of the same problem.
- Motoricity
appears to be the key to appropriate brain development.
- Motoricity
and cognition are essentially the same process, as we shall explain
later.
The most
common "answers" to this problem have been genetics
and imbalances in neurotransmitters. These "answers" appear
too simplistic.
The next
articles in this series will deal with the following issues:
- the uniqueness
of the human brain and bipedalism,
- the brain
hemispheres,
- motoricity
and cognition,
- the consequences
of sedentary lifestyle (decreased motor activity),
- the manifestations
of imbalance between the brain hemispheres,
- the brain
and the contemporary American diet,
- Dr. Z's
"All Possibilities!" program,
- BHSC
(Brain Hemisphere Specific Chiropractic),
- Interactive
Metronome and more.
Some references:
- ADD/ADHD Symposium, Robert Melillo, DC, DACNB and the Carrick Institute for Graduate Studies, 2002.
- Neurobehavioral Disorders of Childhood, Robert Mellillo and Gerry Leisman, Kluwer Academic/Plenum Publishers 2004
- I of the Vortex, Rodolfo R. Llinas, MIT Press 2001
- Synaptic Self, Joseph Ledoux, Viking 2002
- Principles of Neural Science, Kandel, Schwartz, Jessell, McGraw-Hill 1991 and 2000
- Brain Asymmetry, Richard J. Davidson, Kenneth Hugdahl, MIT Press 1996
- Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV)
- Survival of the Busiest, Sharon Begley, Wall Street Journal article, 10/11/2002
Please
review Dr. Z's "All
Possibilities!" program!
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©
Peter M. Zeischegg, MS, DC, DACNB 2013 |
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