ADD and Naturopathic Medicine

ADD and Naturopathic ADD and Naturopathic MedicineMedicine

©Dr. Kevin Passero 2004©Dr. Kevin Passero 2004

Dr. Kevin Passero, N.DDr. Kevin Passero, N.D

203 Ridgely Ave203 Ridgely Ave

Annapolis, Md 21401Annapolis, Md 21401

443-433-5540443-433-5540

Naturopathic MedicineNaturopathic MedicineWhat is it?What is it?

Naturopathic Medicine blends Naturopathic Medicine blends centuries-old natural, non-toxic centuries-old natural, non-toxic therapies with current advances in the therapies with current advances in the study of health and human systems. study of health and human systems.

The Six PrinciplesThe Six Principles

1) The Healing Power of Nature.1) The Healing Power of Nature. Naturopathic Doctors believe that the Naturopathic Doctors believe that the natural state of the body is to be natural state of the body is to be healthy. Our jobs are to help the patient healthy. Our jobs are to help the patient identify and remove obstacles to healing identify and remove obstacles to healing and allow the body to heal itself.and allow the body to heal itself.

The Six PrinciplesThe Six Principles

2) Identify and Treat the Causes. 2) Identify and Treat the Causes. The Naturopath seeks to identify and The Naturopath seeks to identify and remove underlying causes of illness, remove underlying causes of illness, rather than to merely eliminate or rather than to merely eliminate or suppress symptoms.suppress symptoms.

Symptoms as messengersSymptoms as messengers Naturopathic Medicine attempts to find Naturopathic Medicine attempts to find

the underlying cause of the patient’s the underlying cause of the patient’s condition.condition.

Much of modern medicine, conventional Much of modern medicine, conventional and alternative is focused on symptom and alternative is focused on symptom management. Often this means management. Often this means neglecting the possibility of an neglecting the possibility of an underlying cause.underlying cause.

Symptoms are messengers, and what Symptoms are messengers, and what happens when we shoot the messenger? happens when we shoot the messenger? We don’t know from where the message We don’t know from where the message came.came.

The Six PrinciplesThe Six Principles

3) First Do No Harm.3) First Do No Harm.

The Naturopathic Doctor implements The Naturopathic Doctor implements this third rule with the following this third rule with the following preceptsprecepts

Utilize methods and medical substances which Utilize methods and medical substances which minimize the risk of harmful side effects.minimize the risk of harmful side effects.

Avoid when possible the harmful suppression of Avoid when possible the harmful suppression of symptoms.symptoms.

Acknowledge, respect and work with the Acknowledge, respect and work with the individual’s self-healing process.individual’s self-healing process.

The Six PrinciplesThe Six Principles

4) Doctor As Teacher.4) Doctor As Teacher. As Doctor’s we not only believe it is our As Doctor’s we not only believe it is our

job to help people improve their health, job to help people improve their health, it is also our job to educate them so it is also our job to educate them so they can be responsible for their own they can be responsible for their own health as well.health as well.

Encouraging self-responsibility for Encouraging self-responsibility for one’s health is a major goal for the one’s health is a major goal for the Naturopathic Doctor.Naturopathic Doctor.

The Six PrinciplesThe Six Principles

5) Treat the Whole Person5) Treat the Whole Person This is achieved by taking into account This is achieved by taking into account

individual physical, mental, emotional, individual physical, mental, emotional, genetic, environmental, social and spiritual genetic, environmental, social and spiritual factors.factors.

The Six PrinciplesThe Six Principles

6) Prevention6) Prevention Prevention involves assessing individual Prevention involves assessing individual

risk factors, heredity and susceptibility to risk factors, heredity and susceptibility to disease and making appropriate disease and making appropriate interventions in partnership with the interventions in partnership with the patients to prevent illness.patients to prevent illness.

How are ND’s trained?How are ND’s trained?

Naturopathic Medical colleges are Naturopathic Medical colleges are four-year, graduate level medical four-year, graduate level medical schools with admission requirements schools with admission requirements comparable to those of other comparable to those of other medical schools. The Doctor of medical schools. The Doctor of Naturopathic Medicine degree (ND) Naturopathic Medicine degree (ND) is awarded after classroom, clinic is awarded after classroom, clinic and practical study. and practical study.

ND’s are trained in medical ND’s are trained in medical sciences includingsciences including

AnatomyAnatomy NeurologyNeurology PathologyPathology ObstetricsObstetrics PharmacologyPharmacology Lab diagnosisLab diagnosis CardiologyCardiology BiochemistryBiochemistry Minor surgeryMinor surgery

ImmunologyImmunology PediatricsPediatrics Clinical and Clinical and

physical diagnosisphysical diagnosis PhysiologyPhysiology RadiologyRadiology MicrobiologyMicrobiology GynecologyGynecology DermatologyDermatology

What NDs doWhat NDs do

Clinical NutritionClinical Nutrition

This refers to both the practice of using This refers to both the practice of using food to heal people and using food to food to heal people and using food to maintain optimal health.maintain optimal health.

Nutritional supplements are often employed Nutritional supplements are often employed to further help people optimize nutritional to further help people optimize nutritional intake for their particular needs.intake for their particular needs.

What NDs DoWhat NDs Do HomeopathyHomeopathy

Homeopathy is a form of medicine that Homeopathy is a form of medicine that uses extremely diluted preparations of uses extremely diluted preparations of substances to cure illness.substances to cure illness.

As a medicine, it is unparalleled in its As a medicine, it is unparalleled in its ability to effect people on a physical, ability to effect people on a physical, mental and emotional level while at the mental and emotional level while at the same time having virtually no side effects same time having virtually no side effects or drug interactions.or drug interactions.

What NDs DoWhat NDs Do

Botanical MedicineBotanical Medicine

Plant substances are safe and Plant substances are safe and powerful tools in the treatment of powerful tools in the treatment of many illnesses. many illnesses.

Most modern pharmaceuticals are Most modern pharmaceuticals are originally derived from plant originally derived from plant compounds.compounds.

The Egg of The Egg of HealthHealth

ADD/ADHDADD/ADHD

And Naturopathic And Naturopathic PhilosophyPhilosophy

ADD/ADHD- What is it?ADD/ADHD- What is it? ADD/ADHD is classified by the Diagnostic ADD/ADHD is classified by the Diagnostic

and Statistical Manual of Mental Disorders – and Statistical Manual of Mental Disorders – Fourth Edition as a mental disorder primarily Fourth Edition as a mental disorder primarily characterized by a “persistent pattern of characterized by a “persistent pattern of inattention and/or hyperactivity – impulsivity inattention and/or hyperactivity – impulsivity that is more frequent and severe than is that is more frequent and severe than is typically observed in individuals at a typically observed in individuals at a comparable level of development.”comparable level of development.”

ADD/ADHD can be considered as a broad ADD/ADHD can be considered as a broad collection of processing errors and disorders collection of processing errors and disorders in the nervous system. in the nervous system.

The part of the brain controlling focus and The part of the brain controlling focus and concentration is slowed down or concentration is slowed down or dysfunctional. dysfunctional.

ADD/ADHDADD/ADHD

1 in 5 U.S. boys takes a controlled 1 in 5 U.S. boys takes a controlled stimulant medication for the stimulant medication for the management of ADD/ADHD symptomsmanagement of ADD/ADHD symptoms

Between 9 and 12 million children Between 9 and 12 million children currently are diagnosed with ADD or currently are diagnosed with ADD or ADHDADHD

Over 350 million doses of Ritalin are Over 350 million doses of Ritalin are distributed each day in the United Statesdistributed each day in the United States

Why Boys?Why Boys?

It is speculated that boys are more It is speculated that boys are more susceptible to conditions like susceptible to conditions like ADD/ADHD and Autism because of ADD/ADHD and Autism because of the interaction between testosterone the interaction between testosterone and mercuryand mercury

Why Boys?Why Boys?

The main routes of exposure to mercury The main routes of exposure to mercury are via thimerisol containing vaccines and are via thimerisol containing vaccines and mercury found in food. mercury found in food.

The CDC recently released data showing a The CDC recently released data showing a 2.4% increase in the risk of Autism if you 2.4% increase in the risk of Autism if you have received thimerisol containing have received thimerisol containing vaccines.vaccines.

The government considers anything that The government considers anything that results in a 2% increase in the chance of results in a 2% increase in the chance of getting a condition to be causal.getting a condition to be causal.

Central Issues in Central Issues in ADD/ADHDADD/ADHD

The Adrenal Glands and Cortisol The Adrenal Glands and Cortisol RegulationRegulation

Blood Sugar RegulationBlood Sugar Regulation

Gastrointestinal Health and FunctionGastrointestinal Health and Function

Proper Elimination and DetoxificationProper Elimination and Detoxification

The Adrenal The Adrenal Glands and Glands and

CortisolCortisol

Cortisol, What is it?Cortisol, What is it?

A steroid hormone released from the adrenal A steroid hormone released from the adrenal glands to increase energy in response to glands to increase energy in response to stress.stress.

Under times of stress the body needs more Under times of stress the body needs more energy. Cortisol is released in an effort to energy. Cortisol is released in an effort to provide this energy.provide this energy.

The energy derived from cortisol is a result of The energy derived from cortisol is a result of its ability to stimulate the body to release its ability to stimulate the body to release glucose into the blood.glucose into the blood.

Cortisol and Daily RhythmsCortisol and Daily Rhythms

What does Stress MeanWhat does Stress Mean

A stress related rise in cortisol can be A stress related rise in cortisol can be triggered by physical stress triggered by physical stress (strenuous exercise, surgeries and (strenuous exercise, surgeries and physical trauma), mental stress physical trauma), mental stress (school, work, money), and emotional (school, work, money), and emotional stress (relationships, family etc.)stress (relationships, family etc.)

Large fluctuations in blood sugar also Large fluctuations in blood sugar also elicit a cortisol response elicit a cortisol response

Cortisol and ADDCortisol and ADD

Is it high or is it low?Is it high or is it low?

Cortisol and ADDCortisol and ADD Many children with ADD already have a Many children with ADD already have a

significant physiologic stress that significant physiologic stress that predisposes them to the condition. predisposes them to the condition. Coupled with daily stress of family life Coupled with daily stress of family life and school these kids are usually in a and school these kids are usually in a state of cortisol imbalance.state of cortisol imbalance.

Overall Adrenal function is not optimal Overall Adrenal function is not optimal due to overexertion. The situation can due to overexertion. The situation can be likened to burning a candle at both be likened to burning a candle at both ends. ends.

The Adrenal GlandThe Adrenal Gland

The Adrenal ConnectionThe Adrenal Connection

Cortisol is essential for normal functioning of Cortisol is essential for normal functioning of human physiology. Without proper cortisol human physiology. Without proper cortisol regulation energy levels, sleep cycles, regulation energy levels, sleep cycles, immune function and mental capabilities will immune function and mental capabilities will all be compromised. all be compromised.

Secondly, as chronic stress persists the Secondly, as chronic stress persists the portion of the adrenal gland responsible for portion of the adrenal gland responsible for cortisol production can hypertrophy in an cortisol production can hypertrophy in an effort to keep up production. This in turn effort to keep up production. This in turn compromises the ability of other areas of the compromises the ability of other areas of the adrenal gland to function at optimal levels.adrenal gland to function at optimal levels.

The Adrenal ConnectionThe Adrenal Connection

It is hypothesized that Ritalin’s It is hypothesized that Ritalin’s therapeutic effect results from it’s therapeutic effect results from it’s ability to increase availability of ability to increase availability of dopamine levels.dopamine levels.

Dopamine is a precursor to Dopamine is a precursor to important neurotransmitters like important neurotransmitters like epinephrine and norepinephrine.epinephrine and norepinephrine.

A major producer of epinephrine and A major producer of epinephrine and norepinephrine is the inner medulla norepinephrine is the inner medulla of the adrenal gland.of the adrenal gland.

The Adrenal ConnectionThe Adrenal Connection

Cortisol and ADDCortisol and ADD

Many people wonder why a stimulant Many people wonder why a stimulant medication like Ritalin helps calm an medication like Ritalin helps calm an already hyperactive personalready hyperactive person

It is because there adrenal function is It is because there adrenal function is low to begin with and their natural low to begin with and their natural physiologic stimulus is already lowphysiologic stimulus is already low

The hyperactive behavior observed is a The hyperactive behavior observed is a compensatory mechanism in an effort compensatory mechanism in an effort to reach a normal functioning stateto reach a normal functioning state

Blood Sugar and Blood Sugar and ADD/ADHDADD/ADHD

Simple Carbs and Simple Simple Carbs and Simple SugarsSugars

BreadsBreads PotatoesPotatoes PastaPasta Processed Processed

GrainsGrains Some FruitsSome Fruits

Refined Refined SugarSugar

Juice Juice CandyCandy Junk FoodsJunk Foods SodaSoda

Simple CarbsSimple Carbs

Simple carbohydrates are almost Simple carbohydrates are almost immediately broken down by the immediately broken down by the body into simple sugarsbody into simple sugars

This results in a rapid influx of sugar This results in a rapid influx of sugar into the blood streaminto the blood stream

The Physiology The Physiology

The sudden increase in blood sugar The sudden increase in blood sugar triggers a sharp increase in insulin triggers a sharp increase in insulin secretion, which in turn rapidly secretion, which in turn rapidly lowers the sugar level in the bloodlowers the sugar level in the blood

Blood Sugar and InsulinBlood Sugar and Insulin

Blood Sugar and ADDBlood Sugar and ADD

High sugar levels can itself be High sugar levels can itself be activating and can trigger activating and can trigger hyperactive behavior. hyperactive behavior.

Secondly, the quick release of Secondly, the quick release of insulin that leads to low sugar levels insulin that leads to low sugar levels worsens low brain arousal levels of worsens low brain arousal levels of ADD subjects and aggravates ADD subjects and aggravates behavioral problems.behavioral problems.

Take Home MessageTake Home Message

EAT MORE PROTIEN, BENEFICIAL EAT MORE PROTIEN, BENEFICIAL FATS AND FRESH VEGEATABLESFATS AND FRESH VEGEATABLES

Optimal Blood Sugar Optimal Blood Sugar CurveCurve

Back to CortisolBack to Cortisol

We know cortisol is the key hormone We know cortisol is the key hormone that triggers the body to increase blood that triggers the body to increase blood sugar levels.sugar levels.

So this pattern of hypoglycemia serves So this pattern of hypoglycemia serves as a further stress on the adrenal glands. as a further stress on the adrenal glands.

The The Gastrointestinal Gastrointestinal

SystemSystem

What does our GI system What does our GI system have to do with our brains?have to do with our brains?

Our GI SystemOur GI System

Our GI system is our barrier to the Our GI system is our barrier to the outside worldoutside world

It’s job is to act as a selective filterIt’s job is to act as a selective filter

Something does not truly enter our Something does not truly enter our

body until it passes the cells of the body until it passes the cells of the intestinal wallsintestinal walls

Our GI SystemOur GI System

DigestionDigestion

Incomplete digestion of proteins can Incomplete digestion of proteins can result in the production of large result in the production of large molecular by-products.molecular by-products.

Incomplete vs. CompleteIncomplete vs. Complete

DigestionDigestion

Some of these more complex structures are Some of these more complex structures are not easily utilized by the body and have a not easily utilized by the body and have a difficult time passing through the cell difficult time passing through the cell membrane.membrane.

This means less absorption of nutrients.This means less absorption of nutrients.

DysbiosisDysbiosis

Our GI tract is normally inhabited by more Our GI tract is normally inhabited by more than 500 species of micro-organisms.than 500 species of micro-organisms.

These micro-organisms play a large role in These micro-organisms play a large role in the defense of our GI system and in the the defense of our GI system and in the breakdown of food products.breakdown of food products.

They also metabolize food products into They also metabolize food products into vitamins and amino acids that feed the cells vitamins and amino acids that feed the cells of the intestine.of the intestine.

DysbiosisDysbiosis

Incompletely digested structures, like Incompletely digested structures, like the one in my diagram, can not be easily the one in my diagram, can not be easily utilized by our beneficial gut bacteria. utilized by our beneficial gut bacteria.

However, bad bacteria have special However, bad bacteria have special urase enzymes that can break these urase enzymes that can break these structures down. structures down.

The ProblemThe Problem

The break down of these structures by The break down of these structures by urase enzymes cause ammonia by-urase enzymes cause ammonia by-products to be produced.products to be produced.

Elevated ammonia blood levels have been Elevated ammonia blood levels have been measured in children with Autism, ADD measured in children with Autism, ADD and ADHD.and ADHD.

Ammonia is a neurotoxin and further Ammonia is a neurotoxin and further impairs neurological function. impairs neurological function.

DysbiosisDysbiosis

Supplementation with beneficial gut Supplementation with beneficial gut flora and the use of digestive flora and the use of digestive enzymes help to optimize enzymes help to optimize gastrointestinal function.gastrointestinal function.

Diet and Food Diet and Food SensitivitiesSensitivities

A large body of medical literature has A large body of medical literature has indicated that hidden food allergy is a indicated that hidden food allergy is a frequent cause of a wide range of physical frequent cause of a wide range of physical and mental conditions. and mental conditions.

Furthermore, although the concept of hidden Furthermore, although the concept of hidden food allergy remains controversial, the food allergy remains controversial, the evidence strongly suggests that identification evidence strongly suggests that identification and avoidance of allergenic foods can relieve and avoidance of allergenic foods can relieve a number of common and difficult to treat a number of common and difficult to treat medical problems. medical problems.

Common AllergensCommon Allergens

Common foods that cause reactions are dairy Common foods that cause reactions are dairy products, sweeteners, corn, wheat, yeast, products, sweeteners, corn, wheat, yeast, orange, soy, peanut, beef and chicken. orange, soy, peanut, beef and chicken.

Wheat and CaseinWheat and Casein

Some incomplete digestion by-products, like Some incomplete digestion by-products, like the ones from wheat and casein, have the ones from wheat and casein, have molecular structures that mimic opiod like molecular structures that mimic opiod like molecules in the body. These opiod like molecules in the body. These opiod like structures can exert effects on the neurological structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHDsystem and aggravate symptoms of ADD/ADHD

Some trials show as much as an 80% Some trials show as much as an 80% improvement in ADD/ADHD symptoms with improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from just the elimination of wheat and casein from the diet.the diet.

Some incomplete digestion by-products, like Some incomplete digestion by-products, like the ones from wheat and casein, have the ones from wheat and casein, have molecular structures that mimic opiod like molecular structures that mimic opiod like molecules in the body. These opiod like molecules in the body. These opiod like structures can exert effects on the neurological structures can exert effects on the neurological system and aggravate symptoms of ADD/ADHDsystem and aggravate symptoms of ADD/ADHD

Some trials show as much as an 80% Some trials show as much as an 80% improvement in ADD/ADHD symptoms with improvement in ADD/ADHD symptoms with just the elimination of wheat and casein from just the elimination of wheat and casein from the diet.the diet.

Inflammation and Food Inflammation and Food SensitivitiesSensitivities

Low level allergic reactions to food Low level allergic reactions to food serve as a constant source of serve as a constant source of inflammation in the GI tract.inflammation in the GI tract.

Inflammation of the GI tract causes a Inflammation of the GI tract causes a compromise in the tight junctions of compromise in the tight junctions of cells. This allows for the easy cells. This allows for the easy passage of large molecules directly passage of large molecules directly into the circulatory system. into the circulatory system.

Our GI SystemOur GI System

ConsequenceConsequence

This constitutes a compromise of our This constitutes a compromise of our selective filter and barrier.selective filter and barrier.

We now have environmental toxins, We now have environmental toxins, mercury, digestive waste and large mercury, digestive waste and large proteins passing directly into the proteins passing directly into the circulatory system.circulatory system.

Food SensitivitiesFood Sensitivities

The elimination of irritants is The elimination of irritants is essential in the restoration of tight essential in the restoration of tight junctions and GI integrity. junctions and GI integrity.

RecapRecap

Eliminate food allergies and inflammation Eliminate food allergies and inflammation to restore integrity of filterto restore integrity of filter

Improve digestion to enhance nutrient Improve digestion to enhance nutrient absorption and eliminate incompletely absorption and eliminate incompletely digested protein by-productsdigested protein by-products

Establish strong colonization of beneficial Establish strong colonization of beneficial micro-organisms like acidophilus and micro-organisms like acidophilus and bifidus speciesbifidus species

Essential Fatty Essential Fatty AcidsAcids

Omega 3 and Omega 6Omega 3 and Omega 6

Essential Fatty Acids are compounds in Essential Fatty Acids are compounds in our body essential for proper our body essential for proper functioning. functioning.

They can not be synthesized by the body They can not be synthesized by the body so they must be obtained via the dietso they must be obtained via the diet

Essential Fatty AcidsEssential Fatty Acids

All cells in our body are enveloped by All cells in our body are enveloped by membranes primarily composed of membranes primarily composed of essential fatty acids. essential fatty acids.

Proper functioning of this membrane Proper functioning of this membrane is necessary for the health of our is necessary for the health of our cells.cells.

The American DietThe American Diet

The average American Diet provides a The average American Diet provides a ratio of about 300:1 Omega 6 to Omega 3 ratio of about 300:1 Omega 6 to Omega 3 fatty acids.fatty acids.

The ideal ratio for our bodies in about The ideal ratio for our bodies in about 5:1. 5:1.

Omega 3 acids are severely lacking in an Omega 3 acids are severely lacking in an average diet.average diet.

Omega 3Omega 3

Some of the highest concentrations Some of the highest concentrations of Omega 3 fatty acids are found in of Omega 3 fatty acids are found in the brain and nervous system.the brain and nervous system.

There has been encouraging There has been encouraging research revealing improvement of research revealing improvement of ADD/ADHD symptoms with proper ADD/ADHD symptoms with proper Omega 3 supplementation.Omega 3 supplementation.

Where are the good fats Where are the good fats found?found?

Cold water fish is the best source of Cold water fish is the best source of Omega 3 fatty acids.Omega 3 fatty acids.

Beneficial fats are also found in Beneficial fats are also found in freshly shelled nuts, flax seeds, and freshly shelled nuts, flax seeds, and avocadoes.avocadoes.

Ample sources of these fats should be Ample sources of these fats should be a part of every diet.a part of every diet.

A Case StudyA Case Study

14 year old male presenting to the 14 year old male presenting to the clinic with a pervious diagnosis of ADDclinic with a pervious diagnosis of ADD

Mom reports problems at home with Mom reports problems at home with fighting with siblings, not staying on fighting with siblings, not staying on task and lots of mouthing offtask and lots of mouthing off

School reports slipping grades, not School reports slipping grades, not staying focused during class and staying focused during class and problems with teachersproblems with teachers

Initial Treatment PlanInitial Treatment Plan Modify diet to eliminate all dairy products Modify diet to eliminate all dairy products

and sources of refined sugar. This meant and sources of refined sugar. This meant no juice, soda pop or candy. no juice, soda pop or candy.

Coached mom about cooking with more Coached mom about cooking with more whole foods like fresh organic vegetables, whole foods like fresh organic vegetables, whole grains and quality meatswhole grains and quality meats

Also discussed importance of a good Also discussed importance of a good breakfastbreakfast

Initial Treatment PlanInitial Treatment Plan

Support Adrenal GlandsSupport Adrenal Glands. This was . This was done with a multiple B-vitamin complex done with a multiple B-vitamin complex and a regime of going to bed at the and a regime of going to bed at the same time every night and waking up same time every night and waking up at same time every morning. at same time every morning.

Further support for cortisol rhythms Further support for cortisol rhythms was achieved with an essential fatty was achieved with an essential fatty acid supplement that help modulate the acid supplement that help modulate the growth hormone/cortisol interaction. growth hormone/cortisol interaction.

Treatment Plan Cont..Treatment Plan Cont..

150 mg of magnesium once a day.150 mg of magnesium once a day.

Daily supplementation with beneficial GI Daily supplementation with beneficial GI micro-organisms.micro-organisms.

Homeopathic Remedies to aid the body in Homeopathic Remedies to aid the body in the breakdown and elimination of toxins.the breakdown and elimination of toxins.

We also advised mom to discontinue topical We also advised mom to discontinue topical cortisone cream for a small patch of eczema cortisone cream for a small patch of eczema on his leg.on his leg.

1 month follow-up1 month follow-up Little change in overall behavior. Things still Little change in overall behavior. Things still

seem to be getting worseseem to be getting worse

The child was very good about taking the The child was very good about taking the supplements and adjusting to the new diet supplements and adjusting to the new diet without much complaintwithout much complaint

Patch of eczema getting slightly worsePatch of eczema getting slightly worse

Homeopathic remedies changed and patient Homeopathic remedies changed and patient advised to continue protocol for 1 more monthadvised to continue protocol for 1 more month

2 month follow up2 month follow up

Behavior starting to improve. Mom Behavior starting to improve. Mom notices better ability to stay on task notices better ability to stay on task at home and less talking backat home and less talking back

Child comments that he feels he can Child comments that he feels he can now think before he speaks or acts.now think before he speaks or acts.

Treatment protocol continued for 1 Treatment protocol continued for 1 more month more month

3 month follow up3 month follow up

Mom can not believe it is the same Mom can not believe it is the same child. Home life dramatically better, child. Home life dramatically better, school life greatly improved.school life greatly improved.

Child feels it is easier to concentrate Child feels it is easier to concentrate and does not feel as agitated as he and does not feel as agitated as he used to. Overall feels calmer and in used to. Overall feels calmer and in more control.more control.

Dr. Kevin Passero, N.DDr. Kevin Passero, N.D

203 Ridgely Ave203 Ridgely AveAnnapolis Md 21401Annapolis Md 21401

443-433-5540443-433-5540