ADD ADHDMisdiagnosis and Mistreatment

Monika Buerger, D.C.

ADD and ADHD—such

commonly used diagnoses

in today’s world that they

have virtually become

a part of every teacher’s

vocabulary list. But is this

“mental disorder” as com-

mon as we have been lead

to believe, or is it often a

misdiagnosis?

Psychological Evaluation

Unfortunately, too often parents arebeing intimidated by schools/teach-ers to have their child undergo a psy-chological evaluation either throughthe school district, a pediatrician, or a psychiatrist. Perhaps the child is more energetic, lethargic, or lacksconcentration compared to his/her“normal” peers; therefore, the childis hastily slapped with a label of possible ADD or ADHD and there is a predisposed bias going into suchan evaluation. Parents are made tofeel that such evaluations are neces-sary in order for their child to receivea proper education and are oftenmade to feel guilty if they refuse tohave their child subjected to such an

evaluation. It may be of interest toknow that if a child is diagnosed withADD or ADHD, they are consideredlearning-disabled and the school will receive extra money from thestate and federal government whichis to be used for special learning programs. However, the school is not held accountable for how thatmoney is actually spent Furthermore,the diagnosis may be noted in thechild’s permanent school records asa “mental disorder” and follows thechild throughout life.

Medication Therapy

If the child is diagnosed as havingADD or ADHD, chances are sometype of psychotropic drug will be recommended. However, parentsmust educate themselves as to theside effects and necessity of suchmedications. Methylphenidate, commonly known as Ritalin, wasresponsible for 186 deaths between1990 and 2000 as reported by theFDA MedWatch; a voluntary report-ing program accounting for no more than 10-20% of actual incidences.One of the dangers with this drugis that it causes constriction of the veins and arteries; thus, causing the heart to work harder leading toirreversible damage. Increased heartrate, increased blood pressure, andirregular heart beat, along with other

cardiac disorders can be the result.There have also been studies thatsuggest exposure to Ritalin andother stimulant (psychotropic) prescription drugs makes the brainmore susceptible to addictive drugssuch as cocaine and doubles the risk of cocaine abuse. The increasedrisk of suicide and depression hasalso been linked to the use of Ritalinand other such stimulants.

Conditions that Mimic ADD/ADHD

Before accepting a diagnosis of ADD/ADHD other conditions that mimic thisdiagnosis must be ruled out. Childrenwith allergies and asthma may havedifficulty breathing which could leadto difficulty concentrating. Foods(especially dairy products), molds,and chemical odors such as the smellof tar or perfume are common butunsuspected causes. An abundance of yeast caused by repeated coursesof antibiotic use can also be a prob-lem. Sudden unprovoked aggressionin children can be related to allergiesand is often associated with red earlobes, wiggly legs, dark circles underthe eyes, or a “demonic” look.Behavior may include hitting, biting,kicking, spitting, and punching.

ADD ADHDBefore accepting a

diagnosis of ADD/ADHD

other conditions that

mimic this diagnosis

must be ruled out.

continued on page 4

pathways 3

Monika Buerger, D.C.

Diabetes and hypoglycemia can make the child appear distracted and lacking concentration. Childrenwith hypoglycemia can experiencerecurrent fatigue, irritability, tension, hyperactivity, and aggres-sion. Complex carbohydrates foundin vegetables and whole grains help to avoid hypoglycemia byreplenishing glucose to the body at regular intervals allowing the child to better concentrate. Children with hypoglycemia will often show a pattern of“crashing” between 10:30–11:30 and 3:00–4:00 and willoften “demand” food duringthese times. Most breakfastcereals and fruit juices pur-chased in grocery stores havehigh sugar content and shouldbe avoided. Also, food packedfor lunches or snacks should be chosen carefully and checkedfor sugar contents. Children withseizures, middle ear infections,

visual or auditory perceptionproblems will also have trouble

paying attention or appear frustrat-ed with learning.

Often times following an emotional or physical traumatic event, childrenappear inattentive, distracted, orhyperactive. This may be a situa-tional behavior issue and may need

to be addressed through therapy. Ifthe event was physical in nature such

4 winter 2005

Complex carbohydrateshelp to avoid hypo-

glycemia by replenishingglucose to the body at regular intervals,allowing children tobetter concentrate

Early Use of ADHD Drug Alters BrainRitalin use in preteen children may lead to depression later in life. Ritalin and cocaine have different effects on humans.But their effects on the brain are very similar. When given topreteen rats, both drugs cause long-term changes in behavior.

One of the changes seems good. Early exposure to Ritalinmakes rats less responsive to the rewarding effects ofcocaine. But that’s not all good. It might mean that the drugshort-circuits the brain’s reward system. That would make it difficult to experience pleasure—a “hallmark symptom ofdepression,” Carlezon and colleagues note.

The other change seems all bad. Early exposure to Ritalinincreases rats’ depressive-like responses in a stress test.“These experiments suggest that preadolescent exposure to [Ritalin] in rats causes numerous complex behavioral adap-tations, each of which endures into adulthood,” Carlezon andcolleagues conclude. “This work highlights the importance of a more thorough understanding of the enduring neurobio-logical effects of juvenile exposure to psychotropic drugs.”

my.webmd.com/content/article/78/95700.htm?lastselectedguid={5FE84E90-BC77-4056-A91C-9531713CA348}

Nutritional Considerations for ADHD Two books worth having for yourlending libraries:

Smart Fats: How Dietary Fats andOils Affect Mental, Physical andEmotional Intelligence by MichaelA. Schmidt

Omega 3 Connection by Dr. Stoll

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pathways 5

as a car accident or physical abuse, the child should also undergo a chiropractic evaluation for possible vertebral subluxations as the cause or a contributing factor to their behav-ior as should any child diagnosed withany of the above mentioned conditions.

Sensory Integration Disorder

Children are often misdiagnosed ashaving ADD or ADHD when in fact they have an undiagnosed learning

disorder causing them to be frustrat-ed, angry, distracted, and hopeless.There is a wealth of research on earlybrain development and the effects ofpoor sensory processing and delayedmotor development in relation to one’sability to focus and learn. A child maybe labeled with ADD, ADHD, dyslexia,dyspraxia, or central auditory process-ing problems; again, drugs are com-monly prescribed for these children.However, what is really going on isthat their neurological system is inchaos or is immature. The sensoryinformation the child receives can not be organized by the brain; there-fore, the child will not respond appro-priately to various commands or stim-ulation. In short, the brain and nerv-

ous system are “short circuiting”.Because chiropractic deals directlywith allowing the nervous system to function at its highest ability, it is imperative that these childrenundergo a chiropractic evaluation.Specific exercises either through aDoctor of Chiropractic or OccupationalTherapist are also essential.

Sensory input is received from variousentities. The vestibular system isresponsible for movement and balance.It is the first system to fully developand should be developed by sixmonths after conception. This systemis said to have the most influence on the other sensory systems and onthe ability to function in everyday life.

continued on page 6

Because chiropractic deals directly

with allowing the nervous system

to function at its highest ability,

it is imperative that these children

undergo a chiropractic evaluation.

Inefficient Conversion of ALA (Flax Oil) To EPA And DHAA possible cause for the low fish oil status of the ADHDchildren may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highlyunsaturated products, such as EPA and DHA (fish oil fats).

It appears that children with ADHD just are not able to chemically convert the plant omega-3, ALA to fish oil very well. The problem is further worsened whenomega-6 fats are consumed and the ideal omega-6:3ratio of 1:1, progresses to the typical standard Americanratio of 15:1. Many of these children have ratios whichare even worse and can be as high as 50:1.

This study provides the research evidence supportingthe use of the omega-3 fats found in fish oils to effec-tively address the underlying deficiency that is presentin most of these children and appears to be contributingto the ADHD.

Consider Fish Oil Over RitalinChildren with attention-deficit hyperactivity disorder(ADHD) have problems paying attention, listening toinstructions, and completing tasks; they also fidgetand squirm, are hyperactive, blurt out answers, andinterrupt others.

It is conservatively estimated that 3-5% of the school-age population has ADHD. Although drugs, such asRitalin, are frequently used to treat ADHD, they arefraught with complications. Disadvantages include possible side effects, including decreased appetite and growth, insomnia, increased irritability, and rebound hyperactivity when the drug wears off.

One would not expect to find that a single cause or evena handful of factors could explain why ADHD appears to be so rampant in our society. Because it is acceptedthat both genetic and environmental factors play a rolein ADHD, many other factors—both intrinsic and extrin-sic—could influence an individual’s fatty acid status.

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It functions like an air traffic controller,telling each sensation where and when it should take off and where to land. The sensoryorgans for the vestibular systemare located in the inner ear andare largely affected by the nervesassociated with vertebral jointsin the upper neck. Therefore, if a misalignment (subluxation)of the upper neck is present, it may interfere with the abilityof the vestibular system to perform its job effectively.

The proprioceptive system is responsible for telling the

brain where the body is inspace. It gathers sensoryinformation taken in fromthe inner ear, eyes, smell,and through hearing. It also relies on informationreceived by the brain fromtactile, kinesthetic and pro-prioceptive sites throughoutour bodies. Proprioceptivenerve fibers are also located

within each vertebral joint. Therefore,subluxations of any vertebral joint maycause disruption of the proprioceptivesystem. Children may fatigue easily and appear inattentive because theyhave to work hard and concentrate todetermine the position of their bodies.They appear clumsy and have difficultyplaying with toys. Their writing can betoo light and difficult to read or muchtoo heavy and laborious. They may alsohave trouble grasping mathematicalconcepts.

The visual system is also an importantsensory input system. Most peoplethink that if a child’s vision is 20/20then everything is fine. However, thereare many sensory functions that mustwork properly in order for one to under-stand and apply the information thatcomes through the eyes. Binocularcoordination, accommodation, and ver-tical movement are some of the func-tions necessary to understand andprocess visual information. Part of theneurological input for proper accommo-dation of the eyes comes from thelower cervical spine and upper thoracicspine. Vertebral subluxation of theseareas may cause difficulty in focusingon objects or complaints of blurredvision. However, school-aged childrenrarely realize that they are not seeingthings clearly. Therefore, it is necessaryto make sure that the lower cervicaland upper thoracic regions are clear of any vertebral subluxations.

The tactile system receives informationfrom cells in the skin all over our bod-ies providing information about light

touch, pressure, vibration, temperature,and pain. Feedback from the tactilesystem contributes to the developmentof body awareness and motor planningabilities. Some children are hypersen-sitive to touch and in turn try to controltheir environment and the tactile infor-mation they receive; thus, appearinganxious, controlling, aggressive, andunwilling to participate in home andschool activities. This will then leaveless energy and attention for learningand interacting. Some children areunder-responsive to touch and seekout excessive touch sensation in orderto satisfy the nervous system’s cravingfor touch. They may touch everything,appropriate or not, and may appear to be impulsive and distractive. Thenervous system must work properly in order for successful integration ofthe tactile system. This enables us tocreate a balance so that we know whatwe are touching is either harmful ordangerous or what touch is satisfyingand pleasurable and should be furtherexplored.

Sensory input and sensory integrationare essential in order for a child todevelop proper motor skills and properlearning skills. Without a correctlyfunctioning nervous system, this is notpossible and an often misdiagnosis ofADD or ADHD is the result. Removingnervous system interference caused byvertebral subluxations allows the childto develop these much needed sensorysystems to their highest ability. In con-junction with a proper diet and specificsensory integration exercises, chiro-practic is a safe, effective, and naturalform of care for these children.

Dr. Monika Buerger teaches the module:History, Physical Assessment, andOrthopedic Considerations of the PediatricPatient for the ICPA’s 360 Hour Diplomateprogram. She authored History andPhysical Assessment of the PediatricPatient, Pediatric Chiropractic byAnrig/Plaugher; 1998. Dr. Buerger haspracticed in Livermore, CA since 1991.

Children may fatigue easily …

because they have to work hard

and concentrate to determine

the position of their bodies.

6 winter 2005