Knowledge, early intervention and getting support will help families deal with ADD and ADHD. Jane Dostine explains how a healthy diet can make a big difference, too.
What is ADHD?
Attention Deficit Hyperactivity Disorder or ADHD is a diagnosis often given to children with challenging behaviour that causes significant problems at home and at school.
Key symptoms are:
Inattention - children who have ADHD are distracted, find it difficult to complete tasks, forget instructions and are often disorganised.
Impulsive - these children speak and act without thinking, interrupt others and sometimes have angry outbursts or tantrums.
Hyperactivity - ADHD sufferers are constantly 'on the go' and fidgety.
Many children with ADHD have other problems, such as:
Difficulty with maths, reading or spelling.
Anxiety and depression.
Clumsiness and poor co-ordination.
What's the difference between ADHD and ADD?
In the past, ADD (Attention Deficit Disorder) was the term used to describe this condition when it didn't involve hyperactivity. But since 1994, ADHD has been used as an umbrella term to describe all forms of the condition.
For some children, inattention is the biggest problem, others have difficulty with hyperactivity and impulsiveness, and some have to deal with all three symptoms. Using the current terminology, it's possible to have ADHD and not be hyperactive.
Who does it affect?
Often apparent from a young age, ADHD impacts a child's quality of life and affects the whole family. Parents are often blamed for their child's inappropriate behaviour and siblings can also be labelled as a problem. Most parents find having a child with ADHD embarrassing and frustrating.
Although ADHD tends to improve with age, about half of all sufferers will carry some symptoms into adulthood, with restless, impulsive behaviours being replaced with an inability to sustain work output and frustration with learning.
What causes ADHD?
Despite a tremendous amount of research, the cause remains unknown. It's thought that ADHD might be due to a lack of response to the brain chemical called dopamine.
What we do know is that ADHD tends to run in families and is more common in boys. Research carried out jointly by the Sydney Children's Hospital, the Prince of Wales Hospital and the University of New South Wales found that if one identical twin has ADHD, there is an 80-90% chance the other twin will also have it. Most children with ADHD have a close relative (usually male) who also suffers from this condition to some degree.
How is it diagnosed?
Because ADHD is a behavioural problem, it is difficult to diagnose accurately. Not every energetic child is hyperactive, not every shy or dreamy child is inattentive. Paediatricians, psychiatrists and GPs use well-defined guidelines from the Diagnostic and Statistical Manual of Mental Disorders to assist in the diagnosis, while careful evaluation of a child's strengths and weaknesses, school reports, and parents' answers to questionnaires help to determine if behaviours fall at the extreme end of the spectrum for a typical child. Some specialists include brainwave mapping (a safe and non-invasive scan looking at brain activity) as part of the extensive assessment. However, the value of brainwave mapping is debatable.
Is it more prevalent now?
In recent years, the number of children diagnosed with ADHD in the USA, Europe and Australia has increased dramatically. The National Health and Medical Research Council (NHMRC) estimates that ADHD affects about one in 50 Australian school-aged children. It is now the most frequently diagnosed behavioural disorder of childhood.
More girls (often the inattentive type) and adults are also being diagnosed with ADHD. Probably a greater awareness of the condition, our willingness to discuss our child's problem, and the availability of treatment have all led to the increase.
A combination of behaviour treatments and medication is usually used to treat ADHD.
When introduced early on, behavioural treatments can have great benefits - including avoiding a lowered self-esteem and improving academic abilities and social skills. They can also minimise the risk of developing other antisocial behaviours. Behavioural treatments are tailored to suit the individual's needs and include:
Learning support: for kids who have reading or learning issues.
Social training: teaching kids how to talk and play with others.
Anger management: teaching children how to recognise and deal with feelings of frustration.
Parental education: providing parents with the necessary skills to manage their child.
Dietary changes: can improve some of the symptoms of ADHD.
Although medication cannot cure ADHD, it can improve the balance of brain chemicals so thinking is more organised. It can help children get along with others, improve their confidence and make them less disruptive at school.
Stimulant medications such as Ritalin (methylphenidate) and Dexedrine (dexamphetamine) are available in both short and long-acting formulations. Non-stimulant Strattera (atomoxetine) is the newest medication approved for the treatment of ADHD. In most cases, drug treatment is very successful. However, side effects may include loss of appetite and difficulty sleeping. It's also unclear whether these drugs are safe for long-term use and if they really improve performance at school.
There has been concern over the increasing use of prescription medications to treat ADHD. Many people now opt for a nutritional approach to treatment, and there is some evidence that eliminating food additives and specific foods from the diet may help.
Relieve symptoms with diet
Although ADHD isn't caused by a food intolerance, different foods can aggravate the symptoms. For example, UK research found increased levels of hyperactivity in young children who consumed artificial food colours and the preservative sodium benzoate. (This preservative can affect kids without ADHD, too.) Some children also react to naturally-occurring food chemicals and sometimes a supervised food-elimination diet is needed to identify the trigger. Basically, a diet that avoids processed foods can help. Read more in our case study overleaf.
Foods and additives to avoid
Anything with added colours, flavours, preservatives and flavour enhancers - such as pies, sausage rolls, hot dogs, mini pizzas, nuggets, instant noodles, flavoured chips, packet snack foods, lollies, coloured/flavoured ice-creams, sports drinks, soft drinks and cordial.
Preservatives: most 200 numbers (sorbates, benzoates, sulphites, nitrates and nitrites, propionates).
Antioxidants: 310-312, 319-321.
Flavour enhancers: HVP, TVP and 600 numbers.
Foods to increase
Omega-3 fatty acids: These fats are crucial for healthy brain development and are found in foods such as salmon and canola oil. A small number of research trials have shown that omega-3 fatty acids may also help reduce the symptoms of ADHD. A South Australian study gave children with ADHD fish-oil capsules and their parents reported a significant improvement in their behaviour. However, research results are inconsistent and far from convincing.
Help for parents
Caring for a child with ADHD is physically and mentally exhausting, so it's important that parents get a break occasionally. It will also make things easier for you and your child if you:
Stick to a routine: have a fixed regimen for getting ready for school or going to bed.
Make clear rules: write them down so there can be no arguing.
Praise: find opportunities to tell your child how pleased you are with them.
Be positive: tell them what to do rather than what not to do.
Avoid criticism: this can become a vicious circle, which makes them feel negative and behave badly.
ADHD places families under a great deal of stress, but rest assured that many people who care for someone with ADHD say that diagnosis and treatment has transformed their lives. Medical and behavioural support, along with a healthy diet, can control many of the symptoms. And with affection, friends, support and a positive relationship with you, your child can do very well.
Case study: All in the family
Ann's* 10-year-old was diagnosed with ADD at seven and her five-year-old with ADHD at three. Here's how she's coped and used a diet to help.
What did you do when your eldest child was diagnosed with ADD?
I read all the books, newsletters, interviews and websites I could find on the subject, then prepared a list of questions for the paediatrician. I wanted to know more about traditional medicines, alternative therapies, diet and lifestyle factors, such as routines.
How do you treat your children's conditions?
My eldest son has been taking medication since he was in Year 3, but he only takes it on school days. He's now in Year 5 and we're reducing the dose. If all goes well, he should be drug-free by Year 6.
Behaviour management is important for both children – this involves a well-established routine and a set of rules that is enforced consistently.
When it comes to diet, we try to give the children wholefoods. More fresh equals less processed. They're kids, so they like treats, but we're aware which ones contain additives that trigger hyperactive behaviour. We tend to give them plain crisps as opposed to chicken flavoured ones, or plain handmade chocolate rather than M&Ms.
What happens if they go off the diet?
We let them eat what they like on special occasions, like parties, and then live with the consequences - knowing that evening will be interesting and VERY loud. They can't stop talking, interrupt constantly, wrestle, run and run, and usually take a while to go to sleep.
How did you create your diet?
When I read about the effects of some additives, I decided to switch to a whole-food diet, which is good for the entire family. I made laminated cards listing all the additives that are known to cause reactions in hyperactive kids, then I went shopping and overhauled the pantry. It was hard at first, but now it's just second nature.
How does ADHD affect the children's lives?
I think they probably have more structure than other kids and we tend to plan outings well. We wouldn't, for example, go out for dinner after being out all day and we try to limit our weekends to one outing or activity per day. The children are very happy boys with many friends, so I'm sure if you asked them they would say it doesn't affect them.
How are your sons doing at school?
The eldest excels at reading, creative writing, art, drama and public speaking - mostly creative subjects. He'll throw himself into projects he identifies with and ignore those that don't interest him. His teacher has said he'll never be an accountant, but if we can get him through school, he'll be a brilliant graphic designer, playwright, or cartoonist. The youngest is in preschool and starts kindy next year.
What's your advice to other parents?
Read, read and read.
When it comes to diagnosis and treatment, get multiple opinions, then decide what's best for your child.
Find a doctor you trust and like who will listen to you.
Find a routine that works for the family and stick to it.
Don't sweat the small stuff - our family motto. It's important for an ADHD child to have positive feedback. If you worry about the little things, it feels like you're always nagging them and their self-esteem will suffer.
Find out what they're good at and encourage it.
Why have you chosen to remain anonymous?
I don't want people to stereotype my kids. Our sons' teachers, our family and our friends are all aware of their condition, and that's all the people that need to know. I'm not ashamed of my children, I just want to give them every opportunity to be happy and confident, and to succeed at whatever they do.
*Name has been changed.
Reading and links
ADHD: The Facts Mark Selikowitz (Oxford University Press)
Understanding ADHD – A parent's guide to ADHD in children Drs. Christopher Green and Kit Chee (Vermilion/Random House)
Friendly Food: An Essential Guide to Avoiding Allergies, Additives and Problem Chemicals Drs. Anne Swain, Velencia Soutter and Robert Loblay (Murdoch Books)
Biederman J, Mick E, Faraone SV. 2000. Age-Dependant Decline of Symptoms of Attention Deficit Hyperactivity Disorder: Impact of Remission Definition and Symptom Type. Am J Psychiatry 157:5. McCann D, Barret A, Cooper A, Crumpler D, Dalen L, Grimshaw K, Kitchen E, Lok K, Porteous L, Prince E, Sonuga-Barke E, Warner JO, Stevenson J. 2007. Food additives and hyperactive behavior in 3-year-old and 8/9-year-old children in the community: a randomized, double blinded, placebocontrolled trial. School of Psychology, University of Southampton. Lancet Nov 3:370(9598):1524-5. Sinn N. 2007. Omega-3, Concentration and Hyperactivity. Australasian Science Hawksburn: 28(1):23, 24.