Attention deficit disorder is becoming an increasingly prevalent diagnosis in children, so much so that we must often search for causes that could account for the dramatic increase.  While many skeptical holistic doctors would attribute this to over-diagnosing and thus over-prescribing, patients who exhibit symptoms should not be dismissed immediately nor should they be immediately prescribed stimulant therapy (such as methylphenidate or Ritalin).  Often times an environmental cause can be found and then controlled, or the patient's reaction to the environmental cause can be modulated and balanced so that a true cure can occur.  Environmental causes are often sought for such patients at our clinic because we recognize that toxicity has an extraordinary impact on both neurological health and the immune system.  Toxicity is an increasing concern with environmental conditions that both our food and we are exposed to daily.  While toxins such as heavy metals can directly affect neurological function and thus produce symptoms, they can also poison the immune system so that allergies are more predominant and then these allergies can produce the symptoms!  


Basic neurochemistry describes the pathophysiology behind the symptoms of attention deficit disorder.  Basically, our brain is composed of many individual nerve cells that make connections to each other in order to communicate.  These nerve cells, or neurons, can also be grouped together into larger functional structures based on their connections and common functions.  Communication between these cells is made across a very small space called the synapse, and small molecules called neurotransmitters cross the synapse from one cell to another.  In many cases of ADD, a manifestation is that there is a deficiency of the neurotransmitters noradrenaline or dopamine in a specific area of the brain.  The function of these neurotransmitters in these areas is to calm or focus the attention.  It should be noted that these two neurotransmitters are most often used to further stimulate and excite the brain, but that in ADD localized deficiencies where they are used to calm and focus are important.  Thus drug therapy with methylphenidate or similar drugs mainly act to increase the action of these neurotransmitters either by increasing their total number, decreasing the rate at which they are broken down or removed from the synapse, or mimicking their action by binding to the same receptors that they do.


Thus, to be comprehensive and provide a good biological and functional answer to this problem, a search must begin to ask the question why the symptoms of ADD become manifest and why there may be the irregularities described above.  


At the first layer of assessment and treatment, we want to find out if there are other imbalances in the amounts of neurotransmitters, and there most often are!  Neurotransmitters in the brain actually are synthesized from building blocks within the blood.  These building blocks are called amino acids; both dopamine and noradrenaline come from an amino acid in the blood called tyrosine.  In depressed or anxious patients, serotonin is the neurotransmitter targeted by drugs; this neurotransmitter comes from tryptophan.  Thus, in many cases of neurological or psychiatric problems, uncovering imbalances goes beyond just giving a drug to increase one neurotransmitter  instead the blood or urine should be analyzed for ALL the amino acids so that complete balance can be restored!  This approach is less invasive than using drug therapy as the amino acid precursors to the neurotransmitters are found from the protein that we eat in our food!  Thus, once the lab analysis is back, custom amino acid powders to re-establish balance are used and are completely natural.  Furthermore, often times dietary modifications using meats or proteins rich in certain amino acids can be used to re-establish balance.


At the next layer of assessment and treatment, we have to recognize that an imbalance in the amino acid levels within the blood, while useful and a good option for some patients, may not be the reason why the nerve cells are malfunctioning.  Balance of these chemicals may be perfectly normal in the blood and yet the nerve cells in the brain are not responding to these chemicals correctly!  Thus drug therapy may overcome this non-responsiveness, but covers up the fact that there may be another cause, usually a toxicity or allergy, that is making the nerve cells malfunction.  Thus, for most patients, and especially if there is a history of asthma, eczema, or hayfever in the patient or family, we want to assess for food allergies and sensitivities.  This is done through the blood.  Energetic testing with machines seems to vary somewhat between practitioners and scratch testing seems more useful for allergies that present as hives or breathing and respiratory problems.  Blood testing tests for immune proteins directed specifically against individual foods (usually 95 foods are tested but in ADD of children spices and less common foods are tested also) is more appropriate for "sensitivity" reactions that have more subtle symptoms such as fatigue, irritability, and hyperactivity.   Once the results come back, either an avoidance is done with later rotation of the foods or the gastrointestinal symptom has to be treated to prevent further allergies from developing.


At this second layer of assessment and treatment, (not to mean that we do it only after the first layer, but that it is an analysis for a deeper cause) we also want to check the body burden of heavy metals.  This is probably the BIGGEST component as most children who are suggested to use Ritalin or similar medication should be tested for their body burden of lead.  This is not done by a simple blood draw, as lead in the blood is only an indication of acute toxicity!  Even a hair test is not sufficient.  Besides, the problem is in the neurological tissue, and thus an agent called a chelator, usually EDTA or DMSA, must be given to pull the heavy metals from tissue such as the nerve cells and then make them safely excreted into the urine, where we can measure it.  A large body burden means that it should be removed for optimal improvement in the patient.  Usually this is done over a month or two.


Finally, nutritional recommendations need to be made in order to keep two basic principles operating.  One is that the sugar level in the blood must be stable throughout the day to prevent hyperactivity.  In fact, a common mechanism behind some patients ADHD is that the sugar in the blood spikes, either from candy, juice, or refined foods, and then drops because the hormone insulin must come out in large force to balance it.  Unfortunately, the sugar drops too low, and the body secretes adrenaline (in the blood now, not in the brain!) and the typical adrenaline rush happens, which is interpreted as ADHD.  Second is that the essential fatty acids in the diet must be balanced  remember that fatty acids make up the neurological tissue!


In conclusion?  Drug therapy isn't necessary in ADHD, and we feel especially strongly against giving neurological drugs to children.  Rather, the underlying cause should be sought, be it heavy metal toxicity or increased body burden, amino acid imbalances, or food sensitivies.  Once these causes are identified, a program of rebalancing can begin and then restoration of function and relief from symptoms can occur.



- psychoactive drugs are on a major rise in terms of prescriptive use


- these drugs should not be used in the majority of cases especially when underlying causes can be found





- Pollution and other stimuli support a pathological polarization of the immune system


- this polarization of the immune system can the result in sensitivities detectable in the blood that result in symptoms of ADHD


- Heavy metal body burden should be analyzed and special attention paid to lead, AND this should definitely precede use of psychoactive drugs in children


- Amino acid imbalances in the blood can lead to neurochemical imbalances in the brain




- amino acid balancing


- heavy metal chelation with oral or IV agents depending on testing


- allergy elimination


- immune system rebalancing


- dietary modifications for fatty acid balancing and especially sugar control