Pediatric Special Needs - ADD/ADHD

ADHD (attention deficit hyperactivity disorder) and ADD (attention deficit disorder) are often used interchangeably but ADD is actually a sub-type of ADHD. For simplicity, we will use the term ADHD to refer to both classical ADHD as well as the ADD sub-type. Symptoms can vary between individuals but the primary symptoms of ADHD can be categorized into two types of behavioural differences – (1) inattentiveness (difficulty concentrating and focusing) and (2) hyperactivity and impulsiveness.

The main signs of inattentiveness are:
• having a short attention span & being easily distracted (e.g. constantly changing activities or tasks)
• difficulty following and carrying out instructions to completion, particularly if the tasks are time-consuming or tedious/monotonous
• carelessness & disorganization (e.g. making mistakes in schoolwork despite knowing the material)
• forgetfulness (e.g. losing things, forgetting to complete tasks, etc.)
 
The main signs of hyperactivity and impulsiveness are:
• being unable to sit still & fidgeting
• acting without thinking
• difficulty concentrating on tasks
• difficulty waiting their turn (e.g. interrupting conversations or other activities)
• little or no sense of danger
 
Many people with ADHD have symptoms and challenges that fall into both of the above categories, but that is not always the case. About 3 in 10 people diagnosed with ADHD have problems with concentration and focus, but not with hyperactivity or impulsiveness and these individuals have a form of ADHD known as attention deficit disorder (ADD). Symptoms of ADHD in adults may be expressed differently than in children and symptoms may be more subtle (symptoms of inattentiveness are more common and hyperactivity is less common); and therefore, more challenging to diagnose.
 
Causes of ADHD
 
Currently, we do not know exactly what causes ADHD and as with many health conditions, it is likely caused or influenced by many different factors such as genetics, the environment one lives in, and life experiences. We do know that ADHD tends to run in families but it is very unlikely to be related to a single specific gene. We also know that certain groups are more likely to be diagnosed with ADHD such as those born prematurely (before the 37th week of pregnancy), children whose mothers smoked during their pregnancy, people with epilepsy or people with brain injuries (either experienced in the womb or a severe head injury occurring later in life). Research has also identified possible differences in parts of the brain and in the levels of neurotransmitters (chemicals produced in the brain that can affect mood and behaviour) in people with ADHD compared to those without the condition, but the exact significance is unclear.
 
ADHD diagnosis
 
ADHD is estimated to affect about 5% of school-age children and is often diagnosed in childhood, particularly when a child enters school, but can also be diagnosed in later adolescence and adulthood. Initially, parents may notice behavioural differences in their child or teachers may observe inattentiveness or hyperactivity in the classroom setting. Parents can approach their pediatrician, family doctor or Naturopathic doctor with their concerns and their doctor will recommend further assessment to determine if an ADHD diagnosis is appropriate. Statistically, ADHD is more often diagnosed in boys than girls; however, this may be because girls with ADHD are more likely to have symptoms of inattentiveness only (ADD) and since these symptoms may be less obvious and outwardly disruptive, they can often go unnoticed and undiagnosed. In general, children and adults with the ADD sub-group of ADHD are more likely to remain undiagnosed, but this is improving as we become more aware of the differences between all people.
 
The Naturopathic Medicine approach
 
It is important to remember that not every child or adult with behavioural differences has ADHD. In children, many of these behaviours may be completely appropriate for the child’s age, personality, and stage of development. As well, behavioural differences or changes can also be related to other health conditions, which is why thorough assessment and appropriate diagnosis are essential.
 
Naturopathic consultations will include a detailed discussion about a child’s medical history and current physical or behavioural symptoms as well as other aspects of a child’s health such as diet, sleep habits, energy level, cognition (focus and memory), learning skills, mood and mental well-being, amongst many other things. Although, there is currently no conclusive blood or neurological test to diagnosis ADHD, lab tests and medical assessments can still provide vital information – some of them may have already been performed by a pediatrician or other medical specialist or some may be recommended to you during your Naturopathic visit (e.g testing for nutritional deficiencies, heavy metal toxicity or hormonal imbalances). All of the gathered information will assist with a diagnosis (of ADHD or a completely different medical disorder) as well as a treatment plan.
 
Naturopathic medicine addresses each child (and adult) as a unique individual with their own specific symptom picture and health needs. After a thorough assessment and relevant testing, a treatment plan will be tailored specifically for them and will be modified on an ongoing basis as changes and improvements are seen. It is also important to note that a Naturopathic treatment plan for symptoms of inattentiveness, hyperactivity and impulsiveness, can be utilized even if an official diagnosis of ADHD has not been given or if those symptoms are related to a different health condition.
 
Treatment plans for ADHD are often collaborative and can involve many practitioners working as a team. A medical doctor may prescribe medication to manage behavioural symptoms or ADHD specifically, therapists/psychologists may use cognitive behavioural therapy, behaviour skills training or other techniques to address behavioural symptoms, schools may integrate classroom or learning adaptations (e.g. moving their desk to a quieter and less distracting area), etc.
 
As a Naturopathic doctor, many different types of treatments can be utilized but the primary approach will involve supporting the health of the brain and nervous symptom to improve focus and promote a calmer state in the body. Food intolerances often can aggravate ADHD symptoms so identifying and eliminating food triggers is often a part of the assessment (food sensitivity testing) and treatment plan. Nutritional deficiencies can often worsen certain symptoms so targeted supplementation may be of benefit. Sleep and mood regulation (e.g. stress response, anxiety, anger) can be a challenge for people with ADHD and various naturopathic treatments can address a child’s individual behavioural and physical symptoms.
 
Many ADHD children (and adults) using prescription pharmaceutical treatments can also experience side effects from them such as reduced appetite, weight loss, difficulty sleeping, mood changes, irritability, jitteriness, digestive upset, and high blood pressure – integrating naturopathic medicine can often reduce the side effects from those medications or potentially be able to manage symptoms of ADHD without the use of medications.
 
What is the prognosis for ADHD?
 
Most people who are treated appropriately for ADHD are able to manage their symptoms well and have them be less disruptive to their academic, social, mental wellbeing and quality of life. People with ADHD can live very happy and fulfilling lives.
 
Although ADHD can be challenging and complex to diagnose and treat, there are numerous naturopathic treatment options that may be helpful to improve symptoms and behavioural challenges. As a child matures and develops into adulthood, we will continue to support the health of the brain, nervous system and the entire body as a whole.
 
Speak with our reception team to book a visit with Dr. Jennifer Yee who has expertise and experience in treating ADD/ADHD.