Wednesday, November 7, 2007

ADHD: Medical or Psychological?

Attention Deficit Hyperactivity Disorder (ADHD):
A Medical, Psychological, or Behavioral Problem?

Richard Malter, Ph.D.
Retired Clinical Psychologist
School Psychologist
Nutrition Counselor
(c) 1998

One of the most perplexing aspects of the condition that is "diagnosed" as Attention Deficit Hyperactivity Disorder (ADHD) is its complexity. As we become more familiar with children and adolescents whose behaviors and symptoms appear to fit this diagnosis, it seems clear that there is a biochemical factor in the condition. Since Ritalin, a powerful stimulant drug, has been the most widely used treatment for ADHD, the biochemical factor in ADHD has been defined as a “medical” problem. This is because Ritalin is a class II controlled substance and requires a medical prescription. However, there are no known biochemical or physiological tests used by these prescribing physicians. The prescription is essentially a drug “trial” or a biochemical experiment with each child put on medication. When we look carefully at the process by which these children and adolescents are medically “diagnosed”, we see that it has a very flimsy “scientific” and “clinical” foundation. Neurologist Dr. Fred Baughman calls the diagnosis of ADHD a fraud -- a bogus disease.
On the other hand, there is a biochemical test which can shed a great amount of light on the underlying biochemistry of ADHD. This test is the hair tissue mineral analysis (TMA). The TMA provides a great amount of data related to the psychophysiology of the stress response. TMA also provides data on the presence of toxic metals (lead, cadmium, mercury, aluminum, etc.) which can have a neuro-toxic effect. Unfortunately, the TMA is rarely, if ever, used by prescribing physicians. They are really prescribing “in the dark” with no awareness of important biochemical factors (nutrient mineral imbalances and toxic metals) that need to be taken into account when prescribing powerful stimulant medications. Experience with hair TMA profiles of children who have been previously diagnosed with ADHD shows a wide variety of nutrient mineral patterns, but, in most cases, there are substantial amounts of toxic metals present. TMA data indicate that toxic metals are very often present as part of this syndrome of ADHD symptoms.
Since the TMA nutrient mineral data can be closely related to the psycho-physiology of the stress response, these data can also help to account for the “positive” paradoxical effect of Ritalin with many of these children. Initially, many children who are given a trial of Ritalin seem to have a “miraculous” improvement in their behavior and attention span. A stimulant drug seems to calm them down. This behavioral result of a powerful stimulant drug is interpreted as a paradox because, after all, how else could a stimulant drug calm someone down? When we look at TMA data, especially sodium, potassium, zinc and magnesium, the answer becomes quite simple and clear. These four minerals can be closely correlated with the stress response, especially as it relates to the adrenal glands. TMA patterns of ADD and ADHD individuals typically indicate the presence of adrenal gland weakness or insufficiency that adversely affects many other aspects of neuroendocrine and neuropsychological functions. Hence, it is easy to see that a powerful stimulant drug such as Ritalin will provide a temporary “jump start” to weak adrenal glands. This often results in temporary normalization of neuro-endocrine and neuropsychological functions during the short “window of effectiveness” of the drug. The temporary normalization of neuro-endocrine and neuropsychological functions produces temporary behavioral changes which, on the surface, look miraculous. However, they are usually of short duration and, when the stimulant drug effects wear off, there is often a significant rebound effect when the weak adrenal glands become even weaker without drug stimulation.
The continuous repeated drug stimulation of weak adrenal glands eventually burns them out even more than prior to drug treatment. As the adrenal glands become even more burned out and depleted, higher doses of stimulant medication are required to achieve the same behavioral response until a point is reached at which no amount of stimulant drug can produce the desired response. Then, the stimulant drug is discontinued because it no longer “works.” The drug “trial” is over. At that point, adrenal “burn out” is complete and the individual is left in a very vulnerable psycho- physiological condition with even weaker adrenal glands than before this experiment began.
Comparable behavioral changes can be brought about by using the TMA profile as a guide to the selection of vitamins and minerals that will accomplish several goals. One is to restore a better balance between essential nutrient minerals that more naturally support the adrenal glands rather than artificially stimulating them. The other goal that can safely be accomplished with appropriate nutritional supplements is the detoxification of the heavy metals so that their neuro-toxic effect is significantly diminished. Thus, instead of running the risk of burning out the adrenal glands with artificial drug stimulation, these critical glands can be properly nurtured and supported with the nutrients that are known to be needed for their healthy functioning.
Another important aspect of the ADHD syndrome has to do with listening and auditory processing skills, self-esteem, self-confidence, and self-control. These elements strongly suggest the presence of a psychological factor in ADHD. Then, also, the fidgety and hyperactive behaviors suggest that the condition is a behavioral one.
When we look carefully at the ADHD symptoms, some of them clearly suggest that an auditory processing problem may be operative. Other symptoms suggest more of a behavioral problem. These characteristics indicate that ADHD is not a uniform homogeneous diagnosis, but that different syndromes and combinations of symptoms are lumped together under this one label. The more variation there is in the ADHD diagnostic category, then the more one would expect to find psychologically significant differences between different children and adolescents given this one diagnostic label. Since this is, indeed, the case, then much of the so-called scientific research on ADHD may be on very shaky ground.

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