A New Multi-Disciplinary Approach

Mary Ann Block, D.O.

My positive experience with nonpharmacological treatments for Attention Deficit Hyperactivity Disorder (ADHD), learning disabilities, and behavior problems inspired me to become a physician. By age six my son had all these diagnoses, and in my search to help him, I encountered several successful conservative treatments. I chose the medical profession in order to make a positive impact in bringing these treatments to others.

The modalities used successfully with my son included environmental medicine, sensory integration/developmental optometry, and osteopathic manipulation. With this multi-disciplinary approach, my son gradually gained control of, and retrained, his nervous system. He began treatment at age seven, and soon no longer needed educational modifications and mental health services. Eventually he graduated from high school as a National Merit Finalist and was accepted at an Ivy League University. This young man, who before treatment could barely catch, kick, or hit a ball, and had not been able to ride a bike, was selected as one of his college's top five intramural athletes. Peer problems are no longer an issue, and he has been elected to a student body office.

The traditional "multi-disciplinary" approach to ADHD includes medication, educational modification, and mental health services. However, research has shown that most professionals do not utilize educational modification or mental health services to the same extent as drugs, even though the package insert for the usual medications (Ritalin, Dexedrine, and Cylert) indicates that they should not be used without these services. While drug intervention appears effective in the short term in calming a child or allowing for improved attention (about 75% of the cases), success in the long run is not so impressive. Moreover, the use of medication is not without side-effects.

One study followed children diagnosed with ADHD over an eight-year period. Eighty percent of these children were prescribed medications, while only 35% received educational modification and 63% received mental health services. At follow-up, eight years later, 80% of these adolescents or young adults continued to qualify for an ADHD diagnosis, while 60% also qualified for diagnoses of Oppositional Defiant Disorder and Conduct Disorder, which are more serious than ADHD. These subjects also had an increase in the use of recreational drugs and tobacco, an increase in school failures, and continued problems with peers.

In order to effect a long-term change, it is important to address the physical causes involved. ADHD is defined by a list of subjective symptoms, and it is easy to be influenced by the manifestations of those symptoms. Medication alone can at best provide temporary relief.

An autonomic nervous system imbalance may arise from many causes and yield to different approaches. Determining the cause of the imbalance and eliminating it may resolve the problem permanently. Each child is evaluated individually to determine necessary treatments. Medications should be resorted to only when no other therapy is successful.

Nutrition/Environment:

Recently, yet another study was published in the medical literature indicating no association between sugar and behavior. However, all one must do is look at the basic physiologic responses of the human body to see what many parents and teachers already know -- sugar does, indeed, affect the behavior of some youngsters. Ingesting sugar stimulates the release of insulin and adrenaline. If too much insulin is released after eating sugar or any other food that can trigger an episode of reactive hypoglycemia (low blood sugar), adrenalin (our fight-or-flight hormone) is pumped into the blood stream. This can cause some children to show anger, rage, hyperactivity, or, simply, inattention. My first step in treating a child with an ADHD diagnosis is to remove sweets from the diet. It is also imperative to remove or treat for any other foods that produce symptoms of reactive hypoglycemia.

Foods, chemical additives and environmental sensitivities are all factors. Many ADHD children have histories of chronic ear infections, skin rashes, multiple formula changes, asthma, and respiratory problems that are frequently allergy related. Evaluating and treating allergies or sensitivities is crucial since histamine is released in allergic reactions and can affect the nervous system. The techniques employed by environmental allergists, in contrast to traditional allergists, are most successful in this area. Also, many nutrients are essential for proper functioning of the nervous system. It is important to determine if all essential nutrients are available in the body and to replenish those which are not.

Manipulation:

Osteopathic manipulation, particularly using the cranial sacral techniques, can improve the functioning of the autonomic nervous system.

Sensory Integration/Developmental Optometry:

Once nervous system control is improved, reeducation may be necessary to establish new and appropriate neuronal pathways. Many children who manifest symptoms of ADHD are kinesthetic learners (learn best with their hands) and appear to be right-brain dominant. Yet success in most schools depends on auditory and visual learning and left-brain dominance. Sensory integration through a developmental optometrist or a physical or occupational therapist can help to correct some learning difficulties.

Dr. Block is a family physician with a special interest in allergy and environmental medicine, nutrition, and osteopathic manipulation as they relate to chronic childhood problems. She is the author of No More Ritalin, and No More ADHD. Dr. Block is a member of the American Osteopathic Association, the American Academy of Environmental Medicine, the Pan American Allergy Society, the American Academy of Osteopathy in which she serves on the Board of Governors, and the Cranial Academy.

www.blockcenter.com

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