ADD – ADHD Attention Deficit Disorder

and Hyperactivity Disorder Options

James Biddle, MD

Disclaimer

Disclaimer – this is simply an educational

presentation and is not intended to

diagnose or treat any individuals.

Diagnosis and treatment of any disease

should be done by a licensed health

care practitioner in an office setting.

Who We Are…

Asheville Integrative Medicine

Evolving the Standard of Health Care for All,

While Empowering You to Enjoy Optimal Health.

832 Hendersonville Road, Asheville, NC 28803

828-252-5545

www.docbiddle.com

Who We Are…

Physician-Selected Nutritional Supplements

832 Hendersonville Road, Asheville NC 28803

828-210-0188

www.nutrientsetc.com

Who I am…..

• BA in Biology 1984 , University of Missouri – Columbia

(genetics & evolution).

• M.D. 1989 @ University of MO – Columbia.

• Internal Medicine 1992 in Portland OR – Board

Certified; recertified in 2002 and 2012.

• Practicing Integrative Medicine in Asheville since 1997.

• www.earthaven.org , www.acam.org , www.ncims.com

What I do….

“Integrative Medicine”

Holistic, Nature’s Template, Scientific, Orthomolecular, Sherlock Holmes…

• Bio-Identical ‘Natural’ Hormones

• Diabetes and Nutrition

• Cardiovascular Support

• Allergies, ADD, Autism

• Arthritis and Fatigue

• Toxic Metal Syndromes

• “Challenging Cases”

History of

ADD-ADHD: • 1902 - First described medically when English

pediatrician George Still described “Frontal Lobe Syndrome” which some claim is analogous to ADHD.

• 1937 - Dr. Bradley in Providence, RI reported that a group of children with behavioral problems improved after being treated with stimulant medication.

• 1957 - The stimulant methlyphenidate became available.

• 1960 - The concept of hyperactivity not being caused by brain damage was first described by Stella Chess as "Hyperactive Child Syndrome.”

ADHD

• ADD-ADHD, now grouped as ADHD

– “Hyperkinetic Disorder” in UK

• Neurobehavioral disorder

– Inattention and/or hyperactivity-impulsivity.

– Significant functional impairment.

• Dramatic increases in office-based diagnoses.

• Dramatic increases in pharmacological

management.

ADD-ADHD: Stats

• In the years 1990-1993, ADHD outpatient visits increased from 1.6 to 4.2 million per year (Swanson, Lerner, and Williams, 1995).

• During those visits, 90% of the children were given prescriptions, 71% of which were for MPH.

• In 1990-1993, production of MPH in the U.S. rose from 1,784 kg to 5,110 kg.

• Stimulant prescription prevalence for children in the U.S. ranged 6% urban (Safer, Zito, and Fine, 1996) to 7% rural (Angold and Costello, 1997).

• Analyses of managed care datasets reveal a 2.5-fold increase in prescribing in the 1990-1995 time period.

ADD-ADHD: Stats

• 2003 - Ages 4-17:

– 4.4 million diagnosed with ADHD

– 2.5 million receiving medication

treatment.

– 7.8% of school-aged children have

ADD-ADHD diagnosis reported by

their parent. – www.cdc.gov/ncbddd/adhd

What’s Gone Wrong?

• Over-diagnosis and misdiagnosis.

• ADHD is a clinical diagnosis.

• Suppression of symptoms of an epidemic.

• No attention to underlying causes.

• Altered Neuro-Physiology? (i.e Frontal Lobe Syndrome from biochemical rather than physical trauma).

• Another way to address the problem?

What’s Gone Wrong?

‘The Medicalization of America’

http://www.stanford.edu/~kocabas/onbeingsane.pdf

Science, vol 179 (Jan 1973), 250-258.

• "On Being Sane in Insane Places" - David L.

Rosenhan. 8 psuedopatients got themselves

admitted to 12 inpatient psych wards, then

acted completely normal. They then watched

how the staff continued to view them as crazy,

and document it in the med records. Average

= 19 days (7-52).

ADD-ADHD Diagnosis

• The American Psychiatric Association

(APA) recognizes ADD as a mental

disorder, though the cause is unknown,

and there is no medical test for it.

• Children are diagnosed through

subjective observations of a child’s

behavior.

ADHD Types

1. Combined Type: both A1 and A2 are met for the past 6 months

2. Predominantly Inattentive Type: A1 but not A2 is met for the past six months

3. Predominantly Hyperactive-Impulsive Type: A1 but not A2 is met for the past six months.

See www.amenclinic.com for testing.

ADD-ADHD Diagnosis

DSM-4 Criteria: A. Either (1) or (2):

1. Six (or more) of the following symptoms of inattention have persisted for at least 6 months to a degree that is maladaptive and inconsistent with developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities.

• Often has difficulty sustaining attention in tasks or play activities.

ADD-ADHD Diagnosis

DSM-4 Criteria: • Often does not seem to listen when spoken to

directly.

• Often does not follow through on instructions and

fails to finish schoolwork, chores, or duties in the

workplace (not due to oppositional behavior or

failure to understand instructions).

• Often has difficulty organizing tasks and activities.

ADD-ADHD Diagnosis

DSM-4 Criteria: • Often avoids, dislikes, or is reluctant to engage in

tasks that require sustained mental effort (such

as schoolwork or homework).

• Often loses things necessary for tasks or

activities (e.g., toys, school assignments, pencils,

books, or tools).

• Is often easily distracted by extraneous stimuli.

• Is often forgetful in daily activities.

ADD-ADHD Diagnosis

DSM-4 Criteria: A. 2. six (or more) : Hyperactivity

• Often fidgets with hands or feet or squirms in seat.

• Often leaves seat in classroom or in other situations in

which remaining seated is expected.

• Often runs about or climbs excessively in situations in

which it is inappropriate (in adolescents or adults, may

be limited to subjective feelings of restlessness).

• Often has difficulty playing or engaging in leisure

activities quietly.

• Is often "on the go" or often acts as if "driven by a motor“.

• Often talks excessively.

ADD-ADHD Diagnosis

DSM-4 Criteria: A. 2. Impulsivity

– Often blurts out answers before questions have been

completed.

– Often has difficulty awaiting turn.

– Often interrupts or intrudes on others (e.g., butts into

conversations or games).

B. Some hyperactive-impulsive or inattentive symptoms that

caused impairment were present before age 7 years.

C. Some impairment from the symptoms is present in two or

more settings (e.g., at school [or work] and at home).

ADD-ADHD Diagnosis

DSM-4 Criteria: D. There must be clear evidence of clinically significant

impairment in social, academic, or occupational

functioning.

E. The symptoms do not occur exclusively during the

course of a Pervasive Developmental Disorder,

Schizophrenia, or other Psychotic Disorder and are not

better accounted for by another mental disorder (e.g.,

Mood Disorder, Anxiety Disorder, Dissociative Disorder,

or a Personality Disorder).

ADD-ADHD Diagnosis

DSM-4 Criteria: Differential Diagnosis :

• Age-Appropriate Behaviors in Active Children;

• Mental Retardation;

• Understimulating Environments;

• Oppositional Behavior;

• Another Mental Disorder;

• Pervasive Developmental Disorder;

• Psychotic Disorder;

• Other Substance-Related Disorder Not Otherwise

Specified.

Critics of ADHD

"A.D.D.--A DUBIOUS DIAGNOSIS?" 1995

Learning Matters Inc. – a PBS documentary

• http://www-

tc.pbs.org/merrow/tv/transcripts/add.pdf

• Ciba-Geigy funds CHADD (Children and

adults with ADHD) founded in 1987.

• “CHADD tells parents that ADD stems from a

chemical imbalance in the brain … a

psychostimulant corrects that imbalance…”

Critics of ADHD

• “The ADHD Fraud - How Psychiatry

Makes ‘Patients’ Out of Normal

Children” by Fred Baughman Jr., MD

• 1985 = 500,000 US children ADHD.

• now = 5 - 7 million US children ADHD.

• Genetic or environmentally triggered?

• It’s a symptom complex, not a disease!

Critics of ADHD

• The myth of attention deficit-hyperactivity

disorder: symptoms resulting from

multiple causes.

• Weinberg WA, Brumback RA. J Child Neurol.

1992 Oct;7(4):431-45; discussion 446-61.

Department of Neurology, University of

Texas-Southwestern Medical Center, Dallas.

PMID: 1469255

ADD-ADHD Alternative Differential Diagnosis :

1. Age-Appropriate Behaviors in active children. “The

Myth of the ADD Child” by Thomas Armstrong, Ph.D.

2. “Hunter in a Farmer’s World” by Thom Hartmann.

3. “Divergent Thinkers” = 20% – e.g. Thomas Edison

"The Edison Trait" author Lucy Jo Pallidino.

4. Personality Styles - Jungian temperament theory by

David Keirsey of “Please Understand Me”.

5. Overstimulating Environments – TV and games get

kids addicted to too much dopamine.

6. Parenting Skills – see “1-2-3 Magic” by Thomas

Phelan PhD for help.

ADD-ADHD

BioMedical Model

• Charles Gant MD, PhD “ADD and ADHD:

Complementary Medicine Solution.”

• Ken Bock MD “Healing the New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies.”

• Science-based approaches.

• Safer, more natural, fewer drugs.

• BioMedical Differential Diagnosis > > >.

ADD-ADHD BioMedical

Differential Diagnosis:

Nutritional: Food Allergies, Additives,

and Dietary Imbalances (Carbs, Protein,

Fats).

Deficiencies: Vitamins, Minerals, Amino

Acids, Essential Fatty Acids,

Neurotransmitters (esp dopamine).

Hormonal: Thyroid, Adrenals,

Testosterone.

Infection-Inflammation: Gut Dysbiosis/

Candidiasis, chronic Strep, Lyme,

Viruses (HSV, CMV, EBV, etc), atypicals

(mycoplasma & chlamydia pneumo).

Toxicities: Lead, Mercury, Arsenic,

Antimony, Solvents, Pesticides, etc.

ADD-ADHD BioMedical

Differential Diagnosis:

SAD :

Standard American Diet

• Refined Carbohydrates

Empty Calories

Deficient in Fiber

• Bad Fats

Excess Hydrogenated Fats

Deficient in Essential Fatty Acids

• Deficient in Vitamins and Minerals

Low Protein, High Carbs

correlate with ADHD:

• Prinz, RJ et al: Dietary correlates of hyperactive behavior in children, J Consult Clin. Psychol, vol 48, 1980, pp760-769.

• Stein, T.P. et al: Nitrogen metabolism in hyperkinetic young males, Am. J of Clinical Nutrition, vol. 39, 1984, pp 520-524.

Healthy Diet

• Adequate protein

• High fiber

• Low glycemic index

• Healthy fats

• Increase essential fatty acids

• Consider Feingold Diet

• Eat organically

Food and Additive

Allergy

• Consider relationship to foods when indicated (esp. caffeine, milk, wheat).

• Avoid artificial sweeteners = aspartame & sucralose.

• Consider an Allergy Elimination Diet:

• Doris Rapp M.D. documented alterations in EEGs while children were challenged with allergens. The EEG results corresponded with dramatic behavior changes in the children, including hyperactivity. - Is this Your Child? Discovering and Treating Unrecognized Allergies in Children and Adults by Doris Rapp.

Food and Additive

Allergy • Avoid artificial colorings and additives.

• Especially avoid tartrazine, yellow food

coloring.

Med J or Australia. Nov. 1994;161:581.

• Test for food allergies.

• Test for inhalant allergies with “end-point

titration” and “oral drop desensitization ”.

Food and Additive

Allergy • “Favourable effect of a standard elimination diet

on the behavior of young children with attention deficit hyperactivity disorder (ADHD): a pilot study.”

• 40 ADHD kids - 62% showed at least 50% improved behaviour on both the Conners list and the ADHD Rating Scale at the end of a 2-week elimination diet.

Pelsser LM, Ned Tijdschr Geneeskd. 2002 Dec 28;146(52):2543-7. (in Dutch) PMID: 12532668

Food and

Additive Allergy • 26 ADHD kids on elimination diet = 19 (73%)

responded favorably, P < .001. On open challenge, all 19 children reacted to many foods, dyes, and/or preservatives.

• A double-blind placebo-controlled food challenge (DBPCFC) was completed in 16 children. There was a significant improvement on placebo days compared with challenge days (P = .003).

• Atopic children with ADHD had a significantly higher response rate than the nonatopic group.

Boris, M et al: Food and additives are common causes of the attention deficit disorder in children, Annals of Allergy, May, 1994, 72: 462-468.

• 24 hyperactive preschool-aged boys .

• Baseline 3 weeks, a placebo-control 3 weeks, experimental diet of 4 weeks.

• > 50% exhibited a reliable improvement in behavior and negligible placebo effects.

• Several non-behavioral variables improved on the experimental diet, particularly halitosis, night awakenings, and latency to sleep onset.

Kaplan, BJ et al: Dietary replacement in preschool-aged hyperactive boys, Pediatrics, vol 83, 1989, pp7-17.

Food and

Additive Allergy

Food and

Additive Allergy • Crook, WG: Treatment of attention deficit

hyperactivity disorder (comment/letter), Annals of Pharmacotherapy, 26(4):565-566, 1992, April.

• Egger, J, et al: Controlled Trial of hyposensitization in Children with Food Induced Hyperkinetic Syndrome, Lancet, May 9, 1992, 339: 1150-1153.

• Hughes, EC, et al: Food sensitivity in attention deficit disorder with hyperactivity: a procedure for differential diagnosis, Annals of Allergy, vol 49, pp 276-280, 1982.

• Mayron, LW: Allergy, learning and behavioral problems, Journal of Learning Disabilities, vol12(1), 1979, pp 32-41.

• McGovern, J et al: International Journal of Biosocial Research, vol 4, 1983, pp 40-42.

• O’Shea, JA et al: Double-blind study of children with hyperkinetic syndrome treated with multiallergen extract sublingually, J of Learning Disabilities, vol 14(4), 1981, pp 189-191 & 237.

• Rapp, D: Does diet affect hyperactivity? Journal of Learning Disabilities, vol 11(6), 1978, pp 383-388.

Food and

Additive Allergy

Nutrient Supplements

“Rational dosages of nutrients have a prolonged effect on learning disabilities.” 19 L.D. kids in crossover RCT with “nutrient supplements” x 2 yrs.

All showed significant academic and behavioral improvements within a few weeks or months.

Some children gained 3 to 5 years in reading comprehension within the first year of treatment.

All children in special education classes became mainstreamed, and their grades rose significantly.

2 more yrs ‘open label’- the difference in scores between the 2 groups reached statistical significance (P < .01).

Carlton RM. Altern Ther Health Med. 2000 May;6(3):85-91.

Nutrient Supplements

“Do nutrient supplements and dietary changes affect learning and emotional reactions of children with

learning difficulties? A controlled series of 16 cases.” 16/32 L.D. kids in RCT “nutrient supplements” x 22 wks.

• Significantly-improved behaviour at school, at home, and in the clinic.

• Significantly-greater gains in reading skills.

• Increased IQ scores of 5 to 35 points (mean = 17.9) for the experimental group were twice the control group (mean = 8.4).

Colgan M, Nutr Health. 1984;3(1-2):69-77.

Nutrient Supplements

• P-5-P (activated B6), 25 mg once or twice daily to support serotonin.

• Magnesium 200-600 mg per day.

• EFAs = Essential Fatty Acids fom fish oil and ground flax seeds.

• Vitamin B-12, Vit C, Zinc, Selenium, Tyrosine, and others as guided by testing.

Nutrient Supplements:

Vitamin B6 = Pyridoxine 11 ADHD kids and 11 controls:

Serotonin levels were significantly decreased in blood of ADHD kids vs controls. No differences in B6 levels.

Four ADHD kids -> oral doses of pyridoxine resulted in increased serotonin and a very large increase in the B6 content of blood in these hyperactive patients.

Bhagavan, HN, et al: The effect of pyridoxine hydrochloride on blood serotonin and pyridoxal phosphate contents in hyperactive children, Pediatrics, vol 55, 1975, pp 437-441. PMID: 1143984

Vitamin B Deficiency

• Brenner, A: The effects of megadoses of selected

B complex vitamins on children with hyperkinesis:

controlled studies with long term follow-up.

Journal of Learning Disabilities, vol 25, 1982, p.

258.

• Brenner, A, et al: A pyridoxine-dependent

behavioral disorder unmasked by isoniazid, Am J

Dis Child, vol 132, 1978, pp, 773-776.

• Coleman , M, et al: A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double blind crossover comparisonwith methlyphenidate, Biological Psychiatry, vol 4(5), 1979, pp. 741-751.

• Hoffer, A: Treatment of hyperkinetic children with nicotinamide and pyridoxine, Can Med Assoc J ,vol 107, 1972, pp. 111-112.

• Longnecker, J, et al: Effects of prolonged sub-clinical dietary deficiencies on one or more nutrients, Federal Proceedings, vol 46, 1987, p 903.

Vitamin B Deficiency

Mineral Deficiencies:

Magnesium “Improvement of neurobehavioral disorders in children

supplemented with magnesium-vitamin B6. I. Attention deficit hyperactivity disorders.”

• 40 ADHD kids Rx with Mg & B6 (6 mg/kg/d Mg, 0.6 mg/kg/d vit-B6) > 8 weeks.

• Started with lower RBC Mg levels than 36 controls.

• Hyperactivity and aggressiveness were reduced

• School attention was improved.

• Significant increase in RBC Mg. When the Mg-B6 treatment was stopped, clinical symptoms reappeared in few weeks, with a decrease in RBC Mg values.

Mousain-Bosc M, Magnes Res. 2006 Mar;19(1):46-52.

Mineral Deficiencies:

Iron “Effects of iron deficiency on attention and learning

processes in preschool children: Bandung, Indonesia.”

• RTC giving iron to ½ of kids for 8 weeks.

• Pre- and post-treatment psychological tests showed that IDA (iron-deficiency anemia) produces alterations in cognitive processes related to visual attention and concept acquisition, alterations reversed with iron treatment.

• Soewondo S, Am J Clin Nutr. 1989 Sep;50(3 Suppl):667-73.

• Ferritin > 50 !

Mineral Deficiencies

• Brenner, A: Trace mineral levels in hyperactive children responding to the Feingold diet. Journal Pediatrics, 94(6), 1979, pp. 944-945.

• Durlach, J: Clinical Aspects of Chronic Magnesium Deficiency, in MS Seelig, Ed, Magnesium in Health and Disease, NY, Spectrum Publications, 1980.

• Lozoff, B: Behavioral aspects of iron deficiency, Progress in Hematology, vol 14, 1986, pp. 14-53.

• Lozoff, B: Iron and learning potential in childhood, Bulletin of the NY Academy of Science, vol. 65(10), 1989, pp. 1050-1066

• Marlowe, M: Hair selenium levels and children’s classroom behavior, J of Orthomolecular Medicine, vol1(2), 1986, pp.91-96.

• Hansen, C, et al: Copper and zinc deficiencies in association with depression and neurological findings, Biological Psychiatry, vol. 18(3), 1983, pp. 395-401.

• Walther, B, et al: Does dietary phosphate change the neurophysiologic functions and behavioral signs of hyperkinetic and impulsive children, Monatsschr Kinderheilkd, vol. 128(5), 1980, pp 382-385.

• Ward, NI et al: The influence of the chemical additive tartrazine on the zinc status of hyperactive children – a double blind placebo-controlled study, Journal of Nutritional Medicine, vol. 1, 1990, pp. 51-57.

Mineral Deficiencies

Amino Acid Deficiencies

• Nezmer, E D, et al: Amino acid supplementation as therapy for attention deficit disorder, Journal of the American Academy of Child Psychiatry, vol. 25 , 1986, pp 509-513.

• Reimherr, FW, et al: An open trial of l-tyrosine in the treatment of attention deficit disorder, residual type, American Journal of Psychiatry, Aug. 1987, 144:8, 1071-1073.

• Wender, P.H., et al: Amino acid precursors for the treatment of add-residual type, Psychopharmacological Bulletin, vol. 21, 1985, pp 146-149.

• Wood, DR, et al: Treatment of attention deficit disorder with di-phenylalanine, Psychiatry Res. Vol. 16, 1985, pp. 21-26.

Essential Fatty Acid and

Phospholipid Deficiency “Supplementation with flax oil & vitamin C improves the

outcome of ADHD.” • Alpha linolenic acid (ALA)-rich nutritional

supplementation in the form of flax oil and antioxidant emulsion.

• Post-supplementation levels of RBC membrane fatty acids were significantly higher than pretreatment levels or the levels in controls.

• Significant reduction in total hyperactivity scores of ADHD children derived from ADHD rating scale.

Joshi K, Prostaglandins Leukot Essent Fatty Acids. 2006 Jan;74(1):17-21. PMID: 16314082

Essential Fatty Acid and

Phospholipid Deficiency

• Colquhoun, I: A lack of essential fatty acids as a possible cause of hyperactivity in children, Medical Hypotheses, vol 7, 1981, pp.673-679.

• Mitchell, E: Clinical characteristics and serum essential fatty acids in hyperactive children, Clinical Pediatrics, vol. 26, 1987, pp. 406-411.

• Stevens, L: Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder, American Journal of Clinical Nutrition, vol. 62, 1995, pp 761-768.

Gastro-Intestinal

• Nutritional Deficiencies could be due to poor

intake and/or impaired digestion and gut

function.

– Test for H. pylori.

– Treat dysbiosis/candidiasis.

– Test HCL – Heidelberg gastrogram.

– Digestive Enzymes with meals

– Acidophilus after meals.

Thyroid Disorders

• Hauser, P, et al: Attention deficit-hyperactivity disorder in people with generalized resistance to thyroid hormone, NEJM, April 8, 1993, 328(14):997-1001.

• Matochik, J A: Abnormalities in sustained attention and anterior cingulate metabolism in subjects with resistance to thyroid hormone, Brain research, vol. 723(1-2), June 3, 1996, pp. 23-28.

• Weiss, R E: Attention deficit disorder and thyroid function, Journal of Pediatrics, 1993, 123: 539-545.

Lead and ADHD

• The Center for Disease Control, or CDC,

estimates that more than three million

children have lead toxicity at any point in time

in America.

• Their criteria for diagnosis is a serum lead

level of ten mcg/dl or higher. Children get

lead toxic easy since they absorb fifty percent

of the lead they’re exposed to, while adults

only absorb about ten percent.

Lead and Children

When a mother’s blood has low levels of lead, even

below the CDC’s cut-off level of 10 mcg/dl, their

neonatal babies show a dose-effect trend towards

both poorer attention and poorer motor control. – Emory E. Neurobehavioral effects of low-level lead

exposure in human neonates. Am J Obstet Gynecol 1999;181:S2-S11.

By age two, low levels of lead still below 10 mcg/dl

are directly correlated with decreased IQ. - Reuters Health, May 5, 2000.

Lead and Children

• Preschoolers with blood lead levels from 10 to 25 mcg/dl show measurable behavioral changes when compared to those with levels less than 10 mcg/dl. – Mendelsohn Al. Low-level lead exposure and behavior in

early childhood. Pediatrics 1998;101(3):E10.

• In first graders, hair lead levels correlate with children’s attention-deficit behavior in the classroom. – Tuthill RW. Hair lead levels related to children's classroom

attention-deficit behavior. Arch Environ Health 1996;51(3):214-220

Lead and Children

• At age twelve, hyperactive kids have higher blood lead levels than non hyperactive kids. They also have higher urine lead levels after given a binding agent for lead. – David O. Lead and hyperactivity. Lancet 1972;2:900-903.

• At ages eleven to thirteen, lifetime low-level lead exposure correlates with emotional and behavioral deficits. – Burns JM. Lifetime low-level lead exposure to environmental

lead and children's emotional and behavorial development at ages 11-13 years. Am J Epidemiology 1999;149(8):740-749.

Lead and Children

• From ages seven to eleven, bone lead levels

correlate with antisocial and delinquent

behaviors, aggression, and attention deficits. – Needleman HL. Bone lead levels and delinquent behavior. JAMA

1996;275(5):363-369.

• At ages eight thru thirteen, hyperactive kids have

higher urine lead levels after being challenged

with a lead-binging agent than their own siblings. – Gittelman R. Lead and hyperactivity revisited. Arch Gen

Psychiatry 1983;40:827-833.

• Eppright, TD: Attention Deficit Hyperactivity Disorder, Infantile Autism, and Elevated Blood Lead: A Possible Relationship, Missouri Medicine, 93(3), 1996, pp. 136-138.

• Howard, J: Clinical import of small increases in serum aluminum, Clinical Chemistry, vol. 30(10), 1984, pp 1722-1723.

• Thomson, G O, et al: Blood-lead levels and children’s behavior: Results from the Edinburgh lead study, Journal of Child Psychology and Psychiatry, vol. 30(4), 1989, pp.515-528.

Lead and ADHD

Is your home is a safe and

lead-free environment?

• Have your house tested for the presence of lead paint dust.

• Test your drinking water for lead, or you can filter it for safety.

• Our children deserve to have us look for underlying and reversible causes for their developmental and behavioral challenges.

Is your home is a safe and

lead-free environment?

• A blood lead test screens for on-going lead exposure of last 3 months.

• Hair analysis assesses recent or past exposure and the ability to excrete lead. – (Mehta S. What do parents know about lead poisoning? Arch

Pediatr Adolesc Med 1998;152:1213-1218).

• “Provoked” Urine test estimates a person’s total body burden of lead. Urinary Porphyrins! – Lin JL, Chelation Therapy for Patients with Elevated Body Lead

Burden and Progressive Renal Insufficiency. Annals Int Med. 1999;130:7-13.

What about Hg?

• Mercury is the most toxic, non-

radioactive element on the planet.

• It remains detectable in the blood

for only 3-6 weeks.

• As it leaves the blood it enters

every organ, every cell, and every

subcellular organelle in the body.

Mercury and Coal

• Largest source of mercury is our coal-burning

power plants.

– Emit 48 tons of mercury into the air each year.

– EPA reports that rainfall in New England now

contains thirty times the “safe” level of mercury for

surface water.

– EPA also blames mercury for neurological

damage to 60,000 American babies each year

(more U.S. citizens than died in the entire Vietnam

War). > Physicians for Social Responsibility

Pandora’s Box - Hg

• "On average, for each 1000 lb of

environmentally-released mercury, there was

a 43% increase in the rate of special

education services and a 61% increase in

the rate of autism.”

“Environmental mercury release, special education

rates, and autism disorder: an ecological study of

Texas” Health and Place; 17 February 2005 ; U.

Texas Health Science Center in San Antonio.

Pandora’s Box - Hg

in Dental Amalgams: via Stuart Freedenfeld, M.D

• Average filling = 1 gram and is 50-55% Hg.

• The mercury in one filling would cause a 10-

acre lake to be closed to swimming and fishing.

• Over 100 million new amalgam fillings placed

each year (75-80% still).

• 50 million grams (or about 27.5 tons) of

mercury are being newly placed into the mouths

of patients every year.

Mercury and

Dental Fillings

• World Health Organization reported in 1991 that our leading exposure to mercury is our dental fillings. Silver fillings usually contain fifty percent mercury (Americans average eight fillings per person).

• Although dentists have been taught that dental mercury is inert, 1998 U.S. Senate Hearings confirm that it does evaporate and get absorbed into our bodies.

• Mercury amalgam fillings have been banned by several progressive European countries, including Switzerland and Sweden.

Dental Amalgams:

• Mercury levels in feces are 13-fold higher with

dental amalgams, and these levels vary with the

amount of amalgam surfaces.

• More than 25% of the original mercury is gone

from dental amalgams after the first five years.

• Mercury is bio-concentrated by the placenta - it

concentrates 8-fold in the fetus.

Dental Amalgams:

• Imagine 17mcg/day absorbed by a pregnant

mother during a 270-day pregnancy.

• We were concerned about the 237 mcg of

mercury injected into our children over their first

two years in vaccines.

• Should we not give serious concern to the 4590

mcg given to the mother-fetus unit over the more

vulnerable 9 month gestation?

Dental Amalgams:

• 60,000 babies per year in the US are born with

neurodevelopmental disorders due to neonatal

exposure to mercury.

• The EPA estimated that 1 baby in 6 is

born with a blood mercury level that exceeds

the Agency’s safety threshold, or 300,000

infants/year. Env Health Persp 112(5); 562-70.

Vaccine safety

and efficacy?

ELI LILLY: THIMEROSAL

• Merthiolate as a preservative in the final concentration of 1/10,000 could be toxic for tissue cells, lymphocytes, etc.

J.W. Smith, Ph.D., Head of the Biological Regulatory Requirements Department at

Eli Lilly—September 7, 1971.

Vaccine safety

and efficacy?

ELI LILLY: THIMEROSAL

• We have found that for tissue culture work, the merthiolate must be in the concentration of less than 1/1,000,000 in order not to be toxic to the tissue cells.

J.W. Smith, Ph.D., Head of the Biological Regulatory Requirements Department at

Eli Lilly—September 7, 1971.

Vaccine safety and efficacy?

Safe Levels Of Organic Mercury:

EPA--------0.1 mcg/kg/Day

ASTDR----0.3 mcg/kg/Day

FDA--------0.1 mcg/kg/Day

WHO-------3.3 mcg/kg/Week

DTaP, Hib, Hep.B = total 62.5mcg ---

exceeded all “safe” levels combined.

Mercury in Vaccines

• Until about 1989 pre-school children got only 3 vaccines (polio, DPT, MMR). By 1999 the CDC recommended a total of 22 vaccines to be given before children reach the 1st grade, some given to newborns within the first 24 hours of birth. Many of these vaccines contained mercury.

• The cumulative amount of mercury being given to children in this number of vaccines would be an amount 187 times the EPA daily exposure limit.

Mercury in Vaccines

• In the 1990s approximately 40 million children

were injected with mercury-containing

vaccines.

• Between 1989 and 2003, there has been an

explosion of autism. The incidence of autism

(and other related disorders) went from about

1 in 2,500 children to 1 in every 166. Currently

there are more than a half million children in

the U.S. that have autism.

Mercury in Vaccines

• Since mercury was removed from childhood vaccines, the increase in reported rates of autism and other neurological disorders (NDs) in children not only stopped, but actually dropped sharply – by as much as 35%.

• –Geier, David A., B.A., and Mark R. Geier, M.D., PhD. Journal of American Physicians and Surgeons. March 10, 2006.

History has a way of

repeating itself:

Pink Disease - delayed onset of symptoms &

1/500 affected; symptoms included:

• pink hands, peeling pink hands, peeling skin,

infections, irritability, poor muscle tone.

• GI problems – diarrhea, constipation,

encephalitis, tremors/seizures, sound/light

sensitivity, immune system dysregulation.

Does this remind you of anything ???

Does heavy metal toxicity play

a role in my child’s condition?

Food for thought:

• Autism: A Novel form of Mercury Poisoning. Med Hypotheses 56(4): 462-71; Bernard, S. (2001).

• The Role of Mercury in the Pathogenesis of Autism. Molecular Psychiatry 7: S42-S43; Bernard, S. (2002).

Heavy Metal Detox:

• Reduce Exposures.

• Nutrients to support detox pathways,

especially methylation, sulfation, and

glutathione production.

• Natural Chelators.

• Synthetic Chelators.

Reduce Toxic Exposure:

• Avoid amalgam fillings. www.iaomt.org

– Foundation for Toxic-Free Dentistry: 1-800-331-2303

or www.bioprobe.com , www.altcorp.com

• Avoid Hg-containing fish.

• Drink purified water.

• Eat organic foods.

• Avoid hydrogenated fats.

Exercise and Attention

• Exercise Daily.

• Use “Rebounder” or mini-trampoline for

15 min. each morning.

• Consider movement, visual and/or

auditory integration techniques.

Testing

Functional Lab Testing:

• CDSA (comprehensive digestive stool analysis) and Intestinal Permeability.

• Essential Fatty Acid Analysis.

• Amino Acid Analysis. Urinary Porphyrins.

• Hair Analysis and Chelation Challenge.

• Inhalant Allergies (End-Point Titration and Oral-Drop Desensitization).

• Try to avoid Methylphenidate. See www.breggin.com to read about the dangers of Methylphenidate.

Methylphenidate

• First available in 1957

• Methylphenidate (hydrochloride)

• Schedule II drug - Controlled Substances Act

• Can be addictive, enhance brain activity and increase alertness and energy.

• Elevates blood pressure, heart rate, and respiration.

• Very high doses can lead to irregular heartbeat and high body temperature.

Methylphenidate

“[Methylphenidate] is a mild central nervous system stimulant.

• The mode of action in man is not completely understood, but [Methylphenidate] presumably activates the brain stem arousal system and cortex to produce its stimulant effect.

• There is neither specific evidence which clearly establishes the mechanism whereby [Methylphenidate] produces its mental and behavioral effects in children, nor conclusive evidence regarding how these effects relate to the condition of the central nervous system.”

– Novartis Pharmaceuticals Corporation, East Hanover, NJ 07936 © 2001 Novartis.

Methylphenidate

“[Methylphenidate] should not be used in children under six years, since safety and efficacy in this age group have not been established.

Sufficient data on safety and efficacy of long-term use of [Methylphenidate] in children are not yet available.” – Novartis Pharmaceuticals Corporation, East

Hanover, NJ 07936 © 2001 Novartis.

ADHD Industry

• Morgan Stanley Dean Witter

– ADHD “underdiagnosed”,

– Predicted market to grow from $600 milllion to $1.4

bill in 2005.

• Miller, Monica. [Methylphenidate] Goes to Court: Class

Actions, Custody and Damages.

• [Methylphenidate] sales for nine months of

2007 were $271 million.

– January 6, 2008

www.novartis.com/investors/product-sales.shtml

Methylphenidate

• Journal of American Medical Association

study Methylphenidate and Clonidine use.

– 200K children age 2-4 over five year period.

– Patients in HMOs – 310% increase in

Methylphenidate Rx.

– Midwestern Medicaid – 300% increase.

– Mid-Atlantic – 170% increase.

– Midwestern – 28,200% increase in Clonidine (Rx

with Methylphenidate increasingly).

Methylphenidate

in Court • Dawson et al. v. Ciba-Geigy et al.

– Ciba-Geigy, now Novartis Pharmaceuticals

– New Jersey class action suit seeking relief under Consumer Fraud Act.

• Alleges that Novartis conspired with American Psychological Association and “Children and Adults with ADHD” (CHADD) to boost Methylphenidate sales, since 1950s.

Methylphenidate

in Court • Alleges that CHADD received $748,000 from

Ciba-Geigy from 1990-1994 alone.

• Alleges plan between APA and Novartis to create diagnoses of ADHD and to include these illnesses in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and to encourage the overdiagnosis of these disorders to promote Methylphenidate as choice drug. – Amy Westfeldt. NEWARK, N.J. (AP) via NewsEdge

Corporation. September 2000.

Methylphenidate and

Custody

• Carroll family of NY

– School reported parents to Child Protective Services when parents stopped giving Methylphenidate to son Kyle.

– Kyle had become “withdrawn insomniac with no appetite” who had no improvements in reading level (cause for taking Methylphenidate).

• Miller, Monica. [Methylphenidate] Goes to Court: Class Actions, Custody and Damages.

Methylphenidate and

Cardiac Risks

• Long-Term use of Methylphenidate may

have caused 14 year old boy’s death.

• Matthew Smith of Pontiac,MI died of

heart attack after 10 years of taking

Methylphenidate.

– "Doc Links [Methylphenidate] to Boy's

Death," New York Daily News, 17 Apr.

2000, 54.

Methylphenidate

FDA Label Warnings

The following have been reported with use

of Methylphenidate and other stimulant medicines.

1. Heart-related problems:

– sudden death in patients who have heart

problems or heart defects

– stroke and heart attack in adults

– increased blood pressure and heart rate

2. Mental (Psychiatric) problems:

• All Patients – new or worse behavior & thought problems

– new or worse bipolar illness

– new or worse aggressive behavior or hostility

• Children and Teenagers – new psychotic symptoms (such as hearing voices, believing

things that are not true, are suspicious) or new manic symptoms.

FDA-Approved Methylphenidate Medication Guide – April 2007; www.fda.gov/cder/Offices/ODS/MG/methylphenidate_RtabletsMG.pdf

Methylphenidate

FDA Label Warnings

• FDA alert - an animal study of

Methylphenidate has produced a "weak

signal" that the drug may have the

potential to cause cancer.

• www.fda.gov/bbs/topics/ANSWERS/AN

S00705.html - Jan. 12, 1996

Methylphenidate

FDA Label Warnings

DEA -“Drug of Concern”

• The DEA regards Methylphenidate as a

"drug of concern"

• Abusers may dissolve the tablets in

water and inject the mixture, produces

high similar to cocaine.

• This can block small blood vessels and

damage the lungs and retina of the eye.

Stimulants:

• Cocaine

– C17H21NO4

• Methylphenidate

– C14H19NO2

Methylphenidate more

potent than Cocaine • Cocaine blocks 50% dopamine receptors causing

euphoria from dopamine build up in brain – Methylphenidate similar to cocaine in make-up, predicted by

Volkow to have similar effects on the dopamine, but would block fewer dopamine transporters.

• Typical dose of 0.5 mg/kg given to children blocked 70% of dopamine transporters, more than cocaine. Researchers “shocked.”

• Methylphenidate takes more than one hour for its effect, not as addictive; use in childhood increases addiction to other substances more intense, later in life. Long-term effect on brain? – Nora Volkow - Brookhaven National Laboratory, Upton, NY,

JAMA, 2001, 286: pp. 905-906.

Methylphenidate versus

Nutritional Supplementation

• Twenty children with attention deficit/ hyperactivity disorder (AD/HD) were treated with either Methylphenidate (10 children) or dietary supplements (10 children) and tested for audio and visual performance and attention.

• Subjects in both groups showed significant gains for both tests administered. – Harding K, Judah R, Gant C (2003) Altern Med

Rev; 8(3):319-330.

Charles Gant, MD, PhD

• The dietary supplements included vitamins, minerals, phytonutrients, amino acids, essential fatty acids, phospholipids, and probiotics.

• “Findings support the effectiveness of food supplement treatment in improving attention and self-control in children with ADHD and suggest that food supplement treatment of ADHD may be of equal efficacy to Methylphenidate treatment.”

ADD-ADHD BioMedical

Treatments:

Nutritional: Food Allergies, Additives,

and Dietary Imbalances (Carbs, Protein,

Fats).

Deficiencies: Vitamins, Minerals, Amino

Acids, Essential Fatty Acids,

Neurotransmitters (esp dopamine).

Hormonal: Thyroid, Adrenals,

Testosterone.

Infection-Inflammation: Gut Dysbiosis/

Candidiasis, chronic Strep, Lyme,

Viruses (HSV, CMV, EBV, etc), atypicals

(mycoplasma & chlamydia pneumo).

Toxicities: Lead, Mercury, Arsenic,

Antimony, Solvents, Pesticides, etc.

ADD-ADHD BioMedical

Treatments: