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Do 2.5 Million Children Really Need Ritalin?

ADHD is often grossly and carelessly overdiagnosed. All too often a teacher complaint and a 10-minute talk with a pediatrician results in an ill-considered diagnosis and prescription.
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The incidence of Attention Deficit Hyperactivity Disorder, commonly called ADHD or ADD, has exploded -- a relatively uncommon syndrome has become a household word. Three to seven percent of the children in the United States, over 4 million of them, are being diagnosed with this "disease," and 2.5 million are being treated with Ritalin or some other long-term medication. This is a 1,600 percent increase since the 1970s! It sometimes seems that every time we turn around, another child has been diagnosed with ADHD and placed on pharmaceutical medication, which the child is expected to take throughout childhood and even for life. Worse yet, there is very little solid research concerning the long-term benefits or side effects of these medicines.

What is going on here? Have millions of our children become so hyperactive and unable to focus that they are incapable of succeeding at school or dealing with the demands of normal life? Or are we creating an illness where there is none, calling normal variations in temperament and personality a "disease" that requires the intervention of long term, and extremely profitable, pharmaceutical medication?

Furthermore, for those children who really are having difficulties, can we go back to basics? Can we find more natural, less invasive and less dangerous methods for healing these children and enabling them to succeed and thrive without the necessity of pharmaceutical treatment?

As an integrative pediatrician who has helped hundreds of children diagnosed with ADHD over the past 20 years, I offer these practical points to consider:

1. ADHD is often grossly and carelessly misdiagnosed and overdiagnosed. All too often a teacher complaint and a 10-minute talk with a pediatrician results in an ill-considered diagnosis and an indefinite prescription for psychostimulant medication. This hurried process can miss both simple explanations (a gifted child who is bored, a poor fit between student and teacher, parents without adequate time and resources to motivate an intense and difficult child), or more serious problems like anxiety, depression, dyslexia and other learning disabilities.

2. If a child really is having significant attention issues, nutrition, and not medication, is the place to start. Many children begin the day with pop-tarts, Lucky Charms, and similar junk food. We might as well pour table sugar down their throats and send them off to learn. I have seen many children whose attention problems were fixed simply by providing them with a good breakfast and a decent lunch (often hard to obtain at your typical school).

3. In addition to the basics of nutrition, many children have real food allergies or sensitivities. Several research studies have shown, for instance that artificial colors and flavors can make normal children hyperactive and hyperactive children worse. Think about that the next time you see a child downing a huge bottle of bright purple Gatorade. For some kids, even such basic foods as milk and wheat can be triggers for hyperactive behavior.

4. Omega-3 fatty acids, found in fish oil, have been shown in multiple research studies to have significant and sometimes dramatic positive results in children with ADHD. These studies have shown that ADHD children are usually even more deficient in these crucial fats than are most people in our country, and that a daily fish oil supplement can result in dramatic improvement.

5. Recent research has shown that deficiencies of such basic minerals as iron, zinc and magnesium can contribute to ADHD symptoms, and adding simple supplements of these minerals can help improve those symptoms. Levels of these nutrients can be easily checked by your doctor, but very few do so.

By the way, why don't most doctors know and tell you about this? It is because all too many physicians get their information from pharmaceutical representatives and from conferences sponsored by pharmaceutical companies. These companies have no interest in letting anyone know about cheap and simple nonpharmaceutical treatments. It is also a sad fact that most of the "experts" who write articles in prestigious journals about the "correct" treatment for ADHD receive significant financial support from these same companies.

6. Let's not forgot the important role of good parenting in fixing what may look like ADHD. Unfortunately, many have little time for proper parenting. Imagine working or single parents picking their child up at six o'clock, after seven hours in school and three hours in aftercare, then having to rush home and trying to find time to make a decent meal and supervise homework. Is it any wonder everyone is overstressed and kids can't concentrate? Most kids are resilient and will get by, but for the child who may have a harder time concentrating in the first place, this could put him or her over the edge. It's no wonder a simple pill looks like an easy alternative.

7. ADHD has also been linked to too many hours of TV watching and video game playing. These may seriously impair children's ability for sustained attention and focus.

8. Finally, are our schools part of the problem? Caring and hardworking teachers are being given larger classes, less time to teach, and forced by "No Child Left Behind" to teach only for standardized tests. Entire schools are judged by their student's performance on these tests. Again, encouraging parents to place their children on medication can become an all too easy solution.

There are some children with severe ADHD who truly need medication, but many more who are misdiagnosed or have mild symptoms. Let's do better evaluations, and begin with basic, simple and safe interventions before exposing children to what might be a lifetime of powerful medications with long-term effects that are not really known.

For more details and information on natural, safe, effective therapies, see my book "ADHD Without Drugs: A Guide to the Natural Care of Children," with a foreword by Andrew Weil, M.D. It's filled with information that parents, educators and other health professionals can understand and put into immediate practical use.