Hyperactivity - on the go all the time, no peace!

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Hyperactivity is the colloquial term for the condition better described as attention deficit hyperactivity disorder [ADHD].

Making a diagnosis

The key is to get the parents to make the diagnosis! I find that if a child walks into my surgery and I say "He's hyperactive", this is taken as an insult! (My daughters used to make the diagnosis just watching the sufferer walking up the drive!). What I find works best is to do a Conners score. This is a very simple check list which works well in clinical practice and has been used for research purposes. If the parents do the scoring, then they make the diagnosis.

See WebMD discussion of Conners Rating

The above page also discusses making a diagnosis in adults - there are many other children's rating scales and adult rating scales available, as referenced on the above page:

  • For children:
    • Vanderbilt Assessment Scale. This reviews symptoms of ADHD. It also looks for other conditions such as conduct disorder, oppositional-defiant disorder, anxiety, and depression. Parents or teachers answer questions about how well the child does with schoolwork and gets along with others.
    • Behaviour Assessment System for Children (BASC). This looks for things like hyperactivity, aggression, and conduct problems as well as anxiety, depression, attention, and learning problems.
    • Child Behaviour Checklist/Teacher Report Form (CBCL). Among other things, this scale looks at problem behavior in children.
  • For adults:
    • Adult ADHD Clinical Diagnostic Scale (ACDS). A doctor, therapist, or other health care worker asks you 18 questions about your symptoms during an interview.
    • Brown Attention-Deficit Disorder Symptom Assessment Scale (BADDS) for Adults. You answer 40 questions, either on a questionnaire or during an interview with a health care worker. It looks for problems with things like attention, memory, and mood.

There has been much academic study about the accuracy of the various ratings scales - see Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis - and that meta-analysis concluded that:

CBCL-AP and CRS-R (Conners Rating Scale-Revised) both yielded moderate sensitivity and specificity in diagnosing ADHD. According to the comparable diagnostic performance of all examined scales, ASQ (Conners Abbreviated Symptom Questionnaire) may be the most effective diagnostic tool in assessing ADHD because of its brevity and high diagnostic accuracy. CBCL is recommended for more comprehensive assessments.

As said, I have found Conners scale, as described below, the most useful in my clinical practice.

Conners score

Score 0 for not at all.

Score 1 for just a little.

Score 2 for pretty much.

Score 3 for very much.

How true are the following descriptions of your child:

  • Restless or overactive
  • Excitable or impulsive
  • Disturbs other children
  • Fails to finish things
  • Short attention span
  • Constantly fidgeting
  • Inattentive, easily distracted
  • Demands must be met easily
  • Easily frustrated
  • Cries often and easily
  • Mood changes quickly and dramatically
  • Temper outbursts
  • Explosive and unpredictable behaviour

A score of 15 or more suggests that hyperactivity is likely.

ADHD is "migraine of the frontal lobes". Because the frontal lobes have no pain sensation, the kids don't get headaches. Their problems are those associated with the frontal lobes, namely anti-social behaviour, mood swings and general restlessness. Trying to "discipline" them is a waste of time. Short term memory is extremely poor and instructions like "not to climb the ladder" can be heard as "climb the ladder" because the child forgets the "not".

The majority of hyperactive children I have seen in my clinical practice are bright, blond, blue eyed boys. I am not alone in this observation - see THE NATURAL APPROACH TO ADHD By Dr. Zoltan P. Rona who states that:

It is thought that children are usually affected by ADHD before birth and that, left untreated, continue to suffer from the condition into adulthood. ADHD affects more boys than girls with a ratio of 3:1. A high percentage of hyperactive children have blond hair and blue eyes 

Other doctors and patient groups have different views and of course this is only clinical observation - brunette girls have ADHD as well.

In fact, it may be that girls' diagnoses of ADHD have been missed due to better masking of symptoms in girls - see Psych Central - Masking in ADHD: The “Why” Matters This is an emerging area of study.

See also

The joy of treating these children is that once sorted, they often go on to shine in some field or other. I saw one little boy who excelled at the piano as soon as he was able to sit still for more than 2 minutes!

Treating ADHD

  • It is really important that hyperactivity is treated with the environmental approach.
  • All sufferers (indeed all children in my opinion) should take vitamins and minerals. After the age of 12 they can take the adult regime. Between 6 and 12 take half adult dose, proportionately less for younger children. Hyperactive children are nearly always zinc deficient and so add in zinc citrate 30 mgs at night. See The role of zinc in the treatment of hyperactivity disorder in children which stated that:
Studies point to the possible association of zinc deficiency and ADHD pathophysiology. In ADHD children with zinc deficiency or low plasma zinc concentration, zinc dietary supplementation or during therapy for ADHD may be of great benefit. A study of ADHD treatment with zinc sulfate as a supplement to methylphenidate showed beneficial effects of zinc supplementation in the treatment of children with ADHD.  

(Zinc is also a common deficiency in dyslexia - see Developmental dyslexia and zinc deficiency and Zinc deficiency in children with dyslexia: concentrations of zinc and other minerals in sweat and hair).

In conclusion, there is evidence that a ω-3 PUFA treatment has a positive effect on ADHD

[ω-3 PUFA = omega-3 polyunsaturated fatty acids]

  • Expect a response within a week for any dietary change except in the case of wheat and dairy products. Often these cause delayed reactions and the diet must be enforced for one month.

Summary of initial treatment protocol

If there is no or just slight improvement with the above regime...

The diet recommended by the Food Intolerance Network is the RPAH Elimination Diet which avoids about 50 additives, salicylates, amines, glutamates and if symptoms are severe also dairy foods and gluten 

Indeed the Food Intolerance Network goes on to say that:

When highly processed additive-laden foods became widespread in the U.S. in the 1960s, paediatric allergist Dr Ben Feingold suggested that additives such as artificial colours, flavours and preservatives could be responsible for the growing epidemic of children’s behaviour and learning problems, variously called hyperkinesis, hyperactivity, ADD, ADHD, ODD and many more. Further, he suggested that natural chemicals called salicylates – in artificial flavours and natural foods – were also involved. If Dr Feingold had been taken seriously then, it would have saved millions of families from anguish. Instead, a series of food industry funded studies ‘proved’ that he was wrong.

The Food Intolerance Network references 26 studies on that page.

Please refer to also to Category:Allergies, autoimmunity and infections

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