Children’s Health:
The Nation’s Future
A society living in crisis mode, such as ours, tends to postpone long-term solutions, whether it be repairing our infrastructure, revamping health care, or looking 30 years into the future to see how we can improve the lives of our future adults.
A look at the rise in psychiatric medication shows that something is happening to our children, and the changes are not positive. 1) From 1985–1999 prescriptions for stimulant psychotropic drugs for children went up 327%; 2) The percentage increase from 1991–2000 in stimulants prescribed for preschoolers, ages 2–4, rose by 50%; 3) The number of antidepressant medications prescribed annually for children under age 19 is 11 million; 4) In 1985 the number of children diagnosed with ADD/ADHD and medicated with stimulants such as Ritalin and Adderall was 500,000; 5) The number of kids diagnosed with ADD/ADHD today is 6 million, or about 1 in 20 kids. Something is seriously wrong with this picture.
ADHD is a chronic behavioral disorder characterized by inattention, hyperactivity, impulsivity, and difficulty in multi-tasking. While these kids have trouble focusing, outside of school they often have areas of interest where they can focus for many hours. In the western world, the incidence of ADD/ADHD are nearly equal, but the treatment is not. Children in northern Finland are rarely treated with medication. The reason this finding is important is that Finland’s educational system ranks number 1 in the world in reading, and number 2 in math. In Finland, the behaviors we consider abnormal and requiring treatment with medication in America — are not viewed as being pathological.
The incidence of autism has skyrocketed over the last several decades. Currently 1 in 38 British boys are autistic. That’s 2.6%. The incidence of autism in a large Amish community in Ohio, a group with very low rates of vaccinations, is 1 in 10,000. There is controversy about the cause of the skyrocketing incidence of autism. There is no controversy about the numbers. A recent study by the Center for Disease Control (CDC) showed that 1 in 88 children have autism. About 1% of our kids now have autism.
The Big Picture
In order to look at the widespread challenges our children face, I believe the wise approach is to look at the very big picture, while we continue to pay attention to the kind of detail that research studies reveal. The crisis with our children involves “something” that is driving the incidence of autism and ADD/ADHD through the roof, along with the rise in medications used to treat this epidemic. The crisis involves poor nutrition, decreasing levels of exercise, challenges in the educational system, changes in the nuclear family including high divorce rates, a society of youngsters whose world revolves around computers and cell phones, and possibly vaccinations.
As I write this, a new report came out indicating that pregnant women who are obese, diabetic, or have hypertension, have a 67% increased risk of having an autistic child. The study also showed that when women take a prenatal vitamin right before pregnancy and during the first trimester, the incidence of autism goes way down. I like that bit of information about the vitamins. Pregnant women, take your vitamins! What I do not like is the implication that obesity is a significant cause of autism. The study on obesity aired on CNN April 9, 2012. The research scientist made it clear that she was not stating a cause-and-effect relationship between obesity and autism, but rather that obesity during pregnancy was a risk factor. It was also pointed out that if obese pregnant women watching the report suddenly decided to go on a crash diet, there could be a significant risk caused by the dieting. I suggest that pregnant women look at their lifestyle (diet, exercise, stress reduction), and perhaps nutritional supplementation. A healthful diet and exercise will decrease some weight, and will have far-reaching benefits in mind and body. Until there is much more information, I do not suggest that pregnant women panic about their weight.
Child and Adolescent Psychiatry
During the first nine years of my psychiatry practice about half my work was with children who ranged from 4 to 18 years old. I worked with kids in a number of settings: board-and-care residential treatment facilities that provided a lot of freedom, in-patient psychiatric hospitals, and long-term intensive outpatient treatment centers. I treated many kids who had attempted suicide or who were planning to. I treated a few psychotic 4 to 5-year-olds, and a wide spectrum of adolescent problems.
The staff in psychiatric hospitals believe they are there to cure troubled children. That sounds like the right attitude, and certainly the motivation is good. After many years I saw that these kids, mainly adolescents, had a number of places they called “home” — including home, board-and-care facilities, psychiatric hospitals, juvenile hall, and school. These kids interacted with a wide spectrum of professionals including: doctors, nurses, and hospital staff; teachers, parents, the police, and probation officers. I saw how hard psychiatric hospital staff worked to help troubled teens regroup, overcome suicidal thoughts and highly disruptive behavior, and then return home. And I saw how frequently these “treated” kids bounced in and out of psych hospitals. I also saw what to me seemed like excessive amounts of psychotropic medications being prescribed for children and adolescents.
These kids lived in a variety of holding tanks, some better than others, but they were cycling from one facility to another. I asked myself, “What are we really doing? We’re generally not curing kids. We’re helping them feel better, think better, act better, and reintegrate into their families. And, we are keeping them alive.” I worked with many kids who would have killed themselves if they had not received in-hospital psychiatric care. For some kids I felt that, if we could keep them alive until 18, some would leave home and go to college, some would go to work, and others could join the military. I saw that the attempt to treat a child as if he or she is a discreet entity, like treating a case of pneumonia, was a false idea. Far too often the “sick” children had been given that label by their family. All too often it seemed that the family did not see themselves as having a large responsibility for how their children were doing. However, I also worked with many parents who were highly involved in the treatment process, who deeply wanted to know what they could do, and what behaviors of theirs might be part of the problem. I do not mean these comments in a blaming way. There are illnesses like schizophrenia that were once blamed on bad mothering. We now know that schizophrenia has strong genetics and is a highly biological illness, and not so much a mental/emotional/conflict-driven illness. However, it is important to consider most adolescent issues as “family issues,” at least in part.
The Problem with Ritalin
Many of the ADD/ADHD kids are treated with stimulant drugs like Ritalin, Adderall, and Concerta. Research done 20–25 years ago on mice and rats showed that five or more year’s treatment with these drugs could result in permanent brain changes. The US military knows about these studies. You won’t be accepted into the military if you’ve taken one of these drugs consistently for five years or longer.
The August, 2001 issue of the Journal of the American Medical Association (JAMA) reported that long term of use of Ritalin and related drugs causes long-term brain damage similar to cocaine and amphetamine, which are closely related to Ritalin. Amphetamine and cocaine activate genes in the brain that are responsible for addiction. The study reported in JAMA showed that these same genes were activated after exposure to Ritalin.
In 2003, psychiatrist Eric Nestler of the University of Texas Southwestern Medical Center published results of research in which juvenile rats were injected twice a day with a low dose of Ritalin similar to that prescribed for children with ADHD. When the rats became adults, the scientists observed the rodents’ responses to various emotional stimuli. As adults the rodents that had received Ritalin were much less responsive to natural rewards such as sugar, sex, and fun, novel environments than were untreated rats. The study suggested that the drug-exposed animals find normally pleasurable stimuli less pleasurable. This may help explain a British study that suggested that Ritalin raises the risk of depression and anxiety in adulthood.
Parents of ADD/ADHD kids often find themselves in a terrible predicament with schools. Many parents find that Ritalin has become a requirement for their children continuing in school. Countless parents report threats from schools and social agencies that, “If you don’t have a doctor prescribe Ritalin for your ADHD child, we may decide that you are an unfit parent. We may decide to take your child away.” Parents of ADD/ADHD kids often fight endless battles to get special education for their kids without jumping through endless hoops. Because these battles are so difficult, there are attorneys who specialize in helping the parents of ADD/ADHD kids fight these school battles. With that said, there is a role for Ritalin and Adderall. If you child has been taking Ritalin for years, don’t suddenly stop your child’s Ritalin right now.
A study reported in Science News (December 18 & 25, 1999) found that two-thirds of children receiving behavior therapy had a reduction of ADHD symptoms sufficient to negate any need for drugs. Why is that not in the news, hailed as a breakthrough?
Alternative Approaches
Holistic doctors who are looking at underlying causes of ADD/ADHD have faced investigation by state medical boards, including revocation of their medical license. Here is a common pathway to ADD/ADHD. The child is given repeated trials of antibiotics for recurrent ear (or other) infections. The antibiotics kill off friendly intestinal bacteria, which causes normal amounts of yeast in the digestive (GI) tract to grow wildly out of control, leading to intestinal candida. Intestinal candida irritates and inflames the lining of the GI tract, causing leaky gut syndrome. With leaky gut syndrome, undigested food particles slip into the blood stream, leading to massive delayed food allergies. Eventually, the yeast/candida in the GI tract pours into the blood stream causing systemic candida. These issues are enough to explain a high percentage of ADD/ADHD symptoms. Other causes include mercury toxicity and severe total body inflammation. I suggest treating all of the above. If that fails, and the child is not coping well, use stimulant medications. Clearly, there is a place for these medications, but that place is the last resort, not the first.
The best book I suggest on ADD is ADD & ADHD: Complementary and Alternative Solutions by Charles Gant, M.D., Ph.D., N.D. In 2001, Dr. Gant lost his New York medical license for practicing Orthomolecular Medicine, a term coined by Abram Hoffer, M.D., Ph.D. and double Nobel Prize winner Dr. Linus Pauling. Orthomolecular medicine is the same as Nutritional Medicine. It aims at finding the root causes of illness, especially nutritional problems. One of the charges against Dr. Gant was that he ordered a urine test for organic acids as well as comprehensive stool analysis. Organic acids are the breakdown products of a variety of biochemical processes. I order this test through Genova Labs, where they test for 46 organic acids. I consider it one of the 3 most important tests I order, the other 2 being amino acid analysis and comprehensive stool analysis. New York has also made it illegal for doctors to order hair analysis, which is a good screening test for heavy-metal toxicity.
We have begun to scratch the surface of children’s health. In the next issue we’ll look at the role played by vaccinations, protein deficiency, the national children’s nutrition crisis, and the educational system. They are part of the big picture of ADD, ADHD, and autism.
David Gersten, M.D. practices Nutritional Medicine and Integrative Psychiatry out of his Encinitas office and can be reached at 760-633-3063. Please feel free to access information about holistic health, amino acids, and nutritional therapy at www.aminoacidpower.com and mind-body techniques at www.imagerynet.com.