Your doctor or psychologist may have already labeled your child with the diagnosis of attention-deficit disorder (ADD) or attention-deficit hyperactivity disorder (ADHD). Your child’s teacher may have complained that your child isn’t paying attention and isn’t learning his lessons. She may have recommended that you see your doctor to inquire about the use of stimulant medication to help him focus his attention. Perhaps a friend has commented that your child seems awfully hyper and inattentive. Perhaps, you have commented to yourself, “My child is different from other children. His behavior problems are so much more common and severe than his peers.”
Does your child have ADD or ADHD? Only your doctor or psychologist can make that diagnosis for sure. Often, parents (and teachers) are given questionnaires to complete with the statements shown below. They are asked to indicate whether the statements apply to this child “not at all,” “just a little,” ”pretty much,” or “very much.” (These statements are adapted from the criteria for diagnosing ADHD set by the American Psychiatric Association). The problems should have persisted for at least 6 months, with the onset before the age of seven. Rate your child using the above criteria for each statement below.
- My child is easily distracted.
- My child doesn’t listen.
- My child makes careless mistakes.
- My child fails to finish his school work and chores.
- My child has trouble paying attention at school and in play situations.
- My child loses things in school and at home.
- My child avoids tasks that require attention.
- My child has trouble organizing tasks and activities.
- My child often is forgetful.
- My child interrupts or intrudes.
- My child talks incessantly.
- My child engages in dangerous activities.
- My child fidgets and squirms.
- My child blurts out answers.
- My child has problems playing quietly.
- My child cannot remain seated.
- My child is inattentive in school and at play.
- My child is often “of the go” and acts as if “driven by a motor.”
- My child runs about or climbs excessively.
Of the inattention problems, how many of the 9 statements did you rate as “pretty much” or “very much”? If 6 or more, your child may have an inattention problem.
Of the hyperactivity/impulsivity problems, how many of the 10 statements did you rate as “pretty much” or “very much?” If 6 or more, your child may have a hyperactivity problem.
Some children have only inattention problems and are not hyperactive so they are referred to being “Primarily Inattentive.” Other children have only hyperactivity problems and are not inattentive so they are called “Primarily Hyperactive.” And, of course, some children are both inattentive and hyperactive.
What is important to remember is that all children have the symptoms of these problems at various times. What child doesn’t pay attention to instructions from time to time? What child doesn’t engage in dangerous activities occasionally? What child doesn’t fidget or squirm when bored? However, children with ADHD stand out because of thefrequency and severity of their symptoms.
Another thing to consider is that children with other psychiatric problems often show inattention and/or hyperactivity symptoms. So don’t jump to conclusions without a very careful assessment by your doctor and/or psychologist.
If you believe that your child suffers from inattention or hyperactivity problems consult your doctor. Unfortunately, some doctors, because of time restrictions, listen for only 10 or 15 minutes to a parent and then prescribe medication. This is not the way to get help for your child! A proper diagnosis should include as a minimum a physical exam, a health history of the child, his family medical history, a behavior history, and current health and behavior problems. The total process may take a couple of hours. You and your spouse may be asked to complete questionnaires about his behavior. Your doctor should ask about school and should request that a teacher complete a Behavior Rating Scale. Your child may be asked to take a computer test of attention. The benefit of this is that the results are not subjective like the behavior questionnaires.
If your child is seeing a psychologist, your doctor will certainly ask for a report. If your child is not under the care of a psychologist, your doctor may ask you to have your child evaluated by an experienced child clinical psychologist or psychiatrist who has had experience diagnosing and helping children with ADD/ADHD. This person should be someone you like and can work with and should give you specific advice on how to handle inappropriate behaviors.
Your child’s doctor also should be interested in your child’s diet. However, most doctors and pediatricians are not familiar with the excellent research that has been published about diet and behavior. You may have to educate her on this point! You could click on “References for You and Your Doctor” and ask your librarian to get the actual scientific articles for you. Then you can give them to your doctor and ask that she please read them.
In other words, this diagnosis should not be undertaken lightly!!
Research studies show that as many as 20% to 56% of ADHD children and 44% to 50% of ADHD adolescents also suffer from Conduct Disorder (CD).¹ Children with CD areaggressive to people and animals, destroy property, lie, steal and seriously violate rules. Typically, patients with CD are not distressed by their behavior. There are two types of CD based on when the symptoms first appear. These are childhood onset or adolescent onset.
Answer these questions about your child or adolescent:
- My child bullies, threatens, or intimidates other.
- My child initiates physical fights.
- My child has used a weapon (a bat, brick, broken bottle, knife, gun, etc) that can cause serious physical harm to others.
- My child has been physically cruel to people.
- My child has been physically cruel to animals.
- My child has stolen while confronting a victim as in a mugging, purse snatching, extortion, armed robbery, etc.
- My child has forced someone into sexual activity.
- My child has deliberately engaged in fire setting with the intention of causing serious damage.
- My child has deliberately destroyed others’ property.
- My child has broken into someone else’s house, building, or car.
- My child often lies to obtain goods or favors to avoid obligations. My child cons others.
- My child has stolen items without confronting a victim as in shoplifting or forgery.
- My child often stays out at night despite parental prohibitions with the onset before age 13
- My child has run away from home overnight at least twice or at least once has stayed away for a lengthy period.
- My child is often truant from school with the onset before age 13.
If 3 or more of the above statements describe your child’s behavior during the last year with at least 1 occurring in the past 6 months, your child may have Conduct Disorder and he/she should be seen and evaluated immediately by a child or adolescent psychologist or psychiatrist. Your child may also suffer symptoms of learning problems, depression, hyperactivity and/or addiction. It is important to identify and treat Conduct Disorder as early as possible. Your primary care physician should be able to recommend a professional who can help you. If you cannot afford the fee, you should be able to find a mental health clinic in your area that offers services on a sliding fee scale. You and your child need all the help you can get!
Why do some children have conduct disorder? “There appear to be several pieces of this ”jigsaw” puzzle, including genetic, nutritional and biochemical, family and social factors. Children with CD may inherit decreased autonomic nervous system activity, requiring greater stimulation to achieve optimal arousal.”² Serotonin and other neurotransmitters in the brain play a role in aggression. There are also family factors that increase the risk for conduct disorder. These include parental substance abuse, psychiatric illness, marital conflict, child abuse and neglect.
In therapy parents are counseled to communicate more clearly with their children, to set consistent behavior guidelines, to reinforce good behavior and to set consistent penalties for noncompliance.
Drugs are sometimes used to help children with conduct disorder although there are no formally approved medications for conduct disorder and there have been few studies that have studied the effectiveness and safety of these drugs for children with CD. Stimulants such as Dexedrine and Ritalin are often prescribed for CD and may reduce aggressiveness. Antidepressants such as Wellbutrin and Prozac are also used.
What role does nutrition play in Conduct Disorder (CD)? Remember, all the cells and chemicals found in your child’s brain come from the breakdown of foods in your child’s diet. The diet supplies glucose, 10 essential amino acids from which neurotransmitters are made, 2 essential fatty acids to make the membrane and other chemicals that help cells to communicate with each other, and 12 vitamins and 20-30 minerals that participate in numerous biochemical reactions. Your child is what he eats! Garbage in, garbage out! Clearly, much more research needs to be undertaken to study the effects of diet on behavior but there are some interesting studies that may help you now.
First, make sure your child is eating a healthy diet. Get rid of the junk foods in your house so your child won’t be tempted. (I know, it’s tough to enforce this if your child has access to foods outside the home. He/she is not going to choose broccoli over candy!) You’ll want to buy products that are without sugar or other sweeteners or very low in sweeteners because your child won’t have room left for nutritious foods. Choose products that do not contain artificial colors and flavors. These are indicated on packages by the terms “artificial colors,” “tartrazine,” “yellow #5 or 6,” ”Red #40” etc. You’ll be surprised at how many of our foods are artificially colored! Skip those processed foods that are high in saturated, hydrogenated fats, partially hydrogenated fats and trans fatty acids.
Instead, you’ll want your child to eat more fruits and vegetables every day. Choosedifferent colored fruits and veggies because these contain different phytochemicals that are extremely important for good health. You may have read recently about phytochemicals. Unlike vitamins and minerals that must be supplied by the diet, normal metabolism can occur without phytochemicals. However, they appear to be very effective in lowering our risks of cancer, heart disease, diabetes, arthritis, etc. Their effects on behavior really haven’t been studied yet, but it only makes sense that they are important for good mental health given their roles in cells. Of course, fruits and veggies also supply vitamins and minerals. Whole grains also contain different phytochemicals so choose whole wheat bread, yellow kernel popcorn, oatmeal, brown rice, etc. You’ll also want to serve 2-3 servings of low-fat dairy a day. Don’t let your child fill up on milk because this may ruin your child’s appetite for other nutritious foods. Choose lean meats, poultry, fish, unprocessed nuts and beans as sources of protein. As you reduce the “bad” fats in your child’s diet, you’ll want to increase sources of essential fatty acids, especially the omega-3 fatty acids that are found in flax and flaxseed oil, canola oil, walnuts, some beans ( northern, navy, pinto, soy, and black) and cold water fish (fresh salmon, tuna, flounder, sardines, etc.)
Remember when your mother would say, “Don’t skip breakfast. It’s the most important meal of the day.” She was right! Start your child’s day with a good breakfast. This is extremely important. Studies have shown that children who don’t consume breakfast act out in school, can’t pay attention, are more hyperactive, and have more problems learning. Be sure the breakfast is high in protein and very low in refined carbohydrates. The protein sources could be eggs, homemade sausage, yogurt, cheese, or meat left over from the night before.
Unfortunately, many children with CD are picky eaters or prefer to eat foods that are not nutrient dense. You may want to give your child a multi vitamin and mineral tablet—not a mega dose, just the recommended daily allowance (RDA) for your child’s age and gender. This should at least include vitamin A, B1, B2, B6, niacin, folic acid, vitamin C, vitamin D, vitamin E, magnesium, calcium, zinc, and iron. In a fascinating double-blind, placebo-controlled study¹ of children ages 6 to 12, researchers gave the children either a low dose vitamin-mineral tablet or a look-alike placebo tablet for 4 months. The forty children with discipline problems who took the vitamin-mineral supplement were disciplined 47% less than 40 children who took the placebo. The behavior problems studied included threats or fighting, vandalism, being disrespectful, disorderly conduct, defiance, obscenities, refusal to work or serve, etc. There have been similar studies of institutionalized offenders, ages 13 to 17 or 18 to 26. Those who received the active tablets had about 40% less violent or antisocial behavior than those who took the placebo.
Essential fatty acids (EFA) may play an important role too. Essential fatty acids are critical molecules that help makeup the cell membrane that surrounds every cell in the body. EFA are also important for formation of a group of molecules called eicosanoids that help cells communicate with neighboring cells. So EFA are critical for normal brain function. A study of fatty acids in the blood of violent offenders found that violent offenders had values significantly different from the controls who did not have violent behavior problems.²
In 2002, researchers reported another double-blind placebo-controlled intervention study that looked at the impact of supplementing young violent prisoners with13 vitamins, 12minerals and essential fatty acids.³ The fatty acids supplied included 160 mg gamma linolenic acid (GLA), 80 mg eicosapentaenoic acid (EPA) and 44 mg docosahexaenoic acid (DHA). Those who received the active supplement committed on average a significant reduction (26%) of discipline incidents compared to those who took the placebo look-alike tablet. Violent incidents fell 37% in those who received the active capsule. Interestingly, the study also commented on the nutritional knowledge of the prisoners and found that some lacked even the most basic knowledge to choose a healthy diet. For example, some had never heard of vitamins!
Researchers at the Pfeiffer Treatment Center in Naperville IL studies have studied thecopper/zinc ratios in violence-prone young men. Copper was elevated in the serum of the blood while plasma zinc was depressed.4 They studied 135 violent young males and 18 non-violent male controls. The ratio of copper to zinc was significantly elevated in the aggressive subjects compared to the controls. The blood was analyzed at an independent lab, SmithKline Beecham Clinical Lab. Your doctor could easily order these tests if you are interested. Or you could try giving your child 15-30 mgs of zinc every day and observe his behavior over a couple of months. You don’t want to give too much zinc because that can create an imbalance in other important minerals!
A combination of counseling, effective parent discipline, appropriate school placement and intervention, medications such as stimulants and antidepressants, changes in diet and the addition of nutrients help many CD children. If you suspect or know your child has CD, act now because the earlier CD is evaluated and treated the better the outcome! Good luck!
Oppositional Defiant Disorder s a common psychiatric disorder that occurs with or without ADHD in children and adolescents. Children with ODD are aggressive and purposely annoy other family members, teachers or peers. To see if your child or adolescent might fit the criteria for ODD please answer these questions rating them as not at all, just a little, pretty much or very much.
- My child loses his/her temper.
- My child argues with adults.
- My child actively defies or refuses to comply with adults’ requests or rules.
- My child deliberately annoys people.
- My child often blames others for his or her mistakes or misbehavior.
- My child is often touchy and easily annoyed by others.
- My child is often angry and resentful.
- My child is spiteful and vindictive.
Keep in mind that all children show these signs from time to time. However, if you found yourself answering pretty much or very much to many of the questions, you may want to have your child evaluated by an experienced child psychologist or psychiatrist for Oppositional Defiant Disorder. Remember, there is much more to being diagnosed with ODD than this simple questionnaire.
Childhood depression is another common psychiatric disorder. Like ODD, it may occur along with ADHD or by itself. To assess your child for depression, please answer the following questions rating them as not at all, just a little, pretty much or very much. The symptoms must have occurred for 2 straight weeks or longer.
- My child is depressed or irritable most of the day, nearly every day.
- My child has diminished interest or pleasure in all, or almost all activities most of the day, nearly every day.
- My child has had significant weight loss when not dieting or he/she fails to make appropriate weight gains.
- My child has trouble sleeping or sleeps too much nearly every day.
- My child is restless and he/she has slowed down nearly every day which is obvious to others.
- My child shows fatigue or loss of energy, nearly every day.
- My child expresses feeling of worthlessness or excessive guilt nearly every day.
- My child has a diminished ability to think or concentrate or he/she is indecisive nearly every day.
- My child has expressed thoughts of death, suicide or has made a suicide attempt.
Every child, adolescent and adult has times when he/she feels down or depressed, but the frequency and severity is less than a child who has true clinical depression. If you answered at least 5 of 9 symptoms with pretty much or very much, you’ll definitely want to have your child evaluated by an experienced clinical psychologist. Because of the possibility of suicide, depression needs to be treated by a clinician who understands the seriousness of your child’s problems. Steps should be taken to remove possible suicide tools from the home—guns, knives, pills, etc. Remember, diagnosing your child with depression is much more involved that simply answering these questions.
There certainly can be nutritional and biochemical problems in ODD and childhood depression. It just makes sense that if you don’t provide the brain with all the raw materials it needs to function, it won’t perform normally. So providing a good, nutritional diet can help. If your child just refuses to eat much or chooses the wrong foods, you may want to give him/her a vitamin and a mineral pill that contain just RDA amounts of the nutrients. Look for ones that are uncolored and unflavored. Your pharmacist can help you or you can get help at the health food store. Stay away from high potency ones unless you have a doctor to assist you because some children are worse on high levels of B vitamins. At the same time, keep trying to improve your family’s diet. There is much more to nutrition that just getting vitamins and minerals!
There really isn’t much research on foods sensitivities and depression but trying a careful elimination diet as described in Laura Steven’s book “12 Effective Ways to Help Your ADD/ADHD Child” may be helpful. Foods can cause strange reactions. If your child is depressed, make sure you are present when foods are put back into his diet. If he has a severe reaction to a food, try 2 Alka-Seltzer Gold (without aspirin) in a glass of water.
Essential fatty acids have been shown to be helpful in treating adults for depression and bipolar disorder, but no work has been done in children. If your child has excess thirst, frequent urination, dry skin, dry hair, dandruff, brittle nails or nails that peal easily your child may have a deficiency of essential fatty acids, especially the omega-3s. Your child doesn’t need to show all these symptoms.