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The Confusing Picture of ADHD

What causes ADHD? Is it a biological disease as many experts have stated? Is there something in the environment that causes children to excessively fidget, to be distracted and unfocused? It’s worth finding answers. ADHD is the most common pediatric problem facing American children.

The results of two recent landmark studies seem to have added confusion to the question of what causes ADHD. The first was published last month in The British Journal The Lancet. The lead author, Dr. Pellser, of the ADHD Research Center in the Netherlands, has turned the field of ADHD on its head. Her finding? Food is the main cause of ADHD. Using a randomized controlled trial she and her colleagues found sixty-four percent of children diagnosed with ADHD had food hypersensitivity, and when controlled diets were implemented, their behavior became normal. She’s quoted as saying that teachers and doctors were “flabbergasted” at the changes they observed. One teacher, Pellser said, referred to the results as “miraculous”. Her conclusions are that ADHD is not a disease, but a condition, and medications aren’t necessary for the majority of cases. For years, parents have been questioning the role of diet in ADHD symptoms, and experts have been dismissing the possibility as a fad. No longer can this be done. On the issue of diet and ADHD, it seems that parents may have been ahead of the medical curve.

Now to the second study, also published in The Lancet, five months earlier. Its findings pointed in the opposite direction. Analyzing “rare chromosomal deletions and duplications”, genetic evidence of ADHD was found. Widely contrasting research findings like these can be discouraging. It immobilizes the efforts of parents and professionals alike who are seeking reasonable treatments. It’s difficult to solve a problem when there’s no clear consensus over what causes the problem in the first place. Worse, the media sounds bites that surrounded the genetic study have lead many to throw up their hands in frustration. For example, many parents reported to me they felt discouraged using behavioral therapy, a highly effective treatment for ADHD, if the cause of their child’s problems were genetic.

We need a more sensitive analysis and reporting of important research findings. Otherwise, we get trapped in a black or white, nature versus nurture debate that limits our ability to synthesize important, yet seemingly contradictory messages. When looking deeper, findings across studies do begin to overlap and point us toward improved therapeutic efforts. Consider the two aforementioned studies.

No one can argue that ADHD, with its characteristic inattention, impulsivity, and hyperactivity almost certainly has genetic components, as everything does. Accomplished pianists and professional athletes will likely differ in genetic ways from one another, and from the rest of us who aren’t as coordinated or aren’t musically inclined. The influence of genes on every moment of life is unavoidable, as is the environment. As it turns out, searching beyond the headlines, genetic differences likely contribute only a small amount of what we see in ADHD. In the genetic study, eighty-five percent of children labeled with ADHD didn’t have the rare chromosomal deletions and duplications. Further, seven percent of kids without ADHD, the control subjects, did.

Genes seem to be playing a role, perhaps more as a risk factor, but there wasn’t a genetic link found in a majority of these children. This dovetails with the first study finding heavy influences of diet (an environmental factor) in a majority of children diagnosed with ADHD. Many other environmental interventions have also been shown by research to help treat ADHD, including improved parenting and teaching practices, ingesting less food additives, limiting exposure to electronic media, and getting healthy exercise.

Like most medical or psychological problems, there are multiple routes to the symptoms that make up that problem. ADHD is complex and difficult to accurately diagnose. Many things mimic its symptoms, such as vision and hearing problems, learning disorders, anxiety, sleep problems, and stress at home or school. For the millions of children diagnosed with ADHD, we need to follow all reasonable avenues to accurately explain why its happening, if its happening, and for those who truly have the disorder, consider all potentially useful treatments.


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