Hyperactivity - on the go all the time, no peace!
[UPDATED MAY 2023]
Introduction
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
- Medical News Today - How ADHD differs in males and females
- Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children
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.
- The starting point is The general approach to maintaining and restoring good health.
- Most hyperactive children are carbohydrate addicts, see Hypoglycaemia - the full story, and many are food allergic and chemically sensitive as well. See Attention Deficit Disorder Association webpage - "Put down that pizza - seriously!. See also See FOOD INTOLERANCE NETWORK FACTSHEET - ADHD and Diet (which also references chemical sensitivities)
- 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 addition, ADHD sufferers are often thirsty and that can be a sign of deficiency of essential fatty acids. Another sign of EFA deficiency is "chicken flesh skin" over the elbows and back of the upper arms. See Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment which reviewed 25 studies, and concluded that:
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]
- So, take the Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong and add in that extra zinc.
- Elimination diets are essential. I usually do a step wise progression:
- Cut out all sugar in the diet. Don't forget sweetened drinks, added sugar in cereals, cakes etc.
- Cut out all artificial colourings, flavourings, additives, E numbers, preservatives etc. This is the basis of the Feingold diet which has already helped many ADHDchildren. See Feingold Diet
- Cut out all stimulants, particularly caffeine in tea, coca cola, chocolate and of course "energy drinks" such as Lucozade or Red Bull.
- It sounds mean but it often points to a problem, so cut out foods which the child has a particular liking for. For some reason Ribena (blackcurrant juice) is a common offender.
- The eventual aim is to get all children on to a The Paleo Ketogenic Diet - this is a diet which we all should follow. See also
- 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.
- Those children who are multiply allergic need desensitisation and my preferred technique is Enzyme Potentiated Desensitisation (EPD) - how it works. See also EPD - the practical details of what to do for each dose
Summary of initial treatment protocol
- Take Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong and add in 30mg Zinc Sulphate at night
- Do an elimination diet and work towards The Paleo Ketogenic Diet - this is a diet which we all should follow
- Consider Enzyme Potentiated Desensitisation (EPD) - how it works
If there is no or just slight improvement with the above regime...
- Look for heavy metal poisoning: a zinc/selenium urine challenge test is best. This can be done at home and is then sent to the lab. I can send you a kit to do this. See also Comprehensive Urine element Profile
- Do a good chemical clean up: chemical sensitivity is a common cause of hyperactivity. See Do A Good Chemical Clean-Up: chemicals make you fat and fatigued!
- Some kids are sensitive to salicylates and respond to a low salicylate diet. See FOOD INTOLERANCE NETWORK FACTSHEET - ADHD and Diet which concludes that:
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.
- Consider an anti-fungal regime: many kids seem to react in an almost allergic way to yeast in the gut. Because I do not like doing blood tests on children, I often just prescribe high dose probiotics and sometimes suggest a trial of an anti-fungal such as nystatin or oregano complex. See Probiotics - we should all be taking these all the time and double the dose following antibiotics and gastroenteritis
- If you haven't aleady, then start EPD. I have a low threshold for starting EPD in hyperactivity. This is because the kids are often multiply intolerant and EPD works reliably well for them. See Enzyme Potentiated Desensitisation (EPD) - how it works and see also EPD - the practical details of what to do for each dose
Please refer to also to Category:Allergies, autoimmunity and infections
Related Tests
- Comprehensive Urine element Profile
- A Hair Mineral Analysis can be useful - see Smart Nutrition Hair Analysis - but see section 6 of Toxic metals - a problem for us all for the care needed in interpreting Hair Mineral Tests.
Related Articles
- The general approach to maintaining and restoring good health
- Hypoglycaemia - the full story
- Nutritional Supplements - what everybody should be taking all the time even if nothing is wrong
- The Paleo Ketogenic Diet - this is a diet which we all should follow
- My book - Paleo-Ketogenic: The Why and The How
- The Paleo Ketogenic Diet - meals which require no cooking or preparation
- The Paleo Ketogenic Diet - PK Bread
- The Paleo Ketogenic Diet - PK Dairy
- Diet - what you need to eat to slow the normal ageing process
- Ketogenic diet - the practical details
- Enzyme Potentiated Desensitisation (EPD) - how it works
- EPD - the practical details of what to do for each dose
- Do A Good Chemical Clean-Up: chemicals make you fat and fatigued!
- Probiotics - we should all be taking these all the time and double the dose following antibiotics and gastroenteritis
- Toxic metals - a problem for us all
- Category:Allergies, autoimmunity and infections
External Links
- WebMD discussion of Conners Rating
- THE NATURAL APPROACH TO ADHD By Dr. Zoltan P. Rona
- Feingold Diet
- Michiel Bosman MD PhD is a psychiatrist, and editor of the evidence-based mental health self-help website Open Forest This site publishes many ADHD related articles and the current page listing these articles can be viewed here - ADHD related posts on Open Forest
- Psych Central - Masking in ADHD: The “Why” Matters
- Medical News Today - How ADHD differs in males and females
- FOOD INTOLERANCE NETWORK FACTSHEET - ADHD and Diet
- Attention Deficit Disorder Association webpage - "Put down that pizza - seriously!
References
- Diagnostic Accuracy of Rating Scales for Attention-Deficit/Hyperactivity Disorder: A Meta-analysis
- The role of zinc in the treatment of hyperactivity disorder in children
- Critical appraisal of omega-3 fatty acids in attention-deficit/hyperactivity disorder treatment
- Gender Differences in Objective and Subjective Measures of ADHD Among Clinic-Referred Children
- Developmental dyslexia and zinc deficiency *Zinc deficiency in children with dyslexia: concentrations of zinc and other minerals in sweat and hair
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