January 14, 2019
ADHD diagnosis is higher depending on the month of birth says a study by Dr. Layton and colleagues in the
New England Journal of Medicine this past
November. The articles conclusion is as follows: "Rates of diagnosis and treatment of ADHD are higher among children born in August than among children born in September in states with a September 1 cutoff for kindergarten entry. "
I have first hand and second hand experience with this real phenomenon as less mature children get behaviorally diagnosed as hyper and inattentive by their teachers when they are merely young and immature. This is a far cry from true ADHD.
Assessing the reality of this situation can be augmented by a set of Vanderbilt screening tools and even a classroom visit. Think long and hard about why a diagnostic label is being placed on a child. Just as late physical bloomers struggle in sports, late mental bloomers can as well. This is very different than a brain disorder.
While I believe that ADHD/ADD are on the rise in western society, we still need to be vigilant for the mislabeled child.
I take medicating children for behavior that is mildly disruptive, but not affecting their academic ability, very seriously. It is a questionable if they are academically sound.
Before medicating a child, I recommend:
1) Have a thorough evaluation of their academic skills performed to see if there is a comorbid learning concern that could masquerade as inattention. Daydreaming because of reading issues.
2) Make sure that your child is eating a healthy whole foods diet that is devoid of dyes, chemicals or food triggers of behavior. Consider an elimination diet with your providers guidance to assess for food immune reactions. Celiac disease can present as ADHD and mood swings.
3) Increase fiber based whole foods like avocado, beans, berries, steel cut oats, and all vegetables in your child's diet as they provide the intestinal microbiome with a fermentable substrate that leads to healthy gut brain communications.
4) Make sure that micronutrients like zinc, iron, magnesium and vitamin D are sufficient for function. You may need to test blood levels and supplement as needed if your child's diet is inadequate.
5) Consider adding small oily fish or omega 3 fatty acids as fish oil for effective brain function.
6) Make sure that your child is getting adequate sleep nightly as sleep exhaustion can cause poor focus and irritability.
7) Exercise daily to sweat.
8) I have found little benefit from herbs and other non micronutrient supplements, therefore, I generally do not recommend them.
9) Consider behavioral biofeedback which works for a subset of innatentive children.
10) Avoid all forms of toxins and chemicals that are neurologically irritating. See the Link below for PDF from the University of Wisconsin.
If after trying all of these natural approaches you still have a struggling child, then using the stimulant class of medications makes more sense and hopefully the doses needed to achieve the desired effect will be low enough to avoid any side effects or behavior personality changes that are unwelcome.
Dr. M
Layton NEJM Article
Esparham Children Article
University of Wisconsin PDF on ADHD
