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ADHD diagnosis is controversial among doctors

by Dr. Jonathan V. Wright MD

(Published: The Virginia Pilot – Monday, April 17, 2000

ADHD diagnosis is controversial among doctors
Fourth in a six-part series on alternative medicine: Therapies for attention deficit hyperactivity disorder.

CALL IT AN epidemic or better diagnostic tools. No matter how you justify the increased numbers of children diagnosed with attention deficit hyperactivity disorder, everyone from Hilary Rodham Clinton to your aunt Betty has an opinion on how to treat it.

“ADHD is a set of behaviors. Although the ‘Diagnostic and Statistical Manual’ lists necessary criteria, it’s not sufficient for diagnosis,” says Dr. Don Davis, clinical professor of psychiatry at George Washington University Medical School and co-founder of the Family Therapy Institute of Alexandria. “People can have parts, not all, of this syndrome.”

Included in Attention Deficit Disorder is “inattention,” with symptoms such as not listening when spoken to directly, or not following instructions.

“Hyperactivity” and impulsive behaviors define the second criteria, such as fidgeting and acting as if driven by a motor. Adults complain of feeling restless.

At least six symptoms must be present for six months and be consistent with the child’s developmental level. Importantly, there’s no definitive test to determine either ADD or ADHD.

Yet, symptoms can occur if a child is bored or just immature. And with 2-to 4-year-olds attending day care, the child’s developmental level can be disregarded in favor of demanding behavioral conformity. That’s when suppressant drugs can be inappropriately pre-scribed and other therapies overlooked.

Some schools don’t allow enough time for creativity, Davis says. “We need to set aside daydream time.”

To modify ADD behaviors, Davis has created the Institutes’s “ADD Treatment Center.” One of the first therapy-based programs, Davis believes the ideal treatment is to change the enviroment to suit the disorder. He uses neurolinguistics, a method of reframing behaviors.

“ADHD people are biologically different,” Davis says. “Children who have behavioral problems because of genetic defects or brain dysfunction are more likely to develop secondary emotional problems if not treated early.”

The average ADD child is usually more intelligent, more gifted than the normal child, Davis maintains. Many times these children have special skills and can become hyper-focused when interested.

ADD Treatment Center of the Family Therapy Institute of Alexandria, 220 South Washington St., Alexandria, Va. 22314 (703) 549-6000

When it comes to treating couples, Davis trains the other spouse to alter communications patterns to fit the ADD spouse’s behaviors. Still, Davis contends there’s a growing amount of data that children and adults with bona fide ADD/ADHD do better with conventional medication. ADHD kids treated with Ritalin have a significantly lower incidence of substance abuse as teens and young adults than those left untreated.

A recent study showed that behavioral therapies alone don’t work. Between 70 and 85 percent of children didn’t respond adequately until medicated. There’s also a higher incidence of substance abuse in untreated ADHD adults. Clinicians also report depression, anxiety, obsessive compulsive and bipolar disorders with ADHD.

“There’s no evidence for nutritional origin in ADHD, except in very small numbers,” Davis asserts, recommending ADHD people stay away from stimulating foods such as chocolate.

Dr. Jonathan Wright, director of the Tahoma Clinic in Kent, Wash., partially disagrees. He maintains that some hyperactivity is caused by food and chemical allergies.

“Temporarily remove the allergy and the child improves,” Wright says. “Also, baby formula in the U.S., unlike breast milk, is lacking omega-3 fatty acids needed for brain development. Mothers should add a DHA capsule, up to 500 milligrams a day to formula.”

Some alternative products sold over the counter, such as Pycnogenol, have proven effective, agree both Davis and Wright. But supplements such as grape seed extract have not.

Acupuncture, aromatherapy, homeopathic preparations and CranioSacral therapy advocated by John Upledger, an osteopath and founder of the Upledger Institute in Palm Beach Gardens, Fla., haven’t undergone objective clinical testing.

“This is a lifelong battle for at least half of the people with ADHD,” Davis says. “We used to believe that one would outgrow this.”

Write to Alexandria Berger, c/o The Virginia-Pilot,
150 W. Brambleton Avenue, Norfolk, Va., 23510

E-mail her at

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