Awakening to attention deficit disorder
By Dr Raoul Goldberg
BSc (Med), MB ChB (Wits), CEDH (Hom)

Attention deficit disorder with or without hyperactivity (ADD/ADHD) is the most common and fastest-growing diagnosis among childhood disorders in the USA and is increasing at a rapid rate in all developing countries. We may well ask what lies behind this phenomenon of our times. This article will try to shed some light on this condition and show how it illustrates an aspect of human nature common to us all. We have all experienced the child who is disorganised, distracted, impulsive and hyperactive.

I recall 3-year-old Jason darting into my office at high speed and making a beeline for the objects on my table, which his senses tried to consume in one fell swoop. He rushed from there, barely connecting with the toy train, before climbing onto the chairs, as his desperate mother tried to constrain him. It took my breath away and only with great effort could I restrain myself from exerting my authority. I have enormous respect for a mother who has to deal with such a child day in and day out. It is fairly common for kindergarten or primary school teachers to have one or more such children in their classrooms and they will be severely challenged to teach effectively and prevent serious social disruption.

What does conventional biomedical science know about this condition?
ADD/ADHD refers to a syndrome that describes a cluster of symptoms listed in the Diagnostic and Statistical Manual (DSM), the official manual of the American Psychiatric Association (see Table I). These are all subjective symptoms that span a wide spectrum between normal and abnormal and that naturally make consensus difficult. Who is not hyperactive or distracted at some time or other! There are innumerable studies of underdiagnosis and overdiagnosis and it is estimated that millions of children are incorrectly labelled and treated for nothing more than their immaturity. A review[sup]1[/sup] of these studies shows clearly that 50% of children diagnosed with ADD/ADHD do not fit the officially accepted criteria and are therefore wrongly diagnosed.

Table I. Symptoms of ADD and ADHD

Symptoms of attention deficit disorder without hyperactivity (ADD)
Six or more of the following symptoms persisting for at least 6 months that are inappropriate with the developmental level.
Finds it difficult to concentrate on details, makes careless mistakes
[] Finds it difficult to sustain attention
[] Often appears not to listen
[] Often fails to follow through on instructions or finish chores
[] Finds it difficult to organise activities and tasks
[] Finds it difficult to sustain mental activity or concentration
[] Often loses things
[] Easily distracted
[] Often forgetful

Symptoms of attention deficit disorder with hyperactivity (ADHD)
Six or more of the following symptoms of hyperactivity-impulsivity that are inappropriate with the developmental level.
[bul] Often fidgets
[] Finds it difficult to remain seated for long
[] Often runs or climbs about inappropriately
[] Finds it difficult to play or engage quietly
[] Often appears driven
[] Often talks excessively[/bul]
[bul] Finds it difficult to restrain self, blurts out answers
[] Finds it difficult to await turn
[] Often interrupts or intrudes[/bul]

The term ADD/ADHD was first adopted in the 1980s to replace the scientifically unsustainable and inaccurate diagnoses of minimal brain damage or dysfunction. A huge body of literature exists on this subject but to date no definite biological, neurological or genetic impairments have been established to fully explain this condition.[sup]2,3[/sup] There is often a strong family history: 43% of ADD/ADHD children have parents and some 25% have close relatives who suffer or have suffered from the same. Some authors feel that this points to a [i]genetic factor,[/i] whereas others believe this indicates learned family behaviour.

There appear to be many associated [i]environmental factors[/i] which may explain the rising prevalence in developed countries:
[bul] Refined processed foods containing preservatives, colourants and other additives causing food allergies and intolerances
[] Excessive sugar consumption
[] Environmental toxins and pollutants
[] Regular and habitual TV, video and cinematographic viewing and computer activity causing neuro-sensory overload.[/bul]

Other authors cite [i]emotional factors[/i] as the major cause.

However, while it is likely that many or all of these factors may be implicated to some degree, none is able to explain the underlying constitutional disposition and there is a clear admission that this syndrome is still poorly understood.[sup]4[/sup]

So how can a holistic approach help us to understand this epidemic of our times?

[cl=slightgreen]The picture
As is my custom, I start with the child as a physical/spiritual being. With present awareness imagine bearing witness inside the body of a child who exhibits the symptoms of attention deficit with hyperactivity. This body provides the child with a physical home and vehicle for his life’s journey. His body is tense, muscles taut, and his breathing shallow. He does not seem to be aware of his body, he seems disconnected from it, it seems to move as if controlled by a force outside of itself. When we sense more deeply we feel a powerful surge of [i]desire[/i] erupting from his deep subconscious soul life to experience the world outside.

This desire from inside drives him through his finely attuned senses towards a myriad of outer sense impressions so that he is flooded and overwhelmed by them. He lives in his senses, driven by his will; he does not clearly think about what he sees, hears, or touches so that he is not fully conscious of what he senses. For to know what we sense we also have to connect a thought to it. His thinking is powerfully present in driving his desire, in impulsive and often creative ideas: I want to do this, I want to grasp that: and he finds it difficult to rest in reflecting about things. He will therefore continuously overstep his and others’ boundaries, because his reflective thinking is absent He is a doer and a senser, not a thinker. He is therefore distractable, impulsive, fidgety, and disorganised.

Where are his feelings in this mix of soul surges? When we look behind his aggressive and over-emotional exterior, we can sense [i]his deep longing for something that he is painfully missing[/i]. He feels unworthy, inadequate, disappointed in himself, frustrated, doubtful of himself and in this negative frame of mind he is frightened of life. He lives in angst. These feelings will mobilise his basic survival instincts to protect him in the best way he knows. He overcomes his negative self image with an over-powerful positive image, and he overcompensates with an unbridled force of will that expresses itself in the picture we know as ADHD.

When we immerse ourselves imaginatively in the child’s experience, we become aware of the inner soul life, psyche or astral body of the child as it expresses itself through sensing, thinking, feeling or volitional activities. ADHD is a picture of the untamed [i]astral body[/i] which we see fully expressed in the animal world. All animals are controlled by their desires and the gratification that satisfies these desires. A dog cannot control its hunger; it must be appeased by eating. It fundamentally lacks the ability to control its desire by an act of reflection. It cannot control its own animal nature. Likewise the child we are experiencing often cannot control his astral/animal nature. [i]Yet he carries innately the ability to do this[/i], and we see him able to control the wild life of his soul in certain situations: for example, if he finds something that really interests him, or when we engage one-on-one with him, then we can contact the deeper nature of the child and listen to the wisdom which knows [i]that deep longing for what is painfully missing[/i].

Who longs for and who knows there is something missing? What is missing? It is all the same thing. [i]It is the ground and centre of the child’s very existence, his ‘I’, his higher Self, that which gives him a secure sense of himself, which gives to him his unique nature, which makes him different from every other individual and directs his life journey in a unique and special way[/i]. It is this inability to be at the centre of his own experience that the child is longing for, that causes so much inner distress and permits other forces to overwhelm the child’s being. For human nature is exposed to two outside forces which are continuously acting on the spiritual/physical nature of the child, pulling it out of the centre.

The one is the [i]force of too much spirit,[/i] which draws us away from the earth and our own physical bodies, making us too spiritual, driving us to ever-greater heights of creative power, knowledge and beauty; it is the artist, the creative, desiring, impulsive and willful nature in us.. It lives in the air, the light and the warmth and it shuns the earth.

The other one is the [i]force of too much matter,[/i] which draws us down into the earth, into our own materiality, binding us with the experience of power that draws on matter and cold reason and intellect It makes us doubt, fear and hate our true self, so that we hide our true self behind material things, avoiding the light and warmth of the soul and spirit.

We may see these two tendencies expressed in the structural make-up of the body: some tissues are hard and firm, like the skeleton which allows us to live on earth, while the air in our lungs, derived from the life-giving air around us, enlivens our bodies, allowing us to express ourselves in sound and word and connecting us directly to the breathing stream of our fellow human being. In the functioning of all organ systems, these two forces manifest in the polarities of contraction and expansion. We see this most graphically in the systolic contraction of the heart, which becomes harder, smaller and more physical as it squeezes the blood out into the circulation, and the diastolic expansion counterpart where it opens up to the blood which flows in from the wider circulation.

Likewise, the whole spectrum of pathology can be seen as an expression of one polarity gaining the upper hand: the one pole creates the so-called [i]warm illnesses = inflammation,[/i] characterised by softening and expansion and caused by excess warmth, air or fluid such as found in infectious, febrile illnesses, and inflammations of all kinds, glandular disturbances, [i]and in the psycho-behavioural syndrome of ADHD.[/i]

The other pole results in the so-called [i]cold illnesses = sclerosis[/i] characterised by hardening, contracting and cooling of the body such as in the degenerative illnesses of arthritis, hardening of the arteries, cancer and depression.

These two forces work hand-in-hand when the centre is missing so that the one pole calls up the other. For the human condition cannot survive the sole action of the one force: imagine if the lungs did not stop inspiring air or the digestive tract did not stop squeezing the food contents. When the balancing centre is missing it swings the other way. Thus too much squeezing may lead to too much relaxation; hence the asthmatic lung which is squeezed too often, becomes over-dilated with air. Thus when the child contracts too much inwardly, he has to counteract this with an equal dispersive or expansive force. This disharmony will inevitably manifest itself in a variety of physical or psycho-emotional dysfunctions: neuro-sensory, muscular, cardio-respiratory, immune-modulatory, and behavioural.

This is the picture of the child with ADHD. It is a condition of imbalance caused by the missing centre, the balancing power, the ‘I’, which harmonises the soul cognitive (thinking), emotive (feeling) and volitional (willing) functions and holds the polarities of too much spirit-too much matter in check.

[cl=slightgreen]This picture of imbalance also shows us how to solve it
A child with ADD was asked: What is ADD? He replied: ‘That’s when nobody is at home’. There are many reasons why nobody is home. The owner may not be comfortable in his body, it doesn’t really suit him: after all he received a readymade home at birth from his parents, and in the following years he may not have been able to work adequately to mould this home into one that fits his nature. So he hangs outside too often. It is more comfortable outside than inside. Furthermore, it does not help when this body is invaded by nutritional, environmental and chemical pollutants or excesses, or when his neuro-sensory apparatus is assaulted with audiovisual sense impressions. When his sense of self is further eroded by tensions in the parental home-life, and by pressures of many kinds, heightened by his sensitive nature, he feels even less inclined to stay at home and build from within a healthy and stable life.

How then can we invite the child to stay more often at home, how can we make it more comfortable and attractive for him to want to be there in his waking life? The child himself is unable to grasp hold of the missing person just because he is not present to do this, because he is not at the centre of his own experience. By puberty, with time and maturity most children do enter the home of their bodies sufficiently to function ‘normally’, because the progressive penetration of the ‘I’ into the body is the natural developmental process in all children (see my previous articles published in the [i]Journal[/i]).[sup]5-12[/sup] However, if we leave this to happen in its own time there will be a huge cost to the child’s psycho-spiritual wellbeing.

As the child’s caregivers we therefore need to step in. We need to be a model of the power that the child is lacking. This requires us to find our right relationship with our own body and soul, with being at home with ourselves. This means creating in our life the right balance between too much spirit and too much matter, healthy rhythms and routines of living: eating, working, relaxing, and sleeping, a healthy diet and appropriate physical activity, a healthy interest in ourselves, in our relationships and in the world.

We can then offer the right support for the child who knows deep within himself what he is missing and for which he is desperately searching. We are then in the best position to apply all the above health principles to the child. If we have taken the interest to experience the child’s inner life we will know how to support the child in the right way. The child will need to feel our ongoing interest and connection in his life, our consistent and firm containment of his excesses, our regular encouragement and praise for his real person. He will experience this as the support he needs for building up the missing centre.

All efforts should then be made to remove environmental trigger factors as listed above, namely food sensitivities (elimination diet), allergic irritants, dietary excesses, environmental pollutants and excessive TV, video and computer viewing. Counselling family members and particularly the child in question can also play a very important role in reducing stress, creating awareness of the dysfunctions and empowering all family members in discovering their potential resources.

We can then further help the child with an individually prescribed diet, natural dynamic medication and nutritional supplements to strengthen the centre, educational and remedial activities which support the child in his core being and specific therapeutic interventions such as therapeutic eurythmy, body alignment, brain gym, craniosacral therapy and other modalities all aimed at building and maintaining a stronger sense of self.

Unfortunately the scope of this article does not permit a more detailed description of the therapeutic opportunities available. In the light of this picture, Ritalin, the schedule 7 drug routinely used to manage the ADHD child, must be seen as a desperate measure to control symptoms. It does not address the root cause of the problems and has the potential for mild and more serious side-effects.

The phenomenon of ADD/ADHD is a powerful picture of the struggle and challenge we all face in striving to hold the balance between too much light and too much darkness.

1. Debroitner RK, Hart A. [i]Moving Beyond ADD/ADHD. An Effective, Holistic, Mind Body Approach.[/i] Chicago, Illinois: Contemporary Books, 1997.
2. Deutsch G, Paqpinicolau AC, et al. Cerebral blood flow, evidence of right frontal activation in attention demanding tasks. [i]Int J Neurosci[/i] 1987; 36: 23-28.
3. Malone M, Kershner JR, Swanson JM. Hemispheric processing in ADHD. [i]J Child Neurol[/i] 1994; 9:181-189.
4. Behrman RE, Kliegman R, Arvin AM. [i]Nelson Textbook of Paediatrics.[/i] 15th ed. Philadelphia: WB Saunders, 1996.
5. Goldberg R. Enhance the developing child’s potential. [i]South African Journal of Natural Medicine[/i] 2001; 3: 47-49.
6. Goldberg R. Fever: a gift of health. [i]South African Journal of Natural Medicine[/i] 2001; 4: 28-29,60.
7. Goldberg R. Childhood illnesses: a developmental challenge for life. [i]South African Journal of Natural Medicine[/i] 2001; 5: 44-45,73.
8. Goldberg R. Where do I come from? [i]South African Journal of Natural Medicine[/i] 2002; 8: 44-48.
9. Goldberg R. Protecting the heavenly years of childhood. [i]South African Journal of Natural Medicine[/i] 2003; 10: 47-49.
10. Goldberg R. The three births of childhood. [i]South African Journal of Natural Medicine[/i] 2003; 11: 44-46.
11. Goldberg R. Creative nutrition for healthy children: part one. [i]South African Journal of Natural Medicine[/i] 2003; 12: 40-43.
12. Goldberg R. Creative nutrition for healthy children: part two. [i]South African Journal of Natural Medicine[/i] 2004; 13: 33-39.

Further reading
1. Gloeckler M, Goebel W. [i]A Guide to Child Health.[/i] Edinburgh: Floris Books, 1990.

[cl=slightgreen]Complementary medicine and therapies for the treatment of ADD/ADHD

[cl=slightgreen]Nutritional supplements and ADD/ADHD
The ADD/Hyperactivity Support group has a list of foods that are suitable for ADHD children. They can be contacted on 011-484 6632.

The [i]Lancet[/i] published a study demonstrating that supplementing the diet with a multivitamin-mineral formula can increase non-verbal intelligence in children.[sup]1[/sup] This study demonstrates the essential role of many vitamins and minerals in brain function. A deficiency in any of the following nutrients will result in impaired brain and nervous system function: thiamin, niacin, vitamin B6, vitamin B12, copper, iodine, iron, magnesium, manganese, potassium and zinc.

Many cases of ADD may simply reflect poor nutritional status. High-quality nutrition is important throughout one’s life, but it is probably most important earlier in life, during physical, mental, and social development.

Supplements: Essential fatty acids are important for brain function. These should either be supplemented, or a diet rich in cold-water fish, seaweed, algae, nuts, seeds, beans and raw vegetable oils should be given. Evening primrose oil can also be rubbed onto the skin, three capsules morning and evening. Linseed oil is also a good source of omega-3 fatty acids. One to four tablespoons per day are needed. Never cook with linseed oil and keep it refrigerated. However, it can be added to food after cooking. Dr Hoffer (Canadian psychiatrist) claims that his orthomolecular approach will help the majority of children. This approach uses high doses of vitamins and minerals. His regimen includes vitamin B3, C and B6. To this he may add vitamins B complex, E, A, D, essential fatty acids and some minerals. However, the first are the most important.

The elimination diet: If you suspect a certain dietary culprit (sugar is a common one), try eliminating it from your child’s diet for several days, watching to see if symptoms improve. Then, reintroduce the suspected culprit and see if symptoms promptly return. The Feingold diet is an approach that zeroes in on additives and other ingredients see

Ayurvedic medicine: A calming herb such as [i]Macuna prurens[/i] may enable children on Ritalin to stop taking this drug. Another recommended herb is Ashwaganda. An Ayurvedic expert should be consulted before using any of these remedies.

Traditional Chinese remedies: In TCM the heart and liver are the two systems addressed in cases of hyperactivity. Herbs such as Schisandra berries, biota seed and zizyphus seed are used to calm the system.

Homeopathy: Homeopathic medicine can make a big difference in children where chemical stimuli in the environment, such as perfumes, heavy metals and cigarette smoke may have an effect. ADD/ADHA tends to be a very complicated mixture of things and requires that the professional form a dedicated relationship with the child.

Herbal medicine: Herbal treatment can include linden flowers (especially effective when used in a bath before bed) to relax the child, chamomile for the nervous system, and red clover and milk thistle for liver detoxification.

Chelation therapy: Hair analysis and urinalysis tests can confirm metal toxicity. Chelation (binding up of toxins) therapy can remove toxins (such as heavy metals and toxic waste) from the body. This therapy can take 3 – 6 months and should always be performed under doctor’s supervision.

Craniosacral therapy: Craniosacral therapy has also been recommended (see article page in this issue of the [i]Journal[/i]).

1. Benton D, Roberts G. Effect of vitamin and mineral supplementation on intelligence of a sample of schoolchildren. [i]Lancet[/i] 1998; i: 140-143.

A study of hyperactive adults treated with Ritalin as children1 showed that nearly one-quarter of the study group failed to finish high school, compared with the control group, where a larger percentage completed high school. Far fewer members of the study group (on Ritalin) held professional jobs. As adults, one-third to one-half of the study group continued to experience hyperactivity.

1. Mannuzza S, Klein RG, Bellser A, Malloy P, LaPadula M. Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status. [i]Arch Gen Psychiatry[/i] 1993; 50: 565-576.[/just]