A Look at ADHD
Jason Clopton, O.D., F.C.O.V.D., A.B.O. & Heidi Clopton, OTR/L
Center of Vision Comprehensive Vision Care and Therapies
Center of Development Pediatric Therapies
1445 East 10th St. Cookeville, TN 38501
http://www.covd.biz & http://www.developmentaldelay.net
“ADHD Does Not Exist” – Wow, now that’s a book title that will get your attention!
Dr. Richard Saul released this book a month ago and has been on many media circuits explaining his title. He is no newbie to the world of ADHD. Dr. Saul was a pioneer in the diagnosis and treatments of ADHD way back in the 1970’s. He explains this provocative title in the intro to the book. Dr. Saul states, “Attention related symptoms are all too real, with negative consequences for children, adults, and broader society; those affected face challenges in academic, professional, and social settings, often with lifelong repercussions.
But the medical establishment’s reliance on the ADHD diagnosis- and the medical community’s embrace of it- has also had several negative consequences: the failure to diagnose underlying conditions that explain attention symptoms in whole or part; the omission of much-needed treatment for those primary diagnosis; the health related, economic, and emotional costs of undiagnosed and hence untreated conditions.”
Diagnosis- The diagnosis for ADHD is a very subjective diagnosis, often a checklist of symptoms. The Diagnostic and Statistical Manual of Mental Disorders 5th edition was released in 2013 and lowered the number of symptoms needed and raised the age to 12 yrs from 7yrs which will result in more children qualifying for the diagnosis now. Dr. Saul raises the question to the medical, psychological, and educational community, “What if the symptoms of ADHD can be explained fully by other conditions? Once I treated what I saw as the primary diagnosis (the non-ADHD diagnosis) the ADHD symptoms usually disappeared…”.
Research is showing many co-morbid conditions that go along with ADHD that are often not the “focus” as the primary treatment due to 2/3rds of those with ADHD use medications as their only treatment. With 20% of high school aged boys and 7% of the total population with this diagnosis it is vital to find what could be an underlying condition that is mimicking ADHD symptoms. Are the short and long term side effects of stimulant medications worth it when the child may have another issue causing them to look inattentive, hyperactive, and/or impulsive?
Top Underlying Causes of Inattention, Hyperactivity, and Impulsiveness:
1. Vision Problems- “Eyestrain can make classroom attention impossible” reads the subtitle of an online article published by the Children’s Vision Information Network. 20% of school children suffer vision problems that make it difficult for them to sustain focus on academic tasks or near focus tasks. Eye-teaming, meaning how the eyes coordinate with each other, is often not checked in routine vision exams. Children with Convergence Insufficiency (CI) have been researched to show the same symptoms as ADHD.
60% of students identified as “problem learners” have CI. 5-12% of the population have CI. Tennessee only requires a vision “screening” once they entire school yearly, but vision screenings reportedly only catch about 20% of visual issues. The other 80% of students are left feeling like they passed their vision test…when they actually desperately need a comprehensive vision exam from an eye doctor to determine their visual acuity, convergence, eye muscle control, visual perceptual skills, and many more visual skills needed to focus all day in a classroom or even an adult focusing on a computer screen!
The good news is that these conditions are easily treated and backed by research through a comprehensive vision exam, lenses and/or neuro-visual therapies.
2. Sleep Disorders- “Sleep Deprivation Creating a Nation of Walking Zombies” this ABC news article will get your attention too! We are not quite The Walking Dead yet…but if we continue our addictions to gaming, electronics, caffeine, lack of exercise, poor diets, and keep neglecting our basic need for good sleep it is quite scary to think of what a sleep deprived nation would look like! The National Institutes of Health notes: “Sleep deprivation can cause daytime hyperactivity and decreased focused attention. This can be mistaken for ADHD or other behavior disorders in children”. The Mayo Clinic states the following as the right amount of sleep for age groups: Infants 14-15 hrs, Toddlers 12-14 hrs, Schoolchildren 10-11 hrs, and Adults 7-9 hrs.
3. Hearing Problems- “It’s like hearing underwater!” This is a common explanation for how children with sinus issues, allergies, and ear infections hear their environment. No wonder it is so easy for them to “tune out” and not pay attention to the teacher! Hearing and auditory processing are vital parts of our social and educational lives. Over 80% of what a child does in a school day will rely on listening to verbal directions. Hearing problems can result from underdeveloped or damaged inner ear or auditory nerve, prevention of sound waves reaching the inner ear, and as simple as built up wax or multiple ear infections. Central Auditory Processing Disorder is also a newer diagnosis that is the cause of symptoms that look like ADHD.
4. Learning Disabilities- 5-15% of children suffer from a learning disability. Many of the issues that children with ADHD have are often a learning disability that has not been diagnosed. The DSM-V requires one of the following symptoms to be present for 6 months or more to diagnose a learning disability: inaccurate or slow reading, difficulty understanding the meaning of written text, spelling issues, difficulty with written expression, significant challenges with number sense, and/or problems with math reasoning. Getting a proper psychological evaluation that includes IQ testing and visual perceptual skills is vital if your child has symptoms of ADHD.
5. Sensory Processing Disorder- SPD can be diagnosed when an individual has symptoms in multiple areas that involve challenges integrating sensory information and responding to it appropriately. This can be either over or under responsiveness to sensory stimuli, craving of excessive movement, difficulty filtering out background sensory stimuli, or in-coordination that results in avoidance behaviors of writing or fine motor tasks. The potential to confuse SPD as ADHD is so great that a 2007 Time magazine article about SPD was titled, “The Next ADHD?” Sensory processing trained occupational therapists in medical based outpatient clinics are the primary evaluation and treatment source for SPD.
6. Other Conditions- Dr. Saul lists many other conditions in depth in his book that can mimic ADHD. These include but are not limited to: Seizures, Substance Abuse, Mood Disorders, Giftedness or high IQ, OCD, Tourette’s Syndrome, Asperger Syndrome (now included under Autism diagnosis), Neuro-chemical issues, Fetal Alcohol Syndrome, and biomedical issues. Food sensitivities, nutrient and vitamin deficiencies can often cause ADHD like symptoms.
Something as simple as low iron can cause symptoms of ADHD. A 2004 study in France found that 84% of children with ADHD had low serum iron. When given an iron supplement and vitamin C to help absorb the iron their symptoms improved drastically.
A Dutch study in 2011 used food elimination diets to research the effects of special diets for ADHD. This study showed decreased ADHD symptoms for 64% of the children to the point that they would no longer qualify for the ADHD label.
Several research studies have shown improved word reading, spelling, and attention benefits from DHA supplements. Since our American diet is lacking in enough clean and healthy fish, proteins, veggies and fruits it is no wonder that the rise in ADHD could be mistaken for a decline in the American diet.
Too much electronic time and not enough exercise, free play and movement time have also been shown in research to cause ADHD like symptoms.
The take away from this provocative book is that Dr. Saul wants our doctors, therapists, educators, psychologists, and most importantly our families in America to not conform to the “fast paced” diagnosis of ADHD. He urges us to take the time to listen to all of your child’s needs, explore all the possible underlying issues, and do not be hasty in giving out a diagnosis and treatment that may have long term effects on your child. Finding the appropriate diagnosis and treatment for ADHD like symptoms will be a much more accurate treatment plan with a lifetime benefit…and no side effects!