Archives for posts with tag: pediatrics

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
931-372-2020 http://www.drclopton.com
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!

Jan 09 022

Educators often hear from therapists, “When in doubt, crawl, crawl, crawl!” It seems from the onset, crawling is an amazing develop-mental activity that translates into all kinds of academic success.

The importance of a long crawling and creeping period in development is often overlooked by Pediatricians and parents. Many just don’t know the vital importance of this developmental milestone and impact later on in life.

As Occupational Therapists, we see children daily that have poor reading skills, difficulty tracking visually left to right, poor hand dominance or crossing of midline, decreased trunk strength (may look fidgety or ADHD), poor handwriting, immature grasp patterns and difficulty with fine motor skills all due to short or missed belly time!

Infants should spend as much time as possible on their bellies from the time they can turn their head at a few weeks when playing. Babies should not spend their “floor time” in supported sitting, car seats, entertainers, walkers, or johnny jumpers! Floor time should be a priority every day, getting down in the floor on belly learning to control their bodies, gain core strength, learn what their hands can do while their vision is engaged, and making millions of neural connections for later skills. Getting on their bellies sooner will prevent a myriad of developmental and learning delays later in development!

If an infant does not like belly time or is not crawling by 7 months or creeping by 9 months, then there could be issues that need to be evaluated by a pediatric PT and OT. Some children who have food sensitivities to cow’s milk and heavy sinus pressure avoid this position due to the pressure on their ear canals. A child with touch sensory defensiveness will avoid being on belly and hands, a sure sign that pediatric sensory based OT is needed asap! Infants with clinically low muscle tone will need therapy to help get them in this position and help this important stage develop. All red flags need a pediatric OT or PT eval, this is not something to wait and see about.

Please don’t “wait and see”…the time is NOW for therapy evaluation if a child is 9 months and is not crawling and beginning to creep, or avoids belly time all together. Most infants start creeping within a few therapy sessions!

Crawling is when you are on your belly “like an army man or snake”.
Creeping is when you are on your hands and knees like a “cat creeping up on a mouse”

Doing this activity even through older ages helps in all areas of development:
• Calms by activating heavy work receptors in the muscles and joints
• Continues to calm by building muscles that help breathing
• Helps children sit in chairs by building back and stomach muscles
• Coordinates two body sides so hand specialization is more likely to occur
• Improves handwriting by developing shoulder, arm, and wrist stability
• Helps develop fine-motor coordination as it builds the arches of the hand
• Decreases touch sensitivities by deep input and rubbing the floor
• Integrates many of the primitive reflexes, integration of these reflexes is vital to gaining higher motor skills
• Strengthens trunk, shoulder and arm strength which is needed to sit and attend
• Sets up the communication in the brain across the midline of the brain which is needed for reading skills to occur
• Increases muscle tone, muscle strength, and coordination throughout the body

The benefits of a good long crawling and creeping stage are too many to just “wait and see” about. An early walker is not always a sign of good development. Many of the children we see later in 1st-4th grade with reading, writing, and handwriting issues were early walkers. Please don’t hesitate to get an evaluation and necessary treatment for your precious one!
Center of Development Pediatric Therapies Cookeville TN
http://www.developmentaldelay.net 931-372-2567 Heidi@covd.biz