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#678 - ADHD and Children's Environment, 01-Dec-1999

Attention Deficit Hyperactivity Disorder (ADHD) affects somewhere
between 10% and 15% of all school children in the U.S. (1.8
million to 2.7 million children). The estimate is uncertain
because the behavior of children can be erratic under the best of
circumstances and therefore the disorder is not simple to
diagnose. Indeed, many cases are thought to go undiagnosed.[1,2]

According to recent estimates, as many as 1.5 to 2 million
children in the U.S. diagnosed with ADHD are currently taking
Ritalin (methylphenidate hydrochloride), a prescription drug with
cocaine-like characteristics, to calm them down and/or help them
focus their attention.[1,pg.1;2,pg.3] In 1997, more than 10 tons
of Ritalin were ingested by U.S. children to control ADHD. It was
recently found that Ritalin causes liver cancer in mice (though
not in rats), so the long-term consequences of Ritalin use by
millions of children need to be considered.[2,pgs.13-14]

Much evidence suggests that the ADHD problem is growing. Last
month, at a medical conference devoted to the disorder, the
organizers of the conference estimated that occurrence of ADHD
among children in the U.S. is doubling every 3 to 4 years.[3] The
use of Ritalin quadrupled between 1990 and 1997.[1,pg.1]

Children with ADHD often continue the symptoms into adulthood,
with unhappy consequences for job performance. According to one
1997 estimate, somewhere between 6.5 million and 9 million adults
in the U.S. have ADHD -- making it as large a problem as clinical
depression or drug abuse. In 1997, about 730,000 adults in the
U.S. were taking Ritalin by prescription for ADHD.[4]

The causes of ADHD are not known, but they are thought to be a
combination of hereditary predisposition and environmental
factors. Research in recent years has focused on prenatal
exposures to agents such as lead, cigarette byproducts, and
alcohol. Since the 1970s, researchers have been studying the
effects of certain foods and food additives such as dyes and
colorings; over the past 25 years, 16 out of 23 studies have
found that food additives exacerbate the symptoms of ADHD in some
children.[2] Poor diet (malnutrition) undoubtedly contributes to
ADHD.[2,pgs.23,37] Most recently, research has implicated
pesticides and exposure to low levels of industrial chemicals
that may interfere with hormones, especially
thyroid.[2,pgs.53,59] Obviously, combinations of all these
factors could be important.

ADHD was first identified as a specific disorder in 1902. The
definition of the disorder has changed over time. In 1902, George
Still described 43 children with aggression, defiance,
emotionality, limited sustained attention, and deficient
rule-governed behavior. From the 1930s to the 1950s, the term
"minimal brain damage" was used to describe the syndrome, even
though there was no evidence of brain damage in most of the
children so labeled. During the late 1950s, hyperactivity began
to dominate the description of the disorder and the official name
was changed to "hyperkinetic reaction of childhood" or
hyperkinesis. The use of stimulant drugs, like Ritalin and
amphetamines, to treat ADHD began in the 1960s. (Some drugs that
act as stimulants or "speed" in most adults can have a calming
effect in children and even in some adults.) In the 1970s,
researchers considered inatten- tion as central to the syndrome,
and it became officially known as attention deficit disorder or
ADD. In the 1980s and 1990s, the combination of attention
deficits and hyperactivity have both been highlighted, thus the
current name, Attention Deficit Hyperactivity Disorder (ADHD).5

The DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV,
published by the American Psychiatric Association, describes 3
patterns of behavior that may indicate ADHD: consistent
inattention, hyperactivity, and impulsive behavior, or
combinations of these three behaviors.

Signs of inattention include:

(1) the person fails to give close attention to details or makes
careless mistakes in schoolwork, work, or other activities;

(2) the person has difficulty sustaining attention in tasks or
play activities;

(3) the person often does not seem to listen when spoken to;

(4) the person often does not follow through on instructions and
fails to finish schoolwork, chores, or duties in the workplace;

(5) the person often has trouble organizing tasks and activities;

(6) the person avoids or dislikes or is reluctant to engage in
tasks that require sustained mental effort;

(7) the person often loses things necessary for tasks or
activities, such as pencils or tools;

(8) the person is easily distracted by extraneous stimuli -- the
honk of a car's horn, or a bird flying by.

A person with 6 or more of these inattention symptoms for more
than six months might be a candidate for an ADHD diagnosis.

Signs of hyperactivity and impulsiveness include:

(1) feeling restless, often fidgeting with hands or feet, or
squirming in a seat;

(2) running or climbing excessively at inappropriate times;

(3) leaving a seat early in the classroom or in other situations;

(4) the person has difficulty engaging in leisure activities
quietly;

(5) the person is often "on the go" or acting as if driven by a
motor;

(6) the person often talks excessively;

(7) the person blurts out answers before hearing the whole
question;

(8) the person has difficulty waiting in line or for a turn;

(9) the person often interrupts or intrudes on others.

A person with 6 or more of these hyperactivity symptoms for more
than six months might be a candidate for an ADHD diagnosis.

Because everyone exhibits some of these behaviors from time to
time, the DIAGNOSTIC AND STATISTICAL MANUAL specifies additional
guidelines for determining when they indicate ADHD:

(1) Some of the behaviors must have begun early in life, before
age 7;

(2) In children the behaviors must be more pronounced than in
others the same age;

(3) Above all, the behaviors must create a real handicap in at
least two areas of a person's life, such as school, home, work,
or social settings. So, for example, a child would not be
diagnosed with ADHD if he or she seems overly active at school
but functions well elsewhere.

Studies of identical twins reveal that environmental factors
contribute significantly to ADHD. It is not known whether
environmental factors can cause ADHD in an otherwise normal
person, or whether environmental factors only exacerbate ADHD
among those who are genetically predisposed. In either case,
people with ADHD often do poorly in school (many drop out early),
have low self-esteem, and have difficulty making connections with
other people. People with ADHD are often described as messy,
disorganized, inattentive, irritable, and aggressive. Because
their lives can be frustrating and unrewarding, some ADHD
sufferers may become hostile and even violent. In May of this
year, T.J. Solomon, 15, shot six of his schoolmates at Heritage
High School in Conyers, Georgia, a suburb of Atlanta.[6] At the
time, the Solomon boy was taking prescription Ritalin for ADHD.

Malnutrition can trigger ADHD, and large numbers of U.S. children
are malnourished. The U.S. Department of Agriculture (USDA)
publishes "recommended daily allowances" (or RDAs) for various
nutrients. USDA considers that RDAs exceed the average
nutritional requirements of average people; a person is assumed
to be malnourished if he or she receives less than 60% of an RDA
for a particular nutrient. Notably, the number of U.S. children
consuming less than 50% of RDAs has been reported as follows:
vitamin A (9%); vitamin E (15%); vitamin C (6%); calcium (7%);
and zinc (6%).[7] There are roughly 18 million children in the
U.S., so these percentages represent large numbers of
malnourished individuals. These percentages may even be somewhat
optimistic; many scientists consider RDAs inadequate measures of
nutritional status because nutritional requirements vary
considerably from one individual to the next, so averages may be
misleading. Furthermore, the chemical form of a nutrient is
important but is often not considered in typical assessments of
nutrient status.[8]

There is considerable evidence that food dyes can worsen the
symptoms of ADHD in some children, but government authorities
deny the evidence. The U.S. Food and Drug Administration (FDA)
has published a pamphlet called FOOD COLOR FACTS which states
that "there is no evidence that food color additives cause
hyperactivity or learning disabilities in children." The
pamphlet, though published by the FDA, was actually written by
the International Food Information Council, a trade association
representing many makers of food additives including General
Mills, Kraft, Procter and Gamble, Pepsi-Cola, Coca Cola, Monsanto
(maker of aspartame), and Ajinomoto (maker of monosodium
glutamate).[2,pg.25] To make the statement that there is no
evidence that food dyes cause hyperactivity or learning
disabilities in children, the FDA had to ignore 16 double-blinded
studies that have shown that food dyes do worsen the symptoms of
ADHD in some children.[2] (A double-blinded study is one in which
neither the participants, nor those observing and recording the
children's behavior, know which children have been exposed to
food dyes and which have not, the purpose being to avoid bias.)

In 1976, a study of U.S. children between the ages of 6 and 11
found they ingested an average of 76 milligrams of food dyes per
day (mg/day). Ten percent of those studied ingested twice that
amount, or 146 mg each day. Since that time, the quantity of food
dyes manufactured per person in the U.S. has increased
50%.[2,pg.11]

At a time when Americans are searching for causes of aggression
and violence among children, it would make sense to consider
malnutrition, food additives, tobacco additives, toxic metals,
pesticides and other endocrine-disrupting industrial toxicants --all of
which many U.S. children are exposed to from the moment of
conception onward.

--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)

=====

[1] Joseph A. Bellanti, William G. Crook, and Richard E. Layton,
editors, ADHD ATTENTION DEFICIT HYPERACTIVITY DISORDER, CAUSES
AND POSSIBLE SOLUTIONS, CONFERENCE SYLLABUS OF PRESENTATION
PAPERS NOVEMBER 4-7, 1999, KEY BRIDGE MARRIOTT HOTEL, ARLINGTON,
VIRGINIA (Alexandria, Virginia: International Research
Consultants, November, 1999). Available for $25 from:
International Research Consultants, Suite 2J, 4600 King Street,
Alexandria, Virginia 22302. Telephone (703) 998-6091; fax: (301)
320-4688; E-mail: irconsult@aol.com. The conference was sponsored
by the Georgetown University Medical Center (Washington, D.C.)
and the International Health Foundation (Jackson, Tennessee).

[2] Michael F. Jacobson and David Schardt, DIET, ADHD & BEHAVIOR;
A QUARTER-CENTURY REVIEW (Washington, D.C.: Center for Science in
the Public Interest, November, 1999). Available for $8.00 from
the Center, No. 300, 1875 Connecticut Avenue, N.W., Washington,
D.C. 20009; telephone (202) 332-9110; fax: (202) 265-4954;
E-mail: cspi@cspinet.org. Also available free at www.cspinet.org.

[3] Joseph A. Bellanti and William G. Crook, "Introductory
Remarks" in the syllabus cited above in note 1, pg. 1.

[4] David J. Morrow, "Attention Disorder Is Found In Growing
Number of Adults," NEW YORK TIMES September 2, 1997, pgs. A1, D4.

[5] Marianne Mercugliano Glanzman, "What is ADHD," in the
syllabus cited above in note 1, pgs. 3-16.

[6] Associated Press, "Boy's Mother Apologizes Over Shooting in
Georgia," New York Times May 25, 1999, pg. A19.

[7] Donald R. Davis, "Nutritional Deficiencies in American
Children," in the syllabus cited above in note 1, pgs. 17-21.

[8] For example, see Roger J. Williams, NUTRITION IN A NUTSHELL
(Garden City, New York: Doubleday, 1962).

Descriptor terms: adhd; attention deficit disorder; hyperactivity;
children; ritalin; cancer; carcinogens;