A.D.H.S. Anhang 4
https://www.researchgate.net/publication/46165412_A_survey_of_the_perceptions_and_management_of_ADDADHD_by_homoeopathic_practitioners_in_the_Johannesburg_metropolitan_area
[Susan Margaret Nagle]
A survey of
the perceptions and management of ADD/ADHD by homoeopathic practitioners in the
Johannesburg Metropolitan Area.
1. Attention Deficit Hyperactivity
Disorder (ADHD) - a disorder of attention and impulse control with
specific DSM-IV criteria, appears in childhood and may
continue through to adulthood though
it usually subsides during adolescence. Hyperactivity may be a feature but is
not a requirement for diagnosis (Stedmann’s Medical
Dictionary, 1995).
2. Clinical Picture - The
presenting pathological or functional disorder, or existing syndrome named
according to conventional medicine (Bloch and Lewis, 2003).
3. Constitutional remedy - A
remedy prescribed on the basis of temperament, character and general reaction
of the person, as well as local symptoms of the disease
(Bloch and Lewis, 2003).
4. Complex Remedy - A
combination of two or more Homoeopathic medicines which are prepared from more
than one stock and incorporated into one dosage form (Swayne, 2000).
5. D.I.T. – Durban
Institute of Technology, as of 2002, now called Durban University of
Technology, as of 2006 (ex- Natal Technikon).
6. Dopamine
- a neurotransmitter secreted by the neurons that originate in substatia nigra. The terminations
of these neurons are mainly in the striatal region of
the basal ganglia. The effect of dopamine is usually inhibition (Guyton and
Hall, 1997).
7. DSM-IV - Diagnostic
and Statistical Manual of Mental Disorders (Fourth Edition)
8. Essential Fatty Acid (EFA) - any
long chain monobasic organic acid required for normal functioning of the human
body and which must be obtained from a food source (Stedmann’s
Medical Dictionary, 1995).
9. Gamma-aminobutyric
acid (GABA)
- a neurotransmitter secreted by nerve terminals in the spinal cord,
cerebellum, basal ganglia and areas of the cortex. It is believed to always
cause inhibition (Guyton and Hall, 1997).
10. Glutamate
- a neurotransmitter secreted by the presynaptic
terminals in many sensory pathways as well as many areas of the cortex. It is
believed to always cause excitation (Guyton and Hall, 1997).
11. Johannesburg Metropolitan Area -
refer to APPENDIX 4 (MAP)
12. Law of Similars
- “like cures like” (similia similibus
curentur) – The remedy for any individual illness is
the very substance that can produce similar symptom picture and pattern of
illness in a healthy person (Bloch and Lewis, 2003).
13. Miasm - a mode
in which the body reacts, the term used to reflect a certain predisposition, a
defect that can be transferred from one generation to another (De Schepper, 2006).
14. Neurotransmitters - chemicals
that make it possible for nerve impulses to travel from one cell to another and
therefore play an essential role in the functioning of the brain (Guyton and
Hall, 1997).
15. Simillimum
- the single homoeopathic medicine, the drug picture of which most nearly
approaches the total symptom complex of the patient (Gaier,
1991).
16. Simplex Remedy - A
single medicine derived from a single source material (Swayne, 2000).
17. Totality of symptoms - The
complete clinical picture of a patient during the “illness”, comprises all
mental, general and local (particular) symptoms and signs; the complete symptom
pattern from which the simillimum is found (Swayne,
2000).
18. Uni-Jhb
– University of Johannesburg, as of 2005 (ex-Witwatersrand Technikon).
INTRODUCTION Attention
deficit disorder with or without hyperactivity is the most frequent and fastest
growing diagnosis among children in the USA and is increasing at a rapid rate
in all developing countries. It is also currently one of the most researched
conditions; yet it is not fully understood (Picton,
2004). It is estimated that ADD/ADHD occurs in 3 – 7% of the school age
population, and boys are diagnosed 3 – 4x more than girls. Without proper intervention
ADHD can continue through adolescence and into adulthood with research
indicating that it occurs in approximately two to four percent of adults thus
the prevailing belief among professionals that children “outgrow” ADHD by
adulthood is false. Despite increased awareness, ADHD remains under-recognised
with less than half of the affected individuals receiving treatment (Janessen-Cliag, 2005).
Thus the number of children affected
by this condition is potentially higher than stated by formal statistics. It is
thought that ADHD could be more common in rural areas since families do not
have adequate access to health care and nutrition, their awareness and
understanding of the condition is also minimal (Badat,
2004; Byram, 1998; Jannssen-Cliag,
2005). ADD/ADHD is primarily a neurophysiological
disorder, caused by an imbalance in neurotransmitters. There is evidence to
suggest it is also hereditary; that is, there is a genetic predisposition (Naude, 2004). A deficiency in Essential Fatty Acids as well
as other vitamins and minerals seem to either contribute or aggravate the
symptoms associated with ADD/ADHD; therefore nutrition, diet and
supplementation form an important part of the treatment process (Picton, 2004). There is also a tendency for these patients
to be ultra-sensitive to their physical and emotional environment. These
children also frequently have learning, behavioural and social problems, which
need to be addressed (Allen and Harrison, 2004). A diagnosis can only be given
once a comprehensive (multidisciplinary) evaluation has been conducted. An
assessment should include, neurological, medical and developmental history, a
thorough physical examination, psychometric testing and a concurrence with the
DSM IV criteria (Erasmus, 2004). Although it seems that many children are
hyperactive, only a relatively small percentage are truly sick. Many children
have boundless energy, get bored easily, and have little interest in learning
certain school subjects (Ulllman, 1991). 2
The
prescribing of the stimulant Methylphenidate hydrochloride (the active
ingredient in Ritalin®, Adaphen® and Cocerta®) is the conventional form of treatment used by
neurologists and doctors. Depending on the symptomatology
and the severity of the symptoms (such as emotional issues or sensory
defensiveness), the use of other disciplines can be incorporated into the
treatment plan such as: psychology, occupational therapy, speech and hearing
therapy and nutrition. In addition, other complementary therapies are available
such as Homoeopathy, Chiropractic, meditation and relaxation and can be an
alternative and/or adjunct to conventional treatment.
The
ideal way to manage an individual with ADD/ADHD is with an integrated approach
(Picton, 2004). Homoeopathy is becoming a preferred
choice of treatment as parents seek to find alternatives to Methylphenidate
hydrochloride (Badat, 2004). Anecdotal evidence
indicates that homoeopaths consult with a significant number of ADD/ADHD
patients but no formal evidence/study exists to support this. This is one of
the rationales for this research project. It will explore the homoeopathic
practitioners’ approach to patients as
well as the treatment, management and success rate in treating ADD/ADHD. This
research will also include a demographic study of the practitioners and their
practices.
CHAPTER
2 REVIEW OF RELATED LITERATURE 2.1 ADD/ADHD – EPIDEMIOLOGY, PREVALENCE and
PROGNOSIS
ADD/ADHD
is currently one of the most researched childhood conditions, yet there is
still so much controversy and misunderstanding about it. It is also one of the
most commonly diagnosed disorders of childhood development (Picton,
2004). Although official statistics are not available for South Africa, the
Hyperactivity Attention Deficit Disorder Support Group of South Africa (ADHASA)
believes that about 5 - 10% of all South African children are affected
(Health24, 2004). Unfortunately, statistics are affected by many variables,
including the child’s socioeconomic status, gender and even place of birth (Epanchin and Paul, 1987).
More boys than girls are diagnosed
with ADHD, the ratio of male to female being 6:1. ADHD tends to be under
diagnosed in girls the reason for this is thought to be that boys more frequently
present with the hyperactivity/ impulsivity symptoms, which are easily
identified, whereas girls more frequently present with the inattentive
symptoms, which are more difficult to identify (Riordan, 2004). It has also
been suggested that ADHD could be more common in rural areas since these
families do not have adequate access to good health care and nutrition as well
as there is minimal awareness and understanding of the condition – some even
believe it to be witchcraft (Badat, 2004; Byram, 1998; Janssen-Cliag,
2005). There is a research project underway, in the South Western Township in
Johannesburg, with the main aim being to investigate the incidence of ADD/ADHD
in this area (ADHSA Seminar, October 2006). It would appear that statistics
vary from country to country; this could be because the definition of the
disorder varies in different countries (Epanchin and
Paul, 1987). About 33% of children who are diagnosed
with ADD/ADHD have reading problems
and are also likely to have difficulties in mixing with other children; often
because they are aggressive, these problems could extend into adulthood if not
treated (Byram, 1998). Research indicates that this
condition occurs in approximately 2% to 4% of adults. The gender ratio of adult
males to females is 2:1 or lower. The belief among some professionals that
children outgrow ADHD by adulthood is false, this is due to symptoms becoming
less severe and presenting differently in adolescence and adults because of the
development of coping mechanisms to compensate for their impulsivity and
disorganization (Janssen-Cilag, 2005; Wallis et
al, 1994). At least 20-30%, and possibly as much as 80% of children with
ADHD will continue to exhibit symptoms in adulthood. Many adults only come to
realize that they themselves have the condition when one of their own children
is subsequently diagnosed (Stordy and Nicholl, 2002; Riordan, 2004) thus find relief that there
is a name for their condition (Hallowell and Rately,
1996). A diagnosis of ADD/ADHD can help both the child and the family
understands that these problems are not just willful
bad behaviour. According to Diller (1999) “We’ve learned that in dealing with
problem personalities, and the line between he won’t behave and he can’t behave
is very hard to draw”.
Many people with ADD/ADHD have a
normal or above normal intelligence and the symptoms of ADHD do not necessarily
have to be an obstacle to leading a successful life (Janessen-Cilag,
2005). Early diagnosis and appropriate treatment in children is the key to
maximizing positive outcomes and minimizing the negative long-term effects of
ADHD in adulthood (Janssen-Cilag, 2005). Many adults
gravitate into the creative fields or work that provides an outlet for
emotions. Unfortunately people with ADD/ADHD don’t function well in standard
schools and typical office jobs. Increasingly, parents
and
lobby groups are demanding that accommodations in the classroom be made. About
half the children diagnosed with ADHD receive help from inclusive-education
teachers in their schools, as they commonly also have co-existing learning
disabilities (Wallis et al, 1994).
Despite
increased awareness, ADHD remains under-recognised with less than half of the
affected individuals receiving the appropriate diagnosis; and of those persons
diagnosed, few receive proper treatment (Janssen-Cilag,
2005). An NIMH (National Institute of Mental Health) study in 2000 found that
only half of the children positively identified with ADD/ADHD actually received
care in accordance with the guidelines of the American Academy of Child and
Adolescent Psychiatry (Stordy and Nicholl,
2002). There is “no cure” for ADD/ADHD but, without effective treatment, the
risks associated with ADD are very great. Children with ADD fall out of the
mainstream
of
positive social, educational and emotional life with their peers and family
members and too often the label of ADD becomes a stigma with resultant
long-term negative implications (Lawlis, 2005).
IMPLICATIONS
OF SOCIAL FUNCTIONING
Generally
on a social level, children with ADD/ADHD often have difficulty developing
appropriate relationships with authority figures and peers. The disorder does
not only impact on the diagnosed child but also on the child’s family and
peers. A child with ADHD may often be labeled as disobedient
or “strong willed”. This is often because of the difficulties in maintaining
attention and missing important parts of the conversation or instructions.
Several
studies show that children with predominantly inattentive ADHD may be perceived
as shy or withdrawn by their peers.
Research
indicates that aggressive behaviour in children with symptoms of
impulsivity/hyperactivity may play a significant role in peer rejection. Other
factors that contribute to peer rejection are poor impulse control, inability
to wait their turn and follow instructions and excessive talking (Janessen-Cilag, 2005). Once a child is diagnosed with
ADD/ADHD, many parents become upset or confused; others may be relieved once a
cause for their child’s problems is identified. Being a parent of a child with
ADD/ADHD is not an easy task and can be very difficult and stressful, placing
an enormous amount of pressure on family life. There are increased levels of
parental frustration, marital conflict, siblings may feel neglected and family
bonds can be broken. However, on the other hand, it can also strengthen family
bonds (Janssen-Cilag, 2005; Lawlis,
2005). ADD is also a problem for society as a whole. The challenges associated
with this condition have enormous implications. The following statistics were
taken from the Attention Deficit Association and from material provided by
Children and Adults with Attention Deficit/ hyperactivity Disorder (CHADD) –
these figures relate to the USA: 35% of students with ADD never finish high school.
Individuals with ADD have
significantly more hospital visits than non-sufferers.
Parents of ADD children divorce 3x
more often than those whose children do not have ADD.
50 – 75% of incarcerated inmates in
prison have some form of ADD.
52% of ADD sufferers abuse drugs at
some time or other in their lives.
43% of male ADD students are
arrested for a felony before the age of sixteen.
According to a study published in
the Journal of American Academy of Child and Adolescent Psychiatry, the costs
of ADD and ADHD are reflected in the entire family medical profiles. They would
have more medical claims and the direct medical care costs per annum per family
member were found to be twice as high than non-ADD/ADHD families. The indirect
costs for disability and absenteeism were 61% higher than non-ADHD families (Lawlis, 2005).
AETIOLOGY There
is much debate over what exactly causes the symptoms of ADD/ADHD therefore it
is thought that there is no single cause, but rather a combination of
contributing factors. A major report from the British Psychological Society
argues that the concept of ADHD as a single condition is controversial for a
variety of reasons. Many factors affect the way attention is displayed in a
particular situation and doctors should be wary of describing children as
having ADD/ADHD without a thorough investigation (McConnell, 1997). All
children and adults are unique and their reasons for thinking and behaving as
they do will differ. In this chapter the contributing and aetiological factors
will be discussed.
The Neurological and Biological
Basis.
As ADD/ADHD, by definition, is a
neurobiological condition, physicians and mental health professionals attribute
symptoms to an imbalance in neurotransmitters (Reichenburg-Ullman
& Ullman, 1996). It is thought that in
individuals with ADHD there is a lower than normal level of the
neurotransmitter dopamine in the frontal lobe (Riordian,
2004).
The frontal lobe, which is
responsible for executive functioning (regulates impulse control, attention and
other thought processes) is thought to be compromised in people with ADHD.
Recent research was conducted in eight children aged 6 to 12, who had been
diagnosed with the hyperactive-type ADHD and were taking stimulant medication. These children were
compared to eight children without ADHD. It was found, using a type of Magnetic
Resonance Imaging (MRI), that in children with ADHD, levels of glutamate were
increased while levels of GABA (Gamma-aminobutyric
acid) were decreased. The decreased levels of GABA (causes neuro-inhibition)
and the higher levels
of glutamate (causes neuro-excitation) might explain the poor impulse control
these children seem to exhibit. The levels of neurotransmitters were measured
in relation to each other. Therefore, it is not the overall levels but rather
the relative proportion of the neurotransmitters that seem to be of importance
(health24, 2004). Studies using PET (positron emission topography), a brain
imaging technique that uses a radioactive tracer to show chemical activity of
the brain, have shown significant differences in the frontal part of the brain
between healthy subjects and those with ADHD (Janssen-Cilag,
2005; Prichard, 1996).
In 1990 Dr Alan Zametkin
and his colleagues at the National Institute of Mental Health (NIMH), USA,
found that in the PET scans, people with ADD showed lower levels
of electrical activity and decreased
blood flow in the frontal lobes the area of the brain’s cortex known to be
involved in the control of attention, impulses and motor activity. This was
compared to non-ADD adults and children. Those with ADD/ADHD showed slightly
lower rates of metabolism, which could mean that they do not use as much
glucose and therefore their need for oxygen would be less (Stordy
and Nicholl, 2002; Wallis, 1994).
It has
been proposed that ADHD could arise from a number of complications during
antenatal and postnatal periods as well as any trauma to the head, e.g. forceps
delivery (Byram, 1998; Allan, 2004). Brain damage due
to an illness, such as meningitis or encephalitis or a lesion in the frontal
lobes could also cause hyperactive behaviour.
Studies,
using MRI, have discovered that children with ADHD often have smaller right
brains – a finding that makes sense as the right brain is responsible for self-control
(Stordy and Nicholl, 2002).
Genetic
and Familial Factors.
Experts
have documented a hereditary aspect of ADHD because it often occurs in
families. Most children with ADHD are born with this disorder, but it is only
diagnosed
at
school going age. Clear evidence that ADD/ADHD runs in families comes from
studies of twins. In as many as 80 – 90% of identical twins (who possess
identical genes),
if one
had ADHD so did the other. In fraternal twins (who have just 25% identical
genes) the likelihood of both having ADD/ADHD drops to 32 – 50%. The hereditary
aspect can also be seen in children who are mirror images of a parent; they
tend to share behavioural and learning styles. The influence of genes is
unmistakable. Researchers
at the
University of California at Irvine reported finding the first abnormal gene
associated with ADD. The gene controls dopamine receptors in the brain and this
abnormality causes less sensitivity to dopamine (Reichenburg-Ullman
& Ullman, 1996; Stordy
and Nicholl, 2002).
Genetic
research has also indicated that a problem of fat metabolism may be involved.
They found that some of the gene locations could be linked to specific enzymes,
namely Fatty acid-CoA transferase
(associated with the incorporation of fatty acids into the membranes) and Phospholipase C (associated with the breakdown of phospholipid membranes) (Stordy
and Nicholl, 2002).
Environmental
Factors.
It is
thought that the high level skills affected by ADHD are also influenced by the
child’s environment. ADHD behaviour could become manifest or be aggravated in
unfavourable conditions and circumstances. Physical environmental conditions
include: smoke, excess lead exposure, exposure to chemicals and pollutants.
External factors such as birth injuries and maternal alcohol or tobacco
consumption may play a role in less than 10% of cases (Wallis et al., 1994).
A disorganized, unpredictable or unstable family and personal life as well as
any emotional stress (divorce of parents) can affect behaviour and the ability
to learn (Bryam, 1998 and Picton,
1997).
Social
factors have also been implicated by Richman, Stevenson and Graham, who decided
after research that children who grew up with inadequate housing and lack of
financial security were more likely to display behavioural difficulties
(Middleborough, 2003). DeGrandpre (2000) poses the
question of whether ADD/ADHD is really a newly discovered medical disease or if
it is a culture-induced brain dysfunction that results from our growing need
for speed. There is an idea of an over-stimulated, hurried society, i.e. as
society moves faster so do the rhythms of our own consciousness. Children play
Nintendo and watch TV rather than participate in sports or play outdoors, and
movies are scarier and more violent. With the growing atmosphere of
hurriedness, intensity, urgency and pressure to perform it is no wonder that
children behave as they do.
We eat
fast foods and consume caffeine and drugs to go faster and stay awake longer.
Our society places little value on tranquility, quiet,
solitude and the joy of being in nature (DeGrandpre,
2000).
Dietary
Factors.
It has
been claimed that diet has an integral and influential role in ADD/ADHD symptomatology. Food can affect our moods, concentration
and behaviour, especially the typical eating patterns of today’s world, which
does not necessarily ensure an adequate intake of essential nutrients (Picton, 2005). Sugar has received much negative publicity,
but it is not necessarily sugar per se but rather the type and amount of
carbohydrates consumed that influence behaviour. The brain needs a certain
amount of glucose to function but too much or the incorrect type of
carbohydrate can cause symptoms associated with ADD/ADHD (Picton,
2005 and Merlin, SABC 3-Talk).
Keeping
the blood sugar level balanced is probably the most important factor in
maintaining energy levels. The level of glucose in the blood largely determines
appetite.
When
glucose levels drop we feel hungry but can also feel symptoms of fatigue, poor
concentration, irritability, nervousness, depression, sweating, headaches and
digestive problems (Picton, 2005; Holford,
1997). Essential Fatty Acids (EFA‟s) namely,
Omega 3 and Omega 6, are required for optimal brain function and are also
important nutrients required for healthy tissue production and they act as
lubricants for the body. ADD/ADHD has been associated with a deficiency in the reakdown/metabolism of the EFA’s.
Zinc, Vitamin B6, Vitamin B3, Vitamin C and Biotin are some of the co-factors
of EFA metabolism, so a deficiency thereof will interfere with conversion of Cis-Linoliec Acid to Gamma Linolenic
Acid and Prostaglandin E1 (enzyme delta-6-desaturase is inhibited). A defiency in EFA’s can manifest in
a variety of conditions including arthritis, eczema as well as allergies and
hyperactivity. A defiency seems to aggravate
neurological
and other symptoms. It was found that synthetic flavors,
colors, some preservatives (including tartrazine) and certain natural foods (those containing salicylates) also had an adverse effect on behaviour (Picton, 2005; Holford, 1997). It
has been stated that 90% of children’s behavioural problems can be attributed
to food allergies, chemical sensitivities, malnourishment and even high levels
of toxic metals in the tissues (Warren, 2004).
The Gifted
Child
A
child displaying behavioural symptoms of ADD/ADHD could actually have a high
Intelligence Quotient (IQ) and their perceived ability to stay “on task” might
be related to boredom, curriculum, mismatched learning or teaching styles as
well as environmental factors mentioned before. Gifted children may demonstrate
ADD/ADHD behaviour in some settings but not in others. These children may spend
from ¼ - ½ of their regular classroom
time
waiting for others to catch-up and even more time if they are in a mixed group
class. (Reichenburg-Ullman and Ullman,
1996). The behaviour displayed by these children can closely resemble the
behaviour of ADD/ADHD, that these children can be incorrectly diagnosed with
ADD/ADHD.
DIAGNOSIS
AND CHARACTERISTIC SYMPTOMS OF ADD/ADHD Diagnosis.
The
diagnosis of ADD/ADHD is currently based on subjective opinion, with no
scientifically accepted test available (Prichard, 1996). As there is no single
test to diagnose ADD/ADHD, a comprehensive evaluation is favoured
in
order to establish not only a diagnosis, but also investigate possible
co-existing conditions and to rule out other causes of the presenting symptoms.
Diagnosis rests primarily upon the history of the child (taken from parents,
teachers, other care givers and the child itself) – this is the most reliable
diagnostic tool. An assessment is made of the child’s academic, social and
emotional functioning (Riordan, 2005; Hallowell and Rately,
1996).
ADD/ADHD
is generally first diagnosed in childhood (during primary school years). The
signs and symptoms (behaviour) are usually first noticed by teachers, who then
inform parents (who may or may not have picked up on the same/similar behaviour
patterns described by the teacher). The parents will then often take the child
to the family doctor (GP), who does a complete medical examination to exclude
any underlying condition (Wallis et al., 1994; Picton,
2005). Generally, if the doctor suspects ADD/ADHD, he will refer the child to a
specialist for further investigations and assessments. Unfortunately there are
some doctors that prescribe medication without referring to a specialist for
further assessment/ investigation (Allan, 2004).
Further
assessments can be made by a specialist (developmental) paediatrician,
educational or clinical psychologist and occupational therapists (Picton, 2005; Erasmus, 2004) but the final definitive
diagnosis should be made by a neurologist (Allan, 2004). An educational
psychologist assesses academic ability by means of verbal and non-verbal tests.
They use the Wechsler Intelligence scale for children – Fourth Edition USA
(WISC-IV) which provides a measure of general intellectual functioning and four
index scores (verbal comprehension, perceptual reasoning, working memory and
processing speed). The Conners Parent Rating Scale
(CPRS), also available in a teachers version (CTRS), allows parents and
teachers to rate the child’s cognitive, emotional, and behavioural status on a
number of dimensions, including conduct problems, learning problems,
psychosomatic problems, impulsivity-hyperactivity, and anxiety. This scale has
been found to be sensitive to the effects of prescribed medicine for
hyperactivity. These tests are frequently used in pharmacologic research
studies. Another test used is the Children’s Checking Task (CCT), which is
completed by the child. Psychologists are able to identify problem areas and
will assess the child’s behaviour as well as emotional well-being. The
educational psychologist cannot prescribe medication but will refer the child
to a
specialist paediatrician or neurologist, who can prescribe medication if the
case proves that it is needed (Epanchin and Paul,
1987; Picton 2005; Allan, 2004).
Paediatricians have been specially
trained in childhood conditions and will conduct a full medical history and
physical examination of the child. A developmental and or behavioural
paediatrician are the best qualified to diagnose this condition as they have
been specially trained in behaviour and development and will conduct a
comprehensive developmental, medical and behavioural assessment. A Neurologist
will make the final decision by conducting a further test, by means of an
Electroencephalograph (EEG), which measures brain activity (Picton,
2005). Silberstein and his colleagues have developed a signal test that may
provide the first objective and safe method for doctors to diagnose children
with ADD/ADHD, but it is too early for the test to be made available for
general use. The test (steady state probe topography) found significant
differences in the activity in the frontal parts of the brain in 13 boys with
the condition, compared with 18 “normal” boys. The test also seems to confirm
that there is a biological basis
for this condition (Prichard, 1996).
Currently EEG’s, MRI and PET (positron emission topography) scans are being
used to detect abnormal brain function. In the past it was believed that brain
injury was responsible for the condition and was therefore called Minimal Brain
Damage, it was later changed to Minimal Brain Dysfunction. In the seventies the
focus was placed on the over-activity and then came the idea that these
children also had poor concentration, and so the name changed to Attention
Deficit Disorder (ADD), which is now regarded as the umbrella term (Picton, 1997; Wallis et al, 1994).
Not all children (and adults) with
ADD are hyperactive so the diagnosis is either made as ADD or ADD with
hyperactivity (ADHD). The Diagnostic and Statistical Manual
of Psychiatric Disorders, 4th Edition
(DSM IV) sets out the criteria that must be met in order for a diagnosis to be
made (Picton, 1997; Wallis, 1994). For a person to be
diagnosed with ADD/ADHD the problems of thinking and behaviour must
significantly interfere with normal functioning: that is, it must severely
influence or disrupt the child’s life in more than one area: at school, at home
or in social situations (Reichenburg-Ullman and Ullman, 1996). The two most common errors in the diagnostic
process are missing the diagnosis or making the diagnosis too often. The latter
seems to be more common in today’s society as there are a number of conditions
that can present just like ADD and most “normal” children can be distractible,
impulsive and restless at any time (Hallowell and Rately,
1996). Before a diagnosis is made the following conditions should be excluded,
as their symptoms can be similar or can mimic those of ADD/ADHD
DD.:
1) Visual impairment or hearing
impairment.
2) Language and learning
disabilities: dyslexia; autism; speech and language disorders; auditory
processing difficulties.
3) Neurological conditions: Tourette’s Syndrome; seizure
disorder (Petit mal epilepsy.); sleep
disorders; language disorders; mental retardation.
4) Food allergies.
5) Medical conditions:
hypothyroidism; hyperthyroidism; lead poisoning; severe aneamia;
chronic illness.
6) Emotional and psychological
problems such as: anxiety; depression; obsessive-compulsive disorder;
oppositional defiant disorder; conduct disorder; low self esteem; boredom in
the classroom; relationship problems; significant life events or any change
from normal routine.
7) Developmental disorders: low
muscle tone, motor co-ordination difficulties, sensory modulation disorders
(sensory defensiveness).
These conditions can also co-exist
with +/o. be complications of attention deficit hyperactivity disorder.
(Erasmus, 2005; Kewley, 1998; Picton,
2005; Riordian, 2004).
Characteristic Symptoms.
ADD/ADHD can be divided into 3
subgroups according to symptom presentation:
1. Primarily inattentive type: Fails
to give close attention to details or makes careless mistakes; has difficulty
sustaining attention; does not appear to listen; struggles to follow through on
instructions (does not complete tasks); has difficulty with organization;
avoids or dislikes tasks requiring sustained mental effort; easily distracted
or is forgetful in daily activities.
2. Primarily hyperactive/impulsive
type: Hyperactivity symptoms: fidgets with hands or feet or squirms in chair;
has difficulty remaining seated; runs about or climbs excessively (in a
situation in which it is inappropriate); difficulty playing or engaging in
activities quietly; often “on the go” or “driven by a motor”‟ or talks
excessively.
Impulsivity symptoms: Blurts out
answers before questions have been completed; difficulty waiting or taking
turns; interrupts or intrudes on others.
3. Combined type:
individual meets both sets of inattention and hyperactivity/impulsivity.
The following criteria (summarized)
must be met for the Diagnosis of ADD/ADHD:
1. Some of the symptoms of
inattention +/o. hyperactivity that cause impairment must be present before 7
years of age.
2. At least 6 symptoms of
inattention +/o. hyperactivity/impulsivity must have persisted for a minimum
period of 6 months, to such a degree maladaptive and inconsistent with the
individual’s developmental level.
3. Some impairment from the symptoms
is present in two or more settings.
4. There must be clear evidence of
clinically significant impairment of social, academic or occupational
functioning.
5. The disturbance must not occur
exclusively during a pervasive Developmental Disorder, Schizophrenia, or other
Psychotic Disorder and symptoms are not better accounted for by any other mental
disorder
(American Psychiatric Association,
1994).
Although ADD/ADHD is associated with
“bad behaviour” and there seems to be a negative stigma attached to the
diagnosis, children (and adults) with ADD/ADHD possess positive personality
characteristics despite their difficulties in daily life. They can be
enthusiastic (about things they enjoy); creative, imaginative and original
(have more ideas than they can actualize effectively); charming, humorous,
entertaining and interesting to talk
to and be with; spontaneous;
intelligent and eager to please. They can be highly energetic and active;
inquisitive, take risks and have little or no fear, which is not always
something good in the eyes of parents (Hall and Naude,
2003; Hallowell and Rately, 1996; Riechenburg-Ullman
and Ullman, 1996). 25
MISDIAGNOSIS,
OVERDIAGNOSIS OR UNDERDIAGNOSIS?
This
is a controversial topic for all concerned, parents, teachers and all the
professionals involved in the treatment process. Many experts question whether Methylphenidate
Hydrochloride is being over prescribed and whether teachers, doctors and
parents are too quick to diagnose a child as suffering from ADHD. In reality,
too often it is the teachers who are making the diagnosis. A Connecticut law
prohibits schools and teachers from recommending psychotropic medication but a
teacher could recommend a visit to a doctor (health24, 2001). Many teachers
mislabel children as having ADD because they don’t have the time or the
resources to develop real expertise. It is dangerous to label a child without a
scientific basis for diagnosis and too often the treatment that follows treats
only the symptoms and not the person affected (Lawlis,
2005).
The widespread labeling
of ADHD (in North America) to difficult children means that most classrooms and
many families have children so classified. Although ADHD is officially a term
for a category of mental disorder, it has become so widely used that it has a
prominent place in contemporary culture (McConnell, 1997).
As Dr van der
Merwe reports, ADHD has become a fashionable
diagnosis that is made far too easily and quickly.
There are innumerable studies of underdiagnosis and overdiagnosis
and it is estimated that millions of children are incorrectly labeled and treated for nothing more than their immaturity.
A review of these studies showed clearly that 50% of children diagnosed with
ADD/ADHD do not fit the officially accepted criteria and are therefore wrongly
diagnosed (Goldberg, 2004). While much of the debate has focused on overdiagnosis and over medication, some doctors say a
bigger problem is that of the diagnosis being missed (health24, 2001). A report
in the JAMA in 1998 concluded that ADHD actually is underdiagnosed
in the general population (USA) when compared with other countries such as
Germany and New Zealand (Stordy and Nicholl, 2002). In Britain, ADD/ADHD is reported as being underdiagnosed and undertreated, but it could also be overdiagnosed because hyperactivity is confused with more
widespread difficulties (Kewley, 1998). An NIMH
(National Institute of Mental Health) study in 2000 found that only half of the
children positively identified with ADHD actually received care in accordance
with the guidelines of the American Academy of child and adolescent psychiatry (Stordy and Nicholl, 2002). Also,
too many “problem children” don’t have adequate access to good health care in
the first place and so no informed decisions can ever be made (Warren, 2004).
Troublesome aspects of how ADD is currently framed in official psychiatry
(Diller, 1999):
1.) The process of establishing
“objective” diagnostic standards for ADD has itself been quite subjective.
2.) Official guidelines for
evaluating ADD symptoms are vague and open to interpretation, yet they lead to
an all-or-nothing diagnosis.
3.)
The ADD diagnosis has no definitive medical or psychological marker and so it
is often made exclusively on the patient‟s
history. Circumstances and biases of those reporting a child’s behaviour are
seldom taken into account.
4.)
The diagnosis is overly focused on the individual and does not take sufficient
account of family systems and other environmental factors.
5.) In
its current phase as a “disorder for all seasons”, ADD has become too
inclusive. It has lost relevance to the age-related, developmental nature of
some core problems.
6.)
ADD as officially described can look a lot like certain other childhood
psychiatric disorders. And many children meet criteria for some, but not all of
the symptoms of several different conditions.
TREATMENT
AND MANAGEMENT
Most
professionals agree that a team approach is required and this includes
medicinal, psychological, educational, behaviour management and life style
changes. Parents, teachers and the child all need to be involved in the
treatment and management process. Lawlis (2005) a
psychologist, offers advice and suggestions on methods that include drugs and
medication, counseling and biofeedback,
electromagnetic treatments, biocleansing, nutritional
adjustments, strategies for sleep disturbances, neurotherapy,
and self-development management. He will also touch on spirituality and examine
how families can engage their own faith and beliefs in dealing with ADD.
Orthodox
pharmaceutical intervention (medication). The most common
drug prescribed is Methylphenidate Hydrochloride (Trade names: Ritalin®, Adaphen® and Concerta®).
Methylphenidate Hydrochloride is a central nervous system stimulant. It is a
schedule 6 drug (formally schedule 7), is classified as a psychoanaleptic
(antidepressant) and is chemically related to amphetamines. It is indicated for
the treatment of ADHD and narcolepsy. Medication is available in the form of
tablets in strengths ranging from 10mg to 80mg, depending on which variant is
prescribed. Dosage will depend on the individual‟s
age, weight, needs and response (Snyman, 2006;
Novartis, 2002; Stordy and Nicholl,
2002).
This
drug should be prescribed and its dosage monitored by a neurologist, by whom
the definitive diagnosis was made (Allan, 2004). When medication is effective,
it can help the individual to focus better, sustain effort over long periods of
time, reduce anxiety and frustration and reduce irritability and mood swings.
These primary effects can lead to the secondary effects of increased
confidence, greater self-esteem and sense of well being (Hallowell and Rately, 1996). Methylphenidate is also said to have a
greater tendency to relieve the stress in the care giver than the child, and
that the positive effects are important in preserving the self-esteem of the
individual with ADD/ADHD and the sanity of their teachers, families and peers (Reichenburg-Ullman and Ullman,
1996).
It is
ironic that allopathic doctors prescribe Methylphenidate to children who are
hyperactive. One would think that this drug would make the child even more
hyperactive, but it has a noticeably opposite effect. Conventional physicians
refer to the „paradoxical action‟ of drugs as the reason it works the way
it does. This „paradoxical action‟ of a drug can also be seen in
homoeopathic medicines (Law of Similars), a substance
is capable of producing similar symptoms to a particular disease state is
prescribed as a treatment for that very state. The drug does not further relax
children who are already calm; it only calms those who are hyperactive. Methylphenidate
can treat hyperactivity effectively, as it normally causes hyperactivity (Ullman, 1991).
As a
stimulant, Methylphenidate hydrochloride is known to increase the levels of
dopamine in the brain. Stimulants prevent the reabsorption
of neurotransmitters into nerve cells or cause more or the neurotransmitter to
be released, they block the receptors and without sites to bond to, excess
dopamine will remain in the system (Diller, 1999; Warren, 2004). Stimulants
seem to have a short-term effectiveness of 60-80% in reducing hyperactivity,
distractibility and impulsivity in school-age children. When stimulant
medication is not effective, individuals are prescribed other medication for
example tricyclic antidepressants (Warren, 2004).
Other medications, which are used either in place of or together with
methylphenidate, are:
Atomoxetine (Strattera®) – inhibits the
reuptake of noredrenaline by the presynaptic
neurons and is indicated for management of Attention Deficit Hyperactivity
Disorder. Is a non-stimulant with a “favourable” side effect profile and does
not seem to cause dependence (Korb, 2005).
Dextroamphetamines
(Dexedrine® and Eskatrol®) – more severe side effects
have been reported, is habit forming/not recommended for children under 12
years. Amphetamines cannot be prescribed for ADHD in South Africa.
Pemoline (Cylert®) – is less effective than methylphenidate and takes
up to one month before maximum effect is noted, can be habit forming and often
leads to insomnia.
Risperidone (Risperdal®) - used for for the
aggression, behavioural and Conduct Disorder associated with ADHD. It may
assist in concentration. Often used in connection with methylphenidate.
Impiramide (Tofranil) - is used when a child reacts badly to
methylphenidate especially where motor disorders exist (e.g. epilepsy). It is
used when the child presents with depression or anxiety; is older than 5 years
and still wets the bed. Can have severe side effects including heart
irregularities.
Citalopram Hydrobromide (Cipramil) – is an anti-depressant
and is less cardio-toxic than Impiramide. It is often
combined with methylphenidate to counter the relevant side effects.
Thioridazine (Melleril) - used for for
behaviour disorders, hyperactivity and aggression; especially aggression in toddlers
too young for methylphenidate. In too high a dose it can over-sedate a child
and affect his ability to learn.
It does not increase attention span
or reduce distractibility.
Haloperidol (Serenace®)
- used for for over activity, destructive, aggressive
behaviour. It is used for children with Tourette‟s
Syndrome. It is an antipsychotic tranquilliser that reduces severe anxiety and
agitation.
Sulpiride (Espiride®, Eglonyl® and Norton-Supiride®) – an anti-depressant (antipsychotic), sometimes
used to treat the side effects of methylphenidate. Treatment of depression,
schizophrenia and behaviour disorders.
Carbamazepine (Tegretol) – is an anti-convulsant
and anti-epileptic drug. Used for temporal lobe epilepsy and can have a mood
stabilizing effect. Epileptic patients cannot take stimulant medication such as
methylphenidate, so their symptoms are first controlled before stimulants are
prescribed.
Sodium Valporate
(Epilim®) - used for for
treating petit-mal epilepsy and can also have a mood stabilizing affect but can
increase hyperactivity or aggression. Used to control epilepsy before stimulant
medication is administered.
Lamotrigene (Lamictin®) – an anti-convulsant
used on its own or in combination with other anti-epileptic medication.
(Snyman,
2006; Picton, 1997)
Not all parents are convinced that
their children should be given Methylphenidate because of the numerous side
effects, special precautions and drug interactions as well as all the media and
stigma attached to this drug.
Much of the stigma associated with
psychotropic drugs for the treatment of ADHD comes from their potential for
abuse (health24, 2001).
The Drug Enforcement Agency (DEA),
USA, classes Methylphenidate hydrochloride as a “highly addictive controlled
substance” because of its amphetamine structure, this make it fall in the same
category as cocaine, methadone and methamphetamine (speed) (Stordy
and Nicholl, 2002). A report discovered that
Methylphenidate is a more powerful stimulant than cocaine; research has shown
that cocaine can block 50% of dopamine receptors, whereas a typical dose of
methylphenidate, given to children blocked out 70% of dopamine receptors. A
drug enforcement study in Wisconsin, South Carolina and Indiana found that as
many as one-half of all teenagers in drug treatment centres said they had used
Methylphenidate to get a high. As methylphenidate taken orally does not produce
a high, many teenagers were crushing it and inhaling the powder – just like
cocaine (Warren, 2004).
Possible Side Effects of Methylphenidate
Hydrochloride: Sleep disturbances (insomnia), nervousness, decreased appetite,
headaches, drowsiness, dizziness, dyskinesia,
convulsions, choreo-athetoid movements, visual
disturbances, hyperactivity, cramps, tics or exacerbation thereof, blood dyscrasias, Tourette’s syndrome,
depression, toxic psychosis, cerebral arteritis and
occlusion are all possible side effects (Snyman,
2006).
Special
Precautions in the use of Methylphenidate Hydrochloride: It should not be given
in cases of Epilepsy, hypertension, emotional instability, and depression. It
may exacerbate symptoms of behavioural disturbances and thought disorders in
psychotic patients. It should not be used for the treatment of normal fatigue
states. Possible tolerance and dependence can develop, and mass loss and growth
retardation can occur in children during prolonged therapy; therefore it is
advocated that patients have one-month drug free periods or that the drug is
not taken during holidays or weekends. Supervised withdrawal is recommended. Careful
assessment is required before it is prescribed for children under the age of
six years old (Snyman, 2006). Drug Interactions with
Methylphenidate: It interferes with the antihypertensive effect of Guanethidine; and can cause decreased metabolism (inhibition)
of coumarin anticoagulants, anticonvulsants and phenylbutazone (Snyman, 2006) It
is largely unknown what the long-term effects of these drugs have on children (Ullman, 1991) but some of the possible long-term effects
include stroke, hyperthermia, hypertension and seizures.
Homoeopathy
The
Allied Health Professions Council of South Africa assists in the promotion and
protection of the health of the population of South Africa; it governs,
administers and sets policy relating to the professions registered with the
council; controls the practice of the professions and investigates complaints
relating to practitioners and students; and corresponds with the Minister of
Health on any matter falling within the scope of the Act.
The
Homoeopathic Association of South Africa (HSA) is recognized by the AHPCSA as
the official representative of the Homoeopathic Profession on South Africa
(Allied Health Professions Act, 2001). HSA represents and promotes the
Homoeopathic Practitioner, the Profession, Education and interests, for the
better health and well-being of all South Africans and is the only organization
that actively engages Government, Department of Health, Allied Health
Professions Council and all other organizations and structures that influence the
profession. Registration with the HSA is not compulsory (HSA, 2006).
Homoeopaths are able to treat the
same range of conditions as orthodox medicine. Most Homoeopathic doctors will
do a full medical assessment of the patient and will analyse the pattern of
symptoms the individual presents with, taking into consideration the mental,
emotional and physical states of the patient (Heritage Publishers, 1999). The
Allied Health Professions Act stipulates that a homoeopath is qualified and
registered to physically examine any person, taking into account the totality
of symptoms for the purposes of diagnosing any physical defect, illness or
deficiency. Also within their scope of practice is the treatment or prevention
of any physical defect, illness or deficiency in any person by prescribing
remedies, dietary advice or dietary supplementation in accordance with and
based on homoeopathic principles. Registered homoeopaths are entitled to
personally compound, dispense or supply remedies which are prescribed by himself,
for the use by the patient under treatment, new legislation dictates that the
practitioners must have a Compounding and Dispensing Licence to be able to do
this (HSA, 2006).
Homoeopathy and ADD/ADHD
Homoeopathic medicine has been
successful in treating ADD/ADHD and other behavioural conditions using
specific, individualized homoeopathic remedies (Reichenburg-Ullman
and Ullman, 1996). The success rate estimated to be
at least 70%, when individually chosen homoeopathic remedies are used to treat
ADHD for one year, (Reichenburg-Ullman and Ullman, 1996 and Warren, 2004). Dr Weil (2004) claims that
Homoeopathy has been successful when other methods have failed.
The child is treated as an
individual, and the cause of the behaviour/symptoms, including all mental,
emotional and physical aspects are addressed.
Homoeopathy does not need a name for
disease as practitioners prescribe medication (remedies) on the totality of
symptoms. Homoeopathic remedies are safe, non-toxic,
and relatively free from side
effects. An aggravation (temporary worsening of symptoms preceding alleviation
of symptoms) may occur. Remedies have lasting results (long-term
effectiveness). Homoeopathic remedies do not suppress symptoms and even when
given for long periods of time, are safe and do not cause dependency.
Homoeopathy will not interfere negatively with other medication, however if
taken with conventional medication they may not work as effectively (Lawlis, 2005; Reichenburg-Ullman
and Ullman, 1996; Ullman,
1991). Homoeopathic medicines not only improve the health of infants and
children, but probably also help them to become healthy adults (Ullman, 1991). Research into the Homoeopathic Treatment of
ADD/ADHD in South Africa has revealed the following:
1. Strauss, (1998) concluded that
the use of the homoeopathic complex, Selenium Homacord
(= D10, D15, D30, and D200 potencies), resulted in an overall improvement in
the clinical picture of ADHD compared to a control group. Selenium Homacord indicated for the treatment of diminished mental
capacity; lack of concentration; forgetfulness; depression; exhaustion and
deficiency of memory.
2. Muller, (1996) conducted a study
involving the efficacy of mineral therapy in the treatment of ADHD, using mineralloid potassium phosphate in D6 potency. It was found
that this decreased the overall hyperactivity of the ADHD subjects and mineral
therapy was advocated as an alternative to stimulate treatment in some cases
and reinforcing treatment in others.
3. Smith, (2001) investigated the use
of Cerbo® and Nerva 2®,
both of which are homoeopathic complex preparations whose composition includes
remedies that would cover the symptoms expressed by the majority of ADHD
individuals. Participants showed statistically significant improvement in teacher
rating scores, however sustained attention did not show significant
improvement. Although not conclusive, Cerbo® is
indicated for impaired concentration and Nerva 2® is
indicated for nervous hyperactivity.
4. Middelborough,
(2003) conducted a study to determine and compare the relative efficacy of
supplementation using Evening Primrose oil and Homoeopathically potentised GLA, in the management of ADD/ADHD. It was
concluded that Evening Primrose oil was effective as an intervention as it
managed to significantly improve the attention scores. Although the
homoeopathically prepared GLA did no show any statistically significant
improvement, it was clear that there was slight improvement in the attention
scores.
5. Lottering,
(2005) conducted a study to determine and compare the relative efficacy of a
nutritional supplement (Advanced Brain Food®
= Phospatidylcholine); Phospatidylserine;
Vitamin B3; Ginko Biloba;
Vitamin B12; Folic acid; Pantothenic acid and Pyroglutamate) and a homoeopathic complex (Quietude® = Chamomilla vulgaris (9C); Gelsemium sempervirens (9C); Hyoscymus niger (9C); Kali bromatum (9C) and Passiflora incarnata (3X) in the management of ADHD. It was found that
Advanced Brain Food® was effective as an intervention as it managed to significantly
improve the attention span of the subjects. Although Quietude (homoeopathic
complex) did not show any statistically significant improvement, it was clear
that there was a slight improvement in the sustained attention levels.
Homoeopaths have always based, and
continue to base the evidence for the effectiveness of Homoeopathy on clinical
results with many patients. These results are shared in the professional
Homoeopathic journals and at conferences. Double blind clinical studies have
shown the effectiveness of homoeopathic medicine as compared to placebo in
research on common medical conditions. A 1991 review of over 100 homoeopathic
studies published between 1966 and 1990 showed positive results in 76% of the
studied conditions (Reichenburg-Ullman and Ullman, 1996).
Research conducted by Masters
graduates from the University of Johannesburg and Durban University of
Technology have illustrated a clear efficacy of Homoeopathy
(HSA, 2004). The following
international trials conducted to test for effectiveness in the homoeopathic
treatment of ADD/ADHD:
1. Lamont (1997), conducted a study
on the homoeopathic treatment of attention deficit hyperactivity disorder. 43
children diagnosed with ADHD were alternately assigned either placebo or
homoeopathic treatment (similimum) in a double-blind,
partial crossover study to determine the effectiveness of homoeopathy for this
disorder. Statistical comparisons were made on the basis of parent or care
giver ratings of ADHD behaviour before and after treatment. Statistically
significant differences were found, supporting the hypothesis that homoeopathic
treatment is superior to placebo treatment for ADHD. In the same study it was
found that the following remedies were the most successful in treating ADHD: Stramonium, Cina and
Hyoscymus niger and
to a lesser degree, Veratrum album and Tarentula hispanica.
2. A
trial in Europe provided evidence of the effectiveness of homoeopathic
treatment of ADHD (particularly in areas of behavioural and cognitive
functions). A total of 83 children aged 6-16 years, with ADHD diagnosed using
the DSM-IV, were recruited for a randomized, double blind, placebo controlled
crossover trial. Prior to the study;
the
children were treated with individually prescribed Homoeopathic medications. 62
patients, who achieved an improvement of 50% in the Conners
Global Index (CGI), participated in the trial (13 patients did not fulfill eligibility criterion). At the beginning of the
trial and after each crossover period, parents reported the CGI and patients
underwent neuropsychological testing. At entry to the crossover trial,
cognitive performance, impulsivity and divided attention, had improved
significantly. The results of
the
trial provide scientific evidence for the effectiveness of homoeopathy in the
treatment of attention deficit hyperactivity disorder, particularly in areas of
behavioural and cognitive functions (European Journal of Paediatrics [online],
2005).
3. A pilot study was conducted to
evaluate the effectiveness of homoeopathy in the treatment of
attention-deficit/hyperactivity disorder (ADHD). This was a randomized,
double-blind, placebo-controlled trial in which 43 children received a
homoeopathic consultation and either an individualized homoeopathic remedy or
placebo.
Homoeopathic physicians saw patients
every 6 weeks for 18 weeks. There were no statistically significant differences
between homoeopathic remedy and placebo group however, there were statistically
and clinically significant improvements in both groups, suggesting that there
may be some therapeutic value to the homoeopathic approach
to ADHD (Jacobs et al, 2005).
Other Therapies: Psychotherapy:
Psychological therapy is mainly
required for the secondary problems that develop such as low self-esteem,
anxiety and depression. Psychotherapies are especially important
for those children who are unable to
tolerate, or whose parents prefer them not to take medication. The parents as
well as the child need counseling, advice and coping
skills. Cognitive and behaviour modification is recommended with the hallmark
of treatment being structure; e.g. routine (establish a predictable schedule of
activities), boundaries and rules and children need to be taught organizational
skills (use of a diary to record homework and other tasks to be completed).
Tasks need to be tackled one at a time and as each task is completed the child
needs to be given praise and encouragement (Hallowell and Rately,
1996 and Wallis et al, 1994). Support Groups such as the Attention
Deficit Hyperactivity Support Group of South Africa (ADHASA) provide an
important function for families, therapists, teachers and caregivers as well as
the person with ADD/ADHD.
Diet & Supplementation: Healthy
eating, improving essential fatty acid levels and stabilizing blood sugar levels
can make a huge difference in the overall performance of
an ADHD child (Picton,
2004). The diet should contain natural unrefined foods; avoid foods containing
artificial flavors, artificial coloring,
anti-oxidant preservatives, and mono-sodium glutamate; and eliminate foods
poorly tolerated by the patient. Eating regular, small wholesome meals will
stabilize blood glucose levels. Meals should consist mainly of carbohydrates,
which are released slowly into the blood stream (low glycemic
foods), combined with a small portion of protein. As a deficiency of EFA’s seems
to aggravate neurological and other
symptoms of ADD/ADHD, it is logical to increase levels of EFA’s
by supplementing the diet with Omega 6 (Evening Primrose Oil), and Omega 3
(Salmon Oil). In addition, supplementing with Magnesium, Vitamin B6 and Zinc
will assist with the metabolism of the fatty acids (Picton,
2005). By incorporating the above vitamins and minerals in the diet
concentration will improve, as they are essential for brain development and
function (Picton, 2004; Hall and Naude,
2003).
Anti-oxidants
(proanthrocynidins), which protect the body from
oxidation (destruction of the body’s tissues) have also been recommended as an
additional supplement for example Zinc, vitamin E, vitamin A, vitamin C and
Selenium (Holford, 1997; Hall and Naude,
2003). Meyer, (2001) revealed a significant improvement in the experimental
group, who used Melotone Syrup for sustained
attention and vigilance as assessed by the Children’s Checking Task (CCT). Melotone Syrup is a nutritional supplement specially
designed for children and adults who require an essential Fatty Acid supplement
in liquid form. This product contains: EFA’S (Evening primrose and Salmon
oils); vitamin D; vitamin C; B vitamins; Calcium; magnesium; Zinc; Methyl Sulphonyl Methane; Glycine; Taurine; Chromium and Vanadium.
Herbs:
The following herbs could be of some benefit:
Ginkgo Biloba. used
to improve concentration by increasing blood flow to the brain and it also has
anti-oxidant properties.
Chamomile. calmative,
relieving irritability and promoting sleep. Induces clear thinking and
increases attention span.
Valerian. calmative for
restless children. In high doses can cause drowsiness so is used for insomnia.
Passion Flower. calmative with
less sedative effects.
Lemon Balm (Melissa Officinalis.)
relaxing tonic for anxiety, mild depression, restlessness and irritability.
It is best to use herbs under the
supervision of someone suitably qualified as they can cause some side effects
(Hall and Naude, 2003; Weil, 2004).
Bach flower remedies. a series of 38
preparations made from wild flowers and plants.
Biofeedback
and Neurotherapy: Biofeedback is a learning process,
in which people are taught to improve their health and performance by observing
signals generated by
their
own bodies – a method of self-regulation training. Brain waves (as well as
muscle tension, heart rate, respiration, skin temperature and blood flow) are
measured and recorded by sensors attached to the brain and other parts of the
body. Neurotherapy = biofeedback for the brain, using
an EEG monitor and software connected to a
computer.
It has been suggested that children with ADD have brain wave patterns low in
beta waves, which are associated with alert concentration, and children with
ADHD
have excess beta and theta activity. The goal of neuro-
or biofeedback is to retrain the brain and change the brain wave patterns thus
improving concentration
and
focused attention (Weil, 2004).
Occupational
Therapy = recommended for individuals that suffer from “sensory defensiveness”.
Occupational therapists use “sensory modulation”/“sensory integration therapy“
to assist patients overcome an over-reaction or under-reaction to everyday
types of sensory input. Occupational therapists teach patients and parents
activities/ methods specifically designed to meet the needs of the child’s own
nervous system: calming activities/ alterting
activities, organising activities and other suggested coping methods (Allen and
Harrison, 2004).
Tomatis Method This is a unique form of sound therapy
developed by a French physician. This treatment is designed to stimulate the
brain and help a person with ADD
to
focus on sounds without being distracted. The goal of this therapy in ADD is to
correct poor sensory integration (Weil, 2004).
Cranial
Therapy This aims to adjust the body to allow the nervous system to function
smoothly (helpful for hyperactive children who have experienced birth or head
trauma) (Weil, 2004).
Applied
Kinesiology: a therapeutic modality that focuses on the art of energy balancing
by means of energy and muscle testing and is used to identify imbalances in the
body’s
structural, chemical, emotional or other energy fields. It is based on the
acupuncture meridian system and its connection to the muscles and organs (Weil,
2005;
Bothes, 2005).
Other
Exercise or sport to release/
channel pent up energy.
Meditation or anything to relax the
body and mind (Weil).
Art therapy – is the use of art
materials for self-expression and reflection.
CHAPTER
3 MATERIALS AND METHODS
STUDY POPULATION
Seventy-two homoeopathic
practitioners were registered with the Allied Health Professions Council of
South Africa (AHPCSA) in the Johannesburg Metropolitan Area
as at May 2005.
Inclusion Criteria
1. Practitioners had to be
registered as a Homoeopath with the Allied Health Professions Council of South
Africa (AHPCSA).
2. Registered homoeopaths had to be
practicing in the Johannesburg Metropolitan area: Diepsloot/Midrand;
Sandton/Randburg; Northcliff/Rosebank;
Roodepoort; Soweto; Alexandra/Modderfontein;
Johannesburg Central; Johannesburg South; Diepmeadow;
Orange Farm/Enerdale.
The researcher limited the areas to
the above because the entire Gauteng province is too vast an area to cover on a
limited budget. Even though the area was limited the area selected represented
an even demographic spread that covers the socio-economic factors as well as
ethnic groups (Appendix 4).
3. The homoeopaths had to be proficient
in the English language as the questionnaire and interview was conducted in
English.
Note: Although there are eleven
official languages in South Africa for practical purposes the researcher chose
to conduct the study using the English language.
Requirements of the participants
1. Completion of the questionnaire
within two weeks of receiving it.
2. A half an hour of practitioner’s
time for the collection and checking of the questionnaire.
3. Participants were encouraged to
reflect on personal issues and disclose personal principles and practices as a
homoeopath.
STUDY SAMPLE
These were the practitioners who
fitted the inclusion criteria and completed the questionnaire (n=41), initially
63 practitioners agreed to participate, so a final response rate of 65% was
obtained
METHODOLOGY
Data collection started in August
2005 when initial contact with practitioners was made and continued until
February 2006 when collection of the final questionnaires took place and raw
data was handed to the to statistician for analysis.
Focus Group
Before the actual study could
commence, a focus group was conducted at the Durban Institute of Technology on
24th August 2005 (Appendix 6). The aim of the focus group was to assess the
face validity of the questionnaire. Face validity is determined when a group of
experts in a particular field are required to judge the measuring tool, in this
case the questionnaire. They must express their opinion as to whether, on the
face of it, the measuring tool measures what it is supposed to measure. The
focus group consisted of five homoeopathic practitioners and three senior
homoeopathic students from the Durban Institute of Technology. The participants
were given the participant information letter and questionnaire and were required
to make comments and suggestions on the layout, questioning style, grammar and
content. The suggestions and comments were considered and the
amendments/changes were made.
Vorwort/Suchen Zeichen/Abkürzungen Impressum