ADHD: Sleep and diet

I am asked weekly by caring, confused, exhausted, anxious parents, "Does my child have ADHD?" I often wish I could answer this question with a definitive yes or no and design a therapeutic plan for the child's wellness but the answer is not that simple.

Of the thousands of students under my care in my tenure as an elementary principal, school counselor or psychotherapist in private practice, I have seen approximately 20 children who truly have all the criteria required to diagnose ADHD. Sadly, of the thousands of students in my care over the past 15 years, hundreds have been falsely diagnosed with the disorder.

In the last two decades, the number of students diagnosed with ADHD increased from 6.9 percent in 1997 to 11 percent in 2011 according to the Centers for Disease Control. Why this alarming increase in ADHD? Are children changing? Are diagnosticians over-diagnosing active children with the disorder or is possibly our environment changing at an alarming rate affecting a child's mental wellness?

There has to be a better option than to diagnose a hyperactive, impulsive, inattentive 7-year-old with the psychological disorder of ADHD then medicate the child with stimulant medication in hopes to control the child's behavior. Therapists, educators, doctors and parents need to examine the whole child prior to medicating the kid for a misdiagnosed disorder.

According to the National Institute of Mental Health, current available treatments aim at reducing the symptoms of ADHD and improving functioning. Treatments include medication, various types of psychotherapy, education and training, or a combination of treatments. I suggest requesting a nutritional evaluation and sleep study prior to diagnosing a child with ADHD. Most children that I work with who are misdiagnosed with ADHD do not sleep enough nightly and/or have a poor diet.

The National Sleep Foundation suggests children age 6 to 13 need 9-11 hours of sleep a night. Few children receive this needed sleep. There is an increasing demand on a child's time from school, sports and other extracurricular and social activities. In addition, school-age children become more interested in TV, computers, the media and Internet as well as caffeine products - all of which can lead to difficulty falling asleep, nightmares and disruptions to their sleep.

In particular, watching TV close to bedtime has been associated with bedtime resistance, difficulty falling asleep, anxiety around sleep and sleeping fewer hours. Sleep problems and disorders are prevalent at this age. Poor or inadequate sleep can lead to mood swings, behavioral problems such as ADHD and cognitive problems that affect their ability to learn in school.

Joel Fuhrman, M.D., is a board-certified family physician, New York Times best-selling author and nutritional researcher who specializes in preventing and reversing disease through nutritional and natural methods. Dr. Fuhrman believes there is a strong correlation between diet and ADHD traits. Poor nutrition is a significant concern for attentional problems and ADHD - here are some of the dietary factors that have been linked to ADHD risk in scientific studies:

* High sugar intake is associated with hyperactive behavior and ADHD.

* Inadequate micronutrient intake. Supplementation to correct micronutrient deficiencies has been shown to improve ADHD symptoms.

* A low-nutrient diet high in processed foods and soft drinks at age 4 1/2 has been associated with hyperactivity in children at age 7. Similarly, a "western" dietary pattern has also been associated with ADHD in 14-year-olds.

* Food additives and dyes: many colored foods are marketed to children, and hyperactivity in children following ingestion of food dyes is well documented in placebo-controlled studies. Furthermore, a 2004 meta-analysis of 16 studies in children who were already hyperactive showed that their hyperactive behavior increased after ingesting food colorings.

* There is preliminary evidence that certain pesticides (called organophosphates) commonly found on some fruits are associated with ADHD.

* Omega-3 fatty acids (especially DHA) are the building blocks a child needs to build a healthy brain. Insufficient omega-3 levels are common in children with ADHD, and there is evidence that omega-3 supplementation, especially in combination with the omega-6 fatty acid gamma-linoleic acid (GLA; found in borage oil and evening primrose oil) improves behavior and ADHD symptoms.

Prior to starting psychotherapeutic and psychopharmacological treatment for a child exhibiting ADHD traits, I strongly suggest treating the child holistically rather than medically. As a parent, these are effective strategies that will help prevent your children from developing ADHD or diminishing ADHD traits:

* Limit television time and do not expose children younger than 2 to any television. The American Academy of Pediatrics recommends that children younger than 2 should not watch television.

* Feed the whole family a health-promoting, high-nutrient diet of colorful fruits and vegetables, beans, nuts and seeds.

* Encourage sports and other forms of exercise. Physical activity has beneficial effects on brain function, and several studies have reported that exercise improves attention, behavior and/or impulse control in children with ADHD.

* Avoid processed foods, artificially colored foods, and added sugars. The simplest and most effective way to avoid the potential harmful effects of synthetic dyes is to avoid processed foods. When buying the occasional packaged food, check the ingredient list to avoid synthetic dyes and additives.

* To assure adequate omega-3 fatty acids for brain development, give children a DHA supplement and feed them omega-3-rich foods (ground flaxseed, hemp and chia seeds, and walnuts) regularly.

* Buy organic produce when possible to limit pesticide exposure, especially when buying highly pesticide-laden crops.

* Ensure your child sleeps 9-11 hours a night, every night. Remove distraction such as a television, cellphone and computer from your child's room and create a habit of being in bed at the same time every night.

* Limit video game play to less than one hour a day. Video games, particularly violent games have a sizable negative effect to a child's affect, emotional regulation and ability for a child to empathize.

* Be predictable in your parenting. Emotionally charged, unpredictable, abusive or neglectful parenting creates lifelong emotional scars that exhibit themselves much as the behaviors of a child with ADHD.

I offer the above for parents to examine when questioning a child's attention, hyperactivity, impulsivity and inattentiveness. Might a child have ADHD and medication be the best option for treatment? Absolutely. Might a child have an inconsistent sleep schedule and show the same behaviors as a child with ADHD? Absolutely. For my child, I would rule out environmental factors within my control before I medicated my child.

Send comments or other suggestions to William Rutherford at bprutherford@hotmail.com or visit pensiveparenting.com.