Addressing Add Naturally: Improving Attention, Focus, and Self-Discipline with Healthy Habits in a Healthy Habitat

By Kathi J. Kemper

This is a practical, easy-to-use resource for parents who want to help their children
improve attention, focus, self-discipline, and patience. Written by the worlds
leading authority on complementary medicine for children, it provides a solid
scientific basis for using natural therapies to help your child succeed. The charts and
worksheets offer you tools to realize your childs strengths, turning stumbling blocks into
stepping stones to success.
The first chapters introduce basic concepts about ADHD and ADD, identifying
common family goals for improving their childs attention and self-discipline. It frames
these goals as skills to be mastered, building on the childs existing strengths. The next
chapters focus on the five fundamental strategies to achieve success (healthy habits in a
healthy habitat). These strategies include exercise, sleep, nutrition, managing behavior,
emotions, and stress, positive communication, and optimal environment. The next
chapters provide practical tools for translating these fundamentals into habits and tracking
success. Later chapters cover additional strategies such as pills (medications, vitamins,
and herbs), working with schools, counseling, biofeedback, massage, and acupuncture.
The last chapter is a handy summary. The book includes links to helpful resources and
provides over 200 references to recent scientific studies to support its recommendations.

• Language: English
• Publisher: Xlibris US
• Release date: Sep 8, 2010
• ISBN: 9781453560549

Kathi J. Kemper

Kathi J. Kemper is a pediatrician who founded the American Academy of Pediatrics’ Section on Integrative Medicine and authored its definitive book on integrative approaches to promote optimal mental health, Mental Health Naturally. She is known internationally as the founder of the field of integrative pediatrics, and is sought out by major media such as ABC News, the New York Times, the Chicago Tribute, the Wall Street Journal, and the Washington Post. Kemper is the editor-in-chief of the international journal, Complementary Therapies in Medicine, and is engaged in research to promote optimal health and well-being in health professionals as well as the children and families they serve.  

Book preview

Copyright © 2010 by Kathi J. Kemper, MD, MPH.

Library of Congress Control Number: 2010912181

ISBN: Hardcover 978-1-4535-6053-2

ISBN: Softcover   978-1-4535-6052-5

ISBN: Ebook       978-1-4535-6054-9

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This book was printed in the United States of America.

To order additional copies of this book, contact:

Xlibris Corporation

1-888-795-4274

www.Xlibris.com

[e-mail]

83548

CONTENTS

Foreword

Introduction

Chapter 1

What is ADD?

Chapter 2

Goals

Chapter 3

Five Fundamentals for Success:

Healthy Habits in a Healthy Habitat

Chapter 4

First Fundamental: Food

Chapter 5

Second Fundamental:

Fitness and Sleep

Chapter 6

Third Fundamental: Friendship with Others—Communication Skills, Being a Good Role Model, and Behavioral Strategies

Chapter 7

Fourth Fundamental: Friendship with Self-Building Attention and Self-Discipline while Managing Stress and Frustration

Chapter 8

Fifth Fundamental:

Fields—A Healthy Habitat

Chapter 9

Making a SMART Plan

Chapter 10

Tracking Success

Chapter 11

Beyond the Fundamentals—

Safety First

Chapter 12

Pills and Plants

Chapter 13

A Village:

Counseling, Biofeedback, School, and Support groups

Chapter 14

Other Professional Therapists: Massage, Acupuncture,

and Chiropractic

Chapter 15

Bottom Line

Resources

Acknowledgments

References

DEDICATION

To the children, families, and colleagues who have taught me so much and helped me live a more focused, intentional, and fulfilling life. And to Daniel, who makes it all worthwhile.

FOREWORD

WHEN THE MIND spins in twenty directions at once, it is impossible to think clearly, study effectively, work productively, or engage in balanced relationships. Being unable to focus makes even everyday tasks seem unattainable, and trying to do anything that requires concentration often brings intense frustration, anxiety, and demoralization. This is especially true for young children because they cannot describe what they are experiencing and don’t know how to ask for help.

The syndrome that goes under the current label of attention deficit hyperactivity disorder (ADHD) crosses all geographic, age, and cultural boundaries. The rate at which ADHD is diagnosed and treated has increased dramatically since the syndrome was first recognized as a specific disorder in the Diagnostic and Statistical Manual (DSM) in the late 1970s. In the US, as many as 10% of males and 4% of females have been diagnosed with ADHD.1 Many children diagnosed with ADHD also have oppositional defiant disorder and learning disorders; they have an increased risk of developing depression, anxiety disorders, and substance-abuse problems as adults.2 Almost half of children diagnosed with ADHD never graduate from high school, and fewer than 5% complete a four-year university degree program. These statistics underscore the need for more effective, safer treatments of ADHD.

ADHD is caused by diverse genetic, social, medical, and environmental factors. Studies on twins show that ADHD is highly heritable.3 The risk of developing it is probably influenced by genes that affect brain levels of dopamine and serotonin.4 A greater risk of developing ADHD is also associated with fetal exposure to alcohol, tobacco smoke, and lead in addition to a history of premature birth, birth trauma, and serious childhood illnesses. 5-6 As many as one in five cases of ADHD may result from brain injury around the time of birth.6 Some cases of ADHD may be associated with delayed development of the frontal and temporal lobes of the brain and more rapid maturation of motor areas than in non-ADHD children.7 Certain food preservatives are known to worsen symptoms of ADHD, and exposure to certain pesticides is also associated with an increased risk.5

Professor Kemper’s book is a timely response to urgent, unaddressed concerns over the limited efficacy and unresolved safety problems of conventional pharmacological treatments of ADHD. Stimulant medications including methylphenidate (Ritalin) and mixed amphetamine salts (Adderall) are common pharmacologic treatments of ADHD. However, one in three children and adolescents who take stimulants experience significant adverse effects, including abdominal pain, decreased appetite, and insomnia, and 10% have more serious adverse effects including stimulant-induced psychosis.8 The nonstimulant medication atomoxetine (Strattera) may not be as effective as stimulants.10 There are also concerns about its adverse effects, including hypertension, increased heart rate, nausea and vomiting, liver toxicity, and possibly increased suicide risk.11-12

Professor Kemper’s book addresses each of these concerns head-on with practical, well-referenced solutions. Her summary of the scientific evidence for natural therapies is a long-needed and refreshing reply to legitimate concerns about the inappropriate use and overprescribing of stimulant medications in the context of unanswered questions about their efficacy and safety.

Many people diagnosed with ADHD already use natural therapies. Over half of the parents of children diagnosed with ADHD treat their children’s symptoms using one or more natural therapies, including vitamins and dietary changes, but most do not disclose this to their child’s pediatrician.13 Avoiding medical jargon, Dr. Kemper reviews the evidence for natural therapies that are reasonable to use alone or in combination with stimulants or other conventional pharmacologic treatments. Throughout the book, Dr. Kemper emphasizes that the strategy should be tailored to the unique symptoms, circumstances, and needs of each child. The ideal treatment depends on the particular symptoms that are causing distress or impairment in social or academic functioning, your child’s response to previous treatments (if any), the risk of adverse effects, the presence of coexisting medical or mental health problems, and cultural preferences and financial constraints that limit realistic treatment choices.

Starting with commonsense holistic approaches that benefit the body and mind, Dr. Kemper reminds us of the therapeutic value of regular exercise, adequate sleep, and rational food choices. As Dr. Kemper clearly explains, specialized dietary modifications, including reduced intake of refined sugar and elimination of food colorings and additives, are reasonable first-line strategies in children whose predominant symptoms are hyperactivity and impulsivity. Emerging research suggests that purified omega-3 essential fatty acids can help improve symptoms of both hyperactivity and inattention. Although omega-3s are now widely used for ADHD, more research is needed to determine the most effective kind and amount of omega-3 to use. The critical role of good communication in shaping a cooperative relationship between parent and child is the foundation on which effective practical strategies for achieving behavior changes can take place.

Practical reviews of other natural treatments of ADHD included in the book include a preparation made from the bark of the French maritime pine tree, zinc supplementation, and the amino acid acetyl-L-carnitine.

There is a growing research literature on EEG biofeedback training in ADHD, showing it can result in sustained clinical improvement in both hyperactivity and inattention. Furthermore, when EEG biofeedback training is pursued on a regular basis, the doses of stimulants can sometimes be reduced, resulting in fewer adverse effects, improved treatment adherence, and improved overall functioning. Toward the end of her book, Dr. Kemper summarizes emerging evidence for massage, acupuncture, and chiropractic in the treatment of ADHD.

In writing a practical guide for parents of children and adolescents diagnosed with ADHD, Dr. Kemper has successfully translated cutting-edge ideas and research about emerging treatments from obscure medical references into a book that is both accessible and scholarly. This book will have a lasting impact not only on how ADHD is treated but also how parents, teachers, clinicians, and researchers think about ADHD.

Dr. James Lake

Author of the Textbook of Integrative Mental Health Care

INTRODUCTION

CHANCES ARE THAT you or someone you love wants to be more focused, deliberate, thoughtful, and attentive while having fun and enjoying life. The loved one could be your child, teenager, spouse, student, neighbor, or even your boss. Maybe it’s your family doctor or your favorite salesman, athlete, actor, musician, or comedian. Perhaps your child’s teacher has suggested getting an evaluation. Perhaps there’s been an official diagnosis of ADD (attention deficit disorder) or ADHD (attention deficit/hyperactivity disorder). Or perhaps you’re wondering if natural therapies might be safer and work as well as medications. This is the book for you!

Abbreviations

If you were born after 1970, you probably use the term ADHD (attention deficit hyperactivity disorder) or maybe even AD/HD (attention deficit/hyperactivity disorder). The term ADD (attention deficit disorder) was officially retired in 1987 when the DSM[1]-III-R was published. Before it was known as ADD, these symptoms had other names: hyperkinetic disorder of childhood or minimal brain dysfunction (MBD). Some people say it’s illogical to call a syndrome ADHD or AD/HD when hyperactivity is not essential to the diagnosis. I prefer the esthetics of ADDressing ADD! I hope my colleagues who correctly refer to it as ADHD or AD/HD will forgive my preference. Who knows? The next version of the DSM may be back to plain old ADD.

ADD and ADHD are Common

Regardless of what you call it, ADD and ADHD are two of the most commonly diagnosed and costly mental health diagnoses in the US. In addition, many people without a formal diagnosis want to have better focus; make deliberate, well-thought-out decisions; and discover more order in their lives. Millions of children, adolescents, and adults struggle with impulsivity, distractibility, hyperactivity, and their consequences. A growing number of college students and adults turn to medications for an extra mental edge. Parents eager to see their children succeed spend billions of dollars on prescription drugs to improve focus and reduce impulsivity.

Keys to Success

Since you have picked up this book and are reading the Introduction, you have already demonstrated the three keys to helping yourself and your loved one address ADD successfully:

1.   You care, and you want to help. You are compassionate.

2.   You are hopeful that things can be better and humble enough to seek and use help from reliable resources.

3.   You focus on fundamentals (otherwise you would have skipped the Introduction).

Your compassion, hope, humility, curiosity, and commitment are the keys to success. You’re already halfway there. You can succeed.

How This Book Can Help

This book will help you focus on strengths and innate abilities to accomplish your goals (chapters 1 and 2). It will help you understand and use five fundamental strategies for success (chapters 3-8). It will help you make a plan that works (chapters 9-10), and it will help you choose how and when to use additional help (chapters 11-14). If you’re in a hurry, feel free to skip to the bottom line in chapter 15. If you want to dive into more depth and get creative, check out the optional activities at the end of each chapter.

Remember, you don’t have to be sick to feel better, and you don’t need an official diagnosis to enhance attention, patience, and self-discipline; modulate activity levels; and achieve the true freedom of being able to think, speak, and act deliberately. Let’s get started by focusing on your goals for your child and existing strengths to help achieve those goals.

CHAPTER 1

What is ADD?

History, Diagnoses, Labels, and Frames

Jack be nimble.

Jack be quick.

Jack jump over the candlestick.

WHAT WAS JACK thinking? He could have burned himself, knocked over the candle, started a fire, or simply singed his clothes. Did Jack (or the person encouraging him to jump) have ADD? For that matter, did Peter Rabbit, who—after being warned not to—ran straight into Mr. Macgregor’s garden as soon as his mother was out of sight?

History

Impulsivity and distractibility are nothing new in literature or in life. A nineteenth-century pediatrician wrote about a character named Straw Peter who was fidgety, had trouble paying attention, was impulsive and aggressive, and had trouble learning. Sound familiar? If Tom Sawyer and Huck Finn were alive today, would they be diagnosed with ADD?

Historically, impulsivity and distractibility were considered bad character traits that deserved harsh punishments. To counter our human tendencies to be impulsive, careless, distracted, or disorganized, religions have promoted practices to encourage self-discipline, restraint, and spiritual devotion. Those whose problems persisted were sometimes stigmatized as being influenced by immoral or evil forces (devils) and subjected to ostracism, shunning, penances, or worse.

Impulsive, distractible, disorganized, injury-prone children who are constantly criticized, reprimanded, and harshly punished for their behavior can develop low self-esteem leading to worse behavior problems. The sense of not fitting in, not meeting expectations, and failing to please peers, parents, and teachers can contribute to sadness, worry, irritability, and moodiness, leading to outbursts and oppositional and antisocial behaviors.

Negative Labels Have Negative Effects

A downward spiral of inattention, impulsivity, and negative behaviors is partly due to the discouraging effects of the stigma of negative labels. Labeling someone with ADD or ADHD as lazy or stupid is just plain wrong; the vast majority of people with ADD and ADHD are trying as hard as they can. The problem is not lack of intelligence; it’s the need to master specific skills.

Labeling someone with ADD or ADHD as bad or evil is also wrong. Just like everyone else, the vast majority of people with ADD and ADHD want to do well, want to please their parents and teachers, and want to contribute their best to help others. The problem is not lack of willpower; it’s the need to build on their strengths to succeed.

Modern Medical Views of ADHD and ADD

Modern medicine views most problems as combination of genetic and environmental factors correctable through medication. Biologists see a perfect storm of nature and nurture to be treated with biochemical remedies. Often, earlier unscientific stigmas persist, handicapping those with ADD in their pursuit of happy, productive lives.

Whether viewed from the perspective of history or biology, one thing is certain: people with ADD and ADHD do not consciously or deliberately choose to be difficult.

Good News

The good news is that despite the challenges, a number of natural strategies grounded in a commonsense focus on the fundamentals can foster the kind of focus and forethought your child needs to succeed.

As the youngest of three children, Michael’s family loved him. His mother was an award-winning teacher. But by the time he was nine years old, he was a pest, he was disruptive, and he had trouble in school. Michael was diagnosed with ADHD and put on Ritalin. His mom also met regularly with teachers, worked with him closely herself, and found tutors to help him. Once

he found an activity he loved (swimming), a worthwhile goal (winning), and coaches who supported him, Michael developed focus, drive, discipline, persistence, and tenacity in the pool. By the time he was 15, Michael Phelps was off medications, and he became an Olympic swimmer, breaking numerous swimming records and winning more gold medals than any swimmer in history. There’s more to Michael’s story. Keep reading.

How do you know if you or someone you love has ADD or ADHD?

Diagnosing ADD

There are no lab tests or x-rays that confirm or refute the diagnosis of ADD. The diagnosis is based on whether (a) certain behaviors are more common than in most people and (b) whether those behaviors cause significant problems in different parts of their lives.

Technically, attention deficit/hyperactivity disorder is defined as an early (appearing by age seven years), persistent (at least six months), and pervasive (present in at least two settings) pattern (at least six symptoms) of shorter-than-normal attention span (distractibility) and more-than-normal impulsivity and/or hyperactivity that disrupts age-appropriate functioning in two or more arenas: academic, social, athletic, artistic, or occupational. Whew! That is a mouthful. Let’s just say that the problems of short attention span and impulsivity are more than just a passing phase characteristic of the average toddler or puppy.

Behavioral Checklists

Clinicians use standardized behavioral checklists such as the Vanderbilt or Connor questionnaires to assess