Some were more prone to mischief than others. They had more difficulty sitting quietly in class and would be caught not paying attention more often. They also found themselves spending more time than usual in the principal’s office. Parents and teachers found that they required stronger disciplinary measures, but neither thought that they needed medication.

The first published report of hyperactivity in childhood appeared in 1902. The first use of a stimulant to treat the condition occurred in 1940. Sporadic reports continued to appear in medical journals throughout the 1950s and early 1960s, but no distinct diagnostic entity had emerged.

This began to change in the early 1970s. Based on research findings during the mid to late 1960s what had previously been viewed as a disciplinary problem started to be recognized as a medical one. Certain children were reported to have a condition referred to as MBD, Minimal Brain Dysfunction. Boys with the diagnosis outnumbered girls three to one.

It was not until 1981, however, that criteria were established for the condition that was then called Attention Deficit Disorder with Hyperactivity. In 1987 the name was changed to Attention Deficit Hyperactivity Disorder or ADHD.

While diagnostic labels can be helpful in quickly describing a collection of symptoms they have a way of they can also create challenges. Once the diagnosis appeared an ever-increasing number of children were found to have the disorder. Since it was a recognized medical disorder it demanded a medical treatment and a surprisingly large number of children began receiving amphetamines, other stimulants such as methylphenidate (Ritalin), anti-depressants, and other agents. Drug treatment of adolescent ADHD sufferers emerged and the diagnosis and drug treatment of ADHD in adults soon followed.

Just how common is ADHD? No one really knows. Since there is no laboratory test that can be used as in the case of blood sugar for diabetes the criteria rely on the presence of symptoms reported by parents and teachers. The incidence of ADHD seems to be anywhere from two to twenty percent depending upon the institution reporting.

I prefer to view ADHD as the extreme of a spectrum of behavior. In 1999 the Yale Child Study Center in New Haven, Connecticut, reported on their evaluation of 449 elementary school children. Eighty percent of the children were found to have some degree of hyperactivity, inattentiveness, and impulsivity. Upon further evaluation twenty percent of the children were felt to have ADHD, twenty-two percent were said to have “sub-threshold ADHD” and the remaining fifty-eight percent were classified as not having ADHD. According to the Yale Child Study Center 42 percent of the children had ADHD to a greater or lesser degree!

Something is very wrong when two out of five children are considered outside of the norm for childhood behavior. Something is very wrong indeed when up to forty percent of boys in some classrooms are said to be on Ritalin or some other psychiatric medication.

How might some sense be made of the current ADHD craze? Is ADHD a true medical disorder or is it just an acceptable term to explain away a failure to provide an appropriate social, nutritional, and emotional environment for children? I believe that it is both.

Reports dating back nearly a century suggest that a small percentage of the population, probably between one and two percent, are genetically predisposed to hyperactivity, inattentiveness and impulsivity on a level exceeding that of other individuals. This is believed to be due to low levels of certain substances such as dopamine that regulate centers in the brain.

Experts typically state that between two and six percent of individuals meet the established criteria for ADHD and should be offered medication as a part of the management of their condition. Assuming this is true, what of the forty-two percent of children in the Yale survey who were found to have significant behavior difficulty? Each person – child, adolescent or adult - should be given the chance to optimize his or her performance. Individuals throughout the entire spectrum of hyperactivity, inattentiveness, and impulsivity can benefit by addressing factors known to influence these traits. The following areas should be addressed by anyone whose life is being adversely affected by ADHD or ADHD like symptoms.

What is taken into the body is of utmost importance. Certain substances are helpful; others are harmful. This is particularly true when ADHD like symptoms are present. One of the first to explore the connection between diet and hyperactivity was Dr. Benjamin Feingold, a specialist in child and adult allergy. Physicians at the Mayo clinic led by Dr. Stephen D. Lockey, Sr. had begun recommending that people suffering from hives avoid salicylate (found in aspirin and some foods) and tartrazine (Yellow Dye No. 5) in 1948. Dr. Feingold found that many asthmatics improved on the diet as well. Over time he observed that a significant number of children and adults with hyperactivity improved dramatically when avoiding the offending substances.

Dr. Feingold presented his findings to the American Medical Association in 1973, but received an unenthusiastic response. Ritalin was proving to be a “magic bullet” and most physicians considered dietary counseling too cumbersome to be effective. Since that time a number of “controlled studies” have appeared in the medical literature purporting to demonstrate that diet has no effect on hyperactivity. Unfortunately, these studies have usually been conducted on children without a history of behavioral problems, have involved giving children who have been controlled on the Feingold diet foods that would normally cause problems, or have used very small amounts of a single dye or additive.

Phenol Sulfotransferase (PST) is an enzyme that is needed to process chemical messengers in the brain. The same enzyme is needed to process petroleum based food additives and salicylates. When these are present in the body less PST is available to produce brain chemicals. Children with autism and ADHD have been shown to have low PST levels, and would be more vulnerable to chemical depletion of their PST than would other children. If this mechanism is correct, studies such as those describe would not be expected to show any positive results. A wealth of information is available through the Feingold Association (http://www.feingold.org).

Food allergies can also play a role. This concept is rejected by many physicians who are unaware that two distinct types of allergies to food exist. Obvious food reactions that cause immediate symptoms such as hives are caused by a type of antibody called IgE. Food allergies that cause behavioral difficulties are due to a different antibody called IgG. Tests that look only for IgE reactions will be unhelpful in identifying foods that are aggravating ADHD symptoms.

I am convinced that refined sugars also play a role in worsening the condition. While studies exist that claim to prove otherwise, I have never met a teacher that does not dread facing his or her class after Halloween or Valentine’s Day. ADHD sufferers should be encouraged to drink purified water as their beverage of choice. Soft drinks contain chemicals and sugar or artificial sweeteners, and juices are also high in sugar content.

What is placed on the body may be as important as what is taken into the body. Many substances are efficiently absorbed through the skin. Soaps, shampoos, conditioners, deodorants and other personal items as well as home cleaning supplies should be free of dyes and toxic chemicals.

An aspect of ADHD management that is often overlooked is the effect of electromagnetic fields. It has been demonstrated that children that sit within 4 or 5 feet of a television set will experience and increase in ADHD like symptoms. It is logical that other electronic appliances such as computers, clock radios, arcade video games or electric blankets could have a similar effect. I recommend that people sit at least 4 feet away from the television screen and keep clock radios at least 4 feet from the head of the bed.

Nutritional supplements can be very helpful in lessening ADHD symptoms. Essential fatty acids are needed for the production of brain messengers. Subjects with ADHD have been shown to have lower levels of free fatty acids that the rest of the population. Flax oil is an excellent source. One tablespoon for each 100 pounds or one teaspoon for every 30 pounds of body weight is optimum.

Minerals are important. Deficiencies of magnesium, copper, zinc, calcium, and iron are commonly present in children with ADHD. Of these, low levels of magnesium and zinc appear to be the most significant. A multivitamin/mineral preparation containing these minerals or a trace mineral supplement should be given.

Of the vitamin nutrients B vitamins are the most critical in addressing ADHD challenges. B vitamin deficiencies are common in the condition and may be aggravated by an overgrowth of yeast or other organisms in the intestinal tract. B vitamin supplements are essential, and the addition of beneficial bacteria like acidophilus (lactobacillus) can be helpful.

Some investigators have found bioflavanoids, particularly pine bark or grape seed extracts to be beneficial. A loading amount of approximately 2 mg. per pound of body weight is taken for two weeks, followed by a maintenance level of 1 mg. per pound of body weight per day. Finally, phosphatidylserine, either as a specific supplement or in the form of lecithin, can be added to bring about additional improvement.