Professor Barry Carpenter, who has headed up a British govern-ment review into special-needs provisions in schools, says there has been a 29-per-cent increase in pupils with learning difficulties between 2004 and 2009. He pre-dicts that every UK classroom will soon have two pupils with ADHD, and schools are hopelessly ill-prepared for the new teaching challenges ahead.
He blames the rise on the increasing numbers of children who survive a premature birth (see The Times, March 25, 2011). These children will struggle with maths and reading, and have behavioural problems, because their brains are continuing to develop after their birth. On average, four children in any standard primary-school class will have been born prematurely, and half of these will develop ADHD, he says.
However, in previous presentations, he has blamed the 'ADHD avalanche' on:
u young women binge-drinking while pregnant, thereby causing fetal alcohol spectrum disorders (FASD) in their children (www. bma.org.uk/health_promotion_ethics/
u the explosion of births of twins and triplets through in-vitro fertilization (IVF); and
u the economic decline and rise in unemployment levels (Daily Telegraph, January 10, 2009).
In his most controversial statement, Professor Carpenter told the Royal College of Nursing: "Drunken young women are poisoning their babies-it is child abuse by umbilical cord."
However, new research suggests that it isn't quite as simple as that. Researchers from Northwestern University Feinberg School of Medicine have discovered that not all pregnant women who drink cause behavioural problems in their children. Only those who have a gene variation that controls the levels of thyroid hormone in the brain of the developing child will have a child with FASD. Eventually, it will be possible to identify those women with the gene variation and correct the problem with nutritional supplements, say the researchers (FASEB J, 2011; doi: 10.1096/fj10-179234).
Food for thought
A new study from the Netherlands suggests that the rise in ADHD cases is not due to any of the factors cited by Professor Carpenter, but by food sensitivities. Dr Lidy Pelsser, of the ADHD Research Centre in the Nether-lands, estimates that around 64 per cent of cases are the result of hypersensitivity to foods.
She tested the theory on 100 ADHD children, aged between four and eight years, who were randomly assigned to five weeks of either a restricted elimination diet or a general healthy diet. By the end of the trial, 63 per cent of the children on the restricted diet reported a dramatic decrease in,
or a complete reversal of, ADHD symptoms, while none on the general diet reported any improvement (Lancet, 2011; 377: 494-503).
After publication, Dr Pelsser told journalists: "ADHD is just a couple of symptoms-it's not a disease." She also said that teachers who had worked with her on the research project were "flabbergasted" by the results her dietary approach had achieved. "It was so strange that a diet would change the behaviour of a child so thoroughly as they saw it. It was a miracle, a teacher said. After the diet, they were just normal children with normal behaviour."
Junk food and additives have been suspected for many years of causing hyperactivity. Dr Benjamin Feingold was one of the first to suggest a link in 1973, although his discoveries were challenged by the food industry. His beliefs were independently proven only in 1985, when researchers at the Great Ormond Street Hospital in London put 76 hyperactive children on an additive-free diet, and saw their behaviour signifi-cantly improve within a matter of weeks (Lancet, 1985; i: 540-5).
The UK's Food Standards Agency confirmed these findings in 2003, when they gave a group of children without ADHD a cocktail of additives, while another group was given a healthy drink. The behaviour of the children given the cocktail deteriorated rapidly (Food Standards Agency Library [Project T07004], 4 November 2002).
Even foods without additives can cause ADHD-like behaviour. Children may be allergic to foods such as wheat, dairy, chocolate and oranges, which can affect their concentration and ability to learn, several studies have demonstrated.
Environmental pollutants such as lead, mercury and PCBs (polychlorinated biphenyls) are toxic to children, and can affect developing brains (Environ Health Perspect, 2001; 109 [Suppl 6]: 813-6).
Kids on drugs
Dr Pelsser is calling on doctors to try a nutritional approach to the problem before resorting to ADHD amphetamine drugs such as Ritalin, Strattera and Dexedrine. However, judging by the enormous growth in the market, her pleas are likely to be ignored. In 1993, only 3500 prescriptions were written for an ADHD drug in the UK; by 2009, this had jumped to 610,000, and the figures continue to rise. Some are being prescribed to children under the age of five, which goes against 'best-practice' guidelines.
The drugs also have only short-term benefits. They are most effective in the first three months, and any effects last for only 14 months at the outside, at which time they should be stopped, say researchers from the MTA Cooperative Group's Multimodal Treatment Study of Children with ADHD. They tracked 485 children for eight years, and those who were still taking an amphetamine at the end of the study period were showing the same levels of inattention and hyperactivity as those who had never taken a drug (J Am Acad Child Adolesc Psychiatry, 2009; 48: 240-8).
Some doctors say that the increase in ADHD drug prescriptions is the result of pressure from exasperated parents who are looking for a quick solution to their child's bad behaviour. One five-year-old boy was on a double dose of Ritalin "to help mum at home", his head teacher said (The Sunday Times, March 27, 2011).
Even Professor Carpenter says the answer to the heralded ADHD avalanche is not more and more drugs. "Can we do no better than the pharmaceutical cosh?" he asks.
But as long as parents see no other way out, they will continue to resort to drugs as a solution.
WDDTY VOL. 22 NO. 2