Ritalin not Required?

September 6, 2007 6:40 AM

ADHD: Additives or Tonsillitis?
posted by ewkpates (42 comments total)

For me it's the internet.

I can't sit here all day explaining. I have to visit metatalk and askmefi and click 'refresh' repeatedly to see if anything new has popped up.
posted by jiiota at 6:45 AM on September 6, 2007 [1 favorite]

Heredity and brain chemistry.

Hyperactivity itself is not necessarily ADHD.
posted by louche mustachio at 6:51 AM on September 6, 2007

When I was 7, I was on the Feingold diet and had my tonsils and adenoids yanked.

Still ADHD.
posted by dw at 7:00 AM on September 6, 2007

I think that too often these days we are quick to...hang on, there's some kids on my lawn. BRB
posted by DU at 7:00 AM on September 6, 2007

Caffeine.
posted by empath at 7:04 AM on September 6, 2007

The Lancet is The Weekly World News of medical journals, fwiw.
posted by docpops at 7:05 AM on September 6, 2007 [1 favorite]

Yeah, still ADHD here. No tonsil yanking though.

I hate this stuff. The problem isn't that ADHD doesn't exist, or that ADHD is just normal child behavior.

The problem is people think that ADHD simply means people who run around a lot and can't focus on things. And while that's a good descriptor of some ADHD symptoms, it is not the source of a proper diagnosis of ADHD.

People with cancer generally lose weight. Does that mean everyone with weight loss has cancer? Does that mean you can cure cancer by eating more food?

ADHD is a mental disorder that involves a fundamental diffference in the way that the individual processes their own thoughts and interacts with the rest of the world. Hyperactivity and Inattention are behavioral manifestations of this underlying brain pattern.
posted by Deathalicious at 7:15 AM on September 6, 2007 [10 favorites]

Wanna ride bikes?
posted by louche mustachio at 7:16 AM on September 6, 2007 [3 favorites]

How does lack of sleep lead to anything resembling hyperactivity?
posted by edd at 7:16 AM on September 6, 2007

I love how people try to dismiss studies like this with their personal anectdotal evidence. It's like saying "I stood under a big tree during a thunderstorm and didn't get hit by lightning, therefore any suggestion that it's dangerous is bullshit"
posted by rocket88 at 7:19 AM on September 6, 2007

The tonsillitis story had a misleading headline. The kid described in the story itself had disturbed sleep, not ADHD, and once he was breathing properly again, his behaviour improved. ADHD != sleep apnea, but the mouth-breathing reporter who put this story together still gets them confused.

"It clearly shows that about half of those who were diagnosed with ADHD improved significantly after having a simple tonsillectomy and adenoidectomy," said Pransky. ... Taking out the tonsils and adenoids is not the cure for ADHD in every case, according to physicians. It is one of the things that need to be considered when there are breathing problems at night and daytime behavior problems.

The study cited in The Lancet noted that "None of the children had extreme hyperactivity or attention-deficit disorders". And a McMaster prof who reviewed the study said, "This isn't taking very placid children and turning them into kids who are running all over the place. The effects, in general, are very small."

So this study didn't involve ADHD kids, says nothing about the etiology of ADHD, and shows a statistically significant but small effect for a bunch of non-ADHD kids. Yeah, further study is needed. I've got a loonie: anyone else want to chip in?
posted by maudlin at 7:19 AM on September 6, 2007

Wait a second here ...

rocket88's profile
Info
Occupation: Seller of sodium benzoate and artificial food colouring

Hmmm.
posted by barnacles at 7:21 AM on September 6, 2007

Not hyperactivity so much as inattention and punchy restlessness. I know when I'm exhausted I tend to babble, free associate, fidget, and daydream.
posted by louche mustachio at 7:21 AM on September 6, 2007

Crap crap crap
posted by thirteenkiller at 7:25 AM on September 6, 2007

Linked earlier today from Slashdot was this article which puts some of the blame for attention problems in adolescents on that old bugbear, the TV. And while one could argue that young people who are the biggest watchers of TV are probably also the most likely to be consuming products with the additives mentioned in the FPP, the slew of articles and stories on these subjects indicate to me that trying to pin the responsibility for ADHD and ADHD-like symptoms on any one thing is probably a futile exercise.

However, if we're going to point fingers, I blame the internet. At least, that's where my attention seems to stray when I need it to focus ...
posted by barnacles at 7:26 AM on September 6, 2007

I have no position on this. In fact, I am unemployed. But what needs noting is that when kids take bad stuff--no matter what--their much smaller bodies and vital organs can not process things the way adults can. Give a 7 year-old a stiff drink of burbon and watch him. Now give it to me. More, please.
posted by Postroad at 7:27 AM on September 6, 2007 [1 favorite]

I understand having to
posted by eriko at 7:29 AM on September 6, 2007

keep hitting refresh.
posted by eriko at 7:29 AM on September 6, 2007 [1 favorite]

The former is about sleep apnea. I'm surprised at how quickly these adhd diagnoses are made. There's something to be said about a certain laziness is declaring a problem to be psychological when it is fact physical. There's no shortage of anecdotes about how someone was diagnosed with a serious mental illness when the problem turned out to be an allergy, or apnea, or thyroid, etc. I havent seen any studies about this, but its a little harrowing to think of all the people knocking back paxil and doing therapy when they just need a decent doctor.
posted by damn dirty ape at 7:32 AM on September 6, 2007

louche: ah, see what you mean.
posted by edd at 7:51 AM on September 6, 2007

I've been reading about the opioid theory of autism lately, which suggests that digestive problems lead to the transmission of drug-like compounds into the brain, leading to autistic behavior. There's also the studies showing decreases in violent behavior among prisoners taking omega oils and vitamins. Another study was conducted at a British school but I forgot the name of it [hey look, something shiny!].

So anyway, there is definitely something interesting going on with nutrition, biochemistry and cognition, and it may prove helpful to ADD sufferers, but the problem I'm finding is that when I start reading about it I either start sinking into fundamentalist new age allergists, or scientific studies that I don't have the training to understand. Or work by doctors who are actually Chiropractors. There's a real need for a book on nutritional biochemistry that just relies on good science but is written for the layperson.
posted by craniac at 7:58 AM on September 6, 2007 [3 favorites]

We no longer pay attention, we borrow attention - until we can no longer maintain the interest.
posted by dances_with_sneetches at 8:04 AM on September 6, 2007

its not additives, its television, video games and the internet

get outside and play
posted by caddis at 8:10 AM on September 6, 2007 [1 favorite]

The internet is a clever metafiction, and ADHD is all in your head.
posted by Mister_A at 8:12 AM on September 6, 2007

Something to what Craniac said, my nephew seemed hell-bent for an autism diagnosis, albeit early, at only 18 months. He completely ignored everyone (though he could hear), did a lot of repetitive stuff for hours on end, etc. Turns out he was allergic to milk - without the normal allergy symptoms. Two days without the white stuff, and he acted (almost) his age. A year and a half later, he's gone from acting a year behind his age to perfectly average (but especially smart with mechanical things) for his age.
posted by notsnot at 8:16 AM on September 6, 2007

this is weird. I'm a step away from my tonsillectomy and this is after a sleep study and a lifetime of what might appear to be mild ADHD symptoms... WTF?

OH IS IT TRUE? WILL I BE A BETTER PERSON AFTER THIS?
posted by grubi at 8:23 AM on September 6, 2007

Speaking of food coloring, who remembers the Kool-Aid moustache? I seem to recall a distinct correlation between hullabaloo and those supporting a red stain on the upper lip.
posted by well_balanced at 8:52 AM on September 6, 2007

Kool Aid mustache? How about a Kool Aid hairdo? (some would argue that it is the Kool Aid soaking into your brain straight through your skull which causes such mad behavior, while others would argue that you must be mad in the first place to try this)
posted by caddis at 9:13 AM on September 6, 2007

"ADHD is a mental disorder that involves a fundamental diffference in the way that the individual processes their own thoughts and interacts with the rest of the world. Hyperactivity and Inattention are behavioral manifestations of this underlying brain pattern."

Agreed, the lack of knowledge of what exactly ADD or ADHD is is stupifiying. ADD isn't just "lets go ride a bike." Even if it were the domino effect of the constant and quickly changing subjects are unebearable to most people around them.

I wish there were more of us with ADD so that we could 'be the norm' and force 'the others' to interact, behave, and communicate like we do.

(apology for the mini-rant)
posted by dylanSnow at 9:54 AM on September 6, 2007

I was really hoping for an in-depth discussion of nutrition, brain chemistry and ADD.

Oh wait, radical honesty day was *yesterday*.

Metafilter: unbearable to most people around them.
posted by craniac at 12:27 PM on September 6, 2007

I wish there were more of us with ADD so that we could 'be the norm'

I love it when you get the right group of people together and carry on four or five overlapping conversations at the same time. Drives 'the others' crazy, though.
posted by StickyCarpet at 12:33 PM on September 6, 2007

Ice cream, Mandrake. Children's ice cream.
posted by lumpenprole at 12:46 PM on September 6, 2007 [1 favorite]

Wanna ride bikes?

HELL YES I want to ride bikes hey what's that shiny thing up the tree have you ever slept with a strobe light as a pillow what is that thing are you going to eat that I really love chocolate and sugar oh my god kittens and video games sometimes I wonder what would happen if everyone on the planet jumped up and down at the same time do you think we'll ever find a way to turn off gravity I want a real light saber that would be awesome or maybe a Jupiter Brain and a really fast wireless connection oh I love Robot Chicken did I tell you I'm not wearing any underwear what time is the last bus I need more Mountain Dew before the store closes if baby's first words are "locnar" is it time to worry oh God I don't think I like cherry tootsie pops they remind me of Robotussin and what the fuck is moving around in my shoe and why does Jerry Lewis make me want to stab little kids anyway if I ride really fast do you think I could make it up the trunk into the first branch?
posted by loquacious at 1:58 PM on September 6, 2007 [8 favorites]

Somehow I doubt there will ever be a fully publicized correlation between nutrition and brain chemistry. That would mean much of the food industry would have to change its formulations and because money,not health, is the bottom line in this country, that isn't going to happen.

Full disclosure: I did an msg experiment with my endocrinologist and oh surprise, I was allergic to a common food additive (msg) that once removed also took with it 90% of my lethargy and depression. Oh and hives, breathing problems and headaches. It's not an uncommon set of reactions (though the severity of mine is) And yet the food industry persists in calling it hysteria.

It would be interesting to see just how many health and behavioral problems disappeared or were improved if the worst additive offenders were removed (msg, aspertame, ,red 3 etc). Oh and I'm'not a lunatic, my situation was proven to the doctor's satisfaction, it was painful and in once case dangerous, but proven.

These additives may not cause ADHD or autism, but they certainly cause additional problems. Too much anecdotal personal evidence to deny. And as much as I can keep them away from my own kid I do.
posted by pywacket at 2:24 PM on September 6, 2007 [1 favorite]

The problem is that things like ADD and autism are collections of symptoms that can result from many different causes. For example, you can have completely disturbed attention because of trauma: this child looks hyperactive because he jumps at every little sound and doesn't pay attention to cognitive content because he's too busy worrying that the traumatic event will recur.

You can have a child who was severely neglected (I'm talking being left alone for hours a day or more during infancy, not just minor inattentiveness from parents) who looks autistic: sitting in the corner rocking, won't make eye contact, doesn't speak, etc.

And then you have the whole set of individual genetic responses to various chemicals in the environment which may be harmless to 99% of people, but dangerous for 1%.

Until we get better at sorting this stuff out with things like pharmacogenomics, we're going to have thousands of these arguments where people talk past each other because they are talking about different subsets of populations with conditions that look similar but have had multiple different causes.
posted by Maias at 2:47 PM on September 6, 2007

False dichotomy much?
posted by fiercecupcake at 4:36 PM on September 6, 2007

huh?
posted by Maias at 6:01 PM on September 6, 2007

pywacket, I'm glad you found something to help you, but it being proven to your doctor's satisfaction doesn't mean it is published, peer-reviewed, and repeatable.

That is to say - unless you were double-blinded as to what foods contained MSG and what didn't, it's hard to say what changed that affected your symptoms.

Please believe I'm not saying you're not absolutely right, I'm just saying that good science, especially surrounding such a complex topic as what we eat, takes lots and lots of time and good sampling. Then it takes some more because, as mentioned often, finding out one additive or another has nasty side-effects isn't in the interest of anyone who can afford all that time and effort.

Remember when there were wasteful government agencies whose only job was to blow all that money and time making sure that the free market was holding up its end of the deal? Lucky thing they've been shrunk to be so lean and efficient and useless.

/derail
posted by abulafa at 6:24 PM on September 6, 2007

Maias made my point, which my false dichotomy was intended to highlight. There is no such thing as ADHD. This is a catchall category that is currently catching too much.

There may very well be a problem with symptoms similar to some of those linked to the ADHD diagnosis... after eliminating tonsils and additives and behavioral disorders... but it will be named something based on it's cause, like "abnormal neural plasticity syndrome". ADHD will disapper as a diagnosis.

Ditto autism.
posted by ewkpates at 5:54 AM on September 7, 2007

I've written about this very subject elsewhere, but I'll highlight something important here.

What makes this particular study so important is that it is not an association study, which is what everything else is. "We've found that 80% of people who drink more than 10 sodas a day has ADHD." Could there be another explanation than the soda, such as, perhaps, their parents suck? (e.g.)

This study is prospective-- they tested to see what the effects would be.

The news article says "10%" closer to a diagnosis of ADHD. I'll assume that means an absolute difference of 10%. If this is true, then the "number needed to harm" is 10-- so ten kids need to drink that much additive (3x normal) for one to get the effect.

In general, association studies and the like result in an NNT of about the same. Another way of looking at the NNT is to say, "in order to be sure that one kid got ADHD from additives, you'd have to give it to at least ten kids."

So I'm not saying there isn't a link-- hell, the NNT for many antidepressants is about the same-- but there's more to the ADHD story than the additives. For what it's worth, my money is on "ADHD" being multifactorial: no naps, poor sleep, poor diet (including caffeine), and constant but cognitively useless stimulation-- TV, chatter, video games, etc. With no clear focus of concentration, your mind learns to attend to bits and pieces of lots of little things.

You'll notice that I did not put "biological factors." Whenever a psychiatrist cites "biological factors" it means he either doesn't know, or doesn't care.
posted by TheLastPsychiatrist at 12:45 PM on September 7, 2007 [1 favorite]

Maias made my point, which my false dichotomy was intended to highlight. There is no such thing as ADHD. This is a catchall category that is currently catching too much.

Look, just because a lot of people have ups and downs, and all of these people think that they are bipolar, does not mean that bipolar as a mental condition does not exist. ADHD also exists. There is a simple, oh so simple, test involving an impulsivity test that basically has nothing to do with hyperactivity or inattention and everything to do with the specific way that people who really do have ADHD interact with the world. Everyone who "passes" this test (i.e. does spectacularly bad at an exercise that most people do quite well at) has it. Everyone who doesn't, doesn't.

Every time it seems like my life has devolved into chaos, I realize it's generally because I've forgotten to take my meds for a couple of days. Everything starts to pile up -- messes get formed, work falls behind, I focus less, seem to have less pleasant conversations. As soon as I get back on track with my medication, all of a sudden my life just snaps into place again.

I realize that the point of your statement really is that the ADHD label is over-applied, and you think it may be necessary to ditch it in favor of a more specific label in order to avoid all the old baggage it currently has. The thing is, identifying that I had ADHD was one of the more positive things that happened to me. I finally could understand why I was having such a hard time dealing with the world, and it wasn't because I was a fundamentally bad person. So, I personally am quite protective of my ADHD diagnosis, than you very much. I'd much rather kick the bums out and keep ADHD as the exclusive club it ought to be rather than suddenly have to say I have "abnormal neural plasticity syndrome" -- whatever the heck that means.
posted by Deathalicious at 6:43 PM on September 7, 2007

point taken abulafa , however my endocrinologist was interested enough in this to start research and some of the tests he did with me --I had no idea what I was being given to eat. My Doc said much the same as you did--that if I really wanted to take care of this we needed to be exacting. He's actually one of the parts of San Francisco I miss (harder to convince doctors where I am now)and he's the one who suggested what my problem might be in the first place--after two anaphylactic episodes that landed me in the emergency room. And after a LOT of testing for tumors, cancer and all sorts of fun things.

I have hopes that more research will be done on the effects of additives on behavior, it would be enlightening.

/double derail
posted by pywacket at 8:37 PM on September 11, 2007