March 19, 2007
With 40,000 British children now being prescribed drugs to counter hyperactivity, the parents of a son with ADHD tell Victoria Lambert how diet can make a big difference
When 36-year-old lecturer Karen Gray was told that her son Jac, then six, was "hyperactive", she wasn't terribly surprised.
She and her husband Martin, 42, a firefighter, became aware that Jac was different from his younger brother Thomas early on.
"He was always a handful," says Karen. "He was on the go, into everything, but it was more than just boyish energy."
Jac was having trouble concentrating and he couldn't sit still. School holidays were a nightmare.
"He was impulsive and rash, he'd fly off the handle and couldn't empathise with other children," says Karen, who lives in Rustington, Sussex. "He wouldn't make eye contact with us, and he lived at times in a fantasy world. He needed very strict boundaries to keep him happy.
Following concerns at school, Karen and Martin took Jac first to the GP, and then to the paediatric department at Worthing Hospital, where, after an assessment, he was diagnosed with Attention Deficit and Hyperactivity Disorder (ADHD).
The family were then left to get on with the situation alone - much to their surprise.
"I went through a difficult patch emotionally," says Karen. "I wanted him to be healthy and normal. This wasn't his fault. I felt like cuddling him all the time."
Even though his diagnosis was "borderline", Karen knew immediately that she was not interested in medicating him.
"I wouldn't have dreamt of going down the drugs route," she says.
In this decision, Karen is very much alone, if recent figures are to be believed.
According to a report in the journal Health Affairs last week, the NHS bill for drugs used to treat ADHD, such as Ritalin, rose 31 per cent every year from 1999 to 2003, from £4.2 million to £12.4 million.
These figures mean that close to 400,000 prescriptions are being issued each year for drugs to treat the disorder. This suggests about 40,000 children are diagnosed with the problem, although there are estimates that up to seven per cent of all school-age children may be affected to some degree.
The figures are controversial enough. Some GPs are still reluctant to admit the condition exists. There is also a suggestion that ADHD was "invented" by pharmaceutical companies looking to find an application for a drug they had developed.
This "common misconception" is rejected by Stephen Hinshaw, of the department of psychology at Berkeley University, California, who says:
"Cross-cultural research has shown that ADHD exists in all cultures, with increased access to public education a factor in its detection."
Meanwhile, Andrea Bilbow, chief executive of the ADHD support charity Addiss, believes that since it was only just beginning to become more widely recognised as a syndrome in Britain in about 1994, it is inevitably under-diagnosed in this country.
Yet she says: "It is misleading to report there are millions of ADHD kids around because that inevitably creates prejudice against the real sufferers."
But the fundamental controversy over ADHD lies in the very nature of the mainstream treatments, which rely heavily on powerful stimulant drugs such as methylphenidate (Ritalin) and dexamfetamine (Dexedrine). It is this that causes parents and health professionals most anguish.
These drugs are listed on the respected British Medical Journal website BestTreatments.co.uk as "likely to work", sometimes in conjunction with behavioural therapy.
Indeed, Bilbow says that of the parents who contact Addiss, "a higher percentage find medication helpful". But many are uncomfortable with the idea of putting young children on amphetamine-based regimes, particularly as they bring with them a raft of potential side effects, ranging from sleepiness and loss of appetite to cardiac problems and depression.
Karen Gray decided on an approach based on diet and exercise to treat Jac; this therapy is the brainchild of Robin Pauc, a specialist in childhood developmental disorders. She bought his best-selling book Is That My Child?, which is aimed at helping parents to understand and treat learning difficulties, and by the end of last summer she felt the family was making progress.
However, Karen decided to book Jac in for a private consultation with Pauc as well.
Pauc, who runs the Tinsley House Clinic in Beaulieu, Hampshire, has worked in childhood neurology for 30 years but is not a fan of medication.
He believes that before ADHD can be treated, you need to understand where the child's other behavioural problems come from and how they relate to each other.
"You don't see a child with just one developmental problem," he explains.
"They always have more than that - whether it is a touch of dyspraxia, Tourette's or even Obsessive Compulsive Disorder. This is because all these disorders or symptoms are on the same spectrum. And they all originate in the same part of the brain - the right side pre-frontal cortex."
Pauc has christened these complaints Developmental Delay Syndrome (DDS).
His theory is that these problems occur due to slow development in that part of the brain between birth and about 18, a time when, he explains, "the second wave of brain cells develops". He believes that while ADHD may be due to a genetic predisposition, it needs a trigger, which could include birth trauma or even maternal prenatal stress.
Ritalin can help, he says, as it raises the level of activity in this area. However, it is a very blunt instrument - "it stimulates the whole brain, rather than just the part relevant to ADHD".
Addiss supports parents, whatever route they take. "Patients and parents have a right to choice," says Andrea Bilbow. "If changing diets alleviates the symptoms, go for it. But drugs are very useful in many cases. If parents decide to give medication, they have probably exhausted all other routes."
She does, however, suggest a behavioural programme, 1-2-3 Magic: Effective Discipline for Children 2-12, which is a practical parenting guide. "Some children need medication," she says. "For others, specialist help in anger management and social skills can help."
Pauc's treatment relies on the right nutrition combined with simple exercises to stimulate the brain - such as walking up and down stairs with eyes closed, or standing on the left leg, brushing teeth with the right hand. He prescribes supplements such as Omega 3 fish oils, zinc and magnesium. Later, there are complex computer programs that "exercise" the appropriate areas of the brain.
Pauc argues that modern children's diets provide them with glucose highs and lows, not the steady blood sugar levels a body needs to avoid mood swings. He explains that when a child's body is crowded with food that has no nutritional value, it cannot also fit in the good, brain-building nutrients it requires such as protein or vitamins.
Pauc encourages parents to wean their children off high-sugar, high-fat, processed food, which he believes causes a physical and psychological addiction. "These are simple things you can do. You can change a child's life without signing up to medication."
Under Robin Pauc's instruction, Karen Gray overhauled Jac's diet. She had never allowed him fizzy drinks or highly coloured foods, but now she became zealous.
A typical breakfast might be muesli, followed by bacon, scrambled eggs, baked beans and organic toast. Lunch would be a ham and spinach wrap, with a box of raisins, home-made cereal bar, sliced red peppers, grapes and a bottle of water. Supper could be home-made organic burgers with potatoes roasted in olive oil, and salad.
And while Jac has had the odd moment of rebellion since the regime began, Karen says that on the whole he is so much happier in himself, he is quite content to miss out on classmates' junk food snacks - although he is allowed the odd square of high-cocoa-content organic chocolate for a treat.
She and Martin couldn't be more pleased with the transformation they have seen. "Jac was like a child in a straitjacket," she says. "Now it is as if someone has unbuckled the clasps. He makes eye contact with us and can read more comfortably, especially facts. He was always a lovely child. Now he's even nicer."
• 'Is That My Child? The Brain Food Plan' by Robin Pauc (Virgin) is published on April 5. To order for £10.99 plus £1.25 p&p, call Telegraph Books on 0870 428 4112.
• www.addiss.co.uk, tel: 020 8952 2800. Tinsley House Clinic; tel: 01590 612 432; www.tinsleyhouseclinic.co.uk