and Children's Environment
deficit hyperactivity disorder (ADHD) affects somewhere between
10% and 15% of all school children in the U.S. (1.8 million to 2.7
million children). The estimate is uncertain because the behavior
of children can be erratic under the best of circumstances and therefore
the disorder is not simple to diagnose. Indeed, many cases are thought
to go undiagnosed.[1,2]
to recent estimates, as many as 1.5 to 2 million children in the
U.S. diagnosed with ADHD are currently taking Ritalin (methylphenidate
hydrochloride), a prescription drug with cocaine-like characteristics,
to calm them down and/or help them focus their attention.[1,pg.1;2,pg.3]
In 1997, more than 10 tons of Ritalin were ingested by U.S. children
to control ADHD. It was recently found that Ritalin causes liver
cancer in mice (though not in rats), so the long-term consequences
of Ritalin use by millions of children need to be considered.[2,pgs.13-14]
evidence suggests that the ADHD problem is growing. Last month,
at a medical conference devoted to the disorder, the organizers
of the conference estimated that occurrence of ADHD among children
in the U.S. is doubling every 3 to 4 years.
The use of Ritalin quadrupled between 1990 and 1997.[1,pg.1]
with ADHD often continue the symptoms into adulthood, with unhappy
consequences for job performance. According to one 1997 estimate,
somewhere between 6.5 million and 9 million adults in the U.S. have
ADHD -- making it as large a problem as clinical depression or drug
abuse. In 1997, about 730,000 adults in the U.S. were taking Ritalin
by prescription for ADHD.
causes of ADHD are not known, but they are thought to be a combination
of hereditary predisposition and environmental factors. Research
in recent years has focused on prenatal exposures to agents such
as lead, cigarette byproducts, and alcohol. Since the 1970s, researchers
have been studying the effects of certain foods and food additives
such as dyes and colorings; over the past 25 years, 16 out of 23
studies have found that food additives exacerbate the symptoms of
ADHD in some children. Poor diet (malnutrition)
undoubtedly contributes to ADHD.[2,pgs.23,37]
Most recently, research has implicated pesticides and exposure to
low levels of industrial chemicals that may interfere with hormones,
especially thyroid.[2,pgs.53,59] Obviously,
combinations of all these factors could be important.
was first identified as a specific disorder in 1902. The definition
of the disorder has changed over time. In 1902, George Still described
43 children with aggression, defiance, emotionality, limited sustained
attention, and deficient rule-governed behavior. From the 1930s
to the 1950s, the term "minimal brain damage" was used
to describe the syndrome, even though there was no evidence of brain
damage in most of the children so labeled. During the late 1950s,
hyperactivity began to dominate the description of the disorder
and the official name was changed to "hyperkinetic reaction
of childhood" or hyperkinesis. The use of stimulant drugs,
like Ritalin and amphetamines, to treat ADHD began in the 1960s.
(Some drugs that act as stimulants or "speed" in most
adults can have a calming effect in children and even in some adults.)
In the 1970s, researchers considered inatten- tion as central to
the syndrome, and it became officially known as attention deficit
disorder or ADD. In the 1980s and 1990s, the combination of attention
deficits and hyperactivity have both been highlighted, thus the
current name, Attention Deficit Hyperactivity Disorder (ADHD).5
DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS IV, published
by the American Psychiatric Association, describes 3 patterns of
behavior that may indicate ADHD: consistent inattention, hyperactivity,
and impulsive behavior, or combinations of these three behaviors.
of inattention include:
person fails to give close attention to details or makes careless
mistakes in schoolwork, work, or other activities;
person has difficulty sustaining attention in tasks or play activities;
person often does not seem to listen when spoken to;
person often does not follow through on instructions and fails
to finish schoolwork, chores, or duties in the workplace;
the person often has trouble organizing tasks and activities;
person avoids or dislikes or is reluctant to engage in tasks that
require sustained mental effort;
person often loses things necessary for tasks or activities, such
as pencils or tools;
person is easily distracted by extraneous stimuli -- the honk
of a car's horn, or a bird flying by.
person with 6 or more of these inattention symptoms for more than
six months might be a candidate for an ADHD diagnosis.
of hyperactivity and impulsiveness include:
restless, often fidgeting with hands or feet, or squirming in
or climbing excessively at inappropriate times;
a seat early in the classroom or in other situations;
person has difficulty engaging in leisure activities quietly;
person is often "on the go" or acting as if driven by
person often talks excessively;
person blurts out answers before hearing the whole question;
person has difficulty waiting in line or for a turn;
person often interrupts or intrudes on others.
person with 6 or more of these hyperactivity symptoms for more than
six months might be a candidate for an ADHD diagnosis.
everyone exhibits some of these behaviors from time to time, the
DIAGNOSTIC AND STATISTICAL MANUAL specifies additional guidelines
for determining when they indicate ADHD:
of the behaviors must have begun early in life, before age 7;
children the behaviors must be more pronounced than in others
the same age;
all, the behaviors must create a real handicap in at least two
areas of a person's life, such as school, home, work, or social
settings. So, for example, a child would not be diagnosed with
ADHD if he or she seems overly active at school but functions
of identical twins reveal that environmental factors contribute
significantly to ADHD. It is not known whether environmental factors
can cause ADHD in an otherwise normal person, or whether environmental
factors only exacerbate ADHD among those who are genetically predisposed.
In either case, people with ADHD often do poorly in school (many
drop out early), have low self-esteem, and have difficulty making
connections with other people. People with ADHD are often described
as messy, disorganized, inattentive, irritable, and aggressive.
Because their lives can be frustrating and unrewarding, some ADHD
sufferers may become hostile and even violent. In May of this year,
T.J. Solomon, 15, shot six of his schoolmates at Heritage High School
in Conyers, Georgia, a suburb of Atlanta.
At the time, the Solomon boy was taking prescription Ritalin for
can trigger ADHD, and large numbers of U.S. children are malnourished.
The U.S. Department of Agriculture (USDA) publishes "recommended
daily allowances" (or RDAs) for various nutrients. USDA considers
that RDAs exceed the average nutritional requirements of average
people; a person is assumed to be malnourished if he or she receives
less than 60% of an RDA for a particular nutrient. Notably, the
number of U.S. children consuming less than 50% of RDAs has been
reported as follows: vitamin A (9%); vitamin E (15%); vitamin C
(6%); calcium (7%); and zinc (6%). There
are roughly 18 million children in the U.S., so these percentages
represent large numbers of malnourished individuals. These percentages
may even be somewhat optimistic; many scientists consider RDAs inadequate
measures of nutritional status because nutritional requirements
vary considerably from one individual to the next, so averages may
be misleading. Furthermore, the chemical form of a nutrient is important
but is often not considered in typical assessments of nutrient status.
is considerable evidence that food dyes can worsen the symptoms
of ADHD in some children, but government authorities deny the evidence.
The U.S. Food and Drug Administration (FDA) has published a pamphlet
called FOOD COLOR FACTS which states that "there is no evidence
that food color additives cause hyperactivity or learning disabilities
in children." The pamphlet, though published by the FDA, was
actually written by the International Food Information Council,
a trade association representing many makers of food additives including
General Mills, Kraft, Procter and Gamble, Pepsi-Cola, Coca Cola,
Monsanto (maker of aspartame), and Ajinomoto (maker of monosodium
glutamate).[2,pg.25] To make the statement
that there is no evidence that food dyes cause hyperactivity or
learning disabilities in children, the FDA had to ignore 16 double-blinded
studies that have shown that food dyes do worsen the symptoms of
ADHD in some children. (A double-blinded
study is one in which neither the participants, nor those observing
and recording the children's behavior, know which children have
been exposed to food dyes and which have not, the purpose being
to avoid bias.)
1976, a study of U.S. children between the ages of 6 and 11 found
they ingested an average of 76 milligrams of food dyes per day (mg/day).
Ten percent of those studied ingested twice that amount, or 146
mg each day. Since that time, the quantity of food dyes manufactured
per person in the U.S. has increased 50%.[2,pg.11]
a time when Americans are searching for causes of aggression and
violence among children, it would make sense to consider malnutrition,
food additives, tobacco additives, toxic metals, pesticides and
other endocrine-disrupting industrial toxicants -- all of which
many U.S. children are exposed to from the moment of conception
Joseph A. Bellanti, William G. Crook, and Richard E. Layton, editors,
ADHD ATTENTION DEFICIT HYPERACTIVITY DISORDER, CAUSES AND POSSIBLE
SOLUTIONS, CONFERENCE SYLLABUS OF PRESENTATION PAPERS NOVEMBER 4-7,
1999, KEY BRIDGE MARRIOTT HOTEL, ARLINGTON, VIRGINIA (Alexandria,
Virginia: International Research Consultants, November, 1999). Available
for $25 from: International Research Consultants, Suite 2J, 4600
King Street, Alexandria, Virginia 22302. Telephone (703) 998-6091;
fax: (301) 320-4688; E-mail: firstname.lastname@example.org. The conference was sponsored
by the Georgetown University Medical Center (Washington, D.C.) and
the International Health Foundation (Jackson, Tennessee).
Michael F. Jacobson and David Schardt, DIET, ADHD & BEHAVIOR;
A QUARTER-CENTURY REVIEW (Washington, D.C.: Center for Science in
the Public Interest, November, 1999). Available for $8.00 from the
Center, No. 300, 1875 Connecticut Avenue, N.W., Washington, D.C.
20009; telephone (202) 332-9110; fax: (202) 265-4954; E-mail: email@example.com.
Also available free at www.cspinet.org.
Joseph A. Bellanti and William G. Crook, "Introductory Remarks"
in the syllabus cited above in note 1, pg. 1.
David J. Morrow, "Attention Disorder Is Found In Growing Number
of Adults," NEW YORK TIMES September 2, 1997, pgs. A1, D4.
Marianne Mercugliano Glanzman, "What is ADHD," in the
syllabus cited above in note 1, pgs. 3-16.
Associated Press, "Boy's Mother Apologizes Over Shooting in
Georgia," New York Times May 25, 1999, pg. A19.
Donald R. Davis, "Nutritional Deficiencies in American Children,"
in the syllabus cited above in note 1, pgs. 17-21.
For example, see Roger J. Williams, NUTRITION IN A NUTSHELL (Garden
City, New York: Doubleday, 1962).
terms: adhd; attention deficit disorder; hyperactivity; children;
ritalin; cancer; carcinogens
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