Baby and childhood illnesses: hyperactivity


        BABY AND CHILDHOOD ILLNESSES: HYPERACTIVITY
Childhood hyperactivity is currently a controversial and emotive topic. Rather than a symptom (as many suppose), it is a syndrome embracing a number of symptoms.
The symptoms include hyperactivity (excessive movements), a short attention span, being impulsive and being easily distracted. Sometimes learning difficulties and other nervous system signs are also present. From the point of view of the teacher or parent, hyperactivity is most likely to be the main symptom which leads to a visit to the doctor.
However, increasing evidence is accumulating which suggests that, from the child's point of view, it is the disorder of attention which is the most important. The two do not necessarily go hand in hand, for the level of physical activity often bears little relationship to the child's difficulty in learning or with his nervous system disabilities.
The frequency with which the disorder occurs is variable. In school-aged children in primary school, estimates have varied from 4-10 per cent. However, behavioural patterns of children which caused parents and teachers to seek medical help are far more frequently encountered. In one survey reported in the Medical Journal of Australia, restlessness occurred in 50 per cent of boys and 28 per cent of girls.
These sorts of figures are causing considerable concern in countries like the United States, where medication of supposedly hyperactive children is getting out of hand.
It is well-established that boys are affected more commonly than girls, and the ratio of nine to one is frequently reported.
Many other terms are used to describe these children, for the complexity of the disorder is being realized by doctors and psychologists. The terms 'learning disability' and 'minimal brain dysfunction' (MBD) and 'hyperactivity' are now commonly used. Doctors tend to use the term 'MBD' in the medical literature (particularly in American medical literature, although 'hyperactivity' seems more common in Australia). 'Learning disability' and 'hyperactivity' are used widely by educators and psychologists.
Symptoms
A great deal of controversy exists over what constitutes a hyperactive child. The dividing line between normal and abnormal is difficult to establish, as the range of figures of complaints indicates.
Although physical hyperactivity may be a symptom of certain disorders which can be clearly distinguished, it may be a symptom of some other disorder. Because of the implications of treatment, correct diagnosis is necessary, although it may be difficult. It may require special investigation and psychometric tests. For instance, there may be mental retardation (anywhere from borderline to severe); perceptual disorders (relating to the ability to hear and see); psychological disorders (anxiety states, psychoses); neurological disorders (such as lead poisoning or the use of certain drugs); and acute medical disorders (for example, chorea or thyroid excesses). Finally, there may be cultural differences: what is socially acceptable in one society may be attributed to some pathological disorder in another.
Many of these causes may be totally unrecognised by parents or teachers. For example, a child with borderline retardation may react with restlessness and lack of co-operation when his parents indicate excessive expectations of him.
Cause
There are many theories on the cause of the syndrome. Some claim it is a genetically determined developmental abnormality resulting from a low nervous system arousal. It tends to run in families. Parents producing hyperactive children can describe similar problems in their own childhood.
Others believe the condition is 'psychogenic'. There may have been a poor social relationship between mother and child early in life. This may have resulted from early separations, or more commonly from emotional distancing resulting from maternal disturbances. This can commonly occur in the time immediately following birth, and is manifest as a depression, which may persist undiagnosed. The child reacts to this with an increasing aggression and a diminished capacity to develop internal controls on aggression and impulsiveness.
Another group claims hyperactivity is due to 'minimal brain damage'. Damage is slight for general intelligence to be noticeably impaired or for there to be gross nervous system signs of impairment. This damage might occur prenatally or in the postnatal period. Giving weight to this are abnormal brain tracings (EEGs) that are found in up to 50 per cent of these children.
Treatment
Diagnosis of hyperactivity is no simple matter. If a parent or teacher suspects that a child may be suffering from the syndrome and can identify some of the suspect symptoms (some are quite obvious, others are not), then take the child to the doctor. In turn, your family doctor may refer the child to a doctor who specialised in this particular field. Further tests are necessary to clearly establish the correct diagnosis, as has been explained.
If the child is diagnosed as hyperactive, then specialised therapy may be indicated. As an ongoing process, this must be under the general supervision and guidance of persons with the necessary knowledge and expertise in the field, usually child psychiatrists.
The Feingold Diet: A theory which has gained wide credence and support is the one put forth by Dr. Ben Feingold, an allergist who claims certain 'small sized molecules' occurring in some natural foods and in some artificial colours and flavours have an adverse effect on brain cells of children afflicted with the syndrome.
He has put forth proposals that limitation of these foods (simply by dietetic restriction) yields positive benefits to the children.
The Feingold method has attracted considerable criticism, but its following is enormous. Doctors themselves are in disagreement, and medical journals regularly print fiery articles either supporting or denouncing the system.
It seems relevant that many parents with hyperactive children frequently follow the system on their own account, and often report favourable results. Probably they all cannot be right; neither can they all be wrong. The truth of the matter is still unknown. More clinical trials under strict, closely supervised conditions are necessary before the final word is given.
'From my private practice, of 72 families I have instructed and supervised to date, 62 found sufficient change to continue adherence to the diet to date, from 4 to 20 months. A difficult diet is less difficult to manage than a difficult child, and it is surely preferable that a child be "set apart" because of his diet than because of his behaviour,' is typical of the reports appearing in medical magazines in support of the routine. This excerpt came from the Medical Journal of Australia from a doctor in Queensland.
But others are just as convincing in the opposite direction. 'The diet costs averages $120 per week per family,' an MJA editorial states. 'The results suggest that on objective tests, no changes of any kind were observed—physical, behavioural or cognitive—and in school children neither were there any parental or teacher reports of behavioural change.'
'The diet was not designed for use in normal households,' another correspondent says. 'To place this treatment in perspective, the Feingold diet is no more difficult than many other dietary regimes commonly used in medical therapy, for example, diabetic, or gluten free diets.'
The book by Dr. B.F. Feingold which started the controversy on the diet is entitled Why Your Child is Hyperactive, (Random House, New York, 1975). No doubt many parents are already trying out his suggestions on their own.
In 1980 another detailed book which examined the Feingold system in detail came off the press. It is entitled Food Additives and Hyperactive Children by Dr. C.K. Connors (Plenum Press, New York, 1980).
Parents who would like more information are coming together to pool their knowledge and ideas. The National Association of Hyperactivity's address is P.O. Box 100, Narrabeen, Sydney, NSW, 2101. But whatever routine is considered, medical supervision by a medical practitioner specially versed in this difficult field is recommended.
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General Health

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