Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder

Dr. Weyrich's Naturopathic Functional Medicine Notebook

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Etiology

Attention Deficit (Hyperactivity) Disorder appears to have a multifactorial origin.

With the caveat that association does not necessarily distinguish between cause and effect, the following factors have been associated with ADD and ADHD, in no particular order:

High incidence of otitis media (ear infections) [Roberts1994] [Hagerman1987] [Teele1984] [Silva1986] [Sak1982]. This may be associated with hearing impairment or to yeast dysbiosis secondary to antibiotic treatment [Shaw2008].
Toxic metal exposure (mercury, lead, etc.)
Hypothyroidism (72% of males, 43% of females) [Brucker-Davis1995; Starr2005 pg 89].

Differential Diagnosis

Generally speaking, insurance companies are more likely to reimburse for treatment of underlying organic disorders than they are for ADD/ADHD itself. Hence it is particularly important to identify and document any underlying organic disorders that may be associated with or cause autistic behavior. Consider the following:

Heavy metal toxicity.
Gut dysbiosis and Gut-Mediated Neuromuscular Dysfunction.
Hypothyroidism.
Vitamin B12 deficiency [stuart2006].

Note however that insurance companies are reluctant to pay for the tests required to diagnose some of these underlying organic disorders, because a direct linkage between ADD/ADHD and these disorders has not yet been established to the satisfaction of the insurance companies.

Hypotheses

Drugs used to treat AD(H)D such as amphetamines and Ritalin normally act as stimulants (in a manner similar to street-drugs such as "speed"). However in patients suffering from AD(H)D these drugs seem to have a paradoxical effect of reducing hyperactivity and increasing attention span, perhaps because these patients have a low metabolism [Starr2005 pg 89].

In one study it was found that in a population of children with hypothyroidism, 72% of males and 43% of females were hypothyroid [Brucker-Davis1995; Starr2005 pg 89]. That being the case, it has been speculated that if an AD(H)D patient has low basal body temperature, then treating the patient for hypothyroidism may yield the same benefit as treatment with Ritalin and similar drugs, with fewer side effects [Starr2005 pg 89].

ICD-9 Codes

ICD9-Code	Description	Comments

References

Unless specifically noted above, references used in the construction of this web page include the following:

[FDM] Lecture notes from Functional Medicine University.

[SCNM] Lecture notes from Southwest College of Naturopathic Medicine.

[UT] Lecture notes from the University of Tennessee graduate programs in Chemistry and Biochemistry.

[Brucker-Davis1995] F. Brucker-Davis et al. Genetic and clinical features of 42 kindreds with resistance to thyroid hormone. The National Institutes of Health prospective survey Annals of Internal Medicine 123(8):572-583. [Cited by Starr2005].

[Shaw2008] Shaw W. Biological Treatments for Autism & PDD, Third Edition. (2008).

[Roberts1994] Roberts JE, Burchinal MR, Campbell F. Otitis media in early childhood and patterns of intellectual development and later academic performance. J Pediatr Psychol. 1994 Jun;19(3):347-67.

[Hagerman1987] Hagerman RJ, Falkenstein AR. An association between recurrent otitis media in infancy and later hyperactivity. Clin Pediatr (Phila). 1987 May;26(5):253-7.

[Teele1984] Teele DW, Klein JO, Rosner BA. Otitis media with effusion during the first three years of life and development of speech and language. Pediatrics. 1984 Aug;74(2):282-7.

[Silva1986] Silva PA, Chalmers D, Stewart I. Some audiological, psychological, educational and behavioral characteristics of children with bilateral otitis media with effusion: a longitudinal study. J Learn Disabil. 1986 Mar;19(3):165-9. No abstract available.

[Sak1982] Sak RJ, Ruben RJ. Effects of recurrent middle ear effusion in preschool years on language and learning. J Dev Behav Pediatr. 1982 Mar;3(1):7-11.

[Starr2005] Mark Starr. Hypothyroidism Type 2: The Epidemic. Columbia, MO: Mark Starr Trust (2005).

[Stuart2006] J.J. Stuart & S.M. Pacholok. Could it be B12? An Epidemic of Misdiagnoses. Sanger, CA: Quill Driver Books/Word Dancer Press (2006).

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