Is Attention Deficit the New Normal?

Is it just me observing a rise in numbers, or are many more kids and teens being diagnosed with Attention Deficit Disorder (ADD/ADHD/AD(h)D) these days?

One school I am working with has had a surge of cases over the past 3 years and their numbers are now 7x pre-pandemic levels! More teens are also being diagnosed, and it seems to have become the “new normal” in many secondary schools.

AD(h)D issues can become apparent early on in life (some parents swear their baby was hyperactive in the womb!) and can present in two keys ways – the hyper and interruptive type or the head in the clouds dreamy type. Some kids present with a third type, which is a blend of both. Many of these kids seem to be very sensitive souls, and often need a great deal of input to help them navigate life easily. AD(h)D can also cross over with other neurodiverse differences such as autism, dyslexia, dyspraxia, Tourette’s and sensory processing. So, it can be complex to unravel.

Like everything related to neurodiversity, there is always a spectrum and individuality involved, when it comes to causes and symptoms – some individuals are affected more than others, and some are better at hiding their differences. Some people do not reach the full criteria for a diagnosis, or are too young for conventional treatment, but they may still benefit from receiving holistic support to help manage things better.

Non-medical support and therapies for these conditions are very much aimed at helping to rebalance any dysregulation and to help with focus and concentration, which in turn helps to build self-esteem and confidence over time. These interventions provide much needed scaffolding to help to make things easier on a daily basis. We find over time as the body is nourished better, inflammation is in check, and the gut microbiome becomes more diverse, that less and less scaffolding is needed as time goes on.

How is AD(h)D diagnosed?

AD(h)D is diagnosed purely on observation of behaviour, development and learning differences by a psychiatrist, with additional feedback from both the parents and the school if a child is being assessed. There are no scans, blood tests or other lab tests which can diagnose attention deficit disorders or related conditions.

Most people will probably struggle with focus and concentration at some point in their life, relative to their “normal”. So it is important to differentiate a short-term temporary focus issue from a more fundamental and longer-term disorder that can restrict a person’s learning, building friendships and affect their self-esteem and long-term mental health.

There is some evidence of genetic typing, and often in retrospect parents can recognise AD(h)D traits in themselves or close relatives. However, there is no one individual AD(h)D gene that has been identified yet. This is where it is thought that epigenetics plays a role, which means that someone with an AD(h)D-type genetic profile may find that their symptoms are exacerbated by their environment, both in the long and short term.

Research has also found some other maternal factors that can contribute to a child developing AD(h)D traits. And factors during pregnancy such as acute or chronic infection, inflammation and oxidative stress, being overweight or obese and pre-eclampsia or high blood pressure could all play a role. Taking too much paracetamol may also be a contributor, as well as smoking during pregnancy. This information is not to point a finger of blame, but these are areas where meta studies have found correlation. Obviously not all pregnancies with these risk factors lead to neurodiverse outcomes, but it is something to take into consideration.

Some manifestations of AD(h)D can include:

• Short term/working memory and processing challenges
• Trouble keeping up with academic work
• Struggle with a two-way conversation
• Easy to interrupt and impulsive
• Overreact easily – as if everyone around them feels like they are walking on eggshells
• Difficulty making and keeping friendships
• Being bullied or more likely to bully
• Seem unreliable and have difficulty following through
• Problems sleeping at night
• Picky eating

What About Medication?

A psychiatrist may suggest trialling a medication for attention deficit, and even though this used to be prescribed from seven years old, some psychiatrists are now prescribing it as early as five years old. Some people describe these medications as life changing and this treatment can help some people massively with their ability to focus on academic and complete tasks. Other people say it only helps partially, and others would say they do not make much difference at all – we are all very individual.

Methylphenidate is the usual first port of call, in terms of medication, and in the UK is the umbrella term for drugs such as Ritalin, Concerta, Equasym XL or Medikinet XL. They help by regulating dopamine pathways. Methylphenidate is thought to work by blocking dopamine (our reward neurotransmitter) and norepinephrine (adrenaline/fight or flight neurotransmitter) reuptake by neurons in the brain.

But remember these medications only work for a short window of time during the day to help with focus and concentration at school/university or in the workplace. The struggle can still feel very real or even worse during the hours outside of the medication window, and it does not always work 100% for everyone even during the medication window.

The medications can potentially affect appetite and lead to weight loss, they can disrupt sleep in some people and can also sometimes exacerbate anxiety and irritability. And like all medications there will be some people who do not respond well to the medications or react negatively, or even experience withdrawal symptoms. So, medication might not the right option for everyone.

Can Nutrition Help?

Many integrated psychiatrists have been using the nutritional psychiatry, lifestyle and the functional medicine approach to support people who are displaying AD(h)D traits since early on in the 20^th century. This was championed early on by Nobel prize winners Carl Pfeiffer and Linus Pauling and more laterally Doctors William Walsh, James Greenblatt and Kenneth Bock. Dr Alex Richardson and her team at FAB Research at Oxford University and Prof Michael Crawford at Imperial College, London have been leading the research on food for the brain.

The psychiatry team at Cambridge University under Prof Edward Bullmore are looking at the overall effect of the immune system and inflammation on brain development and function. Doctors John Cryan and Ted Dinan have also been investigating the link between the gut microbiome and neurodevelopmental presentations.

Key areas of nutrition and metabolic health to consider that have been highlighted by these scientists, and should ideally be investigated under the supervision of an experienced naturopath, nutritional therapist or functional medicine practitioner include:

• A higher need for Omega 3 – think essential fatty acids from oily fish such as salmon, mackerel, sardines and seafood as well as walnuts, chia seeds, flax seeds and hemp seeds. This is very important brain fuel.
• Blood sugar dysregulation – often people with AD(h)D crave the dopamine hit of white carbs and sugar but these in turn can dysregulate them more – a diet bolstered with more protein, healthy fats, slow-release carbs, fruits and vegetables can make quite a difference.
• Mineral imbalance – testing often finds very low magnesium, iron and selenium as well as a skew towards high copper and low zinc. All of these are needed at the optimal levels to help with neurodevelopment.
• The gut microbiome – the gut-brain connection is very real, and it is well established that gut microbes are the building blocks for key brain neurotransmitters that help with mood, learning, memory and self-regulation.
• Balancing immunity – research has found repeatedly that people with AD(h)D have a higher tendency to atopic conditions such as allergies, eczema and asthma as well as histamine and mast cell activation. A subset find their ADHD seems to be worse for several weeks or months after catching a bacterial or viral infection. This can manifest as brain fog which can affect focus and school performance. Anxiety or OCD tendencies can also be exacerbated for a while after contracting an infection.
• Inflammation and oxidative stress – we have all heard of cytokine storms and oxidative stress since the Covid 19 pandemic, and there is quite a bit of evidence that neurodiverse kids are more vulnerable to both of these and find it harder to restore equilibrium.
• Methylation – a complicated subject, but essentially a key part of your metabolism that converts folate and vitamin B12 through a complex network of pathways into glutathione. This is our master antioxidant made from within, that helps protect the brain and the immune system from inflammation and oxidative stress.
• Genetic SNPs – some people find it hard to make and regulate dopamine and norepinephrine which are central to help us focus and self-regulate. Thankfully specific nutrients are known to support these pathways such as vitamin B6, magnesium, zinc, vitamin D and methionine. As you can imagine this requires very individual genetic SNP testing and support through a practitioner well versed in neurodevelopment and genetics.

Why Do More People Think They Have AD(h)D?

What is exacerbating the situation right now? What is making more people reach out for a diagnosis? Why are so many people suddenly out of the blue having these issues more recently? Logic would say that this phenomenon can’t really boil down to just genetics or better diagnostics if there has been such a surge in only a few years; but the epigenetics theory could be the reason why.

Here is why I think things have escalated recently:

• Screen Time and Social Media is a huge driver of distraction – the human mind is not meant to take in all that information at once!
• Stress plays a major role and distraction is magnified when you are overwhelmed.
• Rebound from lockdowns – many kids have fallen very behind over the past couple of years and are struggling to catch up with their academic schoolwork. People with AD(h)d often share a poor working memory/processing like that of people with dyslexia and dyspraxia.
• Viruses can trigger a cascade of brain inflammation exacerbating brain fog, short-term memory and processing skills. Research on how Covid 19 affects the brain has highlighted numerous effects of the virus on our neural pathways and many people with Long Covid are experiencing significant brain fog as well as poor short-term memory, word retrieval and focus issues.
• Ultra-Processed Food – the rise in convenience food means our kids are eating more highly refined carbs and less good quality proteins and healthy fats than ever before – sadly fruit and veg tend to be an afterthought. The highly processed foods skew the blood sugars and can really affect the ability to focus and concentrate. This is affecting people from all socio-economic backgrounds, however those with lower incomes are statistically more likely to suffer from greater AD(h)D issues. This isn’t being helped by school food options which have overall become beiger, processed and less healthy over the past couple of years since restrictions were put in place.
• Food Trends – eating less red meat, going dairy-free, and low-fat options are not always the best choice when it comes to raising kids and nourishing their minds. Children (especially teens) need huge amounts of iron, zinc, choline and omega 3 to nourish their brains and it is hard to get these important brainy nutrients if key foods are being cut out.
• And last but not least, the lure of medication could affect how much emphasis is put on specific behaviours.

If you are interested in the connection between nutrition and neuro development – as well as the relationship between the gut microbiome and immune system with brain function, then please join in with the conversation. We all need to be talking about this more!

Further Reading

• Finally Focused by Dr James Greenblatt
• They Are What You Feed Them: How Food Can Improve Your Child’s Behaviour, Learning and Mood by Dr Alexandra Richardson
• Brain Inflamed by Dr Kenneth Bock
• Healing the New Childhood Epidemics: Autism, ADHD, Asthma, and Allergies: The Groundbreaking Program for the 4-A Disorders by Dr Kenneth Bock
• The Psychobiotic Revolution by Scott C. Anderson, John Cryan and Ted Dinan
• Nutrient Power by William Walsh
• The Inflamed Mind by Prof Edward Bullmore
• Smart Foods for ADHD and Brain Health: How Nutrition Influences Cognitive Function, Behaviour and Mood by Rachel V Gow

References

• The nature and nurture of ADHD and its comorbidities: A narrative review on twin studies
• Preeclampsia and Neurodevelopmental Outcomes: Potential Pathogenic Roles for Inflammation and Oxidative Stress?
• Maternal immune activation and neuroinflammation in human neurodevelopmental disorders
• Maternal acute and chronic inflammation in pregnancy is associated with common neurodevelopmental disorders: a systematic review
• Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review
• Could excessive sugar intake contribute to aggressive behaviors, ADHD, bipolar disorder?
• Role of food-derived opioid peptides in the central nervous and gastrointestinal systems
• Omega-3 fatty acids in ADHD and related neurodevelopmental disorders
• Omega-3 fatty acids are inversely related to callous and unemotional traits in adolescent boys with attention deficit hyperactivity disorder
• Omega-3 fatty acids are related to abnormal emotion processing in adolescent boys with attention deficit hyperactivity disorder
• Fatty acid correlates of temperament in adolescent boys with attention deficit hyperactivity disorder
• Resting state electroencephalographic correlates with red cell long-chain fatty acids, memory performance and age in adolescent boys with attention deficit hyperactivity disorder
• Autism spectrum disorders: let’s talk about glucose?
• Cross-sectional investigation of insulin resistance in youths with autism spectrum disorder. Any role for reduced brain glucose metabolism?
• Cerebral glucose metabolism in adults with hyperactivity of childhood onset
• Age-Related Changes in Brain Glucose Metabolism in Adults With Attention-Deficit/ Hyperactivity Disorder and Control Subjects
• Serum zinc, copper, zinc-to-copper ratio, and other essential elements and minerals in children with attention deficit/hyperactivity disorder (ADHD)
• Assessment of Copper and Zinc Levels in Hair and Urine of Children With Attention Deficit Hyperactivity Disorder: A Case-Control Study in Eastern India
• Zinc, ferritin, magnesium and copper in a group of Egyptian children with attention deficit hyperactivity disorder
• Familial co-aggregation of attention-deficit/hyperactivity disorder and autoimmune diseases: a cohort study based on Swedish population-wide registers
• Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis
• Atopic dermatitis: More than just a rash
• Childhood atopic dermatitis as a precursor for developing attention deficit/hyperactivity disorder
• Early childhood infections, antistreptococcal and basal ganglia antibodies in adult ADHD: a preliminary study
• Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy
• Rationale for Dietary Antioxidant Treatment of ADHD
• Antioxidants as a Potential Target against Inflammation and Oxidative Stress in Attention-Deficit/Hyperactivity Disorder
• How COVID-19 Affects the Brain
• Brain imaging before and after COVID-19 in UK Biobank