Is Hyperactivity Normal?
Have you ever wondered whether the constant fidgeting of modern children is normal? I have talked to teachers who started their careers many years ago. They have told me that it was unusual, if not rare, to have a hyperactive, non-compliant child in their class. Today, these teachers have many in their class that are troublesome in this way. This has become so widespread that it has come to be regarded as a normal phenomenon in these children. If you go into their private lives, as I did as a pediatrician, you will find that they have diverse sleep problems, temper tantrums and constant fiddling with things that adorn the house. They make the lives of their parents very stressful who often accept that this is normal parenthood to be born philosophically.
Sometimes, parents do not accept this as normal activity and take their child to a pediatrician. Unfortunately, if attention in school is the major phenomenon, it is classified as Attention Deficit Disorder (ADD). If it is associated with hyperactivity, it is classified as Attention Deficit Hyperactivity Disorder (ADHD). I use the word “unfortunately” because they seem to be regarded as separate disease entities rather than “variations on a symphonic theme”. If the pediatrician considers it to be relatively mild, and particularly if laboratory tests are normal, the parents may be accused of lax discipline. On the other hand, if the parents are obviously deeply disturbed by the severity of the child’s behavior, medication is prescribed. This often makes the situation even worse.
From the Difficult Pregnancy, Childhood Infections to ADHD
A typical history for one of the children recognized as having ADHD is as follows. Hyperemesis (excessive vomiting) or toxemia in the mother during pregnancy and other pregnancy complications are often recorded. At birth, the Apgar score may be abnormal and there may be a history of jaundice, (now known to be due to inefficient oxidation) leading to treatment by exposure to ultra violet light. During the next few months, the infant seems to be unusually irritable, suffering from behavior referred to as “colic”, sudden awaking out of sleep and repeated episodes of crying. Later on, repeated ear infections become almost a way of life. Each is treated with antibiotics and the parents often become quite desperate in looking for some kind of treatment that will prevent them. During the preschool years, the fidgeting and constant movement is merely accepted as normal. They only become troublesome as the child starts to go to school.
As a pediatrician in a multi-specialty clinic, I saw a great many of these children. They were often referred by other pediatricians as “emotional” problems. Such problems are still considered by many physicians as psychological due to poor parenting. It was expected that they would be dealt with by cooperation with a psychologist and/or the prescription of an appropriate medication. Often, if the birth had been difficult, the obstetrician might be blamed and the behavior considered due to brain damage. It was the incidence of problems of this nature that arrested my attention and I found little or no evidence of poor parenting. Quite naturally the parents were often distraught due to the recurrence of infections and their multiple visits to the pediatrician.
Unusual Clinical Characteristics of the ADHD Child
My physical examination revealed many unusual observations and I will give a typical description. The child would have bright red cheeks and a zone of pallor around the mouth. The tongue would be covered with red spots which I later learned to be due to inflammation of small projections on the tongue known as filiform papillae. It was often difficult to look at the child’s throat because the gag reflex could be induced by a tongue depressor without even touching the tongue. The knee reflexes would be either highly excitable or nonreactive. It was almost always possible to produce a line of blanching on the legs by stroking the skin with the tip of a finger. Finally, the blood pressure, not usually measured in small children, was abnormal. The upper (systolic) pressure could be as high as 120 or 130 and the lower one (diastolic) would be as low as zero. A normal blood pressure of a child in this age bracket would be 90/60. The heart would be much faster than usual. By placing my stethoscope over the groin I would be able to hear the blood coursing through the femoral artery, the major artery to the leg.
Connecting the Dots: Diet, Thiamine and ADHD
You might be surprised to hear that these physical findings are those that would be found in a child with the vitamin B1 (thiamine) deficiency disease beriberi, naturally turning my attention to the question of diet. Could both the physical and mental defects in these children be explained on the basis of deficiency of a vitamin?
I came across a book with the title “Thiamine and Beriberi” it was written by a group of university-based Japanese scientists. Beriberi had existed in Eastern countries for thousands of years and the discovery that thiamine deficiency was its cause was extremely dramatic and affected the lives of millions. I read it and reread it and became acquainted with the characteristics of the disease. The clinical effects are different in infants, children and adults and it was clear to me that what I had observed in these “emotionally disturbed” children could be explained on this basis. How could such a devastating disease associated with malnutrition affect children in America? Wasn’t this a disease that occurred in poor countries? Wasn’t this associated with poverty?
The answer had come from research done in Cambridge, England and reported in 1936. Sir Rudolph Peters had found that there was no difference in the behavior of brain cells from thiamine deficient pigeons compared with those that were thiamine sufficient until glucose was added to the preparation. There was no activity at all from the thiamine deficient cells, whereas the thiamine sufficient cells immediately began to produce carbon dioxide, showing that they were active. Peters called this effect by a scientific nomenclature (catatorulin). This important observation was the beginning of the research that led to our modern knowledge of how cells produce the energy that enable them to function.
What this means is that if you take sugar in a state of marginal thiamine deficiency, you precipitate the symptoms of beriberi. It is very likely that the mother demonstrated her thiamine deficiency during pregnancy by suffering from hyperemesis and toxemia, thereby passing on a deficiency to her infant long before birth. The ad lib. ingestion of sugar in its many different forms is virtually a way of life in America. By our desire to please the children we love, are we in fact creating the common disasters of childhood by our permissive attitude towards their consumption of sweets? Are we inducing the seeds of addiction in the first years of life? Are we inducing ADHD?
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