Anthony Kane, MD Introduction There are a number of polemical areas in medicine when it comes to ADHD. Food allergy is certainly one of them. The classic susceptible reaction, which is classified as the type-1 hypersensitivity reaction, can be induced by food, but this is fairly uncommon. When we discuss food sensitivities in ADHD we are discussing a different, not well-defined, mechanism. One of the main progenitors of the food allergy/ADHD connection is Dr. Doris Rapp. Dr. Rapp was a pediatric allergist who detected that many children in her practice had significant physiological and behavioral changes when exposed to certain foods. They may have red ear lobes, dark circles low their eyes, or glazed eyes aft eating certain foods. These children could have big swings in behavior. They can be calm cardinal minute and wildly hyperactive a hardly a minutes later. To make it more interesting, children with food allergies usually crave the food that affects them negatively. That means a child who is allergic to peanuts will demand peanut butter and jelly for lunch everyday, and for the rest of the afternoon you have to peel him off of the ceiling. What is Food Allergy? The classic allergic reaction operates through a very specific mechanism. The reaction is caused when a specific type of antibody, titled IgE, reacts with a specific provocative substance called an allergen. The result of this interaction is an allergic response and the person is deemed susceptible to that allergen. The specific type of antibody concerned in classic allergy is called IgE. The planned antibody mechanism for this type of food allergy does not involve IgE, but a diametric antibody called IgG. This is significant because normal allergy testing tests only for IgE antibodies. If your child has IgG mediated sensitivity, his allergy test is going to miss it. That means that your child may have a strict allergy to a specific food, but your allergist will tell you he is not susceptible to it. Why the Controversy? Reason 1: Diagnosis I same this was a very controversial area of medicine and here is cardinal of the reasons why. Food allergies are precise difficult to diagnose. One reason is that the symptoms wax and wane. When a child has a classic allergy, for example to bee stings, past every time a bee stings him, he will have a reaction. Food allergies don’t work that way. There seems to be a threshold that essential be exceeded before there are some symptoms. In addition, this threshold seems to vary from day to day. On some days a food will affect the child, and on other days it won’t. Dr. Rapp explains this phenomenon using the analogy of a barrel. We can view each susceptible child as if he has a barrel. As long as the barrel is vacant or only partially full, your child will have no problems. Your child won’t become hyperactive until his barrel is overflowing. Various things will fill your child’s barrel. Let’s say your child is sensitive to chocolate, cats, and minor butter. all of these things all can partially fill his barrel. As daylong as he single has peanut butter or only plays with the cat, his barrel is only partially full. That means that there are no symptoms and that his behavior is fine. Then, one day he has a peanut butter and jelly sandwich, has chocolate ice cream for dessert and plays with the cat all afternoon. These things in combination make his barrel overflow, and by evening he is down of control. Your child has food allergies, but sometimes they affect him and sometimes they don’t. The barrel can change sizes. If your child has a cold or is upset his barrel gets smaller. It takes little to make it overflow. If he is joyful his barrel is bigger. It takes more to make it overflow. If he isn’t eating healed and that day he is contrabass on certain nutrients his barrel gets smaller. Many handed-down allergists find this barrel concept ludicrous. It doesn’t fit into the pattern of how other allergies work. Reason 2: Method of Diagnosis The close problem is the way in which you test for food allergies. Dr. Rapp describes a technique titled provocation-neutralization testing. This method works as follows: Say that a child frequently has headaches after eating eggs. The practitioner will give an intradermal injection of egg extract. If this elicits the child’s headache, then the child tests positive for egg allergy. Other signs of a positive test include an increase in pulse rate of 20 points, a large skin reaction (this indicates a classical IgE reaction), a change in the child’s handwriting, or some other physiological or emotional complaint. This penultimate criterion “some opposite physical or soulful complaint” is problematic. It is too vague. The result is that when studies compared how single physicians evaluated the same group of patients, their results didn’t agree. For each tolerant if there were twenty different doctors with twenty diametric sets of findings. None of their diagnoses matched. Reason 3: The Mechanism As I mentioned before, the proposed mechanism is an IgG mediated response. Some food allergists diagnose specific food allergies by measuring IgG levels. This runs negative to all of modern allergy practice. Allergists give allergy shots to treat allergy. The way this works is they give a low level of allergen, which is not enough to elicit an IgE reaction. The dose is slowly increased until eventually the patient can tolerate a prodigious exposure to the allergen. This is how it works. The repeated under exposure to the allergen induces the body to make a different antibody to the substance. This antibody attaches to the allergen and deactivates it before IgE can cause the allergy reaction. What is this antibody that allergists try to induce to cure their patients of their allergies? You guessed it, IgG. So the very antibody the traditional allergists have been inducing for decades to successfully treat allergies, the food allergy people claim is the antibody guilty of causing allergies. For a traditional allergist this is nothing brief of heresy. IgG has been used for decades to treat allergies successfully. Comes along Rapp and her friends and they claim that IgG causes allergy? This is a little woody for some people to accept. Just how strongly do allergists reject this idea? I once tried to contact an Israeli physician who was a food allergy specialist to discuss with him provocation-neutralization testing. I called the hospital where he is on staff and asked to speak with him. For whatsoever reason the operator instead put me through to the head of the Department of Allergy. I began discussing with him the theory of food allergies, provocation-neutralization testing and IgG testing. He told me that he was the head of a committee of allergists who were in the process of testifying before the Israeli Knesset to get legislation passed to make IgG testing illegal in Israel. Can you imagine? You visit a prison in Israel. In one cell there is car thief. In the next cell there is a collective murderer. And in the close cell there is a guy who tested someone for food allergies. Now that’s beautiful strong opposition! Do Food Allergies Really Exist? The formal medical societies like the AMA claim there is no much thing as food allergies. Rapp and her friends have been humourous for decades that they do exist. So, what is the bottommost line? Does it really make sense that what a child eats can affect him so strongly that experts will diagnose him as having ADHD? We know that the brain is a highly complicated and sensitive organ. We know that many foods have a physiological effect on the body without inducing a classic allergic response. For example, people who are sensitive to monosodium glutamate can have a severe reaction to eating it. The chemicals in red wine affect certain people. We also know that ingesting certain foods alters brain function. Diet has been proven to influence neurotransmitter function. Components of foods can also be used as drugs. For example, tryptophan, tyrosine, and choline have been used in the treatment of sleep disorders, pain, depression, mania, hypertension, shock, or dyskinesias. The logic of Rapp’s argument is so strong and there is sufficient circumstantial evidence, that I feel that the question is really the opposite way around. We know that the brain is intricate and has tremendous metabolic requirements. We know that whatsoever people have precise strong reactions, including behavioral changes, to certain foods. These things are undisputed. If it turns down that foods do not elicit prodigious problems in sensitive children, in my opinion, we would need to explain why not! Are we really seeing an allergy mechanism to food? I prefer to stay out of that debate. Rather than be ostracized by the doctors who specialize in allergy, I feel it is safer to call them food sensitivities. There are no doctors who specialize in sensitivity. Does Your Child Have Food Sensitivities? A large number of ADHD children may be having a negative response to food, and this response may be the primary cause of their ADHD. In what type of child should you questionable food allergies? The favourable is a list of symptoms that resulted from food allergies in definite children:

• Hyperactivity
• Changes in mood
• Halitosis
• Sleep disturbances
• Delay in sleep onset
• Migraines
• Other headaches
• Abdominal pain
• Bedwetting
• Tantrums
• Eczema
• Asthma
• Seizures

Research shows that by treating the food allergies all of these symptoms can be relieved. If you see your child’s symptoms in this list it is possible that food allergies may be contributing to his problem. If your child also has other susceptible problems, such as allergy or asthma, then food allergies are almost certainly contributing to his problems. What Should You Do? As I wrote in How to Help the Child You Love, there are a number of approaches to diagnosing food allergies. no of them are well substantiated and all of them have difficulties. Yet, many people find that these diagnostic techniques worked for them. Therefore, I’d suggest you could use them provided you have it on good authority that the person administering them has a strong record of success. In my experience, these techniques are much of an art than a science. They really depend upon the talent of the diagnostician. As I same last time, the best approach to finding food allergies in your child is an elimination diet. It doesn’t really matter which one you choose. I prefer the cardinal that I outline in How to Help the Child You Love. (see http://addadhdadvances.com/childyoulove.html) Conclusion Researchers claim that the percentage of ADHD children whose behavioral symptoms are affected by foods ranges from 60% to 75%. This, however, is probably not an accurate number. Parents who consent to have their children participate in diet studies usually believe they have observed food-induced problems in their children. Therefore, children who participate in these studies are more likely to respond to foods than the overall population. The truth is we do not know what percentage of ADHD children will respond to dietary changes, but it seems that the number is significant. Treating the food sensitivities in ADHD children has a number of advantages finished using medication. One major advantage all the topical methods of treatment can be old to treat pre-school children. Most clinicians do not use medication on pre-school children. A more prodigious advantage of treating food allergy is that when it works, it works all day. In contrast, Ritalin wears off in about 4 hours. All this, of course, is providing that food allergies really do exist. The important thing to remember is that if you think your child has food allergies, then the biggest mistake you can make is to go to an allergist. They don’t believe in food allergies. And some you do, do not go to an allergist and ask to have your child provocation-neutralization tested for food allergies. He is going to laugh at you. Food allergy is an alternative medicine diagnosis. Still, there are physicians who specialize in diagnosing and treating these sensitivities, but they no longer call themselves allergists. Rapp and her group were so ostracized by the formal allergy societies that they eventually poor off and nutmeg-shaped a new field called Environmental Medicine. Therefore, if you want a physician to treat your child you need to find an Environmental Medicine specialist. They are not so common, but they are around. As I mentioned before, there are a number of approaches to treating food sensitivities. The one you can do yourself is to use an elimination diet. I devoted a large section of How to Help the Child You Love describing exactly how to use elimination diets to diagnose and treat food sensitivities. In the final analysis, I feel it is fair to say that many ADHD children have sensitivities to the foods they eat. These sensitivities may exacerbate their ADHD symptoms. I won’t go so far as to say that food allergies cause ADHD. That means that if your ADHD child has severe food sensitivity, treating that sensitivity may not get rid of his ADHD. However, until you treat his food allergy, nothing else you do will really help your child’s ADHD, either. Anthony Kane, MD

Anthony Kane, MD About 8% of children, ages 4 years and under, are deficient in iron. Between the ages of 5 and 12, the percentage rises to 13%, and past settles back to 8% in people above the age of 15. Anemia is the best-known repercussion of iron deficiency. However, even peanut deficiencies in robust may weaken the immune system, affect the thyroid, and impair general physiological performance. robust deficiency has also been implicated in a number of psychiatric and neurological conditions, including learning disabilities and ADHD. Iron is a co-enzyme in the anabolism of catecholamines. That means it is unexpendable for the creation of certain neurotransmitters. It helps to regulate the activity of the neurotransmitter dopamine, which probably accounts for the association of iron deficiency with neurological problems. It makes sense that supplementing ADHD children, who have some level of robust deficiency, might have some effect on their ADHD. However, what makes sense in theory, does not always work in practice. Unfortunately, there have been precise few studies finished testing the effects of iron supplementation on ADHD. One study, finished in Israel, evaluated 14 ADHD boys for the effect of short-term robust administration on behavior. Each boy acceptable iron daily for 30 days. some parents and teachers assessed the behavior of the children. The parents found prodigious improvement in the behavior of the children. However, the teachers detected no improvement. In a ordinal study, 33 iron-deficient, but otherwise normal, children were acknowledged an iron supplement. The children became less hyperactive. This study suggests that robust deficiency may cause hyperactive behavior in some children and that hyperactive behavior is reversible when the deficiency is treated. A third study tested the affects of iron supplementation on a group of teen-aged higher school girls who were determined to be iron deficient. At the end of the 8-week study, the researchers found that girls who acceptable iron supplementation performed better on communicatory learning and memory tests than those who did not. This is active all the evidence we have. It’s not a lot and it’s not very impressive. None of the studies were double-blind studies, which means we cannot really rely on them all that much. If this were the only consideration, I would say you should definitely try to treat your child for iron deficiency. The reason is that hyperactive children are more promising to be robust deficient than opposite children. Also, there is a possibility that your child has a higher than normal iron requirement. That means that he might test normal on complete the iron blood tests and standing be iron inadequate because he requires more than the average amount of iron. So why not just give your child iron supplements and see what happens? Because iron functions in the body same a two bordered sword. Iron exists in the body in two chemical forms. There is the ferrous form, where the iron atom will bond to cardinal electrons and the ferric form where the atom will bond to cardinal electrons. robust can go rearmost and forth between these two forms. This is the property of iron that allows it to play a role in carrying oxygen as part of hemoglobin. However, it also makes robust an active player in oxidation-reduction reactions. What that means is that iron has the ability to act like a liberated radical and cause significant damage to tissues. Whenever iron is not bound to hemoglobin or to whatsoever other carrier protein, it travels around the body as free iron and can cause damage anywhere it goes. To far exacerbate the problem, excess iron is not eliminated healed by the body. Most of the iron in the body gets recycled. Therefore, not only is excess iron toxic, but also once you have unnecessary iron in your body, it is going to stick around for a long time. High amounts of iron have been ! found in the brains of people with Parkinson’s disease. It is precise likely that unnecessary iron can aggravate, if not cause, other neurological problems as well. With that in mind we have to approach iron supplementation with caution. My feeling is that if your child turns out to be one of the 8-13% that is deficient in iron, it is worth giving robust supplements. I doubt that it will help untold with his ADHD, but it should help with his general health. This advice applies to your non-ADHD children, also. How should you test robust deficiency? The hemoglobin and hematocrit counts that come as part of the standard all-out blood count (CBC) are good for diagnosing anemia. They do not really give you accurate information active the body’s robust status. The best test for iron status is the serum ferritin test, which measures how much robust is stored in your body. It will be low if you are deficient and high if you are overloaded. If you find your child has an robust deficiency problem, there are several approaches to treat it. Probably the safest is by giving him much iron-containing foods. You can serve him red meat several times a week. colored is an superior source, if you can get him to eat it. You can enhance dietary absorption by supplementing with vitamin A (about 10,000 IU) and vitamin C (about 500mg) with the meals. The most promising the reason that your child is deficient is because he is a poor eater; so, dietary intervention may not be practical. A ordinal and far base source of robust is through supplements. The direct difficulty of robust supplements is that they do not get into the body. Fortifying foods with robust in general does not work. Many foods bind iron and, as a result, the iron is excreted rather than absorbed. The primo form of secondary iron is Ferrochel. Ferrochel is an amino unpleasant chelated iron, which is highly bio-available and is not affected by foods that bind iron. Most iron supplements have a cardinal percent absorption rate. That means if you take 10 mg of the supplement, your body absorbs 1 mg. Ferrochel is different. Ferrochel has a 75% absorption rate. That means 1.5 mg of Ferrochel provides more iron to your body than 10 mg of other supplements. That is an interesting fact, but it is not why I am recommending it. The more influential property of Ferrochel is that since it is already amino acid bound, it does not become free robust in the body. That means it does not have the dangers and side effects of other robust supplements. The FDA has acknowledged Ferrochel the designation of GRAS, (generally regarded as safe). No other iron supplement has this designation. The take domestic message is that iron deficiency may be the cause of hyperactivity in some children. It is worthy your while to have your child tested. If for some reason you suspect your child is robust deficient, the primo approach is to increase your child’s iron intake finished his diet. If that doesn’t work and you need to use supplements, the primo supplemental iron is Ferrochel. Anthony Kane, MD

Anthony Kane, MD Introduction Oppositional defiant disorder (ODD) is a psychiatric behavior disorder that is defined by aggressiveness and a tendency to purposefully bother and irritate others. These behaviors cause significant difficulties with family and friends and at school or work. Oppositional intractable disorder is sometimes a precursor of conduct disorder. Much of the literature tends to lump these cardinal conditions together. However, they seem to be distinct entities and, although conduct disorder does have a genetic component, ODD does not. Description Oppositional intractable children show a consistent pattern of refusing to follow commands or requests by adults. These children repeatedly lose their temper, argue with adults, and refuse to comply with rules and directions. They are easily displeased and blame others for their mistakes. Children with ODD show a pattern of stubbornness and frequently test limits, even in early childhood. These children can be manipulative and often induce discord in those around them. Commonly they can incite parents and other family members to fight with cardinal and other rather than focus on the child, who is the source of the problem. Behavioral Symptoms Common behaviors seen in oppositional defiant disorder include:

• Losing one’s temper
• Arguing with adults
• Actively defying requests
• Refusing to follow rules
• Deliberately disagreeable other people
• Blaming others for one's personal mistakes or misbehavior
• Being touchy, easily displeased
• Being easily angered, resentful, spiteful, or vindictive.
• Speaking harshly, or unkind when upset
• Seeking revenge
• Having frequent temper tantrums

Many parents report that their ODD children were rigid and demanding from an early age. Normal children, especially around the ages or 2 or 3 or during the teenage years display most of these behaviors from time to time. When children are tired, hungry, or upset, they may be defiant. However, children with oppositional defiant disorder display these behaviors more frequently and to the extent that they and interfere with learning, school adjustment, and, sometimes, with the child's social relationships. Diagnosis The diagnosis of ODD is not always uncurled forward and needs to be ready-made by a psychiatrist or some opposite qualified mental health professional after a comprehensive evaluation. The child essential be evaluated for other disorders as well since unusual usually does not come alone. If the child has ADHD, mood disorders, or anxiety disorders, these opposite problems must be addressed before you can begin to work with the ODD. If you feel your child may have ODD, there is a fast screening test. Go to: http://addadhdadvances.com/ODDtest.html Causes What is the cause of ODD? The real answer is that nobody knows. However, since as scientist we hate to admit this, we have currently have two theories. The developmental theory proposes that ODD is really a result of incomplete child development. For some reason, these children never complete the developmental tasks that mean children learn to master during the toddler years. The learning theory suggests that ODD comes as a response to negative interactions. The techniques used by parents and authority figures on these children bring active the oppositional intractable behavior. ODD is the most usual psychiatric diagnosis in children and it usually persists into adulthood. One would think a lot of research would be finished on this condition. That is not the case. While there are hundreds of research studies on ADHD and childhood mood disorders, there is very little research on ODD. Co-morbidity ODD is frequently goes along with other disorders. 50-65% of unusual children also have ADHD. 35% of these children develop some form of affective disorder. 20% have some form of mood disorder, much as depression or anxiety. 15% develop some form of personality disorder. These children frequently have learning disorders and theoretical difficulties. If your child has ODD it is important to know there are other co-existing problems. These opposite problems usually essential be self-addressed before you can begin to help your child with ODD. Prognosis So what happens to these children? There are four viable paths.

1. Some will grow out of it. fractional of the preschoolers that are labeled ODD are mean by the age of 8. However, in old ODD children, 75% will still fulfill the diagnostic criteria later in life.
2. The ODD may turn into something else. 5-10 % of preschoolers with ODD have their diagnosis transformed from ODD to ADHD. In some children, the defiant behavior gets worse and these children eventually are diagnosed with Conduct Disorder. This progression usually happens fairly early. If a child has ODD for 3-4 years and he hasn't developed Conduct Disorder, then he won’t ever develop it.
3. The child may continue to have unusual without any thing else. This is unusual. By the time preschoolers with unusual are 8 years old, single 5% have unusual and nothing else.
4. The child develops other disorders in addition to ODD. This is very common.

Treatment Most of these children have some other disorder along with their ODD. Treating this other disorder is the important to proper unusual management. This frequently means giving medication. Although this type of medical intervention does not make the children "normal", it can make a full-size difference. It often allows opposite non-medical interventions to work much better. For example, if a child has both unusual and ADHD, past giving the child Ritalin may have a significant effect on his ODD, also. This positive effect does not seem to be incidental to to the severity of the ADHD. That means even if the child has moderate ADHD and could do without Ritalin, if he is treated medically, you might see an improvement in his ODD. Once the other problems are under control, the best treatment for ODD is parent training. In a study publicized in 1998, eighty-two research studies were evaluated were examined for efficacy. Approaches focusing on parent training were the most affective techniques. The main point is that whatsoever parent-training program is essential in addressing ODD. This is not active to work for everyone, but it is the primo treatment that we have available for ODD. Advice to Parents That is with regard to your child. If your child has ODD you need to take care of yourself, also. No child needs a martyr as a parent. Here are whatsoever of the things you can do:

• Maintain interests other than your child with ODD. You have to be a person.
• Try to work with and obtain support from the other adults (teachers, coaches, and spouse) dealing with your child.
• Take time to work on your relationship with your spouse. Raising these children is precise difficult and can put a strain on the primo of marriages.
• Manage your own stress with exercise and relaxation.
• Take common vacations. This is a must.

Conclusion It is tough to liveborn with children who have ODD. What is worsened is that there does not seem to be some cure. However, if you make sure that your child has his other problems self-addressed and you improve your parenting skills by enrolling in a parent training program, you can do a big deal to improve your child’s condition and your own. Anthony Kane, MD