A real handful

Active, or hyperactive? That is the question directed at countless children over the past few years, fuelling a huge debate in the medical world. Many people hesitate to label a child as hyperactive, since most children are naturally tireless and misbehave at times. But Attention Deficit Hyperactive Disorder (ADHD), or hyperactivity, is considered to be a true disorder, and doctors and specialists have set to work to pinpoint exactly what causes it and how to reduce the effects - with some surprising results.

There are combinations of symptoms that hyperactive children often display, including poor sleep patterns, poor appetite, impulsive behaviour, speech delay, lack of self-control and even self-abuse. Other signs, particularly in infants, include excessive thirst, head banging, spurning of affection and excessive crying and screaming.

Part-time nanny Cliff Harrop, 28, has had plenty of experience dealing with hyperactive and special needs children on a one-to-one basis and as a teacher's assistant at Jack Taylor's School and Gospel Oak School, both in London. He is more than aware of the destructive effects ADHD can have on a child and the strain it places on the child's carer.

'Looking after children with ADHD can be a nightmare at times,' Cliff says.

'You need a lot of patience and it can make you feel extremely helpless.

You can try everything from putting them on your knee and nurturing and talking to them, to being really strict.

'A lot of schools now employ behavioural teachers to help deal with hyperactive children or those who have a turbulent home life or background.

Some see a psychological officer or get one-on-one education, like reading time with teachers.'

But Cliff feels that labelling children is not the right way to go, and has some definite views on what makes certain children behave erratically.

'I think it's too easy to say, right, that child has ADHD,' he explains. 'I feel it's a convenient way of disguising something that's much larger, though I believe it does exist. I can't say exactly what causes it, but in terms of upbringing, I think the sense of community we once had has declined and education is not the biggest priority of the Government any more. All children do these days is watch TV or play with computer games instead of playing outside. They must get so frustrated. The vital skills of how to communicate simply aren't being learned any more. I feel that every child is a potential ADHD if they don't get the attention, love and nurturing they need.'

Whether or not hyperactivity is a knock-on-effect of frustration or poor education has yet to be proven. But one thing for sure is that children's diets, among a few other surprising suspects, play a strong part in enhancing hyperactive symptoms, and some blame them for causing hyperactivity in the first place.

Studies show that children with ADHD are deficient in nutrients, particularly zinc. Zinc is found in foods including raw vegetables, fruit, nuts, meat, eggs, milk and whole grains and is essential for mental and physical development, particularly in maintaining the immune system.

Many hyperactive children also have low levels of essential fatty acids found in nuts, vegetables, linseed oil and oily fish such as salmon, mackerel and sardines. These are fundamental for brain development and function, maintaining cells in the body and turning fats into energy.

Many ADHD children are also found to be deficient in vitamins and to lack other essential elements such as magnesium, iron, copper and calcium.

During studies in October 1992, supported by the Hyperactive Children's Support Group (HACSG), it was revealed that colourings, flavourings, food and drink preservatives, cow's milk and its products, and even chemical detergents and perfumes had all been linked to hyperactivity in children.

For those already diagnosed with ADHD, these were found to enhance the symptoms of the disorder in 60 per cent of the children; they brought about hyperactivity in 12 per cent who were not considered abnormally hyperactive.

A similar study conducted in June 2000 found that chemicals such as solvents, petrol/diesel, artificial sweeteners and chocolate could enhance the symptoms of hyperactivity. The researchers concluded that the increase in artificial sweeteners in beverages, changes in the chemicals used to produce non-leaded petrol and the increase in traffic congestion could all be to blame.

Sally Bunday, founder of the HACSG, believes these aren't the only factors contributing to ADHD. She says, 'Research has shown that hyperactive children have similar histories like allergies in the family or poor appetite, or they were born with the umbilical cord around their neck. We also believe there is a genetic aspect. Many relatives, including parents of hyperactive children, are hyperactive themselves.'

Dr Neil Ward, senior lecturer in analytical chemistry at Surrey University and research director of the HACSG, adds, 'There is a huge area that we just don't know about yet. But there have been studies suggesting that hyperactive children have an early history of antibiotic use which may have suppressed their immune system.'

Treatments currently used to manage the disorder have aroused controversy.

Along with the increase in ADHD diagnoses have come rising prescriptions for Ritalin, a drug that controls the amounts of dopamine and adrenaline released in the brain.

Dr Ward says, 'I believe it's not the treating of the disorder. It's a drug whose effects are quite similar to cocaine and it's a means of keeping the child controlled by suppressing their neurological system. It's widely used in America, even among pre-schoolers, but its long-term effects are not fully understood.'

There are alternatives to drug treatment. 'Complementary therapies can help, and I've seen them work,' says Dr Ward. These include osteopathy, homeopathy and acupuncture. Osteopathy is used to treat the muscles and skeletal system and relieve headaches, dizziness and lack of concentration.

Homeopathy focuses on introducing a minuscule amount of whatever toxin is causing the symptoms and allowing the child to build up a resistance to it over time. Acupuncture involves using needles to rebalance the flow of energy to all parts of the body.

Recently, omega-3 fish oils have been in spotlight as a remedy for ADHD symptoms, administered to children in capsules and supplements or consumed naturally in fish.

But nannies or anyone caring for a hyperactive child will already be more than aware that there are no miracle cures. However, certain steps can be taken to help manage the symptoms and make life easier for not only the child, but the carer.

Perhaps the most important is keeping a weekly diary of what the child eats and drinks. Dr Ward says, 'The most common foods targeted for elimination are dairy products, sugar, wheat, eggs and chocolate and salicylate-foods such as apples, cherries, grapes, berries, tomatoes and oranges. Not all (hyperactive) children are sensitive to one or more of these foods. In some cases it may be the addition of artificial chemicals to the food that is related to their behavioural effects.'

He adds, 'Some studies have suggested that a combination of sugar-restricted and high-protein diet can have a positive effect.'

Other tips to help you and the child deal with ADHD together include:

* Finding out everything you can about ADHD to understand the source of their behaviour. This will make you more sympathetic and tolerant when you realise the child's actions are not deliberate.

* Imposing structure and routine in the child's daily life, where they can feel secure. Include rules, limits and expectations, and make the child aware of the positive and negative consequences of their actions.

* Intervening as soon as the child becomes overstimulated or frustrated, and removing them from the situation. Remind the child of the consequences of their actions.

* Encouraging the child to share their feelings with you, talking about issues and problems in a calm and patient manner.

* Teaching the child controlled deep-breathing exercises to help relax muscles and reduce stress.

* Playing classical music. Many people find it helps them focus, relax and think creatively.

* Going for a walk or swimming together to relieve excess energy.

* Creating an environment at the child's home free from clutter and the distractions of television and computers, to avoid sensory overload. Keep the curtains open to allow natural light into the room.

This advice was taken from www.promoms.org/articles/insight and www.familyeducation.com/ article/0,1120,23-24394,00.

For more information, contact the Hyperactive Children's Support Group on 01243 551 313.