Our Unique Care

What Makes Us Different From Every Other Doctor You Have Seen?

In this section I will explain the risk factors of ADHD, why medication is not a good long term solution, how we run testing to identify underlying metabolic issues that are damaging your child’s brain, and how imbalances in brain function cause the trademark symptoms of ADHD (poor focus, impulsivity, hyperactivity, anxiety, anger, irritability, etc). I will lay out the way I evaluate and treat your child with ADHD, and why we are the premier clinic serving Arizona for neuro-developmental disorders!

The facts regarding ADHD are staggering:

-Attention deficit hyperactivity disorder (ADHD), also known as attention deficit disorder (ADD) is estimated to effect 1 out of every 6 children in American. It is the most prevalent developmental disorder in the US and prevalence is currently rising at a rate of 3%/year.

- 35% of kids diagnosed with ADHD won’t finish high school
- 52% abuse drugs or alcohol.
- 19% smoke cigarettes (compared to 10% in the general population)
- 43% of ADHD boys will be arrested for a felony by the age of 16.
- Parents of ADHD children divorce three times more often than the general population.

Medications are not a good long term solution!

In 1999 the Multimodal Treatment of Children with ADHD (MTA) was the first
long term (1 year) study that showed that central stimulant medications (ritalin, concerta, etc.) were helpful in ADHD kids. This study was highly publicized!

In 2007 they did a follow-up study (3 years-with the same research team).

What did the LONG TERM STUDY SHOW?

The follow-up study showed that after 36 months of treatment with central stimulants there
were no positive effects whatsoever, contrary to what the research team expected.
It also showed that these central stimulants:
- Decreased children’s growth
- Decreased brain growth
- Increased aggression and anti-social behavior

Not only that but in 1998, Professor Nadine Lambert of University of California, Berkeley performed
a longitudinal study on children with ADHD half of whom were prescribed central stimulants and half of whom were not.

Use of central stimulants for more than 1 year was:
“significantly and pervasively implicated in the uptake of regular smoking, in daily smoking in adulthood, in cocaine dependence, and in lifetime use of cocaine and stimulants.”

What is Going on in Your Child’s Brain?

Typically the ADHD brain is out of balance. In order for us to control our emotions, regulate impulses, and pay attention we need the different areas of the brain to be synchronized like a well trained orchestra. When certain areas of the brain are weak/underdeveloped other areas of the brain begin to over-fire.

The out of sync brain creates the typical symptoms of ADHD:
Loves TV, Videos, computer
Likes sameness, routines, rituals
Often great memory
Normal and often above average intelligence
Poor social skills/poor verbal skills
Tantrums, poor emotional control
Very self-directed, not very passive
Tendency to fidget or stay moving
Tendency to fixate (perseverate)
Often have “sensory” issues

-This is one key piece of my approach that can make a huge different for your child!

I am not here to treat a diagnosis that your child has been labeled with. There is no cookie cutter approach to deal with the unique environmental and genetic history that has brought your child to their current state of health.

I evaluate, identify, and treat the specific areas of your child’s brain that need help…

• We must identify if your child has weakness in the right brain (Hemisphere) vs left brain (Hemisphere)
• When we understand what each side normally does for a child when they are in balance (integrated), we can understand what goes wrong when there is an imbalance (functional disconnection)
more-colorful-picture-of-executive-function

Characteristics of the Right Hemisphere:

• The “brake” pedal of the body
• Withdrawal responses: stop movement, stop thought
• Controls gross motor: posture, big movements (walking, running, jumping)
• Likes Low Frequency Stimulation
• The “Where” part of the brain
• Social learning: how to apply knowledge, social boundaries
• Non-linear, “creative”, “big picture thinker”
• Non-verbal communication: face, eyes, body
• Reading, math comprehension
• Stimulated by novelty, new forms of stimulation
• The “sad” brain

Characteristics of the Left Hemisphere:

• The “gas” pedal
• Approach responses: initiates movement, initiates thought
• Controls fine motor: small movements (penmanship, buttoning a shirt)
• Likes High Frequency Stimulation (TV’s, upbeat music, video games)
• The “What” part of the brain
• Memorization of facts, numbers
• Linear, “detail oriented”
• Verbal fluency
• Likes routines, sameness
• The “happy” brain.

Looking at the list above you may get an idea of which hemisphere of your child’s brain is dominant. You may also see some characteristics on both sides. A good example of why this can happen is illustrated by looking at speech. One thing I often hear from parents is the concern over their child’s verbal communication. As you can see above the language centers of the brain are in the left hemisphere. It is very common for kids that have ADHD to have right brain imbalances. Why would they have problems with verbal communication then? The reason for this is that the right brain leads in development. The right brain is responsible for non-verbal communication so if that fail to develop appropriately it will stunt the development of verbal communication. This is why it is so important to not take a generalized approach to brain therapy in your child. We can thoroughly evaluate what areas of the brain are dysfunctional and target rehab to those areas.

In addition to looking at the hemispheres and the lobes of the brain, we also want to identify the type of ADHD that is present. There are 5 types of ADHD that I look for patterns of in my office. By performing a thorough neurological examination we can identify the specific areas of dysfunction which tells us the pattern of ADHD that the child has. The benefit of identifying these patterns is that there is specific neurotransmitter support (discussed further below) that will be more effective based on the different patterns/locations of dysfunction.
neurofeedback-image
The 5 primary types of ADHD I look for in my office:
(1) Classic ADHD – Poor focus, disorganized, and hyperactivity
- Typical Problemed Areas: Right pre-frontal cortex and cerebellum

(2) Inattentive ADHD – Poor focus, disorganized, low energy, low motivation, (Inattentive ADHD is more common in girls and are at a high risk of going undiagnosed because they don’t get in trouble, but tend to blend in but still struggle).
- Typical Problemed Areas: Left pre-frontal cortex and cerebellum

(3) Over-focused/Anxious ADHD – Poor focus, disorganized, hyperactivity, excessive worrying, gets stuck on negative thoughts, trouble shifting attention, rigid with schedule, holds grudges, needs routine excessively.
- Typical Problemed Areas: Pre-frontal cortex and anterior cingulate (the gear shift of the brain)

(4) Temporal Lobe ADHD – Poor focus, disorganized, hyperactivity, periods of anxiety, headaches, history of head injury, poor memory, rage, anger.
- Typical Problemed Areas: Pre-frontal cortex and temporal lobe

(5) Limbic ADHD – Poor focus, disorganized, sadness, negativity, low energy, low self esteem, poor appetite, poor sleep patterns.
- Typical Problemed Areas: Pre-frontal cortex and limbic escape

By performing a thorough neurological exam and a QEEG (Visit our “neurofeedback” section for more info) we can readily identify the imbalanced areas in your child’s brain and develop a rehab program specific to your child’s brain!

In addition to being able to identify the exact areas of deficit in your child’s brain we also evaluate their metabolic health (their fuel delivery system to the brain).

What Metabolic Testing Needs to be done for ADHD?

The testing needed is different for every patient based on your child’s unique health history, but there are certain areas that must be evaluated. Traditional laboratory testing does not dig deep enough to find the answers you are looking for. They screen for basic metabolic markers and they use a very wide lab range to determine if your child’s labs are normal or not. When we run testing (as discussed below) we are going to dig deeper and we also realize that there is a grey area on the way to disease, meaning that if the normal lab range says the TSH should be less than 5 and the TSH is at 4.8 we know that thyroid is trending towards a disease state. The more comprehensive tests along with a more critical analysis allows us to identify areas of pathology as well as areas that are failing to function as optimally as they should.

The brain and your nervous system require two things to work properly:
#1) Fuel (metabolic factors)
#2) Activation (brain stimulation)

To make sure the fuel supply for your child’s brain is adequate we must ensure that these foundational areas are addressed:

(1) Blood Sugar – If your child is pre-diabetic or hypoglycemic (too low of blood sugar) this will be a roadblock to healing their brain.
(2) Anemia – If any type of anemia is present the brain is being robbed of oxygen!
(3) Vitamin Deficiency/Toxicity – Deficiencies in many vitamins and minerals can drive neurological deficits. At the same time if you are toxic with any of these elements it can also be a problem.
(4) Methylation – Methylation is a chemical process that takes place in your body which allows you to eliminate environmental toxins, reduce inflammation, and get essential nutrients to the brain and the nerves. There are genetic variants that can literally block your nerves and brain from receiving the nutrients that they need to work. It is estimated that 93% of people who suffer from neurological disorders (like Autism Spectrum Disorders, ADHD, etc.) have a genetic defect in MTHFR. This genetic variant can literally be starving your child’s brain!
(5) Auto-Antibodies – In my office I consider neuro-developmental patients to be auto-immune until proven otherwise. Auto-immune diseases are diseases of the immune system where the immune system is attacking your own body! The brain is actually a common target in auto-immune disease. The important thing to understand is that if you are auto-immune the same attack going on against your brain can spread to your thyroid, your pancreas, your digestive system, etc. A common target in auto-immunity is the cerebellum. The cerebellum is responsible for your child’s balance, spinal posture, muscle tone and coordination. If the cerebellum is being damaged it can be a significant road block to frontal lobe development (which is responsible for focus, impulse control, etc.).

If your child is auto-immune the immune system must be stabilized in order for their brain health to be stabilized!

Many practitioners over simplify the idea of auto-immunity. They talk about the immune system like it is a see-saw between what is called the TH1 (natural killer cells) and the TH2 (the B-cells) systems but the truth of it is that the immune system is extremely complex. To work to balance the immune system the TH1, TH2, TH3, TH17, the GALT, and many other chemical interactions need to be evaluated and addressed.

In the case of auto-immunity it becomes extremely important to thoroughly evaluate gut and immune health. Many more of those tests are discussed in the section below.

Other lab testing that may need to be assessed include:

(a) Food Intolerance Testing – Many children with ADHD have poor gut health and have abnormal food reactions. If you are having bad responses to a food you are eating on a daily basis you can be poisoning yourself without even knowing it. Food reactivities are not severe enough that patients can accurately identify if they are present. But when you continually expose yourself to a food that your immune system is reactive to it can trigger rampant inflammation and lead to brain degeneration. The type of testing we run in our office is not a traditional allergy test like what your medical doctor may have tested. The type of test we run is assessing for IgA and IgG food reactivities and can be tested via the saliva, the stool, or the blood. IgA and IgG food reactivities are delayed responses which can make it very difficult to determine what the body is reacting to. This is why thorough testing in this arena is so important.

Common symptoms of food reactivities can be:

- Fatigue after meals – Bloating after meals – Heart burn
- Headaches – Rashes – Inability to lose weight
- Constipation – Eczema/Acne – Increased post nasal drip
- Diarrhea – Mouth ulcers or sores – Chronic pain

(b) Infections – Infections can target the nervous system causing direct damage. They can also mimic the nervous system causing your body to attack the nervous system as if it were an infection. This is an example of how auto-immunity can be developed. Parasites, bacteria, viruses, fungi, and yeast are all examples of infections that can wreak havoc on the body. Most patients I talk to feel like they would know if they had an infection. This is not true. Many times there are low grade infections that don’t make a person acutely ill but do lead to a chronic inflammatory state which gradually weakens the body. We may test for infections with serum testing, stool testing, and/or salivary testing.

(c) Adrenal Stress Profiles – The adrenal glands are the body’s stress glands! This test measures the amount of cortisol being produced by your adrenals at 4 different times throughout the day. This is an important test because cortisol can be ruining your health in many ways. One of the most significant ways I see the adrenals affect children with ADHD is through the release of catecholamines such as nor-epinephrine and epinephrine. When the body is under any type of stress the adrenals release these two chemicals which are adrenaline. If your child is sitting in class with a ramped up sympathetic (stress) nervous system it can be firing up the release of adrenaline. Is this going to cause hyperactivity and impact their ability to sit still? Absolutely!

Other effects of altered cortisol levels:
(1) Weight gain – Elevations in cortisol cause your body to store fat and decrease your ability to burn fat.
(2) Fatigue – Any time your cortisol rhythm dips during the day you will experience energy crashes.
(3) Insomnia – Altered cortisol rhythms causing too high or too low of levels at night lead to interrupted sleep.
(4) Brain Fog/Declining Memory- Cortisol is particularly toxic to an area of the brain called the hippocampus. The hippocampus plays a significant role in memory. Chronic elevations of cortisol are shown to damage this area of the brain and may even lead to conditions like alzheimers!
(5) Food Sensitivities – Elevations in cortisol causes elevations in antibody levels in your gut, which in turn leads to your immune system becoming abnormally reactive to foods.
(6) Hormonal Imbalances – The adrenals play a significant role in the regulation of testosterone, estrogen, and progesterone. When the adrenals are not healthy it can create imbalances in these hormones which can lead to infertility, anxiety, panic attacks, depression, irritability, water retention and weight gain.

(d) Immune Reactivity to Heavy Metals – Many practitioners refer to the need to eliminate heavy metals. There are many technologies to evaluate heavy metal exposure. The truth of the matter is that we live in an extremely toxic world. Everyone has heavy metals in the body. That is not the question. The question that must be asked is, ‘how is your body’s immune system reacting to the different heavy metals?’ Heavy metals can certainly trigger an immune response that can create nerve and brain inflammation and by testing your individual response to each heavy metal we can see what specific metals may be contributing to your migraines.

(f) Immune Reactivity to Environmental toxins – From pesticides, to plastics, to cleaning supplies, we are exposed to toxins on a daily basis. An individuals exposure to the these toxins is not the primary concern. If your immune system becomes hypersensitive to these environmental toxins it can wreak havoc on your body. We can run a comprehensive blood test to assess your individual response to these different toxins and to develop a specialized remediation plan for you.

After running comprehensive lab testing for your child we develop a specific nutritional and dietary support plan to make sure that their brain is getting the fuel it needs to thrive!

We also utilize state of the art brain based rehabilitation to activate and rebalance the areas of the brain that are weak (as stated above). Some of the key brain based therapies we use are listed below.

Brain Based Therapies:

(1) Balance Training: Balance is regulated via 3 systems. The primary centers for balance are the eyes, the vestibular system (inner ear, cerebellum) and the peripheral nerves. The rehabilitation for balance trains the cerebellum of the brain which is a vitally important area for ADHD patients.
(2) Interactive Metronome: This is an assessment and treatment tool used in therapy to improve the neurological processes of motor planning, sequencing and processing. The IM program provides a structured, goal-oriented process that challenges the patient to synchronize a range of hand and foot exercises to a precise computer-generated reference tones heard through headphones. The patient attempts to match the rhythmic beat with repetitive motor actions. A patented auditory-visual guidance system provides immediate feedback measured in milliseconds, and a score is provided.
(3) Eyelights Therapy: These are filtered lenses that help to drown excessive light stimulation which help support patients with sensory issues. These also work to support the stress centers of the brain.
(4) Neurofeedback: It has been well documented that people who suffer neurological problems have abnormal brain waves in certain areas of the brain. Case studies using QEEG “brain maps” have shown that people with ADHD have elevated delta and theta brainwaves, while those who suffer from depression have elevated alpha brainwaves. Those with anxiety will have elevated Beta brainwaves, while those suffering from memory loss usually have decreased theta brainwaves. Training the brain using neurofeedback can change these brainwaves over time, adjusting them into normal, healthy ranges. It can improve alertness, attention, emotional regulation, behavior, cognitive function, and mental flexibility. When the brain moves back into normal ranges, users will often see a reduction in symptoms.
neurofeedback-loop

I have never told a parent in my office that our solution to ADHD is a quick or easy fix. In fact I tell most of the parents that come to our office that they will have to crawl through glass to help their child experience freedom from ADHD.

I want you to imagine your child excelling at school, in friendships, and in the family environment.

Then ask yourself where you see your child if you continue doing what you have been doing.

The one thing that I can assure you of at this point is that I will do everything I can to help your child reach their maximum potential!

The combination of giving the brain the fuel and the activation that it requires gives your child the best chance at experiencing true freedom from ADHD!

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