ADHD: A case of over diagnosis? | Dr. David A. Sousa |TEDxASB

Dr. David A. Sousa is an international consultant in educational neuroscience and author of more than a dozen books that suggest ways that educators and parents can translate current brain research into strategies for improving learning.

This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at http://ted.com/tedx

Madeleine Heide: Hello, good evening.
I'm Madeleine Maceda Heide,

I'm the assistant superintendent
for the American School of Bombay.

We're so fortunate to have
Dr David Sousa with us tonight.

As a consultant
in educational neuroscience,

working with educators in schools
all around the world,

and having writen 16 books
and dozens of articles,

Dr Sousa is highly knowledgeable
about how current research on the brain

can be used to form strategies
for improving learning.

Dr Sousa started out
with a bachelor's degree in chemistry

from Massachussets State College

and then he got a master of arts
teaching degree in science

from Harvard University
and a doctorate from Rutgers.

He taught high school science,
was a K-12 director of science,

a supervisor of instruction
and a district superintendent

in New Jersey.

He's also been an adjunct professor
of education at Seaton Hall University

and a visiting lecturer
at Rutgers University

and a past president of the National
Staff Development Council.

Tonight, Dr Sousa is here to speak
with us about the topic of ADHD,

or attention deficit
hyperactivity disorder;

a condition that affects
many children around the world

and is often un-diagnosed,
misdiagnosed, and over-diagnosed.

For parents and educators, ADHD poses
complex questions of how best to serve

students who have ADHD
within our existing systems.

I'm delighted to present
such a knowledgeable, incredible educator,

to enlighten us
about this important topic.

Please, welcome Dr. David Sousa.

(Applause)

David Sousa: I'd like to talk to you

about a topic that has concerned me
greatly in the last few years.

We know that there's a condition

known as attention deficit
hyperactivity disorder;

probably a genetic condition
that's a spectral disorder,

from very mild to extreme.

People with mild form of ADHD
probably don't even know they have it

or they've adapted to it very easily.

Those with more severe forms of it
do have trouble concentrating

and attention, of course,
is very important

if you want to learn something.

Most learning occurs when we are focused
on what we're trying to learn.

So, attention is a major contributor
to our ability to learn.

What I'm concerned about is the idea

that everytime a student is misbehaving

or not paying attention,
that maybe something is wrong with him.

Now, don't get me wrong.

Any person who has the legitimate disease,

who really is diagnosed as having
the condition known as ADHD,

should definitely get the medical
and other types of therapy

that are available for those people.

What I'm concerned about is the idea
that we jump too quickly to the conclusion

that a misbehaving student
or a student who's not focused,

or students doing something else

while we expect them
to do the task at hand,

may have the disorder.

So, I'm going to talk you about

ways in which kids can behave
as though they have ADHD,

but not have it.

And I worry that we don't give
enough attention to that.

We're too quick to jump to the idea
that lack of attention is a disorder.

Attention is very important;

not paying attention
can get you in trouble

if you're not reading the signs.

But attention is also critical
for being able to acquire information

and to learn skills.

A lot of this work has been done
for over the past 20 years,

looking at what are the cerebral systems
that make up attention.

One of the things we've come
to the conclusion

is that there are three systems involved

in the attention apparatus of our brain.

The first system is what we call
the alerting system.

This is where our brain
perceives something in the environment,

some signal in the environment
that lets us know

that there's something
we ought to pay attention to.

Remember, the brain's main job
is to keep us alive.

And so when there's something
in the environment that's unexpected,

the brain has to assess it to decide
whether or not it's going to be a threat

to our existence.

So, alerting signals are very important.

The next thing we try to do is say,

"Look, turn towards the source
of that information, that unusual input

to see whether or not it's a threat."

And then, after we see what's going on,

we have to make a decision on what to do.

A simple example would be
if you're walking through the park

and all of a sudden
you hear a rustle in the bushes.

Well, that's the alerting signal.

And then you turn toward that noise
to see whether or not

the cause of is going to be a problem.

And if a rabbit jumps up,

then we make the decision,
"this is not a threat," and we move on.

On the other hand, if that happens
to be a snake that pops up,

then, of course,
the decision is quite different,

which is to get away from that
as quickly as possible.

Now, with these three systems
necessary to receive information,

to orient toward it and to make
a decision about what to do,

things can go wrong here and there.

Some of these things that can go wrong
have genetic predispositions for them.

But there are also other things
that can cause a distraction;

that can cause us to look like
we're not paying attention

when we don't really have
a medical disorder.

So, let me to take a few minutes
to talk about that.

I guess the reason
I'm really concerned about this

is the incredible increase
in the number of children

who have been diagnosed with ADHD,
medically diagnosed with ADHD.

Now, this information comes

from the Center for Disease Control
in the United States.

And as you can see, in 2003,
roughly eight percent of school children,

or children between the ages
of four and 17 were diagnosed,

medically diagnosed with ADHD.

That number, just four years later,
jumped to nine and a half percent.

But one thing we have to remember

is that this is voluntary reporting
to the Center for Disease Control,

and there are researchers out there

who believe that a lot
of the medically diagnosed individuals

were not being reported.

And so, in 2010, they got together
and they called and contacted

over 1000 medical practitioners
around the country, and asked them

how many referrals they made
for medical diagnosis of ADHD.

And their results were quite surprising.

By the way, in 2007,
that number reached five,

almost five and a half million children
diagnosed with ADHD.

When they did that study in 2010,
the number was quite different;

almost 18 percent,
almost one out of five children

were being diagnosed with this disorder.

And that translates
to almost 10.5 million children.

Well, why is this? What's going on here?

Look at this almost exponential leap
in just seven years,

from seven and a half percent
to more than double, at 18 percent.

Are we getting better at diagnosing it,

or is there something else
in the environment

that's prompting this behavior,
that's causing it to come forth

and asking us to take a look at it
and say, "Yep, that's ADHD?"

I don't think so.

I think what's happening here

is that we're too quick to jump
at that notion that it's ADHD,

without looking at other possibilities.

And so, let's take a look at what
some of those possibilities are.

What kind of behavior?

What kind of conditions
could produce ADHD-like behavior

when, in fact, the person
does not have ADHD?

Diet: let's take a look at diet first.

And one of our biggest things
to consider here is caffeine.

Caffeine is a stumulant,
we know it's a brain stumulant,

there have been studies that show

that participants who take some caffeine
shortly before cognitive tasks

will do better that those who don't.

It's not a long term effect,
but it is an effect

in improving cognitive processing.

Now, the recommended maximum dose
of caffeine for adolescents

is about 85mg a day.

That's maximum dose.

Now, take a look at a cup or coffee

and that will have somewhere
between 90 and 100mg

depending on how it's brewed.

Now, if 85mg, as what we say
is the maximum amount for adolescents,

let's take a look at some of the things
that adolescents put in their bodies.

And these may look familiar to you.

In fact, if you walk
around school grounds,

you see cans of these things
on the ground, empty cans of them.

And now let me show you
how much caffeine they have.

And by the way, this is for eight ounces.

Many of those are products
that are sold in 12 ounce cans,

which means it's 50 per cent more
than the amounts you see there.

So, what happens is when you get
too much caffeine in your body,

if you've ever had too much
caffeinated beverages

such as coffee or too much tea,

then you know what happens;
you get irritable and you get hyperactive.

Caffeine is one of the major contributors,
I believe, to hyperactivity

in our school children.

And it doesn't mean that they need
to be diagnosed with a disorder;

it means you have to watch their diet.

Let's take a look
at another one: aspartame.

Remember, aspartame is perfectly safe
for adults in moderate quantities,

but it's all over the place, it's not just
in your artificial sweetener.

In North America, there are
over 6 000 products alone

that contain aspartame.

And I wouldn't be surprised

if there are a lot of those products
right here, as well.

And now let's take a look at what
the average recommended dose

of this particular chemical.

Again, remember, it's safe for most adults
in reasonable quantities.

What I'm concerned about is the effect
it has on the growing brain.

Remember, we're talking
about developing brains here.

That's the key; developing brains.

And if the maximum dose
is about eight mg a day,

what we find in a recent study
done at youth in Chicago

show that they were getting anywhere
from 100 to 250mg a day

from the diet sodas they were drinking,

from other products that they had
in the course of the day,

and, as you can see,
that's 10, 15, 20 times or more,

up to 30 times more,
than the amount that's recommended.

And we have studies that show

that excess aspartate in the body,
especially of younger children,

does produced hyperactivity.

So that's another diet element
we need to look at.

Food preservatives are also
an interesting thing to take a look at.

Here, there are studies
that look at three particularly,

and those are sodium benzoate,
benzoic acid, and the food coloring.

When they've looked at these,

they find that excess amounts
of these products

also cause hyperactivity;

a number of studies have shown that.

Now again, I want to remind you:

these are perfectly safe for most adults
in reasonable quantities.

The problem is how much
you're taking in the young body.

And why are kids getting
more food preservatives??

Because they're eating
more preserved foods.

In many homes, they have
a preserved breakfast,

preserved snacks, preserved lunch.

Anything you take out of the freezer,

anything that is packaged
has some kind of preservative in it

and we don't spend enough time
cooking fresh foods for our kids.

And what happens then is they get
these excess dosage of food preservatives,

and excess quantities in children
can produce hyperactivity.

Sleep deprivation is another big one.

Studies in the United States and Canada
show that the average high school student

gets about five to six hours
of sleep per school night.

Yet, the body clock for most kids
is programmed to eight or nine hours.

And so they're only getting six hours,
they get up, they have sleep deprivation,

the sleep hormone called melatonin
is still present in the blood

and, as far as we know,

there are just two ways
to get melatonin out of the blood.

Either with light; light helps
to drive it out of the system

and to shut down the melatonin pump,

or to finish the sleep cycle
as some kids do;

either on the bus on their ways to school
or, sometimes, in first period class.

They are just doing what nature
tells them to do; finish the sleep cycle.

If they don't do that, then
they have sleep deprivation

and that can make them quite irritable
and also hyperactive.

This feeds into another condition
we need to look at, and that is stress.

Children can be under all kinds of stress:

stress at home
because of domestic violence,

stress because of a bullying siblings,
stress because of drugs,

stress because of pressure
from the parents to do well

and, you know, "Make sure
you get all those A's",

and the pressure of that.

It produces stress, and whenever
we have stress in our mind,

it produces an extra amount of cortisol.

Cortisol is the stress hormone.

We always have a little bit
in our blood, it helps keep us alert.

But when we are under stress,

the amount of cortisol dumped in the blood
increases dramatically,

the purpose of which,
is to say to the brain,

"Hey, try to find out
what the source of the stress is

and eliminate it if you can."

When you're under stress, this cortisol,
if it stays in the body for too long,

it produces hyperactive baby.

Now, there's an unfortunated
downward spiral here

because when you have
excess cortisol in the blood,

you don't sleep very well
so you get insomnia.

The insomnia then is sleep deprivation,
which then causes more stress,

and you have to try to break that cycle.

Anyway, the result is some pretty
jittery and hyperactive people.

Another one I think we need to look at
is not being taught the rules of behavior.

Many of you here,
probably when you were children,

you had dinner with your parents
or your caregivers,

you sat down, you talked
about what's going on in school

and they found out how things were going,
they taught you by their way.

I know my parents did.

"There are some things
that you can do here at home

that you'd better not do in school
and you'd better not do in church

and you'd better not do
in the supermarket."

And so we learned that there are
certain rules of behavior

that went with certain environments.

What's happening today is they don't have
that conversation very often.

A surprising study that came out
just two years ago

show that kids spend 15 times more time
in the course of the week

atttending to their technology
than they do talking to their caregivers.

So they're spending that much more time
connected to their outside world

than to their inside world,

where they should be learning
what the rules of behavior are.

So, these kids are not malevolent,
they're just ignorant.

And they need to be taught
what those rules of behavior are.

They don't have ADHD;
they just don't have the information

they need to know how to behave
in certain circumstances.

Another one I'd like to look at
is school-induced ADHD.

You might think about that for a moment.

What does he possibly meant by that?
What can we mean by school-induced ADHD?

Well, we got a 21st century brain
coming across our thresholds

and that 21st century brain is now
used to interact with this environment,

to be part of the learning process,
to search out information.

That's what that brain is used to now.

But if you have a school where it's just,
"Sit down, listen to the teacher,

listen to the sage on the stage
give the information,"

then the environment is incompatible

with the way the brain is trying to learn.

And so, one way you could
summarize it is to say that

hat I mean by that is
you've got a 21st-century brain

in a 20th-century school.

And these kids get restless,
they don't see the meaning

of what they're learning,
and that's the result.

They become hyperactive.

And there are a couple of other things too
that can cause these ADHD-like symptoms:

environmental factors
such as drugs, of course,

and also heavy metals in the environment.

We've done a pretty good job
of getting lead

reduced dramatically in our environment.

But there are some others,
cadmium now is becoming a problem

because cadmium was in batteries
up until about ten years ago.

That cadmium now, because those batteries
were thrown away in the garbage dumps

and as the batteries disintegrate,
the cadmium bleaches into the water table

and eventually into our environment.

So, that's another one to watch for.

And heavy metal poisoning,
one of the signs of it is hyperactivity.

And also, of course, physical disorders
such as obsessive compulsive behavior

and psychological disorders too.

Dyslexia: the child's having trouble
reading the information,

then becomes restless and hyperactive.

So, my whole purpose here today is to say:

look, kids will be kids,
they'll act out, they'll misbehave,

their attention will drift

because they've found
something else that captures it.

It doesn't mean they have
a psychological disorder

and some of these other things.

All I'm saying is we want to make sure

that before we put
a medical diagnosis on the kid

and say, "You have to go on medication,
prescription medication,"

that we are sure we've looked
at all these other things,

checked out all these other possibilities
before we decide that medical evaluation

is their final resort.

Thank you very much.

(Applause)