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ADHD and Diet While clinical evidence and small studies suggest thatneurological and chiropractic treatment and optometrictraining may be effective in treating patients withAttention Deficit Hyperactivity Disorder (ADHD)and learning disabilities by providing the necessarybrain stimulation, nutrition may be helpful in correct-ing biochemical imbalances. Unlike medical practition-ers, who make an ADHD diagnosis based on a ques-tionnaire, nutritionists send patients to the lab. “Evenwhen patients already have the ADHDdiagnosis, we treat them depending on labresults and physical findings,” says GeorgeR. Moon, DC, DACBN, vice president ofthe American Chiropractic Board ofNutrition.

Various metabolic processes in the bodycause reactions similar to symptoms ofADHD, says Ray Bayley, DC, DACBN:“It can be reactions to allergens, varioustoxins, or poisoning. Sometimes kids arediagnosed with ADHD because of a nutri-tional deficiency or amino acid imbalances.”Comprehensive blood analysis and digestive stoolanalysis will show the nutritional profile, including thelevel of essential fatty acids, says Cindy Howard, DC,treasurer of the ACA Council on Family Practice.“Check for hemoglobin disorders, adrenal stress, andblood sugar levels,” she says.

In the early 1970s, Dr. Benjamin Feingold reported thatdietary changes in some patients with hives, asthma, orother allergic reactions decreased their behavioral prob-lems. He claimed that 30 to 50 percent of his hyperactivepatients benefited from diets free of artificial colorings,preservatives and flavorings, and certain natural chemi-

cals (salicylates in apricots, berries, tomatoes, and otherfoods).1 The processed-food industry, many child-behav-ior experts, and many pediatricians reacted to Feingold’sclaim with skepticism, pointing out that it was notbacked by any controlled studies. Over the next twodecades, almost two dozen controlled trials followed,most of which focused on food dyes. Most of those stud-ies found that some children were affected by diet—someslightly, others dramatically.1

Young children and those sufferingfrom asthma, eczema, hives, hay fever,or similar symptoms may respond bestto dietary therapy. Children who stillhave significant problems after takingstimulant medications might also begood candidates. But irrespective ofthe patient’s age or the nature of thebehavioral problem, it could be worthchanging the diet.1 “Correct diet isnever going to hurt,” says Toni Ward,MS, DC, DACBN, a former instructorof clinical nutrition at the Southern

California University of Healthcare Sciences.“Nutrition affects biochemistry at the cellular level.Sugar and sucrose, food additives, and preservativesare not good for the body, anyway. The body has cer-tain thresholds, and allergies develop when it can’t tol-erate the doses of allergens anymore. Additives andpreservatives are just extra things for the body todigest, so it has to work harder,” says Dr. Ward.

Chiropractic nutritionists often deal with ADHD chil-dren whose parents don’t want them to take stimulantmedications. “The most important thing,” says JuaneeSurprise, DC, DACBN, CCN, president of the ACACouncil on Nutrition, “is to reduce exposure to addi-

Children with ADHDMedical vs. Chiropractic

Perspective and Theory–Part 2BY NATALIYA V. SCHETCHIKOVA, PHD

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tives and other factors exacerbating the symptoms, andto make sure the child gets good nutrition.” “Talk toparents and assess the child’s diet,” says Dr. Ward.“Remove as many food dyes, sugar, preservatives, andadditives from the diet as possible. Instead, focus onnatural, mostly organic foods. Determine if there is anallergy—usually starting with dairy and gluten. Tryelimination diets—see what results you get. Hyper-activity goes down with this program in most children.They have better attention spans and are not as impul-sive.”

Allergies and HyperactivityThe influence of allergies and food sensitivities onbehavior is simple—they affect the brain chemistry,says Dr. Surprise. “We can see it in adults—after eat-ing certain foods they get headaches, are tired, irrita-ble, etc. Aspartame (a sweetener) is a big culprit. Insome countries, the amount of aspartame used is statedon the label—and there is a set amount food manufac-turers are not supposed to exceed.”

The myriad of chemicals Americans consume dailyincludes preservatives (such as BHT and BHA, thatare suspected to be human carcinogens,2 nitrates and

sulfites), bleaches, colorings, flavorings, emulsifiers,thickeners, and vegetable gums. “We have more than3,000 food additives, most of which were never stud-ied,” says Dr. Surprise. “The studies that have beendone tested the additives separately. They didn’t showwhat happens when the additives are combined in oneproduct.” Over the years, people have reported to theFood and Drug Administration (FDA) adverse reac-tions to aspartame, monosodium glutamate (a flavorenhancer, also contained in sodium caseinate, calciumcaseinate, autolyzed yeast, textured protein, yeast food,hydrolyzed vegetable protein, and hydrolyzed protein),sulfur-based preservatives, and tartrazine, also knownas FD&C Yellow No. 5 (a food coloring).3

Technically, any food can cause a reaction becauseindividuals are biochemically unique, says MaureenDurkin, RN, children’s program director at NuBasx, anutritional medical clinic. “The most frequent allergensare milk, eggs, peanuts, and red food dyes.” People areoften sensitive to yeast, grains, and corn, saysDr. Moon. Dr. Bayley also observed soy sensitivitiesin patients. “Some people can’t handle excessive man-ganese from soy, which may cause hyperactivity andirritability,” he says.

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While some studies showed that food allergies arelinked with recurrent serous otitis media,4 the frequen-cy of otitis media in early childhood has also been con-nected with later hyperactivity.5 The connectionamong the three can be explained through metabolicprocesses in the body. “At the very least,” says Dr.Surprise, “antibiotics that are used to treat chronic earinfections kill good gastrointestinal flora. Antibioticsare often not used properly—and after their use, noth-ing is done to restore the gastrointestinal flora.”

Nutritional DeficienciesMany research studies link neurological disorders, partic-ularly ADHD, and nutritional deficiencies. Magnesiumdeficiency was found in 95 percent of ADHD children.6

In a preliminary but controlled trial, 50 ADHD childrenwith low magnesium were given 200 mg of magnesiumper day for six months, after which their hyperactivebehavior decreased significantly.7

One of the major problems with the modern Americandiet, says Sally A. Fallon, author of NourishingTraditions, is the inappropriate correlation of harmfuland healthy fats—an abundance of trans fatty acidsand an insufficient intake of essential fatty acids. “Ourancestors didn’t consume trans fatty acids that areknown to impair brain-building processes—especiallyin young children.” But essential fatty acids that makeup 60 percent of the brain, and which are found inflaxseed oil, seeds, nuts, fish, and fish oil, are not in thefood supply anymore, says Durkin. Cod-liver oil isespecially effective in preventing and treating learningdisabilities, says Fallon.

Research shows that boys with ADHD have signifi-cantly lower concentrations of omega-3 and omega-6fatty acids than control subjects and display character-istic symptoms of fatty acid deficiency, such as thirst,frequent urination, and dry hair and skin.8,9 Omega-3fatty acids are vital to the proper function of brain andnerve tissues. Low concentrations of omega-3 fattyacids, or docosahexaenoic acid (DHA) in blood plasmamay be associated with increased risk of depressivebehaviors. Omega-3 fatty acids are especially criticalin infant development. First, the fatty acids are trans-ported from the mother’s blood to the placenta. Afterthe baby is born, the primary source of DHA is breastmilk. Numerous studies show that breast-fed babieshave better brain development than bottle-fed infants,and that they have significantly higher amounts ofDHA in their brains.10 Omega-6 fatty acids thatenhance infant visual acuity are not reproduced ininfant formula.11

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Children with ADHDChildren with ADHDSupplementationSupplementation has become essential for everyone.“Since 1940, our food supply has become veryprocessed,” says Durkin. “Fewer people eat locallygrown, organic foods. Now manufacturers use foodcolorings and flavorings to get kids hooked on pack-aged foods that don’t have basic nutrients.” Peopledon’t eat fish and vegetables anymore, says ShirleyWatson, DC, DACBN, CCN, former director of edu-cation for the ACA Council on Nutrition. “This meansthey do not consume enough essential fatty acids andmagnesium, both of which help prevent nerve irritabili-ty and anxiety. Drinking sodas may cause calciumimbalance—but sodas are sold at schools because itinvolves big profits.”

In patients who don’t respond to dietary changes, sup-plements often will work, says Dr. Ward. “Put thepatients on a high-potency multivitamin/multimineralsupplement and EPA-DHA essential fatty acids com-plex. Tyrosine, an amino acid that is a building blockfor dopamine, is also effective. For proper absorption,tyrosine should be taken with niacin, folic acid, vitaminC, and copper.” If depression is involved, it’s good tosupplement with zinc and magnesium; and if anxiety isa concern, folic acid and vitamin B12 should be used,says Dr. Howard. “To achieve the best results withsupplements and diet,” Durkin says, “clean up the gut.Constipation is a big problem in ADHD kids.”

ADHD CausesHealthcare experts suggest that ADHD is genetic.12 Itoccurs in 35 percent of the extended family populationof those with ADHD, but in only 4 to 6 percent of thegeneral population, says Frederick Carrick, DC, PhD,DABCN, president of the ACA Council on Neurology.

But the genetic nature of the disorder doesn’t meanthat the patients can’t be helped or that the disordercan’t be prevented, says Julie Bjornson, DC, secretaryof the ACA Council on Neurology. “The function ofthe nervous system is not genetically determined. Itadapts to new stimuli, so when we discover what stim-uli are needed to correct brain function, developmentaldelays can be resolved. This is called learning. We areconstantly learning because the nervous system canchange and adapt.” The same holds true for learningdisabilities, says William A. Hurst, OD, a world-classlearning specialist who has been practicing develop-mental optometry for 60 years. “A learning disability isnot a genetic problem, but a problem of the senses ofthe body programming the brain.”

The rapid increase in neurological conditions in pastdecades does not fit the genetic profile either, says

Robert Melillo, DC, DABCN, whose multidisciplinaryclinic in Long Island specializes in treatment of neuro-logical disorders. “All neurological conditions arerelated to environmental factors, so by identifying thefactors and changing them, we can prevent their occur-rence. Even if there is a gene involved, some environ-mental factors must trigger it.”

Tracy Barnes, DC, DICCP, Kentuckiana Children’sCenter board member, says that physical or structuralcauses associated with ADHD include subluxation,birth trauma, head injury, visual perception problems,hearing deficit, brain asymmetry, neurological disorga-nization, and cranio-sacral dysfunction.

Use of cigarettes, alcohol, or other drugs during preg-nancy may have damaging effects on the unborn child,particularly on the brain. Heavy alcohol use duringpregnancy has been linked to fetal alcohol syndrome(FAS), a condition that can lead to low birth weight,intellectual impairment, and certain physical defects.Many children born with FAS show the same hyperac-tivity, inattention, and impulsivity as children withADHD. Drugs such as cocaine affect the normaldevelopment of brain receptors that transmit incomingsignals from the senses and help control our responsesto the environment. Drug abuse may harm these recep-tors and such damage may lead to ADHD.13

A possible connection between vaccination and neuro-logical conditions has generated a lot of concern amongthe public and media. Thimerosal—a preservative con-taining ethyl mercury—has been used in vaccines andother products since the 1930s. Until 1999, more than30 vaccines licensed and marketed in the UnitedStates, including the vaccines administered to infants,contained thimerosal. Prior to 1991, the only thimeros-al-containing vaccine that was recommended for allinfants was the whole-cell pertussis vaccine (DTP). In1991, Haemophilus Influenzae type B (Hib) andhepatitis B vaccines were added to the list.14

The 1999 FDA Immunization Safety ReviewCommittee (ISRC) suggested that some infants,depending on the vaccines they receive and the timingof vaccination, may have been exposed to levels ofethyl mercury that could build up to exceed the federalguidelines for methyl mercury intake.15 Several pub-lished reports have associated deficits in language,attention, and memory with prenatal exposure tomethyl mercury.14

According to the FDA, nearly all vaccines on the rec-ommended childhood immunization schedule are nowproduced thimerosal-free. But, although diphtheria-

F.P.O.FCER

Page 39

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To purchase your copies while supplies last and for additional information, call 800/368-3083 orvisit www.shopaca.com.

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Children with ADHDChildren with ADHDtetanus toxoid (DT), tetanus toxoid(TT), influenza, and Pnu-Immune23 pneumococcal vaccines are noton the schedule, they still containthimerosal as a preservative andmay be given to some children.14

Parents’ ResponsibilityDoctors of chiropractic can play animportant role in the treatment ofneurological conditions and theirprevention by teaching patients tolead a healthy lifestyle and diminishexposure to environmental factorsthat can interfere with their chil-dren’s health. But health and well-ness start in the family.

Prevention should start at the pre-natal level, says Dr. Moon.“Parents’ diets should be correctedat least six months before pregnancy.No pesticides or herbicides shouldbe allowed in foods, and no pesti-cide sprays in the house. Keep themold in the house under control.”Pregnant women’s diets should con-tain essential fatty acids and magnesium. Taking med-ications, nicotine, alcohol, and drugs in pregnancy mayharm the fetus. Dr. Bjornson suggests that the stressthat many jobs bring may affect the unborn baby’shealth. “A calm and peaceful environment for preg-nant mothers is conducive to increased nutritionalintake and healthier babies.”

The first months and years of a child’s life are criticalto physical and psychological development. Breast-feeding is the best option—and, of course, breastfeed-ing mothers’ diets are important. “When adding solidfoods to the infant’s menu, remember that healthy eat-ing habits should be taught from the start,” saysDurkin. “Do not introduce junk foods or sugar to yourchildren.”

When both parents spend more time working than theycan spend with their child, the quality of day carebecomes of great importance. Seventy-five percent ofAmerican children are in early day care, but not alldaycare centers can adequately substitute for contactwith parents, says Dr. Melillo: “For example, childrenlearn the language from being talked to—early in lifeand frequently—and when they don’t get enough indi-vidualized attention, they don’t get enough languagestimuli.” Some studies show that poor quality of daycare may translate into increased aggression, non-com-

pliance, and possibly social withdrawalduring the preschool and early elemen-tary school years, as well as lowergrades and poor work habits.16

Parents need to provide an enrichedenvironment for children, where all thesenses are developed, saysMark S. Smith, DC, DABCN.“Children should smell, hear, taste, see,and touch different objects. Read tochildren, play music to them, anddevelop their motor skills. Parents cando a lot of therapies at home, which notonly saves money but gets the parentcloser to the child, and the childimproves greatly.” Bobby Doscher,DC, president and CEO of OklahavenChildren’s Center, advises parents tomake sure their children aren’t skippingany stages of development: “Crawling isimportant because it helps develop bothsides of the body.”

Children’s physical development isdirectly connected with their braindevelopment, says Dr. Bjornson: “The

nervous system develops fastest in the first seven years,and anything that hinders it is detrimental.” Babiesshouldn’t be in swings, cradles, car seats, or in front ofthe TV for long periods of time, says Scott Bautch,DC, DACBOH, immediate past president of the ACACouncil on Occupational Health. “They need to feeltheir way around the world. TV is the main culprit, asit stimulates children visually but doesn’t develop othersenses. It changes children’s learning patterns, whichleads to learning disabilities. You shouldn’t baby-sityour child with the TV so you can clean the house.Play games with your children. Talk, crawl, and walkwith them.”

Studies have shown a decline in academic functioningsince television was introduced. TV reduces sensemodality coordination and may result in school fail-ure.17 Besides, the use of TV and VCRs contribute tothe increase in the American sedentary lifestyles andcorresponding growth of obesity in children, says Dr.Melillo. “You don’t see children outside anymore.They are sitting most of the time. They have becomeheavier, and their brain development—that is influ-enced by the level of physical activity—is delayed. Ifthe child’s motor activity is limited in the first years oflife, it causes postural muscle problems, which maylead to learning disabilities later in life.”

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Specialists also underline the importance of preparingchildren for school. “A mentally active child will learnmuch more readily than one who has had insufficientstimulation in the first five years of life,” says Dr. Hurst.To help parents prepare children for school, Dr. Hurstadvocates preschool functional neurological assessments:“Waiting until five years to correct disabilities is too latefor many children since brain pathways are alreadyformed.” Some states are already moving in that direc-tion. The Kentucky legislature passed a pre-school eyeexamination law in 2000, and the Kansas legislatureappropriated funds for continuation of a vision therapyand reading research project in several school districts.California legislators are currently considering billsrequiring preschool vision training.If school is a struggle, parents should look into differ-ent ways to help the child, says Dr. Bautch. “Dowhat’s best for your child. Your child may have a dif-ferent way of learning than is taught at school. If youcan’t do homework with your child, find a tutor in yourcommunity. Try scheduling your child’s day accordingto his or her activity level. Some children comehome—and immediately start doing homework—forabout two hours. It may be better for the child to runfor an hour or two after school.”

Parents need to be better advocates for their children,agrees Durkin. “Doctors have much more control overchildren nowadays than they had 100 years ago.Women used to know how to cure simple ailments.Now, parents give Motrin and Tylenol to children atthe drop of a hat. People are looking for a quick fix.”

Choice of TherapyThe existing ADHD treatment models leave parents withchoices. The choice of the medical model—treatmentwith stimulants, sometimes accompanied by behavioraltherapy—is probably the cheapest and the expected wayin the managed care system. But is it best?

Like with any other condition, there is no miracle curethat will help everyone. Treatment should depend onthe patient, says Dr. Ward. “Depending on the severi-ty of the case, medication may be necessary, but thenutritional approach should be tried in conjunctionwith it to gradually wean the child off the medication.A combination of approaches usually works best, sopractitioners should talk to each other.”

For parents with ADHD kids, it’s hard to resist schoolpressure and not put the child on drugs, says Durkin.“But if possible, they should go to a nutritionist toclean up the diet first. If there is a sensory integrationproblem, or a problem with vision/auditory informationprocessing, occupational therapy and speech therapycan be helpful.”

Prescribing medications is often the only option med-ical doctors can offer, says Dr. Melillo. “Pediatriciansare typically not properly trained to treat ADHD, butin the managed care setting, they treat more and morechildren without referrals. Sometimes school psycholo-gists will recommend medications, but they can’t pre-scribe. Many school systems recognize occupationaltherapy, such as sensory integration. Some recognizecognitive behavior-type therapy, especially for autisticchildren.” Dr. Melillo’s clinic often gets referrals frompediatric neurologists. “They can only prescribe med-ications, and they are often not happy to prescribethem, but there is nothing else they can do becausethey get pressured by teachers and parents. Manydoctors are happy to refer children to specialists whocan do more for them.”

There are situations, of course, when medication is neces-sary. “Some children have to be medicated for their ownsafety,” says Dr. Carrick. “For example, if the child can’tcontrol his impulses and may run out into the street and behit by a car, it’s beneficial to use the medication.” But inother cases, medications should be the last resort and usedonly when nothing else works. “Medications control

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Children with ADHDChildren with ADHDsymptoms without getting to the root of the problem,” saysDr. Smith. “If the brain has reduced metabolic rates, themedication will increase them, but if you take away themedication, the problem comes back. Medications willnever create the plasticity of the brain.”

Prescribing medication without doing anything else sendsthe message that it fixes the problem, but it’s not true, saysDr. Melillo. “When patients come to us, it’s their choice totake drugs or not, but we explain to them that we can tryto address their motor-sensory problems by diagnosingand treating them specifically, and their ADHD, learningdisabilities, or autism may improve.”

Taking medications sends another message as well—that the children’s problem is chronic and they have nocontrol over it. “Children will grow up and still haveADHD because the drugs will not teach them the cop-ing skills they need, won’t address their nutritional orother problems,” says Durkin. “Drugs may help themone day in a class, but they don’t help long term—nei-ther to be healthier people nor to feel good about them-

selves.”

What Chiropractors Can DoFortunately, the public preference for the non-pharma-cological approach is growing, says Dr. Carrick.“Society is now well aware of side effects of medica-tions, cigarettes, alcohol, and other chemicals. By far,the majority of children and adults do very well with-out a stimulant medication if the clinician can addressthe problem. Parents should go to a clinician who hasexperience in treating the disorder. They should ques-tion the practitioner, and if the doctor has no experi-ence in treating ADHD, they should ask for a referralto a colleague who does. Before giving medications,take the child to a chiropractic neurologist who istrained to treat conditions like ADHD.”

The Carrick Institute for Graduate Studies is currentlyinvolved in the final stages of a multi-level investigation inlearning, the initial phase of which was conducted at theParker Chiropractic College of Chiropractic. “The studyfocuses on learning and brain activity. We are measuring

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brain activity while applying environmental stimuli, such asspinal adjustments, light, sound, and cognitive tasks, andcompiling the data. The investigation is ongoing throughoutthe world—in Holland, Spain, England, France, Italy,Australia, Japan, Korea, Switzerland, Canada, and theUnited States—by blinded specialists trained to treatADHD with a non-pharmacological approach. The blindedcontrolled study is utilizing ethnographic methodology aswell as multivariate statistical determinations because learn-ing and behavior are individual phenomena.”

Chiropractic neurology opens broad perspectives for DCs,says Dr. Melillo. “No health care profession is taking holdof ADHD treatment—and yet there is such a need.Neurological disorders grow fast—and the problem withchildren now will turn into a problem with the adult popula-tion very soon—in the form of anxiety disorders anddepression. Integrating neurology can put a tremendousthrust into your practice and give you great satisfaction tosee children who couldn’t speak begin to talk—and see theeffect on their families. But we can’t do it haphazardly. Weneed to get proper training—a course specializing in treat-ing the disorders, or a neurological program.”

“Since I have become a chiropractic neurologist, I have hadan increased ability in serving a wider range of patients,”agrees Dr. Smith. “Now I take on difficult cases—MS,Parkinson’s disease, cerebral palsy, Tourette’s syndrome,dystonia, migraines—and feel comfortable. The goal of doc-tors of chiropractic is to improve the neurological functionthat controls all aspects of our health. Our approach is dif-ferent from medical neurology—we are improving the func-tion, not the symptoms. Subluxation correction is essential,but it is not the only thing to do. Without the correction ofthe subluxation, very often there will be no result, but whenthere are other neurological problems, subluxation correc-tion only is often not enough.”

“I haven’t seen much success with medical treatment ofADHD,” says Dr. Bautch. “The patients I’ve treated cometo me after a lot of frustration with medical care, so theythink that anything is better than that. It’s a great opportu-nity for DCs. We have communication skills, and we knowour patients—we can find out what’s wrong with the child.Talk to everyone who has an effect on the child. Find outwhat stress the child may have—physical, emotional, ornutritional—and you will have phenomenal success. If youare uncomfortable talking to the child about some issues,create a network of people who can do that. You have agreat opportunity to do something special for the child, sotake it seriously. Sometimes you have to dig for the answerreal deep, but it’s worth it.” ▼

References1. A Parent’s Guide to Diet, ADHD & Behavior. Center for Science

in the Public Interest. www.cspinet.org/new/adhd_bklt.pdf.2. Butylated Hydroxyanisole (BHA). CAS No. 25013-16-5. NinthReport on Carcinogens. Revised Jan. 2001.http://ehp.niehs.nih.gov/roc/toc9.html.3. FOOD ALLERGIES: RARE BUT RISKY. U. S. Food andDrug Administration. FDA Consumer. May 1994.http://www.cfsan.fda.gov/~dms/wh-alrg1.html4. Nsouli TM, Nsouli SM, Linde RE, O’Mara F, Scanlon RT,Bellanti JA. Role of food allergy in serous otitis media. Ann Allergy1994 Sep;73(3):215-9.5. Hagerman RJ, Falkenstein AR. An association between recurrentotitis media in infancy and later hyperactivity. Clin Pediatr (Phila)1987 May;26(5):253-7.6. Kozielec T, Starobrat-Hermelin B. Assessment of magnesium lev-els in children with attention deficit hyperactivity disorder (ADHD).Magnes Res 1997;10(2):143-8.7. Starobrat-Hermelin B, Kozielec T. The effects of magnesiumphysiological supplementation on hyperactivity in children withattention deficit hyperactivity disorder (ADHD). Positive response tomagnesium oral loading test. Magnes Res 1997;10:149–56.8. Burgess JR, Stevens L, Zhang W, Peck L. Long-chain polyun-saturated fatty acids in children with attention-deficit hyperactivitydisorder 1 & 2, American Journal of Clinical Nutrition, Vol. 71, No.1, 327-330, Jan. 2000.9. Stevens LJ, Zentall SS, Deck JL, Abate ML, Watkins BA, LippSR and Burgess JR. Essential fatty acid metabolism in boys withattention-deficit hyperactivity disorder. Am J Clin Nutr, 62: 761-68,1995.10. Badash M. DHA’s Role In Infant Development.http://www.healthwell.com/hnbreakthroughs/mar98/dhasrole.cfm?path=hw.11. New Evidence on Benefits of Fatty Acids Emerging at NationalMeeting. BOSTON, October 30, 1997.http://www.eatright.com/pr/press103097e.html.12. Attention Deficit Hyperactivity Disorder (ADHD) - Questionsand Answers. National Institute of Mental Health. April 19, 2000.http://www.nimh.nih.gov/publicat/adhdqa.cfm13. Attention Deficit Hyperactivity Disorder. National Institute ofMental Health.www.pueblo.gsa.gov/cic_text/health/attendef/adhd.pdf14. Immunization Safety Review: Thimerosal-Containing Vaccinesand Neurodevelopmental Disorders. 2001. National Academy Press.www.print.nap.edu/pdf/0309076366/pdf_image/74.pdf15. Egan W. Statement before the Committee on GovernmentReform. U.S. House of Representatives July 18, 2000. Office ofVaccine Research and Review. Center for Biologics Evaluation andReview. Food and Drug Administration. Department of Health andHuman Services. http://www.fda.gov/ola/2000/vaccines.html16. Santrock JW. Life-Span Development. 6th Edition. McGraw-Hill. 1997.17. Hurst WA. Sense Modality Coordination (School Failure,Delinquency and Crime), Assessment and Therapy—Part One.National Eye Research Foundation’s 36th Annual InternationalContact Lens Congress, Oct. 1991, Las Vegas, Nevada. GlobalCONTACTO. Vol. 35, No. 1. 1991.

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