Integrative pediatrics: Please don’t label my child

BY Victor S.
Sierpina, MD,
W.D. and Laura
Nell Nicholson
Professor of
Integrative Medicine
and Professor of
Family Medicine at
the University of
Texas Medical Branch, Chair of the
Consortium of Academic Health
Centers for Integrative Medicine

One of the most pressing questions of parents to physicians these days is, “Are there alternatives to drug therapy for my child with ADHD?” Given the highly pervasive nature of this condition (3-10% of American children) and the documented effectiveness of stimulant medications, we immediately enter onto a challenging territory. Children with conditions such as attention deficit disorder, with or without hyperactivity, often respond dramatically to psychostimulants such as methylphenidate. Both school grades and social behaviors improve quickly. Teachers, classmates, and family members are relieved. Yet there remains unease about a large cohort of our children requiring long-term drug therapy that has potential for side effects such as growth, appetite, and sleep disturbance and potential cardiac, endocrine, or sympathetic nervous system effects.

What are we to do? Are there effective, reliable, and safe alternatives to these widely prescribed medications? What is the evidence for their long-term use? Indeed, what is the evidence for long-term effectiveness and safety of the pharmacological treatments for ADD and ADHD?

To address these issues goes beyond the scope and length of this article, however I hope to broaden our readers approach with some information that may be useful and credible. At a recent nutritional supplements conference in San Diego sponsored by the Scripps Integrative Medicine Center, I reconnected with a long-time colleague of mine, Dr. Scott Shannon. Dr. Shannon is a child psychiatrist in private practice in northern Colorado who has started the first holistic and integrative child psychiatry program at a major teaching hospital in Denver. He is past president of the American Holistic Medical Association and has written an excellent academic textbook for professionals on complementary and alternative approaches in mental health (1) and a more recent popular one called Please Don’t Label My Child. (2)

I’d like to review his latest book here with the hope that those with a serious interest in the area of children’s mental health would consider reading it and perhaps his earlier, more detailed work. While written for a lay public audience, Please Don’t Label My Child is informed by a compassionate, experienced child psychiatrist who takes a pragmatic approach to conditions such as ADD/ADHD.

He advocates an approach of moderation and restraint, believing children are designed to function at a high level of wellbeing without a lot of medical intervention. Further, he holds that consistent, loving, focused attention are a constant need of children that may alleviate many of the so-called diagnoses and labels under which they suffer.

The first chapter describes the “high cost of labeling” our children with conditions such as ADHD, anxiety disorders, bipolar disorder, conduct disorder, and depression which result in a cycle of diagnosis and medication. Our children may suffer not only from these conditions but the subsequent stigma attached to the disease labels, the problems with drugs and their side effects, and often the narrowing of their life around a single diagnostic label. Shannon pleads for us to listen more closely (even non-verbally) to our children, to the distress signals they are giving, to try to understand what these mean, and to prevent, if we can premature or inappropriate labeling.

In Chapter 2, he briefs us on the plasticity and growth of the young brain and the effects of this on the emotional climate and even volatility of children and adolescents. Basics for optimal brain development include a safe and secure home life; love and touch; proper nutrition; a clean environment, stimulation’ and strong, stable relationships.

Chapter 3 delves further into the power of relationship, particularly the mother-child bond in creating attunement and attachment and the long-term social and emotional consequences of these going awry. Fatherchild bonds are also highly essential to health child development. Indeed, citing the Harvard Mastery of Stress Study, Shannon points out that “nothing is more important to our emotional and mental health and overall well-being than experiencing a close, loving, supportive relationship with our parents during childhood.” The temperament of children and the match of these temperaments with their parents may support or strain this relationship. Parents are in the best position to overcome such strains by maintaining a degree of nonjudgmentalism and unconditional love while acknowledging their own temperaments and level of consciousness.

Chapter 4 gives a highly detailed and evidence-based review of healthy nutrition in children, something often ignored in children’s mental health. Macronutrients, micronutrients, essential fatty acids, Chapter 4 gives a highly detailed and evidence-based review of healthy nutrition in children, something often ignored in children’s mental health. Macronutrients, micronutrients, essential fatty acids,

Chapters 6 and 7 review how the family system, its relationships and stress levels, divorce, resilience, school, different earning styles, and social context all are highly critical to the optimal development of the brain and the child’s behavior as a whole organism. Kids who manage stress well tend to have high self-esteem, a sense of control over their lives, a safe, consistent family system, and a suppor tive s o c i a l network. Further they have open communication with family members, living supportive relationships with parents or caregivers, recognition and support of their resilience, a sense of humor and optimism and faith in the future.

Chapter 8 on trauma and post-traumatic stress disorder provides an insight into behavioral difficulties rooted in the neurology of the traumatized brain. This can result in a wide variety of acting out behaviors from bullying to avoidant behavior, anxiety, depression, anger, sexual acting out, and learning difficulties. Special approaches and therapies are needed for children suffering with traumatic stress and inappropriate labeling and misdiagnosis only aggravates their condition and delays effective therapy.

Chapter 9, “Parenting for Emotional and Mental Health” is a summative guide to raising children with a strong sense of selfidentify, the ability to self-regulate, and with an inner core of resilience. Practical tips on parenting are given that are direct and clear, though implementation may be a challenge in many families.

I want to emphasize that parents are not made to feel “to blame” for their children’s problems at any point in this last chapter nor throughout the book. In fact, they are empowered, encouraged, and enabled to break out of the “doctor-diagnosis-drug cycle” to a healthier way of life for them and their families. Medications may be necessary for some children, but ought be considered a downstream option rather than the first choice of intervention.

Appendix chapters cover psychiatric labels commonly given to children with a description of each, glossaries of mental health terms and nutritional supplements, and some self-test questionnaires for family stress and trauma. There are also supplemental readings in this area and information on how to find appropriate integrative and holistic practitioners.

When I attended Scott’s lecture on this topic in San Diego, I observed that many of the professional audience, many parents themselves, seemed to want a “magic bullet”(myself included!). This might be a nutritional supplement, a special d i e t , a certain dosage and type of fish oil, neurobiofeedback, or something else to replace medication. All of these can certainly be helpful to children with behavioral problems. However, I respect Dr. Shannon’s not only including such lifestyle and nutritional approaches, but combining them with a more integrative mind-bodyspirit approach to parenting, to family, to social and school dynamics. His approach honors the individuality and personality of each child and each parent and family. By stepping back from labeling, we may be in a better place to love and care for our children better, to respect their differences, and to optimize their physical and mental health.

References: Shannon S (ed).Handbook of Complementary and Alternative Therapies in Mental Health. San Diego: Academic Press, 2002. Shannon SM, Heckman E. Please Don’t Label My Child. New York: Rodale, 2007. ISBN 1- 57954-682-X

Extract of broccoli sprouts may protect against bladder cancer

A concentrated extract of freeze dried broccoli sprouts cut development of bladder tumors in an animal model by more than half, according to a report in the March 1 issue of Cancer Research, a journal of the American Association for Cancer Research

This finding reinforces human epidemiologic studies that have suggested that eating cruciferous vegetables like broccoli is associated with reduced risk for bladder cancer, according to the study’s senior investigator, Yuesheng Zhang, MD, PhD, professor of oncology at Roswell Park Cancer Institute. “Although this is an animal study, it provides potent evidence that eating vegetables is beneficial in bladder cancer prevention,” he said.

There is strong evidence that the protective action of cruciferous vegetables derives at least in part from isothyiocyanates (ITCs), a group of phytochemicals with well-known cancer preventive activities. “The bladder is particularly responsive to this group of natural chemicals,” Zhang said. “In our experiments, the broccoli sprout ITCs after oral administration were selectively delivered to the bladder tissues through urinary excretion.”

Other cruciferous vegetables with ITCs include mature b r o c c o l i , cabbage, kale, collard greens and others. Broccoli sprouts have approximately 30 times more ITCs than mature broccoli, and the sprout extract used by the researchers contains approximately 600 times as much.

Although animals that had the most protection against development of bladder cancer were given high doses of the extract, Zhang said humans at increased risk for this cancer likely do not need to eat huge amounts of broccoli sprouts in order to derive protective benefits.

“Epidemiologic studies have shown that dietary ITCs and cruciferous vegetable intake are inversely associated with bladder cancer risk in humans. It is possible that ITC doses much lower than those given to the rats in this study may be adequate for bladder cancer prevention,” he said.

Zhang and his colleagues tested the ability of the concentrate to prevent bladder tumors in five groups of rats. The first group acted as a control, while the second group was given only the broccoli extract to test for safety. The remaining three groups were given a chemical, N-butyl-N-(4-hydroxybutyl) nitrosamine (BBN) in drinking water, which induces bladder cancer. Two of these groups were given the broccoli extract in diet, beginning two weeks before the carcinogenic chemical was delivered.

only the extract, no tumors developed, and there was no toxicity from the extract in the rats.

About 96 percent of animals given only BBN developed an average of almost two tumors each of varying sizes. By comparison, about 74 percent of animals given a low dose of the extract developed cancer, and the number of tumors per rat was 1.39. The group given the high dose of extract had even fewer tumors. About 38 percent of this high-dose group developed cancer, and the average number of tumors per animal was only .46 and, unlike the other animals, the majority were very small in size.

The study was funded by the Vital Vegetables Research Program of Australia and New Zealand, the National Cancer Institute and the Roswell Park Alliance Foundation..