Friday, June 5, 2009

Anthroposophic Medicine's Take on ADD/ADHD - an Interview with Dr. Adam Blanning

Dr. Blanning, first please explain what Anthroposophic Medicine is.

Anthroposophic medicine is a holistic and human-centered approach to medicine. It is practiced by physicians who have done a conventional medical training, but expands conventional scientific views by incorporating an understanding of the laws of the living organism and the emotional and spiritual aspects of the human being. Instead of trying to define illness into particular categories and to standardize treatment for a given disease, Anthroposophic medicine really strives to recognize the unique aspects of an individual person’s constitution and biographical path.

What kind of health issues do you treat?

A broad range of acute and chronic illnesses, in both children and adults. My training is in family medicine, which I taught for several years at University of Colorado and New York Medical College. But now my practice is really focused on areas where there are holes in traditional medical treatments. I see a lot of children with developmental, learning, or behavioral concerns. Also, a lot of children and adults with digestive problems, allergies. People struggling with depression, fear, anxiety. People stuck in chronic illnesses. The common thread is that for many people there is the sense that a process is out of balance. That imbalance may or may not manifest in symptoms or abnormalities that can be measured on blood tests or other diagnostic studies. Or sometimes a person’s illness simply cannot be explained with blood tests or x-rays, or it only meets four out of five of the standard criteria. Then a person may not actually meet the definition of an illness, but he or she is clearly also not well. This is where an understanding of process is very helpful.

How does Anthroposophic medicine view the subject of ADD/ADHD?

The first step is to gain some freedom from the definition of ADD/ADHD, because I do not it to be therapeutically very useful. It is a description of the problematic behavior, but it does not necessarily really guide you in any healthy directions for solving the problem. Let me get more specific—a very important polarity in “attention deficit” behaviors is the difference between inattention (not noticing what the teacher is saying because you are absorbed in your own thoughts, or are unaware of your environment) and distraction (not noticing what the teacher is saying because you are absorbed in what your neighbor is doing and you are too aware of your immediate environment). Both can result in the same kind of learning issues—not taking in what the teacher is saying—but they are happening for completely different reasons.

One child, whom I will call “inattentive,” may be having trouble connecting with his or her environment, and is probably slow to wake-- often called dreamy. This child is generally more closed off from the world, still (without movement) in his body, with more activity happening in his head than in his limbs. This kind of child usually does not have the hyperactivity component (ADD).

A second child, whom we could call “inattentive,” immediately overflows into his environment. This child is in many ways at the mercy of the environment and is too wakeful, and totally absorbed by: the neighbor’s eraser, and how their own shoe fits, and a million other things that are going on. This child usually wakes quickly and is always exploring the environment with his limbs—“hyperactivity.” Of course both polarities are seen in both boys and girls.

How do you work with this problem?

Well, as a starting point, I generally do not prescribe stimulants like Ritalin. Stimulants can be helpful for getting a child more focused, but they do not help teach the child how to be more focused. In fact, when the medication is stopped, the same problems are usually still present, but now the child (or young adult) is just older. Stimulants are a temporary measure, but they do not really lead to a lasting improvement.

The approach that I use is one of looking at the behaviors or impressions that happen just before a child looses interest or contact with the focused activity. All of us have inclinations—to be dreamy, or to be always playing with something in our hands, or to be strongly influenced by low blood sugar, or to regularly move around. Those same inclinations are also reflected in how we sleep—do we wake quickly or slowly, is it easy or difficult to release from the impressions of the day when falling asleep; and in how we eat and in our digestion—we very commonly work with our food diet in the same way that way that we work with the “sensory diet” of the world around us. If these patterns are true, then they are consistent and point towards a specific therapy. It can be surprising that when someone comes to see me for a behavioral or learning problem I ask many questions about health history, digestion, sleep, habits, illness patterns, and relatively less about the behavior; and when someone is coming with a digestive problem I ask a lot about how that person notices and interacts with the world around them, and less about the actual digestive issue. The goal is really to gain a holistic understanding of each person’s situation and “constitution.”

I very regularly use natural or homeopathic medicines for a “constitutional” treatment, one that balances these strong inclinations. On occasion I also refer to different kinds of movement therapists or special educators that I work with. The work with the constitutional remedies is done over several months to a year, but there are often very good changes, with the eventual goal being that the child needs no medicine or treatment at all. Working on a constitutional level can also be helpful for working with imbalances or challenges on multiple levels, such as sleep, behavior, and illness patterns.

Why does ADD/ADHD seem to be so much on the rise?

We have somehow gotten into thinking that a growing child is a small-sized adult that simply needs to grow larger and then have a bulk of knowledge content poured in. But a child’s life is actually much more dynamic than that. I really don’t think that any child is born with perfect integration of their thoughts, senses and will impulses. These processes are always disjointed, and they have to be integrated. This integration happens through work—the work of physical activity, of imitation, of social interaction. Skipping over this integrative process by stressing early intellectual activity and computers is damaging, and it is certainly asking for problems down the road. The child’s body really is built, refined and improved by experience—not by watching experiences, but by doing experiences. Virtual realities do not count. On many levels we are robbing children of those opportunities. Then in grade school we suddenly expect children to be well integrated in their bodies and in their senses and get upset when they still seem to want to move or wiggle. Many, many of the behaviors that are identified as ADD/ADHD are really just attempts by the child to better integrate or orient themselves in their senses and in their limbs. We would not label a toddler ADHD, because all toddlers are by definition ADHD. In many circumstances the “attention deficit” child is trying to complete his or her integrative process at an older age because it has not been completed earlier on.

If schools were better at adjusting to the student than requiring the student to fit into the school’s frame work, there would probably be a lot less ADD/ADHD diagnoses. Can you comment on that? How can schools do a better job of helping kids succeed just as they are?

Certainly schools that appreciate the importance of this early integration process are more properly matching the child’s own development. The Waldorf schools do this beautifully. Using stimulant medications or simply trying to squelch these behaviors does of course make it easier to function in the classroom, but it does not answer the question of what is the child trying to achieve with these behaviors. It is rare that a child is acting out just to be belligerent—usually it is an expression of some hole that has not been worked through in the child’s development.

How can parents help with issues of attention, impulse control, and behavior?

Give your child opportunities to do experiences, not watch experiences. That is the great danger with so much media available to children—movies, TV, internet—which are indeed all virtual realities. They may seem entertaining for the senses, but they are really depriving a child of much needed opportunities for this developmental integration. Also feed them a diet that does not contain highly processed foods. Refined sugars and flours are like experiencing things through watching them on TV—they are quick and don’t take much actual initiative on your part, but they are not good physical nutrition, just like virtual realities are not good developmental nutrition.

Do nutrition, the arts, nature, and movement play any role in the improvement of these conditions?

Yes, exactly, you are getting the idea. The more a child can be given real experiences (running, climbing, singing, imitating, digging, planting, chewing) the greater the gift you are giving them for healthy development. What is strange is that a child will naturally do all of these things, and children have done them for millennia before we as a society started introducing so many abstractions and replacements. You can’t just skip over childhood—it is a process that has to be done. If we really allow small children to be small children and complete their integrative developmental tasks, and be patient, then we would see a lot fewer of these behavioral and educational challenges down the road.

For more information on Anthroposophic Medicine and Dr. Adam Blanning, go to:

1 comment:

  1. I really love the parallel between digestion and sensory processing. Thanks for this interchange. There is much food for thought here. ;)