Transcriber: Carlos Arturo Morales Reviewer: Ivana Krivokuća
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 written 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 Massachusetts 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 Seton 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 spectrum 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 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 stimulant, we know it's a brain stimulant,
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 produce 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 colorings.
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.
And that is 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 babhavior.
Now, there's an unfortunate 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
attending 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
what 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)