Attention Deficit Disorder
by Alakananda Devi (Alakananda Ma), M.B., B.S. (Lond.)
A diagnosis of hyperactivity or attention deficit disorder may correspond to three different diagnoses:
Prana Vayu Disturbance
Sadhak Pitta Disturbance
Disturbance of both Prana Vayu and Sadhak Pitta
Prana Vayu Disturbance:
Restlessness, inattentiveness, wandering mind, poor memory, stuttering, stammering, nervousness, tics and dyslexia may all result from a serious disturbance of Prana vayu, the form of vata responsible for all higher cerebral functions. According to Ayurveda, this condition may be hereditary, congenital, or acquired. Hereditary prana vayu disorder occurs when one or both parents are severely vata-provoked, and this vata provocation is transmitted within the sperm or ovum. Congenital prana vayu disturbance results from vata provoking intra-uterine conditions; for example, if the mother is in great fear or anxiety, or if she is drinking coffee during the pregnancy. Acquired Prana Vayu disorder of childhood may result from any factor that provokes vata. Since vata is light, dry and mobile, any excess of vata may result in hyperactivity and hyper mobility on the part of the child.
In our vata-provoked society, children are exposed to numerous such factors. Consumption of stimulants such as chocolate, white sugar, coca cola, all cold fizzy drinks, leftovers, dry food such as popcorn and chips; all can provoke vata, as can excess consumption of salads. Exposure to frightening images on television is an important factor, as is an emotional climate of insecurity, fear, or anxiety within the home. With today’s travel, very young babies, less than six weeks of age, are often taken by plane to meet grandparents. This can induce childhood vata provocation.
Children with vata-type hyperactivity will be worse in autumn or on windy days, at the time of eclipses, and at dawn and dusk. Their dhatus, or tissues, are depleted, and they may have white spots on the nails, suggestive of calcium deficiency. They drink excess water, and crave sweets and chocolate. Other symptoms include nocturnal enuresis (involuntary discharge of urine), dry skin, poor circulation, and constipation, all symptoms of generalized vata disturbance.
The most important differential diagnoses of hyperactivity or ADD are chronic constipation and intestinal parasites. The constipated child will often become nervous and hyperactive as part of a generalized vata disturbances. However, in this case, the primary seat of the problem is not Prana vayu but Apana vayu, the form of vata responsible for expelling urine, flatus, and feces. If the fecal matter is hard and dry, difficult for the child to pass, a warm sesame oil enema should be given. As soon as the constipation is relieved, the child will be calm.
Children with intestinal parasites suffer from a variety of problems including bloating and constipation, ama or toxins in the digestive tract, and lack of absorption of minerals, all of which tend to create attention deficit and hyperactivity. They have dry skin, ridged nails, cracks on the soles of the feet, dandruff, tooth marks on the tongue, cracks and fissures on the tongue. Hyperactivity, spaciness, poor memory, and poor performance in school are typical of this condition. Once the underlying digestive disorder is treated, the learning and behavior problems will vanish.
Sadhak Pitta Disorder
A disorder of the pitta sub-type responsible for understanding, comprehension, attention, and concentration, can result in symptoms, which may be diagnosed as hyperactivity or ADD. This is a very serious condition, since it may be a precursor to suicidal depression or alcoholic disease, or even to violent, destructive behavior. The child has incredible energy and throws frequent tantrums. In some cases, a pitta-provoked child may even bang his or her head on the wall, a warning that, if the pitta is not promptly calmed, pitta-type schizophrenia or severe depression may result in early adult life.
Once again, this condition may be hereditary, congenital, or acquired. Hereditary sadhak pitta disturbance is passed on to the embryo from the reproductive tissue of pitta-provoked parents. Congenital sadhak pitta disorder may result if the mother is angry throughout the pregnancy, if she consumes pitta-provoking food, eats excess salt, smokes marijuana or drinks alcohol. Acquired sadhak pitta disorder may result form any factor that tends to provoke pitta.
On a dietary level, consumption of salty, sour, red, oily, or spicy foods, chocolate, white sugar, food additives, and particularly yellow and orange food coloring provoke hyperactivity. On an emotional level, a pitta child will respond with anger, tantrums, and increasing despair to domination, control, or negative criticism. To control or dominate a pitta child is almost a guarantee that the child will have to grapple later in life with depression, low self-esteem, self-criticism, or violent outbursts. Very young pitta children can readily learn simple negotiating skills. They desperately need to understand that they have control over their own bodies, lives, and choices and have no control over those of others.
Sluggish liver function and food allergies are the most important differential diagnoses. A yellowish coat to the skin, reddening of the eyes, yellowing coating of the tongue, skin rashes, skin eruption, and allergies all suggest that the primary problem may lie in the ranjak pitta, the sub-type of pitta in the liver, rather than in the sadhak pitta. A thickly coated tongue, chronically stuffy nose, eczema or asthma, point to food allergies as the root problem. Exclusion of suspected foods such as wheat, corn, and milk should be done to confirm the specific allergies. The child will recover when the allergen is excluded from the diet and relapse if it is reintroduced. In these cases, the apparent hyperactivity or ADD will not be a problem if the offending food is no longer consumed.
Mixed Type Disorder
The worst cases of ADD result from a simultaneous disturbance of both vata and pitta due to a combination of causative factors described above in the sections on prana vayu and sadhak pitta disorders. Symptoms show a combination of restlessness and tantrums. With careful history taking, it may be possible to determine which dosha was involved first, and to treat the original cause.
Treatment of Prana Vayu Disorder
Sesame oil massage is of the utmost importance in this case. The child should be massaged five days in a row, using nine ounces of warm sesame oil each time. At bedtime, give a warm ginger bath to promote sweating. After this treatment, which usually has excellent effects, the soles of the feet and scalp should be massaged with warm sesame oil, each night. Another very effective way to calm Prana vayu is to put five to ten drops of warm sesame oil into the ear and then massage the mastoid bone for five or ten minutes. This will calm the limbic system. Remove the oil with a cotton swab. Then turn the child over and repeat the process in the other ear. Of course, it is extremely important that the oil be warm, not hot or cold. A child over the age of five can be taught to lubricate the nose by placing ghee on the little finger and massaging the nose with it. An oil-medicated bhringaraj can also be used for hyperactivity. Two drops each may be gently massaged on the scalp, third eye, throat, heart, and navel. In addition, herbal treatment should be given.
Sarasvati can be given in doses of 1/8 teaspoon for small children. There are a variety of formulations of Sarasvati churna given in the major and minor Ayurvedic texts, the overall effect of the yoga (combination) being to balance all three doshas within the central nervous system. A simple – and highly effective – version of Sarasvati churna consists of equal parts of Brahmi, jatamansi, and vacha. Jatamansi is particularly effective for balancing vata; brahmi, for pitta; and vacha, for kapha. The formula according to the Sharngadhara Samhita consists of ajwain, ashwagandha, kushta, cumin, Trikatu, shankapushpi, vacha, and rock salt.
Here, the Sarasvati churna used is a combination of equal parts brahmi, jatamansi, and vacha, to calm Prana vayu and enhance memory, learning, and concentration.
To balance overall vata and restore dhatu strength:
Bala, 1/3 tsp
Vidari, 1/3 tsp
Chamomile, 1/3 tsp
Take this mixture as a decoction at bedtime.
Akar karabha This important herb is pungent in taste, heating in energy, and pungent in post-digestive effect. Its active ingredient is anacycline. It acts on the brain, improving the cerebral circulation, stimulating Sadhak pitta, improving memory, understanding, and intelligence, and is anti-tremor, anticonvulsant, antispasmodic, and antidepressant. It is also useful for cough, cold, asthma, and pulmonary edema. It is one of the most useful herbs for ADD, speech disorders, and depression. At the present time, as part of an effort to protect India’s botanical and herbal resources from exploitation by multinational corporations and large western herbal companies, the government of India is not allowing export of this valuable herb. However, for educational purposes or in case of future availability, for the treatment of ADD, Akar karabha should be combined with an equal amount of vacha or sarasvati (1/8 teaspoon for a small child, _ teaspoon for a bigger child, _ teaspoon for a teenager or adult) and taken twice daily.
Treatment of Sadhak Pitta Disorder
As in the vata child, warm oil massage is very valuable. In this case, sunflower oil should be used, or better still, bhringaraj oil. A pitta-pacifying diet is essential, and yellow and orange dyes, food additives, and white sugar should be excluded. In the case of children under school age, it is fairly easy for the parents to control the diet. Older pitta children must be asked by the physician to take some responsibility for their own diet. In my experience, I have found that pitta children as young as seven or eight will readily grasp simple concept such as “don’t eat white sugar” once they understand clearly that white sugar gives them tantrums. They usually take great pride in asking “does this contain sugar?” before they accept foods or snack, and gain a sense of greater control and autonomy. Pitta children often naturally refuse to eat pittogenic foods such as red meat, grapefruit, or tomato sauce, and are only too happy to be validated in their dislikes. However, if the child is already addicted to white sugar, it may be very difficult to wean him/her from the addiction.
For overall pacification of pitta:
Shatavari, 500 mg
Shankha bhasma, 200 mg
Guduchi, 200 mg
For specific treatment:
Brahmi tea: _-1/2 teaspoon of brahmi per cup, steeped for ten minutes, taken in the morning before school and in the afternoon after school. This may be sweetened with a little honey. The tea loses none of its effectiveness and gains greatly in patient compliance if mixed with a pleasant tasting teabag. My own favorites are almond or roasted-grain teabags. However, sour, fruity, or citrus teas should not be used.
Or try: A mixture of equal parts jatamansi and brahmi, taken before and after school with honey (this is given for educational purposes only, since jatamansi is currently under export restriction).
Further measures to calm pitta:
A pearl necklace or pearl earrings are very important in calming pitta. The necklace should be worn inside the clothing so that it makes contact with the skin. In a silver cup, pour hot milk, place a pearl in the milk, and let it sit overnight. In the morning, remove the pearl, mix in the shatavari/shankha bhasma/guduchi formula, and let the child drink it. During a tantrum, sandalwood oil applied to the navel of the child will have an immediate calming effect. During the summer season, hibiscus teas with a dash of rosewater is an excellent cooling and calming drink. Pitta children of five and older should be taught to place brahmi ghee on the little finger and lubricate the nose with it, for a calming effect on sadhak pitta.
ADD in Adults
If untreated, vata-type ADD may persist into adult life, resulting in a restless adult with poor memory, poor concentration, difficulty holding down a job, and difficulty in getting organized. Speech disorders and learning disabilities may continue to be a problem. Treatment is the same as for children with prana vayu disturbance.
As mentioned earlier, pitta-type ADD and hyperactivity readily develop into far more dangerous conditions including depression, alcoholism, pitta-type schizophrenia with suicidal tendencies and violent or bullying behavior. To prevent such tragic outcomes, extremely damaging to the individual, the family and indeed to society as a whole, it is of the utmost importance that children with sadhak pitta disorders be promptly treated to calm and balance pitta. Essential to this treatment is proper counseling of the parents as to treating the pitta child with respect, honoring his or her autonomy and ability to negotiate.
ADD and the Family
A child with symptoms of hyperactivity or ADD may be presenting symptom of a vata-provoked or pitta-provoked family system. In the vata-provoked family, there is an ethos of fear, anxiety, haste, restlessness, insecurity and disorganization. One parent may travel frequently, or the entire family may relocate. The parents may use caffeine, keep irregular hours, or fail to provide routines and daily or seasonal rituals. The physician or Ayurvedic lifestyle counselor must help the family establish a stable routine, with regular meals and bedtimes, assigned chores, daily and seasonal rituals, even if frequent relocations are necessary. Fore example, if a parent is a diplomat or in the military, well-established routines and rituals provide a sense of stability amidst the changes.
In a pitta-provoked family system, there is an angry, critical, judgmental ethos. Children are yelled at or hit. “No” is used several times a day, the children’s life is too regimented, they have too many chores to do and are expected to achieve highly in school. The parents may drink heavily, or use drugs. Such family systems often result in anger, hyperactivity, and underachievement on the part of the children. It is useful for the physician to see the whole family and to determine whether there is a serious underlying problem such as an alcoholic parent, or physical, verbal, or emotional abuse of the child. According to Ayurveda, children are naturally happy, and their tantrums and anger may well be symptoms of a deeper sickness within the family.
While specific treatment of ADD and hyperactivity can be valuable, the most important step is to determine whether the problem is due to vata, pitta, or both, and then to calm the deranged doshas, both in the individual and in the family system.
Peer-reviewed article first published in the Protocol Journal of Botanical Medicine.
Alakananda Devi (Alakananda Ma) is director of Alandi Ayurvedic Clinic in Boulder, Colorado, and principal teacher of Alandi School of Ayurveda, a traditional ayurvedic school and apprenticeship program. She can be reached at 303-786-7437 or by email at: firstname.lastname@example.org.