We have a diagnosis – What now?

March 28, 2021 by drlindenberg
Many children are diagnosed with psychiatric diagnoses these days. The most common of these are Autistic Spectrum Disorder, or Diversity (ASD) and Attention Deficit (And Hyperactivity) Disorder (ADHD). The diagnoses are made according to certain diagnostic criteria described in the DSM (Diagnostic and Statistical Manual of Mental Disorders) currently the 5th edition. ASD and ADHD are neurodevelopmental disorders. ASD presents with challenges in speech and communication, behavioural symptoms, including rigidity and repetitive behaviours, and sensory dysregulation. ADHD presents with concentration problems, hyperactivity and impulsivity, individually or in combination. The important aspect is that we make a diagnosis when there is perceived disfunction.

Let’s talk about getting a diagnosis

By the time one decides to get a diagnosis for a child a lot has happened. Moms are often disregarded when they become concerned about their children, but I have learnt that a mom’s intuition can be trusted and needs to be respected. A diagnosis of autism or ADHD opens the door to a thinking process around therapy options, opportunities and treatment modalities. But, there are often limited resources or offers of help when a diagnosis is given. A diagnosis also brings about a mourning process. In the initial state of denial, which is a valid part of the mourning process, certain messages are often missed. Support and guidance from everybody involved forms an important platform for parents to be able to make valuable decisions about interventions. Early intervention is best.

Does it make sense to have a diagnosis?

In the case of neurodevelopmental conditions, a diagnosis is often a label to allow for a medicine prescription. For me, a diagnosis is just a name. One has to look further and identify the challenges that comes with the diagnosis. One has to individualise and prioritise the areas where developmental resistance is. One has to try and understand what one could optimize to enable ideal neurological development.

How do we go about optimizing health factors related to neurodevelopment?

 Optimise sleep

When talking about sleep, one often wonders what the guidelines are. Between boundaries of individual variations in the need for sleep, a 1–2-year-old child needs about 11-14 hours of sleep, a 3–5-year-old 10 -13 hours, a 6–12-year-old 9-12 hours and teenagers 8-10 hours. One of the big reasons for sleep deprivation is the stimulation that blue light from technology causes. Blue light suppresses melatonin production, leading to a dysregulation of normal day/night biorhythms. Sleep hygiene and proper bedtime routine is important to lay a foundation of good sleep. There are a few reasons why sleep could be disturbed. In the case of a child not being able to sleep properly, one of the first things to address, is sensory integration. Children who have sensory dysregulation, often cannot self soothe effectively. This can be addressed with the help of an occupational therapist. Nutritional deficiencies could contribute to sleep disturbance. Testing for that could be done by a medical professional. Iron deficiency, vit B12 deficiency and vit D deficiency are a few causes of sleep problems. Epilepsy often disturbs sleep and is sometimes difficult to notice. Noises during sleep, abnormal breathing patterns, certain eye movements or jerking during sleep, restless sleep and excessive grogginess in the morning could be indications that this needs to be examined further.

Optimise diet

Children resonate to high calorie, low nutrition (junk) foods, like sweets and fast-food. Good eating habits are extablished early on in life by good role modelling, discipline around food and desensitisation of sensory challenging options. It is, however easier said than done, as one often only realises you have a problem when you reach the end of the line.

There are several good choices of “brain nurturing” foods. The best diet for a child is a whole foods diet (avoiding processed and refined options), including all food groups with variation. It is a well-known fact that the intake of sugar increases ADHD symptoms and hyperactivity. Poor diet worsens mood disorders. There are obviously reasons for exclusion diets, but that should be determined on an individual basis, with specific reasons for doing so. Gastro-intestinal inflammation, which could be confirmed by a stool analysis would be one of the reasons why one would look at excluding certain food groups. Specific food allergies would lead to gastro-intestinal symptoms in younger children, as well as eczema, hay fever, asthma and anaphylaxis. This could be tested by doing a blood test and/or skin prick tests. Food sensitivities would give more subtle symptoms and is evaluated by doing an IgG Food sensitivity screening (also a blood test). The problem with the IgG test is that the results are quite variable, changing from week to week. If there is any inflammation, or a permeable gut, there would be upregulated sensitivities, so this test is better done after gut healing therapy has been followed, if indicated.

To supplement or not?

I like to use indicated, individualised supplements for therapeutic value. There are a lot of ways in which one could develop an understanding of what a particular child needs, but it involves extensive biomedical assessment. As it is an individualised process, there is no one size-fits-all magic formula, although one would find a lot of blanket approach options out there! My advice would be that one gets help from someone who is experienced and knowledgeable.

There are, generally speaking, a few good-option supplements that one could look at without any further digging. The first is Omega 3. Omega 3 from sustainable sourced fish origin is best, but there are vegan options, from kelp too. Our Western diet gives us a lot of Omega 6, from grains, so, unless one is following a grain free diet, one should concentrate on Omega 3 rich products. One would preferably want a good quality product, as the inferior products  contain higher levels of peroxides that are noxious or ethyl esters that could be harmful for pregnant mothers or children.

A good, general multivitamin may be of value, but one must be careful to rather use organic options, as synthetic vitamins are often not metabolised properly. One can never get a plate of food into a capsule, though!

Gut health is extremely important, so if there are any indications, it can do no harm to use an array of good probiotics. Probiotics are a whole science on their own, so using different brands and gauging the response from each to be able to select the appropriate one, is a good strategy. I find that children often don’t get enough fibre in their diet, especially if they are self-selective about food. Fibre is a prebiotic and acts like a fertiliser for probiotic flora. A good example of an effective probiotic is Inulin, a good supplement to add for some nutritious fibre. It is useful to know that, if inulin causes symptoms, the gastro-intestinal tract needs to be investigated, as that might implicate that it is stimulating abnormal, harmful flora.

Iron supplementation should only be given when there is proven iron deficiency, which could be determined by doing a blood test. It is important to investigate further if an iron deficiency is diagnosed in a child, as that could be a solid pointer to underlying gastro-intestinal inflammation or – disease. Giving iron when there is no deficiency could be quite pro-inflammatory, so should be avoided.

Zinc supplementation is generally immune boosting. In the COVID-19 season, we have found, from time to time, that Zinc has been sold out, as there are certain antiviral benefits from Zinc. Zinc can build up, so it is necessary to interrupt the supplementation programme every now and again by skipping a month or 2 of supplementation.

Vitamin C is good to give. What is not so well known, is that synthetic ascorbic acid (vit C) is very short acting, so one needs to give more than one dose per day or use other forms of vit C, such as liposomal options or more organic products, such as Rose-hip.

That’s not all, folks!

Optimal neurological health is something we all, as neuro-diverse beings should aspire to. A healthy lifestyle involves a balance in everything. Exercise cannot be over-emphasized. Family time is hugely important. Stress management is a skill that we need to teach our kids. Some of them will find it harder and we need to understand that. Acceptance, positive feedback and healthy interaction form the support structure to launch a child successfully. To all the parents and caregivers, never forget to invest in and take care of your own health and wellbeing!


Dr Louise Lindenberg runs an integrative medical practice in Durbanville, Cape Town. She incorporates dietary intervention, supplementation, nutrition, phytotherapy/herbal medicine, and allopathic medicine in a holistic health care environment. Her passion is working with children on the Autistic Spectrum, including Autism, PDD, ADD, ADHD and behavioural problems.

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Copyright by Dr L Lindenberg 2020. All rights reserved.