ADHD or family history of histamine-related symptoms

My Mantra these days is that ADHD is not a disease it is a syndrome.  That means a collection of symptoms that seem to occur together a lot and (often, but not always) respond to a particular treatment.  In this case that is stimulants like Methylphenidate but that does not make them all the same thing.  For many people having a strong black coffee helps them concentrate – does that mean they have a disease or deficiency?

I now say that I see and assess for ‘the ADHDs’, a group of conditions that may have similar symptoms but different causes.  I can list many reasons why someone might have those symptoms.  Should they all have methylphenidate (or similar?), or should they have that if it helps AND something to remedy the underlying cause(s)?  You can choose, but I know which I would prefer.  Unfortunately (in my view), there is now an industry in diagnosing ‘ADHD’ and handing out or signposting to medications.  Increasingly I get such referrals with ready-made assessments that have not considered the bigger picture.

P was a case who was 6.  He had ceaseless restlessness and could be quite challenging.  ADHD had been queried. He had never slept well.  Interestingly this was just like his father, who had made a big success of his life but struggled to do so.  Both of them had marked histamine-related symptoms.  Histamine is a very under-appreciated driver of anxiety in some, and so, in my view, often related to inability to concentrate.  In this case both were very allergic, had skin rashes, ran hot (especially at night) and were very bendy in their joints (hypermobile – often seen with histamine issues).  P turned out to have rather a lot of arsenic in him on testing – this is usually related to rice which has a lot of inorganic arsenic in it these days.  We sorted that out (diet alteration and supplement help) and he did well on an older style antihistamine we tried: his sleep improved (not the main reason for giving it but a useful side effect), and he became less active.  We then added a tiny dose of stimulant (2mg dexamfetamine) and that really helped too.  He is doing much better and I am seeing his dad soon!