How mould increased ADHD 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 one such case.  He could not concentrate or do homework.  He had a complicated history with some highly relevant infective issues in the past (we might look at those another day) but one things that emerged was that his parents live in a house they were renovating and his accommodation at school was from the 17^th Century.  Both had damp and mould.

Mould is an important and very under-appreciated cause of major problems in some people who react with major inflammation to it.  So we tested P and his mould test showed this:

That is a pretty severe mould reactivity picture.  We treated it (and dealt with his infective aspects) and his concentration markedly improved.  He is on a very low dose stimulant medication (10mg methylphenidate) and I am certain if he had not eliminated his mould and had building renovation, so removed the source) he would need a much higher dose or not responded well at all.  So ADHD is not one thing.