University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies Legacy Theses 1998 Application of the exorphin hypothesis to attention deficit hyperactivity disorder: a theoretical framework Hoggan, Ronald Hoggan, R. (1998). Application of the exorphin hypothesis to attention deficit hyperactivity disorder: a theoretical framework (Unpublished master's thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/17013 http://hdl.handle.net/1880/25999 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca THE UNTVERSITY OF CALGARY Application of the Exorphin Hypothesis to Attention Deficit Hyperactivity Disorder: A Theoreticai Fmework Ronald Hoggan A ITIESIS SUBMflTED TO THE FACULTY OF GRADUATE STUDlES IN PARTIAL FULriXIMXï OF THE REQUIREMENTS FOR THE DEGREE OF MASER OF ARTS GRADUATE DIVISION OF EDUCATIONAL RESEARCH CALGARY, ALBERTA APRIL, 1998 O Ronald Hoggan 1998 National Libraty Bibliotheque nationale du Canada Acquisitions and Acquisitions et Bibliographie Services services bibliographiques 395 Wellington Street 395. nie Wellingtm OttawaON K1AON4 OttawaON K1A ON4 Canada Canaoa The author has g-anteda non- L'auteur a accordé une licence non exclusive licence allowing the exclusive permettant à la National Library of Canada to Bibliothèque nationale du Canada de reproduce, loan, distriibute or sell reproduire, prêter, disbri'buer ou copies of this thesis in microfonn, vendre des copies de cette thèse sous paper or electronic formats. la forme de rnicrofiche/film, de reproduction sur papier ou sur format élecîrmique. The author retains ownership of the L'auteur conserve la propriété du copyright in this thesis. Neither the droit d'auteur qui protège cette thèse. thesis nor substantial extracts fiom it Ni la thèse ni des extraits substantiek may be printed or otherwise de celle-ci ne doivent être imprimés reproduced without the author's ou autrement reproduits sans son permission. autorisation. Abstract: This document suggests that ment pradces which lead to the diagnosis and treatment of attention deficit hyperadvi~disorder (ADHD) may obscure underiying pathologies which can have dangerous consequences when undiagnosed. Whiie nimulant therapies are sometimes an effective tool for the short-tem management of ADHD symptoms, they offer little long-temi hope to the afioicted child, peihaps placing that person's health in serious jeopardy. Teacher involvernent in this diagnostic and treatment process may aid in perpeniating this problem. An alternative understanding ofADHD, informeci by the exorphin hypothesis, offers a de, powemil tool for dealing with the underiying condition in many cases of ADHD, and an effeaive treatment for ADHD. A large and growing body of evidence supports the application of the exorphin hypothesis to ADHD, and points to some specific research needs in this area. Such research requires a shift away nom the pharmacological paradigm, in recognition of distinctions between pharmaceutid and dietary intementions. Preface The possibihty that exorphins may underiay many cases of ADHD is not a oew perspective (Reicheh, Ekrem, Scott, 1990). What is offered here is an assembiy ofthe various thrdftom peer reviewed, scieminc literaîure, dong with an integration of those threads into a tape* which forms a compehg picaire of what may constitute much of the condition we currently cdADHD. This thesis is infomied and shaped by the growing body of peer rwiewed herature which has increasingS. pointeci toward exorphins as a factor in ADHD (Reichelt et al., 1990; Crawford, Kaplan, Kinsboume, 1994; Uhiig, Merkenschlager, Baodmaier, Egger, 1997). A vaxiety of fimors have contributeci to the deiayed emergence of this perspective regardhg ADHD, incfuding limited access to some of the literatwe in question, the absence of work which inteptes the various elements of supporthg evidence, and a language barrier which distances research findings fkom many of those who rnight benefit fiom knowledge of that meciid and scimtific information. An issue of Med availability of research funding rnay also have contributed to obscuring the applicability of the exorphin hypothesis to ADHD. A variety of 6ictors linnt access to medical libraries, including their smaii numbers, hours of operation, and isolation from the codty. Teaching hospitals have such libraries, but much of the public is unaware of their existence. Perhaps there is an intimidating air for the few who do manage to hdsuch h'braries. Once access is gained, a fiirther limiting fàctor is the scientific language in which research reports are written This language obscures meanhg to aIi who are aot prepared or able to invest the necessary time required to master that lmguage which is the medium of published medical and scientific reports. Part of the offering of this doauneat is to provide an interpretation and an imegration of- reports pertinent to the issue M hand... ADHD. What foilows is offered in a fonn accessible to teachers and parents. The dtimate iment of üUs document is to aid children with ADHD. dong with their parents, th& teadias. and their medicd caregivers &OU@ providing an aitemative perspective of ADHD. Inberent in this view is a deand effective alternative treatment for many, perhaps most, young~s dering from this condition. The hypothesis embodied here is readily testable, and readers djudge for themselveç whether the evidence presented wmtsthe expendiîure of a very few dollars for sem antiibody testins or a few weeks of dietary investigation. The exorphin hypothesis suggests a broadiy apphcabie set of principles which may also deviate some of the current stniggle to undetstand the underiying dynamics in a varie of psychiatric ilinesses, including ADHD. It is also a postulation which offersan alternative, perhaps more appropriate path for teachen and parents who are dishirbed by the behaviour of some of the children in their charge, but who recognize the fdacy underiying the current practice of administering powerful medications to children, thus redu- the unpleasaut symptoms of ADHD, in the absence of a clear understanding of the condition behg treated, or the therapeutic action ofthe dnigs administered. The practice is one of placing some very dangerous band aids on symptoms without an understanding of the underlying cause of those symptoms. Neither does this thesis or its author offer a claim of ceftainty in the representation of ADHD that f'llows. This hypothesis does offer a de,effective, and heaithy means of deaiing with a majonty of cases of ADHD, but it is recognized that there wiU be other causes in some cases of this condition. Aiso embodied here is an understanding which resolves rnany of the apparent anomalies in the mddand popuiar literature regarding this pervasive, debilitating condition that carries Iife-long implications regardles of the therapeutic intervention chosen This thesis refiects the love, support, and encouragement Ite gotien nom my de, Betty, my rnother, Edm, and my children, Donovan, Darren, Kari and Kyra Their contn'butions have helped me fmd my way. It also reflccts the mentoring, support, kindness, and understanding of my advisor, Dr. Anthosy Marini. I am aiso gratefui to Dr. Garth Benson for helping me see science through many windows, and see my ansst as an impetus to explicate those windows. And fhaiiy, I am grarefui to Dr. Jim Paul for heiping me to understaud understanding through the incoqment, dissonant, dichotomous metaphor of moderdy, and through its counterpart. Dedication In memory of my brother, Jack Emest Hoggan, June 17, 1946 to November 18, 1996. His pain inspired the work that lies before you. ffis death inscribed its meaning on my soul. May his passing light a betta path for others. Table of Contents: Title Page .................................................................... i Approval Page............................................................... ...ii Abstract .......................................................................... rrr Pr&ce ........................... ,...,. ................................................................... iv Acknowledgement s ............................................................ vii Dedication ......................................................... viii Table of Contents ...................................................................... ix List of Tables ................................................................ xi List of Figures ............................................................... xii Chapter One ....Parents, Politicians. Physicians. Pedagogues. Pupils. and Peptides.. 1 DSMIV .............................................................................................................. 2 Blind Partnenhip ............................................................................................. 3 The Diagnostic Process .......................................................................... 6 Adjunctive/drugless therapies ................................................................................ 7 Intestinai permeabilrty. ............................................................................................ II Vîous atrophy ....................................................................................................