The most important thing for which we can prepare a child is the experience of freedom, at the right moment in life, through the understanding of one's own being.

 

Rudolf Steiner (1861-1925)

Foundations
ADHD, limb human being, organism as a whole, relationship experiences, Ritalin, toxic stress, cortisol levels, moment of contact, movable classroom, music therapy, father-mother-child triad
By: Georg Soldner, March 2020, Medizinisch Pädagogische Konferenz" Issue 73, May 2015, shortened

Disorders of attention and childhood activity (ADHD)


How do we find our way from a purely neuro-biological perspective to a fully human one? Disturbances of attention and activity and their associated social behaviors are the most common psychiatric diagnoses in children today in countries with a "Western” lifestyle. The following article (part 1) attempts to develop a differentiated understanding of such children on the basis of anthroposophical anthropology as articulated by Rudolf Steiner, and to contribute to their successful pedagogical and therapeutic treatment.

The polarity of head and limbs, female and male constitution

The starting point of this article is the simple fact that attention deficit disorders with a lack of impulse control and hyperactive behavior are much more common in boys than in girls: at puberty, the ratio is about 4:1 according to the KiGGS (K) children's health survey (1). This is supported by other studies. While neurobiological and pharmacological viewpoints dominate ADHD research in childhood and adolescent psychiatry, in anthroposophical medicine and pedagogy we start by looking at the human organism as a whole.

 

If we want to approach the question of how we can understand gender differences (in particular hyperactive, socially inappropriate behavior) taking into account the whole human being, then one comment by Rudolf Steiner is particularly helpful. In the 10th lecture of his introductory course for the teachers of the first Waldorf School, The Foundations of Human Experience (also translated as The Study of Man), Steiner describes the polarity of the sphere and the radius: the relationship of head to the four limbs (2). The spherical, internally centered nature of the human head differs radically from the typical animal skull, with its "retreating forehead," its horizontally oriented limb-like protruding snout (or other mouth opening) and cranium; in contrast, the human skull more closely approximates to the ideal of a self-contained sphere resting on a supporting trunk. Within this, the brain floats almost weightlessly in cerebro-spinal fluid, due to the Archimedean principle of buoyancy. It is within this organ that the cause of attention deficit and hyperactivity is sought today. The spherical shape of the head is in polar contrast to the radiating limbs, whose "center" lies in the ultimate periphery, an infinitely large sphere, which thus has the opposite orientation to the inwardly oriented, spherical shape of the head. Accordingly, limbs differ fundamentally in their design from the head: “If you look at the limbs attached to the entire body, at the real nature of the human limbs, you will find their essence in their clothing of muscles and blood vessels.” (3)

 

From an anthroposophical-medical point of view, it is an unjustifiable reductionism to consider the topic of hyperactivity by exclusively studying the nervous system as the cause of an excessive urge to move while ignoring the human limbs as the primary behavioral organs of movement. Rather, it is the tension and possibly shifted balance of forces between the head and the limbs that must be taken into account.

 

Head development plays a leading role in the human embryonic period in the womb, in the buoyant space of amniotic fluid. Not only the nervous system, but also connective tissue, bones, teeth and the musculature of the head are of "neurogenic origin" and emerge from the neural crest (4). The head and its central organ, the brain, usually represent the most endangered organ at birth. The majority of acquired sensory-nerve disorders which can permanently impair the function of the central nervous system occur in the perinatal period, especially in premature and very premature infants (5). In contrast to primates, the human brain continues to grow after birth up to the age of seven and triples its weight in the first year of life; it still accounts for about 14% of body weight at this age [in the first year of life] and claims more than 50% of the blood sugar for itself at rest. The brain continues to mature up to the age of 20 (myelination, continuous further development of the neural networks depending on sensory impressions, physical activity, learning processes and mental relationship experiences) (6). The phylogenetically oldest parts of the brain and the areas of the limbic system that are connected with body–soul and emotional life mature first, mostly before the age of nine. The prefrontal cortex, the part of the frontal lobe behind the forehead which develops only in humans, only functions fully in the third year of life. The outstanding ability by which a person can mentally intervene in their own bodily actions and inhibit their own impulses and reflexive actions owes its existence to this area of the central nervous system.

 

This stands in contrast to the development of the limbs. The limbs develop in humans especially in the second half of childhood (while in animals the development of the head and limbs occurs much more in parallel); the sexual organs and certain metabolic functions such as fat digestion mature at this same time. The form of the human limbs brings about the possibility of freedom of human action (7) and with it the capacity for 'bad,' ill-judged deeds. It is in the hands of each human being to control themselves from within or let their impulses run free.

 

Not surprisingly, it has been calculated that in the United States the youngest student in a school class is twice as likely to be prescribed methylphenidate (Ritalin) at the age of 10–14 as the eldest (8). The ability to inhibit, to control different impulses, to put the limbs under the control of the head increases physiologically with age. In addition, impulse control is constitutionally more pronounced in girls and women. This ADHD-related disadvantage to the youngest children in a class does not seem to exist to a similar extent when the school starting age is seven years, as is the case in Scandinavia.

 

The brain is physiologically in a resting state while the limbs are in motion as is the heart. Stimulants that strengthen the inhibitory impulses of the brain cannot help to inhibit impulsivity and limb activity, and also not the side effects on the heart (including ventricular arrhythmias). In anthroposophical medicine, medicines which have an effect on the heart, especially those such as Aurum/Hyoscyamus comp. which help prevent the rhythm of the heart being overwhelmed by the metabolism, have a positive effect in boys with constitutionally prevalent limb vitality. The child and adolescent psychiatrists Uwe Mommsen and Arne Schmidt pointed this out early on at specialist conferences. In anthroposophical medicine, the substance Aurum has a special significance for children with ADHD; it represents the sun and also the masculine element (as silver and copper do the feminine).

 

The interaction of father, mother and child
Statistically, children who grow up with their father show about 50% lower ADHD risk. In very poor families, the risk of ADHD triples; in very rich ones it doubles. In addition, [research indicates that] there are social and religious aspects: a boy raised by a separated parent, in a well-off family, who attends a state school in the United States has a 58-fold higher risk of being diagnosed with ADHD than a girl who attends a Catholic school, whose parents live together and earn a middle income (9).

 

Toxic stress in early childhood
In research into early childhood, the dimension of "stress" plays a leading role today already in the prenatal development of the child. In the fetus itself, the cortisol level should remain low until shortly before birth to allow undisturbed growth processes; 75% of cortisol in the fetus is from the mother. If a pregnant woman is under persistent high stress, this can already lead to an increased cortisol level in the unborn child with a consequence, for example, that the development of the frontal brain is impaired.

 

Not every stress or challenge has a lasting destructive or even toxic effect. Tolerable stress is characterized as positive stress if the child experiences the stress in the presence of one or more trusted people. Astral tension can be balanced out in this way. Important here is the moment of physical touch - this form of contact "gets under the skin," a term now standard in research literature.

 

Toxic stress is characterized primarily by the absence of adults who are reliably and attentively available to the young child: the absence of such a person of trust in the event of adversity, severely challenges and stresses the child. This is the decisive point in toxic stress. According to current scientific knowledge,

  • Child neglect
  • Maternal depression, to a lesser degree paternal
  • Substance abuse by parents
  • Sexual abuse can often lead to toxic stress (10).

In the case of toxic stress in early childhood, there is a persistently high blood level of stress hormones, which can still be detected at the age of 18, largely independent of the stress conditions then prevalent. In this case, stress regulation is persistently disturbed, and the reaction of the affected person is usually poorly adjusted and dysfunctional. For example, a recent study (11), which is consistent with other research, suggests that "brain architecture" may be permanently compromised by toxic stress in early childhood, depending on raised adrenal stress hormone levels.

 

A new paradigm for pediatrics
In 2012, the American Academy of Pediatrics announced a paradigm shift based on a key publication by Jack Shonkoff, director of the Center for the Developing Child at Harvard University (12). Shonkoff's work recreates the role of the pediatrician (who in the twentieth century was primarily dedicated to combatting infectious diseases) as one today who must strive primarily to ensure that every child can develop within a dependable social network which is reflected in the successful development of the central nervous system and which provides the warmth and support to protect against premature, fear- and stress-filled awakening and a concomitant, premature and independent process of bodily degradation. By making this paradigm a guiding factor in American pediatrics, Rudolf Steiner's fundamental concerns—particularly the organ-forming importance of early childhood—are recognized and confirmed, especially that disorders of learning ability, social behavior, and health development share the same source and that chronic diseases of adulthood often have their roots in childhood disorders, we should actively take this moment on the part of anthroposophical medicine, to

  • extend the concept of shock, which has been of central importance in anthroposophical medicine from the start (13), to the question of ego presence on the one hand, and chronic, recurrent toxic shock on the other;
  • focus more on the substantial role of the kidney-adrenal system in the formation and function of the central nervous system. Steiner referred to their connection to the HPA axis [hypothalamic-pituitary-adrenal axis];
  • grasp and address the importance of support and affection in the father-mother-child triad and its crucial importance for the child's stress experience, including the differentiated effectiveness of the head and limbs in the sense of a holistic and threefold understanding of the human being as described above. 

Consequences for pedagogy
“In any case, we will learn a very great deal about alleviating the child`s lack of intellectual ability if we look at the parents whom the child imitated up to the change of teeth. If we do so, we will find not only a theoretical explanation, but also suggestions for implementing what we have to do about it. The emotional life plays a very sigificant role in children of school age. It even plays into morality in that it receives the good only through sympathy for the good in the teacher. Children's emotional life becomes transparent when we can see through their feeling into their parents' particular variety of feeling life. This applies equally to the life of the will.” […] However, if we know that things and beings have origins, if we look to the source rather than to something abstract, then we must consider the child's parents and home.” [...] The parents' evenings that are organized by the Waldorf School are there in order to create a bond between school and home. What we do in these parents' evenings is meant to allow the parents to see the attitude and soul-constitution of the faculty.” (14)

 

There can be no doubt that children's behavior is also a reflection of those who teach them, giving them support, affection and age-appropriate opportunity for self-efficacy and internal activity. For adults needing to manage their own stresses, experiencing fragile relationships, economic pressures and a range of burdensome expectations (including managing daily electronic communications), such considerations initially give rise to "more pressure”, rather than helpful guidance.

 

The standard work, Nelson's Textbook of Pediatrics (2003) defines ADHD as a complex of symptoms that is predominant, occurring in different contexts and which has a disruptive effect "[on] the individual's ability to function under normal circumstances." With a definition analogous to an industrial company, the most frequent child and adolescent psychiatric diagnosis in the Western world is introduced here—“normal, to function under normal circumstances." What are "normal circumstances"?

 

Two years ago, when I was a guest one morning in a third grade at the Waldorf School in Munich-West where the concept of a "movable classroom" was implemented competently from the beginning, I was able to experience this to a degree I could scarcely grasp in a class of 37 children, including children with medically defined hyperactivity and attention disorders (especially as I had the comparison of visiting an earlier third grade with the same, excellent teacher in a conventional setting). The children rebuilt the classroom several times, balancing on the balance beam at first, supporting each other, and accompanying the lesson with meaningful limb activity. In the course of two lessons, towards the end of which the teacher wrote on the blackboard for several minutes, the children did not have to be quietened once.

 

The strongest effect on concentration and attention in my experience is music (15). Music has been shown in several studies, sometimes academically researched, to be the strongest force against senseless and harmful violence in deprived areas, perhaps most impressively in the "El Sistema" project in Caracas, which began in 1975. Experience shows that children who learn and really practice an instrument and who perform in a choir and/or orchestra benefit more in terms of attention and impulse control than any other form of activity or therapy. Already the effectiveness of music is proven for massively stressed premature babies and newborns, here by passively performed music therapy.

 

Translated by Neil Boland

 

 

Georg Soldner, Deputy head of the Medical Section of the School of Spiritual Science at the Goetheanum, Switzerland; Head of the Academy of Anthroposophic Medicine in Germany (GÄAD); established paediatrician and youth physician in Munich/ Germany with focus on integrative treatment of children with chronic diseases; editor-in-chief of the Vademecum of Anthroposophic Medicines

 

Literature

(1) Huss et al: KiGGS (Study on the health of children and adolescents in Germany) 2008.

(2) Every reader of this article should (re-)read GA 293, The Foundations of Human Experience, especially the 10th lecture, as background to the following remarks. In this lecture, the relationship of the human limbs to mind, soul and body is developed impressively. For the presentation given here, reading the 13th lecture of the same work is also important, in which the significance of meaningful, consciously directed movement for the development of the child and the control of the limbs is elaborated.

(3) Rudolf Steiner Complete Edition, Dornach/ Switzerland, GA 293, 9th ed. 1992, 149.

(4) Rohen, J.W.: Morphology of the human organism, Verlag Freies Geistesleben Stuttgart 2000.

(5) The interaction of the nervous system and the limbs and also the soul interaction between child and mother is shown in a psychologically disastrous way by the birth of the later German Emperor Wilhelm II. Wilhelm's mother never got over the paralysis of her first-born's left arm, and the Emperor was subjected to innumerable, brutal attempts to compensate for this blemish and become a "real man."

(6) Fuchs, T.: The brain - a relational organ. Kohlhammer, Stuttgart 2008.

(7) Rohen, J., l.c., 76f., And Verhulst, J.: The First-born, Verlag Freies Geistesleben Stuttgart, 1st ed. Stuttgart 1999.

(8) Elder, T.: The Importance of Relative Standards in ADHD Diagnostics: Evidence.

(9) Schneider H., Heisenberg D.: Who receives a diagnosis of attention deficit / hyperactivity disorder in the US elementary school population? Pediatrics 2006,117.

(10) Friedmann, H.: The Long-Life-Formula, Beltz-Verlag 2012.

(11) Burghy et al: Developmental pathways to amygdala prefrontal function, Nature Neuroscience 15, 2012.

(12) Shonkoff et al: The Lifelong Effects of Early Childhood Adverse and Toxic Stress, Pediatrics 129, 2012.

(13) See R. Steiner's remarks on the genesis of bronchial asthma in R. Steiner, Physiological-Therapeutic on the Basis of the Humanities, GA 314, 3rd ed. Dornach 1989, 203f. See also in detail Soldner G., Stellmann H.M., Individual Pediatrics, Scientific Publishing Company Stuttgart, 4th ed. 2011, 529-543.

(14) Rudolf Steiner, Rudolf Steiner in the Waldorf School, Complete Edition, Dornach / Switzerland GA 298, 218.

(15) Bastian, H.G., Stimulate children optimally – with music, Schott Mainz, 3rd ed. 2003.

 

The article presents the - extended - author's presentation on a lecture given on 26 October 2014 at the Goetheanum/Dornach in the context of the anthroposophical medical training for school doctors, paediatricians and child and youth psychiatrists on the subject of attention disorders. The explanatory panel drawings are missing. First publication in "Medizinisch Pädagogische Konferenz" Issue 73, May 2015, shortened by Katharina Stemann



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