An unconventional Saskatoon program is helping six-year-old Syrian refugee Mahmud Alcheikh heal from the trauma of the Syrian civil war.
Once a week, he sits around a large table in a small room at Queen Elizabeth School with his siblings Zeina, 9, Janna, 10, Abdulwhab, 12, and Mohamed Alcheikh, 13. The children draw the new contours of their lives away from war, coloured pens in hand.
Signs of trauma
Nathan Allen loves the colour blue.
His T-shirt is blue, the blanket wrapped around his knees is blue, and his eyes, bright under his baseball cap, are blue.
But blue is also a feeling, and after spending months undergoing near-daily dialysis at the Hospital for Sick Children, who could blame an 11-year-old for feeling a bit down?
Nathan was referred to the hospital’s new on-staff art therapist to help him cope with his emotions. And when Jennifer Bassin came to visit recently week with her case of supplies, he chose the colour blue to start on a sculpture of a car.
“Shocking,” jokes his mom, Judy Chapman.
Nathan was diagnosed with a bilateral Wilms’ tumour, a rare cancer of the kidneys mostly affecting children, at age 5. He started chemo and radiation and had a partial nephrectomy in both kidneys. His left kidney never worked properly again, and after almost five years of remission, cancer returned to his right kidney.
Now he undergoes chemo once every three weeks and dialysis five days a week. That’s a lot of poking and prodding for an 11-year-old who would prefer to be playing defence on the Georgina Blaze novice hockey team and cuddling his 3-year-old beagle, Daisy, at home in Keswick, Ont.
After three more chemo treatments, Nathan can go home. His parents are training to do at-home dialysis and counting down the days until Nathan can receive a new kidney. His mom is praying she can eventually donate one of her own.
Until then, he looks forward to his weekly sessions with Bassin. She visits during the two-and-a-half-hour dialysis process, and they paint or sculpt while the machine whirs in the background.
“It absorbs some of the time,” Nathan says. “I like to build stuff.”
Bassin has brought something called a 3Doodler — a cross between a hot glue gun and a tiny 3D printer, which can make plastic sculptures. This day, after he makes the car, she asks Nathan to make something that resembles his idea of cancer.
“A big, black, blob,” he says.
Nathan is an outpatient but most of Bassin’s patients are long-term in-patients at Sick Kids who have chronic illnesses, complex medical histories or have faced traumatic injuries.
Since the program started in May, she does art therapy just two days a week and sees between four and eight children aged 4 to 18. Psychiatric patients have benefited from art therapy at Sick Kids in the past, but this is the first year the new program, which is entirely funded by donations, has been extended to medical patients.
“Art therapy is taking the language children already speak and meeting them at that level,” Bassin said. “You don’t have to be good at art to participate in art therapy. It doesn’t have to be about the painting or about the drawing. It’s more about finding something they enjoy that we can use as a tool to explore how they’re feeling.”
One patient, who had recently been in a traumatic boat accident, sculpted a vessel out of clay — and then smashed it against the wall in a moment of catharsis. Some enjoy the physicality of painting big murals, and some like to rip up what they’ve drawn. Another drew a landscape so she could imagine herself outside the hospital, at a picnic.
“When you create something outside of you, you can really treat it like it’s at a distance, and it makes it safer for us to explore a little bit.”
Making art helps young patients take back some control in their lives, if only for an hour. Some patients are content with their creation, and others want to delve deeper into their feelings, Bassin says.
Nathan’s family hopes he can go home in late September, when he can rejoin his classmates in Grade 6 and go back to being an annoying older brother to his sister Emma, 7. He’s still quiet, but less withdrawn after a session, his mom says.
As he paints a mask green, with blue lips and black eyes, Bassin asks Nathan if he has a plan.
“Nope,” he says. “Just going step by step.”
Are dietary interventions effective for treating ADHD? For many parents and professionals, trying to parse through the different claims about the impact of diet on ADHD has been challenging and confusing. At this point, substantial research on how dietary interventions impact ADHD has accumulated and several meta-analyses of this work have been published. Recently, a review of several meta-analyses of dietary interventions for ADHD was published [Research review: The role of diet in the treatment of attention-deficit/hyperactivity disorder — an appraisal of the evidence on efficacy and recommendations on the design of future studies]. In this paper, the authors summarize findings across 6 different meta-analyses of the impact of diet on ADHD to provide a high level summary of the best available evidence to date.
Types of dietary interventions
Three types of dietary interventions were reviewed — Restricted Elimination Diets (RED), Artificial food coloring exclusion (AFCE), and supplementation with free fatty acids (SFFA). Although other types of supplements beyond free fatty acids have been investigated, the authors felt there was not sufficient research on any single approach to include in their summary.
1. Restricted elimination diets (RED) — There are 2 different approaches to implementing this diet. In one approach, the child is placed on an extremely restricted diet, e.g., rice, turkey, a range of vegetables (lettuce, carrots, cauliflower, cabbage, beets), pears and water; this is sometimes referred to as the Few Food Diet. When a reduction in ADHD behaviors results — this would generally occur within 2–3 weeks if the diet is going to have a positive effect — new foods can be added back one at a time to see if they are well-tolerated or lead to an increase in problem behaviors. Alternatively, particular foods that are suspected to exacerbate a child’s symptoms may be removed one at a time to see if the child’s behavior improves.
2. Artificial food coloring exclusion (AFCE)- As the title indicates, this involves efforts to remove all artificial food colorings from a child’s diet, e.g.,Yellow #6, Yellow #5, Sodium Benzoate, Blue #2, etc., and observing whether this is associated with a reduction in ADHD behaviors. Carefully conducted trials have demonstrated that AFC’s – in amounts children could typically consume – can increase ADHD symptoms in many children.
3. Essential fatty acid supplementation — Certain fatty acids, e.g., Omega 3 and Omega 6, promote neural functioning. These fatty acids are called essential because they are not synthesized in the body and must be ingested. Children with ADHD may have lower levels of essential fatty acids relative to peers and several studies have demonstrated a link between low levels of EFAs and the severity of ADHD symptoms. Studies investigating the benefits of fatty acid supplementation for youth with ADHD raise fatty acid levels by administering capsules containing the fatty acids or sometimes by introducing diets rich in fish products.