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Is it ADHD or Exposure to Toxins?

In my December 20, 2010 blog  I asked if mental health therapists are asking about Housing Quality.  The CDC has linked housing quality to health.  There are ranges of issues that therapists could be asking but today I will focus on Indoor Pollution.  But first, lets explore the issue.  

The Environmental Protection Agency (EPA) has reported that people from Industrialized Nations spend up to 90% of their time indoors.  This number makes sense when we think about the time we spend at work, socializing, buying (i.e., groceries, mall), and hanging out in our homes.  When we think about small children and the elderly, this number may be even higher.  Because of this time spent indoors, people are more likely to be exposed to pollution and toxins in their homes rather than from the outside.  The EPA, CDC, and Physicians for Social Responsibility (PSR) list a number of indoor pollutants that are of concern.  They include; second hand smoke, lead, radon, biological contaminants (e.g., bacteria, molds, mildew, animal dander, house dust mites, cockroaches, pollen), carbon monoxide, nitrogen dioxide, organic chemicals (e.g., paints, aerosol sprays, pesticides, disinfectants, air fresheners, hobby supplies, dry-cleaned clothing), and asbestos.  This list is overwhelming!!

And while we might be concerned with these issues, we might think that someone else should explore these issues.  There are a number of reasons why a therapist should ask about Indoor Pollution.  First, children and the elderly are highly susceptible to toxins.  Children like to crawl around, put things in their mouth, and have increased metabolisms.  The Elderly are more likely to stay inside thus increasing their expose to molds, mildew, radon, and pesticides.  Reactions to indoor pollution can mimic psychological issues.  For example, children exposed to lead attention deficits, increased impulsiveness, reduced school performance, aggression, and delinquent behavior.  These exposures may also mimic cognitive deficits like memory loss.  As therapists we might be missing a key contextual factor that plays a significant role in the issue that brought a client to us.  Next, exposure to a range of indoor pollutants is harmful to expectant mothers.  Exposure to lead, mercury, alcohol, second hand smoke, and pesticides can adversely affect fetus development.  Lastly, parents are concerned about these issues but their primary care providers are not addressing environmental health issues.  Physicians for Social Responsibility highlight a report in Environment Health Perspective that despite the perceived importance of doing an environmental assessment, pediatricians are not trained to do one and thus lack confidence to ask the questions.

Hopefully you agree that therapists could play a pivotal role and one that does not take time too much time. So here is what you can do: 

• Ask about the occupation of all people in the household that work?  What do they do?  Do they think they might be exposed to chemicals on the job?  Employers are required by federal law to keep a list of all chemicals that are harmful to employees.  This is important because workers can bring chemicals back into their homes.  This information could be collected during the intake.  
• Ask about if they have any hobbies that include solvents (e.g., glue, paints, paint thinners, art materials)?  Where are they stored?  Do kids have access to them?  
• Ask about their diet.  Do they eat a lot of fish?  Where do they get their fish?  Fish can contain high levels of mercury.  
• Is there lead paint in the home? Homes built prior to 1978 used lead paint.  Older apartments can have lead paint.  
• Any hazardous sites near their homes?  Click HERE for an EPA website.  
• Where do they get their drinking water?  This is especially important for your rural clients.  
• When was the last time they had their heating system serviced?  Does not matter the type of heating?  This is also related to my previous post on Home Fires.  
• Have they talked to your Primary Care Provider about environmental health issues?

I know there is a lot of information above but the conversation you have with a client might only take a few minutes.  If you or your clients are curious or have more questions, you can check out the website below.  Leave a comment, questions, or concern below and thanks for following.

John

RESOURCES (Click on the links) 

• Center for Disease Control and Prevention's Environmental Health site.  
• Environmental Protection Agency has many resources.  Here are just a few: 
• The Indoor Quality site is a good start.
•  If you are interested in the science of environmental issues and children's health the Toxicity and Exposure Assessment for Children's Health is all you need.   
• Here is an Introduction to Air Pollution for Health Professionals 
• The International Labour Organization has useful page for Chemicals in the Workplace.  
• Physicians for Social Responsibility has great resources as well. 
• Here is a Pediatric Toolkit to help health care providers   
• Here is a wonderful publication called, In Harm's Way, that you can download.  
• Lastly, you can Continuing Education Course on Pediatric Environmental Health thats FREE.