Although iron is an over-the-counter medication (available without a prescription) and while iron supplementation can prevent (e.g., preterm deliveries, hearing impairment), relieve (e.g., ADHD) or cure diseases (e.g., RLS), and help manage recurring problems (e.g., dysautonomia, migraines, ADHD and RLS), the public perceives its role to be less significant than prescription medications. For example, in clinical care of patients with neuropsychiatric and neurodevelopmental conditions, the impact of ID has not fully been recognized – in fact, a recent cohort study shows a significant association between the ID-syndrome RLS and suicide or self-harm. Experimental studies over two decades are unraveling the role of iron and ID in prenatal alcohol exposure (PAE) and/or FASD, with recent research in PAE models demonstrating that depending on the nutritional status of the mother animal, prenatal alcohol consumption may lead to significant brain IDs (explaining some of the behavioral challenges observed in all PAE models).

Conventionally, neuropsychiatric or neurodevelopmental H-Behaviours are targeted with psycho-pharma. However, short visit times, provider gaps in knowledge, lack of resources for comprehensive evaluations, inability of younger children to report their internal experiences, and less reliable parent report for their children who are in out-of-home care for much of the day add layers of complexity to already multifaceted, multidimensional presentations. These patients are subject to high rates of misdiagnosis, inappropriate treatment, polypharmacy and consequential co-morbidities, which can affect their entire lives and well-beings. Therefore, we see neuropsychiatric and neurodevelopmental disorders as the non-communicable diseases of the 21st century that have an enormous impact on society and healthcare in general. Treatment of children with disruptive “restless” behaviors has been an ongoing task and, despite enormous efforts, unfavorable long-term outcomes (delinquency, suicide, substance abuse) are the sad fate of many of the affected individuals. Desperate clinical circumstances, due to missing evaluation criteria (using standardized core outcome measures), often lead to deviations from common prescription recommendations, e.g., prescribing more than two psychostimulants at a time for one patient or starting off-label prescription of antipsychotics in very young children. “Normative” data of “restless” behaviors are not only missing, but possible causes of restlessness are also not captured. ID as a possible root cause is often overlooked or missed.

The suggested approach, to treat ID as a possible cause of H-Behaviours, exceeds the current clinical practice of using “labeling” categorical diagnoses for challenging or disruptive behaviors and treating them with psycho-pharma. The communication around ID, which is nutrition and lifestyle based, is a game-changer in neuropsychiatry and neurodevelopmental disorders, as it opens a new opportunity for neutral, explorative and respectful communication with individuals, whose challenging behaviors have been an issue of concern and who so far have been labeled as disruptive, non-compliant or even as asocial.

Michael Smith Foundation for Health Research Convening & Collaborating (C2) award (2017); Can-FASD Research Network (2017); BCCH Research Institute (2017-2019); UBC Summer Student Scholarship (Mach-Gaensslen Foundation; 2017) and UBC Medicine FLEX Program (2018).