My $0.02 on ADHD

Attention-Deficit Hyperactivity Disorder: ADHD. It’s everywhere today. More children and adults are diagnosed than ever before. More medications are prescribed than ever before. Even our entire world has been diagnosed with ADHD – what’s myth and what’s reality? And what, if any, are our treatment options other than medications?

Dr. Edward Hallowell, in his new book, “CrazyBusy : Overstretched, Overbooked, and About to Snap! Strategies for Coping in a World Gone ADD,” laments a world mad with overstimulation. Hallowell writes, “Being too busy can become a habit so entrenched that it leads you to postpone or cut short what matters most to you, making you a slave… to a lifestyle you don’t like but can’t escape. In part, it is the desire for control that leads people to lose it. Modern life makes us feel as if we can be everywhere and do everything and gives us the magical tools to heighten the illusion.” When we speak of environmental factors contributing to the explosion of ADHD and associated developmental spectrum disorders, most often we are referring to air, water, and food triggers of genetically-predisposed problems. But what Hallowell is describing goes beyond this concept; he is addressing social and cultural ills that are perhaps far more pervasive influences on our collective attentional abilities. It is a wonder that any of us are able to fully focus on the task at hand when we’re constantly bombarded by multiple aural, visual, olfactory and tactile stimuli. Are we effectively paying “continuous partial attention” or are we just “frazzing” as we whizz through life? In his book, “Delivered from Distraction,” Hallowell has written a chapter asking the provocative question: “Are we training our children to have ADD?” I agree with his sentiment that two major environmental changes, the technological explosion and chemically-dependent world we inhabit, are partially to blame for the rise in distractibility. When do we meet criteria for ADHD? When our lack of focus impairs our ability to function compared to our peers, typically in more than one setting (i.e. home and school). There is no one “test” for ADHD – children and adults must be evaluated carefully from both a psychological and biomedical perspective.

Which brings us to the world of integrative medicine – which assessment techniques and treatment modalities termed “alternative” may in fact be safe and effective? There’s evidence (see my reference list below) that children with ADHD have metabolic differences including levels of iron, zinc, magnesium, fatty acids, and carnitine, and may respond in part to treatment with these supplements. Some in fact have worsening ADHD symptoms with exposure to certain foods and food additives, so that nutritional adjustments may prove helpful. Yoga, homeopathy and exercise/outdoor play have all been shown to be effective for small groups of children with ADHD. But the most exciting therapy, based on differences in electrical brain wave activity (measured by quantitative electroencephalography or QEEG), is neurofeedback.

Neurofeedback, which used computer-assisted biofeedback program to measure changes in brain wave data, can be used to help individuals with ADHD to focus better and has been shown in studies (see below) to be as effective as medication for this purpose. Some parents may consider this therapy a first line option, along with appropriate psychoeducational assessment and therapy. Even when medication is necessary due to ongoing significant functional difficulties, neurofeedback may be used as a complementary modality and theoretically may allow kids to take relatively smaller doses of medication. Look, I am not ant-medication, but we must selective about its use, and more and more families are concerned with increasing media coverage of medication side-effects, whether real or not. We should consider the measured use of nutritional therapies and supplements, especially omega-3 fatty acids, along with neurofeedback treatment, in our treatment plans for all children with ADHD. That’s just my $0.02.

REFERENCES FOR ADHD/CAM

Miscellaneous:

Cala S, et al: A survey of herbal use in children with attention-deficit-hyperactivity disorder or depression. Pharmacotherapy 23: 222-230, 2003.



Chan E: The role of complementary and alternative medicine in attention-deficit hyperactivity disorder. J Dev Behav Pediatr 23: S37-S45, 2002.

Chan E, et al: Complementary and alternative therapies in childhood attention and hyperactivity problems. J Dev Behav Pediatr 24: 4-8, 2003.

Frei H, Thurneysen A: Treatment for hyperactive children: homeopathy and methylphenidate compared in a family setting. Br Homeopath J 90: 183-188, 2001.

Frei H, et al: Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled trial. Eur J Pediatr 2005 Jul 27, Epub ahead of print. PMID: 16047154.

Hattori J, et al: Are pervasive developmental disorders and attention-deficit/hyperactivity disorder distinct disorders? Brain Dev 2006 Feb 24, Epub ahead of print.

Jensen PS and Kenny DT: The effects of yoga on the attention and behavior of boys with attention-deficit/hyperactivity disorder (ADHD). J Atten Disord 7: 205-216, 2004.

Kemper KJ, et al: “At least it’s natural….” Herbs and dietary supplements in ADHD. Contemp Pediatr, September 2000.

Kidd PM: Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev 5: 402-428, 2000.

Koger SM, et al: Environmental toxicants and developmental disabilities. American Psychologist 60: 243-255, 2005.

Kuo FE, Taylor AF: A potential natural treatment for attention-deficit/hyperactivity disorder: evidence from a national study. Am J Public Health 94: 1580-1586, 2004.

Stubberfield TG, et al: Utilization of alternative therapies in attention-deficit hyperactivity disorder. J Paediatr Child Health 35: 450-453, 1999.

Szpir M: Focus: New thinking on neurodevelopment. Environ Health Perspect 114: A100-107, 2006.

Neurofeedback:

Butnick SM: Neurofeedback in adolescents and adults with attention deficit hyperactivity disorder. J Clin Psychol 61: 621-625, 2005.

Fox DJ, et al: Neurofeedback: an alternative and efficacious treatment for attention deficit hyperactivity disorder. Appl Psychophysiol Biofeedback 30: 365-373, 2005.

Fuchs T, et al: Neurofeedback treatment for attention-deficit/hyperactivity disorder in children: a comparison with methylphenidate. Appl Psychophysiol Biofeedback 28: 1-12, 2003.

Lubar JF, et al: Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Biofeedback Self Regul 20: 83-99, 1995.

Nutrition/Supplements:

Akhondzadeh S, et al: Zinc sulfate as an adjunct to methylphenidate for treatment of attention deficit hyperactivity disorder in children: a double-blind and randomized trial. BMC Psychiatry 2004, 4:9.

Bateman B, et al: The effects of a double-blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Arch Dis Chil 89: 506-511, 2004.

Bilici M, et al: Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention-deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry 28: 181-190, 2004.

Burgess JR, et al: Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder. Am J Clin Nutr 71: 327S-330S, 2000.

Harding KL, et al: Outcome-based comparison of Ritalin versus food-supplement treated children with ADHD. Altern Med Rev 8: 319-330, 2003.

Harley JP, et al: Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 61: 818-828, 1978.

Konofal E, et al: Effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder. Pediatrics 116: e732-e734, 2005.

Konofal E, et al: Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 158: 1113-1115, 2004.

Kozielec T, Starobrat-Hermelin B: Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnes Res 10: 143-148, 1997.

Mitchell EA, et al: Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr 26: 406-411, 1987.

Ritz BW, Lord RS: Case study: the effectiveness of a dietary supplement regimen in reducing IgG-mediated food sensitivity in ADHD. Altern Ther Health Med 11: 72-75, 2005.

Rowe KS, Rowe KJ: Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 125: 691-698, 1994.

Starobrat-Hermelin B, Kozielec T: The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD. Magnes Res 10: 149-156, 1997.

Stevens LJ, et al: Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 62: 761-768, 1995.

Toren P, et al: Zinc deficiency in attention-deficit hyperactivity disorder. Biol Psychiatry 40: 1308-1310, 1996.

Van Oudheusden LJ, Scholte HR: Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 67: 33-38, 2002.

Comments

  1. Dear ADHD specialist,
    I would like to bring to your attention a new concept in ADD testing. An objective physiological measure of ADHD has been elusive. However, research by Jason Alster MSc has shown that when an ADD person tries to sit still , do a boring task, or concentrate- they actually enter stress as measured by electro dermal activity. This marker is positive in the majority of ADD clients tested. Then GSR biofeedback may be used to improve the stress result. A protocol using this valid objective physiological marker has just been published in a video- Guide for GSR Biofeedback Techniques For The Natural ADHD Practitioner.

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