ADHD and Alternative Treatments
Google ADHD and you’ll see that there is no shortage of opinions on that topic. Unfortunately, there is also no shortage of misinformation about ADHD. It has been called “a fabrication”, “a fad” and “an excuse for being lazy” even though medical science tells us otherwise. What ADHD is, is this:
- A medical condition that begins in childhood (although sometimes it’s not diagnosed until well into adulthood).
- A condition that can cause a lot of havoc if undiagnosed, misdiagnosed or undertreated.
- And, a condition that doesn’t always travel alone, instead sometimes keeping company with anxiety, depression and/or substance abuse.
Thankfully, ADHD is also something else - it’s a highly treatable condition that with the right approach doesn’t have to make life so hard.
What is ADHD?
Sometimes referred to as hyperkinetic disorder of childhood in the U.K, ADHD is a neurodevelopmental condition that is both complex and chronic. Complex because the specific causes, clinical presentation and response to treatment can vary from person to person. And chronic because the symptoms often persist into late adult life. With ADHD, the ability to plan ahead, maintain concentration (yes, even on boring but necessary tasks) and endure short term pain for long term gain is below average. Along with that can come anxiety (about not getting things done), shame (about deadlines missed and promises broken) and frustration (at how hard it is to do what seems to come so easy to other people).
Symptoms of ADHD
Symptoms of ADHD can be divided into general categories of inattention (“What, were you saying something to me?”), hyperactivity (“I thought I told you to sit down!) and impulsivity (“Did I really just spend £200 on a pair of shoes?!”). These core symptoms in turn cause problems in daily functioning that aren’t isolated to just one aspect of life – if they are present at school/work, they are present at home. At its worst, ADHD has been shown to contribute to lower academic achievement, unemployment, bankruptcy and divorce.
ADHD symptoms onset before the age of 12 and need to endure for at least six months. In other words, ADHD should not be diagnosed if symptoms are temporary. Remember that ADHD is not synonymous with intellectual or academic difficulties. There are many examples of very bright students who quietly (or not so quietly) struggle with ADHD and yet don’t receive the diagnosis because they are considered “too smart” to have the disorder.
Proposed causes of ADHD
ADHD is associated with alteration in brain structure and function. Abnormalities in neurotransmitters such as dopamine and norepinephrine have been reported in ADHD1. The question then becomes, what causes the brain-based differences seen in ADHD? The short answer is both genetic and non-genetic factors. From a genetic perspective, ADHD is considered one of the most heritable psychiatric disorders2 with several genes currently under investigation for their role in this condition. The most important environmental (non-genetic) factors have yet to be definitively determined although there is some evidence that severe early neglect and deprivation (i.e. as seen in certain orphanages) can help precipitate ADHD2. Outside of this extreme circumstance, current research does not support the belief that parenting style can, in and of itself, cause ADHD2. However, parent-child conflict in response to ADHD symptoms can certainly make things worse – both for the child and the parent!
- ADHD is the most common childhood behavioural disorder in the United Kingdom. It has been estimated that 2-9% of school-aged children and adolescents have ADHD.3
- As a chronic condition, 15-20% of children with ADHD will continue to meet the full criteria for the disorder as adults. An even larger number of children will continue to exhibit some symptoms of ADHD into adulthood although not of a number and/or severity sufficient to meet the full diagnostic standard.4
ADHD treatment is multimodal5 including such interventions as:
- Patient and family education.
- Behavioural interventions (i.e. parental skills training).
- Psychological treatments (i.e. cognitive behavioural therapy).
- Educational accommodations and occupational interventions.
Medication can be a very effective treatment for ADHD symptoms although it is not always recommended as a first-line treatment for children and young people.6 It is also important to remember that medications result in symptom management not cure. If medication is discontinued, it remains important to use behavioural interventions to minimize the impact of ADHD on quality of life and daily functioning.
Stimulants are the class of medications with the most evidence for effectiveness in ADHD. Commonly used stimulants include methylphenidate (Ritalin), lisdexamfetamine (Vyvanse) and dextroamphetamine (Adderall). Non-stimulant medication such as atomoxetine (Strattera) and guanfacine (Intuniv) can also be effective in some people with ADHD.
There is no lack of demand for natural treatment for ADHD, either alone or in combination with traditional treatments. In the latter case, it is important to rule out any possible adverse interactions before starting combination therapy for ADHD7.
The interest in natural treatments is understandable given that a significant number of patients don’t respond to, can’t tolerate or prefer not to take conventional ADHD medications.7 Nutritional interventions and herbal remedies are two of the most popular categories of natural treatments for ADHD.8
Nutritional Treatments: Nutritional guidance appropriate for the general population such as reducing simple sugars and emphasising fruits, vegetables, healthy fats (i.e. Omega-3 fatty acids) and complex carbohydrates also applies to the ADHD population. Although a well-balanced diet can provide sufficient nutrients9, not everyone with ADHD (or without ADHD for that matter!) has such a diet. This is one reason that there is a great deal of interest in the potential for nutritional treatment to help improve ADHD symptoms. A 2016 review reported that certain dietary fats (polyunsaturated fatty acids) can improve core ADHD symptoms, with some evidence that eicosapentaenoic acid (EPA, an omega-3 fatty acid) provided the most benefit. The benefit from the polyunsaturated fatty acids was not as clear in children with ADHD with another primary disorder such as autism. As the evidence remains conflicting, Britain’s current ADHD treatment guidelines6 advise that fatty acid supplementation should not be offered or recommended to children or young people. Nevertheless, research in this area continues.
There are some studies indicating that iron and zinc supplements may be useful in children who have both ADHD and a deficiency of these nutrients.10 Similarly, magnesium supplementation may result in behavioural improvements in children with a verified magnesium deficiency.11 If at all possible, eating adequate amounts of foods that are good sources of iron (i.e. dark leafy greens, chicken, lentils), zinc (i.e. wheat germ, almonds) and magnesium (i.e. bananas and avocados)9 is preferable to supplementation. If a healthy diet remains an elusive goal, it will be important to determine the appropriate use of these minerals with a physician and/or registered dietician.
Melatonin, a hormone important to sleep-wake cycle regulation, has been reported to be potentially beneficial for the management of chronic insomnia in childhood ADHD.11
Eliminating certain foods has garnered a lot of discussion by patients, families and professionals. As it currently stands, evidence regarding the impact of specific foods on ADHD is limited and not without controversy. However, at least some professionals in the field have argued that certain children with ADHD may respond positively to the removal of specific foods from their diet.12 Unfortunately, the substantial time and effort needed to undertake and maintain an elimination diet can prove quite challenging9 .
Herbal treatments for the management of ADHD continue to be studied. Select examples of natural treatments for which there is some evidence of effectiveness in the treatment of ADHD include the following8:
Pycnogenol (an extract of the bark of the French maritime pine): Some preliminary evidence that pyconogenol may reduce ADHD symptoms has been reported.8 The mechanism for action in ADHD isn’t entirely clear but pyconogenol has been identified as having potential circulation, immune and antioxidant effects.13
Korean Ginseng (KRG): At least two studies of Ginseng have demonstrated improvement in the core symptoms of ADHD.8
Although considered a chronic condition, there is much that can be done to mitigate the negative impacts of ADHD. Traditional treatment includes a wide scope of options ranging from parent skills training to evidence based pharmacotherapy. For those with a preference for natural treatments, the evidence for effectiveness in ADHD has begun to accumulate with further research continuing throughout the globe. A healthy lifestyle that includes a balanced diet of whole foods, adequate sleep, leisure time and physical activity is a good starting point for anyone with ADHD.
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- Wigal SB, Emmerson N, Gehricke J-G, Galassetti P. Exercise: Applications to Childhood ADHD. Journal of Attention Disorders. 2013;17(4):279-290. http://dx.doi.org/10.1177/1087054712454192
- Tarver J, Daley D, Sayal K. Attention-deficit hyperactivity disorder (ADHD): an updated review of the essential facts. Child Care Health Dev. 2014;40: 762–774. http://dx.doi.org/10.1111/cch.12139
- Conrad P, Bergey V. The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder. Social Science & Medicine. 2014;122:31-43. http://doi.org/10.1016/j.socscimed.2014.10.019
- Canadian Attention Deficit Hyperactivity Disorder Resource Alliance (CADDRA): Canadian ADHD Practice Guidelines, Third Edition, Toronto ON; CADDRA, 2011
- Attention deficit hyperactivity disorder: diagnosis and management
- Clinical guideline Published: 24 September 2008
- Mazhar H, Harkin, EF, Foster BC, et al. Complementary and Alternative Medicine use in Pediatric Attention-Deficit Hyperactivity Disorder (ADHD): Reviewing the Safety and Efficacy of Herbal Medicines. Curr Dev Disord Rep. 2016;3(1):15-24.
- James Ahn, Hyung Seok Ahn, Jae Hoon Cheong, and Ike dela Peña, “Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Potential of Combination Therapy,” Neural Plasticity, vol. 2016, Article ID 1320423, 18 pages, 2016. http://doi.org/10.1155/2016/1320423
- Bloch, MH, Mulqueen, J. Nutritional Supplements for the Treatment of Attention-Deficit Hyperactivity Disorder. Child and Adolescent Psychiatric Clinics of North America. 2014;23(4):883–897. http://doi.org/10.1016/j.chc.2014.05.002
- Phillips, W. Nutrition Management of Children with Attention Deficit Hyperactivity Disorder. Childhood Obesity and Nutrition. 2014;6(6):320-326. 10.1177/1941406414551202
- Pelsser LM, Frankena K, Toorman J, et al. Effects of a restricted elimination diet on the behaviour of children with attention deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. 2011;377: 494-503 doi: 10.1016/S0140-6736(10)62227-1