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Attention Deficit (Hyperactivity) Disorder (ADD/ADHD)

Introduction

What should I know about Attention Deficit Hyperactivity Disorder?

As any parent of a child diagnosed with attention deficit hyperactivity disorder (ADHD) can tell you, coping with the daily frustrations is a challenge at best. ADHD is one of the most frequently diagnosed childhood psychiatric condition. (1) While there are many theories regarding the cause of ADHD, we now know that many of the children diagnosed today, have a biological parent who shares the same diagnosis. Other factors that may contribute to the symptoms of ADHD are fetal alcohol syndrome, lead poisoning, meningitis, and a genetic resistance to thyroid hormone. (2) , (3) Also, while not a primary cause, there seems to be a positive association that exists between negative family environment factors and ADHD. (4) , (5)

We are fortunate that the diagnosis of ADHD has come as far as it has. Before 1980, a child with a short attention span who seemed impulsive and hyperactive was diagnosed with Minimal Brain Dysfunction. However, experts in the field argued that this was not an accurate diagnosis because there was no common neurologic problem that was consistent among the children diagnosed. In 1980, the American Psychiatric Association made a decision to look more at the behavioral side of the diagnosis, calling it ADD, or Attention Deficit Disorder. We now know that hyperactivity is almost always present so the name has been changed to ADHD.

What causes ADHD?

The Lancet published a study in 1985, which reported that 79 percent of hyperactive children improved when suspect foods were eliminated from their diets, only to become worse again when the foods were reintroduced. Artificial colorings and flavorings were the most serious culprits; sugar was also found to have a noticeable effect. The New York public school system initiated an experimental design in which sugar, food additives, and preservatives were gradually eliminated from the school cafeterias. During the four-year period of dietary modifications, the mean academic performance percentile rating increased from 39.2 percent to 54.9 percent. (6) Additives include artificial flavors and colors, preservatives including BHA and BHT, and sugars that can be identified in the forms of sucrose, fructose, corn syrup, mannitol, sorbitol, and other sweeteners.

Mineral status among those with ADHD has been the subject of several published clinical trials. Magnesium deficiency is the most common of the mineral deficiencies associated with ADHD. (7) In one study, magnesium deficiency was identified in 95 percent of the ADHD children examined. (8) ADHD may be influenced by dysbiosis. The presence of dysbiotic flora is encouraged by the use of antibiotics, which can destroy "friendly" or probiotic flora normally inhabiting the intestinal mucosa. The average child undergoes multiple courses of antibiotic treatment in the first five years of life, typically without replacement of probiotics. The resulting overgrowth of yeast and other pathogenic flora has been linked to alterations of immune function, food sensitivities, and ADHD. A study reported that high levels of antimetabolites, consistent with fungal or Candida related complex, were identified in the urine of children with ADHD. (9)

A deficiency in essential fatty acids (EFAs) is being singled out by some as a cause of ADHD. EFAs influence ADHD primarily in two ways: they influence gut permeability and are needed for the proper development of brain tissue. (10)

Statistic

National Attention Deficit Disorder Association, 1999.

    4-6% of the United States population has ADHD. 1/2 - 2/3 of all children with ADHD will continue to have problems with ADHD as adults. 1/3 of people with ADHD do not have the hyperactive or overactive behavior component. There is a 25-35% chance that if one family member has ADHD another member will also, compared to 4-6% of general population.

Centers for Disease Control, 2004.

    4.5 million children 3-17 years of age (7.4%) had ADHD. Between the ages of 3-17 years, boys were more than twice as likely as girls to have ADHD (10.2% and 4.5%).

Signs and Symptoms

The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.

What are the symptoms of ADHD?

A child with ADHD usually shows signs of this disorder by the age of three and almost always by the age of seven. A child with ADHD is unable to focus his/her attention on repetitive tasks, is easily distracted, has frequent outbursts of energy, is often fidgety, and has difficulty following instructions. Depending on the severity, a child may be considered "difficult to control." While adjusting to the symptoms that a child with ADHD displays is difficult, treatment is usually not necessary until the child enters school. In fact, because the condition is more often diagnosed in boys than in girls, (11) the active behaviors associated with boys at a young age may make a parent hesitant to seek medical attention. When a child enters school, however, the demands for performance and consistency of behavior may accentuate the symptoms and the parent or the teacher may request testing to determine if ADHD is present.

Depending on how severe the symptoms are, parents may choose either a pharmaceutical or natural approach. Sometimes a combination of the two will offer the best effects in managing the symptoms. Regardless of the path of treatment, the single most important element that a parent or teacher can offer is patience. This is not always easy because it requires a daily commitment to helping the child and the family deal with behaviors that are disruptive. Nevertheless, patience and support are fundamental.

Inappropriate attention for age

  • Failing to finish tasks
  • Not seeming to listen
  • Becoming easily distracted
  • Having difficulty concentrating on school work or sticking to play activities

Impulsivity

  • Acting before thinking
  • Shifting excessively from one activity to another
  • Needing much supervision
  • Frequently calling out in class
  • Difficulty waiting a turn in games or group activities

Hyperactivity

  • Excessive running about or climbing
  • Difficulty sitting or staying seated
  • Excessive movement during sleep

Treatment Options

Conventional

What are the treatments for ADHD?

The most common treatment for ADHD is the use of stimulant drugs. Whether or not drug therapy is recommended is often related to the severity of the symptoms. The use of methylphenidate, the most commonly prescribed drug for the management of ADHD, has increased 700 percent in the past five years. (12) Sometimes drugs called psychotropic medications may be prescribed. These are drugs that are most commonly used to treat psychiatric disorders. Using the standard tests that are associated with the diagnosis of ADHD, along with a thorough physical examination, your physician will be able to prescribe a medication that is most appropriate.

It seems that stimulant drugs may serve as a homeostat to stabilize arousal and thereby temper the spontaneous fluctuations that are characteristic of ADHD. (13) , (14) Most parents report positive outcomes with the use of these drugs even though the side effects associated with them may cause concern. Some of the side effects include sleeplessness, lack of appetite, and increased thirst. Parents must monitor these side effects during early treatment with stimulant drugs in order to assure the best dosage for the child.

While conventional drug treatment is common, there is mounting evidence that many ADHD sufferers can achieve dramatic results with dietary, nutritional, and environmental interventions. Particularly among young children, non-pharmaceutical interventions provide a risk free alternative that can be explored as a first line of treatment. If drug therapy is chosen as the preferred treatment, then combining that therapy with solid nutrition and dietary supplementation can result in a more comprehensive program.

Nutritional Suplementation


Omega-3, Omega-6

It has been suggested that a lack of essential fatty acids is a possible cause of hyperactivity in children. It is more likely the result of varying biochemical influences. These children have a deficiency of essential fatty acids (EFAs) either because they cannot metabolize linoleic acid normally, cannot absorb EFAs effectively from the gut, or because their EFA requirements are higher than normal.

Some of the physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans. Researchers report that a subgroup of patients expressing many symptoms similar to those seen in EFA deficiency had lower plasma levels of docosahexaenoic acid and arachidonic acid compared to those with fewer symptoms. (15) , (16) Children with low levels of total omega-3 fatty acids exhibited significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of omega-3 fatty acids. (17)


Magnesium

Magnesium is one of the most commonly deficient nutrients in children with attention deficit and hyperactivity disorders. (18)

Magnesium supplementation has been found to reduce levels of hyperactivity when the children being studied were given 200mg each day over a six month period of time. (19) The chief sources of magnesium in the diet are fruits and vegetables.


N-Acetyl Cysteine (NAC)

N-acetyl cysteine is a sulfur-containing amino acid that helps to remove toxins from the body. (20) , (21) Some studies indicate that exposure to toxic metals such as mercury (22) and lead (23) result in declines in attention and memory, as well as many other negative effects. If patients with ADD/ADHD are found to have elevated levels of toxic metals, N-acetyl cysteine is an effective agent to utilize in a detoxification program.


Bifidobacteria, Lactobacillus acidophilus

Studies report an association between ear infections in childhood and the development of hyperactivity. (24) Some practitioners believe that this is because the antibiotics affect the healthy bacteria in the intestines allowing toxins to enter the blood stream. The intestinal tract in a healthy person is populated with beneficial bacteria. Antibiotics can destroy a large percentage of the beneficial bacteria. If probiotics are not taken following a course of antibiotics, "bad" bacteria that are normally present in only small concentrations can compete equally with the few remaining friendly bacteria. If substantial amounts of pathological bacteria proliferate, it is quite possible the toxins excreted from their metabolism can enter the blood stream, causing hyperactivity, blood sugar anomalies, malabsorption of nutrients as well as other conditions.

Herbal Suplementation


Olive Leaf

Olive leaf extract has been reported to be an effective antimicrobial agent against a wide variety of pathogens. (25) It also has antiviral activity (26) , (27) which acts as an antifungal agent.


Kava

Kava has been used for centuries by South Pacific natives. In European phytomedicine, kava has long been used as a safe, effective treatment for mild anxiety states, nervous tension, muscular tension, and mild insomnia. (28) , (29) Some practitioners recommend Kava to children with ADHD to help with the stress and nervousness that accompanies this condition.


Evening Primrose

Evening primrose oil (EPO) is rich in gamma-linolenic acid, which is an omega-6 fatty acid. (30) , (31) The human body can produce all but two fatty acids: omega-3 and omega-6 fatty acids. Both must be obtained through the diet or with the use of supplements. Obtaining a balance of these two fatty acids is essential. Essential fatty acids are needed for building cell membranes and are precursors for production of hormones and prostaglandins. Modern diets tend to be lacking in quality sources of fatty acids.


Grapefruit Seed

Grapefruit seed extract has been reported to be a broad spectrum antimicrobial. (32) It has been found to inhibit some of the "bad" bacterial that may be found in the gut and to help maintain the adequate levels of the healthy bacteria. (33)


Bacopa

Bacopa or water hyssop, is a plant used since approximately the sixth century A.D. in the traditional Ayurvedic Medical System of India as an extract with cognition-enhancing benefits. Termed "Brahmi" in the Hindu language Sanskrit, bacopa is the foremost tonic for the nervous system in Ayurvedic medicine. It has been traditionally used for epilepsy, mental illness, and to improve memory and mental capacities. (34) Bacopa was reported to increase learning ability in laboratory animals. (35) Clinically, bacopa has been reported to be a useful agent for improving intellectual behavior in children.

Diet & Lifestyle

The effect of diet on children with hyperactivity disorder has been the subject of debate for over 30 years. During the 1960's, Dr. Benjamin Feingold, a California pediatrician, studied the effects of a low salicylate diet in the treatment of ADHD after observing an exacerbation of symptoms among hyperactive children when they ate salicylate-containing foods. Feingold’s observations led to a controlled clinical trial, which demonstrated that in addition to artificial colors and preservatives (which contain high amounts of salicylates), 90 percent of the ADHD children in the study had additional food intolerances. (36) The most common allergenic foods among children have been identified as cow’s milk, corn, wheat, soy, peanuts, and eggs. Additional "problem foods" have been identified. An experimental diet among preschool boys with sleep problems and hyperactive behavior demonstrated that after removal of artificial flavors and colors, dairy products, caffeine, MSG, and chocolate, over 50 percent of the children improved. (37) One study compared the treatment success of dietary restriction with methylphenidate and found that while 44 percent responded to the drug treatment, 24 percent had equal success with dietary modifications alone. (38)

    Avoid/eliminate all sugar and simple carbohydrate and white flour/pasta foods. Avoid/eliminate all foods containing artificial flavoring agents, coloring agents, and preservatives. Identify and eliminate food and environmental allergies
Full Spectrum Light: Dr. John Ott reported doing time lapse photography of a hyperactive child in a Sarasota, Florida elementary school. Over the weekend, the standard cool white fluorescent lights in this classroom were changed from their original tubes to full spectrum fluorescent lights. Within a week after the new full spectrum lights had been installed, the films revealed a reduction in the amount of hyperactive behavior with the new full spectrum lighting. (39)

Biofeedback: Numerous trials support the use of biofeedback as a retraining tool for brain patterning.

References

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