A Look at New Treatments for ADHD

June 15, 2013 at 9:53 pm
New ADHD TreatmentsQuestion: If some alternative treatments seem to work to help people with ADHD, why are there so few research projects to prove or disprove their effectiveness?

Answer: Research takes funding. While pharmaceutical companies have millions to spend on research to test their products, there is not much funding available to test other forms of treatment like vitamins and dietary changes.

The alternative therapies for ADHD fall into several categories. There are diets that limit certain foods and additives; there are programs advocating various vitamins and supplements, including herbal supplements; and there are programs that offer brain-based therapies, motor therapies, and visual therapies. Of these, it is important to note, the diets probably have the most research to support their claims, and the dietary recommendations, while they may be hard for children to follow, are not harmful. The vitamin therapies are both unproven and some are potentially harmful; they must be undertaken with medical supervision. The other therapies probably do not cause harm but are expensive and generally ineffective.

DIETARY TREATMENTS FOR ADHD

In 1970, a pediatric allergist Dr. Benjamin Feingold theorized that salicylates (a chemical compound similar to that found in aspirin), artificial colors, and artificial flavors caused hyperactivity in children.

Dr. Feingold proposed a diet that was free of such chemicals. In addition to treating ADHD, Dr. Feingold’s followers claim that his diet also helps with asthma, bedwetting, ear infections, eye-muscle disorders, seizures, sleep disorders, and many other conditions.

The diet is usually presented as a two-step process. In the first step, families eliminate artificial colors and flavors, the antioxidants BHA, BHT, and TBHQ—which are used as preservatives—products containing aspirin, and natural salicylates found in food. If the child shows improvement after four to six weeks, some foods may be carefully introduced.

Over the years, many parents have reported significant improvement in their children’s conditions. In 1980, a double-blind study conducted by the Nutrition Foundation concluded that while some children may in fact have sensitivities to food additives, most children showed no significant changes when the additives were removed, then added back into the diet.

Another study in 1983 concluded that about 2 percent of children respond negatively to food additives. A 2007 article published in the medical journal The Lancet noted that artificial colors and additives do seem to increase hyperactivity among younger children. One additive in particular, sodium benzoate, which is used as a preservative in many foods, seemed to have the greatest impact. The yellow food coloring tartrazine (also known as FD&C yellow #5) has also been linked to hyperactivity, although the relationship has not been definitively proven. The authors note, however, that the effects of the additives varied widely, with some children showing a marked increase in hyperactivity after ingesting the additives and others showing little or no effect.

Avoiding Sugar, Wheat, Carbohydrates, and Dairy

Many individuals believe that the symptoms of ADHD can be treated by the avoidance of sugar and artificial sweeteners, wheat, carbohydrates, and dairy products. There has been no research to date confirming any beneficial effect from eliminating any of these foods from the diet. While some children do improve their behavior when one or more of the foods are eliminated, these children are probably among the few who are actually allergic to these foods. Many parents have reported a significant decrease in hyperactivity when sugar is eliminated from the diet, but no study has confirmed this perception. In fact, one study found that mothers reported decreased hyperactivity when they believed their children had been given sugar-free snacks—even when the snacks were loaded with sugar.

VITAMINS AND OTHER SUPPLEMENTS

Because many children with ADHD have been shown to be deficient in iron and omega-3 fatty acids, many people believe that supplementing the diet with these substances will help lessen the symptoms of the condition. There are also those who believe that people with ADHD can benefit by taking magnesium, vitamin-B, zinc, or other supplements. Some people also think that very large doses of vitamins can help.

Iron

There have been several small studies that suggest that people with ADHD who receive iron supplements (ferrous sulphate) show improved concentration and less hyperactivity. More studies are needed to determine if the benefits found in these studies can be generalized to the larger population.

There are significant dangers with iron supplementation, however. Iron accumulates in the body, and if there is too much, it can be very difficult to eliminate. Even small amounts of excess iron in the body can damage the heart and the brain and lead to heart attack and stroke. No one should take iron supplements except under the supervision of a physician.

Omega-3 Fatty Acids

There have been a number of small studies that suggest supplementing the diet with omega-3 fatty acids can be helpful to people with ADHD. Fatty acids help to form brain and nerve tissue in the body and are important for growth, mental function, a healthy immune system, and brain development. The typical American diet is low in omega-3 fatty acids, which are found in salmon, mackerel, sardines, and flax-seed oil. Supplements of omega-3 contain either flaxseed oil or fish oils. Studies conducted to date include one at Oxford University in England, which found that ADHD symptoms in children taking essential fatty acid supplements improved over those taking a placebo. A 1995 study compared essential fatty acid levels in boys with and without ADHD and found that the boys with ADHD had significantly lower levels of the substance. A 1996 study at Purdue University confirmed that boys with low blood levels of omega-3 fatty acids had a higher incidence of ADHD than boys with normal levels.

Overall, however, there have been no definitive studies confirming the benefits of omega-3 fatty acids in the treatment of ADHD. However, it is known that these oils are necessary for good brain and body development and have no harmful side effects. Parents should always consult with a physician before giving any such supplements to children. There have been instances in which omega-3 fatty acids interacted negatively with medications for diabetes and heart disease in adults.

Magnesium

Magnesium is a mineral that is part of more than 300 metabolic reactions in the body. It helps to produce energy, to create nucleic acids, and to conduct nerve impulses. One small study found that children with ADHD who took 200 mg. of magnesium each day had a significant reduction in symptoms. Magnesium is relatively safe and has few side effects, but it can interfere with some medications and should only be taken under the supervision of a doctor.

Zinc

Zinc is also a mineral that serves many functions in the body. Zinc supplementation has few side effects but it can interfere with the absorption of copper, so it might be necessary to also supplement the diet with copper. Zinc can interfere with the absorption of antibiotics, so the two substances should not be taken together.

In a small study, zinc was given along with Ritalin to a group of children with ADHD. Parents and teachers reported improved attention and reduced hyperactivity. The study used 15 mg. of zinc. This is a rather large amount, and such an amount should not be administered without a doctor’s supervision.

B Vitamins

There have been treatment studies using B-complex vitamins or very large doses (megadoses) of B vitamins. The results of the studies have been inconclusive. Some people have been helped, while others showed no improvements. Generally, B vitamins are water soluble and can be easily eliminated from the body, causing few side effects. Still, it is important to remember that large doses of any vitamin should not be given except under the supervision of a doctor. Large doses of vitamin B-6 can cause nerve damage, for example.

SAMe

S-adenosyl-L-methionine, called SAMe and pronounced “Sammy,” is a serotonin precursor that has been used in treating ADHD. A serotonin precursor is a compound that helps to produce the neurotransmitters serotonin, dopamine, and norepinephrine—brain chemicals that affect mood. Six of eight people in a small, preliminary study responded well to treatment with SAMe. SAMe is safe at recommended doses and has only mild gastrointestinal side effects. Rarely, SAMe can cause mania in people suffering from bipolar disorder.

Ginkgo and Ginseng

Another small study of children with ADHD showed that a combination of ginkgo biloba and American ginseng helped to improve symptoms of distractibility and attention after four weeks on the supplements. The dose was 200 mg. of ginseng and 50 mg. of the ginkgo. As with many of the other supplements, ginkgo and ginseng can interfere with certain medications and should not be used without consulting with a doctor.

ART, AUDIO, AND MOVEMENT THERAPIES

Some practitioners believe that children with ADHD can be helped by various alternative therapies. In general, these therapies may be helpful and do not have any negative side effects. Some of them, however, can be quite expensive, and there is no scientific evidence that they work.

Art Therapy

Some experts believe that creative activities such as drawing, listening to music, or dancing help children with ADHD calm down and focus better. George Lynn, a therapist and author, says in Survival Strategies for Parenting Your ADD Child that “Art utilizes the part of the brain that controls emotions. Children with ADHD often have trouble controlling their emotions and these activities can help them.” There are studies that show that music can help children concentrate more easily, but much more research needs to be done in this area. Any kind of exercise, whether dancing or other kinds of “movement therapy,” can help to combat hyperactivity. The deep breathing of yoga has also been shown to help calm hyperactive children.

Fact Or Fiction?

I read somewhere that kids can be cured of ADHD by playing video games.

The Facts: First of all, there is no cure for ADHD. While it is possible to treat some of the symptoms of the condition and improve functioning, there is as yet no treatment that can effect an actual cure. Moreover, there are no video games being used to treat ADHD. Some children are being taught a biofeedback technique in which they can manipulate their brainwaves and see the result on a computer monitor. It is hoped that this ability will help them manage their impulses and emotions better. To some of the children, watching and manipulating their own brainwaves on a computer may seem like a game, but it is not a game in any other sense of the word.

Audio Integration Training

Dr. Guy Berard, a French otolaryngologist (ear, nose, and throat doctor), invented audio integration training (AIT) to help patients with hearing loss or distorted hearing. After using the treatment for many years, Dr. Berard came to the conclusion that such training was beneficial to people with many other disorders, including ADHD, Asperger’s syndrome, dyslexia, and depression. The therapy is designed to normalize how the brain processes auditory signals. Dr. Berard believes that hypersensitivity to certain sounds can lead to overstimulation, agitation, and distractibility.

There is no scientific evidence that AIT works, and some question whether or not it is safe. The American Academy of Pediatrics considers it experimental and the U.S. Food and Drug Administration (FDA) has banned the audiokinetron, a device used to perform the therapy, from being imported into the United States, because there is no proof that the therapy works.

Interactive Metronome™ Therapy

Interactive Metronome™ (IM) is a neuro-motor tool used to assess and treat motor planning and sequencing, which in turn can help with everything from making coordinated movements to formulating a sentence. In IM training, the patient wears headphones and listens to a computer-generated sequence of tones. The challenge is for the patient to move in sync with the sounds, coordinating hand, foot, and body movements. The movements are recorded on a computer screen allowing the patient to evaluate his or her success. The trademarked treatment claims to improve focus and attention, increase physical strength, help people learn to filter out distractions, and improve mental and physical coordination. There are few studies on the effectiveness of IM for people with ADHD, but in one conducted in 2001 and published in the American Journal of Occupational Therapy, Schaffer and others concluded that IM “appears to facilitate a number of capacities, including attention, motor control, and selected academic skills in boys with ADHD.”

BRAIN-BASED THERAPIES

Both biofeedback and what has been called neurofeedback have been used to help treat children with ADHD. For both treatments, there is a great deal of anecdotal or small-scale evidence about benefits, but controlled scientific studies have yet to find any real proof that the treatments work.

Biofeedback

Proponents of biofeedback say that the technique can help children learn to calm down and focus by using a special machine to control the body’s reaction to stress. When the child is connected to the machine, it gives him or her feedback about pulse rate, breathing rate, and muscle tension. The machine tells the child when he or she is stressed and then indicates when he or she has succeeded in bringing these key rates down through relaxation techniques. In this way, the child learns calming techniques that can also be used away from the machine. Preliminary research suggests biofeedback is helpful in treating some symptoms of ADHD, but much more research is needed. Biofeedback is a very time-consuming technique that may not continue to work outside of the laboratory. It may also be ineffective with young children who have less control over their emotions.

Neurofeedback

Neurofeedback is also called neurobiofeedback, neurotherapy, and EEG biofeedback and is similar to biofeedback. With neurofeedback, however, the patient is connected to a computer while wearing sensors on the scalp. A visual display of brainwave patterns is displayed on the computer screen in real time. The patient is trained to control and alter his or her brainwaves. Most patients enjoy the training, as it is something like playing a video game. Neurofeedback has no known negative side effects but it can be very time-consuming—it requires 40 or more one-hour sessions-and expensive.

The best documented use of neurofeedback is in the treatment of ADHD and several studies have shown the technique to be useful in treating the condition, notably one by Steven M. Butnik, “Neurofeedback in adolescents and adults with attention deficit hyper-activity disorder,” published in the Journal of Clinical Psychology in 2005. Neurofeedback has many critics, including the psychiatrist and ADHD expert Russell Barkley, who believes that positive results are primarily the result of the placebo effect. In addition, in most states there are no licensing requirements for using the therapy, and therapists who have little knowledge of physiology or computer technology can use the technique.

Alternative treatments for ADHD run the gamut from the promising to the deadly. Parents and patients must look carefully at what the treatment claims to offer and what research is presented in its support. It is also important to know who is offering the treatment. Is the treatment offered by a doctor or other certified practitioner or by a for-profit organization? People also need to be aware that labeling a supplement natural does not mean it is safe. When it comes to alternative treatments for ADHD, let the buyer beware applies.

See also: ADHD (Attention-Deficit/Hyperactivity Disorder) ; Asperger’s Syndrome ; Bipolar Disorder ; Depression ; Dyslexia