Controlling ADHD

Most of us have heard of attention deficit hyperactivity disorder (ADHD), and many of us are aware of the commonly prescribed pharmaceutical remedy, Ritalin. But how many of us are aware that there are other avenues of care that provide long-term relief?

Characterized by difficulties with attention, distractibility, excessive motor activity (hyperactivity), and impulsive behaviour, ADHD symptoms often manifest as poor academic or occupational performance, difficulties with others in school or work, aggression, and what has been termed emotional immaturity.

The cause of ADHD remains unknown, although twin studies suggest a genetic component. However, as the research unfolds, it is becoming increasingly clear that ADHD is extremely complex, involving a significant interplay between genetic and environmental factors.

Although the reported incidence of ADHD in children remains controversial, anywhere from 3 to 18 percent of children have been reported to experience the symptoms. While often considered to be a childhood disorder outgrown by puberty, almost 5 percent of adults may have ADHD and over one and a half million North American adults are now taking ADHD medications.

Pharmaceutical Approach

Mainstream ADHD treatments stimulate or turn on the inhibitory pathways in the brain that are responsible for dampening down overactivity. These medications are used in children as young as preschool age, and while effective, they are not without controversy:

• general concerns with giving very young children (with rapidly developing brains) a psychotropic drug
• concerns with blurred lines between normal and abnormal behaviour, and a lowered tolerance for behaviours that lead to an easy prescription
• concerns related to cardiovascular function–recently the US Food and Drug Advisory Committee recommended a “black box” warning (appears on prescription drugs that may cause serious adverse effects) for ADHD medicines and mandatory informational materials related to the risks of cardiovascular-related sudden death
• long-term effects are largely unknown because few patients maintain therapy–Canadian researchers found that only 18 percent of almost 17,000 teens and children (followed for six years) maintained long-term stimulant therapy

Natural Approaches

Behavioural interventions provide adults and children with coping skills. Most behavioural programs work with anger and frustration management, improvement of communication skills, planning, organizing, and changing thought processing to more adaptive thinking.

For children with ADHD, parents and teachers using this approach apply a system of rewards for positive behaviour and consistent consequences for undesirable behaviours in both home and school settings.

Diet and nutrition are areas where parents have significant control. Research has shown that the removal of non-nutrient dietary additives and the addition of some nutritional factors can play a positive role in controlling ADHD.

A connection between ADHD symptoms and artificial colours, flavours, and preservatives was suggested by a large synthesis of studies through 2004. Following this review, another large study showed that the removal of artificial chemicals from the diet can improve ADHD.

In addition, sugar can cause some children with ADHD to react with a hypoglycemia-like response. Blood sugar dips and a stress reaction is initiated. This suggests that symptoms may be regulated by adhering to a healthy, low-sugar diet with plenty of blood sugar-stabilizing lean protein, antioxidant-rich whole grains, whole fruits, vegetables, and healthy snacks.

Nutritional factors including omega-3 fatty acids from fish oil (EPA and DHA) have been used by clinicians for years to treat the symptoms of ADHD. Three recent studies, reviewed in the International Review of Psychiatry (2006), have shown positive effects with fish oil and a small amount of gamma-linolenic acid (GLA) from evening primrose or borage oil.

The mineral nutrients zinc and magnesium are also critically important in ADHD. Zinc regulates enzymes that control the manufacture of brain chemicals and helps in the metabolism of omega-3 fatty acids. Research has shown that people with ADHD have low levels of zinc and supplementing with zinc has shown benefit versus placebo.

Magnesium is also important in brain function, and new research has shown benefit in children when combined with vitamin B6.

We have far more control over the symptoms of ADHD than we may have previously thought. A considered and systematic approach to behavioural modification and careful adherence to proper diet and nutrition can be our most effective antidotes.