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Attention Deficit–Hyperactivity Disorder

Attention Deficit–Hyperactivity Disorder

Also indexed as: ADD, ADHD, Attention Deficit Disorder, Hyperactivity

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Hyperactivity—is it normal behavior or ADHD? When a child is more than rambunctious, it is important to know the facts. According to research or other evidence, the following steps may be helpful:

What you need to know

  • Supplement with essential fatty acids
  • Getting approximately 186 mg of EPA (eicosapentaenoic acid), 480 mg of DHA (docosahexaenoic acid), 96 mg of GLA (gamma-linolenic acid), 864 mg of linoleic acid, and 42 mg of arachidonic acid supplies fatty acids important for brain function
  • Check out L-carnitine
  • To improve behavior, take 100 mg of this supplement for each 2.2 pounds of body weight a day, with a maximum of 4 grams a day
  • Give magnesium a go
  • 200 mg a day can address possible deficiency of this mineral that may influence ADHD
  • Try the Feingold diet
  • Work with the Feingold Association or a diet specialist to reduce or eliminate food additives and other food issues that may affect ADHD

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or pharmacist. Continue reading the full ADHD article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About ADHD

Attention deficit-hyperactivity disorder (ADD or ADHD) is defined as age-inappropriate impulsiveness, lack of concentration, and sometimes excessive physical activity.

ADHD has been associated with learning difficulties and lack of social skills. Obviously what constitutes “normal” in these areas covers a wide spectrum; thus it is unclear which child suffers true ADHD and which child is just more rambunctious or rebellious than another. No objective criteria exist to accurately confirm the presence of ADHD. ADHD often goes undiagnosed if not caught at an early age, and it affects many adults who may not be aware of their condition.

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Product ratings for attention deficit–hyperactivity disorder

Science Ratings Nutritional Supplements Herbs
2Stars

Essential fatty acids

Iodine (to prevent deficiency during pregnancy)

Iron (for deficiency only)

L-carnitine

Magnesium

Zinc

 
1Star

B vitamins

Evening primrose oil

Vitamin B6

Shelled hemp seed

3Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.
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What are the symptoms?

ADHD is generally recognized by a pattern of inattention, distractibility, impulsivity, and hyperactivity estimated to affect 3 to 5% of school-aged children. Learning disabilities or emotional problems often accompany ADHD. Children with ADHD experience an inability to sit still and pay attention in class, and they often engage in disruptive behavior.

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Dietary changes that may be helpful

The two most studied dietary approaches to ADHD are the Feingold diet and a hypoallergenic diet. The Feingold diet was developed by Benjamin Feingold, M.D., on the premise that salicylates (chemicals similar to aspirin that are found in a wide variety of foods) are an underlying cause of hyperactivity. In some studies, this hypothesis does not appear to hold up.1 However, in studies where markedly different levels of salicylates were investigated, a causative role for salicylates could be detected in some hyperactive children.2 As many as 10 to 25% of children may be sensitive to salicylates.3 Parents of ADHD children can contact local Feingold Associations for more information about which foods and medicines contain salicylates.

The Feingold diet also eliminates synthetic additives, dyes, and chemicals, which are commonly added to processed foods. The yellow dye tartrazine has been specifically shown to provoke symptoms in controlled studies of ADHD-affected children.4 Again, not every child reacts, but enough do so that a trial avoidance may be worthwhile. The Feingold diet is complex and requires guidance from either the Feingold Association or a healthcare professional familiar with the Feingold diet.

In one study, children diagnosed with ADHD were put on a hypoallergenic diet, and those children who improved (about one-third) were then challenged with food additives. All of them experienced an aggravation of symptoms when given these additives.5 Other studies have shown that eliminating individual allergenic foods and additives from the diet can help children with attention problems.6 7

Some parents believe that consuming sugar may aggravate ADHD. One study found that avoiding sugar reduced aggressiveness and restlessness in hyperactive children.8 Girls who restrict sugar have been reported to improve more than boys.9 However, a study using large amounts of sugar and aspartame (NutraSweet®) found that negative reactions to these substances were limited to just a few children.10 While most studies have not found sugar to stimulate hyperactivity, except in rare cases,11 the experimental design of these studies may not have been ideal for demonstrating an adverse effect of sugar on ADHD, if one exists. Further studies are needed.

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Lifestyle changes that may be helpful

Smoking during pregnancy should be avoided, as it appears to increase the risk of giving birth to a child who develops ADHD.12

Lead and other heavy-metal exposures have been linked to ADHD.13 14 If other therapies do not seem to be helping a child with ADHD, the possibility of heavy-metal exposure can be explored with a health practitioner.

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Vitamins that may be helpful

Some children with ADHD have lowered levels of magnesium. In a preliminary, controlled trial, children with ADHD and low magnesium status were given 200 mg of magnesium per day for six months.15 Compared with 25 other magnesium-deficient ADHD children, those given magnesium supplementation had a significant decrease in hyperactive behavior.

In a double-blind study, children with ADHD who received 15 mg of zinc per day for six weeks showed significantly greater behavioral improvement, compared with children who received a placebo.16 This study was conducted in Iran, and zinc deficiency has been found to be quite common in certain parts of that country. It is not clear, therefore, to what extent the results of this study apply to children living in other countries.

In a double-blind study, supplementation with L-carnitine for eight weeks resulted in clinical improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.17 The amount of L-carnitine used in this study was 100 mg per 2.2 pounds of body weight per day, with a maximum of 4 grams per day. No adverse effects were seen, although one child developed an unpleasant body odor while taking L-carnitine. Researchers have found that this uncommon side effect of L-carnitine can be prevented by supplementing with riboflavin. Although no serious side effects were seen in this study, the safety of long-term L-carnitine supplementation in children has not been well studied. This treatment should, therefore, be monitored by a physician.

A deficiency of several essential fatty acids has been observed in some children with ADHD compared with unaffected children.18 19 One study gave children with ADHD evening primrose oil supplements in an attempt to correct the problem.20 Although a degree of benefit was seen, results were not pronounced. In a 12-week double-blind study, children with ADHD were given either a placebo or a fatty-acid supplement providing daily: 186 mg of eicosapentaenoic acid (EPA), 480 mg of docosahexaenoic acid (DHA), 96 mg of gamma-linolenic acid (GLA), 864 mg of linoleic acid, and 42 mg of arachidonic acid. Compared with the placebo, the fatty-acid supplement produced significant improvements in both cognitive function and behavioral problems.21 No adverse effects were seen. In a preliminary trial, supplementation with approximately 400 mg of flaxseed oil and 25 mg of vitamin C, each twice a day for three months, was associated with an improvement of symptoms in children with ADHD.22

In a preliminary study of women in Italy, iodine deficiency severe enough to cause hypothyroidism during pregnancy was associated with an increased risk of ADHD in their children.23 Women who are contemplating pregnancy or who are pregnant should get adequate amounts of iodine in their diet and should discuss with their healthcare provider whether iodine supplementation is appropriate.

Iron status, as measured by the serum ferritin concentration, was significantly lower in a group of children with ADHD than in healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared with 18% of the healthy children.24 Since iron deficiency can adversely affect mood and cognitive function, iron status should be assessed in children with ADHD, and those who are deficient should receive an iron supplement. In a case report, a young boy with both ADHD and iron deficiency showed considerable improvement in behavior after receiving an iron supplement.25

B vitamins, particularly vitamin B6, have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.26 In a study of six children with low blood levels of the neurotransmitter (chemical messenger) serotonin, vitamin B6 supplementation (15–30 mg per 2.2 pounds of body weight per day) was found to be more effective than methylphenidate (Ritalin®). However, lower amounts of vitamin B6 were not beneficial.27 The effective amount of vitamin B6 in this study was extremely large and could potentially cause nerve damage, although none occurred in this study. A practitioner knowledgeable in nutrition must be consulted when using high amounts of vitamin B6. High amounts of other B vitamins have shown mixed results in relieving ADHD symptoms.28 29

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

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Herbs that may be helpful

Though it has not been studied, theoretically shelled hemp seed may be useful for people with ADHD due to its content of essential fatty acids.30 31

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

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References
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