Transcript Alternative Treatments for ADHD

Alternative Treatments
for ADHD
Katherine Kiker, M.S.
Elimination Diets

“Feingold hypothesis”
Children are sensitive to dietary salicylates and
artificially added colors, flavors, and preservatives
 Learning and behavior problems (including ADHD)
can be reduced or eliminated by removing these
substances

Elimination Diets


At least 8 controlled studies have demonstrated
significant improvement (w/elimination diet)
compared to a placebo condition, or
deterioration after introducing offending
substances
Typical elimination diet: lamb, chicken, potatoes,
rice, apple, banana, cabbage, cauliflower,
broccoli, brussel sprouts, cucumber, celery,
carrots, salt, pepper, calcium, and vitamins
Elimination Diets

Although some people seem to respond well,
more research is needed to determine who are
diet responders

What proportion are responders from the whole
ADHD population?
Elimination of Sugar & Candy

Good news- No Effects!!!
Controlled 3-week trial of a sugar-restricted diet
(Wolraich et al., 1994)
 Cross-sectional studies: ADHD children don’t
consume more sugar than Non-ADHD children
(Kruesi et al., 1987)


Not a widely applicable tx for ADHD

But, may help for those children who are responders
to “elimination diet”
Discussion: Modifying
Diets to Improve ADHD
Symptomatology??
Nutritional Supplements

Amino Acid Supplementation
Reportedly low levels of amino acids in ADHD
 Short-term benefit for tryptophan, tyrosine, or
phenyalanine



However, no benefit beyond 2-3 months, as tolerance
develops
Essential Fatty Acid Supplementation
Lower levels in ADHD kids
 Further control studies needed

Nutritional Supplements

Glyconutritional Supplements



Vitamin Supplementation


Open 30-day trial with 17 non-anemic ADHD boys, improvement in
parents Conners’ scores (Sever et al., 1997)
Zinc supplementation


Megadose: no effects, risk of toxicity
Iron Supplementation


In open trial (n=17) with these supplements, parents reported reductions
in inattention, hyperactivity-impulsivity, and oppositional behavior
Placebo-controlled trials needed
Little research
Magnesium Supplementation

50 kids with ADHD and magnesium deficiency; 6 months; significant
decrease in parent and teacher Conners scores

Chinese Herbals




Chinese herbal cocktail compared to methylphenidate
Significant improvement rates comparable to stimulate meds,
but more improvement on IQ scores and fewer side effects
Need placebo-controlled, double-blind studies
Acupuncture


Little data on its efficacy
Loo (1998) found decreases on parent and teacher Conners

Noted that kids with most severe ADHD could not comply with tx
Meditation



Mental training that can regulate attention and
brain training?
Research in non-clinical samples has shown
improvements on attentional blink tests
Rationale for using mindfulness meditation with
ADHD: can impact symptoms of inattention
and impulsivity, associated neurocognitive
deficits of inhibition, and help with stress,
anxiety, and depression
Mindful Meditation

3 steps:




bringing attention to an “attentional anchor” (usually a
sensory input such as a breath
Noting that distraction occurs and letting go of distraction
Refocusing or reorienting attention back to the “attentional
anchor”
Pilot Study (Zylowska et al., 2007)



8 week mindful meditation group w/ adults & adolescents
Pre–post improvements in self-reported ADHD symptoms
and test performance on tasks measuring attention and
cognitive inhibition
Next steps: controlled clinical study
“Neurotherapy”
EEG Feedback, Neuro feedback





Basis: ADHD kids produce greater EEG slow wave (theta)
activity, and less beta activity compared to normal controls
Neurotherapy: teach ppl to normalize their brainwave responses
to stimuli
EEG responses to stimuli on a computer are analyzed, then
feedback is provided (visual displays, auditory tones) to show
how well they are doing
“good candidates”: stimulant non-responders, parents afraid of
long-term affects on stimulant meds
Need assessment: neurometric assessment with computer
analysis of a minimum of 19 active scalp electrode sites
necessary to confirm or disconfirm greater theta and less beta
activity to key attentional tasks

New technology: video games!!

Game becomes more difficult as brain waves of ADHD child
show that attention is waning


Child is “rewarded” for decreasing time spent in slow wave activity,
and increasing time spent in fast activity required for focused
attention and concentration on tasks
Does it work?

Barkley 1995, CHADD newsletter: "there is not enough
evidence from well controlled scientific studies to support the
effectiveness of EEG biofeedback for AD/HD children"

However:




Studies using different control groups (waitlists, stimulant meds,
cognitive therapy) have demonstrated that neurofeedback reduces
inattention, impulsivity, task performance variability, and hyperactivity
(Rossiter, 1998)
Outcome studies with samples as large as 530 show reductions in
ADHD symptoms
Studies used objective test data (CPT, IQ tests, TOVA) + behavior
rating scales
Limitations:



Time-consuming (need 6-8 months, up to 80 sessions)
Need to identify who works better for this treatment
Must have assessment: some practitioners don’t use the neurometric
assessment
Instant Alert Hypnosis!



Barabasz & Barabasz: “intended to enhance vigilance performance for either
focused attention or optimal situational awareness depending on the specific
hypnotic instructions given”
experimentally controlled studies show that Instant Alert Hypnosis can
increase frontal EEG beta activity independent of neurofeedback
procedure






patient instructed to roll eyes up, as if trying to look at forehead
Instructed to look at psychologist’s thumb as thumb is slowly moved from nose to
forehead
instructions are then given to take notice of “breathing, relaxation, calm
confidence and special calm alertness”
Once clinician observes subjective signs of hypnosis, patient given instructions:
"in this special state of alertness you will be able to focus your attention anyway
you like, you can concentrate as completely as your desire.”
Then, patient told to let their eyes roll down and enjoy state of alertness
Finally, specific attentional task is done

Efficacy?
Instant alert hypnosis w/neurofeedback: significantly
better than neurofeedback alone
 Positive and substantial clinical changes in average
of 23 sessions (3-14 weeks of treatment for
subjects)
 Decreases in inattentiveness, hyperactivity,
impulsivity

Other treatments… for which I could
find no information!


Mirror feedback
Antifungal treatments
Discussion
 How
would you respond to a parent
who mentioned wanting to try one of
these alternative treatments?
ADHD Coaching

What is ADHD Coaching?
http://www.addcoachacademy.com/whatisadd.html
 http://www.addcoachacademy.com/welltrained.html


Editorial Article