Transcript ADHD and the Brain Non-medication Treatments for ADHD

ADHD and the Brain
Non-medication Treatments for
ADHD
SHARON MOCK, LPC-S, ED.D.
Sharon Mock, LPC-S, Ed.D.
AUTHOR: ACADEMIC SUCCESS OF
EMOTIONALLY DISTURBED STUDENTS
OWNER: CENTER FOR RESEARCH AND
ACADEMIC SUCCESS
PSYCHOTHERAPIST IN PRIVATE PRACTICE
IN KERRVILLE, TEXAS
Goals
 Review of ADHD Symptoms and Impairment
 Brain Imaging
 Genetic Links
 Research Findings on ADHD
 Treatment Implications
 Traditional Treatments
 Non-medication Treatments
What is ADHD
 Frequent
 Affects 4.4% of population
 Kessler et al. 2005
 Lifetime Disorder
 Debilitating
 Under diagnosed
 Treatable
Diagnostic Criteria from DSM IV
 Inattentive Type
 Must meet at lest 6/9 symptoms
Daydreaming
 Forgetfulness
 Losses items frequently

 Hyperactive/Impulsive Type
 Must meet at least 6/9 symptoms
Driven by a motor
 Interrupting
 Excessive talking

 If a patient meets at least 6/9 or more symptoms in
both categories: Combined Type
Continued
 Impairment must be in 2 of the following:
 School
 Family
 Peers
 The onset is before the age of 7
 Note that DSM-IV-TR diagnostic criteria is written
for pediatric ADHD
Growing out of ADHD
 At least 50% of children retain the symptoms into
adulthood
 Frontal lobes mature at a slower rate
 Don’t reach the maturation of a non ADHD brain
 Adult ADHD presents differently:

Feel restless rather an hyperactive

MckAlemanet.al. 2009: Wilens 2004
Adult ADHD
 Significantly lower socioeconomic status
 Lower level of academic achievement
 Higher medical costs
 Increase of motor vehicle accidents
 Increase of unplanned pregnancy
 Increase rate of substance abuse
 Higher rate of unemployment
Affect of ADHD on Prefrontal Lobes
 Prefrontal lobes of the brain hold the executive
functions of the brain
 Help to inhibit and self-regulate:




Direct
Process
Manage
Disseminate information
Frontal Lobe and Pre-Frontal Cortex
What are the Executive Functions that are
Affected?
 Working memory
 Time Management
 Behavioral Inhibition
 Regulation of Emotions
 Planning
 Forethought
 Learning from Consequences
 Organization
 Reconstitution of Information
• Brown 2009, Barkley 2005
Genetic Link to ADHD?
 Executive function impairment in ADHD is genetic
 At a rate of 75%
 Several genes have been identified with ADHD
 Hundreds of gene variations are found in children with ADHD
and not the control group
Elia et al. 2010, Guan et al. 2009, Rietveld et al. 2004
Brain Structure Difference in ADHD?
 Children with ADHD exhibit a smaller volume of
frontal and temporal gray matter and it is correlated
significantly with parent- and clinician- rated
severity measures

Castellanos et al. 2002
 The ADHD brain was found to have a thinner
cerebral cortex compared to the non-ADHD brain
 The non-ADHD brain showed not signs of cortical
thinning

Klein, 2011
Brain Function in ADHD
 In children with ADHD, there is a disconnect
between the frontal cortex of the brain, which
regulates attention, and the visual processing areas
of the brain
 This difference does not occur in non-ADHD
children
 Therefore, the way the brain pays attention is
biologically different in those with ADHD

Mazaheri et al, 2010
Brain Function continued
 Difficulty with reuptake of neurotransmitters
 The ADD brain has a low amount of neurotransmitters called
dopamine
• VOLKOW ET AL, 2009
 Brain scans show a direction in dopamine synaptic
markers associated with symptoms of inattention in
the dopamine reward pathway of the ADD brain
• VOLKOW ET AL, 2009
ADHD: Disorder of Motivation or Inattention?
 ADHD
 Difficulty focusing on uninteresting tasks
 Difficulty hyper focusing on interesting tasks
The frontal lobes of the brain have difficulty getting motivated to
start and stop tasks
Executive Function
Example: Person with ADHD surfing the Internet
Difficulties in Focus and Concentration
 Sleep apnea
(Youssef et al, 2011)
 Chronic otitis media
 Depression
 Anxiety
 The disorders can also be co morbid with ADHD
Traditional Treatments
Medications for ADHD
 Stimulants
 Non Stimulants
 ”FDA-approved for ADHD” means drugs have been
found to be safe and efficacious in clinical trials
 Medications that are not FDA-approved for ADHD
can be prescribed “off label”
Stimulants
 These medications
 Increase attention
 Decrease hyperactivity
 Decrease impulsivity
 Mechanisms of action

Increases dopamine
Stimulant Medication for ADHD
 Concerta (methylphenidate HCI extended-release)
 Vyvanse (lisdexmfetamine)
 Daytrana (methylphenidate)
 Adderall XR (amphetamine of mixed salts)
 Focalin XR 9dexmethylphenidate extended –release)
 Side Effects
 Dry mouth
 Difficulty sleeping
 Reduced appetite
Is Substance Abuse increased because of Taking
Stimulant Medication?
 10 year study of 140 children ages 6-17
 Assessed at baseline and 10years later
 People with ADHD who took stimulant medication
did not have a statistically significant increase in
alcohol, drug, or nicotine use disorders

Biderman et al, 2008
Non-Stimulant Medication for ADHD
 Strattera (atomoxetine)
 Side Effects
Headache
 GI discomfort
 Lightheadedness

 Intuniv (guanfacine extended-release
 Side Effects
 Low blood pressure
 drowsiness
Medication
 Impact on Executive Functions
 Study on methylphenidate versus a placebo in adults with
ADHD
 Participants were given two MRI’s while completing an
Executive function task

Before and after the 6 week study
 Findings
 After 6 weeks the MRIs in the methylphenidate group shower
higher activation in the dorso-lateral prefrontal cortex and
parietal center

Bush et al, 2008
Time Released Effect
Medication
(Bush et.al. 2008)
What do ADHD Medications Increase in the Brain?
 Increases catecholamine levels in the brain
 Methylphenidate
 Dextroamphetamine
 Atomoxetine
 Improves pre-frontal cortex functioning

del Campo et al, 2011
ADHD Young Adults and Stimulant Medications
 Significantly improved driving performance on a
simulator compared to the placebo group
 ADHD rating scale scores were decreased by at least
35% in 80% of the stimulant medication group
• Kay, et al. (2009)
What Positives Come out of Medicating those with
ADHD
 Gives the extra space to decide whether or not to
interrupt
 Helps hold thoughts until a break in conversation
 Helps inhibit behavior
 Helps one to self-regulate behavior
Psychotherapy
 ADHD and couples therapy
 Difficult planning ahead for important events
Birthdays
 Anniversaries

 Messages get garbled in translation
 Difficulty remembering what upsets your partner
 Impulsive spending and not saving up for retirement
or emergencies
 Partner may take ADHD related behavior personally
Cognitive-Behavioral Psychotherapy for ADHD
 Cognitive-Behavioral Approaches
 Focused on changing attitudes and beliefs
 Help research defined goals
 Approaches
 Changing Cognitions
ADHD can cause feelings of failure
 Self-doubts and shame


Set goals and create concrete steps

Nadeau 2002
Social Skills Training
 Picking up on non-verbal cues
 Appropriate person-to-person distance
 Hula-hoop test

Standard distance during conversation
 Basic social graces
 The art of apology
 Showing gratitude
Effects of Coaching for ADHD
 “Counseling lite”
 Brief Interventions
 Assistive support
 Organization skills
 Prioritizing skills
 Goal-setting skills
 Focus on the present and future
 No addressing:
 the family of origin
 pathology
Research on Coaching (Parker and Boutelle, 2009)
 Study of 54 undergraduates with ADHD and /or LD
 7 in-depth interviews
 Opinions after coaching
 Provided a self-determination approach to attaining goals
 Supported their autonomy
 Assisted in the development and execution of functional skills
 Promoted self-efficacy and confidence regarding future success
Effective Movement Techniques
 Exercise
 Integrated movement systems
 Yoga
 Karate
 Tai Chi
Exercise
 Raises dopamine levels in the brain

Volkow et al. 2009
 If done first thing in morning, it can keep the
dopamine at an increased level all day long
 Exercising with a partner can increase the
motivation to continue to exercise
Study: Tai Chi and ADHD
(Hernandez-Reif, et al. 2001)
 13 Teenagers with ADHD attended Tai Chi
 Twice a week
 5 weeks
 Teachers rated their behavior
 before,
 after,
 two weeks after sessions were completed
Continued
 After all the sessions (10), the participants were
rated with:
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



Less anxiety
Improved conduct
Less daydreaming
Less inappropriate emotions
Less hyperactivity
 Improved scores were found after the 2 week follow
up

(Hernandez-Reif, et al. 2001)
Is it the Discipline?
 Yoga, karate and tai chi emphasize form and practice
 Is it the discipline or practice or both?
Frontal Lobe/Working Memory Training
 Improving cognitive ability
 “Brain Gym”
 Integrative listening systems
 “Tomatis Method”
 Interactive Metronome
Working Memory
 One of the executive functions (EF) in the frontal
lobe of the brain
 ADHD produces an impairment
 Some treatments focus on improving working
memory and overall cognitive function
Working Memory (Cont)
Temporary
Storage
Output
of
Information
Manipulation
of
Information
Processing
Information
Decreased Activation During a Working Memory Task
Working Memory Training
 Computer programs
 Tasks that train verbal and visual spatial working memory
 Difficulty level increased with progress
 Client is monitored by a “coach”
 Daily training sessions

30-40- minutes 5 days a week for 5 weeks
•
Klingberg 2006
Study Results
 Multicenter, randomized, controlled, double-blind,
follow –up study
 53 ADHD children 7-12 years old, without medication

Assigned to WMT group or control group
 WMT group had significant improvements on measures
of non trained visual spatial and verbal working memory



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In areas of visual spatial and verbal working memory
Response inhibition
Complex Reasoning
Most effects were present 3 months after the study in a follow up

Klingberg et al. 2005, Starkis, 2012
Attention Training
 Trains the following
Sustained
Selective
Alternating
Divided Attention
 Brain Train
 Play Attention
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23 children participants
16 sessions
Parents and clinicians rated fewer ADHD symptoms
Unable to define if it is sustained for a long term

Klingberg et al, 2005, Sarkis, 2012
Attention Training Continued
 Learning Prescriptions
 Cognitive-Fun
 10 sessions
 Parent/child Dyad
 Assessment of Executive Function and occupational
performance


Initial, post-intervention and 3 month follow up
Significant improvements with medium to large effects on
measures after intervention and at follow up
Tomatis Method
 This addresses the “Central Auditory Processing




Disorder” (CAPD)
Those with CAPD can hear in the sense there is no
damage to the ear’s ability to receive and perceive sounds
But, they cannot fully process the information they hear
due to the inability of the ear and brain to communicate
properly.
Uses sound through an electronic device
Works to strengthen the auditory system and the central
nervous system

The goal: Awaken the connections needed for the brain to process
auditory information
Tomatis Program
 30 hour program
 2 hours daily for 15 days (excluding weekends)
 Follow with 2 sixteen hour programs
 4 weeks to 3 months between each session
Anecdotal Studies of the Tomatis Method
 Client 1:
 6 yr. old female with attention difficulties
 Practitioners stated that after 4 weeks of treatment:
Client could distinguish sounds better
 Client could reproduce sounds better




Client’s speech had improved
Less irritable and frustrated in class
Tomatis Listening Test had shown improvement by 3rd
program

MacDonald & Nicoloff 2008, Sarkis, 2012
Anecdotal Study Number 2
 Cient 2:
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

51 year-old male with lack of comprehension, energy, and
motivation
“Tomatis Listening Test” found a lack of discrimination in
medium and high pitched sounds and “left ear dominance”
By the third program, client was happier and not worrying
excessively
• MacDonald & Nicoloff 2008, Sarkis, 2012
Tomatis Method
 Issues





Expensive
Minimum number of sessions
Beginning sessions must be done consecutively
Little evidence of efficacy
Tomatis used their own testing instrument to measure
effectiveness
• Sarkis, 2012
Interactive Metronome (IM)
 Computerized version of a standard metronome
 Makes a rhythmic beat and can be slowed down or
sped up
 Theory: IM helps the central nervous system
processing

This underlies motor regulation and timing abilities
• Sarkis, 2012
Interactive Metronome
Objective: Assist people to selectively attend without
interruption
 Repetitions of metronome increase with improved
attention
 Exercises try to match movement with metronome
Research of Interactive Metronome (IM)
 56 boys with ADHD
 3 groups: IM, video game treatment, controls
 IM training consists of 13 exercises
 15 daily one-hour IM treatments over 3 – 5 weeks
 Findings:

Six rhythmic deficiency patterns found in participants
Dissociative: Chaotic and random responses
 Contraphasic: between beats
 Hyperballistic: inappropriate snappy motions
 Hyperanticipatory: after the beat
 Auditory hypersensitive: exceptionally distracted by noise


Shaffer et al. 2001
Results of Study of IM
 IM study subjects improved significantly more than
controls in





Attention
Motor control
Language processing
Reading
Ability to regulate aggression
 Video game treatment group improved more than
control group

Shaffer et al. 2001
IV. Vestibular and Cerebellar Exercises
 Deficits in inner ear
 Dyslexia dyspraxia attention treatment
 Sensory integration Theory
 Synthesis
Inner Ear Deficits
 Theorized that vestibular problems (deficit in the
inner ear) may cause motor coordination issues and
difficulties regulating behavior
 Some treatment approaches have aims to correct
these perceived motor deficits

Ramsay, 2010
Dyslexia Dyspraxia Attention Treatment
 DDAT or also known as DORE program
 Individually prescribed exercises
 10 minutes daily , 2 times daily
 12 – 18 months
 Study found that children who completed the
program had improved cerebellar functioning



Balance
Dexterity
Eye movement control

Reynolds et al. 2003
Sensory Integration Therapy
 Some children with ADHD have tactile and auditory
sensitivity



Certain noises: loud noises
Texture of foods
Texture of clothing


Sock seams
Tags in shirts
 Children with ADHD appear to have more difficulties with
sensory processing disorders than the general population
• Mangot et al.2001
 Sensory Integration Therapy :
 Performed by Occupational therapists
 Involves “brushing” techniques
• Sarkis, 2012
Synthesia
 Disorder in which senses “join”

Example: Music is not only heard but also seen, tasted, or felt as a
physical touch
• Cytowic & Eagleman 2009


Almost like an hallucination
About 2-5 % of ADHD are affected
 This phenomenon may occur ina small percentage of
people with ADHD
 Not generally viewed as a deficit of pathology
 Educates a person and family about synthesia can help
 This disorder can also be considered creative and not a
disorder because it is an enjoyable experience

Sarkis, 2012
V. Overstimulation of the nervous System and ADHD
 The “overcharged” nervous system (1/3 of ADHD
population)
 Breathwork and Movement
 Meditation
 Creative Visualization
 Neurofeedback
Meditation
 Studies have shown meditation to change brain
waves

Monks have shown it to bring the brain to a deeper level brain
activity and reach a relaxed state
 Can take practice for a person with ADHD to stop the
“monkey brain”

Ideas that continually pop up without any assistance. Pop into
the brain instead of stopping it when focusing on a task
Mindful Meditation Training (MMT)
 Devoting attention to daily tasks
 Walking
 Eating
 Teaches a person how to “check in" with themselves
when distracted

Sarkis 2012
 The more the practice is used, the easier it gets
The MMT Program
 8 week program for adults and teens with ADHD
 78% of participants that completed the training
reported reductions in ADHD symptoms
 30% had clinically significant improvement
 Improvements were made on conflict attention, and
set shifting on a neurocognitive measure (moving
from task to task)

Zylowska et al. 2008, Sarkis, 2012
Creative Visualization
 Allows the creative ADHD brain to still be motivated
during relaxation periods
 Now more readily assessable



Videos available on You Tube
Libraries have audio video and digital media
Itunes also provides some audios and videos at no charge
Sarkis, 2012
Neurofeedback
 This technique teaches a person how to change their
brain waves in order to improve focus and
concentration

People with ADHD have different theta and beta wave patterns
than non ADHD
 Sensors are used on the scalp and ears
 These sensors are connected to an electroencephalogram
(EEG)
• Sarkis, 2012
Goals of Neurofeedback
 The goal is to decrease theta waves and increase beta
waves


When this process takes place, a character on the computer
screen begins moving
The subject becomes more relaxed and focus is increased
 Several visit are needed in order to complete the
process
• Sarkis, 2012
Effectiveness of Neurofeedback
 Very limited research on long-term effectiveness
 One study showed that neurofeedback was more
effective than NO Treatment at all for ADHD
• Gevensleben et al. 2009
 Drawbacks
 Expensive
 Time constraints
 Insurance may not cover
• Sarkis, 2012
When Is Neurofeedback used?
 If conventional treatment has not been effective
 An alternative treatment is asked for by the patient
 Concerns
 Not enough participants in the studies to validity reliability
 Not enough placebo studies
 Support for use in ADHD treatment does not have conclusive
results
• Ramsey 2010
• Sarkis 2012
Physical Body Treatments
 Massage
 Chiropractic Treatment
 Repetitive Transcranial Magnetic Stimulation
 Acupuncture
Massage Therapy
 A study was conducted with ADHD children and teens
 Comprised of two groups:


Massage group
Control group
 Massage therapy for 20 minutes two times a week for a
month
 Massage therapy group


Significant improvements in self-ratings of mood
Significant improvements in teacher ratings of classroom behavior
• Khilnani et al. 2003
Chiropractic Treatment with ADHD
 Chiropractic treatment opens pathways in the body
due to the increase appropriate alignment of the
bones

Produces a change in communication between the brain and
the body
 The use of chiropractic methods for ADHD is an off
shoot of the purpose of Chiropractic treatment
 Six sessions over a three week period are
recommended by Chiropractors for changes to occur
• Goodsell 2012
Study and Results of Chiropractic Treatment and
ADHD
 Participants = 9 ADHD adults
 Two months/2 sessions weekly of level -1 network
spinal analysis

Gentle, precise touching of the spine
 Subjects were given a continuous performance task
before and after treatment

Significant improvement found after treatment in 8 out of the
9 subjects
• Pauli 2007
Issues with Study
 None of the subjects had a ADHD formal diagnosis
 One CPT measure is not enough to determine an
existence or reduction of ADHD symptoms
 9 subjects is too small of a population to be
significant
 Out of the 9 subjects:


3 stated attention problems were their main issue
6 said attention problems was an additional problem
• Sarkis 2012
Repetitive Transcranial Magnetic Stimulation
(TMS)
 Non-invasive brain stimulation
 Magnetic fields went to the brain though small
electromagnets

Time between fields vary
 Purpose is to stimulate electrical flow and
depolarization of neurons in the cerebral cortex
 FDA-approved for treatment of depression

Sarkis 2012
Repetitive Transcranial treatment Risks
 Seizures
 If a person has epilepsy or brain lesions
 If the electrical impulse used it too strong
 If the electrical impulses are given too closely together
 Headaches and scalp pain
 Common side effect
 Hearing impairment
 Prevent by wearing ear plugs
• Ramsay 2010
Study of Repetitive Transcranial Magnetic
Stimulation (TMS)
 Participants = 8 teen/young adults with ADHD
 Not medicated
 Double –blind study
 Study of Study
 Daily TMS
 10 session over two week time span
 One week of no treatment
 Two weeks of placebo treatment
Results of TMS Study
 Significant improvements on ratings of overall
improvement
 No changes of ADHD symptom measures
 Improvement in functioning


88% of TMS participants
50% of placebo participants
• Weaver et al. 2008
Acupuncture
 Traditional Chinese medicine views causes of ADHD
to be





Liver yang overactive
Effulgent gallbladder fire
Heart-spleen deficiency
Non-interaction of heart and kidney
Yin-yang disharmony

Dissymmetry and unbalanced
• Li et al. 2011
Research on Acupuncture and ADHD
 Minimal studies
 Participants may not participants dues to the use of
needles
 Studies have used

Randomized controlled trials using:
Acupuncture
 Placebo
 Conventional treatment
 Results
 No Evidence in the effectiveness to treat ADHD

Environmental Influences
 Television and video games
 Sleep deprivation
 Second-hand smoke
 Environmental toxicity
 Changes with the environment
Television and Video Games Study 1
 1278 children at age 1
 1345 children at age 3
 10% of children had attention problems at age 7
 Concluded that the amount of hours of television per day at 1
and 3 was associated with the attention problems occurring at
at age 7
 Reliability: The participants in the study were not formerly
diagnosed with ADHD
 A correlation does not mean causation
• Christakis et al. 2004
• Sarkis 2012
Television and Video Games Study 2
 A study of preschool-aged children
 Observed the amount of television viewing per day
and the level of violence in the programs being
viewed
 Results found that television exposure is not related
to ADHD symptoms

It correlated to those students who were conduct disorder,
Oppositional defiant
• Knezevic 2009
Television and Video Games Study 3
 1323 children
 210 late teens/early adults
 Assessed over a 13 month time span
 Parents and children and teens/early adults
reported television and video game time
 Teachers and teen/early adults reported attention
problems
• Swing et al. 2010
Findings from Study 3
 The amount of television viewing and video game
playing was associated with greater attention
problems
 Found in both samples
Swing et al. 2010
 Reasons


ADHD brain is stimulated by novelty
ADHD is genetic


Parents are more likely to have ADHD
Television and video games can keep ADHD children still because
 Moving image stimulation
Video Games Study 4

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125 participants middle school students at two different years
75 diagnosed as ADHD or ADD
50 undiagnosed
ADHD students were not given their medication the day of
participating in the study
Students were given 10 minutes to sit quietly to decrease their
heart rate to a resting heart rate
Heart rate was taken before beginning of the video game
Each participant was given the same video game to play which
was at a low level of intensity (a ski video game)
Each participant played the game for 10 minutes
Heart rate was taken at the end of the ten minutes and
compared to the resting heart rate.
Results of Video Game Heartrate
 All ADHD/ADD participants heart rate decreased
 All non ADHD/ADD participants heart rates
increased except one
 That one participant was later diagnosed with ADHD
 Implication:




This could be one way to diagnose ADHD
Educational materials should include video activities for
ADHD/ADD
Study too small to valid
Study needs to continue to increase the number of participants
• Mock, 1998
Sleep Deprivation
 Symptoms can mimic ADHD
 Difficulty concentrating
 Difficulty focusing
 Slower cognitive speed
 Difficulties with executive function skills
 Difficulties with working memory
• Goel et al. 2009
Sleep Deprivation Study
 ADHD children have higher sleeping difficulties than
general population

Sleep study in ADHD children
55 children participated
 Results
 Motor restlessness (continual movement ) (50%)
 Sleep walking (47.6%)
 Night terrors (38%)
 Confusion upon arousal (28.5%)
 Snoring (21.4%)
 Restless leg (11.9%)

• Silverstri et al. 2009
Techniques to decrease Sleep Deprivation
 Listen to relaxing cds
 Shut down electronic activities 1 hour before bedtime
 No telephone in room
 Have room dark
 When waking next morning have loud noises to wake
them
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Wake, give them their medicine, let them sleep another 30
minutes and wake them for the day
Just being outside during the day helps with ADHD symptoms
as they play and care for animals.
Forms of Sleep Deprivation
 Obstructive sleep apnea (OSA)
 Attention deficits reported in 95% of OSA
 Comorbidity rate of 20 – 30 \% between OSA and ADHD
• Youssef et al. 2011
• Also noted was a weight gain link between OSA and ADHD
Second Hand Smoke literature review with
ADHD
 Both prenatal and postnatal exposure is associated with
increased rates of behavior problems
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Irritability
Oppositional defiant disorder
Conduct disorder
ADHD
• Herrmann et al. 2008
 Issues
 People with ADHD start smoking at an earlier age
 Smoke more
 Find it harder to quit
 Question
 Is the smoke impacting behavior?
 Are children with ADHD more likely to have mothers that smoke?
Need more research
Lead Poisoning and ADHD Study 1
 236 children ages 6-17
 Two groups
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ADHD
Control
 Activities
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Clinical interview
Parent ratings
Teacher ratings
 Blood lead level
 Lead levels were below average
 Blood lead was associated with ADHD but not non
Attentive ADHD
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Nigg et al. 2010
Lead Poisoning and ADHD Study 2
 1378 South Korean children
 Parent ADHD rating scale
 Blood lead and mercury levels taken
 The risk for appearance of ADHD symptoms was
found to increase with the blood lead concentration
 Mean blood lead level was low
 Mercury was not found to be associated with ADHD
symptoms
• Ha et al. 2009
Issues found with Lead Poisoning and ADHD
 Blood lead levels were lower than the average
 Lead toxicity was not reported in study subjects
 Could children with ADHD had an issue that causes
lead not to exit their system?
 Young children with ADHD are more tactile
 Lead poisoning symptoms may mimic ADHD
symptoms
Supplements and ADHD
 Supplements (seen as products and not medication)
 Neutraceuticals/herbals (food-based dietary supplements )
 Quality Assurance through regulation
 Omega 3 - 6 - 9
 Vitamins
Neutraceuticals/Herbals
 Not regulated by the FDA
 Concentrations can vary by product
• Curtis & Gaylord 2005
 Little scientific evidence that they are effective
• Sawni 2008
 If buying supplements follow these guidelines
 Make sure manufacturer adheres to strict quality-control
guidelines
Follows the FDAs Goo Manufacturing Practice regulations
 It will have a “GMP” on the label
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Neutracetuical/Herbs
 Get approval from physician because
 Some interact with central nervous system
Kava kava
 Valerian root
 St. john’s wort
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Some can affect the absorption of medication
St. John’s Wort
 Hyperforin is the ingredient
 Can increase norepinephrine, serotonin and dopamine
 Strattera/atomoxetine (a non-stimulant medication) increases
norepinephrine
 Wellbutrin/bupropion (a non-stimulant medication) increases
serotonin
 Will St. John’s Wort have the same effect and improve ADHD
symptoms
St. John’s Wort Study
 54 children 6-17 years of age
 Participants
 Received 900 mg of St. John’s wort
 Received a placebo
 For 8 weeks in each group
 No difference was found between the groups in
controlling
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Hyperactivity
Improving mental focus
Omega 3 – 6 - 9
 It is believed that ADHD may have significantly
lower levels of omega – 3 fatty acids
• Schuchardt et al. 2010, Antallis et al. 2006
 Fish oil and polyunsaturated fatty acids contain
 Omega – 3 and omega -6
 Found to increase this low level
• Sinn & Bryan 2007, Young et al. 2005
Omega and Vitamin Study
 3 groups of ADHD children
 Omega 3-6-9 and multivitamins
 Omega 3-6-9
 Neither treatment
 After 15 weeks, all study subjects were given omega
3-6-9 plus multivitamins for another 15 weeks
• Sinn et al. 2008
Omega and Vitamin Study Results
 Omega groups
 Improved scores on a test of switching and controlling attention
compared to control group
 After control group started 15 weeks of omegas and multi-
vitamins
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Scores improved
 No significant improvements on other cognitive measures
regardless of treatment
 Multivitamins did not appear to improve attention scores
 Omega 3-6-9: ADHD symptoms improved somewhat in
children who were taking both omega 3 and omega 6
supplements
• Sinn et al. 2008
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Foods: Avocado and fish, Focus Factor does not have the omega 3-6-9 in
it. Has more metal
Potassium Supplements and ADHD
 Anecdotal Study: one person reported that this
supplement helped to reduce overstimulation
 Neurologists found that her symptoms were the
same as in hypokalemic periodic paralysis
Diet and ADHD
 Food additives
 Food allergies
 Pesticides
 Optimal diet for ADHD
Food Additives and ADHD Study
 Randomized, double-blinded, placebo-controlled,
crossover trial on whether artificial food color and
additives affected behavior
 153 3 yr. olds
 144 8 and 9 yr. olds
 Three groups
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Drink with sodium benzoate and AFCA mix A
Drink with sodium benzoate and AFCA mix B
Placebo
• McCann et al. 2007
Results of Food Additives and ADHD
 3- yr-olds
 Mix A had a significantly adverse effect compared to placebo
 Mix B did not have a significantly adverse effect compared to
placebo
 8- 9- yr-olds
 Mix A had a significantly adverse effect compared to placebo
 Mix B had a significantly adverse effect compared to placebo
Food Additives and ADHD Study 2
 Same study was replicated by Stevenson et al. (2010)
 Found histamines may mediate the effect of food
additives on ADHD symptoms
 Variations of the gene pool influence the action of
the histamine
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May explain variations in food additives/ADHD study results
 ADHD children may be more likely to have these
gene variations or lack of
Food Additives, ADHD and governmental input
 Dec. 2009: British gov. Requested that food
manufacturers remove most food dyes from their
products
 Because ADHD is a multifaceted disorder, the
removal of food dyes is not considered a stand alone
intervention
Kanarek 2011
Food Allergies and ADHD
 Children with ADHD
 Higher rate of allergies than general population
 Not a statistical difference
 ADHD and allergies share the same gene
 Study
 Found children with ADHD had more positive skin prick tests
for allergies than non ADHD children
67.5 % in ADHD
 45% in non ADHD
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Research has been proposed to examine ADHD as an allergic
hypersensitive disorder
• Pelsser et al. 2009
Food Sensitivities and ADHD
 65% to 89% of those suspected sensitivities reacted
when challenged with at least 100 mg. of artificial
food coloring (AFC)
 Some of those children with this allergic reaction
were also sensitive to milk, chocolate, soy, eggs
wheat, corn, legumes, grapes, tomatoes, and orange
 Researchers recommend a trial elimination diet if
conventional ADHD treatment has not worked
• Stevens et al. 2012
Pesticides and ADHD Study
 1139 children: ADHD and non ADHD
 94% were found to have some levels of pesticide in
their urine
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Out of children with an above-average level of pesticide: 20%
had ADHD
Rate of ADHD in children without pesticide in urine was 10%
• Bouchard et al. 2010
Issues with Pesticide Study
 Children’s diets were not examined
 Pesticide levels were measured by a one-time urine
sample
 Possible causes of results
 Children with ADHD may have more difficulty breaking down
pesticide compounds
 Families with ADHD tend to have a lower income, so cannot
afford organic food
Feingold Diet
 Restrictive Diet: no food dyes and low salicylate
foods
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Difficult for parents to access, maintain, and afford
Early 70’s found access to non-additive foods difficult
 Studies found the diet not to be effective in treating
ADHD overall
For a Perfect Diet
 Cut out refined sugar
 Cut out high-fructose corn syrup
 Decrease saturated fats
 Eat fresh, non-processed food
 Only eat in moderation
 These changes can help everyone
Summary
 There are alternative treatments available for ADHD
 When looking at the alternatives make sure you:
 Research all treatments
 Look at study methodology
 Weight benefit versus risk
 Consider cost of treatment
 Look at long-term gains
 Avoid any treatment claiming it’s a “cure” for ADHD
References
 Sarkis, Stephanie. Non-Medication Treatments for
ADHD, PESI, 2012