Tips for Parents: A Ten Point Naturopathic Medicine Plan for ADHD

Introduction

As naturopathic doctors, we have worked with a numerous children with a number of different conditions that are along the behavior disorder continuum. In many cases, we have witnessed first-hand how diet, family and lifestyle changes along with appropriate nutrient supplementation will help avoid medicines and create optimal health. Our hope is this article will inform parents of the well-researched effective natural choices available and that medication can often be reserved as either a back up plan if these are not successful or for cases of true urgency. Our experience is that in most cases, more natural means can achieve positive results, address the underlying factors, and avoid side effects that can come with stimulant medications.

Statistics

Attention-Deficit/ Hyperactivity Disorder (ADHD) is an increasingly pervasive condition in our pediatric community. Although the National Institute of Mental Health reports an incidence of 3 to 5 percent, the most recent pediatric investigation shows almost 10 percent of children are now diagnosed.[i] As a result, this illness is now considered the most common childhood behavior disorder with a six-fold increase in boys over girls. The United States claims the greatest prevalence of ADHD over other nations.

Symptoms and Causes

ADHD is considered a neurobiological disorder which inhibits a child’s ability to balance activity, perform tasks, and regulate behavior. Children with this disorder can have functional difficulties in the school environment, at home, and with peer relationships. Typical symptoms include a child’s inability to sit still for a reasonable period of time, act without thinking, and not finishing tasks. Children with this condition become at advanced risk for gambling, depression, anxiety and eating disorders.

ADHD is thought to have a genetic component. Some emerging research suggests medicated hospital birthing procedures may promote ADHD.[ii] Other studies have drawn relationships between simultaneous prenatal toxic exposures to lead and tobacco.[iii] Health difficulties in the mother, including ADHD, seem to predispose a child to this illness.[iv] Finally, parental marital difficulty and tumultuous environments also seem to increase predisposition to ADHD.[v]
Conventional Treatments

Conventional treatments medications and behavioral work. Stimulant medications like Ritalin, Adderall and Dexedrine increase dopamine, a brain chemical known to balance motivation, attention, movement and pleasure. Non-stimulant medications such as atomoxetine (Strattera) increase the level of norepinephrine, but is not found as effective as the stimulants.

In the United States, these drugs are used a greater percentage of time to treat ADHD over any other part of the world. Stimulant medications may prevent certain children to go on to have other mood disorders such as depression later in life,[vi] and thus may be appropriate if other natural treatments are not effective. However, it is in our opinion that these medications should be used more judiciously than currently prescribed. We know that nearly one-third of children on these medications experience worrisome side effects.[vii] There is an association with sudden unexplained deaths in pediatric patients, [viii] suicide risk,[ix] liver toxicity,[x] adolescent medications abuse,[xi] as well as increases in blood pressure and heart rates.[xii]

Naturopathic Medicine Can Help Parents Make a Plan
In many cases, there are wonderful natural, non-drug treatments that can help a child balance, focus and calm. Naturopathic medicine focuses on using various natural therapies together to allow the body to heal itself. Naturopathic physicians are trained to clarify the multiple factors usually involved in the clinical presentation of this challenging condition and create a cohesive individualized plan for health.

Unless there is a dire situation or question of safety, a typical naturopathic plan will attempt to avoid medications, and instead prescribe psychotherapy (not covered in this article) as well as diet, lifestyle, nutrient and herbal suggestions. Although much research is still needed, there is growing evidence regarding the effective use of individual natural therapies for this condition.

In many cases, any one recommendation alone will not necessarily create behavioral change. As a result, it is best to work with a naturopathic physician who will ask the right questions and design a recommendation plan to include the aspects that will help your child the most. Here are some recommendations which collectively we have found most helpful with our young patients:

1 - Foods: Sugar Balance, Additives and Protein

Naturopathic diet recommendations usually revolve around stabilization of blood sugar by avoiding high glycemic foods (foods that can quickly raise blood sugar) and replacing these with more complex carbohydrates, while assuring adequate intake of protein and fats to slow sugar absorption. Academic investigations out of Yale University as well as the University of South Carolina both corroborate the role of sugar intake contributing to changes in behavior and restlessness in ADHD children.[xiii],[xiv] Despite this data, other studies on sugar avoidance have not shown a clear link.[xv] It is possible in these negative studies, other factors (as outlined in this article below) also needed to be addressed simultaneously in order to effect a positive behavioral changes.

Interestingly, some research suggests that a link between sugar and hyperactivity may involve parental perception: mothers who were told the child received sugar reported more hyperactive behavior, even when aspartame-sweetened foods devoid of sugar were actually used. Mothers who were told the child received a low-sugar snack were less likely to report worse behavior.[xvi] It is possible in this study, the artificial sweetner used may have confounded these results.

Meal timing is crucial. Even in non-ADHD kids (and many of us adults) when there are large gaps of time between meals, the result can be irritability and mood change. In patients with susceptibility to ADHD, this likely triggers impulsivity, poor concentration or behavior difficulty. A remedy for this is assuring regular small meals, snacking, and increases in protein intake. These will prevent extreme vacillations in blood glucose. Research has found that hyperactive children who consumed a high-protein meal performed equal or better than non-hyperactive kids who didn't eat as much protein.  As such, it is important to have healthy protein snacks available for regular treats, such as natural protein bars, or apples with natural peanut butter before a child’s behavior changes.

Food sensitivities may play a role in some kids. Published in the 1970’s, the Feingold diet main tenet teaches that chemicals found in food additives can trigger abnormal brain response. Feingold also considered salicylates (aspirin- like compounds in certain foods) to also be a culprit.[xvii] These sensitivities are worth expoloring when other diet changes alone are not helping. The British journal Lancet reported in 1985 that almost 80% of children with hyperactivity improved behavior when sugary foods and foods with artificial colors were removed from the diet.[xviii] A follow up six-week study from 2007 revealed that kids with additives in their diet had clearly higher hyperactive behaviors over children with additive-free diets.[xix]

2- Sleep and Melatonin

It is estimated that up to one-third of children in the United States suffer from inadequate sleep. Inadequate sleep appears to be an independent risk factor for ADHD. In a cross-sectional study of 7 to 8 year-olds, researchers found that kids with less than 7.7 hours of sleep each night were significantly more prone to hyperactivity or inattentiveness, compared with children who were moderate or longer sleepers.[xx] Also important is consistency of bedtimes. Melatonin is a natural hormone made in the brain to help induce sleep. Used as a natural supplement, a presentation at the American Academy of Child and Adolescent Psychiatry showed that melatonin was helpful for treating delayed sleep onset in children with ADHD, according to the results of a double-blind, crossover-design pilot. The side effect profile of melatonin is minimal and is quite safe in children.[xxi]

3 - Exercise / Yoga

The neurotransmitter dopamine and norepinephrine help the brain stay attentive. It is well known that exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. One expert in the field, Dr. J. Ratey is quoted as saying:

            “exercise is like taking a bit of methylphenidate (Ritalin) or amphetamine/dextroamphetamine (Adderall); it's similar to taking a stimulant.[xxii]

Given this knowledge, it makes sense to add significant exercise and movement that a child enjoys to their everyday life. Getting outdoors in nature as often as possible helps raise vitamin D levels and is known to be calming.

Two small trials also looked to yoga as a method to improve symptoms of young patients who were already stabilized on medication. Both studies showed improvement trends, but were not large enough to be definite.[xxiii],[xxiv] Given the positive research about yoga in other mood disorders, it is certainly worth a try.

4 - Home Environment

The home should be evaluated regarding calmness, consistency and sense of security for the child.. Recent evidence shows that children who watch television for 1.5hrs or more have higher blood pressure.[xxv] Early TV watching has been definitively linked to attention problems by age 7.[xxvi] Possibly, less time watching TV and using video games, and more time in nature would be balancing for the ADHD brain. In our clinical experience, we have also found replacing TV time with special parent-child time where one parent spends time doing an activity with the child for at least 15 minutes a day can help calm and focus a child’s challenging behavior. In many cases, we have seen ADHD behaviors linked to marital conflict and general strife[xxvii] within the household, which can contribute to ‘mixed messages’ and lack of consistency. Working on these, and having the guardians involved assure consistency in regards to the children have had major breakthroughs in a few cases.


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