Introduction
Originally, children who simply were incapable of concentrating at school were
thought to have attention-deficit disorder (ADD). Hyperkinesia was used
somewhat synonymously as a descriptive term for children who could not sit still.
The definition has broadened to include adults and has been refined into two
conditions: ADD and ADHD (attention deficit hyperactivity
disorder). Characteristics include difficulty sustaining
attention or completing tasks, easy distractibility, impulsive behavior, and, in
the case of ADHD, an excessive inclination to fidget and move about. These
problems make it difficult to succeed at work or at school.
Conventional treatment focuses on stimulants, such as amphetamine,
dextroamphetamine, and methylphenidate (Ritalin, Concerta),
and the newer drug atomoxetine (Strattera). Certain antidepressants may also be
useful.
Proposed Natural Treatments
2-Dimethylaminoethanol. There is some evidence that the supplement 2-dimethylaminoethanol (DMAE) may be helpful for ADD, according to studies performed in the 1970s. Two such studies were reported in a review article. Fifty children age six to twelve years who had been diagnosed with hyperkinesia participated in a double-blind study comparing DMAE to placebo. The dose was increased from 300 milligrams (mg) daily to 500 mg daily by the third week and continued for ten weeks. Evaluations revealed statistically significant test-score improvements in the treatment group compared with the placebo group.
Another double-blind study compared DMAE with both Ritalin and
placebo in seventy-four children with learning disabilities. (Today, the
participants likely would have been given a diagnosis of ADD.) The study found
significant test-score improvement for both treatment groups over a ten-week
period.
Zinc. The mineral zinc has shown some promise for treatment of ADHD. In a large double-blind, placebo-controlled study (approximately four hundred participants), the use of zinc at a dose of 35 mg daily produced statistically significant benefits compared with placebo. This dose of zinc is higher than nutritional needs, but not so high as to be unsafe. However, the benefits seen were quite modest: About 28 percent of the participants given zinc showed improvement, but so did 20 percent in the placebo group.
Another, much smaller study evaluated whether zinc at 15 mg per day could enhance the effect of Ritalin. Again, modest benefits were seen. Finally, exceedingly weak evidence hints that zinc might enhance the effectiveness of evening primrose oil for ADHD.
Essential fatty acids. Essential fatty acids (EFAs) are “good
fats,” substances as important to general health as vitamins. Based on evidence
that essential fatty acids are necessary for the proper development of brain
function in growing children, EFAs found in fish oil and
evening primrose oil have been used for the treatment of ADHD and related
conditions. The results, however, have been less than impressive.
A double-blind, placebo-controlled trial of seventy-five children with ADHD found that daily supplementation with omega-3 and omega-6 fatty acids may reduce ADHD symptoms in some children. However, in a similarly designed study of fifty such children, the use of essential fatty acids from fish oil and evening primrose oil failed to provide any consistent, significant benefit above and beyond the placebo effect. (The placebo effect, incidentally, was considerable.) In a slightly smaller trial, weak evidence of benefit was seen, but the results are difficult to interpret because of the high number of people who dropped out of the study.
In a double-blind, placebo-controlled trial of children already using stimulant therapy, the addition of the essential fatty acid docosahexaenoic acid (DHA, found in fish oil) for four months failed to further improve symptoms.
Evening primrose oil alone failed to prove effective for ADD in a small, double-blind, placebo-controlled trial. In a placebo-controlled comparative trial, evening primrose oil proved less effective than standard medical treatment. However, a close look at the data in this last trial hinted that evening primrose oil might have been more effective in people with adequate zinc levels. This suggests that combination therapy with zinc and evening primrose oil should be tested, but thus far, this approach has not undergone meaningful study.
Other natural treatments. A small, double-blind, placebo-controlled crossover trial evaluated the possible efficacy of the supplement carnitine for ADD in boys age thirteen years and younger. Approximately 50 percent of the participants responded to carnitine, a significantly higher percentage than responded to placebo. These promising results suggest that a larger trial is warranted.
A combination of American ginseng and Ginkgo biloba has shown some promise for treatment of ADHD. Vitamin B3 (niacin), vitamin B6, and multivitamin-multimineral supplements have been recommended for the treatment of ADD. However, a review of the literature found no meaningful evidence to indicate that these treatments are effective. One study reportedly proves that magnesium is helpful for ADD, but this study’s design was too inadequate to prove much of anything.
Other supplements that are sometimes recommended for ADD include calcium, iron, inositol, trace minerals, blue-green algae, combinations of amino acids (usually gamma-aminobutyric acid, glycine, taurine, L-glutamine, L-phenylalanine, and L-tyrosine), and combinations of the polysaccharides galactose, glucose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, N-acetylglucosamine, and xylose. St. John’s wort has also become popular, but unlike its effectiveness in depression, there is no convincing evidence for its effectiveness against ADD. St. John’s wort interacts with many medications and could conceivably impair the effectiveness of conventional treatments for ADD.
One study hints that massage might be helpful for ADD. Also, it is commonly said that sugar, food allergens, and food additives, such as artificial colors, contribute to ADD symptoms. However, published evidence regarding these therapies remains incomplete and contradictory. The best evidence regards artificial colors and food additives. In a double-blind, placebo-controlled study of 153 persons without ADD, the use of certain food additives significantly increased hyperactivity compared with placebo.
A double-blind study reported in 2005 failed to find benefits for ADD with a
treatment known as Bach flower remedies. Another study
found that the supplement melatonin may be helpful for improving
sleep in children with ADHD who are also taking stimulant medications. However,
melatonin does not appear to be helpful for ADHD symptoms per se.
Homeopathic Remedies
In a double-blind study of sixty-two children with ADD, the use of constitutional, or classical, homeopathic remedies proved more effective than placebo. However, a similar study of forty-three children, again using constitutional remedies, failed to find statistically significant benefits.
Bibliography
Arnold, L. E., S. M. Pinkham, and N. Votolato. “Does Zinc Moderate Essential Fatty Acid and Amphetamine Treatment of Attention-Deficit/Hyperactivity Disorder?” Journal of Child and Adolescent Psychopharmacology 10 (2000): 111-117.
Bilici, M., et al. “Double-Blind, Placebo-Controlled Study of Zinc Sulfate in the Treatment of Attention Deficit Hyperactivity Disorder.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 28 (2004): 181-190.
Breakey, J. “The Role of Diet and Behaviour in Childhood.” Journal of Paediatrics and Child Health 33 (1997): 190-194.
Field, T. M., et al. “Adolescents with Attention Deficit Hyperactivity Disorder Benefit from Massage Therapy.” Adolescence 33 (1998): 103-108.
Frei, H., et al. “Homeopathic Treatment of Children with Attention Deficit Hyperactivity Disorder.” European Journal of Pediatrics 164 (2005): 758-767.
Jacobs, J., et al. “Homeopathy for Attention-Deficit/Hyperactivity Disorder.” Journal of Alternative and Complementary Medicine 11 (2005): 799-806.
Johnson, M., et al. “Omega-3/Omega-6 Fatty Acids for Attention Deficit Hyperactivity Disorder: A Randomized Placebo-Controlled Trial in Children and Adolescents.” Journal of Attention Disorders 12 (2009): 394-401.
Krummel, D. A., F. H. Seligson, and H. A. Guthrie. “Hyperactivity: Is Candy Causal?” Critical Reviews in Food Science and Nutrition 36 (1996): 31-47.
Lyon, M. R., et al. “Effect of the Herbal Extract Combination Panax Quinquefolium and Ginkgo biloba on Attention-Deficit Hyperactivity Disorder.” Journal of Psychiatry and Neuroscience 26 (2001): 221-228.
McCann, D., et al. “Food Additives and Hyperactive Behaviour in Three-Year-Old and Eight/Nine-Year-Old Children in the Community.” The Lancet 370 (2007): 1560-1567.
Pintov, S., et al. “Bach Flower Remedies Used for Attention Deficit Hyperactivity Disorder in Children.” European Journal of Paediatric Neurology 9, no. 6 (2005): 395-398.
Rapp, D. J. “Does Diet Affect Hyperactivity?” Journal of Learning Disabilities 11 (1978): 383-389.
Richardson, A. J., and B. K. Puri. “A Randomized Double-Blind, Placebo-Controlled Study of the Effects of Supplementation with Highly Unsaturated Fatty Acids on ADHD-related Symptoms in Children with Specific Learning Difficulties.” Progress in Neuro-Psychopharmacology and Biological Psychiatry 26 (2002): 233-239.
Schab, D. W., and N. H. Trinh. “Do Artificial Food Colors Promote Hyperactivity in Children with Hyperactive Syndromes?” Journal of Developmental and Behavioral Pediatrics 25 (2004): 423-434.
Stevens, L., et al. “EFA Supplementation in Children with Inattention, Hyperactivity, and Other Disruptive Behaviors.” Lipids 38 (2003): 1007-1021.
Van der Heijden, K. B., et al. “Effect of Melatonin on Sleep, Behavior, and Cognition in ADHD and Chronic Sleep-Onset Insomnia.” Journal of the American Academy of Child and Adolescent Psychiatry 46 (2007): 233-241.
Weber, W., et al. “Hypericum Perforatum (St John’s Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Journal of the American Medical Association 299 (2008): 2633-2641.
Weiss, M. D., et al. “Sleep Hygiene and Melatonin Treatment for Children and Adolescents with ADHD and Initial Insomnia.” Journal of the American Academy of Child and Adolescent Psychiatry 45, no. 5 (2006): 512-519.
Wolraich, M. L., D. B. Wilson, and J. W. White. “The Effect of Sugar on Behavior or Cognition in Children.” Journal of the American Medical Association 274 (1995): 1617-1621.
No comments:
Post a Comment