Attentional deficit hyperactivity disorder (ADHD) is a childhood disorder characterised by symptoms such as hyperactivity, impulsivity and inattention. It is a persistent behavioural syndrome related to abnormal brain functioning particularly in the frontal lobe region. This region is linked to planning complex cognitive behaviours, decision making, personal expression and controlling social behaviour. Imbalances of the neurotransmitters dopamine and noradrenalin (either too much or too little) have also been implicated. Some children can be diagnosed with attention deficit disorder (ADD) rather than ADHD as they are less hyperactive but just as inattentive.
ADHD has a significant negative impact on learning, social interaction, mood, school and family life. It is estimated that approximately 8% of Australian children are diagnosed with ADHD, with boys more likely to be affected. Natural therapies can be of assistance for children with ADHD, through safe and effective supplementation with nutritional medicines and by making changes in the diet and lifestyle.
What causes ADHD?
The causes of ADHD are multifactorial. Factors that are shown to be associated with ADHD include the following:
Heredity plays a significant role. Children with ADHD usually have at least one first-degree relative who also has ADHD. Fathers who had ADHD as a child are one third more likely to have children with ADHD.
Environmental exposure to toxins such as lead, mercury and other toxic metals.
Prenatal and early postnatal health: In-utero exposure to alcohol, tobacco smoke, drugs, lead, dioxins and polychlorinated biphenyls (PCBs) and nutrient deficiencies.
Premature birth and birth trauma is associated with increased risk.
Abnormal thyroid responsiveness (potentially caused by exposure to pollutants in the perinatal period).
Gender ADHD is 4 times more prevalent in boys than girls according to epidemiology studies.
Learning disabilities, communication and tic disorders (Tourette’s syndrome).
Nutritional factors may exacerbate the symptoms of ADHD and may involve allergies, sensitivities or intolerances to certain foods, food preservatives and colourings.
Signs and symptoms
Diagnosis of ADHD requires the presence of at least six symptoms of inattention and/or hyperactivity.
Inattentive behaviours include:
- Easily distracted by others or external stimuli
- Makes simple and careless mistakes, lacking an attention to detail
- Has difficulty sustaining attention in tasks or games
- Doesn’t seem to listen when spoken to directly
- Difficulty following instructions and fails to finish homework and chores
- Has difficulty organising themselves for a task or activity
- Avoids and dislikes tasks that require prolonged attention/mental effort
- Frequently loosing objects such as drink bottles, pens and jumpers
- Forgetful in day to day activities
Hyperactive behaviours
- Fidgeting with hands or feet or squirming while sitting
- Frequently getting up in the classroom or during other activities where remaining seated is expected
- Runs or climbs excessively in inappropriate situations
- Talking excessively and often loudly
- Difficulty engaging in quiet leisure activities
- Difficulty awaiting turn
- Blurts out answers before the sentence has been finished
- Frequently interrupting sentences or activities
- Always ‘on the go’
Challenging behaviours such as moodiness, anxiety, stubbornness, aggression, oppositional behaviour and frustration are additional symptoms that may also be present.
Dietary modification
An elimination diet may be helpful to pinpoint food sensitivities, intolerances or allergens. Typical food allergens are eliminated from the diet and then reintroduced one at a time to see if there are any reactions.
Follow an additive-free diet, with complete exclusion of food colourings, preservatives and flavours. It is estimated that 8% of children with ADHD may have symptoms related to synthetic food colours.
A gentle detoxification program conducted through a qualified practitioner may also be helpful to address toxin exposure, leaky gut and dysbiosis.
Avoid caffeine (particularly if taking stimulant medication) in coffee, tea, cola and other caffeinated beverages.
Eat low glycaemic index foods and small regular meals to balance blood sugars, as hypoglycaemia may trigger symptoms. Avoid refined sugar in processed foods and drinks, eat wholegrains with protein and vegetables at every meal.
Amino acids from protein are important for healthy neurotransmitters and can be obtained from nuts, seeds, eggs, lentils, legumes, yoghurt, cheese, milk, soy, fish and meat. A whey, soy or pea protein can be supplemented if there is inadequate protein intake.
Lifestyle considerations
Adequate sleep and physical exercise are good for general wellbeing and to improve mood. Yoga and regular massage therapy have been shown to reduce the symptoms of ADHD. Behavioural modification programs that help to establish routines and systems for managing undesirable behaviour are highly recommended. Children with ADHD do well in school if there is a highly structured approach to learning.
Essential fatty acids
Omega 3’s are also important nutrients to include in the diet for healthy brain structure and function. Sources include fish, fish oils, flaxseed oil, linseeds, chia seeds and walnuts.
Vitamins and Minerals
Evidence also suggests that children with ADHD are also likely to have low levels of iron, vitamin d, zinc and magnesium. It is important to test for nutrient levels and address nutrient deficiencies if they are present.
Magnesium can be helpful for healthy neurotransmitters and for calming if there is insomnia, anxiety and restlessness and is found in meat, bananas, green vegetables, nuts and seeds.
Low zinc levels may interfere with processing information and maintaining attention. Zinc is found in garlic, mushrooms, red meat, chicken, pepitas, cheese and broad beans.
Vitamin D. Ensure adequate levels by allowing adequate sun exposure. Additionally, vitamin D can be obtained through the diet and sources include egg yolk, cheese, calamari, pickled herring and sardines.
Iron. Abnormally low ferritin levels may be associated with hyperactivity in non-anaemic ADHD children but not with deficits in cognitive performance. In a small twelve week trial non-anaemic ADHD children with abnormally low serum ferritin levels who were administered oral iron showed marked improvements in their symptoms of ADHD that were comparable to improvements obtained from stimulants.
Herbal Medicine
Herbal medicines for use in children with ADHD include:
- Ginkgo (ginkgo biloba)
- American ginseng (panax quinquefolium)
- Pine (pinus pinaster)
- Brahmi (bacopa monnieri)
Ginkgo biloba and panax quinquefolium showed beneficial effects when combined with existing ADHD medication. In another study, Pinus pinaster bark administered to ADHD children showed significant improvements in hyperactivity, inattention and visual-motor coordination over placebo. Bacopa monnieri is traditionaly used as a brain tonic and memory enhancer and may also prove beneficial.
To summarise, ADHD is a complex disorder involving many different causes and presentations. Natural therapies can be of assistance to help improve the symptoms of ADHD by making dietary changes, addressing potential nutritional deficiencies and implementing herbal medicines.
References
Graetz, BW et al. Validity of DSM-IV ADHD subtypes in a nationally representative sample of Australian children and adolescentsJ Am Acad Child Adolesc Psychiatry. 2001 Dec;40(12):1410-7. http://www.ncbi.nlm.nih.gov/pubmed/11765286
http://mindd.org/conditions/add-adhd/
Sarris J & Wardle J. (2010). Clinical Naturopathy, Churchill Livingstone, Australia
Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet 2016 Mar 19;387(10024):1240-50 https://pubmed.ncbi.nlm.nih.gov/26386541/
Swanson JM, et al. Etiologic subtypes of attention-deficit/hyperactivity disorder: brain imaging, molecular genetic and environmental factors and the dopamine hypothesis. Neuropsychol Rev 2007;17(1):39-59 https://pubmed.ncbi.nlm.nih.gov/17318414/
Nigg JT, et al. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Adolesc Psychiatry. 2012 Jan;51(1):86-97 https://pubmed.ncbi.nlm.nih.gov/22176942/
Villagomez A, Ramtekkar U. Iron, magnesium, vitamin D, and zinc deficiencies in children presenting with symptoms of attention-deficit/hyperactivity disorder. Children (Basel). 2014 Sep 29;1(3):261-79 https://pubmed.ncbi.nlm.nih.gov/27417479/
Konofal E, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol 2008;38(1):20-26 https://pubmed.ncbi.nlm.nih.gov/18054688/
Lyon MR, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci. 2001 May;26(3):221-8 https://pubmed.ncbi.nlm.nih.gov/11394191/
Trebaticka J, et al. Treatment of ADHD with French maritime pine bark extract, pycnogenol. Eur Child Adolesc Psychiatry. 2006 Sep;15(6):329-35 https://pubmed.ncbi.nlm.nih.gov/16699814/
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