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Preventing and Treating ADHD in Children

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurobehavioral disorder diagnosed in children, and its prevalence is growing. Between 2003 and 2007, there was a 22% increase in ADHD prevalence in the United States — today, about 9.5% of school-age children have ADHD.1

ADHD is characterized by restlessness, difficulty focusing, poor impulse control, distractibility, and in some cases overactivity; plus these symptoms have significant negative consequences on the child’s academic performance, social skills, and relationships with family members, teachers, and peers. In addition, ADHD is often accompanied by learning disorders, discipline problems, anxiety, and/or depression.2

ADHD is a complex disorder of the brain that is believed to be caused by a combination of genetic and environmental factors. 3, 4 Smoking and alcohol use during pregnancy, micronutrient deficiencies, excessive television watching early in life, and inadequate omega-3 fatty acid intake are a few of the environmental factors that increase risk.3, 5

Nutrition and ADHD
Poor nutrition is a significant concern for attentional problems and ADHD — here are some of the dietary factors that have been linked to ADHD risk in scientific studies:

  • High sugar intake is associated with hyperactive behavior and ADHD.6, 7
  • Inadequate micronutrient intake. Supplementation to correct micronutrient deficiencies has been shown to improve ADHD symptoms.2, 8
  • A low-nutrient diet high in processed foods and soft drinks at age 4 ½ has been associated with hyperactivity in children at age 7.9 Similarly, a “western” dietary pattern has also been associated with ADHD in 14-year-olds.10
  • Food additives and dyes: many colored foods are marketed to children, and hyperactivity in children following ingestion of food dyes is well documented in placebo-controlled studies.6, 11 Furthermore, a 2004 meta-analysis of 16 studies in children who were already hyperactive showed that their hyperactive behavior increased after ingesting food colorings.12
  • There is preliminary evidence that certain pesticides (called organophosphates) commonly found on some fruits are associated with ADHD.13
  • Omega-3 fatty acids (especially DHA) are the building blocks a child needs to build a healthy brain. Insufficient omega-3 levels are common in children with ADHD, and there is evidence that omega-3 supplementation, especially in combination with the omega-6 fatty acid gamma-linolenic acid (GLA; found in borage oil and evening primrose oil) improves behavior and ADHD symptoms. 14, 15

Treatment for most children with ADHD: stimulant drugs
The primary mode of treatment for ADHD is a combination of stimulant drugs and behavioral treatment. The Centers for Disease Control estimates that 2.7 million children in the U.S. are currently taking medication for ADHD.1 There is concern about these drugs because of side effects (the two most common are insomnia and loss of appetite) and the potential for abuse, since stimulants such as Ritalin (methylphenidate) and amphetamines have actions on the brain similar to cocaine.6 Also evidence has recently emerged that these stimulants may adversely affect the cardiovascular system — long-term stimulant use increases heart rate, and elevated heart rate increases the risk of cardiac death. 9, 16, 17

Natural Prevention and Treatment of ADHD
As a parent, these are effective strategies that will help to prevent your children from developing ADHD:

  • Limit television time and do not expose children under the age of 2 to any television. The American Academy of Pediatrics recommends that children under the age of two should not watch television.5
  • Feed the whole family a health-promoting, high-nutrient diet of colorful fruits and vegetables, beans, nuts, and seeds.
  • Encourage sports and other forms of exercise. Physical activity has beneficial effects on brain function, and several studies have reported that exercise improves attention, behavior and/or impulse control in children with ADHD.18-22
  • Avoid processed foods, artificially colored foods, and added sugars. The simplest and most effective way to avoid the potential harmful effects of synthetic dyes is to avoid processed foods. When buying the occasional packaged food, check the ingredient list to avoid synthetic dyes and additives.
  • To assure adequate omega-3 fatty acids for brain development, give children a DHA supplement and feed them omega-3-rich foods (ground flaxseed, hemp and chia seeds, walnuts) regularly.
  • Buy organic produce when possible to limit pesticide exposure, especially when buying highly pesticide-laden crops.


If your child has been diagnosed with ADHD, a family commitment to dietary changes is crucial. My nutritional approach to ADHD used in conjunction with appropriate behavioral treatment has helped many families. Although it may take up to 6 months, significant improvements are almost always observed, and stimulant medications are rarely necessary.

  • Feed the whole family a health-promoting, high-nutrient diet of colorful fruits and vegetables, beans, nuts, and seeds.
  • For adequate omega-3 fatty acids:
    • DHA
    • EPA 400-600 mg per day (taking double the recommended dose every other day is also reasonable and effective).
    • 1 tbsp. ground flaxseed daily
    • Minimum 1 ounce raw walnuts daily, plus other raw nuts
    • Little or no oils
  • Supplemental GLA (60-100 mg per day; an omega-6 fatty acid found in borage oil and evening primrose oil. Taking double the recommended dose every other day is also reasonable and effective)
  • Gluten (from wheat) and/or casein (from dairy products) avoidance for children who are sensitive to these proteins.

 

References

1. Centers for Disease Control and Prevention: Rate of Parent-Reported ADHD Increasing [http://www.cdc.gov/ncbddd/features/adhd-parent-reporting.html]
2. Kidd PM: Attention deficit/hyperactivity disorder (ADHD) in children: rationale for its integrative management. Altern Med Rev 2000;5:402-428.
3. Curatolo P, D'Agati E, Moavero R: The neurobiological basis of ADHD. Ital J Pediatr 2010;36:79.
4. Antshel KM, Hargrave TM, Simonescu M, et al: Advances in understanding and treating ADHD. BMC medicine 2011;9:72.
5. Christakis DA, Zimmerman FJ, DiGiuseppe DL, et al: Early television exposure and subsequent attentional problems in children. Pediatrics 2004;113:708-713.
6. Artificial food colouring and hyperactivity symptoms in children. Prescrire Int 2009;18:215.
7. Schnoll R, Burshteyn D, Cea-Aravena J: Nutrition in the treatment of attention-deficit hyperactivity disorder: a neglected but important aspect. Appl Psychophysiol Biofeedback 2003;28:63-75.
8. Curtis LT, Patel K: Nutritional and environmental approaches to preventing and treating autism and attention deficit hyperactivity disorder (ADHD): a review. J Altern Complement Med 2008;14:79-85.
9. Wiles NJ, Northstone K, Emmett P, et al: 'Junk food' diet and childhood behavioural problems: results from the ALSPAC cohort. Eur J Clin Nutr 2009;63:491-498.
10. Howard AL, Robinson M, Smith GJ, et al: ADHD is associated with a "Western" dietary pattern in adolescents. J Atten Disord 2011;15:403-411.
11. Schab DW, Trinh NH: Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr 2004;25:423-434.
12. McCann D, Barrett A, Cooper A, et al: Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet 2007;370:1560-1567.
13. Bouchard MF, Bellinger DC, Wright RO, et al: Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics 2010;125:e1270-1277.
14. Antalis CJ, Stevens LJ, Campbell M, et al: Omega-3 fatty acid status in attention-deficit/hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 2006;75:299-308.
15. Transler C, Eilander A, Mitchell S, et al: The impact of polyunsaturated fatty acids in reducing child attention deficit and hyperactivity disorders. J Atten Disord 2010;14:232-246.
16. Vitiello B, Elliott GR, Swanson JM, et al: Blood Pressure and Heart Rate Over 10 Years in the Multimodal Treatment Study of Children With ADHD. Am J Psychiatry 2011.
17. Verrier RL, Tan A: Heart rate, autonomic markers, and cardiac mortality. Heart Rhythm 2009;6:S68-75.
18. Medina JA, Netto TL, Muszkat M, et al: Exercise impact on sustained attention of ADHD children, methylphenidate effects. Atten Defic Hyperact Disord 2010;2:49-58.
19. Gapin JI, Labban JD, Etnier JL: The effects of physical activity on attention deficit hyperactivity disorder symptoms: the evidence. Prev Med 2011;52 Suppl 1:S70-74.
20. Archer T, Kostrzewa RM: Physical exercise alleviates ADHD symptoms: regional deficits and development trajectory. Neurotox Res 2012;21:195-209.
21. Berwid OG, Halperin JM: Emerging support for a role of exercise in attention-deficit/hyperactivity disorder intervention planning. Curr Psychiatry Rep 2012;14:543-551.
22. Lenz TL: A Pharmacological/Physiological Comparison between ADHD Medications and Exercise. American Journal of Lifestyle Medicine 2012;6:306-308.

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