ALTERNATIVE AND CONTROVERSIAL TREATMENTS FOR ATTENTION-DEFICIT/HYPERACTIVITY DISORDER
Section snippets
DIETARY MANAGEMENT
Dietary management of ADHD remains a controversial topic that has become more complicated rather than simplified over time. The current research into the interaction of diet and behavior focuses primarily on the roles that nutritional deficiency, malnutrition, metabolic disturbances, food allergies, and food sensitivities play in the biochemical basis of behavior. Diet and nutrition can affect general mood and behavior and have wide implications for neurodevelopmental and neurodegenerative
THE ROLE OF ELIMINATION DIETS IN ADHD
Based on the research of the last 20 years, it is difficult to dismiss summarily the findings that a subgroup of children with ADHD responds favorably to individualized elimination diets. A role for behavioral food sensitivity has been defined more clearly. Several specific conclusions can be drawn from this newer research: (1) behavioral improvement is more likely with appropriate elimination diets in individuals with atopic histories, family history of migraine, and a family history of food
SUGAR
The research on sugar is much clearer in disproving its role in ADHD. The preference for the taste of sugar is hardwired in the brain, which depends totally on glucose as its metabolic substrate. This is reinforced by the social role of sugar as treats, rewards, and consolation. Children with ADHD often have conspicuous sugar cravings. This contributes to the tenacious perception that sugar and candy intake can cause hyperactive behavior, despite ample evidence to the contrary.29
Prinz42
ASPARTAME
Aspartame appeared on the market as an artificial sweetener in 1981 and was used as the placebo in several of the aforementioned sugar studies. Aspartame consists of the neurotransmitter precursor aminoacids aspartic acid and phenylalanine. This raised concern that aspartame could precipitate seizures or ADHD behaviors in susceptible individuals. However, no independent neurologic, metabolic, or behavioral-cognitive effects related to aspartame have been found in studies of persons with seizure
THE YEAST CONNECTION
Dr. William Crook, a practicing allergist and pediatrician, noted a 75% success rate in reducing hyperactive behavior in his patients with ADHD using individualized elimination diets.12 Based on prior research on the immunologic effects of candida infection, Crook maintained that prolonged or frequent antibiotic treatment results in chronic candidiasis and candida toxin production. This, in turn, is responsible for a variety of metabolic and behavioral disturbances, including hyperactivity,
DIETARY SUPPLEMENTS AND DIETARY DEFICIENCY
An adequate diet is clearly a necessary requirement for growth and development and is particularly critical in the first few years of life during the periods of most active brain growth and synaptic formation. Protein-calorie deprivation during this time has been associated with later cognitive, learning, and behavioral dysfunction.19 Adequate protein-calorie supplementation during infancy and early childhood improved cognitive, social, and adaptive parameters at 6 to 8 years compared with
ESSENTIAL FATTY ACIDS
The essential fatty acids (EFAs) linoleic acid and linolenic acid are essential to brain development and neuronal functioning. Interest in a relationship between EFAs and ADHD first arose when epidemiologic studies in Britain revealed a higher rate of nonspecific physical symptoms typical of EFA deficiency (increased thirst and atopic conditions) in children with hyperactivity.36 In a carefully conducted study, Stevens et al53 subsequently found significantly lower plasma levels of EFAs in
ROLE OF NUTRITIONAL SUPPLEMENTATION IN THE TREATMENT OF ADHD
Marginal deficiency of many micronutrients has been identified in a significant portion of the average American population. Children with ADHD may be at a somewhat increased risk because their eating habits are often erratic and because they may experience appetite suppression secondary to treatment with stimulant medications. There is inconsistent evidence that specific micronutrient deficiency may enhance ADHD symptoms and may decrease response to pharmacotherapy. If significant dietary
NOOTROPICS
The term nootropic is derived from the Greek words noos (mind) and tropos (turn) and refers to substances that reportedly enhance mental competence and stave off aging. They are classified as cerebral metabolic enhancers because they appear to be effective by potentiating existing metabolic activity (through neurotransmitter and ion channel function) rather than possessing any direct activity of their own. This is also believed to be the explanation for their low toxicity and absence of
ANTIOXIDANTS AND HERBS
Most of the agents in this category have been used in folk and traditional medicine for cognitive improvement and as antiaging remedies for centuries, but it is only recently that their pharmacologic properties are undergoing scientific evaluation. None has been studied systematically in ADHD, and their effectiveness as adjunctive treatment in standard ADHD treatment is not known.
Pycnogenol, a bioflavinoid antioxidant extracted from pinebark,11 has been used in Europe for some time in the
VISION THERAPY AND OCULOVESTIBULAR TREATMENT
Impairment of visual acuity, oculomotor function, and visuospatial perception has been implicated in the etiology of dyslexia and secondary attentional problems. There is no support for this hypothesis, however, or for the claims that specific ocular exercises or colored lenses can alleviate dyslexia or ADHD.31 Anecdotal reports of remarkable improvement of ADHD symptoms when prismatic lenses are introduced to correct alleged dysfunction of the oculovestibular-cerebellar system also have no
HOMEOPATHY
Homeopathy is a therapeutic system developed 200 years ago by Fr. Hahnemann that runs completely counter to conventional scientific principles. It is based on the concept that illness results from a disorder of “vital energies” and that the purpose of treatment is to restore these energies. Treatment consists of extreme dilutions of plant, animal, or mineral extracts that are highly individualized to the symptoms of the patient. There are several randomized, double-blind, placebo-controlled
AUDITORY STIMULATION: TOMATIS METHOD
There is a growing volume of academic research and publications in the popular press regarding the role of music in emotional and cognitive processes and its specific applications in medicine and education. An interesting controlled study by Abikoff et al1 showed that boys with ADHD improved their ability to solve arithmetic problems when they listened to their favorite music. This was interpreted as the effect of increased arousal with a highly salient stimulus. Otherwise there has been little
BIOFEEDBACK HYPNOTHERAPY
Hypnotherapy, self-hypnosis, guided imagery, biofeedback, and relaxation training are related techniques whose goal is to facilitate physiologic and psychological self-regulation of the patient. The mechanisms of action are not known, but effectiveness can be demonstrated by changes in physiologic parameters. These techniques are successful in many common pediatric conditions ranging from eczema to migraines. Children's ready acceptance of suggestion and the ease of mobilizing physiologic
SUMMARY
ADHD is a syndrome that can be treated effectively, safely, and economically with stimulant medications. There is no equal alternative to these agents in short-term treatment of ADHD symptoms. However, many families seek alternatives to stimulants and other drug treatments for a variety of reasons. Alternative approaches reflect the complexity and heterogeneity of the disorder by being equally manifold, complex, and often obscure in their modus operandi.
Scientific evidence suggests that
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Address reprint requests to Anna Baumgaertel, MD, Department of Pediatrics, Division of Child Development, Vanderbilt University School of Medicine, 2100 Pierce Ave, Nashville, TN 37232, e-mail: [email protected]
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Department of Pediatrics, Division of Child Development, Vanderbilt University School of Medicine, Nashville, Tennessee