Complementary and Alternative Medical Therapies for Attention-Deficit/Hyperactivity Disorder and Autism

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Complementary and alternative medical (CAM) therapies are commonly used by parents for their children who have attention deficit hyperactivity disorder (ADHD) or autism spectrum disorders. The use of these therapies is well documented, yet the evidence of the safety and efficacy of these treatments in children is limited. This article describes the current evidence-based CAM therapies for ADHD and autism, focusing on nutritional interventions; natural health products, including essential fatty acids, vitamins, minerals, and other health supplements; biofeedback; and reducing environmental toxins. The CAM evidence in ADHD is addressed, as is the CAM literature in autism.

Section snippets

Prevalence of attention-deficit/hyperactivity disorder and standard treatment

ADHD is estimated to affect 3% to 12% of school-aged children [1], [2]. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for diagnosis of ADHD requires a minimum of six of nine inattentive or hyperactive/impulsive symptoms for a minimum of 6 months, and the symptoms must be developmentally inconsistent and cause problems in more than one location (home and school) [3]. The most common treatments offered to these children are stimulant medications, such as

Pathophysiology of attention-deficit/hyperactivity disorder

Research is ongoing to determine the cause of ADHD, including studies on genetic risk factors, environmental risk factors, and structural and physiologic alterations in brain function [2]. Twin studies have estimated the heritability of ADHD to be 0.76 [2]. Dopamine receptors are the focus of genetic study, and the dopamine D4 receptor, which is found in the frontal-subcortical networks, functions poorly in individuals who have ADHD [14]. Dopamine and norepinephrine neural pathways are believed

Complementary and alternative medicine therapies for attention-deficit/hyperactivity disorder

The frequency of CAM use in children who have ADHD ranges between 12% and 64%, with the lower estimates likely the result of a narrow definition of CAM [12], [19], [20], [21]. One report documents that nutritional changes were the most common CAM therapy used by children who had ADHD [12]. When parents of children and adolescents who had ADHD were surveyed in community mental health centers, a 19.6% lifetime prevalence of herbal therapy use was found and a 15% prevalence of herbal therapy use

Feingold diet

Much attention was given to the effect of diet on the symptoms of ADHD after Dr. Feingold [23] published his findings that 50% of his patients who had ADHD improved with the elimination of all food additives and naturally occurring salicylates. The Feingold diet eliminates nearly all processed foods and a large proportion of fruits and vegetables, which are high in salicylates, a drastic change for most children. The extensive restriction on dietary intake required by the Feingold diet has made

Electroencephalographic biofeedback

The field of electroencephalographic (EEG) biofeedback is a growing area of research for the treatment of ADHD. This form of treatment is based on the finding that children who have ADHD demonstrate abnormal quantitative EEG findings in a pattern of underactivity in the majority of cases or hyperarousal in some patients [39]. EEG biofeedback uses a series of sessions (more than 30) over several weeks to teach patients how to alter their quantitative EEG activity to a more balanced level by

Herbal and natural health products

The use of herbal treatments in children often is based on use in adults, yet little is known about the safety or appropriate dosing of these herbal treatments in children. Despite the common use of herbal treatments by children who have ADHD, only one study has examined the effect of an herbal product containing Ginkgo biloba and Panax quinquefolius (American ginseng) in pediatric patients who have ADHD [42]. Ginsengs and ginkgo are believed to have nootropic effects to improve memory and

Massage and yoga

A small controlled trial to study the effect of yoga enrolled children who had ADHD whose symptoms were stable on medication. The investigators reported improvement in ADHD symptoms in the yoga group on some of the measures of Conners' Parent Rating Scale, but the limited sample size made between group comparisons underpowered to detect an effect [45]. In another study, when adolescents who had ADHD were randomized to massage therapy or relaxation treatment, the adolescents in the massage group

Vitamins and minerals

Several individual vitamins and minerals are proposed as possible treatments for ADHD, yet there are few randomized controlled trials evaluating the efficacy of these treatments. Zinc reduced symptoms of hyperactivity, impulsivity, and socialization difficulties in children and adolescents who had ADHD, but it did not improve symptoms of inattention [47]. This study used a high dosage of zinc for a period of 12 weeks and more than 50% of both groups dropped out of the study. Even though benefit

Homeopathy

Homeopathy is a medical practice based on the belief that “like treats like” and that the energetics of a small amount of a substance can have healing effects on individuals. At least three randomized controlled trials have evaluated the efficacy of homeopathy for the treatment of ADHD with mixed results [52]. Strauss [53] reported improvements on the Conners' Parent Symptom Questionnaire for children treated with homeopathy for 2 months, although no data on the other outcomes examined were

Environmental issues

Several investigators have discussed the symptoms of ADHD as a physical and mental manifestation of nature deficit disorder [56], [57]. In his book, Last Child in the Woods: Saving our Children from Nature-Deficit Disorder, Louv [56] provides anecdotal evidence of how the loss of green spaces and creative play outdoors is correlated with the increase in childhood mental health disorders, including ADHD. Kuo has started evaluating this theory with rigorously designed research studies. In a

Autism

Autism is a neurodevelopmental disorder characterized by deficits in social interaction, language development, and a restricted or stereotypical pattern of interests and activities. Formerly a rare condition well out of the public eye, the prevalence of autism has increased more than tenfold in the past 20 years, from an estimated prevalence of approximately 5 to 6 per 10,000 children to 65 per 10,000 in more recent studies [60]. There is no scientific agreement as to the cause of this rapid

Complementary and alternative medical therapies for autism

CAM therapies are used with great frequency in the treatment of autism. A study in 2006 showed that overall, an astonishing 74% of families of children who had autism spectrum disorder were using some type of CAM therapy. Although these included the full spectrum of CAM therapies, the highest frequency of use (more than 54% of families) involved what were termed, “biologically based” therapies, including modified diets, vitamins and minerals, and other nutritional supplements [65]. Several

Nutritional deficiencies, including omega-3 fatty acids

It is a tenet of the biomedical approach that nutritional deficiencies are widespread and important in autism. It is believed these are linked mainly to poor digestion and absorption of nutrients resulting from GI problems (discussed previously) and abnormalities in the metabolic processing of nutrients. The evidence for these nutritional deficiencies, however, is uneven and rarely complete.

Vancassel and colleagues [87] evaluated levels of omega-3 fatty acids and other polyunsaturated fatty

Conventional behavioral approaches

Speech therapy is recommended almost universally to deal with the language deficits of children who have autism. Anecdotally, it is believed effective by almost all parents and most professionals. There is little solid research supporting the efficacy of speech therapy for autism. Although several studies show specific areas of language improvement, all of these involve few subjects and none have been randomized or controlled. Considering the almost universal use of speech therapy in the

Dietary interventions

The most common alternative biomedical intervention used with autistic children is the gluten-free casein-free (GFCF) diet. This is based on the theory (discussed previously) that food sensitivities, especially to gluten and casein, can produce not only GI symptoms but also, in association with gut inflammation and increased gut permeability (leaky gut), can lead to many of the neurologic manifestations of autism. In general, for the GFCF diet, parents are advised to strictly avoid all foods

Other complementary and alternative medical therapies

Complementary therapies, such as homeopathy, craniosacral therapy and other manipulative therapies, Reiki and other energy medicine modalities, biofeedback, and traditional Chinese medicine all are used. There are scattered anecdotal reports of efficacy, but no research evidence exists to support their use in the treatment of autism.

Summary

The repeating theme of all of the natural treatments for ADHD and autism is the large gap between high use rate and the low number of well-controlled, large, randomized trials. It is essential for researchers to include a comparison group when studying natural treatments for these conditions, which often are based on parental or teacher reports. The beneficial effects demonstrated in uncontrolled trials could be explained by the regression to the mean phenomenon in a condition with symptoms

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    This work was supported by Grant No. AT000929 from the National Center for Complementary and Alternative Medicine of the National Institutes of Health.

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