Alternative Alternative Treatments for Treatments for

ADHDADHDKatherine Kiker, M.S.Katherine Kiker, M.S.

Elimination DietsElimination Diets

““Feingold hypothesis”Feingold hypothesis” Children are sensitive to dietary Children are sensitive to dietary

salicylates and artificially added colors, salicylates and artificially added colors, flavors, and preservativesflavors, and preservatives

Learning and behavior problems Learning and behavior problems (including ADHD) can be reduced or (including ADHD) can be reduced or eliminated by removing these eliminated by removing these substances substances

Elimination DietsElimination Diets

At least 8 controlled studies have At least 8 controlled studies have demonstrated significant improvement demonstrated significant improvement (w/elimination diet) compared to a (w/elimination diet) compared to a placebo condition, or deterioration placebo condition, or deterioration after introducing offending substances after introducing offending substances

Typical elimination diet: lamb, Typical elimination diet: lamb, chicken, potatoes, rice, apple, banana, chicken, potatoes, rice, apple, banana, cabbage, cauliflower, broccoli, brussel cabbage, cauliflower, broccoli, brussel sprouts, cucumber, celery, carrots, sprouts, cucumber, celery, carrots, salt, pepper, calcium, and vitaminssalt, pepper, calcium, and vitamins

Elimination DietsElimination Diets

Although some people seem to Although some people seem to respond well, more research is respond well, more research is needed to determine who are diet needed to determine who are diet respondersresponders What proportion are responders from What proportion are responders from

the whole ADHD population?the whole ADHD population?

Elimination of Sugar & Elimination of Sugar & CandyCandy

Good news- No Effects!!!Good news- No Effects!!! Controlled 3-week trial of a sugar-Controlled 3-week trial of a sugar-

restricted diet (Wolraich et al., 1994)restricted diet (Wolraich et al., 1994) Cross-sectional studies: ADHD children Cross-sectional studies: ADHD children

don’t consume more sugar than Non-don’t consume more sugar than Non-ADHD children (Kruesi et al., 1987)ADHD children (Kruesi et al., 1987)

Not a widely applicable tx for ADHDNot a widely applicable tx for ADHD But, may help for those children who But, may help for those children who

are responders to “elimination diet”are responders to “elimination diet”

Discussion: Discussion: Modifying Diets to Modifying Diets to

Improve ADHD Improve ADHD Symptomatology??Symptomatology??

Nutritional SupplementsNutritional Supplements

Amino Acid SupplementationAmino Acid Supplementation Reportedly low levels of amino acids in Reportedly low levels of amino acids in

ADHDADHD Short-term benefit for tryptophan, tyrosine, Short-term benefit for tryptophan, tyrosine,

or phenyalanine or phenyalanine However, no benefit beyond 2-3 months, as However, no benefit beyond 2-3 months, as

tolerance developstolerance develops

Essential Fatty Acid SupplementationEssential Fatty Acid Supplementation Lower levels in ADHD kidsLower levels in ADHD kids Further control studies neededFurther control studies needed

Nutritional SupplementsNutritional Supplements Glyconutritional SupplementsGlyconutritional Supplements

In open trial (n=17) with these supplements, parents In open trial (n=17) with these supplements, parents reported reductions in inattention, hyperactivity-reported reductions in inattention, hyperactivity-impulsivity, and oppositional behaviorimpulsivity, and oppositional behavior

Placebo-controlled trials neededPlacebo-controlled trials needed Vitamin SupplementationVitamin Supplementation

Megadose: no effects, risk of toxicityMegadose: no effects, risk of toxicity Iron SupplementationIron Supplementation

Open 30-day trial with 17 non-anemic ADHD boys, Open 30-day trial with 17 non-anemic ADHD boys, improvement in parents Conners’ scores (Sever et al., improvement in parents Conners’ scores (Sever et al., 1997)1997)

Zinc supplementationZinc supplementation Little researchLittle research

Magnesium SupplementationMagnesium Supplementation 50 kids with ADHD and magnesium deficiency; 6 months; 50 kids with ADHD and magnesium deficiency; 6 months;

significant decrease in parent and teacher Conners scoressignificant decrease in parent and teacher Conners scores

Chinese HerbalsChinese Herbals Chinese herbal cocktail compared to methylphenidateChinese herbal cocktail compared to methylphenidate Significant improvement rates comparable to Significant improvement rates comparable to

stimulate meds, but more improvement on IQ scores stimulate meds, but more improvement on IQ scores and fewer side effectsand fewer side effects

Need placebo-controlled, double-blind studiesNeed placebo-controlled, double-blind studies AcupunctureAcupuncture

Little data on its efficacyLittle data on its efficacy Loo (1998) found decreases on parent and teacher Loo (1998) found decreases on parent and teacher

ConnersConners Noted that kids with most severe ADHD could not comply Noted that kids with most severe ADHD could not comply

with txwith tx

MeditationMeditation Mental training that can regulate Mental training that can regulate

attention and brain training? attention and brain training? Research in non-clinical samples has Research in non-clinical samples has

shown improvements on attentional blink shown improvements on attentional blink teststests

Rationale for using mindfulness Rationale for using mindfulness meditation with ADHD: can impact meditation with ADHD: can impact symptoms of inattention and impulsivity, symptoms of inattention and impulsivity, associated neurocognitive deficits of associated neurocognitive deficits of inhibition, and help with stress, anxiety, inhibition, and help with stress, anxiety, and depressionand depression

Mindful MeditationMindful Meditation 3 steps:

bringing attention to an “attentional anchor” (usually a sensory input such as a breath

Noting that distraction occurs and letting go of distraction

Refocusing or reorienting attention back to the “attentional anchor”

Pilot Study (Zylowska et al., 2007) 8 week mindful meditation group w/ adults &

adolescents Pre–post improvements in self-reported ADHD

symptoms and test performance on tasks measuring attention and cognitive inhibition

Next steps: controlled clinical study

““Neurotherapy” Neurotherapy” EEG Feedback, Neuro EEG Feedback, Neuro

feedbackfeedback Basis: ADHD kids produce greater EEG slow wave Basis: ADHD kids produce greater EEG slow wave

(theta) activity, and less beta activity compared to (theta) activity, and less beta activity compared to normal controlsnormal controls

Neurotherapy: teach ppl to normalize their Neurotherapy: teach ppl to normalize their brainwave responses to stimulibrainwave responses to stimuli

EEG responses to stimuli on a computer are EEG responses to stimuli on a computer are analyzed, then feedback is provided (visual displays, analyzed, then feedback is provided (visual displays, auditory tones) to show how well they are doingauditory tones) to show how well they are doing

““good candidates”: stimulant non-responders, good candidates”: stimulant non-responders, parents afraid of long-term affects on stimulant medsparents afraid of long-term affects on stimulant meds

Need assessment: neurometric assessment with Need assessment: neurometric assessment with computer analysis of a minimum of 19 active scalp computer analysis of a minimum of 19 active scalp electrode sites necessary to confirm or disconfirm electrode sites necessary to confirm or disconfirm greater theta and less beta activity to key attentional greater theta and less beta activity to key attentional tasks tasks

New technology: video games!!New technology: video games!! Game becomes more difficult as brain waves Game becomes more difficult as brain waves

of ADHD child show that attention is waningof ADHD child show that attention is waning Child is “rewarded” for decreasing time spent in Child is “rewarded” for decreasing time spent in

slow wave activity, and increasing time spent in fast slow wave activity, and increasing time spent in fast activity required for focused attention and activity required for focused attention and concentration on tasksconcentration on tasks

Does it work?Does it work? Barkley 1995, CHADD newsletter: "there is Barkley 1995, CHADD newsletter: "there is

not enough evidence from well controlled not enough evidence from well controlled scientific studies to support the effectiveness scientific studies to support the effectiveness of EEG biofeedback for AD/HD children" of EEG biofeedback for AD/HD children"

However:However: Studies using different control groups (waitlists, Studies using different control groups (waitlists,

stimulant meds, cognitive therapy) have demonstrated stimulant meds, cognitive therapy) have demonstrated that neurofeedback reduces inattention, impulsivity, that neurofeedback reduces inattention, impulsivity, task performance variability, and hyperactivity task performance variability, and hyperactivity (Rossiter, 1998)(Rossiter, 1998)

Outcome studies with samples as large as 530 show Outcome studies with samples as large as 530 show reductions in ADHD symptomsreductions in ADHD symptoms

Studies used objective test data (CPT, IQ tests, TOVA) + Studies used objective test data (CPT, IQ tests, TOVA) + behavior rating scalesbehavior rating scales

Limitations:Limitations: Time-consuming (need 6-8 months, up to 80 sessions)Time-consuming (need 6-8 months, up to 80 sessions) Need to identify who works better for this treatmentNeed to identify who works better for this treatment Must have assessment: some practitioners don’t use the Must have assessment: some practitioners don’t use the

neurometric assessmentneurometric assessment

Instant Alert Hypnosis!Instant Alert Hypnosis! Barabasz & Barabasz: “intended to enhance vigilance Barabasz & Barabasz: “intended to enhance vigilance

performance for either focused attention or optimal situational performance for either focused attention or optimal situational awareness depending on the specific hypnotic instructions given”awareness depending on the specific hypnotic instructions given”

experimentally controlled studies show that Instant Alert experimentally controlled studies show that Instant Alert Hypnosis can increase frontal EEG beta activity independent of Hypnosis can increase frontal EEG beta activity independent of neurofeedback neurofeedback

procedureprocedure patient instructed to roll eyes up, as if trying to look at foreheadpatient instructed to roll eyes up, as if trying to look at forehead Instructed to look at psychologist’s thumb as thumb is slowly moved Instructed to look at psychologist’s thumb as thumb is slowly moved

from nose to foreheadfrom nose to forehead instructions are then given to take notice of “breathing, relaxation, instructions are then given to take notice of “breathing, relaxation,

calm confidence and special calm alertness”calm confidence and special calm alertness” Once clinician observes subjective signs of hypnosis, patient given Once clinician observes subjective signs of hypnosis, patient given

instructions: "in this special state of alertness you will be able to instructions: "in this special state of alertness you will be able to focus your attention anyway you like, you can concentrate as focus your attention anyway you like, you can concentrate as completely as your desire.”completely as your desire.”

Then, patient told to let their eyes roll down and enjoy state of Then, patient told to let their eyes roll down and enjoy state of alertnessalertness

Finally, specific attentional task is done Finally, specific attentional task is done

Efficacy?Efficacy? Instant alert hypnosis w/neurofeedback: Instant alert hypnosis w/neurofeedback:

significantly better than neurofeedback significantly better than neurofeedback alonealone

Positive and substantial clinical Positive and substantial clinical changes in average of 23 sessions (3-14 changes in average of 23 sessions (3-14 weeks of treatment for subjects)weeks of treatment for subjects)

Decreases in inattentiveness, Decreases in inattentiveness, hyperactivity, impulsivityhyperactivity, impulsivity

Other treatments… for Other treatments… for which I could find no which I could find no

information!information! Mirror feedbackMirror feedback Antifungal treatmentsAntifungal treatments

DiscussionDiscussion How would you respond to a How would you respond to a

parent who mentioned parent who mentioned wanting to try one of these wanting to try one of these alternative treatments?alternative treatments?

ADHD CoachingADHD Coaching

What is ADHD Coaching?What is ADHD Coaching? http://www.addcoachacademy.com/whahttp://www.addcoachacademy.com/wha

tisadd.htmltisadd.html http://www.addcoachacademy.com/wellthttp://www.addcoachacademy.com/wellt

rained.htmlrained.html Editorial ArticleEditorial Article