SHARON MOCK, LPC-S, ED.D.
ADHD and the BrainNon-medication Treatments for
ADHD
AUTHOR: ACADEMIC SUCCESS OF EMOTIONALLY DISTURBED STUDENTS
OWNER: CENTER FOR RESEARCH AND ACADEMIC SUCCESS
PSYCHOTHERAPIST IN PRIVATE PRACTICE IN KERRVILLE, TEXAS
Sharon Mock, LPC-S, Ed.D.
Goals
Review of ADHD Symptoms and ImpairmentBrain ImagingGenetic LinksResearch Findings on ADHDTreatment ImplicationsTraditional TreatmentsNon-medication Treatments
What is ADHD
FrequentAffects 4.4% of population
Kessler et al. 2005Lifetime DisorderDebilitatingUnder diagnosedTreatable
Diagnostic Criteria from DSM IV
Inattentive Type Must meet at lest 6/9 symptoms
Daydreaming Forgetfulness Losses items frequently
Hyperactive/Impulsive Type Must meet at least 6/9 symptoms
Driven by a motor Interrupting Excessive talking
If a patient meets at least 6/9 or more symptoms in both categories: Combined Type
Continued
Impairment must be in 2 of the following: School Family Peers
The onset is before the age of 7
Note that DSM-IV-TR diagnostic criteria is written for pediatric ADHD
Growing out of ADHD
At least 50% of children retain the symptoms into adulthood
Frontal lobes mature at a slower rateDon’t reach the maturation of a non ADHD
brainAdult ADHD presents differently:
Feel restless rather an hyperactive MckAlemanet.al. 2009: Wilens 2004
Adult ADHD
Significantly lower socioeconomic statusLower level of academic achievementHigher medical costsIncrease of motor vehicle accidentsIncrease of unplanned pregnancyIncrease rate of substance abuseHigher rate of unemployment
Affect of ADHD on Prefrontal Lobes
Prefrontal lobes of the brain hold the executive functions of the brain
Help to inhibit and self-regulate:
Direct Process Manage Disseminate information
Frontal Lobe and Pre-Frontal Cortex
What are the Executive Functions that are Affected?
Working memoryTime ManagementBehavioral InhibitionRegulation of EmotionsPlanningForethoughtLearning from ConsequencesOrganizationReconstitution of Information
• Brown 2009, Barkley 2005
Genetic Link to ADHD?
Executive function impairment in ADHD is genetic At a rate of 75% Several genes have been identified with ADHD Hundreds of gene variations are found in children
with ADHD and not the control group Elia et al. 2010, Guan et al. 2009, Rietveld et al. 2004
Brain Structure Difference in ADHD?
Children with ADHD exhibit a smaller volume of frontal and temporal gray matter and it is correlated significantly with parent- and clinician- rated severity measures
Castellanos et al. 2002
The ADHD brain was found to have a thinner cerebral cortex compared to the non-ADHD brain
The non-ADHD brain showed not signs of cortical thinning
Klein, 2011
Brain Function in ADHD
In children with ADHD, there is a disconnect between the frontal cortex of the brain, which regulates attention, and the visual processing areas of the brain
This difference does not occur in non-ADHD children
Therefore, the way the brain pays attention is biologically different in those with ADHD
Mazaheri et al, 2010
Brain Function continued
Difficulty with reuptake of neurotransmitters The ADD brain has a low amount of neurotransmitters
called dopamine• VOLKOW ET AL, 2009
Brain scans show a direction in dopamine synaptic markers associated with symptoms of inattention in the dopamine reward pathway of the ADD brain
• VOLKOW ET AL, 2009
ADHD: Disorder of Motivation or Inattention?
ADHD Difficulty focusing on uninteresting tasks Difficulty hyper focusing on interesting tasks
The frontal lobes of the brain have difficulty getting motivated to start and stop tasks
Executive Function
Example: Person with ADHD surfing the Internet
Difficulties in Focus and Concentration
Sleep apnea (Youssef et al, 2011)
Chronic otitis mediaDepressionAnxietyThe disorders can also be co morbid with
ADHD
Traditional Treatments
Medications for ADHD
StimulantsNon Stimulants
”FDA-approved for ADHD” means drugs have been found to be safe and efficacious in clinical trials
Medications that are not FDA-approved for ADHD can be prescribed “off label”
Stimulants
These medications Increase attention Decrease hyperactivity Decrease impulsivity
Mechanisms of action Increases dopamine
Stimulant Medication for ADHD
Concerta (methylphenidate HCI extended-release)Vyvanse (lisdexmfetamine)Daytrana (methylphenidate)Adderall XR (amphetamine of mixed salts)Focalin XR 9dexmethylphenidate extended –
release)
Side Effects Dry mouth Difficulty sleeping Reduced appetite
Is Substance Abuse increased because of Taking Stimulant Medication?
10 year study of 140 children ages 6-17Assessed at baseline and 10years laterPeople with ADHD who took stimulant
medication did not have a statistically significant increase in alcohol, drug, or nicotine use disorders Biderman et al, 2008
Non-Stimulant Medication for ADHD
Strattera (atomoxetine) Side Effects
Headache GI discomfort Lightheadedness
Intuniv (guanfacine extended-release Side Effects Low blood pressure drowsiness
Medication
Impact on Executive Functions Study on methylphenidate versus a placebo in adults
with ADHD Participants were given two MRI’s while completing an
Executive function task Before and after the 6 week study
Findings After 6 weeks the MRIs in the methylphenidate group
shower higher activation in the dorso-lateral prefrontal cortex and parietal center Bush et al, 2008
Time Released Effect
Medication (Bush et.al. 2008)
What do ADHD Medications Increase in the Brain?
Increases catecholamine levels in the brain Methylphenidate Dextroamphetamine Atomoxetine
Improves pre-frontal cortex functioning del Campo et al, 2011
ADHD Young Adults and Stimulant Medications
Significantly improved driving performance on a simulator compared to the placebo group
ADHD rating scale scores were decreased by at least 35% in 80% of the stimulant medication group
• Kay, et al. (2009)
What Positives Come out of Medicating those with ADHD
Gives the extra space to decide whether or not to interrupt
Helps hold thoughts until a break in conversation
Helps inhibit behavior
Helps one to self-regulate behavior
Psychotherapy
ADHD and couples therapy Difficult planning ahead for important events
Birthdays Anniversaries
Messages get garbled in translationDifficulty remembering what upsets your
partnerImpulsive spending and not saving up for
retirement or emergenciesPartner may take ADHD related behavior
personally
Cognitive-Behavioral Psychotherapy for ADHD
Cognitive-Behavioral Approaches Focused on changing attitudes and beliefs Help research defined goals
Approaches Changing Cognitions
ADHD can cause feelings of failure Self-doubts and shame
Set goals and create concrete steps Nadeau 2002
Social Skills Training
Picking up on non-verbal cuesAppropriate person-to-person distance
Hula-hoop test Standard distance during conversation
Basic social graces The art of apology Showing gratitude
Effects of Coaching for ADHD
“Counseling lite”Brief InterventionsAssistive support
Organization skills Prioritizing skills Goal-setting skills
Focus on the present and futureNo addressing:
the family of origin pathology
Research on Coaching (Parker and Boutelle, 2009)
Study of 54 undergraduates with ADHD and /or LD
7 in-depth interviewsOpinions after coaching
Provided a self-determination approach to attaining goals
Supported their autonomy Assisted in the development and execution of
functional skills Promoted self-efficacy and confidence regarding
future success
Effective Movement Techniques
ExerciseIntegrated movement systemsYogaKarateTai Chi
Exercise
Raises dopamine levels in the brain Volkow et al. 2009
If done first thing in morning, it can keep the dopamine at an increased level all day long
Exercising with a partner can increase the motivation to continue to exercise
Study: Tai Chi and ADHD (Hernandez-Reif, et al. 2001)
13 Teenagers with ADHD attended Tai Chi Twice a week 5 weeks
Teachers rated their behavior before, after, two weeks after sessions were completed
Continued
After all the sessions (10), the participants were rated with: Less anxiety Improved conduct Less daydreaming Less inappropriate emotions Less hyperactivity
Improved scores were found after the 2 week follow up
(Hernandez-Reif, et al. 2001)
Is it the Discipline?
Yoga, karate and tai chi emphasize form and practice
Is it the discipline or practice or both?
Frontal Lobe/Working Memory Training
Improving cognitive ability
“Brain Gym”
Integrative listening systems
“Tomatis Method”
Interactive Metronome
Working Memory
One of the executive functions (EF) in the frontal lobe of the brain
ADHD produces an impairment
Some treatments focus on improving working memory and overall cognitive function
Working Memory (Cont)
Temporary Storage
Manipulation of
Information
Processing Information
Output of
Information
Decreased Activation During a Working Memory Task
Working Memory Training
Computer programs Tasks that train verbal and visual spatial working
memory Difficulty level increased with progress Client is monitored by a “coach” Daily training sessions
30-40- minutes 5 days a week for 5 weeks
• Klingberg 2006
Study Results
Multicenter, randomized, controlled, double-blind, follow –up study
53 ADHD children 7-12 years old, without medication Assigned to WMT group or control group
WMT group had significant improvements on measures of non trained visual spatial and verbal working memory In areas of visual spatial and verbal working memory Response inhibition Complex Reasoning Most effects were present 3 months after the study in a follow
up Klingberg et al. 2005, Starkis, 2012
Attention Training
Trains the followingSustainedSelectiveAlternatingDivided Attention
Brain TrainPlay Attention
23 children participants 16 sessions Parents and clinicians rated fewer ADHD symptoms Unable to define if it is sustained for a long term
Klingberg et al, 2005, Sarkis, 2012
Attention Training Continued
Learning PrescriptionsCognitive-Fun
10 sessions Parent/child Dyad Assessment of Executive Function and occupational
performance Initial, post-intervention and 3 month follow up
Significant improvements with medium to large effects on measures after intervention and at follow up
Tomatis Method
This addresses the “Central Auditory Processing Disorder” (CAPD)
Those with CAPD can hear in the sense there is no damage to the ear’s ability to receive and perceive sounds
But, they cannot fully process the information they hear due to the inability of the ear and brain to communicate properly.
Uses sound through an electronic deviceWorks to strengthen the auditory system and the central
nervous system The goal: Awaken the connections needed for the brain to process
auditory information
Tomatis Program
30 hour program
2 hours daily for 15 days (excluding weekends)
Follow with 2 sixteen hour programs 4 weeks to 3 months between each session
Anecdotal Studies of the Tomatis Method
Client 1: 6 yr. old female with attention difficulties Practitioners stated that after 4 weeks of treatment:
Client could distinguish sounds better Client could reproduce sounds better
Client’s speech had improved Less irritable and frustrated in class Tomatis Listening Test had shown improvement by 3rd
program
MacDonald & Nicoloff 2008, Sarkis, 2012
Anecdotal Study Number 2
Cient 2:
51 year-old male with lack of comprehension, energy, and motivation
“Tomatis Listening Test” found a lack of discrimination in medium and high pitched sounds and “left ear dominance”
By the third program, client was happier and not worrying excessively
• MacDonald & Nicoloff 2008, Sarkis, 2012
Tomatis Method
Issues
Expensive Minimum number of sessions Beginning sessions must be done consecutively Little evidence of efficacy Tomatis used their own testing instrument to measure
effectiveness • Sarkis, 2012
Interactive Metronome (IM)
Computerized version of a standard metronome
Makes a rhythmic beat and can be slowed down or sped up
Theory: IM helps the central nervous system processing This underlies motor regulation and timing abilities
• Sarkis, 2012
Interactive Metronome
Objective: Assist people to selectively attend without interruption
Repetitions of metronome increase with improved attention
Exercises try to match movement with metronome
Research of Interactive Metronome (IM)
56 boys with ADHD3 groups: IM, video game treatment, controlsIM training consists of 13 exercises15 daily one-hour IM treatments over 3 – 5 weeksFindings:
Six rhythmic deficiency patterns found in participants Dissociative: Chaotic and random responses Contraphasic: between beats Hyperballistic: inappropriate snappy motions Hyperanticipatory: after the beat Auditory hypersensitive: exceptionally distracted by noise
Shaffer et al. 2001
Results of Study of IM
IM study subjects improved significantly more than controls in Attention Motor control Language processing Reading Ability to regulate aggression
Video game treatment group improved more than control group
Shaffer et al. 2001
IV. Vestibular and Cerebellar Exercises
Deficits in inner earDyslexia dyspraxia attention treatmentSensory integration TheorySynthesis
Inner Ear Deficits
Theorized that vestibular problems (deficit in the inner ear) may cause motor coordination issues and difficulties regulating behavior
Some treatment approaches have aims to correct these perceived motor deficits
Ramsay, 2010
Dyslexia Dyspraxia Attention Treatment
DDAT or also known as DORE programIndividually prescribed exercises
10 minutes daily , 2 times daily 12 – 18 months
Study found that children who completed the program had improved cerebellar functioning Balance Dexterity Eye movement control
Reynolds et al. 2003
Sensory Integration Therapy
Some children with ADHD have tactile and auditory sensitivity Certain noises: loud noises Texture of foods Texture of clothing
Sock seams Tags in shirts
Children with ADHD appear to have more difficulties with sensory processing disorders than the general population
• Mangot et al.2001Sensory Integration Therapy :
Performed by Occupational therapists Involves “brushing” techniques
• Sarkis, 2012
Synthesia
Disorder in which senses “join” Example: Music is not only heard but also seen, tasted, or felt as
a physical touch• Cytowic & Eagleman 2009
Almost like an hallucination About 2-5 % of ADHD are affected
This phenomenon may occur ina small percentage of people with ADHD
Not generally viewed as a deficit of pathologyEducates a person and family about synthesia can helpThis disorder can also be considered creative and not
a disorder because it is an enjoyable experienceSarkis, 2012
V. Overstimulation of the nervous System and ADHD
The “overcharged” nervous system (1/3 of ADHD population)
Breathwork and Movement
Meditation
Creative Visualization
Neurofeedback
Meditation
Studies have shown meditation to change brain waves Monks have shown it to bring the brain to a deeper
level brain activity and reach a relaxed stateCan take practice for a person with ADHD to
stop the “monkey brain” Ideas that continually pop up without any assistance.
Pop into the brain instead of stopping it when focusing on a task
Mindful Meditation Training (MMT)
Devoting attention to daily tasks Walking Eating
Teaches a person how to “check in" with themselves when distracted
Sarkis 2012
The more the practice is used, the easier it gets
The MMT Program
8 week program for adults and teens with ADHD
78% of participants that completed the training reported reductions in ADHD symptoms
30% had clinically significant improvementImprovements were made on conflict
attention, and set shifting on a neurocognitive measure (moving from task to task)
Zylowska et al. 2008, Sarkis, 2012
Creative Visualization
Allows the creative ADHD brain to still be motivated during relaxation periods
Now more readily assessable Videos available on You Tube Libraries have audio video and digital media Itunes also provides some audios and videos at no
chargeSarkis, 2012
Neurofeedback
This technique teaches a person how to change their brain waves in order to improve focus and concentration People with ADHD have different theta and beta wave
patterns than non ADHDSensors are used on the scalp and ears
These sensors are connected to an electroencephalogram (EEG)
• Sarkis, 2012
Goals of Neurofeedback
The goal is to decrease theta waves and increase beta waves When this process takes place, a character on the
computer screen begins moving The subject becomes more relaxed and focus is
increasedSeveral visit are needed in order to complete
the process• Sarkis, 2012
Effectiveness of Neurofeedback
Very limited research on long-term effectiveness
One study showed that neurofeedback was more effective than NO Treatment at all for ADHD
• Gevensleben et al. 2009Drawbacks
Expensive Time constraints Insurance may not cover
• Sarkis, 2012
When Is Neurofeedback used?
If conventional treatment has not been effective
An alternative treatment is asked for by the patient
Concerns Not enough participants in the studies to validity
reliability Not enough placebo studies Support for use in ADHD treatment does not have
conclusive results• Ramsey 2010• Sarkis 2012
Physical Body Treatments
Massage
Chiropractic Treatment
Repetitive Transcranial Magnetic Stimulation
Acupuncture
Massage Therapy
A study was conducted with ADHD children and teens
Comprised of two groups: Massage group Control group
Massage therapy for 20 minutes two times a week for a month
Massage therapy group Significant improvements in self-ratings of mood Significant improvements in teacher ratings of classroom
behavior• Khilnani et al. 2003
Chiropractic Treatment with ADHD
Chiropractic treatment opens pathways in the body due to the increase appropriate alignment of the bones Produces a change in communication between the
brain and the bodyThe use of chiropractic methods for ADHD is
an off shoot of the purpose of Chiropractic treatment
Six sessions over a three week period are recommended by Chiropractors for changes to occur
• Goodsell 2012
Study and Results of Chiropractic Treatment and ADHD
Participants = 9 ADHD adultsTwo months/2 sessions weekly of level -1
network spinal analysis Gentle, precise touching of the spine
Subjects were given a continuous performance task before and after treatment Significant improvement found after treatment in 8
out of the 9 subjects• Pauli 2007
Issues with Study
None of the subjects had a ADHD formal diagnosis
One CPT measure is not enough to determine an existence or reduction of ADHD symptoms
9 subjects is too small of a population to be significant
Out of the 9 subjects: 3 stated attention problems were their main issue 6 said attention problems was an additional problem
• Sarkis 2012
Repetitive Transcranial Magnetic Stimulation (TMS)
Non-invasive brain stimulationMagnetic fields went to the brain though
small electromagnets Time between fields vary
Purpose is to stimulate electrical flow and depolarization of neurons in the cerebral cortex
FDA-approved for treatment of depression Sarkis 2012
Repetitive Transcranial treatment Risks
Seizures If a person has epilepsy or brain lesions If the electrical impulse used it too strong If the electrical impulses are given too closely
togetherHeadaches and scalp pain
Common side effectHearing impairment
Prevent by wearing ear plugs
• Ramsay 2010
Study of Repetitive Transcranial Magnetic Stimulation (TMS)
Participants = 8 teen/young adults with ADHD
Not medicatedDouble –blind studyStudy of Study
Daily TMS 10 session over two week time span One week of no treatment Two weeks of placebo treatment
Results of TMS Study
Significant improvements on ratings of overall improvement
No changes of ADHD symptom measuresImprovement in functioning
88% of TMS participants 50% of placebo participants
• Weaver et al. 2008
Acupuncture
Traditional Chinese medicine views causes of ADHD to be Liver yang overactive Effulgent gallbladder fire Heart-spleen deficiency Non-interaction of heart and kidney Yin-yang disharmony
Dissymmetry and unbalanced• Li et al. 2011
Research on Acupuncture and ADHD
Minimal studiesParticipants may not participants dues to the
use of needlesStudies have used
Randomized controlled trials using: Acupuncture Placebo Conventional treatment Results
No Evidence in the effectiveness to treat ADHD
Environmental Influences
Television and video gamesSleep deprivationSecond-hand smokeEnvironmental toxicityChanges with the environment
Television and Video Games Study 1
1278 children at age 11345 children at age 3
10% of children had attention problems at age 7 Concluded that the amount of hours of television per
day at 1 and 3 was associated with the attention problems occurring at at age 7
Reliability: The participants in the study were not formerly diagnosed with ADHD
A correlation does not mean causation• Christakis et al. 2004 • Sarkis 2012
Television and Video Games Study 2
A study of preschool-aged childrenObserved the amount of television viewing
per day and the level of violence in the programs being viewed
Results found that television exposure is not related to ADHD symptoms It correlated to those students who were conduct
disorder, Oppositional defiant• Knezevic 2009
Television and Video Games Study 3
1323 children210 late teens/early adultsAssessed over a 13 month time spanParents and children and teens/early adults
reported television and video game timeTeachers and teen/early adults reported
attention problems• Swing et al. 2010
Findings from Study 3
The amount of television viewing and video game playing was associated with greater attention problems
Found in both samples Swing et al. 2010 Reasons
ADHD brain is stimulated by novelty ADHD is genetic
Parents are more likely to have ADHD Television and video games can keep ADHD children still because
Moving image stimulation
Video Games Study 4
125 participants middle school students at two different years75 diagnosed as ADHD or ADD50 undiagnosedADHD students were not given their medication the day of
participating in the studyStudents were given 10 minutes to sit quietly to decrease
their heart rate to a resting heart rateHeart rate was taken before beginning of the video gameEach participant was given the same video game to play
which was at a low level of intensity (a ski video game)Each participant played the game for 10 minutesHeart rate was taken at the end of the ten minutes and
compared to the resting heart rate.
Results of Video Game Heartrate
All ADHD/ADD participants heart rate decreasedAll non ADHD/ADD participants heart rates
increased except oneThat one participant was later diagnosed with ADHDImplication:
This could be one way to diagnose ADHD Educational materials should include video activities for
ADHD/ADD Study too small to valid Study needs to continue to increase the number of participants
• Mock, 1998
Sleep Deprivation
Symptoms can mimic ADHD Difficulty concentrating Difficulty focusing Slower cognitive speed Difficulties with executive function skills Difficulties with working memory
• Goel et al. 2009
Sleep Deprivation Study
ADHD children have higher sleeping difficulties than general population Sleep study in ADHD children
55 children participated Results
Motor restlessness (continual movement ) (50%) Sleep walking (47.6%) Night terrors (38%) Confusion upon arousal (28.5%) Snoring (21.4%) Restless leg (11.9%)
• Silverstri et al. 2009
Techniques to decrease Sleep Deprivation
Listen to relaxing cdsShut down electronic activities 1 hour before
bedtimeNo telephone in room Have room darkWhen waking next morning have loud noises
to wake them Wake, give them their medicine, let them sleep
another 30 minutes and wake them for the day Just being outside during the day helps with ADHD
symptoms as they play and care for animals.
Forms of Sleep Deprivation
Obstructive sleep apnea (OSA) Attention deficits reported in 95% of OSA Comorbidity rate of 20 – 30 \% between OSA and
ADHD• Youssef et al. 2011
• Also noted was a weight gain link between OSA and ADHD
Second Hand Smoke literature review with ADHD
Both prenatal and postnatal exposure is associated with increased rates of behavior problems Irritability Oppositional defiant disorder Conduct disorder ADHD
• Herrmann et al. 2008Issues
People with ADHD start smoking at an earlier age Smoke more Find it harder to quit
Question Is the smoke impacting behavior? Are children with ADHD more likely to have mothers that smoke?
Need more research
Lead Poisoning and ADHD Study 1
236 children ages 6-17 Two groups
ADHD Control
Activities Clinical interview Parent ratings Teacher ratings
Blood lead levelLead levels were below averageBlood lead was associated with ADHD but not non
Attentive ADHD Nigg et al. 2010
Lead Poisoning and ADHD Study 2
1378 South Korean childrenParent ADHD rating scaleBlood lead and mercury levels takenThe risk for appearance of ADHD symptoms
was found to increase with the blood lead concentration
Mean blood lead level was lowMercury was not found to be associated with
ADHD symptoms• Ha et al. 2009
Issues found with Lead Poisoning and ADHD
Blood lead levels were lower than the average
Lead toxicity was not reported in study subjects
Could children with ADHD had an issue that causes lead not to exit their system?
Young children with ADHD are more tactileLead poisoning symptoms may mimic ADHD
symptoms
Supplements and ADHD
Supplements (seen as products and not medication) Neutraceuticals/herbals (food-based dietary
supplements )
Quality Assurance through regulation
Omega 3 - 6 - 9
Vitamins
Neutraceuticals/Herbals
Not regulated by the FDA Concentrations can vary by product
• Curtis & Gaylord 2005Little scientific evidence that they are effective
• Sawni 2008
If buying supplements follow these guidelines Make sure manufacturer adheres to strict quality-control
guidelines Follows the FDAs Goo Manufacturing Practice regulations It will have a “GMP” on the label
Neutracetuical/Herbs
Get approval from physician because Some interact with central nervous system
Kava kava Valerian root St. john’s wort
Some can affect the absorption of medication
St. John’s Wort
Hyperforin is the ingredient Can increase norepinephrine, serotonin and dopamine Strattera/atomoxetine (a non-stimulant medication)
increases norepinephrine Wellbutrin/bupropion (a non-stimulant medication)
increases serotonin Will St. John’s Wort have the same effect and improve
ADHD symptoms
St. John’s Wort Study
54 children 6-17 years of ageParticipants
Received 900 mg of St. John’s wort Received a placebo For 8 weeks in each group
No difference was found between the groups in controlling Hyperactivity Improving mental focus
Omega 3 – 6 - 9
It is believed that ADHD may have significantly lower levels of omega – 3 fatty acids
• Schuchardt et al. 2010, Antallis et al. 2006Fish oil and polyunsaturated fatty acids
contain Omega – 3 and omega -6 Found to increase this low level
• Sinn & Bryan 2007, Young et al. 2005
Omega and Vitamin Study
3 groups of ADHD children Omega 3-6-9 and multivitamins Omega 3-6-9 Neither treatment
After 15 weeks, all study subjects were given omega 3-6-9 plus multivitamins for another 15 weeks
• Sinn et al. 2008
Omega and Vitamin Study Results
Omega groups Improved scores on a test of switching and controlling attention compared
to control groupAfter control group started 15 weeks of omegas and multi-
vitamins Scores improved
No significant improvements on other cognitive measures regardless of treatment
Multivitamins did not appear to improve attention scoresOmega 3-6-9: ADHD symptoms improved somewhat in
children who were taking both omega 3 and omega 6 supplements
• Sinn et al. 2008 Foods: Avocado and fish, Focus Factor does not have the omega 3-6-9 in it.
Has more metal
Potassium Supplements and ADHD
Anecdotal Study: one person reported that this supplement helped to reduce overstimulation
Neurologists found that her symptoms were the same as in hypokalemic periodic paralysis
Diet and ADHD
Food additives
Food allergies
Pesticides
Optimal diet for ADHD
Food Additives and ADHD Study
Randomized, double-blinded, placebo-controlled, crossover trial on whether artificial food color and additives affected behavior
153 3 yr. olds144 8 and 9 yr. oldsThree groups
Drink with sodium benzoate and AFCA mix A Drink with sodium benzoate and AFCA mix B Placebo
• McCann et al. 2007
Results of Food Additives and ADHD
3- yr-olds Mix A had a significantly adverse effect compared to
placebo Mix B did not have a significantly adverse effect
compared to placebo8- 9- yr-olds
Mix A had a significantly adverse effect compared to placebo
Mix B had a significantly adverse effect compared to placebo
Food Additives and ADHD Study 2
Same study was replicated by Stevenson et al. (2010)
Found histamines may mediate the effect of food additives on ADHD symptoms
Variations of the gene pool influence the action of the histamine May explain variations in food additives/ADHD study
resultsADHD children may be more likely to have
these gene variations or lack of
Food Additives, ADHD and governmental input
Dec. 2009: British gov. Requested that food manufacturers remove most food dyes from their products
Because ADHD is a multifaceted disorder, the removal of food dyes is not considered a stand alone intervention
Kanarek 2011
Food Allergies and ADHD
Children with ADHD Higher rate of allergies than general population Not a statistical difference
ADHD and allergies share the same geneStudy
Found children with ADHD had more positive skin prick tests for allergies than non ADHD children 67.5 % in ADHD 45% in non ADHD
Research has been proposed to examine ADHD as an allergic hypersensitive disorder
• Pelsser et al. 2009
Food Sensitivities and ADHD
65% to 89% of those suspected sensitivities reacted when challenged with at least 100 mg. of artificial food coloring (AFC)
Some of those children with this allergic reaction were also sensitive to milk, chocolate, soy, eggs wheat, corn, legumes, grapes, tomatoes, and orange
Researchers recommend a trial elimination diet if conventional ADHD treatment has not worked
• Stevens et al. 2012
Pesticides and ADHD Study
1139 children: ADHD and non ADHD94% were found to have some levels of
pesticide in their urine Out of children with an above-average level of
pesticide: 20% had ADHD Rate of ADHD in children without pesticide in urine
was 10%• Bouchard et al. 2010
Issues with Pesticide Study
Children’s diets were not examinedPesticide levels were measured by a one-time
urine sample
Possible causes of results Children with ADHD may have more difficulty
breaking down pesticide compounds Families with ADHD tend to have a lower income, so
cannot afford organic food
Feingold Diet
Restrictive Diet: no food dyes and low salicylate foods Difficult for parents to access, maintain, and afford Early 70’s found access to non-additive foods difficult
Studies found the diet not to be effective in treating ADHD overall
For a Perfect Diet
Cut out refined sugarCut out high-fructose corn syrupDecrease saturated fatsEat fresh, non-processed foodOnly eat in moderation
These changes can help everyone
Summary
There are alternative treatments available for ADHD
When looking at the alternatives make sure you: Research all treatments Look at study methodology Weight benefit versus risk Consider cost of treatment Look at long-term gains Avoid any treatment claiming it’s a “cure” for ADHD
References
Sarkis, Stephanie. Non-Medication Treatments for ADHD, PESI, 2012
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