RUNNING HEAD: ADHD CAM Modalities
1
ConditionMonograph for NAT 504
CAM Modalities & ADHD
Management
By Kimmer Collison-Ris, MSN, FNP-C, WOCN
ADHD and CAM Modalities
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ADHD Management via Complimentary Medicine
Name of Condition
Attention Deficit Hyperactivity Disorder (ADHD) is a neurological condition characterized
by the inability to concentrate in a sustained manner, pay attention to tasks, and to control
impulsive actions (Sorgi, Hallowell, Hutchins, and Sears 2007). The exact etiology is unknown
but major multifactorial contributors include brain inflammation (Sears, 2011) adverse food
additive responses, food intolerances, sensitivities to environmental chemicals, molds, and fungi,
and exposures to neurodevelopmental toxins (ie. heavy metals and organohalide pollutants).
Thyroid hypofunction may also be a link with toxic insults in ADHD symptomatologies (Kidd,
2000). The Huffington Post (March 26, 2013) cited a study published in The Journal of
Neurology demonstrating “an association between having higher infection levels in the blood
and risk of cognitive problems." Genetics is also suspected to play a role.
Persons with ADHD struggle with development in emotional, educational, and social deficits;
the impact of poor therapy has a negative effect on their future possibilities. Many individuals do
not respond to conventional stimulant therapy alone, however, reported nutritional intervention
appears to compliment conventional therapy, possibly playing a greater role in the etiology of
ADHD syndrome (Starobrat-Hermelin and Kozielec 1997).
Body System Affected
Brain and Nervous System
Pathophysiology
Scientific theorists, believe ADHD is related to abnormalities in the frontostriatal brain
circuitry and possible hypofunctioning of dopaminergic pathways; this is consistent with the
benefits obtained in some cases with the use of psychostimulants (Kidd, 2000). Among the
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genetic and environmental influences is an observed decrease in long-chain (LC)
polyunsaturated fatty acids (PUFAs) in children with ADHD. Proposed mechanisms for the low
levels of PUFAs include insufficient dietary intake, inefficient conversion of shorter chain
PUFAs to LC PUFAs or rapid metabolism of LC PUFAs (Sorgi, Hallowell, Hutchins, and Sears,
2007). Other recent evidence also suggests a deficit in cortical inhibition via the GABA-ergic
system (γ-aminobutyric acid) report researchers Edden, Crocetti , Zhu, Gilbert, and Mostofsky
(2012). As previously mentioned, The Journal of Neurology found a link between brain
inflammation and infection and cognitive problems.
Allopathic Diagnosis and Treatment
Diagnosis is based upon a medical history, physical exam, and a comparison of the Connor’s
Parent Teacher rating scales showing behavioral disruption in two different environments over a
period of time . Laboratory data would show no evidence of other medical conditions.
Allopathic providers believe the primary factor in ADHD development is related to the status of
the monoamine system which impacts serotonin, dopamine, norepinephrine, and epinephrine.
Pharmaceutical treatment is aimed to impact the monoamine systems with neutral sulfate salts
like dextro-amphetamine and amphetamine, methylphenidate, dexmethylphenidate, atomextine,
and lisdexamfetamine dimesylate. However, they are unable to increase the total number of
neurotransmitter molecules in the central nervous system (Hinz, Stein, Neff, Weinberg, and
Uncini, 2011).
When to Refer
Clinical Diagnosis of ADHD requires a licensed medical provider, psychologist, psychiatrist,
or PhD educational specialist. If the client is suspected of having ADHD but has not been
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formally diagnosed, a CAM provider must refer to one of the above providers for testing and
analysis because other conditions like nutritional deficiencies, inflammation, or
allergy/sensitivities can mimic attentional and behavioral problems.
Integrative Perspective of Causes
The dietary intake pattern of general populations in Asian and American countries often
reflects many nutrient deficiencies, especially essential vitamins, minerals, and omega-3 fatty
acids. Rao, Asha, Ramesh, and Rao (2008) report, that “few people are aware of the connection
between nutrition and depression while they easily understand the connection between
nutritional deficiencies and physical illness. A notable feature of the diets of patients suffering
from mental disorders is the severity of deficiency in these nutrients”.
The Western diet is inflammatory. In sensitive individuals, an inflammatory diet may cause
symptoms of inattention, hyperactivity, aggression, irritability, and mood swings (Bube, 2013;
Sears 2011; Feingold n.d.). Research is also suggestive of toxic buildup in sensitive individual’s
systems which can contribute to the symptoms of ADHD. The Western diet is unable to
eliminate environmental or food contaminants and likely intensifies these symptoms. Murray and
Pizzorno (2010) hypothesize that dietary alterations may serve as a useful tool to detoxify
individuals unable to eliminate toxic buildup.
Specialized Integrative Analysis
Increasing evidence demonstrates that many adolescents with behavioral problems are
sensitive to >1 food components that negatively impact their behavior. Schnoll, Burshteyn, and
Cea-Aravena (2003) found that individual response was an important factor for determining the
proper approach to treating children with ADHD. Artificial food colors (AFCs) have not been
established as the main cause of ADHD, but accumulated evidence suggests that a subgroup
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shows significant symptom improvement when consuming an AFC-free diet and reacts with
ADHD-type symptoms on challenge with AFCs. Of children with suspected sensitivities, 65% to
89% reacted when challenged with at least 100 mg of AFC. Oligoantigenic diet studies
suggested that some children in addition to being sensitive to AFCs are also sensitive to common
nonsalicylate foods (milk, chocolate, soy, eggs, wheat, corn, legumes) as well as salicylate-
containing grapes, tomatoes, and orange (Stevens, Kuczek, Burgess, Hurt, Arnold 2011;
Feingold n.d.; Murray and Pizzorno 2010).
Reactive hypoglycemia is a commonly undiagnosed problem that manifests as symptoms of
ADHD, treatment includes eating protein and a complex carbohydrate about every two hours to
avoid the spikes and extreme drops in blood sugars which cause irritability, agitation,
restlessness, hyperactivity, poor concentration, and fatigue. Dr. Barry Sears (2011) reports
inflammation of the brain cells results in increased neurological disorders, including ADHD.
Integrative Support Protocols
Integrative ADHD support protocols are designed to help maintain focus and concentration;
as well as channel frustrations, anxiety, and energy. Whole foods diet is a key CAM Therapy in
the management of ADHD and is comprised of an organic nutrient dense whole foods diet that
omits food aggravators. Because nutrient deficiencies are common in ADHD; supplementation
with minerals, the B vitamins, omega-3 and omega-6 essential fatty acids, flavonoids, and the
essential phospholipid phosphatidylserine can ameliorate ADHD symptoms. Nutritional factors
such as food additives, refined sugars, food sensitivities/allergies, and fatty acid deficiencies
have all been linked to ADHD. There is increasing evidence that many children with behavioral
problems are sensitive to one or more food components that can negatively impact their behavior
(Schnoll, Burshteyn, and Cea-Aravena, 2000). When individually managed with
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supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and
other features of a holistic program of management, the ADHD subject can lead a normal and
productive life (Kidd, 2000).
Dietary Support
The following steps have been useful in decreasing ADHD symptoms in the table below.
Step Rationale
1. Treat reactive hypoglycemia. Hypoglycemia can mimic ADHD
2. Consume an anti-inflammatory whole foods diet. Inflammation has been implicated in ADHD
3. Eliminate all caffeine, sodas, prepared/prepackaged
foods, candy, and cookies .
Food colors, preservatives, flavorings, and additives can
cause behavioral issues in sensitive individuals.
4. Eat whole low-processed foods like eggs, meats,
cheeses, fresh vegetables and fruits, nuts, seeds, and
legumes.
A whole /low processed foods diet is anti-inflammatory and
decreases food sensitive triggers.
5. Avoid all white flour, refined sugars, high fructose
corn syrup, artificial colors & additives .
These foods are implicated in contributory to symptoms of
ADHD.
6. Consume a low gluten, low casein diet. These foods have been helpful in some individuals sensitive
to casein & gluten.
7. Make whole foods appealing by choosing color,
variety, and textures.
A varied diet may help avoid food triggers and cravings &
is higher in anti-oxidants.
8. Drink large amounts of fresh filtered water, to help
brain and body cells function properly and flush out
body toxins.
Chemical water additives have been implicated in
environmental causes of ADHD; fresh water flushes out
toxins.
9. Keep weight healthy and monitor it regularly. Obesity and ADHD are directly linked.
10. Ingest appropriate levels of high dose
micronutrients.
Micronutrients help to correct nutritional imbalances, boost
the immune system, & help detoxify the body.
11. Get 60 minutes of physical activity/exercise daily. Physical activity increases circulation; helping to detoxify
the body, & channels excess energy.
Food Supplement Therapy (Vitamins & Minerals)
CAM providers have found food supplements help decrease ADHD symptoms (see table 2).
Name Rationale Caution
Vitamin C Antioxidant, anti-inflammatory,
improved the behavior in persons w/ ADHD
L-carnitine formed from an amino acid and helps cells in the
body produce energy
- A study found that 54% of a group of boys with
ADHD showed behavioral improvement
-no studies exist on safe use in children
-may also worsen hypothyroid symptoms,
interact with some medications, and lower
seizure threshold persons with previous
seizure history
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Vitamin B6 Adequate levels of vitamin B6 are needed for the
body to make and use brain chemicals, including
serotonin, dopamine, and norepinephrine
- B6 pyridoxine was slightly more effective than
Ritalin in improving behavior among hyperactive
children.
High doses of Vitamin B6 can be dangerous
and cause nerve damage
GABA Is a neurotransmitter in the brain and is the main
inhibitory neurotransmitter, resulting in
calming effects.
Essential
fatty acids
from fish oil
(omega-3
fatty acids)
play a key role in normal brain function
- Studies reveal that children with ADHD who take
the oil supplements for a period of three months,
show significant improvements in spelling, reading,
and behavior.
-use with caution as high doses may increase
the risk of bleeding
Iron - ADHD kids tend to have low ferritin levels ( iron
storage protein)
-Low iron alters dopamine activity & slows brain
development
Iron levels must be analyzed before
instituting treatment.
Magnesium Symptoms of magnesium deficiency include
irritability, decreased attention span, and mental
confusion
- A study of 75 magnesium-deficient children with
ADHD, those who received magnesium supplements
showed an improvement in behavior compared to
those who did not receive the supplements
Caution should be exercised as magnesium
can interfere with certain medications,
including antibiotics and blood pressure
medications and be dangerous.
Zinc regulates the activity of brain chemicals, fatty acids,
& melatonin which are related to behavior; helps
regulate the function of the neurotransmitter
dopamine; Research shows that zinc significantly
reduces hyperactivity and impulsivity; Low zinc is related to weakened intestinal integrity
Adult women who are pregnant or
breastfeeding should limit their intake of zinc
to 40 mg per day to avoid pregnancy or
infant development complications.
Botanical Therapy
Herbs help to strengthen and tone the body's systems; several botanical formulations for
ADHD management are sold in the United States and Europe, but few scientific studies
have investigated whether these herbs improve symptoms of ADHD. Herbs are formulated as
dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol
extracts). One or more of the following botanicals may be recommended for reducing ADHD
symptoms people (see table 3 below):
Name Rationale Caution
Bacopa (Bacopa monnie
ri)
aka brahmi
sedative and improves anxiety &hyperacti
vity;
improves memory and concentration
Can cause temporary hearing loss in
women, interacts w/estrogen therapy
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Roman chamomile
(Chamaemelum nobile).
Calming;
relieves allergies, inflammation, & insom
nia
-may cause an allergic reaction in people
sensitive to Ragweed;
-may have estrogen-like effects
--use with caution in hormone-related
conditions, (ie. breast, uterine, or ovarian
cancers, or endometriosis).
-can interact with some medications
Evening Primrose
Oenothera biennis
(contains Omega 3 Fatty
Acids, Linoleic Acid,
Gamma Linoleic Acid &
omega-6 fatty acids)
lack of various polyunsaturated fatty
acids can contribute to attention deficit
hyperactivity
Lowers seizure threshold in persons
taking anti-epileptics, schizophrenic meds
Ginkgo Biloba(Gingko
biloba)
-used to improve memory & mental
sharpness; improves inattention &
immaturity problems; increases blood
flow to the brain; helps w/ADHD sx that
affect intellectual functions
- used with caution in diabetes, seizures,
infertility, & bleeding disorders
-can interact with meds (esp. blood-
thinning agents)
Ginseng (American or
Siberian)
American ginseng
(Panax quinquefolium)
- known for memory boosting benefits
- increases brain levels of
neurotransmitters dopamine and
norepinephrine
-- Imbalances lead to disruption in
attention span, motor behavioral
dysfunctions, and auditory processing
delays.
- One study found gingko along
w/ginseng improved ADHD sx
American ginseng caution in diabetes,
hormone-sensitive conditions, insomnia,
or schizophrenia
-can interact (esp blood-thinning agents)
Gotu Kola (Centella
asiatica)
improves memory, concentration
& mental fatigue
breast feeding women and pregnant
women must avoid the use
Grapeseed Extract protects from excitotoxins
Hawthorn Relieves acting out & stops inflammation
caused by allergies
Interacts w/cardiac meds, not indicated
for use in children, pregnancy, or
lactation
Lemon balm
(Melissa officinalis)
gentle, safe calming herb for anxiety
& depression; relaxes
nervous system, eases agitation.
avoided by individuals affected by
glaucoma
Passionflower
(Passiflora incarnata)
calming sedative that causes less drowsin
ess than drugs
-may interact with sedative medications.
Scullcap Indicated for aggressive & agitated
persons; helps decrease
anxiety, restlessness, crying spells, irritabi
lity, &nervousness.
Useful daytime sedative that works
w/o drowsiness;
prevents allergic reactions.
-may decrease leukocyte count
-use under supervision as can damage the
liver
St. John’s Wort
(Hypericum perforatum)
nervine tonic, antidepressant,
regulates mood and attention;
inhibiting the
reuptake of serotonin, inhibits the reupta
ke of norepinephrine and dopamine w/eq
ual affinity;
has an affinity for GABA receptors
Interacts w/other meds, esp anti-
depressants
Valerian (Valerian increase in concentration and abilities and -can interact with some meds
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officinalis) energy levels -can induce drowsiness
-can interact with sedative meds
Digestion/Apsorption of Nutrients
Maximum absorption of key nutrients is essential for overall body health and nervous system
function. Digestive enzymes can increase nutrients and supplement absorption; many persons
note improvement in ADHD symptoms when taking broad-spectrum enzyme or those targeting
specific compounds.
Digestive Enzymes Rationale
Amylase breaks down carbohydrates, starches, &sugars
Cellulase breaks down cellulose, plant fiber
Protease breaks down proteins (found in meats, eggs, cheese, and nuts
Lipase breaks down fats (found in most dairy products, meats, oils, and nuts)
Papaya digestive
enzymes
Important for food/nutrient breakdown & assimilation
Homeopathy
Homeopathic remedies address each person's constitutional type -- physical, emotional, and
psychological makeup; an experienced homeopath assesses these factors when determining the
most appropriate individual’s treatment. One study of 43 ADHD diagnosed children, showed
significant improvement in behavior when they received an individualized homeopathic remedy
compared to children who received a placebo. Homeopathic remedies found to be most effective
included: Stramonium, for children who are fearful, especially at night; Cina -- for children who
are irritable and dislike being touched; whose behavior is physical and aggressive ; and
Hyoscyamus niger -- for children who have poor impulse control, talk excessively, or act overly
exuberant (Wisegeek, 2013).
Sleep Hygiene
Persons with ADHD often have disordered sleep patterns that contribute to behavior and
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attention issues. Stimulant medications prescribed for ADHD often disrupts sleeping patterns
causing insomnia. Melatonin helps to promote sleep in persons with ADHD and may improve
behavioral and attention (Wisegeek, 2013).. Experts suggest melatonin is effective when taken
for 3 weeks on and one week off (Sears, 2011).
Adjunctive CAM techniques
Yoga, meditation, and self-calming activities, along with increased physical activity (walking,
weight lifting, swimming and biking have been useful in persons with attentional issues.
Massage
Relaxation techniques and massage can reduce anxiety and activity levels in children
adolescents, and adults with ADHD. In one study, teenage boys with ADHD who received 15
minutes of massage for 10 consecutive school days showed significant improvement in behavior
and concentration compared to those who were guided in progressive muscle relaxation for the
same duration of time (WiseGeek, 2013).
Biofeedback
Mind/body techniques such as hypnotherapy, progressive relaxation, and biofeedback may be
useful in treating individuals with ADHD. Through these techniques, individuals are often able
to learn coping skills they can use for the rest of their lives. These treatments allow persons to
gain a sense of control and mastery, increase self esteem, and decrease stress. Biofeedback
operates on the principle that individuals can be trained to modify brain activity associated with
ADHD and increase brain activity associated with attention. Several studies have shown positive
results (Burton, 2008).
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Summary
Further research is needed in the area of CAM ADHD botanical and food supplement therapy
and management; as well as the dietary and environmental influences that cause inflammation in
ADHD. Children, Adolescents, and adults respond differently to ADHD treatments and need a
variety of modalities available to address their unique needs beyond Allopathic prescription
medications.
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