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