Complimentary and Alternative Biomedical Treatments for ADHD
Currently, there are two evidence-based options available for the treatment of attention-deficit hyperactivity disorder (ADHD) in adolescents and adults: FDA-approved medicines and behavioral therapy. Often these treatments are used in conjunction with one another; however, some patients choose to not participate in medicine management for one reason or another. Therefore, additional options have been proposed for those patients, called complementary and alternative (CAM) treatments, and Hurt and colleagues have reviewed and categorized these treatments based upon effectiveness and use by different subsets of patients.2
According to Hurt and colleagues, two CAM treatments have been cited as worth a treatment trial for adolescents with ADHD. The first is RDA/RDI multivitamin supplementation.2 Although RDA/RDI multivitamin supplementation has not been systematically assessed in adolescent patients with ADHD, Benton and colleagues have published pieces stating that compared to placebo, RDA/RDI multivitamins have shown to improve concentration and maintain attention, as well as decrease excessive motor behavior., While no research focused on RDA/RDI multivitamin use in adults, it is thought that similar effects will be experienced. Also, Hurt and colleagues state that stimulant medicine may cause ADHD patients to have difficulty absorbing some nutrients and may also be at risk of vitamin deficiency due to the appetite suppressant side-effect; therefore, RDA/RDI multivitamin supplementation would be a reasonable treatment, even if ADHD symptoms do not improve.2
The second CAM treatment cited to be worth a treatment trial is fatty acid supplementation. Essential fatty acid (EFA) deficiency has been noted in patients with ADHD, and 16 studies have been conducted on the effects supplementation has on adolescent patients. The three most effective EFA supplements are eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma-linelenic acid (GLA).2 Dr. William E. Connor reports EFA supplements to benefit cardiovascular functioning, brain development, and certain other common psychiatric conditions such as depression. While EFA supplementation does not decrease the symptoms of ADHD as FDA-approved medicines, it is worth a treatment trial.2
Hurt and colleagues report that elimination diets have enough evidence to be recommended as treatment for certain subsets of patients with ADHD. Back in the 1970s, Dr. Feingold proposed that some children may be sensitive to certain artificial colors, flavors, and preservatives that are found in food, which may cause behavioral and learning problems.2 More recently, research has found that elimination diets may have a positive impact on a subpopulation of patients with ADHD; however, the diets may only be recommended for patients who have a history of adverse reactions to artificial ingredients. As an elimination diet should last no longer than two weeks for nutritional purposes, foods that have been avoided should then be introduced back into the patient’s diet one at a time, with documentation recording effects on mood and behavior.2 Therefore, only those substances that are directly linked to ADHD symptoms can be avoided in the future, and the most nutrients may be obtained naturally.
For patients who do not respond to medicine, micronutrient supplementation may be explored, as well as homeopathic treatment. Patients with ADHD-Inattentive Type may try carnitine as a treatment, and those with mild ADHD symptoms may try dimethylaminoethanol. However, Hurt and colleagues state that these options are not recommended as first-line treatments.2 First, patients who may be able to explore the option of micronutrient supplementations usually have a co-occurring mood disorder and prefer to refrain from medicine treatments.2 While trials of the supplement suggest it is effective in reducing ADHD symptoms, mood disorder symptoms, and disruptive behavior after an average of eight weeks, close monitoring by a physician is required., Homeopathic treatment, such as herbs, has been explored in adolescents in several trials; however, with a lengthy response time of between one and 16 months, close monitoring by a physician is also required throughout the trial.
Van Oudheusden and colleagues and Arnold and colleagues conducted clinical trials regarding the use of L-carnitine supplements in adolescents with ADHD-Inattentive Type. Both found that while the supplement improved symptoms of inattention, it did not improve hyperactivity or impulsivity. Therefore, the supplement may be tried as treatment for adolescent patients who have not responded to the first-line treatments.2 For patients with mild ADHD symptoms, dimethylaminoethanol may be an option, although the benefits will not be as effective as FDA-approved medicines.2
According to Hurt and colleagues, there are also several CAM treatments that have been initially supported as possible ADHD treatments, including immune therapy, herbal remedies, and glyconutritional supplementation. However, further research is needed before recommendations to patients may be made. With immune therapy, forty percent of adolescents who undergo such for pediatric autoimmune neuropsychiatric disorder show symptoms of ADHD; therefore, while immune therapy’s effectiveness of reducing ADHD’s symptoms have yet to be studied, Hurt and colleagues recommend it be considered in the future.2 Research has also not fully evaluated the effectiveness of herbal remedies, but thus far, none have been found to substantially benefit patients with ADHD. Pycnogenol showed promise in children but not in adults, a combination of gingko biloba and ginseng had mixed results, and St. John’s Wort did not prove effective. On the other hand, glyconutritional supplementation has been found to reduce symptoms of ADHD in two of three trials regarding adolescents.
Hurt and colleagues state that eliminating sugar, amino acid supplementation, and mega-doses of vitamins are not found to be effective treatments. Twenty-three studies found that eliminating sugar from an adolescent’s diet did not improve the child’s attention, mood, motor activity, or behavior. Regarding amino acid supplementations, while it was initially thought to be promising, tolerance has been found to develop after two to three months, making the supplementation useless.2 Also, mega-doses of vitamins pose the risk of toxicity.2
Therefore, for patients who prefer to opt out of medicine management, RDA/RDI multivitamin supplementation, fatty acid supplementation, and elimination diets have shown the most promise in effective treatment.
 Kutcher S, Aman M, Brooks SJ, et al. International consensus statement on attention-deficit/hyperactivity disorder (ADHD) and disruptive behaviour disorders (DBD5): clinical implications and treatment practice suggestions. Eur Neuropsychopharmacol. 2004;14(1):11-28.
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