:: January/February 2006 Volume 5/Number 1

Research Review: Attention Deficit Hyperactivity Disorder (ADHD)

By Felicia M. Tomasko

Childhood is a time of daydreaming, playing and exploring the world. Within this field of play, there can sometimes be a fine line between daydreaming and chronic inattention, playfulness and hyperactivity. For the children who struggle with the condition identified as attention deficit hyperactivity disorder (ADHD, formerly known as attention deficit disorder, or ADD), going to school, building social relationships and developing study skills can be challenging. These challenges, though, are not insurmountable.

Symptoms of ADHD include restlessness, hyperactivity, inattention and impulsivity and can appear early in life, even at a preschool age.(1) It is important for a child to be appropriately diagnosed, as not only do the symptoms resemble normal childhood behavior (although on the extreme end), it is necessary to rule out causative factors like dietary allergies and treat possible coexisting conditions including anxiety.

According to the American Academy of Pediatrics, 8% to 10% of American school-age children have ADHD,(2) making it one of the most frequently diagnosed childhood disorders. While everything from poor parenting to refined sugar to the over-stimulation rampant in our society has been blamed for ADHD, the condition appears to be more complex, and includes the influences of a number of factors including genetics, brain structure, food allergies and environmental toxicity(3). It is likely that there is no single cause, even in each individual child.

There are three subtypes of ADHD: inattentive, hyperactive-impulsive and combined. The combined subtype is the most common(4). Although it is commonly thought that hyperactive, disruptive, inattentive boys represent the majority of kids with ADHD, this is not necessarily the case. Girls are also affected, although they tend to be more inattentive than hyperactive. ADHD can often continue throughout life; somewhere between 30-70 % of children with ADHD continue to exhibit symptoms of the disorder as an adult.(5)

Recent Centers for Disease Control and Prevention statistics estimate that 2.5 million children ages 4-17 take medication to treat ADHD.(6) But the standard pharmaceutical treatments, many of them stimulants such as the commonly-used Ritalin, or the amphetamines Adderal and Dexedrine, or antidepressants like Wellbutrin and Effexor have a number of risks and are not effective for everyone.(7) Additionally, their long-term safety has not been comprehensively studied. Because of this, complementary and alternative treatments are being increasingly investigated to find safe and effective methods of not merely managing the condition but also improving the child’s life. A number of therapies and treatments have been used and investigated, including biofeedback, dietary therapies, yoga, meditation and massage. The full list is more comprehensive than can be included in this review, so here only some recent areas of research and investigation are highlighted.

Diet

Sugar is often mentioned as a culprit in hyperactivity and inattention. While parents and teachers anecdotally report on the negative effects of refined sugars, the hard data in this area is lacking. Studies investigating the impact of sugar have not noted a negative effect, but analysis reveals that the doses of sugar used may have been too low to elicit an impaired response from children used to the sugar-laden standard American diet. This suggests the need for more thorough research in the area of sugar consumption and ADHD.(8)

Essential fatty acids, including omega-3 and omega-6 fatty acids found in foods including flax, pumpkin seeds, walnut, avocado, sesame seeds, some dark green leafy vegetables and cold water fish are currently being scrutinized for their effect in ADHD. EFAs have been shown to be important in depression and other disorders involving both body and mind. The current evidence for their effectiveness is still mixed, but their safety makes them excellent candidates for further investigation.(9)

Ayurveda

Although Ayurvedic treatments have not yet been formally studied in children or adults with ADHD, many therapeutic interventions can be effective, based on the individual imbalances in the child. From an Ayurvedic perspective, ADHD is a disorder of the bodymind, impacting the ability to focus and concentrate. In order to treat ADHD, it is thus necessary to treat not only the mind, but the body, and to address the variety of causative factors in the disorder. Daily routine, meditation, diet, sleep schedule, massage, yoga, relaxation and appropriate attention are as important medicinally as pharmaceuticals or herbs.

In his writings about his clinical experience, Ayurvedic physician John Douillard finds that massage, the use of nasya (nose drops) with the herb brahmi to focus the mind, as well as herbs to rejuvenate the nervous system can be beneficial. Dr. Douillard also states that meditation is one of the most important self-help techniques to treat ADHD.(10) 

Yoga

People who teach yoga to kids assert that the practice can help alleviate symptoms associated with ADHD by increasing the ability to both concentrate and relax. According to Marsha Wenig, coordinator of the YogaKids program and author of YogaKids, regular practice including poses that develop strength and concentration (including standing and balancing poses) are beneficial to increase focus, while using eye pillows and teaching breathing techniques foster relaxation.(11)

Studies have evaluated the Yoga Ed program and the Tools for Teachers program. These offer a yoga curriculum and yogic techniques for teachers to incorporate in the classroom in schools. The studies have had promising results when considering the needs of children with ADHD. Students demonstrated improved self-esteem and academic performance as well as the ability to relax.(12,13)

Yoga has also been directly studied with children diagnosed with ADHD, with promising results. A program introduced yoga to boys with ADHD and was effective for stabilizing emotions and reducing children’s oppositional and disruptive behavior. The majority of the boys in the study were taking medication during the school day. Interestingly, researchers found that yoga was particularly beneficial in the evening when daytime medications wore off. The yoga practice was not limited to the time on the mat: parents and children utilized the yogic breathing and relaxation techniques taught in class to become calm before bed. Parents also reported that children were able to hold their attention and were less restless after yoga.(14)

Meditation

Dr. Douillard is not the only proponent of meditation in ADHD. Because meditation techniques emphasize training the mind to hold its attention, a study is currently underway, sponsored by the Santa Barbara Institute for Consciousness Studies and Dr. Susan Smalley at the UCLA Institute for Behavioral Genetics, to evaluate the effectiveness of Buddhist contemplative techniques in benefiting children with ADHD.

Homeopathy

Some recent studies have investigated the use of homeopathic consultations and treatments for children with ADHD. A pilot study in Seattle found that although children who received homeopathic remedies did not show statistically significant differences when compared to those receiving a placebo, both of the groups studied improved significantly after a series of consultations with the homeopathic physician. This suggests the potential benefit from the sessions themselves and indicates the need for further study.(15)  Also investigating homeopathy, a randomized, double-blind, placebo-controlled crossover study found that children with ADHD who received homeopathy benefited from the treatment.(16) 

A Sense of Self

Self-esteem is an important concept to address when working with a child diagnosed with ADHD. Improving a child’s self-esteem can help them manage their own attention and energy levels. Rather than merely dispensing medications, school nurses have been considered to be an effective person to intervene with kids with ADHD and help them increase their sense of self-worth through support groups that increase self-empowerment.(17)

In Conclusion

The behaviors associated with ADHD can be frustrating, and navigating treatment options can be even more so. But as holistic investigation continues, it is emerging that treatment plans including numerous approaches and modalities to improve all aspects of a person’s life, such as yoga, meditation, diet and behavioral therapies, may be the most effective.

(1)Strock, M. 2005. Attention Deficit Hyperactivity Disorder. NIMH Publication Number 3572.

(2)American Academy of Pediatrics. 2000. Clinical practice guideline: diagnosis and evaluation of the child with attention-deficit/hyperactivity disorder. Pediatrics. 105:1158-70.

(3)Strock, M. 2005. Attention Deficit Hyperactivity Disorder. NIMH Publication Number 3572.

(4)Attention Deficit Hyperactivity Disorder. 2005. Natural Medicines Database Monograph.

(5)Silver LB. Attention-deficit hyperactivity disorder in adult life. Child and Adolescent Psychiatric Clinics of North America, 2000:9:3: 411-523.

(6)Centers for Disease Control and Prevention. 2005. Mental health in the United States. Prevalence of diagnosis and medication treatment for attention-deficit/hyperactivity disorder—United States, 2003. Morbidity and Mortality Weekly Report.

(7)Daley, K.C. 2004. Update on attention-deficit/hyperactivity disorder. Current Opinion in Pediatrics. 16(2):217-26.

(8)Rojas, N.L., and Chan, E.2005.  Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews. 11:116-130.

(9)Rojas, N.L., and Chan, E.2005.  Old and new controversies in the alternative treatment of attention-deficit hyperactivity disorder. Mental Retardation and Developmental Disabilities Research Reviews. 11:116-130.

(10)Douillard, J. 2002. Attention Deficit Disorder: Ayurvedic Approach. Light on Ayurveda. 1(1): 4-5.

(11)Wenig, M. 2003. YogaKids, Educating the Whole Child Through Yoga. Stewart, Tabori & Chang: New York.

(12)Slovacek, S.P., Tucker, S.A., and Pantoja, L. 2003. A study of the Yoga Ed program at the Accelerated School. Program Evaluation and Research Collaborative, Charter College of Education: Los Angeles.

(13)Davison, E. 2005. A study of the Yoga Ed tools for teachers program with 4th graders at Public School #198 in Bronx, N.Y. A Summary of Research.

(14)Jensen, P.S., and Kenny, D.T. 2004. The effects of yoga on the attention and behavior of boys with attention deficit hyperactivity disorder (ADHD). Journal of Attention Disorders. 7(4): 205-16.

(15)Jacobs, J., Williams, A.L., Girard, C., Njike, V.Y., and Katz, D. 2005. Homeopathy for attention-deficit/hyperactivity disorder: a pilot randomized-controlled trial. Journal of Alternative and Complementary Medicine. 11(5): 799-806.

(16)Frei, H., Everts, R., von Ammon, K., Kaufmann, F., Walther, D., Hsu-Schmitz, S.F., Collenberg, M., Fuhrer, K., Hassink, R., Steinlin, M., and Thurneysen, A. 2005. Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomized, double blind, placebo controlled crossover trial. European Journal of Pediatrics. 164(12): 758-67.

(17)Frame, K., Kelly, L., and Bayley, E. 2003. Increasing perceptions of self-worth in preadolescents diagnosed with ADHD. Journal of Nursing Scholarship. 35(3): 225-9.

 

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