Attention Deficit–Hyperactivity Disorder

Also indexed as: ADD, ADHD, Attention Deficit Disorder, Hyperactivity

Hyperactivity—is it normal behaviour or ADHD? When a child is more than rambunctious, it is important to know the facts. According to research or other evidence, the following steps may be helpful:

Supplement with essential fatty acids
Getting approximately 186 mg of EPA (eicosapentaenoic acid), 480 mg of DHA (docosahexaenoic acid), 96 mg of GLA (gamma-linolenic acid), 864 mg of linoleic acid, and 42 mg of arachidonic acid supplies fatty acids important for brain function

Check out L-carnitine
To improve behaviour, take 100 mg of this supplement for each 2.2 pounds of body weight a day, with a maximum of 4 grams a day

Give magnesium a go
200 mg a day can address possible deficiency of this mineral that may influence ADHD

Try the Feingold diet
Work with the Feingold Association or a diet specialist to reduce or eliminate food additives and other food issues that may affect ADHD

These recommendations are not comprehensive and are not intended to replace the advice of your doctor or chemist. Continue reading the full ADHD article for more in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and lifestyle changes that may be helpful.

About ADHD

Attention deficit-hyperactivity disorder (ADD or ADHD) is defined as age-inappropriate impulsiveness, lack of concentration, and sometimes excessive physical activity.

ADHD has been associated with learning difficulties and lack of social skills. Obviously what constitutes “normal” in these areas covers a wide spectrum; thus it is unclear which child suffers true ADHD and which child is just more rambunctious or rebellious than another. No objective criteria exist to accurately confirm the presence of ADHD. ADHD often goes undiagnosed if not caught at an early age, and it affects many adults who may not be aware of their condition.

Product ratings for attention deficit–hyperactivity disorder

Science Ratings

Nutritional Supplements

Herbs

Essential fatty acids

Iodine (to prevent deficiency during pregnancy)

Iron (for deficiency only)

Reliable and relatively consistent scientific data showing a substantial health benefit.
2Stars

Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1Star

For a herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support and/or minimal health benefit.

What are the symptoms?

ADHD is generally recognized by a pattern of inattention, distractibility, impulsivity, and hyperactivity estimated to affect 3 to 5% of school-aged children. Learning disabilities or emotional problems often accompany ADHD. Children with ADHD experience an inability to sit still and pay attention in class, and they often engage in disruptive behaviour.

Medical options

The most commonly prescribed prescription drugs, methylphenidate (Ritalin®, Metadate®) and amphetamine mixtures (Adderall®), are considered stimulant drugs, though they produce a paradoxical calming effect in people with ADHD. Another medication less frequently used is pemoline (Cylert®).

Dietary changes that may be helpful

The two most studied dietary approaches to ADHD are the Feingold diet and a hypoallergenic diet. The Feingold diet was developed by Benjamin Feingold, M.D., on the premise that salicylates (chemicals similar to aspirin that are found in a wide variety of foods) are an underlying cause of hyperactivity. In some studies, this hypothesis does not appear to hold up.¹ However, in studies where markedly different levels of salicylates were investigated, a causative role for salicylates could be detected in some hyperactive children.² As many as 10 to 25% of children may be sensitive to salicylates.³ Parents of ADHD children can contact local Feingold Associations for more information about which foods and medicines contain salicylates.

The Feingold diet also eliminates synthetic additives, dyes, and chemicals, which are commonly added to processed foods. The yellow dye tartrazine has been specifically shown to provoke symptoms in controlled studies of ADHD-affected children.⁴ Again, not every child reacts, but enough do so that a trial avoidance may be worthwhile. The Feingold diet is complex and requires guidance from either the Feingold Association or a healthcare professional familiar with the Feingold diet.

In one study, children diagnosed with ADHD were put on a hypoallergenic diet, and those children who improved (about one-third) were then challenged with food additives. All of them experienced an aggravation of symptoms when given these additives.⁵ Other studies have shown that eliminating individual allergenic foods and additives from the diet can help children with attention problems.⁶ ⁷

Some parents believe that consuming sugar may aggravate ADHD. One study found that avoiding sugar reduced aggressiveness and restlessness in hyperactive children.⁸ Girls who restrict sugar have been reported to improve more than boys.⁹ However, a study using large amounts of sugar and aspartame (NutraSweet®) found that negative reactions to these substances were limited to just a few children.¹⁰ While most studies have not found sugar to stimulate hyperactivity, except in rare cases,¹¹ the experimental design of these studies may not have been ideal for demonstrating an adverse effect of sugar on ADHD, if one exists. Further studies are needed.

Lifestyle changes that may be helpful

Smoking during pregnancy should be avoided, as it appears to increase the risk of giving birth to a child who develops ADHD.¹²

Lead and other heavy-metal exposures have been linked to ADHD.¹³ ¹⁴ If other therapies do not seem to be helping a child with ADHD, the possibility of heavy-metal exposure can be explored with a health practitioner.

Vitamins that may be helpful

Some children with ADHD have lowered levels of magnesium. In a preliminary, controlled trial, children with ADHD and low magnesium status were given 200 mg of magnesium per day for six months.¹⁵ Compared with 25 other magnesium-deficient ADHD children, those given magnesium supplementation had a significant decrease in hyperactive behaviour.

In a double-blind study, children with ADHD who received 15 mg of zinc per day for six weeks showed significantly greater behavioural improvement, compared with children who received a placebo.¹⁶ This study was conducted in Iran, and zinc deficiency has been found to be quite common in certain parts of that country. It is not clear, therefore, to what extent the results of this study apply to children living in other countries.

In a double-blind study, supplementation with L-carnitine for eight weeks resulted in clinical improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.¹⁷ The amount of L-carnitine used in this study was 100 mg per 2.2 pounds of body weight per day, with a maximum of 4 grams per day. No adverse effects were seen, although one child developed an unpleasant body odour while taking L-carnitine. Researchers have found that this uncommon side effect of L-carnitine can be prevented by supplementing with riboflavin. Although no serious side effects were seen in this study, the safety of long-term L-carnitine supplementation in children has not been well studied. This treatment should, therefore, be monitored by a physician.

A deficiency of several essential fatty acids has been observed in some children with ADHD compared with unaffected children.¹⁸ ¹⁹ One study gave children with ADHD evening primrose oil supplements in an attempt to correct the problem.²⁰ Although a degree of benefit was seen, results were not pronounced. In a 12-week double-blind study, children with ADHD were given either a placebo or a fatty-acid supplement providing daily: 186 mg of eicosapentaenoic acid (EPA), 480 mg of docosahexaenoic acid (DHA), 96 mg of gamma-linolenic acid (GLA), 864 mg of linoleic acid, and 42 mg of arachidonic acid. Compared with the placebo, the fatty-acid supplement produced significant improvements in both cognitive function and behavioural problems.²¹ No adverse effects were seen. In a preliminary trial, supplementation with approximately 400 mg of linseed oil and 25 mg of vitamin C, each twice a day for three months, was associated with an improvement of symptoms in children with ADHD.²²

In a preliminary study of women in Italy, iodine deficiency severe enough to cause hypothyroidism during pregnancy was associated with an increased risk of ADHD in their children.²³ Women who are contemplating pregnancy or who are pregnant should get adequate amounts of iodine in their diet and should discuss with their doctor whether iodine supplementation is appropriate.

Iron status, as measured by the serum ferritin concentration, was significantly lower in a group of children with ADHD than in healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared with 18% of the healthy children.²⁴ Since iron deficiency can adversely affect mood and cognitive function, iron status should be assessed in children with ADHD, and those who are deficient should receive an iron supplement. In a case report, a young boy with both ADHD and iron deficiency showed considerable improvement in behaviour after receiving an iron supplement.²⁵

B vitamins, particularly vitamin B6, have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.²⁶ In a study of six children with low blood levels of the neurotransmitter (chemical messenger) serotonin, vitamin B6 supplementation (15–30 mg per 2.2 pounds of body weight per day) was found to be more effective than methylphenidate (Ritalin®). However, lower amounts of vitamin B6 were not beneficial.²⁷ The effective amount of vitamin B6 in this study was extremely large and could potentially cause nerve damage, although none occurred in this study. A practitioner knowledgeable in nutrition must be consulted when using high amounts of vitamin B6. High amounts of other B vitamins have shown mixed results in relieving ADHD symptoms.²⁸ ²⁹

Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.

Herbs that may be helpful

Though it has not been studied, theoretically shelled hemp seed may be useful for people with ADHD due to its content of essential fatty acids.³⁰ ³¹

Are there any side effects or interactions?
Refer to the individual herb for information about any side effects or interactions.

References
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1. Harley JP, Ray RS, Tomasi L, et al. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 1978;61:818–21.

2. Levy F, Dumbrell S, Hobbes G, et al. Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Med J Aust 1978;1:61–4.

3. Williams JI, Cram DM. Diet in the management of hyperkinesis: a review of the tests of Feingold’s hypotheses. Can Psychiatr Assoc J 1978;23:241–8 [review].

4. Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125:691–8.

5. Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72:462–8.

6. Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69:564–8.

7. Egger J, Stolla A, McEwen LM. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet 1992;339:1150–3.

8. Prinz RJ, Roberts WA, Hantman E. Dietary correlates of hyperactive behavior in children. J Consult Clin Psychol 1980;48:760–9.

9. Rosen LA, Booth SR, Bender ME, et al. Effects of sugar (sucrose) on children’s behavior. J Consult Clin Psychol 1988;56:583–9.

10. Wolraich ML, Lindgren SD, Stumbo PJ, et al. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med 1994;330:301–7.

11. Wolraich ML, Wilson DB, White JW. The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA 1995;274:1617–21.

12. Milberger S, Biederman J, Faraone SV, et al. Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children? Am J Psychiatry 1996;153:1138–42.

13. Tuthill RW. Hair lead levels related to children’s classroom attention-deficit behavior. Arch Environ Health 1996;51:214–20.

14. Krigman MR, Bouldin TW, Mushak P. Metal toxicity in the nervous system. Monogr Pathol 1985;(26):58–100.

15. Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res 1997;10:149–56.

16. Akhondzadeh S, Mohammadi MR, Khademi M. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial [ISRCTN64132371]. BMC Psychiatry 2004;4:9.

17. Van Oudheusden LJ, Scholte HR. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 2002;67:33–8.

18. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr 1987;26:406–11.

19. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761–8.

20. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation by Efamol in hyperactive children. J Abnorm Child Psychol 1987;15:75–90.

21. Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:233–9.

22. Joshi K, Lad S, Kale M, et al. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids 2006;74:17–21.

23. Vermiglio F, Lo Presti VP, Moleti M, et al. Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 2004;89:6054–60.

24. Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2004;158:1113–5.

25. Konofal E, Cortese S, Lecendreux M, et al. Effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder. Pediatrics 2005;116:e732–4.

26. Bhagavan HN, Coleman M, Coursin DB. The effect of pyridoxine hydrochloride on blood serotonin and pyridoxal phosphate contents in hyperactive children. Pediatrics 1975;55:437–41.

27. Coleman M, Steinberg G, Tippett J, et al. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biol Psychiatry 1979;14:741–51.

28. Brenner A. The effects of megadoses of selected B complex vitamins on children with hyperkinesis: controlled studies with long term followup. J Learning Dis 1982;15:258–64.

29. Haslam RHA. Is there a role for megavitamin therapy in the treatment of attention deficit hyperactivity disorder? Adv Neurol 1992;58:303–10.

30. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761–8

31. Fitzsimmons S. Hemp seed oil: Fountain of youth? Br J Phytother 1998;5:90–6.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.