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Attention Deficit Disorder
Originally, the term attention deficit disorder (ADD) referred to children who were incapable of concentrating at school. Hyperkinesia was used somewhat synonymously, as a descriptive term for children who simply couldn’t sit still. Today, the definition has broadened to include many adults, and has been refined into two conditions: ADD and ADHD (attention deficit and hyperactivity disorder). Characteristics include difficulty sustaining attention or completing tasks, easy distractibility, impulsive behavior, and, in the case of ADHD, an excessive inclination to fidget and move about. These problems make it difficult to succeed at work or at school.
Conventional treatment focuses on stimulants, such as amphetamine, dextroamphetamine, and methylphenidate (Ritalin, Concerta), as well as the newer drug atomoxetine (Strattera). Certain antidepressants may also be useful.
Proposed Natural Treatments
There is some evidence that the supplement DMAE (2-Dimethylaminoethanol) may be helpful for ADD, according to studies performed in the 1970s. Two such studies were reported in a review article.1 Fifty children aged 6 to 12 years who had been diagnosed with hyperkinesia participated in a double-blind study comparing DMAE to placebo. The dose was increased from 300 mg daily to 500 mg daily by the third week and continued for 10 weeks. Evaluations revealed statistically significant test score improvements in the treatment group compared to the placebo group.
Another double-blind study compared DMAE with both Ritalin and placebo in 74 children with "learning disabilities."1 (It appears that today, the participants would have been given a diagnosis of ADD). The study found significant test score improvement for both treatment groups over a 10-week period.
For more information, including dosage and safety issues, see the full DMAE article.
The mineral zinc has shown some promise for treatment of ADHD. In a large double-blind, placebo-controlled study (approximately 400 participants), use of zinc at a dose of 35 mg daily produced statistically significant benefits as compared to placebo.26 This dose of zinc is higher than nutritional needs, but not so high as to be unsafe. However, the benefits seen were quite modest: about 28% of the participants given zinc showed improvement, but so did 20% in the placebo group.
Another, much smaller study evaluated whether zinc at 15 mg per day could enhance the effect of Ritalin.27 Again, modest benefits were seen. Finally, exceedingly weak evidence hints that zinc might enhance the effectiveness of evening primrose oil for ADHD (see next section).28
For more information, including dosage and safety issues, see the full Zinc article.
Essential Fatty Acids
Essential fatty acids (EFAs) are "good fats," substances as important to your general health as vitamins. Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs found in fish oil and evening primrose oil have been tried for the treatment of ADHD and related conditions. The results have been mixed, though.
A double-blind, placebo-controlled trial of 75 children with ADHD found that daily supplementation with omega-3 and omega-6 fatty acids may reduce ADHD symptoms in some children.37 However, in a similarly designed study of 50 such children , use of essential fatty acids from fish oil and evening primrose oil failed to provide any consistent, significant benefit above and beyond the placebo effect.29 And, in a slightly smaller trial, weak evidence of benefit was seen. But, the results are difficult to interpret due to the high number of people who dropped out.3 In a double-blind, placebo-controlled trial of children already using stimulant therapy, the addition of the essential fatty acid docosahexaenoic acid (DHA, found in fish oil) for 4 months failed to further improve symptoms.20 A systematic review produced more promising results, though. In the review, 10 randomized trials involving 699 children with ADHD found that those who took omega-3 fatty acids experienced modest improvements in certain symptoms like inattentiveness and hyperactivity.38
Evening primrose oil alone failed to prove effective for attention deficit disorder in a small double-blind, placebo-controlled trial.21 In a placebo-controlled, comparative trial, evening primrose oil proved less effective than standard medical treatment.22 However, a close look at the data in this last trial hinted that evening primrose oil might have been more effective in people with adequate zinc levels. 28 This suggests that combination therapy with zinc and evening primrose oil should be tested, but, thus far, this approach has not undergone meaningful study.
Other Natural Treatments
A small, double-blind, placebo-controlled crossover trial evaluated the possible efficacy of the supplement carnitine for ADD in boys 13 and younger.23 Approximately 50% of the participants responded to carnitine, a significantly higher percentage than responded to placebo. These promising results suggest that a larger trial is warranted.
Vitamin B3 (niacin), vitamin B6, and multivitamin/multimineral supplements have been recommended for the treatment of ADD. However, a review of the literature found no meaningful evidence to indicate that any of these treatments are effective.4
Other supplements that are sometimes recommended for ADD include calcium, iron, inositol, trace minerals, blue-green algae, combinations of amino acids (usually GABA, glycine, taurine, L-glutamine, L-phenylalanine, and L-tyrosine), and combinations of the polysaccharides galactose, glucose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, N-acetylglucosamine, and xylose. St. John's wort has also become popular recently, but unlike depression, there is no convincing evidence for its effectiveness against ADD.36 Note : St. John's Wort interacts with many medications and could conceivably impair the effectiveness of conventional treatments for ADD.
It is commonly said that, sugar, food allergens, and food additives, such as artificial colors, contribute to ADD symptoms. However, the body of published evidence regarding these therapies remains incomplete and contradictory.5-19,31,35 The best evidence regards artificial colors and food additives. In a 2012 review of 35 controlled trials, researchers focused on the possible effects that artificial food coloring may have on ADHD symptoms.39 A sub-analysis of 6 trials involving 195 children with ADHD found that restricting these dyes resulted in an improvement in symptoms. A larger sub-analysis of 20 trials and 794 children provided further evidence by showing that children experienced a worsening of symptoms when they returned to their normal diet after following a restriction diet. However, most of these improvements were not observed when the analysis was narrowed to include only FDA-approved food additives. The researchers estimated that about 8% of children may experience worsening ADHD symptoms when exposed to artificial food coloring.
One study found that the supplement melatonin may be helpful for improving sleep in children with ADHD taking stimulant medications.33 However, melatonin does not appear to be helpful for ADHD symptoms per se.34
Suntheanine, a supplement that contains a compound of black tea, showed some promise in improving sleep quality in boys with ADHD.40
References[ + ]
1. Re' O. 2-Dimethylaminoethanol (deanol): a brief review of its clinical efficacy and postulated mechanism of action. Curr Ther Res Clin Exp. 1974;16:1238-1242.
2. Knobel M. Approach to a combined pharmacologic therapy of childhood hyperkinesis. Behav Neuropsychiatry. 1974-1975;6:87-90.
3. 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;26:233-239.
4. Kleijnen J, Knipschild P. Niacin and vitamin B 6 in mental functioning: a review of controlled trials in humans. Biol Psychiatry. 1991;29:931-941.
5. Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child. 1993;69:564-568.
6. Egger J, Carter CM, Graham PJ, et al. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet. 1985;1:540-545.
7. Egger J, Stolla A, McEwen LM. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet. 1992;339:1150-1153.
8. Rapp DJ. Does diet affect hyperactivity? J Learn Disabil. 1978;11:383-389.
9. Rapp DJ. Food allergy treatment for hyperkinesis. J Learn Disabil. 1979;12:608-616.
10. Rippere V. Food additives and hyperactive children: a critique of Conners. Br J Clin Psychol. 1983;22:19-32.
11. Rippere V. Placebo-controlled tests of chemical food additives: are they valid? Med Hypotheses. 1981;7:819-823.
12. Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy. 1994;72:462-468.
13. Schoenthaler SJ, Crook WG, Brenner A, et al. Sugar and children's behavior [letters]. N Engl J Med. 1994;330:1901-1904.
14. Weiss B. Food additives and environmental chemicals as sources of childhood behavior disorders. J Am Acad Child Psychiatry. 1982;21:144-152.
15. Weiss B, Williams JH, Margen S, et al. Behavioral responses to artificial food colors. Science. 1980;207:1487-1489.
16. Wolraich ML, Wilson DB, White JW. The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA. 1995;274:1617-1621.
17. Schmidt MH, Mocks P, Lay B, et al. Does oligoantigenic diet influence hyperactive/conduct-disordered children—a controlled trial. Eur Child Adolesc Psychiatry. 1997;6:88-95.
18. Breakey J. The role of diet and behaviour in childhood. J Paediatr Child Health. 1997;33:190-194.
19. Krummel DA, Seligson FH, Guthrie HA. Hyperactivity: is candy causal? Crit Rev Food Sci Nutr. 1996;36:31-47.
20. Voigt RG, Llorente AM, Jensen CL, et al. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. J Pediatr. 2001;139:189-196.
21. 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.
22. Arnold LE, Kleykamp D, Votolato NA, et al. Gamma-linolenic acid for attention-deficit hyperactivity disorder: placebo-controlled comparison to D-amphetamine. Biol Psychiatry. 1989;25:222-228.
23. Van Oudheusden L, Scholte H. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids. 2002;67:33.
24. 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;10:149-156.
25. Field TM, Quintino O, Hernandez-Reif M, et al. Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Adolescence. 1998;33:103-108.
26. Bilici M, Yildirim F, Kandil S, et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2004;28:181-190.
27. 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 Apr 8. [Epub ahead of print]
28. Arnold LE, Pinkham SM, Votolato N. Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivifty disorder? J Child Adolesc Psychopharmacol. 2000;10:111-117
29. Stevens L, Zhang W, Peck L, et al. EFA supplementation in children with inattention, hyperactivity, and other disruptive behaviors. Lipids. 2003;38:1007-1021.
30. Lyon MR, Cline JC, Totosy de Zepetnek J, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci. 2001;26:221-228.
31. Schab DW, Trinh NH. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr. 2004;25:423-434.
32. Pintov S, Hochman M, Livne A, et al. Bach flower remedies used for attention deficit hyperactivity disorder in children-A prospective double blind controlled study. Eur J Paediatr Neurol. 2005 Oct 26. [Epub ahead of print]
33. Weiss M, Wasdell M, Bomben M, et al. Sleep Hygiene and Melatonin Treatment for Children and Adolescents With ADHD and Initial Insomnia. J Am Acad Child Adolesc Psychiatry. 2006 Mar 10. [Epub ahead of print]
34. Van der Heijden KB, Smits MG, Van Someren EJ, et al. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry. 2007;46:233-241.
35. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Sep 5. [Epub ahead of print]
36. Weber W, Vander Stoep A, McCarty RL, et al. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA. 2008;299:2633-2641.
37. Johnson M, Ostlund S, Fransson G, Kadesjö B, Gillberg C. Omega-3/omega-6 fatty acids for attention deficit hyperactivity disorder: a randomized placebo-controlled trial in children and adolescents. J Atten Disord. 2009;12:394-401.
38. Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. 2011;50(10):991-1000.
39. Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012;51(1):86-97.
40. Lyon MR, Kapoor MP, Juneja LR. The effects of L-theanine (Suntheanine) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Altern Med Rev. 2011;16(4):348-354.
Last reviewed December 2015 by EBSCO CAM Review Board
Last Updated: 12/15/2015
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