Attention Deficit–Hyperactivity Disorder

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

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, and 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.

Checklist for Attention Deficit–Hyperactivity Disorder

Rating Nutritional Supplements Herbs
2Stars Magnesium  
1Star B vitamins
Evening primrose oil
Vitamin B6		  
3Stars 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 An herb is primarily supported by traditional use, or the herb or supplement has little scientific support and/or minimal health benefit.

What are the symptoms of ADHD? 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 behavior.

How is it treated? The main drug treatment for ADHD, Ritalin® (methylphenidate), is similar to amphetamine drugs. Although methylphenidate is a stimulant, it has a paradoxically calming effect in people with ADHD.

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

Lead13 and other heavy-metal exposures14 have been linked to ADHD. 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.

Nutritional supplements 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 behavior.

A deficiency of several essential fatty acids has been observed in some children with ADHD compared with unaffected children.16 17 One study gave children with ADHD evening primrose oil supplements in an attempt to correct the problem.18 Although a degree of benefit was seen, results were not pronounced.

B vitamins, particularly vitamin B6, have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.19 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.20 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.21 22

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

References:

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. 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.

17. 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.

18. 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.

19. 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.

20. 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.

21. 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.

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