ADHD Alternative/Complementary Treatments
Essential Fatty Acids
Essential fatty acids (EFAs), also known as omega-3 and omega-6 fatty acids, have been claimed to have beneficial effects as a treatment for attention-deficit-hyperactivity disorder (ADHD). Animal experiments have provided information about the role of EFA in the brain, and several mechanisms of EFA activity are well known. Clinical studies and review papers of EFA blood levels and EFA supplementation trials in children with ADHD support that Children with ADHD present lower levels of blood EFAs, and open-label EFA supplementation trials in ADHD raise EFA blood levels and improve symptoms of ADHD. Randomized controlled trials, however, have generally been unsuccessful in demonstrating any behavioural treatment effects.
INTERPRETATION: current findings do not support the use of EFA supplements as a primary or supplementary treatment for children with ADHD. However, the risk-benefit ratio may be worthwhile.
Pycnogenol
Pycnogenol is an antioxidant plant extract from the bark of the French maritime pine tree, reduces ADHD in children, according to a 2006 study that was published in the journal of European Child & Adolescent Psychiatry.
The study sampled 57 outpatients with ADHD with an average age of 9 years, from the Department of Child Psychology at the Children University Hospital in Slovakia. Forty-one patients received Pycnogenol and 16 received placebo. Patients were not supplemented with any other drugs or with vitamins E or C during the study. Participants in the Pycnogenol group received 1 milligram of Pycnogenol or placebo for every kilogram of body weight, on a daily basis each morning, for one month.
Stress hormones were quantified from urine samples of the children taken before and after supplementation with either Pycnogenol or the placebo for a one-month period. After a one-month discontinuation of treatment, a third urine sample was taken that revealed that ADHD symptoms had recurred. The stress hormone levels had increased again during the period when children had stopped taking Pycnogenol, suggesting the effect of Pycnogenol on stress hormones accounts for the improvement of inattention and hyperactivity of the children.
The results reveal Pycnogenol lowers stress hormones by 26.2 percent in the case of adrenaline and decreases neurostimulant dopamine by 10.8 percent, which plays an important role in brain physiology involving learning, cognition, attention and behavior.
The studies findings support observations that children with ADHD have dramatically elevated levels of stress hormones and that these may increase heart rate and blood pressure to cause excitement, arousal and irritability, as compared to children without ADHD symptoms.
ADHD symptoms recurred after a one-month discontinuation of Pycnogenol treatment. Participants were given a basic psychiatric examination by teachers and parents one month after the study began and one month after the end of the study. After one month of treatment, there was a significant drop in hyperactivity and inattention compared to the start of the study and placebo. The researchers also found that, one month after termination of treatment, symptoms returned to their levels as measured before the study started in the Pycnogenol group, strongly suggesting the antioxidant’s effect on reducing ADHD symptoms.
INTERPRETATION: This report appears to support the use of pcynogenol in the treatment of ADHD. What is confusing for this psychiatrist, is that our understanding of ADHD is that it is related to lower levels of DA and NE in certain brain regions. I wonder what criteria were used to diagnose ADHD. I wonder whether Youth in Slovokia dont have fairly high levels of stress and anxiety that may mimic ADHD and result in higher stress hormones? At this time, the risk/benefit ratio suggests that a trial seems reasonable, with caution.
Visual therapy
Visual problems have been implicated in several developmental conditions, such as dyslexia. There is no scientific support for any theory claiming specific ocular exercises or coloured lens can alleviate ADHD (Lennerstrand & Ygge, 1992; Baumgaertel, 1999). There is also no evidence to support anecdotal reports of improvements in ADHD symptoms after introducing prismatic lenses (Baumgaertel, 1999). Any concerns about a child’s vision should be referred to an optometrist immediately.
INTERPRETATION: There are no scientific studies supporting the use of vision therapy to treat ADHD.
Homeopathy
200 years ago, Fr Hahnemann developed a therapeutic system based on the concept that illness resulted from an imbalance of “vital energies”. This therapeutic system is now known as Homeopathy. Homeopathic treatments generally consist of highly individualised blends of plant, animal and/or mineral extracts. Homeopathic treatment regimes have become very popular throughout Europe and the United States. Linde et al (1994) conducted a careful review of homeopathic treatments and found them to be more effective than a placebo for various conditions.
Several homeopathic studies have also been conducted on ADHD children (Lamont, 1997) and statistically significant improvements have been shown. But these studies were not blinded (the investigators knew which children were getting which treatment and this may have influenced the outcome).
INTERPRETATION: The mechanisms at work in homeopathy are unknown and, therefore, further research is required before any definitive answer can be given on homeopathic treatments.
Auditory Stimulation
For a long time there has been a growing movement concerning the role of music in emotional and cognitive processes. However, there is only one study (that we know of) that has explored auditory stimulation as a possible treatment for ADHD. Abikoff et al. (1996)reported that the ability of ADHD boys to solve arithmetic problems improved when they were allowed to listen to their favourite music.
A French otalaryngologist, A. Tomatis has developed the Tomatis Metohd of Sound training. This system is based on the theory that auditory integration is critical to brain maturation and learning. It proposes that improvements to focus and attention can be achieved by combining auditory stimulation and listening training.
INTERPRETATION: There are no scientific investigations into this technique and the number of training sessions required (at least 75) is concerning.
Hynotherapy
Hypnosis is not a very effective means of controlling ADHD (Baumgaertel, 1999).
INTERPRETATION: Hypnosis has little to no effect on the core symptoms of ADHD. It is effective, though, in removing problems associated with the ADHD, such as sleep disturbances or tics (Sugarman, 1996)
Biofeedback
The goal of biofeedback is the self regulation of physiological processes. This is achieved by monitoring a physiological process using a computerized feedback system. The threshold for a particular physiological activity is set and the patient’s task is to maintain or better the threshold. Generally biofeedback has been used (successfully) on people trying to lower their blood pressure. More recently, however, the technique has started to show positive results with children that have ADHD. Lubar (1997) and Mann et al. (1992) demonstrated that children with ADHD children with ADHD have increased theta (4-7.75 Hz) and decreased beta 1 (12.75-21 Hz) when compared with children without ADHD, with Lubar’s study showing improvements in 12/19 children.
Most of these treatment all state that they are most effective when part of a multi-modal treatment.