Alternative Treatments for ADHD

Katherine Kiker, M.S.

Elimination Diets

Feingold hypothesis
Children are sensitive to dietary salicylates and artificially added colors, flavors, and preservatives Learning and behavior problems (including ADHD) can be reduced or eliminated by removing these substances

Elimination Diets

At least 8 controlled studies have demonstrated significant improvement (w/elimination diet) compared to a placebo condition, or deterioration after introducing offending substances Typical elimination diet: lamb, chicken, potatoes, rice, apple, banana, cabbage, cauliflower, broccoli, brussel sprouts, cucumber, celery, carrots, salt, pepper, calcium, and vitamins

Elimination Diets

Although some people seem to respond well, more research is needed to determine who are diet responders

What proportion are responders from the whole ADHD population?

Elimination of Sugar & Candy

Good news- No Effects!!!

Controlled 3-week trial of a sugar-restricted diet (Wolraich et al., 1994) Cross-sectional studies: ADHD children dont consume more sugar than Non-ADHD children (Kruesi et al., 1987)

Not a widely applicable tx for ADHD

But, may help for those children who are responders to elimination diet

Discussion: Modifying Diets to Improve ADHD Symptomatology??

Nutritional Supplements

Amino Acid Supplementation

Reportedly low levels of amino acids in ADHD Short-term benefit for tryptophan, tyrosine, or phenyalanine

However, no benefit beyond 2-3 months, as tolerance develops

Essential Fatty Acid Supplementation

Lower levels in ADHD kids Further control studies needed

Nutritional Supplements

Glyconutritional Supplements

In open trial (n=17) with these supplements, parents reported reductions in inattention, hyperactivity-impulsivity, and oppositional behavior Placebo-controlled trials needed Megadose: no effects, risk of toxicity Open 30-day trial with 17 non-anemic ADHD boys, improvement in parents Conners scores (Sever et al., 1997) Little research 50 kids with ADHD and magnesium deficiency; 6 months; significant decrease in parent and teacher Conners scores

Vitamin Supplementation

Iron Supplementation

Zinc supplementation

Magnesium Supplementation

Chinese Herbals

Chinese herbal cocktail compared to methylphenidate Significant improvement rates comparable to stimulate meds, but more improvement on IQ scores and fewer side effects Need placebo-controlled, double-blind studies
Little data on its efficacy Loo (1998) found decreases on parent and teacher Conners

Acupuncture

Noted that kids with most severe ADHD could not comply with tx

Meditation

Mental training that can regulate attention and brain training? Research in non-clinical samples has shown improvements on attentional blink tests Rationale for using mindfulness meditation with ADHD: can impact symptoms of inattention and impulsivity, associated neurocognitive deficits of inhibition, and help with stress, anxiety, and depression

Mindful Meditation

3 steps:

bringing attention to an attentional anchor (usually a sensory input such as a breath Noting that distraction occurs and letting go of distraction Refocusing or reorienting attention back to the attentional anchor
8 week mindful meditation group w/ adults & adolescents Prepost improvements in self-reported ADHD symptoms and test performance on tasks measuring attention and cognitive inhibition Next steps: controlled clinical study

Pilot Study (Zylowska et al., 2007)

Neurotherapy EEG Feedback, Neuro feedback

Basis: ADHD kids produce greater EEG slow wave (theta) activity, and less beta activity compared to normal controls Neurotherapy: teach ppl to normalize their brainwave responses to stimuli EEG responses to stimuli on a computer are analyzed, then feedback is provided (visual displays, auditory tones) to show how well they are doing good candidates: stimulant non-responders, parents afraid of long-term affects on stimulant meds Need assessment: neurometric assessment with computer analysis of a minimum of 19 active scalp electrode sites necessary to confirm or disconfirm greater theta and less beta activity to key attentional tasks

New technology: video games!!

Game becomes more difficult as brain waves of ADHD child show that attention is waning

Child is rewarded for decreasing time spent in slow wave activity, and increasing time spent in fast activity required for focused attention and concentration on tasks

Does it work?

Barkley 1995, CHADD newsletter: "there is not enough evidence from well controlled scientific studies to support the effectiveness of EEG biofeedback for AD/HD children"

However:

Studies using different control groups (waitlists, stimulant meds, cognitive therapy) have demonstrated that neurofeedback reduces inattention, impulsivity, task performance variability, and hyperactivity (Rossiter, 1998) Outcome studies with samples as large as 530 show reductions in ADHD symptoms Studies used objective test data (CPT, IQ tests, TOVA) + behavior rating scales
Time-consuming (need 6-8 months, up to 80 sessions) Need to identify who works better for this treatment Must have assessment: some practitioners dont use the neurometric assessment

Limitations:

Instant Alert Hypnosis!

Barabasz & Barabasz: intended to enhance vigilance performance for either focused attention or optimal situational awareness depending on the specific hypnotic instructions given experimentally controlled studies show that Instant Alert Hypnosis can increase frontal EEG beta activity independent of neurofeedback procedure

patient instructed to roll eyes up, as if trying to look at forehead Instructed to look at psychologists thumb as thumb is slowly moved from nose to forehead instructions are then given to take notice of breathing, relaxation, calm confidence and special calm alertness Once clinician observes subjective signs of hypnosis, patient given instructions: "in this special state of alertness you will be able to focus your attention anyway you like, you can concentrate as completely as your desire. Then, patient told to let their eyes roll down and enjoy state of alertness Finally, specific attentional task is done

Efficacy?
Instant alert hypnosis w/neurofeedback: significantly better than neurofeedback alone Positive and substantial clinical changes in average of 23 sessions (3-14 weeks of treatment for subjects) Decreases in inattentiveness, hyperactivity, impulsivity

Other treatments for which I could find no information!

Mirror feedback Antifungal treatments

Discussion
How

would you respond to a parent who mentioned wanting to try one of these alternative treatments?

ADHD Coaching

What is ADHD Coaching?

http://www.addcoachacademy.com/whatisadd.html http://www.addcoachacademy.com/welltrained.htm l

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