It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States.

Attention-Deficit Hyperactivity Disorder (ADHD) is a diagnosis applied to children and adults of all ages who consistently display certain characteristic behaviors over a period of time. The most common behaviors fall into three categories: inattention (difficulty focusing on any one thing for a given period of time), hyperactivity (difficulty sitting still and quietly), and impulsivity (inability to curb ones immediate reactions and think before acting). A subgroup of people with attention difficulties are found to have inattention and impulsivity without hyperactivity. These people are classified as having ADD (attention deficit disorder) not ADHD.

Currently there is no known single causative factor behind the development of ADD or ADHD. Many factors, singularly or in combination, may play a role in the development of these conditions including genetics, nutrition, exposure to environmental toxins, and/or cultural influences and expectations.

Since there may be other scientific evidence that is not reported in the major U.S. biomedical databases, this list of treatments cannot be considered comprehensive.

Types of Treatment in Integrative Medicine:

Biofeedback

Scientific evidence suggests that individualized dietary management may be effective in some children. Trace element supplementation also may be beneficial when specific deficiencies are present. Nootropics, herbs, and homeopathy are being seriously researched regarding their role in neurologic functioning, but evidence to support their role in the specific treatment of ADHD is inconsistent or lacking. Self-regulatory techniques such as hypnotherapy and biofeedback do not alter core symptoms but may be helpful in controlled secondary symptoms. Auditory stimulation with individualized music may help to improve situational performance in cognitive tasks.
Baumgaertel, A., Alternative and controversial treatments for attention-deficit/hyperactivity disorder, Department of Pediatrics, Vanderbilt University School of medicine, Nashville, Tennessee, Pediatric Clinics of North America. 46(5):977-92, 1999.

Studies indicate clinical improvement using neurotherapy biofeedback is largely related to measurable improvements in the EEG signature, evidenced by declining theta/beta ratios over the frontal/central cortex and/or reduced theta/alpha band amplitudes. Neurotherapy offers an effective alternative for patients whose treatment is limited by side effects, poor medication response, or those who refuse medication management.
Nash, JK. Treatment of attention deficit hyperactivity disorder with neurotherapy, Behavioral Medicine Associates, Inc., MN 55434, Clinical Electroencephalography. 31(1):30-7, 2000.

Literature searches dating as far back as 1968 were carried out in order to review the scientific literature on EEG biofeedback treatment of attention deficit disorder (ADD). Many anecdotal and case reports provided promising evidence. Yet due to methodological problems as well as a scarcity of research, few definitive conclusions as to the efficacy of enhanced alpha and hemisphere-specific EEG biofeedback training can be drawn. One of the more promising EEG biofeedback treatment paradigms involves theta/beta training. Academic, intellectual, and behavioral gains have been reported in studies involving this approach. Training in sensorimotor rhythm (SMR), the rhythm that governs the setpoint, or the poise, of the motor system, has also shown significant behavioral and cognitive changes. However, research into theta/beta and SMR training have also been marred by methodological inadequacies and lack of sufficient follow-up studies. Further high quality research is necessary.
Ramirez PM, Desantis D, and Opler, LA, EEG biofeedback treatment of ADD. A viable alternative to traditional medical intervention? Doctoral Program in Clinical Psychology at Long Island University (Brooklyn Campus), Brooklyn, NY 11201, Annals of the New York Academy of Sciences. 931:342-58, 2001.

Cognitive Behavioral Therapy

The nature of cognitive functioning, the treatments, and the outcome of treatment studies are described and examined for aggression, anxiety, depression and attention-deficit hyperactivity. In looking at ADHD, the author suggests that the multifaceted nature of ADHD has implications for determining the type of treatment to follow. The most widely used treatment approach, stimulant medication, effectively addresses attention but may not always improve symptoms in complex cognitive skills. Data suggests that cognitive-behavioral training can reduce one feature of ADHD- impulsivity, yet it has not been uniformly found to rectify other features of ADHD. The overall effectiveness of cognitive-behavioral therapy as a treatment of ADHD has remained relatively inconsistent; although some studies have shown promising preliminary results, others have failed to show a positive impact. It is important to note that the form of cognitive-behavioral therapy utilized varied substantially across studies. As a result, some researchers suggest that effective cognitive-behavioral treatment will require understanding the specific nature of the child’s problems accompanied by a more tailored application of the various components of the treatment to the particular child’s needs.
Kendall, PC, Cognitive-behavioral therapies with youth: guiding theory, current status, and emerging developments, Department of Psychology, Temple University, Philadelphia, PA 19122, Journal of Consulting & Clinical Psychology. 61(2):235-47, 1993.

Herbal Medicine

Improvements at two weeks were seen for the anxious-shy attribute as well as for the psychosomatic attribute. At four weeks, further improvements were seen in the social problems attribute on the Conners’ ADHD index and the DSM-IV hyperactive-impulsive attribute. Five of the thirty-six subjects reported adverse events, only two of which were considered related to the study medication. AD-FX treatment may improve symptoms of ADHD and should encourage further research on the use of ginseng and Ginko biloba extracts to treat ADHD symptoms.
Lyon MR, Cline JC, Totosy de Zepetnek J, et al, Effect of the herbal extract combination Panax quinquefolium and Ginko biloba on attention-deficit hyperactivity disorder: a pilot study, Oceanside Functional Medicine Research Institute, Nanaimo, BC, Journal of Psychiatry & Neuroscience. 26(3):221-8, 2001.

Homeopathy

Two statistical comparisons were made: the scores of the initial placebo group with the initial homeopathic group, and the scores of the initial placebo group with their scores after they received homeopathic medicines. Statistically significant differences were found for both comparisons, providing support for the hypothesis that homeopathic treatment is superior to placebo treatment for ADHD.
Lamont J., Homeopathic treatment of attention deficit hyperactivity disorder: a controlled study, British Homoeopathic Journal. 86: 196-200, 1997.

Massage Therapy

Type of intervention: A 15-minute upper-body massage after school for 10 consecutive school days

Primary outcome measure(s): Ratings of mood (Happy Face Scale), fidgeting, self-report measures of depression and empathy, and teacher assessments measuring attention on a task and behavior problems (Conners scale).

Outcome: The massage therapy group demonstrated longer lasting positive effects, such as spending more time on classroom tasks and receiving significantly better scores on the Conners scale. They also showed short-term benefits, reporting feeling happier after the massage sessions and were less fidgety on observation. No significant changes were noted on the depression or empathy scales. The relaxation therapy group did not display significant improvement on any of the primary outcome measures. It appears that massage therapy may be an important addition to the standard treatment for ADHD and may be useful in cases where standard therapies have been ineffective or not well tolerated.
Field TM, Quintino O, Hernandez-Reif, et al, Adolescents with attention deficit hyperactivity disorder benefit from massage therapy, Touch Research Institute, University of Miami School of Medicine, Adolescence. 33(129): 103-108, 1998.

Nutrition/Supplementation

This article reviews the literature on the possible connection between essential fatty acid (EFA) deficiency and ADHD. In a cross-sectional study of 6-12 year old boys from Indiana, the authors found that 53 subjects with ADHD had significantly lower proportions of key fatty acids in the plasma polar lipids and in red blood cell total lipids than did 43 control subjects. A further finding was that a subgroup of 21 subjects who exhibited a greater frequency of EFA deficiency symptoms (thirst, frequent urination, and dry hair) had significantly lower plasma proportions of arachidonic acid (AA) and docosahexanoic acid (DHA) than did the other 32 subjects with ADHD who had few symptoms of EFA deficiency. This study also revealed an inverse relationship between total plasma n-3 fatty acid proportions and behavioral assessment scores (Conner’s Parent Rating Scale) and teacher scores of academic abilities. This was not the case for n-6 fatty acids. However, low plasma proportions of both types of fatty acids were associated with a higher frequency of symptoms indicative of EFA deficiency. The authors consider three possible explanations for why certain ADHD children have lower proportions of AA and DHA in their plasma phospholipids: 1) intake-related factors, such as marginal consumption of EFA, 2) inefficient conversion to long chain polyunsaturated fatty acids (LCPUFA) from EFA, and 3) enhanced metabolism of LCPUFAs. The authors are currently testing these explanations in a double-blind, placebo-controlled trial to determine whether LCPUFA deficiency contributes to abnormal behavior in children with ADHD who suffer from EFA deficiency.
Burgess JR, Stevens L, Zhang W, et al, Long-chain polyunsaturated fatty acids in children with attention-deficit hyperactivity disorder, Department of Foods and Nutrition, Purdue University, West Lafayette, IN 47907-1264, American Journal of Clinical Nutrition. 71(1 Suppl):327S-30S, 2000.

Twelve children (24%) showed significant behavioral improvements in two behavior ratings when consuming a special diet versus the control group. Of the 36 children using methylphenidate, 44% showed greater improvement in behavior ratings than the children on an oligoantigenic diet. Subjects receiving both treatments showed similar results as those taking the drug alone. Although dietary treatment was only effective in a minority of children (24%), it should not be neglected as a possible means of treating hyperactive/disruptive children and merits further investigation.
Schmidt MH, Mocks, P, Lay B, et al, Does oligoantigenic diet influence hyperactive/conduct-disordered children – A controlled trial, Central Institute of Mental Health, Department of Child/Adolescent Psychiatry, 68159 Mannheim, Germany, European Child & Adolescent Psychiatry. 6(3):88-95, 1997.

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