Attention Deficit–Hyperactivity Disorder
Also indexed as: ADD, ADHD, Attention Deficit Disorder,
Hyperactivity
Hyperactivity—is it normal behavior or ADHD? When a child
is more than rambunctious, it is important to know the facts. According to research or other
evidence, the following steps may be helpful:
- Supplement with essential fatty acids
- Getting approximately 186 mg of EPA (eicosapentaenoic acid), 480
mg of DHA (docosahexaenoic acid), 96 mg of GLA (gamma-linolenic acid), 864 mg of linoleic
acid, and 42 mg of arachidonic acid supplies fatty acids important for brain function
- Check out L-carnitine
- To improve behavior, take 100 mg of this supplement for each 2.2
pounds of body weight a day, with a maximum of 4 grams a day
- Give magnesium a go
- 200 mg a day can address possible deficiency of this mineral that
may influence ADHD
- Try the Feingold diet
- Work with the Feingold Association or a diet specialist to reduce
or eliminate food additives and other food issues that may affect ADHD
These recommendations are not comprehensive and are not intended to replace
the advice of your doctor or pharmacist. Continue reading the full ADHD article for more
in-depth, fully-referenced information on medicines, vitamins, herbs, and dietary and
lifestyle changes that may be helpful.
About ADHD
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; 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.
Product ratings for
attention deficit–hyperactivity disorder
What are the symptoms?
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.
Medical options
The most commonly prescribed prescription drugs, methylphenidate (Ritalin®, Metadate®) and amphetamine mixtures (Adderall®), are
considered stimulant drugs, though they produce a paradoxical calming effect in people with
ADHD. Another medication less frequently used is pemoline (Cylert®).
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
Lead and other heavy-metal exposures have been linked to ADHD.13 14
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.
Vitamins 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.
In a double-blind study, children with ADHD who received 15 mg of zinc per day for six weeks showed significantly
greater behavioral improvement, compared with children who received a placebo.16
This study was conducted in Iran, and zinc deficiency has been found to be quite common in
certain parts of that country. It is not clear, therefore, to what extent the results of this
study apply to children living in other countries.
In a double-blind study, supplementation with
L-carnitine for eight weeks resulted in clinical improvement in 54% of a group of boys
with ADHD, compared with a 13% response rate in the placebo group.17 The amount of
L-carnitine used in this study was 100 mg per 2.2 pounds of body weight per day, with a
maximum of 4 grams per day. No adverse effects were seen, although one child developed an
unpleasant body odor while taking L-carnitine. Researchers have found that this uncommon side
effect of L-carnitine can be prevented by supplementing with riboflavin. Although no serious
side effects were seen in this study, the safety of long-term L-carnitine supplementation in
children has not been well studied. This treatment should, therefore, be monitored by a
physician.
A deficiency of several essential fatty acids has been observed in some children with ADHD
compared with unaffected children.18 19 One study gave children with
ADHD evening primrose oil supplements in an
attempt to correct the problem.20 Although a degree of benefit was seen, results
were not pronounced. In a 12-week double-blind study, children with ADHD were given either a
placebo or a fatty-acid supplement providing daily: 186 mg of eicosapentaenoic acid (EPA), 480
mg of docosahexaenoic acid (DHA), 96 mg of gamma-linolenic acid (GLA), 864 mg of linoleic
acid, and 42 mg of arachidonic acid. Compared with the placebo, the fatty-acid supplement
produced significant improvements in both cognitive function and behavioral
problems.21 No adverse effects were seen. In a preliminary trial, supplementation
with approximately 400 mg of flaxseed oil and 25 mg of vitamin C, each twice a day for three
months, was associated with an improvement of symptoms in children with ADHD.22
In a preliminary study of women in Italy,
iodine deficiency severe enough to cause
hypothyroidism during pregnancy was
associated with an increased risk of ADHD in their children.23 Women who are
contemplating pregnancy or who are pregnant should get adequate amounts of iodine in their
diet and should discuss with their healthcare provider whether iodine supplementation is
appropriate.
Iron status, as measured by the serum
ferritin concentration, was significantly lower in a group of children with ADHD than in
healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared
with 18% of the healthy children.24 Since iron deficiency can adversely affect mood
and cognitive function, iron status should be assessed in children with ADHD, and those who
are deficient should receive an iron supplement. In a case report, a young boy with both ADHD
and iron deficiency showed considerable improvement in behavior after receiving an iron
supplement.25
B vitamins, particularly vitamin B6, have also been used for ADHD. Deficient
levels of vitamin B6 have been detected in some ADHD patients.26 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.27 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.28 29
Are there any side effects or interactions?
Refer to the individual supplement for information about any side effects or interactions.
Herbs that may be helpful
Though it has not been studied, theoretically
shelled hemp seed may be useful for people with ADHD due to its content of essential fatty
acids.30 31
Are there any side effects or interactions?
Refer to the individual herb 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. 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;4:9.
17. Van Oudheusden LJ, Scholte HR. Efficacy of carnitine in the treatment
of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent
Fatty Acids 2002;67:33–8.
18. 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.
19. 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.
20. 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.
21. 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;26:233–9.
22. Joshi K, Lad S, Kale M, et al. Supplementation with flax oil and
vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD).
Prostaglandins Leukot Essent Fatty Acids 2006;74:17–21.
23. Vermiglio F, Lo Presti VP, Moleti M, et al. Attention deficit and
hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine
deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin
Endocrinol Metab 2004;89:6054–60.
24. Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in
children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med
2004;158:1113–5.
25. Konofal E, Cortese S, Lecendreux M, et al. Effectiveness of iron
supplementation in a young child with attention-deficit/hyperactivity disorder.
Pediatrics 2005;116:e732–4.
26. 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.
27. 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.
28. 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.
29. Haslam RHA. Is there a role for megavitamin therapy in the treatment
of attention deficit hyperactivity disorder? Adv Neurol 1992;58:303–10.
30. 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
31. Fitzsimmons S. Hemp seed oil: Fountain of youth? Br J
Phytother 1998;5:90–6.