Attention-deficit Hyperactivity Disorder
Causes and cures
In general, the principles behind the none-medication treatment for attention-deficit/hyperactivity disorder (ADHD) (ADHD the umbrella term includes hyperactive type, inattentive type, and combined type) are looking at brain function and optimizing that. The foundations of proper body and brain function are exercise, nutrition, hydration, sleep, sunshine, outdoor activity, and good relationships including healthy parent child relationships and proper discipline and boundaries. Anything in the environment impacts brain function. The brain is the most complex and therefore sensitive organ in the body. There are about one hundred billion neurons in the brain and each of these has about one thousand connections. Every thought, feeling, behavior and experience is a connection of neurons in the brain and those connections change, weaken, and strengthen, thus changing the brain structurally with every passing second as we experience life. It requires inference from the integration of several lines of evidence to understand the foundations of the pathophysiology of ADHD. Once one understands the pathophysiology then one can understand that medication is not the only solution to ADHD symptoms.
This short video reviews ADHD theory in a simple format.
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Diets rich in processed food, sugar, fat, oil or the typical western diet, lead to brain dysfunction. This documentary explains some of the emerging and ongoing research that is showing that sugar for example acts like a drug in the brain and leads to dysfunction in the reward pathway where dopamine is the primary neurotransmitter. Dopamine dysfunction is implicated in ADHD. The possible connection between diet and ADHD is then that reward dopamine channels are .
Better Brain Health DW Documentary
Feingold diet for ADHD eliminates sugar along with additives such as food dyes and many other foods. Many children have had improvements in behavior and ADHD symptoms on this diet. These articles review evidence for nutrition interventions for ADHD symptoms.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4322780/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5266211/
One other source of nutrition information in general is nutritionfacts.org. The information there is based on evidence in the literature.
https://nutritionfacts.org/?s=adhd
What diet do I recommend?
I think the evidence shows that the best diet for anyone is a whole food plant-based diet free from processed food as much as possible. Books by T. Colin Campbell such as Whole and The China Study and by Michael Greger, “How Not to Die” highlight the overwhelming evidence for a plant only diet. Processed highly palatable foods disrupt the normal dopamine reward system in the brain. The book “The Pleasure Trap” highlights the pitfalls of hyperpalatable foods. The western diet leads to nutrient excesses and deficiencies including an imbalance between omega-6 and omega-3 fatty acids important for the brain to function normally. There has been some research with mixed results in supplementing omega-3 fatty acids. Whole plant foods have a better balance between omega-6 and omega-3. Foods high in the omega-3 fatty acids I recommend have the added benefit of reducing inflammation in the body are walnuts, flax seed, chia seed, and mung beans. Eating more vegetables and especially greens improve the fatty acid balance. If supplements are preferred an algae based product is my best recommendation. There is good evidence that the western diet and by that I mean fast food, processed food, high fat, high sugar diet increases the risk of ADHD. More on this later.
Meats and other animal products are often high sources of chemical pollutants because animals concentrate the chemicals from the environment, that are impossible to avoid (even in organic meat), in their bodies. Eating low on the food chain reduces chemical exposure. Higher levels of chemicals have been found in the urine of children with ADHD. https://pediatrics.aappublications.org/content/125/6/e1270.short
https://www.nature.com/articles/s41390-018-0200-z
Data from the Centers for Disease Control and Prevention (CDC) indicate a rise in prevalence of ADHD from 6.3% in 1997 to 9.5% in 2010. ADHD is more common in boys with the prevalence being 12.4% ...
www.nature.com
Attention-Deficit/Hyperactivity Disorder and Urinary Metabolites of Organophosphate Pesticides
OBJECTIVE: The goal was to examine the association between urinary concentrations of dialkyl phosphate metabolites of organophosphates and attention-deficit/hyperactivity disorder (ADHD) in children 8 to 15 years of age. METHODS: Cross-sectional data from the National Health and Nutrition Examination Survey (2000–2004) were available for 1139 children, who were representative of the general US population. A structured interview with a parent was used to ascertain ADHD diagnostic status, on the basis of slightly modified criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition . RESULTS: One hundred nineteen children met the diagnostic criteria for ADHD. Children with higher urinary dialkyl phosphate concentrations, especially dimethyl alkylphosphate (DMAP) concentrations, were more likely to be diagnosed as having ADHD. A 10-fold increase in DMAP concentration was associated with an odds ratio of 1.55 (95% confidence interval: 1.14–2.10), with adjustment for gender, age, rac
pediatrics.aappublications.org
The elimination diet I have recommended before, and families that were able to implement it have found helpful, is reducing the diet for one to three weeks to a few foods. If meats must be eaten lamb or venison is recommended, rice, quinoa, pears, organic bananas and organic potatoes. After one week and improvement in symptoms of ADHD has happened then adding food back one at a time looking for return of symptoms can pinpoint foods that are contributing to behavior problems. If symptoms do not improve with one week, then stretching the trial longer until symptoms do improve. Admittedly this is a difficult prospect but for some who are reluctant to use medication the results are worth it. (If one wants to eliminate animal products and the diet has previously been heavy in animal products then remember that the child will need to eat much more food than previously to get the same calories. Buy large quantities of fruits and other produce rather than the smaller amounts eaten previously.) Studies show that when families change the diet in this way it can actually lower the overall food cost.
The introduction of screen entertainment has had I would argue a major impact on children’s development. Screen-time is a big issue. Screen-time is not so much a problem for what the child is watching, although that can be a problematic issue, but from the activities it is replacing. We have only so many hours in a day. The brain wires based on what we do, what we think about, what experiences we have. I would say that screen-time takes away from normal brain development. Free play is important for brain development and when children are in school and other supervised activities all day long and then go to screens, free imaginative play is neglected. The brain does not wire normally under these circumstances. There is much evidence that unsupervised play is critical for brain development.
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0213995&type=printable Screen-time is associated with inattention problems in preschoolers: Results from the CHILD birth cohort study
I do not unfortunately have a book I have read that I would recommend to parents for ADHD. There are many books and there is going to be in every book some accurate and some not accurate information. There is a valid critique in one book I have not read and that is ADHD is not one thing (this could be said for any psychiatric diagnosis). I believe there are multiple etiologies within the umbrella of what is called ADHD, and they all result in brain dysfunction. I agree with that analysis, but the book has some things I do not agree with even in the first 2 pages. (ADHD Does not Exist, The Truth About Attention Deficit and Hyperactivity Disorder)
Rough and tumble play is greatly curtailed or reduced in our current society. All mammals engage in rough and tumble play. The brain needs and especially boys need rough and tumble play to understand proper bodily limits. Free and rough play is vital for development. How many hours per day does your child have free play? How often do you wrestle with your son or daughter? I have recently started doing some physical gymnastic type play with my four year old son and he loves it. I know from experience how easy it is to pop a phone in my son’s hand when he is bugging me and I need to get something done. Every time we are tempted to do this we need to think about our child’s brain development.
Sleep is very important for brain function also. Sleep is required to renew neurotransmitters and promote daytime alertness and attention. Many children with ADHD do not sleep well. Children typically need at least 10 hours of sleep if not more. Light suppresses melatonin your body’s natural sleep hormone. Light from screens and especially blue light is the biggest culprit in suppressing melatonin. Cherries and kiwi are two of the foods that have melatonin in them, and a snack of such foods can be helpful before bed. Good sleep hygiene includes having a bedtime routine that is as consistent as possible, cutting off screens an hour before bedtime, read a bedtime story (reading to children helps instill a desire to learn to read. One of my classmates in medical school did not read until she was 10 years old, and she is today a doctor. It’s not too late to instill in your child a love for reading. In my home growing up we did not have any screens, no T.V. and of course other screens were not even a thing, our greatest pleasure besides playing outside was our parents reading to us), avoiding caffeine and chocolate, and having complete darkness at bedtime. Sleep aides such as over the counter melatonin and l-theanine have some effectiveness for children that still have trouble sleeping even with a good bedtime routine. Establishing good sleep habits is worth putting a lot of effort into for proper brain development and especially in the treatment of ADHD. Sleep habits are a foundation for a healthy body and a healthy brain.
Another non-medication treatment for ADHD is a prescription video game for ADHD. It is designed for 8-12 year-old children, and it is FDA approved which means research has shown significant improvements to attention and focus with the game. The game is played 30 minutes daily. It shuts down after 30 minutes so no need to worry that it will cause excessive screen time.
I do sometimes suggest or prescribe complimentary and alternative therapies for ADHD. Some supplements that have some evidence for their use are Gingko Biloba, Magnesium, multi-micronutrient formulations, zinc, iron, inositol, and l-methylfolate (deplin).
Coaching for ADHD persons to help them with organizational skills and other behavior change strategies is also a treatment for the disorder.
In summary, exercise, sleep, proper nutrition, outdoor and play activity all contribute to brain health, development and proper function. Medication use and diagnosis of ADHD is common. Every medication has risks and benefits. Lifestyle changes I am suggesting do not typically have any adverse side-effects. They only have benefits.