Lining the shelves in supermarkets, health stores and pharmacy front shops, you’ll see a large number of products for various different ailments, most of which will promise health, vitality and, quite often, few to no side effects.

These products can be as simple as the novel multivitamin or as complicated as herbal diet programmes. If you have a problem with your body, there’s probably some kind of supplement you can take for it. When your child has been diagnosed with Attention-Deficit/Hyperactivity Disorder and the horror stories about the awful things the prescribed medicines do to children’s bodies and brains start to get tossed around like confetti at a wedding, you may find yourself wondering if you should wander around the front shop instead of filling a prescription at the dispensary.

What is the rationale for using natural remedies for ADHD?

 When treating a condition, the best place to start is to identify the underlying cause of that condition and then try to act on that specific factor or pathway. In the case of ADHD there is a lack of conclusive evidence regarding its aetiology. This, combined with arguments regarding the ideal treatment of the disorder, has resulted in an ever-increasing range of therapies for ADHD management. For many parents, the use of prescription medication for ADHD has poor connotations as a result of media reports (and unsubstantiated articles scattered across the internet), while there is also an overwhelming school of thought which dictates that if something is “natural”, it is a better option than pharmaceutically manufactured drugs. This perspective, however, may be unhealthy in that the efficacy of many of these alternative treatments has not been scientifically proven.

A number of complementary and alternative therapies have been developed which target hypothesised ADHD aetiological factors. This article will focus on some of the more commonly used natural alternatives.

Essential Fatty Acids

 The effects of essential fatty acid (EFA) intake on central nervous system (CNS) functioning has become a highly researched area, with deficiencies in these fats being linked to the development of ADHD. It is thought that EFAs, particularly arachidonic acid (AA), eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are influential in ADHD as these have roles in structural and functional development and maintenance of neuronal mem­branes. EFAS cannot be synthesised by the body and are sourced from dietary intake, with alpha linoleic acid (ALA) (a precursor to other EFAs) being available from plants con­taining vegetable oils such as soybeans, canola and flaxseed, while fatty fish such as salmon and mackerel provide EPA and DHA. Studies in children with ADHD identified reduced EFA plasma concentrations, lead­ing to the hypothesis that EFA deficiency may be related to some of the core behavioural deficits seen in ADHD.

Studies evaluating EFA supplementation as a treatment for ADHD have, thus far, not established any benefits due to their use. EFA supplementation is not recommended for the treat­ment of ADHD in children or adults by the National Institute for Health and Clinical Excel­lence.

Vitamins, minerals and amino acids

A number of different vitamins, amino acids and minerals are reported to modulate dopamine (DA) and noradrenalin (NA) levels via different mechanisms. Amino acids like tyrosine and phenyl­alanine are precursors (a chemical which is part of a biological synthesis to form another chemical compound) to L-dopa, a precursor to DA, thus supplementation of these amino acids is thought to bolster DA levels. Folic acid, niacin and iron have roles as co-factors in the conversion of these amino acids to L-dopa, while pyridoxine is required for conversion of L-dopa to DA. Vitamin C is a co-factor for the metabolic pathway in which NA is synthesised. A study has reported that ADHD-diagnosed individuals have significantly lower levels of these amino acids, as well as tryptophan, histidine and isoleucine than controls, thus resulting in the theory that a deficiency in amino acid transport and/or absorption may influence the development of ADHD. It is thought that supplementation with these amino acids, minerals, vitamins and herbs can modulate CNS neurotransmitter levels and thereby treat the underlying cause of ADHD.

Deficiencies in magnesium and zinc due to poor dietary behaviour are also thought to play a role in ADHD development. Zinc is a co-factor in neurotransmitter, melatonin and fatty acid metabolism. Impulsive behaviours and socialisation skills were found to improve in a study examining the effect of zinc supplementation in conjunction with stimulant treatment. Some studies have shown reduced magnesium levels in the serum and red blood cells of children with ADHD and reported improvement of symptoms following supplementation of magnesium with pyridoxine. Little evidence supports the use of megavitamin doses.

Massage and meditation

Massage is often part of different complementary healing systems and is thought to activate an innate healing ability of the body through the release of endogenous endorphins. Owing to observed effects of promoting relaxation, massage therapy has been investigated as a management option for ADHD. Small studies have been conducted to assess the benefits of massage therapy in ADHD, with reports of improved classroom behaviour and mood. These studies are, however, considered to be preliminary due to the small sample sizes, lack of generalisability and lack of comparison to established ADHD treatments.  No studies have de­mon­­strated beneficial effects on ADHD due to chiropractic manipulation.

Yoga stems from Ayurvedic principles which aim to modify the body’s physiology through the use of breathing techniques, postures and meditation. Yoga has been investigated as a treatment for ADHD due to its possible CNS effects and the perceived benefits in stress reduction and improved concentration. Results from one study of improved rating scale scores indicate that yoga may be beneficial as an adjunct to ADHD therapy.

Biofeedback or Neurofeedback

This is a non-invasive treatment and has been used in individuals with ADHD since the 1970s. It is based on reports that ADHD-subjects were found to have higher rates of electro-encephalography (EEG) abnormalities. Most ADHD-individuals, in comparison with controls, had excess (theta) slow wave activity, associated with a state of low arousal; decreased fast sensorimotor rhythm, inversely associated with movement; and decreased (beta) fast wave activity, asso­ci­at­ed with attention and memory processes. The aim of EEG biofeedback mechanisms is to normalise these rhythms through training indi­vid­uals to be able to control their brainwave activity and thus reduce the symptoms of ADHD.

When undergoing biofeedback training, the clinician programmes the desired thresholds, based on treatment goals, into the equipment. Electrodes are placed on the subject’s head to allow for detection of brain wave activity while the subject is given exercises, often in the form of a video game, to encourage concentration. When the physiologic changes due to these exercises near and surpass the programmed thresholds, auditory or visual feedback is provided to the subject as positive reinforcement for the desired changes. The effect on slow cortical potentials due to this self-regulation is postulated to involve similar neuro-biologic feedback pathways to medication.

Studies evaluating the efficacy of biofeedback training have, however, been inconclusive. Many studies had serious methodological flaws, including small sample sizes, lack of control groups and lack of long-term follow-up, while only three compared biofeedback to methylphenidate use. Drawbacks to this therapy are, however, its high cost, high num­ber of therapy sessions required and the widespread lack of medical aid re-imburse­ment for its use.

The bottom line

The interventions listed in this article are non-invasive and considered to be safe. When contemplating use of these methods, it is advised to discuss the decision with your healthcare professional (and your child). Please do not withhold prescribed treatment from your child in favour of implementing these methods, especially given that their effectiveness has not been conclusively proven and may result in impairing the overall management of your child’s condition. - Judith Regnart

*This article is copyrighted. You are welcome to share it, without altering the contents, giving proper credit to the author and link to this article. All views expressed in articles are that of the person being interviewed. Please consult your care giver for professional advice on your birth choice.

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