Weighing Nondrug Options for ADHD

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Weighing Nondrug Options for A.D.H.D.

By TARA PARKER-POPE

June 17, 2008

http://www.nytimes.com/2008/06/17/health/17well.html

About 2.5 million children in the United States take stimulant drugs for

attention and hyperactivity problems. But concerns about side effects

have prompted many parents to look elsewhere: as many as two-thirds of

children with attention deficit hyperactivity disorder, or A.D.H.D.,

have used some form of alternative treatment.

The most common strategy involves diet changes, like giving up processed

foods, sugars and food additives. About 20 percent of children with the

disorder have been given some form of herbal therapy; others have tried

supplements like vitamins and fish oil or have used biofeedback, massage

and yoga.

While some studies of alternative treatments show promise, there is

little solid research to guide parents. That is unfortunate, because for

some children, prescription drugs aren't an option.

The drugs have been life-changing for many children. But nearly

one-third experience worrisome side effects, and a 2001 report in The

Canadian Medical Association Journal found that for more than 10

percent, the effects could be severe --- including decreased appetite

and weight loss, insomnia, abdominal pain and personality changes.

Although the drugs are widely viewed as safe, many parents were alarmed

when the Food and Drug Administration ordered in 2006 that stimulants

like Adderall, Ritalin and Concerta carry warnings of risk for sudden

death, heart attacks and hallucinations in some patients.

What about the alternatives? Last week, The Journal of the American

Medical Association reported that the first study of the herb St. 's

wort worked no better than a placebo to counter A.D.H.D. But the trial,

of 54 children, lasted only eight weeks, and even prescription drugs can

take up to three months to show a measurable effect.

But the larger issue may be that in complementary medicine, one

treatment is rarely used alone, making the range of alternative remedies

difficult to study. Natural treatments may well be beneficial, said the

report's lead author, Weber, a research associate professor at the

school of naturopathic medicine at Bastyr University in Kenmore, Wash.

" We just need to do more studies and document the effect. "

Other herbal treatments for the disorder include echinacea, ginkgo

biloba and ginseng. There are no reliable data on echinacea; a 2001

study showed improvement after four weeks in children using ginkgo and

ginseng, but there was no control group for comparison.

There is more hope for omega-3 fatty acids, found in fish and fish-oil

supplements. A review last year in the journal Pediatric Clinics of

North America concluded that a " growing body of evidence " supported the

use of such supplements for children with A.D.H.D.

As for dietary changes, a 2007 study in The Lancet examined the effect

of artificial coloring and preservatives on hyperactive behavior in

children. After consuming an additive-free diet for six weeks, the

children were given either a placebo beverage or one containing a mix of

additives in two-week intervals. In the additive group, hyperactive

behaviors increased.

The study caused many pediatricians to rethink their skepticism about a

link between diet and A.D.H.D. " The overall findings of the study are

clear and require that even we skeptics, who have long doubted parental

claims of the effects of various foods on the behavior of their

children, admit we might have been wrong, " reported a February issue of

AAP Grand Rounds, a publication of the American Academy of Pediatrics.

Data on sugar avoidance are less persuasive. Several studies suggest

that any link between sugar and hyperactivity is one of parental

perception, rather than reality. In one study, mothers who were told the

child received sugar reported more hyperactive behavior, even when the

food was in fact artificially sweetened. Mothers who were told the child

received a low-sugar snack were less likely to report worse behavior.

One interesting option is a form of biofeedback therapy in which

children wear electrodes on their head and learn to control video games

by exercising the parts of the brain related to attention and focus.

Research has suggested that the method works just as well as medication,

and many children report that they enjoy it.

The challenge is finding a doctor who will help explore the range of

options. For instance, the best way to tell whether dietary changes may

help is to eliminate the foods and then reintroduce them, monitoring the

child's behavior all the while. The best evidence may come from a

teacher who is unaware of any change in diet.

The Integrative Pediatrics Council, at www.integrativepeds.org, offers a

list of pediatricians who offer alternative treatments. Its chairman,

Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at

Hackensack University Medical Center in New Jersey, says parents should

seek a holistic approach. But he notes that that may well include

prescription drugs.

" I do prescribe medications in my practice, and there are kids whose

lives have been saved by that, " he said. " But it's a holistic approach

that is very different than one pill, one symptom. We're addressing not

just the physical, chemical needs of kids, but their total emotional and

mental health. "

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