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

June 17, 2008
Well
Weighing Nondrug Options for A.D.H.D.
By TARA PARKER-POPE

<http://topics.nytimes.com/top/reference/timestopics/people/p/tara_parkerpope/index.html?inline=nyt-per> About 2.5 million children in the United States take stimulant drugs forattention and hyperactivity<http://health.nytimes.com/health/guides/symptoms/hyperactivity/overview.html?inline=nyt-classifier> problems. But concerns about side effectshave prompted many parents to look elsewhere: as many as two-thirds ofchildren with attention deficit hyperactivity disorder<http://health.nytimes.com/health/guides/disease/attention-deficit-hyperactivity-disorder-adhd/overview.html?inline=nyt-classifier> , orA.D.H.D., have used some form of alternative treatment. The most common strategy involves diet<http://health.nytimes.com/health/guides/specialtopic/food-guide-pyramid/overview.html?inline=nyt-classifier> changes, like giving up processedfoods, sugars and food additives<http://health.nytimes.com/health/guides/nutrition/food-additives/overview.html?inline=nyt-classifier> . About 20 percent of children with thedisorder have been given some form of herbal therapy; others have triedsupplements like vitamins<http://health.nytimes.com/health/guides/nutrition/vitamins/overview.html?inline=nyt-classifier> and fish oil or have used biofeedback, massageand yoga. While some studies of alternative treatments show promise, there islittle solid research to guide parents. That is unfortunate, because forsome children, prescription drugs aren't an option. The drugs have been life-changing for many children. But nearlyone-third experience worrisome side effects, and a 2001 report in TheCanadian Medical Association Journal found that for more than 10percent, the effects could be severe - including decreased appetite<http://health.nytimes.com/health/guides/symptoms/appetite-decreased/overview.html?inline=nyt-classifier> and weight loss, insomnia<http://health.nytimes.com/health/guides/specialtopic/insomnia-concerns/overview.html?inline=nyt-classifier> , abdominal pain<http://health.nytimes.com/health/guides/symptoms/abdominal-pain/overview.html?inline=nyt-classifier> and personality changes. Although the drugs are widely viewed as safe, many parents were alarmedwhen the Food and Drug Administration<http://topics.nytimes.com/top/reference/timestopics/organizations/f/food_and_drug_administration/index.html?inline=nyt-org> ordered in 2006that stimulants like Adderall, Ritalin<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/ritalin_drug/index.html?inline=nyt-classifier> and Concerta carrywarnings of risk for sudden death, heart attacks and hallucinations<http://health.nytimes.com/health/guides/symptoms/hallucinations/overview.html?inline=nyt-classifier> in some patients.What about the alternatives? Last week, The Journal of the AmericanMedical Association reported<http://jama.ama-assn.org/cgi/content/abstract/299/22/2633> that thefirst study of the herb St. John's wort worked no better than a placeboto counter A.D.H.D. But the trial, of 54 children, lasted only eightweeks, and even prescription drugs can take up to three months to show ameasurable effect. But the larger issue may be that in complementary medicine, onetreatment is rarely used alone, making the range of alternative remediesdifficult to study. Natural treatments may well be beneficial, said thereport's lead author, Wendy Weber, a research associate professor at theschool 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, ginkgobiloba and ginseng. There are no reliable data on echinacea; a 2001study showed improvement after four weeks in children using ginkgo andginseng, but there was no control group for comparison.There is more hope for omega-3 fatty acids, found in fish and fish-oilsupplements. A review last year in the journal Pediatric Clinics ofNorth America concluded that a "growing body of evidence" supported theuse of such supplements for children with A.D.H.D.As for dietary changes, a 2007 study<http://www.thelancet.com/journals/lancet/article/PIIS0140673607613063/abstract> in The Lancet examined the effect of artificial coloring andpreservatives on hyperactive behavior in children. After consuming anadditive-free diet for six weeks, the children were given either aplacebo beverage or one containing a mix of additives in two-weekintervals. In the additive group, hyperactive behaviors increased.The study caused many pediatricians to rethink their skepticism about alink between diet and A.D.H.D. "The overall findings of the study areclear and require that even we skeptics, who have long doubted parentalclaims of the effects of various foods on the behavior of theirchildren, admit we might have been wrong," reported a February issue ofAAP Grand Rounds, a publication of the American Academy of Pediatrics<http://topics.nytimes.com/top/reference/timestopics/organizations/a/american_academy_of_pediatrics/index.html?inline=nyt-org> .Data on sugar avoidance are less persuasive. Several studies suggestthat any link between sugar and hyperactivity is one of parentalperception, rather than reality. In one study, mothers who were told thechild received sugar reported more hyperactive behavior, even when thefood was in fact artificially sweetened. Mothers who were told the childreceived a low-sugar snack were less likely to report worse behavior.One interesting option is a form of biofeedback therapy in whichchildren wear electrodes on their head and learn to control video gamesby 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 ofoptions. For instance, the best way to tell whether dietary changes mayhelp is to eliminate the foods and then reintroduce them, monitoring thechild's behavior all the while. The best evidence may come from ateacher who is unaware of any change in diet. The Integrative Pediatrics Council, at www.integrativepeds.org<http://www.integrativepeds.org> , offers a list of pediatricians whooffer alternative treatments. Its chairman, Dr. Lawrence D. Rosen, chiefof pediatric integrative medicine at Hackensack University MedicalCenter in New Jersey, says parents should seek a holistic approach. Buthe notes that that may well include prescription drugs."I do prescribe medications in my practice, and there are kids whoselives have been saved by that," he said. "But it's a holistic approachthat is very different than one pill, one symptom. We're addressing notjust the physical, chemical needs of kids, but their total emotional andmental health<http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/mentalhealthanddisorders/index.html?inline=nyt-classifier> ."well@nytimes.com well@nytimes.com>