Are you looking for alternatives to traditional stimulant medications to treat your child’s ADHD?
Is there a more natural way to treat ADHD?
Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder that is associated with the following symptoms. There are two broad groups.
Inattention that negatively impacts social, occupational, and or academic functioning.
Symptoms in this category include:
- Forgetfulness
- Distractibility
- Inability to listen
- Frequently loses items
- Trouble organizing
- Difficulty in maintaining attention
- Not able to follow instructions or finish tasks
- Avoids activities that require attention
- Fails to focus on details or makes careless mistakes on schoolwork
Hyperactivity and impulsivity
symptoms include:
- Excessive talking
- Impulsive (doesn’t wait turn and blurts out answers)
- Runs and climbs when not appropriate to do so
- Cannot remain seated
- Fidgets or squirms in seat
- Constantly on the go
- Unable to engage in quiet activities
ADHD was estimated to affect 9.4% of children in the US, according to a national parent survey in 2016.
Of these children, 77% were receiving treatment. This treatment was as follows:
- 30% treated with medication alone.
- 15% received only behavioral treatment.
- 32% received both medication and behavioral treatment.
NSCH 2016: Redesigned as an online and mail survey, estimate includes children 2-17 years of age. 1
Is there a reasonable alternative to stimulants for these children?
Polyunsaturated Fatty Acids (PUFAs)
Omega-3 fatty acids must be obtained through our diet. The following foods are high in this substance:
- Fish (salmon, trout, sardines, halibut, herring, albacore tuna)
- Walnuts
- Flaxseed oil
- Canola oil
Other foods that contain omega-3 fatty acids are:
- Clams
- Shrimp
- Catfish
- Cod
- Spinach
The Western diet consists of a higher quantity of omega-6 fatty acids. Foods that contain omega-6 are poultry, eggs, cereals, nuts, whole-grain bread, and durum wheat.
Why is this important in ADHD?
One meta-analysis that contained ten trials, including 699 children with ADHD found that PUFA supplementation produced a small but significant improvement compared to a placebo group.2
A significant relationship was also shown between the eicosapentaenoic acid (EPA) dose within the omega-3 supplements, and the efficacy obtained.3
The mechanism of action of the omega-3 in the treatment of ADHD is likely due to its effect on serotonin and dopamine neurotransmission.4
There have been other systemic reviews that have raised questions about the use of omega-3 supplementation in the treatment of ADHD.5
The methods in these reviews were different, which may have led to altered results.
I believe an omega-3 supplement is worth a try. The possible benefits seem to outweigh the risks involved.
Melatonin
Melatonin is a hormone produced by our bodies to regulate circadian rhythm. Adults and children have used melatonin as a sleep aid.
As a pharmacist, it is the first-line medication for sleep that I recommend. Melatonin has very few side effects and is non-addictive.
We know that sleep problems are common in children with ADHD. We also know that a lack of sleep can cause symptoms such as hyperarousal, disinhibition, and executive function problems that mimic ADHD symptoms.
The two studies I located showed melatonin was effective for sleep but had no effect on ADHD symptoms.
Iron
A meta-analysis published in 2012 found that children and adolescents with ADHD had lower serum ferritin levels than healthy controls.
A small randomized, placebo-controlled study showed children with ADHD, and low serum ferritin levels demonstrated significant improvement when receiving ferrous sulfate (80 mg/day) compared to placebo.
More studies with a larger sample size are needed before iron can be recommended as a standard treatment of ADHD.
Pycnogenol
Pycnogenol is an extract obtained from the bark of the French maritime pine. Pycnogenol was the subject of the very first post I made to this blog. You can read this post by clicking here!
Case reports have shown Pycnogenol can improve ADHD symptoms either alone or in combination with psychostimulants.
A four week randomized, placebo-controlled trial of 61 children found Pycnogenol significantly improved ADHD symptoms according to the Child Attention Problems (CAP) teacher rating scale.
A significant improvement was not found using Connor’s Parent and Teacher Ratings, but trends were similar to CAP.
This study also found lower catecholamine levels in the urine of the pycnogenol subjects suggesting a possible effect on catecholamine formation or metabolism.
More studies are needed to determine the safety and efficacy of Pycnogenol in the treatment of ADHD.
Parents are often reluctant to put their children on medications to treat ADHD. At times, this leads to the use of nutritional supplements that are ineffective in the treatment of this disorder.While researching this topic, I discovered supplements such as St. John’s Wort, carnitine, and Gingko Biloba either were ineffective or had minimal evidence to support their use in the treatment of ADHD.
These substances may also produce unwanted side effects.
Zinc can be useful when a deficiency exists, but this is rare in the United States. There have been studies in Israel, Turkey, and Poland demonstrating lower zinc levels in children diagnosed with ADHD.
Correcting this deficiency of zinc can improve ADHD symptoms.
Magnesium supplementation has been tried, but no randomized, placebo-controlled trials are available to support its use.
Iron supplementation has shown to be effective in one small study.
Pycnogenol has also shown positive results although more studies are needed to confirm its benefits in the treatment of ADHD.
The most robust evidence available at this time is for omega-3 fatty acid supplementation in the treatment of ADHD and melatonin for sleep-onset insomnia.
The Omega-3 fatty acids are still not as effective as traditional ADHD medications, but they may be beneficial in those with mild symptoms.
Melatonin is always my first recommendation for patients of all ages for insomnia.
Please feel free to send me an email if you have any questions regarding this post or any other subject regarding medications, diet, fitness, or happiness.
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Michael J. Brown, RPh, BCPS, BCPP
Mr. Brown is a Clinical Pharmacist specializing in pharmacotherapy and psychiatry.
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- http://childhealthdata.org/learn/NSCH/topics_questions/2016-nsch-guide-to-topics-and-questions
- Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry. Oct; 2011 50(10):991– 1000. [PubMed: 21961774]
- Bloch MH, Qawasmi A. Omega-3 fatty acid supplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematic review and meta-analysis. Journal of the American Academy of Child and Adolescent Psychiatry. Oct; 2011 50(10):991– 1000. [PubMed: 21961774]
- Chalon S. Omega-3 fatty acids and monoamine neurotransmission. Prostaglandins Leukot Essent Fatty Acids. Oct-Nov;2006 75(4–5):259–269. [PubMed: 16963244]
- Gillies D, Sinn J, Lad SS, Leach MJ, Ross MJ. Polyunsaturated fatty acids (PUFA) for attention deficit hyperactivity disorder (ADHD) in children and adolescents. The Cochrane database of systematic reviews. 2012; 7:CD007986. [PubMed: 22786509]
- Puri BK, Martins JG. Which polyunsaturated fatty acids are active in children with attention-deficit hyperactivity disorder receiving PUFA supplementation? A fatty acid validated meta-regression analysis of randomized controlled trials. Prostaglandins, leukotrienes, and essential fatty acids. May; 2014 90(5):179–189.
- Weiss MD, Wasdell MB, Bomben MM, Rea KJ, Freeman RD. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. Journal of the American Academy of Child and Adolescent Psychiatry. May; 2006 45(5):512–519. [PubMed: 16670647]
- Van der Heijden KB, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child and Adolescent Psychiatry. Feb; 2007 46(2):233–241. [PubMed: 17242627]
- Scassellati C, Bonvicini C, Faraone SV, Gennarelli M. Biomarkers and attentiondeficit/ hyperactivity disorder: a systematic review and meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry. Oct; 2012 51(10):1003–1019. e1020. [PubMed: 23021477]
- Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatric neurology. Jan; 2008 38(1):20–26. [PubMed: 18054688]
- Trebaticka J, Kopasova S, Hradecna Z, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. European child & adolescent psychiatry. Sep; 2006 15(6):329–335. [PubMed: 16699814]