Attention deficit hyperactivity disorder (ADHD) is a very common condition that affects approximately 3-5% of the population based on current estimates. Inattention and distractibility are two features of this condition that may occur with or without hyperactivity.

For those who suffer from this common condition, it causes significant social or academic impairment.  Further estimates suggest that it is far more common in boys than in girls.  Typical ratios suggest that it is actually  3-5 times more common in boys.

Proper diagnosis and treatment are tremendously important for those who have this condition.  Those diagnosed with ADHD are at risk for substance abuse disorders later on in life.  There is a strong familial component to ADHD as well.

One interesting story of the importance of proper treatment for this condition involved a classmate of mine during medical school.  After high school, he went on to work as a delivery man for a number of years.  Later on, he was diagnosed with ADHD as an adult and received appropriate treatment which enabled him to enroll in a university.  Today, he’s working as a successful radiologist.

The diagnosis of Attention-Deficit/Hyperactivity Disorder (ADHD) is a complex process that typically involves a comprehensive evaluation by a qualified healthcare professional. Diagnosing ADHD requires a careful assessment of an individual’s behavior, symptoms, and developmental history. Here are the key steps and considerations in the ADHD diagnosis process:

1. Clinical Interview: The initial step in diagnosing ADHD involves a detailed clinical interview with the individual and, in the case of children, their parents or caregivers. The healthcare professional will ask about the individual’s current symptoms, their duration, and the impact of these symptoms on daily functioning. They may also inquire about the individual’s medical and family history.
2. Diagnostic Criteria: The healthcare professional will refer to the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), as mentioned in the previous response. The individual’s symptoms must meet these criteria for an ADHD diagnosis to be considered.
3. Developmental and Behavioral History: A thorough developmental history is essential, especially for children, to determine whether symptoms of inattention, hyperactivity, and impulsivity were present before the age of 12. This information is typically gathered from parents, caregivers, or teachers who can provide insights into the individual’s behavior over time.
4. Behavioral Observations: The healthcare professional may directly observe the individual’s behavior, both in clinical settings and through reports from teachers or other relevant parties. These observations help confirm the presence and severity of ADHD symptoms in different environments.
5. Psychological and Neuropsychological Testing: While not always necessary, psychological and neuropsychological assessments may be conducted to rule out other potential conditions or to gain further insight into an individual’s cognitive functioning. These tests can help identify specific cognitive strengths and weaknesses.
6. Rule Out Other Conditions: It’s crucial to rule out other medical or psychological conditions that can mimic or co-occur with ADHD. Conditions such as anxiety, depression, learning disorders, and certain medical conditions may have symptoms that overlap with ADHD.
7. Functional Impairment Assessment: ADHD diagnosis requires evidence that the symptoms significantly interfere with daily functioning in various settings, such as school, work, home, or social relationships. The healthcare professional will assess the extent to which the symptoms impact the individual’s life.
8. Collateral Information: Gathering information from multiple sources, such as teachers, parents, or other caregivers, can provide a more comprehensive view of the individual’s behavior and symptoms in different contexts.
9. Duration and Consistency: For an ADHD diagnosis, symptoms must have persisted for at least six months and be consistent across different situations.
10. Exclusion Criteria: The healthcare professional will ensure that the symptoms are not better explained by another medical or psychological condition, such as a mood disorder, anxiety disorder, or substance use.
11. Discussion with the Individual: In the case of adolescents and adults, it’s important to engage in a discussion with the individual about their experiences and how symptoms affect their daily life. This helps ensure that the diagnosis takes into account the individual’s perspective.

Once all of these steps are completed, the healthcare professional can make an informed diagnosis of ADHD and recommend appropriate treatment options. Treatment for ADHD often includes a combination of behavioral interventions, psychoeducation, and, in some cases, medication.

It’s important to note that the diagnostic process may vary slightly depending on the age of the individual being evaluated, the healthcare professional’s approach, and the available resources. A comprehensive evaluation by a qualified healthcare provider is essential to ensure an accurate diagnosis and appropriate treatment plan for ADHD.

Natural Treatment Options?

In the vast majority of cases, adequate treatment of ADHD involves medication with stimulants such as methylphenidate (Ritalin) or dextroamphetamine (Dexedrine) being among the most commonly prescribed.  Newer regimes based on these molecules, but longer duration of action are now more commonly prescribed.  In Canada, even extended-release methylphenidate preparations such as Concerta® require a triplicate prescription which is why the extended-release amphetamine derivatives tend to be more commonly prescribed (such as Vyvanse®)

However, a recent study published in the journal, Lipids in Health and Disease, suggest that there may be some effective natural treatment options (Huss et al , 2010)

Specifically, this study involved supplementation with omega-3 and omega-6 fatty acids (Polyunsaturated fatty acids) along with magnesium and zinc.  Polyunsaturated fatty acids (PUFAs) are often touted as ‘brain food’ since they comprise neuronal cell membranes and may play a role in signal transmission between nerve cells.

Though the mechanism of Zinc Sulfate in ADHD is not yet understood, a recent study found that a dosage of 55 mg/d of zinc sulfate was effective in treating symptoms of ADHD in children (Dodig-Curković et al, 2009).  The study authors noted that many children with ADHD are also deficient in the mineral, zinc.

Study design:

For this particular study which also involved PUFAs, they used an open-label, observational-based design, which does not provide as robust of evidence as a randomized double-blind placebo-controlled trial.

However, they did monitor a total of 810 children between the ages of 5-12 for a period of at least 3 months.  They used a food supplement called ESPRICO(R) which contained the previously listed ingredients as follows:

Study results:

“After 12 weeks of consumption of a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc most subjects showed a considerable reduction in symptoms of attention deficit and hyperactivity/impulsivity assessed by SNAP-IV.”

Study author conclusions:

“Our results suggest a beneficial effect of a combination of omega-3 and omega-6 fatty acids as well as magnesium and zinc consumption on attentional, behavioural, and emotional problems of children and adolescents. Thus, considering the behavioural benefit in combination with the low risk due to a good safety profile, the dietary supplementation with PUFA in combination with zinc and magnesium can be recommended.”

The study authors did not observe any significant side effects related to the treatment group who consumed the Esprico(R) supplement.  As previously noted, the study results are limited in the context of lack of blinding or randomization.  Further, with the combined therapy, it’s also impossible to determine which component(s) were efficacious especially since zinc sulfate alone has shown positive effects on symptoms of ADHD.

Future studies are needed to confirm these results and determine the relative importance of omega-3 / omega-6 fatty acids in the treatment of ADHD. Previous studies have shown some promising results as well.

This Research in Perspective?

Of note, in contrast to the conclusions made in the previous study, a newer Cochrane Review concluded that there’s little evidence that polyunsaturated fatty acids (PUFA) provide any benefit in treating the symptoms of ADHD in children and adolescents (Cochrane Review).

In another recent update, researchers in New York cite the importance of screening for iron deficiency in children with ADHD (source).  One particular concern that they mention is that iron deficiency could be one cause of poor response to psychostimulants.

References:

• Huss M, Volp A, Stauss-Grabo M. Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems – an observational cohort study. Lipids Health Dis. 2010 Sep 24;9(1):105.
• Dodig-Curković K, Dovhanj J, Curković M, Dodig-Radić J, Degmecić D. [The role of zinc in the treatment of hyperactivity disorder in children] Acta Med Croatica. 2009 Oct;63(4):307-13.