Natural Treatment Options for Attention Deficit Disorder

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.

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.