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Complementary and Alternative Medicine ADHD

Source: Rojas NL and Chan E. Old and New Controversies in the Alternative Treatment of Attention-Deficit Hyperactivity Disorder.
MRDD Research Reviews. 2005; 11: 116-130.

It is estimated that approximately 54% of American children with ADHD use complementary and alternative medicine (CAM) therapies. Some of the most common CAM therapies used for ADHD include:

Biofeedback

Rationale:

Studies have shown that children with ADHD have more EEG abnormalities than control children, including increased theta wave rhythms, decreased fast sensorimotor rhythm, and decreased beta rhythm.

Method

  • Audio/visual stimuli are used to give children with ADHD feedback on their wave rhythm frequencies, with the
    hope that they will be able to consciously normalize these rhythms and alter their AHDH symptoms
  • There are four different subtypes of biofeedback:
    • SMR biofeedback
    • Theta/beta biofeedback
    • Alpha biofeedback
    • Hemisphere specific biofeedback

Rojas and Chan’s conclusions on the evidence:

  • There is no conclusive scientific evidence that biofeedback is an effective treatment for ADHD
  • Most of the studies in the area have serious design flaws

Play Attention (www.playattention.com)

Rationale:

The brain has the ability to build new neural networks and strengthen existing neural networks to compensate for ADHD symptoms.

Method:

EEG biofeedback-based system that is different than traditional biofeedback in that it integrates educational and behavior shaping strategies.

  • Child wears helmet with sensors that record theta/beta wave activity
  • Child’s attention controls characters in computer-based educational games that are designed to improve time on
    task, visual tracking, short term memory sequencing, and discriminatory processing
  • Computer program gives written feedback on the child’s performance and sets goals for each training session
    based on previous performance
  • Company recommendations:
    • Use for children and adults ages 6 and over
    • Use for a minimum of 40 hours to promote permanent skill acquisition
  • Do not use with a person who has a history or possibility of seizures, closed head trauma, or who experiences
    anxiety
  • Cost
    • Home-based unit: $1795
    • Institutional unit: $2500
    • World-wide “Play Attention” Learning Centers: $35-250/hour

Rojas and Chan’s conclusions on the evidence:

  • There is no conclusive scientific evidence that Play Attention significantly improves ADHD symptoms
  • The company cites two non-peer reviewed studies and testimonials as evidence that the product is effective (http://www.playattention.com/research-links/)

Diet Modification

Rationale:

Children with ADHD may have some food/food component sensitivities that are causing their behavioral symptoms.

Method:

The Feingold (additive free) diet:

  • Artificial/natural salicylates, artificial food colorings, and artificial sweeteners are eliminated from the diet

Rojas and Chan’s conclusions on the evidence:

There is no conclusive evidence that the Feingold diet is an effective treatment for ADHD.

  • Several reviews and a meta-analysis conclude that the majority of the studies on the Feingold diet have serious design flaws
  • Well-designed studies have yielded negative/unclear results
  • Some well-designed studies have demonstrated that some children (not necessarily children with ADHD) may be sensitive to specific artificial colors/preservatives (i.e. tartrazine and calcium propionate)

Method:

The oligoallergenic/oligoantigenic (few foods) diet (OAD):

  • All foods except for a defined group of foods with a low risk of causing an allergy are eliminated from the diet
  • Typical OAD diet used in research setting: two meats (usually turkey and lamb), two carbohydrate sources (usually rice and potatoes), a few fruits (usually bananas, apples, and/or pears), a few vegetables, water, salt, and pepper
  • Double-blind, placebo-controlled food challenge used to determine if food elimination improves symptoms

Rojas and Chan’s conclusions on the evidence:

  • Four studies using food challenge methodology reported improved parental behavior ratings during the OAD and placebo periods of the study
  • Study sample sizes were small

Method:

The sugar restriction diet

  • Refined sugar is eliminated from the diet
  • Many parents strongly believe that sugar causes hyperactivity in their children

Rojas and Chan’s conclusions on the evidence:

  • Very few studies support a causal relationship between sugar and hyperactivity
  • Animal studies: rats exposed to amphetamines respond to sugar with hyperactivity
  • Systemic review of 16 double-blind, placebo controlled studies found that sugar has no effect on children’s behavior/cognitive performance; did not rule out potential effects for specific subsets of children

Diet Modification Cautions:

  • Elimination diets have the potential to be deficient in vitamins, minerals, protein, and fiber
  • Referral to a registered dietitian (R.D.) is warranted for any child who is placed on a restrictive diet
  • Refined sugar (soda, candy, and other sweets) can generally be safely eliminated from children’s diets without placing them at nutritional risk

Fatty Acid Supplementation

Rationale:

Studies have found low plasma concentrations of fatty acids in children with ADHD.

Method

  • Fatty acid dose varied based on study
  • Examples of different preparations:
    • 350-360 mg linoleic acid and 40-45 mg of gamma-linolenic acid (GLA)
    • 186 mg eicosapentaenoic acid (EPA), 480 mg docosahexanoic acid (DHA), 96 mg GLA, 864 mg cis-linoleic
      acid, and 42 mg arachidonic acid (AA)
    • 60 mg DHA, 10 mg EPA, and 5 mg AA
    • 345 mg DHA

Rojas and Chan’s conclusions on the evidence:

  • There is no conclusive evidence that fatty acid supplementation significantly improves ADHD symptoms
  • There were several methodological problems with all of the studies conducted in the area

Cautions:

  • The quality of fatty acid dietary supplements may vary significantly among manufacturers

Homeopathy

Rationale:

Substances that cause the symptoms of ADHD in healthy people should cure ADHD symptoms in affected people.

Method

Individualized remedies are developed based on a person’s symptoms.

Evidence:

  • There is no conclusive evidence that homeopathy improves the symptoms of ADHD
  • Of the 3 clinical trials completed, all reported improved parental behavior ratings – but all had significant design flaws

Cautions:

  • Some liquid homeopathic remedies contain alcohol

Yoga

Rationale:

Yoga should help children with ADHD improve their ability to concentrate/focus.

Method:

There are several different forms of yoga. Yoga incorporates physical poses, breathing, and meditation.

Rojas and Chan’s conclusions on the evidence:

  • The results of one peer-reviewed, controlled trial suggest that yoga may be an effective adjunct to medication in the treatment of ADHD
  • Study sample size was small

Massage

Rationale:

Massage should help children with ADHD to relax by reducing muscle tension.

Method:

The soft tissues of the body are manipulated through pressure/movement.

Rojas and Chan’s conclusions on the evidence:

  • The results of two peer-reviewed, controlled trials showed improvements in ADHD symptoms following massage treatment
  • The results are promising but inconclusive due to the study designs

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