Definition:

Attention Deficit Disorder- with or without hyperactivity, aka ADHD or ADD, is the most common and costly mental health problem affecting children which can continue into adulthood.

• The symptoms may include early onset of age-inappropriate persistent and pervasive symptoms of inattention, difficulty organizing work, and impulsivity. Other symptoms include hyperactivity and fidgeting, short attention span, risky behaviors, difficulty following instructions, etc.
• Common comorbidities associated with AD(H)D include oppositional defiant disorder and conduct disorders, mood or anxiety disorders, self-esteem issues, learning disabilities, sleep problems, tic disorders, etc.
• Strengths associated with ADHD can include creativity, imagination, sociability, flexible attention, interest in the environment, energy, vitality, enthusiasm, adaptability, confidence, exuberance, spontaneity, and desire to please others.
• It is estimated that about 3 to 5 percent of children globally and 3 to 10 percent of school-aged children in the US are diagnosed with AD(H)D.  30 to 50 percent of those individuals diagnosed in childhood continue to have symptoms into adulthood, estimated to affect around 4.7 percent of American adults.
• ADHD is more common in boys than girls (3:1 ratio); the peak age of diagnosis is between 8 and 10 years of age.  Boys are more likely than girls to have hyperactivity as a presenting symptom.
• Twin and adoption studies show ADHD to be highly heritable.  It is postulated by some researchers that as humans migrated out of Africa around 50,000 years ago and moved across the planet, ADHD genes linked to risk-taking, rapidly shifting focus, and adventurousness offered advantages to surviving such migration better.
• Smoking cigarettes and drinking alcohol during pregnancy has been linked to an increased risk of developing ADHD in the fetus.
• In some studies, chemical abnormalities such as disorders of metal metabolism, methylation, pyrroles, toxic metals, glucose, and absorption, have been observed in this population. These biochemical tendencies may persist which suggests genetic or epigenetic origin.

Biochemistry of ADHD and its subtypes

• There are three major subtypes of ADHD, and each has a different chemical signature:

1. Predominantly inattentive: These children have normal to high intelligence but have poor focus and concentration and are prone to daydreaming and boredom. It has been noted that more than half of these patients are deficient in folic acid, vitamin B-12, zinc, and choline, and when treated they develop better focus.
2. Predominantly impulsive and hyperactive: These patients are commonly in constant motion, are easily distractible, and have a short attention span. The typical chemical imbalance in this group is a metal metabolism disorder involving copper overload and zinc deficiency which may cause low dopamine and elevated norepinephrine and adrenalin activity.
3. Combined hyperactive/impulsive and inattentive: This is the largest subtype of ADHD and generally involves more severe academic underachievement than subtypes 1 and 2. The chemical imbalances may include 68% exhibiting a seriously elevated copper/zinc ratio and may also have a methylation disorder, toxic overload, pyrrole disorder, or other imbalances, and therefore blood and urine testing is necessary for accurate diagnosis.

Treatment:

• Find and correct the chemical abnormality
• Use other supplements as needed

Other Diagnosis & Treatment Considerations

• Confirm the diagnosis with formal testing and behavioral rating scales such as the Vanderbilt and Conners.  Use these scales to monitor progress with various treatments.
• Consider psychological testing for intelligence evaluation, learning disability, mood issues, etc.
• Diagnose and treat hearing and vision problems, thyroid issues, sleep problems, etc.
• Diagnose and treat allergies including food sensitivities
• Diagnose and treat gut issues
• Diagnose and treat amino acid deficiencies

Environment

• Consider schools that understand this condition and have plans and policies in place on how to address the needs of children with ADHD appropriately.
• Smaller classes with a low student-to-teacher ratio with age-appropriate structure are preferred.
• Provide a safe and structured environment at home, have consistent routines, break down tasks into smaller steps, and reward positive behavior.
• Limit television and video game time and use of cell phones
• Avoid exposing children to lead, secondary-hand smoke, and pesticides
• Use full spectrum fluorescent lighting indoors as much as possible

Life Style

• Eat whole foods rich in omega-3 fatty acids, amino acids, vitamins and minerals
• Maintain steady blood glucose by eating regular meals with high protein, good fats, and low glycemic index.
• Avoid sodas, trans fatty acids, artificial colors, flavors, sweeteners, and preservatives
• Reduce Omega 6 fatty acid
• Increase daily physical activity and exercise, preferably outdoors in natural surroundings
• Get adequate sleep
• Reduce stress and learn to regulate your emotional state

Special Diets

• Diagnose and eliminate food allergies such as dairy, soy, nuts, and peanuts.
• Multiple ADHD diets eliminate different ingredients such as salicylates, amines, glutamine, tyramine, phenylethylamine, etc.  There are reports that some patients may respond to a combination of such diets.
• Some patients may respond to the Feingold diet.  The Feingold diet is an elimination diet initially devised by Benjamin Feingold, MD. (1899–1982). The diet is an elimination diet of salicylate, artificial food coloring, and artificial flavors as well as preservatives such as BHA, BHT, and TBHQ.
• Some patients may respond to the FAILSAFE diet.  FAILSAFE stands for Free of Additives and low in Salicylates, Amines, and Flavor Enhancers. It is a diet that focuses on reducing your intake of three chemical compounds that occur naturally in many fresh foods, as well as food additives and preservatives.

Mind-Body

• Consider psychological counseling, such as cognitive-behavioral therapy or family therapy, especially in patients with mood or behavioral issues.
• Consider daily meditation, start with 5-10 minutes, and then expand to longer periods.
• Consider yogan and tai chi
• Consider massage therapy
• Consider joining social support networks

EEG Biofeedback (AKA Neurofeedback)

• Similar to biofeedback training to modulate one’s EEGs. The results seem promising.
• A non-medication alternative to ADHD treatment

Medications

• Stimulants such as Methylphenidate, Dextroamphetamine etc.
• Non-stimulants such as Atomoxetine, Bupropion, Guanfacine, etc.
• Other medications to treat associated mood issues such as anxiety etc.