Attention Deficit Disorder
• AADD, ADD, ADHD, Adult Attention Deficit Disorder, Attention Deficit and Hyperactivity Disorder, Hyperkinetic Syndrome
• Bach Flower Remedies, Blue-Green Algae, Calcium, Combined Amino Acids (GABA), Combined Polysaccharides (Galactose), Food Allergen Avoidance and Other Dietary Changes , Fucose, Glucose, Glycine, Inositol, Iron, L-Glutamine, L-Phenylalanine, L-Tyrosine, Magnesium, Mannose, Massage, Melatonin, N-acetylgalactosamine, N-acetylglucosamine, N-acetylneuraminic Acid, St. John's Wort, Taurine, Trace Minerals, Xylose
Originally, the term attention deficit disorder (ADD) referred to children who were incapable of concentrating at school. Hyperkinesia was used somewhat synonymously, as a descriptive term for children who simply couldn’t sit still. Today, the definition has broadened to include many adults, and has been refined into two conditions: ADD and ADHD (attention deficit and hyperactivity disorder). Characteristics include difficulty sustaining attention or completing tasks, easy distractibility, impulsive behavior, and, in the case of ADHD, an excessive inclination to fidget and move about. These problems make it difficult to succeed at work or at school.
Conventional treatment focuses on stimulants, such as amphetamine, dextroamphetamine, and methylphenidate (Ritalin, Concerta), as well as the newer drug atomoxetine (Strattera). Certain antidepressants may also be useful.
Proposed Natural Treatments
There is some evidence that the supplement DMAE (2-Dimethylaminoethanol) may be helpful for ADD, according to studies performed in the 1970s. Two such studies were reported in a review article. 1 Fifty children aged 6 to 12 years who had been diagnosed with hyperkinesia participated in a double-blind study comparing DMAE to placebo . The dose was increased from 300 mg daily to 500 mg daily by the third week and continued for 10 weeks. Evaluations revealed statistically significant test score improvements in the treatment group compared to the placebo group.
Another double-blind study compared DMAE with both Ritalin and placebo in 74 children with "learning disabilities." 1 (It appears that today, the participants would have been given a diagnosis of ADD). The study found significant test score improvement for both treatment groups over a 10-week period.
For more information, including dosage and safety issues, see the full DMAE article.
The mineral zinc has shown some promise for treatment of ADHD. In a large double-blind, placebo-controlled study (approximately 400 participants), use of zinc at a dose of 35 mg daily produced statistically significant benefits as compared to placebo. 26 This dose of zinc is higher than nutritional needs, but not so high as to be unsafe. However, the benefits seen were quite modest: about 28% of the participants given zinc showed improvement, but so did 20% in the placebo group.
Another, much smaller study evaluated whether zinc at 15 mg per day could enhance the effect of Ritalin. 27 Again, modest benefits were seen. Finally, exceedingly weak evidence hints that zinc might enhance the effectiveness of evening primrose oil for ADHD (see next section). 28
For more information, including dosage and safety issues, see the full Zinc article.
Essential Fatty Acids
Essential fatty acids (EFAs) are "good fats," substances as important to your general health as vitamins. Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs found in fish oil and evening primrose oil have been tried for the treatment of ADHD and related conditions. However, the results have been less than impressive.
In a double-blind, placebo-controlled study of 50 children with ADHD, use of essential fatty acids from fish oil and evening primrose oil failed to provide any consistent, significant benefit above and beyond the placebo effect. 29 (The placebo effect, however, was considerable.) In a slightly smaller double-blind, placebo-controlled trial, weak evidence of benefit was seen, but the results are difficult to interpret due to the high number of people who dropped out of the study. 3
In a double-blind, placebo-controlled trial of children already using stimulant therapy, the addition of the essential fatty acid docosahexaenoic acid (DHA, found in fish oil) for 4 months failed to further improve symptoms. 20
Evening primrose oil alone failed to prove effective for attention deficit disorder in a small double-blind, placebo-controlled trial. 21 In a placebo-controlled, comparative trial, evening primrose oil proved less effective than standard medical treatment. 22 However, a close look at the data in this last trial hinted that evening primrose oil might have been more effective in people with adequate zinc levels. 28 This suggests that combination therapy with zinc and evening primrose oil should be tested, but, thus far, this approach has not undergone meaningful study.
Other Natural Treatments
A small, double-blind, placebo-controlled crossover trial evaluated the possible efficacy of the supplement carnitine for ADD in boys 13 and younger. 23 Approximately 50% of the participants responded to carnitine , a significantly higher percentage than responded to placebo. These promising results suggest that a larger trial is warranted.
Vitamin B 3 (niacin), vitamin B 6 , and multivitamin/multimineral supplements have been recommended for the treatment of ADD. However, a review of the literature found no meaningful evidence to indicate that any of these treatments are effective. 4
Other supplements that are sometimes recommended for ADD include calcium, iron , inositol , trace minerals, blue-green algae, combinations of amino acids (usually GABA, glycine, taurine , L-glutamine , L-phenylalanine , and L-tyrosine ), and combinations of the polysaccharides galactose, glucose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, N-acetylglucosamine, and xylose. St. John's wort has also become popular recently, but unlike depression, there is no convincing evidence for its effectiveness against ADD.36Note : St. John's Wort interacts with many medications and could conceivably impair the effectiveness of conventional treatments for ADD.
It is commonly said that, sugar, food allergens, and food additives, such as artificial colors, contribute to ADD symptoms. However, the body of published evidence regarding these therapies remains, incomplete and contradictory. 5-19,31,35 The best evidence regards artificial colors and food additives. In a double-blind, placebo-controlled study of 153 without ADD, use of certain food additives significantly increased hyperactivity as compared to placebo. 35
One study found that the supplement melatonin may be helpful for improving sleep in children with ADHD taking stimulant medications. 33 However, melatonin does not appear to be helpful for ADHD symptoms per se. 34
3. Richardson AJ, Puri BK. A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties. Prog Neuropsychopharmacol Biol Psychiatry . 2002;26:233-239.
20. Voigt RG, Llorente AM, Jensen CL, et al. A randomized, double-blind, placebo-controlled trial of docosahexaenoic acid supplementation in children with attention-deficit/hyperactivity disorder. J Pediatr. 2001;139:189-196.
24. Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res . 1997;10:149-156.
26. Bilici M, Yildirim F, Kandil S, et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuropsychopharmacol Biol Psychiatry . 2004;28:181-190.
27. Akhondzadeh S, Mohammadi MR, Khademi M. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: A double blind and randomized trial [ISRCTN64132371]. BMC Psychiatry . 2004 Apr 8. [Epub ahead of print]
28. Arnold LE, Pinkham SM, Votolato N. Does zinc moderate essential fatty acid and amphetamine treatment of attention-deficit/hyperactivifty disorder? J Child Adolesc Psychopharmacol . 2000;10:111-117
30. Lyon MR, Cline JC, Totosy de Zepetnek J, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci . 2001;26:221-228.
31. Schab DW, Trinh NH. Do artificial food colors promote hyperactivity in children with hyperactive syndromes? A meta-analysis of double-blind placebo-controlled trials. J Dev Behav Pediatr . 2004;25:423-434.
32. Pintov S, Hochman M, Livne A, et al. Bach flower remedies used for attention deficit hyperactivity disorder in children-A prospective double blind controlled study. Eur J Paediatr Neurol . 2005 Oct 26. [Epub ahead of print]
33. Weiss M, Wasdell M, Bomben M, et al. Sleep Hygiene and Melatonin Treatment for Children and Adolescents With ADHD and Initial Insomnia. J Am Acad Child Adolesc Psychiatry . 2006 Mar 10. [Epub ahead of print]
34. Van der Heijden KB, Smits MG, Van Someren EJ, et al. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry . 2007;46:233-241.
35. McCann D, Barrett A, Cooper A, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. 2007 Sep 5. [Epub ahead of print]
36. Weber W, Vander Stoep A, McCarty RL, et al. Hypericum perforatum (St John's wort) for attention-deficit/hyperactivity disorder in children and adolescents: a randomized controlled trial. JAMA. 2008;299:2633-2641.
Last reviewed June 2008 by EBSCO CAM Review Board
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