Tips for Parents: A Ten Point Naturopathic Medicine Plan for ADHD (page 2)

By — New York Association of Naturopathic Physicians
Updated on Jan 18, 2010

Naturopathic Medicine Can Help Parents Make a Plan

In many cases, there are wonderful natural, non-drug treatments that can help a child balance, focus and calm. Naturopathic medicine focuses on using various natural therapies together to allow the body to heal itself. Naturopathic physicians are trained to clarify the multiple factors usually involved in the clinical presentation of this challenging condition and create a cohesive individualized plan for health.
Unless there is a dire situation or question of safety, a typical naturopathic plan will attempt to avoid medications, and instead prescribe psychotherapy (not covered in this article) as well as diet, lifestyle, nutrient and herbal suggestions. Although much research is still needed, there is growing evidence regarding the effective use of individual natural therapies for this condition.
In many cases, any one recommendation alone will not necessarily create behavioral change. As a result, it is best to work with a naturopathic physician who will ask the right questions and design a recommendation plan to include the aspects that will help your child the most. Here are some recommendations which collectively we have found most helpful with our young patients:

1 - Foods: Sugar Balance, Additives and Protein

Naturopathic diet recommendations usually revolve around stabilization of blood sugar by avoiding high glycemic foods (foods that can quickly raise blood sugar) and replacing these with more complex carbohydrates, while assuring adequate intake of protein and fats to slow sugar absorption. Academic investigations out of Yale University as well as the University of South Carolina both corroborate the role of sugar intake contributing to changes in behavior and restlessness in ADHD children.[xiii],[xiv] Despite this data, other studies on sugar avoidance have not shown a clear link.[xv] It is possible in these negative studies, other factors (as outlined in this article below) also needed to be addressed simultaneously in order to effect a positive behavioral changes.
Interestingly, some research suggests that a link between sugar and hyperactivity may involve parental perception: mothers who were told the child received sugar reported more hyperactive behavior, even when aspartame-sweetened foods devoid of sugar were actually used. Mothers who were told the child received a low-sugar snack were less likely to report worse behavior.[xvi] It is possible in this study, the artificial sweetner used may have confounded these results.
Meal timing is crucial. Even in non-ADHD kids (and many of us adults) when there are large gaps of time between meals, the result can be irritability and mood change. In patients with susceptibility to ADHD, this likely triggers impulsivity, poor concentration or behavior difficulty. A remedy for this is assuring regular small meals, snacking, and increases in protein intake. These will prevent extreme vacillations in blood glucose. Research has found that hyperactive children who consumed a high-protein meal performed equal or better than non-hyperactive kids who didn't eat as much protein.  As such, it is important to have healthy protein snacks available for regular treats, such as natural protein bars, or apples with natural peanut butter before a child’s behavior changes.
Food sensitivities may play a role in some kids. Published in the 1970’s, the Feingold diet main tenet teaches that chemicals found in food additives can trigger abnormal brain response. Feingold also considered salicylates (aspirin- like compounds in certain foods) to also be a culprit.[xvii] These sensitivities are worth expoloring when other diet changes alone are not helping. The British journal Lancet reported in 1985 that almost 80% of children with hyperactivity improved behavior when sugary foods and foods with artificial colors were removed from the diet.[xviii] A follow up six-week study from 2007 revealed that kids with additives in their diet had clearly higher hyperactive behaviors over children with additive-free diets.[xix]

2- Sleep and Melatonin

It is estimated that up to one-third of children in the United States suffer from inadequate sleep. Inadequate sleep appears to be an independent risk factor for ADHD. In a cross-sectional study of 7 to 8 year-olds, researchers found that kids with less than 7.7 hours of sleep each night were significantly more prone to hyperactivity or inattentiveness, compared with children who were moderate or longer sleepers.[xx] Also important is consistency of bedtimes. Melatonin is a natural hormone made in the brain to help induce sleep. Used as a natural supplement, a presentation at the American Academy of Child and Adolescent Psychiatry showed that melatonin was helpful for treating delayed sleep onset in children with ADHD, according to the results of a double-blind, crossover-design pilot. The side effect profile of melatonin is minimal and is quite safe in children.[xxi]

3 - Exercise / Yoga

The neurotransmitter dopamine and norepinephrine help the brain stay attentive. It is well known that exercise increases the concentration of both dopamine and norepinephrine, as well as other brain chemicals. One expert in the field, Dr. J. Ratey is quoted as saying:
            “exercise is like taking a bit of methylphenidate (Ritalin) or amphetamine/dextroamphetamine (Adderall); it's similar to taking a stimulant.[xxii]
Given this knowledge, it makes sense to add significant exercise and movement that a child enjoys to their everyday life. Getting outdoors in nature as often as possible helps raise vitamin D levels and is known to be calming.
Two small trials also looked to yoga as a method to improve symptoms of young patients who were already stabilized on medication. Both studies showed improvement trends, but were not large enough to be definite.[xxiii],[xxiv] Given the positive research about yoga in other mood disorders, it is certainly worth a try.

4 - Home Environment

The home should be evaluated regarding calmness, consistency and sense of security for the child.. Recent evidence shows that children who watch television for 1.5hrs or more have higher blood pressure.[xxv] Early TV watching has been definitively linked to attention problems by age 7.[xxvi] Possibly, less time watching TV and using video games, and more time in nature would be balancing for the ADHD brain. In our clinical experience, we have also found replacing TV time with special parent-child time where one parent spends time doing an activity with the child for at least 15 minutes a day can help calm and focus a child’s challenging behavior. In many cases, we have seen ADHD behaviors linked to marital conflict and general strife[xxvii] within the household, which can contribute to ‘mixed messages’ and lack of consistency. Working on these, and having the guardians involved assure consistency in regards to the children have had major breakthroughs in a few cases.

Clinical Case: Joshua
Joshua was a 8 year-old who came to our diagnosed with ADHD about one year prior and was placed on Ritalin . Unlike some kids with ADHD, Joshua did well academically, but acted very restless in school which was getting him in trouble with the teachers. He also struggled with being a bit recluse from peer relationships, suffered from insomnia, had frequent colds, and had some digestive problems. The Ritalin had helped his symptoms, but when his mother discontinued the medication about four months prior, Joshua’s moody symptoms returned.
Joshua lived at home with his parents. There had been some strife in the house since the father lost his job at the onset of the recession. From that point, there was increased arguing, mostly over money issues, which spilled over into how the parents cared for their son. His mother brought Joshua in due to the Ritalin side effect of low appetite, and she was concerned about some long-term consequences to the heart that she read about. Joshua was already doing cognitive therapy work and was put on a low sugar diet, although juices were consumed liberally.
After a one-hour first visit with Joshua and his mom and learning their story, we recommended a regular schedule of protein-based small frequent meals as opposed to less-frequent larger meals to help increase food intake and balance blood sugar and avoidance of juice and milk products. We recommended he continued his behavioral therapy. We also recommended counseling for the parents to help them learn how to work together when addressing Joshua care for best consistency. We stressed the need for consistent ritual around bedtime, which the parents were able to agree upon. Joshua was placed on essential fatty acids, a multiple vitamin, Bacopa, melatonin in the evening, and recommended child-specific probiotics for his digestive issues. Joshua’s lab tests unearthed low B12 status, which was then supplemented accordingly.
In one month, Joshua’s digestive symptoms and colds had cleared. In four months, we began to work with his prescribing doctor to wean off his medications, at which point we increased his bacopa. Joshua remained off the medication for two months with no regression in his symptoms, so we began the process of decreasing the bacopa, and continued monitoring of his diet, food schedule, environment and other nutrients status.

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