Attention Deficit Disorders (ADD/ADHD)

Attention Deficit Disorder (ADD) / Attention Deficit Hyperactivity Disorder (ADHD)

In my mind there is no question that a child’s behaviour can be adversely affected by what they eat, insufficient sleep, gastrointestinal issues, and nutrient deficiencies. Addressing these issues and checking for any other underlying medical conditions, can produce amazing results in improving a child’s behaviour.

Trying to make changes to a defiant child’s diet is not always easy and parents sometimes just find it easier to give a small “pill”. Unfortunately, medications come with their own problems. The child may have a change in appetite, can’t sleep, or as I have seen in clinic, been diagnosed with atypical depression and talks of killing himself (this is a 5 year old!). I have seen some very sad cases. The long-term effect of these medications on the developing brain are still unknown. However the future for these children does not need to be so bleak.

Please seriously consider the natural approach to treating this disorder, for the sake of your child’s long-term health. There are sufficient studies now that show they work. Pharmaceutical options are not free of side-effects and studies are emerging of long-term health concerns for these children.

There are alternative treatment options to pharmaceutical medications. Read the evidence. Your child should have the opportunity to be assessed for underlying causes to their behaviour. Medication should not be an alternative to low iron and nutritional deficiencies, high blood lead, food intolerances, low zinc, high copper, etc

Current ADHD Research – Selected ADHD research to read prior to medicating your child

Risk Factors and ADHD

Developmental PBDE Exposure and IQ/ADHD in Childhood: A Systematic Review and Meta-analysis. Full pdf. “Polybrominated diphenyl ethers (PBDEs) in flame-retardant chemicals are measured ubiquitously in children. We concluded there was sufficient evidence supporting an association between developmental PBDE exposure and reduced IQ. Preventing developmental exposure to PBDEs could help prevent loss of human intelligence.”

Childhood polybrominated diphenyl ether (PBDE) exposure and neurobehavior in children at 8 years.Prenatal polybrominated diphenyl ether (PBDE) exposure has been associated with decrements in IQ and increased attention deficit/hyperactivity disorder related behaviors in children; however, data are limited for the role of postnatal exposures. Postnatal PBDE exposure was associated with decrements in FSIQ and increases in hyperactivity and aggressive behaviors.”

Formula Feeding as a Risk Factor for AttentionDeficit/Hyperactivity Disorder: Is Bisphenol A Exposure a Smoking Gun?Compared with breastfed infants, ADHD was more common among formula-fed infants in the 2007 but not the 2011/12 sample, where exposure to BPA was markedly reduced. These findings suggest that the reduced prevalence of ADHD among breastfed infants may not be due to the nutritional benefits of breast milk, but rather early exposure to BPA, a neurotoxic chemical previously found in infant formula.”

Concurrent and Subsequent Associations Between Daily Digital Technology Use and High-Risk Adolescents’ Mental Health Symptoms.Adolescents are spending an unprecedented amount of time using digital technologies (especially mobile technologies), and there are concerns that adolescents’ constant connectivity is associated with poor mental health, particularly among at-risk adolescents. Results from multilevel regression models showed that daily reports of both time spent using digital technologies and the number of text messages sent were associated with increased same-day attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) symptoms. Adolescents’ reported digital technology usage and text messaging across the ecological momentary assessment (EMA) period was also associated with poorer self-regulation and increases in conduct problem symptoms between the baseline and follow-up assessments.”

Maternal cell phone use during pregnancy and child behavioral problems in five birth cohorts.Overall, 38.8% of mothers, mostly from the Danish cohort, reported no cell phone use during pregnancy and these mothers were less likely to have a child with overall behavioral, hyperactivity/inattention or emotional problems. Evidence for a trend of increasing risk of child behavioral problems through the maternal cell phone use categories was observed for hyperactivity/inattention problems. Maternal cell phone use during pregnancy may be associated with an increased risk for behavioral problems, particularly hyperactivity/inattention problems, in the offspring.”

Overdiagnosis of mental disorders in children and adolescents (in developed countries). Full pdf. “A large body of ADHD research shows that children born close to kindergarten or school cut-off dates, and who are therefore young compared to their classmates, are between 30 and 60% more likely to be diagnosed with ADHD and receive psychostimulants twice as often as children born only a few days later, but after the cut-off date. Translated to the American population, this means that “approximately 1.1 million children received an inappropriate diagnosis [of ADHD] and over 800,000 received stimulant medication due only to relative [im]maturity”. The relative age effect was found not only in the United States, but also in Canada, Sweden, and Iceland and was shown to be stable over an 11-year period.” A recent Australian study has found the same correlation: “Children who are younger than their school peers are much more likely to be on medication for attention deficit hyperactivity disorder (ADHD) than their older classmates, a new study has found.”

The effects of risk factors on EEG and seizure in children with ADHD. Any ADHD child with a birthing history of prematurity and lack of oxygen, should have an EEG for siezure activity in the brain. “History of asphyxia and prematurity do seem to increase the risk of EEG abnormality in patients with ADHD.”

Antibiotics in the first year of life and subsequent neurocognitive outcomes. This study demonstrates an association between antibiotic use in the first year of life and subsequent neurocognitive outcomes in childhood.”

Inverse associations between cord vitamin D and attention deficit hyperactivity disorder symptoms: A child cohort study.An inverse association between cord 25(OH)D and attention deficit hyperactivity disorder symptoms in toddlers was found, suggesting a protective effect of prenatal vitamin D.”

Comorbidity of Allergic and Autoimmune Diseases Among Patients With ADHD: A Nationwide Population-Based Study.

Long-Term Outcomes for ADHD

Smoking, alcohol and drug use in youth and adults with attentiondeficit hyperactivity disorder. Full pdf. “Individuals with ADHD started smoking at a younger age. They consumed more alcoholic drinks on drinking days, and women with ADHD were more likely to engage in binge drinking. Women over the age of 25 and men with ADHD were more likely to meet alcohol-dependence lifetime criteria. People with ADHD were at a greater risk of drug misuse and dependence.”

Irritability in ADHD: Associations with depression liability.The sample consisted of 696 children (mean age 10.9 years) with a diagnosis of ADHD, recruited from UK child psychiatry and paediatric clinics. Irritability was common, with 91% endorsing at least one irritable symptom. 3-month DMDD [Disruptive Mood Dysregulation Disorder] prevalence was 31%. Children with higher levels of irritability or DMDD were more likely to have comorbid symptoms of anxiety, depression and a family history of depression.

Prevalence and correlates of ADHD in individuals with substance use disorder in Nigeria. Substance use disorder (SUD) is associated with ADHD. ADHD increases the severity of SUD and has negative influence on the prognosis of the disorder. The prevalence of ADHD in SUD patients was 21.5%, with the combined subtype being the most prevalent. SUD patient with ADHD had more history of severe dependence on cigarette, depression, suicidal ideation, aggression, dependence on benzodiazepine and heroin, number of relapses, poor QoL and number of hospitalization. The prevalence of ADHD in SUD individuals is high and may be associated with a more severe phenotypic expression of SUD.”

Academic Achievement in Adults with a History of Childhood AttentionDeficit/ Hyperactivity Disorder: A Population-Based Prospective Study.This is the first prospective, population-based study of adult academic outcomes of childhood ADHD. Our data provide evidence that childhood onset ADHD is associated with long-term underachievement in reading and math that may negatively impact ultimate educational attainment and occupational functioning in adulthood.”

Long-Term Outcomes of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder: A Systematic Review and Meta-Analysis. ADHD was associated with adverse outcomes including academic achievement (e.g. failure to complete high school; odds ratio), other mental and substance use disorders (e.g. depression), criminality (e.g. arrest), and employment (e.g., unemployment).”

Dietary Intervention and ADHD

Relationships between Dietary Intake and Cognitive Function in Healthy Korean Children and Adolescents. Full text. “This study finds many meaningful correlations between food and nutrition intake and cognitive function in pediatric and adolescent subjects. Widely recognized sources of good nutrition such as vitamins B1, B6, and C, rice with mixed grains, and mushrooms are positively correlated with better cognitive function. In contrast, processed carbohydrates such as white rice and noodles or fast food and
Coca-Cola are negatively correlated with cognitive capacities. Our study verifies that there are various significant relationships between many nutrients, food additives, and specific foods and cognitive function.”

Psychiatric disorders and symptoms severity in pre-school children with cow’s milk allergy. “It was established that 65% of the group with cow’s milk allergy received at least one psychiatric diagnosis, while 36.6% of the control group received at least one psychiatric diagnosis, with a statistically significant difference. Within the psychiatric disorders, attention deficit hyperactivity disorders , oppositional defiant disorder, and attachment disorder were found significantly higher compared with the healthy control group.”

Malnutrition at Age 3 Years and Externalizing Behavior Problems at Ages 8, 11, and 17 Years. Full pdf. Yet another study clearly showing a link with nutritional deficiencies and aggressive behaviour.

Diet in the treatment of ADHD in children – a systematic review of the literature.

Dietary sensitivities and ADHD symptoms: thirty-five years of research.

Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder–an appraisal of the evidence on efficacy and recommendations on the design of future studies.

Sugar-Sweetened Beverage Consumption Is Adversely Associated with Childhood Attention Deficit/Hyperactivity Disorder. Full text. “In this case-control study of Taiwanese children, a dose-response relationship was found between SSB [Sugar Sweetened Beverage] intake and ADHD. In this case-control study, we have shown an association between SSB consumption and ADHD.”

Nutritional Issues and ADHD

Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD? Full pdf. “Whilst conventional medications have a role to play in the management of ADHD symptoms, new clinically trialled evidence indicates that omega-3/6 supplementation programmes can provide a promising adjunctive therapy, lowering the dose of psychopharmacologic medications needed and subsequently improving compliance with these.”

Omega-3 Polyunsaturated Fatty Acids in Youths with Attention Deficit Hyperactivity Disorder (ADHD): A Systematic Review and Meta-Analysis of Clinical Trials and Biological Studies.In summary, there is evidence that n-3 PUFAs supplementation monotherapy improves clinical symptoms and cognitive performances in children and adolescents with ADHD, and that these youth have a deficiency in n-3 PUFAs levels. Our findings provide further support to the rationale for using n-3 PUFAs as a treatment option for ADHD.”

Iron Status in AttentionDeficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. Full pdf. “Iron, an important trace element, is implicated in brain function and dopaminergic activity. Lower serum ferritin rather than serum iron is associated with ADHD in children.”

Vitamin levels in adults with ADHD. Full pdf. “Lower concentrations of vitamins B2, B6 and B9 were associated with the ADHD diagnosis, and B2 and B6 also with symptom severity.

Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. “Vitamin D supplementation as adjunctive therapy to methylphenidate improved ADHD evening symptoms.”

Nutritional status and feeding problems of children with attention deficit hyperactivity disorder.Almost half of the ADHD children had suboptimal nutrition compared to 11.1% TD children. It is imperative to screen ADHD children for nutritional status and feeding problems to prevent negative health impacts later on. About 5.6% of the ADHD children were stunted as compared to 3.7% of the TD children, while none of the TD children were severely stunted compared to 3.7% of the ADHD children.”

“Food for Thought: The Role of Nutrients in Reducing Aggression, Violence and Criminal Behavior.”

Magnesium, Iron, and Zinc Supplementation for the Treatment of Attention Deficit Hyperactivity Disorder: A Systematic Review on the Recent Literature. Full pdf. A review of nutritional supplements in the treatment of ADHD. The review concludes that studies are mixed. However, there is clearly a subgroup of children that respond well. Unfortunately, often the big unknown is the quality of the supplements used and adequate dosages.

Changed Plasma Levels of Zinc and Copper to Zinc Ratio and Their Possible Associations with Parent- and Teacher-Rated Symptoms in Children with Attention-Deficit Hyperactivity Disorder.

Vitamin–mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Full pdf. The evidence is mounting that nutrients do make a difference in ADHD, even in adults.

Relationship between serum zinc levels and attention deficit hyperactivity disorder in children.

Non-Nutritional Supplements and ADHD

Lead and ADHD

There is no safe threshold for lead exposure: Α literature review.Continuous [lead] exposure in children produces neurobehavioral symptoms, such as decreased concentration, inability to follow instructions, difficulty to play games and low IQ, which are associated with concentrations of 10-35 μg/dL. However, some studies claim that cognitive decline and low IQ can occur in concentrations <10 μg/dL. Despite the fact that lead has been banned from gasoline, paint and water pipes, quite significant quantities of lead still exist, particularly in deprived areas of modern cities, in transition zones and city centers, and there are also great concentrations around lead mines and in developing countries, but even for the remaining areas there is no safe threshold.”

Blood lead concentrations and attention deficit hyperactivity disorder in Korean children: a hospital-based case control study. Full text. “This hospital-based case-control study demonstrated that even low blood lead concentration is also a risk factor for ADHD in children. The environmental risk factors for ADHD have meaningful implications for prevention because they are easier to modify than genetic factors. The current consensus is that there is no safe threshold for neurotoxic lead exposure.”

The Role of Lead Exposure on AttentionDeficit/ Hyperactivity Disorder ‎in Children: A Systematic Review. Full text. “Blood Lead level (BLL) of less than 10µg/dL in children has been attributed to at least one ‎type of ADHD i.e., Combined / Inattentive / Hyperactive-Impulsive. The results of this ‎study revealed that in 16 out of the 18 studies, a significant association was found between ‎BLL and one of the types of ADHD. Based on the findings of this study, even the BLL of less than the action level of 10µg/dL, ‎chosen by Centers for Disease Control and Prevention (CDC), may affect children with ‎ADHD.”

Lead is still a very common pollutant in our environment. Read Lead Where We Least Expect It.

Testing blood identifies current exposure to lead. Hair Tissue Mineral Analysis is a non-invasive test and identifies past exposure, as well as ongoing exposure to lead and other heavy metals.

Sleep Issues and ADHD

Sleep Problems as Predictors in Attention-Deficit Hyperactivity Disorder: Causal Mechanisms, Consequences and Treatment. Full pdf. “Previous studies have attempted to clarify the bidirectional relationship between ADHD and sleep problems, proposing a potential role for sleep problems as early predictors of ADHD. Sleep deprivation, sleep-disordered breathing, and circadian rhythm disturbances have been extensively studied, yielding evidence with regard to their induction of ADHD-like symptoms. The long-term consequences of sleep problems in individuals with ADHD include obesity, poor academic performance, and disrupted parent-child interactions. Early intervention has been proposed as an approach to preventing these debilitating outcomes of ADHD.

The Functional Impact of Sleep Disorders in Children With ADHD.Common sleep complaints in participants were insomnia, excessive daytime sleepiness (EDS), and variability in sleep schedule. Regression analysis indicated that sleep problems and ADHD symptoms independently predicted lower levels of QoL (Quality of Life) and social functioning. The results suggest that ADHD may coexist with somnolence and that both conditions have a significant impact on a child’s functioning and QoL.”

Sleep Disturbances in Children with AttentionDeficit/Hyperactivity Disorder (ADHD): Comparative Study with Healthy Siblings. Full text. “Sleep disturbances are more prevalent in pharmacologically treated ADHD, making it an important aspect of ADHD management.

Attention Deficit/Hyperactivity Disorder and Sleep in Children.

Pharmacological Medications and ADHD

Age-dependent, lasting effects of methylphenidate on the GABAergic system of ADHD patients. Full pdf. “While adult stimulant treatment seems to exert no major effects on GABA+ levels in the mPFC, MPH may induce long-lasting alterations in the adult mPFC GABAergic system when treatment was started at a young age.”

Gastrointestinal adverse events during methylphenidate treatment of children and adolescents. Full pdf. “Methylphenidate increases the risks of decreased appetite, weight loss, and abdominal pain in children and adolescents with attention deficit hyperactivity disorder.”

Cardiovascular Effects of Stimulant and Non-Stimulant Medication for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of Trials of Methylphenidate, Amphetamines and Atomoxetine.Statistically significant pre-post increases of SBP [systolic blood pressure], DBP [diastolic blood pressure] and HR [heart rate] were associated with AMP [amphetamines] and ATX [atomoxetine] treatment in children and adolescents with ADHD, while MPH [methylphenidate] treatment had a statistically significant effect only on SBP in these patients. These increases may be clinically significant for a significant minority of individuals that experience larger increases. Since increased BP and HR in general are considered risk factors for cardiovascular morbidity and mortality during adult life, paediatric patients using ADHD medication should be monitored closely and regularly for HR and BP.”

The age-dependent effects of a single-dose methylphenidate challenge on cerebral perfusion in patients with attentiondeficit/hyperactivity disorder. Full text. “An acute challenge with MPH [methylphenidate] decreased CBF [cerebral blood flow] in thalamic areas only in children, but not adults. Our findings highlight the importance of taking the developmental perspective into account when studying the effects of stimulants in ADHD patients.

Impact of attention deficit hyperactivity disorder therapy on fracture risk in children treated in German pediatric practices.Patients receiving attention deficit hyperactivity disorder (ADHD) medications were at a lower risk of fractures than patients without ADHD medications.” However this does NOT give the full picture of long-term ADHD medication usage and bone density in patients. ADHD Medication Use Tied to Reduced Bone Density in Children.

Dyskinesia in Treatment-Naive and Stimulant-Treated Children With ADHD.Before methylphenidate administration, the treated ADHD group showed significantly higher Abnormal Involuntary Movement Scale (AIMS) total score than the control group and the treatment-naive ADHD group. These results call attention that clinicians should take special care for the possible development of dyskinesia during the treatment of their ADHD patients with methylphenidate.” In another study that looked at involuntary movements in ASD children treated with methylphenidate, found that these involuntary movements persisted even after discontinuing the medication.

Chondrocyte proliferation, viability and differentiation is declined following administration of methylphenidate utilized for the treatment of attentiondeficit/hyperactivity disorder. This study looks at methylphenidate (MPH) derivative drugs and their effect on cartilage tissue in bones. “It was emphasized that clinicians should not disregard the fact that this drug might suppress chondrocyte cell proliferation and chondrogenic differentiation.”

Comparison of the effects of methylphenidate and the combination of methylphenidate and risperidone in preschool children with attention-deficit hyperactivity disorder. Full text. “Forty-seven children with ADHD aged 3–6 years were enrolled in a 6-week, single-blind clinical trial and administered with methylphenidate (5–30 mg/dl) or the combination of methylphenidate and risperidone (0.25–2 mg/dl). Two parents in combination group decided to discontinue the medication before week 3 due to severely increased appetite (one patient) and sleepiness (one patient). The most common adverse effects in this group were anorexia (21.7%) and sedation (17.4%). Three parents in risperidone group discontinued medication due to decreased appetite (one patient), agitation (one patient), and nervousness and aggression (one patient). The most common adverse effects in this group were insomnia (33.3%) and anorexia (25%).” For such a small study, side effects were high for both groups over 6-weeks. Long-term effects – unknown.

Cardiovascular safety of methylphenidate among children and young people with attention-deficit/hyperactivity disorder (ADHD): nationwide self controlled case series study. The relative risk of myocardial infarction and arrhythmias is increased in the early period after the start of methylphenidate treatment for ADHD in children and young people. Increased risk of arrhythmia was observed in all exposed time periods-that is, periods of treatment with methylphenidate…..the risk was highest in the children who had congenital heart disease.

United Nations Expresses Concern Regarding Australia’s Over-Prescription of ADD and ADHD Drugs to Children. Concern of significant increases and incorrect prescription of psycho-stimulants to australian children diagnosed with ADHD and ADD.

Case Report: Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate.

Early Morning Functioning in Stimulant-Treated Children and Adolescents with Attention-Deficit/Hyperactivity Disorder, and its Impact on Caregivers. Full pdf. Research article examining caregiver reactions to their child’s early morning ADHD symptoms and unwanted behaviors and feeling overwhelmed, exhausted, and constantly stressed.

Biochemical Abnormalities and ADHD

Attention deficithyperactivity disorder suffers from mitochondrial dysfunction.Since cybrids are shown to replicate mitochondrial defects seen in post-mortem brains, these observed defects in ADHD cybrids strongly suggest mitochondrial pathology in this disorder.”

Psychiatric Comorbidities and Outcomes Associated with ADHD

The Co-Occurrence of Autism Spectrum Disorder in Children With ADHD. Approximately one in eight children currently diagnosed with ADHD was also diagnosed with ASD. Children diagnosed with both disorders had greater treatment needs, more co-occurring conditions, and were more likely to have a combined hyperactive/impulsive and inattentive ADHD subtype.”

Psychiatric Comorbidities in a New Zealand Sample of Adults With ADHD. “Lifetime rates of psychiatric disorders were significantly higher in the ADHD group (83%) versus the control group (52%) with higher rates of major depressive disorder (MDD; 65% vs. 36%), social phobia (31% vs. 11%), substance abuse (26% vs. 8%), and alcohol abuse (32% vs. 14%).”

Troubled adolescents: substance abuse and mental disorder in young offenders.

A 4-year follow-up study of attention-deficit hyperactivity symptoms, comorbidities, and psychostimulant use in a Brazilian sample of children and adolescents with attention-deficit/hyperactivity disorder. Full pdf. This study shows a high comorbidity associated with ADHD and support the importance of evaluation and treatment for ADHD and comorbidities throughout life.

Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men.

Attention Deficit Hyperactivity Disorder Symptoms, Comorbidities, Substance Use, and Social Outcomes among Men and Women in a Canadian Sample. Full pdf.

Childhood Symptoms of ADHD Overrule Comorbidity in Relation to Psychosocial Outcome at Age 15: A Longitudinal Study. Full pdf. Early ADHD symptoms stand out as the most important risk factor for later antisocial development and impaired daily functioning.

 

ADHD Consultations

There are many issues that may be the cause of your child’s behavioural issues. It is not their fault. Finding the cause and rectifying it requires a knowledgeable and supportive practitioner. In Melbourne, John Pietryka is a Mindd accredited practitioner, specifically trained in paediatric disorders. Should you book a consultation for your child, this will include:

  • A Comprehensive Children’s Health Questionnaire for you to complete so that we have an accurate assessment of their medical, sleep, gastrointestinal and behavioural issues
  • A dietary assessment for nutritional deficiencies as well as food, chemical or other intolerances
  • Working with you to set achievable goals as I acknowledge every child has their unique challenges
  • Support in implementing dietary changes for your child
  • Suggestion of basic supplements if required; determined by nutritional evaluation
  • Occasionally may need referral to your child’s medical practitioner for some basic tests, parasitology, abdominal X-ray, iron and other blood work, only if you feel your child would able to cope with a blood draw. These tests may be covered by Medicare.
  • A follow-up call to check on your child’s progress and answer any questions or difficulties you may have with implementing dietary changes or supplements (if prescribed)