Attention Deficit–Hyperactivity Disorder

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Attention Deficit–Hyperactivity Disorder

Need to Know

Attention Deficit–Hyperactivity Disorder
Hyperactivity—is it normal behavior or ADHD? When a child is more than rambunctious, it is important to know the facts. According to research or other evidence, the following self-care steps may be helpful.
  • Supplement with essential fatty acids

    Getting approximately 186 mg of EPA (eicosapentaenoic acid), 480 mg of DHA (docosahexaenoic acid), 96 mg of GLA (gamma-linolenic acid), 864 mg of linoleic acid, and 42 mg of arachidonic acid supplies fatty acids important for brain function

  • Check out L-carnitine

    To improve behavior, take 100 mg of this supplement for each 2.2 pounds of body weight a day, with a maximum of 4 grams a day

  • Give magnesium a go

    200 mg a day can address possible deficiency of this mineral that may influence ADHD

  • Try the Feingold diet

    Work with the Feingold Association or a diet specialist to reduce or eliminate food additives and other food issues that may affect ADHD

About

About This Condition

Attention deficit-hyperactivity disorder (ADD or ADHD) is defined as age-inappropriate impulsiveness, lack of concentration, and sometimes excessive physical activity.

ADHD has been associated with learning difficulties and lack of social skills. Obviously what constitutes “normal” in these areas covers a wide spectrum; thus it is unclear which child suffers true ADHD and which child is just more rambunctious or rebellious than another. No objective criteria exist to accurately confirm the presence of ADHD. ADHD often goes undiagnosed if not caught at an early age, and it affects many adults who may not be aware of their condition.

Symptoms

ADHD is generally recognized by a pattern of inattention, distractibility, impulsivity, and hyperactivity estimated to affect 3 to 5% of school-aged children. Learning disabilities or emotional problems often accompany ADHD. Children with ADHD experience an inability to sit still and pay attention in class, and they often engage in disruptive behavior.

Eating Right

The right diet is the key to managing many diseases and to improving general quality of life. For this condition, scientific research has found benefit in the following healthy eating tips.

Recommendation Why Get started
Go hypoallergenic Eliminating additives and allergenic foods from the diet has been shown to help children with attention problems. Read labels to avoid problem foods.

Go hypoallergenic

In one study, children diagnosed with ADHD were put on a hypoallergenic diet, and those children who improved (about one-third) were then challenged with food additives. All of them experienced an aggravation of symptoms when given these additives.1 Other studies have shown that eliminating individual allergenic foods and additives from the diet can help children with attention problems.2 , 3
Look for sugar alternatives While further research is needed, some evidence shows that avoiding sugar reduces aggressiveness and restlessness in children with ADHD.

Look for sugar alternatives

Some parents believe that consuming sugar may aggravate ADHD. One study found that avoiding sugar reduced aggressiveness and restlessness in hyperactive children.4 Girls who restrict sugar have been reported to improve more than boys.5 However, a study using large amounts of sugar and aspartame (NutraSweet®) found that negative reactions to these substances were limited to just a few children.6 While most studies have not found sugar to stimulate hyperactivity, except in rare cases,7 the experimental design of these studies may not have been ideal for demonstrating an adverse effect of sugar on ADHD, if one exists. Further studies are needed.

Try the Feingold diet Some parents of ADHD children have found success with the Feingold diet, a program that eliminates foods with artificial chemicals and additives.

Try the Feingold diet

The two most studied dietary approaches to ADHD are the Feingold diet and a hypoallergenic diet. The Feingold diet was developed by Benjamin Feingold, M.D., on the premise that salicylates (chemicals similar to aspirin that are found in a wide variety of foods) are an underlying cause of hyperactivity. In some studies, this hypothesis does not appear to hold up.8 However, in studies where markedly different levels of salicylates were investigated, a causative role for salicylates could be detected in some hyperactive children.9 As many as 10 to 25% of children may be sensitive to salicylates.10 Parents of ADHD children can contact local Feingold Associations for more information about which foods and medicines contain salicylates.

The Feingold diet also eliminates synthetic additives, dyes, and chemicals, which are commonly added to processed foods. The yellow dye tartrazine has been specifically shown to provoke symptoms in controlled studies of ADHD-affected children.11 Again, not every child reacts, but enough do so that a trial avoidance may be worthwhile. The Feingold diet is complex and requires guidance from either the Feingold Association or a healthcare professional familiar with the Feingold diet.

Supplements

What Are "Star" Ratings?

a7_3star   Reliable and relatively consistent scientific data showing a substantial health benefit.

a7_2star   Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

a7_1star   For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.


Supplement Amount Why
Essential Fatty Acids
 186 mg of EPA, 480 mg of DHA, 96 mg of GLA, 864 mg of linoleic acid, and 42 mg of arachidonic acid daily 2 stars   In one study, children with ADHD who were given a fatty-acid supplement saw significant improvements in both cognitive function and behavioral problems.


2 stars  Essential Fatty Acids

186 mg of EPA, 480 mg of DHA, 96 mg of GLA, 864 mg of linoleic acid, and 42 mg of arachidonic acid daily

A deficiency of several essential fatty acids has been observed in some children with ADHD compared with unaffected children.12 , 13 One study gave children with ADHD evening primrose oil supplements in an attempt to correct the problem.14 Although a degree of benefit was seen, results were not pronounced. In a 12-week double-blind study, children with ADHD were given either a placebo or a fatty-acid supplement providing daily: 186 mg of eicosapentaenoic acid (EPA), 480 mg of docosahexaenoic acid (DHA), 96 mg of gamma-linolenic acid (GLA), 864 mg of linoleic acid, and 42 mg of arachidonic acid. Compared with the placebo, the fatty-acid supplement produced significant improvements in both cognitive function and behavioral problems.15 No adverse effects were seen. In a preliminary trial, supplementation with approximately 400 mg of flaxseed oil and 25 mg of vitamin C, each twice a day for three months, was associated with an improvement of symptoms in children with ADHD.16

Supplement Amount Why
Iodine
(Iodine Deficiency, Pregnancy)
 Consult a qualified healthcare practitioner 2 stars   In one study, iodine deficiency during pregnancy was associated with the babies being born with increased ADHD risk. If you are pregnant or trying to get pregnant, discuss whether you might need iodine supplements with your doctor.


2 stars  Iodine

Consult a qualified healthcare practitioner

In a preliminary study of women in Italy, iodine deficiency severe enough to cause hypothyroidism during pregnancy was associated with an increased risk of ADHD in their children.17 Women who are contemplating pregnancy or who are pregnant should get adequate amounts of iodine in their diet and should discuss with their healthcare provider whether iodine supplementation is appropriate.

Supplement Amount Why
Iron
(Iron-Deficiency Anemia)
 Consult a qualified healthcare practitioner 2 stars   In one study, iron levels were significantly lower in a group of children with ADHD than in healthy children. In the case of iron deficiency, supplementing with the mineral may improve behavior.


2 stars  Iron

Consult a qualified healthcare practitioner

Iron status, as measured by the serum ferritin concentration, was significantly lower in a group of children with ADHD than in healthy children. Ferritin levels were below normal in 84% of the children with ADHD, compared with 18% of the healthy children.18 Since iron deficiency can adversely affect mood and cognitive function, iron status should be assessed in children with ADHD, and those who are deficient should receive an iron supplement. In a case report, a young boy with both ADHD and iron deficiency showed considerable improvement in behavior after receiving an iron supplement.19 Iron supplementation was also beneficial in a double-blind study of children with ADHD and iron deficiency.20

Supplement Amount Why
L-Carnitine
 100 mg per 2.2 lbs (1 kg) of body weight daily, up to a maximum of 4 grams per day 2 stars   In a double-blind study, supplementing with L-carnitine resulted in improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.

2 stars  L-Carnitine

100 mg per 2.2 lbs (1 kg) of body weight daily, up to a maximum of 4 grams per day

In a double-blind study, supplementation with L-carnitine for eight weeks resulted in clinical improvement in 54% of a group of boys with ADHD, compared with a 13% response rate in the placebo group.21 The amount of L-carnitine used in this study was 100 mg per 2.2 pounds of body weight per day, with a maximum of 4 grams per day. No adverse effects were seen, although one child developed an unpleasant body odor while taking L-carnitine. Researchers have found that this uncommon side effect of L-carnitine can be prevented by supplementing with riboflavin. Although no serious side effects were seen in this study, the safety of long-term L-carnitine supplementation in children has not been well studied. This treatment should, therefore, be monitored by a physician.

Supplement Amount Why
Magnesium
 If deficient: 200 mg daily 2 stars   Some children with ADHD have low magnesium levels. In one trial, children with ADHD and low magnesium status who were given magnesium had a significant decrease in hyperactive behavior.

2 stars  Magnesium

If deficient: 200 mg daily

Some children with ADHD have lowered levels of magnesium. In a preliminary, controlled trial, children with ADHD and low magnesium status were given 200 mg of magnesium per day for six months.22 Compared with 25 other magnesium-deficient ADHD children, those given magnesium supplementation had a significant decrease in hyperactive behavior.

Supplement Amount Why
Pycnogenol
 1 mg daily per 2.2 pounds body weight daily 2 stars   Though another story did not find effect, one study reported that Pycnogenol reduced symptoms of hyperactivity and improved attention, coordination, and concentration after one month in a group of children with ADHD.


2 stars  Pycnogenol

1 mg daily per 2.2 pounds body weight daily

A double-blind study in Slovakia reported that 1 mg daily per 2.2 pounds body weight of Pycnogenol reduced symptoms of hyperactivity and improved attention, coordination, and concentration after one month in a group of children with ADHD.23 However, a double-blind study in adults with ADHD did not find 1 mg Pycnogenol per pound of body weight daily was effective for ADHD symptoms.24

Supplement Amount Why
Zinc
 If deficient: 15 mg per day 2 stars   In one study, children with ADHD who received zinc showed significantly greater behavioral improvement, compared with children who received a placebo.

2 stars  Zinc

If deficient: 15 mg per day

In a double-blind study, children with ADHD who received 15 mg of zinc per day for six weeks showed significantly greater behavioral improvement, compared with children who received a placebo.25 This study was conducted in Iran, and zinc deficiency has been found to be quite common in certain parts of that country. It is not clear, therefore, to what extent the results of this study apply to children living in other countries.

Supplement Amount Why
Evening Primrose Oil
 Refer to label instructions 1 star   A deficiency of several essential fatty acids has been observed in some children with ADHD. In one study, children who received evening primrose oil showed minor improvements.


1 star  Evening Primrose Oil

A deficiency of several essential fatty acids has been observed in some children with ADHD compared with unaffected children.26 , 27 One study gave children with ADHD evening primrose oil supplements in an attempt to correct the problem.28 Although a degree of benefit was seen, results were not pronounced. In a 12-week double-blind study, children with ADHD were given either a placebo or a fatty-acid supplement providing daily: 186 mg of eicosapentaenoic acid (EPA), 480 mg of docosahexaenoic acid (DHA), 96 mg of gamma-linolenic acid (GLA), 864 mg of linoleic acid, and 42 mg of arachidonic acid. Compared with the placebo, the fatty-acid supplement produced significant improvements in both cognitive function and behavioral problems.29 No adverse effects were seen. In a preliminary trial, supplementation with approximately 400 mg of flaxseed oil and 25 mg of vitamin C, each twice a day for three months, was associated with an improvement of symptoms in children with ADHD.30

Supplement Amount Why
L-Tryptophan
 Refer to label instructions 1 star   Imbalances in the brain chemical serotonin, or low blood levels of its precursor, L-tryptophan, have been associated with ADHD in some (though not all) studies


1 star  L-Tryptophan

Imbalances in the brain chemical serotonin, or low blood levels of its precursor, L-tryptophan, have been associated with ADHD in some,31 though not all,32 studies.33 , 34 Preliminary human studies report that creating deficiencies in L-tryptophan worsens some symptoms of ADHD. A small double blind trial found that giving children with ADHD a daily supplement of 100 mg L-tryptophan per 2.2 pounds body weight per day for one week improved behavior according to parents’ ratings, but not teachers’ ratings.35 More studies are needed to better evaluate L-tryptophan as a treatment for ADHD.

Supplement Amount Why
Shelled Hemp Seed
 Refer to label instructions 1 star   Theoretically shelled hemp seed may be useful for people with ADHD due to its essential fatty acid content.

1 star  Shelled Hemp Seed

Though it has not been studied, theoretically shelled hemp seed may be useful for people with ADHD due to its content of essential fatty acids.36 , 37

Supplement Amount Why
Vitamin B6
 Refer to label instructions 1 star   In one study, high amounts of vitamin B6 was more effective than methylphenidate (Ritalin). A healthcare practitioner knowledgeable in nutrition must be consulted when using high amounts of this vitamin.


1 star  Vitamin B6

B vitamins , particularly vitamin B6, have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.38 In a study of six children with low blood levels of the neurotransmitter (chemical messenger) serotonin, vitamin B6 supplementation (15–30 mg per 2.2 pounds of body weight per day) was found to be more effective than methylphenidate (Ritalin®). However, lower amounts of vitamin B6 were not beneficial.39 The effective amount of vitamin B6 in this study was extremely large and could potentially cause nerve damage, although none occurred in this study. A practitioner knowledgeable in nutrition must be consulted when using high amounts of vitamin B6. High amounts of other B vitamins have shown mixed results in relieving ADHD symptoms.40 , 41

Supplement Amount Why
Vitamin B-Complex
 Refer to label instructions 1 star   B vitamins have been used for ADHD. High amounts of B vitamins have shown mixed results in relieving ADHD symptoms.

1 star  Vitamin B-Complex

B vitamins , particularly vitamin B6, have also been used for ADHD. Deficient levels of vitamin B6 have been detected in some ADHD patients.42 In a study of six children with low blood levels of the neurotransmitter (chemical messenger) serotonin, vitamin B6 supplementation (15–30 mg per 2.2 pounds of body weight per day) was found to be more effective than methylphenidate (Ritalin®). However, lower amounts of vitamin B6 were not beneficial.43 The effective amount of vitamin B6 in this study was extremely large and could potentially cause nerve damage, although none occurred in this study. A practitioner knowledgeable in nutrition must be consulted when using high amounts of vitamin B6. High amounts of other B vitamins have shown mixed results in relieving ADHD symptoms.44 , 45

References

1. Boris M, Mandel FS. Foods and additives are common causes of the attention deficit hyperactive disorder in children. Ann Allergy 1994;72:462–8.

2. Carter CM, Urbanowicz M, Hemsley R, et al. Effects of a few food diet in attention deficit disorder. Arch Dis Child 1993;69:564–8.

3. Egger J, Stolla A, McEwen LM. Controlled trial of hyposensitisation in children with food-induced hyperkinetic syndrome. Lancet 1992;339:1150–3.

4. Prinz RJ, Roberts WA, Hantman E. Dietary correlates of hyperactive behavior in children. J Consult Clin Psychol 1980;48:760–9.

5. Rosen LA, Booth SR, Bender ME, et al. Effects of sugar (sucrose) on children’s behavior. J Consult Clin Psychol 1988;56:583–9.

6. Wolraich ML, Lindgren SD, Stumbo PJ, et al. Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N Engl J Med 1994;330:301–7.

7. Wolraich ML, Wilson DB, White JW. The effect of sugar on behavior or cognition in children. A meta-analysis. JAMA 1995;274:1617–21.

8. Harley JP, Ray RS, Tomasi L, et al. Hyperkinesis and food additives: testing the Feingold hypothesis. Pediatrics 1978;61:818–21.

9. Levy F, Dumbrell S, Hobbes G, et al. Hyperkinesis and diet: a double-blind crossover trial with a tartrazine challenge. Med J Aust 1978;1:61–4.

10. Williams JI, Cram DM. Diet in the management of hyperkinesis: a review of the tests of Feingold’s hypotheses. Can Psychiatr Assoc J 1978;23:241–8 [review].

11. Rowe KS, Rowe KJ. Synthetic food coloring and behavior: a dose response effect in a double-blind, placebo-controlled, repeated-measures study. J Pediatr 1994;125:691–8.

12. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr 1987;26:406–11.

13. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761–8.

14. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation by Efamol in hyperactive children. J Abnorm Child Psychol 1987;15:75–90.

15. 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;26:233–9.

16. Joshi K, Lad S, Kale M, et al. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids 2006;74:17–21.

17. Vermiglio F, Lo Presti VP, Moleti M, et al. Attention deficit and hyperactivity disorders in the offspring of mothers exposed to mild-moderate iodine deficiency: a possible novel iodine deficiency disorder in developed countries. J Clin Endocrinol Metab 2004;89:6054–60.

18. Konofal E, Lecendreux M, Arnulf I, Mouren MC. Iron deficiency in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2004;158:1113–5.

19. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention defecit hyperactivity disorder in children. Pediatr Neurol 2008; 38:20-6.

20. Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol 2008;38:20–6.

21. Van Oudheusden LJ, Scholte HR. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins Leukot Essent Fatty Acids 2002;67:33–8.

22. 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;10:149–56.

23. Trebatická J, Kopasová S, Hradecná Z, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur Child Adolesc Psychiatry 2006;15:329-35.

24. Tenenbaum S, Paull JC, Sparrow EP, et al. An experimental comparison of Pycnogenol and methylphenidate in adults with Attention-Deficit/Hyperactivity Disorder (ADHD). J Atten Disord 2002;6:49-60.

25. 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;4:9.

26. Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr 1987;26:406–11.

27. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761–8.

28. Aman MG, Mitchell EA, Turbott SH. The effects of essential fatty acid supplementation by Efamol in hyperactive children. J Abnorm Child Psychol 1987;15:75–90.

29. 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;26:233–9.

30. Joshi K, Lad S, Kale M, et al. Supplementation with flax oil and vitamin C improves the outcome of Attention Deficit Hyperactivity Disorder (ADHD). Prostaglandins Leukot Essent Fatty Acids 2006;74:17–21.

31. Comings DE. Serotonin and the biochemical genetics of alcoholism: lessons from studies of attention deficit hyperactivity disorder (ADHD) and Tourette syndrome. Alcohol Alcohol Suppl 1993;2:237–41 [review].

32. Ferguson HB, Pappas BA, Trites RL, et al. Plasma free and total tryptophan, blood serotonin, and the hyperactivity syndrome: no evidence for the serotonin deficiency hypothesis. Biol Psychiatry. 1981;16:231–8.

33. Stadler C, Zepf FD, Demisch L, et al. Influence of rapid tryptophan depletion on laboratory-provoked aggression in children with ADHD. Neuropsychobiology 2007;56:104–10.

34. Zepf FD, Stadler C, Demisch L, et al. Serotonergic functioning and trait-impulsivity in attention-deficit/hyperactivity-disordered boys (ADHD): influence of rapid tryptophan depletion. Hum Psychopharmacol 2008;23:43–51.

35. Nemzer ED, Arnold LE, Votolato NA, McConnell H. Amino acid supplementation as therapy for attention deficit disorder. J Am Acad Child Psychiatry 1986;25:509–13.

36. Stevens LJ, Zentall SS, Deck JL, et al. Essential fatty acid metabolism in boys with attention-deficit hyperactivity disorder. Am J Clin Nutr 1995;62:761–8

37. Fitzsimmons S. Hemp seed oil: Fountain of youth? Br J Phytother 1998;5:90–6.

38. Bhagavan HN, Coleman M, Coursin DB. The effect of pyridoxine hydrochloride on blood serotonin and pyridoxal phosphate contents in hyperactive children. Pediatrics 1975;55:437–41.

39. Coleman M, Steinberg G, Tippett J, et al. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biol Psychiatry 1979;14:741–51.

40. Brenner A. The effects of megadoses of selected B complex vitamins on children with hyperkinesis: controlled studies with long term followup. J Learning Dis 1982;15:258–64.

41. Haslam RHA. Is there a role for megavitamin therapy in the treatment of attention deficit hyperactivity disorder? Adv Neurol 1992;58:303–10.

42. Bhagavan HN, Coleman M, Coursin DB. The effect of pyridoxine hydrochloride on blood serotonin and pyridoxal phosphate contents in hyperactive children. Pediatrics 1975;55:437–41.

43. Coleman M, Steinberg G, Tippett J, et al. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biol Psychiatry 1979;14:741–51.

44. Brenner A. The effects of megadoses of selected B complex vitamins on children with hyperkinesis: controlled studies with long term followup. J Learning Dis 1982;15:258–64.

45. Haslam RHA. Is there a role for megavitamin therapy in the treatment of attention deficit hyperactivity disorder? Adv Neurol 1992;58:303–10.

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