Attention Deficit/Hyperactivity Disorder (ADHD)
Dietary and Lifestyle Considerations
A growing body of research indicates that dietary changes can substantially improve ADHD symptoms, either alone or as a complement to medical therapies (Millichap 2012).
Some children have a high sensitivity to some food additives and preservatives, particularly food colorings. A 2007 trial from Southampton University called into question the safety of certain food dyes. The randomized controlled trial assessed the effects of certain food colorings (ie, tartrazine (E103), quinolone yellow (E104), sunset yellow (E110), carmoisine (E122), ponceau 4R (E124) and allura red (E129)) on 153 three-year-old and 144 eight-to-nine-year-old children. The researchers found these artificial colorings resulted in increased hyperactivity in this population when added to their diet. Although artificial food coloring has not been established as a primary causative factor for ADHD, a subgroup of children have shown significant improvement when provided food lacking these additives. Similarly, they developed symptoms reminiscent of ADHD when exposed to artificial food coloring. Children with sensitivity to food coloring are often also sensitive to foods such as milk, eggs, wheat, and soy (Stevens 2011).
Although the majority of research does not support a causative role for sugar intake and ADHD, many parents anecdotally report that foods high in sugar can make their child’s ADHD hyperactivity symptoms more pronounced. However, children are more vulnerable to the effects of reactive hypoglycemia (ie, low blood sugar following the rise in blood sugar from a high carbohydrate meal) on cognitive function. Avoiding foods high in sugar may help limit reactive hypoglycemia symptoms, which may mimic some aspects of ADHD symptoms, in sensitive children (Millichap 2012).
Studies indicate that children who eat a balanced breakfast containing proteins, vitamins, and minerals, such as found in whole grains, have less deterioration in attention levels during morning hours at school (Arnold 2013).
Neurofeedback. Neurofeedback is a technique introduced in the 1960s that helps people regulate their own mental states by viewing an EEG (electroencephalogram) recording of their brain activity in real time. It utilizes sensors placed on the scalp that detect brainwaves and then graphs them on a computer screen that the test subject can visualize. This allows the subject to recognize ways of thinking that favorably alter their neurological function and can help them gain better control over their brain activity (Moriyama 2012).
This therapy aims to change the threshold that triggers brain activity in the cortex, which appears to be impaired in ADHD. The great majority of studies have been conducted on school-age boys, so it is still unclear whether its results are as promising in adults, younger children, and girls. Nevertheless, the majority of clinical studies conducted to date have reported promising, long-lasting results (Moriyama 2012). For example, in one study on children and adolescents aged 6–18 years, neurofeedback was as effective as methylphenidate in treating attentional and hyperactivity symptoms (Duric 2012). A comprehensive review of several studies examining the efficacy of neurofeedback for ADHD management concluded that it confers robust benefits for inattention and impulsivity and modest benefits for hyperactivity (Arns 2009).
Cognitive behavioral therapy. Cognitive behavioral therapy (CBT) uses behavioral skill training and interventions that target dysfunctional patterns of thought to improve functional performance (Knouse 2010). Many cognitive training programs for ADHD are commercially available, and the practice is growing in popularity. This method seems to be particularly effective during adolescence and has the advantage that it can be adapted to technologies like cell phones and tablets and is designed to be engaging to users (Rutledge 2012).
For children with ADHD, training of parents and educators can also be very effective at improving symptoms (Anastopoulos 1993). In a 2013 analysis of published studies on interventions for preschoolers with disruptive behavior including ADHD, parent behavior training had more evidence of effectiveness than methylphenidate and combined home/school interventions, with consistently good results and no adverse effects (Charach 2013). One trial involving canine assistance in addition to CBT achieved greater reduction of ADHD symptoms compared to cognitive therapy alone (Schuck 2013). A program for children aged 4 to 5, which involved games designed to reduce impulsivity, inattention, and improve memory achieved significant improvements in ADHD symptoms in a pilot study of 29 children. The positive effects were still present three months after treatment (Halperin 2012).
Physical activity. Exercise may have a positive impact on ADHD symptoms in both adults and children (Berwid 2012). Thirty adults with ADHD were enrolled in a study comparing frequent aerobic exercise with infrequent activity. The 'exercise' group showed a significant decrease in impulsive symptoms and anxiety (Abramovitch 2013). Another study showed that cognitive symptoms in children with ADHD were improved after just twenty minutes of moderate exercise (Pontifex 2013).
Yoga may also be helpful in reducing ADHD symptoms (Jensen 2004). A small-scale study in nine children demonstrated a significant improvement in ADHD symptoms as a result of learning and practicing yoga (Hariprasad 2013).