Attention deficit hyperactivity disorder, commonly known as ADHD, is one of the most common neurodevelopmental conditions in children.
Symptoms of ADHD
The characteristics of ADHD include patterns of inattention and/or hyperactivity and impulsivity. These symptoms are often severe, persistent and interfere with functioning or development. In most cases, children exhibit both inattention and hyperactivity and impulsivity.
Two subgroups of ADHD have been identified based on which behavior is more pervasive, depending on which takes precedence over the other: inattention or hyperactive-impulsive state. The diagnosis of ADHD usually occurs in children aged 3 to 6 years, and its symptoms may also persist into adolescence and adulthood, although they are often less severe.
Symptoms of inattention often include:
- Difficulty listening and paying attention.
- Difficulty following instructions and meeting deadlines.
- Poor time management.
- Poor organization of tasks and belongings.
- Child is forgetful or often loses things.
- Easily distracted.
Symptoms of hyperactivity and impulsivity include:
- Difficulty sitting or sitting still. Restlessness.
- Running or climbing in inappropriate situations.
- Inability to play or participate in quiet activities.
- Talks incessantly.
- Frequently interrupts and finishes the sentences of others.
- Talks or acts out of turn.
What causes ADHD?
While the causes of ADHD in children remain unclear, it is believed that a combination of genetic and environmental factors play an important role in the development of the condition. For example:
- Very low birth weight, lack of oxygen at birth.
- Exposure to alcohol, cigarette smoke or drugs during pregnancy.
- Brain damage.
Other conditions commonly diagnosed in people with ADHD include anxiety disorders, depression, learning disabilities and substance abuse.
How to Treat ADHD: Diet, Supplements and Lifestyle
It is a disorder that is usually addressed with medication (such as stimulants), psychotherapy, or a combination of both. According to the 2016 study at the Centers for Disease Control and Prevention, 62% of children diagnosed with ADHD were taking medication and 47% had received behavioral therapy in the past year. However, researchers recommend a multimodal approach to the treatment of pediatric ADHD.
Diet and ADHD
In the 1970s, the Feingold diet was the first dietary intervention proposed for ADHD. Based on the belief that ADHD symptoms in children were caused by food additives, it involved omitting several foods from the diet: apples, grapes, processed meats, and any foods with artificial flavors, colors, and preservatives. There is mixed evidence on the effectiveness of the Feingold regimen, although recent versions recommend only the exclusion of artificial colors and other additives.
Current ADHD research suggests that food additives may be implicated in a subset of ADHD cases4,5. A 2012 meta-analysis reported that synthetic food coloring may be linked to ADHD symptoms and signs in approximately 8% of children with the condition.Unfortunately, research in this area is often conducted with small sample sizes and prone to publication bias.
On the other hand, several studies have examined the link between ADHD and food intolerances, allergies, or both.In a subgroup of children, an elimination diet may be a valuable method of uncovering possible dietary triggers involved in the manifestation of ADHD.
The second stage of the diet involves reintroducing possible triggers, progressively. This is followed by monitoring for changes in behavior and symptoms.
Nutrition and ADHD
Research has identified a number of dietary supplements for children that may be beneficial in addressing ADHD symptoms. Consultation with a physician is recommended before resorting to the appropriate dietary supplement for each case. These are not a substitute for a healthy, balanced diet.
|Acetyl-L-Carnitine||Better behavior at home and school. Less attention problems and aggressive behavior. Plasma-free carnitine and acetyl-L carnitine in children with ADHD. With no effect on the general ADHD population, it improved inattention symptoms in children with the inattentive subtype of ADHD.|
|Multivitamins and Multiminerals||Improvement of ADHD symptoms and mood in adults.|
|GABA||A reduced concentration of GABA has been found in children with ADHD compared to typically developmental control subjects. Note: No research is available on supplementation.|
|Ginkgo Biloba||Improvement of the general symptoms of ADHD and inattention in children and adolescents with this disorder, treated with methylphenidate. Fewer ADHD symptoms observed by parents and teachers were found, less effective than methylphenidate in children with ADHD. Improvement of general symptoms, reducing hyperactivity, inattention or immaturity.Iron|
|Improvement of ADHD symptoms (reduction in severity of clinical global impression) in children with low serum ferritin levels.|
|Magnesium||Improved cognitive function in magnesium-deficient children with ADHD.|
|Melatonin||Less clinical severity of sleep disorders in 45/74 children with ADHD receiving methylphenidate (MPH) treatment. Lower mean sleep latency scores and overall sleep disturbances in children receiving methylphenidate (Ritalin) treatment. 16-minute decrease in initial insomnia in stimulant-treated children with ADHD who did not respond to sleep hygiene interventions. Advanced sleep and appearance of melatonin in dim light, total sleep time, no significant effect on behavior, cognition and quality of life in children with ADHD who do not take medication.|
|Phosphatidylserine (FS) Omega-3||Improvement of ADHD symptoms and short-term auditory memory in children with ADHD who do not take medication. In particular, fewer symptoms in the hyperactive-impulsive, emotionally and behaviorally dysregulated subtype.|
|Polyunsaturated Fatty Acids||Better parent-rated care, with lower levels of DHA phospholipids and no effect on cognitive control or functional magnetic resonance measures of brain activity in young children with ADHD. Improvement of symptoms observed by parents, inattention and hyperactivity and impulsivity. ADHD symptoms are reduced in subgroups, particularly in children with the inattentive subtype of ADHD and comorbid neurodevelopmental disorders. Improvement in the subgroup of children with ADHD.|
|EPA||Improvement of ADHD symptoms. It raises the concentration of EPA and lowers that of omega-6 fatty acids in two subgroups of ADHD (less hyperactive and impulsive children).|
|DHA||Lower plasma content of DHA phospholipids; no statistically significant improvement in ADHD symptoms.|
|Pycnogenol||Lower levels of hyperactivity. Improves attention and visual-motor coordination in children with ADHD.|
|Zinc||Hyperactive, impulsive, impaired socialization symptoms and attention deficit are reduced in children with ADHD. Amelioration of symptoms in methylphenidate-treated children with a newly diagnosed attention deficit disorder subtype of ADHD. Greater improvements demonstrated with omega-3 supplementation.|
Physical activity and ADHD
To date, no consensus has been established on the frequency, intensity and duration of physical exercise; however, several studies have observed beneficial effects of sports programs on ADHD symptoms and fine motor skills9. In a systematic review and meta-analysis of eight randomized controlled trials, both aerobic physical activity and yoga improved ADHD symptoms in children and adolescents: attention, hyperactivity and impulsivity. In addition, aerobic exercise also improved cognitive function, executive function, anxiety and social interaction.
Similarly, another study examined the effects of physical activity on cognitive function in 43 children with ADHD between the ages of 7 and 12 years. The children were placed in two experimental groups and a control group. The first experimental group underwent training in ball handling, balance and manual dexterity; while the second group played sports, but did not focus on specific skill development. After 12 weeks, improvements in working memory, motor performance and executive function were observed in both experimental groups, indicating that physical activity, regardless of specificity, positively affects children with ADHD.
For other studies, physical activity has been shown to improve behavior observed by parents and teachers. The same is true for muscular abilities, motor skills, information processing40 and performance in reading and arithmetic .
Sleep and ADHD
It is estimated that 25-50% of people with ADHD experience sleep problems. Of note are difficulty starting to fall asleep, nocturnal awakenings, reduced sleep duration, and bedtime resistance.
Insomnia may present as a symptom of ADHD, possibly attributed to changes in circadian rhythms or melatonin levels. Insomnia may also be an unwanted side effect of certain medications used to treat ADHD. Children treated with stimulants are often twice as likely to develop sleep onset latency.
Also, sleep training and maintaining proper sleep hygiene has been shown to benefit children with ADHD. A randomized case-control trial examined the effects of sleep training on the emotional, social, and behavioral functioning of children with ADHD compared with healthy children who do not receive sleep training. After 12 weeks, those who were trained experienced improvements in physical and psychosocial well-being: mood, emotions, and social relationships.
Several sleep habits, which may take months or years to develop, have been suggested to improve sleep hygiene:
- Maintain a consistent sleep routine and schedule. In this regard, energy levels should be gradually reduced to promote relaxation.
- Use relaxation techniques at bedtime: take a warm bath or drink a cup of chamomile tea.
- Reduce screen time and other activating stimuli in the bedroom, especially before bedtime: television, video games, loud music….
- Maintain a pleasant temperature and ventilation in the bedroom.
- Practice regular physical activity during the day.
- If necessary, use sound screens to muffle the noise; or even an eye mask to block the light.
It should be noted that several studies have demonstrated the efficacy of melatonin in improving sleep in children with untreated and stimulant-treated ADHD.
ADHD is believed to be an epigenetic condition triggered by environmental factors in genetically susceptible individuals6. While treatment with stimulant medication remains the standard, ADHD should be addressed through a multimodal approach. An elimination diet can help identify trigger foods associated with ADHD symptoms.
Research has also identified a number of nutrients and supplements that may be beneficial, including omega-3 fatty acids, phosphatidylserine, acetyl-L carnitine, pycnogenol, ginkgo biloba, melatonin and some minerals.
In addition, they focus on lifestyle changes, such as regular physical activity and proper sleep hygiene. These factors can also improve ADHD symptoms and daily functioning.