I will discuss the most well-known and researched interventions shortly, but let me start with this: The best integrative treatment of ADHD is to not over diagnose the problem! This would be the subject of an entirely different piece, but I believe, and evidence confirms, that much of our “epidemic” of ADHD is caused by misdiagnosis, and a lack of understanding of the normal variability of childhood behavior and development.
Given that a child does have ADHD, what are the important parts of an integrative approach? Since such an method means taking account of all aspects of a child’s life and environment, rather than simply treating a specific set of symptoms, there are many areas that need to be considered. These are the ones I use most often.
Nutrition: There is ample evidence that nutrition plays a significant role in the presence and severity of ADHD. First, repeated studies, the latest from the Lancet in 2011, show that a significant proportion of ADHD children respond positively to an elimination diet. This is not based on true Immunoglobulin E allergies, which they usually do not have. The most common offending foods are gluten and dairy, but eggs, soy, corn, and nuts are also implicated. I have found this successful in a significant proportion of my patients.
Second, basic nutrition is important. Eating foods loaded with sugar, refined carbohydrates, and fat can lead to a cycle of blood sugar spikes and crashes which result in increased hyperactivity and decreased attention. Think of a Pop-Tart or waffles and syrup for breakfast. Artificial colors and other additives have been shown to increase hyperactivity and decrease attention even in normal children. In Europe, the evidence is considered strong enough that a warning label is attached to foods with certain artificial colors. Improving basic nutrition often has a highly positive effect on ADHD symptoms.
Omega-3 Fatty Acids: Research has shown that children with ADHD have decreased blood levels of Omega-3s. the reason for this is not known. There have been a number of studies examining whether Omega-3 supplements could improve ADHD symptoms. Most of these have shown positive results, some have not.
However, a 2011 meta-analysis came to the conclusion that Omega-3 fatty acid treatment was “modestly effective” in the treatment of ADHD — in fact 40% as effective as stimulants. This is very good for a supplement with minimal side effects and other health benefits.
Iron and Zinc: A number of studies have shown that ADHD children have low ferritin levels compared to non-ADHD children. Functional MRI research has shown abnormal brain iron metabolism in ADHD children. One study showed positive effects in treating ADHD children whose ferritin was less than 30 with iron supplements. Of note, these children have low ferritin but are generally not anemic.
Zinc has also been studied in children with ADHD. Results have varied, but a few studies in zinc deficient children have shown positive results. One interesting study showed that the addition of zinc decreased necessary stimulant dose by 37%. I always check ferritin and zinc levels in children with ADHD.