Our Integrative Approach to ADHD
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder diagnosed in childhood and is increasing in prevalence! There has been a 42% increase in ADHD diagnosis over the past 8 years. In 2015, the National Health Interview Survey reported that 7.7% of children between ages of 4-11 and 13.5% of children between 12-17 carry the diagnosis of ADHD. A few factors may be contributing to this rise in ADHD:
- There are the same number of children with ADHD, but we are better at finding and helping them.
- We have loosened the definition, so more people are being diagnosed and treated.
- We are actually misdiagnosing and treating many individuals who don’t have ADHD, even by a loosened definition.
- There are now more people who actually have ADHD due to new environmental influences.
The answer? Probably a combination of all of these; however, we particularly believe more focus should be placed on factors 3 and 4. The child needs an appropriate medical workup with a specialist in neurodevelopment to determine if ADHD is the correct diagnosis. Once the diagnosis is established, we are here to isolate the potential contributing factors and offer integrative complimentary care.
Suffering with ADHD from Overload
People with ADHD suffer from overload, causing them to be very sensitive to external stimuli, such as, sight, sound, and touch. This constant stimulation from the environment makes it difficult for them to keep focus on the task at hand. While those with ADHD are often extremely intelligent, they may be perceived as underachievers, as they struggle to complete a task. These individuals tend to be very cluttered and disorganized. In children, this may look like a messy room; in adults, this may appear as a disorganized desk cluttered with books, papers, and miscellaneous projects. This constant stimulation can also result in a great deal of internal stress, which leads to greater susceptibility to frustration, anger, and episodes of explosivity.
Problems With Medication:
Unfortunately, treating ADHD is not always as simply as taking a pill. Twenty to 35% of patients with ADHD do not respond to the medication. In those that do experience benefit from medication, the positive effects have been shown to diminish overtime. Additionally, stimulants come with a whole profile of side effects, including issues with sleep, decreased appetite, tics, decreased growth, bizarre behavior, headaches, abdominal pain, and more. While medication may be part of a successful treatment plan, individuals often do better when medication is combined with additional integrative care.
We have come to understand that the development of ADHD is a complex interplay between genetics and the environment. A child with a parent who has ADHD has more than a 50% chance of developing ADHD and a 30% chance of developing ADHD if an older sibling has it. However, genetics, are not the only factor.
As in many other neurodevelopmental conditions, the environment during pregnancy has been found to play a major role in the risk for the development of ADHD. Maternal exposure to toxins during pregnancy including, alcohol, drugs, heavy metals, PCBs, and pesticides is believed to increase risk of ADHD. Additionally, maternal mental health problems, maternal infection, and prenatal inflammation from maternal autoimmunity are believed to play a role in the development of ADHD. Finally, factors such as preterm birth and low birth weight increase the risk of ADHD. As you can see, the health of mom prior to and during pregnancy is an integral piece in a child’s neurodevelopment. This is why we believe preconception care is so important.
An Integrative Approach to Neurotransmitter Balance:
It is well recognized that neurotransmitter imbalance plays a role in ADHD; however, the exact imbalance may be different for different subtypes of ADHD. The most common neurotransmitter imbalances recognized in ADHD are in dopamine, norepinephrine, and serotonin. From an integrative perspective, there several ways to view and address neurotransmitter imbalances.
- Genetics: What genes may be influencing the metabolism of neurotransmitters, as well as the binding receptors?
- Micronutrients: What micronutrients are necessary for the production and metabolism of the respective neurotransmitters?
- Gut Health: Is there a dysbiosis or infection that is impacting neurotransmitter balance, causing neuroinflammation, or impairing absorption of key amino nutrients?
Within our practice, we follow the work and research of Dr. William Walsh, who has pioneered the field of individualized nutrient therapy for mood disorders. Dr. Walsh has found zinc and B6 to be particularly important in ADHD, which are depleted by a condition known as pyroluria.
Dr. Walsh reports zinc deficiency to be present in 96% of individuals with ADHD. Zinc is needed for the production of GABA, the main calming neurotransmitter in the brain, and is necessary for proper formation of the connections between neurons. Low zinc has been shown to be associated with increased severity of hyperactivity and impulsivity.
Pyridoxine (Vitamin B6) is an important nutrient for the production and metabolism of several neurotransmitters, including, serotonin, glutamate, GABA, and dopamine. B6 has been shown to positively influence the behavior or children with ADHD and has even been created into a medication (metadoxine) that has been shown to improve inattentive symptoms in the adult population with ADHD.
Iron is another extremely important mineral involved in the production and metabolism of neurotransmitters. Multiple studies have shown that ADHD in children is associated with low levels of serum iron and ferritin, and iron supplementation has been shown to improve symptoms in these children. Iron deficiency has also been implicated in childhood sleep disturbance, and thus should be evaluated in any child who is struggling with both ADHD and difficulty sleeping.
Omega 3 deficiency is a very common occurrence with today’s standard American diet. As a society, we are consuming less fish and more processed foods with high amounts of omega 6 oils, and this is especially popular in our kids. Omega 3 supplementation with high doses of EPA have been found to be about 40% as effective as stimulant medication.
We now understand that there is a clear connection between the gut and the brain. The gut has actually been found to have its own nervous system, which creates neurotransmitters and communicates information to the brain along the vagus nerve. The nervous system within the gut is highly affected by the bacteria within the gut (aka the microbiome), and there is increasing evidence to support poor gut health as a contributing factor to psychiatric and behavioral disorders. The establishment of the microbiome primarily occurs within the first 3-5 years of life, beginning in utero. It has been clearly documented that Cesarean section birth negatively impacts the development of the microbiome vs vaginal delivery. Interestingly, cesarean birth is also a major risk factor for the development of ADHD, which has been proposed to be due to the effects on the microbiome. Within our practice, we evaluate the microbiome and potential overgrowth of bacteria, yeast, and parasites through the use of a stool panel.
There are greater than one million pounds of over 83,000 different chemicals produced each year, and we know very little about the potential effects on neurodevelopment. Of those that have been studied, over 200 have been identified as neurotoxins. Children are much more susceptible to the damage of environmental toxins than adults, and brain injury can occur at much lower doses. The following toxins have been linked to increased risk of ADHD when exposed in utero or during early childhood.
- Polychlorinated bisphenyls (PCBs)
- Food Additives
- Heavy Metals (Lead, Mercury, Arsenic)
We feel it is extremely important to screen for past and current environmental exposure and frequently recommend testing if toxins are in question as a contributing factor.
Our modern-day Western diet is full of inflammatory oils, sugar, and artificial colorings, all of which have been implicated in the aggravation of ADHD symptoms. Thus, we highly recommend a whole foods-based diet with ample amounts of protein and fat and low to moderate intake of carbohydrates in order to regulate blood sugar throughout the day. Additionally, food sensitivities can aggravate ADHD symptoms, especially in the case of gluten sensitivity. Food sensitivities are different than allergies and can be tested with a simple finger prick in office.
Exercise can be an extremely powerful tool to improve focus, behavior, social interactions, cognitive function, and mood in children with ADHD. These effects can be realized immediately after an episode of exercise, but are amplified when long-term consistent exercise is put into practice. The timing and type of exercise does make a difference! Best results are seen when exercise is implemented at the beginning of the day and the activity consists of both cardiovascular and coordinative elements, such as running and kicking a ball into a goal.
ADHD is commonly associated with sleep disturbance, and this is a multidirectional relationship. Sleep disturbances have been proposed as an intrinsic feature of ADHD, and it has been found that lack of sleep can lead to the development of ADHD or ADHD like symptoms. Furthermore, a common side effect of stimulant medication is impaired sleep function. It is extremely important that an individual suffering from ADHD has an in-depth workup for sleep disturbances and is given lifestyle measures to support sleep with the addition of supplemental aids if necessary.
Increased screen-time is associated with worse problems with inattentiveness. Media viewed on screens bombards the nervous system with signals, and individuals with ADHD are sensitive to this overstimulation.
ADHD is a complex disorder requiring a comprehensive system-based approach. Regardless of whether medication has been implemented or not, integrative care can greatly improve symptoms associated with ADHD. If you are interested in taking a deeper dive into the root causes leading to the development of you or your child’s ADHD, we would love to join you in this mission.
For more information:
Visit our Pediatrics page for more information on health support and treatments for childhood health concerns.
Written By: Dr. Ari Calhoun, ND