ADHD

• Introduction
• Research
• TCM Clinical Trials

Introduction

Two of the most common paediatric conditions met with by practitioners of Traditional Chinese Medicine in the West are A.D.H.D. (Attention Deficit Hyperactivity Disorder) and A.D.D. (Attention Deficit Disorder). This is not surprising considering approximately two million school-aged children in the United States (at least 5 percent) are thought to have these conditions. The percentage of children with A.D.D. and A.D.H.D. is similar in other developed countries. The presenting traits in children with A.D.D. and A.D.H.D. reflect their inborn, neurologically based temperament. The four main qualities that define A.D.D. are selective attention, distractibility, impulsivity, and in many children, hyperactivity (A.D.H.D.).

A.D.D. can be interpreted as a variation of normal patterns of behavior. Unlike other diseases, which produce abnormal symptoms, A.D.D. is a grouping of normal characteristics which appear in some children more frequently, more obviously, and more intensely than in other children of the same age. All children are impulsive, distractible and inattentive, some of the time. Children with A.D.D. are impulsive, distractible, and inattentive most of the time. They think, act, feel, and learn differently.

Unlike certain childhood conditions such as enuresis, eczema, asthma etc., children usually do not out grow A.D.H.D. or A.D.D., though there tends to be less hyperactivity after puberty. If unrecognized and untreated (around 30 to 50 percent), children with these conditions are at risk of having severe school difficulties that may result in being placed in a special education classroom, repeating a grade, dropping out, or being expelled.

Treatment

When this chronic condition is recognized and managed properly, most children with A.D.D./A.D.H.D. can be inspired to use their areas of uniqueness to their advantage and be a credit to themselves, their family, and society. The modern medical consensus is children diagnosed with A.D.D. or A.D.H.D. should not be treated with drugs only. Traditional Chinese Medicine including acupuncture and/or Chinese herbal medicine is an effective option for this condition and may be used in conjunction with modern medicine or used exclusively. These treatments should also be combined with techniques to improve the child’s behavior and learning skills.

In 1995, 1.5 million children in the United States (2.8 percent of school children) between the ages of five to eighteen years were being treated with Ritalin. Ritalin is the most common drug prescribed to treat A.D.D. and A.D.H.D. From 1990 to 1995, the number of children on A.D.D. drugs tripled in the United States and Canada. In 1990, a monthly survey of 2,400 practicing physicians found that there were two million patient visits associated with the diagnosis of A.D.D. By 1994, this number had increased to 4.7 million. Approximately 90 percent of these patient visits resulted in a prescription for drug therapy. Ritalin has been used for over 30 years to treat A.D.H.D. but unfortunately many children suffer side effects, including decreased appetite, stomachache, headaches, insomnia, etc., from taking this medication. Various studies in China have demonstrated that Chinese herbal medicine can enhance the effectiveness of Ritalin as well as mitigate its side effects when taken conjunctively.

Success Story

Michael

We started seeing Robert for Michael’s ADHD when he was 8 years old. Michael was having trouble in school due to his ADHD and he also had stomach problems since he was very young. Robert was referred to me by another parent. He was fantastic. He assessed him medically and looked at the whole child as opposed to just a diagnosis. We discussed what he ate and what he reacted to well or not. After my son took the herbal medicine and changed his diet, I was contacted by his school principal who reported that “Michael was doing much better in school and was happy that I decided to give him Ritalin”, but to his surprise I informed him Michael wasn’t taken Ritalin he was just using TCM.


Research

• Nutrition and ADHD
• Iron and ADHD
• Zinc and ADHD
• Smoking During Pregnancy
• Smoking and Alcohol During Pregnancy Linked to ADHD
• ADHD or Sleep Deprivation?
• Canada Bans Adderall XR and the United States does not
• TV and ADHD
• Helping children with ADHD begins with helping parents
• Persistent Infant Crying Increases Chance of ADHD

Nutrition and ADHD

Good news for parents of 3 year olds everywhere! Removing artificial colors and preservatives from the diet was dramatically effective at reducing hyperactivity according a study carried out at the University of Southampton which included over 1800 three-year-old children. In fact, the behavioral effect of excluding these two elements from the children’s diets was comparable to the effectiveness of clonidine and Ritalin, two common ADHD drugs. After initial behavioral testing, all of the children experienced one week of a diet without any artificial food colorings and without any chemical preservatives. The children's behavior measurably improved during this week and the task for researchers was to determine whether the behavioral improvement was a result of the extra attention, from eating more fruits and vegetables, or from the absence of the preservatives and artificial colors? To answer this question, the researchers continued the diet, but gave the children disguised capsules containing either a mixture of artificial colorings, or the preservative benzoate, or nothing - each for a week. The results were published in the June 2004 Archives of Diseases in Childhood. The study found that the children’s behavior was substantially worse during weeks that children consumed either the hidden colors or the hidden chemicals. This held true regardless of whether or not they had been diagnosed with hyperactivity, and whether or not they had tested positive for allergies.

Another study performed in Britain study showed that artificial food coloring and benzoate food preservatives increase the hyperactivity of 225 preschool kids. Both studies assert that healthy changes to what your child eats can make a profound difference in your child’s physical, intellectual and emotional well being. One simple way to improve your child’s diet is to stop buying foods with artificial colors, additives, preservatives, and sweeteners.

Iron and ADHD

In Paris, France, when 110 children from the same school district were referred to a university hospital between March 2002 and June 2003 to be evaluated for school-related problems 53 of them met the criteria for a definite diagnosis of ADHD. Researchers analyzed blood samples from these children and from 27 of the other children who did not turn out to have ADHD. The stunning results were reported in the December 2004 Archives of Pediatrics and Adolescent Medicine. An astonishing 84 percent of the children with ADHD were iron deficient and the lower the iron level of the participants in this study, the worse the ADHD symptoms – worse hyperactivity, worse oppositional behavior, and worse cognitive scores. Moreover, when other researchers gave appropriate iron supplements to children with ADHD, their test scores and ADHD symptoms improved.

Zinc and ADHD

According to a small, well-designed study published April 8, 2004 in Biomed Central Psychiatry, children who took zinc supplements along with their ADHD medications had greater improvement and improved much more quickly than those who took medications alone. Half of the 44 school-aged children in the study received 15 mg of elemental zinc each day, and the other half received a placebo pill. All of them also took Ritalin. Parents, teachers, and a child psychiatrist assessed the children at the beginning, and 2, 4, and 6 weeks after starting the medicine. At the time of the assessments, no one knew which children were getting the zinc and which were getting the placebo. In these kids, getting the zinc made a significant difference.

Smoking During Pregnancy

According to a Brown University study published in the June 2003 issue of Pediatrics, smoking regular cigarettes during pregnancy can have the same toxic effects on the baby’s brain as using heroin or cocaine. In this study, the babies of mothers who smoked as little of 6.7 cigarettes a day during their pregnancy showed the same behavioral and developmental problems and withdrawal symptoms as babies who had been exposed to harder drugs while en utero. The severity of the withdrawal symptoms corresponded with the number of cigarettes the mother smoked per day. The data suggest that these effects on the brain could lead to long-term lower IQs and a higher risk of ADHD.

Smoking and Alcohol During Pregnancy Linked to ADHD

More news on smoking … A study in 2004 of 500 kids showed that if a mom smoked during pregnancy, the child had twice the risk of having Attention Deficit Hyperactivity Disorder than the children of non-smoking mothers. If mom drank alcohol, the risk was 2.5 times higher than kids not exposed to alcohol en utero.

ADHD or Sleep Deprivation?

ADD is an important problem in its own right, but research in sleep laboratories has shown that some (and perhaps a great many) kids are mislabeled with ADD when the real problem is chronic, partial sleep deprivation. If your child snores, he or she may not be experiencing a quality night’s sleep. If your child is regularly exposed to passive cigarette smoke, his or her likelihood of snoring increases by 100 to 300 percent. In fact, more and more children (both those who snore and who do not) are being diagnosed with obstructive sleep apnea and this common medical condition can have a severe impact on both a child’s intellect and behavior. The common symptoms of sleep apnea are difficulty paying attention during the day, decreased academic performance, oppositional behavior and restlessness. According to the Journal of Clinical Psychology (September 1997) many children experiencing sleep apnea or other sleep problems such as sleepwalking and restless leg syndrome are often misdiagnosed as having ADD. Moreover, sleeping problems can be further exemplified by stimulant medications such as Ritalin or Dexedrine. Regardless of whether ADD is the cause or result of restless interrupted sleep, this research is good news to parents because an improvement in your child’s sleep quality will likely result in an improvement in their behavior.

Canada Bans Adderall XR and the United States does not

Adderall XR, a popular drug used in treating ADHD has been linked to 20 known sudden deaths and 12 known strokes; 1/6 of the strokes and more than 2/3 of the sudden deaths were in children who were being treated for ADHD. Though no strokes or deaths occurred in Canada, Health Canada has removed the drug from the market and also required that the manufacturers of similar ADHD medicines submit worldwide safety data for review. Though approximately 700,000 people are taking this drug in the United States, the FDA concluded in February 2005 that no action needed to be taken with regards to getting this drug off the market. Many children currently taking this drug and have not experienced serious ramifications, however in light of the stroke and death statistics the fact remains that alternative methods need to be considered in the treatment of ADHD.

TV and ADHD

Perhaps exposure to the rapidly shifting images of television during the first three years of life alters the way the brain develops. A study reported in the April 2004 issue of Pediatrics found that the more television toddlers watch, the more likely they are to have ADHD when they are school age. The study followed more than 2,600 children, initially at ages 1 to 3. The overall rate of ADHD at age 7 was about 10 percent. But for the top 10 to 20 percent of television viewers, the ADHD rate was about 3 times higher - and increased by about 9 percent for every additional hour of daily television watched. The study does not identify whether hyperactive children naturally seek out TV more or whether parents of these children need to watch more TV in order to just relax. Until we know more, it is wise to be cautious about excess television viewing during the first 3 years of your child’s life.

Helping children with ADHD begins with helping parents

A study conducted at the University of Maryland acknowledges the parental factor when addressing the treatment of ADHD in children. To explain further, the parents of children with ADHD had higher rates of depression and other psychological problems, including alcohol and other types of substance abuse. Moreover, the parents of children with ADHD also presented an increased likelihood of having ADHD themselves. The psychological problems the parents experienced are probably the result of dealing with the stress of raising an ADHD child in combination with genetics. The study found that all modes of treating ADHD were less effective if the child’s parents had ADHD themselves or were dealing with psychological issues. Dealing with a child with ADHD can be exhausting, frustrating, and embarrassing (as well as creative, energizing, and delightful) and a child’s treatment plan should be developed with parental support in mind.

Persistent Infant Crying Increases Chance of ADHD

A UK study of 128 children showed that infants who were persistent criers beyond 4 months of age had a 20% chance of hyperactive behavior as a child, versus a 2% chance in non-criers. They also tended to not perform as well in school and displayed more antisocial behavior. Babies diagnosed specifically with colic did not show these tendencies. The researchers believed one reason for these findings was the attitude, or lack thereof, of the caregivers towards the fussy infants.


TCM Clinical Trials

Study 1

The results of a research study using Chinese herbal medicine combined with Ritalin to treat ADHD appeared in a August 2005 edition of Fujian Journal of Chinese Medicine & Medicinals. This clinical trial included 56 patients between the ages of 5-11 years old. These participants were divided into two groups. The treatment group and comparison group both took five milligrams of methylphenidate (Ritalin®) two times per day in the morning and evening. In addition to Ritalin, the treatment group was administered Chinese herbal medicine. The formula used was Liu Wei Di Huang Tang He Gan Mai Da Zao Tang (Six Flavors Rehmannia Decoction plus Licorice, Wheat & Red Date Decoction). In both groups, one course of treatment equaled one month, and all patients in the study continued treatment for three months.

Using the above protocol, 26 cases in the treatment group were cured, eight cases improved, and two cases did not improve. Therefore, the cure rate for this group was 72.2% and the total amelioration rate was 94.4%. In the comparison group, 12 cases were cured, four cases improved, and four cases did not improve. Thus the cure rate for this group was 60% and the total amelioration rate was 80%.

Follow-up visits six months later showed that symptoms had reappeared in 70% (14/20 cases) of the patients in the comparison group, while symptoms reappeared in only 13.9% (5/36 cases) of the patients in the treatment group. In addition, only eight children in the treatment group had side effects (which included poor appetite and slight difficulty sleeping), whereas, in the comparison group, 12 cases (60%) had side effects which had a tendency to be more severe than the treatment group and included decreased appetite, insomnia, abdominal pain, and rapid heartbeat.