Contents

 

Introduction

 

Part I: Western Biomedicine

1. DSM IV
1. Diagnostic criteria
2. Differential Diagnosis
2. Neurological Information
3. 3 clinical subtypes
4. Ethics Issues in Diagnosis and Treatment
5. Meyers Brigg Temperment Indicator Types for ADHD
6. Gifted and Talented Children Misdiagnosed
7. Medications
8. Western Herbs
9. Diet

 

Part II: Chinese Medicine

1. ADHD and TCM
2. Frequency of ADHD Patterns
3. ADHD Patterns, Symptoms and Treatment Principles
4. Etiologies
5. Treatment with Acupuncture
6. Herbal Treatments and Diet
7. Treatment Plan and Prognosis

 

Conclusion

 

Biography

 

Sources

 

            Chinese Medicine can treat ADHD in much the way it treats all diseases; diagnosis involves pattern-differentiation, and treatment follows from correct identification of the pattern(s) involved.  There is also a growing body of specific information about the treatment and pathomechanisms of ADHD gathered from the clinical experience of TCM practitioners.

 

 

 

 

 

 

 

Part I:

Western Biomedicine

 

DSM IV Diagnostic Criteria

 

The DSM IV (1994) criteria are much more exact than the DSM III criteria. 

 

A.  Either 1 or 2

        1.Six or more of the following symptoms of inattention have persisted for at least six months to a degree that is maladaptive and inconsistent with

          developmental level:

• Often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• Often has difficulty sustaining attention in tasks or play activities
• Often does not seem to listen when spoken to directly
• Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions)
• Often has difficulty organizing tasks and activities
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as school work or homework)
• Often loses things necessary for tasks or activities (e.g., toys, school assignments, pencils, books, or tools)
• Is often easily distracted by extraneous stimuli
• Is often forgetful in daily activities

 

        2.Six or more of the following symptoms of hyperactivity/impulsivity have persisted for at least six months to a degree that is maladaptive and inconsistent with developmental level

 

          Hyperactivity

• Often fidgets with hands or feet or squirms in seat
• Often leaves seat in classroom or in other situations in which remaining seated is expected
• Often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• Often has difficulty playing or engaging in leisure activities quietly
• Is often "on the go" or often acts as if "driven by a motor"
• Often talks excessively

 

Impulsivity

• Often blurts out answers before questions have been completed
• Often has difficulty awaiting turn
• Often interrupts or intrudes on others (e.g. butts into conversations or games)

 

   B.Some hyperactive, impulsive or inattentive symptoms that caused impairment were present before 7 years of age

 

  C.Some impairment from the symptoms is present in two or more settings (e.g., at school or work and at home)

 

  D.There must be clear evidence of clinically significant impairment in social, academic, or occupational functioning

 

   E.The symptoms do not occur exclusively during the course of a pervasive developmental disorder, schizophrenia, or other psychotic disorder, and are not better accounted for by another mental disorder (e.g., mood disorder, anxiety disorder, dissociative disorder, personality disorder.)

 

 

Clinical Subtypes

1. ADHD combined type: qualifies for both the inattentive and the hyperactive/impulsive portions of the DSM IV criteria
2. ADHD, predominantly Inattentive type
3. ADHD, predominantly Hyperactive-Impulsive type

Differential Diagnosis

 

Be sure the symptoms are not actually more due to:

 

• Mood disorder
• Anxiety disorder
• Dissociative disorder
• Personality disorder
• Oppositional behavior
• Psychotic disorder
• Age-appropriate behaviors in active children
• Mental Retardation with attentiveness and behavior appropriate to child's mental age

• Allergies
• Hypoglycemia
• Abusive/stressful home situation
• Malnutrition
• Chronic middle ear infection
• Sinusitis
• Visual/hearing problems
• Dyslexia
• Other neurological problems (e.g. CFIDS)
• Intelligent/Gifted but in an understimulating environment

Neurological Information

 

Anatomic Studies

 

• Symmetry of the frontal lobes instead of the normal right greater than left pattern
• Smaller left caudate and globus pallidus

 

Positron Emission Scanning

 

• Glucose metabolism in the adults with residual type AD/HD has been measured by PET scan and was found to be globally decreased.

 

Blood Flow Analysis

 

• Alterations in blood flow to the frontal and basal ganglia regions have been reported in patients with AD/HD. These abnormalities of flow are reversed by treatment with methylphenidate.

 

Clinical Correlation

 

• The right hemisphere may be dominant for mediating attention.
• Left hemisphere lesions are associated with no effect on attention.
• However, lesions of the right hemisphere will induce severe inattention and an inability to sustain simple motor acts.
• Lesions of the medial and dorsolateral frontal lobes are associated with inattention, impaired response inhibition and motor impersistence.
• The right frontal lobe and right striatum appear to be particularly important for inhibiting unwanted action in response to stimuli.
• The neurons of the prefrontal cortex respond to sensory stimuli and are thought to integrate motivational events with complex sensory stimuli. They are also involved in inhibiting or delaying motor response to stimuli. The right frontal lobe has been implicated as one potential site of pathologic neurotransmission in AD/HD.
• Prefrontal damage is known to cause disturbance in drive and executive control. This lack of executive control results in impulsive actions do to an inability to think ahead to the consequences of an action.
• Circuits connecting the basal ganglia with the prefrontal cortex may also be important in cognition. Abnormalities of blood flow to these regions are noted in patients with AD/HD.
• One fx of the LC (locus ceruleus)/noradrenergic system is modulation of behavioral state.  It can enhance the processing of relevant stimuli and increase the SNR (signal to noise ratio).  In primates, the PFC (prefrontal cortex) is the major region that inhibits the processing of irrelevant stimuli... LC dysfx can also cause decreased levels of PFC dopamine. LC hypofx could therefore produce ADD because an individual's ability to decide what is salient when exposed to sensory input would be impaired-  norepinephrine xu -> low SNR  (Goldstein, p59)
• the Locus Ceruleus is important is arousal and vigilance. Vigilance is a state of increased arousal. Vigilance is necessary for focus or directed attention but not suffecient. Focused attention requires that incoming sensory information be given a priorty according to importance. The process of habituation occurs if stimuli is not reinforced. A lack of directed attention can appear as impaired concentration.

 

Neuroanatomy of AD/HD

 

The frontal lobe, right cerebral hemisphere, globus pallidus, hippocampus, nucleus acumbens, locus ceruleus, and thalamus have been implicated in the etiology of AD/HD

 

Putting It All Together: A Neuroanatomical/Neurochemical Model for ADHD

 

Several anatomic locations in the brain contain pathways which modulate cortical motor and cognitive output. At each anatomic location a different neurotransmitter is used primarily.

 

1. Dopaminergic pathways exist at the cortical and subcortical level (with in the right cerebral hemisphere, prefrontal cortex, hippocampus and nucleus accumbens) which when impaired prevent appropriate sensory filtering and cognitive processing. Deficiencies in these Dopaminergic pathways are most closely related to the inattentive form of AD/HD.
2. Arousal level is mediated in the brain stem by the reticular formation and locus coeruleus. The primary neurotransmitter is norepinephrine.  Disorders in this pathway result in the hyper-aroused AD/HD.
3. The prefrontal cortex modulates behavior inhibition and serotonin is the predominant central inhibiting neurotransmitter. Defects in this pathway lead to AD/HD-like behaviors secondary to impulsivity.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Here is a graphic representation of this model:

 

All three types meet DSM IV criteria for AD/HD but represent different neurochemical pathologies which may respond differentially to specific pharmacotherapies.

 

These concepts remains to be evaluated in a controlled fashion. However, such a model may ultimately prove useful in choosing the best therapeutic agent for a given child, predicting comorbid disorders, aid in defining prognosis and in designing better case specific behavioral interventions.

 

Ethical Issues in Diagnosis and Treatment

 

• Gifted children exhibit significantly more "overexcitabilities" than average children, including physical, emotional, intellectual, sensual and imaginational overexcitabilities
• Lists of creative behaviors are strikingly similar to the ADD diagnostic criteria (see inset above)
• Children diagnosed with ADD score higher on tests of creativity.  In one study, more than a quarter of the children previously diagnosed as ADHD scored high enough to qualify for a Creative Scholars program in Louisiana
• Most people diagnosed with ADD can focus extremely well on something they find interesting - even better than the average person;
• A 1999 survey of two Virginia school districts (30,000 children) found that 20% of the 5th-grade white boys were taking ADD medications; in another study between 1 and 1.5 percent of preschoolers were found to be taking psychotropic medications in 1995, often two or three medications simultaneously (usage is probably much higher now) - compare 20% to the DSMIV's stated 3-5% prevalence.
• Temperament experts believe ADD behaviors are within the realm of "normal" behavior for certain MBTI temperament types
• Professionals espousing a positive view of ADD are usually ADD themselves (Hallowell, Hartmann, Weiss) while professionals sticking to a strictly negative view are not ADD (Barkley) or are associated with the pharmaceutical industry (CHADD).
• A Purdue University study found that kids deficient in omega-3 fatty acids are more likely to have ADD, learning disorders, behavior problems, depression and dyslexia
• Some researchers argue that ADD traits such as impulsivity and restlessness are adaptive behaviors that once helped humans to survive in harsh, unstable environments
• The Center for Science in the Public Interest recently reviewed 25 years of scientific studies and determined that food additives and certain foods DO cause behavior problems in a significant number of people and that public policy should be changed accordingly. Groups such as CHADD (funded by the makers of Ritalin) adamantly tell parents not to waste their time checking for food sensitivities
• Top psychiatrists are increasingly beginning to speak out against their peers for over-medicating America's children, especially preschool children. Dr. Joseph T Coyle, chair of the psychiatry department at Harvard Medical School said "these drugs are being used at ages for which there is abolutely no justification." Dr. Coyle polled the editorial board of the Journal of Child and Adolescent Psychopharmacology (48 physicians) and found "most of the experts said they have not or very rarely use these drugs" on young children.  He says this raises the question: If the experts feel that this is inappropriate, then who's prescribing these drugs?

Meyers Brigg Temperament Indicator

The MBTI is a system of personality differentiation.  There are 16 types, which come from 4 either/or attributes; Extrovert/Introvert, Sensing/iNtuituing, Thinking/Feeling, Judging/Perceiving.  For example, Someone who has preferences for Extraversion, iNtuition, Thinking and Perceiving is said to be an "ENTP" type.

Brief Descriptions of the 4 Most Common Temperaments To Visit Borntoexplore.org (a website devoted to alternative views on ADHD):

Quotes are from the book "The Pathfinder" by Nicholas Lore.

INFP "The Healer" (By far the mostly likely type to identify themselves as ADD, considering they are only 1% of the population): "Idealistic, warm, caring, creative, imaginative, original, artistic, perceptive, supportive, empathetic, cooperative, facilitative, compassionate, responsive, sensitive, gentle, tenderhearted, devoted, loyal, virtuous, self-critical, perfectionist, self-sacrificing, deep, multifaceted, daydreamer, persistent, determined, hard-working, improviser, initiator of new projects and possibilities, agents of change. Drawn to possibilities, 'what could be' rather than 'what is.' Values-oriented with high level of personal integrity.  Their focus is on understanding themselves, personal growth, and contributing to society in a meaningful way.  If their career does not express their idealism and drive for improvement, they usually become bored and restless. Dislike conflict, dealing with trivialities, and engaging in meaningless social chatter.  Needs a private work space, autonomy, and a minimum of bureaucratic rules." Some of the best novelists are INFPs. Suggested careers: Counselor, artist, and journalist.  INFPs are prone to depression when they cannot meet their own sense of perfection or the expectations of others. The very often accept blame, even when it's not deserved, and really dwell on how bad they think they are, but they are not likely to let people know that.  They also tend to write me the nicest letters. 

ENFP "The Advocate": "Enthusiastic, expressive, emotional, warm, evocative, imaginative, original, artistic, improviser, perceptive, affirming, supportive, cooperative, positive, open responsive, sensitive, playful, fun-loving, multifaceted, gregarious, zestful, spontaneous, idealistic, initiators of new projects and possibilities, agents of change.   Their focus is on self-expression and possibilities, "what could be' rather than 'what is.' Life is a celebration and a creative adventure.  Enthusiastic initiators of new projects, relationships, and paradigms.  Masters of the start-up phase. Lose interest when the project or relationship gets routine or when the primary goal is well on the way to accomplishment.  Often eloquent in expressing their vision of a world where ideals are actualized. Frequently have a positive attitude in situations others would consider to be negative.  Work in bursts of enthusiasm mixed with times when little gets done. Need careers that are personally meaningful, creative, and allow for full self-expression and that contribute to other people in some way.  Extremely versatile.  They may have friends from many walks of life, a wide range of interests and hobbies, and they gain a professional level of mastery without formal training." Suggested careers: Public relations, actor, teacher.

ENTP "The Inventor":  "Enthusiastic, puzzle master, objective, inventive, independent, conceptual thinker, creative problem solver, entrepreneurial risk taker, improviser, competitive, questioning, rebellious, rule breaker, gregarious, witty, involved, strategic, versatile, clever, adaptable, energetic action-oriented agents of change.  Improves systems, processes, and organizations. Relentlessly tests and challenges the status quo with new, well-thought-out ideas, and argues vehemently in favor of possibilities and opportunities others have not noticed ["Born To Explore" is a prime example of an ENTP doing this!].  Can wear out their colleagues with their drive and challenging nature.  See the big picture and how the details fit together.   The most naturally entrepreneurial of all types. Usually not motivated by security.   Their lives are often punctuated with extreme ups and downs as they energetically pursue new ideas.  They have only one direction: ahead at full speed, leaving a trail of incomplete projects, tools, and plans in their wake.  Their idea of fun and best creative self-expression involves devising new conceptual modeling and dreaming up imaginative and exciting ventures.  Need lots of room to maneuver.  When forced to dwell on details and routine operating procedures, they become bored and restless.   Respect competence, not authority.  Seek work that allows them to solve complex problems and develop real-world solutions. Often surrounded with the latest technology."  Suggested careers: High tech engineer, marketer, entrepreneur. This type is the most likely to switch careers.

INTP "The Architect": "Logical, original, speculative quick thinkers, ingenious, inventive, cerebral, deep, ruminative, critical, skeptical, questioning, reflective problem solver, flaw finder, architect and builder of systems, lifelong learner, precise, reserved, detached, absent-minded professor.  Seeker of logical purity. They love to analyze, critique, and develop new ideas rather than get involved in the implementation phase. Continually engage in mental challenges that involve building complex conceptual models leading to logically flawless solutions.  Because they are open-ended and possibility-oriented, an endless stream of new data pours in, making it difficult for them to finish developing whatever idea they are working on.  Everything is open to revision.   Consequently, they are at their best as architects of new ideas where there are endless hypothetical possibilities to be explored, and no need for one final concrete answer.  Their holy grail is conceptual perfection.  May consider the project complete and lose interest when they have it figured out.  To them, reality consists of thought processes, not the physical universe.  Often seem lost in the complex tunnels of their own inner process.  Seek work that allows them to develop intellectual mastery, provides a continual flow of new challenges, offers privacy, a quiet environment, and independence.  Thrive in organizations where their self-reliance is valued and colleagues meet their high standards for competency."  Suggested careers: Chemist, lawyer, mathematician.  INTPs are prone to depression when they dwell on their inability to meet their extremely high expectations of themselves.

Gifted and Talented Children Misdiagnosed

Many people diagnosed as ADD are "gifted."    The definition of giftedness is somewhat arbitrary, and there are probably many kids out there who are not quite gifted but still smarter than most of their peers.   "Bright" kids may display the same behavioral traits as gifted kids, which are strikingly similar to ADD traits (see below).

 

There are various definitions of giftedness out there, but in general a person is considered gifted by meeting one of the following characteristics:

1. An IQ of 130 or over.
2. Aptitude or achievement in a particular subject, such as math (generally being in the 97th percentile).
3. Creative and productive thinking.  ADDers are more likely to be gifted in this area than others.  Characteristics include openness to experience, setting personal standards for evaluation, ability to play with ideas, willingness to take risks, preference for complexity, tolerance for ambiguity, positive self-image, and the ability to become submerged in a task.  Students may be identified through tests like the Torrance Test of Creative Thinking or through demonstrated creative performance.
4. Leadership ability. 
5. Visual and performing arts.   ADDers may be over-represented in this category.
6. Psychomotor ability (seldom used).

The link between ADD traits and IQ might be explained by the presence of Over-Excitabilities (OEs). Dabrowski's Theory of Positive Disintegration suggested that people with OEs have a higher level of potential development than others. Later research verified that OEs are related to intelligence. Over-excitabilities include physical, imaginational, and cognitive excitabilities, all of which would lead someone down the path to an ADD diagnosis.

Many proponents of the Gifted will say that a child with an IQ of 130 is not ADD, rather, they are Gifted.  However, the DSM IV diagnostic criteria for ADD do not exclude people who meet the criteria due to giftedness, and gifted ADDers can experience the same problems as non-gifted ADDers.  For example, they are often underachievers and have social difficulties. 

 

Medications

 

Choosing a Medication

Methylphenidate and Dextroamphetamine have been used for first line therapy for many years. Clonidine is being used with increasing frequency by the primary care provider particularly for patients with aggressive/hyperaroused behaviors or comorbid tic disorders. The mechanisms by which these drugs modulate their effects are not fully understood. It is presumably through their effects on multiple catecholamine neurotransmitters.  With this approach 60-90% of children respond to therapy.

 

No clinical data clearly predict the medicine to which a particular child is most likely to respond. The presence of a comorbid diagnosis and parental

preference best dictate the choice of medication. The advantages and disadvantages of each medication are detailed in each medication summary.

 

Pemoline a central nervous system stimulant structurally dissimilar to dextroamphetamine and methylphenidate, was being used with increasing frequency in the primary care setting. However, because of reports of life threatening liver failure, pemoline is no longer felt to be a first line treatment agent. Other medications (e.g. tricyclic antidepressants, carbamazepine) are used primarily in patients with complicating factors (e.g., comorbid psychiatric conditions, contraindications to first line agents) or if symptoms are resistant to first line agents. These medications are used infrequently in the primary care setting and are not discussed in this review.

 

METHYLPHENIDATE  (e.g. Ritalin)

     Advantages/Disadvantages:

          Long track record

          May unmask/exacerbate a tic disorder

     Availability:

          5mg,10mg(scored), 20mg (scored)

          20mg SR

     Starting Dose:

          preschool aged: 2.5 mg q am (w/ breakfast)

          school aged: 5 mg q am (w/ breakfast)

     Onset of Action:

          15-30 minutes

     Duration of Action:

          2-4 hrs

     Dosage Adjustment:

          Increase 5 mg every 3-5 days until effect observed.

          When a therapeutic effect achieved, a second dose of the same amount can be given at lunch to control afternoon symptoms.

          An occasional child with severe symptoms may need a 4:00pm dose to control evening symptoms.

          Once the regimen has been adjusted the child can be switched to the long acting form. The total daily dose of long acting preparation often needs to be

          slightly higher than the total daily dose of short acting preparation. Long acting preparations may not be effective for some patients.

     Maximum Dose:

          0.8-1 mg/kg/dose (Doses higher than 1mg/kg have been shown to impair cognitive abilities in some patients.)

 

DEXTROAMPHETAMINE (e.g. Dexadrine/Adderall)

     Advantages/Disadvantages:

          Long track record

          Longer half life -- less likely to need afternoon dose.

          Adderall is a mixture of dextro and levo amphetamine and has a slightly longer half-life (8-12 hours) potentially allowing less frequent dosing. These

          isomers have been shown to have equal effects on noradrenergic function but differential effects on dopaminergic function and clinical symptoms of

          inattention. The levo isomer is not as active as the dextro. These differences may have implications regarding the mixtures efficacy.

          May unmask/exacerbate a tic disorder

     Availability:

          5,10 mg

          5,10,15 mg SR

          Adderall: 10, 20, 30 mg (double scored tabs).

     Starting Dose:

          preschool aged: 2.5 mg q am (w/ breakfast)

          school aged: 5 mg q am (w/ breakfast)

     Onset of Action:

          15-30 minutes

     Duration of Action:

          2-6 hrs

     Dosage Adjustment:

          Increase 2.5-5 mg every 3-5 days until effect observed.

          When a therapeutic effect achieved, a second dose of the same amount can be given at lunch to control afternoon symptoms -- usually slightly less than

          the am dose.

          An occasional child with severe symptoms may need a 4:00pm dose to control evening symptoms.

          Once the regimen has been adjusted the child can be switched to the long acting form. The total daily dose of long acting preparation often needs to be

          slightly higher than the total daily dose of short acting preparation. Long acting preparations may not be effective for some patients.

     Maximum Dose:

          1.5 mg/kg/day (rarely need to exceed 40mg/day)

 

CLONIDINE (e.g. Catapress)

     Advantages/Disadvantages:

          May suppress tics

          May be preferred agent to treat aggressive or hyperaroused behaviors

               More effective in controlling aggressive/hyperaroused symptoms than other agents

               Improves inattentive symptoms to a lesser extent than other agents

          Somnolence may limit use but often resolves with time

          Rebound HTN if stopped rapidly

          May be contraindicated for patients with cardiac pathologies

     Availability:

          0.1, 0.2, 0.3 mg

          Transdermal Patch 0.1, 0.2, 0.3 mg/day (Lasts 7 days)

     Starting Dose:

          0.025-0.05 mg qhs

     Onset of Action:

          1-2 weeks for maximal effect

     Duration of Action:

          N/A

     Dosage Adjustment:

          Increase to BID after 5-7 days, then to TID after another 5-7 days. Then increase by 0.025-0.05 mg/day every 5-7 days till therapeutic effect

          achieved. (Titrate up very slowly to minimize somnolence --- one of the most common reasons parents dislike/discontinue this medication.)

          Monitor blood pressure and heart rate with each increase in dose

          To discontinue, wean over one week.

 

Medication Side Effects

     Anorexia, abdominal discomfort, insomnia and weight loss are side effects that are common to these medications but appear to resolve in most patients with continued therapy.

     Potential growth suppression has been a concern. Patients may show a temporary decrease in linear growth and weight gain however there is no evidence that these medications affect ultimate adult stature or weight.

     Stimulant medications are now considered safe in children with seizure disorders if the child's seizures are well controlled on a single anticonvulsant.

     Cardiovascular Effects: Dextroamphetamine and methylphenidate have sympathicomimetic effects and may elevate blood pressure and heart rate. Clonidine may lower blood pressure or cause rebound hypertension if stopped rapidly.

     The risk of unmasking or exacerbating a tic disorder with methylphenidate, dextroamphetamine and pemoline is only 1.3%. This risk could be higher if there is a family history of a tic disorder. Clonidine is the preferred initial medication for children with tics because it suppresses tic disorders. The presence of or family history of a tic disorder is not an absolute contraindication to the stimulants but the patient should be monitored closely for exacerbation of tics.

     This effect is reversible with discontinuation of the drug.

 

Western Herbs

 

For alleviating depression. St. John's wort extract; 300(milligrams) mg., three times daily. It is a mild antidepressant and increases norepinephrine levels in the brain.   It appears to increase dopamine activity in the brain with almost no side effects.  Dopamine is the "feel-good" neurotransmitter responsible for concentration. All the major ADD medications are said to work on dopamine.  St. John's Wort is not a stimulant however, and you are not likely to feel like you're "on something".  To get a significant effect you may have to take two to three times the normally recommended dosage and it takes up to six weeks for it to really start working.  You must also be sure to purchase high-quality product because there is a lot of St. John's Wort on the market that doesn't contain what is claimed on the package.  Kira is the brand that was used in studies showing effectiveness in treating depression. St. John's Wort is probably the most studied of all the herbs and it is actually prescribed quite a bit in Germany for mild depression.  It has not been tested for use in treating ADD

 

For increased memory and mental acuity. Ginkgo biloba; 240 mg. in pill or powder form, divided into two or three doses per day. This herb increases blood flow to the brain.  For difficulties with concentration and memory due to blood circulation problems, especially associated with aging.  It's a popular herb and a lot of people try it out for ADD.  It's a blood thinning or anti-clotting agent, so there are potential sides effects such as bleeding under the skin or into the eye, and there are possible interactions with other medicines that also thing blood such as aspirin or heart medications.

 

For energy and endurance. Siberian ginseng (Eleutherococcus senticosus); 300 mg. to 400 mg. in two or three daily doses. (In tincture, 8 milliliters (ml.) to 10 ml. in two to three divided doses). Use for four to six weeks, stop for one to two weeks, then, resume.

 

Pine bark extract (or Pycnogenol) and grape seed extract contain proanthocyanidin,a bioflavonoid which has reportedly demonstrated anti-oxidant properties and may be closer to a nutritional supplement than a medication.  Very popular for treating ADD, with some scientific backing.

 

Primrose oil, flax oil, fish oil and Effalex are nutritional supplements rather than medicinal herbal supplements because they contain essential fatty acids, something the body must have.

 

For liver cleansing. Milk thistle is useful in counteracting the effect of drugs, yeast infections and toxic byproducts resulting from food allergies: Milk thistle extract of 420 mg. Is recommended, divided into three doses. Milk thistle is particularly valuable for protecting the liver when taking prescription antidepressants, which is sometimes part of the ADHD treatment plan.

 

For insomnia. Valerian root extract; 300 mg. to 500 mg., one hour before bedtime. Combine with passionflower, lemon balm and skullcap. Consult with an herbalist to determine the right amount of each. Valerian is a mild central nervous system sedative that helps children get to sleep faster and enjoy deeper sleep.

 

For calming. Chamomile extract; two to three ml. Of liquid extract in warm water before bed. Or, if the child is allergic to ragweed (related to chamomile, botanically), use other mild herbal sedatives such as skullcap and passionflower.

 

Coenzyme Q₁₀ in high doses reportedly stimulates dopamine activity in nerve cells.  Dopamine is the neurotransmittor implicated in ADD.  The National Institute of Health has launched new studies of coQ₁₀ as a treatment for Parkinson's and Huntington's diseases.  

 

 

 

 

 

Diet

 

All children need healthful diets to learn and feel their best. It is important that children with AD/HD eat a well-balanced diet. However, because of behaviors and medications, it may be difficult for them to eat right.

Children with AD/HD don't always pay attention to their own body signals for hunger, rest, or need to use the toilet. Even when they do, they often don't sit still long

enough to finish the job! They may eat just enough to "take the edge off" before they are off to do something else. Because of their high activity level and need for

calories they may crave sweets to meet their energy needs. Medication often decreases the appetite during the daytime.

 

What can you do to help?  Advice for Parents:

·        Give your child 3 regular meals.

o       He/she should be seated at a table with the family rather than in front of the TV or wandering around the house.

·        Offer a variety of health foods.

o       Let him/her choose what and how much to eat.

o       Give milk to drink and fruit for dessert.

·        Make healthful snacks part of your diet plan.

o       Midmorning and afternoon snacks of fresh or dried fruit, graham crackers, popcorn of juice will supply calories and vitamins.

·        An evening or bedtime snack may be really important since medication effects will usually have worn off by then.

o       A protein snack such as peanut butter or meat sandwich, yogurt, cheese, nuts, milk and cereal or a milkshake are some good choices.

·        Increase your child's interest in meals.

o       Include him/her in the planning or preparation.

·        Save sweets and other "junk foods" for occasional use.

o       It is best not to have them in the house on a regular basis.

·        Give stimulant medication with milk or after meals.