Integrative Approaches to ADHD Toward a Middle Ground Between Medications and Alternative Therapies

by Dr. James Lake, Past INIMH Chair

The most effective and appropriate pharmacologic, behavioral and alternative treatments of ADHD depends on the particular symptoms that are being addressed, how severe they are, and each unique history in terms of how well or not they responded to previous pharmacologic or non-pharmacologic treatment approaches. Other important considerations include side effects with different medications or natural products and whether there are other mental health or medical problems. The choice of treatment should take into account whether you can find a therapist in your geographic area who is qualified to treat you (or your child) using a particular approach (e.g. EEG biofeedback) or provide competent advice about the safe, appropriate use of a natural product. If you are considering taking an herbal medicine or any other natural product it is very important to first notify the healthcare provider who is treating you (or your child) for ADHD in order to be sure you have a good understanding of safety issues associated with the herbal or supplement you are considering. Before taking any natural product supplement I encourage you to first identify a reputable brand with a high safety rating.

To learn more about the range of non-pharmacologic treatments of ADHD and how to use them safely and effectively to treat your ADHD symptoms or those of your child, read my recently published e-book, ‘ADHD: The Integrative Mental Health Solution.”

Important considerations when deciding how to approach your child’s symptoms of ADHD 

You may have found this blog because you are searching for information on how to think about the various treatment choices for a child who has ADHD. Or perhaps you are struggling with ADHD yourself. Whichever your situation, the treatment of ADHD should be individualized to your (or your child’s) particular symptoms. Different ADHD symptoms may respond quite differently to the same treatment, whether it is a prescription medication or an alternative (i.e. non-medication therapy). For example some treatments work better for problems focusing or getting distracted easily, while other treatments are more effective for symptoms of fidgeting or hyperactivity. I encourage you to work with a healthcare provider who has expertise in ADHD, starting with a thorough assessment of any medical, psychological or social factors that may contribute to your (or your child’s) symptoms. For example, toxic exposure, food sensitivities, poor nutrition, chronic stresses and family and cultural issues may ‘look like’ ADHD but when they are resolved through an appropriate medical intervention or individual or family therapy these symptoms often improve dramatically and no further treatment is needed. Although there are risks associated with prescription stimulants and other medications such conventional treatments are often effective and well tolerated. However when a medication causes adverse effects it is reasonable and appropriate to reduce the dose or stop taking the medication. It is always preferable to do so in consultation with the physician or other healthcare provider who prescribed the medication to make you are aware of possible safety problems that may arise when changing a medication dose or stopping it. If you’ve tried prescription medications for ADHD and they either haven’t worked or you (or a child) have experienced adverse effects it is reasonable to consider trying a natural product alone or in combination with the medication. Deciding whether to take a natural product alone or together with a medication should always be done in consultation with the physician or other healthcare provider who is treating you (or your child’s) ADHD.
In some cases dietary habits and food allergies may underlie symptoms of inattention or hyperactivity. If you are a parent of a child diagnosed with ADHD and are considering trying an elimination diet or making other changes in your child’s diet, I strongly encourage you to first consult with your child’s pediatrician or a nutritionist who has expertise treating ADHD in children, before initiating any elimination diet. The same considerations hold when considering trying any natural product to treat your symptoms or those of a child. In some cases zinc supplementation at doses of 150mg per day may be helpful when symptoms of hyperactivity and impulsivity do not improve with stimulants alone. Zinc may be safely combined with stimulants and other medications used to treat ADHD. Limited ressearch findings suggest that supplementation with iron (ferrous sulfate up to 80mg per day) may be helpful for symptoms of distractibility and inattention. High doses of omega-3 essential fatty acids (up to 16g/day) may improve ADHD symptoms. However large well-designed studies are needed before any of these natural products can be generally recommended as first-line treatments of childhood ADHD.
Preliminary findings suggest that standardized extracts of Ginkgo biloba, Panax quinquefolium, Pinus pinaster and Bacopa monnieri may be safe and beneficial treatments of childhood ADHD symptoms however more conclusive findings from large well-designed placebo-controlled studies are needed to confirm efficacy, safety, and optimal dosing strategies. More studies are also needed to evaluate use of select Chinese medicinal herbals before they can be recommended for ADHD. Some evidence suggests that regular yoga or massage may reduce the severity of ADHD symptoms. Finally, in cases where conventional pharmacologic treatments are ineffective or poorly tolerated, specific EEG biofeedback protocols including SMR training for primarily hyperactive type ADHD and theta suppression for primarily inattentive type ADHD should be considered. In some cases regular EEG biofeedback over several weeks may reduce the severity of ADHD symptoms enough to permit a reduction in the dose of a prescription medication resulting in fewer adverse effects.
To learn more about the range of non-pharmacologic treatments of ADHD and how to use them safely and effectively to treat your ADHD symptoms or those of your child, read my recently published e-book, ‘ADHD: The Integrative Mental Health Solution.”