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Can we treat ADHD without medication?

Michel Cameron, PhD
Michel Cameron, PhD
Associate Director, Pharmacogenomics, Medical Science Liaison
LinkedIn

Chamomile tea, melatonin and hypnotherapy are just a few examples of alternative medicine and therapies that many adults and parents of children with ADHD use as treatments. But are they effective? And can they replace medication? In this overview of the main drug-free approaches, find out which ones have worked best.

In an article published in 2007, [1] David Jean and Claude Cyr of the Centre hospitalier universitaire de Sherbrooke (CHUS) reported that more than half of the children attending their pediatric outpatient clinic were using one or more types of alternative medicine. About 25% of them were doing so for psychological problems, including ADHD, and more than 50% were doing so without their physicians' knowledge! Fear of the side effects of methylphenidate (Ritalin) or amphetamines used to treat ADHD is likely behind this. [2]

According to the Institut national d'excellence en santé et services sociaux du Québec (INESS), 6% of Quebecers aged 1 to 25 received a prescription for an ADHD medication between 2014 and 2015, which is 2.7 times higher than in other Canadian provinces. [3] For those aged 6 to 17, statistics show that more than 10% use a drug to treat ADHD.

This data worries many parents, who are not the only ones alarmed. In 2019, 48 health experts, including 45 pediatricians, published an open letter about the overuse of drugs to treat ADHD at the expense of other critical components of treatment, such as psychosocial interventions and support for parents and teachers. [4]

What causes ADHD?

The exact causes of ADHD are not clear. A genetic imbalance in the metabolism of neurotransmitters (catecholamines) seems to play a significant role, and medications (methylphenidate, amphetamines) tend to restore this balance. Many environmental factors could also contribute to the onset of symptoms, but how they contribute is not unanimously agreed upon. This explains why learned societies approve few alternative techniques targeting these environmental factors. [5-7]

Drug-free interventions

It is clear that drug treatments are very useful in treating ADHD, at least in the short term and that they have a prominent place in the guidelines of major learned societies such as CADDRA in Canada. [5] However, all agree that no single drug treatment can ensure good long-term results. Therefore, treating ADHD in children, adolescents and adults should include non-drug interventions, such as healthy lifestyle and sleep habits and psychological interventions. [5-7] However, the following other types of interventions are also being studied:

1. Dietary approaches

Many parents have rightly or wrongly suspected that certain foods interfere with their children's behaviour. Others believe that a lack of vitamins or other nutrients could lead to the same results. So, it is not surprising that dietary changes are the most common alternative methods of reducing ADHD symptoms or even eliminating the need for drugs. [8]

Elimination diets

The benefits of diets such as the Feingold diet without artificial colours or salicylates [9] on attention, hyperactivity or behaviour are controversial. [10] Although the effects of food additives, allergies and sensitivities on some ADHD symptoms are documented, they are limited in most cases. However, because they may be significant in some children, some advocate removing certain components from their diet for a few weeks to see if this can mitigate ADHD symptoms. [7]

Supplement diets: Megavitamin and essential fatty acid therapy

Studies have failed to show whether megavitamin therapy is actually effective in controlling certain behaviours of children with ADHD. [11] In addition, consuming mega-doses of vitamins could be risky, especially for the liver. [12]

Some studies have also shown that essential fatty acid levels are lower in children with ADHD. [13] Therefore, one might expect that supplementing with essential fatty acids (omega-3) would lead to improvement. Unfortunately, this hypothesis has only been confirmed in a small number of cases. On the other hand, unlike vitamins, it is unlikely that supplementing with essential fatty acids would pose any health risks. [14]

2. Medicinal plants, nootropics, antioxidants and melatonin

Our drugstore shelves are full of all kinds of "natural" products to use for a wide variety of conditions. Most of them come from medicinal plants. These products are not subject to the same strict preparation requirements as "official" drugs. Doubts about the exact concentration of the active ingredients or the presence of other unidentified components make it very difficult to conduct rigorous scientific studies on their effects. [15]

Medicinal plants

Trouble sleeping is common in children with ADHD. Several medicinal plants such as chamomile, lemon balm, valerian and passionflower are known for their power to relax and reduce anxiety. Herbal teas of all kinds have been used with some success to control certain ADHD symptoms. [8]

Nootropics

By definition, a nootropic is a substance that improves brain function. According to this definition, methylphenidate and amphetamines can be considered nootropics. However, there are several natural or non-pharmaceutical nootropics, some of which are well known and widely used, such as caffeine, nicotine and Ginkgo biloba. Deanol, found in salmon caviar, shellfish and fish oils, is the most widely tested nootropic in children with ADHD. Overall, the results are mixed. Early promising studies [16] have been heavily criticized [8], and no more recent studies have confirmed deanol's role in treating ADHD.

Antioxidants

There is no consensus on the hypothesis of an oxidant and antioxidant imbalance as an important factor in ADHD, [17] and using products to correct the imbalance is equally controversial.

Pycnogenol™ is a French maritime pine bark extract with strong antioxidant activity. As with many other natural substances, initial isolated cases of symptom improvement have been reported with this antioxidant. [18, 19] It will take several other high-quality studies to confirm the role of Pycnogenol.

Melatonin

On the other hand, melatonin is well known for its positive effects on sleep. [20] High-quality studies have shown it to be effective, safe and cost-effective. Although long-term safety data are not available, it is one of the few alternative approaches endorsed by some official practice guidelines such as CADDRA. [5]

3. Non-dietary approaches

The following is likely an incomplete list: [8]

  • Visual training and vestibular-ocular therapy
  • Homeopathy
  • Auditory stimulation
  • Biofeedback
  • Hypnotherapy
  • Yoga
  • Meditation
  • Routine management tools

Within this list, treatments such as biofeedback, hypnotherapy, yoga, and meditation may be appealing, especially for adults who refuse to take drugs or experience too many side effects. Therapies such as visual training and auditory stimulation are still poorly supported by rigorous scientific studies. The same holds true for homeopathy.

4. Using video games to help children's routines

As parents of children with ADHD know, routine is an important part of daily life, but it can be challenging to maintain. In recent years, "gamification" – the use of game elements in learning content – has proven its value, particularly in the field of education.

For example, the Quebec application Kairos uses this concept to help children develop independence within their routines. Tasks become missions that advance the avatar in the game. The application's effectiveness has been validated with neurotypical and neuroatypical children from 216 families. [21]

Are alternative therapies a good idea?

In some cases, non-traditional approaches can improve ADHD symptoms. Unfortunately, these therapies have been poorly studied, and their results are often mixed. There is no guarantee that they are safe or effective.

Therefore, being cautious and well-informed before trying an alternative therapy is essential. And it is always best to talk to your doctor to avoid any toxic effects or harmful interactions with drugs.

In fact, the only proven non-drug approaches are a healthy diet, daily physical activity and good sleep habits. No wonder since this combo is crucial to anyone's health!

We are here to offer professional support.

We offer services that can help your doctor determine the right medication at the right dose to treat ADHD.

Do you have a medical prescription for one of these tests? Book an appointment online or call Biron Health Group's customer service at 1-833-590-2713.

Sources21
  1. JEAN, D., et C. Cyr. «Use of complementary and alternative medicine in a general pediatric clinic», Pediatrics, vol. 120, no 1, juillet 2007, p. e138-e141.
  2. SWAMSON, J.M., et coll. «Young adult outcomes in the follow-up of the multimodal. treatment study of attention-deficit/hyperactivity disorder: symptom persistence, source discrepancy, and height suppression», J Child Psychol Psychiatry, vol. 58, no 6, juin 2017, p. 663-678.
  3. Institut national d’excellence en santé et en services sociaux (INESSS). Prévalence de l’usage des médicaments spécifiques au trouble du déficit de l’attention avec ou sans hyperactivité (TDAH) chez les canadiens de 25 ans et moins, portrait rédigé par Éric Tremblay et Jean-Marc Daigle, INESSS, 2017, 21 p.
  4. POULIN, P. C. «Médicaments et TDAH : sommes-nous allés trop loin» (lettre ouverte), Journal de Québec, 31 janvier 2019.
  5. CADDRA (Canadian ADHD Ressource Alliance). Lignes directrices canadiennes sur le TDAH, 4e édition, Toronto (Ontario), 2018.
  6. WOLRAICH, M. L., et coll. «Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents», Pediatrics, vol. 144, no 4, octobre 2019, p. 2019-2528.
  7. National Institute for Health and Care Excellence (NICE). «Attention deficit hyperactivity disorder: diagnosis and management NICE guideline [NG87]», mars 2018.
  8. Société canadienne de pédiatrie. «Le recours à la médecine parallèle dans le traitement des enfants atteints de trouble de déficit de l’attention avec hyperactivité», Paediatr Child Health. vol. 7, no 10, décembre 2002, p.721-730.
  9. FEINGOLD, B.F. « Hyperkinesis and learning disabilities linked to artificial food flavors and colors», Am J Nurs, vol. 75, no 5, mai 1975, p. 797-803.
  10. NIGG, J. T., et coll. «Meta-Analysis of Attention-Deficit/Hyperactivity Disorder or Attention-Deficit/Hyperactivity Disorder Symptoms, Restriction Diet, and Synthetic Food Color Additives», J Am Acad Child Adolesc Psychiatry, vol. 51, no 1, janvier 2012, p. 86-97.
  11. HASLAM, R.H. «Is there a role for megavitamin therapy in the treatment of attention deficit hyperactivity disorder?», Adv Neurol, vol. 58, 1992, p. 303-310. 
  12. Nutrition Committee, Canadian Paediatric Society, «Megavitamin and megamineral therapy in childhood», CMAJ, vol. 143, no 10, novembre 1990, p. 1009-1013.
  13. RAZ, R., et L. Gabis. «Essential fatty acids and attention-deficit-hyperactivity disorder: a systematic review», Dev Med Child Neurol, vol. 51, no 8, août 2009, p. 580- 592.
  14. National Center for Complementary and Integrative Health. Clinical Digest. «Spotlight on a modality: Omega-3 fatty acids», août 2013, https://files.nccih.nih.gov/s3fs-public/Omega-3_11-30-2015.pdf, consulté en ligne le 24 août 2022.
  15. VOHRA, S., et D. Moher. «Complementary and alternative medicine in Canadian children: A call for action», Paediatr Child Health, vol. 10, no 3, mars 2005, p. 154-156.
  16. LEWIS, J.A., et R. Young. «Deanol and methylphenidate in minimal brain dysfunction», Clin Pharmacol Ther, vol. 17, no 5, mai 1975, p. 534-540. 
  17. CEYLAN, M. F., et coll. « Changes in oxidative stress and cellular immunity serum markers in attention-deficit/hyperactivity disorder», Psychiatry Clin Neurosci, vol. 66, no 3, mars 2012, p. 220-226.
  18. HEIMANN, S. «Pycnogenol for ADHD? Case Reports», J Am Acad Child Adolesc Psychiatry, vol. 38, no 4, avril 1999, p. 357-358.
  19. TREBATICKA, J., et coll. «Treatment of ADHD with French maritime pine bark extract, Pycnogenol», Eur Child Adolesc Psychiatry, vol. 15, no 6, septembre 2006, p. 329-335.
  20. CRÉPEAU, C. «La mélatonine pour le sommeil? 5 choses à savoir», https://www.scientifique-en-chef.gouv.qc.ca/impacts/ddr_la-melatonine-pour-le-sommeil-5-choses-a-savoir/, consulté en ligne le 24 août 2022.
  21. KAIROS. «La science derrière Kairos», https://kairosgame.com/la-science-derriere-kairos, consulté en ligne le 24 août 2022.
Michel Cameron, PhD
Michel Cameron, PhD
Associate Director, Pharmacogenomics, Medical Science Liaison
LinkedIn
Seeking to make the science of genetics accessible for everyone, in 2014 Michel Cameron co-founded BiogeniQ, a company specialized in genetics, where he directed the design and development of pharmacogenomics tests. Today this company is owned by Biron. Michel Cameron holds a Ph.D. in pharmacology from the Université de Montréal and completed postdoctoral studies in pharmacogenomics at the Montreal Heart Institute’s Pharmacogenomics Centre.