Attention-deficit hyperactivity disorder, commonly referred to as ADHD, is one of the most common neurodevelopmental conditions in children. (18)(23) From 2003 to 2011, the National Survey of Children’s Health (NSCH) reported a 42% increase in the prevalence of ADHD in the U.S. (23) By 2016, according to a national Centers for Disease Control and Prevention study, 6.1 million children between the ages of two and 17 had been diagnosed with ADHD. (7)
Characteristics of ADHD include patterns of inattention and/or hyperactivity and impulsivity that are severe, persistent, and interfere with functioning or development. (18)(22) While most children display both inattention and hyperactivity/impulsivity, two subgroups of ADHD have been identified based on which behavior is more pervasive: primarily inattentive and primarily hyperactive-impulsive. (14)(22) ADHD diagnosis typically occurs in children between the ages of three and six, and its symptoms may also persist throughout adolescence and adulthood, although often less severe. (23)
- Inattention to detail, careless mistakes
- Difficulty listening and paying attention
- Difficulty following instructions and meeting deadlines
- Poor time management
- Poor organization of tasks and belongings
- Forgetful, often lose things
- Easily distracted
Symptoms of hyperactivity and impulsivity include:
- Difficulty sitting still, fidgeting, squirming
- Running around or climbing in inappropriate situations
- Inability to play or engage in activities quietly
- Talking incessantly
- Interrupting frequently, blurting out answers, finishing others’ sentences
- Speaking or acting out of turn (22)
What causes ADHD?
While the causes of ADHD in children remain unclear, a combination of genetic and environmental factors are believed to play a role in the development of the condition, including:
- Very low birth weight, lack of oxygen at birth
- Exposure to alcohol, cigarette smoke, or drugs during pregnancy (14)(22)
- Exposure to environmental toxins during pregnancy and/or at a young age Brain injury
- Gender (more common in males) (22)
Dr. Holly Lucille discusses the evidence-based research surrounding ADHD.
How to treat ADHD: diet, supplementation, and lifestyle
ADHD is typically addressed using medication (e.g., stimulants), psychotherapy, behavioral therapy, or a combination. (22) According to the 2016 Centers for Disease Control and Prevention study, 62% of children diagnosed with ADHD were taking medication and 47% had received behavioral therapy in the past year. (6) However, researchers recommend a multimodal approach to pediatric ADHD treatment. (18)
Did you know? According to a 2015 study examining the use of nutritional supplements in the treatment of ADHD, 12–64% of children use some form of complementary medicine to address their condition. (4)
The information below provides an overview of the roles of diet, supplementation, physical activity, and sleep in the treatment of ADHD.
Diet and ADHD
In the 1970s, the Feingold diet was the first proposed dietary intervention for ADHD. Based on the belief that ADHD symptoms in kids were caused by food additives, the diet involved omitting a number of foods from the diet, including apples, grapes, processed meats, and any foods with artificial flavoring, coloring, and preservatives. While there is mixed evidence on the effectiveness of the Feingold diet, recent versions of the diet now recommend only the exclusion of artificial coloring and other additives. (18)
Current research on ADHD suggests that food additives may be implicated in a subgroup of ADHD cases. (27)(36) A 2012 meta-analysis reported that synthetic food coloring may be related to symptoms and signs of ADHD in approximately 8% of children with the condition. Unfortunately, research in this area is often conducted with small sample sizes and prone to publication bias. (27)
Several studies have also examined the link between ADHD and food intolerances, allergies, or both. In a subgroup of children, an elimination diet may be a valuable method to uncover potential dietary triggers involved in the manifestation of ADHD. (26)(28)(29)
Did you know? The elimination diet involves temporarily restricting the intake of potential dietary triggers, such as dairy, wheat, eggs, nuts, and chocolate.
The second stage of the diet involves reintroducing potential triggers, one at a time, and monitoring for changes in behavior and symptoms. (18)
Visit the Fullscript blog to learn more about the elimination diet.
Nutrients and supplementation for ADHD
While the elimination diet may help determine a relationship between certain foods and symptoms of ADHD, research has also identified a number of nutrients and botanicals that may be beneficial in addressing the symptoms of ADHD. The following table provides examples of these supplemental nutrients and supporting evidence.
Physical activity and ADHD
While a consensus has not yet been established for frequency, intensity, and duration of exercise, several studies have noted the beneficial effects of exercise programs on symptoms of ADHD and fine motor skills. (24) In a systematic review and meta-analysis of eight randomized controlled trials, both aerobic physical activity and yoga improved ADHD symptoms in children and adolescents, such as attention, hyperactivity, and impulsivity. Additionally, aerobic exercise also improved cognitive function, executive function, anxiety, and social interaction. (8)
Similarly, another study examined the effects of physical activity on the cognitive function of 43 children with ADHD between the ages of seven and 12. The children were placed into two experimental groups and a control group; the first experimental group underwent training in ball handling, balance, and manual dexterity, while the second group was trained in sports but did not focus on developing specific skills. After 12 weeks, improvements in working memory, motor performance, and executive function were observed in both experimental groups, indicating that physical activity, regardless of specificity, positively affects children with ADHD. (44)
Other studies have found that physical activity improves parent and teacher-observed behavior, as well as muscular capabilities, motor skills, information processing, (40) and reading and arithmetic performance. (30)
Sleep and ADHD
It is estimated that approximately 25-50% of individuals with ADHD experience sleep issues, (21) such as sleep onset difficulties, nighttime awakenings, reduced sleep durations, and bedtime resistance. (42)
Did you know? Compared to healthy children, those with ADHD appear to more than twice as likely to develop insomnia, which may exacerbate symptoms of ADHD and mood issues. (21)
Insomnia may present itself as a symptom of ADHD, possibly attributed changes in circadian rhythms or melatonin levels. (42) Insomnia may also be an unwanted side-effect of certain medications used to treat ADHD. (9) Children treated with stimulants appear to be twice as likely to develop sleep onset latency or insomnia. (21)
Sleep training and maintaining proper sleep hygiene has been shown to benefit children with ADHD. A randomized case-control trial examined the effects of sleep training on the emotional, social, and behavioral functioning of children with ADHD compared to children with ADHD and healthy children who do not receive sleep training. After 12 weeks, those who received training demonstrated improvements in physical and psychosocial well-being, including mood, emotions, and social relationships. (16)
A number of sleep habits, which can take months or years to develop, have been suggested to improve sleep hygiene, such as:
- Maintaining a consistent routine and bedtime, gradually reducing energy levels to promote relaxation
- Utilizing relaxation techniques and bedtime “cues”, such as taking a warm bath, drinking a cup of chamomile tea, and engaging in relaxing imagery
- Reducing screen time and other activating stimuli in the bedroom, especially before bed (e.g., tv, video games, loud music)
- Maintaining a comfortable temperature and ventilation in the bedroom
- Engaging in regular physical activity during the day
- If necessary, using sound screens to muffle sounds or eye masks to block light (6)
In addition, as demonstrated in the table above, several studies have shown the effectiveness of melatonin in improving sleep in untreated and stimulant-treated children with ADHD.
The bottom line
ADHD is believed to be an epigenetic condition triggered by environmental factors in genetically susceptible individuals. (26) While stimulant medication treatment continues to be the standard, ADHD should be addressed using a multimodal approach. (18) An elimination diet can help to identify trigger foods related to ADHD symptoms.
Research has also identified a number of nutrients and botanicals that may be beneficial, including omega-3 fatty acids, phosphatidylserine, acetyl-L carnitine, pycnogenol, ginkgo biloba, melatonin, and certain minerals. Further lifestyle changes, such as engaging in regular physical activity and practicing proper sleep hygiene, may also improve ADHD symptoms and daily functioning.
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