Other Treatments

Dietary Approaches

A number of diets have been suggested for people with ADHD. Several well-conducted studies have failed to support dietary effects of sugar and food additives on behavior, except possibly in a very small percentage of children. Still various studies have reported behavioral improvement with diets that restrict possible allergens in the diet. Parents may want to discuss with their doctor implementing an elimination diet of certain foods or adding supplements that would not be harmful and that might help.

Food Allergies. Evidence suggests that children with behavioral difficulties may be sensitive to certain chemicals in foods. Studies vary widely, however, on how many cases of ADHD may be associated with sensitivities or allergies to food chemicals or additives, with results ranging widely from 5 - 62%. Among the suspected additives and foods that parents and studies report as inciting behavioral changes are the following:

• Any artificial colorings (particularly yellow, red, or green)
• Other chemical additives -- for example, BHT or BHA
• Milk
• Chocolate
• Eggs
• Wheat
• Foods containing salicylates, including all berries, chili powder, apples and cider, cloves, grapes, oranges, peaches, peppers (bell & chili), plums, prunes, tomatoes.

In one small study, 62% of children who were given only rice, turkey, pears, and lettuce to eat for two weeks experienced at least a 50% improvement in symptoms. Nevertheless, about a quarter of the children pulled out because they could not stick with diet or they became ill.

Feingold Diet. The most well known diet for ADHD is the Feingold diet, a salicylate- and additive-free diet, which requires rigorous vigilance over a child's eating habits. This diet also prohibits aspirin, which contains salicylates. Some parents report great success with this diet, although it may be difficult to impose, particularly on an ADHD child. One study that reported its efficacy suggested that it might not provide enough nutritive value, although the diet provides a wide range of healthy foods to select from. It is certainly wise, in any case, to avoid food with artificial colors and flavors and to provide a healthy balance of fresh, natural foods.

It should be noted that allergies themselves have been associated with a higher risk for behavioral problems. Children who respond to allergen-restrictive diets, then, may not have had true ADHD in the first place.

Essential Fatty Acids. Omega-3 fatty acids, found in fatty fish and certain vegetable oils, are important for normal brain function and may have some benefits for people with ADHD. It is not clear if supplements of fatty acid compounds, such as docosahexaenoic acid (DHA) and eicosapentaneoic acid (EPA), provide any advantages. A 2001 study of DHA alone reported no reduction in ADHD symptoms.

Zinc. Zinc is important for the metabolism of certain neurotransmitters that play a role in ADHD, and deficiencies have been associated with some cases of ADHD. Long-term use of zinc, however, can cause anemia and other side effects in people without deficiencies and it has no effect on ADHD in these patients. In any case, testing for trace minerals, such as zinc, is not standard procedure when evaluating children suspected to have ADHD.

Sugar. Although parents often blame sugar for causing children to become impulsive or hyperactive, a number of studies now strongly suggest that sugar plays no role in hyperactivity. One study reported, in fact, that ADHD children had fewer problems after a high-carbohydrate breakfast than after a high-protein one. Another reported that children actually moved more slowly after a high-sugar meal, suggesting the carbohydrates may have a sedative effect. (Still, it's probably always wise for any child to cut down on sugar.)

Feedback Approaches

Techniques that use biologic or auditory feedback and proving to be effective tools for increasing children's attention--a primary factor in low academic performance.

Neurofeedback. Neurofeedback is an approach that uses electronic devices to help the child control his or her own brain wave activity. Electrodes are pasted to the child's head and pick up signals from the brain. The child watches images, such as moving graphs, on a computer monitor that reflect the child's brain wave activity. Typically, children are then taught certain high-level mental activities at the point when feedback information on the screen indicates that they are fully concentrating. Typically children attend forty 50-minute sessions, usually twice a week. Small studies have reported significant improvement in inattention, impulsivity, and response time. In one study IQs increased by an average of 12 points and Ritalin use had dropped significantly at the end of training period. To date, however, studies have been very limited and the results could have been due to factors other than neurofeedback. It is also very expensive ($40 to $120 per session). More research, however, is certainly warranted.

Interactive Metronome and Musical Therapy. Interactive metronome uses feedback from sound to improve attention, motor control, and certain academic skills. In this technique study, children wear headphones and sensors on their hands and feet. They perform a number of exercises to a rhythmic computer-beat. Training sessions are completed in three to five weeks. Some small studies have reported improvement in attention, motor control, language processing, and behavior. (In support of this, some parents report that learning a musical instrument helped their children significantly.)

Other Alternative Remedies

Procedures and Non-Drug Therapies. A number of alternative approaches may benefit children and adults with mild ADHD symptoms. For example, daily massage therapy helps ADHD adolescents feel happier, fidget less, be less hyperactive, and focus on tasks, according to a study published in 1998. Other alternative approaches that may be helpful include relaxation training, meditation, and music therapy.

Natural Remedies. A number of parents resort to alternative remedies as an alternative to psychostimulants and other drugs. Small trials have found some herbs and supplements, such as oral flower essence, ginkgo biloba, panax ginseng, and melatonin may possibly have benefits for ADHD. Based on existing evidence, however, none can be recommended, particularly for children.

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Review Date: 12/7/2005
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.