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Alternative Treatments for ADHD

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Elimination of Sugar & Candy. Good news- No Effects! ... Research in non-clinical samples has shown improvements on attentional blink tests ... – PowerPoint PPT presentation

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Title: Alternative Treatments for ADHD


1
Alternative Treatments for ADHD
  • Katherine Kiker, M.S.

2
Elimination Diets
  • Feingold hypothesis
  • Children are sensitive to dietary salicylates and
    artificially added colors, flavors, and
    preservatives
  • Learning and behavior problems (including ADHD)
    can be reduced or eliminated by removing these
    substances

3
Elimination Diets
  • At least 8 controlled studies have demonstrated
    significant improvement (w/elimination diet)
    compared to a placebo condition, or deterioration
    after introducing offending substances
  • Typical elimination diet lamb, chicken,
    potatoes, rice, apple, banana, cabbage,
    cauliflower, broccoli, brussel sprouts, cucumber,
    celery, carrots, salt, pepper, calcium, and
    vitamins

4
Elimination Diets
  • Although some people seem to respond well, more
    research is needed to determine who are diet
    responders
  • What proportion are responders from the whole
    ADHD population?

5
Elimination of Sugar Candy
  • Good news- No Effects!!!
  • Controlled 3-week trial of a sugar-restricted
    diet (Wolraich et al., 1994)
  • Cross-sectional studies ADHD children dont
    consume more sugar than Non-ADHD children (Kruesi
    et al., 1987)
  • Not a widely applicable tx for ADHD
  • But, may help for those children who are
    responders to elimination diet

6
Discussion Modifying Diets to Improve ADHD
Symptomatology??
7
Nutritional Supplements
  • Amino Acid Supplementation
  • Reportedly low levels of amino acids in ADHD
  • Short-term benefit for tryptophan, tyrosine, or
    phenyalanine
  • However, no benefit beyond 2-3 months, as
    tolerance develops
  • Essential Fatty Acid Supplementation
  • Lower levels in ADHD kids
  • Further control studies needed

8
Nutritional Supplements
  • Glyconutritional Supplements
  • In open trial (n17) with these supplements,
    parents reported reductions in inattention,
    hyperactivity-impulsivity, and oppositional
    behavior
  • Placebo-controlled trials needed
  • Vitamin Supplementation
  • Megadose no effects, risk of toxicity
  • Iron Supplementation
  • Open 30-day trial with 17 non-anemic ADHD boys,
    improvement in parents Conners scores (Sever et
    al., 1997)
  • Zinc supplementation
  • Little research
  • Magnesium Supplementation
  • 50 kids with ADHD and magnesium deficiency 6
    months significant decrease in parent and
    teacher Conners scores

9
  • Chinese Herbals
  • Chinese herbal cocktail compared to
    methylphenidate
  • Significant improvement rates comparable to
    stimulate meds, but more improvement on IQ scores
    and fewer side effects
  • Need placebo-controlled, double-blind studies
  • Acupuncture
  • Little data on its efficacy
  • Loo (1998) found decreases on parent and teacher
    Conners
  • Noted that kids with most severe ADHD could not
    comply with tx

10
Meditation
  • Mental training that can regulate attention and
    brain training?
  • Research in non-clinical samples has shown
    improvements on attentional blink tests
  • Rationale for using mindfulness meditation with
    ADHD can impact symptoms of inattention and
    impulsivity, associated neurocognitive deficits
    of inhibition, and help with stress, anxiety, and
    depression

11
Mindful Meditation
  • 3 steps
  • bringing attention to an attentional anchor
    (usually a sensory input such as a breath
  • Noting that distraction occurs and letting go of
    distraction
  • Refocusing or reorienting attention back to the
    attentional anchor
  • Pilot Study (Zylowska et al., 2007)
  • 8 week mindful meditation group w/ adults
    adolescents
  • Prepost improvements in self-reported ADHD
    symptoms and test performance on tasks measuring
    attention and cognitive inhibition
  • Next steps controlled clinical study

12
Neurotherapy EEG Feedback, Neuro feedback
  • Basis ADHD kids produce greater EEG slow wave
    (theta) activity, and less beta activity compared
    to normal controls
  • Neurotherapy teach ppl to normalize their
    brainwave responses to stimuli
  • EEG responses to stimuli on a computer are
    analyzed, then feedback is provided (visual
    displays, auditory tones) to show how well they
    are doing
  • good candidates stimulant non-responders,
    parents afraid of long-term affects on stimulant
    meds
  • Need assessment neurometric assessment with
    computer analysis of a minimum of 19 active scalp
    electrode sites necessary to confirm or
    disconfirm greater theta and less beta activity
    to key attentional tasks

13
  • New technology video games!!
  • Game becomes more difficult as brain waves of
    ADHD child show that attention is waning
  • Child is rewarded for decreasing time spent in
    slow wave activity, and increasing time spent in
    fast activity required for focused attention and
    concentration on tasks
  • Does it work?
  • Barkley 1995, CHADD newsletter "there is not
    enough evidence from well controlled scientific
    studies to support the effectiveness of EEG
    biofeedback for AD/HD children"

14
  • However
  • Studies using different control groups
    (waitlists, stimulant meds, cognitive therapy)
    have demonstrated that neurofeedback reduces
    inattention, impulsivity, task performance
    variability, and hyperactivity (Rossiter, 1998)
  • Outcome studies with samples as large as 530 show
    reductions in ADHD symptoms
  • Studies used objective test data (CPT, IQ tests,
    TOVA) behavior rating scales
  • Limitations
  • Time-consuming (need 6-8 months, up to 80
    sessions)
  • Need to identify who works better for this
    treatment
  • Must have assessment some practitioners dont
    use the neurometric assessment

15
Instant Alert Hypnosis!
  • Barabasz Barabasz intended to enhance
    vigilance performance for either focused
    attention or optimal situational awareness
    depending on the specific hypnotic instructions
    given
  • experimentally controlled studies show that
    Instant Alert Hypnosis can increase frontal EEG
    beta activity independent of neurofeedback
  • procedure
  • patient instructed to roll eyes up, as if trying
    to look at forehead
  • Instructed to look at psychologists thumb as
    thumb is slowly moved from nose to forehead
  • instructions are then given to take notice of
    breathing, relaxation, calm confidence and
    special calm alertness
  • Once clinician observes subjective signs of
    hypnosis, patient given instructions "in this
    special state of alertness you will be able to
    focus your attention anyway you like, you can
    concentrate as completely as your desire.
  • Then, patient told to let their eyes roll down
    and enjoy state of alertness
  • Finally, specific attentional task is done

16
  • Efficacy?
  • Instant alert hypnosis w/neurofeedback
    significantly better than neurofeedback alone
  • Positive and substantial clinical changes in
    average of 23 sessions (3-14 weeks of treatment
    for subjects)
  • Decreases in inattentiveness, hyperactivity,
    impulsivity

17
Other treatments for which I could find no
information!
  • Mirror feedback
  • Antifungal treatments

18
  • Discussion
  • How would you respond to a parent who mentioned
    wanting to try one of these alternative
    treatments?

19
ADHD Coaching
20
  • What is ADHD Coaching?
  • http//www.addcoachacademy.com/whatisadd.html
  • http//www.addcoachacademy.com/welltrained.html
  • Editorial Article

21
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