Another summer has drawn to a close and the stores have been displaying backpacks, study supplies and school ready clothes for a month. For children with ADHD, this time of year can often be a sad or anxious period, as they anticipate another year of struggles, both academic and social, disappointment, and possibly failure. Parents of children with ADHD use many strategies to help their children succeed. Schedules are in place to insure they are mentally and physically prepared to make a smooth and organized transition back to school. The checklist is at the ready, lunch packed, backpack organized, healthy breakfast eaten and fish oil taken. Fish oil taken? What does this have to do with ADHD, school and success?
ADHD is an acronym for Attention Deficit Hyperactivity Disorder. It is a classified as a behavioral disorder, but can also be a sign of nutritional imbalances. Children affected by ADHD are often hyperactive, have trouble concentrating and completing a task, are poorly organized, talk and fidget frequently and can be perceived as disobedient and defiant. While pharmaceuticals can improve the symptoms of ADHD, they come with a host of side effects including loss of appetite, insomnia, changes in personality, and heart damage. There is also some evidence that they may stunt growth. Unbeknownst to many parents, simple nutritional and lifestyle changes can increase focus and attention in children with ADHD, and can help avoid or reduce the use of these medications.
Fish oil, as mentioned above, is a perfect example of a natural substance that can help the brain, not to mention its positive impact on mood, immune and heart function. Fish oil contains essential fatty acids called DHA and EPA which are critically important for brain health. Multiple studies provide support for the beneficial effects of fish oil supplementation on ADHD symptoms and in some cases the benefits have been greater than what was achieved with medication. We also see an increase in allergies among children with ADHD. Since essential fatty acids can also reduce allergy symptoms, they have an added benefit in these cases.
Certain minerals such as magnesium, iron and zinc are also key players in supporting attention and reducing hyperactivity. When children were given a mineral supplement in a research setting, ADHD symptoms improved. It should not be surprising that school age kids can benefit from a multivitamin, since their diets are generally fruit and vegetable poor and high in nutrient depleted processed foods which do not contain these key minerals. Multiple studies have shown that children with low iron stores do more poorly on standardized tests and that iron deficiency worsens ADHD symptoms. Zinc plays multiple roles in addressing ADHD. It can reduce hyperactivity, improve response to fish oil, positively affect brain waves and is essential for the production of melatonin, which will be discussed later. Magnesium is a calming nutrient which has been used successfully in children with ADHD. Blood tests show that these children are often low in both fish oil and minerals.
Herbs, such as pycnogenol (from French pine bark) have also successfully improved attention and focus in children with ADHD. In one study, the children with ADHD who were given pycnogenol showed a reduction in stress hormones and an improvement in dopamine levels that correlated with improvement in ADHD. When the pycnogenol was discontinued, symptoms returned.
Food sensitivities are more common than true food allergies and may be under diagnosed, yet sensitivity to dairy, gluten or another food can have profound effects on behavior. Removing a problem food from the diet for a defined period of time, with appropriate nutritional supervision, can be key to promoting improvements in behavior and attention. Children with a past history of ear infections or chronic congestion are especially good candidates for a dairy free trial.
The overall quality of food can not be overlooked. Beyond the obvious benefit of a nutritious diet, which includes plenty of fruits and vegetables, good quality proteins and is low in processed carbohydrates, other factors play a role as well. While there are still some who discount the relationship between artificial ingredients and ADHD, a number of studies in the past few years have brought the issue back to the forefront. In one such study, children eating a “western” diet were more than twice as likely to have ADHD. A western diet was low in fruits, vegetables and fish, and high in take-out or processed foods, sweets and fried items. In another study, when artificial ingredients were removed from the diet, symptoms decreased in over 65% of children. While the studies remain small, the results are compelling. Chemicals such as PFCs (polyfluoroalkyl) and pesticides have been linked to ADHD so an organic, chemical free diet is indicated. Since there is no downside to avoiding artificial and chemical ingredients and no nutritional requirement for them, this simple change should be at the top of the list.
Some important factors are unrelated to diet, such as sleep and vision. Unlike adults, who get drowsy when lacking sleep, tired children often become restless, overactive and inattentive. Some medications for ADHD will disrupt sleep, further exacerbating the problem. Chronic sleep deprivation from poor quality or too little sleep can be a result of ADHD, but in the absence of ADHD can also strongly mimic the symptoms and result in an inappropriate diagnosis. Making sure a strict bed time, with a calming routine beforehand, is part of the daily schedule can go a long way to reducing these behaviors. For children who go to bed on time but have trouble falling asleep, there are some simple solutions. Aside from its behavioral benefits during the day, magnesium is a calming mineral which also promotes good sleep. A small dose of magnesium or an Epsom salt (magnesium sulfate) bath is an excellent addition to the pre-bed routine. Melatonin is another option that has benefits beyond bed time. It is a hormone produced by the pineal gland, which regulates sleep patterns and has been shown to help children with ADHD fall asleep. It is also a potent antioxidant, supporting the immune system, which can be poorly regulated in kids with ADHD. Finally, a small study also described a reduction in aggression during the day after melatonin supplementation.
Vision problems can also cause symptoms similar to ADHD and this possibility should always be ruled out. Convergence insufficiency (CI) is a condition in which the patient has difficulty using both eyes together when looking near, as is necessary for reading and writing. In addition to reducing the ability to focus, it can cause early fatigue and the appearance of inattention. One clue is if a child can pay attention much better when listening than when reading independently. A developmental optometrist can evaluate this.
Helping a child with ADHD to succeed requires a multifaceted approach, which includes behavioral work, planning, and organizational strategies; however these techniques should be used in combination with diet and lifestyle changes for the greatest outcome. When your child walks out the door in the morning, be sure he has not only his organized backpack and healthy breakfast on the schedule, but add some fish oil as well!
Vicki Kobliner MS RD, CD-N is a Registered Dietitian and owner of Holcare Nutrition (www.holcarenutrition.com). Vicki works with infants, children and adults with digestive disorders, food allergies, ADHD, autism and other chronic illness, and provides fertility and prenatal nutrition counseling. Vicki has extensive experience in using dietary modification, appropriate supplementation and functional lab testing to achieve optimal wellness. She can be reached at 203.834.9949 or vicki@holcarenutrition.com.