Desoxyn

Abstract

Attention Deficient Hyperactive Disorder (ADHD) is a disorder that is prevalent in many children today. It is reaching epidemic portions and the current conventional medical treatment and management of the disorder offers limited success. Ritalin is by far the most common pharmaceutical used to treat the disorder. However, Ritalin and other drugs like it do not always treat the disorder and the drugs have many short and long-term side effects. Alternative medicine presents effective therapies for parents without the side effects of drugs. These alternatives include examining nutrition therapies, herbs, homeopathy, allergies, and in addition, hypothyroidism or under-active adrenal glands. Considering the effective results of treating children with ADHD, parents should strongly consider alternative medicine.

Attention Deficient Hyperactive Disorder or better known as ADHD, is becoming more common in children throughout the United States. It is reaching epidemic portions and yet few advancements have been done to effectively treat, manage or eliminate ADHD. Current treatment relies on pharmaceutical drugs, which not only do not eliminate the condition but have both short and long-term side effects. Alternative therapies focus on nutrition, vitamins and minerals, amino acids, herbs, homeopathy, food and environmental allergies, and proanthocyanidins. In addition, hypothyroidism and adrenal glands have also been mentioned in the literature in relation to ADHD. An integrative alternative approach should be considered in the treatment and management of ADHD.

The term ADHD was originally derived from the term ADD (attention deficit disorder). ADD was further subcategorized as ADD with hyperactivity or ADD without hyperactivity. However, in the 1994 DSM-IV the official term was stated as ADHD. (1)

A child with ADHD has a wide range of symptoms including hyperactivity, short attention span, distractibility, and difficulty with organizational skills and not paying attention to details. These children are restless, forgetful and react impulsively. (2) They may have mood swings, temper tantrums and are unable to cope with stress. (1) Boys seem to be two to three times more likely to be diagnosed with ADHD. (2) Some of the current research examines the possibility that ADHD is inherited. Twin and adoption studies suggest that ADHD has a relatively high degree of hereditability. However, to date there is insufficient data linking ADHD to an inherited trait. (1)

In order to diagnose a child with ADHD the behaviors must appear before age seven and be present at a minimum of six months. ADHD occurs in 3% to 5% of children in the United States, and approximately half of those children continue to have ADHD symptoms as adults. (2) Those that continue to have symptoms into adulthood may develop antisocial behavior, substance abuse, suffer from poor self-esteem and social skill deficits. (3) In 1993, more than two million children were diagnosed with ADHD; this was an increase from 902,000 in 1990. It is estimated that as many as four million children currently have been diagnosed with ADHD. (1)

Currently, conventional medical interventions include pharmaceutical drugs. Psychostimulants are the first line of defense used in ADHD. Methylphenidate or Ritalin is the most common drug prescribed to treat ADHD. In 1993, more than 2.5 million prescriptions were written for Ritalin. (1) Other stimulants that can be used are dextroamphetamine (Dexedrine), a mixture of four salts of dextroamphetamine (Adderall), methamphetamine (Desoxyn) or pemoline (Cylert). Ritalin and Ritalin-SR are preparations of methyl-alpha-pheny1-2-piperidineacetate hydrochloride. Ritalin acts on the central nervous system with a dopamine-agonistic effect that works slower but is mechanically almost identical to cocaine and amphetamines. (1,4) Most all of the mood altering drugs (alcohol, cigarettes, caffeine, heroin, cocaine, and the stimulant medications for hyperactive children) affect dopamine. (5)

Research has found that ADHD children have a deficiency in dopamine, a chemical in the brain necessary for several vital brain functions. The dopamine system is involved in the reward-seek behavior, sexual behavior, control of movements, regulation of the pituitary-hormone secretion and memory functions. Dopamine has been shown in young animals to exert a protective influence against hyperactivity. (6) It is thought ADHD children have too many molecules that use up the dopamine before it can be used for its vital functions. Ritalin binds to these molecules allowing the dopamine levels to increase in the brain and be used for the normal vital functions. (4)

Even though Ritalin is the drug of choice for children with ADHD, it has many side effects and presents many risks for the children who use it. A child who is treated with Ritalin is moved from a hyperactive state to the opposite state. Children develop appetite suppression, weight loss, retarded growth, emotional blunting and detachment, and many parents complain that the child acts like a "zombie." (6) Children on higher doses and chronic use may develop paranoid symptoms -- withdrawal, anger, restlessness, and suspicious behavior. It has been shown that adults who abuse amphetamines regularly develop psychotic states with paranoid features. (6) Other serious side effects of methylphenidate are auditory and visual hallucinations, drug abuse-rebound depression, psychic dependence, increased euphoria and cocaine-like activity, insomnia and tachycardia. Also, researchers reported that Ritalin caused liver cancer in mice.' No drug that affects the dopamine system is free of long-term toxicity to the motor syste m. Ritalin may produce disruption of movement control and facial and head tics may appear. (6) Amphetamines are commonly referred to as "speed or uppers" and are one of the most dangerous medications ever discovered. They are chemically similar to dopamine and are the synthetic replacement in the dopamine receptor sites of the brain. Amphetamines have the potential to cause injury to healthy tissue, interfere with growth and development, sleep problems, or aggressive and depressed moods in children. (7)

How can we increase dopamine levels in children with ADHD naturally without using Ritalin or other amphetamines? Dopamine is made from the amino acids tyrosine, or phenylalanine. These amino acids are converted by enzymes into L-dopa. Folic acid, niacin and iron are required for the enzyme to make L-dopa from tyrosine. Finally, another enzyme converts L-dopa to dopamine as long as vitamin B6 is available. By supplementing nutrients and amino acids the body can make dopamine naturally, increasing its levels in the brain. (7) In addition, one study examined the plasma amino acids in 28 patients diagnosed with ADD and 20 control subjects. Compared to the controls, the ADD subjects had significantly lower levels of phenylalanine, tyrosine, tryptophan, histidine, and isoleucine. This suggests there may be a general deficiency in amino acid transport, absorption or both in ADD. (8)

Rhodiola rosea (Rose root) has been used in traditional European medicine for over 3,000 years and it is a way to increase dopamine in the brain. Current research shows that it increases the body's resistance to any type of stress by regulation of the hormonal response in the body. It has a protective effect upon neurotransmitters such as serotonin and dopamine in the brain. It improves neurotransmitter activity by inhibiting their enzymatic destruction and preventing their decline caused by excessive stress hormone release. (9)

Much has been said in the literature relating diet to ADHD. Dietary influences such as food and environmental allergies and nutritional deficiencies have been linked to hyperactivity. By focusing on nutrition, proanthocyanidins, essential fatty acids, supplementing with vitamins/minerals, and eliminating allergens have been very effective in treating ADHD.

Food allergies and food chemistry are important in causing learning and behavior problems in children. When children are sick or influenced by food and/or airborne chemicals it can compromise brain function. Their learning is impaired and behavior may be disturbed. (6) Feingold research found that up to 50% of all hyperactive children were sensitive to food additives (artificial food colors, flavorings and preservatives) plus salicylates occurring naturally in some foods, making the connection between food allergies and hyperactivity. (1) Since then research has made the connection with foods and ADHD. Seventy-eight children with hyperactive behavior were placed on an elimination diet. Fifty-nine (76%) of the children improved in behavior. These 59 children who responded were then challenged with various foods and some food additives. It was found the additive containing foods were the worst offenders (70% reacted). Then the list was as follows: chocolate (64%), cow's milk (64%), orange (57%), cow's cheese (4 5%), wheat (45%), other fruits (35%), tomato (22%) and egg (18%). (10) Another study with 26 children who met the criteria for ADHD were put on a multiple item elimination diet and showed 19 children responding favorably and with an open challenge all 19 children reacted to many foods, dyes and/or preservatives. This study shows the benefit of eliminating reactive foods and artificial colors in the diets of children with ADHD. (11) Finally; a study involving 40 children who were given a diet free of artificial food dyes and other additives for five days; 20 of the children were classified as hyperactive and the other 20 were controls without a hyperactive classification. On oral challenges with food dyes the performance of the hyperactive children was impaired relative to their performance after receiving the placebo. The performance of the nonhyperactive group was not affected by the challenge of the food dyes. (12) The United States consumes an enormous amount of food additives. Per capita daily consumption of food additives is 13-15 grams, and the population's total annual consumption of food colors alone is approximately 100 million pounds. There are some 5,000 additives currently in widespread use. Other countries have significantly restricted artificial food additives. The removal of artificial food colorings and preservatives from the diet of a child with ADHD is vital and a realistic clinical intervention. (1)

Environmental illness can play an important role in ADHD. Environmental toxins include everything from molds, dust, and pollens to toxic chemicals (pesticides, herbicides, solvents, etc.). All of these toxins have been linked to changes in behavior, perception, cognition or motor ability. Children who have been exposed to lead, arsenic, aluminum, mercury or cadmium can have permanent neurological damage including attention deficits, emotional and behavioral problems. (1)

Nutritional deficiencies have been shown throughout the literature to make a significant impact on the learning and behavior of children. For example, in one study reading skills and IQ tests improved significantly after children started taking multivitamins. (13) Another study showed that learning-disabled children who were placed on vitamin/mineral supplements improved in reading comprehension, their grades improved and those in special education classes were able to become mainstreamed. Those that discontinued the treatment saw their skills drop off, and those who remained on the therapy continued to improve. (14) Research continues to show that poor nutritional habits in children lead to low concentrations of water-soluble vitamins in the blood, impair brain function and subsequently cause violence and other serious antisocial behavior. After correcting the nutrient intake, either by a well-balanced diet or low-dose vitamin/mineral supplementation, this corrected the low concentrations of vitamins in the blood, improved brain function and subsequently lowered institutional violence and antisocial behavior by almost half. (15) The brain and the rest of the body need nutrients for normal vital functioning. Therefore, brain function can be affected by any nutrient deficiency or imbalance. ADHD children often have nutrition deficiencies or imbalances that if corrected can make a significant impact on their behavior. (1)

Zinc deficiency has been noted in children with ADHD. Hyperactive children had significantly lower zinc levels in hair, blood, fingernail and urine compared to the age and sex-matched controls. The yellow food dye tartrazine may bind to zinc in the blood as a chelating agent and reduce levels of zinc in the blood. (16) Another study found that ADHD children with zinc deficiency had a poorer response to amphetamine treatment. (17)

Magnesium was linked with ADHD in a study involving ADHD children with a recognized magnesium deficiency in the blood. In a period of six months, those examined regularly took magnesium preparations in a dose of approximately 200 mg/day. After a period of six months, there was an increase in magnesium content in hair and a significant decrease of hyperactivity compared to their clinical state before the supplementation and the control group, which was not treated with magnesium. (18)

Vitamin B6 (pyridoxine) is an essential component in a majority of the metabolic pathways of amino acids, including decarboxylation pathways for dopamine, adrenaline and serotonin. (1) One study reported that B vitamins improved the behavior of some children with ADHD in comparison to methylphenidate. In addition, it was further investigated giving children who were responsive to methylphenidate, supplementation of B6. In a double blind, multiple crossover trial, each child received placebo, low and high doses of methylphenidate, and low and high doses of B6 in a 21-week period. Results showed that serotonin blood levels increased dramatically on B6, and teacher ratings showed a 90% level of statistical trend in favor of B6 being slightly more effective than methylphenidate. (19)

There is an abundance of information correlating the connection of ADHD and essential fatty acids (EFA). There are two main classes of fatty acids -- omega-3 and omega-6. Fatty acids function as pro-homeostatic parts of cell membranes and as precursors to smaller molecules (eicosanoids) that transduce information inward to the cell interior, and outward from each cell to influence other cells. One consistent symptom of EFA deficiency in both animals and humans is excessive thirst (polydypsia) without the matching frequent urination (polyuria). C22:6 omega-3 (docosahexaenoic acid, DHA) and C20:4 omega-6 (arachidonic acid) are in human breast milk. (11) Unfortunately, the average DHA content of breast milk in the US is the lowest in the world; probably due to the fact Americans eat comparatively little fish. DHA is the building block of human brain tissue and is abundant in the gray matter of the brain and in the retina. Low levels of DHA have been associated with depression, memory loss, dementia, and visual p roblems. Low DHA levels have been linked to low brain serotonin levels, which can, be connected to depression, suicide and violence. (20) Researchers at Purdue University found that subclinical deficiency in DHA is responsible for the abnormal behavior of children with ADHD. They pointed out the supplementation with a long-chain omega-6 fatty acid (evening primrose oil) was unsuccessful in ameliorating ADHD and this is believed to be due to ADHD children needing more omega-3 fatty acids than more omega-6 acids. The researchers also found that children with ADHD were less often breastfed as infants than were children without ADHD. Breast milk is an excellent source of DHA. (21) Another research study at the School of Medicine at the University of Auckland in Auckland, New Zealand found upon blood analyses that hyperactive children had significantly depressed levels of docosahexaenoic, dihomogammalinolenic and arachidonic acids. The researchers pointed out that male animals require three times as much EFA as do females in order to achieve normal neonatal and infant development; this is consistent with the finding that hyperactivity is more common among boys than among girls. (22)

Proanthocyanidins may prove effective in treating ADHD. It was reported in a pediatric practice that children were treated with nutritional supplements similar to pycnogenol (pine bark extract). The biologically active compounds found in pycnogenol are oligomeric proanthocyanidins (OPCs). The results showed that patients in areas relating to sustained attention and distractibility, rather than hyperactivity and impulsivity found the most significant improvement. A few side effects were noted in some children becoming irritable and having decreased energy. OPCs are a class of flavonoids. Flavonoids are a group of polyphenolic substances, which are present in most plants. OPCs have been extracted from many plants including apples, berries, grapes, raspberries and may also be present in many red wines. (23)

When treating ADHD, homeopathy should be considered as a treatment option. In a study comparing the effectiveness of homeopathy vs. methylphenidate it was found that in cases where treatment of the hyperactive child was not immediate, homeopathy is a valuable alternative to methylphenidate. The reported results of the homeopathic treatment appear to be similar to the effects of methylphenidate. Only in children who did not achieve the high level of sensory integration for school had to be changed to methylphenidate. In preschoolers, homeopathy appears to be particularly useful in the treatment of ADHD. (24)

Chinese herbal therapies have been used in numerous studies with children who had ADHD and proved to be very effective. From a traditional Chinese medical viewpoint, ADD is caused by a "kidney essence deficiency" that affects brain development. Furthermore, the yin aspect of the kidney is mainly deficient, which leads to excessive statement of yang. This excessive yang can manifest as hyperactivity and wandering of the mind. Therefore ADD should be treated by nourishing the kidney yin, opening the heart orifices (which are the passages that affect the brain function), and settling the agitated yang. The main herbs that can be used for nourishing the kidney in ADD children are rehmannia, tortoise shell, deer antler gelatin, lycium, and cornus. In clearing the heart orifices and enhancing the mental function the main herbs used are acorus, polygala, curcuma, and alpinia. To settle an agitated yang energy (manifesting as hyperactivity and insomnia) the alleged "heavy sedating agents" are used. The traditional id ea is that these mineral-rich substances bear down on the rising and disordered yang. The main substances given for ADD by Chinese doctors are dragon bone or dragon teeth, oyster shell or mother of pearl, succinum, and cinnabar.

One study, showing the effectiveness of Chinese herbals on ADHD children used a sugar paste. Two formulas were made in this form -- Zhili Tangjiang, composed mainly of acorus and polygala, and Kangyi Tangjiang, which contained acorus, polygala, plus tortoise shell, hoelen, dragon bone, alpinia, dioscorea, and lotus seeds. The dose of these pastes was 10-15 ml each time, two to three times per day. Of 170 cases (two studies), 132 (77%) were improved. Treatment time was approximately one month. (25) Another study showed 30 children with ADD were treated with a syrup and powder, for two to four months, with the result that 22 (73%) showed improvements. The syrup was made with alpinia, hoshou-wu, lycium, dragon bone, oyster shell, acorus, curcuma, and salvia, boiled down to a thick liquid and preserved with benzoic acid. Three times per day, the children would take 25 ml of the liquid and 2 grams of deer antler powder. A similar method was used in a study of 50 children with ADD who consumed a decoction of acorus , polygala, dragon bone, and oyster shell, modified by adding three to six herbs according to symptoms, and who also consumed a powder of succinum. The duration of the therapy was not specified but 38 of the children (76%) showed improvements. (25)

Another study showed interesting results using an Ayurvedic formulation -- Mentat. In this study, 40 hyperactive children were enrolled in a double-blind placebo-controlled study to receive either an active drug Mentat or a placebo. One group of 20 received Mentat syrup and another a placebo. The drugs were given for 3 to 7 months in both groups. Evaluation was done on Yale's Behavior Inventory before and after the twelve weeks of treatment. It was observed that there was remarkable improvement in behavioral pattern along with an increase in concentration. There was significant reduction in hyperactivity, temper tantrums and improvement in language usage. Social behavior improved in those who received Mentat treatment as opposed to those on placebo. Mentat is an Ayurvedic formulation (Himalayan) that has been reported to be effective in disorders involving memory and attention. (26)

Thyroid should be examined in children with ADHD. One study was done examining the relationship between thyroid hormone and attention in 85 seven-year old children with congenital hypothyroidism. It was found that children with higher circulating levels of thyroxine (T4) had significantly more distractibility on an index of cognitive attention. (27) Another study showed that ADHD was strongly associated with generalized resistance to thyroid hormone. (28)

A study of ADHD children suggests that the lack of ability to control impulsive thoughts and actions may be caused by an underactive rather than an overactive adrenal hormone response. The ability to control behavior is thought to be related to the body's release of stress hormones such as cortisol. Researchers compared cortisol secretion in two groups of children: those who had ADHD symptoms for over a year, and those whose symptoms had declined. Salivary cortisol assays performed on both groups showed that children with persistent ADHD had a significantly lower adrenal response. In addition, after performing a series of academic and psychological tests, these children exhibited cortisol responses that were two to three times lower than those children who no longer were experiencing ADHD symptoms. It was concluded that a blunted cortisol response to stress might indicate a more developmentally persistent form of ADHD. (29)

This paper discusses some of the alternative options for treating attention deficit hyperactivity disorder in children. This has become a serious condition that is affecting many children today. Ritalin, the most popular pharmaceutical choice in treating ADHD, has many short and long-term side effects. Alternative therapies should be considered as viable options to Ritalin. There are many effective alternative treatments that can be used to treat and manage ADHD.

References

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(2.) www.parentsofallergicchildren.org

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(26.) Experience with Mentat in Hyperkinetic Children. Mrs. Renu B. Patel, M.D., D.C.H., Professor and Head of the Dept. of Pediatrics, Institute of Child Health, Grant Medical College and J.J. Group of Hospitals, Bombay And Mrs. Leela Pereira Medical and Psychiatric Social Worker

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(29.) King J., Borkley R., Barrett S.. Attention-Deficit Hyperactivity Disorder and the Stress Response. Journal of Biological Psychiatry 1998; 44: 73-74

Correspondence:

Farhang Khosh, ND

Email: frk67@yahoo.com

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