Natural treatments for attention deficit hyperactivity disorder (ADHD)
Natural treatments for attention deficit hyperactivity disorder (ADHD) encompass various alternatives to conventional therapies, which primarily rely on stimulant medications. Some of the principal natural treatments include 2-dimethylaminoethanol (DMAE) and zinc, both of which have shown some evidence of efficacy in improving ADHD symptoms. Other proposed remedies range from dietary changes—such as food allergen avoidance and specific nutrient supplementation (e.g., magnesium, iron, and essential fatty acids)—to herbal options like St. John’s wort and ginseng.
While certain treatments, such as essential fatty acids, have garnered attention for their potential benefits, studies indicate their effectiveness is often marginal. Additionally, some methods, including Bach flower remedies and evening primrose oil, are not supported by substantial evidence. The complex nature of ADHD, which can manifest variably among individuals, calls for a thoughtful approach to treatment that considers both conventional and natural options, respecting the diverse perspectives on managing this condition. Overall, while there are promising avenues for natural treatments, further research is often needed to establish their effectiveness definitively.
Natural treatments for attention deficit hyperactivity disorder (ADHD)
DEFINITION: Treatment of attention deficit hyperactivity disorder (ADHD).
PRINCIPAL PROPOSED NATURAL TREATMENTS: 2-dimethylaminoethanol, zinc
OTHER PROPOSED NATURAL TREATMENTS: Bach flower remedies, blue-green algae, calcium, combined amino acids, combined polysaccharides (galactose), food allergen avoidance and other dietary changes, fucose, glucose, glycine, inositol, iron, L-glutamine, L-phenylalanine, L-tyrosine, magnesium, mannose, massage, melatonin, N-acetylgalactosamine, N-acetylglucosamine, N-acetylneuraminic acid, St. John’s wort, taurine, trace minerals, xylose
PROBABLY NOT EFFECTIVE TREATMENTS: Essential fatty acids (fish oil); evening primrose oil
Introduction
Originally, children who struggled to concentrate at school were thought to have attention-deficit disorder (ADD). Hyperkinesia was used somewhat synonymously as a descriptive term for children who could not sit still. The American Psychological Association later broadened its definition of ADD to include adults and listed the condition in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) under the term attention deficit hyperactivity disorder (ADHD). This diagnosis is refined into three categories—ADHD with a combined presentation, ADHD with a predominantly inattentive presentation, and ADHD with a predominantly hyperactive-impulsive presentation. Characteristics include difficulty sustaining attention or completing tasks, easy distractibility, impulsive behavior, and an excessive inclination to fidget and move about. These problems make it difficult to succeed at work or school.
Conventional treatment focuses on stimulants, such as amphetamine (Adderall), dextroamphetamine (Dexedrine Spansule, Zenzedi), methylphenidate (Ritalin, Concerta), and the drug atomoxetine (Strattera). Certain antidepressants may also be useful, like bupropion (Wellbutrin), desipramine (Norpramin), and venlafaxine (Effexor).
Proposed Natural Treatments
2-Dimethylaminoethanol. There is some evidence that the supplement 2-dimethylaminoethanol (DMAE) may be helpful for ADHD, according to studies performed in the 1970s. Two such studies were reported in a review article. Fifty children aged six to twelve years who had been diagnosed with hyperkinesia participated in a double-blind study comparing DMAE to placebo. The dose was increased from 300 milligrams (mg) daily to 500 mg daily by the third week and continued for ten weeks. Evaluations revealed statistically significant test-score improvements in the treatment group compared with the placebo group.
Another double-blind study compared DMAE with both Ritalin and placebo in seventy-four children with learning disabilities. (Today, the participants likely would have been given a diagnosis of ADHD.) The study found significant test-score improvement for both treatment groups over a ten-week period.
Zinc. The mineral zinc has shown some promise for the treatment of ADHD. In a large, double-blind, placebo-controlled study (approximately four hundred participants), using zinc at 35 mg daily produced statistically significant benefits compared with placebo. This dose of zinc is higher than nutritional needs but not so high as to be unsafe. However, the benefits were relatively modest: About 28 percent of the participants given zinc showed improvement, but so did 20 percent in the placebo group.
Another much smaller study evaluated whether zinc at 15 mg per day could enhance the effect of Ritalin. Again, modest benefits were seen. Finally, exceedingly weak evidence hints that zinc might enhance the effectiveness of evening primrose oil for ADHD.
Other research suggests individuals with ADHD may be prone to zinc deficiencies, which could be addressed by screening patients with ADHD diagnoses for low zinc levels and adding a zinc supplement to the medicinal regimen of those who need it. However, adding a supplement is unlikely to improve symptoms in individuals with normal zinc levels.
Essential fatty acids. Essential fatty acids (EFAs) are “good fats,” substances as important to general health as vitamins. These include omega-3 polyunsaturated fatty acids (n-3 PUFAs), such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Based on evidence that essential fatty acids are necessary for the proper development of brain function in growing children, EFAs found in fish oil and evening primrose oil have been used to treat ADHD and related conditions. The results, however, have been marginal.
A double-blind, placebo-controlled trial of seventy-five children with ADHD found that daily supplementation with omega-3 and omega-6 fatty acids may reduce ADHD symptoms in some children. However, in a similarly designed study of fifty such children, the use of essential fatty acids from fish oil and evening primrose oil failed to provide any consistent, significant benefit above and beyond the placebo effect. (The placebo effect, incidentally, was considerable.) In a slightly smaller trial, weak evidence of benefit was seen, but the results are difficult to interpret because of the high number of people who dropped out of the study.
In a double-blind, placebo-controlled trial of children already using stimulant therapy, the addition of the essential fatty acid docosahexaenoic acid (DHA, found in fish oil) for four months failed to improve symptoms further. Other small studies support DHA's use, but the effects can take as long as four months to begin to make an impact. Typical doses for children under twelve are 500 mg per day and 1000 to 1500 mg per day for those over twelve. Eating salmon, sardines, tuna, nuts, vegetable oil, and herring is beneficial for individuals who wish to increase their natural intake of good fats.
Evening primrose oil alone failed to prove effective for ADHD in a small, double-blind, placebo-controlled trial. In a placebo-controlled comparative trial, evening primrose oil proved less effective than standard medical treatment. However, a close look at the data in this last trial hinted that evening primrose oil might have been more effective in people with adequate zinc levels. This suggests that combination therapy with zinc and evening primrose oil should be tested, but thus far, this approach has not undergone meaningful study.
Other natural treatments. A small, double-blind, placebo-controlled crossover trial evaluated the possible efficacy of the supplement carnitine for ADHD in boys aged thirteen years and younger. Approximately 50 percent of the participants responded to carnitine, a significantly higher percentage than those who responded to the placebo. These promising results suggest that a larger trial is warranted.
A combination of American ginseng and Ginkgo biloba has shown some promise for the treatment of ADHD. Vitamin B3 (niacin), vitamin B6, and multivitamin-multimineral supplements have been recommended to treat ADHD. However, a literature review found no meaningful evidence indicating these treatments' effectiveness. One study reportedly proves that magnesium is helpful for ADHD, but this study’s design was inadequate for confirmatory findings.
Other supplements that are sometimes recommended for ADHD include calcium, iron, inositol, trace minerals, blue-green algae, combinations of amino acids (usually gamma-aminobutyric acid, glycine, taurine, L-glutamine, L-phenylalanine, and L-tyrosine), and combinations of the polysaccharides galactose, glucose, mannose, N-acetylneuraminic acid, fucose, N-acetylgalactosamine, N-acetylglucosamine, and xylose. St. John’s wort has also become popular, but unlike its effectiveness in depression, there is no convincing evidence for its effectiveness against ADHD. St. John’s wort interacts with many medications and could conceivably impair the effectiveness of conventional treatments for ADHD.
One study hints that massage might be helpful for ADHD. Also, it is commonly said that sugar, food allergens, and food additives, such as artificial colors, contribute to ADHD symptoms. However, published evidence regarding these therapies remains incomplete and contradictory. The best evidence regards artificial colors and food additives. In a double-blind, placebo-controlled study of 153 persons without ADHD, the use of certain food additives significantly increased hyperactivity compared with placebo.
A double-blind study reported in 2005 failed to find benefits for ADHD with a treatment known as Bach flower remedies. Another study found that the supplement melatonin may be helpful for improving sleep in children with ADHD who are also taking stimulant medications. However, melatonin does not appear to be helpful for ADHD symptoms per se.
Homeopathic Remedies
In a double-blind study of sixty-two children with ADHD, the use of constitutional, or classical, homeopathic remedies proved more effective than placebo. However, a similar study of forty-three children, again using constitutional remedies, failed to find statistically significant benefits. Another large double-blind study that evaluated patients over eight months found homeopathic consultations with traditional treatment were useful for patients, but homeopathic treatment alone was ineffective.
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