A recent study was published in the New England Journal of Medicine (NEJM) stating that a review of patients who had been taking ADHD medications like Adderall and Ritalin were not shown to have increased risk of heart disease or other cardiovascular diseases like strokes. With more than 2.7 million American children with ADHD, this is an important finding.
This study was funded by the Food and Drug Administration and the Agency for Healthcare Research and Quality. It identified 81 heart attacks, strokes and sudden deaths in the study with more among those taking the medicines than in a comparison group who wasn't on the medication. The study looked at medical records for 1.2 million children and young adults covered by four U.S. health plans and derived its findings based on this systematic review.
The limitation of this study is that the findings of the number of patients who had cardiovascular events were surprisingly low. Could this study size not be large enough to have picked up statistical significance, and would we perhaps benefit more from a confirmatory study of these findings with a larger sample size study? The answer is likely that we would indeed benefit from a larger study to confirm this finding.
However, in the interim, because ADHD can create significant limitations in school and work achievements, and other options can mostly be looked at as only adjunctive therapies, a study such as this helps to allay some of our fears for those who are on the medication until we can further obtain additional confirmatory data.
When I see patients with ADHD, we discuss potential pros and cons of medications such as Ritalin and Adderall. But we also frequently discuss potential alternatives or adjunctive therapeutic options for ADHD as well.
With a recent study as the one published in NEJM, patients who are on the stimulant medications may decide they want to continue on the medications. However, some of the options for adjunctive therapies may also be worth looking into so as to optimize daily functionality in the work place, home and school environment.
Clinically, there are some indications that avoidance of food preservatives, food allergens and processed foods is a good idea for those dealing with ADHD. There is also suggestion that supplements such as fish oil may be beneficial. In this article, I would like to discuss a few other behavioral options as well that have been seen to potentially be helpful with ADHD as adjunctive therapies.
1. Positive parenting and relationship training is essential to ADHD therapy. The American Academy of Pediatrics recommends behavioral therapy programs for children with ADHD. Although behavioral therapy programs are best utilized in conjunction with medications, the adjunctive therapy is seen to be very beneficial for ADHD therapy. Training programs where parents are taught to reward good behavior instead of reprimanding bad behavior have led to positive long-term benefits for those dealing with ADHD.
2. Neuro-Feedback (aka EEG biofeedback). This treatment tries to train patients to control brain waves typically associated with focus and attention. The positive aspect of neuro-feedback is that it is likely to work permanently after training sessions are completed and a positive response has been achieved. However, it is labor intensive and potentially expensive for patients since most insurance companies may not cover it.
3. Meditation. In a pilot study in the 2008 issue of Current Issues in Education, transcendental meditation seemed to improve overall attention and behavior in children with ADHD. Reduction of stress and anxiety seemed to lessen symptoms as well by allowing prefrontal cortex of the brain to function more optimally.
Aside from these suggestions, I always recommend plenty of sleep and immersion in natural environments. Lack of sleep undoubtedly can worsen symptoms, and a study in the American Journal of Public Health in 2004 suggested that kids with ADHD exhibited improvement in symptoms after being allowed to play in natural outdoor environments. This was supported by a study by the University of Illinois in 2008 that children with ADHD fared better after being able to be out in nature for a 20-minute stroll in the park compared to those who strolled in downtown or residential areas.
When it comes to ADHD, it appears that a combination of medication with behavioral and environmental modifications yield the best results. So, for all those who are dealing with ADHD and for those parents trying to optimize the environment for your children with ADHD, keep in mind that even if medications are deemed relatively safe, the chance that you can achieve optimal results is still better with the creation of a supportive environment, optimal rest and nutrition, and creating situations that lessen distractions (such as seating closer to the front of a classroom or reducing anxiety and stress with daily mind-body therapies). In my opinion, in the case of most disease states or health concerns, a multi-modal approach to wellness and healing is the best option for achieving multi-dimensional symptomatic improvement.
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To date, both of these should be considered "complementary" and cannot be considered replacements for evidence-based interventions.
What we DO know is that a multi-modal approach -- including parent-education and training, behavioral interventions, appropriate educational supports (for children and teens), and medication if necessary -- produces the best outcomes for children, teens and adults correctly diagnosed with ADHD.
For more information about such science-based interventions, as well as information about ADHD related conditions in general, visit the National Resource Center on ADHD at http://www.help4adhd.org.
Tim MacGeorge, MSW
Director, National Resource Center on ADHD
"I'd have no hesitation of giving a youngster with ADHD a trial of oral marijuana," said Lester Grinspoon, emeritus professor of psychiatry at Harvard Medical School and the author of "Marihuana: The Forbidden Medicine."
"For some kids, it appears to be more effective than traditional treatments. And marijuana certainly has fewer potential dangers than Ritalin."
http://www.aolnews.com/2009/11/24/marijuana-prescribed-to-kids-with-adhd/
Sure, there's an overlap between 'playing outdoors in natural environments' and getting exercise, but if that was to emphasise exercise it misses the mark. There's plenty of data to back up the fact that both simple acrobatic and aerobic exercise is great for the ADHD Brain, and there's also the added benefit of mentorship that comes through some martial arts disciplines.
Personally, I'm med free these days - but that's only a result of lifestyle, exercise and dietary changes. Definitely not something to be overlooked.
By the way, if you have a child with ADHD the ADDvance website is a really great tool.
http://www.addvance.com/
It's true - meds do help some people. The only problem with them is that some people rely on them to make all the difference - ignoring the importance of the basics like diet and exercise.
A few ADHDers I've worked with have made the comment to me that they can't focus or get anything done. When I check out what they've been doing, it's invariably a mix of eating processed foods/gluten/sugars and sitting around. This does nothing good for an ADHDer. If the basics aren't taken care of (life sans meds), then meds shouldn't be an ongoing option.
This is a real condition that has to be dealt with seriously. No psychiatrist I have ever worked with (in my 45 years) has ever told me that meds would handle everything. Coping skills, organizers, exercise, learning how to think like other people instead of existing only in my ADHD world -- those are also a must.
I do take meds when I need to write. I am an academic and probably wouldn't be as successful in my field without the intervention meds allow. I am fortunate, however, that while I have ADHD, I've been able to learn how to use it to work for me in most cases. I've always been successful in academic pursuits but for many children and adults, ADHD prevents any sense of success in school.
Honestly, I don't know why some people have such a problem with others taking meds. These meds are well studied and help folks. What I argue for is a comprehensive program that includes working on coping skills.
Gluten is only a problem if you are intolerant to gluten. I have lots of serious food allergies and a very healthy diet because none of my food can be bought processed.
It's funny. I was writing this morning in my office and a colleague came in. She said, "I always know you are writing because I can hear classical music." I winced and said, "Oh, I'm sorry. I didn't realize anyone could hear it." She assured me it was not too loud and that she liked it. Then she asked me why classical and not another genre. She knows that in my former life I was a musician. I told her that it was because of my ADHD. If I hear sounds outside my office, I'm pulled off task. If the music has lyrics, I sing along and my mind wanders. Even some classical (stuff I've played many times as a member of an orchestra) can distract me. So -- I use music that can calm and center me. That's my routine when I'm writing. That, and the lamp being just "so" and the chair being in the proper position, away from the windows.
http://www.tm.org/blog/students/adhd-tm/
http://www.tm.org/videocafe#fYPdAbvQpIw
and here is a link to an article which highlights a very recent independently published peer-reviewed study concerning ADHD.
http://www.safeminds.org/research/library/GenerationZeroPowerPoint.pdf
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3051071/
This was a preliminary study with a small sample size, so it's tough to draw any definitive conclusions, other than that the treatment is unproven.
What is the one connection? Eating
The answer is simple: Our Food is contaminated!
We eat food processed with artificial hormones, food that should never be consumed like dairy, food that has had pesticides sprayed on it in the fields that eventually becomes part of it's DNA.
Why is there so many cases of ADHD?
Why is there so many Women with Breast cancer?
Our Food is poisoned people!
Add to that our society is addictd to drugs and alcohol.
Vaccines are linked to ADHD.
See this:
http://www.safeminds.org/research/library/GenerationZeroPowerPoint.pdf
And by the way, vaccines are not in any way linked to ADHD. Look at real peer-reviewed literature instead of powerpoints from fly-by-night organizations.