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Author(s): |
L. Arnold M.Ed. |
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Reprinted with Permission From: |
International Dyslexia Association (info) |
Printed Date: Summer 2001
Date Posted on this Website: October 03 2002
Alternative or complementary or nontraditional treatments refer to treatments other than the established treatments commonly used by traditional physicians and other mainstream professionals for the disorder in question (Arnold, 1994;1995). Because these often lack convincing controlled evidence, they are sometimes controversial (Silver, 1995). In this article I will focus on a narrow band of the wide spectrum of alternative treatments, those concerned with diet, nutrition, and herbs; that is, ingestible things other than Food and Drug Administration (FDA)-approved drugs. Many published reports do not clearly define the population studied; thus, the boundary between Attention Deficit Hyperactivity Disorder (ADHD), dyslexia, and other learning disorders (LD) is often difficult to differentiate. What adds to this difficulty is that approximately 20-25 percent of individuals with ADHD will also have a learning disorder.
A recent literature search for alternative treatments for ADHD found more than two dozen treatments, of which ingestive treatments constituted about a third (Arnold, 1999; 2001). An additional literature search for ingestive treatment of LD turned up few additional reports and no additional treatments. In this article I will discuss elimination diets, the use of megavitamins and trace elements, essential fatty acids, deanol, amino acids, glyco-nutritional supplements, and herbs.
Elimination Diets
In 1975, Feingold wrote a book, Why Your Child is Hyperactive, in which he proposed that synthetic flavors and colors in the diet were related to hyperactivity (1975). Since then other diets that eliminate suspected foods or additives to which a child might be allergic or otherwise sensitive were proposed as treatments for ADHD and LD. In 1982, the National Institutes of Health held a consensus conference to review all of the literature to date (National Institutes of Health, 1982). This Conference on "Defined Diets and Childhood Hyperactivity," concluded, "these studies did indicate a limited positive association between the 'defined diets' [i.e., Feingold's diet] and a decrease in hyperactivity" (National Institutes of Health, 1982). The panel noted that there was insufficient evidence available to permit identification beforehand of this small group of individuals who may respond and to determine under what circumstances they may derive benefits. The panel believed that the defined diets should not be universally used in the treatment of childhood hyperactivity.
Since this Conference, later studies, using more careful subject selection and more restrictive approaches, have resulted in at least eight controlled positive studies (Breakey, 1997; Arnold, 1999; 2001). The effect sizes range from moderate to large in the samples. It appears that this approach does work. The question is for how many? Perhaps less than half, maybe as low as a single digit percentage responded positively. The best descriptor of an ideal responder is a preschooler with an allergic history, irritability, sleep disturbance, and physical complaints. One preliminary report suggests a 30 percent response rate (medium effect) in three-year-olds (Baternan et al., 2001)."
Restriction or elimination of simple sugars was also studied. In these related studies, simple sugar restriction alone showed no benefits (Arnold, 1999; 2001).
Megavitamins and Trace Minerals
An adequate amount of vitamins and trace minerals in one's diet is necessary for optimal brain function and learning. Trace elements include copper, zinc, magnesium, manganese, and chromium, along with more common elements such as calcium, potassium, sodium, and iron. A placebo-controlled trial of multivitamins and trace minerals at the recommended daily allowance (RDA) in lower socioeconomic class children with poor diets showed an eight point rise in IQ as compared to the placebo group (Benton, Buts, 1990). Poor diets can also occur by choice in middle-class children. A RDA multivitamin with trace minerals may be useful for these children as well, until better data are available.
However, there is no controlled evidence for benefit from mega dose multivitamins. An added concern is that at extremely high doses, these may be toxic. Individual minerals or vitamins may be indicated in cases of demonstrated deficiency; but, supplementation beyond the RDA guidelines without demonstration of frank deficiency is a hypothesis remaining to be proven for ADHD and LD.
This concept of megavitamins to treat LD was proposed in a book by Dr. Alan Cott, The Orthomolecular Approach to Learning Disabilities (1985). By his definition, many of the children in his study population were autistic or schizophrenic. He concurred that his finding that megavitamins helped "these" children had not been confirmed by others. In a report by the American Academy of Pediatrics (1976), focused on megavitamin therapy and learning disabilities, no validity of the concept nor of the proposed treatment was found.
Essential Fatty Acids
Both the n-3 and the n-6 series of essential fatty acids (EFA) have been reported to be low in children with ADHD as compared to controls. Both human and monkey infants show changes in visual attention with n-3 deficiency. Infants whose formula is supplemented with n-3 fatty acid show better cognitive abilities than those taking a regular formula. In children with dyslexia, highly unsaturated fatty acid deficiency correlated significantly with poorer reading, spelling, and auditory working memory (Richardson et al., 2000). Adults with dyslexia had significantly more signs of EFA deficiency than controls and the degree of EFA deficiency correlated with visual, auditory, linguistic, and motor features of dyslexia (Taylor et al., 2000). At both ages, the findings were more prominent in males. However, controlled trials of EFA for ADHD have shown equivocal results (Arnold 1999; 2001). A literature search showed no controlled study for LD. The distributor of one preparation that had been advertized for LD agreed to stop making that claim.
The failure to find significant benefit in supplementation trials thus far might result from failure to consider individual differences or from failure to consider the critical role of l-carnitine in EFA metabolism. No controlled studies of phospholipids for ADHD or LD could be found. Adequate EFAs are clearly necessary for optimal brain function; but, it remains to be shown how much supplementation beyond the ordinary diet may be useful. For those who remain concerned about deficiencies, the simple expedients of eating ocean fish a couple of times a week and baking with unhydrogenated soybean or canola oil rather than margarine or corn oil could supply adequate amounts in most cases.
Dimethylaminoethanol (DMAE), Deanol
DMAE has many other names, including dimethylethanolamine. It is an immediate precursor of choline and was initially believed to function by increasing the amount of the neurotransmitter, acetylcholine. More recent information suggests that dosage is critical to its mechanism of action and that at higher doses it may actually exert antiacetylcholine effect in the brain. This product was marketed under the trade name of Deaner and proposed for leaming and behavior problems during the 1950s through the 1970s. When the FDA began to require evidence of efficacy as well as safety, approval was withdrawn.
The company sponsored several controlled studies in an effort to salvage it. The best such study (Lewis, Young, 1975) showed an effect better than placebo but negligible to moderate on several measures. It is now marketed as a nutritional supplement which does not require FDA approval as effective.
"Treatment with herbs (plants or parts of plants) is essentially primitive pharmacology." |
Amino Acids
Other precursors of neurotransmitters have been proposed as treatment, including phenylalanine, tyrosine, 1-DOPA, and tryptophane. Controlled supplementation trials in ADHD suggest a mild acute benefit in some cases that dissipates in a few weeks with continued use (Arnold, 1999; 2001). Excessive metabolic loads of amino acids have some risks, especially in the presence of liver impairment Although this approach to neurotransmission was at first hailed as safer and more natural than drugs, more recent thinking questions this assumption.
Glyconutritional Supplements
Basic saccharides (sugar derivatives) are necessary for cell communication and manufacture of glycolipids and glyoproteins. Two open pilot trials of glyconutritional supplementation in ADHD showed some promise. A third trial was discouraging (Arnold, 2001). Given our current state of knowledge, this treatment is probably harmless but ineffective for ADHD. No data were found for LD.
Herbs
Treatment with herbs (plants or parts of plants) is essentially primitive pharmacology. There is no doubt that plants contain pharmacologically active chemicals. Many, if not most, modem drugs were first derived from plants (including fungi); for example, quinine, aspirin, digitalis, antibiotics, cancer chemo-therapies, atropine, opioids, ephedrine, curare, reserpine. Many of these are psychoactive substances. The purification and standardization of the active plant chemicals and their derivatives constituted a great advance in safety and effectiveness. Most pharmacologists believe that there are many more as yet unidentified useful chemicals in plants.
Though herbs may thus be effective, there are several cautions. Since most herbs have not been systematically studied in a controlled way, information on safety and efficacy is generally unsatisfactory. This problem is compounded by the wide variance in strength of the active compounds from one brand to another and even from one batch to another. A third problem is that many herbs contain more than one active substance. For example, hypericum (St. John's Wort) has about two dozen psychoactive chemicals, and hypericin itself is probably not the most important.
There is practically no information on how the various active components interact with each other and little on how they interact with prescription or over-the-counter drugs. Polypharmacy, even with purified standardized drugs, can pose problems. New interactions are continually discovered, many of them harmful. Primitive polyphannacy is even more problematic. Therefore, if one is taking an herb, it is important to apprise any physician who may be prescribing another drug.
The concept of using herbs as a treatment for ADHD and possibly forLD has become very widespread. Since they are advertised as nutritional supplements, they are not controlled by the FDA. Most of what is known is found in flyers and advertisements distributed by the individuals selling the product. No research is presented, yet claims are made about the effectiveness of the treatment.
Dr. Larry Silver, in his book, The Misunderstood Child, A Guide for Parents of Children with Learning Disabilities, noted how he tried to review the use of herbs (Silver, 1998). He wrote for more information on several products he found advertised in magazines, flyers, or shown at conferences. He found that there was little information beyond what was noted in the ads or flyers. Three of the companies written to for more information offered him the opportunity to be the "exclusive" salesperson for his area. In his book, he lists these products (Silver, 1998, p. 328). For each, there was no research in the packaging to defend the claims made. Testimonies were common. Large technical words were used, often undefined. Efforts to find these words in any scientific dictionary were unsuccessful. The copy created a feeling that if parents did not give the product to their child, they were preventing him or her from making progress. Examples of products reviewed at that time were:
God's Recipe: "... a mixture of colloidal minerals, antioxidant with ginkgo biloba, and multienzymes.:
PediActive ADD: Noted to contain DMAE and "phosphatidylserine" and stated to be the "most advanced neuronutrients available," including a diversified combination of "other ingredients."
Kids Plex, Jr: The ingredients listed included multivitamins, amino acids, a mixture of "Ergogens and Krebs Cycle Intermediates and Lipotropics."
Calms Kids: This is a mixture of "vitamins, minerals, and amino acids."
Pycnogenol: This is described as a "water processed extract from the bark of the French Maritine Pine Tree." It is noted to be "...(the most) potent nutritional antioxidant discovered by science."
New Vision: A mixture of "sixteen juices and eighteen fruit blends" made into a capsule.
Super Blue Green Algae: This product comes in many forms. Its benefits are stated to be based on the fact that algae is the "very basis of the entire food chain - it is largely responsible for creating and renewing all life on earth." (It contains n-3 EFAs.)
In Conclusion
When considering a new ingestive treatment, it is important for the consumer (or the professional suggesting such treatment) to:
References
American Academy of Pediatrics, Committee on Nutrition, (1976). Megavitamin therapy for childhood psychoses and learning disabilities. Pediatrics 58: 910-911.
Amold, L.E., (1994). Screening and evaluating alternative and innovative psychiatric treatments: A contexual framework. Psychopharmacology Bulletin 30(1): 61- 67.
Arnold, L.E., (1995). Some nontraditional (unconventional and/or innovative) psychosocial treatments for children and adolescents: critique and proposed screening principles. J Abnonnal Child Psychology 23(1):125-140.
Arnold, L.E., (1999). Treatment alternatives for attention-deficit/hyperactivity disorder (ADHD). J of Attentional Disorders 3:30-48.
Arnold, L.E., (2001). Treatment Alternatives for attention-deficit/hyperactivity disorder. A chapter in Jensen P.S. and Cooper J., eds. Diagnosis and Treatment of ADHD: an Evidence-Based Approach. Washington, D.C., American psychological Press, in press.
Baternan, B., Hutchinson, E. Warner, J.O., Dean, T., Rowlandson, P., Grant, C., Grundy, J., Fitzgerald, C., Stevenson, J., (2001). The effects of double blind placebo controlled artificial food colourings and benzoate perservatives challenge on hyperactivity in a general population sample of preschool children. Poster at loth meeting of International Society for Research in Child and Adolescent Child Psychopathology. Vancouver, June 30, 2001.
Benton, D., Buts, J.P., (1990). Vitamin/mineral supplementation and intelligence. Lancet 335:1158-1160.
Breakey, J., (1997). The role of diet and behavior in childhood. J of Pediatrics and Child Health, 33: 190-194.
Cott, A., (1977). The Orthomolecular Approach to Learning Disabilities. New York, Huxley Institute, 1977.
Feingold, B.F., (1975), Why Your Child is Hyperaaive. New York, Random House.
Lewis, J.A., Young, R., (1975), Deanol and methylphenidate in minimal brain dysfunction. Clinical Pharmacology & Therapeutics, 17:534-540.
National Institutes of Health, (1982), Defined Diets and Childhood Hyperactivity. Bethesda, MD,
National Institutes of Health Consensus Development Conference Summary, vol 4, No 3.
Silver, L.B., (1995), Controversial Therapies. J Child Neurology 10 (supplement): S96- Sl00.
Silver, L.B., (1998), The Misundel:5tood Child. A Guide for Parents of Children with Learning Disabilities. Third Edition. New York, TImes/Random House.
Taylor, K.E., Higgins, C.J., Calvin, C.M., Hall, J.A., Easton, T., McDaid, A.M., and Richardson, A.J. (2000). Dyslexia in adults is associated with clinical signs of fatty acid deficiency. Prostaglandins LeukiJt. Essent. Fatty Acids 63, 75-78.
