Attention Deficit Disorder

Individuals considered to suffer from ADHD may have acquired brain damage, neural systems mediating attention or inhibition may have developed slowly, or not fully developed, they may have brain or cognitive dysfunction due to some other biological or psychological cause, the issues may be motivational it may be extremes of temperament. Some of these issues are

• Insufficient Sleep                  
• Sleep Apnea                                
• Night terrors
• Extremes of Temperament Masquerading as ADHD 
• Too focused on sports                            
• Overscheduled - too busy
• Anxiety                              
• Signs of Stress 
• Bipolar Disorder              
• Depression
• Verbal Learning Disability                  
• Nonverbal Learning Disability
• Family Stress            
• Parenting Issues                      
• Insufficient exercise
• Peer problems            
• Bullying                        
• Teacher issues                    
• Trauma
• Seizure Disorder              
• Head Injury                
• Oppositional Defiant Disorder        
• Visual problems                
• Substance abuse 
• Impact of Television on attention

Diagnostic Criteria

• Ruling out other possibilities
• Determination of neuropsychological strengths & weaknesses
• Identifying exacerbating conditions
• Identifying skill deficits & maladaptive habits
• Finding motivators

Diet

One of the first indications that diet could be a factor in ADHD occurred when a young woman was put on a very restrictive diet by her allergist, Dr. Feingold, to treat a skin condition. The result was a dramatic improvement in the symptoms for which she was under the care of a psychiatrist. From this was born the Feingold Diet. The percentage of patients for whom this very restrictive diet (it eliminates many fruits and vegetables as well) is successful is controversial. Because the Feingold diet can entail the elimination of many generally very healthy fruits and vegetables, it should not be undertaken lightly. One criticism is that when it does work, the attention and placebo effect surrounding the diet may be a big factor.
Despite the above criticisms of the Feingold diet, I believe that there is clear evidence that a subset of children are sensitive to one or more artifical food colors or preservatives. What is controversial is how many children are affected and whether their respones even looks like ADHD. In 2008 the European Parliament voted to requre warning labels on foods containing artificial food colors. In March 2011, the U.S. FDA held hearings on the link between food additives and ADHD. This was prompted by a 2004 meta-analysis of prior studies in which Harvard researchers looked at prior studies of ADHD and food additives and concluded that there is a link.The FDA did not decide to take action.
Many parents believe that sugar produces hyperactivity; however, research generally has not supported this claim. At the other end of the spectrum, Judith Wurtman, PhD, of MIT argues that carbohydrates, including sugar, raise brain serotonin levels (via insulin secretion which increases transport of tryptophan, from which serotonin is produced, across the blood-brain barrier). Wurtman argues that increased serotonin elevates mood, suppresses appetite and may facilitate sleep. What is for sure is that simple sugars are empty calories and usually not a good diea, whether or not they produce hyperactivity.

The amino acid precursors to specific neurotransmitters have been promulgated as an alternative to medication. The research is muddy. There are some indications that this may work for some, but only for a time. 

Low iron levels are so well known to impact attention and initiation in infants that it is called the Solemn Baby Syndrome. In a pilot study that we never published, a student of mine found reduced attention in mildly anemic women. However, you may not need to be anemic, just mildly low iron levels may be enough to reduce the sensitivity of Dopamine D2 receptors. Medications such as Ritalin raise levels of the neurotransmitter Dopamine. Only a few case reports have looked at low iron and ADHD. There are also old case reports for low zinc levels which has been supported by more recent research looking at zinc and ADHD. 

I have improved the ability to focus in the classroom in the hour before lunch with several students. In all cases, they were distracted by thoughts of food. In two cases, the students began eating a heavier breakfast. In two others, they would eat a sports bar between classes. 

Some books suggest high dosages of B vitamins. The problem is that they are suggesting pyridoxine, vitamin B6, in dosages that have been reported to cause nerve damage. Even though it is water soluble, vitamin B 6 can be toxic in high dosages.
Ritalin increases brain levels of dopamine and noradrenaline (by slowing their re-uptake just as Prozac and other SSRIs increase levels of serotoning by slowing re-uptake). Another way to increase brain levels of dopamine and noradrenaline is by supplying more of the precursor from which they are produced in the brain. The precursor is L-tyrosine, an amino acid. While some people swear by L-tyrosine, buyer beware. There are reports of too high a dose producing headaches and even panic attacks. Simply being a natural substance does not mean that something is harmless. A typical starting dose might be 200 mg. 

Omega 3 fatty acids have also been suggested. While this may be a good idea for other reasons, research has not demonstrated fish oil to be a magic bullet. There is an erroneous belief that fish oil contains mercury. It does not, but it could contain other nasties such as PCBs, depending on what was in the fish. Plant based omega 3 is found in flax seed, but only a percentage is converted to the biologically useful form. It is possible to take so much fish oil that you reduce your blood's clotting time too much.
L-theanine is a substance found in green tea which has calming properties. Some of my patients have found that they can function as well or better on a lower dose of Ritalin when also taking L-theanine. Note that L-theanine is NOT a nutritional intervention, it is an herbal (aka pharmacological) intervention. 

The bottom line is that optimizing one's diet is always an extremely good idea. This includes shying away from food full of articial ingredients put there for cosmetic reasons. However, don't expect it to be a cure for your or your child's ADHD.
Look at the research, then discuss options with your doctor.

Medication

Good management of true ADHD without medication is difficult. 

Medication can often result in immediate dramatic improvement in many symptoms along with a rise in grades and improvement in social relations. 

However, medication will not replace bad habits with good habits. Coaching - training - education is often if not usually necessary to optimize functioning.

Medication is never without risk.Risks must be weighed against the costs of allowing an unmedicated child to fail socially and academically.

Concerns include subtle damage to dopamine neurons as well as sudden death. With regard to sudden death, remember that there may be more deaths from accidents caused by impulsivity in the untreated.

Television

Being a couch potato is not good for attention

Neither is being constantly on the go and over scheduled. Tightly scheduled children are deprived of opportunities to learn to structure their own time, learn to amuse themselves & be creative. 

Some are over stimulated with no time to calm down. 

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