Alternatives in the Treatment of Attention Deficit Hyperactivity Disorder

The diagnosis and treatment of Attention Deficit Disorder and Attention Deficit Hyperactivity Disorder are still controversial. In reality, we are still trying to discover more about what ADD/ADHD actually is. Hard evidence, from current medical technologies that can map the brain, now exists to show biochemical and physical differences between ADD and non-ADD brains.

"A number of studies have been done using the MRI in attention deficit disorder, notably by George Hynd, by Jay Giedd, and by Margaret Semrud-Clikeman. These studies have revealed various morphological differences - or differences in shape - in certain parts of the brain in subjects with ADD as compared to normal controls. The differences are very small, but the small differences are significant. They are mainly in the part of the brain responsible for communication between the brain's two hemispheres called the corpus callosum, which may help to explain why we see slowed responses at times in individuals with ADD. The studies all found that the corpus callosum was smaller in certain areas in individuals with ADD." [ Answers to Distraction , by Hallowell and Ratey, p.190]

No therapy that we can imagine today is going to change any physical difference in the corpus callosum. Traditional drug therapy attempts to alter the levels of neurotrans-mitters in the brain. For many, Ritalin, the favored stimulant drug, has given them a new lease on life. However, it does not work for many others, and some may not want to live with side effects, while others simply want nothing to do with prescription drugs coursing through their bodies. What are their alternatives? Actually, there are quite a number of options, some controversial.

The point is not moot that treatment for a disorder is based upon what is believed to be the etiology, and the symptomatology, of that disorder. Vast disagreement exists in the case of the cause(s) of ADD. In his newest book, Healing ADD , noted expert Thom Hartmann sums them up under the following categories:

"1. ADD is a brain disease or an indication of brain damage . This is the most extreme of the medical models...

2. ADD is a physiological reaction to the environment . Dr. Benjamin Feingold first championed this theory...

3. ADD is a psychological reaction to the environment . This theory has been around the longest...

4. ADD is a normal and natural part of the spectrum of human behavior, but is not as useful in modern society as it may have been in the past . This theory is my personal favorite...

5 . ADD is a myth made up by greedy drug companies and doctors eager to increase their income, or incompetent teachers looking to place the blame for children's academic failures away from themselves . This theory is the favorite of Rush Limbaugh and his ilk, and has appeared in The Wall Street Journal ..." [pp. 46-49]

Drs. Hallowell and Ratey, in Answers to Distraction , expand further on aspects of numbers one through three.

" Q. Is there any evidence of environmental factors causing or affecting ADD?

A. ... Environmental factors that disturb normal brain activity can affect the attentional network and look like classic ADD. Some 90 to 95 percent of people diagnosed with ADD have inherited it ... while the other 5 to 10 percent develop it as a result of external factors.

The rapidly developing and very plastic brain in utero and in the young baby is particularly sensitive to injury, trauma, or toxins, and thus taxing events at this time, such as prematurity, difficult labor and delivery, and early head trauma can all lead to an ADD-like picture. Throughout life toxic chemicals, radiation, trauma to the brain, seizures, tumors, and strokes can all produce or worsen ADD. In addition, temporary changes caused by infections, drugs, allergic states, hormonal abnormalities, and acute psychiatric disorders like anxiety, depression, mania, OCD, and psychological trauma will all create an ADD-like state or make resident ADD worse. The knowledge that these influences from the environment can create ADD-like symptoms underscores the need to obtain a proper medical diagnosis that would rule out these other causes and establish the legitimate condition before treatment is begun." [pp. 213-214]

With all the preceding factors in mind, it is no wonder that there is a proliferation of treatments, and that there are claims of efficacy for all of them, some of the time. It is only sensible to attempt to address the particular identifiable causative factor(s) rather than run to the drugstore for Ritalin. Then there are the secondary symptoms resulting from repeated failures at school, at home, in relationships, and at work. Some treatments are aimed more at these secondary symptoms: for example, low self-esteem, depression, possible addictions, and so on.

In Healing ADD , Hartmann explains the techniques of NeuroLinguistic Program­ming (NLP) as they relate to treating different symptoms of ADD. First, Hartmann questions the disease/disorder model itself. Actually, many ADD symptoms are only a problem in the context of a society that is as rigidly structured as ours is today. A sense of time that flows does not mesh well with our overly busy and scheduled days. A mind that can make quantum leaps does not fit in the standard classroom environment. A person occupied with creating art, a new business venture, or a scientific invention may not remember to balance his or her checkbook or that the phone bill is due on the tenth.

NLP has very effective techniques that can change a person's perception of him/herself, his/her situation, and the world in general. A symptom such as low self-esteem (a common secondary symptom of ADD) is a mistaken attitude, which can be altered by changing the perception of the underlying experiences that resulted in that belief. Many other "mistaken" attitudes can be changed this way, too, and there are far-reaching positive implications.

In his book, Hartmann outlines a number of mental exercises he developed to assist those with ADD, and even LD, to deal with certain problem behaviors. Children and adults with ADHD, for instance, often have difficulty in conversation. They tend to talk so much that they can dominate the exchange, often interrupt people, and give the impression that they are not listening to you at all because they don't remember what you said. Hartmann details a fifteen-minute impromptu session with an ADD woman who not only constantly interrupted conversations but also would interrupt with a complaint. He already knew she accepted this as part of her ADD, but also was interested in checking out this technique because she didn't like this behavior pattern. Through a process some call core transformation, Hartmann got her to communicate with the "part" of her that was responsible for the complaining. He assisted her in discovering that the intent of the part governing that behavior was to make things "to be all right" [p. 76]. There were other, deeper meanings underlying the one on the surface. Each in turn was acknowledged and dealt with, until the woman was in a state I can't call anything but bliss. She, and her part, realized that "Everything is all right." [p.78] Since this treatment episode, she has not interrupted anyone in conversation with her complaining. Also, the new behavior is through no conscious effort on her part, but is automatic, since it stems from a true change in her unconscious motivations.

In Healing Words: The Power of Prayer and the Practice of Medicine , Dr. Larry Dossey addresses achieving sustained and focused attention, a common concern of those who have ADD.

Attention Training
Paying attention to any object --- whether an actual physical thing or the object of one's prayer, imagery or visualization --- sounds simple, but it is quite difficult to sustain for any length of time. As anyone who has tried to do so quickly realizes, the mind tends to wander wildly --- likened by St. Teresa of Avila to riding a bucking horse. But with practice one can acquire the skill of sustained and focused attention.... People who achieve success in laboratory experiments utilizing imagery, visualization, or prayer frequently describe a feeling of actually bonding with the object ... Some of the earliest subjects in biofeedback experiments­ at Harvard Medical School were frequently asked how they managed to control bodily processes ... [W]hen the researchers asked them how they felt when they did it, they began to make statements that sounded genuinely mystical ---'becoming one' with the biofeedback instruments that were measuring the bodily processes, ‘fusing' with the entire surroundings, and so on. [pp. 102-3]

The only conclusion I can draw here is that by paying intentional rapt attention to something, a person can experience a captivating state of mind where he/she is almost all-knowing about that something, and therefore feeling "at one" with it. That would seem to preclude the feeling of boredom, which is what can interfere with an ADD person's ability to pay attention over a period of time.

An article in the August 1997 issue of Natural Way titled "Taming the Wild in the Child" explains a number of natural treatments for ADD/ADHD and its symptoms. The first of these is the Feingold Diet, developed on the 1960's by allergist Dr. Benjamin Feingold. Although the diet has not had universal success, some of the successes are very impressive.

"... a New Jersey mother ... wrote to describe her daughter, whose aggressiveness, tantrums and sleep problems turned their family life into a living nightmare. 'We were thrown out of our La Leche League chapter, ... asked to leave synagogue, not invited to anything, told we were obviously abusive parents, accused of spoiling, etc.' One day a friend of the family suggested that they try the Feingold Diet. 'Within three days,' says the mother, 'Julie spoke completely intelligibly, slept the night and stopped hitting.' "

The Feingold Diet is based on the premise that hyperactive children have chemical sensitivities that are triggered by eating processed foods with artificial ingredients, and even foods with naturally occurring salicylates. This affects their behavior. Studies show anywhere from 10 to 30% of children will benefit. It is certainly worth trying.

Another treatment outlined in the article is to replace dietary minerals, enzymes, etc., which are deficient in the child.

"Low iron levels were found to impair judgment, reasoning ability and all aspects of left brain activity, including scientific, mathematical and spoken and written language skills. ... Technically classified as a food, dimethylglycine (DMG) is found in very small amounts in some foods ... resembles water-soluble vitamins ... DMG was used to help autistic children; when administered, parents reported improved behavior and speech as well as an increase in the frustration threshold, all within 24 hours. ... The body manufactures a limited supply of enzymes for digestion; ... Only raw foods contain enzymes; ... Thus, a child who consumes a diet mainly of cooked, processed foods is at high risk for developing enzyme deficiency and its related symptoms --- chronic irritability and fatigue... impaired mental capacity ... behavior anomalies. ... Also known as omega-3s or omega-6s, EFAs (essential fatty acids) aid transmission of nerve impulses and are needed for normal brain function, which is their direct connection with treating ADD. ... Clinically low levels [of magnesium] in blood plasma are associated with states of hyper-excitability and inattention in children." [p.39]. Whether the above factors cause or exacerbate ADD, the importance of these nutrients to general mental and physical health cannot be ignored.

Using biofeedback with children (a relatively new technique) aims at changing brain waves. "It's believed that some children labeled ADD produce excessive theta waves [associated with daydreaming] and not enough beta waves [associated with focused attention]." [p. 41]

"Research suggests that physical relaxation is an effective treatment for hyperactivity when used with other supportive measures." [p. 41] The article goes on to talk about several methods and how they can be specially adapted for children, including yoga, progressive relaxation tapes, meditation, and aerobic exercise. Of particular interest were several visual/physical exercises. They included imagining yourself as a balloon slowly and deeply inflating and deflating (breathing), and playing robot/rag doll by stiffening then going limp for several seconds, two or more times. Also suggested were stretching, arching, and yawning like a cat, imagining a comfortable elevator going down and feeling more relaxed as it descends, and standing up and imagining that you are in a jar of honey and can only move very slowly. From my hypnotherapy training, I can attest that these would be fun and effective for children.

Rachel Bell and Dr. Howard Peiper, in their book The A.D.D. and A.D.H.D. Diet! , have a long list of factors they have found that exacerbate or cause ADD/ADHD and its' symptoms.

"1. Poor Nutrition
a. intake of fresh foods is down
b. soil is depleted of essential nutrients, therefore, fresh foods that we do eat may have less nutritional value ...
c. intake of highly processed foods containing additives, preservatives, and artificial chemical colorings and flavorings is up ... d. vitamin, mineral, enzyme, amino acid, neurotransmitter, and essential fatty acid deficiencies ...

2. Environmental Contaminants
a. insecticide and pesticide residues in our food and water
b. heavy metal contamination
c. chemical cleaners
d. [toxic] chemical [laden] building and decorating products
e. poor quality drinking water
f. indoor air pollution at home, at school, and at the office

3. Nervous system allergies to food and/or environmental factors
a. some can begin in utero
b. may go undetected for years ...

4. Increased and repeated use of antibiotics in babies and young children
a. kills beneficial intestinal bacteria
b. promotes overgrowth of harmful yeast organisms (candida) causing many physical and mental symptoms, some of which are ADD/ADHD

5. Spinal column misalignments and/or craniosacral system obstructions
a. The first cervical vertebra of the spine is often found to be out of alignment in ... ADD/ADHD. In some cases this misalignment occurs at birth." [Pp. 10-11]

Bell and Peiper advocate the Feingold Diet. They expand this concept to include more possible allergens in more foods, and recommend keeping a food journal and testing each possible allergen one at a time. They also have a section on recommended nutritional supplements. Chapter 10 of their book is devoted to non-dietary approaches. Some of these include Hair Mineral Analysis, Phase Contrast Microscopy Analysis (live blood analysis), Atlas Subluxation Adjustment, Craniosacral Therapy, Aromatherapy, Flower Remedies, Homeopathic Remedies, Herbs, Tachyonized Energy, and Educational Kinesiology.

Some mainstream Western doctors and researchers accept only certain research and only pharmacological treatments for ADD/ADHD. Others, like Dr. Larry Silver, at least are willing to say that an alternative treatment is still controversial or that studies are still inconclusive.

"I do not know what to believe at this time. I have seen patients who were evaluated by Dr. [Doris] Rapp and placed on specific elimination diets or monitored to eliminate exposure to certain chemicals who improved (that is, their level of hyperactivity and aggressive behaviors decreased). On several occasions, exposure to the food or chemical resulted in several hours of hyperactivity and aggressive behavior. For some of these children, my clinical observations showed that a stimulant medication helped the ADHD; however, when the children were exposed to the suspected food or chemical, their hyperactivity increased. The final answers are not yet in." [p. 205]

Drs. Ingersoll and Goldstein, in their book on ADD and LD, not only review many of the alternative treatments mentioned so far, but also dispel some myths about Ritalin and other stimulants used to treat ADD/ADHD.

"Table 4: Myths and Facts About Stimulant Medication

Myth Fact
Children treated with stimulant There is no evidence that treatment with medication become addicted. stimulant medication leads to dependence or addiction in ADHD individuals. Stimulant medication stunts growth. Stimulant medication has minimal effect on ultimate adult height and weight. Stimulant medication turns a child Sedation and personality change are not into a "zombie." typical side effects of stimulant medication. Stimulant medication is not effective Treatment with stimulant medication with adolescents. continues to be helpful during teen and adult years. Stimulant medication causes There is no evidence that stimulant Tourette's Syndrome. medication causes Tourette's Syndrome." [P.92]

Later on in their book, Ingersoll and Goldstein also review the work of Dr. Doris Rapp. While citing recent research in England and Canada that "suggests that food allergies and sensitivities may contribute to behavior problems and physical symptoms, at least in a select group of children ." [p. 161], the authors are mostly critical of Dr. Rapp.

"How does Dr. Rapp explain the fact that her approach has failed to gain acceptance within her own profession? Citing 'the powerful pharmaceutical, food, and/or chemical industries,' she states that 'the bottom line, unfortunately, appears possibly to be vested interests.' ... Dr. Rapp provides only anecdotes and case studies. At this time, there are no well-controlled studies in which her approach has been evaluated and shown to be helpful to youngsters with learning and behavior problems." [p. 161]

Perhaps in the near future we will have the studies to back up or refute Dr. Rapp's theory. I do, however, have to wonder how some doctors can continually question "alternative" methods and seemingly accept with blind faith that the well-heeled lobbies of the vested interests Dr. Rapp mentioned are working solely for the health and good of all citizens. Perhaps they should be nominated for membership in the Flat Earth Society.

There is no one thing to conclude from the literature on ADD/ADHD and alternative treatments, except that this disorder has a complex etiology and therefore a complex set of possible effective treatments. One has to ask many questions about many things in order to begin deciding which options to try. Would Ritalin work if I decided to try it? Are my most troubling symptoms primary or secondary? Do I already know I have some allergies? Can I even find a practitioner of another therapy I'd like to try? To what extent am I willing to go to feel and act better? Would I be willing to change my diet, or even that of the whole family? If others in my family also have ADD, will the same thing help all of us? And on and on. For my own son, one of the most debilitating symptoms was a secondary depression, which group therapy has recently helped. My hope is that everyone who has a difficult life because of ADD/ADHD can be first diagnosed and then find the optimal treatment for their particular symptoms.



Attention Deficit Disorder: A Different Perception , by Thom Hartmann, Underwood Books, 1993

Attention Deficit Disorder and Learning Disabilities: Realities, Myths, and Controversial Treatments, Barbara D. Ingersoll, PhD, and Sam Goldstein, PhD, Bantam Doubleday Dell Publishing Group, 1993

Dr. Larry Silver's Advice to Parents on Attention-Deficit Hyperactivity Disorder, by Larry B. Silver, M.D., American Psychiatric Press, Inc., 1993

Healing ADD: Simple Exercises that Will Change Your Daily Life , by Thom Hartmann, Underwood Books, 1998

Healing Words: The Power of Prayer and the Practice of Medicine, by Larry Dossey, M.D., HarperCollins Publishers, 1993

The A.D.D. and A.D.H.D. Diet! , by Rachel Bell and Dr. Howard Peiper, foreword by Doris Rapp. M.D., Safe Goods, 1997

The Natural Way , "Soothing the Wild in the Child," August 1997 issue, N. Andersen,

T. Armstrong, PhD, S. Lewis, H. Peiper, A. Scrivani, Dr. N. Lu

Women with Attention Deficit Disorder , by Sari Solden, MS, Underwood Books, 1995