By Dr. Mercola
Drugs prescribed for attention deficit hyperactivity disorder (ADHD) are among the most controversial on the market. Such drugs are the most common psychotropic drugs used by children (tied for first place with antidepressants),1 yet they have questionable benefits and serious risks.
Medicating children with ADHD is in itself controversial, especially because there is no laboratory test or objective method to determine which children have ADHD.
Some may be labeled as such by parents or teachers, and even those diagnosed by a mental health professional may be displaying symptoms that could be attributed to other causes.
Many of the symptoms, such as being easily distracted, squirming and fidgeting, are seen in virtually all children at some point or another and, should they become problematic, may be better dealt with via lifestyle changes and psychotherapy than powerful stimulant drugs.
Any parent considering drug treatment for a child with ADHD must carefully weigh the benefits versus the risks, and new research suggests the purported benefits do not extend to improvements in school.
ADHD Drugs Don’t Help Kids Get Better Grades
A major concern of parents of children with ADHD is how it might affect their schoolwork. Worried that their child may fall behind other students or struggle with poor grades, some parents resort to drug treatment, believing it will help. Some drug companies even advertise their treatments as helping to improve homework time.
“Evidence indicates that children with Attention Deficit Hyperactivity Disorder (ADHD) experience acute and prolonged academic impairment and underachievement including marked difficulty with completing homework,” researchers wrote in a new study.2
It’s the first to examine the effects of drug versus behavioral treatment on homework performance in children with ADHD.
Seventy-five children between the ages of 5 and 12 participated. One group was assigned to receive either a stimulant drug or a placebo for three weeks, then switched. Another group received behavioral therapy.
The drug treatment led to no significant improvements in homework completion or accuracy compared to placebo. The behavioral therapy, however, led to children finishing up to 13 percent more homework problems and increased accuracy by 8 percent.
This homework boost could be the difference between a child receiving a passing “C” grade or failing a class, the researchers noted, adding:3
“Behavioral treatment focused on homework problems results in clear benefits for children's homework completion and accuracy (the difference between passing and failing, on average), whereas long-acting stimulant medication resulted in limited and largely nonsignificant acute effects on homework performance.”
Expectations of Benefit From ADHD Drugs Are ‘Greater Than They Should Be’
Many people assume that giving a child with ADHD drug treatment will make the symptoms disappear, but research reveals such expectations may be unrealistic.
Research published in The Cochrane Database of Systematic Reviews found the drug methylphenidate (brand names Ritalin, Concerta, Medikinet and Equasym) may lead to modest improvements in symptoms, general behavior and quality of life.4
However, the modest benefit was based on poor-quality studies, leading the researchers to caution against using the drug without careful consideration. Study author Morris Zwi, a clinician and consultant for child and adolescent psychiatry, said:5
"Our expectations of this treatment are probably greater than they should be … Whilst our review shows some evidence of benefit, we should bear in mind that this finding was based on very low-quality evidence. What we still need are large, well-conducted trials to clarify the risks versus the benefits."
Side Effects of ADHD Drugs: Sleep Problems and More
The Cochrane Database of Systematic Reviews study also found methylphenidate is associated with an increased risk of sleep problems and appetite loss.
Overall, those taking methylphenidate had a 29 percent increased risk of experiencing a non-serious adverse event, the most common of which were sleep problems and decreased appetite.
Among children taking the drug, the risks were especially pronounced. Compared to the control group, children taking methylphenidate had a 60 percent greater risk for trouble sleeping/sleep problems and a 266 percent greater risk for decreased appetite.
A separate study published in Pediatrics also found that stimulant medications such as Ritalin may harm children’s sleep.6
Although the drugs have stimulant effects, they may have a calming effect on children with ADHD, and some have suggested the drugs may improve sleep by reducing bedtime-resistant behaviors.
However, this research, which reviewed nine individual studies, found that in general children taking stimulant drugs:
- Took longer to fall asleep than others (with the time lengthening as the dose increased)
- Had shorter sleep duration
- Had worse sleep efficiency, which is the ratio of time spent asleep to the time spent in bed
The effect is particularly troublesome because lack of sleep makes ADHD symptoms worse, with researchers noting, “sleep adverse effects could undermine the benefits of stimulant medications in some cases.”7
Why Is ADHD on the Rise?
Approximately 11 percent of U.S. children between the ages of 4 and 17 years (6.4 million) have been diagnosed with ADHD,8 and no one really knows what’s causing this condition. Many factors are likely involved, including poor nutrition and environmental toxins.
Children with higher levels of the endocrine-disrupting chemical bisphenol-A (BPA), for instance, are more likely to be diagnosed with ADHD.9
Pesticide exposure, including pyrethroids,10 has also been linked to ADHD. Children exposed to higher levels of organophosphate pesticides may have a twofold to threefold increased risk of being diagnosed with ADHD.11 Exposure to tobacco smoke in utero is also associated with ADHD.12
Nutritionally speaking, a number of factors have been linked to ADHD and/or similar behavioral problems in children. One study even suggested that eating an unhealthy diet during pregnancy may increase ADHD symptoms in youth.13 In addition:
- Drinking sugar-sweetened beverages like soda is associated with ADHD14
- Gluten sensitivity may be common in children with ADHD. According to a 2011 study, celiac disease is "markedly overrepresented among patients presenting with ADHD,"15 and a gluten-free diet has been shown to significantly improve behavior in kids.
- Artificial food coloring and other food additives, such as preservatives, are associated with increased hyperactivity in children16
Exercise May Improve Schoolwork and Other Symptoms in Children With ADHD
While the featured study found no benefit to homework among children taking drugs to treat ADHD, there are other options, namely exercise.
Research published in the journal Pediatrics found that kids who engaged in a regular physical activity program had an improvement in executive control, which is the ability to maintain focus, working memory and cognitive flexibility (or switching between tasks).17
Executive functioning is often impaired in children with ADHD, which means exercise may directly help to improve symptoms. Further, exercise is well known to boost test scores and academic performance in children, and this association is particularly strong among kids with ADHD.
One study found, for instance, that a before- and after-school physical activity program reduced inattention and moodiness among young children at risk of ADHD, as well as improved math and reading test scores.18 Other research revealed that 26 minutes of physical activity each day helped to significantly reduce ADHD symptoms in grade-schoolers.19
In a TED talk from 2012, John Ratey, an associate professor of psychiatry at Harvard, suggested that exercise be viewed as medication for ADHD, as it triggers your brain to release dopamine and serotonin, which improve mood and boost cognitive performance. You can view that talk below.
Natural Methods to Help Overcome ADHD-Like Symptoms
If your child struggles with behavioral difficulties or other ADHD-like symptoms, behavioral therapy may help. However, whether he or she has been diagnosed with ADHD or not, I strongly recommend addressing the following factors in addition to such therapy:
• Too much sugar. High-sugar foods and starchy carbohydrates lead to excessive insulin release, which can cause falling blood sugar levels, or hypoglycemia. Hypoglycemia, in turn, causes your brain to secrete glutamate in levels that can cause agitation, depression, anger, anxiety and panic attacks.
Besides that, sugar promotes chronic inflammation in your body, and many studies have demonstrated the connection between a high-sugar diet and worsened mental health.
• An unhealthy gut. As explained by Dr. Natasha Campbell-McBride, a medical doctor with a postgraduate degree in neurology, toxicity in your gut can flow throughout your body and into your brain, where it can cause symptoms of autism, ADHD, dyslexia, dyspraxia, depression, schizophrenia and other mental disorders.
Reducing gut inflammation is imperative when addressing mental health issues, so optimizing your child's gut flora is a critical step.
This includes not only avoiding processed, refined foods but also eating traditionally fermented foods. Fermented vegetables are excellent, although many kids enjoy fermented dairy products like kefir, especially if you blend them into healthy smoothies.
If you cannot get your child to eat fermented foods on a regular basis, a high-quality probiotic supplement may be highly beneficial in correcting abnormal gut flora that may contribute to brain dysfunction and behavioral issues.
• Animal-sourced omega-3 deficiency. Research has shown that kids low in omega-3 fats are significantly more likely to be hyperactive, struggle with learning disorders and display behavioral problems. Omega-3 deficiencies have also been tied to dyslexia, violence and depression. A clinical study published in 2007 examined the effects of krill oil on adults diagnosed with ADHD.20
In that study, patients improved their ability to concentrate by an average of over 60 percent after taking a daily 500-milligram (mg) dose of krill oil for six months. They also reported a 50 percent improvement in planning skills and a close to 49 percent improvement in social skills.
• Food additives and GMO ingredients. A number of food additives are thought to worsen ADHD, and many have subsequently been banned in Europe. Potential culprits to avoid include Blue #1 and #2 food coloring; Green #3; Orange B; Red #3 and #40; Yellow #5 and #6; and sodium benzoate, a preservative.
Additional Factors to Help Relieve ADHD Symptoms
Along with addressing your child's nutrition and activity levels, I also recommend implementing the following strategies:
- Clear your house of dangerous pesticides and other synthetic chemicals.
- EMF. Limit exposure to radiofrequency microwave radiation, cell and portable phones and electro-pollution. This is especially true for the sleeping environment where rest and repair occurs. It should be as electrically neutral as possible.
- Avoid commercial washing detergents and cleaning products used on clothes and around your home and replace them with naturally derived cleaning products free of added perfumes and softeners.
- Spend more time in nature. Researchers have found that exposing ADHD children to nature is an affordable, healthy way of controlling symptoms.
- Investigate sensory therapy and emotional wellness tools. Energy psychology tools such as the Emotional Freedom Techniques (EFT) may help improve emotional coping and healing.