Understanding ADHD and children
Children’s behaviour can be affected by emotional and physical issues, or their neurological wiring. Physical problems will often affect a child’s behaviour, and perhaps especially when they are not able to express themselves verbally this may be interpreted as behavioural issues before the root of the behavioural change is discovered.
If changes to a child’s behaviour are observed over a prolonged period, it is advisable to seek professional help, to assist in assessing the root cause of any problems.
How does children’s hyperactivity, behaviour and ADHD work?
The foundation of neurotypical children’s behaviour is largely formed through the input they receive from the environment surrounding them. This primarily consists of care-givers behaviour (this can include parents and other care-givers), including the type of nurturing, whether and how they communicate love to a child, provision of learning and play experiences, disciplinary techniques used, and behaviour as role models (1,2).
Alongside this the dietary intake of a child has, in numerous ways, been shown to have an impact on their behaviour. For example, eating refined sugar products often leads to hyperactive or disruptive behaviour (3); a ‘sugar challenge’ of a high carbohydrate breakfast (consisting of sugarcoated cereal, milk, and orange juice) has been shown to reduce the attention span of hyperactive children and those who were not previously labelled as hyperactive (4). There is also a suggestion that artificial flavours and additives in food may be a contributing factor for hyperactivity in children (3,5).
This is just one small example of how children are prone to behavioural changes often due to external factors such as diet, and behavioural issues may be difficult to resolve unless appropriate changes to these underlying factors are also implemented.
However attention-deficit/hyperactivity disorder has different root causes as it is the wiring in the childs brain that effects their behaviour, and has much less to do with environmental factors.
ADHD is the most common disorder affecting behaviouraand is estimated to affect between 5 – 15% of children, however some experts believe that it is over-diagnosed as differentiating between ADHD and other conditions can be challenging (7). Onset often occurs before age 4 and invariably before age 12. The peak age for diagnosis is between ages 8 and 10.
ADHD used to be considered a behaviour disorder, probably because children typically exhibit inattentive, impulsive, and overly active behaviour, whereas now it is considered a neurodevelopmental disorder. Neurodevelopmental disorders are neurologically based conditions that appear early in childhood typically before school entry. They impair development of personal, social, academic, and/or occupational functioning.
Current treatment of ADHD
Conventional drug-based treatments for the symptoms of ADHD have side-effects, and doses often need to be adjusted to find a balance between reducing symptoms so that daily life is not disrupted but ensuring that medication side-effects also do not disrupt daily life.
ADHD is categorised in three types according to the prevalent behaviour involved:
- Inattention
- Impulsivity
- Hyperactivity
Many patients will have more than one of these which is classed as combined ADHD.
It is important that children with hyperactive behaviour or ADHD receive support and treatment, because one factor which prevails for many children with ADHD is not being able to cope well with school. This is not because of the academic abilities of a child but rather the way that schools are set up to have a student sat, in the same seat for many hours a day focusing (a feat that many children struggle with!). Some may find it difficult to connect with peers/ having difficulty making friends, especially if they are labelled disruptive. This can then lead to social isolation.
Understanding the root of ADHD
There are various contributing factors to ADHD, and more is now being understood about the brain chemistry that causes it. This section explains the neuroscience as well as other possible contributing factors that can cause ADHD or make symptoms worst.
The neuroscience of ADHD
The brain is full of different regions all with different functions. In people with ADHD different regions have formed differently to neurotypical people. A study shows that people with ADHD have smaller anterior cingulate cortex’s (ACC), and that that are formed differently (2). “The anterior cingulate cortex (ACC) is a central brain node for the integration of cognitive control and allocation of attention, affect and drive. Thus, its anatomical alteration may give rise to impulsivity, hyperactivity and inattention, which are cardinal behavioural manifestations of ADHD”. The anterior cingulate gyrus is a part of this, and is involved in sociability and behaviour. It is also an important regulator of other brain regions, and its disconnection seems to be consistent with the symptoms encountered in ADHD (12).
More analysis of imaging studies across 23 sites in more that 1713 ADHD patients and 1500 controls found volume reductions in the insula, the basal ganglia, and in limbic areas such as amygdala and hippocampus (13). These regions of the brain affect many different behaviours and cognitive processes such as sustained attention, response variability and cognitive switching. This can explain why people with ADHD often have the ability to switch rapidly between topics in conversation and work.
Science is now showing that children with ADHD are not merely hyperactive, rather that is the result of the neurology of their brain. Therefore whilst symptoms can be supported and quality of life significantly improved, ADHD can not be cured. It is also important to note that whilst ADHD can certainly cause problems for people sometimes, people living with ADHD may have a variety of skills and abilities beyond those of their neurotypical counterparts. For example, people with ADHD can often experience hyperfocus, high levels of creativity, good conversational skills, spontaneity and lots of energy.
There has also been a link between dopamine and ADHD. Dopamine levels are implicated in a person’s mood, attention, movement, motivation and reward. Dopamine transporters remove dopamine from the brain cells, and people with ADHD may have a higher concentration of dopamine transporters in the brain. When there are too many transporters in one region, dopamine is removed too quickly and so has less time to exert its effects.
Other potential contributing factors
Despite much more neuroscience research being conducted, there is still no specific cause identified for ADHD. It is believed to be a combination of genetic, biochemical, sensorimotor, physiologic, and behavioural factors being suggested, and it is sometimes associated with adverse childhood experiences.
Some risk factors for ADHD include (7):
- Low birth weight (< 1500 g)
- head trauma
- iron deficiency
- obstructive sleep apnoea
- lead exposure
- prenatal exposure to alcohol, tobacco, and cocaine
The nervous system can also be depleted by emotional stress, which can contribute to symptoms of ADHD by increasing the body’s use of vital nutrients. Therefore, understanding if there are any factors which may be contributing to a child’s emotional stress is also important in getting to the root of the problem.
Links between accumulation of heavy metals in the body and ADHD have been hypothesised (3, 5), since diagnosis of the condition has become something of a phenomena coinciding with the growth of global pollution of air, water, and food systems. Increased diagnosis could be due to increased understanding of this condition, but intoxication with certain heavy metals has been linked with neurological changes which result in increased impulsivity and addictive behaviour (8).
A study of over 2000 children in an area of Chile where there is reported heavy metal contamination, and arsenic in the water, found that children with higher levels of blood lead concentrations were significantly more likely to develop ADHD compared to children with lower levels of lead toxicity (9). This study is not conclusive evidence of heavy metal toxicity being a direct cause of ADHD due to potential other variables being involved, but certainly suggests that it may well be a contributing factor in the likelihood of developing ADHD.
Diet and nutrition
It has long been clear that food allergies or intolerances are one frequent reason for behavioural changes in neurotypical children which can result in trouble sleeping, temper tantrums, aggression, and mood swings. Inevitably, this will affect children with ADHD too and can worsen their symptoms. Hypoglycaemia (low blood sugar) can also cause mood swings and erratic behaviour in children, which can occur with the over-consumption of sugar and refined carbohydrates (3).
The gut-microbiome consists of natural bacteria which live in our digestive tract and help to keep our internal environment in harmony. There is now an increasing understanding of the important link between these gut-microbes and many aspects of health. The gut-microbiome is considered a part of the unconscious system regulating behaviour, having a major impact on cognitive function and behavioural patterns, and in their absence profound alterations in neurochemistry are observed (10).
Nutritional deficiencies are also a cause of disrupted nervous system function, which in themselves can also predispose to food allergies. Nutritional deficiencies often stem from a diet high in sugar, refined foods, and low in vegetables and fruit (3), an often typical ‘Western diet’.
Since the gut microbiome thrives on a variety of plant-based whole-foods (vegetables, fruits, grains, nuts, seeds, fermented foods such as sauerkraut, kimchee, kefir), this suggests a link between diet and nutrition, increased tendency for food intolerances and allergies which in turn will lead to inflammation. This causes further difficulties absorbing nutrients, and results in a lower level of gut microbes, all resulting in the greater likelihood of behavioural problems in children.
A study looking at the Mediterranean diet and ADHD diagnosis found that out of 120 children / adolescents (60 with an ADHD diagnosis and 60 in a control group without diagnosis), lower adherence to a Mediterranean diet was associated significantly with ADHD diagnosis. It also found that consuming less fruit, vegetables, pasta, skipping breakfast, and eating fast foods were associated with ADHD diagnosis, however sometimes behavioural problems and ADHD can be conflated hence causing misdiagnosis. High consumption of eating sugar, candy, cola beverages and other soft-drinks, and low consumption of fatty fish were also associated with higher prevalence of ADHD diagnosis (11). This suggest that a balanced whole foods diet (rather than specific nutrients) is likely to be beneficial in preventing and / or treating ADHD. However as stated earlier it is important to note that sometimes ADHD diagnosis can be incorrect, as it can be difficult to distinguish between other conditions.
Another study looked at eliminating food components by using the Oligoantigenic Diet (OD) which led to a reduction of ADHD symptoms for more than two-thirds of patients (6). The aim of this study was to reveal how to identify foods having an impact on ADHD symptomatology. After four weeks of elimination diet the individual food sensitivities were identified in a reintroduction phase. Twenty-seven food sensitivity reactions were identified. Most of the participants were sensitive to more than one food. In all patients, ADHD symptoms were intensified by various foods during the food challenge after elimination phase. An example is that 70% of children reacted to milk products, and of these 73% did not react to dairy products which were free from lactose. This sample size was small with only 16 participants completing the study, and whilst it does not identify specific allergens which may trigger ADHD, it does suggest that children with ADHD diagnosis and no previous sign of food intolerances (as in this study), would benefit from exploring elimination diets to understand if food may be causing reactions and stimulating ADHD symptoms.
This offers a perspective on ADHD which suggests that although root causes are not clear, there is great scope to potentially reducing symptoms with dietary adjustments towards whole food diets and through elimination diets to discover potential intolerances. This is particularly important because of the side effects of medication which do not really resolve the root cause of the condition, and also because of the potential long-term consequences going into adolescence and adulthood if the condition is left undiagnosed and / or untreated. Whilst these lifestyle choices can not cure the condition, they can significantly improve quality of life. Herbalism can also really offer hope in providing support.
Signs and symptoms
These criteria requires more than 6 symptoms and signs from one or each group. Also, the symptoms need to:
- Be present often for ≥ 6 months
- Be more pronounced than expected for the child’s developmental level
- Occur in at least 2 situations (eg, home and school)
- Be present before age 12 (at least some symptoms)
- Interfere with functioning at home, school, or work
Inattention symptoms:
- Does not pay attention to details or makes careless mistakes in schoolwork or with other activities
- Has difficulty sustaining attention on tasks at school or during play
- Does not seem to listen when spoken to directly
- Does not follow through on instructions or finish tasks
- Has difficulty organizing tasks and activities
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort over a long period of time
- Often loses things necessary for school tasks or activities
- Is easily distracted
- Is forgetful in daily activities
Hyperactivity and impulsivity symptoms:
- Often fidgets with hands or feet or squirms
- Often leaves seat in classroom or elsewhere
- Often runs about or climbs excessively where such activity is inappropriate
- Has difficulty playing quietly
- Often on the go, highly energetic
- Often talks excessively
- Often blurts out answers before questions are completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others
Herbal solutions
The herbal treatment of ADHD and hyperactivity will need to be implemented alongside the relevant dietary and lifestyle changes such as eliminating junk food and replacing with nutritious whole foods diet, parental or caregiver support in how to implement and sustain this, as well as relevant emotional support for child and caregivers. It is recommended to seek professional guidance from a herbalist for complex conditions, and also it must be noted that this is for symptom management not a cure.
Nervous system support: supporting the nervous system would be the main herbal approach in cases of children experiencing hyperactivity and behavioural issues, to help relieve the stress involved, and also nourish and support the nervous system to function well. Nourishing nervines and adaptogens will help and increase resilience to this stress, and reduce feelings of anxiety which may be present.
Nervous system tonics
Vervain is helpful to re-establish healthy sleep patterns and is energetically grounding helping to calm energy down. It can be given throughout the day during periods when a child becomes run-down from lack of sleep (3), until a healthy sleeping pattern is re-established.
Skullcap is helpful in cases of overthinking or ‘busy head’. It can be taken as an infusion before bed for cases of insomnia.
Rose is particularly helpful for calming irritability and anger. It restores the nervous system and is helpful in insomnia. For children a strong infusion or essential oil can be added to a bath before bed.
Oats are a nutrient for the nervous system, and a tonic nervine action, so toning and restoring the nervous system. Oat straw and oat seed are highly recommended.
Liquorice will support adrenal gland function and so responses to stress, though caution must be taken if one has high blood pressure.
Ashwagandha for adaptogenic support, to increase resilience to stress, balance hormones and to nourish the nervous system.
For sleep issues include: catnip, lime flower, as a tea before bed. Also as a strong infusion can be added to the bath water.
For children who are particularly tense and prone to temper tantrums and angry outbursts, chamomile, lime flower, tulsi, rose, skullcap, and liquorice can be beneficial.
Aid support of heavy metal elimination:
Red clover is a relaxant and also has blood purifying properties so is helpful for eliminating heavy metals from the body, along with charcoal, kelp and nettle.
Ayurvedic Perspective
From an Ayurvedic perspective ADHD is likely a disorder associated with imbalance of Vata and Pitta, and so herbs will be given to support balance of these Doshas.
Vata reducing herbs for cases of a nervy, restless and easily distracted child: ashwagandha, wild oats, gotu kola, shatavari.
Sweet flag (Acorus calamus)is used by Indian doctors as a brain tonic and for memory problems (3). Interestingly from a western herbal perspective it is considered a healing tonic for the whole gastro-intestinal tract where it has a soothing and toning effect, whilst also bitter components will promote digestive function and appetite, and digestive support may well be indicated in most cases of ADHD.
Pitta calming herbs are used in cases of aggression and anger, including gotu kola, chamomile, coriander, shatavari.
Bacopa and gotu kola will also potentially help with memory, as may ginkgo biloba.
Holistic solutions
Dietary
- Based on all the points discussed regarding diet and ADHD, paying attention to a balanced nutritious whole-foods diet is likely to be beneficial in managing symptoms of ADHD or general hyperactivity.
- Ensuring regular meals to avoid hypoglycaemia and checking that the child is eating during the school day.
- Trying an elimination diet and reintroduction may also be helpful in establishing any connection between food intolerances or allergies and ADHD.
- Reducing or cutting out refined sugar and junk foods for one month initially may be beneficial to establish change in behaviour.
- A b-vitamin complex may also be beneficial for additional nervous system support. In a trial it has been shown to be more effective, safer, and less expensive than treatment with Ritalin (4).
Family support in the form of behavioural management may be beneficial for the whole family in terms of finding strategies to help cope with the behaviours. Also sharing constructive creative activities between parent and children such as painting, crafts, singing, story-telling can be great to enforce positive behaviour and help build bonds between children and parents / caregivers (3).
Additional supportive practices such as physical exercise, Yoga, meditation, and breathing exercises may all help to calm the nervous system and relieve stress therefore reducing symptoms of ADHD.
References
- Britannica. Human Behaviour, Development in Childhood. https://www.britannica.com/topic/human-behavior/Self-concept-or-identity. Accessed 21 August, 2022.
- Kopp CB, Self-Regulatory ProcessesIn: Haith MM, Benson JB, eds. Encyclopedia of Infant and Early Childhood Development. Elsevier Inc.2008: 102-117. https://doi.org/10.1016/B978-012370877-9.00140-7. Accessed 21 August, 2022.
- Minsky BC. Our Children’s Health. Connecticut: Vital Health Publishing; 2002.
- Hoffmann D. The New Holistic Herbal. 3rd Edition. Shaftesbury Dorset: Element Books Ltd; 1990.
- Yorgidis E, Beiner L, Blazynski N, Schneider-Momm K, Clement H-W, Rauh R, Schulz E, Clement C, Fleischhaker C. Individual Behavioral Reactions in the Context of Food Sensitivities in Children with Attention-Deficit/Hyperactivity Disorder before and after an Oligoantigenic Diet. Nutrients. 2021; 13(8):2598. https://doi.org/10.3390/nu13082598
- Attention-Deficit / Hyperactivity Disorder (ADD / ADHD). MSD Manual Professional Version website. Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) – Pediatrics – MSD Manual Professional Edition (msdmanuals.com). Accessed 19 August, 2022.
- Pizzorno J, Murray M, Joiner-Bey H, The Clinician’s Handbook of Natural Medicine. 2nd ed. St Loius, Missouri: Churchill Livingstone Elsevier; 2008.
- MP, Rubilarad P, Macarena Valdés, et al. Attention deficit hyperactivity disorder and its association with heavy metals in children from northern Chile. International Journal of Hygiene and Environmental Health: 2020;226;113483. https://doi.org/10.1016/j.ijheh.2020.113483
- Dinan TG, Stilling RM, Stanton C, Cryan JF. Collective unconscious: how gut microbes shape human behavior. J Psychiatr Res. 2015;63:1-9. doi:10.1016/j.jpsychires.2015.02.021.
- Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics. 2017;139(2):e20162027. doi:10.1542/peds.2016-2027
- Makris N, Seidman L, Valera E et al. Anterior Cingulate Volumetric Alterations in Treatment-Naïve Adults With ADHD. J Atten Disord. 2009;13(4):407-413. doi:10.1177/1087054709351671
- Rubia K. Cognitive Neuroscience of Attention Deficit Hyperactivity Disorder (ADHD) and Its Clinical Translation. Front Hum Neurosci. 2018;12. doi:10.3389/fnhum.2018.00100
