Attention Deficit Disorder – ADD and ADHD

Attention deficit disorder (ADD) and Attention Deficit Hyperactivity disorder (ADHD) are clinical names for symptoms typically related to problems with attention.  These conditions appear most frequently in school-age children, although they can affect people at any age.  People suffering from these disorders seem incapable of coping with school, work, or life in general, and they are constantly distracted, moody and sometimes aggressive.  The most common psychiatric children’s disorders are ADHD, anxiety disorders, depression, substance-use disorders, and conduct disorder (Cassidy and Jellinek 1998). In one sense ADD/ADHD is plain, old-fashioned nervousness and excitability.

Parents often come to our clinic hoping to wean their children off problematic drug therapy (is Ritalin a form of cocaine ). Immediately we note that ADD is a Vata disorder, disordered nervous energy.  Secondly we notice that ADHD is a Vata-Pitta disorder attention dysfunction with the additional problem of excess/disordered energy or inflammation.  Sometimes we see poor mental performance in school related to Kapha, with signs of poor digestion (dampness), sluggishness, and perhaps a greasy coating on the tongue. This differential diagnosis allows us to pinpoint and work on the underlying causes of these disorders.

Vata disorders are caused by excess nerve system stimulation, including bright lights, loud sounds, a complex rapidly changing environment and stressful situations— a snapshot of today’s world.  Therefore, all children with ADD or ADHD would theoretically benefit from quiet meditative time, or time with Nature.  In fact, it is my clinical experience that exercise and/or stress reduction practices can be extremely useful in managing ADD or ADHD symptoms.

Many adults and children with ADHD have reported that vigorous daily exercise to be their most important management tool, and parents of children have reported similar results.  However, this approach seems to works slowly over time, and although there is a biological basis (Jansen et. al., 1999, Rowland, 1998) no well-designed studies have been done.  Studies done in other stressed patient populations, such as airline crews (Singh, 1999) make it very likely, in my opinion, that reports of benefits are real.  For example, college students using Yoga to control the stress of exams reported “improved concentration, self confidence, improved efficiency, good interpersonal relationship, increased attentiveness, lowered irritability levels, and an optimistic outlook in life” (Malathi and Damodaran, 1999).

• One condition that can cause, or at least exacerbate ADD, is hypoglycemia.
• A review of the ridiculously sparse literature on diet related to this problem shows that dietary changes definitely have positive benefits on some children (Breakey, 1997).  A controlled clinical study of a nutritional supplement showed some benefit (Dykman and Dykman, 1998).  Dr. William Mitchell, one of the founders of the John Bastyr Naturopathic University in Seattle suggests daily dietary intake of foods rich in aromatic polyphenols, such as apricots, russet potatoes, yellow onions and broccoli.  These would reduce inflammation and oxidative stress.

After correcting any underlying problems, such as basic vitamin deficiencies, we have found it helpful at our Delaware herbal medicine clinic to employ one or two of the following four strategies.

• If the child is aggressive and agitated, they can often be calmed with kava root, valerian root, or milky oat seed-scullcap tincture. Numerous commercial tinctures and capsules contain one or more of these herbs.  Unlike many pharmaceutical calmatives, the calming action of these herbs is not associated with decline in reaction time, alertness or concentration (Kuhlmann et. al., 1999, Munte et. al., 1993).  Ashwaghanda root is also quite calming, reducing Vata and Kapha. As is the green tea extract called L-theanine, which comes in chewable form suitable for kids.

• To improve memory and concentration, I use bacopa, gotu kola, guduchi stem, shilajatu and valerian root.  Bacopa is especially effective in sufficient dose. Some children respond to St.John’s wort.

• To “calm the spirit” and reduce mucus and inflammation according to TCM theory, we use Acorus tablets, available to professionals from ITM. The tablets contain 12 herbs tested in China for the treatment of ADD and ADHD.  They are made in small (300mg.) size, easy for children to swallow.

• If the child requires increased nutrients, Nai-shing will often make a formula using herbs designed to nourish the Yin energy, considered useful for the brain.  Such herbs include rehmannia root, tortoise shell and lycium fruit (gou qi zi).  She may also include herbs to “open the heart orifices,” such as polygala root (yuan zhi) and acorus rhizome (shi chang pu).  Polygala root is considered good for releasing pent-up emotions, and Ayurvedic doctors also use acorus rhizome as a brain tonic and for memory problems.

Most ADD children require at least two of the above strategies. In addition, I have heard many personal reports of the value of grapeseed extract and evening primrose oil supplementation in this condition, both of which would reduce inflammation and oxidative stress.