Alternative Treatment and ADHD
(originally published in the Lake Travis View)

Stacey (not her real name) sat in my office with tears in her eyes as she talked about her difficulties at school. Frequently she found herself in trouble with her teacher and rarely did she finish her schoolwork. Stacey’s mother described homework as a “nightmare”. Requests to complete homework assignments deteriorated into power struggles marked by complaining, crying, and yelling. Midway through the fifth grade Stacy already felt like a failure. She described herself as “stupid”. Her mother was equally sad and discouraged. Stacy had shown much promise when she started elementary school. Teacher’s had described her as a bright, inquisitive and eager student. Stacy was a little too “social” but had done very well academically. Now Stacy’s teacher was frustrated and unsure how to help Stacy be more successful and feel better about school. Following the initial interview, which involved extensive history taking, review of report cards and other school documents, and completion of a lengthy intake questionnaire, Stacy completed a comprehensive battery of tests. Emotional, developmental, intellectual, academic, and cognitive functioning was evaluated. Stacy was diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). A comprehensive treatment plan was developed. Three months later I received a letter from Stacy bragging about her success at school and expressing gratitude that she now knew how to manage her difficulties. She no longer believed that she was “stupid.” Follow-up with Stacy’s mother confirmed that she was doing well.

A recent article published in the Lake Travis View may lead some to form a false impression about what we know about diagnosing and treating Attention-Deficit/Hyperactivity Disorder. The conclusions of the National Institutes of Health Consensus Statement are incorrectly summarized. NIH consensus statements are produced by a panel of unbiased experts and reflect the panel’s assessment of medical knowledge available at the time the statement was written. The NIH consensus statement discussed in the LT View article was produced in 1998. Since then there has been an explosion of information on ADHD, much of which can be easily accessed at the NIH web site. In 1998 the panel concluded:

ADHD is a commonly diagnosed behavioral disorder of childhood that
represents a costly major public health problem. Children with ADHD
have pronounced impairments and can experience long-term adverse
effects on academic performance, vocational success, and social-
emotional development, which have profound impact on individuals,
families, schools, and society.

The authors of the report acknowledge that controversy continues regarding the treatment of ADHD. However, this controversy exists outside of treatment guidelines published by leading medical organizations such as the American Academy of Pediatrics. To be considered a valid treatment option, the treatment must have been evaluated in controlled studies. The treatment must be more successful than placebo. The only treatments that have been proven more successful than a placebo in controlled studies are medication and behavioral interventions. Despite numerous attempts to validate “alternative” treatments, they do no better than placebo. The Integrative Medicine Consult, a leading publication dedicated to informing professionals about the benefits of integrating conventional and alternative (or complementary) approaches acknowledges the benefits of traditional medical approaches to the treatment of ADHD. Dr. Scott Shannon, writing for The Integrative Medicine Consult, noted that a variety of alternative approaches have been offered for the treatment of ADHD and some people have received some benefit [about what you’d expect with a placebo]. However regarding these alternative approaches Dr. Shannon states: “at this point there is no scientific base for them. I remain curious but skeptical.”

As any parent with a child that has ADHD can tell you, the disorder can have a devastating impact. Children with ADHD are at risk for academic failure, substance abuse, behavioral problems, underemployment, and unstable interpersonal relationships. So why does the diagnosis and treatment remain controversial? For one, it is largely an unseen disorder. Children with ADHD look like normal children and frequently act like typical children. Children with ADHD frequently pay attention for long periods of time to things in which they are interested. It is a myth that children with ADHD cannot pay attention. Children with ADHD have difficulty with sustained attention to tasks that they find tedious or boring (e.g., homework). A growing body of evidence, including PET scans and MRIs of individuals with ADHD, implicates the prefrontal cortex of the brain (along with some other smaller structures in the brain). Stimulant medication stimulates those areas of the brain involved in attention so that 70 to 80% of people with ADHD can focus better on tasks they find difficult and tedious. Stimulant medication remains controversial simply because it is a stimulant. In use for over fifty years in the treatment of ADHD it has been extensively studied and used to treat millions of individuals with ADHD.

It has been well documented that children with ADHD frequently suffer from other coexisting or comorbid disorders. These can include fine and gross motor problems, auditory processing deficits, learning disabilities, and depression. Some of these children also have allergies and food sensitivities that may exacerbate the ADHD. Occupational Therapists and Physical Therapists can evaluate your child for motor difficulties. Both professions are licensed by the State of Texas. A licensed audiologist or speech and language therapist can evaluate you child for language and auditory processing deficits. Your child’s school is able to evaluate for learning disabilities. Psychologists, Clinical Social Workers, and Licensed Professional Counselors are licensed by the state of Texas and may be helpful if your child is experiencing emotional or social problems. Should you suspect allergies or food sensitivities consult with your physician. Should you choose to consult with a nutritionist make sure they are licensed by the state. The Integrative Medicine Consult, which frequently carries articles regarding the benefits of nutritional interventions recommends using a professional that is certified by one of three national organizations: The Commission on Dietetic Registration, American Association of Clinical Nutritionists, or Board for Nutrition. Treatment by any of the above providers should be coordinated and integrated with medical treatment provided by the child’s physician. Your child’s school counselor can discuss how best to accommodate your child in the school environment.