An Integrative Medicine Approach to ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in childhood – impacting an estimated 15% of kids – and affects more than 8% of adults. ADHD can make it challenging for individuals to pay attention, manage words and actions, and control movement and activity throughout the day. It can also make long-term planning and task completion difficult. These symptoms can impact many aspects of life, including interpersonal relationships, academic and professional performance, and self-esteem. 

An Integrative Medicine approach to ADHD may help improve quality of life, reduce stress, and support symptom management. 

This article will cover a comprehensive approach to ADHD that includes testing, nutrition, herbal medicine, pharmaceuticals, therapy, and more that you and your loved ones can explore to support well-being.

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What is ADHD?

ADHD is a disorder that affects the part of the brain responsible for executive functioning. As a result, people with ADHD may experience issues with concentration, planning, completing tasks that require high attention, and controlling behavior. 

There are three types of ADHD.

• Predominantly Inattentive ADHD
• Predominantly Hyperactive-Impulsive ADHD
• Combined Type ADHD
  

ADHD Symptoms

The three primary symptoms of ADHD include

• Difficulty staying focused and paying attention
• Difficulty controlling behavior
• Hyperactivity (over-activity)

Symptoms vary according to the type of ADHD someone has. Not every person with ADHD will have all of the above symptoms.

Predominantly Inattentive ADHD 

Predominantly Inattentive ADHD is characterized by difficulty organizing or finishing tasks, paying attention to details, and following instructions or conversations. 

Children with this type of ADHD may often be told that they frequently daydream, appear not to be paying attention in school, miss important directions, and forget what was said to them by parents, teachers, and friends. It's important to note that these symptoms in ADHD are due to lack of attention, not lack of intellect. 

Adults with inattentive ADHD may have difficulty remembering appointments, keeping a schedule, staying focused on one topic at a time, and completing essential but attention-requiring tasks like billing, taxes, car repair, etc. They also frequently report losing or misplacing things like keys, phones, etc.

They may need accommodations to perform well in school, particularly as their coursework requires more preparation, intense studying, and weeks-long sustained attention on projects as in higher grades, college, and graduate school. 

Predominantly Hyperactive-Impulsive ADHD 

Predominantly Hyperactive-Impulsive ADHD includes symptoms like difficulty sitting still, often feeling restless, and exhibiting impulsivity. This can result in fidgeting; constantly moving, interrupting, or grabbing things from others; and commenting inappropriately. 

In children, this can lead to classroom and daycare disruptions. Children with hyperactive ADHD tend to have difficulty waiting their turn and may engage in erratic or dangerous play. In clinical observations, people with hyperactive-impulsive ADHD can often feel anxious when they have to sit for long periods, and they tend to avoid long lines or situations in which they will have to wait (like renewing a driver's license or waiting in a doctor's office waiting room). 

Adults with hyperactive ADHD may feel better in active jobs and playing sports and may feel poorly if forced to participate in sedentary activities. They can feel that they are thrill-seekers and may feel more comfortable participating in intense sports activities than at a desk job. 

Combined Presentation 

Patients can also have a combined presentation, meaning the symptoms of the above two types of ADHD are equally present in the person.

Diagnosing ADHD

Diagnosing ADHD requires both a medical and psychiatric exam. Medical exams are used to rule out possible medical causes of inattentive/hyperactive behaviors, mood or sleep disorders, vision or hearing problems, and medical conditions or pharmaceuticals that can impact behavior or thinking. 

Diagnostic criteria are defined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), published by the American Psychiatry Association. It sets the following criteria for an ADHD diagnosis: a person must present with onset before age 12 with symptoms that cannot be accounted for by another mental health or medical condition that has persisted for at least six months; exhibit inattention, and hyperactivity and/or impulsivity, for at least six months; and exhibit impairment or struggle in social, academic, or occupational settings.

Psychological And Psychiatric Examinations For Diagnosing ADHD

Psychological and psychiatric examinations for ADHD include a comprehensive evaluation by a psychiatrist, psychologist, pediatrician, or medical specialist with ADHD expertise. This evaluation might consist of delving into symptoms by exploring a person's history, plus an assessment using ADHD rating scales and diagnostic criteria.

Psychological evaluations must rule out other issues, including learning or language concerns, that could result in symptoms similar to ADHD but must be treated differently.

Rating Scales For Diagnosing ADHD

Rating scales can be used to assess and measure symptom severity in ADHD and can be used in conjunction with other diagnostic tools to help diagnose ADHD. These can include the Vanderbilt ADHD Diagnostic Parent Rating Scale completed by a child's parents; the Conners Comprehensive Behavior Rating Scale for parents, teachers, caregivers, or the person suspected of having ADHD; ADHD Rating Scale-5 to assess children and adolescents; and the Adult ADHD Self-Report Scale for older persons seeking a diagnosis.

ADHD Possible Root Causes 

No single risk factor completely explains how a person develops ADHD. Instead, Attention Deficit Hyperactivity Disorder is generally the result of a combination of genetic, neurological, environmental, nutrient, lifestyle, and factors that vary by the individual.

Genetics May Play a Role

Studies have shown that ADHD tends to run in families and links genetic factors with ADHD. For example, a study of 894 people with ADHD and 1135 of their siblings aged 5–17 found an increased risk of ADHD in siblings of people with ADHD compared with siblings of controls.

Neurological Differences

People with ADHD may have altered metabolic activity in areas of the brain, like the prefrontal cortex, and altered function in areas of the brain responsible for executive function and motivation. Neuropsychological testing has revealed several well-documented differences between children with and without ADHD, such as altered response to reinforcement which may play a central role in its symptoms. Additionally, a previous or current brain injury is a risk factor for developing ADHD. 

Environmental Exposures

Prenatal exposure to toxins - including heavy metals like lead and mercury, substances like alcohol and tobacco smoke, and pesticides - have been linked to an increased risk of ADHD. 

Stress and Trauma

Factors such as premature birth, low birth weight, and early exposure to stress or trauma like family adversity can also be linked to ADHD.

Nutrient Deficiencies and ADHD

There are a number of nutrient deficiencies that appear to be more common in people with ADHD.

• Vitamin D: 78.4% of children with ADHD are deficient in vitamin D compared to 48% of children without ADHD. 
• Iron: The prevalence of iron-deficiency anemia is up to 8 times higher in women with ADHD than those without it. 
• Omega 3's: Children with ADHD are more likely to be deficient in omega 3's than children without ADHD.
• Zinc: is involved in regulating neurotransmitters and is implicated in affecting learning, memory, emotion, and mood. 
• Magnesium: has a calming effect on the brain, which may help support focus and attention. 
• Vitamin B6 deficiency has been found in many patients with Attention Deficit and Hyperactivity Disorder. 

Food Sensitivities

People with ADHD are more likely to experience adverse reactions to food dye than people without ADHD and have an increased risk of food allergies and sensitivities compared to controls. Some studies suggest an improvement in symptoms when allergenic foods are removed from people with ADHD diets.

Inflammation

An anti-inflammatory diet is associated with a reduced risk of developing ADHD. Likewise, children who consume higher amounts of sugar, candy, and soda are at an increased risk of developing ADHD compared to children who consume more fruit, vegetables, pasta, rice, and fatty fish. This data suggests that food choices, sensitivities, and nutrient deficiencies may all play a role in ADHD pathophysiology. 

Functional Medicine Labs to Test for Root Cause of ADHD

Functional medicine labs can help explore potential root causes of why a person has ADHD, starting with tests for nutrient deficiencies, heavy metals, food sensitivities, and hormone imbalances. These tests provide an in-depth look into potential contributing factors beyond conventional diagnostic methods.

Nutrient Testing in ADHD

Nutrient deficiency tests might include a whole blood nutrient profile measuring various vitamins and minerals linked with ADHD symptoms. You can learn more about specific nutrient tests here. 

Nutrient tests that use a finger prick method include things like Vitamin D, Omega-3 index, and a Whole Blood Nutrient Profile that tests for magnesium, zinc, iron, and vitamin D. 

Nutrients checked using a blood draw include RBC magnesium, RBC zinc, iron and ferritin, and more. 

Heavy Metal Testing in ADHD

Heavy metals, like lead or mercury, when present in excess in the blood, can interfere with how the brain sends signals and may worsen ADHD symptoms. Even low levels of lead — which has been extensively researched with regard to ADHD — can impact neural development. Functional tests can screen for up to 20 of the most common heavy metals.

Hormone Testing in ADHD

Hormone imbalance doesn't mean just low levels; both high and low dopamine levels, the "feel good" neurotransmitter, have been associated with ADHD. The disorder also has been linked with the loss of dopamine-producing cells and varying dopamine concentrations in the neurons. 

Estrogen, testosterone, and progesterone imbalances have been shown to affect concentration, impulsivity, and inattention symptoms in ADHD patients.

One study found that boys with ADHD were far more likely to have higher sex hormone-binding globulin (SHBG) levels and lower DHEA levels than their peers. Functional tests can look for 13 sex hormones and related biomarkers.

To order all of these tests for ADHD, you can use the ADHD test kit bundle found here.

Conventional Treatment for ADHD

Conventional treatments typically address ADHD symptoms. They can include medication, behavioral therapy, or both.

• Medications: Stimulants are often prescribed to help manage symptoms by increasing dopamine and norepinephrine to improve attention and reduce impulsivity and hyperactivity. The most commonly prescribed are methylphenidate (Ritalin) and amphetamine (Adderall). Non-stimulants often increase norepinephrine levels to achieve the same goals like atomoxetine (Strattera) or control nerve impulses along specific nerve pathways, like guanfacine (Intuniv). Nutrients like zinc may help to reduce the amount of a stimulant someone may need to manage their symptoms by up to 37%.
  

• Cognitive-behavioral therapy (CBT), also called behavior modification or psychotherapy, helps individuals to identify and change negative thought patterns and behaviors and to teach new skills and strategies to manage symptoms. Managing ADHD through therapy may also include parent training, classroom management, and peer interventions. Additionally, executive functioning coaching may also help people with ADHD.
  

• Combined treatment: Using both pharmaceuticals and behavioral therapy addresses ADHD's biological and behavioral aspects. One study demonstrated that combined treatment is effective for those who continue exhibiting symptoms despite medications.
  

In many cases, ADHD may be best managed with a combination approach. Functional medicine approaches can be used alongside conventional therapies to help people reduce side effects, improve their symptom management, and support overall health with ADHD.

Functional Medicine Treatment for ADHD

Designing a diet for someone with ADHD should include the following considerations. 

Anti-inflammatory Whole Foods Diet

One study found that those who skipped breakfast, ate fast foods, and had a high consumption of sugar, candy, and soda had a higher prevalence of ADHD diagnosis. On the other hand, the study showed A whole-food low inflammatory diet, like the Mediterranean diet, may support symptom management of ADHD. 

Increase Fruits And Vegetables

This study suggests that consuming more fruits and vegetables may support improved symptoms of inattention in people with ADHD – truly the definition of food-as-medicine!

Replete Nutrients 

Proteins and B vitamins are needed to create essential neurotransmitters like dopamine that are extensively linked to symptoms of ADHD. But other nutrients matter as well! For example, by optimizing zinc, some people may reduce the need for medications by 37%. This can result in better symptom management and fewer side effects and is an excellent example of how nutrition and pharmaceuticals can work together.

Another study showed that 12 weeks of a combination of omega-3 and omega-6 fatty acids, magnesium, and zinc showed a considerable reduction in attention deficit, emotional issues, hyperactivity, and impulsivity.

In our clinic, we focus on optimizing every one of the 80 essential nutrients people need to thrive daily using a done-for-you meal plan or meal options list. This helps people relax and focus on eating foods they love rather than having to track nutrients.

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Elimination Diet Based on Test Results

For kids and adults with severe ADHD, it may be helpful to test for food sensitivities rather than guessing, as elimination diets can be stressful and challenging to maintain without good executive function. 

If it isn't possible to test for food sensitivities (or while you wait for test results to come back), it can be helpful to design an elimination diet protocol that helps clients eliminate food dyes, dairy, and gluten, as these are common reactions in ADHD. 

When test results come back, a registered dietitian can create a custom plan that is allergy and sensitivity free.

Easy-To-Cook And Consume

People with undertreated ADHD often benefit from using tools like batch cooking, frozen or premade meals, and snacks or grab-and-go options like trail mix, healthy power bars, and more to stay nourished. Once their executive function is optimized, we focus on cooking a few whole foods meals each week. Getting someone with severe ADHD to cook and consume three made-from-scratch meals daily is a big ask, as it demands significant executive function. Instead, we start by having clients eat enough, frequently enough. Then, as they heal, we help them build a sustainable plan that contains organic, sustainable, whole foods.

Supplements For ADHD

Many supplements may support ADHD management. Most are available at the local pharmacy and many at grocery stores. Your healthcare provider can determine if a given supplement is safe for you and compatible with medication. You should never start herbs or supplements without consulting with a medical provider. 

The following supplements can be part of a natural nutritional strategy to support ADHD management alongside other treatments.

Multivitamins: Comprehensive multivitamins have been found to support mood and other symptoms like emotional dysregulation and conduct problems in people with ADHD.

Phosphatidylserine: showed support for general ADHD symptoms and short-term auditory memory.

Vitamin D: supplementation may support symptom management of ADHD.

Iron: repletion in people with anemia may support improved attention scores.

Omega 3, magnesium, and zinc: combined may support attention, behavior, and emotional problems of children and adolescents with ADHD.

Magnesium and Vitamin B6: supplementation for eight weeks improved symptoms of hyperactivity, aggressiveness, and attention in children with ADHD. Symptoms reappeared when supplementation was stopped, which suggests that supplementation with these nutrients may be beneficial long-term. This is likely due to the habitually inadequate consumption of these nutrients in standard western diets. Vitamin B6, after all, is the number one nutrient deficiency in the US, according to the CDC.

Herbal Medicine For ADHD

The following herbal medicines have been found to be potentially helpful in managing ADHD. Always ask your doctor, herbalist, naturopathic physician, or another trained medical professional before adding these to your health regimen.

• Ginseng combined with ginkgo biloba has been shown to support ADHD symptom management.
• Pycnogenol (pine bark) supplementation may support hyperactive behavior, attention and visual-motor coordination, and concentration.
• Saffron therapy may have similar efficacy to methylphenidate in the management of ADHD.
• Bacopa monnieri (also known as Brahmi) may help reduce symptoms of restlessness, lack of self-control, attention-deficit symptoms, learning problems, impulsivity, and psychiatric problems in people with ADHD.

Mind-Body Therapies for ADHD

Mind-body techniques such as yoga, meditation, and deep breathing may help people with ADHD to control attention and focus and may help reduce stress. The bonus - they're also low-cost or free, have no side effects, and can be performed at home! Parents and kids can meditate, do yoga together, and add to their family time. They can even find fun kid-centered meditations on apps or youtube that draw on vivid imagery and help to grow kids' imaginations.

Exercise for ADHD

Exercise may help reduce cognitive, behavioral, and physical symptoms of ADHD without adverse side effects. Regular exercise comes with side benefits - it can help improve other health conditions, including cardiovascular health, anxiety, and more. 

In our practice, we explain to kids with hyperactive ADHD that they sometimes just have "too many wiggles" to sit still and that one way to get the wiggles "out" is to exercise, run and play until they are tired. Then, they can leave their wiggles outside, and they won't bother them inside. 

We also celebrate that having tons of wiggles means they are natural-born athletes! Organized sports and tons of play are excellent activities for people of all ages. To our parents of kids with ADHD, we usually say, "your kiddo should be playing a sport every season. They'll be healthy, strong, and benefit from learning to play on a team and more that will set them up for success in all aspects of life." Seeing hyperactive ADHD as an asset on the playing field, rather than a disability, can be an empowering reframe for people with ADHD and their families.

Hormone Optimization for ADHD

Hormone treatments should focus on eliminating the barriers to normal hormone production using a combination of lifestyle changes, nutrient therapy, herbs, and even pharmaceuticals. If hypothyroidism is present, managing it can include pharmaceuticals and other natural treatments. If a DHEA deficiency is present, practitioners will educate their clients about lifestyle changes necessary to support adrenal function and may supplement with DHEA. 

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Summary

An integrative approach to managing ADHD includes identifying potential contributing factors and combining therapy, nutrition, herbal medicine, supplements, pharmaceuticals, coaching, and more to help people thrive. The best thing about this approach is that it may support overall well-being! You can read Mike's story of how he managed ADHD using an integrative approach to see the possibilities. It's possible to thrive with ADHD. Using this approach, you can explore ways to support your health!

Sources for this article can be found here.