Parents of children with ADHD (Attention Deficit Hyperactivity Disorder) search for anything that will help their children overcome the hindrances of this condition. They watch their children struggle with school and relationships. The parents struggle with the stress of ADHD on their own relationship with the affected child. Arguments and frustrations can abound. With this pressure, the parents are willing to try even stimulant medications with their side effects hoping for relief. Researchers in this study hold out another hopeful avenue for therapy, nutrient supplementation.
ADHD affects approximately in 20 children today (1) often lasting into adulthood with other secondary adverse effects (2,3). The foundation symptoms included inattention and hyperactivity or impulsivity. This is often compounded by “emotional dysregulation”. Numerous medications have been developed and offered to relieve the symptoms but they come with side effects, primarily slight growth suppression (4,5,6). Other options are sought by parents looking for something with lower adverse effect risks.
Nutrient supplementation has been studied in hopes of offering such safe alternatives. Omega 3 supplementation has showed the most promise (7) while other single nutrients have had mixed results (8). The study in focus builds on prior studies showing some benefits of “broad spectrum micronutrients” in adults and kids (9,10,11,12). The potential for such micronutrients to work comes from their roles in brain processes and neurotransmitter production (13,14).
Researchers from the Oregon Health & Science University and Helfgott Research Institute, National University of Natural Medicine enrolled 135 children with ADHD diagnosis while off of any stimulant medications from 3 geographical sites. The children were randomized in a 3:2 ratio between 8 weeks of a micronutrient mix and a placebo group of capsules. The children took between 9 and 12 capsules per day with a collection of known micronutrients at amounts higher than the Recommended Daily Allowance (RDA). Care was taken to avoid doses above the upper tolerable limits.
Both parents and trained clinicians evaluated the efficacy of the intervention at the end of the 8-week period. In the objective evaluation by the clinicians, 54% of the children on the nutrient mix demonstrated improvement versus only 18% in the placebo group. There was a small trend of improvement for the therapy group according to the separately scored parental report, but it was not statistically significant. The researchers question if the lack of improvement by parental scoring resulted from the known tendency of parental scores to under-report differences from placebo in past studies.
Interestingly, the other finding of note was an increase in growth for the nutrient supplemented children. They grew 6 mm more on average than the children on placebo. Given the problem of growth retardation with stimulant medications, this is promising.
Overall, this study offers hope for non-medication therapies to assist in the care of children with ADHD. Despite requiring 9 to 12 capsules per day, 3 of 4 children met adherence requirements. There was no difference in adverse events reported against placebo. With 126 of the initial 135 participants completing the study, statistically significant results were available.
The study authors look beyond these results and consider directions for further research. They suggest alterations in the gut microbiome, modulation of methylation, and lowering of inflammatory cytokines as potential mechanisms by which these micronutrients exert positive effects. Attention to overall dietary quality has the potential for benefiting these children as well.
In functional medicine, we appreciate support for our ongoing practice of identifying nutritional deficits in our patients with ADHD. We replace nutrients like B vitamins and minerals when found to be deficient. We also aim to optimize necessary nutrients rather than getting “just enough” to get by. With this approach, we see subjective and objective improvements reported by parents and other caregivers like teachers or extended family. For parents wanting to avoid or limit the use of stimulant medications these are a piece of the puzzle in helping children with ADHD live healthier, more abundant lives.
Original Article:
Jeanette M. Johnstone, Irene Hatsu, Gabriella Tost, Priya Srikanth, Leanna P. Eiterman, Alisha M. Bruton, Hayleigh K. Ast, Lisa M. Robinette, Madeline M. Stern, Elizabeth G. Millington, Barbara L. Gracious, Andrew J. Hughes, Brenda M.Y. Leung, L. Eugene Arnold. Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child & Adolescent Psychiatry, 2022; 61 (5): 647 DOI: 10.1016/j.jaac.2021.07.005
Thanks to Science Daily:
Elsevier. “Micronutrients (vitamins + minerals) show benefit for children with ADHD and emotional dysregulation: Evidence from a randomized clinical trial shows broad-spectrum micronutrient supplementation with all known vitamins and essential minerals resulted in global improvement of attention and mood based on blinded clinician ratings.” ScienceDaily. ScienceDaily, 26 April 2022. <www.sciencedaily.com/releases/2022/04/220426101650.htm>.
Other references:
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5). Arlington, VA: American Psychiatric Publishing.
- Kessler R.C. Adler L. Barkley R. et al. The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry. 2006; 163 (doi:163/4/716 [pii] 10.1176/appi.ajp.163.4.716): 716-723
- Klein R.G. Mannuzza S. Olazagasti M.A.R. et al. Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry. 2012; 69: 1295-1303https://doi.org/10.1001/archgenpsychiatry.2012.271.
- Cortese S. Holtmann M. Banaschewski T. et al. Practitioner review: current best practice in the management of adverse events during treatment with ADHD medications in children and adolescents. J Child Psychol Psychiatry. 2013; 54: 227-246https://doi.org/10.1111/jcpp.12036
- Hennissen L. Bakker M.J. Banaschewski T. et al. Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: a systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine. CNS Drugs. 2017; 31: 199-215https://doi.org/10.1007/s40263-017-0410-7
- Lofthouse N. Hurt E. Arnold L.E. Complementary and alternative treatments for pediatric and adult ADHD. Attention-deficit hyperactivity disorder in adults and children. 2015; 307https://doi.org/10.4088/JCP.15r10601
- Sonuga-Barke E.J. Brandeis D. Cortese S. et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013; 170: 275-289https://doi.org/10.1176/appi.ajp.2012.12070991
- Bilici M. Yıldırım F. Kandil S. et al. Double-blind, placebo-controlled study of zinc sulfate in the treatment of attention deficit hyperactivity disorder. Prog Neuro-Psychopharmacol Biol Psychiatry. 2004; 28: 181-190https://doi.org/10.1016/j.pnpbp.2003.09.034
- Gordon H.A. Rucklidge J.J. Blampied N.M. Johnstone J.M. Clinically significant symptom reduction in children with attention-deficit/hyperactivity disorder treated with micronutrients: an open-label reversal design study. J Child Adolesc Psychopharmacol. 2015; 25: 783-798https://doi.org/10.1089/cap.2015.0105
- Rucklidge J. Taylor M. Whitehead K. Effect of micronutrients on behavior and mood in adults with ADHD: evidence from an 8-week open label trial with natural extension. J Atten Disord. 2011; 15: 79-91https://doi.org/10.1177/1087054709356173
- Rucklidge J.J. Frampton C.M. Gorman B. Boggis A. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatry. 2014; 204: 306-315https://doi.org/10.1192/bjp.bp.113.132126
- Rucklidge J.J. Eggleston M.J. Johnstone J.M. Darling K. Frampton C.M.Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. J Child Psychol Psychiatry. 2018; 59: 232-246https://doi.org/10.1111/jcpp.12817
- Ames B.N. Elson-Schwab I. Silver E.A. High-dose vitamin therapy stimulates variant enzymes with decreased coenzyme binding affinity (increased Km): relevance to genetic disease and polymorphisms. Am J Clin Nutr. 2002; 75: 616-658https://doi.org/10.1093/ajcn/75/4/616
- Ames B.N. A role for supplements in optimizing health: the metabolic tune-up. Arch Biochem Biophys. 2004; 423: 227-234https://doi.org/10.1016/j.abb.2003.11.002
Sanctuary Functional Medicine, under the direction of Dr Eric Potter, IFMCP MD, provides functional medicine services to Nashville, Middle Tennessee and beyond. We frequently treat patients from Kentucky, Alabama, Mississippi, Georgia, Ohio, Indiana, and more... offering the hope of healthier more abundant lives to those with chronic illness.
