Attention Deficit Disorder (ADD)
Attention Deficit Hyperactivity Disorder (ADHD)

This section was compiled by Frank M. Painter, D.C.
Make comments or suggestions to   Frankp@chiro.org

If there are terms in these articles you don't understand, you can get a definition from the Merriam Webster Medical Dictionary. If you want information about a specific disease, you can access the Merck Manual. You can also search Pub Med for more abstracts on this, or any other health topic.

Introduction

Attention Deficit/Hyperactivity Disorder (ADD/ADHD) is the most commonly reported childhood behavioral disorder, affecting between between 3 and 7% of American children. It is characterized by poor attention span, impulsive behaviors, and hyperactivity in some children. The diagnostic criteria are strictly observational, and there are no objective laboratory tests to confirm that diagnosis. Subjective evaluations of annoying, distracting, or inattentive behavior makes the “diagnosis” of ADD/ADHD speculative at best.

The most common medical “treatment” for this controversial “disease” is prescriptions of Methylphenidate (Ritalin), a Class II controlled and addictive substance. The long–term effects of this drug on children is unknown, but the side–effects, including addiction, are becoming better understood.

What is ADD/ADHD?   Although it's exact “cause” is unknown, major etiologic contributors include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins, such as heavy metals and organohalide pollutants.   [1]

Nutrient deficiencies are common in ADD/ADHD. Supplementation with minerals, B vitamin complex, flavonoids, and the omega-3 and omega-6 essential fatty acids have shown promising results, as are reported in the Abstracts Section section below.

A wholistic/integrative management program will include supplementation, dietary modification, detoxification, and removal of environmental toxins and toxic cleaners from the home.

This page is devoted to sharing research information about ADD/ADHD to help parents and teachers make informed decisions, and to support the children who stand to benefit from a drug–free existance. The following articles and journal abstracts discuss ADD/ADHD and a “natural treatment” program.

ADD Articles

	The Effects of Spinal Manipulation on Oculomotor Control in Children with Attention Deficit Hyperactivity Disorder: A Pilot and Feasibility Study Brain Sciences 2021 (Aug 6); 11 (8): 1047 ~ FULL TEXT Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent, chronic neurodevelopmental disorder that affects oculomotor (eye movement) control. Dysfunctional oculomotor control may result in reading or educational difficulties. This randomized controlled crossover study sought to investigate the feasibility of a larger scale trial and effects of a single session of spinal manipulation on oculomotor control in children with ADHD. Thirty children participated in the study and were randomized into either control-first or spinal manipulation first groups. The results indicate that the trial was feasible. Secondary outcomes showed that there was a significant decrease in reading time after the spinal manipulation intervention compared to the control intervention. Future studies of the effects of spinal manipulation on oculomotor control in children with ADHD are suggested.
	A Possible Link Between Early Probiotic Intervention and the Risk of Neuropsychiatric Disorders Later in Childhood: A Randomized Trial Pediatr Res. 2015 (Jun); 77 (6): 823–828 At the age of 13 y, ADHD or AS was diagnosed in 6/35 (17.1%) children in the placebo and none in the probiotic group (P = 0.008). Probiotic supplementation early in life may reduce the risk of neuropsychiatric disorder development later in childhood possible by mechanisms not limited to gut microbiota composition.
	Complementary and Alternative Medical Therapies for Children With Attention-deficit/Hyperactivity Disorder (ADHD) Alternative Medicine Review 2011 (Dec); 16 (4): 323–337 ~ FULL TEXT Attention-deficit/hyperactivity disorder (ADHD) is a commonly diagnosed childhood disorder characterized by impulsivity, inattention, and hyperactivity. ADHD affects up to 1 in 20 children in the United States. The underlying etiologies of ADHD may be heterogeneous and diverse, and many possible risk factors in the development of ADHD have been identified. Conventional treatment usually consists of behavioral accommodations and medication, with stimulant medication most commonly being prescribed. Parents concerned about the side effects and long-term use of conventional medications are increasingly seeking alternatives to pharmacologic treatment. Complementary and alternative medicine (CAM) offers parents various treatment options for this condition, including dietary modifications, nutritional supplementation, herbal medicine, and homeopathy.
	Chiropractic Care for Pediatric and Adolescent Attention-Deficit/ Hyperactivity Disorder: A Systematic Review Chiropractic & Osteopathy 2010 (Jun 2); 18: 13 ~ FULL TEXT The search yielded 58 citations of which 22 were intervention studies. Of these, only three studies were identified for pediatric and adolescent AD/HD cohorts. The methodological quality was poor and none of the studies qualified using inclusion criteria. To date there is insufficient evidence to evaluate the efficacy of chiropractic care for pediatric and adolescent AD/HD. The claim that chiropractic care improves pediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of pediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for pediatric and adolescent AD/HD.
	Some Food Additives Raise Hyperactivity, Study Finds New York Times Research Section (Sep 6, 2007) Common food additives and colorings can increase hyperactive behavior in a broad range of children, a study being released today found. It was the first time researchers conclusively and scientifically confirmed a link that had long been suspected by many parents. Numerous support groups for attention deficit hyperactivity disorder have for years recommended removing such ingredients from diets, although experts have continued to debate the evidence. But this new, carefully controlled study in The Lancet Journal shows that some artificial additives increase hyperactivity and decrease attention span in a wide range of children, not just those for whom overactivity has been diagnosed as a learning problem.
	ADHD, Ritalin, and Big Brother Alternative Medicine Review 2000 (Oct); 5 (5): 401 ~ FULL TEXT The year: 2000. Location: somewhere in the United States. "Doug and Marie," loving, well-intentioned parents of a school-aged child are sitting in a jail cell, awaiting a hearing in which they will be charged with child abuse and neglect. The reason? Refusing to dose their son with Ritalin. This scenario is fictitious; however, it is not far from what could happen.
	Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management Alternative Medicine Review 2000 (Oct); 5 (5): 402–428 ~ FULL TEXT ADHD begins in childhood and often persists into adulthood. The exact etiology is unknown; genetics plays a role, but major etiologic contributors also include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants. Mounting controversy over the widespread use of methylphenidate and possible life-threatening effects from its long-term use make it imperative that alternative modalities be implemented for ADHD management. Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine (PS) can ameliorate ADHD symptoms. When individually managed with supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and other features of a wholistic/integrative program of management, the ADHD subject can lead a normal and productive life.
	Polyunsaturated Fats and Neurological Disorders Nutrition Science News (Sep 2000) For he past 50 years, major psychiatric disorders generally have been attributed to neurotransmitter system abnormalities. Neurotransmitters are biochemicals that transfer information from one neuron, or central nervous system cell, to another. While this concept is still considered valid, it has limited ability to explain the origins and guide the treatment of mental illness. Furthermore, there is a growing consensus in scientific circles that the phospholipid metabolism of the neuron cells themselves also plays a crucial role in the development of mental conditions. [1] Phospholipids are substances composed of two fatty acids linked to a phosphate group (e.g. choline, serine, inositol). This consensus has come because numerous studies have linked low brain levels of these substances to conditions such as depression, dyslexia, schizophrenia and more.
	ADHD: A Modern Malady Nutrition Science News (August 2000) ADHD is being identified as epidemic throughout the United States: The National Institutes of Health in Washington, D.C., estimates that from 3 to 5 percent of all American schoolchildren have been diagnosed with the disorder. This trend alone is reason for concern, but perhaps more troubling is that more than 6 million American children currently diagnosed with ADHD are being treated with central nervous system stimulants--usually methylphenidate (Ritalin)--when more natural approaches exist. [1] A sad commentary on the seriousness of this problem was related by a patient who recently visited his child's school and outside the nurse's office found a long line of children waiting to get their dose of Ritalin.
	Diet, ADHD & Behavior: A Quarter-Century Review Center for Science in the Public Interest (CSPI) ~ October 25, 1999 This report reviews 23 controlled studies of the effect of food dyes and other dietary constituents on the behavior of children with Attention-Deficit/Hyperactivity Disorder (ADHD) or other behavioral problems. Though the studies are limited due to the number of subjects, extent of dietary changes tested, assessment techniques, and other factors, 17 of the 23 studies found evidence that some children’s behavior significantly worsens after they consume artificial colors or certain foods, such as milk or wheat. Limited research with such tools as electroencephalography (EEG) indicates that certain foods trigger physiological changes in sensitive individuals. You will also enjoy their 20-page guide, titled: A Parent’s Guide to Diet, ADHD Behavior You will also enjoy this letter from the authors to the HHS Secretary Donna Shalala at the Department of Health and Human Services
	What is Methylphenidate (Ritalin) National Library of Medicine's MedlinePlus Drug Information This page from the NLM is a real eye–opener!
	Drug-free Treatment for Attention Deficit Disorders Nutrition Science News (December 1998) Food, while nourishing, can also energize or subdue, comfort or agitate. A growing body of evidence implicates diet in the commonly diagnosed attention deficit disorder (ADD). Simple meal modification may eliminate the need for the frightening array of drugs being prescribed to control children. Diet can mean the difference between a normal childhood and years of difficult behavior or behavior-modifying drugs.
	Stress-Reducing Fatty Acids Also May Defuse Health Risks Nutrition Science News (May 1997) More than half of all patients who visit general physicians suffer from symptoms triggered or made worse by stress -- headaches, ulcers, fatigue or even emotional distress. Two research studies demonstrated that essential fatty acid nutritional supplements can increase resistance to stress--and its debilitating and costly side effects.
	Top Child Health Agencies Urge Testing to Protect Early Brain Development From Toxins: One Out of Six Affected Learning Disability Association of America One out of six children are suffering from behavioral disorder according to the Learning Disabilities Association and the National Institute of Environmental Health Sciences (NIEHS–NIU). Both are calling for research testing to recognize, reduce and eliminate the environmental toxins scientifically linked to learning disabilities.
	Fish Oil Could Be an Alternative to Ritalin Dr Basant Puri, a consultant and senior lecturer at Hammersmith Hospital in Ireland has been using sophisticated imaging techniques to study the role of fatty acids in brain function. He says he has unearthed a wealth of evidence about how supplementation with specific fatty acids can not only help those with ADD/ADHD (attention deficit/ hyperactivity disorder), but also dyslexia and dyspraxia.

Journal Abstracts About ADD/ADHD

A)   Chiropractic Care for ADD/ADHD

	Chiropractic Care for Pediatric and Adolescent Attention-Deficit/ Hyperactivity Disorder: A Systematic Review Chiropractic & Osteopathy 2010 (Jun 2); 18: 13 ~ FULL TEXT To date there is insufficient evidence to evaluate the efficacy of chiropractic care (reffing to solely spinal manipulation, as opposed to full holistic management by a chiropractor) for pediatric and adolescent AD/HD. The claim that chiropractic care improves paediatric and adolescent AD/HD, is only supported by low levels of scientific evidence. In the interest of paediatric and adolescent health, if chiropractic care for AD/HD is to continue, more rigorous scientific research needs to be undertaken to examine the efficacy and effectiveness of chiropractic treatment. Adequately-sized RCTs using clinically relevant outcomes and standardised measures to examine the effectiveness of chiropractic care verses no-treatment/placebo control or standard care (pharmacological and psychosocial care) are needed to determine whether chiropractic care is an effective alternative intervention for paediatric and adolescent AD/HD.
	The Chiropractic Care of Children with Attention-deficit/Hyperactivity Disorder: A Retrospective Case Series Explore (NY). 2010 (May); 6 (3): 173–182 Pediatric patients (aged < or =18 years) attending chiropractic care for a minimum period of five months following a medical diagnosis of ADHD were included in this review. Our review found four patient files satisfying the inclusion criteria. All patients were males, ranging in age from nine to 13 years (mean age, 10 years), with three patients having a history of medication use and two patients having prescribed medication at the start of chiropractic care. Using a 15–item parent/teacher ADHD questionnaire, the patients' responses to chiropractic care were monitored. Using the Friedman test to compare observations repeated on the same subjects, our findings found improvement in ADHD symptoms (ie, hyperactivity, impulsivity, and inattentiveness, as well as behavioral, social, or emotional difficulties) and provide supporting evidence on the effectiveness of chiropractic in the treatment of children with ADHD.
	Children, ADD/ADHD, and Chiropractic The Chiropractic Journal Psychiatrist Peter Breggin wrote, "Hyperactivity is the most frequent justification for drugging children. The difficult-to-control male child is certainly not a new phenomenon, but attempts to give him a medical diagnosis are the product of modern psychology and psychiatry. At first psychiatrists called hyperactivity a brain disease. When no brain disease could be found, they changed it to 'minimal brain disease' (MBD). When no minimal brain disease could be found the profession transformed the concept into 'minimal brain dysfunction.' When no minimal brain dysfunction could be demonstrated, the label became attention deficit disorder. Now it's just assumed to be a real disease, regardless of the failure to prove it so. Biochemical imbalance is the code word, but there's no more evidence for that than there is for actual brain disease." [1]
	Developmental Delay Syndromes: Psychometric Testing Before And After Chiropractic Treatment of 157 Children J Manipulative Physiol Ther. 2009 (Oct); 32 (8): 660–669 ~ FULL TEXT Each patient received a multimodal chiropractic treatment protocol, applied kinesiology chiropractic technique. The outcome measures were a series of 8 standardized psychometric tests given to the children by a certified speech therapist pre- and posttreatment, which evaluate 20 separate areas of cognitive function, including patient- or parent-reported improvements in school performance, social interaction, and sporting activities. Individual and group data showed that at the end of treatment, the 157 children showed improvements in the 8 psychometric tests and 20 areas of cognitive function compared with their values before treatment. Their ability to concentrate, maintain focus and attention, and control impulsivity and their performance at home and school improved.
	Comorbidity of Dyslexia, Dyspraxia, Attention Deficit Disorder (ADD), Attention Deficit Hyperactive Disorder (ADHD), Obsessive Compulsive Disorder (OCD) and Tourette's Syndrome in Children: A Prospective Epidemiological Study Clinical Chiropractic 2005 (Dec); 8 (4): 189–198 The patterns of comorbidity occurred with such frequency that it would suggest that there could be an argument for the downgrading of these conditions from disorders per se to symptoms and that further investigation might suggest that the patterns of comorbidity may fit the criteria for a developmental delay syndrome.
	Manual Therapy in Children: Proposals for an Etiologic Model J Manipulative Physiol Ther 2005 (Mar); 28 (3): e1–15 ~ FULL TEXT This article proposes such a framework through a model: the kinematic imbalances due to suboccipital strain (KISS) concept. This concept groups the symptoms and signs associated with functional disorders of the cervical spine into an entity linked to easily recognizable clinical situations. By using this concept as a term in the communication with other caregivers of infants and children, we may be able to improve the contact between pediatricians and specialists of MTC, thus facilitating the identification of those cases where the use of MTC will be most useful. The definition of a functional disorder that is caused primarily vertebrogenically enables pediatricians, physiotherapists, speech therapists, and others who address infants and schoolchildren to widen their scope of available therapeutic options and to include the “functional approach” [5] in their therapeutic considerations.
	Cervical Kyphosis is a Possible Link to Attention-deficit/hyperactivity Disorder J Manipulative Physiol Ther 2004 (Oct); 27 (8): e14 ~ FULL TEXT A 5–year-old patient was diagnosed with ADHD and treated by a pediatrician unsuccessfully with methylphenidate (Ritalin), Adderall, and Haldol for 3 years. The patient received 35 chiropractic treatments during the course of 8 weeks. A change from a 12 degrees C2–7 kyphosis to a 32 degrees C2–7 lordosis was observed after treatment. During chiropractic care, the child's facial tics resolved and his behavior vastly improved. After 27 chiropractic visits, the child's pediatrician stated that the child no longer exhibited symptoms of ADHD. The changes in structure and function may be related to the correction of cervical kyphosis.
	Chiropractors Offer Hope and Help to Children With Attention Deficit Hyperactivity Disorder (ADHD) American Chiropractic Association ~ September 27, 2002 In the past decade, prescriptions for Ritalin, a stimulant medication commonly used for attention deficit hyperactivity disorder (ADHD), increased five-fold, with 90 percent of all prescriptions worldwide consumed in the United States. As many parents grow leery of the traditional medical approach to ADHD, doctors of chiropractic are offering promising results with non-drug treatments that focus on postural muscles, nutrition and lifestyle changes that affect brain activity. You might also enjoy this 2 part article, titled: “Children with ADHD-Medical vs. Chiropractic Perspective and Theory” Part I as a webpage      OR    Part I as an Adobe Acrobat file (754 KB.) Part II as a webpage    OR    Part II as an Adobe Acrobat file (1.02 MB.)
	A Multi–faceted Chiropractic Approach to Attention Deficit Hyperactivity Disorder: A Case Report ICA Internat Rev Chiro 1995 (Jan): 41–43 An 11–year-old boy with medically diagnosed Attention Deficit Disorder has been a patient and student at the Kentuckian Children's Center for three years. His case shows a history of early disruptive experience, repeated ear infections, consistent temporomandibular joint dysfunction, heavy metal intoxication, food allergy, environmental sensitivity and multiple levels of biomechanical alteration. This report emphasizes the need for care of all aspects of the structural, chemical and mental triangle of health in children with Attention Deficit Hyperactivity Disorder.
	An Evaluation of Chiropractic Manipulation as a Treatment of Hyperactivity in Children J Manipulative Physiol Ther 1989 (Oct); 12 (5): 353–363 While the behavioral improvement taken alone can only be considered suggestive, the strong interest agreement can be taken as more impressive evidence that the majority of the children in this study did, in fact, improve under specific chiropractic care. The results of this study, then, are not conclusive, however, they do suggest that chiropractic manipulation has the potential to become an important nondrug intervention for children with hyperactivity. Further investigation in this area is certainly warranted.

B)   Abstracts Supporting Nutritional Intervention for ADD/ADHD

	Effects of a Restricted Elimination Diet on the Behaviour of Children With Attention-deficit Hyperactivity Disorder (INCA study): A Randomised Controlled Trial The Lancet 2011 (Feb 4); 377 (9764): 494–503 According to this new study published in Lancet, a restrictive diet free of processed foods significantly reduced symptoms of ADHD in 78% of children 4–8 years old. The 5–week study found with 100 subjects also found that upon re-introduction of problem foods into the diet, 63% experienced a relapse in ADHD symptoms.
	Study Links Nutrition and Children’s Behaviour Functional Foods & Nutraceuticals July 2005 The double-blind study gave the 5– to 12–year-old children, many of whom had accompanying attention deficit problems and dyslexia, either an olive oil placebo or a fish oil-derived omega-3 fatty acid supplement. Those on the supplement showed greatly increased concentration and ability to process information within three months of taking the supplement, with an average advancement in reading age of about nine months and spelling age of six months. Here's a report on the Durham Dyspraxia Trial.
	Outcome-based Comparison of Ritalin versus Food-supplement Treated Children with ADHD Alternative Medicine Review 2003 (Aug); 8 (3): 319–330 ~ FULL TEXT Numerous studies suggest that biochemical heterogeneous etiologies for AD/HD cluster around at least eight risk factors: food and additive allergies, heavy metal toxicity and other environmental toxins, low-protein/high-carbohydrate diets, mineral imbalances, essential fatty acid and phospholipid deficiencies, amino acid deficiencies, thyroid disorders, and B-vitamin deficiencies. The dietary supplements used were a mix of vitamins, minerals, phytonutrients, amino acids, essential fatty acids, phospholipids, and probiotics that attempted to address the AD/HD biochemical risk factors. These findings support the effectiveness of food supplement treatment in improving attention and self-control in children with AD/HD and suggest food supplement treatment of AD/HD may be of equal efficacy to Ritalin treatment.
	Long–chain Polyunsaturated Fatty Acids in Children With Attention–deficit Hyperactivity Disorder Am J Clin Nutr 2000 (Jan); 71 (1 Suppl): 327S–330S Several previous studies indicated that some physical symptoms reported in ADHD are similar to symptoms observed in essential fatty acid (EFA) deficiency in animals and humans deprived of EFAs. In another study using contrast analysis of the plasma polar lipid data, subjects with lower compositions of total n–3 fatty acids had significantly more behavioral problems, temper tantrums, and learning, health, and sleep problems than did those with high proportions of n–3 fatty acids.
	Essential Fatty Acid Metabolism in Boys With Attention–deficit Hyperactivity Disorder Am J Clin Nutr 1995 (Oct); 62 (4): 761–768 Attention–deficit hyperactivity disorder (ADHD) is the term used to describe children who are inattentive, impulsive, and hyperactive. The cause is unknown and is thought to be multifactorial. Based on the work of others, we hypothesized that some children with ADHD have altered fatty acid metabolism.

C)   Side–Effects of Methylphenidate (Ritalin)

	The Sleep of Children With Attention Deficit Hyperactivity Disorder on and off Methylphenidate: A Matched Case-control Study J Sleep Res 2010 (Jun); 19 (2): 366–373 In the present study, we assessed the effects of regular use of methylphenidate medication in children diagnosed with attention deficit hyperactivity disorder (ADHD) on sleep timing, duration and sleep architecture. Methylphenidate in ADHD children prolonged sleep onset by an average of 29 min, and reduced sleep efficiency by 6.5%, and shortened sleep by 1.2 hours. An adequate amount of sleep is integral to good daytime functioning, thus the sleep side effects of methylphenidate may affect adversely the daytime symptoms the drug is targeted to control.
	Cerebral Arteritis Following Methylphenidate Use J Child Neurol 2000 (Apr); 15 (4): 265–267 Stroke is a well–documented complication of amphetamine abuse. Methylphenidate, chemically and pharmacologically similar to amphetamines, is widely used in the treatment of attention deficit disorder in children. The possibility of vasculitis connected to methylphenidate should not be surprising. A case is reported of stroke associated with ingestion of methylphenidate in an 8–year–old boy.
	Methylphenidate, Tics and Compulsions Encephale 2000 (Mar–Apr); 26 (2): 45–47 Obsessive compulsive (OC) symptoms following methylphenidate (MPH) administration are seldom reported and usually not even mentioned among its adverse effects. We report here a case of MPH–induced OC symptoms which began ten months after the treatment was initiated and that were exacerbated 14 months later.
	Suspected Adverse Methylphenidate–imipramine Interactions in Children J Dev Behav Pediatr 1986 (Aug); 7 (4): 265–267 Two cases are presented which illustrate the dangers inherent in utilizing a polypharmacy approach in treating children with psychotropic medication. In each case, severe adverse effects, including cognitive and mood deterioration, were experienced by the child when treated with a combination of methylphenidate and imipramine.

D)   Abstracts About Reducing Exposure to Household Toxins

Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management Alternative Medicine Review 2000 (Oct); 5 (5): 402–428 ~ FULL TEXT An intense debate has developed around the diagnosis, etiology, and medical management of ADHD. Parent groups, consumer advocacy organizations, and progressive physicians are calling for alternatives to methylphenidate and the many other potent stimulants used to treat ADHD, while pharmaceutical interests and physicians particularly oriented to prescribing pharmaceuticals attempt to defend the status quo (currently in the United States, between 1.5 million and 3 million ADHD children are likely taking methylphenidate). This review is intended to bring the medical and scientific issues surrounding ADHD into sharper focus, to better define a wholistic/integrative strategy for its medical management.

Parallels Between Attention Deficit Hyperactivity Disorder and Behavioral Deficits Produced by Neurotoxic Exposure in Monkeys Environ Health Perspect 2000 (Jun 3); 108 Suppl: 405–408 Both lead and PCB exposure produce deficits on discrimination reversal and spatial delayed alternation performance; treated monkeys exhibit deficits in their ability to change an already established response strategy and inhibit inappropriate responses. Monkeys exposed developmentally to lead or PCBs also perform differently from control monkeys on a fixed interval schedule of reinforcement, which requires the temporal organization of behavior using only internal cues. Whereas the etiology of ADHD is multifactorial, the possibility that neurotoxic agents in the environment contribute to the incidence of ADHD warrants attention.

E)   ADD/ADHD and Food Colourings and/or Preservatives

	Food Additives and Hyperactive Behaviour in 3–year-old and 8/9–year-old Children in the Community: A Randomised, Double-blinded, Placebo-controlled Trial The Lancet 2007 (Nov); 370 (9598): 1560–1567 This carefully controlled study shows that some artificial additives increase hyperactivity and decrease attention span in a wide range of children, not just those for whom overactivity has been diagnosed as a learning problem. You may also enjoy this New York Times review.
	The Effects of a Double Blind, Placebo Controlled, Artificial Food Colourings and Benzoate Preservative Challenge on Hyperactivity in a General Population Sample of Preschool Children Arch Dis Child 2004 (Jun); 89 (6): 506–511 There is a general adverse effect of artificial food colouring and benzoate preservatives on the behaviour of 3 year old children which is detectable by parents but not by a simple clinic assessment. Subgroups are not made more vulnerable to this effect by their prior levels of hyperactivity or by atopy.
	Foods and Additives Are Common Causes of the Attention Deficit Hyperactive Disorder in Children Ann Allergy 1994 (May); 72 (5): 462–468 This study demonstrates a beneficial effect of eliminating reactive foods and artificial colors in children with ADHD. Dietary factors may play a significant role in the etiology of the majority of children with ADHD.
	Synthetic Food Coloring and Behavior: A Dose Response Effect in a Double–blind, Placebo–controlled, Repeated–measures Study J Pediatr 1994 (Nov); 125 (5 Pt 1): 691–698 Behavioral changes in irritability, restlessness, and sleep disturbance are associated with the ingestion of tartrazine in some children. A dose response effect was observed.
	Synthetic Food Colourings and "Hyperactivity": A Double-blind Crossover Study Aust Paediatr J 1988 (Apr); 24 (2): 143–147 The findings raise the issue of whether the strict criteria for inclusion in studies concerned with 'hyperactivity' based on 'attention deficit disorder' may miss children who indicate behavioural changes associated with the ingestion of food colourings. Moreover, for further studies, the need to construct a behavioural rating instrument specifically validated for dye challenge is suggested.

Other Management Approaches for ADD/ADHD

Study Links Nutrition and Children’s Behaviour Functional Foods & Nutraceuticals July 2005 The double-blind study gave the 5– to 12–year-old children, many of whom had accompanying attention deficit problems and dyslexia, either an olive oil placebo or a fish oil-derived omega-3 fatty acid supplement. Those on the supplement showed greatly increased concentration and ability to process information within three months of taking the supplement, with an average advancement in reading age of about nine months and spelling age of six months. Here's a report on the The Durham Dyspraxia Trial.

Attention Deficit/Hyperactivity Disorder (ADHD) in Children: Rationale for Its Integrative Management Alternative Medicine Review 2000; 5 (5) Oct: 402–428 ~ FULL TEXT The exact etiology is unknown; genetics plays a role, but major etiologic contributors also include adverse responses to food additives, intolerances to foods, sensitivities to environmental chemicals, molds, and fungi, and exposures to neurodevelopmental toxins such as heavy metals and organohalide pollutants. Nutrient deficiencies are common in ADHD; supplementation with minerals, the B vitamins (added in singly), omega-3 and omega-6 essential fatty acids, flavonoids, and the essential phospholipid phosphatidylserine (PS) can ameliorate ADHD symptoms. When individually managed with supplementation, dietary modification, detoxification, correction of intestinal dysbiosis, and other features of a wholistic/integrative program of management, the ADHD subject can lead a normal and productive life.

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