Attention deficit and hyperactivity disorder (ADHD) is not just for kids. Difficulty concentrating, inability to complete tasks, forgetfulness and other symptoms in adults can be due to ADHD. ADHD can cause significant problems in adults, ranging from increased anxiety, depression, substance abuse, financial problems, poor job performance and social difficulties.
Diagnosis of adult ADHD is important and management of symptoms, through mainstream or Naturopathic treatments should be considered to improve quality of life for people with this condition.
Diagnosis of Adult ADHD
It is estimated that 4% of North American adults have ADHD, a disorder that is most commonly diagnosed in childhood and persists through adolescence and into adulthood.
Diagnosis of adult ADHD is very similar to that of children. Diagnosis requires confirmation of at least 6 ADHD traits within the inattentive or impulsive/ hyperactive categories, or in both. Impairment must also be present within at least 2 life settings. The Adult ADHD self report scale is also a useful tool for identifying adult ADHD.
DSM-IV Criteria for ADHD
Inattention Symptoms
Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.- Often has trouble keeping attention on tasks or other activities.
- Often does not seem to listen when spoken to directly.
- Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
- Often has trouble organizing activities.
- Often avoids, dislikes, or doesn’t want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
- Often loses things needed for tasks and activities (e.g. school assignments, pencils, books, or tools).
- Is often easily distracted.
- Is often forgetful in daily activities.
Hyperactivity Symptoms
- Often fidgets with hands or feet or squirms in seat when sitting still is expected.
- Often gets up from seat when remaining in seat is expected.
- Often excessively runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
- Often has trouble doing leisure activities quietly.
- Is often “on the go” or often acts as if “driven by a motor”.
- Often talks excessively.
Impulsivity Symptoms
Often blurts out answers before questions have been finished.- Often has trouble waiting one’s turn.
- Often interrupts or intrudes on others (e.g., butts into conversations or games).
Six or more of any of the above symptoms, persisting for at least 6 months to a point that causes disruption in daily activities and work performance is adequate for a diagnosis of adult ADHD.
A diagnosis of ADHD must also eliminate the possibility that the symptoms are due to another disorder such as a mood disorder, anxiety disorder, personality disorder, schizophrenia or other diagnosis.
What Causes ADHD?
No one knows what leads to ADHD in children or adults. It is known that genetics plays a significant role in the development of ADHD – if your parents, siblings or children have ADHD you are more likely to have it as well.
Food allergies or sensitivities have also been suggested as a potential causative factor in the development of ADHD. The Feingold diet has been used since the 1970s to treat ADHD by eliminating food additives, dyes and salicyclates.
Some research suggests that a gene affecting the transport of the neurotransmitter dopamine may be a factor. This gene increases dopamine transport, leading to dopamine inactivation. Less available dopamine can impair memory and some brain functions.
Researchers also suggest that norepinephrine (another neurotransmitter) may also have a role in ADHD. Without sufficient norepinephrine the brain can’t respond fully to new stimuli.
Other researchers think that ADHD is just an imbalance in overall neurotransmitter activity. Dopamine may be over-active when compared to norepinephrine, but under-active when compared to serotonin. Ask your Naturopathic Doctor to give you a questionnaire to assess your individual neurotransmitter balance.
Natural Treatment Options for Adult ADHD
ADHD is usually treated with prescription stimulant medications. Many people diagnosed with ADHD do not want to take these medications and seek out natural treatment options. Luckily there are many highly effective treatment options available, and a comprehensive individualized approach to adult ADHD can diminish or eliminate many of the symptoms and promote lifelong health.
Food Allergy Elimination/ Feingold Diet
Allergies to food or food additives have been suggested as a causative agent for ADHD in children and adults. The Feingold diet was the first of many diets to eliminate preservatives and dyes in food to manage symptoms of ADHD. Eliminating known food allergens (identified through IgG or IgA blood tests) can also decrease severity of ADHD symptoms.
Balance Neurotransmitters
As discussed above, imbalances in neurotransmitters – both frank deficiencies (overall low levels) and relative deficiencies (low levels of one or more neurotransmitter related to another) can lead to symptoms of ADHD. Stimulant medications, like Ritalin are used in ADHD to increase norepinephrine and dopamine activity in the brain. However, these stimulants can have significant side effects such as decreased appetite, insomnia, and jitteriness.
Your Naturopathic Doctor can use a questionnaire to help identify your individual neurotransmitter balance and uncover deficiencies. This information is used to tailor a treatment to balance your neurotransmitters and enhance your overall health without the negative side effects of stimulant medications.
Nutritional supplements are used to help balance levels of dopamine, serotonin, norepinephrine and acetylcholine. SAMe (S-adenosyl-L-methionine), phosphatidylserine, L-carnitine, iron, B vitamins, and tyrosine all have been used in the treatment of adult ADHD to balance individual neurotransmitters.
Essential Fatty Acids
Essential fatty acids are just that – essential. Our bodies need them, but can not produce them. They must come from dietary sources. Levels of omega-3 and omega-6 fatty acids have been shown to be lower in people with ADHD than in people without it. Additionally, men need nearly three times the volume of daily essential fatty acids compared to women to function well. This may be one reason why ADHD is more common in boys and men.
Fish oils are the preferred form of essential fatty acid supplements. Various studies have shown that supplemental fish oil improves cognitive function, behaviour, hyperactivity, and inattentiveness in patients with ADHD. Omega 3s are necessary for health and should be taken by all individuals with ADHD, both adults and children.
Zinc and Magnesium
Zinc and magnesium are two nutrients that appear in lower concentrations in people with ADHD. Magnesium deficiency can mimic the symptoms of ADHD (hyperactivity, irritability, fatigue, difficulty sleeping, poor concentration, and restlessness). Zinc has been shown in studies to improve response to ADHD therapies – natural or pharmaceutical.
Ginkgo biloba and American ginseng (Panax quinquefolius)
Ginkgo biloba increases blood flow to the brain and when combined with American ginseng has been shown to improve some symptoms of ADHD. Research has suggested that the combination of these two botanicals is more useful than either one in isolation.
L-Theanine
A component in green tea, L-theanine is used to promote a state of calm alertness. Suggested to be partially responsible for the calm seen in zen monks, it has a long history of use as a natural stimulant.
These, and other natural treatments can be effective in managing ADHD in adults when used properly. It is not recommended that you attempt to self medicate with these treatments, but instead seek out the care of a knowledgeable Naturopathic Doctor who can individualize your treatment and support you through your journey to health.
Disclaimer
The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.
Selected References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000.
Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med 1999;340:780-8.
Kessler, R.C., Adler, L., Barkley, R., Biederman, J., et al. The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. Am Journal of Psychiatry (2006), 163:724-732.
Lyon MR, Cline JC, Totosy de Zepetnek J, et al. Effect of the herbal extract combination Panax quinquefolium and Ginkgo biloba on attention-deficit hyperactivity disorder: a pilot study. J Psychiatry Neurosci 2001;26:221-8.
Mitchell EA, Aman MG, Turbott SH, Manku M. Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clin Pediatr (Phila) 1987;26:406-11.
Oades RD. Dopamine may be ‘hyper’ with respect to noradrenaline metabolism, but ‘hypo’ with respect to serotonin metabolism in children with attention-deficit hyperactivity disorder. Behav Brain Res 2002;130:97-102.
Shekim WO, Antun F, Hanna GL, et al. S-adenosyl-L-methionine (SAM) in adults with ADHD, RS: preliminary results from an open trial. Psychopharmacol Bull 1990;26:249-53.
As a doctor who has and treats adult ADHD, I often recommend dietary changes as you’ve suggested. I’m a big believer in EFAs (Essential Fatty Acids) for numerous reasons ranging from decreased inflammation to healthy skin and hair and have recently discovered first-hand the benefits of the amino acid L-Theanine for increasing alertness without increasing anxiety. It’s great to see a well balanced article about adult ADHD and natural options for improving. Keep up the great work.
Thanks for the lovely compliment Dr. Fairweather!