How Nutrition as a supplement to the treatment of ADHD

Complementary and alternative treatments for ADHD are in high demand, highly promoted, and yet poorly supported by empirical evidence. However, they are still necessary. I reviewed much of this landscape a few years ago in Getting Ahead of ADHD (2017). Although multiple stimulants and non-stimulant medications for ADHD are available and well-studied over the past 70 years and provide significant help for most patients, concerns remain. Its long-term value is less clear.

Side effects discourage continued use for many patients, and discontinuation rates are high (perhaps contributing to unclear long-term benefits in many studies).

Fortunately, evidence is rapidly accumulating on several fronts to support complementary treatments.

One of the most promising treatments is multi-nutrient supplementation. The latest study warranted an editorial in the most recent (August) issue of the Journal of the American Academy of Child and Adolescent Psychiatry. She was referencing a study by Johnstone and her colleagues at the Oregon Health & Science University ADHD Research Center.

Multinutrient supplementation, in this case, does not mean a commercially available vitamin pill. Rather, it refers to a complete package of all vitamin and mineral nutrients in doses higher than the Recommended Daily Minimum but lower than the maximum tolerable dose. The study by Johnstone et al. was the second double-blind, randomized, controlled trial of this treatment to be completed in children. It was the first time it had been done in the United States (previous studies were done in New Zealand and elsewhere).

Johnstone and his colleagues studied 135 children (ages 6 to 12) with ADHD. They received supplements or a placebo for eight weeks while remaining drug-free. In the treatment group, more than 50 percent were classified as having improved physician ratings, compared to just 18 percent in the placebo group. Notably, all of these children had elevated symptoms or irritability (temper tantrums and difficult-to-regulate emotions). Those symptoms are among the outcomes that improved in this study and a previous one.

The future of complementary nutritional supplements

There is still work to be done to optimize the dose, reach a larger population to participate in the trial, test this supplement in combination with other treatments, and understand how the supplements work. Still, these results are very promising.

Brain function requires a full and integrated range of vitamins and minerals for its many steps of neurotransmitter synthesis and signaling, as well as to maintain healthy cells. If a subset of children with ADHD has difficulty processing nutrients, then an extra-high dose would be helpful.

The editorial concluded that "micronutrients may provide a more benign combined intervention with behavioral treatment for ADHD, especially for people with problems associated with emotion regulation."

That result fits with previous work in our lab, showing that it is possible to mathematically identify a subgroup of children with ADHD who have marked difficulties with emotion regulation and, as a result, may need a modified treatment regimen.

Thus, the stars may align to identify clinically significant subgroups of children with ADHD and optimize their treatment recommendations accordingly in relation to emotional functioning