It is a part of an epidemic, rampant in our children and spilling into adulthood. ADHD and ADD, or attention-deficit/hyperactivity disorder, continues to challenge parents, teachers and doctors, leaving them looking for answers that are often pharmaceutical.
ADHD, like many other conditions that affect our children today, is another hallmark of inflammation and the result of an interplay between diet, genetics, environmental triggers and lifestyle. Like much of what we talk about with other diseases, ADHD requires a well-rounded, holistic approach, not a one shot solution, or doctors and parents find themselves playing medication roulette, constantly adjusting and changing doses of medications to get results. The more I work with ADHD, the more I understand that it is not a learning issue or a neurological issue; instead it is that blend of multiple factors that work together to alter the chemistry of our brains, rendering them inattentive or hyperactive.
The first step in managing ADHD is to really get to the core or root of the symptoms. There are many different types of ADHD and for each child, the cause can be very different. Here are my steps to managing ADHD in practice and at home.
Step 1: Find Your (or Your Child’s) ADHD Type
Type 1: The Serotonin Imbalance
Serotonin, or the feel good neurotransmitter, is primarily manufactured in the gut. When too low or too high, children can display signs of poor impulse control, aggression and inattention. Adults can experience low serotonin symptoms like anxiety, which impair their ability to focus. Researchers have found a gene correlating to serotonin balance that can be passed down through a family, but has to be activated or turned on by cellular environment or chemistry (1).
Anxiety, mild depression and sleep disorders are additional signs of low serotonin. High serotonin levels typically result in more aggression and issues with impulse control.
Risk factors for Type 1 ADHD include low cholesterol levels, low fatty acids and depleted B vitamins, all key ingredients for serotonin production and regulation.
Type 2: Dopamine
Dopamine is another neurotransmitter, made in the gut, but critical in attention and learning. Dopamine regulates the pleasure response or the sense of well-being. Low dopamine will result in inattention, forgetfulness and poor impulse control. High dopamine, on the other hand, makes the mind race and increases sensory processing issues and excitability. (2)
Many of the current ADHD drugs focus on dopamine regulation, including Ritalin, Strattera and Concerta. Natural alternatives to improving dopamine include increasing the intake of tyrosine and phenylalanine, amino acids that boost dopamine production, along with phosphatidylserine- now available in prescription form as Vayarin.
Type 3: Norepinephrine/ Epinephrine
Low and high levels of norepinephrine and epinephrine are associated with ADHD. These are the adrenaline hormones that help regulate attention. Many of the stimulant medications act on norepinephrine and epinephrine regulation. This includes medications like Adderall and Ritalin (3).
Children with norepinephrine imbalances have inattention and hyperactivity. Trying to regulate their “adrenaline” brains becomes a key focus. Improving sleep quality and exercise are two very critical components of norepinephrine and epinephrine imbalance.
Type 4: Glutamate/ Gaba Imbalance
Low gaba levels are also associated with ADHD. The gaba-glutamate balance of neurotransmitters plays a role in ADHD. Low gaba is usually accompanied by inattention while high glutamate levels can lead to aggression and impulsivity. GABA, like serotonin, is primarily processed and manufactured in the gut.
Gaba is an amino acid and neurotransmitter that calms the brain, while glutamate is more excitatory in nature, wiring the brain or putting it in overdrive. There are medications that increase gaba, but are not recommended for routine use. These medications include xanax, ativan and valium (4).
Instead, gaba can be increased by increasing amino acids and supplementing with niacin and theanine, which seem to cross the blood brain barrier easier than supplementing with gaba alone.
Step 2: Find Your Child’s Learning Style
It’s not all chemistry! Understanding your child’s learning style and matching that style to the classroom is important for school success. Sometimes a child’s frustration with school, classmates or teachers can be mislabeled as ADHD.
Leaders need challenge, recognition and accomplishment. The right classroom for a leader is one in which they are given the chance to lead and be an example for their peers. Repetitive or redundant work may be irritating for a leader, so make sure they are challenged! These are the children who light up with project based learning rather than worksheets or assignments. They also are good collaborators.
Curious and investigative, the hunter seeks new opportunities and unusual experiences. An overly structured classroom may not be best for the hunter, whose keen mind wants to explore beyond what is given to him. The hunter is your researcher, investigative journalist or explorer; their minds stretch beyond the boundaries of an assignment and look for the oddities, synchronicities and surprises.
Imaginative and creative, your artist child may have trouble staying grounded in a traditional classroom. These kids do better on the floor, on their backs or in settings where their imagination is allowed to flourish. Montessori or progressive education models are best for the artist child. You can find them drawing, painting, building, or just creating.
Conflict in the classroom can be disturbing for peacekeepers who just want everyone to get along! The social environment of the class is key to attention and concentration, since peacekeepers can only thrive when there is harmony in the classroom. These kids are often highly intuitive, getting anxious when there is tension, noise or disturbance in the classroom.
Analytical and methodical, these kids DO need the structure of a classroom and opportunities to build and create. These children will do well in school but may need a balance of rigorous academics with outlets for building and constructing- think legos, design thinking and robotics!
Step 3: Find the Core Cause
While medicating or enhancing the neurotransmitter imbalance and examining the classroom are the fundamentals of ADHD management, getting to the root, or centre, of this issue usually is the key to lasting success. Again, I have had the opportunity to work with thousands of ADHD patients and here are the patterns that I see over and over again.
It’s all about the gut! I really do believe that this is ground zero for ADHD. Research is supporting what we see in practice. The microbiome, affected by food allergies, intolerances and the digestive system directly impact all the neurotransmitters. Losing fat, due to malabsorption can affect behavior as well (5).
Using digestive enzymes, gut builders like inulin or glutamine are a few strategies to improve digestive health. Probiotics can help the microbiome as well, but each child often needs an individualized plan.
With a direct impact on digestion, food allergies and food intolerances can have an impact on digestive health and affect behavior and focus. The most common culprits are gluten, dairy, sugar and preservatives. Many of the preservatives and dyes in food today function as excitotoxins, affecting the brain and triggering neuro-inflammation (6).
Especially for the adrenaline type ADHD, children with ADHD need more sleep. Helping them get to sleep can be a challenge. Adding in magnesium or melatonin can help with better sleep hygiene, but parents should aim for at least 10 hours of sleep in children with ADHD.
With a lower overall stress tolerance, children with ADHD may need outlets to manage stress- so that anxiety is not being masked by a diagnosis of ADHD. Teaching children stress management tools, including breath work, journaling or guided imagery is helpful. Sports, nature and losing the electronics also help with stress management (7).
Finally, studies show there is a genetic link to ADHD and there can be a familial tendency. But, like all genetic markers, it is the environment and chemistry that activates these genes and determines the health journey. MTHFR variants are among the gene markers that influence expression of ADHD and are variants in COMT (8).
A number of studies are starting to show the relationship between prenatal and early infant exposure to toxins and diagnosis of ADHD. These include thimerisol, bisphenol A (BPA), lead, mercury and polychlorinated biphenyls, found in industrial waste (9,10).
Putting It All Together
I know this is a lot of information, but once we all realize the many pieces to the ADHD puzzle, we can work together to get our kids – and ourselves – thriving and focused! At CentreSpring MD, we can help you and your child put together a comprehensive plan to beat ADD and ADHD and leave your child less medication dependent. From natural solutions to medication, our recommendations our individualized and personalized for you.
|Dr. Tasneem Bhatia, MD, is a board-certified physician, specializing in integrative and emergency medicine, pediatrics and prevention, with expertise in women’s health, weight-loss and nutrition. She is the author of “What Doctors Eat” and “The 21-Day Belly Fix.”|
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