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Neurology Now:
doi: 10.1097/01.NNN.0000279080.99700.4c
Department: Ask the Experts

Your Questions Answered: ADHD

Brown, Lawrence W. M.D.

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Lawrence W. Brown, M.D., is associate professor of neurology and pediatrics at Children's Hospital of Philadelphia.

Q Are there any effective alternatives to medication for my son's attention-deficit disorder?

A A diagnosis of ADHD (attention-deficit hyperactivity disorder) implies significant difficulties with attention, hyperactivity, or impulsivity in multiple settings—difficulties that go beyond appropriate development expectations for that child, interfere with the child's life, and cannot be medically explained in any other way.

Figure. DR. LAWRENCE...
Figure. DR. LAWRENCE...
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A child who is having academic trouble should first be evaluated with psychoeducational testing and treated with learning support. Even when a child fulfills all of the criteria for ADHD, medication should not be the first or only treatment. Behavioral management in school may include selective seating and a behavior chart using appropriate rewards and consequences. The behavioral approach is even more important for preschoolers because hyperactivity and social difficulties are less likely to be specific to ADHD at that age. If behavioral management hasn't completely resolved the child's problems, pharmacological treatment is by far the most effective approach, and it has a long history of safety and efficacy.

If you are trying to avoid stimulants or other medications, there are alternatives. Some studies have shown that a diet that eliminates foods containing dyes and preservatives may control ADHD symptoms, especially in younger children from families with a history of food allergies and migraine.

You could also try relaxation training and other mind-body approaches. Most other alternative approaches should be avoided because they remain untested or unproven. These include dietary supplements (essential fatty acids or herbal preparations), homeopathy, biofeedback, massage, vestibular training, and antifungal therapy. Megavitamins are probably ineffective and possibly dangerous, as they can cause nerve injury and liver damage. Lead chelation, thyroid treatment, and nutrient replacement may also be ineffective or dangerous except for those rare children whose ADHD symptoms are actually caused by lead poisoning, thyroid disease, or nutrient deficiencies. Non-traditional therapies may delay appropriate treatment and many have their own risks, so speak to your neurologist before experimenting with any of them.

©2007 American Academy of Neurology

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