ADHD

What is ADHD?

ADHD is a neurodevelopmental condition that has long been recognized to negatively impact cognitive and social functioning, work and school productivity, and quality of life of sufferers. Children with ADHD show patterns of developmentally inappropriate levels of hyperactivity, inattentiveness, or impulsivity (Wolraich et al., 2019a). Approximately 5.29% of children are affected by ADHD worldwide (Polanczyk et al., 2007) and this condition has a significant global socio-economic burden (Sayal et al., 2018). A study by Schoeman and de Klerk (2017) found that between 2-16% of children worldwide are diagnosed with ADHD. ADHD may persist into adulthood, with around 2.5 – 4.3% of adults being affected (Schoeman & de Klerk, 2017; Fayyad et al., 2007).

Treatment

 Conventional treatment of ADHD

Conventional treatment of ADHD includes non-pharmacologic treatments as well as pharmacological therapy, which primarily includes the use of stimulant or non-stimulant medications (Catalá-López et al., 2015).

• Pharmacological treatment

Stimulant medication usually includes methylphenidate and amphetamines, which act to boost norepinephrine and dopamine neurotransmission in the prefrontal cortex. Possible side effects include loss of appetite, nausea, gastroenteritis, weight loss, insomnia, transient headaches, exacerbation of tics, behavioural rebound, tachycardia or a hypertensive state. Irritability, psychosis, mania and severe depression are more serious adverse effects associated with the use of stimulants (Brown et al., 2018). Non-stimulant medications include selective norepinephrine reuptake inhibitors and alpha-2-agonists, and these may be prescribed when stimulants are ineffective or produce severe adverse effects. Side effects of non-stimulant medications may include anorexia, nausea, vomiting, diarrhoea, fatigue, mood changes and dizziness; these side effects may subside with continued use. There is limited data on the long-term effectiveness and safety of ADHD medications (Brown et al., 2018).

• Non-pharmacological treatment

Non-pharmacological treatment typically consists of behavioural accommodation therapy (Sprich et al., 2015) psychosocial therapy, cognitive training, neurofeedback, dietary modification, coaching programs, mindfulness therapies as well as motivational interviews (Caye et al., 2018).

Homeopathic treatment

·        Organotherapy

Organotherapy is a sub-classification of a group of remedies known as sarcodes. Sarcodes are homeopathic remedies made from organ extract. They are potentized preparations containing healthy organs, tissues and/or their secretions of humans and animals. These substances from which the medicine is produced consists of biological molecules that have a particular physiological function within the human body.

(Mashru et al., 2017). Brain. In the Delphi technique participants indicated that the Brain (Cerebrum) organotherapy remedy is useful in the management of ADHD in children. As described above the Brain organotherapy remedy may be used to stimulate, balance or suppress physiological function within the brain. This means it can improve memory, cognitive function and concentration, by stimulating or balancing the physiological function (Kuznetsova & Lukach., 2004). Adrenal The Adrenal organotherapy remedy was identified by the participants of the Delphi study. The stimulation, balance or suppression action of this remedy is determined by the potency in which it is prescribed (Mashru et al., 2017).

·        Tissue salts

Tissue salts are mineral compounds that can be utilized in the management of medical conditions (Helmstädter, 2006). In this study two of the twelve tissue salts in use today were identified as being useful in the management of ADHD in children. Kali phos and Mag phos. Tissue salts for Healthy Living by Margaret Roberts (2008), described Kali phos as the natural tranquilizer, it may be used as complementary treatment in the management of hyperactivity. Mag phos is described as the “antispasmodic” remedy and it is well indicated as a nerve and muscle relaxant and nutrient. Mag phos may also assist with restlessness (Roberts, 2008).

·        Mother tinctures

Mother tinctures are a low potency homeopathic remedy manufactured in accordance with homeopathic pharmacopeia. Homeopathic mother tinctures are prescribed based on their autotropic effect and play a vital role in homeopathic treatment (Jütte & Riley., 2005; Csupor et al., 2013). The following mother tintures achieved consensus in this study: Avena sativa is a remedy made from milky oat seeds. According to Vermeulen (2011) Avena sativa is indicated for the inability to keep the mind focused on any one subject, for mental exhaustion and anxiety. Kennedy et al. (2020) found that Avena sativa improves cognitive function. It is considered to be a nourishing nerve tonic (Akhondzadeh, 2017).

Passiflora incarnata is an effective remedy for reducing stress reactivity, anxiety, depression-like behaviour and insomnia. It is made from the purple passionflower. The pharmaceutical effect of this remedy can be compared to that of conventional medications such as Oxazepam or Midazolam (Janda et al., 2020).

Valeriana officinalis. The effect of Valeriana officianlis in the management of ADHD was assessed in a double-blind placebo-controlled pilot study. Participants in the study showed improvement of symptoms especially in sustained inattention, as well as hyperactivity and/or impulsivity. The therapeutic effect is attributed to the Valerenic acid acting on the gamma-aminobutyric acid (GABA) receptors, as GABA is the main inhibitory neurotransmitter of the brain (Ahn et al., 2016).

·        Nosodes

Vieracker (2015) defines nosodes as homeopathic remedies obtained from disease products, whereas Rieder & Robinson (2015) define them as biological preparations utilized in homeopathic practice to prevent disease. Nosodes identified in this study is Medorrhinum and Tuberculinum. Further research on the efficacy of these nosodes for the management of ADHD in children is required.

·        Health supplements

Health supplements are defined as any substance, extract or mixture of substances as determined by the South African Health Products Regulatory Authority (SAHPRA), sold in dosage form used or purported for use in restoring, correcting or modifying any physical or mental state by, complementing health; supplementing the diet; or have a nutritional effect (SAHPRA, 2014). The following has been recommended in the management of ADHD in children.

• Omega 3
• Magnesium
• Vitamin B complex
• Probiotic and
• Prebiotic

• Dietary intervention
• It is advised to eliminate artificial colourants
• It is advised to eliminated artificial flavourants
• It is advised to eliminate artificial sweeteners
• It is advised to avoid preservatives
• It is advised to eliminate refined sugar
• It is advised to eliminate gluten and
• It is advised to avoid stimulants such as caffeine
• A whole foods diet is recommended
• Patients should be advised to include superfoods in their diet
• Patients should be advised to increase vegetables and fruit in their diet
• It is advised to increase water intake
• Consumption of fermented foods is recommended
• An anti-inflammatory diet is recommended.

·        Lifestyle interventions

• Yoga
• Breathing techniques
• Physical activity
• Meditation
• Fixed home routine and boundaries
• Limiting blue light exposure

Ahn J., Ahn H.S., Cheong J.H., & dela Peña I. (2016). Natural Product-Derived Treatments for Attention-Deficit/Hyperactivity Disorder: Safety, Efficacy, and Therapeutic Poten. Neural Plasticity. [Online]. Available at: doi: 10.1155/2016/1320423.

Akhondzadeh S., Mohammadi M.R. & Momeni F. (2005). Passiflora incarnata in the treatment of attention-deficit hyperactivity disorder in children and adolescents. Therapy. Volume 2(4), pp.609-614. [Online]. Available at: https://www.openaccessjournals.com/articles/passiflora-incarnata-in-the-treatment-of-attentiondefici.

Brown K.A., Samuel S., Patel D.R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Translational Paediatrics. Volume 7 (1), pp 36- 47 doi: 10.21037/tp.2017.08.02.

Catalá-López F., Hutton B., Núñez-Beltrán A., Mayhew A.D., Page M.J., Ridao M., Tobías, A., Catalá M.A., Tabarés-Seisdedos R., Moher D. (2015). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adoles. Systemic Review Journal. Volume 4(Articale 19), [Online]. Available at: doi.org/10.1186/s13643-015-0005-7

Fayyad J., De Graaf R., Kessler R., Alonso J., Angermeyer M., Demyttenaere K., De Girolamo G., Haro J.M., Karam E.G., Lara C., Lépine J.P., Ormel J., Posada-Villa J., Zaslavsky A.M., Jin R. (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry. Volume 190(5), pp 402-409. doi:10.1192/bjp.bp.106.034389.

Helmstädter A. (2006). [Wilhelm Heinrich Schüssler’s healing system “Biochemie” and its further development by Dietrich Schöpwinkel]. Gesnerus. Volume 63 (3-4), pp.240-258. [Online]. Available at: https://pubmed.ncbi.nlm.nih.gov/17451116/

Janda K., Wojtkowska K., Jakubczyk K., Antoniewicz J., Skonieczna-Żydecka K. (2020). Passiflora incarnata in neuropsychiatric disorders—A systematic review. Nutrients. Volume 12 (12), p 3894. [Online]. Available at: doi: 10.3390/nu12123894

Jütte R., Riley D. (2005). A review of the use and role of low potencies in homeopathy. Complementary Therapies in Medicine. Volume 13(4), pp.291-296. [Online]. Available at: doi: 10.1016/j.ctim.2005.10.003.

Kuznetsova S.M. & Lukach O.I. (2004). Effect of cerebrum compositum preparation on functional state of the central nervous system in elderly patients with ischemic strokes. Likars’ka sprava. Volume 5-6, pp.88-93. [Online]. Available at: https://pubmed.ncbi.nlm.nih.gov/15605833/

Mashru R., Gandhi K., Ekta A., Raole V. (2017). Sarcode therapy as a restorative of health. World Journal of Pharmacy and Pharmaceutical Sciences. Volume 6(8), pp.2579-2598. [Online]. Available at: https://www.academia.edu/36317140/SARCODE_THERAPY_AS_A_RESTORATIVE_OF_HEALTH

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Roberts M. (2008). Tissue Salts for Healthy Living. Cape town: Struik Nature. pp.40-41, 57-62.

SAHPRA. (2014). Complementary Medicines – Health Supplements Safety and Efficacy. [Online]. sahpra.org.za. Last Updated: March 2022. Available at: https://www.sahpra.org.za/wp-content/uploads/2022/03/7.04_CM_SE_Health_Supplements_Mar22_v4_3.pdf

Sayal K., Prasad V., Daley D., Ford T., Coghill D. (2018). ADHD in children and young people: prevalence, care pathways, and service provision. The Lancet, Psychiatry. Volume 5(2), pp 175-186, doi: 10.1016/S2215-0366(17)30167-0

Schoeman R., de Klerk M. (2017). Adult attention-deficit hyperactivity disorder: A database analysis of South African private health insurance. The South African Journal of Psychiatry. Volume 23, pp. 1-7. eCollection 2017. doi: 10.4102/sajpsychiatry.v23.1010.

Sprich S.E., Burbridge J., Lerner J.A., Safren S.A. (2015). Cognitive-behavioral therapy for ADHD in adolescents: Clinical considerations and a case series. Cognitive and Behavioral Practice. Volume 22 (2), pp 116-126. doi.org/10.1016/j.cbpra.2015 .01.001

Vieracker V. (2015). [Nosode and sarcode therapies and their history–a controversial inheritance]. Medzin, Gesellchaft, und Geschichte. Volume 33, pp.155-177. [Online]. Available at: https://pubmed.ncbi.nlm.nih.gov/26137646/

Wolraich M.L., Chan E., Froehlich T., Lynch R.L., Bax A., Redwine S.T., Ihyembe D, Hagan J.F Jr . (2019a). ADHD diagnosis and treatment guidelines: A historical perspective. Pediatrics. Volume 144 (4), doi: 10.1542/peds.2019-1682.