The information contained in this book is for informational purposes only. It is not intended as a substitute for the advice and care of your physician, and you should use proper discretion, in consultation with your physician, in utilizing the information presented. The author and publisher expressly disclaim responsibility for any adverse effects that may result from the use or application of the information contained in the book.

Copyright © 2017 by James Greenblatt, M.D., and Bill Gottlieb, CHC

All rights reserved.

Published in the United States by Harmony Books, an imprint of the Crown Publishing Group, a division of Penguin Random House LLC, New York.

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Harmony Books is a registered trademark, and the Circle colophon is a trademark of Penguin Random House LLC.

Library of Congress Cataloging-in-Publication Data

Names: Greenblatt, James, author. | Gottlieb, Bill, author.

Title: Finally focused: the breakthrough natural treatment plan for ADHD that restores attention, minimizes hyperactivity, and helps eliminate drug side effects / James Greenblatt, M.D., and Bill Gottlieb, CHC.

Description: New York: Harmony Books, [2017] | Includes bibliographical references and index.

Identifiers: LCCN 2016036817| ISBN 9780451496591 (paperback) | ISBN 9780451496607 (eBook)

Subjects: LCSH: Attention-deficit hyperactivity disorder--Alternative treatment. | Behavior therapy for children. | BISAC: MEDICAL / Nutrition. | PSYCHOLOGY / Psychopathology / Attention-Deficit Disorder (ADD-ADHD).

Classification: LCC RJ506.H9 G744 2017 | DDC 618.92/8589--dc23 LC record available at https://lccn.loc.gov/​2016036817

ISBN 9780451496591

Ebook ISBN 9780451496607

Cover design by Alane Gianetti

Cover photograph by Martin Barraud/The Image Bank/Getty Images

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This book is dedicated to the millions of creative, energetic, and passionate children and adults with ADHD, and to the millions of parents of ADHD children. To each one—may this book help your unique star shine ever brighter.

“You have changed the lives of my child and my family.”

That passage is from an e-mail sent to me at the end of a school year by Cynthia D., the mother of ten-year-old Michael, a patient of mine who has attention-deficit hyperactivity disorder, or ADHD. (Their names have been changed for confidentiality, as have the names of the patients and parents featured throughout the book.) Here’s more from her inspiring message…

“Michael is doing very well,” she wrote. “In fact, as long as we follow your recommendations, he is a different child.

“Before he started treatment, he ended third grade at the 10th percentile in both math and reading, and I was told his executive function, his ability to plan, organize, and complete tasks, was at the 1 percentile level—in other words, his ‘executive functioning’ couldn’t have been worse.

“At the year-end meeting with his third grade teachers—a year in which he’d had eighteen write-ups for bad behavior—they more or less told us that Michael was academically doomed.

“But with the supplements and dietary changes you recommended—particularly avoiding dairy products—he’s now at 70% in math and reading, and his executive function is 100%.

“At the year-end meeting with his fourth grade teachers—a year in which he had just one write-up for behavior problems—they told us Michael is an above-average student, a sweet, funny, smart child who is a pleasure to work with.

“Once again,” Cynthia concluded, “thank you for all your work.”

—

Hearing a story like Michael’s is commonplace for me—where a dietary factor that is triggering the symptoms of ADHD is detected and removed; a nutritional supplement helps repair imbalances in the brain caused by a nutritional deficiency; and a child suffering from the symptoms of ADHD is freed to be the “sweet, funny, smart” child he truly is.

This happens so often, I feel completely confident that the happy ending of Michael’s story—symptoms controlled, life lived to its full potential—could happen to your child or adolescent with ADHD. Or it could happen to you, if you’re an adult with ADHD.

—

I’ve gained my confidence from three decades as a child psychiatrist and an integrative psychiatrist, treating thousands of children and adolescents with ADHD.

During those thirty years, I’ve learned this essential fact about the disorder:

ADHD is not a “behavior problem” or a “discipline problem.” ADHD is a medical disorder, in which genetic, neurological, nutritional, and environmental factors imbalance the brain, causing imbalanced behavior.

As an integrative psychiatrist, I don’t limit myself to prescribing medications to control the symptoms of ADHD. I look for and detect the underlying causes of the disorder and I address those causes, using natural treatments first and medications only when necessary. And even if I do prescribe an ADHD drug, I do so in conjunction with powerful natural treatments that give patients with ADHD relief from medication side effects.

And as an integrative psychiatrist, I don’t take a one-size-fits-all approach to treatment, because it doesn’t work! Every person with ADHD—child, adolescent, or adult—has a unique pattern of deficiencies and excesses that imbalance the brain. Correcting these deficiencies and excesses—adding what is needed and subtracting what isn’t—is what my Plus-Minus Plan is all about.

For Michael, the protein in dairy (casein) was a symptom-triggering excess, and we took it out of his diet—a “Minus” you’ll read more about in Chapter 6. Like nearly all kids with ADHD, Michael also had a magnesium deficiency, and we added a nutritional supplement to correct it—a “Plus” you’ll read about in Chapter 1.

Having successfully treated thousands of people with ADHD using this Plus-Minus approach, I’m still frustrated that there are millions of people with diagnosed ADHD who are searching for answers. According to the Centers for Disease Control and Prevention, 11% of children ages 4 to 17 have been diagnosed with ADHD—more than six million kids. Another eight million adults have the disorder, with only about one in five treated.

I wrote this book because I wanted to bring relief to as many of those millions as possible. To your child or adolescent with ADHD. To you, if you’re an adult with ADHD. But first, I’d like you to know a little bit about the newest scientific understanding of the underlying causes of the symptoms of ADHD—and why the Plus-Minus Plan addresses them.

And because this book is a powerful tool to effectively control symptoms, I’d like you to know exactly how to use it before you begin.

One Disorder, Many Names

The most important point about ADHD: it is not a disease. It’s a disorder or syndrome, which are both ways to label a collection of symptoms.

In ADHD the symptoms are behavioral and can cause problems at home, at school, or at work, with a spouse, with a family member, or with a friend.

But these problematic symptoms are usually just one side of a very lively personality. Kids and adults with ADHD are energetic, creative, intuitive, and passionate about what interests them, with great strengths and talents. Well-known people diagnosed with the disorder include billionaire Richard Branson, Pulitzer Prize–winning author Katherine Ellison, comedian Jim Carrey, and six-time Tony Award winner Audra McDonald.

But just as water can hurt you if you drink too much of it, an excess of the characteristics of ADHD—the high energy, the dreamy creativity, the need for new experiences, the willingness to take risks—can hurt personal development, relationships, and productivity.

The disorder has the following three main symptoms, as a parent or teacher might describe them. I’m sure you’re familiar with one or more of them if you have a child or adolescent with ADHD, or if you’re an ADHD adult.

Inattention. She doesn’t listen, even when spoken to directly. He has a tough time sticking with or completing a task, whether it’s homework or a game. She’s disorganized and messy. He loses things constantly. She’s forgetful. He doesn’t pay attention to details and makes a lot of seemingly “careless” mistakes. She doesn’t like to do things that require focus. He’s easily distracted.

Hyperactivity. She fidgets and squirms constantly. He’s always “on the go.” She can’t stay in her seat, at school or at the dinner table. He runs around or climbs when it’s inappropriate, like at the mall. She talks all the time. He can’t play quietly.

Impulsivity. She blurts out an answer before you finish the question. He can’t wait his turn. She interrupts, or otherwise intrudes, when you’re trying to talk to your spouse. He’s irritable, angry, or aggressive. She can’t delay short-term pleasure for long-term results.

But those symptoms aren’t anything new. Doctors have been identifying and labeling those types of symptoms for more than a century, often pejoratively.

In 1902, the symptoms were branded Defective Moral Control—in other words, the child with these symptoms was a “bad” human being, a perspective that’s still all too common today.

In the 1920s, the symptoms were dubbed the Restlessness Syndrome.

In the 1930s, after a worldwide epidemic of encephalitis, an infection of the brain, scientists called it Post-Encephalitic Behavior Disorder.

In the 1940s, the favored term was Brain-Injured Child.

In the 1950s, that term was changed to Minimal Brain Damage.

In the 1960s, with many scientists challenging the concept that brain “damage” was present in every child with the symptoms, the commonly used term became Minimal Brain Dysfunction.

In 1968, the nomenclature for the disorder became more formalized after it was included for the first time in the DSM (The Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders used by mental health professionals in the United States). The name: Hyperkinetic Reaction of Childhood.

In 1980, inattention was formally recognized as part of the disorder, with its name in the DSM changing to Attention Deficit Disorder, with “subtypes” that included ADD with hyperactivity, ADD without hyperactivity, and ADD residual type.

In 1987, the DSM labeled the syndrome Attention-Deficit Hyperactivity Disorder (ADHD), without subtypes.

In 2000, the DSM listed three types of ADHD: ADHD, Combined Type (both inattention and hyperactivity); ADHD, Predominantly Inattentive Type; and ADHD, Predominantly Hyperactive Type.

In 2013, the newest edition of the DSM kept the same names—a surprising development, given this century-long history of constant renaming.

Why so many names?

The answer is simple. Scientists and clinicians didn’t understand the factors underlying the symptoms. They were caused by defective morals…no, they were caused by a viral infection…no, they were caused by brain damage. This century-long lineup of misunderstandings led to a century-long lineup of wrong-minded names.

But in the mid-’90s, the causes of ADHD became the focus of serious scientific research, with more than ten thousand scientific papers on ADHD generated in the last two decades. And that new research has firmly established ADHD as a genetic, neurological, nutritional, and environmental disorder, in which an imbalanced brain triggers imbalanced behavior.

Let’s take a closer look at the factors scientists now understand are the root causes of ADHD. After we do that, we’ll examine how the Plus-Minus Plan helps control those factors.

One Disorder, Many Causes

There is no single cause of ADHD. Rather, multiple factors can trigger ADHD symptoms. In some people, it’s one factor; in others, it’s many. Here are the most fundamental causes.

Genetic

The fact that ADHD has a genetic component is obvious to many parents of ADHD children—because 50% of parents with an ADHD child have the disorder, too. Scientists certainly haven’t missed the heritable nature of the disorder—and they now estimate that 75% of those diagnosed with ADHD have genetic drivers.¹ In other words, three out of four people with ADHD have different genes than non-ADHD people.

The main genes affected are those that control neurotransmitters, chemicals that relay messages from neuron to neuron. Specifically, the genes that control dopamine and norepinephrine, neurotransmitters that regulate attention, or the ability to focus, and supply a person’s pleasurable sense of reward. When dopamine is plentiful, you’re focused and you feel good—a feeling most of us try to repeat, in many different ways, from a lifetime of rewarding work to the briefer rewards that come from food and sex.

Because of their genes, people with ADHD have far fewer receptors for dopamine—and the fewer receptors, the greater the symptoms of inattention, according to a study from researchers at the National Institute of Drug Abuse.² It’s no surprise, then, that most medications for ADHD work by boosting dopamine levels in the brain.

“Compared with the rest of us, [people with ADHD] have sluggish and underfed brain reward circuits, so much of everyday life feels routine and understimulating,” wrote Richard Friedman, M.D., a professor of clinical psychiatry at the Weill Cornell Medical College in New York.³ “To compensate, they are drawn to new and exciting experiences and get famously impatient and restless with the regimented structure that characterizes our modern world.”

Neurological

People with ADHD not only have different genes than non-ADHD people; they have different brains, too. Different developing brains.

Kids with ADHD have areas of their brains that are, on average, smaller than the same areas in non-ADHD kids.⁴ These areas control attention, impulsivity, and executive function, or the ability to plan, organize, focus, and complete a task. The ADHD brain isn’t permanently smaller—it lags about two to three years behind normal development, and eventually catches up.⁵ That’s one reason why ADHD symptoms tend to decrease or disappear in adolescence.

Those same areas of the brain are also less active metabolically: when compared to the brains of non-ADHD kids, ADHD brains receive less oxygen-rich blood flow and are less able to utilize blood sugar for fuel.⁶ The very brain cells of an ADHD kid have a tougher time getting what they need for optimal functioning!

The brain of an ADHD kid is smaller. It gets less oxygen and blood sugar. And there’s one more big difference. The ADHD brain has a different set of brain waves.

It’s easy to think of the brain as a spongy chunk of matter. But the brain is more like a big bulb with a mysterious, multidimensional light show inside, a pulsing parade of electrical waves—alpha, beta, delta, theta—that send communications from one mass of neurons to another, unifying the regions of the brain to produce experience. In fact, brain waves are so central to experience that it’s not an exaggeration to say they are the very definition of what it is to be alive: when there are no more brain waves, a person is declared legally dead.

Two types of brain waves are different in 80% to 90% of ADHD kids. Children with ADHD have more theta, the high waves that slowly move through the brain when you’re dreamy, tired, or sluggish. And kids with ADHD have less beta, the low waves that speedily buzz through the brain when you’re focused, alert, and energized.⁷

Scientific findings like these reinforce the fact that ADHD is not a behavior or discipline problem, but a genetically driven neurological condition. To me, this new scientific understanding sends a hopeful message to people with ADHD, overturning the belief that ADHD is a character defect of some kind, a sign of a “bad” child or a “bad” parent.

Environmental

When we’re talking about the “environment,” we’re usually talking about nature and pollution. But when medical experts use the word environment, they’re using a technical term to designate causes of disease outside the body and the mind.

For example, it’s no accident ADHD is more prevalent among kids who live in cities—a study shows that a mother’s exposure to air pollution during pregnancy raises the risk of having a child with ADHD.⁸ Poorer kids are twice as likely to have ADHD.⁹ And as I was writing this chapter, a new study was published in the journal Environmental Research which showed that kids with higher urinary levels of the toxin BPA—a hormonelike molecule in plastic—were more likely to be diagnosed with ADHD.¹⁰ There are many ways to imbalance the brain, and a toxic environment is one of them.

Environment also means home and school. For example, a kid who is “hyperactive” in a classroom of thirty-five with one teacher might behave normally in a special education classroom of twelve with two teachers, because his unique energy and drive isn’t being shackled to a desk. In a recent study on hyperactivity, researchers analyzed data from 63 studies on ADHD—and found kids and adults were most hyperactive when they were faced with challenging “environmental factors.”¹¹

Nutritional

Of all the underlying causes of ADHD, this is the one that is most overlooked by conventional doctors. But I’ve found that correcting nutritional imbalances can make all the difference in ADHD, dramatically changing behavior for the better.

Many of the chapters in Finally Focused are about nutrition. For example, you’ll learn that nine out of ten ADHD children have a deficiency of the nerve-nourishing mineral magnesium, worsening focus, irritability, anxiety, sleep problems, and a range of other ADHD symptoms. You’ll discover how taking pigment-rich plant extracts can balance brain waves, how omega-3 fatty acids can reinforce the structure of brain cells, and how removing a protein in dairy from the diet can sometimes make all the difference.

Bottom line. A well-nourished brain is a well-balanced brain.

One series of landmark studies, conducted over forty years by Janina Galler, M.D., a professor of psychiatry at Harvard Medical School, dramatically illustrates the link between poor nutrition and the symptoms of ADHD.

Dr. Galler studied children from Barbados who were hospitalized at least one time during their infancy for “moderate to severe” malnutrition. But she didn’t just study them as infants. She tracked their health and well-being for the next forty years, with measurements taken at the ages of 5 to 11, 11 to 17, and 37 to 43. Compared to similar, nourished children, the malnourished children had:

• Lower IQs—50% had IQ scores below 90, compared to 17% of the nourished children.

• Shorter attention spans, more distractibility, more restlessness, and poorer memory—60% of the malnourished children had those symptoms, compared to 15% of the nourished.

• Poorer performance at school—in reading, mathematics, science, arts and crafts, and many other subjects.

• Poorer behavior—with lower scores on tests that measured social skills like having friends and getting along with family members.

• More aggression.

• Poorer executive functioning, with less ability to plan, organize, and complete tasks.

• More temper tantrums and crying as children.

Most of these problems persisted into adolescence. And then continued into adulthood, forty years after the kids were born.¹² I don’t think anyone should have to suffer the same fate, especially since there are so many simple ways to fix ADHD-causing nutritional deficiencies.

The Misery of Untreated ADHD

Michael’s story had a happy ending.

But when ADHD goes untreated, there are millions of unhappy endings, for kids, adolescents, and adults.

Untreated, children with ADHD tend to do poorly in school, with nearly 50% of ADHD kids being suspended at some point.¹³ They have more problems with their family and fewer friends. They’re relentlessly criticized for their behavior, and their self-esteem plummets.

Untreated, adolescents with ADHD tend to engage in risky behavior. Compared to their peers without ADHD, they’re more likely to smoke, use illegal drugs, drive recklessly and get into accidents, and have sex earlier. Thirty percent drop out of high school, compared to 10% of non-ADHD kids.¹⁴

Untreated, adults with ADHD can be inattentive and distractible and find it hard to get organized and on track. They often do poorly at work. They’re twice as likely to get separated or divorced from their spouses. They experience more anxiety and depression. And they’re more likely to be addicted to tobacco or illegal drugs.¹⁵

If you’re a parent with an ADHD child or adolescent or an adult with ADHD, effective treatment is literally at hand in Finally Focused and its Plus-Minus Plan.

How to Use This Book

I’ve written Finally Focused like a book-length prescription that provides all the background information and practical guidelines you need to confidently treat your ADHD child or yourself. This book and your efforts will be enough to effectively relieve the symptoms of ADHD.

Think of Finally Focused as a manual for the ADHD brain, teaching you how to balance it, thereby controlling imbalanced, counterproductive behaviors of all kinds.

I know that for a manual to really work in your overwhelming world, the instructions have to be easy, quick, and effective. Nothing I suggest will be that hard to do or take a long time. I’ll walk you through a hierarchy of things to try that have been time tested with thousands of my patients. Part I is composed of the eleven elements of the Plus-Minus Plan itself. All of the eleven treatments in my Plus-Minus Plan are simple and well documented. There’s nothing included in the Plus-Minus Plan that has failed to prove its effectiveness over three decades of treating children with ADHD. Part II includes my own unique guidance about medication and behavior therapy, the two main conventional treatments for ADHD. Here are the most important points about using the Plan:

You’re in charge. I’ve used words like prescriptions and instructions and guidelines to describe my advice. But the most accurate word is suggestions. I’m describing in every necessary detail what to do, but I’m not telling you what to do. You have to decide for yourself what to do. True change and healing typically occur when the whole person is involved—intellect, feeling, and intention. You have to think and feel that the recommendations in the Plus-Minus Plan are right for your child or you—and then carry them out. (Of course, I’ve been using these treatments to help children and parents for nearly thirty years, so I hope you find them as compelling as I do.)

You can partner with a health professional. You can safely and effectively implement the treatments in the Plus-Minus Plan on your own; this is a book for parents and ADHD adults who want to take charge of the symptoms of ADHD. But it can be very helpful to work with one or more health professionals when managing ADHD. And that includes your doctor—a must, of course, if medication is involved.

As you’ll see, each chapter provides plenty of scientific support for the treatments in the Plus-Minus Plan. If you or your doctor want to read more of any of the studies I’ve summarized, please see the Notes at the back of the book for study citations. You can find those same citations on my website, www.finallyfocusedbook.com.

The chapters are stepping-stones—so follow them one by one. The elements of the Plus-Minus Plan appear in the exact order in which they’re most effectively applied: the first Plus-Minus treatment to apply is in Chapter 1; the eleventh treatment to apply is in Chapter 11. For the fastest, most reliable results, I recommend you start with Chapter 1 and work your way through the book, chapter by chapter, monitoring each step’s effectiveness with your child or yourself. For some cases of ADHD, you might only have to implement the recommendations in Chapters 1, 2, and 3 for complete control of symptoms; in others, you might need many elements of the Plan.

All my patients first get a prescription for magnesium, a nerve-nourishing mineral supplement. Magnesium deficiency afflicts 90% of all people with ADHD and triggers symptoms like restlessness, poor focus, irritability, sleep problems, and anxiety. These symptoms can lessen or vanish one month after supplementation starts. Magnesium can also prevent or reverse ADHD drug side effects (I tell the whole story in Chapter 1). It’s a simple action with maximum impact. That’s why it’s the first step in the Plus-Minus Plan. I want you to see results, fast.

A supplement that delivers extracts of OPCs—oligomeric proanthocyanidins, powerful plant pigments, like the blue in blueberries and the green in green tea—is in the same curative category, balancing brain waves and restoring attention (I discuss this in Chapter 2).

The third step—Chapter 3—is another supplement that usually produces an excellent outcome: low-dose nutritional lithium, a mineral commonly found in water and soil. This is not high-dose prescription lithium carbonate, the drug for bipolar disorder. Nutritional lithium is the closest thing there is to a brain tonic, and many people with ADHD are deficient in it—particularly people whose symptoms include irritability, anger, and aggression.

The next steps are correcting biochemical imbalances that have a big effect on the brain. Copper-zinc imbalance is discussed in Chapter 4; an excess of HPHPA, a by-product of gut metabolism, in Chapter 5; and food sensitivity and food allergy, which often imbalance the vulnerable brains of children ten and younger, in Chapter 6. Discovering if your child or you have these imbalances may take a little bit of detective work. But each has an easy and safe treatment to use even if you’re not 100% sure the imbalance is in play.

Chapters 7 through 11 deliver other key features of the Plus-Minus Plan. Chapter 7 features omega-3 fatty acids, which strengthen the outer layer (membrane) of brain cells, the site of intrabrain communication. Chapter 8 presents the importance of regularly eating protein to nourish the brain; in fact, just adding protein to a sugary snack or meal can neutralize the impact of sugar. Chapter 9 reveals a unique formula of amino acids and B vitamins that can duplicate the results of ADHD drugs, perhaps obviating the need for a stimulant medication. Chapter 10 is a practical address to solving sleep problems, common in ADHD, and also advocates regular exercise. Chapter 11 explores the many benefits of mindfulness, for ADHD kids and their parents, and for ADHD adults.

Although I recommend working your way through the book beginning with Chapter 1, of course, you can start with any chapter. You’re in charge—follow your instincts and intuition in treating your child or yourself.

Use the “Step-by-Step Action Plan” at the end of every chapter. Each chapter delivers all the information you need. Why the treatment works. What it does. How to use it safely and effectively. To practically apply that information, go to the end of the chapter, where you’ll find a “Step-by-Step Action Plan” for the chapter’s Plus-Minus treatment. These miniplans show you what to do, step-by-step. I’ve asked you to think of the book as a prescription and a manual. You could also think of Finally Focused as your ADHD coach—guiding you step-by-step as you control symptoms, unleash potential, and achieve success.

When in doubt, test. Each chapter provides questions and checklists that help you decide if your child or you need the featured treatment. But in some cases I recommend specific medical testing as the best way to get answers.

Does your child have an imbalance of the minerals copper and zinc, upsetting dopamine metabolism and triggering symptoms? A simple medical test for copper and zinc levels is the best way to find out.

Does your child have an excess of HPHPA, a by-product of intestinal bacteria that can trigger dopamine excess in the brain, causing hyperactivity and impulsivity? Only a medical test can answer that question for sure.

Does your child have a food sensitivity or food allergy, particularly common in kids ten and younger? Again, a medical test can detect problematic foods.

These tests aren’t a must to implement the Plus-Minus Plan. But they’re sometimes extremely helpful.

Be reassured by the science. All the treatments in my Plus-Minus Plan are backed by scientific proof. In every chapter, I present a representative sampling of respected scientific studies to help give you the intellectual clarity and emotional confidence you need to implement the Plus-Minus Plan.

I also want you to know that it’s not just me claiming that these methods work. It’s an entire, worldwide community of researchers and clinicians. These engaged experts have delved deeply into the genetics, neurology (brain activity), and biochemistry (cellular activity) of ADHD. They’ve understood the obvious but overlooked role of nutrition in the well-being of body and brain. They’ve studied thousands of children with ADHD to objectively test their findings and theories. And they’ve inspired me to synthesize their effective results—results I’ve been implementing in my own practice for more than two decades—into the practical advice of the Plus-Minus Plan.

Don’t forget Part II: The Best of Medical and Behavioral Care. ADHD medications and behavior therapy are the two mainstays of conventional treatment for ADHD.

As for medicines: I rarely prescribe them until I’ve made sure I can’t achieve the same level of symptom control with natural treatments. That’s what makes me an integrative psychiatrist—a doctor who integrates both natural and more traditional medical treatments into a single safe and effective approach. But I’m not against medications—sometimes they’re a must, as I explain in Chapter 12. By giving medication with supplements, and by using a slow and cautious pattern of prescribing, it’s extremely likely that there will be no side effects from the medications. Freedom from side effects is the reality for nearly 100% of my patients with ADHD who take medications.

I discuss behavior therapy in Chapter 13, where I’ve distilled the advice that’s proved most effective in three decades of counseling kids and their parents—advice that puts a premium on respect, positive feedback, and stress relief.

Finally Focused is for everyone—children, adolescents, and adults. I’m a child psychiatrist, so I wrote this book as if I were talking to the parent of an ADHD child—the stressed-out, worried people I’ve seen in my office, every day, day after day, for the past thirty years.

In the book, when I refer to a “child” with ADHD, I mean any child—a preschooler, a grade-schooler, a teen, or a young adult. (If I need to specify an age, I always do.)

But if you’re an adult with ADHD reading this book—well, just imagine you’re parenting yourself! Finally Focused and the Plus-Minus Plan can work for anyone with ADHD, no matter their age. Yes, some treatments are “age-appropriate,” like treating food sensitivity and food allergy, factors that typically produce symptoms in kids ten and younger. But the effectiveness of the Plus-Minus Plan is age-neutral. Six or sixty, if you implement the Plan, you’re going to benefit. Speaking of which…

Enjoy the results—starting today. The results from implementing the Plus-Minus Plan don’t take months or years. The Plan should start working in about four weeks.

Attention will strengthen and steady.

Distractions will seem less compelling.

Restlessness will turn into restfulness—the ability to slow down and savor life, rather than rushing from one thing to the next.

Parenting is always a challenge, of course, but now it will feel more like a team sport and less like a boxing match. Your child can be a “different child”—the child he or she was always meant to be. If you’re an adult with ADHD, you can find the focus and purpose that always seem just out of reach.

I wish you well in this journey to full potential. In fact, please feel free to visit the website below and let me know how you’re doing. As of now, we’re on this journey together.

Yours for health and happiness,

James Greenblatt, M.D.

www.finallyfocusedbook.com

I’ve been treating children with ADHD for thirty years—and I can’t remember one child with the disorder who didn’t benefit from taking a magnesium supplement.

Take Noah, for example. Twelve-year-old Noah and his parents were in my office for help with the same stressful symptoms that have brought thousands of frustrated parents and unhappy children to my clinic: Noah was impulsive, hyperactive, and inattentive, and his life at home and at school was in shambles.

His parents told me that as a young child, Noah was often fidgety and couldn’t sit still for more than a few minutes. Noah himself told me the only time he felt happy these days was when he was “wandering around” outside.

Noah, said his parents, had done well in school until he was in the second grade, when he started to interrupt his teachers constantly. Sometimes the school called, asking that Noah be taken home.

Noah struggled socially, too. He found it hard to make friends. He couldn’t sit down and play a board game without becoming restless when the other children took their turns. Sometimes when he lost the game he threw the board at a friend. Playdates became increasingly rare.

When Noah was eight, his parents took him to a doctor, hoping an ADHD medication might provide relief. The doctor agreed to the treatment and prescribed Ritalin.

But the drug made things worse. Noah became extremely emotional. He cried easily. His appetite disappeared.

He was taken off Ritalin and put on Adderall.

He stopped feeling sad all the time, but instead started feeling agitated and anxious. After a month on the drug, Noah developed a facial tic.

Adderall was halted—and Noah’s problems continued, year after year.

When Noah became my patient, he was hyperactive, found it hard to focus, and—because he couldn’t control his impulsiveness—didn’t have any friends.

Noah’s story and symptoms made my first choice of treatment obvious: Twice daily, Noah was to take 200 milligrams (mg) of brain-balancing, body-calming magnesium.

One month after he started magnesium, I also restarted Noah on a low dose of Vyvanse (20 mg), a stimulant medication.

And this integrative approach—treating Noah with a key nutrient and a dose-regulated stimulant—produced tremendous results.

“I’m doing awesome,” Noah enthusiastically said to me when I saw him and his parents two months later.

He told me that he could sit still and participate in class. And that he was making some friends.

“I used to feel like my brain was a dull knife,” Noah said, sitting between his smiling parents. “It didn’t work right. It couldn’t cut through anything. But now it’s like a sharp knife—it works great.”

Why Magnesium Works

How can one nutrient make such a big difference in the symptoms of an ADHD child—in her life, and in the lives of her parents, teachers, and friends? There are many answers to that question.

The first fact to know: Magnesium plays a role in more than three hundred enzyme systems, biochemical spark plugs that ignite cellular activity. For example, if magnesium is minimal, so is ATP (adenosine triphosphate), the fundamental fuel that powers every cell. Blood sugar isn’t correctly regulated, and the immune system is weakened. Most important for your ADHD child, the brain is compromised.

Too little magnesium weakens the brain because the mineral plays a key role in the formation of neurotransmitters, chemicals that help send messages between brain cells. If magnesium levels are suboptimal, your child is likely to have imbalanced levels of two neurotransmitters: attention-regulating dopamine, and mood-regulating serotonin. Low magnesium can also undercut the functioning of glutamate receptors, areas on brain cells that assist the movement of neurotransmitters.

The end result of a magnesium-deprived brain? In children and adolescents, it’s often the symptoms of ADHD. Research links low magnesium levels in children with:

• Poor concentration

• Irritability and anxiety

• Depression and apathy

• Mood swings

• Fatigue

• Sleeping problems, like insomnia

Okay, low levels of magnesium are bad for your ADHD child. But why are levels low? Shockingly, magnesium deficiency could be a side effect of the ADHD drug your child is taking!

Yes, stimulant drugs like Ritalin and Adderall that are intended to help ADHD might actually be complicating the problem—because they leach magnesium from the body. In my experience, a deficit of nerve-nourishing magnesium is often behind ADHD drug side effects like irritability, agitation, anxiety, insomnia, facial tics, and nail-biting. Add supplemental magnesium to the mix, and all those symptoms are likely to disappear. That’s what happened with Noah. He couldn’t take an ADHD drug without side effects. But when he took the drug and magnesium, he was fine. (Or as Noah said, he was awesome.)

Noah is hardly alone. Relieving the side effects of ADHD with magnesium has generated more “Thank yous” from parents and their children than any other ADHD treatment I use.

Many Children Are Low in Magnesium

But even if your ADHD child isn’t taking an ADHD medication, odds are 50-50 that he has a low level of magnesium. Research shows that half of Americans (including children) get less than the government’s Recommended Daily Allowance (RDA) for magnesium¹—probably because we Americans eat so many processed foods, most of which are stripped of magnesium during processing.

In the first decade of the twentieth century, when Americans ate more whole foods, people ingested 475 to 500 mg of magnesium daily. That level of intake has declined decade by decade, until now we consume 175 to 225 mg daily.

The nonstop pace of modern life also puts us under nonstop stress, which drains the body of magnesium.

How many ADHD children are actually deficient in magnesium? Nearly all of them!

In one study, doctors measured the magnesium levels of 114 children with ADHD and found that an astounding 110 of the children—96%—were deficient in magnesium.² My clinical experience is similar, with rates at 90%.

Because magnesium deficiency is so common among children with ADHD, and because supplementing with magnesium can make such a huge difference in a child’s behavior (on or off medication), I recommend every patient with ADHD take a supplement of the mineral. The appropriateness of my approach to magnesium supplementation is confirmed by many scientific studies on magnesium and ADHD.

Scientific Support for…The Power of Magnesium to Heal the Symptoms of ADHD

I’d like to tell you about several studies that show the importance of magnesium in ADHD…

Less hyperactivity, inattention, impulsivity, and opposition—with 200 mg of magnesium a day. In the most recent study, Egyptian scientists measured magnesium levels in children with ADHD, finding deficiency in 72%.³ They also found that those with the lowest magnesium levels had the most hyperactivity and the lowest IQs.

They divided the children into two groups: half took 200 mg of magnesium daily and half took a placebo. After eight weeks, the children taking magnesium had “significant improvements” compared to the placebo takers. Specifically:

• hyperactivity was 90% less

• inattention was 66% less

• oppositional behavior was 33% less

• executive function was 40% better (Executive function includes keeping track of time, finishing work on time, problem-solving, and using memory for everyday tasks.)

Add magnesium, symptoms decrease. Subtract magnesium, symptoms return. In a study of 40 children with ADHD, French scientists supplemented their diets with magnesium and vitamin B₆, a “cofactor” that helps cells use magnesium.⁴

As levels of magnesium went up over two months, symptoms went down. The children were less hyperactive, aggressive, and irritable; had more focus at school; and slept better.

But when the children stopped taking the two nutrients, their magnesium levels started to decrease—and so did the behavioral improvements created by the mineral. “Clinical symptoms of ADHD appeared in a few weeks, together with a decrease” in levels of magnesium, reported the scientists in Magnesium Research.

The scientists concluded that magnesium supplementation “could be required in children with ADHD.” Not just recommended, but required.

Better brain waves, better behavior. In a similar study, published in the journal Neuroscience and Behavioral Physiology, doctors supplemented the diets of ADHD children with magnesium and B₆—with very positive results.⁵ The children had less hyperactivity, better attentiveness, and less anxiety.

Looking at the children’s behaviors at school, the researchers noted the children had “improvement in task performance,” “decreases in the proportion of errors,” and “increases in the rate of work.”

The supplemented ADHD children also had a complete disappearance of two types of activities sometimes seen in ADHD: perseveration (rote, repetitive behaviors and movements); and stereotypy (senseless acts or words).

The doctors also took EEG (electroencephalographic) measurements before and after the supplementation with magnesium and B₆. The postsupplement brain waves were far more normal: fewer spikes and flurries of random activity; and higher frequencies, a type of brain wave linked to better focus.

More happiness, less loneliness, better sleep. In several other studies, the diets of children with ADHD were supplemented with magnesium and other brain-supporting nutrients, like omega-3 fatty acids (EPA and DHA) and zinc—an approach I use in my own practice, where children typically take more than one supplement.

In one such study, published in the medical journal Lipids in Health and Disease, German researchers gave hundreds of children with ADHD a daily supplement containing magnesium, zinc, omega-3 fatty acids (EPA and DHA), and an omega-6 fatty acid (GLA).⁶

After three months, the researchers saw a “clear reduction” in symptoms of ADHD, including hyperactivity, inattention, and impulsivity. They also saw fewer emotional problems, less isolation (among “children who were described as loners”), and fewer problems with sleeping.

“No Ritalin was needed.” Writing in the Journal of the American College of Nutrition, a team of French researchers reported the case history of L., a seven-year-old boy, and one of 52 ADHD children they had treated with magnesium and vitamin B₆.⁷

“L. developed a breath-holding spell in his first year, he was hyperexcitable at 3 years, and reports sleep disturbances at 5 years,” they wrote. At the end of nursery school, when L. was six years old, “the clinical evaluation indicated aggressivity, anxiety…inattention and no self-control.”

At that time, the doctors discovered his magnesium levels were low and began supplementing with the mineral and vitamin B₆.

Six months later, L. had normal magnesium levels. He also had normal sleep, no aggressivity, and was “more tender, more concentrated, more quiet.”

Magnesium is effective. The last study I’d like to tell you about is a “meta-analysis”—a study that analyzes the results of several other studies. In this meta-analysis, researchers looked at six other studies on magnesium and ADHD. Their conclusion: magnesium shows “promise” in the effective treatment of ADHD.⁸

Bottom line. In my practice, magnesium is more than a promise. It is a much-needed and effective treatment for the symptoms of ADHD, and a way to eliminate side effects from ADHD medications.

Iron: Another Mineral That’s Often a Must for ADHD

You’ve probably heard of iron-poor blood. But have you heard of an iron-poor brain…?

You’re about to, because iron-poor brains are very common among children with ADHD. And since iron is a must for a healthy brain—studies show that iron-deficient children score poorly in math and language tests,⁹ for example—a lack of iron can cause or worsen the symptoms of ADHD.

However, even though you’re learning about iron in this chapter about magnesium, and they’re both minerals crucial to cognition, they’re not the same. Nearly everyone with ADHD is deficient in magnesium and should take the mineral; but lab work is needed to detect an iron deficiency, and iron should not be taken unless there’s a test-proven deficiency. Additionally, it’s possible to take too much iron, and dosing needs to be carefully monitored by a doctor. That said, magnesium deficiency and iron deficiency are similar—because both can cause or contribute to ADHD symptoms. Let’s look at some of the evidence…

Brains that are starving for iron. Researchers at the Center for Biomedical Imaging at the Medical University of South Carolina used sophisticated tests to evaluate iron levels in the brains of children with and without ADHD.¹⁰ They found that those with ADHD who had never taken Ritalin had “significantly lower” levels of brain iron. However, those with ADHD who had taken Ritalin had normal levels of brain iron. The researchers theorized that one way Ritalin works is by boosting iron in the brain.

Low iron, higher risk of ADHD. In a study published in BMC Psychiatry, children with iron deficiency anemia had a 67% higher risk of developing ADHD.¹¹

Ferritin—stored iron—is low, too. ADHD children also have lower levels of ferritin, or stored iron. In one study, 84% of children with ADHD had abnormally low ferritin levels, compared to 18% of children without ADHD.¹² In another study, 92% of ADHD children had low ferritin.¹³

And the lower the ferritin, the more hyperactive, inattentive, and impulsive the child, according to research in the Journal of Child and Adolescent Psychopharmacology. The research also showed that ADHD children with low ferritin needed a higher dose of ADHD medication to control symptoms.¹⁴

Low iron is bad for the brain—in all kinds of ways. Low levels of iron have also been linked to sleep disorders, common in ADHD. A study from the Institute of Child Development at the University of Minnesota linked low iron to low IQ.¹⁵ And other research links iron deficiency anemia in children to a higher risk of: depression, bipolar disorder, anxiety disorder, autism spectrum disorder, delayed development, and mental retardation.¹⁶

Iron supplements improve ADHD symptoms. Fortunately, an iron deficiency isn’t ironclad—iron supplements can reverse it.

In one study, treating children with ADHD with an iron supplement improved their Conners’ Ratings, a standard measurement of ADHD that includes symptoms like hyperactivity, poor impulse control, aggressiveness, learning problems, and poor performance at school.¹⁷

Iron is so effective for ADHD that the authors of one study, published in Pediatric Neurology, said it was “comparable to stimulants.”¹⁸ Getting enough iron can also prevent lead poisoning—a possible cause of ADHD symptoms, which you can read about in Chapter 4.

Compelling Case Report: A Child Is “Transformed”—with Iron

A case report in the journal Pediatrics presented a three-year-old child diagnosed with ADHD who was inattentive, hyperactive, and impulsive, at home and at school—and had a low ferritin level.¹⁹ But after eight months of treatment with 80 mg of iron in the form of ferrous sulfate, the child’s “Conners’ Parent Rating Scale” (a tally of symptoms) dropped from 30 to 19, and the “Conners’ Teaching Rating Scale” (same tally, by teachers) dropped from 32 to 13.

The authors of the case report note that the parents said the child was “transformed.” The teachers noted he was more organized in his activities, more attentive, and less forgetful and impulsive.

Bottom line. Your ADHD child may need more iron. A study in the medical journal Expert Reviews analyzed the results of 22 studies on iron and ADHD.²⁰ The experts—an international team from prestigious institutions in the United States, France, and Italy—concluded: “Iron supplementation could be considered as an important adjunctive [integrative] therapy,” strengthening the effectiveness of ADHD drugs.

Iron is central to ADHD because it plays a key role in the metabolism of the neurotransmitter dopamine—and a deficiency of dopamine is behind many of the symptoms of ADHD.

Should your child take iron? The most accurate test for iron measures ferritin. Most doctors will tell you that your child’s ferritin is normal if it’s over 9 ng/ml (nanograms per milliliter). But scientific findings and my clinical experience tell me that if your child’s ferritin level is below 40—he needs an iron supplement. I also find that iron deficiency is common in those with celiac disease, and in lifelong vegans and vegetarians.

Treating an iron deficiency. If testing finds that a child is low in ferritin, I start her on a supplement of ferric pyrophosphate: for children 6 to 12 years old, 45 mg daily, in three 15 mg doses, with meals; for adolescents, 90 mg daily, in three 30 mg doses, with meals.

After three months, I test again, continuing the supplement if iron levels are low, but stopping supplementation if levels have normalized.

For children, I like the product “Iron Liquid” from Pure Encapsulations, a good-tasting, well-absorbed supplement that supplies 15 mg per dropper.

Don’t forget about food. And don’t forget about iron-rich foods. They include: iron-fortified breakfast cereals like Cheerios and Wheaties; iron-fortified whole-wheat bread; beef (including hamburger), turkey, and tuna; beans and peas; vegetables like spinach and other leafy greens, baked potato, avocado, and beets; dried fruits like dates and prunes; and blackstrap molasses.

How to Supplement with Magnesium

Supplementing your child’s diet with magnesium is fairly straightforward.

Should my child be tested for a magnesium deficiency? The likely answer is no. Most magnesium tests are inaccurate. They measure blood levels—when 99% of the mineral is found in cells and bones. Such a test is likely to show a child with ADHD has a “normal” level of magnesium—when, in fact, he’s deficient. A hair test for minerals is a better indicator of a magnesium deficiency, and I routinely order this test to determine levels of lithium and copper—but even without the results, I know in advance that every child with ADHD will benefit from supplemental magnesium.

Should my ADHD child take magnesium? Yes, if your child has been diagnosed with ADHD. It’s that simple.

Other indications that make the necessity for taking magnesium even more compelling:

• Your ADHD child is on a stimulant medication—which drains the body of magnesium.

• Your ADHD child has side effects from a stimulant medication—which magnesium can often resolve.

• Your ADHD child sleeps poorly, is anxious, and/or is prone to constipation—all telltale signs of a magnesium deficiency.

How much magnesium is best? Dosages vary by age. Typically, I recommend magnesium glycinate, using the powdered product Natural Calm, from Natural Vitality, which contains 325 to 350 mg of magnesium per serving dose. (The product is widely available online, and in many pharmacies, like Walmart and CVS.) I like it because the child can take magnesium in a tasty drink, rather than swallowing a pill.

Here are the dosage guidelines I follow in my practice:

13 and older: 200 mg, twice daily.

10 to 12: 100 mg, twice daily.

6 to 9: 50 mg, twice daily.

Under 6: I recommend microdoses of 10 mg daily, in liquid form, using Liquid Ionic Magnesium, from New Beginnings. (Please see the Appendix at the end of the book for ordering information.)

What form of magnesium is best? There are many different forms of magnesium, like magnesium glycinate, magnesium oxide, magnesium citrate, and magnesium gluconate. In my clinical experience, all of them are equally effective, with one exception: magnesium oxide, which is poorly absorbed.

Lately, a few health experts have been touting magnesium L-threonate as the best form of magnesium for the brain. That’s because several studies (all but one of them on laboratory animals) show brain-based benefits, like healthier brain cells and protection against age-related mental decline. There’s nothing wrong with magnesium L-threonate but it is more expensive than other forms.

What brand is best? Magnesium supplements are generally reliable—what the label says, the product delivers. When consumerlab.com—a supplement-testing company—investigated twenty-six products, it found only one of them didn’t contain the amount of magnesium on the label. The “Not Approved” magnesium product was from the company New Capstone.

In my clinical practice I use a magnesium supplement from Natural Calm, a kid-friendly magnesium powder by the company Natural Vitality (not tested). I also use magnesium supplements from Pure Encapsulation (“Approved” by consumerlab.com), and from New Beginnings (not tested).

What about side effects from the supplement? The main side effect from magnesium is loose stools. This laxative effect from magnesium is most common with magnesium oxide, another reason not to use it. If your child develops loose stools, split or decrease the dose, or switch her to a slowly absorbed, long-acting form of magnesium.

Should B₆ be added to the regimen? Definitely! As you read earlier in the chapter, magnesium is more effective when it’s given with vitamin B₆—a strategy I always use in my practice. For adolescents 13 and older, use 50 mg daily. For children 7 to 12, use 25 mg.

What about magnesium-rich foods? Do your best to increase your child’s intake of magnesium-rich foods. In fact, a study by Australian researchers of nearly 700 adolescents found that those with the highest intake of dietary magnesium were the least likely to have “externalizing behaviors” like hyperactivity, aggression, and delinquency.²¹

Fun-to-eat magnesium-rich foods include nuts and dark chocolate. Categories of food rich in the mineral include whole grains, beans, and green leafy vegetables.

But if you’re looking for magnesium to ease or eliminate symptoms, or protect your child from drug side effects—your child needs to take a daily magnesium supplement. A supplement is the only way to reliably boost magnesium levels—and produce reliable results.

How long will results take? Be patient. Magnesium relieves symptoms gradually. For example, constipation will be relieved in the first month of supplementation, sleep problems in the second month, and anxiety in the third.

Magnesium isn’t a drug. It’s a natural, slow-acting but incredibly effective natural agent for relieving the symptoms of ADHD. Give magnesium—and give it time to work. Your patience will be rewarded.

This High-Dose Multivitamin Eases ADHD

My approach to therapeutic nutrition for ADHD is individualized: I discover my patient’s specific nutritional deficiencies and excesses and treat them, bringing the brain back into balance. But an individualized nutritional approach to ADHD isn’t the only nutritional approach.

A team of psychologists at the University of Canterbury in New Zealand, led by Julia J. Rucklidge, Ph.D., have researched a new “broad-based” multivitamin-mineral formula for protecting and restoring mental health, including ADHD. The formula contains 14 vitamins, 16 minerals, 3 amino acids, and 3 antioxidants—and studies show it works in ADHD, for children and adults.

Inattention, hyperactivity, and impulsivity—“much improved.” In a two-month study of 80 adults with ADHD, 42 took the formula and 38 took a placebo, with the symptoms of ADHD (inattention, hyperactivity, and impulsivity) measured at the start and end of the study.²² The ADHD symptoms of those taking the high-dose vitamin-mineral supplement—attention, hyperactivity, and impulsivity—were “more improved” than those taking the placebo, wrote the scientists in the British Journal of Psychology. In fact, more than 70% of those taking the supplement had an improvement, with nearly 40% “very much improved” or “much improved.”

Better “executive functioning.” In another study on 28 adults with ADHD (14 taking the supplement; 14 not), the psychologists measured executive function: the ability to learn, remember what was learned, and “verbal fluency,” the ability to quickly recall and speak words related to a category, like “animals” or “fruits.”²³ Those taking the supplement improved in every category, reported the researchers in the Journal of Alternative and Complementary Medicine. They also had “improved mood.” Those not taking the supplement didn’t have any measurable changes.

Nutritional “earthquake insurance.” On September 4, 2010, a massive 7.1 earthquake hit the South Island of New Zealand, with an epicenter twenty-five miles from Christchurch, the city where the University of Canterbury is located—with nearly one thousand aftershocks in the next two weeks. Seeing an “opportune moment” to test their formula’s ability to protect against stress, the psychologists measured the postearthquake depression, anxiety, and stress levels of 33 adults with ADHD who were already participating in a study on the formula—17 taking the formula, 16 taking a placebo. Seven and 14 days after the earthquake, those taking “the nutritional supplement were more resilient to the effects of the earthquake than the 16 individuals not taking the supplement,” wrote Dr. Rucklidge in the journal Psychiatry Research. Specifically, they were 67% less depressed, 76% less anxious, and 55% less stressed.²⁴

A year later—nutrition works better than medicine. One year after the larger study ended, the researchers contacted ADHD adults who had participated to see how they were doing with their symptoms of inattention, hyperactivity, and impulsivity. “Those staying on the micronutrients performed better than those who switched to medications or discontinued micronutrients,” wrote the researchers in the Journal of Attention Disorders.²⁵

Works for kids, too. In a recent study, ADHD kids 8 to 12 who took the formula for four months had a “reduction in ADHD symptoms, improved mood, and improved overall functioning,” reported the researchers in the Journal of Child and Adolescent Psychopharmacology.²⁶ Much like the adults, 79% of those who took the supplement were “much improved” or “very much improved.” These benefits, wrote the researchers, included “emotional symptoms, conduct problems, and prosocial behaviors.”

The psychologists theorize that the supplement works in some of the same ways as the nutritional treatments in the Plus-Minus Plan: by providing “cofactors” for biochemicals that control brain function (for example, vitamin B₆ helps produce dopamine and other neurotransmitters); by correcting genetic problems (“inborn errors of metabolism”); by energizing brain cells; and by strengthening the membrane of the brain, the site of neuron-to-neuron communication.²⁷

Step-by-Step Action Plan for Healing ADHD

Plus: Magnesium

Use this practical, step-by-step summary to implement the symptom-controlling actions discussed in this chapter:

Step #1: Give your child a magnesium supplement.

For adolescents (13 and older): 200 mg, twice daily

For children 10 to 12: 100 mg, twice daily

For children 6 to 9: 50 mg, twice daily

For children under 6: 10 mg daily, in liquid form

Step #2: Accompany the magnesium with vitamin B₆, which improves the cellular use of magnesium.

For adolescents (13 and older): 50 mg daily

For children 7 to 12: 25 mg daily

Step #3: Have your child tested for ferritin (stored iron). If levels are 40 ng/ml or lower…

Step #4: Supplement with ferrous iron for three months, retesting to see if levels have been normalized, at which point you can stop the supplement.

For adolescents: 90 mg daily, in three divided 30 mg doses, with meals

For children 6 to 12: 45 mg daily, in three divided 15 mg doses, with meals

She has difficulty focusing on and completing even the most basic tasks. She talks excessively. She feels overwhelmed at school. She leaves home without telling her mother. During church service, she sometimes runs down the aisle. And she’s so distracted that she’s accident-prone, breaking an arm and a leg in the last three years.

That was Carole, a thirteen-year-old I saw in my office, along with her stressed and worried mother. Carole was diagnosed with ADHD when she was nine and prescribed Ritalin. But the drug was stopped after a few months when Carole developed facial tics.

My first round of tests revealed that Carole didn’t have any severe metabolic abnormalities, like a copper-zinc imbalance, intestinal imbalance, or food sensitivity. (I always check for metabolic abnormalities first, because if they’re present, they must be cleared up to clear up symptoms.) After I had the test results in hand, I scheduled Carole for a second visit, during which I gave her an EEG (electroencephalogram), a test that measures brain waves.

As I suspected, Carole had a pattern of brain waves that is common in children with inattentive-type ADHD: a predominance of slow-moving theta waves. This type of electrical pattern in the brain tends to happen when a child is daydreaming, inattentive, or distracted. And Carole had few fast-moving beta waves, a pattern linked to focus. My testing also showed that Carole’s theta waves occurred when she was reading poorly, when her handwriting and drawing were chaotic, and when she was distracted.

Given these results, I started Carole on a supplement of OPCs (oligomeric proanthocyanidins), plant extracts that can actually affect brain waves. OPCs are a type of polyphenol, which is a compound that plants produce to protect themselves from environmental harm. Oftentimes, the polyphenol is a plant pigment: the blue in blueberry; the red in grapes; the green in green tea; the dark brown in dark chocolate.

For us humans, the most helpful molecules in OPCs are flavonols, a type of antioxidant. Flavonols easily enter human cells, including brain cells. And they work well once they get there, reducing oxidation, which can harm and kill cells. In fact, OPCs are stronger antioxidants than either vitamin C or vitamin E, two nutrients famous for fighting oxidation.

Over the decades, I have prescribed OPCs to hundreds of ADHD children and have seen the supplement dramatically normalize brain waves—and behavior. And while no one knows exactly how OPCs work to change brain waves for the better, there are several theories, based on cellular and animal research:

• Regulate levels of norepinephrine and epinephrine, neurotransmitters that direct the flow of information within the brain; irregular levels can undermine focus.

• Limit the production of glutamate, an excitatory (stimulating) neurotransmitter that is toxic in large quantities.

• Slow the production and release of histamine, a neurotransmitter and inflammatory biochemical released during allergic reactions. Some children with ADHD have a mutation in the gene that breaks down histamine, leading to stronger allergic reactions to food dyes and other artificial ingredients—reactions that can trigger the symptoms of ADHD.

• Protect the fat-rich cells of the brain from lipid peroxidation, a kind of internal rust generated by renegade molecules called reactive oxygen species or free radicals. These molecules are formed by pollutants, diets high in fat and sugar, stress, smoking, and other factors. Antioxidants like OPCs stabilize free radicals so that they do less damage.

• Strengthen the delicate blood-brain barrier, keeping neurotoxins like pesticides and food additives out of the brain.

• Improve blood flow to the brain, helping deliver crucial brain-supporting nutrients like zinc.

• Absorb and disarm metals that can harm the brain, like lead.

• Boost enzymes that decrease inflammation in the brain.

With those many mechanisms of action, OPCs seem like they could be powerful natural treatments for ADHD—and as it turns out, they are.

I saw those types of improvements in Carole when she visited my office after taking OPCs for two months. She was much less distracted and didn’t talk incessantly. And what was happening in my office was also happening at school.

“Her teachers tell me she can sit through an entire period of schoolwork without becoming restless,” her mother told me. “One teacher even said Carole was ‘totally focused’—something I never expected anyone would say about her!”

I once again gave Carole an EEG and found it improved, with a significant decrease in theta. While I monitored the EEG, Carole performed tasks like reading, drawing, and listening. I saw that a decrease in her theta waves matched her ability to concentrate.

Of course, OPCs don’t work for every child. But for many inattentive, distractible children, they can make a huge difference—which is why they’re number two in my Plus-Minus Plan. Let’s look at some of the scientific research supporting that statement.

Scientific Support for…The Brain-Balancing Power of OPCs

Researchers who have put OPCs to the test have seen the biggest benefits in attention, with OPCs effectively treating symptoms like lack of focus, distractibility, poor concentration, weak memory, and disorganization. The discovery of OPCs can actually be traced back to 1534, when French explorer Jacques Cartier and his crew were saved from scurvy by Native Americans who made them tea from pine bark and needles. Fast-forward four centuries to 1947, when French doctor Jack Masquelier read Cartier’s journal. Masquelier reasoned that pine bark and needles couldn’t have contained enough vitamin C to have saved Cartier and his crew, and he began to look for other components of pine bark that could have made the lifesaving difference. That search led him to be the first scientist to identify and isolate OPCs in pine bark, peanuts, and grapes—and the first to create OPC supplements, one with pine bark extract and one with grape extract.¹

Pine Bark Extract—Evergreen Energy for the Ailing Brain

Over the decades since their discovery, the best-studied OPC for ADHD is the OPC that started it all: pine bark extract, which is mainly marketed as the supplement Pycnogenol. Studies show that children with ADHD who took Pycnogenol had increased alertness and focus; decreased impulsivity, restlessness, aggression, and disruptive behavior; and improved cooperation with parents and teachers.

Here are the results from several standout studies on ADHD and Pycnogenol:

Normalizing neurotransmitters. Taking Pycnogenol for one month balanced neurotransmitters in ADHD children, according to European researchers writing in Nutritional Neuroscience.²

Less oxidation, better attention. ADHD children who took Pycnogenol for one month had higher levels of antioxidants, lower levels of oxidation, and “improvement of attention,” reported scientists in Free Radical Research.³

Better focus and concentration in 30 days. In another study, 61 children with ADHD took Pycnogenol. After one month, researchers noted improvements in distractibility, focus, and hyperactivity.⁴ Doctors and parents should consider the “use of Pycnogenol as a natural supplement to relieve ADHD symptoms,” concluded the researchers in European Child and Adolescent Psychology.

Clearer thinking, stronger memory, sharper focus, better mood in non-ADHD students on Pycnogenol. Fifty-three high school, college, and graduate students took Pycnogenol or a placebo.⁵ After two months, those taking Pycnogenol experienced all the mental and emotional benefits listed above—and had higher test scores, too.

THE STORY OF JAY

Steven Heimann, M.D., a pediatrician in Illinois, wrote a letter to the Journal of the American Academy of Child and Adolescent Psychiatry about giving Pycnogenol to Jay (not his real name), a 10-year-old boy who was taking the amphetamine Dexedrine for ADHD, which had “provided only a slight improvement in ADHD symptoms.”⁶

“The patient had difficulties with hyperactivity, impulsivity, and inattention,” Dr. Heimann wrote. “Poor social skills led to frequent physical altercations at school.”

Jay’s parents added Pycnogenol to the child’s medication—and “noted significant improvement in symptoms.” Then, wrote Dr. Heimann, Jay became the subject of a scientific experiment.

“The parents reluctantly agreed to give Jay a trial off of Pycnogenol for 4 weeks, to compare the effects of stimulant plus Pycnogenol to stimulant alone. Within 2 weeks of stopping Pycnogenol, the patient became significantly more hyperactive and impulsive, marked by numerous demerits in school. He was also involved in several physical altercations, which previously had abated with Pycnogenol.”

Fortunately, that wasn’t the end of the experiment. “Jay’s regimen of Pycnogenol was reinstated,” Dr. Heimann wrote, “and again he demonstrated significant improvement in ADHD symptoms within 3 weeks.”

Multiply Jay by the millions—because that’s the number of children with ADHD who might be helped by OPCs.

Green Tea Extract—A Sip of Pure Healing

Green tea extract protects and energizes the brain in several ways.

More beta waves, better attention. Brain wave activity increases in the hour after drinking green or black tea—including an increase in the beta waves that are linked to better attention, according to a study in Nutritional Neuroscience.⁷

Better intrabrain connections—and more ability to stay on task. A brain scan showed that people who took green tea extract had improved neural connections between different parts of the brain—and also had improved short-term memory and mental performance, reported scientists in Psychopharmacology.⁸

A shield against brain-battering stress. In an animal experiment, stress caused loss of brain cells, and impaired memory and learning—unless the animals were also given EGCG (epigallocatechin gallate), the most powerful antioxidant in green tea.⁹

More mental power, fewer mental mistakes. White tea is also rich in EGCG—and for one hour after drinking white tea, people had less mental fatigue and made fewer errors on a math test, reported researchers from the Brain, Performance and Nutrition Research Centre in England.¹⁰

Boosting BDNF—a protein that powers the brain. In a laboratory study by Japanese scientists, giving newborn animals L-theanine—an amino acid in green tea—boosted BDNF (brain-derived neurotrophic factor). BDNF protects neurons from harm, helps neurons create new cell-to-cell connections, and generates new neurons. The animals getting L-theanine also had better memory.¹¹

Blueberry Extract—Berry, Berry Good for a Child’s Brain

There are many studies on the power of blueberries and blueberry extracts to improve failing memory in middle-aged and older people. Now, new research out of England shows blueberries can improve memory in children, too—a huge benefit for forgetful ADHD children. In fact, blueberry extract improved a wide range of mental abilities.

Every measure of mental ability—improved. In one study, 21 children, ages 7 to 10, drank either a beverage with blueberry extract (15 or 30 grams) or a nonblueberry look-alike beverage.¹² Over the next three hours, the children underwent a series of tests to measure mental ability. Those who ingested blueberry extract had better results on every test: remembering words; recognizing words; responding quickly to a mental challenge; controlling behavior in order to complete a mental task; and problem-solving. And those who got the 30 gram dose of blueberry outperformed those who got 15 grams. In other words, the berrier the better!

In another study from the same team of researchers, 14 children, ages 8 to 10, drank either blueberry extract or a nonblueberry look-alike.¹³ Two hours after they drank the beverages, the children took several tests to measure mental ability—and the children who consumed blueberry did far better remembering newly learned words.

These scientific findings show you what OPCs can do one by one. Now it’s time to find out what a combination of them might do for your ADHD child.

Treat Your Child’s Brain—to Dark Chocolate

Ounce for ounce, dark chocolate delivers more brain-balancing flavonols (a type of OPC) than any other food. And study for study, research shows that an ounce or so of dark chocolate is good for your child’s brain.

In a study of 18 children, with an average age of 10, getting a dose of dark chocolate lowered brain inflammation from urban pollution—and improved short-term memory, according to a study in Frontiers in Pharmacology.¹⁴

In another study of young adults, ages 18 to 25, eating dark chocolate (60% cacao) improved focus and concentration.¹⁵ Eating dark chocolate can increase attention—particularly in students who can’t pay attention, said Larry Stevens, Ph.D., a study researcher and professor of psychology at Northern Arizona University.¹⁶

How does dark chocolate perform its mental magic? Studies show dark chocolate can:

• Increase blood flow to the brain

• Decrease inflammation in the brain

• Improve neurotransmission

• Boost BDNF, a protein that protects and energizes neurons

• Guard neurons from neurotoxins

A great lunchtime dessert or after-school treat: one ounce of dark chocolate (at least 60% cocoa) with a handful of protein-rich almonds to balance the sugar. Another way to deliver daily dark chocolate: make your child a cup of hot chocolate with dark chocolate cocoa powder.

How to Use OPCs

Over the decades I’ve slowly but surely found the best way to treat with OPCs: Use a combination of OPCs rather than just one. In fact, I conducted an informal study in my office, tracking brain waves after giving (1) a supplement with one OPC, or (2) a supplement with many OPCs. Number 2—the multi-OPC supplement—produced far more beta waves.

The combined OPC supplement that I use in my practice is one I formulated myself and suggest you give to your ADHD child: CurcumaSorb Mind, from Pure Encapsulations. It contains many of the OPCs we’ve already talked about: pine bark extract, green tea extract, blueberry extract, and grape extract. Or you could try OPC-3 from Isotonix, which was the supplement I used in the informal studies on OPCs that I conducted in my office several decades ago.

You might notice that the form of pine bark extract in this supplement is not Pycnogenol, which is from French maritime pine; it’s an extract from Monterey pine. In my experience, Monterey pine bark extract works just as well as Pycnogenol but is far less expensive.

As the name CurcumaSorb Mind indicates, the supplement also contains curcumin, an extract of turmeric—an herb that numerous studies show is good for the brain, decreasing neuroinflammation and balancing neurotransmitters. The result: improved attention, alertness, and memory. Curcumin has also been shown to affect emotions: People who take the extract regularly are calmer and more content.

And curcumin helps people resist fatigue from psychological stress. I certainly don’t have to tell you that children with ADHD are under just about nonstop psychological stress, at home, at school, and with their friends.

I recommend two multi-OPC pills a day, one with breakfast, one with dinner. In my experience, most children benefit from the supplement, with more focus and better behavior—and most parents think the expense is worth the improvement. But if you don’t see improvements in your ADHD child’s behavior after one to three months, discontinue the supplement.

Safe as Can Be

As for safety: In twenty-five years of treating ADHD with OPCs, I’ve never seen a negative side effect. However, it’s theoretically possible a child could have an unexpected allergic reaction to a plant-based extract like an OPC. If your child develops hives after he starts taking an OPC supplement, stop the supplement. But it’s likely the only “side effect” will be a more attentive child.

Neurofeedback: Another Drugless Way to Balance Brain Waves

Twice a year, the American Academy of Pediatrics evaluates all the scientific evidence supporting treatments for ADHD and grades them from best to worst, with top treatments earning “Level 1—Best Support.” (The other four levels range from Good Support to No Support.)

In 2012, the Academy decided to move a nondrug treatment—neurofeedback—into Level 1, declaring it just as effective as medication.¹⁷

Neurofeedback—sometimes called “EEG biofeedback” or “brain wave biofeedback”—uses a similar approach to traditional biofeedback. But in neurofeedback, the sensors run from an electroencephalograph (EEG) to the scalp, and they measure brain waves.

Brain waves are measured in frequency, or cycles per second, also called Hertz (Hz). Beta waves (around 12 to 38 Hz) are produced by everyday hustle and bustle. Alpha waves (from 8 to 12 Hz) are activated when you’re quietly alert and calm. Theta waves (from 3 to 8 Hz) occur during creative “Aha!” moments, daydreaming, and dreaming. Delta waves (0.5 to 3 Hz) happen during deep, dreamless sleep.

Studies show that many children with ADHD have too many theta waves (inattentive) and not enough beta waves (attentive). When a child uses neurofeedback to increase beta and decrease theta, she can become more attentive, less impulsive, and less hyperactive. Self-esteem also improves. Or, as one study put it: “…neurofeedback therapy has the capacity to functionally normalize the brain systems…in ADHD children.”¹⁸

A neurofeedback session might look like this: The patient sits in front of a computer wearing a cap lined with electrodes that measure brain waves. He plays a computer or video game—and there are many different types available, from a skateboarding competition, to a field that bursts into flowers. Lack of focus causes the game to stop, allowing the patient to slowly but surely understand when he loses focus, and how to regain it.

Some studies show that neurofeedback is just as effective as medication in improving the symptoms of ADHD.¹⁹ And the results are lasting: one long-term study showed that improvements from neurofeedback lasted years after the last session.²⁰

In a recent study with more than 100 elementary-school children—conducted by doctors at Tufts Medical Center and the Harvard School of Public Health and published in the journal Pediatrics—neurofeedback outperformed cognitive therapy (learning specific skills and strategies to deal with ADHD) in improving inattention, impulsivity, hyperactivity, and “executive function” (managing time and attention, switching focus, planning and organizing, remembering details, and curbing inappropriate speech and behavior).²¹

Additionally, the ADHD children in the neurofeedback group didn’t have to increase their medication in the three-month period after the study; the cognitive therapy group did.

The downside of neurofeedback is that it’s expensive and time-consuming: it takes 20 to 40 sessions, at $75 to $150 per session, with a total cost of $2,000 to $4,000—that’s sometimes not covered by insurance. Also, some neurofeedback practitioners aren’t particularly skilled—they’ve taken a weeklong course, are “certified,” and offer the therapy. If you decide to use neurofeedback, look for a licensed clinician experienced in ADHD who is also trained in neurofeedback.

Step-by-Step Action Plan for Healing ADHD

Plus: OPCs

Use this practical, step-by-step summary to implement the symptom-controlling actions discussed in this chapter:

Step #1: Make the decision. On your own or partnering with your doctor, decide if an OPC supplement is the right treatment for your ADHD child. Consider OPCs if your child has inattentive-type ADHD.

Step #2: Supplementation regimen. I recommend the product CurcumaSorb Mind, from Pure Encapsulations. Two pills a day, one with breakfast, one with dinner.

Step #3: Dark chocolate, for more OPCs. For a dessert or snack for your child, consider 1 ounce of dark chocolate (60% or higher cacao). To balance the sugar, combine the dark chocolate with a handful of protein-rich almonds. Or serve hot chocolate made with dark chocolate cocoa powder.

Step #4: Consider neurofeedback. Talk to your doctor about whether or not neurofeedback might be worthwhile for your ADHD child. I recommend using OPCs first, and only considering this effective but expensive and time-consuming treatment if OPCs don’t work.

Does your ADHD child have one or more of these symptoms?

• Near-constant irritability—he’s often impatient, annoyed, or downright angry.

• He frequently loses his temper, throwing tantrums, getting into fights, or behaving in other aggressive ways.

• He yells or screams until he gets his way.

• He rarely does what you ask him to do, arguing instead.

• He’s impulsive.

• He’s intrusive, often inserting himself into situations with urgent and unreasonable demands—in fact, it sometimes seems as if he’s deliberately doing things to annoy you.

• If your child is an adolescent, irritation, anger, aggression, and impulsivity may have morphed into delinquency and substance abuse.

If you found yourself nodding yes to any or all of these descriptions—don’t despair. There’s real hope for your irritable, angry, aggressive, impulsive ADHD child, because there’s real help. Uniquely effective, natural, fast-acting help:

The mineral lithium.

Wait a second, you might be saying to yourself—isn’t lithium a drug, prescribed for bipolar disorder?

Yes, in high daily doses of 600 to 1,800 milligrams (mg), lithium is a medication for bipolar disorder (BD), formerly known as manic-depression. In this disorder, extremes of excitement, confidence, and energy alternate with depression, hopelessness, and lethargy, with normal periods in between. Children with BD are frequently aggressive in the excitable phase and irritable in the depressed phase.

But in very low daily doses of 1 to 10 mg, lithium isn’t a pharmaceutical treatment—it’s a nutritional treatment. And “nutritional lithium” can dramatically soothe the troubled, turbulent emotions that agitate and upset some ADHD children, leading them to helplessly lash out at others.

Even if you’re familiar with natural treatments for ADHD, this may be the first time you’re hearing about nutritional lithium—because very few doctors and parents know about the mineral’s ability to treat irritability, anger, and aggression. So before I tell you about the practical details of supplementing your ADHD child’s diet with nutritional lithium, I’d like to tell you a bit more about this unique, brain-balancing mineral, including its history in healing; how and why I started to prescribe it; how it works to balance, protect, and strengthen the brain; and the scientific evidence supporting its use in irritable, angry, and aggressive children. If you’re interested in what is likely to be the best and most effective treatment for your irritable, angry, aggressive ADHD child, keep reading….

The Health-Giving History of Lithium

Lithium is a mineral—albeit an unusual mineral, so soft you can cut it with a knife, and so light it floats on water. In fact, it’s often found in drinking water and soil—with studies from around the United States and worldwide linking low levels in an area’s water supply to higher rates of mental and emotional disorders and violent crime in that area.

Back in the 1920s, the link between lithium and mood was so well known that a soft drink entrepreneur introduced a soda called Bib-Label Lithiated Lemon-Lime Soda with a slogan that promised an end to the inner pain of irritability and anger: “It takes the ouch out of the grouch.” The soda was soon renamed 7UP. The “7” represented the rounded-up atomic weight of the element lithium (6.9). The “Up” pointed to the soda’s ability to brighten mood. Although don’t look to today’s 7UP to supply lithium—as of 1950, lithium citrate was no longer an ingredient in the soda.

Strange as it seems, the original 7UP was part of an ancient medicinal tradition: people have been making use of the brain-balancing power of lithium for millennia.

Soranus, a Greek physician in AD 200, prescribed “natural waters, such as alkaline springs” for people suffering manic episodes—springs we moderns have discovered are rich in lithium.¹

Lithia Springs, in Georgia, was the site of an ancient stone temple and an enormous earthen pyramid, both estimated to be thousands of years old. Later, it was a sacred healing site of the Cherokee. In 1888, Lithia Springs became a posh spa, subsequently used by American presidents like Cleveland, Taft, McKinley, and Theodore Roosevelt.² Lithium-rich waters bottled at the spa—Bowden Lithia Water, delivering about ½ milligram of lithium per liter—were sold widely in the United States and around the world from the 1880s to the end of World War I. At that time, medications containing lithium were also all the rage: by 1907, one medical textbook included forty-three different medicinal preparations containing the mineral.³

After World War I, lithium’s popularity faded. But in 1949, Australian physician John Cade used high doses of the mineral to treat “mania.”⁴ By the 1970s, high-dose, pharmaceutical lithium had been approved by the FDA for “acute mania” and “recurrent” mania, and it became the standard treatment for manic-depression. In the 1990s, however, there were new medications to treat “bipolar disorder” (a term first used in 1980, sparing people with the condition from being called “maniacs”), and pharmaceutical lithium became an afterthought. But that doesn’t mean lithium itself has lost its therapeutic power or promise. Just the opposite.

In my opinion as a clinician, it’s time for low-dose nutritional lithium to be included among nondrug treatments for emotional, mental, and behavioral disorders. (You also can find nutritional lithium in drinking water and in foods like vegetables, grains, meat, and fish. Also, many herbal experts say that the spice thyme is rich in the mineral. However, you can’t reliably get enough day-to-day nutritional lithium to make a symptom-controlling difference.) Nutritional lithium is certainly at the forefront of my psychiatry practice. I’d like to tell you the story of how I first started using the mineral—a story of bipolar disorder patients whose everyday lives were saved by the mineral.

How I Started Prescribing Low-Dose Nutritional Lithium

As I discussed earlier in the chapter, high-dose pharmaceutical lithium (in the form of lithium carbonate) is an effective treatment for bipolar disorder, recurrent depression, and suicidal tendencies. But many physicians don’t prescribe pharmaceutical lithium because of its potential to cause negative side effects, like irreversible kidney damage, thyroid disease, tremors, muscle weakness, poor coordination, tinnitus, and blurred vision.

In 1990, I was as familiar as any psychiatrist with these side effects. And I was also weary of constantly monitoring blood lithium levels in patients taking the drug to make sure levels were in the “therapeutic range”—a nonstop process that tends to shift the focus from the well-being of the patient to correct numbers from the lab. I started to wonder if lower doses of lithium might alleviate my patients’ symptoms—without side effects.

I was led to low-dose lithium by Jonathan Wright, M.D., a Harvard-trained physician who specializes in integrative medicine and nutritional therapies, and who had been treating people with nutritional lithium—and writing about it—for more than thirty years.

Like Dr. Wright, I began to prescribe the mineral in the form of lithium orotate or citrate, in low nutritional doses, doses far too low to generate the “therapeutic range” of pharmaceutical lithium. To my delight, low-dose nutritional lithium had dramatic effects on mood and behavior in many patients, young and old.

Like Audrey, a bipolar patient who was experiencing intolerable side effects from high-dose pharmaceutical lithium—and whose mood stabilized on 10 mg of nutritional lithium.

Or Paul, a fifty-year-old with severe bipolar disorder who developed chronic kidney disease on high-dose pharmaceutical lithium. Needless to say, he had to stop the drug before it killed him. He was depressed and unemployed for three years. Until he took 20 mg of low-dose nutritional lithium, resumed everyday activities, and returned to work.

Twenty-five years later, I continue to prescribe low-dose nutritional lithium to my patients. I use the treatment to stabilize mood, to help with addictions, to slow or stop memory loss in seniors. And I use it to effectively ease or erase irritability, anger, and aggression in children with ADHD.

Two Plus-Minus Success Stories: Peter and Ethan

Six-year-old Peter is a great example of a child who benefited big-time from nutritional lithium.

Peter had struggled with severe symptoms of ADHD: his parents had been asked to remove him from preschool because of his disruptive behavior, and he was shunned by other children.

Desperate to help their son, Peter’s parents had put him on two “elimination diets,” first removing dairy, then wheat. Neither diet improved Peter’s behavior.

At his first office visit, I found out that Peter had a family history of substance abuse—over the years, I’d found this type of family history is often a clinical indicator of a child who will benefit from nutritional lithium.

I also observed Peter’s anger and aggression firsthand—the symptoms for which nutritional lithium is a perfect match.

With these two clinical indications, I ordered a medical test: the Hair Tissue Mineral Analysis (HTMA), which reveals long-term lithium levels.

As I suspected, Peter had “nondetectable” levels of lithium—the test couldn’t find any lithium in his hair. In reviewing thousands of these tests over the years, I’ve realized that a hair sample with no detectable lithium is very likely pointing to a lithium deficiency.

It was obvious to me that Peter could benefit from nutritional lithium. But, as a four-year-old, he required a very low dose. I prescribed 250 micrograms (mcg) in liquid form, taken once a day; 250 mcg is 0.25 mg.

Nutritional lithium turned out to be just what the doctor ordered. Day by day, Peter’s aggressive behavior began to diminish. He was more able to participate in group activities. He got along better with his older brother and two younger sisters. And he was much less hyperactive.

Ethan, an eight-year-old who struggled with severe behavioral problems, was also helped by nutritional lithium.

Much like Peter, Ethan was easily agitated, aggressive toward other children, and disruptive in the classroom. His parents were often summoned to parent-teacher conferences to discuss what to do about Ethan’s behavior. And the teachers invariably remarked on how precocious and intelligent Ethan was—and how he was equally debilitated by his agitation and aggression.

Ethan’s doctor prescribed a stimulant medication. But it didn’t control his symptoms. In fact, Ethan became more agitated. Other stimulants were tried, but each one had negative side effects.

When I saw Ethan, and heard about his agitation and aggression, I ordered a round of nutritional testing, including the HTMA. Like Peter’s test, the analysis showed nondetectable levels of lithium. I also learned that Ethan had a history of depression and substance abuse on both sides of his family.

I started Ethan on a daily dose of 1 mg of nutritional lithium. His parents and teachers noticed an improvement in his behavior—in just two weeks. I increased his daily dose to 2 mg.

Over the next two months, Ethan became less disruptive in class, could participate in activities with his peers, and lost interest in bullying other children.

He remained on daily nutritional lithium for nearly two years before stopping the supplement. He continues to have no behavioral difficulties at school.

Scientific Support for…The Use of Lithium in ADHD

So-called anecdotal evidence like the stories of Peter and Ethan are very compelling—but they don’t tend to convince doctors and scientists, who look to scientific studies for proof of efficacy. Well, there are quite a number of studies that show the effectiveness of lithium to ease irritation, anger, aggression, and other symptoms of ADHD. And while these studies are on pharmaceutical lithium, my clinical experience tells me that nutritional lithium has a similar, and much safer, effect.

Lithium—twice as powerful as Ritalin for decreasing aggression. A team of psychiatrists and neurologists studied young adults (average age 25) with ADHD, giving them either Ritalin or lithium for two months.⁵ Both groups had improvements in their symptoms—less aggression, irritability, impulsivity, hyperactivity, restlessness, and antisocial behavior. But lithium outperformed Ritalin in several key categories. Lithium decreased “aggressive outbursts” by 71%, compared to 26% for Ritalin. Decreased irritability by 42%, compared to 35% for Ritalin. And decreased antisocial behavior by 28%, compared to 20% for Ritalin.

Less fighting, bullying, angry outbursts, hostility, and hyperactivity—with lithium. Conduct disorder (CD) is found in 25% to 45% of children and adolescents with ADHD.⁶ CD is a pattern of emotional and behavioral problems like bullying, starting fights, stealing, lying, truancy, and even more extreme antisocial behaviors like cruelty to animals and fire setting. Anger and aggression are always part of the pattern.

In a study from psychiatrists at New York University Medical Center, 81 children hospitalized with “treatment-resistant” CD were given either lithium or Haldol (haloperidol), an antipsychotic drug.⁷ Although both drugs decreased symptoms, lithium was more effective in decreasing aggression and hostility.

Lithium outperformed Haldol in another way—lithium didn’t sedate the child; it solved the problem.

“When asked to characterize the actions of the two drugs,” wrote the psychiatrists, “the staff agreed that lithium reduced the explosiveness, and because of this, other positive changes took place, whereas haloperidol made the child only more manageable.” They continued: “Quite a few children receiving haloperidol said that they felt ‘slowed down,’ whereas children receiving lithium carbonate said they felt the drug ‘helped to control’ themselves.”

One 11-year-old boy was “explosive, aggressive, destructive, and dangerous” on admission. After taking lithium, however, he “became the leader of the ward and very supportive toward younger children.”

There are other, similar studies on CD and lithium. Here are three of the best:

The first study was published in the Journal of the American Academy of Adolescent & Child Psychiatry: Fifty children with conduct disorder, aged 5 to 12, were divided into two groups, with half taking lithium.⁸ After six weeks, those taking the mineral had less aggression and restlessness and a better attention span. “Lithium can be used in aggressive children,” concluded the study researchers.

A second study was published in the Archives of General Psychiatry (now JAMA Psychiatry): Doctors studied 40 children (average age 12) with conduct disorder, giving 20 of them lithium.⁹ After one month, 16 were much less aggressive.

I’d like to end this review of the scientific literature on treating aggression with lithium by sharing a third “remarkably” impressive case study, published in the Journal of Child and Adolescent Pharmacology in 2014:¹⁰

H., an 8-year-old girl, had been diagnosed with ADHD, disruptive behavior disorder (uncooperative, defiant, and hostile behaviors) and mood disorder (irritability and depression). She’d been prescribed many medications, including stimulants, antidepressants and antipsychotics—none of which had improved her behavior.

H.’s problems, wrote her doctor, “included yelling, screaming, throwing things, hitting, biting and destroying property,” as well as “a very low frustration tolerance, and demonstrated hyperactivity, impulsivity and inattentiveness.”

H. was referred to a psychiatric clinic at the University of Arkansas for Medical Studies—and her psychiatrist, after having exhausted all his options, put her on lithium. He describes what happened next:

“With the addition of lithium, H.’s symptoms improved remarkably. Her inattention, hyperactivity, and restlessness attenuated, and irritability was reported by her parents to be reduced by ‘60–70%.’ Sleep initiation improved, and she was able to sleep uninterrupted 6–7 hours every night. Improvement in her academic performance was noted, as concentration improved and hyperactivity decreased. Mood regulation was significantly improved as well.”

How did lithium work to calm H., and how does it continue to work to calm so many other aggressive, angry children?

How Nutritional Lithium Works

Lithium is a restorative tonic for the brain, strengthening and protecting neurons (brain cells) and balancing levels of the neurotransmitters that allow neurons to communicate.

Balancing neurotransmitters. Lithium increases serotonin, a neurotransmitter that regulates mood and behavior. It also increases dopamine—a neurotransmitter well known to play a key role in the symptoms of ADHD, with imbalanced levels triggering hyperactivity and mood swings. It decreases the neurotransmitter glutamate, which can damage neurons if levels are too high. And it increases the action of monoamine oxidase (MAO), an enzyme that regulates neurotransmitters; low levels of MAO are linked to aggression.

Protecting brain cells. The mineral may protect neurons from excitotoxicity—damage or death by excessive stimulation from brain-based biochemicals. It also helps activate neurotrophins like BDNF (brain-derived neurotrophic factor), proteins that nourish and protect neurons. Additionally, lithium boosts levels of n-acetyl-aspartate, a biomarker for healthy neurons. Lithium can even increase the amount of gray matter, where brain cells reside. But lithium doesn’t stop there.

Lithium can affect genes in the frontal cortex, the part of the brain that controls aggression. The mineral also decreases neuroinflammation in the brain, a factor in many chronic mental health disorders. Last but not least, lithium helps move vitamin B₁₂ and folate into nerve cells—a must for a healthy brain and nervous system.

Why Don’t More Doctors Prescribe Nutritional Lithium?

As you’ve just found out, lithium is a literal tonic for the brain, able to control angry, aggressive behavior. So why don’t more doctors know about and use nutritional lithium for these symptoms of ADHD? I think there are several reasons.

One, pharmaceutical companies have nothing to gain by marketing or researching this inexpensive mineral. You’ll never see ads for nutritional lithium in medical journals.

Two, lithium is typically used for treating severe mental disorders, so doctors don’t think of it as a treatment for ADHD.

Three, there’s very little understanding and acceptance among MDs of any nutritional treatment. It’s a bit much to expect a conventional doctor with little interest in nutritional medicine to first understand the difference between pharmaceutical lithium and nutritional lithium and then prescribe nutritional lithium.

But if your ADHD child is irritable, angry, aggressive, and impulsive, you can begin to supplement his diet with low-dose nutritional lithium, in partnership with your physician. Here’s how to go about it.

How to Use Lithium

There are three criteria I use to decide which of my ADHD patients need lithium: (1) symptoms; (2) family history; and (3) an HTMA test, to measure hair levels of lithium. Let’s look at these one by one…

Symptoms. Inattention is not the main symptom of an ADHD child who is likely to benefit from nutritional lithium. The main symptoms are irritability, anger, aggression, impulsivity, and hyperactivity.

I’m talking about a child who has a low tolerance for frustration, who blows up often, who might throw things or hit the teacher at school, and who is irritable, and not really happy with anything.

Family history. Because lithium is so effective in bipolar disorder, you’d think a family history of depression and mood swings would be the most telling sign that a child in the family would benefit from nutritional lithium. But it’s not. Years of treating ADHD children has shown me over and over again that the key factor in family history is actually substance abuse. If substance abuse is a factor in your family, do your best to talk openly about it with your doctor, telling the doctor it may be a sign your child needs nutritional lithium.

However, a family history of bipolar disorder is also important. So is a family history of depression or suicide. Even a distant relative with substance abuse, bipolar disorder, depression, or a suicide is a sign to me that the patient may need lithium.

Hair Tissue Mineral Analysis (HTMA). This test measures a number of minerals, including toxic elements like cadmium, lead, and mercury, and essential elements like calcium, magnesium—and lithium. Most children do have detectable levels of lithium in their hair. Those who don’t need nutritional lithium. (But just about any child with ADHD with these symptoms will probably benefit from the supplement.)

In terms of who does and who doesn’t need nutritional lithium, I’d also like to mention research conducted by the late Shirley Lacy, Ph.D., a certified clinical nutritionist, author of a book on ADHD, and herself a person diagnosed with ADHD. She conducted a study on 29 ADHD children, giving them a hair test—25 of the 29 children had below-detectable levels of lithium. She also found that 22 of the children had parents or grandparents with psychiatric disorders like bipolar and depression that had been effectively treated with lithium. The results of her study match what I’ve been seeing in my practice over three decades: many kids with ADHD are low in lithium, and family history is a reliable indicator of deficiency.

Bottom line. Any one of these three factors—behavioral symptoms like anger and aggression; a family history of substance abuse or the other factors I discussed above; and no or low levels of lithium—is reason enough to prescribe nutritional lithium. Here are my guidelines:

Dose and Form

Children 12 and under. Doses for children 12 and under are typically 1 milligram (mg). That’s 1,000 micrograms (mcg), or half a dropper of liquid lithium. Give ¼ dropper (500 mcg), twice a day, with meals.

I favor Lithium Liquid, from Pure Encapsulations; it uses lithium citrate.

It’s fine to give your child 1 mg or less of nutritional lithium without your doctor’s supervision or approval, and many parents do this. With higher doses, you should partner with your doctor.

Teenagers. For most kids 16 and older, I recommend a starting and maintenance dose of 2 mg, or two full droppers of liquid nutritional lithium: one dropper with breakfast; and one dropper at bedtime, to aid sleep. If you don’t see an improvement within 30 days, consider a higher dose, up to 5 mg. (More than 5 mg daily might be appropriate for a teen with ADHD and a history of depression.) But for maximum safety, I suggest using more than 2 mg of low-dose nutritional only with the approval and supervision of a physician, preferably a doctor who has experience using the supplement with patients.

But remember: 2 to 5 mg is not a high dose. The upper end of that range is just a little bit higher than the 1 to 3 mg of lithium the typical American gets from the water supply and diet.

It’s also good to remember that neither of the forms of nutritional lithium—lithium citrate and lithium orotate—is the same as lithium carbonate, the form used in the pharmaceutical drug. Orotate and citrate are absorbed more easily and have fewer potential side effects.

One more point: I don’t recommend lithium aspartate, which you can buy over-the-counter. That’s because aspartate is an excitotoxin, which can cause neurons to transmit impulses at a rapid rate, triggering headaches and brain inflammation in some individuals.

Results: What to Expect

If lithium is going to produce results, you’ll usually see an improvement in behavior in two to four weeks.

If lithium hasn’t worked by three months—if your ADHD child isn’t less irritable, angry, and/or aggressive—stop giving your child the supplement.

Safety

In all my years of prescribing nutritional lithium, I have never seen a negative side effect. Never. However, in rare cases children can feel too calm or mellow, with a subdued or “flat” affect. Or a child says she just doesn’t “feel right.” If that happens, stop the supplement.

Another point to discuss with your doctor if he or she isn’t familiar with nutritional lithium: when people take pharmaceutical lithium, they need to be monitored for lithium levels, since high levels are dangerous. That’s probably not the case when your child is taking nutritional lithium—levels are low, which means no monitoring is required.

A theoretical contraindication (a condition that could possibly make a particular treatment inadvisable) is an underlying thyroid disorder, since pharmaceutical lithium can hurt the thyroid. However, if my child had a thyroid disorder and needed nutritional lithium, I wouldn’t hesitate to prescribe it—that’s how safe I have found this supplement in my clinical practice. No one in my practice has ever been harmed by it.

My “lithium mentor” and colleague Dr. Wright concurs: In his practice, doses up to 40 mg daily have been completely safe, with no negative side effects.

Bottom line. I’ve seen lots of positive effects from nutritional lithium—less irritability, anger, and aggression; more happiness, calm, and focus. It’s not an exaggeration to say that lithium can grant new life—for your ADHD child and for you.

Step-by-Step Action Plan for Healing ADHD

Plus: Nutritional Lithium

Use this practical, step-by-step summary to implement the symptom-controlling actions discussed in this chapter:

Step #1: Does your ADHD child have the signs of a child who needs nutritional lithium? A family history of substance abuse, bipolar disorder, depression, and/or suicide? Irritability, anger, and aggression?

Step #2: If yes, talk to your doctor about testing for lithium, asking for a Hair Tissue Mineral Analysis. The test costs about $50.

Step #3: If your ADHD child has low or “nondetectable” levels of lithium, he needs a supplement of nutritional lithium. (If testing isn’t possible, and your child has the signs described in Step #1, you can give nutritional lithium at the doses described below.)

Step #4: Supplement your child with nutritional lithium.

Ages 16 and older: 2 mg daily, with breakfast and at bedtime. If you see no improvement in four weeks, consider increasing the dosage to 5 mg daily, but only with the approval and under the supervision of a physician, preferably one experienced in using the supplement with patients.

Ages 6 to 15: Start with 500 mcg daily for one week. After one week, increase to a total of 1,000 mcg daily, in two 500 mcg doses, with meals. Use the liquid form.

Step #5: If you haven’t noticed an improvement in behavior after three months, discontinue the supplement.

There are two types of minerals in the diet: those the body needs a lot of every day, the “macrominerals” like calcium; and those it needs just a little of, the “trace minerals” like zinc and copper.

I’m introducing zinc and copper together because they’re something like a nutritional seesaw: if the level of one goes up, the level of the other goes down. High zinc, low copper. High copper, low zinc.

And that’s a seesaw a child with ADHD can easily fall off. Getting too much copper can hurt the brain. Getting enough zinc is a must for a healthy brain. But nearly half the ADHD children I see in my practice have too much copper and too little zinc! When I partner with parent and child to correct the problem—bringing the two minerals back into balance—ADHD symptoms almost always improve. Dramatically.

To start our exploration of this key therapy in the Plus-Minus Plan, let’s take a closer look at these two minerals and their role in brain health.

Zinc plays an essential role in the manufacture of proteins (the building blocks of nearly all cellular structures) and enzymes (the spark plugs that drive cellular activity). In other words, zinc is essential for the creation and operation of every cell in the body. Zinc also helps create several neurotransmitters, including dopamine, norepinephrine, and serotonin. These brain chemicals relay messages from neuron to neuron. And balancing them is at the core of effective treatment for the imbalanced brain and behaviors of ADHD.

The production of melatonin—the hormone that regulates the sleep-wake cycle, which must be normal for normal daytime functioning—depends on zinc. And melatonin itself is part of the biochemical assembly line that builds neurotransmitters.

The hippocampus—the section of the brain that is the master controller for functions ranging from memory to movement—also requires zinc for its development.

In fact, zinc nourishes the entire brain, neuron by neuron: it’s a must for the stability of the outer covering (membrane) of neurons; it protects neurons from oxidative damage, a kind of internal rust; and it keeps neurons energized.

If you’re not zincing, you’re not thinking.

Like zinc, copper has its shiny side: Taking in a tiny amount daily is a must for good health. But too much copper is a toxic ticket to misery and can lead to headaches and hair loss, to nausea and poor appetite, to liver and kidney damage. And because it blocks the production of serotonin, a mood-balancing neurotransmitter, excess copper can also trigger emotional, mental, and behavioral problems—from the everyday, like depression and anxiety, to the severe, like paranoia and psychosis. And among the many possible symptoms of excess copper are some of the symptoms of ADHD, particularly hyperactivity, impulsivity, and aggressiveness.

High copper and low zinc is a seesaw you don’t want your child to ride. That’s why it’s so important to make sure that there are high enough levels of zinc to counteract the effects of any excess copper.

Scientific Support for…The Importance of a High-Zinc/Low-Copper Level in Healing ADHD

Since I started treating children in 1990 I have seen thousands of patients with copper/zinc imbalances. And new studies about the problem were appearing even as I was writing this book.

ADHD children are low in zinc. Researchers at the Yale Child Study Center found that children with ADHD had much lower levels of zinc than healthy children—in fact, 30% were severely deficient in the mineral, meaning they had abysmally low levels.¹

Low zinc equals hyperactivity and inattention. Researchers tested 118 children with ADHD, finding that those with the lowest blood levels of zinc had the highest levels of inattention, distractibility, hyperactivity, impulsivity, anxiety, and other symptoms of ADHD, as measured by the Conners’ Parent Rating Scale, a standardized and widely used approach to quantifying the behavioral problems of children.²

Children with “low levels of zinc might be at increased risk of having higher levels of hyperactivity…conduct problems and anxiety,” reported the researchers in the medical journal Child Psychiatry & Human Development.³

Better brain waves with zinc. A team that included experts in neurology, psychiatry, and biochemistry studied 28 boys.⁴ They found that boys with ADHD had lower levels of zinc—and abnormal brain waves that could interfere with “information processing” (attention) and “inhibition” (impulsivity).

Zinc supplements improve ADHD symptoms. Doctors studied 218 third-graders, giving half of them 15 mg of zinc daily.⁵ Those who took the mineral had significant decreases in hyperactivity, inattentiveness, and oppositional behavior—and these were children with normal zinc levels at the start of the study!

Low zinc interferes with ADHD medication. In other research, zinc levels predicted whether or not a stimulant medication would work: the lower the zinc, the less effective the drug. For example, hyperactive children with low zinc were 60% less likely to respond to Ritalin.⁶

Zinc boosts the effectiveness of Ritalin. In this study, published in the medical journal BMC Psychiatry, a group of children took Ritalin and zinc, while another group took Ritalin only.⁷ Those on the nutrient-drug combo had much greater improvement in their ADHD symptoms, as evaluated by their parents.

New study on copper/zinc and ADHD. In a recent study—published in the scientific journal Biological Trace Element Research—a pediatric psychiatrist, a biochemist, and an expert in trace minerals evaluated 108 children aged 6 to 14.⁸ Fifty-eight of the children had ADHD, and all of them had been diagnosed by the age of 6 or 7.

To start the study, the researchers measured (1) levels of zinc and (2) zinc/copper ratios. You now know enough about this topic not to be surprised by the study’s results.

On average, children with ADHD had lower zinc levels, and a high-copper/low-zinc ratio; children without ADHD had normal levels of zinc and a normal ratio. And the ADHD kids who had the highest levels of copper and the lowest levels of zinc had the most attention problems.

Those studies are just a sampling of many studies with similar results, not to mention my own positive experiences using zinc with ADHD children. In my clinical practice, I test for a high-copper/low-zinc imbalance. If I find it, I treat the child with zinc—and symptoms almost always improve.

Plus-Minus Success Story

Patient: Micah, a 9-year-old boy

Treatment for: Zinc and magnesium deficiency

“I can’t remember the last time we went to a restaurant together and it was enjoyable,” said Micah’s father, Fraser, his voice flat and drained of emotion. “It was one of the things I always loved doing when I was growing up—going out to eat with my family. I was looking forward to that with my own family.” He lowered his eyes. “It hasn’t worked out that way.”

It’s hard to overstate how having a child with ADHD challenges your assumptions about the way your parenting was going to be. For Micah’s family, his disorganization, irritability, and anger made most of the activities that families usually find fun to share very difficult instead.

And it wasn’t only the dinners out. Home life was difficult, too. Micah had no friends and few playdates. He angered quickly and told his parents how much he “hates them.” He had threatened to hurt them.

“I know a nine-year-old can’t really hurt us,” Isabelle, his mother, told me. “But he is getting bigger. Sometimes he can hurt me. And I worry about when he gets older.”

“I love going to work,” Fraser added. “When I’m at home, I feel like I’m constantly walking on eggshells.”

Previous diagnosis and medications: Micah was diagnosed with ADHD at the age of 6 and put on a medication. But he struggled with the side effects. Now his parents felt like they were stuck: either give Micah medication again and watch him suffer from side effects, or deal with Micah’s unpredictable, disturbing behavior.

Plus-Minus Testing: I found Micah surprisingly cooperative during our one-on-one discussion. Like every child with ADHD, he didn’t want to be bad—he just couldn’t help himself. And when I got the results from the lab tests, I could see why: Micah was deficient in magnesium and had a severe copper excess and low zinc.

Plus-Minus Treatment: I supplemented Micah’s diet with magnesium and zinc.

Healing Success: After two months, Micah’s parents called to report that his teachers had seen a dramatic change in Micah. They noted that he was participating in activities, completing assignments, and interacting more successfully with his peers. “It’s a miracle,” Fraser said. “We can even go out to eat!”

The Possible Signs of Copper Excess

There are many telltale signs of an ADHD child with a high-copper/low-zinc imbalance. I describe them below, from the most to the least telling. If even a few of these are a match to your child, it would be wise to supplement the diet with zinc.

An ADHD stimulant medication like Ritalin didn’t work—in fact, it might have made your child worse. In my clinical experience, stimulants don’t work well in children with a copper excess. The ADHD child with a copper excess also tends to have more side effects from stimulant medication, like becoming more agitated and anxious, sleeping poorly, or losing her appetite.

Most ADHD medications work by increasing levels of dopamine, the neurotransmitter that provides alertness, mental acuity, positive mood, and the motivation to seek and find pleasure or a sense of reward. In this case, copper is a good guy: it helps generate dopamine. But an excess of copper creates an excess of dopamine and its partner norepinephrine, causing symptoms like hyperactivity, agitation, irritability, and aggressiveness. And a dopamine-boosting medication only makes matters worse!

Dopamine excess is also produced by elevated levels of HPHPA, a by-product of imbalanced intestinal bacteria; you’ll read about HPHPA in the next chapter. Many of the ADHD children I see in my practice have both copper excess and intestinal imbalance, and their symptoms don’t improve until both problems are treated. That’s why detecting and correcting (1) copper excess and (2) intestinal imbalance are top priorities in my Plus-Minus Plan.

Your drinking water is or was high in copper. Copper pipes are common in homes built from the 1960s to the present—and these pipes can corrode, leaching copper into drinking water. Oddly, newer homes are more likely to have the problem: over time, a coating forms on the inside of copper pipes, shielding the water from the copper. (Brass pipes are an alloy of copper and zinc and can also contribute to the problem.)

There are several ways to protect your ADHD child (and yourself) from copper in drinking water:

Let the cold water run. If you haven’t used the faucet for a few hours, let the cold water run for thirty to sixty seconds before drinking it.

Don’t use the hot water faucet for drinking or cooking. Hot water dissolves copper more quickly. If you need hot water for drinking or cooking, get it from the cold water tap, and heat it up. That’s particularly important when making baby formula.

Install a water filter. Reverse osmosis, ultrafiltration, distillation, ion exchange, and activated carbon all take a high percentage of copper out of the water.

Check copper levels. You can contact your local water supplier to find out the level of copper in the water. Levels that exceed 1,300 parts per billion are harmful, according to the EPA. Copper can also be a problem in well water, from the copper in rock. Have your well checked for copper (and other contaminants) at least once yearly. (Please see the Appendix for a link to a list of state-certified laboratories that test drinking water.)

Your ADHD child is a picky eater. Low levels of zinc dull the sensations of taste and smell, decrease appetite, and (strangely enough) make meat seem repulsive. Restore zinc and your child with ADHD might actually stop playing with her food and start eating it.

Your ADHD child has digestive problems. Zinc is a must for the digestion of carbohydrates, proteins, and fats—which is why children with low zinc and high copper often have poor digestion.

Your ADHD child is a vegetarian or vegan. Red meat, seafood, and chicken deliver lots of zinc; meatless diets can be low in the mineral, elevating copper. In fact, choosing to be a vegetarian might also be the result of a high-copper/low-zinc imbalance.

Your ADHD child has allergies. Allergies are a common symptom of copper excess, which weakens the immune system.

Your ADHD child has white spots on his or her fingernails. Your doctor might disparage this as a symptom of zinc deficiency, saying it’s self-care folklore, not scientific fact. But it’s commonplace for me to see patients who have white spots on their fingernails—and who then test positive for a zinc deficiency.

Your ADHD child has sleeping problems. As I pointed out earlier, zinc plays a key role in the production of melatonin, a hormone that helps us snooze. If your child is a poor sleeper, chances are he needs more zinc.

Your ADHD child was overactive and had sleeping problems as an infant. If mom had a copper excess, baby might have it, too—the pregnant body automatically dumps extra copper into the placenta. Your child might have been born with high-copper/low-zinc—and hyperactivity and sleeping problems, two common symptoms of ADHD.

Your ADHD child has started puberty. The metabolic demands of puberty burn up zinc, sometimes causing copper excess. This may be a major (and usually overlooked) reason why ADHD sometimes worsens when puberty begins.

Your ADHD child is under stress. And what child with ADHD isn’t? Children with this disorder are stressed in every area of their lives—at school, at home, with their friends, with no respite anywhere. High levels of stress translate into high levels of the “stress hormone” cortisol—which blocks the activity of zinc. With less brain-balancing zinc available, your child is more likely to feel overwhelmed by stress and pump out more cortisol, further interfering with zinc. But you can break this vicious cycle by supplementing your child’s diet with zinc.

Your ADHD child is a nonstop competitive athlete, with frequent practices and games. Zinc is lost through sweat—and high-intensity daily exercise can drain the body of zinc. Vegan and vegetarian athletes are particularly at risk for zinc deficiency.

Your ADHD child was exposed to BPA (bisphenol A). Worldwide, billions of pounds of this zinc-binding, zinc-blocking chemical are produced each year, for the lining of food cans, for plastic products, and for the coating on receipts. But even BPA-free products might not be the answer: BPA is often replaced with similar chemicals that also bind zinc. (In fact, many environmental toxins deplete zinc.) The National Institute of Environmental Health Sciences offers a few ways to reduce your child’s exposure to BPA and similar chemicals.

Don’t microwave polycarbonate plastic containers. Avoid recyclable plastic containers with codes 3 or 7; they may contain BPA. Opt for glass, ceramic, or stainless steel containers, particularly for hot foods or liquids. Use baby bottles that are BPA-free.

Your child has ADHD and anorexia. The symptoms of anorexia nervosa are almost a perfect match for the symptoms of zinc deficiency: decreased appetite and meat avoidance; decreased taste and smell; nausea and bloating after eating; insomnia and poor sleep habits; depression; and attention difficulties. The good news is that a study shows that anorexic adolescents supplemented with 50 mg of daily zinc had improvements in many symptoms of the eating disorder.

Any Lead Is Bad for Your Child’s Brain

Copper is a so-called heavy metal, meaning it’s very dense—and potentially very damaging to a child’s growing body and brain. But there’s another heavy metal that’s notoriously bad for children’s brains…

Lead. As in lead pipes.

In recent years, officials discovered that the drinking water in Flint, Michigan, had extremely high levels of lead—as did the blood of many children in Flint. As I was writing this book there were news stories reporting that lead poisoning from contaminated water was twice as common in Cleveland as in Flint (14% of children, compared to 7%).⁹ As a story in the New York Times put it, “…too much lead in children’s blood has long been an everyday fact in Cleveland and scores of other cities…largely because a decades-long attack on lead in household paint has faltered. ‘Unless there is some sort of concerted national effort to do something about this problem, it’s going to persist for years to come,” said Philip J. Landrigan, a leading expert on lead and professor of pediatrics at the Mount Sinai School of Medicine. ‘Lead is a big problem in this country, and it frustrates me to no end that except in rare cases, it passes unnoticed.’ ”¹⁰

In other words, for parents and children everywhere in America, lead poisoning is a threat—and evidence of lead in the blood is very worrisome. It’s now scientifically proven that any level of lead in the blood can hurt your child’s brain.¹¹ There is no safe level. Lead is unsafe, period. As a neurotoxin, the metal can damage the synapses that help relay messages from neuron to neuron. The higher the level of lead in the blood, the more likely it is a child will have a lower-than-normal IQ and impaired attention. Researchers matched lead blood levels in 256 children to the symptoms of ADHD, finding that “Even low blood levels—under 5 mcg/dl—are associated with inattentive and hyperactivity symptoms and learning difficulties in school aged children.”¹²

The good news about lead: Since 1978, when lead was generally banned for commercial use in the United States, there has been a dramatic reduction in the lead content of gasoline, household paint, food cans, and smokestack pollutants.

But that doesn’t mean lead isn’t still a threat.

Lead can be found in paint chips and dust in houses built before 1978—chips and dust that are ingested or inhaled by children six and under, whose vulnerable brains are at the greatest risk for lifetime damage from the metal.

And now there’s a new lead-laden threat on every block in America where a child lives: lead in toys imported from countries where lead hasn’t been banned—particularly China, the source of 85% of toys sold in the United States.

Preventing Lead Poisoning

If your child has been diagnosed with ADHD, make sure he’s tested for lead. Doctors routinely test children for lead during their first two years of life—but rarely test children older than two. That’s a mistake.

For instance, I recently saw a five-year-old child whose doctor detected a slightly elevated lead level when he was two—but who never treated the child with a lead-removing drug because he thought the level was too low to worry about. Now the child has severe hyperactivity and other behavioral problems.

If blood lead is detected, ask your doctor about treatment options. High blood lead levels are a serious health problem and need to be treated, perhaps with a lead-removing drug. Other ways to help keep lead to a minimum:

Dust! Lead-contaminated dust is the most common source of lead exposure in children. If you’re living in a pre-1978 house, make sure you wet-mop floors and wet-wipe dusty surfaces every two to three weeks.

For water, follow the same advice that I gave for copper in water (see this page). Let cold water run. Don’t use hot water from the tap for cooking. Get a water filter. Have your water tested.

Make sure your child washes his hands after play, before eating, and at bedtime. Toys and soil can be contaminated with lead. Wash toys regularly. Provide a sandbox for your child, and encourage him to play in it.

Don’t worry too much about another heavy metal that’s in the news—mercury. There’s a lot of concern out there about elevated mercury levels, from eating fish, mercury amalgams in dentistry, air pollution, and mercury in vaccines. But in my thirty years of treating thousands of children with ADHD, I’ve seen only a few cases where the only cause of a child’s symptoms was elevated mercury levels.

Testing for Excess Copper

There’s only one way to know for certain if your child has excess copper and low zinc: the Hair Tissue Mineral Analysis, a hair test that measures zinc and copper levels. (For an additional evaluation of zinc/copper status, your doctor can also consider the Zinc/Copper Profile, available from Great Plains Laboratory.) With results in hand, your doctor can definitively determine whether or not your child has excess copper and low zinc. And if she does, there’s a straightforward, simple way to treat the problem: take zinc.

For Excess Copper, Supplement with Zinc

There’s a happy ending to the drama of a high-copper/low-zinc imbalance: Add zinc and subtract copper.

I think it’s safe for parents to give their ADHD child a zinc supplement without the approval and supervision of a doctor (with one caveat, which I’ll discuss in a second). The amount of zinc depends on the age of your ADHD child…

For children 12 and older. I recommend 30 mg of zinc, twice daily, with meals. (I prescribe zinc picolinate, the most-studied and best-absorbed form.)

For children 6 to 11. I recommend 15 mg, twice daily, with meals.

For children 5 and younger—zinc supplementation is not advised, unless it’s under a doctor’s supervision. I don’t routinely recommend nutritional supplementation for children 5 or younger. And the more likely causes of their ADHD symptoms are intestinal imbalance (Chapter 5) or food allergies/sensitivities (Chapter 6).

Zinc is a mineral, not a fast-acting medication: it can take three to four months for zinc supplementation to restore a normal copper/zinc balance. Your ADHD child should stay on the zinc for at least six months, after which he should again be tested. If your child wasn’t tested, look to his symptoms to tell you if zinc is working.

If, after six months, zinc and copper are back in balance, but ADHD symptoms are still a problem, you and your doctor can consider reintroducing an ADHD medication that previously didn’t work and might have worsened your child’s symptoms. Now that zinc/copper has been balanced, medication is more likely to be effective.

Additionally, if testing shows copper/zinc levels have returned to normal, you can take your child off supplemental zinc and put her on a multivitamin/mineral supplement with at least 15 mg of zinc and 1 to 2 mg of copper. If your child’s symptoms are better, do the same.

One possible but rare problem when giving zinc: The nutrient may force copper out of tissues and into the blood—and physical and behavioral symptoms (like agitation, hyperactivity, headache, and stomachache) may worsen before they get better. If this happens—and, once again, I’d like to say it’s very unlikely—stop zinc for a few days until the worsened symptoms resolve. Restart zinc, giving it once rather than twice a day—in other words, halve the dose. If symptoms remain stable for three weeks, increase the dose back to twice a day.

What About Zinc-Rich Foods?

You might be wondering if you should also try to correct a zinc/copper imbalance by feeding your ADHD child more zinc-rich foods, like red meat, seafood, chicken, cheese, whole grains, fortified breakfast cereals, beans, and nuts. In a word, my answer is no.

Sure, these are all excellent foods that belong in your child’s diet. But trying to cure a copper excess by emphasizing your child’s intake of zinc-rich foods isn’t going to work—it’s nearly impossible to reliably decrease copper and optimize zinc that way. And like any specialized diet, trying to get your child to consistently eat more zinc-rich foods is sure to drive you (and your child) crazy. To address a copper/zinc imbalance, supplement the diet with zinc. Your child’s brain will thank you for it!

Step-by-Step Action Plan for Healing ADHD

Minus: Copper

Plus: Zinc

Use this practical, step-by-step summary to implement the symptom-controlling actions discussed in this chapter:

Step #1: Look over the list of signs that your child may have a high-copper/low-zinc imbalance. If your child has a few of the telltale signs, consider supplementing with zinc picolinate.

For children 12 and older: 30 mg, twice daily, with meals

For children 6 to 11: 15 mg, twice daily, with meals

For children 5 and under: No zinc supplements!

Step #2: For certainty about your child’s copper/zinc levels, ask your doctor to test your child, using a hair test. If your child tests high for copper, you must treat with zinc, as in Step #1.

Step #3: If your child was tested and her copper levels were high, retest six months after starting daily treatment with zinc. If levels are normal but behavioral problems persist, consider reintroducing an ADHD medication—even if it didn’t work before, it’s likely to work now, without side effects.

Additionally, if copper/zinc levels are normal, switch your child to a multivitamin/mineral supplement containing at least 15 mg of zinc, but no copper.

Step #4: If your child has been diagnosed with ADHD, make sure he’s tested for lead levels. With results in hand, follow up with your doctor or local lead clinic to rule out lead poisoning.

I’d like to start this chapter with two case histories—stories of seven-year-old Mark and nine-year-old Sam. Both of them had been diagnosed with ADHD. But both of them—unbeknownst to their parents and doctors—were suffering from intestinal imbalance, an overgrowth of unfriendly gut bacteria. Once their intestinal imbalance was corrected, their ADHD symptoms were dramatically reduced.

—

Mark was always playful and energetic, but his teachers said he could become “disruptive” and “silly” in class. He also had difficulty transitioning into new activities. When boundaries were set, he sometimes became aggressive and violent with his siblings and peers. He had a high IQ and no learning disabilities.

When he was seven, Mark was diagnosed by his doctor with an “extreme case of ADHD” and started on medication. But his aggression, agitation, and anxiety only increased—while his appetite decreased and he developed vocal tics, both side effects of his medication.

In my office, seven-year-old Mark seemed shy and somewhat withdrawn, but within minutes his eyes were darting in all directions. He found magnets to play with, but after doing that for a few minutes, he pushed them aside. Soon after, he tried to leave the office—when he opened the door, his dad held on to his squirming boy—and Mark finally started screaming.

I ordered an organic acid test (OAT) for Mark—a urine test that can detect a wide range of metabolic imbalances. It revealed that Mark had high levels of HPHPA, a harmful metabolite of Clostridia, a type of bacteria that can overwhelm the gut. As I’ll explain in more detail later in the chapter, HPHPA creates superhigh levels of the neurotransmitter dopamine, leading to hyperactivity and aggression, which were just the problems I saw in Mark.

I treated Mark with high-dose probiotics—supplements of friendly bacteria—to reduce the Clostridia and the HPHPA.

At his four-month follow-up visit, Mark was visibly calmer. He sat on the floor with me and played the magnet game as his parents sat on the couch. He spoke very little, other than making it clear that school was better—and asking his parents about where the family was going to have dinner after the appointment. It was clear to me that Mark was less anxious, more interactive, and deliberate and focused while playing. In private, his parents confirmed that he was less aggressive and better able to participate in the classroom.

Mark continues to do well—without medication.

—

Sam, a nine-year-old boy, was in my waiting room with his parents—and got up without warning, entering my office with a purposeful, strong stride. I tried to engage him in conversation, and he answered my questions quickly as he simultaneously lifted pencils, then papers, then pads on my desk, which is far across the room from the couches and chairs where Sam’s parents and I sat. Sam started playing with my computer, pressing keys, and asking me if I had games he could play.

Sam’s parents were noticeably struggling with embarrassment. They told him repeatedly—and in louder and louder voices—to sit down. But as the session continued, Sam became more agitated, moved more quickly, and answered my questions in a louder and louder voice. His movements were intense, and it became clear to me that his behavior wasn’t willful or even volitional: he had an automatic internal engine that was powering his thoughts, his speech—and his hyperactivity.

As Sam became increasingly agitated, the only way to proceed with the session was for Sam’s father to take Sam for a walk in the long hallways of my office building.

While they were gone I continued with Sam’s mother and it was obviously painful for her to share with me what it was like for Sam at home and at school. She told me—as I had just seen for myself—that Sam was extremely hyperactive and disorganized. At home, he couldn’t follow directions and threw temper tantrums. When he was in preschool, he had twice been asked to leave until his behavior improved.

Sam had been diagnosed with severe behavioral problems and ADHD. He had undergone multiple psychological and psychiatric evaluations prior to my meeting him. He had been prescribed stimulant medications, but his response was poor—he became more agitated. With his aggressive and impulsive behaviors increasing, he was prescribed the antipsychotic Risperdal, but he became so sedated that he was unable to attend school. He also was prescribed the antidepressant medication Prozac, although he had no evidence of depression.

As with Mark, the OAT showed extremely high elevations of the Clostridia metabolite HPHPA. Once again, I prescribed high-dose probiotics. The results were remarkable.

Within thirty days, his parents happily reported that Sam’s symptoms had improved. His behavior was much more under his control, and his (pleased and surprised) teachers said he was able to participate more in class—he even had a number of days when he got extra stars on his behavior chart!

When I saw him three months after his first visit, Sam walked quickly to my desk, stopped, turned, looked directly at me, and asked if it was okay for him to play with the computer. That moment of hesitation—taking a second to stop, and think, and ask permission—was a moment of courage and triumph for Sam. Clearly, it was a victory for his self-esteem. He had a powerful sense of personal happiness that he communicated with his hesitation and eye contact. I received a grateful “Thank you” from his parents, who knew that Sam’s life had changed dramatically for the better.

—

To understand why Mark’s and Sam’s symptoms improved when they took probiotics, you need to first understand the role friendly and unfriendly bacteria play in the gut, how those bacteria influence the brain, and how the widespread prescribing of antibiotics for children is creating an epidemic of intestinal imbalance, affecting the brains—and behaviors—of millions of American children. Let’s start with the bacteria themselves.

Microbiota 101

Bacteria are everywhere. They’re everywhere on earth—from desert sands to Antarctic ice, from the depths of the ocean to the upper atmosphere.

And they’re everywhere on and in you: one hundred trillion microbes, from more than one thousand species, happily inhabiting your ears, nose, and mouth, hanging out under your arms and between your toes—and riotously thriving in the warm, wet, and well-stocked precincts of your bowels.

Yes, your gastrointestinal (GI) tract is “tract housing” for a complex, ever-changing population of bacteria called gut microbiota. A microbiota is any group of microbes that occupy a specific habitat. Just who are these gut-based germs, and what are they doing inside you?

Many of us still think of any and all bacteria as “bad.” And we think of antibiotics as the medical militia that can stop those marauding germs from taking over.

True, there are a lot of bacteria that can sicken us. But many species of bacteria are partners in good health—including so-called friendly gut bacteria. There are three to four pounds of these microorganisms in the gut, providing many important functions critical for maintaining our health. And calling them “friendly” is an understatement. “Indispensable” is more like it. Because without those bacteria, you wouldn’t be alive. Among their many metabolic talents, friendly gut bacteria do the following:

• Help propel digesting food through the intestines

• Ease food cravings and regulate appetite

• Keep the lining of the intestines strong and intact (instead of weak and leaky)

• Stop bad bacteria from multiplying

• Thwart carcinogens

• Activate the gut-based immune system (70% of your total immune system)

• Stabilize intestinal pH (acid/alkaline balance), allowing beneficial bacteria to flourish

• Break down and rebuild hormones

• Manufacture essential fatty acids, B vitamins, and vitamin K

• Boost the absorption of vitamins and minerals

Given their health-sustaining power, it’s no surprise that scientific studies have found friendly bacteria can help prevent, control, or reverse a wide range of conditions. These include high cholesterol, prediabetes and diabetes, gum disease and cavities, colds, flu and pneumonia, colic, irritable bowel syndrome, eczema, vaginal infection, chronic constipation, rheumatoid arthritis, cirrhosis, overweight, canker and cold sores, chronic kidney disease, inflammatory bowel disease, allergies and asthma, high blood pressure…and the list goes on.

Along with these metabolic and medical benefits, scientists have recently discovered a new—and very surprising—way that gut microbiota influence our lives. This mass of microscopic creatures affects the brain, playing a central role in how we think and feel. And they may be affecting your ADHD child’s brain, and therefore his behavior.

Which leads me to introduce this chapter’s essential therapeutic insight, based on scientific research and my clinical experience:

Some strains of bacteria—including one called Clostridia—generate a chemical called HPHPA that can affect the brain, making your ADHD child more agitated and aggressive.

That’s the bad news. Here’s the good:

A simple test—the OAT—can detect if HPHPA is overwhelming your child’s gut. And, if it is, a straightforward integrative treatment can normalize gut flora, decrease HPHPA, and improve behavior.

The Brain-Bacteria Connection

The new and expanding scientific field that studies the link between the brain and gut microbiota is called neurogastroenterology. The title of a recent scientific paper in the Journal of Neuroscience—“Gut Microbes and the Brain: A Paradigm Shift in Neuroscience”—gives you a good idea of how quickly and how radically scientific thinking is changing.¹ So does the bestseller Brain Maker: The Power of Gut Microbes to Heal Your Brain—for Life, by neurologist David Perlmutter, which presents this breakthrough field to the public.² Like Dr. Perlmutter, neurologists worldwide are realizing that bacteria in the gut play a huge role in how the brain works.

Researchers in the field have discovered that communication between the gut and the brain—the “gut-brain axis,” as they’ve dubbed it—is a two-way process whose goal is keeping your body in a state of balance, or homeostasis. Examples of homeostasis include a body temperature that’s not too hot or too cold, a heartbeat that’s not too fast or too slow, and a rate of digestion that’s not too speedy or too sluggish. In the words of Goldilocks—the systems and organs of the body are “just right.”

Gut microbiota also directly balance or imbalance the brain—through neurotransmitters. These chemicals are produced in neurons (brain cells) and relay messages between neurons. They fall into two main categories. There are inhibitory or calming neurotransmitters; and there are excitatory or stimulating neurotransmitters.

The inhibitory neurotransmitters include serotonin and GABA: they calm you down, playing key roles in stabilizing mood, appetite, and sleep. The excitatory neurotransmitters include norepinephrine and epinephrine: They rev you up and play key roles in attention, energy, and sleep.

And then there’s dopamine, a neurotransmitter that plays key roles in both inhibition and excitation. Balanced levels of dopamine are a must for focus and motivation. Imbalanced dopamine is common in ADHD.

Next, I’d like to discuss a few of the many studies that are establishing the link between the microbiota and the mind. They all involve supplementing the diet with a probiotic—a friendly, gut-inhabiting microorganism found in fermented food like yogurt, or in a probiotic supplement. Ingested in adequate amounts, these live organisms produce a beneficial effect in patients suffering from behavioral, emotional, or mental problems.

Scientific Support for…The Gut- and Mind-Healing Power of Probiotics

Probiotics work as well as Ritalin. Yes, that was the result of a study involving 20 children with ADHD, half taking Ritalin and half taking a probiotic and other nutritional supplements, like fish oil.³ The researchers (three doctors from the McLean Hospital, a psychiatric hospital affiliated with Harvard Medical School) were astonished by the results: The probiotics and other supplements worked as well as Ritalin! The children on both regimens had more impulse control and were more attentive. “These findings support the effectiveness of food supplement treatment in improving attention and self-control in children with ADHD, and suggest food supplement treatment of ADHD may be of equal efficacy to Ritalin,” concluded the researchers in Alternative Medicine Review.

Probiotics mean less stress, anxiety, and depression, along with better problem-solving skills. In one research case, 70 people were divided into groups, with some eating a probiotic-rich yogurt or taking a probiotic supplement.⁴ After six weeks, those eating the probiotic-rich yogurt had 85% less stress, anxiety, and depression than the non-probiotic groups, and those taking the supplement had 51% less, reported researchers in the medical journal Nutritional Neuroscience. In a study from the British Journal of Nutrition, researchers found that taking probiotics for thirty days decreased anger and hostility, depression and anxiety, and increased problem-solving ability.⁵

How Do Friendly Bacteria Make Us Happier?

Exactly how do gut microbiota influence communication between the gut and the brain? Or, as scientists like to ask, What is their mechanism of action? Turns out there are quite a few. Gut microbiota affect the brain through:

• The vagus nerve. It starts at the brain stem and ends at the colon, home to most gut microbiota.

• Neurotransmitters. As I mentioned earlier, neurotransmitters like serotonin influence emotions and mood. Neurotransmitters are also sent from the brain to the gut, and the gut to the brain. In fact, gastroenterologists like to call the gut the “second brain,” because microbiota and nerve cells in the gut produce more than forty neurotransmitters—sometimes outproducing the brain!

• Hormones. The gut microbiota also help regulate hormones, which affect the hypothalamic-pituitary-adrenal axis, a part of the endocrine (hormone-generating) system, which has command-and-control responsibility for the body’s stress response.

• The immune system. Bacterial imbalance in the gut generates cytokines, messengers in the immune system that tell other immune cells to handle infection, inflammation, and injury. Problem is, cytokines can do a lot of collateral damage, inflaming the rest of the body—including the brain.

• Toxic by-products of bacteria. These molecular by-products, like HPHPA, can leak out of the gut into the bloodstream, enter the brain, and imbalance brain function. And it’s this mechanism of action that can worsen the symptoms of ADHD—when an overgrowth of Clostridia bacteria generates the toxin HPHPA, which bashes the brain.

Now that you have some basic knowledge, we can discuss how HPHPA is produced, how it affects the brain, and what you and your doctor can do to detect—and correct—the problem.

The Clostridia Crisis

There are more than one hundred species of Clostridia bacteria, but the most “famous” species is Clostridium difficile (also called C. diff). These bacteria cause C. difficile infection (CDI) of the colon, a potentially deadly disease with distressing symptoms that can include watery diarrhea, bloating, abdominal pain, fever, and poor appetite.

CDI is common in hospitals and nursing homes, typically showing up after high-dose or long-term treatment with antibiotics, which can wipe out good bacteria in the colon, allowing C. diff to multiply.

Outbreaks of CDI, which can be contagious, now routinely involve more people, produce severer symptoms, and are harder to control with the antibiotics that were previously effective. This is a problem called “antibiotic resistance,” as fast-evolving bacteria develop a defense against a drug. Perhaps most worrisome to parents, CDIs are now starting to occur regularly among people who almost never used to get them: children.

In one study, a remarkable 68% of children aged 2 months to 2 years had an abnormally high level of C. diff—probably because of the overprescription of antibiotics for ear infections and other childhood health problems. A course of tetracycline can expand the population of C. diff from 5% of intestinal bacteria to a shocking 90%.

How do certain strains of Clostridia play a role in the symptoms of ADHD? The answer to that question is biochemically complex, so I’ll explain it step-by-step, numbering each step:

1. Strains of Clostridia generate HPHPA. As I pointed out earlier, bacterial activity generates bacterial by-products. Certain strains of Clostridia—not only C. diff—can generate a molecular toxin called HPHPA.

2. HPHPA destroys dopamine-beta-hydroxylase. HPHPA molecules sneak through the walls of the gut into the bloodstream and float to the brain. Once there, they inactivate the enzyme dopamine-beta-hydroxylase (DBH). An enzyme is a type of protein that sparks and regulates cellular activity. DBH transforms the neurotransmitter dopamine into the neurotransmitter norepinephrine, maintaining a balance between the two. And that balance is a must for mental and emotional well-being.

Dopamine controls feelings of satisfaction; activities are pleasurable because dopamine is increased. And dopamine regulates the link between the brain and the muscles. (The rigidity and tremors of Parkinson’s disease are caused by a dopamine deficiency.) Normal, easeful, nonagitated movement is impossible without normal levels of dopamine.

Norepinephrine regulates attentiveness, learning, emotions, and sleep. It also regulates many bodily functions, including the heart, lungs, stomach, and intestines.

3. Dopamine levels shoot up. More dopamine may sound like a good thing. After all, who doesn’t like to feel satisfied? But like many pleasure-giving substances (alcohol, coffee, and chocolate, for example), a little dopamine can be healthful, while a lot can be harmful.

To understand how an excess of dopamine can affect the brain, picture a neuron. Unlike most cells, neurons have extensions that communicate with other neurons. Each neuron has one transmitting extension (axon) and many receiving extensions (dendrites). Both the axon and dendrites are treelike structures, with every branch ending in a synapse. The synapses of the axon send out neurotransmitters; the synapses of the dendrite receive them.

Dopamine is stored in vesicles, tiny structures in the synapse. But when HPHPA gums up the works, dopamine levels build up and the neurotransmitter spills out. And like any spill, the results aren’t pretty…

4. High dopamine levels and imbalanced norepinephrine levels cause mental, emotional, and behavioral havoc. Neurons become superstimulated, causing agitation and anxiety. It’s harder to focus. Learning is more difficult. Impulse control is weakened, so there’s less self-control. Behavior is more repetitive—there’s less spontaneity and creativity, and decision making is impaired. In other words, the symptoms of ADHD.

All that extra dopamine hurts the brain in another way: It sparks oxidation. For every molecule of dopamine the body produces, it also produces a thousand molecules of oxidants, which erode neurons. To fight oxidation, the body uses up the antioxidant glutathione—leaving less of that biochemical to fight other brain-hurting oxidants, like mercury, pesticides, and chemicals in antibacterial soaps. Plus, the fight against HPHPA and excess dopamine also depletes zinc, magnesium, and B vitamins—all of which are crucial for a healthy, balanced brain.

The Discovery of a Toxic Molecule

The discovery of HPHPA and its connection to ADHD (and to other mental, emotional, and behavioral problems, like autism and schizophrenia) was made by William Shaw, Ph.D. Dr. Shaw is a biochemist and the director of the Great Plains Laboratory, which—along with many other laboratories—offers the OAT, a urine test I routinely use to discover whether or not a patient of mine has a high level of HPHPA and other metabolic abnormalities linked to ADHD.

Here, in brief, is the story of the discovery, in Dr. Shaw’s own words, from a personal interview, and from an article published in the journal Nutritional Neuroscience.⁶ The story starts with a teenage boy diagnosed with ADHD, oppositional defiant disorder, and depression:

“About 20 years ago, I was the director of a testing laboratory, and I was given the project of setting up testing for urine organic acids. At the time, this type of testing was mostly used for diagnosing genetic disease, or what scientists call ‘inborn errors of metabolism.’ As part of my ongoing scientific interest in developing a comprehensive metabolic test using a urine specimen, I decided to set up the test to detect as many chemicals as possible, not just those associated with genetic diseases. I tested for food additives, vitamins, minerals, drug metabolites (chemicals produced by the metabolism of medications) and other substances.

“Then I approached the director of a children’s psychiatric hospital to begin screening for metabolic causes of psychiatric diseases. He said he had the perfect patient for me—a teenage boy with a variety of severe behavioral disorders. The director was himself a psychiatrist, and he was convinced the boy’s problems had a biological cause.

“He sent me the boy’s urine sample, and my analysis showed that there was a large amount of the biochemical I later identified as HPHPA. After a few months, the boy’s condition deteriorated, he was hospitalized, and another urine sample was submitted. This time, the concentration of HPHPA was massive—so massive that it nearly obliterated all the other peaks in the chromatogram, the visual graph indicating levels of chemicals in the organic acids test. The amount was likely 1,000 times or more than the amount of HPHPA found in normal individuals, and I was certain that this metabolite was playing a large role, if not the role, in his illness.”

Is HPHPA a factor in your child’s ADHD? I strongly urge you to find out, by discussing the information in this chapter with your doctor, and—if it seems advisable—testing your child for HPHPA.

Testing for HPHPA

In my clinical experience, 10% to 20% of children with ADHD have elevated levels of HPHPA. Treatment for the problem—which I describe in detail in the next section—often improves symptoms within a few months.

Should your child be tested for HPHPA?

The answer is yes—if any one of the following three descriptions fits your ADHD child.

Your ADHD child was prescribed a stimulant medication like Ritalin, but became more agitated and anxious. Stimulant medications work by boosting dopamine. If your child became worse when he started taking his meds, it’s likely that his dopamine may already have been elevated—because HPHPA was preventing the breakdown of dopamine to norepinephrine. In my opinion, approximately half of ADHD children who get worse on stimulants are likely to have Clostridia overgrowth and high levels of HPHPA—and are likely to get much better after treatment to banish the bacteria.

Your ADHD child is hyperactive, agitated, and aggressive. This is a strong sign that dopamine levels are elevated—and a possible cause of those elevated levels is HPHPA. For aggressive ADHD children, the Plus-Minus Plan offers several options. You can supplement with magnesium and lithium first, and if your child’s aggressiveness hasn’t lessened in a month or two, then test for HPHPA. Or you can test for HPHPA immediately, either confirming the problem and then treating it, or ruling it out. I favor testing immediately, if possible—because if you detect and treat HPHPA, you can save your ADHD child from months of struggling with symptoms. Think of it this way: It’s important to detect and treat any infection as soon as possible, and in the same way it’s important to detect and treat an overgrowth of Clostridia and the resultant high levels of HPHPA.

Your child has digestive symptoms like abdominal pain, bloating, and constipation or diarrhea. Chronic digestive problems are a strong indicator that your child has Clostridia overgrowth. However, your child can have an overgrowth of Clostridia and not have digestive symptoms—so don’t eliminate Clostridia as a possible cause if your son or daughter never complains about tummy troubles.

—

If after thinking about these criteria you decide your ADHD child should be tested, ask your doctor to order the Microbial Organic Acids Test (MOAT), which focuses on analyzing levels of HPHPA and other biochemical markers of intestinal imbalance (including the yeast Candida albicans, which I’ll be discussing in a moment). The test costs $199.

However, if your child meets the above criteria and testing is too expensive, you can always decide to go straight to treatment with high-dose probiotics (which I talk about in a moment). The treatment won’t hurt your child if he doesn’t have high HPHPA. I don’t recommend this approach, but it is an option.

Treating HPHPA

If my patient has an HPHPA result on the high end of normal or higher—180 mmol per mol of creatine, or higher—I always treat him with a high-dose probiotic supplement, or even a course of Clostridia-killing antibiotics. I have been analyzing the results of the OAT for twenty-five years—and although not all ADHD children have elevated levels of HPHPA, those who do inevitably have behavioral, emotional, or mental symptoms that do not improve unless they are treated for an overgrowth of Clostridia. The treatment for decreasing HPHPA is simple, easy, safe, and very effective.

Start with a high-dose probiotic. I start with a daily, high-dose probiotic supplement for two to three months. When it comes to probiotics, dose is measured by “colony-forming units,” or CFUs. The probiotic supplement I prescribe delivers 50 billion CFUs. I prescribe two to four capsules daily, taken at least thirty minutes after a meal.

80% success rate. In four out of five cases, natural treatment produces noticeable improvement: less hyperactivity, agitation, and aggression (and fewer tummy troubles, if they were part of the picture). In fact, the changes in symptoms are often dramatic—for your child, you, his teachers, and his friends. The two stories about treating HPHPA that began this chapter aren’t atypical; in my practice, they’re routine.

No retesting. If your child gets better, the doctor doesn’t need to retest for HPHPA. And since the treatment is working, you should keep your child on a maintenance dose of probiotics: one capsule of 10 to 20 billion CFUs, twice daily, taken at least thirty minutes before or after a meal.

If probiotics don’t work in two to three months, talk to your doctor about adding an antibiotic to the probiotic. In my practice, probiotics alone don’t work in about one out of five ADHD patients with high HPHPA. Typically, the patient is an adolescent fifteen or older and has other symptoms along with ADHD, like depression. In that case, I keep the patient on the supplement and also prescribe an antibiotic that kills Clostridia (either Flagyl or Vancomycin). Yes, many rounds of antibiotics can cause Clostridia overgrowth—but a Clostridia-specific antibiotic can be the solution. Vancomycin is prescribed for 30 days, in three 10-day courses.

THE 30-DAY SCHEDULE IS:

• Day 1, Antibiotic/Probiotic

• Day 2: Probiotic

• Day 3: Probiotic

• Day 4: Antibiotic/Probiotic

• Day 5: Probiotic

• Day 6: Probiotic

• Day 7: Antibiotic/Probiotic

• Day 8: Probiotic

• Day 9: Probiotic

• Day 10: Antibiotic/Probiotic

Retest for HPHPA. If the patient’s symptoms improve with antibiotics, I’ll retest for HPHPA three to four months after the antibiotic treatment, to make sure HPHPA levels are still low. (Remember, the patient is still on the probiotic.)

Even after all these years of treating ADHD, it is still remarkable to me that such a simple test and simple treatment can often end the nightmare of hyperactive, aggressive behavior—for your child and for you. This urine test isn’t routine, but it is used more and more by integrative physicians in the United States and around the world. And it can explain why medications are not helping your child. Results from the treatment may be gradual, but they establish a foundation for other treatments, like medication—which will work much better once HPHPA is eliminated.

Of course, not every child with ADHD has HPHPA; and sometimes lowering HPHPA is only part of the healing process. But for children who are often aggressive or who have had side effects to stimulant medication, a simple urine test can be the first step to providing the child with the relief he so urgently needs.

And the organic acids test often reveals that HPHPA isn’t the only form of intestinal imbalance suffered by an ADHD child. There’s another common intestinal troll that can trouble your child: the yeast Candida albicans.

The Ferment Over Yeast

Back in the 1980s, an intestinal overgrowth with the yeast Candida albicans got as much attention as gluten does today—it was seen as the source of health problems ranging from heartburn and depression to headaches and ADHD, with antiyeast books, like The Yeast Connection by pediatrician William Crook, M.D., being read by millions.

But the medical community never got behind the concept. For example, the American Academy of Allergy and Immunology criticized Dr. Crook’s claim that rampaging yeast—one-celled organisms in the fungus family—were the real cause of many conditions and illnesses. “The concept is speculative and unproven,” they declared.

I agree: Candida overgrowth is not the cause of most health problems, any more than gluten is. But I don’t want to throw out the proverbial baby with the bathwater. Intestinal overgrowth with Candida is a very real problem for some children with ADHD, particularly those with high-sugar diets that “feed” Candida, or those who have been given round after round of antibiotics for recurrent ear infections. (The average American child will receive ten to twenty courses of antibiotics by the time he is eighteen, according to a report in Nature, a prestigious scientific journal.) Those antibiotics can destroy good bacteria in the gut, allowing Candida free rein. And the metabolic by-products (metabolites) of yeast, just like the metabolites of Clostridia, can affect the brain and cause behavioral problems.

Candida is usually well behaved, living out its brief life in the gut, mouth, and vagina. But when it runs rampant, it can produce various toxins. Those internal poisons can then leak out of the gut into the bloodstream and enter the brain—where they collectively press the mute button on the prefrontal lobe, the brain’s command-and-control center. The resulting range of symptoms that can be suffered by your ADHD child includes:

• Hyperactivity

• Hyperexcitability

• Irritability, anger, and mood swings

• Memory problems

• Poor attention span

• Inappropriate behavior

• Sleep disturbances

Fortunately, the MOAT measures nine different yeast and fungal metabolites. If the results show that the amounts of several of those metabolites are abnormally high, it’s likely the child has a fungal infection—and I treat it.

A stool test is also helpful in identifying yeast and fungal imbalances, bacterial imbalances like an overgrowth of Clostridia, and parasites, all of which can contribute to ADHD.

Plus-Minus Success Story

Patient: Andy, a 7-year-old boy

Treatment for: Candida Infection

Andy’s hyperactivity, aggression, and poor impulse control were increasing. His behavioral problems had started in kindergarten, and his teachers described him as moody and irritable. Some days, he was sullen and mopey. Other days, he would run around constantly. Tests at school showed he was reading below his grade level. Andy also had social difficulties, easily becoming frustrated and arguing with his peers. Additionally, he had intense cravings for candy and sweets, a sign of possible Candida overgrowth.

Previous diagnosis and medications. From the time he was two, Andy had suffered multiple ear infections—about one per year—and had been treated with many rounds of antibiotics, another warning sign for yeast infection.

At the age of five, Andy was diagnosed with ADHD and started taking medications, but experienced multiple side effects, in one instance ending up at the emergency room because of breathing difficulties.

Andy’s office visit. Andy came to my office with his parents. He was a handsome young boy with a big smile on his face. When I met the family, Andy reported that there were no problems at school or home, and he was very happy. When his parents reminded him of difficulties at school, he nodded his head and agreed.

When I met with Andy alone, I asked him the same question that I ask every young child I have seen over the past twenty-five years: If you could make a magic wish to change one thing, what would you change? The majority of seven-year-old boys who aren’t struggling with ADHD ask to be taller, to be faster, to have a million dollars, to own ponies or horses, or to get straight A’s—these and a whole host of other dreams and fantasies are common among boys that age.

But when I asked Andy that question, he looked at me with a sad expression and a tear in his eye—and said he wished that he could behave. A seven-year-old boy normally wants to have fun and play and wish for the moon; Andy’s only wish was to somehow control himself and behave.

Plus-Minus Testing. Testing showed that Andy had extremely high levels of several Candida metabolites.

Plus-Minus Treatment. I put Andy on a high-dose probiotic and a multivitamin, and instructed his mother to eliminate highly processed, high-sugar foods from his diet.

Healing Success. Andy’s wish was granted. At his three-month follow-up, Andy’s parents reported that his behavior was excellent. He could have playdates for the first time in a long time. His reading skills were improving. At his first appointment, Andy had an outward smile. Now he also had an inner sense of confidence and self-esteem.

Treating Candida Overgrowth

Like treating HPHPA, treating yeast is simple, easy, and effective.

Start with a targeted probiotic. If the MOAT reveals a yeast infection, I often put the child with ADHD on the probiotic Saccharomyces boulardii (5 billion CFU, 4 times a day)—which, strangely enough, is itself a yeast. But just as there are good and bad bacteria, there are good and bad yeasts—and S. boulardii is good: It regulates gut health and protects the gut from toxins.

Increase intake of antifungal foods and spices—and decrease sugar. Antifungal foods include coconut, garlic, oregano oil, and ginger. Don’t mistake them for lightweights when it comes to battling Candida—one study showed that garlic extract, gingerroot, and oregano oil were just as powerful as Nystatin, a powerful antibiotic. As for sugar: The sweet stuff is Candida’s favorite food and fuels its growth.

75% success rate. In my clinic, the problem of yeast overgrowth is solved in three out of four children with either a high-dose probiotic supplement or the S. boulardii probiotic.

No retesting. As with the treatment for HPHPA, if your child does better on a probiotic, your doctor doesn’t need to retest for yeast infection. Just keep her on the supplement.

If the probiotic doesn’t work in two months, start an antifungal medication. If after two months of treatment there isn’t a significant change in your child’s behavior, talk to your doctor about treatment with an antifungal medication: Diflucan (fluconazole) for children 6 and older; Nystatin for children 5 and younger. The medication should be used for two months. In most cases, this clears up the problem, changing behavior for the better.

Step-by-Step Action Plan for Healing ADHD

Minus: Intestinal Imbalance

Plus: Probiotics

Use this practical, step-by-step summary to implement the symptom-controlling actions discussed in this chapter:

Step #1: Ask yourself these three questions: (1) Did my child get worse on stimulant medications? (2) Is my child agitated and hyperactive? (3) Does my child have digestive difficulties? If you answer yes to one or more of these questions…

Step #2: It’s possible your child has an overgrowth of the intestinal bacteria Clostridia. Ask your doctor to test for HPHPA—a metabolic by-product of Clostridia—using the MOAT. If you think your child has an overgrowth and can’t afford testing, go to the next step: high-dose probiotics.

Step #3: If results for HPHPA are high-normal or higher, talk to your doctor about treating for Clostridia overgrowth, starting with high-dose probiotics for three months. (50 billion CFU capsule, taking two to four per day, 30 minutes after a meal.)

Step #4: If after three months your child’s behavior is improved, switch to a maintenance dose of one 10 to 20 billion CFU capsule, twice daily, 30 minutes after a meal.

Step #5: If there is no improvement, and your child is 15 or older, consider adding vancomycin or metronidazole (Flagyl).

Step #6: Also check the MOAT results for Candida overgrowth.

Step #7: If there is Candida overgrowth, treat with S. boulardii (5 billion CFU, 4 times daily) or high-dose probiotics (same regimen as Step #3) for one to two months.

Step #8: Add antifungal foods and spices to the diet, like coconut, garlic, oregano oil, and ginger.

Step #9: If there are no behavioral results after one to two months, talk to your doctor about prescribing Nystatin or Diflucan (fluconazole).

From bestselling antiwheat books like Grain Brain and Wheat Belly, to popular milk-bashing diets like paleo and vegan—in the last decade or so, gluten-containing grains and dairy products have gone from nutritional staples to villainous victuals that only the uninformed (or the undisciplined) dare devour.

I’m joking, of course—about our national tendency to demonize gluten and dairy, a tendency that can sometimes seem a bit faddish. Can foods that have been an essential and nourishing part of the human diet for thousands of years—the wheat in “the staff of life” and the dairy in the “land of milk and honey”—really be that bad for you and your ADHD child?

My answer is yes, but only sometimes.

As I often tell the parents of my patients: “Sometimes the right, healthy food—like a bowl of fiber-rich whole-grain cereal, or a slice of protein-rich cheese—might be the wrong food for your child.”

I don’t say that because I want parents to put children with ADHD on restrictive diets. I definitely do not! You and your child have enough to deal with, without having to feel frustrated and furious about food. Eating should be a daily pleasure, not a daily battle.

I say it because a significant percentage of children with ADHD (particularly children twelve and younger) do, in fact, have a food sensitivity to proteins found in dairy and wheat, an assertion supported by scientific evidence and by my decades of clinical experience treating thousands of ADHD children. This food sensitivity can directly impact a child’s delicate brain, causing or contributing to the symptoms of ADHD. And these children—perhaps your ADHD child among them—often benefit greatly from a diet that minimizes or eliminates these sometimes troublesome foods.

These two foods (along with many others) can also cause a food allergy—when the immune system reacts to an ordinarily harmless food or ingredient as if it’s a foreign invader to isolate and destroy. Food allergies can trigger many symptoms: dark circles under the eyes, a runny nose, colic, ear infections, eczema, belly pain, bad breath, and insomnia, to name a few. But like a food sensitivity, a food allergy can also affect the brain, likewise causing or contributing to the behavioral, emotional, and mental symptoms of ADHD. And, just as in food sensitivity, eliminating the offending food allergen can make a big difference.

I’d like to share with you a letter of endorsement I received from a grateful mother whose six-year-old son Billy I treated. I reprint it with her permission as a great example of how powerful this one treatment can be. She wrote me:

“At the age of 3 my son Billy began to have a lot of problems with emotional control. He exhibited a lot of anger and irritability, and had big temper tantrums, used disrespectful tones when he spoke, and had disdain for rules in any setting. By age 5, he had physically lashed out at his brother too many times, put holes in his bedroom walls on more than one occasion, and there seemed to be nothing that I could do to reach him. At school, he was continually restless and uncooperative, lashing out at his teachers and the other kids. I trained myself in several behavior mod programs, but nothing helped in any life-changing way. It was always one step forward, two steps back.

“At age 6, Billy received two diagnoses: attention-deficit hyperactivity disorder, and oppositional defiance disorder. As much as a parent is heartbroken to hear this about their child, I had to admit it fit. He was failing at school, angry, irritable, and emotionally out of control. I was devastated as his mom, because his behaviors didn’t reflect the morals of either myself or my husband. Also, every now and then there would be a glimpse of a different child—a different side to Billy, a sensitive, compassionate, bright, funny child that I just felt was somewhere inside of him…a side to Billy that perhaps only a mom could see.

“And as his mother, I knew I would never give up on my quest to help my son.

“One night, in desperation, I spent hours scouring the Internet to see what I might find—and I found the work of Dr. James Greenblatt, who focused on discovering the biological causes of symptoms in ADHD kids and kids with other behavioral problems. After reading about the kids that he had helped, I knew in my heart that I had finally found some answers.

“I contacted him, and arranged for Billy and myself to go see him. He conducted a battery of tests—and they revealed that Billy was sensitive to both milk and gluten proteins. It took about two weeks to remove all of these things from Billy’s diet—and at the end of two weeks, I started to see a different child emerge. Right before my eyes. Magic. By the end of the month, I had a completely different kid.

“All his ADHD and oppositional behaviors melted away—100%. His restlessness, inattentiveness, anger, irritability. His reading leaped up one grade level in just one month. This child was able to talk to me about making a poor choice and correcting it—instead of running away, slamming doors, or falling to the ground in a pool of tears. He became reachable. He started saying things like, ‘I’m sorry, Mom,’ ‘Thank you,’ ‘You’re welcome,’ and ‘I love you.’ He stopped shutting down. And best of all, he looked happy.

“Although this happened right before my very eyes, it was still almost impossible to wrap my mind around it. All of my child’s issues were stemming from…a sensitivity to foods? It took several months of seeing a consistent, stable transformation in Billy for me to really get it.

“My Billy was not a bad child. I was not a bad parent. My child had a medical problem that led to behavioral problems—and the medical problem had been corrected by Dr. Greenblatt’s treatment! A special heartfelt thank you to you, Dr. Greenblatt. Thank you for all your work.”

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In this part of my Plus-Minus Plan, I’ll first help you figure out if your ADHD child has a food sensitivity to either dairy, gluten, or both.

Then I’ll help you discover whether or not your child has a food allergy to one or more foods in his diet.

After that, I’ll provide a step-by-step process to solve those problems, a process that has worked for the many children with ADHD in my practice with food sensitivity and/or food allergy. (Yes, some ADHD children have both.)

The good news: Detection is simple, treatment is straightforward, and relief from the symptoms of ADHD can be dramatic.

Let’s start by looking at food sensitivity to dairy or gluten—one of the most unacknowledged and overlooked causes of the symptoms of ADHD.

Is Your Child “Eating” Morphine?

Starting off a section on food sensitivity by asking you if your child’s diet includes a pain-relieving opiate might seem quite strange. But surprisingly, it’s a crucial question to ask—because the answer can help you understand a prevalent but neglected cause of ADHD: a food sensitivity to a protein found in dairy or a protein found in wheat.

Dairy foods like milk and cheese contain a protein called casein.

Grains like wheat, oats, rye, and barley contain a protein called gluten.

In the body, casein becomes casomorphin and gluten becomes gliadorphin. And this is where that question about morphine comes in…

As their names indicate, both casomorphin and gliadorphin are morphinelike compounds. And just like morphine, they attach to opiate receptors in the brain—literally drugging your ADHD child! (Imagine taking low levels of morphine several times a day, every day, and you can get a sense of the debilitating effect.) Too-high levels of these compounds can cause:

• Problems with speech and hearing

• Spaciness and “brain fog”

• Near-constant fatigue

• Irritability and aggression

• Moodiness

• Anxiety and depression

• Sleep problems

Too-high levels of casomorphin and/or gliadorphin are particularly common in children (and adults) who have inactive dipeptidyl peptidase IV (DPP-IV), an enzyme that breaks down both casein and gluten. Plus, a zinc deficiency (covered in Chapter 4) can cause problems with DPP-IV. In other words, food sensitivity and the symptoms that it causes are not your child’s fault—this problem is just one more piece of evidence proving that ADHD is a medical disorder, not a discipline problem.

How many children with ADHD are inadvertently “overdosing” on casomorphin or gliadorphin? It’s not all that common. But when I detect and correct the problem, it usually makes a huge difference—since children with the disorder who have high levels of casomorphin or gliadorphin often have severe, uncontrolled symptoms.

Detecting Casomorphin, the “Dairy Drug”

The most reliable method of detection is a simple, doctor-ordered urine test—the Gluten/Casein Peptide Test, available from Great Plains Laboratory. (See the Appendix for contact and ordering information.) More often than not, what’s detected is a high level of casomorphin—of ADHD children who have elevated levels of one of these compounds, 90% are high in casomorphin.

A test is the most accurate, reliable method of detection. But there are also a few telltale signs of a child with this type of food sensitivity. Think of it as a food addiction—because your child is literally addicted to a morphinelike substance! So, using dairy as the example:

1. If your ADHD child has a craving for cheese or any kind of dairy food, practically pushing you out of the way to get to the food; and

2. if your ADHD child becomes irritable when he doesn’t eat cheese or dairy foods, and behaves better after he does…

  Then he very well may have too-high levels of casomorphin.

Curing Casomorphin Excess

Fortunately, there are two straightforward ways to solve the problem of food sensitivity: a diet and a supplement.

The diet. If you suspect dairy (or gluten) might be contributing to or causing your child’s behavioral problems, or a urine test has confirmed high levels of casomorphin (or gliadorphin), do your best to eliminate or minimize dairy and dairy-containing foods (or gluten-containing foods) in your ADHD child’s diet. If she improves, she’s on the right track and should continue the diet.

One complication: Casein is found not only in dairy foods, but also as a filler in processed foods and in food supplements. Please check the Appendix for websites that can help you eliminate casein (or gluten) from your child’s diet.

But please don’t drive yourself and your child crazy trying to completely prohibit these proteins. Just eliminate casein or gluten as much as possible, without worrying too much if your ADHD child’s diet is “perfect.” As I’m sure you know—it never will be!

The supplement. Does your ADHD child have the telltale signs of sensitivity to casein or gluten? Has a urine test confirmed too-high levels of casomorphin (or gliadorphin)? If so, then you definitely want not only to restrict dairy or gluten—but also to supplement your child’s diet with DPP-IV, the enzyme that breaks down casein and gluten. (I want to emphasize that I’m not talking about taking an enzyme to deal with lactose, the sometimes-indigestible milk sugar that can cause lactose intolerance. Lactose intolerance and the inability to digest casein are two completely different problems.)

Your ADHD child should take at least two capsules at every meal and snack that contains casein (or gluten). In some cases, a higher dose is needed to control symptoms. After three to six months, he may be able to cut the dose in half. But if the dose is cut and postmeal behavioral problems flare, ask him to go back to the two-per-meal dose.

Four Capsules at Mealtime Did the Trick

I had one patient—an eleven-year-old girl diagnosed with both OCD and ADHD—with extremely high levels of casomorphin. If she was at a friend’s house and knew she would be eating dairy, she took four to six capsules before she ate—and her symptoms never worsened after the meal.

So far we’ve been talking about a food sensitivity to dairy or wheat. But these two common foods—along with many others—can also cause a food allergy that triggers the symptoms of ADHD. Unfortunately, it’s a particular subset of food allergy that most allergy doctors ignore.

Is a “Secret” Food Allergy Sabotaging Your Child’s Health?

When parents think of food allergy, they usually think of something like a food allergy to peanuts: for example, a child who is allergic to peanuts inadvertently eats a peanut-containing or peanut-contaminated food and has an allergic reaction—sometimes within minutes.

Those reactions can range from the distressing, like a runny nose, to the disastrous and deadly, like anaphylactic shock.

But whether the symptoms of food allergy are annoying or life-threatening, the physiological basics of the reaction are the same. The immune system mistakenly identifies a protein in peanuts as a foreign invader. It then creates an antibody to alert invader-slaying cells about the substance—in this case, the antibody is immunoglobulin E (IgE). As the antibody does its job, it triggers the release of histamine. This chemical expands capillaries, the tiniest of blood vessels, triggering a runny nose and eyes, redness, itching, swelling, and the like.

Both children and adults can have IgE-mediated allergies to not only foods, but also to pollen, dander, dust, and many other everyday substances.

Intriguingly, children with ADHD have a much higher rate of IgE allergies than children without the disorder—in fact, one study shows they are seven times more likely to have IgE-caused food allergies than non-ADHD children.¹ They are also more likely to have ear infections, eczema, and asthma, all of which are linked to allergies. I see it this way: As it fights allergens, the active immune system creates inflammation. In the ADHD child, the brain also gets inflamed.

IgE is the type of food allergy most parents know about. Here’s the food allergy most parents (and their doctors) don’t know about…

The Brain-Inflaming Allergy Most Allergists Ignore

There’s a second kind of food allergy, a little-known, “secret” kind—and it can be just as troublesome to a child. Particularly a child with ADHD who is six or younger, when the immune system is at its most vulnerable.

These food allergies aren’t mediated by IgE. Instead, they’re mediated by another antigen: immunoglobulin G (IgG). And these allergies don’t kick in minutes after your child eats. They usually happen hours afterward—or even two to three days! I call this type of allergic reaction “delayed hypersensitivity.”

I owe my recognition of the existence of IgG food allergies, and their role in ADHD, to two groundbreaking doctors who, back in the 1970s and 1980s, first linked this type of allergy to behavioral problems in children.

One was Doris Rapp, M.D., a pediatric allergist and author of the national bestseller Is This Your Child?—Discovering and Treating Unrecognized Allergies in Children and Adults. In her book, Dr. Rapp writes, “Many traditional allergy specialists believe that allergies can only affect limited and specific parts of the body. The nose, eyes, lungs, skin and intestines are accepted areas. They would not believe that the brain functions [emphasis mine] of children could be influenced by a food.”²

And in her chapter on hyperactivity, she writes, “Some of these children merely have undetected allergies affecting their brain.” Allergy, she continues, can produce the following symptoms, among many others:

• Hyperactive, uncontrollably wild, unrestrained

• Nonstop talk, repetition, loud talk, stuttering

• Inattentive, disruptive, impulsive

• Short attention span, unable to concentrate

• Nervous, irritable, upset, short-tempered, moody

• High-strung, excitable, agitated

Another ahead-of-his-time allergist was Marshall Mandell, M.D., author of Dr. Mandell’s 5-Day Allergy Relief System. I interned for Dr. Mandell in his office in Norwalk, Connecticut, where I saw people from all over the world bringing their ADHD children to him for treatment and relief.

Dr. Mandell systematically tested children with ADHD with oral drops of hundreds of different food proteins. Before and after the drops, he tested the children for handwriting legibility and math ability. I have a vivid memory of one ADHD child who received a drop of peanut antigen: his handwriting went from readable to unreadable, and he was no longer able to solve the type of math problems he’d been solving easily just an hour before.

Remember, neither the mother nor her child knew which drop was which: the child received many drops, and only peanut caused the behavioral problems. Needless to say, the mother stopped feeding her son daily peanut-butter-and-jelly sandwiches with “healthy” whole-wheat bread!

Does your ADHD child have an IgG food allergy that is affecting behavior? If your child is under twelve, the answer is probably yes. In my practice, IgG food allergy is the main (and sometimes the only) problem I need to detect and correct in about 25% of ADHD children under twelve and about 75% of ADHD children under six.

Take Johnny, a seven-year-old patient of mine. When he ate dairy, he was more distractible, had temper tantrums, and didn’t respond to parental limits. When dairy was eliminated, so were Johnny’s symptoms.

However, the behavioral changes aren’t always that dramatic. Some parents, for instance, don’t notice much of a difference when the food is removed from the diet—but see a spike in symptoms if the child starts eating the food again.

Detecting an IgG Food Allergy

How can you tell if your ADHD child has an IgG food allergy? There are two main ways…

At-home pulse test. An IgG food allergy can cause the heart to race, sometimes up to twenty or thirty beats per minute above normal. If you suspect a food is an allergen, check your child’s pulse before he eats and again one to two hours later. If his pulse is racing, consider eliminating the food from his diet.

Doctor-ordered blood test. The “IgG Food Allergy Test,” available from Great Plains and many other labs, tests nearly one hundred foods. I give this test—a finger prick blood test—to every one of my ADHD patients under twelve. I also give it to adolescents and adults I suspect might have an IgG food allergy: those who have an IgE allergy to pollen or other substances; a family history of allergies; or an allergy-related disease like asthma or eczema.

The IgG Food Allergy Test rates the IgG response from 1 to 5, with 1 the weakest and 5 the strongest. If the test score is 3.5 or higher, I recommend parents do their best to eliminate the food from the child’s diet. Dairy is by far the most common food allergen, followed by wheat, corn, and eggs.

The current IgG Food Allergy Test is accurate. But IgG allergy tests weren’t always that way. Earlier tests tended to inaccurately show that a child was allergic to scores of foods—and parents went crazy trying to create and implement a complex “elimination diet” for their children. But with the newer, more sophisticated and more accurate test, it has become relatively easy to detect offending foods. Eliminating them is, of course, always a challenge.

But it’s a challenge that’s worth it. For some children, eliminating the offending food(s) can completely resolve symptoms. For others, this is part of a multifactor approach—because there are multiple factors to take into account. There is never a one-size-fits-all approach.

However your child responds, once the food (or foods) have been eliminated, her immune system will start to calm down. You can usually reintroduce the food after one to three years, if your child eats the offending food no more than once every three to four days. More frequent intake tends to retrigger an IgG food allergy.

But if your child has eliminated a food and his behavioral problems have faded away—why reintroduce it? If your child is tempted to break the diet in adolescence, do your best to help him respect his body, his mind, and his well-being. Find other “fun” foods that don’t worsen his symptoms.

One more important point: Constant allergic reactions use up a lot of magnesium and vitamin C. If your child has any type of allergy, she’s likely to be deficient in these nutrients. So pay special attention to Chapter 1 on magnesium.

Pesticides: The Unavoidable Ingredient

Insecticides kill bugs. Herbicides kill weeds. Fungicides kill fungus. All of them are pesticides—chemicals designed to kill. And your child may be sensitive to them.

Among pesticides, insecticides may be the most toxic to us humans. No surprise, really. Insecticides were first developed during World War II as nerve gases, targeting and destroying acetylcholinesterase. This enzyme powers acetylcholine, a neurotransmitter that plays a key role in many mental functions—including attention. In one shocking study of 307 children aged 4 to 9, researchers found that lower acetylcholinesterase activity in boys was linked to a four times greater risk of poor attention and executive function, and a six times greater risk of memory and learning problems.³

Could pesticides be contributing to your child’s ADHD? It’s possible.

There are 17,000 pesticides on the market. Many are used on farms, of course—but ten times more are used in homes. They’re also used in schools and parks. They’re in our water and food—and they’re probably in your child’s body, too, affecting her developing nervous system and brain.

Several scientific studies link exposure to organophosphates (OPs)—a widely used class of insecticides that target the brain and the nervous system—and ADHD.

Pesticides in the blood, ADHD in the brain. Scientists at the Center for Children’s Environmental Health Research at the University of California, Berkeley studied 321 mothers and their children.⁴ They evaluated the children for urinary levels of breakdown products (metabolites) of OPs when the mothers were pregnant; when the children were 3 and 5 years old, they were evaluated for ADHD. The results: Children with mothers who had the highest levels of the OP metabolites were five times more likely to develop ADHD. At the age of 5, children with the highest levels of the OP metabolites were 3.5 times more likely to have ADHD.

Double the risk for ADHD. Researchers at the Harvard University School of Public Health studied more than 1,000 children—and found that those with detectable urinary levels of an OP metabolite were nearly twice as likely to be diagnosed with ADHD.⁵ “These findings support the hypothesis that organophosphate exposure, at levels common among US schoolchildren, may contribute to ADHD prevalence,” the researchers wrote in Pediatrics.

Detectable pesticides, diagnosable ADHD. In a study of another category of pesticides (organochlorine), researchers at the University of Florida studied 2,546 children aged 6 to 15, categorizing them by undetectable, low, or high levels of detectable urinary metabolites.⁶ Compared to those with undetectable levels, those with low levels had a 54% higher risk of ADHD, and those with high levels a 77% higher risk. “Exposure to organochlorine compounds may increase the risk of behavioral impairment in children,” concluded the researchers in Occupational and Environmental Medicine.

What can you do to protect yourself and your children from pesticides? Take these simple precautions, from the book Health-Defense: How to Stay Vitally Healthy in a Toxic World, by my coauthor Bill Gottlieb.

Look for the USDA Organic Certification. It’s the only guarantee that the food you’re buying was produced without pesticides.

If organic is too expensive, just choose organic for the fruits and vegetables most likely to be laced with pesticides. The twelve worst, according to the Environmental Working Group: strawberries, apples, nectarines, peaches, celery, grapes, cherries, spinach, tomatoes, sweet bell peppers, cherry tomatoes, and cucumbers.⁷

Watch out for these packaged foods. According to the FDA’s Total Diet Study, the nonorganic versions of these foods have the most pesticide residues. They are bread; tomato-based products like tomato sauces, ketchup, and salsa; crackers, pretzels, and potato chips; canned chili; and frozen dinners.⁸

Don’t use pesticides to kill bugs and weeds in your home and garden. Use natural pest control measures instead. Example: To avoid an ant invasion, quickly clean up spills, store food in secure containers, and sprinkle entry areas with crushed, dry cinnamon.

Scientific Support for…The Role of Food Allergies in ADHD

To give you more confidence in the crucial role of food allergy in many cases of ADHD, I’d like to tell you about a few revealing studies.

Getting better when food allergens are eliminated—and getting worse when they’re reintroduced. European scientists studied 100 children aged 4 to 8, putting half of them on a diet that eliminated food allergens—and then, five weeks later, adding IgG food allergens to the diet. On the elimination diet, 64% of the children improved—and symptoms worsened in 63% of the children when they started eating IgG foods.⁹

“Normal range of behavior achieved”—by eliminating food allergens. In a study published in the prestigious journal Lancet, treatment for food allergies improved behavior in 62 of 76 ADHD children—with a “normal range of behavior achieved” in 21.¹⁰ The children also had fewer headaches and less abdominal pain. But when the offending foods were reintroduced—mainly milk, wheat, eggs, and nuts—“symptoms returned or were much exacerbated.”

Better sleep. An anti-allergy diet dramatically reduced sleep problems in ADHD children aged 3 to 8, and also eased physical complaints like headaches and bellyaches, according to a study by doctors at the ADHD Research Centre in Holland.¹¹

Better patient behavior. In a case history reported in the journal Alternative Therapies, an ADHD child with food allergies was put on an elimination diet.¹² The diet, write the study authors, was “accompanied by a drastic improvement in the patient’s behavior, as reported by his mother, teacher, and clinician. Primary outcomes were positive comments by the teacher, completion of school assignments on time, a marked improvement in handwriting, and an ability to stay focused on a task.”

In ADHD Adolescents and Adults—Keep an Eye Out for Celiac Disease

In celiac disease, gluten triggers the immune system to attack the lining of the small intestine. And that attack has a lot of collateral damage: The disease has been called the “great masquerader” because its wide range of possible symptoms mirror those of many other health problems.

Not only that—because the symptoms of celiac disease are so diverse, the “masquerader” is mostly unmasked. Only 5% of the approximately 3 million Americans with celiac disease have been diagnosed.

Here’s why this might matter to your child and you.

One of the undiagnosed 95% could be your ADHD child—if ADHD was diagnosed in high school or college. Here’s a scenario I sometimes see in my practice.

A child who performed fine in high school goes off to college (or a child who performed fine in middle school goes to high school) and finds he can’t focus and is prescribed Ritalin, Adderall, or another ADHD medication. He might also feel tired a lot of the time and depressed.

But what is really happening is that years of celiac disease have taken their toll. The disease blocks the absorption of nutrients, eventually leading to deficiencies in B₁₂, zinc, and iron, nutrients key to concentration and clear thinking. The mental demands, stress, and typically poor diet of a high school or college student bring the disease to the fore, along with the symptoms of ADHD.

That scenario could be the case even if your ADHD child doesn’t have digestive symptoms. Although it’s a disease of the gut, many people with celiac disease don’t have any GI complaints.

In a scientific study that looked at celiac disease and ADHD, 67 people with ADHD were tested for the disease—and 10 tested positive.¹³ “After initiation of the gluten-free diet,” writes the German psychiatrist who led the study, “patients or their parents reported a significant improvement in behavior and functioning compared to the period before celiac diagnosis and treatment.”

Bottom line. If you have a child who developed ADHD when he started high school or went away to college, consider having him tested for celiac disease.

If he tests positive, strongly encourage him to eat a gluten-free diet, the only treatment for celiac disease. (For more information on eating a gluten-free diet, please see the Appendix.)

There are two categories of tests: the EMA (IgA endomysial) and TTC (IgA tissue transglutaminase) blood tests, which are 90% to 95% accurate in screening for celiac disease; or a biopsy of the small intestine, which is the definitive test to confirm the diagnosis. However, celiac disease can appear in patches in the small intestine, so a single biopsy sample may fail to detect the disease, even when it’s present. Make sure the doctor takes at least four to six samples.

And your child shouldn’t get gung ho and start a gluten-free diet before the blood test and/or biopsy. For these tests to detect celiac disease, the body needs to be reacting to gluten at the time of the test.

Where Does the “Feingold Diet” Fit In?

One of the most controversial treatments for ADHD is the Feingold Diet. It advocates eliminating artificial (synthetic) food additives like flavorings, preservatives, and—most especially—artificial colors, with an emphasis on red food dye.

The diet was first presented in 1973 by retired pediatrician and allergist Ben Feingold, M.D., at a meeting of the American Medical Association. A few years later, Dr. Feingold authored the bestselling book Why Your Child Is Hyperactive. More than forty years later, clinicians and researchers are still debating whether or not the diet works!

In 2011, the FDA evaluated all the scientific evidence, pro and con, and declared that artificial food colors are not a proven risk to children.

But in 2009, on the other side of the Atlantic, the British Food Standards Agency had taken a far different position: It advised every parent to consider eliminating artificial food colorings from their child’s diet.

In 2010, the European Union went one step further, declaring that artificial food colorings “may have an adverse effect on activity and attention in children,” and requiring food labeling for six artificial colors: FD&C Red #40, FD&C Yellow #5, and FD&C Yellow #6, and three colors used in Europe but not the United States.

Both European agencies were responding to a rigorous study on 267 children, conducted by researchers at the Department of Child Health at the University of Southampton in the United Kingdom and published in the prestigious medical journal Lancet in 2007.¹⁴ It showed that 3-, 8-, and 9-year-old children who consumed food colorings, a preservative, or both had an increase in hyperactivity.

Recently, there was a “meta-analysis” of 24 studies on synthetic food colors and ADHD, published in the Journal of the American Academy of Child and Adolescent Psychiatry.¹⁵ And it found that “an estimated 8% of children with ADHD may have symptoms related to synthetic food colors.” That finding mirrors my own experience in my clinical practice.

And another study, published in the American Journal of Psychiatry, may have discovered the cause of ADHD in those children: The food additives spark the release of histamine from immune cells—and children most likely to be affected have a genetic inability to metabolize the chemical, triggering ADHD symptoms.¹⁶

Bottom line. It’s likely that 1 of every 12 ADHD children under the age of twelve has a genetic mutation that contributes to ADHD—in their cases, ADHD should be helped by reducing or eliminating artificial food colors. I’ve treated a calm, cooperative six-year-old who became aggressive and hyperactive minutes after drinking a glass of Hawaiian punch and its dose of red food dye. Eliminating food colorings and other additives was a must for this patient, as important as any other treatment in the Plus-Minus Plan.

Is that child your ADHD child? Currently, there’s no test to find out. So my advice to parents who are interested in experimenting with the Feingold Diet is this: Without becoming fanatical or crazed, do your best to eliminate foods containing artificial dyes, flavors, sweeteners, preservatives, and other synthetic additives; and food containing salicylates. The Feingold Association of the United States has lists of common foods that contain these ingredients, and nonadditive foods to replace them. See if your child improves after you eliminate these foods from her diet. If she does, help her stick with the diet.

Step-by-Step Action Plan for Healing ADHD

Minus: Food Sensitivity and Food Allergy

Plus: Digestive Enzymes

Here’s a practical, step-by-step summary of the actions discussed in this chapter:

Minus: Food Sensitivity (Example, Dairy)

Step #1: Ask yourself, Does my child seem to be addicted to dairy products? Does he crave and demand cheese or other types of dairy? If he doesn’t eat dairy, does he become irritable—feeling better and behaving better once he eats the food?

Step #2: If your answer to those questions is yes, consider eliminating dairy from your child’s diet.

Step #3: If you’re not certain whether your child is sensitive to dairy or wheat, ask your physician to order the Gluten/Casein Peptide Test, from Great Plains Laboratory. If the test is positive…

Step #4: Eliminate casein.

Step #5: Supplement with DPP-IV, an enzyme that breaks down casein (and gluten). I recommend Gluten/Dairy Digest, 2 capsules at every meal and snack.

Step #6: After three to six months, cut back to 2 capsules daily. If symptoms flare, go back to the previous regimen.

Minus: Food Allergy (IgG, delayed)

Step #1: If you suspect your child has an IgG food allergy, take her pulse one to two hours after the end of a meal. A pulse twenty to thirty beats per minute above normal could indicate a food allergy, and you may want to eliminate that food from your child’s diet.

Step #2: Or have your child tested for an IgG food allergy, using the IgG Food Allergy Test from Great Plains.

Step #3: If your child scores high on any foods (3.5 or higher), eliminate those foods from the diet.

Celiac Disease

Step #1: If you have an older child who has recently been diagnosed with ADHD, consider a test for celiac disease, which could be the cause.

Step #2: If celiac disease is detected, encourage your child to eat a gluten-free diet.

There’s a reason why the American Psychiatric Association recommends that every man, woman, and child in America eat fish—particularly fatty fish like salmon and tuna—two or more times a week. And why they also recommend that people with “impulse control disorders” like ADHD supplement their daily diets with at least 1 gram of fish oil. The reason is…we’re all fatheads. Literally.

Yes, 60% of your brain is fat—which means your brain depends on a steady supply of dietary fat for its health and well-being. Specifically, it depends on essential fatty acids (EFA), the building blocks of fat. And fatty fish and fish oil supply two of the most important essential fatty acids for your brain: EPA, or eicosapentaenoic acid; and DHA, or docosahexaenoic acid. Both fatty acids are omega-3s, a chemical label indicating the placement of carbon atoms in a fat molecule. But, fittingly, omega is also the Greek word for great—because when enough omega-3s are on the job, they do a great job protecting your brain. But if levels are low…

• The outer covering (membrane) of brain cells (neurons) degenerates.

• Neurons make less serotonin, a neurotransmitter that helps control mental activity, mood, and behavior.

• Cellular receptors for the neurotransmitter dopamine become malformed, lowering levels—and low dopamine is a recognized cause of the symptoms of ADHD.

• Dendrites, the branching extensions that channel messages into and out of neurons, have fewer branches.

• There are fewer synapses, the bridges between neurons.

In short, just about every aspect of neurotransmission—the movement of information from brain cell to brain cell that supports every thought, emotion, and action—is affected by omega-3. Omega-3 also protects the brain by decreasing low-grade inflammation, the chronic cellular fire that can singe brain cells.

Bottom line. A deficiency of omega-3 is bad news for your child’s brain. And omega-3 deficiency is common.

Our hunter-gatherer ancestors ate a diet with a ratio of about 2 to 1 omega-6s to omega-3s. Today, we eat a diet with the ruinous ratio of 15 to 1. (In the modern diet, omega-6s are mostly from mass-produced meat, vegetable oils, and the trans fats used to make baked goods and chips.) This double whammy—a barrage of omega-6s and a paucity of omega-3s—is a little-recognized factor in the symptoms of ADHD.

Little recognized, that is, by doctors. But not by scientists. There have been more studies conducted on the link between ADHD and omega-3s than on any other nutrient. Let’s look at some of the best research…

Scientific Support for…The Power of Omega-3s to Nourish the Brain

From prevention to treatment, omega-3s play a key role in ADHD.

Eating less omega-3 increases the risk of developing ADHD. In a study of nearly 200 schoolchildren, those who ate a diet low in omega-3s had a 31% higher risk of being diagnosed with ADHD.¹

Children diagnosed with ADHD have lower blood levels of omega-3. Blood levels of omega-3 in children with ADHD are on average 38% lower than in children who don’t have the disorder, according to an analysis of nine studies by researchers at the Oregon Health & Science University.² In a study of 493 schoolchildren, those with lower blood levels of DHA had more defiance, hostility, mood swings, and learning difficulties.³ And a study from English scientists showed that children with ADHD and low levels of omega-3 had poor “emotion processing” (the ability to understand and respond to emotions) and poor “emotion regulation” (the ability to control emotions in various situations).⁴

Low omega-3 in ADHD children may be genetic. Remember, ADHD is not a behavioral problem—it’s a medical disorder, usually with a genetic component that creates a shortfall of dopamine, norepinephrine, and serotonin. Scientists at the MRC Social Genetic Developmental Psychiatry Centre in London decided to find out if the genetic profile of ADHD extended to essential fatty acids. They studied 180 ADHD children and 180 without the disorder—and found that the ADHD children had a 60% to 70% greater likelihood of a variation in a gene necessary to metabolize fatty acids (fatty acid desaturase 2, or FADS2).⁵

Disorderly brain waves—with low omega-3. ADHD children with low blood levels of DHA have a type of disorderly brain activity linked to ADHD, according to a study in the journal Neuropharmacology.⁶

Supplementing with omega-3 eases hyperactivity. Analyzing data from 16 studies on ADHD and omega-3, researchers at Oregon Health & Science University found that supplementing the diet with omega-3s consistently lessens hyperactivity, as evaluated by parents and teachers.⁷ “There is sufficient evidence to consider omega-3 fatty acids as a possible supplement to established [medication and behavioral] therapies” in ADHD, the researchers concluded in the journal Clinical Psychology Review. Another analysis of 10 studies on ADHD/omega-3 showed the supplement also decreases moodiness (“emotional lability”) and aggression (“oppositional behavior” and “conduct problems”).⁸

Less inattention, less hyperactivity, less disobedience, less hostility—and better spelling, too. Those were among the symptom-relieving benefits experienced by children with ADHD who took an omega-3 supplement every day for four months, according to Australian researchers.⁹

Better memory, better learning. Studying 95 children diagnosed with ADHD, German researchers found that supplementing with omega-3s improved “working memory”—the short-term recall that is key to learning.¹⁰

Better reading ability. Australian researchers studied 90 children (ages 7 to 12) with ADHD, giving half an EPA/DHA supplement and half a placebo.¹¹ After four months, the children taking omega-3s could read better—and also had better spelling, less inattentiveness, less oppositional behavior, less hyperactivity, and less restlessness. Increasing blood levels of omega-3—particularly DHA—may “improve literacy and behavior in children with ADHD,” concluded the researchers in the journal Nutrition.

Putting sleeping problems to bed—with omega-3. Israeli researchers studied 78 ADHD children (ages 9 to 12) with sleep problems, giving them either an omega-3/omega-6 supplement or a placebo.¹² (The supplement contained gamma-linoleic acid, or GLA, an omega-6 essential fatty acid found in evening primrose oil, borage oil, and currant oil. Later in the chapter, you’ll read about why it’s sometimes important to supplement with a combination of EPA, DHA, and GLA.) After 10 weeks, the children taking the supplement were not only sleeping better—they were also less fatigued during the day, could concentrate better, had better moods, and were better able to cooperate with others.

Ritalin and omega-3 are better than Ritalin alone. Combining a stimulant medication with an omega-3/omega-6 supplement improved the drug’s ability to reduce hyperactivity and impulsivity and reduced negative side effects, according to a study in the Journal of Attention Disorders.¹³

Where stimulants failed, omega-3 succeeded. Researchers studied 98 ADHD children who weren’t helped by stimulant medications and behavioral therapy, giving half of them omega-3 and half a placebo.¹⁴ After six months, the children taking omega-3 were less restless, less aggressive, less impulsive, and more cooperative with parents and teachers, and they were doing better at school.

Important: Omega-3s take time to work! In a similar experiment, researchers studied 98 children with ADHD who had been treated unsuccessfully with a stimulant medication (methylphenidate, which is marketed under many brands, including Ritalin, Concerta, Metadate, Methylin, Quillivant, and Aptensio). They gave half the children an omega-3/omega-6 supplement, and half a placebo, measuring changes in behavior three and six months later.¹⁵ At three months, the researchers didn’t find any difference in behavior between the two groups. But at six months, the children taking the omega-3/omega-6 supplement had less inattention, less impulsivity, and better cooperation with parents and teachers. The main takeaway from this study: If you give your child a daily omega-3 supplement, give the supplement plenty of time to work. As one study put it, your ADHD child is likely to improve “slowly and consistently” with a supplement containing omega-3.¹⁶

All children might benefit from omega-3. Researchers in Holland studied the effect of omega-3 supplements on children with and without ADHD—and found inattention lessened in both groups.¹⁷

Parents behave better, too. Scientists from the University of Pennsylvania and the National Institutes of Health studied “anti-social behavior” in 200 children and their parents.¹⁸ They gave half the children a daily supplement of 1 gram of omega-3 for six months and tracked the participants for an additional six months after supplementation was stopped. After six months of supplementation, the level of the children’s aggressiveness plummeted by up to 68%—and aggression stayed low for the next six months. Parents were far less aggressive, too—after six months and twelve months. In fact, as children became better behaved, so did their parents—and then the behavior of the children improved even more! “Because caregivers and their children have reciprocal effects on one another, it is not surprising to anticipate improvements in child behavior evoking improvements in parental behavior that further improves child behavior,” wrote the researchers in the Journal of Child Psychology and Psychiatry.

During pregnancy, take omega-3. Scientists funded by the Bill and Melinda Gates Foundation analyzed data from 15 studies involving more than 2,500 children and their mothers.¹⁹ They found that mothers-to-be who supplemented their diet with omega-3 for at least seven months had infants with superior “neurodevelopment” (intelligence and coordination) compared to mothers-to-be who didn’t supplement. “Omega-3 supplementation during either pregnancy or infancy improves child neurodevelopment,” concluded the researchers in the FASEB Journal.

But it’s not just fish oil supplements that nourish the fetus—fatty fish are good, too. In a five-year study of more than 3,000 mothers and children, the children of women who ate more fatty fish during pregnancy had slightly better “cognitive functioning,” according to a study in the American Journal of Epidemiology.²⁰ (If you’re concerned about mercury and tuna, canned light tuna is a good choice.)

National Institutes of Health: Omega-3s should be “investigated.” Researchers in the Section of Nutritional Neurosciences at the National Institutes of Health analyzed one year of studies on omega-3s and ADHD. Their conclusion: Because ADHD costs Americans tens of billion of dollars yearly, and because children with ADHD often don’t respond to medication or stop using medication because of side effects—omega-3s are an important area for future scientific investigation.²¹

Well, I’m glad government scientists think omega-3s are important to investigate in the future—but you shouldn’t have to wait for an act of Congress before your child gets enough omega-3s! Here’s how to make sure your child’s brain is well nourished with omega-3s—today.

Turbocharge Omega-3s—with Phosphatidylserine

Sometimes, parents ask me what else they can do to help their ADHD child in addition to the supplements I’ve already prescribed. One supplement I often suggest is phosphatidylserine (PS).

This nutritional compound is a type of phospholipid, a fat that helps form the outer covering (membrane) of the cell, including brain cells. And neurons with healthy membranes do a much better job of communicating with each other—resulting in more balanced emotions, more focus and clearer thinking, and better behavior.

Studies show that not only does adding PS to omega-3 improve ADHD symptoms,22, ²³ but it can even work by itself. Children had better attention, less impulsivity and restlessness, and better short-term memory.²⁴ Israeli scientists also tested the safety of an omega-3/PS supplement, giving it to 150 children for 30 weeks²⁵ (most nutritional studies last only 8 to 12 weeks). They concluded that the supplement is “safe and well-tolerated.” My recommendation is 200 to 300 mg daily of PS, with 100 mg doses taken at two or three meals. (Example: 100 mg at breakfast and 100 mg at dinner.) Phosphatidylserine is widely available in retail stores where nutritional supplements are sold, and online.

How to Supplement Your ADHD Child with Omega-3

Does your ADHD child need to take an omega-3 supplement? Unfortunately, that isn’t always an easy question to answer, and I’ll explain why.

Fish oil supplements are currently the most popular nutritional supplement, with two out of every three people taking them, in a survey of supplement users by consumerlab.com. But that vote of confidence from the public doesn’t necessarily mean fish oil should be the most-used nutritional treatment among children with ADHD.

For one thing, there are no clear, overt signs of an omega-3 deficiency, as there are with other nutrients like magnesium (sleep problems, anxiety, and constipation). For another, my clinical experience has shown me that months or years of taking a high-dose omega-3 supplement (more than 4 grams a day) can actually create an imbalance in essential fatty acids: too much of the omega-3s DHA and EPA can drive down levels of the omega-6 GLA.

Now, that doesn’t mean there aren’t any telltale signs of a deficiency of essential fatty acids. In my clinical experience, an ADHD child with frequent thirst, frequent urination, and/or allergies is likely to need high-dose (above 2 grams daily) omega-3s.

And a child with a skin disorder—typically eczema or “chicken skin” (the tiny bumps that dermatologists call keratosis pilaris)—may have a GLA deficiency and need supplementation.

The Best No-Test Strategy for Supplementation

If your child doesn’t have any overt signs of an omega-3 deficiency, and you and your doctor don’t plan to test for a deficiency, I suggest your ADHD child take a daily fish oil supplement that supplies a total of 1 to 2 grams of DHA and EPA. In my practice, I use a supplement that combines EPA/DHA and GLA, for a total of 3 grams per day of essential fatty acids. For example, if the supplement you choose contains 800 mg of EPA, 400 mg of DHA, and 100 mg of GLA per capsule or serving size, you would take it two to three times daily.

When to Test

If your ADHD child has one or more overt signs of an EFA deficiency, you and your doctor may want to consider testing for a deficiency. (Remember, you shouldn’t supplement your child’s diet with more than 2 grams a day of fish oil unless you test for a deficiency—otherwise, you run the risk of creating a deficiency of GLA.)

The test for your doctor to order: the Essential Fatty Acids test, which is available from Great Plains Laboratory (Comprehensive Fatty Acids Test) and from many other labs. The test can detect a deficiency in a wide range of EFAs, guiding your doctor in a supplementation strategy.

However, while I do this test routinely, it’s likely to be anything but routine for a conventional doctor. My advice: Ask your doctor to read this chapter and then talk to you about the advisability of testing.

When my testing shows a deficiency of omega-3s, I typically prescribe 4 grams of omega-3 daily, as fish oil, for easy intake and assimilation. I give this daily dose for six months; in almost all cases, the deficiency is corrected. After six months, I prescribe an ongoing supplement with a balanced omega-3/omega-6 ratio.

Supplement Strategy Recap

You’ve now read about two supplement strategies:

1. a daily supplement of 1 to 2 grams of fish oil, for any child, and

2. testing EFA levels and, if there’s a deficiency, supplementing with 4 grams a day of fish oil.

There are several other dietary and supplement approaches to make sure your ADHD child gets the good fats he needs.

It’s Never Too Early to Start Supplementing

Omega-3s are crucial for neurodevelopment—the healthy development of the brain as a fetus, an infant, a child, and an adolescent. It’s never too early to start supplementing with omega-3s.

In fact, while I was writing this book, scientists from Tufts University and Harvard University reported results from their analysis of data from 15 studies on omega-3, involving 2,552 children. They found that supplementing the diet with DHA and/or EPA during pregnancy and infancy improved mental development and motor skills in children.²⁶

“Clearly, these are exciting results and corroborate what many scientists have believed for a long time: omega-3 supplementation, during either pregnancy or infancy, has an impact on a child’s neurodevelopment,” said Harry Rice, Ph.D., of the Global Organization for EPA and DHA Omega-3s (GOED), an organization that recommends a daily supplement of 250 mg of DHA for pregnant mothers and infants.²⁷

Many other national and international organizations have a similar recommendation, including the European Food Safety Authority, the Austrian Society for Nutrition, the German Society for Nutrition, the Healthy Start–Young Family Network, the Swiss Society for Nutrition Research, and the March of Dimes.

Omega-3s are also one of the easiest nutrients to get from food. I’m not talking about ordering fried fish at a fast-food restaurant. I’m talking about encouraging your child to eat more fish and seafood at home and when you go out to eat.

I have one more brain-nourishing fat to discuss before I close the chapter….

Is Your ADHD Teen Aggressive, Depressed, and/or a Marijuana User? Test His Cholesterol.

Cholesterol—the fatlike substance found in every cell of the body—is a must for a healthy brain, with studies linking very low levels to aggression, violent crime (including homicide), depression, and suicide.

In my clinical experience, ADHD adolescents with abnormally low total cholesterol (under 130 mg/dl) are often very aggressive, depressed, tend to use marijuana as a calming drug, and may have been diagnosed with bipolar disorder. And I’m not the only health professional to have noticed the link between low cholesterol and behavioral symptoms.

In a study of nearly 5,000 children ages 6 to 16, those with total cholesterol lower than 145 were three times more likely to be suspended or expelled from school than children with normal cholesterol.²⁸ And very low cholesterol doesn’t only put children’s brains at risk.

Cholesterol-lowering statin medications are linked to memory loss, lack of focus, confusion, and feeling “fuzzy” mentally, all of which resolve when people stop taking a statin. The Statin Effects Study from the University of San Diego, California, even found patients who started taking statins and developed “Alzheimer’s”—only to find the disease “went away” when they stopped taking the drug.²⁹ The problem is common enough that in 2014 the FDA issued a warning for statin-taking patients and their doctors to be on the lookout for “cognitive (brain-related) impairment.”

Yes, many health professionals advocate lowering cholesterol for a healthier heart. But I think that very low total cholesterol—less than 130 mg—interferes with optimal brain function. The possible mechanism: Cholesterol stabilizes receptors for serotonin, the mood-balancing neurotransmitter. Without enough cholesterol, serotonin can’t do its job. This mechanism also explains why many cholesterol-deficient patients respond poorly to serotonin-boosting medications.

Bottom line. If your ADHD teen fits the description above—aggressive, depressed, marijuana user, bipolar—consider having his total cholesterol checked. If his cholesterol is low, it probably isn’t because he’s not eating enough cholesterol—it’s probably because he has a genetic defect in cholesterol metabolism.

To correct low levels, increase his cholesterol intake with one or two eggs daily.

Also, supplement his diet with lipase, a digestive enzyme that aids cholesterol absorption.

Plus-Minus Success Story

Patient: Tammy, a 15-year-old girl

Treatment for: Depression, eating disorder, self-injury, and ADHD

I was seeing Tammy in my clinic for the first time. Her previous medical evaluations described her as “spacey” and “imitative.” She also had a history of skin disorders: eczema; and “chicken skin” (the tiny bumps dermatologists call keratosis pilaris) on her neck and arms. Both are telltale signs of a deficiency in essential fatty acids like EPA, DHA, and GLA.

“Tammy has been sneaking food from the kitchen and hiding it for later,” Judy, her mother, told me. “I have been finding candy wrappers in her drawers and closet and behind her bed.” Judy also told me that Tammy had been bingeing on junk food for the last year, gaining twenty-five pounds.

Tammy’s parents wanted to be sensitive to her weight issues and not make her feel ashamed, so they didn’t say much to her about her eating habits. But when Tammy started wearing long-sleeved blouses even when it was warm out, they challenged her—and discovered she’d been cutting her arms with a pocketknife. At that point, they made an appointment for Tammy to see me.

When I talked to Tammy, she told me she felt depressed. So I wasn’t surprised to learn that her doctor had prescribed Prozac, an antidepressant, which caused suicidal thoughts, and then another antidepressant, which caused nausea. Unfortunately, neither provided relief. And because of the side effects, Tammy had stopped taking them.

It was clear to me that Tammy’s biochemistry was likely very imbalanced, and I ordered extensive metabolic tests. The results showed Tammy had an extreme metabolic imbalance: a severe deficiency in the omega-3 essential fatty acids EPA and DHA, and in the omega-6 essential fatty acid GLA. She also had a magnesium deficiency.

I immediately prescribed a supplement containing a total dose 4 grams (4,000 mg) of EPA, DHA, and GLA. And I started Tammy on 240 mg a day of magnesium, twice a day.

When Tammy returned in four weeks, her parents told me that there had been a slight improvement in her behavior. Tammy told me that her mood was better, and she felt less of an urge to cut herself.

I also learned for the first time that Tammy had been diagnosed with ADHD by her doctor when she was in elementary school—but had never been treated. I added a low-dose stimulant to her nutritional supplements. I also recommended family therapy for the entire family, and psychotherapy for Tammy; Tammy and her parents agreed to both.

Three months later, Tammy was doing great. She was very successful at school. She was functioning better at home. She no longer described herself as being depressed. And at the end of the school year—with her EPA, DHA, GLA, and magnesium levels normalized—we agreed she could stop taking stimulant medications for her ADHD.

Step-by-Step Action Plan for Healing ADHD

Plus: Omega-3s

Here’s a practical, step-by-step summary of the actions discussed in this chapter:

Step #1: Give your ADHD child a daily supplement of 1 to 2 grams EPA/DHA, with meals.

Step #2: If your child has overt signs of an essential fatty acid deficiency, ask your doctor to test for a deficiency, using the Essential Fatty Acids test. If there is a deficiency, supplement with fish oil supplying 4 grams of total EPA/DHA for 6 months, and then switch to the maintenance dose in Step #1.

Step #3: Encourage your ADHD child to eat more fatty fish and seafood.

Step #4: If your ADHD teen is depressed, aggressive, uses marijuana, and has been diagnosed with bipolar disorder, ask your doctor to test his cholesterol. If it is very low (under 130 ng/ml), feed your child cholesterol-rich food, like an egg or two a day, and supplement with lipase, an enzyme that aids cholesterol absorption.

I’m going to start this chapter by getting on my soapbox and speaking out against…sugar! I have a few important points on the subject.

First and foremost, doctors who dismiss the connection between a sugary diet and ADHD have their heads in the sand—or maybe in the sugar bowl.

For example, a so-called state-of-the-art article in the journal Pediatrics reviewed the link between sugar and ADHD and flatly declared that “diets high in sucrose…had no effect on children’s behavior or cognitive function.”¹

But the article also begrudgingly admitted that “Parents of children with ADHD frequently report a worsening of hyperactivity after an excessive ingestion of candy or diet soda.”²

Well, that’s exactly my experience with thousands of parents of kids with ADHD: Many see behavior worsen after their child consumes a lot of sugar—and behavior gradually improve when their child eats a diet low in sugar and other refined carbohydrates.

And although some scientific studies don’t support the sugar/ADHD connection, many do. For example:

Eating lots of sweets quadruples the risk of ADHD. A study published in the journal Nutrition showed that children who eat a “sweet” dietary pattern (“highly loaded with ice cream, refined grains, sweet desserts, sugar, and soft drinks”) are four times more likely to develop ADHD than children who eat a diet with a minimal amount of sugar and refined grains.³

With a “Western” diet, your child’s brain heads south. In a similar, 14-year study of nearly 3,000 children, published in the Journal of Attention Disorders, children who ate a “Western” diet (loaded with sugar, refined carbohydrates, saturated fat, and salt) were twice as likely to be diagnosed with ADHD as children eating a “healthy” diet (low in sugar, refined carbohydrates, fat, and salt and rich in omega-3 fatty acids and fiber).⁴

In fact, the connection between sugar and ADHD is so strong that a team of experts from the University of Colorado who specialize in sugar and health have theorized that chronic sugar intake is the cause of ADHD.⁵ That’s right, the cause. Their theory: Sugar and high-fructose corn syrup increase levels of the neurotransmitter dopamine, triggering feelings of reward and pleasure. Because eating sugar feels so good, a child begins to demand and eat more and more of it. This chronic intake blunts the dopamine response—causing the child to demand and eat even more sugar in order to feel good. Eventually, overused dopamine receptors wear out, leading to lower levels of dopamine—and the symptoms of ADHD.

To support their theory, the doctors cite twin phenomena: the simultaneous increase in chronic sugar intake (accounting for 15% to 20% of caloric intake) and a 20% increase of ADHD cases.⁶

Unlike these experts, I don’t think chronic sugar intake is the cause of ADHD—that’s not my clinical experience with the thousands of ADHD children I’ve treated. But sugar definitely contributes to the symptoms of many children. And cutting back on sugar usually helps.

Even if a sugary diet didn’t worsen the symptoms of ADHD—which it does—excess sugar is still bad for your child’s health, now and in the future.

However, the best way to deal with sugar isn’t to drive yourself and your child crazy by trying to cut every last speck of the stuff out of his diet. A smarter approach: Reduce or remove sugar-sweetened drinks like soda. As one study, in the journal Child Obesity, succinctly put it: “Currently, sugar-sweetened beverages are the primary source of added sugar in the diet of children and adolescents.”⁷ (Emphasis mine.)

If you can help your ADHD child reduce or remove sugar-sweetened beverages (SSBs)—soft drinks, fruit drinks, sports drinks, energy drinks, and coffee/tea drinks—you’ll reduce or remove the largest source of sugar from her diet. And (as you’ll read later in the chapter) you’ll also reduce or remove the source of sugar many experts say is most likely to worsen the symptoms of ADHD.

Last, research shows that keeping your child’s blood sugar balanced is the key factor in stopping sugar and other refined carbohydrates from unbalancing his brain—and his behavior. Do your best to get your child to eat protein-rich foods throughout the day. That steady supply of slow-digesting protein will keep blood sugar (glucose) levels steady.

But before I get into the details of how to limit sweetened beverages in your child’s diet (it’s easier than you might think), and how to add more protein (ditto), I’d like to spend a little more time emphasizing the link between sugar and ADHD; and the link between sugar and poor health.

Sugar and the ADHD Brain

Blood sugar (glucose) is the fuel that powers every cell in the body—but brain cells need the most. By weight, the brain is 2% of the body, but it uses 20% of the body’s available glucose.⁸ And when glucose metabolism in the brain isn’t working right—when neurons don’t get the glucose they need—the brain doesn’t work right, either. And ADHD may be the result. Let’s look at some of the evidence:

ADHD brains use less glucose. A team of scientists in the Child Psychiatry branch of the National Institute of Mental Health conducted a study on 75 adults, trying to find a biochemical cause for ADHD.⁹ Twenty-five who had been diagnosed with ADHD in childhood “continued to have considerable difficulty with both restlessness and inattentiveness as adults” and were currently the parent of a child diagnosed with hyperactivity. Fifty others didn’t have ADHD but were similar in age, IQ, income, and education.

For the study, the scientists first asked all the participants to perform an “auditory-attention task”—pressing a button to identify the lowest intensity tone among three tones, which were played repeatedly, in varying order. Next, they injected all the participants with radioactive glucose, which was tracked in the brain via a PET scan. Thirty-five minutes after the injection, they asked the participants to once again perform the auditory-attention task. The results: “Cerebral glucose metabolism” was 8.1% lower in the ADHD adults during the task. In other words, their brains used a lot less of the available glucose.

And when the researchers looked closely at 60 specific regions of the brain, they found glucose metabolism in people with ADHD was “significantly reduced” in 30 of the 60 regions. Those regions included the premotor cortex and the superior prefrontal cortex—the areas in the brain that control attention and distractibility, “motor activity” (how much or how little a person moves, including how physically restless they are), and impulsivity.

Lower levels of key neurotransmitters. In another study on glucose and ADHD, researchers in the Children’s Clinical Research Center at Yale University School of Medicine studied 28 children ages 7 to 14—17 with ADHD and 11 without.¹⁰ Early in the morning, they gave the children a “glucose tolerance test”—a dose of pure glucose. Over the next several hours, they repeatedly measured several behavioral and biochemical parameters, like attentiveness and blood sugar levels. They also measured blood levels of the hormone epinephrine (adrenalin) and the neurotransmitter norepinephrine (noradrenalin). Both tend to be low in ADHD, and low levels of epinephrine are linked to aggressive and even violent behavior.

The results: The researchers found that there was virtually no difference between the way children with ADHD and those without the disorder responded to glucose. Both metabolized it normally, with a rise in blood glucose followed by a decline. However, as hours passed and blood sugar dropped, the non-ADHD children continued to generate normal levels of epinephrine and norepinephrine—while the ADHD children had lower levels of both. Epinephrine was 50% lower, a huge variation. The results, said the researchers, were “particularly noteworthy” and “surprising”—they hadn’t expected to see such a marked difference between the two groups.

They speculated that the lower levels of these two compounds “are related to regional alterations in brain glucose metabolism as has been reported in adults with childhood-onset ADHD.”¹¹ In other words, the low levels were probably caused by the same phenomenon seen in adults with ADHD in the previous study: low levels of glucose in the brain.

Kids with ADHD fail the “sugar test.” The test I’m talking about is the glucose tolerance test, in which a supersugary solution of pure glucose is consumed, and then the blood sugar level is tracked for one, two, or three hours. If blood sugar levels rise slightly and then stay steady, your sugar metabolism is normal; if they shoot up, plunge down, or never rise in the first place, sugar metabolism is skewed.

And in a study at the University of Texas Health Science Center, 29 kids with ADHD, ages 5 to 17, took a glucose tolerance test—with terrible results.¹² In many children, blood sugar levels skyrocketed then plummeted. In others, blood sugar levels never rose. And during those hours, many of the kids had brain-based physical and emotional symptoms: headaches, drowsiness, and temper tantrums.

The practical takeaway here isn’t that your ADHD child needs more glucose for his brain. It’s that your ADHD child’s brain needs a reliable, steady, balanced supply of glucose, not the highs and lows caused by eating a sugary diet or drinking sugar-sweetened beverages. And this chapter provides two simple strategies to achieve that brain-balancing goal: (1) reducing the intake of sweetened beverages, and (2) adding protein.

But first, let’s explore another side effect of sugar and how it relates to ADHD.

A Blizzard of Added Sugar, a Whiteout of Good Health

Each week, the average American adult consumes 3 pounds of sugar, or about 156 pounds yearly of sucrose, high-fructose corn syrup, and other caloric sweeteners—an excess that scientific research links to obesity, heart attacks, stroke, diabetes, kidney disease, and cancer. (Even the conservative American Heart Association has acknowledged the link between “added sugar” in the diet—like the eight teaspoons of sugar in a twelve-ounce soda—and risk factors for heart attack and stroke.) If your child is eating a sugary diet, and continues to eat that diet for the rest of his life, those are some of the health problems he’s likely to have to deal with as an adult.

But the average American diet is now so sugary—with 75% of all our packaged and processed foods and beverages containing added sugar—that many twenty-first-century children are already dealing with health problems that were once reserved for adults. They include:

• Severe overweight, or obesity

• Type 2 diabetes, which used to be called “adult-onset diabetes”—until children started to get it, too

• The metabolic syndrome, a collection of heart-hurting factors like high blood sugar, extra abdominal fat, and low levels of artery-protecting good HDL cholesterol

Of the preceding three conditions, obesity is the most common.

The rates of overweight and obesity in American children have tripled since the 1980s, with one out of three children either overweight or obese. And where there’s overweight and obesity, there’s more ADHD.

Extra pounds = extra risk for ADHD. A recent study in Mayo Clinic Proceedings looked at 1,000 children with and without ADHD—and found that children with the disorder are 23% more likely to be obese than non-ADHD children.¹³

In fact, my clinical experience and scientific research show that there is an overlap between obesity, eating disorders (particularly binge eating disorder), and ADHD—all which may be caused by neurotransmitter imbalance in the brain. In binge eating disorder, the imbalance of dopamine and norepinephrine leads to poor self-control—a common symptom in ADHD.

But even if your child isn’t overweight or obese, excess sugar in the diet is still a risk factor for ADHD. Particularly when that sugar comes from a sugar-sweetened beverage (SSB)—a soft drink, fruit drink, sports drink, energy drink, or tea/coffee drink.

Soft Drinks Are Hard on Your ADHD Child

Since the 1980s the amount of SSBs consumed by American children and adolescents has doubled. Now two-thirds of high school students drink at least one SSB daily, and many drink two or more—with energy drinks on the rise, and sodas on the decline. Other research shows that 40% of American children aged 2 to 11 drink at least one soda daily.

Writing in the Journal of the National Association of School Nurses, a health expert summed up the situation this way: “The majority of children between 2 and 19 years drink sugar-sweetened beverages on any given day.”¹⁴

And that’s probably not a good day.

Just one soda can trigger hyperactivity and inattention. In a recent study, researchers from the Yale School of Public Health analyzed data from 1,649 middle schoolers—and found that the risk of hyperactivity and inattention increased by 14% for each sweetened beverage a child consumed daily.¹⁵ In other words, three sweetened beverages raised the risk by 42%. Not good odds for good behavior.

Sweetened and caffeinated beverages are even worse. The Yale scientists found that students who drank just one energy drink were 66% more likely to be hyperactive and inattentive.¹⁶

The experts from Yale weren’t the first scientists to find a connection between SSBs and ADHD.

For a 5-year-old, one soda can double aggression. Compared to 5-year-old children who didn’t drink sodas, those consuming one a day were nearly twice as likely to behave aggressively, according to researchers from Harvard School of Public Health and Columbia University, who studied nearly 3,000 5-year-olds.¹⁷ Those consuming four or more per day were nearly five times more likely to act aggressively. The soda-drinking children were also more likely to be inattentive. And this link between soda and bad behavior was the case even when the researchers took into account other sources of sugar, like candies, sweets, and fruit.

“Soft drinks,” wrote the researchers in the Journal of Pediatrics, “are highly processed products containing carbonated water, high-fructose corn syrup, aspartame, sodium benzoate, phosphoric or citric acid, and often caffeine, any of which might affect behavior.”¹⁸

More bad news about phosphorous. Of that list of ingredients, phosphoric acid—a form of the mineral phosphorous—is definitely one of the worst. One 12-ounce soda of cola contains 60 mg of phosphorous, which is a big dose. If your child gets too much phosphorous, she’ll absorb less magnesium—and magnesium deficiency is already common in children with ADHD, generating symptoms like sleep problems and anxiety. She’ll also absorb less calcium, a must for healthy bones. One German pharmacist even fingered a diet high in phosphoric acid as the main cause of her son’s ADHD. When she put him on a low-phosphorous diet, his school performance, sense of well-being, and behavior improved—so much so that he no longer needed ADHD medication. In her book The Hidden Drug, Dietary Phosphate: Cause of Behavior Problems, Learning Difficulties and Juvenile Delinquency, she asserts that many children with ADHD could improve just by removing phosphorous-containing beverages like soda from the diet.¹⁹

Sugar, phosphoric acid, and the other ingredients in soda might also affect the respiratory tract—because, along with ADHD, asthma is another way soda and other SSBs can sabotage health.

Five times more asthma with high-fructose corn syrup. One study showed that children aged 2 to 9 who drank a beverage sweetened with high-fructose corn syrup just about every day were five times more likely to develop asthma than children who hardly ever drank them.²⁰ In another study, of 11-year-olds, those who drank the most sodas had almost double the risk of developing asthma.²¹ And in a study of high school students, those who drank two sodas daily had a 28% higher risk of asthma, while those who drank three or more had a 64% higher risk.²²

Ten times more metabolic syndrome with sugar-sweetened beverages. In a study of more than 2,700 adolescents aged 12 to 16, boys who drank the most sugar-sweetened beverages were ten times more likely to have metabolic syndrome.²³ Another study shows that drinking two, 16-ounce sugar-sweetened beverages daily can trigger factors of the metabolic syndrome—in just six months.²⁴

Sodas get an F. In a study of more than 16,000 high school students, researchers found that those who drank at least one sugar-sweetened soda per day were twice as likely as non–soda drinkers to get mostly D/F grades.²⁵ And it might not just be the sugar causing academic problems.

In a study of 475 college students, researchers found that those who consumed the most sodium benzoate—an additive found in sodas, juice drinks, and tea/coffee drinks—were twice as likely to have symptoms of ADHD like inattention, restlessness, and impulsivity.²⁶

More headaches, stomachaches, and insomnia with cola and energy drinks. Another study links sugar-sweetened, caffeinated beverages like cola and energy drinks to a wide range of everyday (and every night) health problems in children: headaches, stomachaches, poor appetite, and sleeping problems.²⁷ The results of this study “support recommendations to limit consumption of sweetened beverages and to avoid consumption of energy drinks among children,” wrote the study researchers in Academic Pediatrics, the journal of the Academic Pediatric Association.

I wholeheartedly agree with that recommendation.

Among my patients, eliminating SSBs can be an important step in gradually controlling the symptoms of ADHD. But as I said earlier, it’s not the only step when it comes to sugar and ADHD.

There are two important strategies for any parent who wants to help control the symptoms of ADHD. And they’re both straightforward, for you and your child:

1. Reduce or remove soft drinks, fruit drinks, energy drinks, sports drinks, and tea/coffee drinks.

2. Add protein to every meal and snack.

Let’s look at how to implement those two strategies, starting with reducing SSBs.

Just Say No to Soft Drinks—for Your Child and Yourself

Because soft drinks and other sugar-sweetened beverages (SSBs) are so bad for children, experts in nutrition and public health have put a lot of thought into figuring out how to get kids to cut back or stop. And they’ve come up with some proven (and practical!) approaches for parents to use.

When researchers from the government’s Centers for Disease Control analyzed SSB intake in children and adolescents aged 2 to 19, they discovered that more than half of all SSBs are consumed at home.²⁸

Which is why another team of researchers conducted a massive study of nearly 8,000 children and more than 6,000 parents, analyzing the effectiveness of 11 “family-related factors” that helped 10- to 12-year-old children drink fewer SSBs.²⁹

One successful factor was pretty obvious: If SSBs were in the house, the child drank them; if they weren’t in the house, the child didn’t drink them.

The moral of this story: If you don’t want your child to drink SSBs, keep them off your shopping list and out of your house. Don’t give in to your child’s pleas and pestering. The study also found that if parents drank SSBs, so did the child—but if parents didn’t drink them, the child was less likely to do so.

And the same goes for the rest of the family: If a child’s siblings drank SSBs, so did the child.

If parents want to limit a child’s intake of SSBs, they should focus “especially” on the “availability of these beverages at home” and their own intake, concluded the study researchers in the medical journal Appetite.³⁰

And children tend to agree!

“My parents let me have as much orange juice or milk as I want, but they never have pop around—so they are completely in control,” said a child who was interviewed as part of a survey of nearly 1,000 fifth- and sixth-graders, published in the Journal of Nutrition Education and Behavior.³¹ “It’s not in the house, we don’t have it at school, and I just don’t drink it,” said another.

Your attitude toward sugary drinks—particularly soft drinks—is the most important factor in whether or not your child will drink them regularly, according to a study from Australian researchers in the journal Appetite.³² If your attitude toward soda is positive, it’s more likely your child will drink it. It’s much better for your child if you encourage him to drink healthy beverages, like water. Not only can drinking water help your child drink fewer SSBs—it also gives her more of an essential nutrient she’s probably lacking. Researchers at the Center for Public Health Nutrition at the University of Washington analyzed health data from nearly 5,000 children ages 4 to 13. They found that 75% of children ages 4 to 8, 87% of girls ages 9 to 13, and 85% of boys ages 9 to 13 didn’t drink the daily “Dietary Reference Intake” for water, which is about 1 liter (33.8 ounces) for every 1,000 calories consumed.³³

These results are “cause for concern,” noted the researchers in Nutrition Journal. They also noted that “drinking plain water” instead of “caloric beverages” like SSBs is a sensible approach to managing weight.

Cutting out SSBs will dramatically reduce the amount of sugar in your child’s diet. But apart from SSBs, I advise parents to let their child have occasional sugary treats. That’s because studies show if you try to forbid a food, your child is likely to overeat it whenever she gets a chance, like at a friend’s house or at school. (In one study of 6-year-olds, normal weight children were twice as likely to drink SSBs when the mother tried to keep the child from eating too much of his or her favorite foods.³⁴) Occasional treats like cookies and candy are okay; sweetened drinks are not.

And there’s a way to help your child eat a treat and not feel like his brain was tricked: make sure he eats protein at the same time.

Boost Your Child’s Brainpower with More Protein

Carbohydrates, protein, and fat are three macronutrients—nutrients that provide energy.

Trouble is, refined carbohydrates like sugar and white flour supply too much energy, too fast, unbalancing blood sugar—along with your child’s brain.

But as I’ve said throughout this chapter, the secret to a steady supply of blood sugar isn’t getting rid of every speck of sugar in your child’s diet. Any parent who’s tried that approach knows it doesn’t work. It may even be counterproductive, leading a child to secretly eat more sugar.

No, the secret to blood sugar control is making sure your child eats slow-digesting protein throughout the day, at every meal, and at snack time. The “glycemic index” (GI) is a measurement of how quickly foods turn into glucose (blood sugar). High-GI meals that are rich in sugar and refined carbohydrates launch blood sugar into the stratosphere. Low-GI, protein-rich meals keep blood sugar levels down to earth. Take a look at the difference in how low- and high-GI breakfasts affect children’s mood, behavior, emotions, and mental abilities:

More alert and happier. In a study of 74 schoolchildren, published in the British Journal of Nutrition, those eating a low-GI breakfast were more alert, happier, and less nervous 90 to 140 minutes after breakfast and had better memory for facts and words.³⁵

Similarly, in a study of college students, those eating a high-protein breakfast every morning for seven days were more alert, attentive, and happier than those eating high-carbohydrate breakfasts.³⁶

More attentive, with better memory. In a study of 42 children, with an average age of 12, those eating a low-GI breakfast were more attentive and had better short-term memory, reported researchers in the journal Physiology & Behavior.³⁷ (Their attentiveness and memory were even better if they had a low-GI breakfast and exercised, a “Plus” you’ll read about in Chapter 10.)

Attentive throughout the morning. In a study of 64 schoolchildren, ages 6 to 11, a low-GI breakfast “significantly reduced” the decline of attentiveness throughout the morning.³⁸

Less hunger and food cravings. Other studies show that a low-GI, high-protein breakfast burns more calories and fat and reduces hunger and food cravings—particularly in overweight children and adolescents.³⁹

Those studies were on children who didn’t have ADHD, but a low-GI breakfast can work for a child with ADHD as well.

High carbs, low attentiveness. Researchers at George Washington University studied 39 children with ADHD and 44 non-ADHD children, feeding them either a high-carbohydrate breakfast, a high-protein breakfast, or no breakfast at all. In children with ADHD, a high-carbohydrate breakfast worsened attention, compared to a high-protein breakfast.⁴⁰

High-protein snacks are good for the brain. Snacks matter, too. In a study of 31 adolescents, with an average age of 17, those who ate high-protein snacks in midafternoon had more “cognitive flexibility” (the ability to take on new mental tasks) and less confusion than those who ate high-carbohydrate or high-fat snacks, according to a study in the Journal of Nutrition.⁴¹

Adding Protein at Breakfast—and Throughout the Day

Nutritionists who focus on children’s health have plenty of smart tips for putting more protein in your child’s breakfast and daily diet. I’d add one caution to their recommendations, below: Allergy and sensitivity to dairy products is common in ADHD, so only include dairy in your child’s diet after medical testing has shown his body can handle it. (See Chapters 5 and 6 for more on food allergies and food sensitivities.)

Laura Stevens, M.S., an expert in nutrition and ADHD, and author of Solve the Puzzle of Your ADHD Child: Natural Alternative for Hard-to-Raise Children, has these suggestions for high-protein breakfast for ADHD children.⁴² She stated that these are “easy” breakfasts, and most can be eaten in the car on the way to school.

• Natural peanut butter on whole-grain bread, with a dab of all-fruit jam.

• Eggs; glass of orange juice. To save time, make hard-boiled or deviled eggs the night before.

• Slice of whole-grain bread with a little whipped butter or margarine and a dab of all-fruit jam; low-fat milk.

• Whole-grain cereal with low-fat milk; lean meat from last night’s dinner (pork chop, chicken); orange sections.

• Plain yogurt with fresh fruit.

• Grilled-cheese sandwich made with whole-grain bread and 2% cheese; glass of orange juice.

• Homemade instant breakfast shake or sausage patties.

• Mixed nuts; fruit; glass of low-fat milk.

And here are some strategies used by Stephanie Walsh, M.D., medical director of Child Wellness, Children’s Healthcare, in Atlanta, to get her own children to eat more protein:⁴³

• Make a “Protein-wich” out of scrambled eggs between two mini whole-grain waffles.

• Turn boiled eggs into egg salad (add low-fat yogurt for an even bigger protein punch); serve on whole-wheat bread.

• For waffles, skip the syrup and smear a light layer of peanut or almond butter on top.

• For an afternoon snack, make a super-simple parfait: spoon in a layer of low-fat Greek yogurt, then a layer of fresh fruit, and repeat. Sprinkle on some protein-fortified cereal.

• Grilled cheese on whole-wheat bread, increasing the protein by adding ham. Serve with apple wedges and peanut butter for dipping.

• Spoon leftover chicken or pork tenderloin chunks onto mini whole-grain basket-shaped tortilla chips. Add a sprinkle of cheese, some black beans, microwave, and finish with a touch of mild salsa.

As for high-protein snacks, the possibilities are just about endless.

For example, a brief tour of the health-oriented website greatist.com yielded these ideas:

• A celery stick with nut butter, topped with almonds or raisins

• Jerky, particularly from a company that uses grass-fed, no-antibiotic meats, like U.S. Wellness Meats, at grasslandbeef.com, the source I recommend to parents

• Mixed nuts or trail mix

• A slice of deli meat rolled up with 1 slice of cheese and 1 slice of tomato

• A smoothie with banana, peanut butter, and low-fat chocolate milk

• Edamame, steamed, salted soybeans in the pod

• Tuna on a whole-wheat cracker

• Hummus and vegetable sticks

• Greek yogurt and granola

A high-protein breakfast, lunch, and dinner, with a high-protein snack midmorning, midafternoon, and in the evening or before bed—that’s the best way to help your ADHD child handle sugar.

Step-by-Step Action Plan for Healing ADHD

Minus: Sugar-Sweetened Beverages

Plus: Protein

Here’s a practical, step-by-step summary of the actions discussed in this chapter:

Step #1: Don’t bring sugar-sweetened beverages (soft drinks, sports drinks, energy drinks, and coffee/tea drinks) into the house and don’t drink them yourself.

Step #2: Explain to your child why sugar-sweetened beverages are bad for health. Just say no when you’re asked to serve a sugar-sweetened beverage. And keep saying no.

Step #3: Help your child eat high-protein foods at every mealtime, and for snacks.

Step #4: Don’t forbid sugary foods, but limit them to occasional treats. Help your child eat sugar with protein.

Right now, as you read this sentence, your brain is a hive of activity, with millions of minuscule capsules of neurotransmitters buzzing from brain cell to brain cell. Without those tiny “transmitters,” information would stay stuck inside your neurons—you couldn’t see this page, sound out these words in your head, or understand what they mean. In fact, without neurotransmitters, you couldn’t do anything—not think, feel, or move.

What are these crucial components of cerebral accomplishment? How do they do their jobs? And what do they have to do with ADHD? I’m glad you asked.

Enclosed in a tiny sphere like a pearl in a bubble, a neurotransmitter is a chemical messenger that transports signals from one neuron to another, across a microscopic space between brain cells called the synapse.

Before traveling, neurotransmitters dock like boats at the tip of a branching neuron, in a presynaptic area called the active zone. Launched, they cross the synapse, landing at a postsynaptic receptor on a neighboring neuron, where they attach and are absorbed.

I’ve just used a couple of metaphors to help you visualize neurotransmitters—a bee, a pearl, a boat—but perhaps the most accurate way to describe them is this: Neurotransmitters are the active data of the brain. And when I say data, I mean computer data. Neurotransmitters behave much like a computer’s “bits” (binary digits) of data, which use 0 and 1 to create a boundless world of information. Yes, that’s right; there are just two types of neurotransmitters:

• Excitatory, turn-it-on neurotransmitters, like energizing dopamine and norepinephrine

• Inhibitory, turn-it-off neurotransmitters, like calming serotonin and GABA (gamma-aminobutyric acid)

But whether our neurotransmitters are signaling on or off, they’re doing a lot of signaling. There are about 100 billion neurons in the brain, and each has an estimated 15,000 connections with neighboring neurons—for a total of 150 trillion communications. (Talk about multitasking!)

Given that galactic volume of messaging, there are plenty of disorders and diseases that can develop when levels of neurotransmitters are out of balance. Like ADHD.

In ADHD, dopamine is often too low. So is serotonin. So is GABA. The likely results of low levels of those neurotransmitters: Activity becomes hyperactivity. Focus becomes distraction. Self-control becomes impulsivity. Energy becomes aggression.

Most ADHD medications attempt to relieve these symptoms by acting on neurotransmitter receptors. Specifically, the medications cut down on dopamine reuptake—its reabsorption into the cell. (Similarly, the most-prescribed class of antidepressant drugs—the SSRIs, or serotonin selective reuptake inhibitors—block the reabsorption of serotonin.) The result: More dopamine is available for signaling, making your child more alert and focused. And when ADHD medications have side effects, like sleeplessness or tics, the cause is typically too much dopamine.

But what ADHD medications don’t do is affect the overall amount of dopamine and other neurotransmitters. The drugs make more of the dopamine that’s already there readily available to your child’s neurons, but they don’t make more dopamine. There’s no way to do that, right?

Well, it turns out that there is a way to increase the amount of dopamine, serotonin, and the other neurotransmitters that play a role in the symptoms of ADHD. There’s a way for you—on your own, or partnering with your doctor—to help optimize neurotransmitters in your ADHD child’s brain.

You can supplement your child’s diet with neurotransmitter precursors—the nutrients and herbal extracts that help create neurotransmitters. Just as flour, yeast, salt, fat, and water are the ingredients of bread, neurotransmitter precursors are the ingredients of neurotransmitters. And the main ingredients are as follows:

For focus-improving dopamine: tyrosine, an amino acid (a subunit of protein); and the B vitamins pyridoxine (B₆) and folate.

For calming serotonin: tryptophan, an amino acid; and the B vitamins pyridoxine (B₆) and folate.

Like all treatments, timing is everything. Basically, you should give your child precursors before you try medications. But there are many other natural treatments to try first, as you already know. In fact, before supplementing with precursors, it’s best to try most of the other treatments in the Plus-Minus Plan, all of which affect neurotransmitters, some dramatically. Treatments like taking magnesium or lithium, balancing zinc and copper, clearing up harmful bacteria in the digestive tract, and so on.

However, if you haven’t tried any of those other treatments (or you’ve tried with little success), your child is twelve or older, and you want to try a nondrug treatment before your child begins taking medication—a treatment that works like an ADHD drug to boost dopamine and/or serotonin—then treating with precursors might be your answer.

It’s also important to know that neurotransmitter precursors won’t address every symptom of ADHD. Their primary impact is in the realm of attention, sharpening your child’s focus, and deepening his ability to plan, organize, and persist.

In my clinical practice, partnering with patients (and patients’ parents), I often prescribe precursors before medication, moving to medication only when precursors have failed to control symptoms. But success is more common than failure. I’ve treated thousands of ADHD children with neurotransmitter precursors, with excellent results.

You’re probably ready to find out how to use the precursors. But first, I’d like you to take a look at some of the scientific literature on the topic. As with the rest of the Plus-Minus Plan, I’m asking you to review the studies in the next section so you feel confident that neurotransmitter precursors have been scientifically shown to work by scientists and physicians—after which, you can feel confident about giving them to your child, or partnering with your doctor to implement treatment.

Scientific Support for…The Importance of Neurotransmitter Precursors in ADHD

There are two types of scientific literature on neurotransmitter precursors: (1) studies showing that low levels of neurotransmitter precursors (and neurotransmitters) are a common problem in ADHD children; and (2) studies showing that supplementing the diet with neurotransmitter precursors can reduce ADHD symptoms.

Low levels of neurotransmitter precursors, high levels of symptoms. Researchers at Ohio State University measured blood levels of neurotransmitter precursors in 28 children with ADHD and 20 non-ADHD children. The children with ADHD had lower levels of three amino acids:

• 60% less tyrosine, a precursor for dopamine

• 27% less phenylalanine, a precursor for dopamine

• 44% less tryptophan, a precursor for serotonin

Not only that, the lower the level of the precursors, the “more prominent” the symptoms of ADHD, wrote the researchers in Psychiatry Research.¹ For example, children with low blood levels of dopamine-creating tyrosine and phenylalanine had more problems with impulsivity.

Why do children with ADHD have lower levels of precursors? The researchers point to a possible “abnormality” in the “absorption” of amino acids or their “transport” in the body.

In my experience, that abnormality can be caused by multiple factors. Genetic mutation. Stress. Inflammation. A diet with too much sugar, which burns up precursor B vitamins. Or by a diet that delivers too little protein. Or by neurotoxins, like pesticides and lead.

One more point to make about this study: The researchers measured blood levels of precursors, not urine levels. When they measured urine levels, the amount of precursors in the ADHD and non-ADHD children were nearly identical. This inaccuracy is one reason why I don’t find the now-popular urine testing for neurotransmitters consistently helpful.

The ADHD brain blocks tryptophan. Swedish researchers tested tryptophan transport—the ability of the serotonin-creating amino acid to enter the brain—in ADHD and non-ADHD boys. The boys with ADHD had “significantly decreased” tryptophan transport.²

Less tryptophan, more aggression. German researchers gave 20 ADHD children, ages 9 to 15, a beverage that safely decreased their levels of tryptophan. Aggression immediately increased.³ In a similar study on ADHD adults, decreasing tryptophan led to poorer focus and slower reaction time.⁴

Less GABA, more impulsivity. Researchers at Johns Hopkins School of Medicine studied 13 children with ADHD and 19 children without the disorder—and found that those with ADHD had 27% less GABA, a calming neurotransmitter. GABA therapy “may have a role in the future treatment of ADHD,” wrote the researchers in Archives in General Psychiatry.⁵ (As you’ll discover in a moment, GABA therapy has a role now.) In a similar study, ADHD children had “significantly lower” levels of GABA—and significantly more impulsivity.⁶

From these studies, you can see that it’s likely your ADHD child is low in neurotransmitter precursors—and in neurotransmitters. What happens when you provide more precursors? The symptoms of ADHD are likely to improve.

For 65 ADHD children: “significant improvement” or “complete relief” with neurotransmitter precursors. Researchers from Miami University of Ohio and other institutions studied 85 ADHD children, ages 4 to 18.⁷ Many of the children had never taken an ADHD medication because their parents didn’t want them to. Or the child had taken medication but it hadn’t worked or had caused unacceptable side effects. And some of the children were currently on medication.

But whether they were taking medication or not, all of the children in the study took a nutritional supplement that included two neurotransmitter precursors: tyrosine, a precursor for dopamine and norepinephrine; and tryptophan, a precursor for serotonin. They also took a number of other nutrients and natural compounds that play a role in either forming or preserving neurotransmitters, including vitamin B₆, folate, and mucuna pruriens, a bean that supplies L-DOPA, a dopamine precursor. The results were positive, to say the least:

After two months, 57 of 85 children “achieved significant improvement” in their ADHD symptoms—an average 74% decrease, as measured by the Attention-deficit Hyperactivity Disorder Rating Scale.

Of those 57 children, 28 achieved “complete relief”—they no longer had any measurable symptoms of ADHD.

When the children who didn’t improve had their dose adjusted, another 8 improved.

The power of neurotransmitter precursors to ease or relieve these and other symptoms of ADHD “appears superior to some ADHD prescription drugs,” concluded the researchers in Neuropsychiatric Disease and Treatment. They also pointed out that the precursors “do what drugs are unable to do”—increase the total number of neurotransmitter molecules in the central nervous system.”⁸

B₆ is a must for the brain. Researchers at the Geha Mental Health Center in Israel have conducted several studies on ADHD and vitamin B₆ (pyridoxine), a precursor that helps form dopamine.

In one small study, children with ADHD who’d had a poor response to medications were given B₆ daily—15 to 30 mg for every kilogram of body weight. The vitamin was just as effective as Ritalin in controlling symptoms.⁹

In another study, researchers gave a pyridoxine-derived drug (Metadoxine) or a placebo to 36 adults with ADHD—and the vitamin-based drug “significantly improved sustained and selective attention.”¹⁰ In a similar study, inattentiveness and other symptoms decreased by 40% after adults took the drug.¹¹

Pyridoxine is so essential to the formation of neurotransmitters and the health of the brain that ADHD could be considered a “pyridoxine-dependent condition” caused by an “inborn [genetic] disorder of vitamin B₆ metabolism,” wrote another team of Israeli researchers in Medical Hypotheses.¹²

Carnitine: another powerful precursor. Created in the body from the amino acids tyrosine and methionine, carnitine helps synthesize DHA, an essential fatty acid. It may also help regulate dopamine—and ADHD.

In a study of rats bred to mimic the behavior of adolescents with ADHD, carnitine reduced impulsivity and balanced neurotransmitter levels.¹³

As for us humans: In one study of 63 ADHD boys, ages 6 to 13—boys who also had Fragile X syndrome, a genetic condition that causes cognitive problems, sometimes as severe as mental retardation—a year of taking carnitine improved attention and behavior.¹⁴ In another study, of 26 ADHD boys ages 6 to 13, two months of taking carnitine improved attention and lessened aggressive behavior. And in a third study of 24 boys, those who took carnitine had less inattention, aggression, and delinquency.¹⁵

Enough about what scientists have discovered. Now it’s time to discover how you can use precursors to help your ADHD child.

Vitamin D: A Must for Serotonin

Every child knows that vitamin D—the sunshine vitamin—is good for building strong bones. But few children (or adults) know that vitamin D plays many roles in the body. In fact, every cell in the body has a vitamin D receptor—which means that every cell requires vitamin D for maximum functioning and health. Vitamin D helps to invigorate the heart, boost immunity, regulate blood sugar, and strengthen muscles.

Vitamin D is also a neurotransmitter precursor, helping create serotonin—and serotonin is serious about your child’s well-being. Serotonin energizes executive function, the mental skills that help your child get things done. It eases impulsivity, allowing your child to choose long-term benefits over short-term gratification. It improves social behavior and your child’s ability to be friendly, even when disappointed or frustrated. It upgrades sensory gating, so your child is able to filter out extraneous input and focus on the task at hand. Vitamin D also affects dopamine and norepinephrine, neurotransmitters that regulate attention.

That’s the good news. The bad news is that few of us get enough vitamin D. Seventy percent of Americans—adults and children—have low levels. An estimated 50% of us have an outright deficiency. And children with ADHD are no exception.

In one study, children with ADHD had average vitamin D levels that were 33% lower than non-ADHD children.¹⁶ In another, they were 41% lower.¹⁷ In both studies, the lower levels were either just slightly above or below deficiency levels—in other words, very low. And here’s the most important point about vitamin D deficiency, which few doctors know:

If your ADHD child has a vitamin D deficiency, that deficiency must be treated for your child to get better; in fact, boosting a very low vitamin D level to a healthy level can make all the difference in relieving symptoms.

An outright deficiency is below 20 nanograms per milliliter (ng/ml). In the studies I just cited, the children had average levels of 19.1 and 20.9—deficiency and borderline deficiency, respectively.

Given the facts about vitamin D, I strongly urge you to have your child’s blood level of vitamin D tested. You can do it relatively cheaply on your own, through a company like Direct Labs; or you can work with your doctor to order the test.

If your child has a level of 20 or lower, give him a daily supplement of vitamin D₃, the natural and most active form. I suggest 5,000 IU per day for 60 days, aiming for a truly healthy blood level of between 40 and 50 ng/ml. Retest after 60 days; if that healthy level hasn’t been achieved, continue supplementing at 5,000 IU, and retest again 60 days later. Repeat that process until your child’s blood level is between 40 and 50—and then switch to 2,000 IU daily, a maintenance dose that should keep levels normal.

How to Use Neurotransmitter Precursors

Research shows that daily serotonin levels aren’t very amenable to dietary manipulation. For example, SSRIs, which boost serotonin, don’t improve the symptoms of ADHD. But dopamine is a different story; you can easily raise levels if you give your child the right precursors. They include:

L-tyrosine, an amino acid that forms dopamine.

Folate, a B vitamin that helps convert tyrosine to dopamine. However, many ADHD children have a genetic mutation that stops the synthetic folate found in most supplements from converting tyrosine to dopamine. A more effective form: L-5-MTHF, or Metafolin, which delivers the same, brain-friendly form of folate found in food.

Vitamin B₆, in the form of pyridoxal 5’ phosphate, a biologically active form of the nutrient that does the best job of helping the body convert tyrosine to dopamine.

L-DOPA, supplied naturally by mucuna pruriens, or the velvet bean, which grows mainly in India and China.

Zinc, a mineral that helps keep dopamine in the synapse between neurons, making it more available. Put another way, zinc is a natural dopamine reuptake inhibitor.

Rhodiola, an herb that turbocharges dopamine, speeding it across the synapse.

Green tea extract, which helps preserve dopamine.

That’s a long list, and right now you might be thinking: I’m not going to try to get my ADHD child to take all those supplements. Relax, you don’t have to. I’ve formulated one supplement that includes each of those precursors: DopaPlus, from Pure Encapsulations.

The formula of DopaPlus reflects my more than twenty years of treating ADHD children with precursors, and slowly but surely learning what did and didn’t work for my patients. What didn’t work was prescribing individual amino acids, like tyrosine. What did work was prescribing dopamine-creating amino acids with nutritional cofactors that preserve dopamine and enhance its action in the brain. DopaPlus contains precursors and cofactors.

DopaPlus is safe, but dosages need to be increased gradually, allowing your child’s brain to adjust to the new surge of neurotransmitters. Also, the formula takes two to four weeks to work, so you and your child won’t see immediate benefits.

Start your child on one pill twice a day, on an empty stomach, fifteen to thirty minutes before breakfast and dinner. (Taking the supplement on an empty stomach improves absorption.)

Increase the dose two weeks later, to two pills, twice a day.

If, after four weeks, you haven’t seen improvements in symptoms, increase the dose to three pills, twice a day. Most children do best on four to six pills.

If the supplement is working, you should start seeing improvements in attention—more attention to detail, fewer careless mistakes, less of a tendency to lose things, less of a tendency to be forgetful. Your child should also have a greater ability to sustain effort—to stick with a chore until it’s done, finish homework, or play a game to its completion.

As I said, DopaPlus is very safe. But there are sometimes side effects. Occasionally, a child with ADHD has a dopamine excess, not a dopamine deficiency, with symptoms of hyperactivity, anger, and aggression. In those children, DopaPlus may create more agitation, not less. If your child becomes more agitated after starting the supplement, stop the supplement; it’s not for him.

Boosting “excitatory” dopamine is key to improving focus and mental persistence in many ADHD children. And boosting “inhibitory” serotonin and GABA is key to easing hyperactivity and impulsivity.

GABA, for Easier Evenings

As I reported earlier in the chapter, research shows that many kids with ADHD have low levels of GABA, a calming neurotransmitter. But unlike other neurotransmitters, your child doesn’t have to take precursors to increase GABA—she can take a GABA supplement.

GABA works best for children who are overactive or anxious in the evening, calming them down before bedtime. Some of my ADHD patients have had good results with Pure 20, from Pure Encapsulations, a citrus-flavored GABA spray. The formulation also contains lemon balm, a calming herb, and L-theanine, a calming amino acid. Try one squirt of the spray, two or three hours before your child’s bedtime. If you use a pill, look for a 100 mg dose (there are several brands with this dosage), giving it to your child in the evening.

Occasionally, a child will have a “paradoxical” reaction to GABA, becoming more active and anxious. That reaction isn’t dangerous—trying out GABA won’t hurt your child—but if you don’t notice a calming effect after two or three days, stop the supplement.

Tryptophan, for Better Sleep

If your child has problems falling asleep, giving her a supplement of tryptophan—a precursor for calming serotonin—is a good strategy to help her fall asleep and stay asleep. I suggest 500 mg, thirty minutes before bedtime. Look for a product that provides L-Tryptophan and a small dose of vitamin B₆ to help the body use it.

If after a week tryptophan hasn’t worked, try another serotonin-boosting sleep aid: 5-HTP (5-hydroxytryptophan), an enzyme that helps tryptophan become serotonin. I suggest 50 mg, thirty minutes before bedtime.

If tryptophan relaxes your ADHD child at bedtime, could it work any time of day? As I said earlier, scientific research shows that supplementing the diet with serotonin precursors (or taking a serotonin-boosting SSRI drug) does not improve ADHD symptoms.

When Your Child Needs More B₆. A Lot More.

Many years ago I had a patient with ADHD whose parents gave her the wrong dose of the supplements I’d prescribed—including 400 mg of vitamin B₆ (pyridoxine). Their daughter’s symptoms vanished after this mistreatment, which they enthusiastically told me about. I was pleased by the strange turnaround, but concerned about the child. B₆ is a must for the brain, helping to synthesize dopamine, norepinephrine, serotonin, and GABA. But in high doses of 200 mg or more, it can harm the central nervous system, causing sensory neuropathy—pain and numbness in the legs and arms, in some cases so severe that it’s crippling. Needless to say, I immediately cut the girl’s dose. To my surprise, her symptoms returned. Intrigued, I put her back on the 400 mg dose—and her symptoms once again disappeared. What was happening?

I discovered that this child had pyroluria, a genetic defect in handling hemoglobin, the oxygen-carrying protein in red blood cells. People with pyroluria produce too much kryptopyrrole, a compound that binds to vitamin B₆ and zinc, causing a deficiency in these two nutrients. That deficiency in turn causes a deficiency in neurotransmitters, with symptoms like an inability to handle stress, intense anxiety, frequent and explosive anger, mood swings, poor short-term memory, reading problems, and depression. (Sounds like the symptoms of ADHD, right?) Other symptoms can include frequent infections, obesity, morning nausea, sensitivity to light and sound, and an inability to tan.

If those symptoms sound like a match for your child’s, ask your doctor to order a urine test to detect kryptopyrrole. If the test shows your child has pyroluria, talk to your doctor about nutritional therapy to correct it. Corrective doses include high-dose vitamin B₆ (200 mg daily, in the form of pyridoxal-5-phosphate) and zinc (25 to 100 mg daily, in the form of zinc picolinate).

MTHFR Testing: A Genetic Test That Can Help

There’s a test that can guide you and your doctor as you work together to balance your child’s neurotransmitters: the MTHFR (methylenetetrahydrofolate reductase) test.

Methylenetetrahydrofolate is an enzyme that changes folic acid into L-methylfolate, the form of the nutrient that helps create neurotransmitters. The test itself looks for genetic mutations that slow or stop the conversion of folic acid into L-methylfolate—slowing or stopping the creation of dopamine and serotonin, and possibly causing the behavioral problems of ADHD, and emotional problems like depression.

I order this test for every ADHD child I treat—because if the test is positive, the child needs to take at least 3 mg of folate daily. And for effective treatment, he needs to take the right, brain-friendly kind of folate: L-5-MTHF, or Metafolin, which is the type found in DopaPlus.

In fact, the synthetic folate found in most supplements actually blocks L-5-MTHF from entering the brain. Again, talk to your doctor about whether or not this test is right for your ADHD child.

The Best Diet to Support Neurotransmitters

A low-protein diet doesn’t supply your child with the precursors she needs. Favor a high-protein diet: a high-protein food with every meal, and a high-protein food at snack times.

A diet rich in refined carbohydrates like sugar, soda, and white flour burns up B vitamins without supplying any—and the B vitamins pyridoxine and folate are crucial for normal levels of neurotransmitters.

Plus, a sugary diet is inflammatory, another cause of low neurotransmitters.

In other words, the high-protein, low-sugar diet recommended in Chapter 4 is the right diet for boosting neurotransmitters.

Step-by-Step Action Plan for Healing ADHD

Plus: Neurotransmitter Precursors

Here’s a practical, step-by-step summary of the actions discussed in this chapter.

Step #1: Use neurotransmitter precursors only in children twelve or older, and mainly for children with attention-predominant ADHD.

Step #2: Use DopaPlus, a unique combination of precursors that I formulated for maximum effectiveness. Give two pills a day for the first two weeks, and four pills a day for the next two weeks. If there is no improvement in focus and follow-through, go to six pills a day.

Step #3: Discontinue the supplement if your child becomes more hyperactive; he may have excess dopamine. Consider testing for copper/zinc imbalance and HPHPA, two common causes of excess dopamine.

Step #4: Test for vitamin D deficiency. If levels are below 20 ng/ml, supplement with 5,000 IU of vitamin D for two months. Retest. If levels are still low, continue supplementing. If levels have stabilized between 40 and 50 ng/ml, lower the dose to 2,000 IU vitamin D and continue it.

Step #5: If your child is hyperactive in the early evening, consider GABA two to three hours before bedtime, particularly one spritz of an easy-to-use GABA spray.

Step #6: For problems falling asleep, consider L-tryptophan, giving 500 mg thirty minutes before bedtime. If L-tryptophan hasn’t worked after one week, try 50 mg of 5-HTP.

Step #7: Consider whether your child has the symptoms of pyroluria, a genetic mutation that stops the body from using vitamin B₆ and zinc. If this seems like a strong possibility, ask your doctor to test for pyroluria; if the test is positive, ask your doctor about corrective doses of B₆ and zinc.

Step #8: Consider having your child tested for genetic changes in MTHF, the gene that is responsible for folate metabolism. This genetic mutation may interfere with the conversion of folate into L-methylfolate, the form of folate needed to produce neurotransmitters. If the MTHFR test is positive for the mutation, supplement with L-methylfolate, which supplies a biologically active form of the B vitamin.

Step #9: Encourage your child to eat a diet rich in protein (a precursor for serotonin) and low in sugar and other refined carbohydrates.

Good sleep and good health are like night and day—you can’t have one without the other. Unfortunately, a lot of us have lost our passports to the Land of Nod.

Forty-five million Americans fit the official definition of insomnia: having trouble falling asleep, staying asleep, or waking up too early, at least three times a month for more than one month. Another sixty million have those same symptoms, but less often.

Millions of us also have a sleep disorder, like sleep apnea (interrupted breathing during sleep) or restless legs syndrome (unpleasant sensations in the legs when lying down to sleep, and the urge to move).

Scientific studies link insomnia and sleep disorders to an A-to-ZZZs of health problems, including anxiety, burnout, chronic pain, depression, diabetes, fibromyalgia, heartburn, heart disease, high blood pressure, memory loss, menopausal problems, and overweight.

Well, you can add another health problem to that long list caused by poor sleep and sleep disorders: ADHD.

Attention Deficit—or Sleep Deficit?

ADHD isn’t just an attention-deficit disorder.

It’s also a nutritional-deficit disorder, with low levels of magnesium, zinc, omega-3s, and other nutrients causing or contributing to symptoms.

And—as just about every parent of a child with ADHD knows—it’s a sleep-deficit disorder, too.

According to a study published in the journal Sleep Medicine, an estimated 55% of children with ADHD have a sleep problem, like not getting enough sleep, waking up repeatedly during the night, and daytime sleepiness because of poor sleep.¹ My experience tells me the percentage of ADHD children with sleep issues is closer to 100: In my thirty years of treating kids with ADHD, I’ve rarely seen a patient who didn’t have some type of difficulty with sleep. Dozens of other scientific studies on ADHD and sleep have added more items to that catalog of nighttime woes: resisting going to sleep, anxiety about sleeping, difficulty falling asleep (the most common sleep problem among ADHD children), and difficulty waking up in the morning.

A host of other studies show that many children with ADHD have a sleep disorder. The most common type of sleep disorder is sleep-disordered breathing (SDB): chronic mouth breathing, snoring, or sleep apnea. Some kids with the disorder have a sleep movement disorder, usually restless legs syndrome. And some have a parasomnia—they sleepwalk, have frequent nightmares (frightening dreams that wake a child up), or have frequent sleep terrors (extreme nightmares, with the child crying or screaming when he wakes up).

One recent study on sleep-disordered breathing provided a dramatic demonstration of the link between sleep disorders and ADHD.² The researchers evaluated more than 9,000 children, from when they were 6 months old to when they were 7 years old. By the age of 7, the children who had sleep-disordered breathing sometime during their childhood were:

• 85% more likely to be hyperactive.

• 60% more likely to have conduct problems.

• 37% more likely to have difficulties with their peers.

• 65% more likely to have emotional difficulties.

“Lack of sleep is an insult to a child’s developing body and mind that can have a huge impact,” Karen Bonuck, Ph.D., the study leader, told the New York Times.³

In other studies, children who had sleep-disordered breathing and subsequent surgery to correct the problem by removing adenoids (lymph tissue at the back of the nose and top of the throat) and tonsils (two round lumps of lymph at the back of the throat) were much less likely to be diagnosed with ADHD, compared to children with SBD who didn’t have surgery.

As for children already diagnosed with ADHD who had the surgery—well, their symptoms of hyperactivity, inattention, and impulsivity were sometimes so improved that they no longer met the criteria for the diagnosis of ADHD.⁴

A study in the Journal of Attention Disorders summed up the link between sleep issues and ADHD with a set of startling statistics.⁵ Compared to non-ADHD children, ADHD children were:

• 41% more likely to resist going to bed.

• 49% more likely to have anxiety about sleeping.

• 36% more likely to have trouble falling asleep.

• 36% more likely to wake up during the night.

• 57% more likely to sleep less.

• 88% more likely to have daytime sleepiness.

• 89% more likely to have sleep-disordered breathing.

But here’s the most disturbing part of this sad tale of poor sleep: the sleep problems that are a common, complicating factor in ADHD are rarely evaluated and treated by doctors. In fact, the medical profession seems to be going in the opposite direction.

The diagnosis for ADD (its old acronym) in the 1980 DSM (The Diagnostic and Statistical Manual of Mental Disorders, the standard classification of mental disorders used by mental health professionals in the U.S.) includes the symptom “move excessively during sleep.” But the 1987 version of the DSM had no mention of sleep issues in the diagnosis of ADHD. Thirty years later, sleep issues still aren’t mentioned.

From my perspective, that’s a nightmarish disservice to children with ADHD and their parents. Because as I said a moment ago, in my clinical experience just about every ADHD child has one or more issues with sleep—and treating those issues can dramatically reduce the symptoms of ADHD.

Fortunately, the Plus-Minus Plan has its eyes open about sleep issues. Here are my tried-and-true suggestions for controlling your child’s problems with sleep. They’ve worked for my patients and their parents, and I think they’re likely to work for your child and you.

Putting Sleep Issues to Bed

It’s important to emphasize that there are two types of sleep issues that affect children with ADHD. This is important, because their treatment is different.

As I explained earlier, the two issues are:

1. sleep problems, like difficulty falling asleep; and

2. sleep disorders, like snoring, restless legs syndrome, and frequent nightmares.

Since sleep problems are the more common of the two, let’s start with them.

Solving Your Child’s Problems with Sleep

The first thing I’d like you to know is that the amount of sleep your child gets shouldn’t be your sole focus: a lot of kids with ADHD seem to do better when they get a little less sleep than their peers without ADHD. How much less?

Many ADHD children do fine with an hour or so less than the recommended sleep durations from the American Academy of Sleep Medicine (recommendations endorsed by the American Academy of Pediatrics): 10 to 13 hours for preschoolers (3- to 5-year-olds); 9 to 12 hours (for children 6- to 12-year-olds); and 8 to 10 hours for teenagers.⁶

Rather than concentrating on the quantity of your child’s sleep, concentrate on the quality. Ask yourself these questions:

• Does my child resist going to bed?

• Is he anxious about falling asleep?

• Does she have difficulty falling asleep? (Almost a given.)

• Does he regularly wake one or more times throughout the night?

• Does she have difficulty waking up in the morning?

• Does he have daytime fatigue, perhaps falling asleep at his desk during class?

If you answered yes to any of these questions, it’s important to treat your child’s sleep problem. And there are two ways to do that: with a nighttime nutritional sleep aid, like magnesium, coupled with what sleep experts call sleep hygiene, the habits and routines that can help your child fall asleep.

And it’s never too soon to start treating sleep problems. Left untreated, a seemingly small-scale sleep problem can develop over many years into chronic insomnia, with your child sleeping only five to six hours a night. No child can feel good or function well with so little sleep.

Fortunately, treating sleep problems is surprisingly simple. And the first treatment is one you already read about in Chapter 1 of the Plus-Minus Plan: the mineral magnesium. Later in the chapter you’ll also read about bedtime sleep habits—sleep hygiene—that are important for a good night’s sleep. None of the nutritional sleep aids I’m about to discuss are a substitute for good sleep hygiene.

Magnesium: A Dream Mineral for ADHD

The mineral magnesium—which helps relax the body and calm the mind—is one of the best (if not the best) sleeping aid you can give to your ADHD child.

In fact, my clinical experience has shown me that a deficiency of magnesium—which research shows afflicts nine out of ten kids with ADHD—is often the cause of sleeping problems. And my clinical experience also shows me that those problems typically clear up in one to two months when you supplement with the mineral. (It takes that long for cellular magnesium levels to rise to normal.)

Here’s the regimen I use in my practice and that you can safely use with your child:

I suggest supplementing with 400 mg of magnesium citrate daily, in powder form: 200 mg with breakfast, and 200 mg thirty minutes before bedtime.

I suggest using the product Natural Calm, from Natural Vitality. This popular magnesium supplement is available in several flavors that kids like. It also uses a water-soluble form of the mineral that is easily absorbable. And because it’s a powder, you can add it to any beverage—water, juice, a smoothie, you name it. Each two-teaspoon serving delivers 325 to 350 mg of magnesium, allowing you to easily adjust the dose. I suggest two, divided doses, with breakfast and thirty minutes before bedtime. The amounts I use are the same as the Recommended Daily Allowance (RDA) for magnesium from the National Institutes of Health:

• 1 to 3 years old: 80 mg

• 4 to 8: 130 mg

• 9 to 13: 240 mg

• 14 to 18: 410 mg (males), 360 mg (females)

• 19 to 30: 400 mg (males), 310 mg (females)

• 31 and older: 420 mg (males), 320 mg (females)

If, after one month, your child’s sleep problem hasn’t lessened significantly, maintain the breakfast dose and double the bedtime dose.

Or you could stick with the above dosing schedule, adding 120 mg of magnesium glycinate thirty minutes before bedtime, which is also helpful in solving sleep problems.

And if, after one month on magnesium, your child continues to have sleep problems, it’s time to add another sleep aid: melatonin, a hormone generated by the brain’s pineal gland.

Melatonin: Setting Your Child’s “Body Clock” for Deeper Sleep

Normally, we’re awake during the day and sleep during the night—what could be more natural? But the sun and moon have an internal assistant: melatonin, which helps set the biological “clock” in the brain that makes us sleepy when it’s dark outside and alert during daylight.

In a normal day-night cycle, the brain starts manufacturing melatonin around 9:00 p.m., with levels staying high throughout the night and falling around 9:00 a.m. To aid that process, I suggest giving your child a supplement of 1 to 3 mg of melatonin, about thirty minutes before bedtime. (Don’t stop magnesium, however.)

That dose of melatonin was used in a recent study, published in JAMA Pediatrics: Children and adolescents with sleep problems who took 3 mg of melatonin before bedtime fell asleep an average of 21 minutes faster than children who took a placebo.⁷

If your child’s sleeping problems haven’t improved after two weeks of melatonin, stop the melatonin, stay on the magnesium, and add another sleep aid: tryptophan.

Tryptophan: The Natural Way to Boost Serotonin

As you learned in the chapter on neurotransmitter precursors, the amino acid tryptophan helps your body manufacture serotonin, a calming neurotransmitter. A multitalented amino acid, tryptophan helps your body make more melatonin, too.

I suggest giving your child 500 mg of tryptophan, thirty minutes before bedtime.

Theanine and Glycine: Two More Snooze-Inducing Amino Acids

If your child’s sleeping problem isn’t solved in the next two weeks—that is, if she still has trouble sleeping after taking magnesium, melatonin, and tryptophan—it’s time to switch to another before-bedtime regimen: the amino acids L-theanine (from green tea) and glycine (found in high-protein foods like red meat and chicken).

In a study on L-theanine, 98 ADHD boys, ages 8 to 12, were divided into two groups: one group took L-theanine every day, and the other took a placebo.⁸ After six weeks, the boys taking L-theanine woke up less during the night, had longer periods of restful sleep, felt more refreshed in the morning, and were less sleepy during the day. Boys who had restless legs syndrome also experienced significant relief.

The researchers speculate that the supplement may work by regulating levels of serotonin and GABA, two calming neurotransmitters, and by increasing alpha brain waves, which trigger relaxation.

I suggest supplementing with 100 to 200 mg of L-theanine, thirty minutes before bedtime.

Like L-theanine, studies show that the amino acid glycine can help people fall asleep faster and sleep deeper and longer, with less daytime fatigue and better daytime focus.9, ¹⁰ Glycine may work by keeping core body temperature low, a must for a good night’s sleep, according to Japanese researchers.¹¹

I suggest 1 to 3 grams, thirty minutes before bedtime.

When It’s Time to Use Medication

In my clinical experience, magnesium usually works on its own. If it doesn’t, adding melatonin and L-tryptophan often does the trick. If those three supplements aren’t sufficient, replacing them with L-theanine and glycine generally works.

But when sleeping problems are severe, and a fatigued, moody, aggressive, inattentive, impulsive child is in dire need of help, I may start treatment with magnesium and a prescription drug that aids sleep.

For children and adolescents, the safest, most reliable medication for this purpose is clonidine, a seldom-used high blood pressure medication, FDA approved for the treatment of ADHD. The dose I prescribe is one-fourth or one-half of a 0.1 mg pill. (The adult dose for high blood pressure is from 0.2 to 0.6 mg.)

I always start with the medication and magnesium, adding more supplements as needed on the schedule I just described. After a few months, when sleeping problems are fully under control, discontinue clonidine but continue with magnesium.

Talk to your doctor about whether or not clonidine is right for your child. But use the natural treatments first—particularly magnesium.

Sleep Hygiene: Bedtime Routines for Reliable Sleep

Night follows day in a regular pattern—and sleep should naturally follow along. Which means that one of the best ways to help your ADHD child sleep is to establish a regular sleep-wake pattern that matches the rhythms of daytime and nighttime.

Sleep experts call these habitual patterns “sleep hygiene”—just as habitual dental hygiene helps prevent and control dental problems like cavities, habitual sleep hygiene helps prevent and control sleep problems like difficulty falling asleep. In fact, studies show that sleep hygiene, consistently implemented, can clear up nearly all cases of insomnia in children.¹²

For example, one study compared children with ADHD who used sleep hygiene techniques to those who didn’t.¹³ The kids with good sleep hygiene had fewer sleep problems, slept more—and had a greater decrease in ADHD symptoms, including better behavior, more focus, better ability to perform daily tasks, and better memory. And they were less likely to be late for school, too!

The top techniques of sleep hygiene are:

#1: Establish a regular schedule of going to bed and waking up. The most important habit for your ADHD child: going to bed and waking up at the same time, most nights and mornings. Now, I’m not suggesting bedtime boot camp—but I am urging you to pick set times that work for you and your child, and try not to vary them by more than sixty to ninety minutes. This regular pattern of going to bed and getting up will help establish a sleep-wake rhythm that is ideally conducive to falling asleep, staying asleep, and waking up refreshed.

#2: Design a consistent and enjoyable bedtime routine. A regular routine of relaxing activities, starting thirty minutes before bedtime, can help your child sleep. The routine might include: a warm bath; reading a story or two; shutting the blinds, turning off the lights, and closing the door.

#3: Set up a “sleep friendly” bedroom. The best environment for sleeping is quiet, dark, with a comfortable temperature.

#4: Check the digital devices at the bedroom door. Screen time and sleep time don’t mix. An hour or two before bedtime, stop the use of TV or video games. And there shouldn’t be any use of a cell phone, computer, or other device while going to sleep.

#5: Teach your child one or more relaxation techniques. Deep breathing, for example, can be very relaxing: ask your child to breathe in through her nose for a count of four, pause two to three seconds, and breathe out through her nose for a count of four. Have her do this a couple of times once she’s in bed.

Or teach him progressive relaxation: progressively tensing and relaxing muscle groups in the body, for a few seconds each. A typical sequence: feet, calves, thighs, hands, forearms, abdomen, chest, shoulders, and face.

If your child is anxious, ask her to keep a bedtime “worry journal,” writing down everything she’s worried about—and forgetting about it until morning.

#6: Ask your child to avoid caffeine in the afternoon and evening. Colas, energy drinks, and other caffeine-containing beverages—particularly if they’re consumed six hours or less before bedtime—can stimulate your child, making falling asleep more difficult.

Bottom line. You can usually solve your child’s sleep problems with natural sleep aids like magnesium and sleep hygiene (and, in the most severe cases, with a prescription drug). But solving a sleep disorder almost always requires medical care.

From Snoring to Sleepwalking: Treating the “Disorders” That Disorder Sleep

Because sleep issues play such a big role in creating ADHD symptoms, it’s crucial to identify any sleep disorders that your child might have and work with your doctor (and perhaps a sleep specialist) to correct them as soon as possible.

There are several clues—some obvious, some not—that can alert you to the possibility that your child may have a sleep disorder. Ask yourself if your child:

• Breathes through his mouth while sleeping.

• Huff-and-puffs or gasps for breath while sleeping, as if struggling for air.

• Snores.

• Has interrupted breathing, with inhalations and exhalations stopping for a few seconds.

• Feels a strong urge to move her legs when she lies down to sleep, an urge that’s relieved when she moves them.

• Feels itching or tickling sensations in his legs.

• Sleepwalks.

• Has regular nightmares or sleep terrors.

Other symptoms that might point to sleep-disordered breathing include feeling groggy or tired after waking up, chronic morning headaches, early morning thirst, and a dry mouth or throat in the morning. Sleep-disordered breathing is also more common among children with a medical history that includes chronic sinus problems, respiratory allergies, wheezing, and/or a family history of sleep apnea.

If you can answer yes to any of the above questions, or if one or more of the additional symptoms and the medical history seem like a match for your child, then it’s time to talk to your doctor about your child’s sleep. Your doctor may recommend seeing a sleep specialist, who is likely to order a sleep study (polysomnogram).

A sleep study usually occurs from just after dinner to 7 a.m. the next morning, with your child sleeping overnight in a bedroom in a hospital’s sleep lab. You’ll be invited to sleep in the room with your child.

During the night, your child’s sleep is monitored with sensors that measure breathing patterns, oxygen levels, eye movements, leg movements, brain waves, and the stages of sleep. (Most children sleep well, in spite of the sensors.)

After the study, you’ll meet with the sleep specialist to go over the results of the sleep study and, if necessary, discuss treatment options. They can include:

• Weight loss, since overweight is often the cause of sleep-disordered breathing.

• A dental appliance (mouth guard) worn at night, to help sleep-disordered breathing.

• A CPAP (continuous positive airway pressure), a device used during sleep that helps prevent apnea.

• Surgery to remove enlarged adenoids and tonsils that are interfering with breathing; a study shows this type of surgery in children can cure four out of five cases of sleep apnea.

• Supplementing the diet with iron, for restless legs syndrome. An effective dose is 1 to 2 mg per kilogram of body weight, with the goal of raising ferritin (stored iron) to levels higher than 50 ng/dl. Taking a vitamin C supplement of 100 mg with the iron helps the body absorb the mineral.

Effectively treating a sleep disorder is likely to have a wide range of positive effects on ADHD symptoms—and may even clear up symptoms completely.

Is ADHD Medication Keeping Your Child Awake?

It’s possible that a stimulant medication can overstimulate an ADHD child, keeping him awake. This side effect is most likely in kids taking a long-acting stimulant. If you suspect stimulant-caused insomnia, talk to your doctor about these strategies:

Wait it out. Insomnia caused by stimulants may go away after one to two weeks of taking the drug.

Change the dose or the timing. Give a smaller dose of the medication, or don’t give it in the evening.

Switch medications. Sometimes one stimulant causes sleeping problems but another doesn’t. It’s unlikely a short-acting stimulant will cause this side effect.

Use a nonstimulant ADHD medication. Consider Tenex or clonidine, which are less likely to cause sleeping problems.¹⁴

“Exercise Is ADHD Medication”

That was the startling (to most doctors, anyway) headline of an article in an online issue of The Atlantic, reporting the work of researchers at the University of Illinois. The researchers found that elementary-school children who exercised regularly had larger brains, better memory, and clearer thinking, more “cognitive control” (better reasoning and problem-solving), superior academic achievement, and a greater ability to deal with everyday tasks that require judgment, like crossing the street.¹⁵

It didn’t surprise the same researchers when another of their studies found the same types of benefits in ADHD children who began to exercise regularly.¹⁶

For that study, the researchers divided children with ADHD, ages 7 to 9, into two groups: one group exercised regularly after school, and one group didn’t. After nine months, the exercisers had:

• 49% increase in “response inhibition”—the ability to control bad behavior, respond to feedback, and set and achieve goals.

• 43% increase in “cognitive flexibility”—the ability to face and respond to new and unexpected events and activities, to switch tasks, and to learn.

• 89% increase in “attentional resources”—the ability to focus and concentrate.

Dozens (yes, dozens) of other studies on ADHD and exercise have shown similar results. Exercise can:

• reduce hyperactivity.

• reduce inattention.

• reduce impulsivity.

• help children get along and cooperate with parents, siblings, teachers, and friends.

• improve motor skills, balance, and strength, giving ADHD children a greater sense of physical competence and comfort.

• improve “executive function”—the ability to organize, make decisions, think ahead, and delay short-term gratification for long-term results.

• boost math and reading scores and other types of school performance.

• ease stress.

• decrease intrusive, unwanted thoughts.

• lessen worry and anxiety.

• improve mood.

Exercise works by triggering the release of dopamine and serotonin, neurotransmitters that regulate attention and mood. It also boosts levels of BDNF (brain-derived neurotrophic factor), a protein that protects and energizes brain cells.

Encouraging Your Child to Be More Active

I’m sure you know as a parent of an ADHD child that exercise helps your child focus and control behavior—the more exercise, the better. In fact, you may have discovered that your child can only do his homework after he’s participated in afternoon sports. Or you may have found that if your child exercises regularly, he doesn’t need medication. Or if your child takes medication and exercises, he does much better than on medication alone.

Bottom line. Never limit exercise. Always maximize it.

But whatever you do, don’t nag your child about exercise, or criticize him for spending so much time in front of the TV or playing video games. Instead, encourage your child to engage in sports and other physical activities that he enjoys.

For instance, many parents tell me that martial arts are wonderful for their ADHD child. Several studies show that yoga can help with ADHD symptoms. Other studies on exercise and ADHD have used walking (including guided walks in a park, and treadmill walking), jogging, running and races, bicycling, swimming and aquatic exercise, skipping rope, dancing, weight training, basketball, soccer, and tag. In other words, it’s not the type of exercise that matters—it’s exercising. And even a little goes a long way.

In one study, for instance, just five minutes of running improved attention by 31% compared to a group of ADHD children who didn’t run.¹⁷ In fact, the kids with ADHD became just as focused as a group of kids without the disorder.

That’s the kind of “fitness” every parent of a child with ADHD loves to see.

Does Screen Time Hurt Your ADHD Child?

Your ADHD child is a child of his generation—which means he probably spends a lot of time looking at screens.

He’s gaming; she’s browsing; he’s texting; she’s watching a movie on the computer; he’s watching TV; she’s checking out her friends on social media.

And the question you’re asking yourself is: Does all this screen time make my child’s symptoms worse? And if it does, how can I limit my kid’s screen time?

Parents ask me those questions all the time. And I wish they were easy to answer. But they’re not. Here’s what scientists do and don’t know about screen time and the ADHD child.

Children with ADHD seem particularly vulnerable to a pattern of screen overuse that experts variously call “Internet addiction,” “computer game addiction,” and “video-game addiction.” This type of addiction isn’t only about the amount of time spent on the Internet or gaming. It’s also about how that time affects your child. Is he preoccupied with the Internet or gaming? Is she unable to control her use? Is he upset when use is restricted? Does Internet use or gaming interfere with schoolwork, socializing, eating, or sleeping? Those are all possible signs of addiction.

Apart from addiction, some studies link increased screen time to worsened ADHD symptoms. And common sense tells us that browsing and gaming might reinforce the symptoms of ADHD, since they’re highly stimulating and put minimal demands on attention.

As one expert put it, writing in the journal Attention Deficit and Hyperactivity Disorders: “…prolonged hours of Internet and gaming use may further reinforce and consolidate the child’s proclivity to impulsive, rapid, hyperfocused reactivity.”¹⁸

But there are several caveats to these possible downsides of too much screen time.

First, experts haven’t really figured out if screen time actually worsens inattention, hyperactivity, or other ADHD symptoms.

Yes, there are studies that link screen time to attention problems. Like a one-year study of more than 1,300 third-, fourth-, and fifth-graders and more than 200 college students, conducted by researchers at the University of Iowa.¹⁹ They found that middle-school children who exceed two hours a day of TV and video-game watching were 67% more likely to have attention problems, and college students were more than twice as likely.

But plenty of other studies have failed to link screen time and attention problems, in either ADHD or non-ADHD children. As one study, published in the Journal of Psychiatric Research, concluded: “Television and video games do not appear to be significant predictors of childhood attention problems. Intervention and prevention efforts may be better spent on other risk factors.”²⁰

And some experts (and parents, and children) think that screen time can improve the lives of kids with ADHD, opening up new avenues of learning and increasing opportunities to relate to friends.

Even if these pixilated facts never come into focus—it’s clear that getting children to limit their screen time is difficult.

My recommendations:

Provide time limits for the use of screens. I agree with the recommendation of the American Academy of Pediatrics to limit screen time to no more than two hours a day.

Provide structure for the use of screens. Some families limit screen use to weekends and vacations. Others use it as an after-homework reward. Some restrict use by shutting down devices one to two hours before bedtime, an approach I heartily recommend, especially because sleep problems are so common in ADHD.

Watch out for addiction, particularly with video games. For some ADHD children, video games become a primary way to boost dopamine—and their use can become addictive, providing one of the few pleasures of a child’s life. If you see any of the addictive behavior I described earlier in the chapter, it’s time to work with your child to set limits on screen use.

Step-by-Step Action Plan for Healing ADHD

Minus: Sleep Problems and Disorders

Plus: Exercise

Here’s a practical, step-by-step summary of the actions discussed in this chapter.

#1: Using the questions on this page, determine if your child has a sleeping problem—and treat it.

#2: Supplement the diet with magnesium at breakfast and bedtime, using the age-determined dosages on this page.

#3: If, after one month, sleep problems haven’t lessened significantly, add 1 to 3 mg of melatonin thirty minutes before bedtime.

#4: If, after two weeks of melatonin, sleep problems haven’t lessened, stop melatonin and add 500 mg of L-tryptophan, thirty minutes before bedtime.

#5: If, after two weeks of tryptophan, sleep problems haven’t lessened, stop all supplements and add theanine and glycine thirty minutes before bedtime: 100 to 200 mg of L-theanine, and 1 to 2 grams of glycine.

#6: If sleep problems persist, talk to your doctor about using clonidine, a sleep medication FDA approved for ADHD. Resume magnesium.

#7: After a few months, when sleeping problems are under control, discontinue clonidine and continue with magnesium.

#8: Implement one or more of the six “sleep hygiene” suggestions detailed on this page.

#9: Determine if your child has a sleep disorder like snoring or sleep apnea—and if you suspect she does, work with your doctor and/or a sleep specialist to diagnose and treat it.

#10: If you suspect your child’s ADHD medication is causing sleep problems, follow the suggestions on this page.

#11: Encourage your child to exercise regularly, emphasizing activities your child enjoys.

#12: Limit “screen time” on devices such as video games, tablets, computers, and cell phones to no more than two hours daily.

I’ve treated thousands of kids, but I’ve never forgotten Joseph, a fourteen-year-old boy with severe ADHD. Joseph could hardly stay in his seat in class or focus on a task. And he was impulsive, frequently losing his temper and shouting at his parents, his sister Sarah, and his friends.

But in spite of the severity of his symptoms—in spite of seemingly being unable to sit still—Joseph loved to fish. He would take a rowboat out on a nearby pond and fish for hours. Sit for hours.

I couldn’t account for it, of course. But every ADHD child is unique, and that was certainly true of Joseph. “Why do you go fishing?” I asked him.

“I just really like being there,” he replied. “I like rowing around. I like being rocked by the water. I like sitting in the sun by myself, not bothering anyone. I like feeling the breeze. And I love it when I feel that sudden tug and start to reel in a fish.”

Joseph widened my horizons, helping me understand that a hyperactive, inattentive, impulsive, aggressive, and angry child could find a way to be mindful, quietly attentive to the here and now. In the twenty years since I treated Joseph, mindfulness—paying attention to the present, openly, curiously, and without judgment—has become a household word, and scientists study it intensively. In fact, researchers have found that mindfulness can be a treatment for ADHD, rewiring neurology and activating sluggish areas of the brain.

Joseph was doing much better in his late teens, when I stopped seeing him. He had benefited from many of the treatments in the Plus-Minus Plan—and from the treatment he intuitively developed on his own, before I ever thought to recommend it.

What Is Mindfulness?

Mindfulness is based on Vipassana, a meditation technique from Buddhism. Its two main principles are simple:

1. Be attentive to the present moment—now, and now, and now.

2. Be open, accepting, and curious about the present moment, no matter what is happening, within or without.

“Paying attention to something, in a particular way, on purpose, in the present moment, non-judgmentally,”¹ is the way mindfulness was summed up by Jon Kabat-Zinn, Ph.D., one of the founders of modern-day mindfulness who started the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School.

For an adolescent with ADHD, mindfully “paying attention to something in a particular way” can take many forms, including mindfulness during daily activity and mindfulness meditation.

And, after a few weeks, this type of “mindfulness training” can produce what psychologists call a new “trait” or “skill”—your adolescent can be mindful not only when she is specifically practicing mindfulness but throughout the day. And being more mindful means being more attentive, less impulsive, better organized, and better able to think clearly and plan. Most important, it teaches self-acceptance, which is a crucial trait for the emotional well-being of an adolescent with ADHD, who is often mired in a negative self-image.

The many benefits of mindfulness training (also called mindfulness-based stress reduction) have led researchers to conduct hundreds of scientific studies on mindfulness, testing its power to help with dozens of physical, mental, and emotional problems. These problems include: ADHD, aggression (verbal and physical), anxiety, bipolar disorder, burnout, cancer, depression, diabetes, eating disorders, fatigue, insomnia, lung disease, memory loss, multiple sclerosis, pain, PTSD, skin problems, smoking, stress, and substance abuse.

Scientific Support for…The Attention-Improving Power of Mindfulness Training

To give you more confidence in using mindfulness training with your child, let’s take a look at a few of the dozens of scientific studies showing that mindfulness training can help with the symptoms of ADHD.

“An effective approach” for adolescents and their parents. Researchers in Holland conducted a study on 10 ADHD adolescents (5 boys and 5 girls) and their parents.

The adolescents were taught several mindfulness techniques, and also how to “apply mindfulness in difficult and stressful situations, like having conflicts with a parent, teacher or peer” and “when doing their homework for school,” wrote the researchers in the Journal of Child and Family Studies.

The parents were taught “to (1) be deliberately and fully present in the here and now with their adolescent child in a non-judgmental way; (2) take care of themselves, as an important basis for parenting; (3) accept difficulties of their adolescent; and (4) respond rather than react to difficult behavior of the adolescent child.”

The results: After two months of mindfulness training, “adolescents’ attention and behavior problems reduced, while their executive functioning improved,” wrote the researchers.

A quick aside about “executive function,” which many experts use in many different ways. For this study, it was defined as the ability to: resist impulses and control behavior; move freely from one situation or activity to another; control emotional responses, without outbursts, frequent mood changes, or excessive upset; begin a task and generate ideas and solve problems; hold information in mind to complete a task, or generate plans and goals (working memory); manage tasks by planning and organizing; maintain order, organizing materials at school and play, and managing storage spaces like backpacks, desks, and bedrooms; and evaluate personal performance and reach a goal.

The adolescents also took computer-based attention tests—and “improvements in…actual performance on attention tests were found after mindfulness training.”

But the benefits of mindfulness weren’t limited to the kids in the study. Many of the parents had “reduced parenting stress” and “reduced overactive parenting,” the researchers reported.

“Mindfulness training for adolescents with ADHD (and their parents) is an effective approach,” concluded the researchers.²

The many benefits of mindfulness training. In a study conducted at the UCLA Mindful Awareness Research Center, people with ADHD—7 high school students and 25 adults—took a two-month mindfulness training course: Mindful Awareness Practices for ADHD.³

“The primary practice” of mindfulness, wrote the researchers in the Journal of Attention Disorders, “involves three steps: (a) bringing attention to an ‘attentional anchor’ (usually a sensory input like breath), (b) noting that distraction occurs and letting go of the distraction, and (c) refocusing or reorienting attention back to the ‘attentional anchor.’ ”

The participants in the study were trained in mindfulness practices that included using mindfulness during daily activities, sitting or walking mindfulness meditation, and a “loving-kindness meditation” at the end of each training session to address the low self-esteem common in ADHD. After two months of training, they experienced many benefits, including:

• More focus in the midst of interruptions and distractions

• Increased ability to shift attention from one task to another

• Less hyperactivity

• Less impulsiveness

• Less anxiety

• Less depression

• Less perceived stress (the feeling you can’t cope with a demand)

• More mindfulness

Not surprisingly, 90% of the participants had a “high measure” of satisfaction with mindfulness training, according to the researchers.

Parents should meditate, too. That’s the opinion of Canadian researchers who looked at several studies on mindfulness and ADHD. “Mindfulness training should be incorporated into current treatment guidelines as an option for families with ADHD,” they concluded.⁴ (Emphasis mine.)

Those studies were on adolescents. But mindfulness can work in ADHD kids younger than 13, too.

Fewer symptoms for kids, less stress for parents. In one study, ADHD children ages 8 to 12 and their parents participated in mindfulness training.⁵ After eight weeks, there was “significant reduction of inattention and hyperactivity” and a “significant reduction of parental stress and overreactivity,” reported the researchers. The kids also were better able to stay on task.

Math scores improve by 88%. In a recent study, 4 fifth-graders with ADHD—all on either Adderall or Strattera—were trained in mindfulness meditation, starting with 10 minutes a day, and gradually increasing to about 15 minutes.⁶

“They were taught to focus on their breathing,” explained the researchers in the journal Mindfulness. “They learned to count an inhalation and exhalation as one breath until they reached 10 breaths, before restarting the counting cycle. When they realized their minds had wandered away from their breathing and counting, they were taught to gently bring their minds back and refocus on their breathing and restart the counting process. They were taught to simply observe their discursive thoughts and emotions, without engaging them or trying to suppress them. That is, they were required to focus their awareness on whatever took place in their mind without judgment or engagement.”

After eight weeks, the students were instructed to use the skills developed during meditation to “bring their minds back to their lessons during class.”

The results: Their daily “active engagement in math instruction” increased dramatically: 70% more engagement for Andy; 32% more for Barry; 58% for Maurice; and 48% for Robyn. (Not their real names.)

And the boys were better at math, too. Their test scores improved, respectively, by 88%, 64%, 82%, and 71%. Robyn, for example, solved only 18% of his math problems before practicing meditation; after two months of meditation, he solved 63%.

“Self-regulation of attention is one of the key aspects of mindfulness and appears to have…validity as an intervention that may likely assist students to better control their inattentiveness in the classroom,” concluded the researchers, from Brown University, the Medical College of Georgia, and other institutions.

And the researchers were quick to point out that any type of mindfulness practice—not just the one they taught—will work.

10 studies show: Mindfulness works for ADHD. That positive assessment of the power of any type of mindfulness training was reaffirmed by a recent study in the Journal of Attention Disorders, which analyzed data from 10 studies on mindfulness-based therapies for ADHD.⁷ Overall, attention improved by 66%, and hyperactivity and impulsivity decreased by 53%.

Can Mindfulness Really Work for My ADHD Child?

I’ve talked to many parents who have worked with their ADHD children to learn and use mindfulness techniques—and most of those parents have answered that question in the affirmative. After practicing mindfulness, their kids are better able to focus, more able to start and complete tasks, and feel more positive about themselves.

That was certainly the case with Tyler (not his real name), who was diagnosed with combined-type ADHD (inattentiveness and hyperactivity) when he was 10—and who took the Mindful Awareness Practices for ADHD training when he was 16.

Lydia Zylowska, M.D.—an integrative psychiatrist in Los Gatos, California, cofounder of the UCLA Mindful Awareness Research Center, and the author of The Mindfulness Prescription for Adult ADHD—tells Tyler’s story in a chapter on ADHD in the book Clinical Handbook of Mindfulness.⁸

Tyler, she writes, “had been taking stimulants such as amphetamine [Adderall] or methylphenidate [Ritalin] since the diagnosis, which he reported as helpful for paying attention in school and doing his homework. However, even when taking his medications, he still endured having periods of inattention and restlessness, and frequently needed to get up out of his seat. He also described ‘freaking out’ when he forgot to take his medication because he couldn’t seem to focus at all, and felt especially irritable and moody as a side effect of discontinuing the medication.

“During the Mindful Awareness Practices training sessions, he found himself needing to get up even during 5-minute meditations, but learned to use walking meditation as a way to continue the formal practice for the required duration.

“He attended most Mindful Awareness Practices for ADHD sessions, and reported that while his formal practice at home was irregular (5–10 minutes, twice per week), he had been frequently applying mindful awareness throughout his day.

“He gave examples of being mindful of his body moving during a soccer practice, and being more aware of his emotions and thoughts during an argument with his friend. He was noticing his hypercritical thoughts more readily, and found that, without berating himself, he was more motivated to ‘try again.’ He kept a Post-it note at his computer, reminding him to ‘breathe,’ and used a cell phone reminder at lunchtime to ‘eat more mindfully.’

“Overall, he felt more empowered to be able ‘to do something for my ADHD.’ He found that it was easier to regulate his mood and his attention when he forgot his medication. He stated: ‘Whenever I get distracted…I can put myself back in the thing…whenever I can feel my mind wandering, I am able to realize that it’s wandering and let go of the feeling.’ ”

The Inner Mechanics of Mindfulness

How does mindfulness help Joseph, Tyler, and many other teens handle their ADHD? In three ways…

Improving Attention

In mindfulness meditation, for example, the meditator focuses on the breath, returning to it whenever he becomes distracted. Attentiveness is learned. And inattentiveness is unlearned.

“Mindfulness could lead to more automatic disruptions of periods of ‘daydreaming’ or ‘spacing out’ or ‘being caught in thinking,’ ” wrote researchers from the UCLA Mindful Awareness Research Center in a scientific paper titled “Mindful Awareness and ADHD” (included as a chapter in the Clinical Handbook of Mindfulness).⁹

But mindfulness doesn’t only improve attention. It also strengthens the brain.

Normalizing the Brain

Studies show that mindfulness training energizes the parts of the brain responsible for attention, impulsivity, and executive function.

As one study on mindfulness and ADHD put it: “Neuroimaging studies suggest that mindfulness meditation engenders…changes in brain areas associated with attentional functioning typically impaired in ADHD.”¹⁰

One of those areas is the default mode network, a group of interacting brain areas that have subpar functioning in ADHD—functioning that is normalized by ADHD medications. Mindfulness meditation may work in ADHD by improving “connectivity” in this network, wrote the researchers in the journal Cognitive and Behavioral Practice.¹¹

Calming Emotions

Mindfulness training also helps ADHD symptoms by calming emotions, say those researchers. In mindfulness, the meditator observes and accepts “emotional states,” seeing them as “temporary and passing phenomenon that can be responded to in a nonreactive manner.” In that way, mindfulness “helps patients” with ADHD “resist impulsive urges to act out on emotions.”

Mindfulness Isn’t the Only Type of Meditation That Works for ADHD

Although most studies on meditation and ADHD have looked at mindfulness meditation, a few other types of meditation have worked to ease ADHD symptoms.

Mantra meditation. In this technique, the object of meditation is a mantra, a word that is thought repeatedly. In the most popular form of mantra meditation—transcendental meditation, or TM—a meaningless word like eng or shirim (two official TM mantras) is thought recurrently, without trying to concentrate on it. As with mindfulness meditation, when the mind wanders you simply, easily, and without concern bring it back to the mantra.

In a study on TM and ADHD, 10 kids with ADHD, ages 11 to 14, practiced the technique in two daily sessions of 10 to 15 minutes each.¹² After three months, ADHD symptoms were reduced, executive function was improved, and anxiety was eased.

Yoga. Some types of yoga use deep breathing exercises and concentration meditation (concentrating on a specific thought, like the word Om). In one study, ADHD children ages 6 to 11 participated for one year in a program involving yogic deep breathing and concentration meditation.¹³ They had “remarkable improvements in…school performances that were sustained throughout the year,” reported the researchers in the journal ISRN Pediatrics.

Mindfulness Training for ADHD Kids

Mindfulness is the new ABCs: Attention, Balance, and Compassion. That’s the opinion of Susan Kaiser Greenland, author of The Mindful Child, whose “Inner Kids” program has been studied at the Mindful Awareness Center at UCLA.

“By practicing mindfulness,” she writes, “kids learn life skills that help them soothe and calm themselves, bring awareness to their inner and outer experience, and bring a reflective quality to their actions and relationships.”¹⁴

The practices below are adapted from those used by the UCLA Mindful Awareness Program (MAPS for ADHD), as described by Lidia Zylowska, M.D., in her book The Mindfulness Prescription for Adult ADHD.¹⁵ “They can be used with teens and younger kids with ADHD, and by their parents,” Dr. Zylowska told me. Here, the instructions below are addressed directly to “you”—the person following them, whether it’s your ADHD kid or yourself.

The S.T.O.P. Technique

S.T.O.P. is a four-part mindfulness technique that allows you to be more attentive to what’s happening, and to make better decisions. There are four parts:

S = Stop. Stop whatever you’re doing or intending to do.

T = Take a few breaths. The best breath is a deep breath, filling the abdomen, and exhaling completely. Count as you breathe: 1…2…3 on the inhale, feeling the abdomen as it expands. 1…2…3 on the exhale, feeling the abdomen empty and relax.

O = Observe. Observe what’s going on, internally and externally. You might ask yourself:

What am I thinking? What am I feeling? What am I doing? What am I about to do?

Maybe your answer goes something like this:

I’m bored with doing homework, and about to put it aside and play a video game. I’m fuming because my little sister is in my room, and I’m about to scream at her. I’m craving a cigarette, and about to sneak one in the bathroom at school.

Whatever you are thinking, feeling, doing or about to do, accept yourself completely. The attitude is: Nothing that is happening is “bad” or “good”—it’s just things appearing and disappearing, like clouds in the sky.

Finally, you might ask: Does what I’m about to do match where I want my focus?

You might observe that you’re off task from the action you were intending—finishing your homework, being nicer to your little brother, not sneaking a cigarette. And having practiced S.T.O.P., you might find yourself able to get back on task.

P = Proceed. Now you have an opportunity to go in a purposeful direction—to do the action you intended to do.

Mindful Breathing in Daily Life

Mindful breathing is one of the key techniques of mindfulness.

“You can incorporate mindfulness into daily life simply by remembering to notice the breath, even for a few seconds, in the midst of activity,” says Dr. Zylowska. She offers this example:

“As you’re reading, you can simply notice your breath, sensing the rising and falling of your belly as you breathe in and out, and noticing the pause between the in-breath and the out-breath. You can do this for a few breaths and decide to either return to reading or take a break from reading.”

Another good practice, she says, is taking one deep, conscious breath before starting an activity. “Even one breath can make a difference in how focused and aware you feel, and can change the rest of your experience. For example, you can take a deep breath before starting homework, before texting a friend or before answering a question in class.”

Mindful Breathing: Sitting Meditation

Your child can also try a few minutes a day of mindfulness breathing meditation, perhaps starting with five minutes the first week or two, then increasing to ten minutes, and then to fifteen. A basic technique, with instructions for your teen:

Sit or lie in a comfortable position. Keep your eyes closed or open, as you choose.

Move your attention to the process of breathing. Notice the sensations of each breath as it happens, focusing on the rise and fall of your chest or abdomen, or the sensation of the breath at the nostrils. Really feel what it is like to breathe, just observing it as it happens.

As you engage in this exercise, you will find that your mind wanders, to thoughts, or emotions, or bodily sensations, or noises in the room. This is okay. When you notice that this happens, gently bring your attention back to the breath.

At the end of meditation, let your attention move from the breath into the space around you. When you’re ready, bring the exercise to a close.

Mindful Breathing: Walking Meditation

If your ADHD child is too restless to meditate, he can use a mindfulness walking meditation, according to Dr. Zylowska. Here are her instructions, once again addressed directly to the child.

“If restlessness makes it difficult to sit, practice awareness of the breath while walking,” she says. “You can do this practice indoors or out. When doing the walking meditation indoors, you don’t need a lot of space—you can simply find a small area and practice walking in a straight line, then turning and walking back along the same line.

“You should walk slowly with your eyes open and softly focused a short distance in front of you. (You should avoid looking around, as it can be distracting. However, you should keep yourself aware of where you’re going.)

“You should focus on the sensations of the breath as you slowly walk. If you like, you can synchronize your breathing with your footsteps. For example, as you step with your right foot, you can inhale; and when you step with your left foot, you can exhale.”

Body Scan

People with ADHD often have a complicated relationship to their bodies, says Dr. Zylowska. “Frequently it is a relationship of frustration and neglect. Those with hyperactivity can feel aggravated at their restlessness and look for ways to diffuse it. Those with inattention can be frustrated at their lack of energy and sluggishness.”

Mindfulness, she says, can develop a “curious and kind relationship with the body—by exploring mindfulness of physical sensations and movement.” And one of the best ways to do that is with a mindfulness technique called the body scan.

“This mindfulness practice involves listening to the body by sequentially focusing on different regions of the body and noting whatever sensations are present there,” Dr. Zylowska explains. Her instructions are as follows:

Find your position either sitting upright or lying down on your back. Use pillows and blankets to make yourself feel comfortable and supported.

Take a few deep breaths and let your body relax. Close your eyes, or keep them half closed and resting in one spot.

Imagine that your attention is like a flashlight, and you are pointing your attention at each section of the body to illuminate it.

Start by focusing on the top of your head. Can you feel any sensations there? Maybe an itching, vibration, or tightness? Or maybe there’s no sensation at all. Whatever you notice, label it in your mind: for example, “tingling.”

Move your attention to your forehead. Pause to see if there’s any sensation, and label it. Relax any areas of tension.

Repeat the process, moving to your eyes, your cheeks and your nose, your mouth and jaw, your chin, the front of your throat, and the back of your head and neck.

Now move your attention to your right shoulder, your right upper arm, your right elbow, your right lower arm, your right wrist and hand, and all five fingers. Now repeat the process on your left shoulder, arm, and hand.

Now move your attention to your upper back, down your spine, and to your lower back.

Move your attention to the chest.

Move your attention to your belly, your hips on each side of the belly, and your buttocks.

Now move your attention to your right leg, to your thigh, your knee, your calf, your ankle, and to your foot and all five toes. Repeat the process on your left leg, from thigh to feet and toes.

“As you note each body area, you also can imagine that you are ‘breathing into it,’ ” says Dr. Zylowska, “as if you’re providing fresh air to each corner of your body. Imagine that the breath helps each area relax, open up, and release any stress.”

Be Your Child’s “Mindfulness Buddy”

This technique is similar to having an “exercise buddy” who helps you exercise regularly. Once a day, text your child and remind her to do the S.T.O.P. technique. Your child also texts you to remind you to do the same.

Speaking of texting: there are now more than five hundred apps to increase mindfulness, according to a team of Australian researchers who evaluated iPhone mindfulness apps for their effectiveness.

According to the study, published in 2015 in the Journal of Medical Internet Research, the best mindfulness apps are Headspace, Smiling Mind, iMindfulness. and Mindfulness Daily.¹⁶

Loving-Kindness Meditation

I’ll end this chapter with a loving-kindness meditation. Dr. Zylowska and other experts often end their training sessions with this type of meditation. She explains why:

“ADHD causes much emotional pain, shame, despair, and hopelessness. Loving-kindness meditation helps your ADHD child transform those difficult feelings and create a more caring and supportive attitude toward herself.”

The practice is simple; you simply send wishes of well-being to yourself and others. Her instructions:

Settle into a comfortable sitting position. Take a couple of deep breaths and relax your body. First, imagine a person or being in your life that easily evokes feelings of love and warmth—a friend, a pet, a grandparent. Do you feel happiness, a smile on your face, or warmth in your body? That’s loving-kindness.

Now bring an image of yourself to mind, standing in front of you, as if you were looking in a mirror.

Silently wish yourself happiness and well-being. You can use words like, May you be happy, may you be safe, may you be healthy and live with ease. Or come up with your own phrases.

Gently repeat the wishes of well-being several times. As you do, continue to notice how your body feels.

If you notice that you’re not feeling anything, or that you’re feeling something other than loving-kindness, just bring curiosity to that. Notice what’s arising in your thoughts and in your body. You can learn from this experience, no matter what it’s like.

Step-by-Step Action Plan for Healing ADHD

Plus: Mindfulness

Here’s a practical, step-by-step summary of the actions discussed in this chapter:

Step #1: Consider mindfulness practice as a possible treatment for your ADHD child—and for yourself.

Step #2: If you decide the approach is right for your child, introduce him to one or more of the techniques in this chapter:

• The S.T.O.P. technique

• Mindful breathing in daily life

• Mindful breathing: sitting meditation

• Mindful breathing: walking meditation

• Mindful breathing: body scan

• Loving-kindness meditation

Step #3: Be your child’s “mindfulness buddy”—once a day, text her a reminder about being mindful.

Step #4: Consider if a mindfulness app might work well for your child.

There’s a reason I put this chapter in Part II of the book rather than in Part I; a reason I discuss medications after natural treatments, not before.

As an integrative psychiatrist who treats behavioral, mental, and emotional problems with drug and nondrug therapies, I always look for the answer to the following two questions before I prescribe a drug to control the symptoms of ADHD:

1. Is there a neurological, nutritional, genetic, or environmental imbalance causing or contributing to the patient’s symptoms of inattention, hyperactivity, and/or impulsivity?

2. If there is such an imbalance, can I correct it effectively and safely with a natural compound—sparing the child the possible risks of taking a prescription drug?

As a parent using the Plus-Minus Plan to control your child’s symptoms, you’re attempting to answer these questions, too, using all the information you’ve learned from Part I of this book, and perhaps enlisting your doctor’s help as well. Questions like…

Does my child have a magnesium deficiency?

Does my child have a lithium deficiency?

Does my child have an imbalance of the minerals zinc and copper?

Does my child have imbalanced bacteria in the gut?

Does my child have an allergy or sensitivity to foods in his diet?

Does my child eat protein throughout the day?

Does my child have difficulty falling asleep or staying asleep?

If you’ve answered some or all of those questions, and used natural treatments to control symptoms effectively, good for you! Because of your care, your child may not need medication to control her symptoms.

But sometimes medication is needed. And as a child psychiatrist—a doctor committed to helping parents create an effective treatment plan to manage ADHD symptoms, allowing children to achieve their full potential for happiness, competency, and health—I don’t hesitate to write a prescription for an ADHD drug.

Studies show that ADHD medications can provide real and immediate help, reducing symptoms in seven out of ten children who take them.

I’ve certainly seen them benefit some of my patients. In fact, sometimes taking a medication has made the difference between a child who happily thrives and a child who struggles and suffers; between a child who can live up to his full potential and a child who can’t.

Like Paul, a thirteen-year-old who was hyperactive, impulsive, aggressive, and reckless—who was getting into fights and failing in school, and who couldn’t have a conversation with his parents without yelling at them. Paul didn’t have any glaring deficiencies or imbalances. It was only medication that made a difference for him. And what a difference. He calmed down. He focused. He started doing well in school. His life turned around—and now he’s in college, studying hard and thinking about his future. Paul is one of the reasons why I haven’t given up my prescription pad.

Paul’s parents knew how much trouble their son was in, and they were willing to have him take a medication that might help him. But when I suggest to parents that a medication might be right for their child, I sometimes hear objections like this:

“My child will end up addicted.”

“This medication will destroy his brain.”

“My child will be on medications forever.”

“This medication will change my child’s personality and turn him into a zombie.”

“She never learned how to pay attention on her own—this medication won’t help.”

“My child will end up abusing drugs.”

“My child is just lazy—he doesn’t need meds, he needs to try harder.”

“I’ve read about the side effects—poor appetite, facial tics, sleeping problems, stunted growth—and I’m very worried about them.”

Aside from the criticisms (which I address in the next chapter, about respect and positive feedback), these are valid fears and concerns. Concerns I’d like to immediately allay.

After treating thousands of ADHD children, I have developed an approach to ADHD medications that maximizes their effectiveness and virtually eliminates their side effects.

Yes, you heard me right. My approach can prevent side effects when a child starts taking an ADHD drug and can eliminate side effects in a child who is already taking an ADHD drug. And because that statement probably came as somewhat of a shock, I’m going to repeat it once again:

I can give the parents of my patients this virtually foolproof guarantee: Your child won’t suffer from side effects when taking an ADHD drug.

Here are the reasons I can make that guarantee.

First, I’ve found that many children suffer side effects from dopamine-boosting ADHD medications because there’s already too much dopamine in the brain. This neurological problem is often caused by either a zinc/copper imbalance or high levels of HPHPA, a bacteria by-product in the gut. Or maybe the child has a magnesium deficiency, which allows the ADHD drug to play havoc with her appetite, sleep, and nerves. Clearing up problems like these first—which I show you how to do in the Plus-Minus Plan—frequently prevents side effects when a medication is started.

Second, I start my patients on a low dose of medication. I increase the dose at two and four weeks, keeping an eye out for side effects and effectiveness. This approach is different from that used by many doctors, who prescribe a medication and dose they’re familiar with and that has worked in other children. The result: Many children are either overmedicated (causing side effects) or undermedicated (with poor results), and parents quickly stop the drug because it’s causing health problems and isn’t working.

Third, I test every ADHD child for specific genetic mutations that affect drug metabolism. These mutations can cause a child to metabolize dopamine too slowly or too quickly.

Although their exact mechanism of action isn’t known, the theory is that ADHD drugs work by increasing the activity of dopamine and norepinephrine, neurotransmitters that send signals from neuron to neuron. Children with these genetic mutations are far more likely to have levels of dopamine that are too high (resulting in side effects) or too low (resulting in poor symptom relief). I’ll tell you more about this test later in the chapter.

If you think ADHD medications are overused, I’m with you. Too many kids get a prescription for a medication when what they really need is a neurological, biochemical, and genetic evaluation, followed by natural treatments to address the deficiencies and imbalances that are causing their symptoms.

If you think ADHD medications are the enemy, I respectfully disagree. In my view, medications are just one among many treatments that might help relieve the symptoms of a suffering ADHD child; used only when absolutely necessary, a medication might do a kid a lot of good.

One last but very important point: If your child has already taken a medication with less-than-positive results—it caused side effects, or it didn’t work, or both—you and your doctor can use these same guidelines to safely and effectively reintroduce medication.

Is ADHD medication right for your ADHD child’s health and well-being? Let’s find out.

ADHD Meds, Yesterday and Today

The story of ADHD drugs starts in 1937, at the Emma Pendleton Bradley Home in Rhode Island. (Today it’s the Bradley Hospital, a teaching hospital of the medical school at Brown University.) It was one of the first institutions in America to treat children with neurological and behavioral disorders—children who were, in the words of one historical report, “inattentive, restless, rambunctious, and selfish.”¹ And its medical director was Charles Bradley, a psychiatrist whose great-uncle founded the institution after his seven-year-old daughter was struck by encephalitis, leaving her with mental retardation, cerebral palsy, and epilepsy.

Dr. Bradley subjected many of his patients to pneumoencephalograms, an early form of testing for brain abnormalities—and the test gave them severe headaches. To try to relieve the problem, he prescribed Benzedrine, an amphetamine that had recently been marketed by the drug company Smith, Kline & French. The drug didn’t help the headaches. But it made a remarkable difference in the children’s behavior.

“The most striking change in behavior occurred in the school activities of many of these patients,” Bradley wrote in the American Journal of Psychiatry. “There appeared a definite ‘drive’ to accomplish as much as possible.”²

But—as with today’s ADHD drugs—many of the children didn’t become more active. They settled down. “Fifteen of the 30 children responded to Benzedrine by becoming distinctly subdued in their emotional responses,” Bradley wrote. “Clinically in all cases, this was an improvement from the social viewpoint.”³

Bradley conducted two scientific studies on Benzedrine, mostly involving boys aged 5 to 14. He noted that patients “began to spend their leisure time playing quietly or reading, whereas formerly they had wandered aimlessly about antagonizing and annoying others.” He found children on Benzedrine “more self-sufficient and mature,” more “helpful,” with more “conscious control over their activities.”⁴

But Benzedrine didn’t catch on as a treatment for children with behavioral problems. Instead, Smith, Kline & French marketed it primarily as a way to boost mental performance in healthy students—an approach stopped a few years later after reports that students were abusing the drug and patients were becoming addicted to it.⁵

The Rise of Ritalin

Exit Benzedrine, enter Ritalin.

Ritalin—a so-called pep pill stronger than caffeine but weaker than Benzedrine—was first marketed by the pharmaceutical company Ciba (now Novartis) in the mid-’50s. The FDA quickly approved its use for “minimal brain dysfunction,” an early name for the symptoms that are now collectively called ADHD.

In 1964, the first scientific study was conducted on Ritalin and children with behavioral problems, showing the drug reduced impulsivity.

In 1968, “Hyperkinetic Reaction of Childhood” was officially acknowledged as a disorder in the DSM, the Diagnostic and Statistical Manual of Mental Disorders, the publication health professionals use to uniformly define mental health problems. Doctors used Ritalin to treat it.

In 1980, stimulant medications became an official treatment, when the American Academy of Pediatrics published a statement asserting that “there is a place for stimulant drugs in the treatment of hyperkinetic children.” That same year, the name “hyperkinetic impulse disorder” was changed to “attention deficit disorder” in the latest edition of the DSM.

$12 Billion Yearly for ADHD Meds

Over the next three decades, more and more ADHD children took amphetamines and stimulants. Today, nearly five million American children, adolescents, and adults take the drugs, at a yearly cost of more than $12 billion. In fact, yearly spending on ADHD drugs is rising faster than that on any other well-established class of drugs, increasing a remarkable 25% from 2014 to 2015.⁶

Not surprisingly, the rise in the use of ADHD drugs has matched the rise in the diagnosis of ADHD among children 4 to 17: 7.8% in 2003; 9.5% in 2007; and 11% in 2011.⁷

Adults, of course, take plenty of ADHD medications, too: people 19 and older take 44% of ADHD drugs, and the prescriptions for ADHD drugs for adults increased more than 50% from 2008 to 2012.⁸

Why do so many people take these medications? Because they often work, reducing symptoms and improving lives.

For example, a recent scientific review of more than 23 studies on amphetamines for ADHD, involving nearly 3,000 children, showed that the drugs helped reduce inattention, hyperactivity, and impulsivity, according to parents, teachers, and doctors.⁹

Let’s take a closer look at the most-prescribed ADHD drugs.

Meet the Medications

There are three main classes of ADHD medications, accounting for 80% of all prescriptions:

Amphetamine drugs (amphetamine, dextroamphetamine, lisdexamfetamine), which include Adderall, Adzenys, Dexedrine, Dyanavel, Evekeo, and Vyvanse.

Methylphenidate drugs, which include Aptensio, Concerta, Daytrana, Focalin, Metadate, Methylin, Quillivant, and Ritalin.

Nonstimulant drugs (atomoxetine), which include clonidine, Strattera, and Tenex.

Some of these drugs are short-acting, lasting three to six hours. Some are intermediate-acting, lasting six hours. Some are long-acting or extended release, lasting six to twelve hours. Some of the newer, nonstimulant medications last twenty-four hours.

But there are two problems with all these drugs. They don’t always work. And they often cause side effects.

Effective and Safe? Sometimes.

ADHD drugs are far from foolproof.

For example, researchers talked to 290 “primary caregivers” (mostly parents) about whether or not their child’s ADHD medication was working.¹⁰ Of those, 280 said there was at least one period during the day when their child’s symptoms weren’t “adequately controlled”—usually during the “early morning routine” before school, and “evening homework time.”

Three out of five parents also said their child’s symptoms were “moderate to severe” throughout the day, in spite of the drug.

Overall, more than half of the parents weren’t completely satisfied with the treatment: 39% were “somewhat satisfied,” 11% were “not very satisfied,” and 3% were “not at all satisfied.”

Children Suffer from Side Effects

There’s another “not very satisfying” feature of ADHD drugs. Side effects. Studies show that 60% to 80% of children who take ADHD drugs suffer from “mild to moderate” side effects. They include:

• Appetite problems (decreased appetite or loss of appetite)

• Sleeping problems like difficulty falling asleep and waking up throughout the night

• Digestive issues like stomach pain, constipation, diarrhea, nausea, and vomiting

• Neurological problems like headaches, dizziness, drowsiness, and tics

• Emotional problems like irritability and anxiety

• Other ills, like allergic reactions, dry mouth, hair loss, overheated skin, muscle aches, and weight loss

There are also side effects most studies don’t quantify, like a loss of childhood joy. As many parents have told me: “The medication is working, but he’s not the same kid anymore.”

And there are rare but severe side effects. Strattera, for example, includes a “black box” warning on the label, telling doctors and parents that 4 out of 1,000 children on the drug develop suicidal thoughts.

Additionally, there are serious, long-term side effects from drugs now being used “off-label” for ADHD, like antipsychotics; they include diabetes and tardive dyskinesia (irreversible facial tics).

Sometimes a side effect from an ADHD drug is so severe that a person has to go to the ER. Between 2005 and 2010, the “number of emergency department visits involving ADHD stimulant medications” more than doubled, increasing from 13,379 to 31,244, according to the Drug Abuse Warning Network.¹¹ (The majority of those visits involved people 18 and older.)

Side Effects in Preschoolers

One-third of ADHD children are diagnosed before the age of 6, and 30% of those children are prescribed ADHD drugs.¹² Those kids experience their share of side effects, too, like loss of appetite, sleep problems, stomach pain, emotional outbursts, repetitive behaviors and thoughts, sluggishness, and social withdrawal.

The drugs can even stunt growth. Among children 3 to 5, kids taking ADHD drugs have 20% lower growth rates for height (0.6 fewer inches per year) and 55% lower growth rates for weight (2.9 fewer pounds per year).¹³

Stunted growth isn’t only a problem among preschoolers. A recent study in the Journal of Pediatric Orthopedics looked at bone mineral density (BMD) in more than 5,000 children ages 8 to 17.¹⁴ On average, kids on an ADHD drug had lower BMD in the femur (thighbone), the femoral neck (where the thighbone connects to the hip bone), and the lumbar spine (lower back).

Abusing ADHD Drugs

There’s another problem with ADHD amphetamines and stimulants among the 18-and-over age group, particularly among college students: substance abuse. A study in the journal Addictive Behavior estimated that 4% to 11% of college students misuse prescription stimulants—to concentrate better during studying, to study longer, to complete assignments, to lose weight, and just to “get high.”¹⁵ Focusing on nearly 700 students at one university, the researchers found 95 had misused ADHD stimulants in the past year—19 from their own prescription, 73 from someone else’s medication (usually a friend’s), and 1 from both.

Bottom line. As I said at the beginning of the chapter, I am not against ADHD medication. Because the problem is not the medicines themselves.

The problem is that conventional doctors don’t use an integrative approach. For many doctors, medication is the treatment. But medication should be one among many possible treatments—with the treatment individualized for the patient’s unique neurological, nutritional, genetic, and behavioral profile. Used in this way, an ADHD drug can be a truly safe and effective treatment.

Rhodiola rosea: The Herb That Can Work as Well as an ADHD Drug

When parents with an inattentive-type ADHD child want to try a nondrug treatment before a drug, I sometimes prescribe the herb Rhodiola rosea, with great success.

A hardy plant from Siberia and other arctic regions, Rhodiola stops the breakdown of dopamine and norepinephrine, improving attention.

I start with a dose of 100 mg, once a day, with breakfast.

If that dose hasn’t worked in two weeks, I increase it to 200 mg: 100 mg with breakfast and 100 mg with dinner. If 200 mg hasn’t worked in two weeks, I increase the dose to 300 mg: 100 mg with breakfast, lunch, and dinner. Typically, Rhodiola takes one to two months to work, so try to be patient while waiting for positive results. If the herb hasn’t worked in two months, discontinue it.

However, parents sometimes don’t notice positive results—but the ADHD child does. Like eleven-year-old Ethan.

After two months, Ethan’s parents told me the herb wasn’t working—they hadn’t noticed any change in their son’s behavior. But when I talked to Ethan one-on-one, he told me that since he’d been taking “those pills” it was easier for him to pay attention in class, and that it took him less time to get his homework done.

The moral of this particular story: Before you decide a treatment isn’t working, ask your child if he or she has noticed a difference.

Rhodiola is very safe, but there are a few precautions. If your child has been diagnosed with bipolar disorder, Rhodiola isn’t for him; it might make mania worse. And be aware that Rhodiola might increase energy in an already energetic child.

As for buying Rhodiola: Buyer beware! Testing shows that many herbal products don’t contain the amount of herb promised on the label. It’s always best to do some personal research and find a reputable supplement company, perhaps subscribing to a service like consumerlab.com, which publishes reviews of nutritional and herbal supplements, or checking customer reviews in a supplement category you’re investigating. For my information on high-quality suppliers, please see the Appendix at the end of the book.

For reliable sources of Rhodiola, Richard Brown, M.D., and Patricia Gerbarg, M.D., the authors of the Rhodiola Revolution, list Rosavin, the 100 mg Rhodiola supplement from Ameriden International, as a reliable product.¹⁶ I’ll end this sidebar with a wonderful case history from their book:

“Alice’s mother brought her to see Dick [Dr. Brown] when she was 14 years old. She had already been diagnosed with ADHD and anxiety—and it was easy to see why. She was so scattered and impulsive that she immediately went to the small bubbling fountain in the office and thrust her hands into the water. During the session, she couldn’t sit down. She was up and down, pacing the room. Not surprisingly, Alice was having difficulty doing her schoolwork and relating to her peers.

“Dick suggested that Alice try taking 300 milligrams a day of Rhodiola rosea. Her schoolwork and organization skills rapidly improved. She made friends and took up running. A few years later, she went on to college, where she continued to do well.”

Prescribing and Monitoring ADHD Medications—My Therapeutic Dos and Don’ts

Each ADHD patient is a unique individual—a person with a unique brain, unique genes, unique biochemistry, and unique behaviors at home, at school, and with friends; a person who requires an individualized treatment plan to control symptoms.

For my patients, that individualized treatment plan starts with tests to detect neurological, genetic, nutritional, and metabolic imbalances. If imbalances are found, I treat them—a process that helps prevent side effects if a drug is subsequently prescribed. And if a drug is prescribed, I start with the lowest possible dose, increasing it gradually—another way to prevent side effects.

Here are my medications dos and don’ts.

DO Start Magnesium—Immediately

As I pointed out in Chapter 1, nine out of ten children with ADHD are deficient in magnesium, a mineral that supports nearly every system and organ in the body, including nerves and muscles.

A low level of magnesium is a setup for ADHD symptoms, like restlessness, lack of focus, and sleep problems. A low level of magnesium also makes your child more susceptible to side effects from ADHD medication, like agitation, sleep problems, headaches, and facial tics.

That’s why I prescribe magnesium for every patient with ADHD, whether they’re on a drug or not. In fact, I strongly recommend you supplement your child’s diet with magnesium for at least thirty days before starting a medication. You may find her symptoms come under control. And even if they don’t, the magnesium will boost the effectiveness of the ADHD drug and help shield her from side effects.

DO Test for Nutritional and Biochemical Imbalances

At the beginning of this chapter I recapped the nutritional deficiencies and biochemical imbalances that are rampant in children who suffer side effects from ADHD medication. Some of these imbalances cause dopamine excess. And when the child takes a dopamine-boosting medication, his brain is flooded with dopamine, causing side effects like agitation, sleep problems, irritability, and aggression. The specific deficiencies and imbalances that tend to cause side effects are:

• Magnesium deficiency (Chapter 1)

• OPC deficiency (Chapter 2)

• Lithium deficiency (Chapter 3)

• Zinc/copper imbalance (Chapter 4)

• HPHPA, a metabolic by-product of an overgrowth in the gut of the Clostridia difficile bacteria (Chapter 5)

• Food allergies or sensitivities (Chapter 6), common in children ten and younger.

Tests that can detect these deficiencies and imbalances are available from Great Plains Laboratory and many other labs. Unfortunately, they’re not covered by insurance.

A hair test for minerals can detect magnesium and lithium deficiency; the cost is around $60.

The Microbial Organic Acids Test can detect HPHPA excess; the cost is around $200.

The IgG Food Allergy Test can detect food allergies; the cost is around $200.

The Gluten/Casein Peptide Test can detect food sensitivity to dairy and/or gluten; the cost is around $100.

If it’s financially possible, I strongly urge you to have your child tested for these deficiencies and imbalances before she starts medication.

If testing is too expensive, I recommend you supplement your child’s diet with magnesium, lithium, zinc, and high-dose probiotics, using the guidelines in the Plus-Minus Plan.

If your child is ten or younger, I recommend you try eliminating dairy—the most common food allergy and sensitivity and a frequent cause of ADHD symptoms—to see if symptoms are reduced. Again, refer back to the Plus-Minus Plan for more details.

DO Use Genetic Testing to Help Determine the Right Medication and Dose for Your Child

I order a genetic test for every patient with ADHD. (Good news: It’s often covered by insurance.) This simple test, requiring nothing more than a swab of saliva from the inside of the cheek, tells me a lot about what kind and dose of medication is most likely to work best.

If the child has a Val/Val genetic variant (mutation) in the COMT gene (which helps regulate the neurotransmitters dopamine and norepinephrine), he probably breaks down dopamine too quickly—and may need a higher dose of medication to control symptoms. Also, research shows that a child with Val/Val may respond best to methylphenidate drugs.

If the child has a Met/Met variant in the COMT gene, she probably breaks down dopamine too slowly—and it’s best to start her on a low dose of a long-acting stimulant, gradually increasing the dose after two and four weeks of use.

If you’re considering medication for your child, talk to your doctor about ordering this genetic test. I consider it a must for making an effective treatment decision. In fact, a study shows that children with ADHD who had genetic testing before being prescribed a drug were far more likely to be “compliant”—to take the drug regularly—than children who didn’t get tested. The likely reason for compliance: The medication worked and didn’t cause burdensome side effects.

DON’T Think There’s No “Going Back” Once Your Child Starts Medication

Many parents experience a lot of anxiety when they’re making a decision about whether their child should or shouldn’t take a drug for ADHD. They tend to think that once their child starts medication, he’ll never be able to stop. I reassure them that the decision is not a lifetime commitment for their child—it’s a short-term trial. We’ll see if the medication works, with clearly defined goals for behavioral change. We’ll watch for any side effects and strategize to minimize them. And in six months to a year, we can reevaluate the decision. You can take this same approach with your doctor.

DON’T Give Medications to a Child Age Six or Younger

Medications are effective for many children, adolescents, and adults with ADHD. But in my clinical experience, they’re rarely necessary for children six and younger. My advice: Before you decide to medicate your young child, try other options in the Plus-Minus Plan—which control symptoms in nine out of ten children age six and younger.

The two most important options: supplementing the diet with magnesium; and testing for and correcting food sensitivity and allergy, which are common in children six and younger, and often the main cause of symptoms.

DON’T Match Dose to Weight or Height

Many doctors match dose to a child’s height or weight. I haven’t found that approach helpful. For example, sometimes a child under twelve needs a higher dose than an adolescent.

The only way to determine the most effective dose of medication for your child is to: start with the lowest dose possible; increase the dose every two weeks for one month; and monitor symptoms to determine if the drug is working.

DO Start with a Low Dose, and Slowly Increase It Over Two to Four Weeks. (Or Decrease It, If There Are Immediate Side Effects)

A common prescriptive scenario: A physician starts a child on too high a dose of medication, the child has side effects, and the medication is quickly discontinued.

A better scenario: Start your child on a low dose of an ADHD medication.

If, after two weeks, the child doesn’t have any side effects but symptoms aren’t under control, increase the dose.

If, after four weeks, there are no side effects and no response, increase to the standard dose.

DO Consider These Effective Stimulant Medications

I start many children at the lowest effective dose of a long-acting stimulant. My preference is Concerta, at 18 mg daily, or Vyvanse, at 10 mg daily.

Vyvanse comes in a capsule; you can mix the contents in a liquid, making it easier for some kids to take. (Many kids don’t like swallowing pills.) Another advantage to this approach: you can put the contents in eight ounces of liquid—and easily cut the dose in half (four ounces) if the initial dose causes side effects.

DO Consider a Nonstimulant Medication for Hyperactivity and Impulsivity

If your child has hyperactivity-dominant ADHD, consider a nonstimulant medication, like Tenex or Intuniv (guanfacine) or Catapres (clonidine), all of which are FDA approved for use in ADHD. In my experience, the nonstimulant Strattera (atomoxetine) does not have consistent results, so I don’t prescribe it.

Similar to stimulants, I start with the lowest possible dose and increase every two to four weeks.

Tenex is available in a 1 mg pill; I start with 0.5 mg, twice a day.

Intuniv is the long-acting form of Tenex, and doses are available in 1, 2, and 3 mg. I start with the lowest possible dose, increasing every two to four weeks.

Catapres comes in a 0.1 mg pill; I start with ¼ or ½ pill, once or twice a day.

The most common side effect of nonstimulant drugs is drowsiness. On the upside, that makes the drug helpful in ADHD kids who have trouble falling asleep.

For children who are severely hyperactive, impulsive, and aggressive, a combination of stimulants and nonstimulant Intuniv may be the best treatment.

DO Watch Out for These Common Signs of a Too-High Dose

If your child has an increase in heart rate or energy, or becomes irritable or anxious, or says her thoughts are racing—symptoms similar to what you would experience if you downed five expressos—it’s very likely the dose is too high.

DO Switch Medications If There Are Side Effects

If your child has side effects, switch medications immediately—from one class of medications to another (e.g., from an amphetamine like Adderall to a methylphenidate drug like Ritalin), starting the second drug about one week after you stop the first one.

If a child needs medications but has side effects, I always try two to three medications before I give up on medication as a treatment. Unfortunately, there’s no way to predict in advance which drugs will cause side effects in your child—your friend’s child may have had stomachaches and sleeplessness on Adderall, but your child might be just fine.

DO Understand That Some Emotional “Side Effects” Are the Effect of the Medication Wearing Off

Some long-acting medications “act” for six to eight hours—if you give your child the medication at 8 a.m., it may start to wear off around 2 to 4 p.m. A typical result: Your child might be more emotional and sensitive for thirty minutes or so, crying or getting cranky for no apparent reason.

There are a few ways to deal with this very common but little-recognized problem. You can talk to your doctor about switching to a longer-acting medication. You can give a short-acting medication an hour or so before the “withdrawal” period, as long as it doesn’t interfere with your child’s sleep. And you can respect your child, understanding that the withdrawal period probably isn’t the best time to ask him to clean up his room or do other challenging tasks.

DO Individualize Monitoring

To monitor whether or not a medication (or another ADHD treatment) is working, doctors, child psychiatrists, and psychologists frequently use standardized checklists and scales. Some of these tests can be helpful—particularly comparing a computerized Conners’ Continuous Performance Test (CPT) with checklists from parents, teachers, and the ADHD child.

However, all these standard forms have a big drawback: They’re standard, the same for everyone. And all ADHD children are not the same. Just the opposite: Every child with ADHD is unique, with his or her own unique set of symptoms and struggles.

Instead of standardized checklists, I recommend you personalize your checklist, identifying the symptoms that are the most relevant for your child and your family, and tracking those. If you find those symptoms are not being relieved in the first month or so of treatment, you may want to switch your child to another drug or dose.

DON’T Expect Your ADHD Child to “Feel” Better

Your ADHD child shouldn’t feel any different on medication. That’s because ADHD is not a “feeling disorder,” like depression. When using medicine to treat a disorder like depression—a disorder marked by feelings like sadness, hopelessness, guilt, and apathy—questions like “How do you feel today?” or “How have you been feeling on the medication?” make sense. If the patient answers, “I feel less sad” or “I actually felt happy yesterday,” the treatment is working.

But for ADHD, answers to those questions won’t indicate a medication’s therapeutic effect. As I’ve been saying throughout the book, ADHD is a neurological, nutritional, genetic, and environmental disorder that imbalances the brain, producing imbalanced behavior. Improvement from an ADHD medication will not be felt. In fact, if a child with ADHD feels differently after starting a medication, it’s likely she is experiencing a side effect.

Rather, improvement will show itself in improved behavior—in an increased ability to focus and complete tasks, in more success at school, and in better everyday behavior, like less hyperactivity and impulsivity.

And often, depending on your child’s age, those improvements will be obvious to you, his siblings, and his teachers before they’re obvious to him. My patient Johnny is a good example of parents noticing the effect of an ADHD drug before the child did.

When I met with Johnny at his first postprescription appointment and asked him how he was doing, he said, “I’m fine, there’s no change. School is okay. Home is okay.”

But when I met with his parents and asked them how things were going, they said, “Amazing! He completed all of his homework, and his teacher called to tell us how well he’s doing in school.”

DON’T Make Daily, Weekly, or Even Monthly Adjustments of the Dose (If There’s a Problem, Look to Other, Nondrug Treatment Options)

Once you’ve found the best dose and medication for your child, maintain that regimen for six to twelve months. Don’t start adjusting doses for a “bad day” or a “bad week.”

Always go back to your personalized checklist, acknowledging the specific symptoms and behaviors that are the most difficult for your child and your family—and, if those symptoms and behaviors are worsening, look to nondrug solutions.

Perhaps your child needs more academic support, like a tutor.

Perhaps you need to revisit the behavioral management techniques I recommend in the next chapter.

Remember: An effective plan to control the symptoms of ADHD has to be a comprehensive plan, taking into account all the factors that might be contributing to your child’s symptoms.

Final Thought: DO Use Medications If They Can Help

As I said in the beginning of the chapter, many parents fear medication will harm their child or won’t work. But with the guidelines in the chapter, you can be assured that the ADHD medication your child takes will be safe and effective—reducing symptoms, improving everyday functioning, and opening the doors to a happier, more successful life.

Treating ADHD at Any Age

If you’re an adult with ADHD and your disorder isn’t treated, you’re more likely to have all kinds of problems.

Behind the wheel, you’re more likely to speed, have accidents, and lose your license. If you marry, you’re more likely to separate or divorce. And you’re also more likely to be addicted to cigarettes or illegal drugs—which you’re probably using as a way to deal with your symptoms. Or forget them.

But in spite of these and other problems, you may think that taking a medication for ADHD is an admission of “failure,” just one more sign that you’re not “normal.” Please, think again.

I treat many adults with ADHD, and I let every one of them know that they have a medical disorder—and that seeking and getting treatment for ADHD is just the same as seeking and getting treatment for high blood pressure or diabetes. It’s sensible. And it’s a way to be kind to yourself, something that adults with ADHD often find hard to do, having internalized a lifetime of hearing from parents, teachers, and friends that they’re “bad,” “lazy,” “thoughtless,” and the like.

Also, it may be reassuring for you to know that if you decide to take medication for ADHD, you’re hardly alone: Adults are already taking nearly half of all prescribed ADHD medications.

And if you’re a woman with ADHD, you also should know that more ADHD women than ADHD men take medications for the disorder—probably because they’re catching up!

It’s very common for a girl’s ADHD to have been overlooked; after all, a hyperactive, impulsive boy is far more noticeable than an inattentive, withdrawn girl. But that doesn’t mean a girl’s ADHD symptoms go away when she turns eighteen. It just means she’s dealing with them on her own. And she may not be dealing very well.

As an adult, a woman with ADHD might find it next to impossible to meet life’s relentless demands for attention to detail, organization, and planning. She might start every day vowing to “get organized”—and then spend the rest of the day looking for things amid a mess of papers and stuff, catching up, trying to cope…and feeling overwhelmed.

Woman or man, treatment can make a big difference in controlling the symptoms of adult ADHD.

Have you been diagnosed with ADHD but not treated? Do you think you’re an adult with ADHD who has never been diagnosed?

In either case, it may be time to see a health professional who treats adults with ADHD. And bring this book with you. All the treatments discussed in Finally Focused—including medications—can help adults.

As you know quite well if you’ve read the rest of this book, I think the best way to treat ADHD is to find and address the underlying factors that cause or contribute to the disorder.

But there’s a set of causes that aren’t inside your child’s brain and body. Rather, they’re in what medical experts call your child’s environment—his environment at home; his environment at school; any environment in which your child spends a lot of time.

For example, a child with ADHD who is “hyperactive” in a classroom with thirty students and one teacher might be “well behaved” in a special education classroom with twelve students and two teachers—because in the environment of a smaller classroom she has the freedom to express her unique energy, creativity, and passions without those rambunctious qualities being considered a “discipline problem.”

Of all your child’s environments, one of the most important is the home, especially how you and your child interact. Study after study shows that how a parent behaves toward a child with ADHD—the attitudes and strategies the parent brings to bear to control symptoms—is one of the most important factors in how the child behaves.

That’s why the American Academy of Pediatrics recommends “parent- and/or teacher-administered behavior therapy” for ADHD; and, for some age groups, the AAP recommends medication only if behavior therapy doesn’t provide “significant improvement.”¹

That’s also why there are dozens of customized programs for the behavioral treatment of ADHD. And hundreds of books on the subject. (My research assistant counted 492, to be exact!)

This chapter isn’t meant to replace those programs or books. What I’d like to share are a few key behavioral strategies for parents—strategies that my three decades of experience treating ADHD has shown me are those most likely to help you help your child.

Trust the Top Expert on Your Child: You

Yes, you.

Not teachers. Not friends or relatives. Not the doctor. Not even other parents who have a child with ADHD.

You live with your child, day after day.

You live with his emotional ups and downs, his frustrations and failures, his talents and strengths.

You know her unique potential—her energy, passion, curiosity and creativity, qualities that can get buried under the symptoms of distractibility, impulsiveness, and restlessness.

Bottom line. The best strategies for making sure your ADHD kid gets what she needs to thrive are the strategies created by your instincts, intuition, and intelligence; by your natural ability to understand and care for your child. There are as many approaches to behavioral management as there are children, and you should be the one to decide on the best approach for your child.

Never Forget This Essential But Surprising Truth: Your Child Wants to Behave

Since starting to practice as a child psychiatrist in the 1980s I have asked thousands of children on their first visit to my office the same question that I mentioned earlier when talking about my seven-year-old patient Andy:

“If you could change one thing with a magic wish—and it can be anything at all—what would you change?”

Most children wish they could make school disappear…or have a recess that’s eight hours long…or get a dog…or a pony…or take a trip to the moon…or be a sports star…or eat ice cream every day…and on and on.

A lot of different kids, a lot of different wishes.

But most kids with ADHD make the same wish. And it’s not for a daily banana sundae.

Nearly every ADHD kid wishes that his behavior could magically improve or that he’d be able to pay attention better. And he wishes Mom and Dad wouldn’t get so upset at him anymore.

A lot of different kids, the same wish.

Hearing this honest helplessness from so many children with ADHD—hearing again and again how much they don’t want to be “bad”—I’ve come to realize that ADHD kids are looking and asking for help for symptoms that they cannot control.

Hard as it might be to believe, your ADHD child is not deliberately willful or disobedient or scattered or demanding or obnoxious or distracted or manic or aggressive or lazy—some of the many terms that are routinely used to describe the symptoms of ADHD. In fact, you’ve probably used some of these terms yourself when you were at your wit’s end, trying to integrate your child’s behavior into your family life and the lives of those around you—at home, at school, with friends, and when you’re out and about. Times when you just wanted your child to behave.

But ADHD is not a “behavior problem” or a “discipline problem.”

As I’ve said throughout the book and at the beginning of this chapter, ADHD is a neurological, genetic, nutritional, and environmental medical disorder, which imbalances the brain. And if that disorder is left untreated, ADHD can lead to behavior problems.

Bottom line. Your child is not a bad child. You are not a bad parent. Nobody is to blame for ADHD. And therefore assigning blame for your child’s “bad” behavior—and trying to correct it with criticism—is useless. Which leads me to the next strategy…

Minimize Criticism

As I was writing this book, new scientific research was published that proved the soundness of this strategy: the study showed that criticizing your ADHD child is likely to make her symptoms worse, not better.²

The study was funded by the National Institutes of Mental Health, conducted by psychologists from Florida International University in Miami, and published in the Journal of Abnormal Psychology.

For the study, the psychologists recruited 515 families with children 7 to 11 years old—338 children with ADHD, and 127 children without ADHD. For three years, the researchers tracked the trajectory of ADHD symptoms, using questionnaires filled out by parents, teachers, and the children themselves.

Twice during those three years, the psychologists also measured the probable level of criticism being meted out by parents. They did so by conducting a 5-minute, uninterrupted, recorded interview with each parent, asking each to “tell us about your child and your relationship with your child.”

The psychologists analyzed the interview and quantified the level of criticism—of “negativity or resentment directed toward the child.” For example, a comment like “Charlie is a really bad kid; he always gets into trouble” rated a higher level of criticism than a comment like “Charlie sometimes does bad things.” The difference is talking about behavior critically versus talking about the child critically, said Erica Musser, Ph.D., one of the study authors.

The results: Sustained critical parenting—a high level of harsh, negative comments about the child—was linked to ADHD symptoms that didn’t lessen over time.

“The new finding here is that children with ADHD whose families continued to express high levels of criticism over time failed to experience the usual decline in symptoms with age, and instead maintained persistent, high levels of ADHD symptoms,” Dr. Musser said.

Knowing that being overly critical may be sending an ADHD child on a more negative trajectory can help the parents change their behavior, she added.

But how do you stop yourself from being “overly critical”? How do you show your child respect rather than subjecting him to a barrage of negativity? How do you change your behavior to help your child’s behavior? One strategy I’ve used with many parents: Go for a SAIL.

SAIL: A Journey to Understanding and Respect

These four letters are an acronym for a strategy you can use to help yourself stop criticizing your child:

• S: Symptom

• A: ADHD

• I: It’s okay.

• L: Listen

Let’s explore that process letter by letter.

S is for Symptom. Your child may have many behaviors that annoy you: poor impulse control, not being attentive, not listening, clanging the silverware, and so on. I’m sure you could make a fairly long list. But whether there are five or fifty items on your list, they are all symptoms of the medical disorder called ADHD. In other words, whatever the annoying behavior, don’t see it as “bad” behavior—see it as a symptom.

Think of it this way: If your child has a runny nose, you don’t say she’s a bad child. You say she has a symptom of a medical problem, like a cold or an allergy. Well, if your ADHD child is running uncontrollably around the house, it’s the same thing—she has a symptom of a medical problem. And without parental help, your child can no more inhibit her motor activity than she can stop her nose from running.

A is for ADHD. After you’ve labeled the behavior a symptom, say to yourself: ADHD is a medical problem—not a behavior problem.

Whatever the behavior, your child is not doing it to irritate you. Your child wants to behave. But he can’t, without your help. And criticism doesn’t help.

I is for It’s okay. In the grand scheme of life—your life and the life of your child—the behavior is probably not that big a deal. Whatever your child is doing that annoys you, tell yourself, It’s okay.

L is for Listen. One of the most important points I make with parents is the value of listening to their ADHD child.

In my experience, ADHD children have great strengths and talents—including the insight to help you understand how to best parent them. If you tap in to your child’s intuitive and creative energy, she can help you help her.

And the best way to do that is to listen to what your child has to say and then respond positively. When I meet with a child alone and listen, the child is often able to articulate the exact information his parents need.

I might ask, “What do you need to help you study better?” And she might tell me that she studies best in the dining room, with loud music playing. But her parents might have already decided she’s best off studying in her bedroom without any “distractions.” What you think is best for your child may not match what she has already figured out is best for her.

Please use this listening exercise as soon as possible:

Find the place where you think your child would be most comfortable talking—the kitchen, the car, a coffee shop, the bedroom, the backyard. Anywhere. In fact, walking and talking might be better for your child than sitting and talking.

Explain to him that you want to ask him a few questions.

Ask your questions—things you really want and need to know about controlling your child’s symptoms.

Don’t respond at all while she’s talking. Yes, if your child is very young she may need some gentle encouragement. But if you become defensive, projecting concerns about anything she is telling you, she will shut down.

The goal is to listen—to let your child guide you to the best possible understanding of how he interacts with the world around him, and what he needs to function at his best.

And if you make these “listening times” a regular event—once a week is best, at a minimum; more is fine—I think you’ll be amazed at what your child tells you, and how helpful that information is.

Why Does My ADHD Child Lie to Me All the Time?

Parents of children with ADHD often tell me that their child is a “liar”—that he tells lies even when the lie is blatantly obvious, like saying “I didn’t eat the cookie” when there’s chocolate all over his face.

There’s an understandable reason for these lies.

After being told thousands of times that he’s screwing up (studies show that by the time an ADHD child is twelve, he’s heard twenty thousand more negative messages than a non-ADHD child), he can’t tolerate criticism anymore and starts trying to protect himself by telling lies.

You say, “You left your coat at your friend’s house.” She says, “No, Johnny’s mother said she would bring it home.”

You say, “You left the refrigerator door open.” He says, “No, the refrigerator door is broken.”

You say, “Your clothes are all over the floor—pick them up.” She says, “My brother put them there.”

The SAIL technique is a good way to help you respond to your child’s “lies.” S: Remind yourself the lie is a symptom. A: Remind yourself it’s a symptom of ADHD. I: Remind yourself that it’s okay. L: Then listen to your child rather than criticizing him for lying. Tune in to his world. You may find that he’s filled with sadness, doubt, and low self-worth. You may find that a lecture about lying again is easier for him to face than his feelings of failure. And you may find another reason to stop criticizing him.

Let Go

You might want to add a second L to the end of SAIL: L for let go.

Frequently, parents come into my office and describe in great detail an upsetting episode that happened weeks or even months in the past just as if it had happened an hour before the appointment.

I understand: As the parent of an ADHD child, you might have many frustrating days, filled with fighting, fidgeting, and so on. Resentment can build up and not go away. But for your child’s well-being and yours, you need to learn to let go, forgiving your child and moving on.

This nugget of wisdom is emphasized by ADHD expert Russell Barkley, Ph.D., in his book Taking Charge of ADHD.

“Practicing forgiveness is the most important principle, but often the most difficult to implement consistently in daily life,” he writes.³

When you find yourself rehashing your child’s behavior in your mind, he recommends three minutes of mindfulness meditation (see Chapter 11). Conclude the meditation by “saying in your mind about your child, ‘I love you and forgive you,’ ” Barkley advises.

“Try practicing forgiveness at the end of the day after your child is put to bed or before you retire for the night,” he adds. “Take just a moment to review the day and forgive your child for any transgressions. Let go of anger, resentment, disappointment, or other personally destructive emotions that have arisen that day because of your child’s misconduct or disruptions.”

Better than focusing on your anger: Focus on constructive ways to control your child’s symptoms so that they no longer impair her ability to function. One effective way to do that is with rewards and positive feedback.

Reward Rather Than Punish

Because ADHD children “misbehave” so often, they receive a lot of punishments, which create hostility and resentment. Rewards work much, much better.

In fact, kids with ADHD respond better to rewards and positive feedback than kids without the disorder, according to research.⁴

In a recent study on this topic, neuroscientists and psychiatrists at Northwestern University compared short-term memory in 17 ADHD boys and 17 non-ADHD boys, all of whom were asked to remember the location of objects on a computer screen. The boys got immediate results about their performance in the form of rewards (money symbols on the screen) and feedback (green or red squares on the screen).

The non-ADHD boys had “high performance” whether or not they got a reward or feedback. But the ADHD boys only had “high performance” when they got a large reward (more money) or feedback.

And here’s perhaps the most interesting result: During the memory exercise, the researchers tracked the boys’ moment-to-moment brain activity using a real-time brain scan called “functional MRI.” They found that the boys with ADHD had the most brain activity linked to short-term memory when they received large rewards.

Reviewing their study and previous research on the topic, the scientists concluded: “Children with ADHD display increased reliance on external feedback and reward.”⁵

What kind of rewards work? Anything you think will be appealing to your child, whether it’s extra time playing his favorite video game, or the chance to rent a DVD for the evening. Make that reward part of a verbal contract that applies to any task you want your child to do, like finishing his homework or cleaning his room. Other rewards might be physical affection, special snacks or treats, or small toys or collectible items.

Use Positive Feedback

Along with rewards to keep a child with ADHD on task, it helps to give positive feedback. Two tips:

Make the feedback immediate—otherwise your child might not connect it to what she’s doing. For example, praise your child for being cooperative, sharing, and kind when she’s playing with a friend.

Make the feedback frequent—for example, giving positive feedback throughout a homework assignment rather than just at the end.

Discover and Support the Activities Your Child Enjoys

Your child with ADHD moves in a lot of different directions—seemingly all at once! But while the child may have trouble focusing on subjects that don’t hold her interest, she tends to excel at her strengths. Discover those strengths, and encourage your child in her pursuits.

“Help your child match her strengths to her passions, and offer experiences that allow her to be engaged with her interests,” writes Tracey Goodwin, M.Ed., author of Navigating ADHD.⁶

Charles Schwab, founder of the investment company by the same name and a person with ADHD, talks about how this personal “investment strategy” worked for him.

“I was always aware of the fact that I excelled with numbers, even though I struggled with reading,” said Schwab. “I focused on my strengths, and used my natural affinity for numbers and economics as the focus of my career.”⁷

Don’t Hold On Too Tight—or You Might “Lose” Your Child

So many parents tell me that they’re going to help their ADHD child by becoming “firmer” or “stricter” or “tougher”—the so-called Tiger Mom approach of correcting a child with relentless discipline. That approach never works with a child who has ADHD.

When I meet with the parents of an ADHD child, I ask them to imagine holding a handful of sand in their open palm, and then trying to hold on to the sand by squeezing their hand into a fist. “What happens to the sand?” I ask. It trickles out of their hand.

Well, it’s the same with your ADHD child. The harder you try to hold on—by getting tougher, firmer, or stricter—the more likely you are to lose a real connection with your child.

Yes, there are going to be plenty of times when you feel frustrated and angry, even full of rage. You’ll struggle with tangled emotions, feeling sorry for your child and for yourself. But try to remember this essential wisdom about your child, summarized so well by psychologist Dr. Don Griffin:

The more parents try to control the behavior of a child with ADHD by the usual methods, the worse they feel—and the kid’s behavior doesn’t get any better.

Join a Support Group for Parents of Children with ADHD

Maybe you think the last thing you want to do is hang out with other people who have the same problems as you do and talk about them. But support groups can provide tremendous comfort and deep friendship: These are the people who really understand what you’re going through—and who can share practical, parent-proven ideas for helping children with ADHD.

“As a parent of a child with ADHD, you may feel alone, frustrated and misunderstood by ‘ordinary’ parents,” writes Michele Novotni, Ph.D., a mother of a young adult with ADHD, former president and CEO of the Attention Deficit Disorder Association, and author of Adult ADHD. “That’s why parent support groups are important for us. They can help us to see the light at the end of the tunnel, and to find support along the way.”⁸

Research supports that statement. For example, a recent study in the journal Qualitative Health Research found that an ADHD parental support group “served to absolve parents of guilt” and “preserved their identities as ‘good parents.’ ”⁹ And a scientific study on support groups in the journal Health & Social Care in the Community states: “Group members were uplifted by exchanging emotional and practical support; they gained self-esteem, knowledge and confidence, thereby increasing their control over their situation.”¹⁰

You’ll find information about support groups in the Appendix at the end of the book. Many of the most established support groups are part of CHADD: Children and Adults with ADHD. Their website is www.chadd.org.

For Self-Care, Focus on Stress Relief

No doubt about it: Raising a child with ADHD can be very stressful at times. A study published in the Journal of Abnormal Psychology highlighted the problem.

Researchers asked 145 mothers and 98 fathers—60% of them parents of an ADHD adolescent; 40% of them parents of a non-ADHD adolescent—to fill out the “Stress Index for Parents of Adolescents,” a standard measurement of parental stress.

Overall, parents of ADHD children had “elevated levels of stress” compared to parents of non-ADHD kids.¹¹ The forms of stress included:

Role restriction—feeling like your entire life is about nothing but being a parent, and that you don’t have any time for yourself.

Social alienation—being cut off from family and friends.

Conflict with partner—as you and your spouse’s tempers easily flare, and parental decisions are difficult to make.

Feelings of guilt and incompetence—because you blame yourself for your child’s disorder, and see yourself as a failure.

Relationship with other children—because your ADHD child dominates the household, and your other child or children get less care.

“Addressing parenting stress” is a must for parents of kids with ADHD, concluded the researchers from the Department of Applied Psychology & Human Development at the University of Toronto.

Needless to say, I agree.

Reducing your stress is key to your well-being and the well-being of your ADHD child—because when you feel less stressed, it’s likely he’ll feel less stressed, too.

Let’s start that relief with this essential message to help ease those stressful “feelings of guilt and incompetence”:

Don’t be so hard on yourself as a parent—your child’s ADHD is not your fault!

As I’ve repeated many times throughout the book and this chapter (because it’s so crucial to understanding and treating ADHD): ADHD is a neurological, genetic, nutritional, and environmental disorder. Blaming yourself for your child’s behavior is like blaming yourself for the color of your child’s eyes!

Just as it’s counterproductive to blame or shame your child, it’s counterproductive to blame or shame yourself.

In fact, when you stop blaming yourself, you can start to feel that you deserve a little TLC—and start caring for yourself and your spouse.

And one of the best and easiest ways to care for yourself is to use a very simple, fast, and effective way to relieve stress: deep breathing. Here’s a version of that stress relief technique from Fred Luskin, Ph.D., a senior consultant in health promotion at Stanford University and coauthor of Stress Free for Good: 10 Scientifically Proven Life Skills for Health and Happiness:

1. As you inhale, imagine that your belly is a big balloon that you’re slowly filling with air.

2. Place your hands on your belly while you slowly inhale.

3. Watch your hands as you slowly breathe out, letting the air out of the balloon.

4. As you exhale, make sure your belly stays relaxed.

5. Take at least two or three more slow and deep breaths, making sure to keep your attention on the rise and fall of your belly.

Use this technique whenever you’re feeling stressed, or if you feel like yelling at your child. Use it to help you fall asleep at night. Use it whenever you notice that your breathing is shallow, rapid, tight, or tense.

The ADHD Child’s Bill of Rights

Around the time I first started to treat ADHD, I found this wonderful document, which was first printed in the newsletter of the Delaware Association for the Education of Young Children, and I put it on my website. It turned out to be the most popular item on the site! Authored by Ruth Harris, and first printed in the newsletter of the Delaware Association for the Education of Young Children, the ADHD Child’s Bill of Rights can help every parent better understand their ADHD child and what he or she needs. I’d like to end the book with these ten “rights”—because they’re so right for every child with ADHD.

1. Help me to focus. Please teach me through my sense of touch. I need “hands-on” help and body movement.

2. I need to know what comes next. Please give me a structured environment where there is a dependable routine. Give me an advance warning if there will be changes.

3. Wait for me, I’m still thinking. Please allow me to go at my own pace. If I’m rushed, I get confused and upset.

4. I’m stuck, I can’t do it…! Please offer me options for problemsolving. If the road is blocked, I need to know the detours.

5. Is it right? I need to know. Please give me rich and immediate feedback on how I’m doing.

6. I didn’t know I wasn’t in my seat…! Please remind me to stop, think, and act.

7. Am I almost done…? Please give me short work periods with short-term goals.

8. What…? Please don’t say, “I already told you that.” Tell me again, in different words. Give me a signal. Draw me a symbol.

9. I know it’s all wrong, isn’t it…? Please give me praise for partial success. Reward me for self-improvement, not just for perfection.

10. But why do I always get yelled at…? Please catch me doing something right and praise me for the specific positive behavior. When I’m having a bad day, remind me—and yourself—about my good points.

I would like to thank my wife, Judy, for her ongoing support, patience, and partnership; and my children, Julia and Nathan.

Thank you to Diana Harrington and the Bunny Fund for financial assistance with research.

Thanks to Courtney Bean and Winnie To for their research assistance, without which this book could not have been written.

Thanks to my editor at Harmony Books, Michele Eniclerico, for her intelligent and sensitive response to the manuscript.

Thanks to my coauthor, Bill Gottlieb, for the pleasure and ease of our partnership, his openness in exploring ideas, and his hard work, insight, and skill.

And thanks to our literary agent, Chris Tomasino, for believing in the need to educate parents with ADHD children and adults with ADHD about a new approach to the disorder—and for bringing thirty years of my clinical experience treating thousands of children with ADHD to a larger audience.

Finally Focused website

www.finallyfocusedbook.com

The website includes:

• A full list of scientific references in Finally Focused for you to share with your doctor or other health professional, to substantiate the scientific validity of the treatments in the book.

• A blog featuring updates on information and advice in Finally Focused, including the latest scientific research on ADHD, and responses to reports about ADHD in the media.

• Dr. Greenblatt’s ongoing schedule of webinars and presentations about ADHD, and about other mental health issues that he specializes in, such as depression and eating disorders.

• A listing of resources for ADHD children and their parents, and ADHD adults.

Recommended Manufacturers of Nutritional Supplements

Pure Encapsulations, Inc.

490 Boston Post Road

Sudbury, MA 01776

800-753-2277

www.PureEncapsulations.com

New Beginnings Nutritionals

7797 Quivira Road

Lenexa, KS 66216

877-575-2467

www.nbnus.net

Recommended Laboratories

Great Plains Laboratory

11813 W. 77th St.

Lenexa, KS 66214

913-341-8949

www.greatplainslaboratory.com

Genova Diagnostics

63 Zillicoa St.

Asheville, NC 28801

800-522-4762

www.gdx.net

Genomind

2200 Renaissance Blvd., Suite 100

King of Prussia, PA 19406

877-895-8658

www.genomind.com

Trace Elements, Inc.

4501 Sunbelt Drive

Addison, TX 75001

800-824-2314

www.traceelements.com

Integrative Health Professionals
(Organizations and Registries)

Integrative Medicine for Mental Health: Referral Registry & Resources (IMMH)

11813 W. 77th St.

Lenexa, KS 66214

800-288-0383

www.integrativemedicineformentalhealth.com

IMMH provides referrals to and information on integrative medicine practitioners.

American Board of Integrative Holistic Medicine (ABIHM)

5313 Colorado St.

Duluth, MN 55804

218-525-5651

Fax: 218-525-5677

www.abihm.org

ABIHM is an association that establishes and promotes standards for integrative holistic medicine. It is also a resource for physicians desiring certification in integrative holistic medicine, as well as for those seeking physicians certified in holistic medicine.

American Holistic Medical Association (AHMA)

23366 Commerce Park, Suite 101B

Beachwood, OH 44122

216-292-6644

Fax: 216-292-6688

www.holisticmedicine.org

AHMA is dedicated to the advancement of holistic and integrative medicine in health care. It is committed to increasing awareness and understanding of integrative, complementary, and alternative medicine techniques.

American College for Advancement in Medicine (ACAM)

8001 Irvine Center Drive, Suite 825

Irvine, CA 92618

800-532-3688

Fax: 949-309-3535

www.acam.org

ACAM is a nonprofit association dedicated to educating physicians and other health care professionals on the latest findings and emerging procedures in complementary, alternative, and integrative medicine.

International College of Integrative Medicine (ICIM)

P.O. Box 271

Bluffton, OH 45817

866-464-5226

Fax: 610-680-3847

www.icimed.com

ICIM is a community of dedicated health care professionals advancing emergent innovative therapies in integrative and preventive health care. It conducts educational sessions, supports research and publications, and cooperates with other professional and scientific organizations.

Institute of Functional Medicine (IFM)

4411 Point Fosdick Drive NW, Suite 305

P.O. Box 1697

Gig Harbor, WA 98335

800-228-0622

Fax: 253-853-6766

www.functionalmedicine.org

IFM is a resource for training physicians and patients about the principles of functional medicine. It also provides referrals to functional medicine practitioners.

American Association of Naturopathic Physicians (AANP)

818 18th St., NW, Suite 250

Washington, DC 20006

202-237-8150

www.naturopathic.org

The AANP is the national professional society representing licensed naturopathic physicians. It aims to increase awareness of and expand access to naturopathic physicians, help its members build successful medical practices, and expand the body of naturopathic medicine research.

American Academy of Environmental Medicine (AAEM)

6505 E. Central Ave., #296

Wichita, KS 67206

316-684-5500

www.aaemonline.org

The AAEM is an international association of physicians and other professionals interested in the clinical aspects of humans and their environment. The academy is interested in expanding the knowledge of interactions between human individuals and their environment, as these may be demonstrated to be reflected in their total health. The AAEM provides research and education in the recognition, treatment, and prevention of illnesses induced by exposures to biological and chemical agents encountered in air, food, and water.

National ADHD Organizations

Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD)

4601 Presidents Drive, Suite 300

Lanham, MD 20706

301-306-7070

www.chadd.org

CHAAD is a national nonprofit organization that provides up-to-date information, advocacy, and support for individuals with ADHD. Its website includes educational materials, discussion boards, and webinars. CHADD’s National Resource Center on ADHD provides science-based information, education, and consultation about assessment, diagnosis, and treatment.

National Resource Center on ADHD (NRC)

A Program of CHADD

4601 Presidents Drive, Suite 300

Lanham, MD 20706

800-233-4050

www.help4adhd.org/​NRC.aspx

The NRC provides evidence-based information to understand issues related to ADHD. The website includes free monthly webinars, an online library database, and a discussion board.

Attention Deficit Disorder Association

800-939-1019

www.add.org

Attention Deficit Disorder Association is an international, volunteer-run, virtual organization. Its website offers support for adults with ADHD with virtual support groups, webinars, and newsletters.

ADDitude Magazine

108 West 39th St., Suite 805

New York, NY 10018

646-366-0830

www.additudemag.com

ADDitude is a quarterly publication that provides expert guidance and advice to families and adults living with ADHD. The website contains discussions, blogs, newsletters, webinars, directory of professionals, and free digital guides.

American Academy of Child Adolescent Psychiatry’s ADHD Resource Center

www.aacap.org/​aacap/​families_and_youth/​resource_centers/​adhd_resource_center/​Home.aspx

AACAP’s website includes consumer-friendly information on issues that affect children, teenagers, and their families; a child and adolescent psychiatrist finder; and guides for parents about treatment options.

ADHD & You

Shire US Inc.

Wayne, PA 19087-5637

800-828-2088

www.adhdandyou.com

ADHD & You aims to help people understand ADHD and how it is managed, focusing on school-age children with ADHD and what can be done to help with their challenges. The website includes educational information and tips for adults with ADHD, parents and caregivers, teachers, and professionals.

ADHD Support Groups

CHADD Support Group Chapter Directory

A listing of local support groups, by state.

www.chadd.org/​Support/​Chapter-Directory.aspx

ADDitude’s ADDConnect

Connect online with parents of ADHD children and ADHD professionals to share experiences and ask questions.

http://connect.additudemag.com/​groups

Attention Deficit Disorder Association’s Virtual Support Groups

Online peer support groups for adults with ADHD.

www.add.org/​adda-virtual-programs

Dairy-Free Resources

GFCF

Information on food buying and cooking.

www.gfcf.com

Go Dairy Free

Online source for shopping tips, recipes, reviews of dairy-free products, cookbook guide, and book recommendations.

www.godairyfree.org

Living Without

List of casein-free foods.

www.livingwithout.com/​resources/​casein_free.html

Gluten-Free Resources

Celiac.com

4927 Sonoma Hwy., Suite C

Santa Rosa, CA 95409

707-509-4528

www.celiac.com

Information on Celiac Disease and a Gluten-Free Diet

Celiac Disease Foundation

20350 Ventura Blvd., Suite 240

Woodland Hills, CA 91364

818-716-1513

www.celiac.org

Celiac Sprue Association

1941 S. Forty-Second St., Suite 522

Omaha, NE 68105

402-558-0600

www.csaceliacs.org

The GFCF Diet Intervention

P.O. Box 1692

Palm Harbor, FL 34683

www.gfcfdiet.com

Gluten-Free Living

85 Quincy Ave., Suite 2

Quincy, MA 02169

800-437-5828

www.glutenfreeliving.com

Gluten Intolerance Group of North America (GIG)

31214 124th Ave. SE

Auburn, WA 98092

253-833-6655

www.gluten.net

Living Without

800 Connecticut Ave.

Norwalk, CN 06854

800-474-8614

www.livingwithout.com/​resources/​gluten_free.html

National Foundation for Celiac Awareness (NFCA)

P.O. Box 544

Ambler, PA 19002

215-325-1306

www.celiaccentral.org

Before You Begin

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2. Volkow ND, et al. Evaluating dopamine reward pathway in ADHD: clinical implications. JAMA. September 9, 2009;302(10):1084–91.

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4. Castellanos FX, et al. Developmental trajectories of brain volume abnormalities in children and adolescents with attention-deficit/hyperactivity disorder. JAMA. October 9, 2002;288(14):1740–48.

5. Shaw P, et al. Attention-deficit/hyperactivity disorder is characterized by a delay in cortical maturation. Proceedings of the National Academy of Sciences of the United States of America. December 4, 2007;104(49):19649–54.

6. Langseth L & Dowd J. Glucose tolerance and hyperkinesis. Food and Cosmetics Toxicology. April 1978;16(2):129–33.

7. Monastra VJ. Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child and Adolescent Psychiatric Clinics of North America. January 2005;14(1):55–82.

8. Perera FP, et al. Early-life exposure to polycyclic aromatic hydrocarbons and ADHD behavior problems. PLoS One. November 5, 2014;9(11):e111670.

9. Russell AE, et al. Socioeconomic associations with ADHD: findings from a mediation analysis. PLoS One. June 1, 2015;10(6):e0128248.

10. Tewar S, et al. Association of bisphenol A exposure and attention-deficit/hyperactivity disorder in a national sample of U.S. children. Environmental Research. June 6, 2016;150:112–18.

11. Kofler MJ, et al. Is hyperactivity ubiquitous in ADHD or dependent on environmental demands? Evidence from meta-analysis. Clinical Psychology Review. June 2016;46:12–24.

12. Waber DP, et al. Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a 40-year study. Nutritional Neuroscience. February 2014;17(2):58–64.

13. Barkley, RA. Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment. New York: Guilford Press; 2014.

14. Ibid.

15. Ibid.

CHAPTER 1 The Miracle Mineral

1. Rosanoff A, et al. Suboptimal magnesium status in the United States: are the health consequences underestimated? Nutrition Reviews. March 2012;70(3):153–64.

2. Kozielec T & Starobrat-Hermelin B. Assessment of magnesium levels in children with attention deficit hyperactivity disorder (ADHD). Magnesium Research. June 1997;10(2):143–48.

3. El Baza F, et al. Magnesium supplementation in children with attention deficit hyperactivity disorder. Egyptian Journal of Medical Human Genetics. January 1, 2016;17(1):63–70.

4. Mousain-Bosc M, et al. Improvement of neurobehavioral disorders in children supplemented with magnesium-vitamin B₆. I. Attention deficit hyperactivity disorders. Magnesium Research. March 2006;19(1):46–52.

5. Nogovitsina OR & Levitina EV. Neurological aspects of the clinical features, pathophysiology, and corrections of impairments in attention deficit hyperactivity disorder. Neuroscience and Behavioral Physiology. March 2007;37(3):199–202.

6. Huss M, et al. Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems—an observational cohort study. Lipids in Health & Disease. September 24, 2010;9:105.

7. Mousain-Bosc M, et al. Magnesium VitB₆ intake reduces central nervous system hyperexcitability in children. Journal of the American College of Nutrition. October 2004;23(5):545S–548S.

8. Ghanizadeh A. A systematic review of magnesium therapy for treating attention deficit hyperactivity disorder. Archives of Iranian Medicine. July 2013;16(7):412–17.

9. Halterman JS, et al. Iron deficiency and cognitive achievement among school-aged children and adolescents in the United States. Pediatrics. June 2001;107(6):1381–86.

10. Adisetiyo V, et al. Multimodal MR imaging of brain iron in attention deficit hyperactivity disorder: a noninvasive biomarker that responds to psychostimulant treatment. Radiology. August 2014;272(2):524– 32.

11. Chen MH, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry. June 4, 2013;13:161.

12. Konofal E, et al. Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of Pediatrics and Adolescent Medicine. December 2004;158(12):1113–15.

13. Juneja M, et al. Iron deficiency in Indian children with attention deficit hyperactivity disorder. Indian Pediatrics. November 2010;47(11):955–58.

14. Calarge C, et al. Serum ferritin and amphetamine response in youth with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology. December 2010;20(6):495–502.

15. Doom JR, et al. Institutional care and iron deficiency increase ADHD symptomology and lower IQ 2.5–5 years post-adoption. Developmental Science. May 2015;18(3):484–94.

16. Chen MH, et al. Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study. BMC Psychiatry. June 4, 2013;13:161.

17. Sever Y, et al. Iron treatment in children with attention deficit hyperactivity disorder. A preliminary report. Neuropsychobiology. 1997;35(4):178–80.

18. Konofal E, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatric Neurology. January 2008;38(1):20–26.

19. Konofal E, et al. Effectiveness of iron supplementation in a young child with attention-deficit/hyperactivity disorder. Pediatrics. November 2005;116(5):e732–34.

20. Cortese S, et al. Iron and attention deficit/hyperactivity disorder: What is the empirical evidence so far? A systematic review of the literature. Expert Review of Neurotherapeutics. October 2012;12(10):1227–40.

21. Black LJ, et al. Low dietary intake of magnesium is associated with increased externalising behaviours in adolescents. Public Health Nutrition. July 2015;18(10):1824–30.

22. Rucklidge JJ, et al. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. British Journal of Psychiatry. 2014;204:306–15.

23. Rucklidge JJ, et al. Can micronutrients improve neurocognitive functioning in adults with ADHD and severe mood dysregulation? A pilot study. Journal of Alternative and Complementary Medicine. December 2011;17(12):1125–31.

24. Rucklidge JJ & Blampied NM. Post-earthquake psychological functioning in adults with attention-deficit/hyperactivity disorder: positive effects of micronutrients on resilience. New Zealand Journal of Psychology. 2011;40(4):51–57.

25. Rucklidge JJ, et al. Vitamin-mineral treatment of ADHD in adults: a 1-year naturalistic follow-up of a randomized controlled trial. Journal of Attention Disorders, in press.

26. Gordon HA, et al. Clinically significant symptom reduction in children with attention-deficit/hyperactivity disorder treated with micronutrients: an open-label reversal design study. Journal of Child and Adolescent Psychopharmacology. December 2015;25(10):783–98.

27. Rucklidge JJ & Kaplan BJ. Broad-spectrum micronutrient treatment for attention-deficit/hyperactivity disorder: rationale and evidence to date. CNS Drugs. September 2014;28(9):775–85.

CHAPTER 2 Balancing Brain Waves for Sharper Focus

1. Carper J. Miracle Cures. New York: HarperPerennial; 1998:221–36.

2. Dvoráková M, et al. Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (pycnogenol). Nutritional Neuroscience. June-August 2007;10(3–4):151–57.

3. Chovanová Z, et al. Effect of polyphenolic extract, Pycnogenol, on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder. Free Radical Research. September 2006;40(9):1003–10.

4. Trebatická J, et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. European Child & Adolescent Psychiatry. September 2006;15(6):329–35.

5. Luzzi R, et al. Pycnogenol® supplementation improves cognitive function, attention and mental performance in students. Panminerva Medica. September 2011;53(3 Suppl 1):75–82.

6. Heimann SW. Pycnogenol for ADHD? Journal of the American Academy of Child and Adolescent Psychiatry. April 1999;38(4):357–58.

7. Okello EJ, et al. Effects of green and black tea consumption on brain wave activities in healthy volunteers as measured by a simplified Electroencephalogram (EEG): A feasibility study. Nutritional Neuroscience. June 2016;19(5):196–205.

8. Schmidt A, et al. Green tea extract enhances parieto-frontal connectivity during working memory processing. Psychopharmacology. October 2014;231(19):3879–88.

9. Gu HF, et al. Epigallocatechin-3-gallate attenuates impairment of learning and memory in chronic unpredictable mild stress-treated rats by restoring hippocampal autophagic flux. PLoS One. November 13, 2014;9(11):e112683.

10. Veasey RC, et al. The effect of white tea administration during performance of mentally demanding tasks in healthy, young adults. Appetite. 2011;57(2):566.

11. Takeda A, et al. Facilitated neurogenesis in the developing hippocampus after intake of theanine, an amino acid in tea leaves, and object recognition memory. Cellular and Molecular Neurobiology. October 2011;31(7):1079–88.

12. Whyte AR, et al. Cognitive effects following acute wild blueberry supplementation in 7- to 10-year-old children. European Journal of Nutrition, October 5, 2015.

13. Whyte AR & Williams CM. Effects of a single dose of a flavonoid-rich blueberry drink on memory in 8 to 10 y old children. Nutrition. March 2015;31(3):531–34.

14. Calderón-Garcidueñas L, et al. Flavonol-rich dark cocoa significantly decreases plasma endothelin-1 and improves cognition in urban children. Frontiers in Pharmacology. August 22, 2013;4:104.

15. Montopoli M, et al. The acute electrocortical and blood pressure effects of chocolate. NeuroRegulation. 2015;2(1):3–28.

16. Northern Arizona University, Flagstaff, Arizona. Eat dark chocolate to beat the midday slump, NAU study says. NAU News. May 7, 2015. Available at www.news.nau.edu/​eat-dark-chocolate-to-beat-the-midday-slump-nau-study-says.

17. American Academy of Pediatrics. Evidence-based child and adolescent psychosocial interventions. October 2013. Available from www.aap.org/​en-us/​Documents/​resilience_anxiety_interventions.pdf.

18. Beauregard M & Lévesque J. Functional magnetic resonance imaging investigation of the effects of neurofeedback training on the neural bases of selective attention and response inhibition in children with attention-deficit/hyperactivity disorder. Applied Psychophysiology and Biofeedback. March 2006;31(1):3–20.

19. Duric NS, et al. Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports. BMC Psychiatry. August 10, 2012;12:107.

20. Monastra VJ. Electroencephalographic biofeedback (neurotherapy) as a treatment for attention deficit hyperactivity disorder: rationale and empirical foundation. Child and Adolescent Psychiatric Clinics of North America. January 2005;14(1):55–82.

21. Steiner NJ, et al. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial. Pediatrics. March 2014;133(3):483–92.

CHAPTER 3 Breakthrough Natural Therapy for Irritability, Anger, and Aggression

1. Georgotas A & Gershon S. Historical perspectives and current highlights on lithium treatment in manic-depressive illness. Journal of Clinical Psychopharmacology. January 1981;1(1):27–31.

2. Ibid.

3. Strobusch AD & Jefferson JW. The checkered history of lithium in medicine. Pharmacy in History. 1980;22(2):72–76.

4. Cade JF. Lithium salts in the treatment of psychotic excitement. Medical Journal of Australia. September 3, 1949;2(10):349–52.

5. Dorrego MF, et al. A randomized, double-blind, crossover study of methylphenidate and lithium in adults with attention-deficit/hyperactivity disorder: preliminary findings. Journal of Neuropsychiatry and Clinical Neurosciences. Summer 2002;14(3):289–95.

6. NRC on ADHD. What we know #5: ADHD and coexisting conditions. Landover, MD: National Resource Center on ADHD; 2004.

7. Campbell M, et al. Behavioral efficacy of haloperidol and lithium carbonate. A comparison in hospitalized aggressive children with conduct disorder. Journal of the American Academy of Child and Adolescent Psychiatry. July 1984;41(7):650–56.

8. Campbell M, et al. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. Journal of the American Academy of Child and Adolescent Psychiatry. April 1995;34(4):445–53.

9. Malone RP, et al. A double-blind placebo-controlled study of lithium in hospitalized aggressive children and adolescents with conduct disorder. Archives of General Psychiatry. July 2000;57(7):649–54.

10. Deepmala & Coffey B. Challenges in psychopharmacological management of a young child with multiple comorbid disorders, history of trauma, and early-onset mood disorder: the role of lithium. Journal of Child & Adolescent Psychopharmacology. November 2014;24(9):519–24.

CHAPTER 4 Balanced Nutrients, Balanced Behavior

1. Toren P, et al. Zinc deficiency in attention-deficit hyperactivity disorder. Biological Psychiatry. December 15, 1996;40(12):1308–10.

2. Oner O, et al. Effects of zinc and ferritin levels on parent and teacher reported symptom scores in attention deficit hyperactivity disorder. Child Psychiatry and Human Development. August 2010;41(4):441–47.

3. Ibid.

4. Yorbik O, et al. Potential effects of zinc on information processing in boys with attention deficit hyperactivity disorder. Progress in Neuropsychopharmacology & Biological Psychiatry. April 1, 2008;32(3): 662–67.

5. Uçkardeş Y, et al. Effects of zinc supplementation on parent and teacher behaviour rating scores in low socioeconomic level Turkish primary school children. Acta Paediatrica. April 2009;98(4):731–36.

6. Arnold LE, et al. Does hair zinc predict amphetamine improvement of ADD/hyperactivity? International Journal of Neuroscience. January 1990;50(1–2):103–7.

7. Akhondzadeh S, et al. Zinc sulfate as an adjunct to methylphenidate for the treatment of attention deficit hyperactivity disorder in children: a double blind and randomized trial. BMC Psychiatry. April 8, 2004;4:9.

8. Viktorinova A, et al. Changed plasma levels of zinc and copper to zinc ratio and their possible associations with parent- and teacher-rated symptoms in children with attention-deficit hyperactivity disorder. Biological Trace Element Research. Janurary 2016;169(1):1–7.

9. Wines, M. Flint is in the news, but lead poisoning is even worse in Cleveland. New York Times. March 3, 2016. Available from www.nytimes.com/​2016/​03/​04/​us/​lead-paint-contamination-persists-in-many-cities-as-cleanup-falters.html.

10. Ibid.

11. Bijoor AR, et al. Neurochemical and neurobehavioral effects of low lead exposure on the developing brain. Indian Journal of Clinical Biochemistry. April 2012;27(2):147–51.

12. Kim Y, et al. Association between blood lead levels (<5 μg/dL) and inattention-hyperactivity and neurocognitive profiles in school-aged Korean children. Science of the Total Environment. November 1, 2010;408(23):5737–43.

CHAPTER 5 Heal the Gut, Help the Brain

1. Mayer EA, et al. Gut microbes and the brain: paradigm shift in neuroscience. Journal of Neuroscience. November 12, 2014;34(46):15490–96.

2. Perlmutter D. Brain Maker: The Power of Gut Microbes to Heal and Protect Your Brain—for Life. New York: Little, Brown and Company; 2015.

3. Harding KL, et al. Outcome-based comparison of Ritalin versus food-supplement treated children with AD/HD. Alternative Medicine Review. August 2003;8(3):319–30.

4. Mohammadi AA, et al. The effects of probiotics on mental health and hypothalamic-pituitary-adrenal axis: a randomized, double-blind, placebo-controlled trial in petrochemical workers. Nutritional Neuroscience. April 16, 2015.

5. Messaoudi M, et al. Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. British Journal of Nutrition. March 2011;105(5):755–64.

6. Shaw W. Increased urinary excretion of a 3-(3-hydroxyphenyl)-3-hydroxypropionic acid (HPHPA), an abnormal phenylalanine metabolite of Clostridia spp. in the gastrointestinal tract, in urine samples from patients with autism and schizophrenia. Nutritional Neuroscience. June 2010;13(3):135–43.

CHAPTER 6 These Good Foods May Be Bad for Your Child

1. Bellanti JA. 59th annual meeting of the American College of Allergy, Asthma, and Immunology. 2001.

2. Rapp DJ. Is This Your Child?: Discovering and Treating Unrecognized Allergies in Children and Adults. New York: William Morrow Paperbacks; 1991.

3. Suarez-Lopez JR, et al. Acetylcholinesterase activity and neurodevelopment in boys and girls. Pediatrics. December 2013; 132(6):e1649–58.

4. Marks AR, et al. Organophosphate pesticide exposure and attention in young Mexican-American children: the CHAMACOS study. Environmental Health Perspectives. December 2010;118(12):1768–74.

5. Bouchard MF, et al. Attention-deficit/hyperactivity disorder and urinary metabolites of organophosphate pesticides. Pediatrics. June 2010;125(6):e1270–77.

6. Xu X, et al. Urinary trichlorophenol levels and increased risk of attention deficit hyperactivity disorder among US school-aged children. Occupational and Environmental Medicine. August 2011;68(8):557–61.

7. Environmental Working Group. EWG’s 2016 Shopper’s Guide to Pesticides in Produce. 2016. Available from www.ewg.org/​foodnews/​summary.php.

8. U.S. Food and Drug Administration. Total Diet Study Statistics on Element Results—2006–2011. February 2016. Available from www.fda.gov/​downloads/​food…totaldietstudy/​ucm184301.pdf.

9. Pelsser LM, et al. Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. Lancet. February 5, 2011;377(9764):494–503.

10. Egger J, et al. Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet. March 9, 1985;1(8428):540–45.

11. Pelsser LM, et al. Effects of food on physical and sleep complaints in children with ADHD: a randomised controlled pilot study. European Journal of Pediatrics. September 2010;169(9):1129–38.

12. Ritz BW & Lord RS. Case study: the effectiveness of a dietary supplement regimen in reducing IgG-mediated food sensitivity in ADHD. Alternative Therapies in Health and Medicine. May–June 2005;11(3):72–75.

13. Niederhofer H. Association of attention-deficit/hyperactivity disorder and celiac disease: a brief report. Primary Care Companion for CNS Disorders. 2011;13(3).

14. McCann D, et al. Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. Lancet. November 3, 2007;370(9598):1560–67.

15. Nigg JT, et al. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child & Adolescent Psychiatry. January 2012;51(1):86–97.e8.

16. Stevenson J, et al. The role of histamine degradation gene polymorphisms in moderating the effects of food additives on children’s ADHD symptoms. American Journal of Psychiatry. September 2010;167(9):1108–15.

CHAPTER 7 Strengthening Brain Cells, Weakening ADHD

1. Woo HD, et al. Dietary patterns in children with attention deficit/hyperactivity disorder (ADHD). Nutrients. April 14, 2014;6(4):1539– 53.

2. Hawkey E & Nigg JT. Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clinical Psychology Review. August 2014;34(6):496–505.

3. Montgomery P, et al. Low blood long chain omega-3 fatty acids in UK children are associated with poor cognitive performance and behavior: a cross-sectional analysis from the DOLAB study. PLoS One. June 24, 2013;8(6):e66697.

4. Gow RV, et al. Omega-3 fatty acids are related to abnormal emotion processing in adolescent boys with attention deficit hyperactivity disorder. Prostaglandins, Leukotrienes and Essential Fatty Acids. June 2013;88(6):419–29.

5. Brookes KJ, et al. Association of fatty acid desaturase genes with attention-deficit/hyperactivity disorder. Biological Psychiatry. November 15, 2006;60(10):1053–61.

6. Sumich A, et al. Resting state electroencephalographic correlates with red cell long-chain fatty acids, memory performance and age in adolescent boys with attention deficit hyperactivity disorder. Neuropharmacology. December 2009;57(7–8):708–14.

7. Hawkey E & Nigg JT. Omega-3 fatty acid and ADHD: blood level analysis and meta-analytic extension of supplementation trials. Clinical Psychology Review. August 2014;34(6):496–505.

8. Cooper RE, et al. The effect of omega-3 polyunsaturated fatty acid supplementation on emotional dysregulation, oppositional behaviour and conduct problems in ADHD: a systematic review and meta-analysis. Journal of Affective Disorders. January 15, 2016;190:474– 82.

9. Milte CM, et al. Increased erythrocyte eicosapentaenoic acid and docosahexaenoic acid are associated with improved attention and behavior in children with ADHD in a randomized controlled three-way crossover trial. Journal of Attention Disorders. November 2015;19(11):954–64.

10. Widenhorn-Müller K, et al. Effect of supplementation with long-chain Ω-3 polyunsaturated fatty acids on behavior and cognition in children with attention deficit/hyperactivity disorder (ADHD): a randomized placebo-controlled intervention trial. Prostaglandins, Leukotrienes and Essential Fatty Acids. July–August 2014;91(1–2):49–60.

11. Milte CM, et al. Eicosapentaenoic and docosahexaenoic acids, cognition, and behavior in children with attention-deficit/hyperactivity disorder: a randomized controlled trial. Nutrition. June 2012;28(6):670–77.

12. Yehuda S, et al. Effects of essential fatty acids in iron deficient and sleep-disturbed attention deficit hyperactivity disorder (ADHD) children. European Journal of Clinical Nutrition. October 2011;65(10):1167–69.

13. Barragán E, et al. Efficacy and safety of omega-3/6 fatty acids, methylphenidate, and a combined treatment in children with ADHD. Journal of Attention Disorders. January 24, 2014.

14. Perera H, et al. Combined Ω3 and Ω6 supplementation in children with attention-deficit hyperactivity disorder (ADHD) refractory to methylphenidate treatment: a double-blind, placebo-controlled study. Journal of Child Neurology. June 2012;27(6):747–53.

15. Ibid.

16. Barragán E, et al. Efficacy and safety of omega-3/6 fatty acids, methylphenidate, and a combined treatment in children with ADHD. Journal of Attention Disorders. January 24, 2014.

17. Bos DJ, et al. Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology. September 2015;40(10):2298–306.

18. Raine A, et al. Reduction in behavior problems with omega-3 supplementation in children aged 8–16 years: a randomized, double-blind, placebo-controlled, stratified, parallel-group trial. Journal of Child Psychology and Psychiatry. May 2015;56(5):509–20.

19. Shulkin ML, et al. Effects of omega-3 supplementation during pregnancy and youth on neurodevelopment and cognition in childhood: a systematic review and meta-analysis. The FASEB Journal. 2016;30(Suppl 1):295–305.

20. Julvez J, et al. Maternal consumption of seafood in pregnancy and child neuropsychological development: a longitudinal study based on a population with high consumption levels. American Journal of Epidemiology. February 1, 2016;183(3):169–82.

21. Gow RV, et al. Current evidence and future directions for research with omega-3 fatty acids and attention deficit hyperactivity disorder. Current Opinion in Clinical Nutrition & Metabolic Care. March 2015;18(2):133–38.

22. Vaisman N, et al. Correlation between changes in blood fatty acid composition and visual sustained attention performance in children with inattention: effect of dietary n-3 fatty acids containing phospholipids. American Journal of Clinical Nutrition. May 2008;87(5):1170–80.

23. Manor I, et al. The effect of phosphatidylserine containing omega3 fatty-acids on attention-deficit hyperactivity disorder symptoms in children: a double-blind placebo-controlled trial, followed by an open-label extension. European Psychiatry. July 2012;27(5):335–42.

24. Hirayama S, et al. The effect of phosphatidylserine administration on memory and symptoms of attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled clinical trial. Journal of Human Nutrition & Dietetics. April 2014;27(Suppl 2):284–91.

25. Manor I, et al. Safety of phosphatidylserine containing omega3 fatty acids in ADHD children: a double-blind placebo-controlled trial followed by an open-label extension. European Psychiatry. August 2013;28(6):386–91.

26. Shulkin ML, et al. Effects of omega-3 supplementation during pregnancy and youth on neurodevelopment and cognition in childhood: a systematic review and meta-analysis. The FASEB Journal. 2016;30(Suppl 1):295–305.

27. Daniells S. Exciting results: Tufts/Harvard meta-analysis supports omega-3s for child brain development. NutraIngredients-USA. April 6, 2016. Available from www.nutraingredients-usa.com/​Research/​Exciting-results-Tufts-Harvard-meta-analysis-supports-omega-3s-for-child-brain-development.

28. Zhang J, et al. Association of serum cholesterol and history of school suspension among school-age children and adolescents in the United States. American Journal of Epidemiology. April 1, 2005;161(7):691–99.

29. Golomb BA, et al. The UCSD Statin Study: a randomized controlled trial assessing the impact of statins on selected noncardiac outcomes. Controlled Clinical Trials. April 2004;25(2):178–202.

CHAPTER 8 Solve the Sugar Problem: Just Add Protein

1. Millichap JG & Yee MM. The diet factor in attention-deficit/hyperactivity disorder. Pediatrics. February 2012;129(2):330–37.

2. Ibid.

3. Azadbakht L & Esmaillzadeh A. Dietary patterns and attention deficit hyperactivity disorder among Iranian children. Nutrition. March 2012;28(3):242–49.

4. Howard AL, et al. ADHD is associated with a “Western” dietary pattern in adolescents. Journal of Attention Disorders. July 2011;15(5):403–11.

5. Johnson RJ, et al. Attention-deficit/hyperactivity disorder: is it time to reappraise the role of sugar consumption? Postgraduate Medicine. September 2011;123(5):39–49.

6. Ibid.

7. Keller A & Bucher Della Torre S. Sugar-sweetened beverages and obesity among children and adolescents: a review of systematic literature reviews. Childhood Obesity. August 2015;11(4):338–46.

8. Mergenthaler P, et al. Sugar for the brain: the role of glucose in physiological and pathological brain function. Trends in Neurosciences. October 2013;36(10):587–97.

9. Zametkin AJ, et al. Cerebral glucose metabolism in adults with hyperactivity of childhood onset. New England Journal of Medicine. November 15, 1990;323(20):1361–66.

10. Girardi NL, et al. Blunted catecholamine responses after glucose ingestion in children with attention deficit disorder. Pediatric Research. October 1995;38(4):539–42.

11. Ibid.

12. Lacy S. Hyperactivity/ADHD—New Solutions. Bloomington, IN: AuthorHouse; 2004.

13. Aguirre Castaneda RL, et al. Childhood attention-deficit/hyperactivity disorder, sex, and obesity: a longitudinal population-based study. Mayo Clinic Proceedings. March 2016;91(3):352–61.

14. Tipton JA. Reducing sugar-sweetened beverage intake among students: school-based programs and policies that work. NASN School Nurse. March 2016;31(2):102–10.

15. Schwartz DL, et al. Energy drinks and youth self-reported hyperactivity/inattention symptoms. Academic Pediatrics. May-June 2015;15(3):297–304.

16. Ibid.

17. Suglia SF, et al. Soft drinks consumption is associated with behavior problems in 5-year-olds. Journal of Pediatrics. November 2013;163(5):1323–28.

18. Ibid.

19. Hafer H. The Hidden Drug—Dietary Phosphate: Cause of Behavioral Problems, Learning Difficulties and Juvenile Delinquency. Armadale, WA: PHOSADD Australia; 2001.

20. DeChristopher LR, et al. Intakes of apple juice, fruit drinks and soda are associated with prevalent asthma in US children aged 2–9 years. Public Health Nutrition. January 2016;19(1):123–30.

21. Berentzen NE, et al. Associations of sugar-containing beverages with asthma prevalence in 11-year-old children: the PIAMA birth cohort. European Journal of Clinical Nutrition. March 2015;69(3):303–8.

22. Park S, et al. Regular-soda intake independent of weight status is associated with asthma among US high school students. Journal of the Academy of Nutrition and Dietetics. January 2013;113(1):106–11.

23. Chan TF, et al. Consumption of sugar-sweetened beverages is associated with components of the metabolic syndrome in adolescents. Nutrients. May 23, 2014;6(5):2088–103.

24. Bray GA & Popkin BM. Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care. April 2014;37(4):950–56.

25. Park S, et al. Self-reported academic grades and other correlates of sugar-sweetened soda intake among US adolescents. Journal of the Academy of Nutrition and Dietetics. January 2012;112(1):125–31.

26. Beezhold BL, et al. Sodium benzoate-rich beverage consumption is associated with increased reporting of ADHD symptoms in college students: a pilot investigation. Journal of Attention Disorders. April 2014;18(3):236–41.

27. Schwartz DL, et al. Energy drinks and youth self-reported hyperactivity/inattention symptoms. Academic Pediatrics. May–June 2015;15(3):297–304.

28. Ogden CL, et al. Consumption of sugar drinks in the United States, 2005–2008. NCHS Data Brief. August 2011;(71):1–8.

29. Van Lippevelde W, et al. Associations between home- and family-related factors and fruit juice and soft drink intake among 10- to 12-year-old children. The ENERGY project. Appetite. February 2013;61(1):59–65.

30. Ibid.

31. Battram DS, et al. Sugar-sweetened beverages: children’s perceptions, factors of influence, and suggestions for reducing intake. Journal of Nutrition Education and Behavior. January 2016;48(1):27–34.e1.

32. Pettigrew S, et al. Factors influencing the frequency of children’s consumption of soft drinks. Appetite. August 2015;91:393–98.

33. Drewnowski A, et al. Water and beverage consumption among children age 4–13y in the United States: analyses of 2005–2010 NHANES data. Nutrition Journal. June 19, 2013;12:85.

34. Park S, et al. Mothers’ child-feeding practices are associated with children’s sugar-sweetened beverage intake. Journal of Nutrition. April 2015;145(4):806–12.

35. Micha R, et al. Glycaemic index and glycaemic load of breakfast predict cognitive function and mood in school children: a randomised controlled trial. British Journal of Nutrition. November 2011;106(10):1552–61.

36. Fischer K, et al. Carbohydrate to protein ratio in food and cognitive performance in the morning. Physiology and Behavior. March 2002;75(3):411–23.

37. Cooper SB, et al. Breakfast glycaemic index and exercise: combined effects on adolescents’ cognition. Physiology & Behavior. February 2015;139:104–11.

38. Ingwersen J, et al. A low glycaemic index breakfast cereal preferentially prevents children’s cognitive performance from declining throughout the morning. Appetite. July 2007;49(1):240–44.

39. Baum JI, et al. Breakfasts higher in protein increase postprandial energy expenditure, increase fat oxidation, and reduce hunger in overweight children from 8 to 12 years of age. Journal of Nutrition. October 2015;145(10):2229–35.

40. Conners CK & Blouin AG. Nutritional effects on behavior of children. Journal of Psychiatric Research. 1982–1983;17(2):193–201.

41. Leidy HJ, et al. Consuming high-protein soy snacks affects appetite control, satiety, and diet quality in young people and influences select aspects of mood and cognition. Journal of Nutrition. July 2015;145(7):1614–22.

42. Stevens LJ. Solving the Puzzle of Your ADD/ADHD Child: Natural Alternatives for Hard-to-Raise Children. Springfield, IL: Charles C Thomas Pub Ltd; 2016.

43. Walsh S. How to get your kids to eat protein. Children’s Healthcare of Atlanta. Available at http://www.strong4life.com/blog/getting-your-picky-eater-to-eat-protein.

CHAPTER 9 A Natural Alternative to ADHD Drugs

1. Bornstein RA, et al. Plasma amino acids in attention deficit disorder. Psychiatry Research. September 1990;33(3):301–6.

2. Johansson J, et al. Altered tryptophan and alanine transport in fibroblasts from boys with attention-deficit/hyperactivity disorder (ADHD): an in vitro study. Behavioral and Brain Functions. September 24, 2011;7:40.

3. Kötting WF, et al. Effects of tryptophan depletion on reactive aggression and aggressive decision-making in young people with ADHD. Acta Psychiatrica Scandinavica. August 2013;128(2):114–23.

4. Zimmermann M, et al. The effects of acute tryptophan depletion on reactive aggression in adults with attention-deficit/hyperactivity disorder (ADHD) and healthy controls. PLoS One. 2012;7(3):e32023.

5. Edden RA, et al. Reduced GABA concentration in attention-deficit/hyperactivity disorder. Archives of General Psychiatry. July 2012;69(7):750–53.

6. Ende G, et al. Impulsivity and aggression in female BPD and ADHD patients: association with ACC glutamate and GABA concentrations. Neuropsychopharmacology. January 2016;41(2):410–18.

7. Hinz M, et al. Treatment of attention deficit hyperactivity disorder with monoamine amino acid precursors and organic cation transporter assay interpretation. Neuropsychiatric Disease and Treatment. January 26, 2011;7:31–38.

8. Ibid.

9. Coleman M, et al. A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: a double-blind crossover comparison with methylphenidate. Biological Psychiatry. October 1979;14(5):741–51.

10. Manor I, et al. Attention benefits after a single dose of metadoxine extended release in adults with predominantly inattentive ADHD. Postgraduate Medicine. September 2014;126(5):7–16.

11. Manor I, et al. Efficacy of metadoxine extended release in patients with predominantly inattentive subtype attention-deficit/hyperactivity disorder. Postgraduate Medicine. July 2013;125(4):181–90.

12. Dolina S, et al. Attention-deficit hyperactivity disorder (ADHD) as a pyridoxine-dependent condition: urinary diagnostic biomarkers. Medical Hypotheses. January 2014;82(1):111–16.

13. Adriani W, et al. Acetyl-L-carnitine reduces impulsive behaviour in adolescent rats. Psychopharmacology. November 2004;176(3–4):296–304.

14. Torrioli MG, et al. A double-blind, parallel, multicenter comparison of L-acetylcarnitine with placebo on the attention deficit hyperactivity disorder in fragile X syndrome boys. American Journal of Medical Genetics. April 1, 2008;146A(7):803–12.

15. Van Oudheusden LJ & Scholte HR. Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder. Prostaglandins, Leukotrienes, and Essential Fatty Acids. July 2002;67(1):33–38.

16. Sharif MR, et al. The relationship between serum vitamin D level and attention deficit hyperactivity disorder. Iranian Journal of Child Neurology. Fall 2015;9(4):48–53.

17. Goksugur SB, et al. Vitamin D status in children with attention-deficit-hyperactivity disorder. Pediatrics International. August 2014;56(4):515–19.

CHAPTER 10 The Finally Focused Lifestyle: Deep Sleep and Regular Exercise

1. Efron D, et al. Use of sleep medication in children with ADHD. Sleep Medicine. April 2014;15(4):472–75.

2. Bonuck K, et al. Sleep-disordered breathing in a population-based cohort: behavioral outcomes at 4 and 7 years. Pediatrics. April 2012;129(4):e857–65.

3. Murphy, K. Attention problems may be sleep-related. New York Times. April 16, 2012. Available from www.well.blogs.nytimes.com/​2012/​04/​16/​attention-problems-may-be-sleep-related.

4. Chervin RD, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics. April 2006;117(4):e769–78.

5. Li S, et al. Sleep problems in Chinese school-aged children with a parent-reported history of ADHD. Journal of Attention Disorders. July 2009;13(1):18–26.

6. Paruthi S, et al. Recommended amount of sleep for pediatric populations: a statement of the American Academy of Sleep Medicine. Journal of Clinical Sleep Medicine. June 15, 2016;12(6):785– 86.

7. Chang YS, et al. Melatonin supplementation for children with atopic dermatitis and sleep disturbance: a randomized clinical trial. JAMA Pediatrics. January 2016;170(1):35–42.

8. Lyon MR, et al. The effects of L-theanine (Suntheanine®) on objective sleep quality in boys with attention deficit hyperactivity disorder (ADHD): a randomized, double-blind, placebo-controlled clinical trial. Alternative Medicine Review. December 2011;16(4):348– 54.

9. Yamadera W, et al. Glycine ingestion improves subjective sleep quality in human volunteers, correlating with polysomnographic changes. Sleep and Biological Rhythms. 2007;5(2):126–31.

10. Inagawa K, et al. Subjective effects of glycine ingestion before bedtime on sleep quality. Sleep and Biological Rhythms. 2006;4(1): 75– 77.

11. Bannai M & Kawai N. New therapeutic strategy for amino acid medicine: glycine improves the quality of sleep. Journal of Pharmacological Sciences. 2012;118(2):145–48.

12. Moturi S & Avis K. Assessment and treatment of common pediatric sleep disorders. Psychiatry. June 2010;7(6):24–37.

13. Hiscock H, et al. Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. British Medical Journal. January 20, 2015;350:h68.

14. Konofal E, et al. Sleep and ADHD. Sleep Medicine. August 2010;11(7):652–58.

15. Hamblin J. Exercise is ADHD medication. The Atlantic. September 29, 2014. Available from www.theatlantic.com/​health/​archive/​2014/​09/​exercise-seems-to-be-beneficial-to-children/​380844.

16. Hillman CH, et al., Effects of the FITKids randomized controlled trial on executive control and brain function. Pediatrics. October 2014;134(4):e1063–71.

17. Silva AP, et al. Measurement of the effect of physical exercise on the concentration of individuals with ADHD. PLoS One. March 24, 2015;10(3):e0122119.

18. Weiss MD, et al. The screens culture: impact on ADHD. Attention Deficit and Hyperactivity Disorders. December 2011;3(4):327–34.

19. Swing EL, et al. Television and video game exposure and the development of attention problems. Pediatrics. August 2010;126(2):214–21.

20. Ferguson CJ. The influence of television and video game use on attention and school problems: a multivariate analysis with other risk factors controlled. Journal of Psychiatric Research. June 2011;45(6):808–13.

CHAPTER 11 Improving Attention, One Breath at a Time

1. Kabat-Zinn J. Mindfulness-based interventions in context: past, present, and future. Clinical Psychology: Science and Practice. 2003;10(2):144–56.

2. van de Weijer-Bergsma E, et al. The effectiveness of mindfulness training on behavioral problems and attentional functioning in adolescents with ADHD. Journal of Child and Family Studies. October 2012;21(5):775–87.

3. Zylowska L, et al. Mindfulness meditation training in adults and adolescents with ADHD: a feasibility study. Journal of Attention Disorders. May 2008;11(6):737–46.

4. Cassone AR. Mindfulness training as an adjunct to evidence-based treatment for ADHD within families. Journal of Attention Disorders. February 2015;19(2):147–57.

5. van der Oord S, et al. The effectiveness of mindfulness training for children with ADHD and mindful parenting for their parents. Journal of Child and Family Studies. February 2012;21(1):139–47.

6. Singh N, et al. Effects of samatha meditation on active academic engagement and math performance of students with attention deficit/hyperactivity disorder. Mindfulness. 2016;7(1):68–75.

7. Cairncross M & Miller CJ. The effectiveness of mindfulness-based therapies for ADHD: a meta-analytic review. Journal of Attention Disorders. February 2, 2016.

8. Zylowska L, Smalley SL, & Schwartz JM. Mindful awareness and ADHD in Clinical Handbook of Mindfulness. New York: Springer Science + Business Media; 2009:319–38.

9. Ibid.

10. Mitchell JT, et al. Mindfulness meditation training for attention-deficit/hyperactivity disorder in adulthood: current empirical support, treatment overview, and future directions. Cognitive and Behavioral Practice. May 2015;22(2):172–91.

11. Ibid.

12. Grosswald SJ, et al. Use of the transcendental meditation technique to reduce symptoms of attention deficit hyperactivity disorder (ADHD) by reducing stress and anxiety: an exploratory study. Current Issues in Education. 2008;10.

13. Mehta S, et al. Multimodal behavior program for ADHD incorporating yoga and implemented by high school volunteers: a pilot study. ISRN Pediatrics. 2011:780745.

14. Greenland SK. The Mindful Child: How to Help Your Kid Manage Stress and Become Happier, Kinder, and More Compassionate. New York: Free Press; 2010.

15. Zylowska L. The Mindfulness Prescription for Adult ADHD: An Eight-Step Program for Strengthening Attention, Managing Emotions, and Achieving Your Goals. Boston: Trumpeter; 2012.

16. Mani M, et al. Review and evaluation of mindfulness-based iPhone apps. JMIR Mhealth and Uhealth. August 19, 2015;3(3):e82.

CHAPTER 12 ADHD Medication—Minus the Side Effects

1. Strohl MP. Bradley’s Benzedrine studies on children with behavioral disorders. Yale Journal of Biology and Medicine. March 2011;84(1):27– 33.

2. Bradley C. The behavior of children receiving benzedrine. American Journal of Psychiatry. 1937;94:577–85.

3. Ibid.

4. Ibid.

5. Strohl MP. Bradley’s Benzedrine studies on children with behavioral disorders. Yale Journal of Biology and Medicine. March 2011;84(1):27– 33.

6. Express Scripts Lab. Turning attention to ADHD: U.S. medication trends for attention deficit hyperactivity disorder. Express Scripts Holding Company. March 2014. Available from http://lab.express-scripts.com/​lab/​insights/​industry-updates/​~/​media/​89fb0aba100743b5956ad0b5ab286110.ashx.

7. Visser SN, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child Adolescent Psychiatry. January 2014;53(1):34–46.e2.

8. Express Scripts Lab. Turning attention to ADHD: U.S. medication trends for attention deficit hyperactivity disorder. Express Scripts Holding Company. March 2014. Available from http://lab.express-scripts.com/​lab/​insights/​industry-updates/​~/​media/​89fb0aba100743b5956ad0b5ab286110.ashx.

9. Punja S, et al. Amphetamines for attention deficit hyperactivity disorder (ADHD) in children and adolescents. Cochrane Database of Systematic Reviews. February 4, 2016;2:CD009996.

10. Sallee FR. Early morning functioning in stimulant-treated children and adolescents with attention-deficit/hyperactivity disorder, and its impact on caregivers. Journal of Child and Adolescent Psychopharmacology. September 2015;25(7):558–65.

11. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report: Emergency Department Visits Involving Attention Deficit/Hyperactivity Disorder Stimulant Medications. January 24, 2013. Rockville, MD. Available from www.samhsa.gov/​data/​sites/​default/​files/​DAWN073/​DAWN073/​sr073-ADD-ADHD-medications.pdf.

12. Visser SN, et al. Vital signs: national and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2–5 years—United States, 2008–2014. MMWR Morbidity and Mortality Weekly Report. May 6, 2016;65(17):443–50.

13. Ibid.

14. Howard JT, et al. Preliminary evidence of an association between ADHD medications and diminished bone health in children and adolescents. Journal of Pediatric Orthopaedics. September 20, 2015.

15. Gallucci AR & Martin RJ. Misuse of prescription stimulant medication in a sample of college students: examining differences between varsity athletes and non-athletes. Addictive Behaviors. December 2015;51:44–50.

16. Brown RP & Patricia GL. The Rhodiola Revolution: Transform Your Health with the Herbal Breakthrough of the 21st Century. Emmaus, PA: Rodale; 2005.

CHAPTER 13 Parenting-Plus: Key Strategies for Better Behavior

1. Subcommittee on Attention-Deficit/Hyperactivity Disorder, et al. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. November 2011;128(5):1007–22.

2. Musser ED, et al. Attention-deficit/hyperactivity disorder developmental trajectories related to parental expressed emotion. Journal of Abnormal Psychology. February 2016;125(2):182–95.

3. Barkley, RA. Taking Charge of ADHD: The Complete, Authoritative Guide for Parents (3rd ed.). New York: Guilford Press; 2013.

4. Hammer R, et al. Functional neuroimaging of visuospatial working memory tasks enables accurate detection of attention deficit and hyperactivity disorder. Neuroimage: Clinical. September 1, 2015;9:244–52.

5. Ibid.

6. Goodwin TB. Navigating ADHD: Your Guide to the Flip Side of ADHD. Bloomington, IN: AuthorHouse; 2011.

7. Gilman L. Career advice from the corner office: famous people with ADHD. ADDitude Magazine. December/January 2005.

8. Novotni M. Support groups for parents of children with ADHD. ADDitude Magazine. Available from www.additudemag.com/​adhd/​article/​2535.html.

9. Frigerio A & Montali L. An ethnographic-discursive approach to parental self-help groups: the case of ADHD. Qualitative Health Research. June 2016;26(7):935–50.

10. Seebohm P, et al. The contribution of self-help/mutual aid groups to mental well-being. Health and Social Care in the Community. July 2013;21(4):391–401.

11. Wiener J, et al. Parenting stress of parents of adolescents with attention-deficit hyperactivity disorder. Journal of Abnormal Child Psychology. April 2016;44(3):561–74.

JAMES GREENBLATT, M.D., is board-certified in both child and adult psychiatry, and has treated thousands of children and adults with ADHD over the past thirty years using a unique science-based approach that combines both natural and medical therapeutics. During his career, Dr. Greenblatt has trained and supervised medical professionals in integrative strategies for depression, anxiety, obsessive-compulsive disorder, and schizophrenia, and currently serves as chief medical officer and vice president of medical services at Walden Behavioral Care in Waltham, Massachusetts. Dr. Greenblatt is also on the clinical faculty of Tufts Medical School and Dartmouth’s Geisel School of Medicine. His previous books include Breakthrough Depression Solution, Answers to Binge Eating, and Answers to Anorexia. www.finallyfocusedbook.com

BILL GOTTLIEB, CHC, is the author of sixteen health books that have sold three million copies and have been translated into ten languages; a health journalist whose articles have appeared in Prevention, Men’s Health, Bottom Line Health, and many other magazines and periodicals; a health coach certified by the American Association of Drugless Practitioners; and the former editor in chief of Rodale Books and Prevention Magazine Health Books. www.billgottliebhealth.com

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