A Western Diet Can Worsens ADHD

A Western Diet Can Worsens ADHD

Some patients do not respond to ADHD Inattentive medication and in some patients ADHD medication is not indicated because of co-occurring conditions such as Tourette’s Syndrome, Anxiety or other side effects. In patients with Sluggish Cognitive Tempo and Inattentive ADHD treatment failures may be more common. Pyschiatrist and mental health specialist are coming around to believing that for a certain subgroup of patients with ADHD symptoms, dietary changes may be the answer.

According to J. Gordon Millichap, MD, and Michelle M. Yee, CPNP, of Children's Memorial Hospital in Chicago, a great alternative to traditional treatment is an ADHD diet treatment regimen.  They report that diet treatment is especially helpful for:

• Parents of children that do not respond to medications
• Parents that want an alternative to medications 
• Children that may have dietary vitamin or mineral deficiencies.

Their findings, just published in the Online version of the journal Pediatrics concluded that a diet that was low in saturated fats, high in fruits, vegetables and grains was one of the very best alternatives to drug therapy. The also noted that Omega-3 and omega-6 fatty acid supplements had been shown, in well performed controlled studies, to help with ADHD symptoms.

Millichap and Yee did a literature review of 70 trials that used diet as a medical intervention for the treatment of ADHD symptoms and found the following:

• Diet was an intervention that was easy for parents to implement. 
• The symptoms of ADHD were significantly associated with "Western" diets. 
• Children with allergies have improved ADHD symptoms when foods that contain colorings, preservatives, and allergens such a wheat, dairy, nuts and citrus are restricted. 
• Zinc and iron deficiency may cause symptoms in a small group of patients with ADHD and confirmed deficiencies should receive supplements or appropriate dietary adjustments. 
• The best trial performed to date on the Omega-3 and Omega-6 fatty acids confirmed that these supplements are helpful for the treatment of ADHD symptoms. 

Regarding fatty acid supplementation, Yee and Millichap reported that other trials that have failed to confirm benefits may have failed to do so because the researchers of those trials used too many different methodologies to come to any firm conclusions. They also report that they, themselves, now recommend these supplements to their patients but not as a sole treatment for ADHD symptoms or Inattentive ADHD symptoms.

The researchers are quoted as saying the following: "Supplemental diet therapy is simple, relatively inexpensive, and more acceptable to patient and parent,"

Millichap and Yee concluded. "Public education regarding a healthy diet pattern and lifestyle to prevent or control ADHD may have greater long-term success."

Inattentive ADD, ADHD and the DSM V

Inattentive ADD, ADHD and the DSM V

I have not posted in a long time about the proposed changes to the Psychiatric Diagnostic Manual, the DSM, which is used to diagnose all mental impairments including ADHD.   The reason for this is not neglect but rather there has not been much new to say.

What is new now is the fact that there appears to be so little clarification to the question of what will happen to the ADHD subtypes even though the deadline for the proposed new edition is just 12 months away.

 The manual, that last had a major revision 1994, is called the DSM IV.   It is the fourth edition of the diagnostic manual but now almost 20 years latter, a new manual is necessary.   Much has changed in psychiatry and psychiatrists have been working on the revised version of the manual, the DSM V for over two years.

The new manual was supposed to sort out, among other things, whether there was value in dividing ADHD into three subtypes. The subtypes were developed for the DSM-IV but they have been found to be both helpful and problematic.

The subtypes are helpful because they establish and recognize that there is a subgroup of people with attention deficits that are not inattentive because of hyperactivity and impulsive behavior. The subtypes however are confusing because calling something without hyperactivity, Attention Deficit Hyperactivity Disorder, makes no sense. It is also confusing because the grouping has had the affect, in my opinion, of having psychiatrist treat ADHD, regardless of subtype, much the same.

The two conditions both have Executive Function problems but the problems that they have are not the same. People with Inattentive ADHD do not have the debilitating emotional control and impulse problems of the Combined type though they do have in common much of the organization, time management, motivation and perseverance problems.

There are many conditions in the DSM-IV that also have executive function issues and they are not all lumped into one diagnostic pile. People with Post Traumatic Stress Disorder, Depression and schizophrenia all have executive function problems but they are not all lumped into the same DSM category.

The American Psychiatric Association (APA) was hoping to have some empirical data (research findings, scholarly analysis, etc) to inform them of how to best sort out the entire subtype dilemma by February of 2013 and they still may make their deadline.

Functional MRI studies are shedding light on the ways that the brains of the Inattentive and the Sluggish are different from the brains of the impulsive and the hyperactive and there are some extremely brilliant people working this out. Hopefully they will come to a conclusion that improves recognition, diagnosis and treatment of all the subtypes of ADHD as that, after all, is the goal.

Two other proposed ideas for the new DSM had to do with the age of diagnosis and the number of symptoms that had to be present to determine if there was a 'true' ADHD diagnosis. Currently the DSM-IV states that for you to be diagnosed with ADHD, you have to have had symptoms before the age of seven and that you have to have 'X' number of these symptoms or 'X' number of that symptom.

The symptom number is an issue because as people age, their hyperactivity symptoms can improve or they may control their impulses better than they did when they were six, but they are still impaired despite not having the exact number of symptoms needed for a diagnosis. The age of onset stipulation is also problematic and especially detrimental to those with Inattentive ADHD because Inattentive ADHD kids can sit in a classroom until middle school without anyone noticing that they are not focused on school.

These latter two issues will likely be clarified in the new DSM-V but only time will tell if the APA is able to sort out the subtype issues before the February 2013 deadline for the publication of the new edition.

Inattentive ADHD, Baby Boomers and the Aging Brain's Default Mode

The world works in mysterious ways. People with Inattentive ADHD and Sluggish Cognitive Tempo (SCT) may finally get more scientific insight into what is causing their symptoms thanks to Baby Boomers and a new discovery called the Brain's Default Mode.

As the cohort of Baby Boomers age, this huge demographic is driving research into what happens to our aging brains that make us forgetful, mentally slower, unfocused and unable to tune out irrelevant distractions.

I have just finished a book called The Secret Life of the Grown Up Brain by Barbara Strauch and I was struck by how the aging brain resembles the brain of people with Inattentive ADHD. Researchers are now, with Pet Scans and other diagnostic tools, able to see a decrease in brain cell communication in the aging brain, they are able to actually see the brain daydreaming and they have just discovered a brand new brain state which they have called the Brain's Default Mode.

This default mode is described by researchers as a brain mode where the brain is distracted by silent but continuous chatter. This is the part of the brain that when you are doing nothing starts thinking thoughts like, 'Boy, that cobweb on the wall has an interesting pattern and maybe I will make a design on my notebook with that pattern..."

Apparently, as the brain ages, it's ability to switch off the default mode starts to become less efficient and scientist are now seeing that older individuals have poorer memories, slower processing speeds and are less focused because, during problem solving, they use their prefrontal cortex less and the default mode of their brain more.

Using scanners, neuroscientist at the University of California at Berkeley have been able to see the aging brain struggle to maintain focus. The researchers did a study where they showed older adults faces and scenes and told them to concentrate on the faces. The older adults were able to focus but it took them longer, their processing speeds were slower, because they were less able to filter out the distractions of the scenes that accompanied the faces.

Does this not sound familiar? Inattentive ADHD (ADHD-PI)could be the results of our brains being stuck in default mode. It not only explains our problems with working memory and focus, it also explains why some of us have Sluggish Cognitive Tempo. The great news is that Baby Boomers are also driving research into the interventions that will keep us from getting stuck in the brain's default mode.

The aging brain does not look as much like the Combined type or the Hyperactive type of ADHD but it does look an awful lot like Inattentive ADHD and Sluggish Cognitive Tempo. Hopefully all this new research on the aging brain will, inadvertently, turn out to bring more insight into what is going on in the brains of people with ADHD-PI and SCT.