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Chinese medicine and ADD/ADHD: an integrative approach.

Attention deficit disorder (ADD) or attention deficit/hyperactivity disorder (ADHD) is considered to be a neurobehavioral disorder. It interferes with a person's ability to stay on a task and to exercise age-appropriate inhibition (cognitive alone or both cognitive and behavioral). Some of the warning signs of ADHD include failure to listen to instructions, inability to organize oneself and schoolwork, fidgeting with hands and feet, talking too much, leaving projects, chores and homework unfinished, and having trouble paying attention to and responding to details. There are several types of ADHD: a predominantly inattentive subtype, a predominantly hyperactive-impulsive subtype, and a combined subtype. ADHD is usually diagnosed in childhood. However, this condition most often continues into adulthood. (1)

It is estimated that 4.5 million youth ages 4 through 17 have been diagnosed with ADHD by a healthcare professional, and as of 2003, 2.5 million youth ages 4 through 17 are currently receiving medication for the disorder. In 2003, 7.8% of school-aged children were reported to have an ADHD diagnosis by their parent. The diagnosis of ADHD has increased by an average of 3% per year from 1997 to 2006. (23)

The standard medications for this condition are called stimulants. The most commonly used stimulants are various preparations of Ritalin (methylphenidate) or Adderall (amphetamine salts). Both of these pharmaceuticals are powerful central nervous stimulants listed as Schedule II drugs under the Controlled Substances Act due to their highly addictive nature. (4) While stimulant drugs have been shown to reduce the core symptoms of ADHD, the jury is still out on how safe these pharmaceuticals are for children. Some studies have shown that Ritalin use can affect growth and development in preadolescent children, as well as trigger cardiac conditions. (5), (6) Many people develop a tolerance to stimulants, wherein they have to keep increasing the dose to achieve the same effect. The side effects of these medications can be troubling. They include decreased appetite, weight loss, digestive disorders, emotional lability, insomnia, and hypertension (to name a few). (7) Stimulants do not cure ADHD, they just treat the symptoms. At present, there is no known cure for ADHD.

I began researching ADHD treatment from a Traditional Chinese Medicine (TCM) and nutritional perspective four years ago. At the time, I was treating some college students with the disorder at the UCLA Arthur Ashe Student Health and Wellness Center. I have discovered, over time, that an integrative approach incorporating acupuncture therapies (with or without needles), herbs, nutritional counseling, and supplementation can have a dramatic effect on the symptoms of ADHD.

Acupuncture has an effect on brain chemistry and the central nervous system. In its 1997 Consensus Development Conference Statement, the National Institutes of Health (NIH) reported that acupuncture "activate(s) the hypothalamus and the pituitary gland, resulting in a broad spectrum of systemic effects. Alteration in the secretion of neurotransmitters and neuro-hormones and changes in the regulation of blood flow, both centrally and peripherally, have been documented (with acupuncture)." (8) Research has shown that the hypothalamus-pituitary axis (as well as the CNS in general) plays a role in ADHD. (9) The hypothalamus assists in the production of dopamine. It is strongly suspected that low levels of dopamine in the brain play an important role in the ADHD process. Dopamine is a neurotransmitter that is involved with memory, attention, motivation, and problem solving. A study in 2009 furthered the case that ADHD may be related to a reduction in dopamine activity. (10) Acupuncture, through its regulatory effect on the production of neurohormones and neurotransmitters, can help to regulate dopamine production. As also noted in the NIH Consensus, acupuncture helps to stimulate blood circulation. Acupuncture helps to stimulate blood flow to the brain. Acupuncture can be administered with needles, finger pressure (acupressure), and/or laser. Both acupressure and laser therapy are completely needle-free and suitable for young children.

There is also auricular (ear) acupuncture. The ear is a microcosm of the whole body in TCM. There are ear points that have direct correlations to the hypothalamus gland, the pituitary gland, the sympathetic nervous system, and the brain. "Ear seeds" are applied to specific points in the ear with an adhesive tape and can be left in for one to two weeks. These are tiny balls that don't actually pierce the skin; they just apply steady pressure on a specific point. This type of therapy is extremely effective for children with ADHD."

From a TCM internal medicine standpoint, there are different patterns of imbalance that can manifest as symptoms of ADHD. With children, even though they may individually present with different internal patterns, the root cause tends to be what is called Spleen Qi Deficiency. The spleen, in TCM, is one of the few organs in which the function is different from its Western counterpart: it relates to digestion and assimilation of nutrients, similar to the function of the pancreas in Western physiology. The pancreas produces digestive enzymes that aid in the assimilation and breakdown of carbohydrates, proteins, and fats. The TCM spleen organ serves a similar function as well. The digestive function of children with ADHD, autism spectrum disorders, and other learning disabilities tends to be weak and inefficient. With a weak digestive system, nutrients aren't absorbed properly. When nutrients aren't absorbed properly, the child begins to suffer from malnutrition. With malnutrition, the body, especially the brain, cannot function at optimum capacity. This has a terrible domino effect, leading to all sorts of problems both physically and mentally. Even if the child has relatively "good" eating habits (which most children don't), it can be for naught if they aren't absorbing properly. The most common nutritional deficiencies seen in ADHD tend to be amino acids, fatty acids, minerals, as well as the B-complex vitamins. There are numerous reasons why children have impaired digestion. Chronic antibiotic use (as an infant or older), food sensitivities (which are different from allergies), environmental toxins, and a weakened immune system can all lead to impaired absorption. It is the initial process to determine the root cause of this impaired absorption so that it can be corrected. The good news is that all of these situations can be addressed effectively with an integrative approach. There are nutritional and neurotransmitter lab tests that can point directly to the specific area(s) where the imbalances exist. With acupuncture, herbs, dietary counseling and nutritional supplementation the symptoms can be reduced or eliminated altogether. In addition, an integrative approach can help to balance out the side effects and reduce the tolerance of stimulant medication. While real ADHD may not be "caused" by diet or food sensitivities, these factors can definitely exacerbate the condition.

In certain situations, stimulants can be effective if used judiciously and in combination with other therapies. However, I have found, through working with many children with a "diagnosis" of ADHD, that stimulants are overprescri bed. There are children on stimulants who do not actually have real ADHD. Many times in these situations an integrative approach, alone, is enough. Real ADHD must be treated in some fashion. Untreated ADHD can cause numerous problems that can follow your child into adulthood, affecting school performance, finances, relationships, and career. If your child has received a diagnosis of ADHD, a comprehensive approach is essential. You should work with a holistic-minded physician, a cognitive/behavioral therapist, a psychologist, and an integrative health-care practitioner. The practitioners you work with should all have a solid understanding of ADHD. It is a unique condition and requires health-care practitioners with a specialized knowledge in this area.

Notes

(1.) National Institute of Neurological Disorders and Stroke. NINDS attention deficit-hyperactivity disorder information page [online document]. http://www.ninds.nih.gov/disorders/adhd/adh.htm.

(2.) US Centers for Disease Control. Attention-deficit / hyperactivity disorder (ADHD): data & statistics in the United States [online document]. http://www.cdc.gov/ncbdddiadhd/data.html.

(3.) Ibid. Medication treatment.

(4.) Controlled Substances Act: Schedule II controlled substances [online document]. Wikipedia. http://en.wikipedia.org/wiki/Controllecl_Substances_Act#Schedule_ll_controlled_substances.

(5.) DeNoon DJ. ADHD drug does stunt growth [online article]. WebMD. July 20, 2007. http:// www.webmd.com/add-adhd/news/20070720/adhd-drug-does-stunt-growth.

(6.) Boyles S. ADHD Drugs: sudden death risk higher? [online article]. WebMD. June 15, 2009. http:// www.webtrid.com/add-adhd/news/20090615/adhd-drugs-sudden-death-risk-higher?page=2.

(7.) Drugs & medications--Adderall oral [online document]. WebMD. http://www.webmd.com/drugs/drug-63163-Adderall+Oral.aspx?drugid=63163&drugname--Adderall+Oral.

(8.) National Institutes of Health. Acupuncture. NIH Consensus Statement [online document]. 1997 Nov 3-5;15(5):1-34. http://consensus.nih.gov/1997/1997Acupuncture107html.htm

(9.) Van West D, Claes S, Deboutte D. Differences in hypothalamic--pituitary--adrenal axis functioning among children with ADHD predominantly inattentive and combined types. Eur Child Adolesc Psychiatry. 18(9):543-553;doi:10.1007/s00787-009-0011-1. Available at: http://www.springerlink.com/content118738362h7502762/

(10.) Phend C. Low dopamine implicated in ADHD attention symptoms [online article]. WebMD. Sept. 8, 2009. http://www.medpagetoday.com/Pediatrics/ADHD-ADD/15872.

(11.) Medical acupuncture treats ADHD without drugs [online press release]. American Academy of Medical Acupuncture. August 16, 2000, http://www.medicalacupuncture.org/acu_info/pressrelease/adhd.html.

by Noah Samuels, LAc, Dipl OM

Noah Samuels, LAc, Dipl OM, is an acupuncturist, herbalist, and nutritional consultant. He is licensed in the District of Columbia and Maryland. He specializes in ADD/ADHD and autism spectrum disorders. Noah practices at Pekoe Acupuncture and Wellness in Washington, DC. He can be reached at tcmnoah@gmail.com. Website: http://www.PekoeDC.net.
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Title Annotation:attention deficit disorder or attention deficit/hyperactivity disorder
Author:Samuels, Noah
Publication:Townsend Letter
Geographic Code:1USA
Date:Oct 1, 2013
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