The Latest on Alternative Treatments

Patient Expert

In the past week, both the New York Times and the Washington Post reported on alternative treatments for ADHD, partly because a new study was released showing that St. John's Wort is not an effective treatment for ADHD in children.

The St. John Wort study was published in the June 11, 2008 issue of the Journal of the American Medical Association. Wendy Weber, study author and a research associate professor in the School of Naturopathic Medicine at Bastyr University in Kenmore, WA said this was the first placebo-controlled study of its kind; they found that St. John's Wort was no more effective than a placebo in the children, ages 6-17 that were studied.

Since many parents do use herbal remedies in treating their children with ADHD, she warned that many of these products can create problems, as they can interact with other medications. In fact, herbs like St. John's Wort increase the metabolism of other drugs a child might be taking.

Fifty-four children between the ages of 6 and 17 were recruited for this particular study; all met the diagnostic criteria for ADHD. All of the children were given a placebo the first week; no ADHD meds were allowed. Then, half of the group was given St. John's Wort while the other half received a placebo. Both groups received the pills three times a day for eight weeks. The researchers found no difference in symptom relief between the two groups at the end of the eight weeks.

Dr. Eugenia Chan, director of the ADHD Program at the Developmental Medicine Center at Children's Hospital Boston wrote an editorial in the journal, praising the design of the study. She emphasized the need for parents to "be as critical of complementary and alternative medicines as they are about conventional medicines."

Further, she stated that parents tend to be more comfortable with herbs and other natural supplements, while being leery of stimulants even though little might be known about the side effects of the alternative medications. She questioned whether parents feel safer with herbs because they conjure up the notion of being natural and natural might make parents think they are therefore safer.

"The evidence is definitely lagging far behind the interest," said Chan, who cautioned that these natural substances often are not studied, thus it's hard to know what the risks might be in using them. She recommended that parents discuss with their child's pediatrician whenever an alternative medication is being used.

The June 17, 2008 issue of the New York Times explores the area of alternative ADHD treatment. According to the article, 2/3 of children with ADHD have taken some sort of alternative treatments, with the most common being diet changes. Other non-traditional therapies include herbal, fish oils, vitamins, biofeedback and others. The article points out that there are few studies showing that these alternative treatments are effective, citing the St. John's Wort results. The writer, Tara Parker-Pope, notes that perhaps eight weeks was not a long enough trial, adding that traditional medications can often take up to three months to take effect.

Still, she points out that there are some alternative treatments that show promise, such as Omega-3 fatty acids.

The article points to other studies, such as whether there is a correlation between consuming sugar and food additives and subsequent ADHD symptoms. In the journal, the Lancet, a study reviewed in 2007 showed that hyperactive children who were given additives actually showed an increase in their symptoms.   Before this study, pediatricians were skeptical of the possible link between diet and ADHD.   A February issue of AAP Grand Rounds, a publication of the American Academy of Pediatrics  reports: "The overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong."

Long thought to be a cause of hyperactivity, sugar was not found to be a culprit. Rather, studies show that it was the parents' perception that sugar was problematic.

All in all, parents will continue to look into alternative treatments for their children, but it's very important that they study the research, and make sure the methods are safe and effective. And most of all, it's imperative to discuss these options with the child's pediatrician.