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Attention deficit hyperactivity disorder (ADHD)

Attention deficit hyperactivity disorder (ADHD) is the most common behavioral disorder in children affecting approximately 4 to 5 million children in the United States. Behavioral measures and pharmacotherapy are the cornerstone of medical management of ADHD with stimulant drugs the mainstay of treatment for more than 60 years. Since up to 30% or more of children do not respond to pharmacotherapy many families and physicians alike look to diet and nutrient interventions as an adjunct in long term management of this disorder.

In the USA the prevalence of ADHD in school age children is estimated between 3 and 10%. Onset is typically between age four and seven years with boys affected six times more than girls. ADHD may persist in adulthood in 40-60%. The core features include developmentally inappropriate inattention, impulsivity and hyperactivity. The precise cause remains unknown, but ADHD appears to have a multifactorial etiology including genetic, biological and environmental contributors.

The initial work up of a child should include thyroid studies, iron status and evaluation for lead toxicity. Reinforce eating a whole foods well balanced diet with minimal processed and artificial foods. Encourage the entire family to eat healthier so as not to single out the child. Reduce sugary foods and beverage, being careful also of sugar substitutes. Breakfast with complex carbohydrates and protein can help maintain steady blood sugar levels. Encourage eating fatty fish three times weekly or alternatively, consider supplementation with omega 3 fatty acids. Supplementation with B vitamins, zinc and carnitine are also helpful. Behavioral therapy and mind body approaches can be employed. Evaluate sleep quality and quantity as imbalances of nutrients associated with ADHD can interfere with sleep.

This is a complex problem and pharmacotherapy may not give the desired results. Many practitioners are thus turning to nutrition, diet and lifestyle to treat the disorder.

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