Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder among children and adults. ADHD can significantly affect various aspects of life, including school, work, and personal relationships. Naturopathic doctors have an essential role in educating the public about ADHD and how they can assist people with this condition.
Understanding ADHD
ADHD is characterized by persistent patterns of inattention, hyperactivity, and impulsivity. Individuals with ADHD may struggle to stay focused, organize tasks, manage time, and control impulsive behaviors. These challenges can lead to difficulties at school, work, and in social settings. Estimates vary, but ADHD affects about 8% to 11% of U.S. children and 4% to 5% of U.S. adults.1Goodman DW, Thase ME. Recognizing ADHD in adults with comorbid mood disorders: implications for identification and management. Postgrad Med. 2009;121(5):31-41. https://doi.org/10.3810/pgm.2009.09.2049 An estimated two-thirds of people with ADHD are treated with medication; less than half receive behavioral or psychotherapy interventions; and about 20% do not pursue treatment after diagnosis.
ADHD diagnoses have increased over the past decades. One theory associates this surge with greater ADHD awareness and stigma reduction, leading more people to seek evaluation. Another relates to social media. In a study of 2,587 adolescents, a modest statistical correlation between social media use and ADHD symptoms indicated association but not causation, an important distinction.2Ra CK, Cho J, Stone MD, et al. Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA. 2018;320(3):255-263. https://doi.org/10.1001/jama.2018.8931 In addition, people with ADHD may have co-occurring depression and anxiety, conditions that interact with each other. Many people with ADHD experience significantly lower anxiety levels with treatment, as they report having fewer distracting thoughts, feeling calmer and more present, and gaining a sense of productivity and effectiveness in organizing and attending to their tasks.
A Naturopathic Doctor’s Role in ADHD Diagnosis
As primary care providers, naturopathic doctors (NDs) can screen and evaluate people for ADHD and refer patients to specialized providers (psychiatrists, psychiatric nurse practitioners, and psychologists) for a more comprehensive evaluation. NDs also facilitate the diagnostic process by evaluating for other medical and behavioral health issues that mimic ADHD, such as thyroid disease, sleep apnea, insomnia, hormonal changes, anxiety, and depression.
Developing a Treatment Plan
Once an ADHD diagnosis is confirmed, naturopathic doctors collaborate with patients, their families, and specialists to develop a personalized treatment plan. This often involves a multimodal approach, combining various strategies for optimal symptom management and overall well-being.
Nutrition
Nutrition plays an important role in managing ADHD. A literature review3Ahn J, Ahn HS, Cheong JH, Dela Peña I. Natural product-derived treatments for attention-deficit/hyperactivity disorder: Safety, efficacy, and therapeutic potential of combination therapy. Neural Plast. 2016;2016:1320423. https://doi.org/10.1155/2016/1320423 summarized various natural substances for which randomized controlled trial data showed improved ADHD symptoms. Examples include essential fatty acids, zinc, magnesium, L-carnitine, ginkgo, and ginseng. One clinical trial among children saw global benefits with a combination of micronutrient interventions (as opposed to a single, specific micronutrient), noting improvements in growth and height compared with a placebo.4Johnstone JM, Hatsu I, Tost G, et al. Micronutrients for attention-deficit/hyperactivity disorder in youths: A placebo-controlled randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2022;61(5):647-661. https://doi.org/10.1016/j.jaac.2021.07.005 Another review indicated that a healthy diet, including vegetables, fruits, legumes, and fish, reduces ADHD risk when compared with diets high in sugar, meat, and processed foods.5Shareghfarid E, Sangsefidi ZS, Salehi-Abargouei A, Hosseinzadeh M. Empirically derived dietary patterns and food groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis. Clin Nutr ESPEN. 2020;36:28-35. https://doi.org/10.1016/j.clnesp.2019.10.013
Medications
Stimulants, such as Adderall and Ritalin, and non-stimulants, such as Strattera, are often prescribed to improve focus, attention, hyperactivity, and impulse control. They may also cause side effects, which should be discussed in detail with patients. Developing a specific treatment plan that starts with a low dose but titrates upward could reduce the risk of side effects, allow patients to adjust to any side effects, and minimize effects overall. Stimulant medications may suppress appetite, affecting children’s growth and development. NDs help patients and their families design calorie-appropriate and nutritionally dense meal plans that meet health and growth needs.
Behavioral Interventions, Psychotherapy, and Social Support
Interventions and therapy help patients expand self-awareness, knowledge, and skills for coping with and improving ADHD symptoms. Focus areas include prioritization, organization, time management, emotional regulation, impulse control, and communication. Parents can practice these skills with their children at home and model behaviors that will help ensure success at school and in social settings. Advocating environments that promote focus and calm and supporting patients who seek reasonable accommodations are necessary elements of social support.
NDs are equipped to provide behavioral interventions, psychoeducation, nutrition counseling, medication management or referrals, and social support resources. As primary care providers, NDs can guide their patients through a more holistic approach that goes beyond medication as the sole treatment.6Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46. https://doi.org/10.1016/j.jaac.2013.09.001
Footnotes
- 1Goodman DW, Thase ME. Recognizing ADHD in adults with comorbid mood disorders: implications for identification and management. Postgrad Med. 2009;121(5):31-41. https://doi.org/10.3810/pgm.2009.09.2049
- 2Ra CK, Cho J, Stone MD, et al. Association of digital media use with subsequent symptoms of attention-deficit/hyperactivity disorder among adolescents. JAMA. 2018;320(3):255-263. https://doi.org/10.1001/jama.2018.8931
- 3Ahn J, Ahn HS, Cheong JH, Dela Peña I. Natural product-derived treatments for attention-deficit/hyperactivity disorder: Safety, efficacy, and therapeutic potential of combination therapy. Neural Plast. 2016;2016:1320423. https://doi.org/10.1155/2016/1320423
- 4Johnstone JM, Hatsu I, Tost G, et al. Micronutrients for attention-deficit/hyperactivity disorder in youths: A placebo-controlled randomized clinical trial. J Am Acad Child Adolesc Psychiatry. 2022;61(5):647-661. https://doi.org/10.1016/j.jaac.2021.07.005
- 5Shareghfarid E, Sangsefidi ZS, Salehi-Abargouei A, Hosseinzadeh M. Empirically derived dietary patterns and food groups intake in relation with Attention Deficit/Hyperactivity Disorder (ADHD): A systematic review and meta-analysis. Clin Nutr ESPEN. 2020;36:28-35. https://doi.org/10.1016/j.clnesp.2019.10.013
- 6Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53(1):34-46. https://doi.org/10.1016/j.jaac.2013.09.001
