A recent study was published in the New England Journal of Medicine (NEJM) stating that a review of patients who had been taking ADHD medications like Adderall and Ritalin were not shown to have increased risk of heart disease or other cardiovascular diseases like strokes. With more than 2.7 million American children with ADHD, this is an important finding.
This study was funded by the Food and Drug Administration and the Agency for Healthcare Research and Quality. It identified 81 heart attacks, strokes and sudden deaths in the study with more among those taking the medicines than in a comparison group who wasn't on the medication. The study looked at medical records for 1.2 million children and young adults covered by four U.S. health plans and derived its findings based on this systematic review.
The limitation of this study is that the findings of the number of patients who had cardiovascular events were surprisingly low. Could this study size not be large enough to have picked up statistical significance, and would we perhaps benefit more from a confirmatory study of these findings with a larger sample size study? The answer is likely that we would indeed benefit from a larger study to confirm this finding.
However, in the interim, because ADHD can create significant limitations in school and work achievements, and other options can mostly be looked at as only adjunctive therapies, a study such as this helps to allay some of our fears for those who are on the medication until we can further obtain additional confirmatory data.
When I see patients with ADHD, we discuss potential pros and cons of medications such as Ritalin and Adderall. But we also frequently discuss potential alternatives or adjunctive therapeutic options for ADHD as well.
With a recent study as the one published in NEJM, patients who are on the stimulant medications may decide they want to continue on the medications. However, some of the options for adjunctive therapies may also be worth looking into so as to optimize daily functionality in the work place, home and school environment.
Clinically, there are some indications that avoidance of food preservatives, food allergens and processed foods is a good idea for those dealing with ADHD. There is also suggestion that supplements such as fish oil may be beneficial. In this article, I would like to discuss a few other behavioral options as well that have been seen to potentially be helpful with ADHD as adjunctive therapies.
1. Positive parenting and relationship training is essential to ADHD therapy. The American Academy of Pediatrics recommends behavioral therapy programs for children with ADHD. Although behavioral therapy programs are best utilized in conjunction with medications, the adjunctive therapy is seen to be very beneficial for ADHD therapy. Training programs where parents are taught to reward good behavior instead of reprimanding bad behavior have led to positive long-term benefits for those dealing with ADHD.
2. Neuro-Feedback (aka EEG biofeedback). This treatment tries to train patients to control brain waves typically associated with focus and attention. The positive aspect of neuro-feedback is that it is likely to work permanently after training sessions are completed and a positive response has been achieved. However, it is labor intensive and potentially expensive for patients since most insurance companies may not cover it.
3. Meditation. In a pilot study in the 2008 issue of Current Issues in Education, transcendental meditation seemed to improve overall attention and behavior in children with ADHD. Reduction of stress and anxiety seemed to lessen symptoms as well by allowing prefrontal cortex of the brain to function more optimally.
Aside from these suggestions, I always recommend plenty of sleep and immersion in natural environments. Lack of sleep undoubtedly can worsen symptoms, and a study in the American Journal of Public Health in 2004 suggested that kids with ADHD exhibited improvement in symptoms after being allowed to play in natural outdoor environments. This was supported by a study by the University of Illinois in 2008 that children with ADHD fared better after being able to be out in nature for a 20-minute stroll in the park compared to those who strolled in downtown or residential areas.
When it comes to ADHD, it appears that a combination of medication with behavioral and environmental modifications yield the best results. So, for all those who are dealing with ADHD and for those parents trying to optimize the environment for your children with ADHD, keep in mind that even if medications are deemed relatively safe, the chance that you can achieve optimal results is still better with the creation of a supportive environment, optimal rest and nutrition, and creating situations that lessen distractions (such as seating closer to the front of a classroom or reducing anxiety and stress with daily mind-body therapies). In my opinion, in the case of most disease states or health concerns, a multi-modal approach to wellness and healing is the best option for achieving multi-dimensional symptomatic improvement.