Neurodevelopmental conditions are one of the most prevalent childhood health and wellness concerns. In the United States, 1 in 11 children is diagnosed as having Attention-Deficit/Hyperactivity Disorder (ADHD). While it can start in young kids, diagnosis typically does not happen until 5 years old to be able to decipher between toddler behavior and true ADHD. Most diagnoses of ADHD in children occur by 12 years old. With that being said, addressing the root cause and risk factor is an avenue to explore with an integrative healthcare practitioner who can guide you through testing and treatment options.

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What is Attention-Deficit/Hyperactivity Disorder (ADHD)?

Attention Deficit/Hyperactivity Disorder is the most common neurobehavioral disorder. Rates of ADHD have been steadily increasing, with the current prevalence being 9.3% of US children diagnosed. This condition is characterized by inattention, or hyperactivity and impulsivity behaviors. Diagnosis of ADHD is determined by evaluating a child using the DSM-5 criteria, which is found in the American Psychiatric Association's (APA) Diagnostic and Statistical Manual. ADHD is diagnosed when there is a presentation of six or more symptoms of inattention or six or more symptoms of a combination of hyperactivity and impulsivity. In some children, a combination of these categories creates an ADHD picture.

Clinical diagnosis requires that the child has displayed symptoms for a minimum of 6 months, and their presentation is either disruptive or interruptive to their environment for their developmental level. Based on a child's symptoms, they can fall into predominately inattentive, predominately hyperactive-impulsive, or have a combination presentation. Listed below are the symptoms of each category.

ADHD Symptoms in Kids

Inattentive ADHD Symptoms

• Forgetful
• Difficulty staying on task, even with play activities
• Lack of focus and easily distracted
• Struggles with organization
• Appears not to be listening when spoken to
• Fails to complete schoolwork and chores
• Does not follow through on instructions given to them
• Will avoid, be reluctant to or dislike tasks that require long-duration mental effort (Ex: homework and school work)
• Often loses items like school materials, eyeglasses, and other personal belongings

Hyperactivity ADHD Symptoms

• They're in constant motion, "on the go" or "driven by a mother" appearance
• Frequently squirms and fidgets
• Can not stay seated for extended periods
• Runs, jumps, and climbs on things when inappropriate to
• Excessive talking
• Difficulty playing quietly

Impulsivity ADHD Symptoms

• Will blurt out answers before the question is completed (difficulty waiting their turn in conversation or class)
• Difficulty waiting their turn in line
• Interrupts or invades others' space and activities
• May run into the street or engage in other dangerous behaviors

Possible Causes of ADHD in Children

There is no one exact cause of AHDH. Science has found that there is a genetic predisposition that is impacted by health factors and environmental exposures. A review of thirty-seven separate twin studies on the development of ADHD revealed a heritability risk of 74%. Another study in the same review was conducted amongst twins and their non-twin family members, such as siblings and parents, in which an 80% heritability rate was revealed. This data provides validity that genetics does play a key role. With that being said, not all individuals of the same family will develop ADHD, and ADHD can occur without a family history. This has led science down different paths as to what can be contributing to this condition. The additional areas currently being studied as risk factors for ADHD development are:

Brain Injury

Traumatic brain injuries (TBI), specifically severe TBIs in pediatrics, have been associated with ADHD. A meta-analysis found that the timing of assessment relative to the brain injury and the severity of the injury were two important variables in determining if ADHD is correlated to TBIs. Results from the data suggest that mild and moderate TBIs do not have a significant causal relationship to the development of ADHD, but severe traumatic brain injuries do.

Environmental Influences

Exposure to harmful substances in the environment has been linked to the development of childhood ADHD. Lead, organophosphates, and microbial pathogens have all been looked at as potential risk factors for ADHD. Two studies examined the association between dialkyl phosphate urinary metabolites, common pesticide organophosphates, and ADHD. Both studies found that those diagnosed with ADHD had increased dimethyl alkylphosphate (DMAP) in their urine, a type of dialkyl phosphate (6, 31).

Infections

Both viral and bacterial infections have shown some connection to the development of ADHD. Enterovirus Encephalitis is caused by viral strains that cause brain inflammation. One common enterovirus that young children contract is the coxsackie virus, better known as hand-foot-and-mouth disease. One study in Taiwan looked at the long-term neuropsychiatric effects of hand-foot-and-mouth disease and found a significant prevalence of ADHD symptoms. From a bacterial implication, a different investigation found that there was a 62% prevalence of ADHD in children who had meningitis in comparison to kids who did not have meningitis in their first year of life.

Maternal Alcohol and Tobacco Use During Pregnancy

Substance abuse during pregnancy is a risk factor for their offspring to develop ADHD. Both smoking and alcohol consumption during fetal development has significant implications for the brain. On neuroimaging, the whole brain, the cerebellum, and the prefrontal cortex revealed some level of decrease in size in those with ADHD who were exposed to one or both substances in utero.  

Premature Delivery or Low Birth Weight

Shortened fetal development in utero and low weight are both highly correlated to ADHD. Research points to a 300% increased risk of a child having ADHD if they were born preterm or with low birth weight. Based on results like these, this is potentially the most impactful risk factor for developing this neurocognitive condition.

Nutrient Deficiencies

While research does not prove diet and nutrition to cause ADHD, there is evidence that nutrient deficiencies and poor diet can contribute to symptoms. Vital minerals and vitamins could be lacking in children who are not adhering to a well-rounded diet. Some micronutrients correlated to an ADHD symptom picture are Vitamin D, Magnesium, Zinc, Iron, and Omega 3 Fatty Acids.

Functional Medicine Labs Test for Root Cause of ADHD in Children

Functional lab testing can be beneficial in evaluating underlying contributory factors for ADHD. Looking at heavy metal levels, environmental toxins accumulating in the body, pathogenic factors, and micronutrient status can all help pinpoint root cause disturbances. This data will help with the direction of care and treatment protocols that your holistic doctor will assist you with.

Heavy Metals

Lead is one heavy metal you'll want to rule out as a contributor to ADHD. You can obtain blood results by doing a single marker Lead Test, or a more comprehensive and possibly easier (for the child) option would be a toxic metal Hair Elements test by Doctor's Data. Hair analysis is a great option because toxic elements can be more abundant (200 to 300 times) in hair compared to blood or urine.

Environmental Toxins Panel

Evaluating for organophosphates is warranted if there is a suspicion of exposure or you want to investigate all avenues. Environmental toxins can accumulate in body tissues and blood, creating a total body burden that negatively impacts a child's neurocognitive function. Investigating environmental toxicity through an environmental toxins panel will give a comprehensive insight into environmental toxins, including pesticide organophosphates, known risk factors for ADHD.

Micronutrients

A blood spot Whole Blood Nutrient Profile from SpectraCell Laboratories can reveal your child's vitamin, mineral, and amino acid status. To get a comprehensive picture that includes fatty acid status, you'll want to also get an Omega-3 Index Complete blood spot test from Ayumetrix. This will help determine where your child needs replenishment and optimization. Symptomatically, vitamin and mineral interventions may help your child cope while addressing other root causes or risk factors.

Additional Labs to Check When Testing for ADHD in Children

Conventional healthcare offers some tests that can be beneficial in ruling out causations. One example is Bacterial Meningitis. This condition results in inflammation around the brain and spinal cord, which causes flu-like symptoms that progressively worsen. Acute medical care is necessary, in which they will perform one or all three of these tests: bacterial cultures, a spinal tap, and brain imaging. In cases of TBIs, brain imaging such as an MRI and CAT scan should be done to evaluate the severity of the injury.

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Conventional Treatment for ADHD in Children

Behavioral therapy and medications are the primary modes of treatment in conventional medicine. A combination of behavioral interventions, ranging from in-school management, parental directives, and peer interaction, are employed when addressing ADHD in a school-aged child. Working with a skilled behavioral therapist that provides clear behavioral strategies can assist your child in managing symptoms of ADHD.

Medication for ADHD is typically a second line of therapy after behavioral interventions have been established. Evidence states that pharmaceutical drugs can reduce core ADHD symptoms in kids. Categories of medications used to treat ADHD are short or long-acting psychostimulants such as Ritalin and Adderall and non-psychostimulants such as Atomoxetine and Ganfacine. Depending on your child's needs, parental preference, and how well your child tolerates a medication will determine which medication course is most appropriate.

Functional Medicine Treatment for ADHD in Children

With ADHD, the primary intervention is medication. While these can be beneficial for many kids, knowing there are other options for treatment or additional support can be helpful.

Complementary treatment options give patients choices when it comes to healthcare. Some parents may opt to add these natural interventions to conventional treatment modalities for their kids. Dietary changes are one area that can profoundly impact improving their symptoms and well-being.

ADHD Diet for Kids

Like most chronic health conditions, maintaining a whole-food, abundant fruits and vegetables, protein, fats, low-sugar, and minimally-processed diet is essential. A Mediterranean diet focuses on these areas, in addition to quality fatty acid content, which has been found to be beneficial for children with ADHD.

The body can not produce essential fatty acids (EFA), so you must get them from your diet. Docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) are two kinds of Omega-3 EFAs that benefit neurocognitive function because of their anti-inflammatory properties. For those with ADHD, these healthy fatty acids can help modulate inflammation by decreasing oxidative stress while supporting neurotransmitter function and improving cognitive function.

A Mediterranean diet is considered an anti-inflammatory diet partially because it emphasizes healthy essential fatty in the form of Omega-3s versus Omega-6 fatty acids. Great quality food items that include Omega-3 fatty acids in this diet include fish, eggs, nuts, and seeds. Focusing on healthy foods your child will eat and introducing beneficial foods at opportune times can be a non-stressful way to achieve sustainable eating habits.

Supplements and Herbs for ADHD in Children

In addition to nutrition and dietary modifications, supplementation can be beneficial. Botanical medicine, phospholipid supplementation, vitamins, minerals, and probiotics are all great options to consider for pediatric ADHD.

Nootropics Used for ADHD

There are a variety of natural nootropic supplements that can improve symptoms of ADHD. Nootropics are plant, vitamin, or mineral substances that can be taken internally to enhance cognitive function.

Phosphatidylserine with Omega-3

Phosphatidylserine with Omega-3 has shown significant success in research. Phohsphatidyleserine is a phospholipid that is found in our cellular membranes. They have a key role in cell signaling. A recent study has shown that phosphatidylserine combined with Omege-3 fatty acid is beneficial for hyperactivity, impulsivity, emotional dysregulation, and behavioral components of ADHD. Scientists at MIT found an interesting revelation in brain communication between the posterior cingulate cortex and the medial prefrontal cortex, in which synchronization between the two stops in those with ADHD. Interestingly, these brain parts are target areas of stimulant medications but can also be areas where phosphatidylserine can play an important role. The Standard recommended dosing for phosphatidylserine in children with ADHD is 200-300mg by mouth per day, and the dosing for Omega-3s is .07g-1.6g in (ages 5 to 18)

Herbs for ADHD

Bacopa monnieri, Ginkgo Biloba and Saffron are all nootropic botanicals that have been studied in pediatric ADHD. Bacopa has promising results, as one study showed drastic improvement in restlessness, self-control, impulsivity, and problem-solving scores. In a randomized, double-blind study, the children taking the saffron capsules had the same efficacy as those that took methylphenidate pharmaceuticals for ADHD. Regarding Ginkgo Biloba, one area of research looked at its use as a complementary treatment for those taking Methylphenidate. Compared to the Methylphenidate plus placebo group, the G. Biloba and Methylphenidate resulted in more reduction of ADHD symptoms.

Vitamins and Minerals for ADHD

Vitamins and Minerals are vital to replenish, based on functional laboratory testing. Understanding what markers are off can provide context on what supplementation is best. The most common micronutrients depleted in children with ADHD are, Magnesium, Iron, Zinc, and Vitamin D. With each of these micronutrients, you'll want to have testing done to see if supplementation is necessary. The recommended daily dosing for each nutrient in those ages 5 to 18 is Magnesium (130mg to 410mg), Iron (10mg to 15mg), Zinc (5mg to 11mg), and Vitamin D (15mcg). With micronutrient dosing, you'll want to ensure you are dosing appropriately based on age and gender. Working with an integrative practitioner is best to ensure your child takes the appropriate amounts of each nutrient.

Probiotics for ADHD

Taking probiotics to support the gut-brain connection and the body's ability to detox is a viable way to address variables involved with ADHD. With a heavy metal or an organophosphate toxic load potentially contributing to the development of ADHD, supporting a child's microbiome and detox pathways is important.

Complementary and Integrative Medicine for ADHD in Children

Integrating complementary medicine therapies and interventions with conventional treatment options can assist a child with managing ADHD symptoms. Behavioral therapy is a key intervention for ADHD and can be incorporated through multiple avenues, such as equine therapy.

Equine Therapy for ADHD

Horse therapy, also known as equine therapy, can be of multifactorial benefit to children with ADHD. Horses are highly responsive animals. They can pick up on spoken and unspoken communication, making them a great option in providing input or a calming environment for hyperactive or inattentive children. Behavioral goals like increased focus, improved executive functioning, and organizational skills can all be part of your child's task with the horse.

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Summary

Although we aren't aware of the exact cause of ADHD, there are areas we can focus on to reduce our child's chances of developing it. This starts with pregnancy, ensuring women optimize their health, receive adequate prenatal care, aim for full-term pregnancies, and decrease their exposure to environmental toxins. After birth, minimizing your child's risk factors to the best of your ability will be your main hope against any genetic predispositions that your child may have. Working alongside your functional medicine doctor would be a great way to start your child's integrative healthcare journey.