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May/Jun 2009 | www.MyFamilyDoctorMag.com | 11 Alternate REAlITY naturally attentive by robert a. Pendergrast, Jr., M.d. I f there were ever a place in medicine for a truly integrative approach, it would be attention- deficit hyperactivity disorder in kids. Unfortunately, much of what we hear instead is polarization: parents refusing meds like Ritalin and doctors asserting that all the alternative rem- edies don't work. As in most things, the truth is somewhere in the middle. DO WE REALLy HAVE TO WORRy ABOuT STIMuLAnTS LIKE RITALIn? Just like any medicine, if you don't need them, stimulants increase risk beyond benefit. They can cause ap- petite suppression, poor weight gain, insomnia, rare hallucinations and serious heart rhythm problems. But there is a group of kids for whom these prescriptions are ben- eficial. They increase school success; decrease impulsive behavior; and improve self-esteem, making risks like drug and alcohol abuse less likely. WHAT CAn WE DO In ADDITIOn TO MEDS? There are some basic lifestyle ap- proaches from which any kid with ADHD will benefit—on a prescrip- tion or not. • School-age kids need 10 to 11 hours of sleep per night and daily physi- cal activity to regulate mind-body energy. • There's evidence that the more kids connect to nature, the less problem they have with inattention and be- havior. • Aggressive behavior is associated with more time in front of a televi- sion. Anxiety may increase even with exposure to the evening news, leading to more behavioral prob- lems. So parents can be careful about what images regularly get into young minds. DOES FOOD MAKE A DIFFEREnCE? Yes, especially breakfast. A morning meal of simple carbohydrates, like white bread or sugar, leads to a mid- morning sugar crash and accompa- nying adrenaline surge as the body tries to compensate. This can create inattention and hyperactivity. Instead, try a low-glycemic breakfast—one not made of simple sugars. It may include whole grains, protein, fruits and healthy fat such as that in nuts and special eggs that have omega 3s. The Feingold hypothesis about artificial colors and ADHD was for a while discredited. But more recent re- search has shown there is a subgroup of kids whose symptoms improve when you eliminate artificial colors and preservatives. The only way to tell is to cut out these things for three weeks and then reintroduce them to see if they make a difference. WHAT ABOuT OTHER STuFF? There are good studies that support using fish oil. Dosages vary widely, but I recommend 4 to 6 grams daily for teens and 1.5 to 2 grams for younger kids. In teens already on stimulant medication, adding zinc has been shown to improve performance be- yond the medicine alone. I recom- mend a maximum of 30 milligrams per day long-term. This is debated, and some think this much is danger- ous, especially if your teen isn't zinc- deficient. (It's definitely too much for children.) Talk to your health-care provider. A bedtime dose of melatonin can help with poor sleep, with the caution that this can cause night- mares at higher doses. I suggest try- ing 1 to 3 milligrams, but many rec- ommend starting at 0.3 milligrams or lower and only increasing if needed. A strong chamomile tea is ex- cellent at reducing anxiety, inducing sleep and calming an upset stomach. Try three to five teabags in 8 ounces of boiling water steeped for 10 min- utes. (People allergic to ragweed could react to chamomile.) There are some promising stud- ies for neurofeedback (biofeedback for the brain), but this can be costly, and it's early to draw definite conclu- sions. So for the time being, while you should talk to your health-care pro- vider, it seems some alternative mea- sures may help, whether the child is on prescription medication or not. RobeRt a. PendeRgRast, JR., M.d., is an integrative physician and board-certified pediatrician in Augusta, Ga., and director of adolescent medicine at the Medical College of Georgia.