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L. Eugene Arnold, MD, Professor Emeritus of Psychiatry, Ohio State U.S.A.

Dr Arnold Wrote to us saying:

"The evidence for alternative or complementary treatments varies widely, from reasonably documented to completely unstudied. Most of the better documented ones are applicable to small subgroups and do not show as strong group effects as stimulant drugs. I prefer the term complementary rather than alternative for most such treatments because in many cases they can be used along with standard Tx rather than as substitute. The model for this concept is the combination of stimulant and behavioral Tx, in which we now have good evidence that combination Tx with Beh. Tx can reduce the dose of stimulant needed for optimal results. A further point is that many of the alternative Tx address putative causes, whereas stimulants and Beh Tx palliate and prevent complications.

Another principle to keep in mind is that herbs constitute primitive pharmacology. They are essentially drugs that have not been purified or subjected to the quality control that "proper" drugs have been. Many modern drugs have taken their inspiration from plant chemicals --examples include malarial treatments, antibiotics, digitalis, reserpine, opiates, atropine, ephedrine and derivative sympathetic agents, cancer treatments, even lowly aspirin. It is very likely that other useful pharmaceutical agents remain to be discovered within plant chemistry. Therefore it is likely that some herbs will work, though probably not as well as their more refined cousins. The problem is the lack of good scientific evidence in most cases as to which ones might work, the extent of benefit, in what way, and at what safety risk.

There is pretty convincing research about the value of omega-3 EFAs for babies. Promotes optima eye and brain development. Don't know of equally convincing research for school age.

Here are some reviews that I have done;

Arnold, LE. Treatment Alternatives for attention-deficit/hyperactivity disorder. In: Jensen, PS & Cooper, J (Eds.). Attention Deficit Hyperactivity Disorder: State of the Science; Best Practices. Kingston, NJ: Civic Research Institute, 2002.

Arnold, L.E. Alternative/Complementary treatments for attention-deficit/hyperactivity disorder. In: Rogers BT, Montgomery TR, Lock TM, & Accardo PJ, eds.: Attention Deficit Hyperactivity disorder: The Clinical Spectrum. Timonium, MD: York Press, pp. 197-207, 2001.

Arnold, L.E. Screening and evaluating alternative and innovative psychiatric treatments: A contextual framework. Psychopharmacology Bulletin 30(1):61-67, 1994.

Arnold, LE. Treatment alternatives for attention-deficit/hyperactivity disorder (ADHD). Journal of Attention Disorders, 3:30-48, 1999.

Arnold, LE. Alternative Treatments for Adults with ADHD. in: Wasserstein J, Wolfe LE, & Lefever FF, eds.: Adult Attention Deficit Disorders: Brain mechanisms and Life Outcomes. NY: New York Academy of Sciences, PP.310-341, 2001.

Arnold LE. Ingestive treatments for learning disorders. Perspectives 27:18-21, 2001.

Arnold, L.E. Some nontraditional (unconventional and/or innovative) psychosocial treatments for children and adolescents: critique and proposed screening principles. J. Abnormal Child Psychology 23(1):125-140, 1995.

Some of these have extensive bibliographies to the original research. Most of them include EEG biofeedback, which has promising pilot data but needs more evidence to justify the expense of time, effort, and money."



Below is a copy of "Alternative Treatments for Adults with ADHD" mentioned in the Reference list above.

Treatment alternatives for Attention-Deficit Hyperactivity Disorder (ADHD)

L. Eugene Arnold, MD

Objective:

To review alternate treatments (Tx) of Attention-Deficit/Hyperactivity Disorder (ADHD) – those other than psychoactive medication and behavioral/psychosocial Tx – for the November, 1998 National Institute of Health (NIH) Consensus Development Conference on ADHD.

Method:

The literature was searched on Medline and PsychInfo 1963-1998 and investigations known to be interested in alternate Tx were contacted for unpublished data.

Results:

Twenty-three alternate Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a restricted etiological subgroup. The oligoantigenic or few-foods diet has convincing double-blind evidence of efficacy in multiple trials for a properly selected subgroup. Enzyme-potential desensitization to foods, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Glyconutritional supplementation, iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data. Single-vitamin megadose has some intriguing pilot data. Zinc supplementation is hypothetically supported by systematic case-control data but has no systematic clinical trial. Laser acupuncture has promising unpublished pilot data. Essential fatty acid supplementation has promising systematic case-control data but trials are equivocal. Recommended-Daily-Allowance vitamin supplementation, non Chinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and possibly dangerous. Simple sugar restriction and hypnosis seem ineffective. Amino acid supplementation, though mildly effective in the short term, is not effective beyond a few weeks. Thyroid Tx is effective in the presence of documented thyroid abnormality, but not otherwise.

Conclusion:

Some alternate Tx of ADHD are effective or probably effective, but mainly for restricted etiologic subgroups. In some cases they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, though not safer than standard Tx, may be preferable for an etiologic subgroup.

This information has been written by L. Eugene Arnold, MD, Professor Emeritus of Psychiatry, Ohio State U.S.A and we thank Dr Arnold for allowing adders.org to reproduce this.

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