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Focusing the mind

Interest rises in non-drug therapies for attention deficit in children.

September 15, 2003|Benedict Carey | Times Staff Writer

Some parents of children diagnosed with attention deficit disorder will try just about anything to avoid drug treatment -- homeopathy, chiropractic, massage, even faith healing.

"There's a label, a stigma that goes with drug treatment," said Dr. Regina Bussing, a child psychiatrist at the University of Florida who conducted a recent survey of 1,600 families in that state.

Although national statistics are not available, some doctors and other experts say that more than half of families coping with ADHD, or attention deficit hyperactivity disorder, now try alternatives before considering treatment with drugs, such as Ritalin or Adderall. The trend is on the rise, doctors say, as more children are diagnosed with attention problems and more ADHD products and programs crowd the marketplace. These include not only restrictive diets, vitamin and mineral supplements, but brain wave-measuring technology, and biofeedback.

Parents' wariness of drug therapies is partly due to suspicions about the diagnosis of ADHD. There's no single test for the condition, and doctors don't always agree on the diagnosis. Nor are they sure how the standard treatment -- Ritalin, a powerful stimulant -- actually calms people and improves mental focus. "Many parents are worried about being ridiculed about it, by relatives or friends saying, 'You better be careful, kids turn into zombies if they're over-sedated,' " Bussing said.

The growing popularity of alternative treatments for ADHD may further confound the understanding of one of the most common diagnoses in child psychiatry. Because no one is tracking these families closely to see what alternatives are effective and in whom, nontraditional therapies remain largely untested. In the meantime, they can prevent families from considering proven therapies: drug treatment, which can help about 70% of children with ADHD, and family counseling, which improves symptoms in about 50% of them. The result, psychiatrists say: Many children may be getting worse as their parents sample treatments.

Dr. James McGough, director of ADHD programs at UCLA's Neuropsychiatric Institute, is disturbed by the tendency of parents to discount drug treatment that has been shown to work. "The saddest cases I see are parents of sixth- or seventh-graders who are dejected about school, who want to drop out, who're doing nothing but ride their skateboard -- and the parents say, 'The doctor told us to try medication in third grade and we didn't want to do it.' "

For only in recent years have researchers begun to evaluate nontraditional therapies in a scientifically rigorous way. "What you find is that the evidence for these alternatives ranges from fair to none at all," said Dr. L. Eugene Arnold, professor emeritus of psychiatry at Ohio State University in Columbus, who recently reviewed studies of alternative therapies for ADHD. "I think people simply need to proceed with the understanding that, when it comes to alternatives, they're experimenting."

Among the popular alternatives that have been studied:

* Diet. The notion that food dyes, preservatives and other ingredients can cause mental problems in youngsters goes back some 50 years.

There is some evidence that children on so-called "elimination diets" may become more focused and settled. Such diets exclude processed and other foods thought to prompt allergic or other problematic reactions. A typical diet might include lamb, chicken, potatoes, rice and a variety of fruits and vegetables, such as apples, broccoli and celery.

In one widely cited study, researchers at the University of Alberta in Calgary found that an elimination diet improved behavior in 12 of 24 hyperactive preschool-age boys, according to their parents' reports. The improvements were noticeable within the first month on the diet. In another, German researchers in 1997 found that 12 of 49 school-age children with ADHD showed similar improvements.

But overall, the studies have been small and not convincing to many doctors who treat attention problems.

Many other parents are reluctant to consider a program that may involve battle with a defiant, finicky eater over every meal. For them, imposing a diet could worsen already strained family relations.

But for those families who can manage a change in diet without drawn-out turmoil, some doctors say that well-balanced elimination regimens are at least worth a try, Arnold said. He estimates that 5% to 10% of children diagnosed with ADHD might respond. This group appears to include many preschoolers with allergies, irritability and sleep problems, according to Arnold.

Scientists have found no good evidence that another popular alternative treatment -- a dietary program that strictly limits artificial sugars -- is helpful.

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