Natural Treatments for ADHD: What to Try After Medications Have Failed (2016 Edition)

The world of natural treatments for ADHD can be bewildering.  There are many treatments out there to choose from, but some are probably more likely to help than others.  What adds to the confusion is the large number of treatments that have been evaluated with one or two small trials, often generating more questions than answers about whether the treatment really worked and if it was really safe.  For most patients with ADHD, the research backing the treatments in this article is just not enough to justify a trial at home.  However, for some patients, especially those who have been unable to take medications, or have been unable to find a medication that works, these are worth consideration.

A note about this article:  I have reviewed many of these treatments in detail in separate articles on this blog.  The links to those articles (with their accompanying references) are in the heading to the corresponding paragraph in this article.

Neurofeedback.  Also known as EEG biofeedback, this therapy focuses on modifying brainwaves associated with ADHD.   While many studies have been done, the results are difficult to interpret, and it isn’t clear yet how to deliver neurofeedback to maximize its’ effects.  Despite many studies, no major side effects have been identified, so it’s likely to be quite safe.  Some insurance companies cover this treatment and some do not.

Restrictive Diet (Feingold/salicylate free/dairy free/gluten free).  The original research on the Feingold diet and similar diets is now decades old and outdated in today’s standards to the degree that it is difficult to conclude much.  A recent review of dietary treatments in ADHD suggested a 10-30 % response rate to all restrictive diets, with perhaps a 10% rate of full remission of symptoms.  On the other hand, one study of restrictive diets similar to the Feingold diet demonstrated a link to a high frequency of eating disorders in children.  With this in mind, it is important to remember to add back foods to achieve the least restrictive diet possible and to consult a dietician if multiple foods are eliminated at once.

Mineral supplements (magnesium, iron, zinc, calcium).  All of the minerals listed are linked to ADHD symptoms.  However, they can all have serious side effects if given in inappropriately high doses.  Patients should be tested for deficiency before treating with mineral supplements.

Caffeine.  While you can get caffeine without a prescription, it is a stimulant in the same class as other ADHD drugs, with all of the same side effects and a short half life.  It can be tricky to dose reliably and should not be used with other medications without a doctor’s guidance.  That being said, some people do find that a morning cup of coffee is all they need to help them get through the day, and some people do successfully use a caffeine containing drink in the afternoon as a booster to their long acting med.

Weighted vest.  Weighted vests, usually prescribed by an occupational therapist, have been shown in one medium sized trial, to reduce hyperactive behaviors in children with ADHD.  They were ineffective for impulsive and verbal behaviors (such as blurting or excessive talking).    Weighted vests are known to sometimes cause short term problems with posture and back pain (which is why they should be fit by an OT) , and some children take them off and use them as missiles, otherwise they seem to be harmless.  

Interactive Metronome.  This therapy usually involves 15 sessions of training involving timing movements to sounds.  It is unlikely to have significant side effects, but only two smaller studies demonstrate its effectiveness and due to the nature of the treatment, it can be quite expensive, even if it is covered by insurance.

Vayarin/phosphatidyl serine.  Vayarin is essentially omega 3 fatty acids plus phosphatidyl serine.  While omega 3 fatty acids have a great track record for safety and a pretty good one for effectiveness, there are only a few smaller studies which suggest that adding phosphatidyl serines adds anything to the effectiveness of omega 3s.  The main risk of phosphatidyl serine is that it can be sourced from cow’s brains, with a very tiny risk of acquiring Creutzfeld-Jacob disease, a progressive neurodegenerative disorder.  If you can find phosphatidyl serine sourced from plants, it definitely improves the safety of the product, but it clouds the research on effectiveness.

EMPower Plus.  This proprietary herbal therapy was the subject of a single, randomized controlled non-industry sponsored trial involving a modest number of patients (all adults), with improvements noticed only by patients, not by clinicians.  It isn’t possible to know what side effects this preparation might have due to the size of the trial, and the therapy is expensive, about $65-75/bottle for the baseline treatment.  Also, we don’t know what effect it might have on the developing brain of a child or adolescent. 

Essential oils.  The research done in the area of essential oils and ADHD has been hugely overblown, and their long term safety is unknown.  There is some potential for long term hormonal effects, as well as allergic reactions.   However, for short term use, say for break through symptoms, they may be worth looking at if other therapies have failed.

                                                               

Homeopathy.  The great thing about homeopathy is that it is unlikely to have side effects.  The bad thing about homeopathy is that clinical trials do not support the effectiveness of homeopathic treatments, especially those available as mass produced, over the counter remedies.   It is possible that researchers have not found the right way to study homeopathy, as practitioners often customize their treatments to the individual.

Pycnogenol.  There have been only two studies on this antioxidant extract of the maritime pine, so neither efficacy nor safety have been well demonstrated. 

Probiotics.  The evidence that probiotics could be a useful treatment for ADHD rests on a single trial done in infants and was more of a preventive type therapy.  Unfortunately, treating infants with live bacteria also carries a risk of active infection.  No studies of probiotics have been done in children and adults already diagnosed with ADHD.  There is little harm to trying probiotics, provided your immune system is normal and you are not allergic to any carrier, such as yogurt or gluten (present in many probiotic supplements).

As you can see, there is no shortage of natural treatments that have been tested in at least one clinical trial, which may be useful in treating ADHD, but not all of them have been extensively enough to say for certain that they are safe or to compare their effectiveness among other therapies.