20 de junio de 2008

Holistic approach - NYT - Weighing Nondrug Options for A.D.H.D.



June 17, 2008
Well
Weighing Nondrug Options for A.D.H.D.
By TARA PARKER-POPE
About 2.5 million children in the United States take stimulant drugs for attention and hyperactivity problems. But concerns about side effects have prompted many parents to look elsewhere: as many as two-thirds of children with attention deficit hyperactivity disorder, or A.D.H.D., have used some form of alternative treatment.
The most common strategy involves diet changes, like giving up processed foods, sugars and food additives. About 20 percent of children with the disorder have been given some form of herbal therapy; others have tried supplements like vitamins and fish oil or have used biofeedback, massage and yoga.
While some studies of alternative treatments show promise, there is little solid research to guide parents. That is unfortunate, because for some children, prescription drugs aren’t an option.
The drugs have been life-changing for many children. But nearly one-third experience worrisome side effects, and a 2001 report in The Canadian Medical Association Journal found that for more than 10 percent, the effects could be severe — including decreased appetite and weight loss, insomnia, abdominal pain and personality changes.
Although the drugs are widely viewed as safe, many parents were alarmed when the Food and Drug Administration ordered in 2006 that stimulants like Adderall, Ritalin and Concerta carry warnings of risk for sudden death, heart attacks and hallucinations in some patients.
What about the alternatives? Last week, The Journal of the American Medical Association reported that the first study of the herb St. John’s wort worked no better than a placebo to counter A.D.H.D. But the trial, of 54 children, lasted only eight weeks, and even prescription drugs can take up to three months to show a measurable effect.
But the larger issue may be that in complementary medicine, one treatment is rarely used alone, making the range of alternative remedies difficult to study. Natural treatments may well be beneficial, said the report’s lead author, Wendy Weber, a research associate professor at the school of naturopathic medicine at Bastyr University in Kenmore, Wash. “We just need to do more studies and document the effect.”
Other herbal treatments for the disorder include echinacea, ginkgo biloba and ginseng. There are no reliable data on echinacea; a 2001 study showed improvement after four weeks in children using ginkgo and ginseng, but there was no control group for comparison.
There is more hope for omega-3 fatty acids, found in fish and fish-oil supplements. A review last year in the journal Pediatric Clinics of North America concluded that a “growing body of evidence” supported the use of such supplements for children with A.D.H.D.
As for dietary changes, a 2007 study in The Lancet examined the effect of artificial coloring and preservatives on hyperactive behavior in children. After consuming an additive-free diet for six weeks, the children were given either a placebo beverage or one containing a mix of additives in two-week intervals. In the additive group, hyperactive behaviors increased.
The study caused many pediatricians to rethink their skepticism about a link between diet and A.D.H.D. “The overall findings of the study are clear and require that even we skeptics, who have long doubted parental claims of the effects of various foods on the behavior of their children, admit we might have been wrong,” reported a February issue of AAP Grand Rounds, a publication of the American Academy of Pediatrics.
Data on sugar avoidance are less persuasive. Several studies suggest that any link between sugar and hyperactivity is one of parental perception, rather than reality. In one study, mothers who were told the child received sugar reported more hyperactive behavior, even when the food was in fact artificially sweetened. Mothers who were told the child received a low-sugar snack were less likely to report worse behavior.
One interesting option is a form of biofeedback therapy in which children wear electrodes on their head and learn to control video games by exercising the parts of the brain related to attention and focus. Research has suggested that the method works just as well as medication, and many children report that they enjoy it.
The challenge is finding a doctor who will help explore the range of options. For instance, the best way to tell whether dietary changes may help is to eliminate the foods and then reintroduce them, monitoring the child’s behavior all the while. The best evidence may come from a teacher who is unaware of any change in diet.
The Integrative Pediatrics Council, at http://www.integrativepeds.org/, offers a list of pediatricians who offer alternative treatments. Its chairman, Dr. Lawrence D. Rosen, chief of pediatric integrative medicine at Hackensack University Medical Center in New Jersey, says parents should seek a holistic approach. But he notes that that may well include prescription drugs.
“I do prescribe medications in my practice, and there are kids whose lives have been saved by that,” he said. “But it’s a holistic approach that is very different than one pill, one symptom. We’re addressing not just the physical, chemical needs of kids, but their total emotional and mental health.”
well@nytimes.com

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