Tag Archives: medical advice

Alternative Treatments for ADHD: Do They Work?

Mother and daughter visiting doctor
If your child is one of the 6.4 million American kids diagnosed with attention deficit hyperactivity disorder (ADHD), he or she is probably being treated with medication or behavior modification therapy—or both. Studied extensively, these first-line ADHD treatments have been found to reduce the symptoms or negative effects of ADHD on a child’s daily functioning.

You may have also heard about alternative treatments for ADHD, such as biofeedback or special diets. But what do we really know about these treatments? Do they improve symptoms and functioning? What evidence do we have? The following brief review will help answer these questions for several different treatments.

Addressing organization, time management, and planning (OTMP) skills: In school settings, teaching OTMP skills in groups has been found to be effective for middle and high school students. In clinical settings, the only program that has been tested and found effective was created at NYU Langone Medical Center’s Child Study Center. Clinical intervention improved children’s OTMP skills and academic productivity and performance, and decreased homework problems and family conflict.

Neurofeedback: Also called biofeedback, neurofeedback is a self-regulation technique in which an individual is taught to alter his or her brain’s electrical activity in an attempt to stay focused and attentive. The American Academy of Pediatrics (AAP) does not recommend neurofeedback in its recently revised clinical guidelines for diagnosis and management of ADHD. On top of concerns about its efficacy, neurofeedback is extremely expensive and time-intensive, and may not be covered by insurance.

Cogmed: A commercially available, proprietary neurocognitive training program, Cogmed is marketed as a computer-based solution for attention problems caused by poor working memory. A 2011 study concluded that Cogmed does lead to memory improvement, but does not improve function in the area of the brain associated with ADHD symptoms.

Feingold diet: Restricted in sugar and free of additives and salicylate, this diet shows no significant benefit for ADHD except for those children with related food sensitivities.

Elimination/oligoantigenic diet: An oligoantigenic diet eliminates most known sensitizing food antigens or allergens, such as cow’s milk, eggs, wheat cereals, nuts, and more. Although the AAP does not recognize dietary interventions as effective ADHD treatments, a 2012 meta-analysis of 14 studies suggests that an elimination diet can benefit some children with ADHD.

Ketogenic diet: A diet high in fat and low in carbohydrates does not help with ADHD; however, it may offer some benefit to reducing hyperactivity in epileptic patients.

Poly-unsaturated fatty acid supplements: Some children may be helped by doses of 300 to 600 mg/day of omega-3 and 30 to 60 mg/day of omega-6 fatty acid supplements. These supplements can be continued for two or three months, or longer if indicated, as a complement to medication and behavior treatment.

Other diet considerations: Sugar does not usually affect the behavior or cognitive performance of children, but a small effect on subsets of children cannot be ruled out or proven. Iron deficiency is not linked to ADHD. Any effects of food dyes or artificial food coloring on hyperactivity are inconsistent and moderate. Herbal supplements, such as ginko biloba and kava kava, have shown no positive effects on ADHD.

Exercise: A 2011 review found exercise to have positive effects on the behaviors of children with ADHD, but not necessarily on ADHD symptoms. Exercise can be used as a supplemental—but not stand-alone—treatment.

Occupational therapy techniques: There is not enough evidence to support either the wearing of a weighted vest or the use of an interactive metronome to increase on-task behavior.

If you are considering alternative ADHD treatments for your child, be sure to talk with your doctor about evidence of their efficacy, potential costs and benefits (including side effects), what concerns the treatment will address, and how to measure those concerns.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Richard Gallagher, PhD, is a clinical psychologist and neuropsychologist who directs the Selective Mutism Program and Organizational Skills Training Program at NYU Langone Medical Center’s Child Study Center. He also is an associate professor of clinical psychiatry, as well as child and adolescent psychiatry, at the NYU School of Medicine. With a PhD from Temple University, Dr. Gallagher focuses on selective mutism, disruptive behavior disorders, attention deficit disorders in children and adults, organizational skills, and parenting.

How to Prevent or Treat Infant Flat Head Syndrome

Happy laughing funny baby boy wearing a colorful shirt learning to crawl playing on his tummy, on white background
Many parents are understandably worried when their baby is referred to a doctor for an evaluation for plagiocephaly, also known as flat head syndrome—but there is no cause for alarm.

As an infant’s growing brain pushes the skull’s thin, moldable bones apart, new bone forms at expansion joints, or sutures. When pediatricians see an irregularly shaped skull, they often refer patients to a neurosurgeon or other specialist to rule out craniosynostosis, a rare condition in which a baby is born with a premature closure of one or more of these sutures.

Much more common is an easily treatable condition called positional molding or deformational plagiocephaly. This occurs when babies get into the habit of lying on one side of the head, resulting in repeated pressure that flattens that side and back of the skull.

Deformational plagiocephaly is not a brain problem, does not cause neurologic or developmental issues, and does not require surgery. It is usually a minor cosmetic issue noticeable primarily from behind. For the very small percentage of children who have a significant asymmetric frontal appearance, unaddressed plagiocephaly could affect how people treat them later in life, potentially leading to psychosocial issues.

The key to plagiocephaly is prevention. You can prevent it the same way it is corrected: by encouraging tummy time and changing your baby’s sleeping position.

Tummy Time
Unfortunately, many parents confuse the recommendation of placing babies on their backs for safe sleeping with avoiding time on their bellies altogether. Engaging in tummy time while awake is both good for babies developmentally and the best way to prevent plagiocephaly. For babies with signs of the condition, tummy time will keep them off of the flattened portions of their heads as much as possible.

When babies are awake and under supervision, position them on their bellies for as long as they can tolerate. Infants who are used to lying on their backs most of the time may fuss when put on their bellies, so it’s best to start early—within the first month or two from birth.

Early Repositioning
Early repositioning is important if your baby’s head is starting to flatten on one side or you notice that your baby sleeps with his/her head always turned to the same side—a condition called behavioral torticollis. You can change the sleeping position by propping your baby up to prevent putting pressure on the side he or she prefers.

A variety of commercial devices are promoted to counteract torticollis, but the simplest way to lift a child off the flattened or preferred side is to simply prop up that half of the body about 30 to 45 degrees. The cheapest method involves rolling a dishtowel into a cylinder, wrapping it with some tape to make sure it stays firm, and placing it vertically under your baby from the shoulder to the buttock.

Mildly abnormal face-on skull deformities can almost always be corrected with repositioning, as long as they are caught by age four or five months.

A Word About Helmets
Treating plagiocephaly with a helmet works by applying pressure to the skull in the reverse direction of the pressure that caused the initial molding. Helmets work; however, for the vast majority of children, they are not any more effective than simple repositioning and are much more expensive. That’s why it’s best if helmets are considered only for the small group of kids whose skulls are still severely misshapen at four or five months old.

At the end of the day, plagiocephaly is an aesthetic issue, particularly if it is only noticeable at the back of the head. If you are concerned about it, talk to your pediatrician—but the key thing to remember is the importance of tummy time and repositioning.

NYULMC-2011_2CP_RGB_300dpiFrom the Real Experts at NYU Langone Medical Center:

Jeffrey H. Wisoff, M.D. is the director of the Division of Pediatric Neurosurgery at NYU Langone Medical Center and professor of neurosurgery and pediatrics. Over the past 30 years, he has made innovative contributions to the surgical treatment of neurological disorders in children—particularly brain tumors, Chiari malformations, hydrocephalus, and craniosynostosis. A renowned expert in the treatment of craniopharyngioma and other brain tumors, Dr. Wisoff has published more than 160 scientific articles and book chapters, and has been an invited speaker and visiting professor at numerous international sites. Dr. Wisoff received his medical degree from George Washington University School of Medicine, and completed a neurosurgical residency and a fellowship in pediatric neurosurgery at NYU.