Behavioral Effects of Micronutrient Supplementation on Children with ADHD
ADHD Affects Millions of Children Worldwide
ADHD (Attention Deficit Hyperactivity Disorder) is a relatively common disorder of childhood onset, characterized by a persistent pattern of over activity, inattention and impulsivity. The worldwide prevalence of ADHD has been estimated at about 5%, although differences in diagnostic criteria, methods of assessment and sample selection have resulted in estimates ranging from 2% to 11%.
ADHD is often associated with violent or aggressive behavior
At the Violence Research Foundation, our interest in ADHD stems from the fact that approximately 50% of all children diagnosed with ADHD also have difficulty controlling aggressive behavior. Indeed, diagnostic studies of offender populations have consistently indicated that up to 60% of all incarcerated felons have had a history of ADHD.
Current Treatment of ADHD
While the pathophysiology of ADHD remains unclear, variations in the brain’s dopaminergic networks have long been implicated. This association is primarily based on the effectiveness of stimulants (i.e. dopamine agonists) such as dextroamphetamine or methylphenidate and their various refinements in reducing ADHD symptoms. Indeed, stimulants have proven efficacious for a vast majority of children in whom the diagnosis of ADHD has been carefully confirmed.
Problems associated with current treatment methods
However, stimulant medications have not been uniformly effective in modifying ADHD symptoms, with estimates of non-responders ranging from 25% to 35%. Additionally, stimulant drugs, irrespective of their efficacy in reducing ADHD symptoms, often have adverse side effects. Finally, even if stimulants were found to be 100% efficacious with no adverse side effects, many families would remain unalterably opposed to treatment of their child with prescription drugs, preferring instead to seek out complementary and alternative methods.
Impact of Nutrition on Behavior
Over the past few decades the Violence Research Foundation has been studying the correlation between nutrition and behavior. What we have found is that inadequate nutrition can cause abnormally low levels of the neurotransmitter serotonin (5-HT) in certain parts of the brain, which in turn can result in inappropriate aggressive behavior. This brain/behavior connection is the rationale behind this project.
Related studies by others
Numerous studies have been completed that demonstrate the benefits of various nutrients for optimal brain functioning.
As part of the organization’s goals of making society a safer, more peaceful place by identifying and addressing the root causes of violent and inappropriately aggressive behavior, the Violence Research Foundation is sponsoring a study on the Behavioral Effects of Micronutrient Supplementation on Children with ADHD.
Program hypothesis and goal
We believe that nutritional supplementation with a daily multivitamin and fish oil capsule can be effective in modifying the symptoms of ADHD in children, including the inappropriate aggression that often accompanies the problem. If the study proves this hypothesis to be true, the result will be a treatment for ADHD that is:
- Readily available
- Free of adverse side effects
- Safe for most and possibly all children
We will be investigating the effect of dietary supplementation, using a combination of vitamins, minerals and essential fatty acids (micronutrients), on the behavior of children with ADHD.
Specifically, we intend to use standard diagnostic criteria to identify a group of 120 children, 7 to 12 years of age, who meet DSM-IV criteria for ADHD, either the predominantly hyperactive/impulsive or the combined subtype (i.e., DSM-IV 314.01). All children will participate in a standardized format, 12-week social skills training program conducted by the University of California, Irvine, Child Development Center. We will additionally randomly assign each of the subjects to one of three treatment groups:
- Group 1 – Social Skills Training Program + micronutrient supplementation (n = 40)
- Group 2 – Social Skills Training Program + placebo supplementation group (n = 40)
- Group 3 – Social Skills Training Program only (the control group, n = 40)
This will be a 3-phase program:
- Phase I – Children will be screened, randomized to one of the above treatment groups, and then followed over an eight-week ramp-up period, during which Group I will begin taking the active micronutrient supplement, Group II will begin taking placebo, and Group III will simply be waiting to begin their Social Skills Training Program.
- Phase II – The children in all three groups will be assigned to a 12 week, bi-weekly Social Skills Training Program, while continuing on with their respective supplementation assignments.
- Phase III – Following the conclusion of the 12-week Social Skills Training Program, children in all three groups will be offered the opportunity to continue with the active supplement for an additional 12 weeks.
At the onset of Phase I, we will evaluate each child with respect to diagnostic indices of ADHD and inappropriate aggression. Included in this evaluation will be results of the SWAN rating scale and the Social Skills Intervention System rating scales (SSIS-RS), as well as standardized laboratory neuropsychological assessments. Prior to beginning the Social Skills Training Program, the child will once again be rated on the SWAN and the SSIS-RS.
During Phase II, children will be evaluated weekly over the 12-week intervention period by both parents and trainers, using the SSIS-RS. We will also conduct an exit evaluation at the conclusion of Phase II, using the SWAN, SSIS-RS and laboratory neuropsychological measures.
At the conclusion of Phase III, we will perform and exit evaluation using the SWAN, SSIS-RS, and laboratory neuropsychological measures. Over the course of the study, then, behavior ratings will be performed at 16 discrete time points, and laboratory neuropsychological tests will be conducted at 3 discrete time points.
The Principal Investigator on the Behavioral Effects of Micronutrient Supplementation on Children with ADHD will be Francis M. Crinella, Ph.D, Professor of Pediatrics, Psychiatry and Human Behavior, and Physical Medicine and Rehabilitation at the University of California, Irvine’s Child Development Center.
We invite you to browse the wealth of information available in the reports, studies, articles and PowerPoint presentations in our Library. Many of these were sponsored by VRF; others were prepared by close associates of VRF, while others deserve to be included in this important conversation. All of them are included with the hope that they each contribute to the cost-effective reduction of violent behavior within Attention Deficit Hyperactivity Disorder.