Natural Treatment Options for ADD and ADHD

Vivian F. DeNise,DO
Integrative Pediatrician
Patients Medical

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Integrative Medicine


Introducing our speakers:

Vivian DeNise, DO
Integrative Pediatrics


 Completed her medical degree at
New York College of Osteopathic
Medicine
 Residency in Pediatrics
 Certifications in Integrative
Medicine with the American
Academy of Anti-Aging Medicine
(A4M)


 Specialties include
 Behavioral Concerns
 Hormonal Imbalances
 Nutritional Imbalances
 Gastro-Intestinal Problems
 Detoxification
 And many more!


 ADD and ADHD
 Allergies
 Anxiety
 Asperger’s Syndrome
 Asthma
 Autism
 Celiac Disease
 Chronic fatigue
 Chronic pain
 Depression
 Fibromyalgia
 Headache & migraine
 Immune dysfunction
 Irritable Bowel Syndrome
 Stress disorders
 Weight gain
 Weight loss


Attention deficit hyperactivity disorder, is a
variable neurobehavioral condition generally
characterized by inattentiveness and/or
hyperactivity and impulsivity.


DSM-IV Criteria for ADHD

Either A or B:
Six or more of the following
symptoms of inattention
have been present for at least
6 months to a point that is
inappropriate for
developmental level:

 Inattention
 Often does not give close attention to details or makes careless mistakes in
schoolwork, work, or other activities.
 Often has trouble keeping attention on tasks or play activities.
 Often does not seem to listen when spoken to directly.
 Often does not follow through on instructions and fails to finish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or failure to
understand instructions).
 Often has trouble organizing activities.
 Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort
for a long period of time (such as schoolwork or homework).
 Often loses things needed for tasks and activities (e.g. toys, school assignments,
pencils, books, or tools).
 Is often easily distracted.
 Is often forgetful in daily activities.


Six or more of the following symptoms of
hyperactivity-impulsivity have been present for
at least 6 months to an extent that is disruptive
and inappropriate for developmental level:


Hyperactivity
 Often fidgets with hands or feet or squirms in seat when
sitting still is expected.
 Often gets up from seat when remaining in seat is
expected.
 Often excessively runs about or climbs when and where it
is not appropriate (adolescents or adults may feel very
restless).
 Often has trouble playing or doing leisure activities
quietly.
 Is often "on the go" or often acts as if "driven by a motor".
 Often talks excessively.

Impulsivity
 Often blurts out answers before questions have been
finished.
 Often has trouble waiting one's turn.
 Often interrupts or intrudes on others (e.g., butts into
conversations or games).


II. Some symptoms that cause impairment were present
before age 7 years.
III. Some impairment from the symptoms is present in two or
more settings (e.g. at school/work and at home).
IV. There must be clear evidence of clinically significant
impairment in social, school, or work functioning.
V. The symptoms do not happen only during the course of a
Pervasive Developmental Disorder, Schizophrenia, or other
Psychotic Disorder. The symptoms are not better accounted
for by another mental disorder (e.g. Mood Disorder, Anxiety
Disorder, Dissociative Disorder, or a Personality Disorder).


 ADHD, Inattentive Subtype: Diagnosis is confirmed if the criteria of
Category 1 have applied for six months or longer, but not those of
Category 2.

 ADHD, Hyperactive-Impulsive Subtype: Diagnosis is confirmed if the
criteria of Category 2 have applied for six months or longer, but not
those of Category 1.

 ADHD, Combined Subtype: Diagnosis is confirmed if the criteria of
both Category 1 and Category 2 have applied for six months or longer.
This is referred to as Mixed Subtype.

 ADHD Not Otherwise Specified: Diagnosis is confirmed in this
subtype if children do not meet the certain the classic criteria of the
three types, but still have certain qualities and characteristics of
ADHD.

 Classic PFC/CB- Dopamine
 Inattentive PFC/CB- Dopamine
 Over-focused-AC/PFC-Dopamine/Serotonin
 Limbic-Limbic/PFC-(NE)/Dopamine
 Temporal Lobe- TLs/PFC-Dopamine/Gaba
 Ring of Fire-Gaba/Dopamine


 Short attention span for
routine tasks
 Distractibility
 Organizational
problems
 Difficulty with follow
through
 Poor internal
supervision

 Trouble shifting attention,
looks like they cannot pay
attention
 Worrier
 Tends to hold grudges
 Gets stuck on thought
patterns or behavior patterns
 Upset if things don’t go
they’re way
 Often
argumentative/oppositional


 Emotional instability
 Memory problems
 Periodic anxiety
 Illusions/shadows
 Frequent headaches
 Too sensitive to others
 External or Internal aggression


 Sad, moody,
irritable
 Many negative
thoughts
 Low motivation/
finds little pleasure
 Sleep/appetite
problems
 Social isolation

 Too many thoughts
 Often very hyper
 Hyper-verbal
 Oppositional
 Aggressive
 Hypersensitive to light, sound, taste, touch
 Moodiness
 Cyclical behavioral changes *may be bipolar
equivalent

The American Psychiatric
Association states in the
Diagnostic and Statistical
Manual of Mental Disorders
(DSM-IV-TR) that 3%-7% of
school-aged children have
ADHD. However, studies have
estimated higher rates in
community samples.


Recent data from surveys of parents indicate that:
 Approximately 9.5% or 5.4 million children 4-17 years of
age have ever been diagnosed with ADHD, as of 2007.

 The percentage of children with a parent-reported ADHD
diagnosis increased by 22% between 2003 and 2007.

 Rates of ADHD diagnosis increased an average of 3% per
year from 1997 to 2006 and an average of 5.5% per year
from 2003 to 2007.

 Boys (13.2%) were more likely than girls (5.6%) to have ever
been diagnosed with ADHD.


• Rates of ADHD diagnosis increased at a greater rate
among older teens as compared to younger children.

• The highest rates of parent-reported ADHD diagnosis
were noted among children covered by Medicaid and
multiracial children.

• Prevalence of parent-reported ADHD diagnosis varied
substantially by state, from a low of 5.6% in Nevada to a
high of 15.6% in North Carolina.


 Attention Deficit/Hyperactivity is a serious
public health problem because of the large
estimated prevalence of the disorder, significant
impairment in the areas of school performance
and socialization, the chronic nature of the
disorder.
 Using a prevalence rate of 5%, the annual
societal ‘‘cost of illness’’ for ADHD is estimated
to be between $36 and $52 billion, in 2005
dollars. It is estimated to be between $12,005
and $17,458 annually per individual.

 35% never finish high
school
 43% of untreated boys
with ADHD are arrested
 Up to 50% of the prison
population has ADD/LD
 52% of ADD adults abuse
substances
 75% have interpersonal
problems


Two thirds of children with AD/HD have at
least one other coexisting conditions


 Oppositional defiant disorder (ODD)-40%
 Conduct disorder (CD)-25% of children,
45-50% of adolescents and 20-25% of adults


 Depression
 10-30% of children with
AD/HD
 47% of adults with AD/HD
 Mania/Bipolar Disorder
20% of individuals with
AD/HD
 Anxiety
 30% of children with AD/HD
 25-40% of adults with AD/HD

 Only about 7% of those with AD/HD
 60% of those with Tourette Syndrome have
AD/HD


50% of children with AD/HD have a
co-existing learning disorder.


25%-50% of parents of children with AD/HD report
that their children suffer from a sleep problem,
especially problems with falling asleep and staying
asleep.
This includes
 greater activity during sleep
 restless legs/periodic leg movements during sleep
(PLMS)
 unstable sleep patterns
 greater sleepiness than other children during the
daytime

 Researchers speculate that AD/HD is
associated with hypo-arousal rather than
hyper-arousal.
 The coping mechanism of hyperactivity may
be to counteract the daytime sleepiness.


Black Box Warning for Ritalin

Give cautiously to patients with a
history of drug dependence or
alcoholism. Chronic abusive use may
lead to marked tolerance and
psychological dependence with
varying degrees of abnormal
behavior. Careful supervision required
during withdrawal from abusive use.


Black Box Warning for Adderal

High potential for abuse; avoid
prolonged use. Misuse of
amphetamine may cause sudden
death and serious cardiovascular
adverse events.


Black Box Warning for Concerta

Caution with history of drug dependence or
alcoholism. Marked tolerance and
psychological dependence with varying
degrees of abnormal behavior may occur with
chronic abusive use. Careful supervision is
necessary during withdrawal from abusive use
to avoid severe depression.


Many medications used to treat ADHD aim to restore chemical balance.

Medication Neurotransmitters Affected

Ritalin® Dopamine

Strattera® Norepinephrine

Concerta® Epineprhine

Adderall® PEA


 Neurotransmitter Imbalance
 Vitamin Deficiency
 Mineral Deficiency
 Heavy Metal Intoxication
 Allergies
 Food additives
 Thyroid Disorders
 Sleep Disorders
 Pandas Syndrome

The brain is the master
controller of nervous
system, using
chemicals called
neurotransmitters to
“talk” with itself.


The brain uses
neurotransmitters to
maintain focus
& concentration


Imbalances in brain
chemistry can lead
to inattentive and
hyperactive
behaviors.


Epinephrine

Histamine Serotonin GABA

PEA Glutamate

Norepinephrine Dopamine

Inhibitory Excitatory
 GABA  Glutamate
 Glycine  Neorepinephrine
 Serotonin  Epinephrine
 Taurine  Dopamine
 Histamine
 Aspartic Acid
 PEA


Responsible for
 feelings of pleasure and satisfaction
 muscle control
 muscle function
 GI issues


Limit video games


 Important for motivation,
energy, and mental focus.
Also, known as adrenaline.
 Primarily made in the adrenal
glands.


 Necessary for learning
and memory
 One of the most
common
neurotransmitters in
the brain


Important for mental focus, emotional stability
and endocrine function.


The Primary neurotransmitter in the brain necessary to feel calm and relaxed.

Glutamine

Glutamate

B6

GABA


 Plays an important role in mood, sleep and
appetite

Tryptophan 5-HTP B6 Serotonin


 High levels of stress
 Poor dietary habits
 Toxins
 Lack of sleep


 Chronic stress leads to imbalances in brain
chemistry
 Busy schedules
 Emotional trauma
 Personal issues


Symptoms can be:
• Numbness
• Tingling
• Facial pressure or tightness
• Headache
• Nausea
• Rapid Heartbeat
• Drowsiness
• Chest pain
• Difficulty breathing


Always contains MSG Often contains MSG or creates
MSG during processing
 Glutamate  Flavorings such as natural
 Monopotassium chicken flavoring
Glutamate  Stock
 Seasonings
 Textured Protein  Soy Sauce
 Hydrolyzed protein  Broth
 Yeast Nutrient  Cornstarch
 Calcium Caseinate  Pectin
 Gelatin  Bouillion
 Glutamic Acid  Barley Malt


 Vitamin C
 Vitamin B6, B12


 Reduces harmful oxidants
 Balances levels of dopamine
 Helps balance phenylalanine and tyrosine


 Zinc
 Copper
 Iron
 Magnesium


 Toxins: environmental, occupational, and recreational
poisons can disrupt proper communication in the brain
 Heavy Metals: Lead and Mercury
 Sources of Mercury:
 Eating fish or shellfish
 Dental work such as Mercury amalgams
 Breathing contaminated vapors or skin contact with:
antiseptics, bactericides, batteries, cosmetics, fabric
softeners, floor wax and polish, paints, tattoo inks,
perfumes, etc.


 Poor sleeping habits
 An inadequate amount of sleep,
or having a poor or irregular
sleeping schedule can lead to
poor brain function and a lack of
concentration.
 Exhibited by up to 50% of
children in the United States.


Sleep deprivation adds up over time, so an hour less per night is
like a full night without sleep by the end of the week. Among
other things, sleep deprivation can lead to:
 decreased attentiveness
 decreased short-term memory
 inconsistent performance
 delayed response time
 generally bad tempers, problems in school, stimulant use,
and driving accidents (more than half of "asleep-at-the-
wheel" car accidents are caused by teens).


Vitamin
Deficiencies

Thyroid Mineral
Disorders Deficiencies

Heavy
Allergies
Metals

 Feed Your Brain
 Lean protein
 Complex carbohydrates
 Decrease simple sugars
 Decrease bad fat not all fat
 Omega 3 Fatty Acids


 Lifestyle Changes
 Head injuries matter
 Avoid toxic substances
 Get enough sleep
 Manage stress
 Exercise
 Limit video games


Supplements that can help

 Omega 3  5 HTP
 Probiotics  DL phenylalanine
 Vitamin C  SAMe
 Vitamin B complex
 L theanine
 Phosphatidylserine
 L-tyrosine
 Gaba

Please fill out your pink event evaluation form
and return it to us.


Get started TODAY by making an appointment
with Dr. DeNise.


Patients Medical’s Team of Holistic Doctors


To get more information or to schedule an
appointment,
call 212-679-9667 or
email media@patientsmedical.com


Natural Treatment Options for ADD and ADHD

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