Alternative and controversial treatments for attention-deficit/hyperactivity disorder.

Approximately 2500 years ago, the great physician-scientist Hippocrates described a condition that is quite compatible with attention-deficit/hyperactivity disorder (ADHD). He described the patient as having "quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression," and attributed these symptoms to an "overbalance of fire over water." His treatment recommendation was "barley rather than wheat bread, fish rather than meat, watery drinks, and many natural and diverse physical activities." 24 Hippocrate's formulation was scientific avant-garde for his time, because he hypothesized a disorder that was due to an imbalance of physical elements, fire and water, rather than to divine and supernatural forces. His treatment approach, however, was mainstream classical Greek and rested on the "dietetic" system of maintenance and restoration of mind and body integrity through specific physical, mental, and musical exercises and diet. Hippocrate's management plan contained most of what we currently would consider to be alternative treatments. His dietary prescription interestingly anticipated modern theories of the benefit of a gluten-free diet and essential fatty acids in brain-behavior functions. Since the publication of the article by Eisenberg et al 16 about unconventional medicine usage in the United States, alternative medicine has come out of the closet and has become a significant focus of discussion and funded research within the orthodox medical community. Alternative medicine is a somewhat ambiguous term, spanning a broad spectrum from nonwestern medical traditions to the experimental application of molecular biology research, with many different shades in between. Alternative also implies different disease conceptualization, diagnostic techniques, and treatment expectations in addition to different treatment methods. Alternative approaches often lack scientific validation, sometimes taking isolated facts or findings out of context and turning them into fads. Complementary and alternative treatments are not at all unique in this aspect, however, because only approximately 15% of mainstream medical treatment is evidence based. 17 Fortunately, alternative medicine is no longer dogmatically exclusive of mainstream approaches. Proponents often recommend combining mainstream and nonmainstream modalities into a holistic, complementary, and integrative treatment for complex medical conditions. Alternative treatments often mirror the scientific uncertainty and complexity of the conditions for which they are intended. ADHD is such a complex condition that has diverse symptoms and no clearly identifiable etiology. Stimulant medications are generally recognized as the treatment of choice for ADHD. Because of their effectiveness, relative safety, and enormous frequency of use, stimulant medications have achieved the status of a gold standard against which any treatment for ADHD, mainstream or alternative, is held. Despite this, alternatives to stimulant medications are sought for many reasons. Many parents turn to alternative treatments because they are concerned about the risk of giving their child a powerful psychoactive medication over an indeterminable and often prolonged period of time. This concern is fueled by negative publicity in the lay press regarding stimulants. To some parents, stimulants represent a symptomatic quick fix rather than a long-term solution. Other parents may seek a more natural approach to treatment or greater involvement in the therapeutic process. Finally, nonpharmacologic alternatives may be sought when stimulants are ineffective, produce unacceptable side effects, or are contraindicated because of a comorbid condition. Publications on alternative treatments for ADHD are sparse in the peer-reviewed literature but abound in the popular press and on the Internet. A plethora of websites provide information ranging from well-researched articles to pure opinion. Parents often have ready access to these resources and may approach their health care provider for more information regarding alternative treatment options. Consequently, the practitioner must be prepared to provide accurate information and answer questions. This article strives to give a general overview of those alternative approaches that are commonly discussed in the scientific and lay literature. The intent is to illustrate the diversity of these approaches and not to advocate or endorse any of the discussed treatments as the solution to the problem of ADHD.