Complementary Treatment for ADHD: Nutrition Supplementation
The case for full-spectrum vitamin-mineral supplementation just got stronger.
Posted October 4, 2021 | Reviewed by Davia Sills
- A recent study of 135 children confirmed some benefits for ADHD using multi-nutrient supplementation.
- The main benefit may be for those with emotional dysregulation.
- Next steps will include studying combined multi-nutrient and other treatment for ADHD.
Complementary and alternative treatments for ADHD are in high demand, much-touted, and yet thinly supported by empirical evidence. Yet, they remain needed. I reviewed much of this landscape a few years ago in Getting Ahead of ADHD (2017). Although multiple stimulant and non-stimulant medications for ADHD have become available and been well-studied in the last 70 years, and although they do provide significant help for most patients, concerns remain. Their long-term value is less clear. Side effects discourage continued use for many patients, and discontinuation rates are high (perhaps contributing to unclear long-term benefits in many studies).
Fortunately, evidence is rapidly accruing on several fronts for supporting complementary treatments.
One of the most promising treatments is multi-nutrient supplementation. The latest study warranted an editorial in the most recent (August) issue of the Journal of the American Academy of Child and Adolescent Psychiatry. It referenced a study by Johnstone and colleagues at Oregon Health & Science University’s Center for ADHD Research.
Multi-nutrient supplementation, in this case, does not mean an off-the-shelf vitamin pill. Rather, it refers to a complete package of all vitamin and mineral nutrients at doses higher than the Recommended Daily Minimum (RDA) but lower than the maximum tolerable dosage. The Johnstone et al. study was the second double-blind, randomized, controlled trial of this treatment to be completed in children. It was the first to ever be done in the United States (prior studies were conducted in New Zealand and elsewhere).
Johnstone and colleagues studied 135 children (6-12 years old) with ADHD. They received either supplements or a placebo for eight weeks while remaining medication-free. In the treatment group, over 50 percent were classified as improved in clinician ratings, versus only 18 percent in the placebo group. Notably, these children all had elevated symptoms or irritability (tantrums and difficult regulation emotions). Those symptoms were among the outcomes that improved in this study and a prior one.
The future of complementary nutritional supplements
Work remains to be done on optimizing dosage, reaching out to a broader population for trial participation, examining this supplement in combination with other treatments, and understanding how the supplements work. Even so, these results are very promising. Brain function requires a full, integrated array of vitamins and minerals for its many steps of neurotransmitter synthesis and signaling, as well as maintaining healthy cells. If a subset of children with ADHD has difficulty processing nutrients, then extra-high dosing would help. The editorial concluded that “micronutrients may provide a more benign combined intervention with behavioral treatment for ADHD, especially for individuals with accompanying problems with emotion regulation.”
That result dovetails with prior work in our lab, showing that it is possible to mathematically identify a subgroup of children with ADHD who do have marked difficulties with emotion regulation and may need a modified treatment regimen as a result. Thus, the stars may be aligning for identifying clinically meaningful subgroups of children with ADHD and optimizing their treatment recommendations accordingly in relation to emotional functioning.
Please note: Dr. Nigg cannot advise on individual cases for ethical, legal, and logistical reasons.
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2019). Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Molecular psychiatry, 24(3), 390–408. https://doi.org/10.1038/s41380-018-0116-3
Johnstone, J. M., Hatsu, I., Tost, G., Srikanth, P., Eiterman, L. P., Bruton, A. M., Ast, H. K., Robinette, L. M., Stern, M. M., Millington, E. G., Gracious, B. L., Hughes, A. J., Leung, B., & Arnold, L. E. (2021). Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, S0890-8567(21)00473-1. Advance online publication. https://doi.org/10.1016/j.jaac.2021.07.005
Karalunas, S. L., Gustafsson, H. C., Fair, D., Musser, E. D., & Nigg, J. T. (2019). Do we need an irritable subtype of ADHD? Replication and extension of a promising temperament profile approach to ADHD subtyping. Psychological assessment, 31(2), 236–247. https://doi.org/10.1037/pas0000664
Nigg, J. T. (2017). Getting Ahead of ADHD: What Next-Generation Science Says about Treatments That Work—and How You Can Make Them Work for Your Child. Guilford Press.
Nigg, J. T., Karalunas, S. L., Feczko, E., & Fair, D. A. (2020). Toward a Revised Nosology for Attention-Deficit/Hyperactivity Disorder Heterogeneity. Biological psychiatry. Cognitive neuroscience and neuroimaging, 5(8), 726–737. https://doi.org/10.1016/j.bpsc.2020.02.005
Rucklidge, J. J., Eggleston, M., Johnstone, J. M., Darling, K., & Frampton, C. M. (2018). Vitamin-mineral treatment improves aggression and emotional regulation in children with ADHD: a fully blinded, randomized, placebo-controlled trial. Journal of child psychology and psychiatry, and allied disciplines, 59(3), 232–246. https://doi.org/10.1111/jcpp.12817
Stevenson J. (2021). Editorial: Accumulating Evidence for the Benefit of Micronutrients for Children With Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, S0890-8567(21)01352-6. Advance online publication. https://doi.org/10.1016/j.jaac.2021.08.008