Parents increasingly are turning to alternative therapies to manage their child's ADHD. This review of the pharmacology and toxicology of the most popular herbs and dietary supplements for treating ADHD and what the literature shows about their efficacy should help you advise parents.
A family physician referred an 11-year-old boy for pediatric management of attention deficit hyperactivity disorder (ADHD) because the child's behaviors had not responded to methylphenidate. During the pediatrician's interview, the boy's mother revealed that she actually had stopped giving the boy the prescribed medication after only two weeks since "he just wasn't himself" while taking it. Instead, for the past six months she had been giving him one capsule of blue-green algae three times a day and three capsules of fish oil each day Had she noticed any improvements? "No," she said, "but at least it's more natural."
ADHD is a common behavioral disorder, with an estimated childhood prevalence of 3% to 11%.  The cause of ADHD is unknown, but it is probably multifactorial. Although treatment of ADHD is often notoriously difficult, the preponderance of evidence clearly indicates that stimulant medications are beneficial.  Parents have serious concerns, however, about giving their child a psychoactive ("mind-altering") substance with undesirable side effects for an unspecified but probably long period of time. These misgivings have contributed to increasing interest in the use of alternative therapies for ADHD. Concerned parents are willing to spend a significant amount out of pocket for promising alternative treatments (Table 1), and mass marketing and easy availability have made natural therapies a profitable industry. Kava kava and valerian, both used to relieve stress and anxiety, for example, have generated total sales of $2.9 million and $6.1 million, respectively. 
As in adults, the use of complementary and alternative medicine (CAM) by children has increased over the past few years, particularly in those with chronic illnesses such as cancer, cystic fibrosis, and asthma.  A recent survey of 381 families of children with ADHD found that 69% were using conventional stimulant therapy, and 64% had used or were using nonprescription therapy.  Of the nonprescription therapies, dietary regimens were the most common.
In a self-assessment exercise conducted recently by the American Academy of Pediatrics Ambulatory Care Quality Improvement Program, 93% of responding pediatricians reported that parents had asked them about alternative therapies for ADHD, and 38% had patients who were using such therapies.  Of the parents who had asked about alternative therapies, 48% were exploring recommendations to eliminate food additives, 42% to eliminate food preservatives, 27% to use vitamins, 27% to use visual training, and 9% to eliminate sugar from the diet. Other common therapies for ADHD include chiropractic, electroencephalogram biofeedback, herbs, food supplements, and homeopathy.
Exerience at our institution suggests that herbs and food supplements are among the most common treatments for ADHD; within these two categories, sedative herbs and other dietary supplements, such as special oils, melatonin, and blue-green algae, are among the most popular. Table 2 summarizes herbs and supplements that...
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