Attention deficit hyperactivity disorder (ADHD) is a neurological disorder that impacts the parts of the brain that help us plan, focus on, and execute tasks. It is a chronic condition that affects millions of children and often continues into adulthood. ADHD includes a combination of persistent problems, such as difficulty sustaining attention, hyperactivity and impulsive behavior. They have trouble with impulse-control, focusing, and organization.

Children with ADHD may also struggle with low self-esteem, troubled relationships and poor performance in school. Symptoms sometimes lessen with age. However, some people never completely outgrow their ADHD symptoms. But they can learn strategies to be successful. ADHD is not a behavior disorder or mental illness or a specific learning disability, instead, a developmental impairment of the brain’s self-management system.

It is the most prevalent mental disorder in children, with a worldwide-pooled prevalence of 5.3%. In India, the prevalence of ADHD has been reported to be 1.6–17.9%. ADHD occurs more often in males than in females, and behaviors can be different in boys and girls. Boys may be more hyperactive and girls may tend to be quietly inattentive.

Causes of ADHD

While the exact cause of ADHD is not clear, research efforts continue. Factors that may be involved in the development of ADHD include genetics, heredity, the environment or problems with the central nervous system at key moments in development. Investigations related to certain genes, especially ones linked to the neurotransmitter dopamine are progressing. Risk factors

Risk factors for ADHD

• Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder
• Exposure to environmental toxins — such as lead, found mainly in paint and pipes in older buildings
• Maternal drug use, alcohol use or smoking during pregnancy
• Premature birth

Sub-types of ADHD

The Diagnostic and Statistical Manual of Mental Disorders (DSM) previously identified three subtypes of ADHD

• Primarily hyperactive-impulsive type
• Primarily inattentive type
• Primarily combined type

The subtypes were primarily based on overt behavioral symptoms, and ignored less visible symptoms like emotional dysregulation, cognitive patterns, and sleep difficulties. Researchers determined that people often move from one subtype to another. For example, a child may present as primarily hyperactive-impulsive in preschool, and lose much of the hyper-arousal in adolescence to fit the primarily inattentive presentation. In college and adulthood, the same individual may transition to combined presentation.

Symptoms of ADHD

The primary features of ADHD include inattention and hyperactive-impulsive behavior. ADHD symptoms start before age 12, and in some children, they’re noticeable as early as 3 years of age. ADHD symptoms can be mild, moderate or severe, and they may continue into adulthood.

Symptoms in three subtypes of ADHD

The symptoms of ADHD are spelled out in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), which lists nine symptoms that suggest ADHD–Primarily Inattentive and nine that suggest ADHD–Primarily Hyperactive/Impulsive. A child may be diagnosed with ADHD only if he or she exhibits at least six of nine symptoms from one of the lists below, and if the symptoms have been noticeable for at least six months in two or more settings — for example, at home and at school. Older teens and adults may need to consistently demonstrate just five of these symptoms in multiple settings.

Symptoms in subtypes

Predominantly inattentive. The majority of symptoms fall under inattention.

Predominantly hyperactive/impulsive. The majority of symptoms are hyperactive and impulsive.

Combined. This is a mix of inattentive symptoms and hyperactive/impulsive symptoms.

9 symptoms of inattention

• Fail to pay close attention to details or make careless mistakes in schoolwork
• Have trouble staying focused in tasks or play
• Appear not to listen, even when spoken to directly
• Have difficulty following through on instructions and fail to finish schoolwork or chores
• Have trouble organizing tasks and activities
• Avoid or dislike tasks that require focused mental effort, such as homework
• Lose items needed for tasks or activities, for example, toys, school assignments, pencils
• Be easily distracted
• Forget to do some daily activities, such as forgetting to do chores

9 symptoms Hyperactivity and impulsivity

• Fidget with or tap his or her hands or feet, or wriggle in the seat
• Have difficulty staying seated in the classroom or in other situations
• Be on the go, in constant motion
• Run around or climb in situations when it’s not appropriate
• Have trouble playing or doing an activity quietly
• Talk too much
• Blurt out answers, interrupting the questioner
• Have difficulty waiting for his or her turn
• Interrupt or intrude on others’ conversations, games or activities

Complications of ADHD

ADHD can make life difficult for children. Children with ADHD:

Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

Tend to have more accidents and injuries of all kinds than do children who don’t have ADHD

Tend to have poor self-esteem

Are more likely to have trouble interacting with and being accepted by peers and adults

Are at increased risk of alcohol and drug abuse and other delinquent behavior

Treatment of ADHD

Types of treatment for ADHD include

Behavior therapy, including training for parents

Medications.

Treatment recommendations for ADHD

For children with ADHD younger than 6 years of age

The American Academy of Pediatrics (AAP) recommends parent training in behavior management as the first line of treatment, before medication is tried.

Behavior therapy of ADHD

The goals of behavior therapy are to learn or strengthen positive behaviors and eliminate unwanted or problem behaviors. Behavior therapy for ADHD can include

Parent training in behavior management

Behavior therapy with children

Behavioral interventions in the classroom

For children 6 years of age and older

The recommendations include medication and behavior therapy together- parent training in behavior management for children up to age 12 and other types of behavior therapy and training for adolescents.  Schools can be part of the treatment as well. AAP recommendations also include adding behavioral classroom intervention and school supports.

Parent training in behavior management;

Behavioral interventions in the classroom;

Peer interventions that focus on behavior; and

Organizational skills training.

These approaches are often most effective if they are used together, depending on the needs of the individual child and the family.

Medications of ADHD

Medication can help children manage their ADHD symptoms in their everyday life and can help them control the behaviors that cause difficulties with family, friends, and at school.

Different types of medication approved by FDA are

Stimulants are the best-known and most widely used ADHD medications. Between 70-80% of children with ADHD have fewer ADHD symptoms when taking these fast-acting medications.

Nonstimulants were approved for the treatment of ADHD. They do not work as quickly as stimulants, but their effect can last up to 24 hours.

Medications can affect children differently and can have side effects such as decreased appetite or sleep problems. One child may respond well to one medication, but not to another.

Healthcare providers who prescribe medication may need to try different medications and doses. The AAP recommends that healthcare providers observe and adjust the dose of medication to find the right balance between benefits and side effects. It is important for parents to work with their child’s healthcare providers to find the medication that works best for their child.

Complications of ADHD

ADHD can make life difficult for children. Children with ADHD:

Often struggle in the classroom, which can lead to academic failure and judgment by other children and adults

Tend to have more accidents and injuries of all kinds

Tend to have poor self-esteem

Are more likely to have trouble interacting with and being accepted by peers and adults

Are at increased risk of alcohol and drug abuse and other delinquent behavior

Ayurveda and ADHD

 

ADHD is a condition that cannot be treated and cured only with medication alone. Modern medicine relies more on behavioural therapy and cognitive therapy than on medication in treating the condition. However, those who have this condition can be cured of the complications related to this if treated early according to Ayurvedic principles.

Physical well-being occurs when the Tri-Dosha – Vata, Pitta, and Kapha – are in equilibrium. However, the uncontrollable increase in the Vata Dosha can lead to an increase in severity, bodyweight loss, chill, rigidity (Khara Swabhavam), immobility, and other subtle effects (Sukshma Vyapanam).  In this, when immobility, which is the vitiation of the primary function of Vata Dosha goes out of control, it results in the distorted and excessive manifestations of the malfunctioning of the body. This aggravated air (Kupitha Vayu) in turn impairs the equilibrium of the Sattva – Rajas – Tamas, the three unique mental qualities (Gunas). In particular, the aggravated air disproportionately increases the Rajas resulting in the manifestation of the various conditions of ADHD.

Reasons for the Disease & Maturation

Genetic disorders and the many harmful vitiations in nature can all be reasons for the incidence of the disease.

However, as per Ayurveda scriptures, a child can get ADHD if any undesirable or prohibited events or acts occur during the time the child is in the womb. In addition to this, the wrong diet and physical routines that a mother follows during pregnancy and while breastfeeding her child can lead to the creation of a toxin that causes a harmful effect in the body of the child.

When toxic ingredients that are present in the food and the water enter the bodies of such children who are born with weak physical and mental conditions, the Dosha that is in equilibrium in their bodies gets into a vitiated condition. This leads to the source of wrath/disease (Srothorodham). The correct formation and development of tissues (Dhatu Pushti) do not happen leading to the production of defective and degraded life essence (Ojas). The nature, behaviour, and thinking abilities of the children are affected especially by the impairment of the mental condition.

Ayurveda Treatment for ADHD

In Ayurveda, the effectiveness of the treatment is dependent on how early the treatment is started.

The treatment goes through primarily four stages:

Management of ADHD through Diet

Some foods, especially sugar, wheat, milk products, etc. are known to cause hyperactivity in children with ADHD. The treatment will be effective only if such foods are completely avoided. Accordingly, as a first step, the consumption of such foods should be stopped. Visible changes are observed in children when this routine is followed even for a month. The parents should make every effort to ensure that the prescribed diet is followed. A strict diet ensures the proper functioning of the digestive system (Agni).

2. Toxin Removal (Aama Pachana)

The toxic elements that are present in the body should be expelled for the proper functioning of the bodily functions. The medicines that can be given to removing toxins from the body are listed below:

1. i) Vilwadi Gulika –            ½ tablet daily

(½ tablet can be given daily to a child below 5years and one tablet to child above that age)

1. ii) Dooshivishari Gulika –            ½ tablet daily

(½ tablet can be given daily to a child below 5years and one tablet to child above that age)

iii)          Nirgundyadi Kashayam  –

5ml Kashayam mixed in 45ml boiled and cooled water to be given twice daily

1. iv) Krimighna Vati –            One each twice daily
2. v) Vilangasaaradi Kashayam –            5ml Kashayam mixed in 45ml boiled and cooled water to be given twice daily.
3. vi) Makkippoovadi Kashayam –            5ml Kashayam mixed in 45ml boiled and cooled water to be given twice daily.

vii)         Vizhalveradi Kashayam                –            5ml Kashayam mixed in 45ml boiled and cooled water to be given twice daily.

3. Agni Deepana Chikitsa (Metabolic Correction / Rekindling of Digestive Fire)

The deficiency of Agni is the reason for all diseases. Due to this, medicines that enhance the digestive fire (Agni) should be given after the completion of toxin removal therapy (Aama Pachana).

1. i) Vaishwanara Choornam –            2g mixed in honey
2. ii) Ashta Choornam –            2g mixed in honey

iii)          Rajanyadi Choornam                    –            2g mixed in honey and ghee

1. iv) Vaishwanara Choornam –            2g mixed in honey
2. v) Gandharvahasthadi Kashayam
3. vi) Guluchyadi Kashayam

vii)         Chiruvilwadi Kashayam

viii)        Abhayarishtam – 10ml Arishtam mixed in 20ml of boiled and cooled water

1. ix) Hinguvachadi Choornam
2. In-patient Treatment for ADHD

Some Vata-inhibiting external procedures can be performed at the time of in-patient treatment.

1. i) Abhyangam (Body Massage)

Ksheerabala Tailam, Bala Thailam, Chinchadi Thailam, etc. can be massaged on to the body. The body should be given a mild dose of heat after this. This is an ideal treatment for inhibiting Vata.

1. ii) Shirodhara (Application of Oils on the forehead)

When oils (Thaila Dhara) are applied on the forehead, it helps in inhibiting Vata and while also stimulating and ensuring the proper functioning of the central nervous system which is the main functional part of Vata Dosha.

The following can be used for Shirodhara:

–             Balaa Thailam

–             Madhuyashtyadi Thailam

–             Ksheerabalaa Thailam

iii)          Karnapooranam (Cleansing of the Ears)

Performing ear cleansing (Karnapooranam) with Vata-inhibiting oils (Thailam) is said to be effective in some conditions as ears are one of the main locations of Vata Dosha.

Oils that can be used for cleaning include:

–             Kshara Thailam

–             Murivenna Thailam

–             Ksheerabalaa Thailam

1. iv) Shirovasti (Application of Oil on the head)

Even though this cannot be done on small children, Shirovasti with Vata-inhibiting oils (Thailam) can be done on older children and adults. Though, it would be a bit difficult to do Shirovasti on patients who have hyperactivity, if carried out, can prove to be an effective method for inhibiting  Vata Dosha and ensuring the proper functioning of the central nervous system.

Medicines that can be used for Shirovasti:

–             Ksheerabalaa Thailam

–             Dhanwantaram Thailam

1. v) Shiropichu (Placing of Medicated Cotton Pad on the head)

Shiropichu with the same oils (Thailam) mentioned above can be done on patients who cannot undergo Shirovasti treatment.

1. vi) Thalam (Retaining Medicinal Oils on the pate of the head)

Thalam (retaining medicinal oil on the pate of the head using a suitable cap) procedure is performed on the pate of the head.

–             Kachooradi Choornam mixed with Ksheerabalaa Thailam / Sudhabala Thailam

–             Rasnadi Choornam mixed with Ksheerabalaa Thailam / Sudhabala Thailam

vii)         Shirolepam (Application of Medicinal Paste on Scalp)

Vata-inhibiting medicines can be mixed into a paste with buttermilk or other substances and applied on the skull scalp. The head should be shaved or closely trimmed before the application of the paste (Lepanam).

–             Mix Panchagandha Choornam with buttermilk and apply

–             Mix Amla Choornam with buttermilk and apply

–             Choornam of Gooseberry (Nellikka), Cyprus rotundus (Muthanga), etc. can be mixed in buttermilk and applied

viii)        Shodhana Chikitsa (Waste Elimination Therapy) for ADHD

Purification Therapy (Shodhanam) together with Sneha (Medicated oils internally and externally) and Sweda (sweating) cannot be carried out on children who are affected with ADHD. However, for adults with ADHD, Intake of medicated oils (Snehapanam) should be done with Ghritham and other things described in Unmada Chikitsa. This is to be followed by induced sweating (Swedanam). Vasti / Virechanam / Vamanam, etc. can be done after this. Kashaya Vasti will be helpful if the main objective is to bring down hyperactivity levels. However, doing Vamanam or Virechanam is ideal if the objective is toxin removal. The most suitable treatment can be chosen based on the condition of the disease.

If the patients are children with ADHD, then medicines that have Virechana properties should be given and Vata-inhibition should be ensured.

1. ix) Mathra Vasti (Therapeutic Enema)

Considerable reduction in the disease condition is observed when Matra Vasti is judiciously applied to children with ADHD. Vata pacification (Shamanam) and a small amount of nourishing (Bruhanam) are possible with this treatment.

Oils (Thailam) that can be used:

–             Pippalyadi Anuvasana Thailam

–             Murivenna

–             Balaa Thailam (Avarthi)

–             Dhanwantharam Thailam (Avarthi)

1. x) Nasyam (Application of Medicines through the Nostrils)

Nasya Prayogam can be performed as Marsha Nasyam (high dose) in adults and Prati Marsham (low dose) in children. By performing this method, it is possible to obtain relief from the disease and ensure the smooth functioning of the brain functions.

Medicines that can be used:

–             Ksheera Bala Aavarthi (7/14/21/41/101)

–             Anu Thailam

–             Dhanwanthara Thailam

Ojavardhakam (Invigorating the Body and Mind) for ADHD

Medicines that stimulate the brain and mind should be given in the last stage of the treatment. Consumption of medicines that has rejuvenating properties (Rasayana Swabhavam) will result in the correct regeneration of the tissues (Dhatu Parinamam) and hence result in the invigoration of the body and mind (Ojovridhdhi).

Medicines that can be given to ADHD:

–             Swarna Bhasmam

–             Brahmee Swarasam

–             Shankhupushpee Swarasam / Choornam

–             Kalyanavaleham

–             Saraswatharishtam

–             Vachadi Choornam

–             Chyavanaprasham

–             Yashtimadhu Choornam

–             Mandukaparni Swarasam

Yoga for ADHD

Regularly doing light exercises and Yoga will help in the development and evolution of the body and mind. However, it is usually not possible to make ADHD patients sit in place to perform yoga. Due to this inability, the Yoga Asanas should be converted into small games and presented to the children to engage and maintain their interest.

The patients should be made to perform the following Asana in this manner:

–             Surya Namaskaram

–             Vrikshasanam

–             Dandasanam

–             Sarvangasanam

–             Dhanurasanam

–             Pavanamukthasanam

Pranayama for ADHD

It would be a difficult task to make ADHD patients sit still in place and perform Pranayama. However, as they progress with performing the Yoga Asanas, breathing exercises should also be slowly included in the Asana routines. The following Pranayama could be performed if possible:

–             Nadi Shodhana Pranayamam

–             Chandrabhedana Pranayamam

–             Sheethkari

–             Sheethali

Things to be taken care of / Dietary Controls

–             This should be treated as a disease condition and parents and the society should behave with the children accordingly. The parents should be given the necessary training to take care of the children.

–             Proper interventions should be made to divert the attention of the children towards games and entertainments that are relaxing.

–             Other avenues that help in reducing the severity of the disease should be utilized:

o            Music Therapy

o            Behavioural Therapy

o            Cognitive Therapy

o            Parent Counselling

o            Occupational Therapy

Things to avoid in the diet for ADHD

–             Avoid wheat, maida, and rava

–             Avoid all types of bakery items, chocolate, and ice cream

–             Avoid apple, Nenthran banana, oats, soya bean, corn flakes, corn, soya milk, milk, and milk products

–             Avoid food in which yeast or baking soda is added

–             Avoid excessive use of tamarind as also groundnuts, cashew nuts, and sugar in foods

Food items that can be consumed for ADHD

–             Gluten-free and caffeine-free food that is prepared at home

–             Food that is fermented using coconut water instead of yeast and baking soda

–             Pure honey and sugar

–             Rice and millets (Ragi, Baajra, Chama, Cholam, Varagu, etc.)

–             Local eggs

–             Seasonal and ripe fruits

Conclusion

The problems encountered by ADHD affected children can be solved if they are made to promptly undergo scientific Ayurveda and related treatments even if the reasons for the disease are beyond control. There is a high chance that they could become anti-social elements or people who indulge in criminal activities in the future if they are not given proper and timely treatment. For this very reason, it is also the responsibility of society to ensure that such people get proper treatment. In addition to this, practicing proper pregnancy care and new mother/new-born care will help to a certain extent in preventing this sort of condition to develop.

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