ADHDAttention deficit

/hyperactivity disorderhelp pack

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3Index1. ADHD overview: facts and symptoms

1.1. What is ADHD?

1.2. ADHD symptoms

1.3. ADHD statistics

1.4. ADHD diagnosis

2. ADHD risk factors

2.1. Contributing influences

2.1.1. Genetic influences

2.1.2. Environmental influences

2.1.3. ADHD and nutrition

- Prenatal nutrition

- Postnatal nutrition

3. Treatments for ADHD

3.1. Pharmaceutical medication

3.2. Alternatives to pharmaceutical treatments?

4. Diet and nutrition

4.1. Major food groups

4.2. Dietary allergens

4.3. Prebiotics & probiotics

4.4. Treating nutritional deficiencies

- Omega-3 fatty acids and EPA

- Pure EPA supplements

- Vegetarian sources of omega-3

- Vitamins and minerals

Support networks

Further reading

Contacts

References

Attention deficit/hyperactivity disorder (ADHD)4

ADHDhelp pack

2. ADHD risk factors

2.1. Contributing influencesWhilst the actual causes of ADHD are still far fromclear, both genetic and environmental factors arethought to be involved.

2.1.1. Genetic influencesResearch involving genetic twin studies suggeststhat there is a strong genetic link in thedevelopment of ADHD. In the last fifteen years,considerable progress has been made inidentifying specific genes involved, both in thedevelopment and progression of this disorder.Several neurotransmitter pathways, includingdopamine and serotonin, are now known to beinvolved (Khan & Farone 2006). Neurotransmittersare simply chemicals that send messages fromone cell to another. In order to function, they haveto be received by another cell and anyneurotransmitter not used is taken back up andrepackaged for later use. This process forms a‘neurotransmitter pathway’, and many genes areinvolved in its function. Small changes (known assingle nucleotide polymorphisms or ‘SNPs’) in anyof these genes can have a profound anddetrimental effect on the pathway or system.What researchers are finding is that many childrenwho are screened have one or more of the sameSNP in one or more of the same gene, which tellsus that there is a common genetic link.Dopamine, for example, has an important role incognition, behaviour, motivation, reward andmovement. Genetic changes in any of thedopamine pathway genes may have a negativeinfluence on the way the message is sent orreceived, and will therefore affect aspects such asbehaviour or motivation. It is not surprising,therefore, that many of the common drugs usedto treat ADHD work by increasing the efficiency ofneurotransmitters in the brain.

It has also been clearly established that specificareas of the brain involved in socialisation,impulse, reasoning and judgement tend to besmaller and exhibit different biochemicalprocessing in children with ADHD.

2.1.2. Environmental influencesEnvironmental exposure to harmful chemicalssuch as pesticides, tobacco, lead and mercuryduring pregnancy can increase the chances of achild developing ADHD. This is because thesecompounds are potentially toxic and onceingested or absorbed can often become moretoxic after being processed in the liver. In theory,the liver does have the capacity to ‘detoxify’ thesecompounds and, if this is done efficiently, can

1. ADHD overview: facts and symptoms1.1. What is ADHD?ADHD is a common developmental problem in which childrendemonstrate problems with hyperactive and often impulsive behaviour,and inattention. As a result, ADHD can cause serious problems in relationto a child’s ability to learn, socialise and form relationships.

1.2. ADHD symptomsChildren with ADHD often exhibit temper tantrums, as well as antisocial ordefiant behaviour. They also tend to be accident-prone or overly clumsy,and often have difficulty sleeping. ADHD is also associated with cognitiveproblems including learning difficulties such as reading, writing andproblems with language. Difficulties with learning can be very hard toovercome since several inherent features of ADHD – such as distractibility,poor discipline, lack of emotional control and concentration – makelearning even more of a challenge.

1.3. ADHD statisticsADHD is the most common of the childhood neuro-developmentaldisorders, with symptoms usually arising between the ages of 5 and 9,and this is generally when most children are diagnosed. ADHD isestimated to affect 2-18% of children, with figures on the rise (Rowland etal, 2002). The condition continues throughout school years and as manyas 60% of diagnosed children will carry some symptoms (as well as itsrepercussions) through to adulthood.

1.4. ADHD diagnosisADHD requires a medical diagnosis by a doctor – usually a child- oradolescent- psychiatrist, a paediatrician or paediatric neurologist. Childrenmust present a range of symptoms that have persisted for at least sixmonths, to an extent that is unusual for their age and level of intelligence.

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5render the compound harmless. If, however, thebody is overwhelmed by toxins and the livercannot physically cope or is not provided with theproper chemicals to detoxify these compounds(such as a good supply of antioxidant vitaminsand minerals in the diet) then toxins build up andhave the ability to interfere with certain genes(such as the ones described above), causinggenetic damage. If this results in an SNP and therelevant biochemical pathways are affected, thisincreases the risk of developing ADHD.

2.1.3. ADHD and nutritionNutrition appears to play a significant role in thedevelopment and progression of ADHD, at boththe prenatal (before birth), neonatal (newbornbaby) and postnatal stages. The mother’s diettherefore plays an important role in thedevelopment of the foetus, and this also affectsthe child’s diet after delivery, during thebreastfeeding stage – a crucial period of growthand development.

Prenatal nutrition

Ideally, all women should enter pregnancynutritionally balanced, although this is often notthe case. As the developing foetus is entirelydependent on the mother for its nutritional needs,the mother’s diet is extremely important, withextra demands on protein needs, essential fattyacids (discussed in section 4.4), as well as manymicronutrients, including vitamins and minerals.Failure to ensure the nutritional needs of thedeveloping foetus can have profound effects onoverall growth and development, especially that ofthe brain. This can result in long-term deficienciesafter birth and during the child’s early years, whenthe majority of growth and development takesplace.

Children with ADHD often have extremely lowlevels of a variety of essential micronutrients andlong-chain omega-3 fatty acids. Encouragingly,however, extremely positive results have beenseen with straightforward changes to the diet. Wediscuss the diet in detail in section 4.

Postnatal nutrition

Leaky gut syndrome and ADHD

Many children with ADHD have extreme food intolerances because of acondition called leaky gut syndrome. The most common allergies forchildren with ADHD are dairy products, wheat, corn, yeast, soy, citrus,egg, chocolate and peanuts, as well as food colourings and additivesassociated with many processed and packaged foods. But why is this?Well, the general function of the gastrointestinal tract is to digest andabsorb food and water, and eliminate the waste that is left over orgenerated in the process. Once protein, fat and carbohydrate aredigested into their individual components (amino acids, simple sugars,fatty acids, vitamins, and minerals), they can be absorbed through thetightly packed surface cells of the intestine, either directly or by specialproteins called ‘carrier proteins’. These are responsible for binding tocertain nutrients and transporting them through the intestinal wall and intothe bloodstream.

With leaky gut syndrome, the specialised cells of the intestine are notpacked correctly, allowing much larger molecules (as well as bacterianormally present within the gut) to pass through and enter thebloodstream. The result of this is that the body sees these particles as‘foreign’ material and begins an immune response in an attempt to destroythe ‘invader’ – what might be described as an allergic reaction. Havingallergies to many food types can further exacerbate any nutritionaldeficiencies that may already exist.

Dietary deficiencies: impact on the brain

The brain is a highly complex organ that requires specific nutrients, notonly during early development (prenatal, neonatal etc) but also during theearly years up until it is fully developed. During development,micronutrients including vitamin B complex, vitamin C, vitamin E, iodine,iron, zinc, copper, taurine and choline are crucial. Comprisingapproximately 70% fat, of which the majority are ‘long-chain’ fatty acids,the fatty acid composition of the foetal brain depends upon the fatty acidcontent of the mother’s diet. During the last three months of pregnancythere is a huge growth spurt, with further growth in the months after birth,and another 15% during the first year of life; the remaining 10% growthoccurs during preschool years. The majority of brain growth is completedby the age of five.

Many children with ADHD have significant deficiencies in specific fattyacids, which are needed for normal growth and development. These fattyacids are known as omega-3 long-chain fatty acids, which are typicallyfound in oily fish. Since these fatty acids are needed for normal braingrowth, specific areas of the brain associated with controlling hyperactivity,impulsivity and inattention tend to be smaller in children with ADHD.

Many children with ADHD have significantdeficiencies in specific fatty acids, which areneeded for normal growth and development.These fatty acids are known as omega-3 long-

chain fatty acids, which are typically found in oily fish. Sincethese fatty acids are needed for normal brain growth,specific areas of the brain associated with controllinghyperactivity, impulsivity and inattention tend to be smallerin children with ADHD.

6ADHDhelp pack

3. Treatments for ADHD3.1. Pharmaceutical medicationThere are two pharmaceutical drug types that have been approved fortreating ADHD – psychostimulants and selective noradrenaline reuptakeinhibitors (SNRIs). Psychostimulants are by far the most common choice,and work by stimulating specific neurotransmitters that are involved inattention and concentration. The best known of the psychostimulantsfamily is Ritalin, which is routinely prescribed to children with ADHD.Whilst many sufferers have exhibited benefits from taking this drug, thereare many associated side effects that often outweigh the benefits, and canresult in individuals coming off these drugs.

Side effects include:

• Increased anxiety

• Decreased appetite

• Difficulty in sleeping

Other reactions include:

• Hypersensitivity (such as skin rash, fever, exfoliative dermatitis)

• Anorexia/weight loss

• Abdominal pain

• Nausea

• Dizziness

• Palpitations

• Headache

• Dyskinesia (involuntary movements)

• Drowsiness

• Changes in blood pressure

• Tachycardia (rapid heart beat)

• Angina

When psychostimulants don’t work or individuals react badly to them,SNRIs are often prescribed. These drugs are not stimulants but they alsoincrease the levels of neurotransmitters in the brain, specificallynoradrenaline. Like stimulants, however, they have their own set of sideeffects including insomnia, increased heart rate, palpitations and can alsohave detrimental effects on the liver.

3.2. Alternatives to pharmaceuticaltreatments?The side effects of prescription medication inADHD deter many parents, who would ratherpursue alternative approaches for managingtheir child’s ADHD symptoms. Frequently,parents turn to nutrition and other non-pharmaceutical interventions such as naturalsupplements and certain therapies, to treat thesymptoms associated with the condition, oftenwith extremely successful results.

• Cognitive behavioural therapy (CBT)

Pharmaceutical intervention is often combinedwith a type of behavioural therapy called CBT,which refers to a range of techniques that focuson the construction and re-construction ofpeople’s cognitions (which refers to how anindividual thinks about themselves) andbehaviours (which refers to how they then actand behave). CBT can help to retrain how achild thinks, acts and behaves, whilst nurturingnew skills that improve how they manage otherdifficult symptoms. CBT is often very helpful inmanaging the associated problems such as lowself-esteem and relationship difficulties.

• The Sunflower Therapy

The Sunflower Therapy is a comprehensiveapproach to the diagnosis and treatment ofhealth, learning and behavioural difficulties. It isbased on the concept that physically,neurologically balanced, healthy, well-integratedchildren naturally perform better, feel better,achieve more, have greater self-esteem, get onbetter with others and make the most of theiropportunities.

The Sunflower Therapy is a unique way ofrelieving stress and promoting wellbeing, usingan array of safe, natural therapies matched toindividual needs. The Sunflower Programmeinvestigates, in measured ways, hundreds offactors which contribute to the difficulties that anincreasing number of children suffer from inregard to learning, health, confidence, behaviourand self-esteem. Applied Kinesiology (AK) andManual Muscle Testing (MMT) are used inconjunction with more conventional methods toevaluate the functional neurology as it affects thestructure, feelings and behaviours, dietary andnutritional factors. Appropriate treatments areapplied at each stage of the programme in waysthat are clearly monitored.

By tackling many of the underlying causes,children are able to achieve more of their ownpotential. It is a comprehensive and efficientnatural health system devised for screening outand effectively dealing with learning difficulties.

4. Diet and nutritionThere is increasing evidence that children withADHD benefit significantly from changes to thediet, both from a reduction of symptoms and inimprovements to their overall health and relatedallergies, dry skin or eczema and dry hair.

The approaches listed below could result in ahappier, more settled, more focused child.

1.Major food groups: reducing sugar, increasingquality protein

2.Eliminating/reducing dietary allergens

3.Restoring normal gut flora

4.Treating nutritional deficiencies:supplementation with EPA and other nutrients

4.1. Major food groups

Sugar

It appears that many of the behaviouralproblems associated with ADHD are directlylinked to sugar intake. White sugar and otherrefined (simple) carbohydrates, such as thosefound in processed white bread and whitepasta, white rice and most convenience foods,supply few nutrients to the body but use upimportant B vitamins, which are essential for ournervous and immune systems, as well as forhealthy digestion. The brain needs energysupplied at an even rate in order to functionoptimally, so it is important to maintain bloodsugar levels. Avoiding sudden peaks anddramatic dips in blood sugar will positivelyinfluence behaviour, anxiety, depression andfatigue.

The glycaemic index (GI) ranks carbohydratesaccording to their effect on blood glucose levels,and is a good guide as to which foods weshould be eating more of, and which we shouldbe reducing. Foods with a low GI release theircomplex carbohydrates slowly, thus avoiding thesudden spike in blood sugar – these we shouldeat more of! Avoiding refined foods and sugar(rated high on the GI scale), as well asconsuming foods with a low GI value, will help tokeep blood sugar levels even and avoid ‘sugarrushes’. Good low GI carbohydrates includehigh fibre cereals, whole grain products, beans,pulses, brown rice, wholewheat pasta, fruit andvegetables. Because these products are notrefined or processed, they tend to be high invitamins and minerals such as thiamine, folateand zinc – all known to play a positive role inbehaviour and mood. Furthermore, restrictingsugar in the diet and increasing fibre can helpsymptoms associated with leaky gut syndromeand help to heal the cell surface of the gut,restoring it to its healthy state, whereby nutrientsare more fully digested.

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7Protein

Protein needs are particularly high in times of growth and developmentand it is thought that children with ADHD may not be consuming enoughprotein (children should consume around 24 to 30 grams of protein a day).A protein-rich diet that is low in sugar and carbohydrates may thereforehelp.

Proteins are comprised of amino acids, which are important for brainhealth via their role in the function of neurotransmitters, known to have amajor role in ADHD symptoms. Essential amino acids are those that mustbe consumed in the diet to avoid deficiency since they cannot beproduced by the body. Whilst animal-derived proteins contain all theessential amino acids and are considered ‘complete’ proteins, vegetablesources are not always complete. For vegetarians it is advisable to eat acombination of grains and legumes to get all the necessary amino acids.Increasing protein in the diet can improve the production of necessaryamino acids, which improve brain function. Tyrosine and phenylalanine, forexample, are both essential amino acids that are the precursors to theneurotransmitter dopamine, thus increasing intake can positively affectdopamine levels.

4.2. Dietary allergensSalicylates

Salicylates are naturally-occurring chemicals found in many plants,including certain fruits, vegetables and herbs, to which children with ADHDare often highly sensitive. Salicylates also inhibit the conversion of essentialfats, which are usually already low in children with ADHD. The websitebelow contains a comprehensive list of safe foods, and those to avoid:'http://www.salicylatesensitivity.com/food-guide

Good low GIcarbohydrates includehigh fibre cereals,whole grain products,

beans, pulses, brown rice,wholewheat pasta, fruit andvegetables. Because theseproducts are not refined orprocessed, they tend to be high invitamins and minerals such asthiamine, folate and zinc – allknown to play a positive role inbehaviour and mood. Furthermore,restricting sugar in the diet andincreasing fibre can helpsymptoms associated with leakygut syndrome and help to heal thecell surface of the gut, restoring itto its healthy state, wherebynutrients are more fully digested.

Food additives

A food additive is a substance intentionally added to food for a specificfunction (for example to preserve or colour it) and which is not normallyeaten as a food or used as a characteristic ingredient in food. Artificialcolourings, often found in soft drinks, sweets, cakes and ice cream, seemto be particularly aggressive in triggering symptoms.

Watch out for and avoid:

• allura red (E129)

• carmoisine (E122)

• ponceau 4R (E124)

• quinoline yellow (E104)

• sunset yellow (E110)

• tartrazine (E102)

4.3. Prebiotics & probioticsIf your child has ADHD it is very likely that the balance of flora (bacteria) inthe intestines is abnormal. Also called intestinal dysbiosis (an overgrowthof ‘bad bacteria’, which can thrive in high sugar diets in vulnerable people),this can produce waste products that may have a toxic effect, triggeringhyperactive behaviour and concentration problems.

Our digestion is also closely linked to immunity, and introducing probioticbacteria into the digestive system can have a positive influence on theeffectiveness of our immune system. Probiotics are live microorganisms (inmost cases, bacteria), similar to beneficial microorganisms found in thehuman gut. Look out for ’friendly bacteria’ or ‘good bacteria’ on productlabels.

Probiotics are available in the form of dietary supplements and foods suchas yogurt, with most products containing one of two types of bacteria –Lactobacillus or Bifidobacterium. Within each group, there are differentspecies (for example, Lactobacillus acidophilus and Bifidobacteriumbifidus) and within each species, different strains (or varieties). Probioticsare often combined with prebiotics to form synbiotics. Prebiotics aresimply non-digestible food ingredients that selectively stimulate the growthand/or activity of beneficial microorganisms already in the colon.

4.4. Treating nutritional deficienciesOmega-3 fatty acids and EPA

A whole range of nutrients are essential for the normal functioning of thebrain, and there is increasing evidence that deficiencies or imbalances inhighly unsaturated omega-3 fatty acids contribute to both thepredisposition and the development of ADHD. Given that fatty acids playa key role in the structure and function of the brain (moderatingneurotransmitters and the structure and function of neurotransmitterreceptors), abnormalities in fatty acid metabolism are thought to accountfor many of the features of ADHD; visual symptoms, motor function,attentional problems and language processing may be affected, as well assome of the associated difficulties with mood, appetite or digestion, andsleep.

The body’s ability to make these important fatty acids is also hindered bydeficiencies of various vitamins and minerals that help the enzymes drivingthese processes – vitamins B3 (niacin), B6, C, biotin, zinc and magnesium.Both zinc and magnesium deficiencies are common in children withADHD.

Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are bothomega-3 fatty acids essential for optimal brain function, but each hasdifferent functions. DHA is important in the structure of neuronalmembranes; hence, adequate supplies are needed during early8

ADHDhelp pack

development to support brain growth. EPA hasvery little structural role in the brain, but it isessential for the regulation of brain function andso it is important to provide the brain with aregular supply. The strongest evidence nowsuggests that EPA, rather than DHA, is theomega-3 fatty acid most effective in improvingattention, perception, memory and mood, notonly in ADHD but also in dyslexia, dyspraxia,and autism (Richardson, 2001).

Fish is a vital source of the long-chain omega-3polyunsaturated fatty acid EPA, which is crucialfor moderating the amounts of neurotransmittersin the brain. Fundamentally, the purpose of thisfat is to ensure that cell membranes in the brainand body are functioning fluidly and allowingelectrical messaging to function optimally. WhenEPA levels are low, this creates a chemicalimbalance in the brain, which affects theproduction of neurotransmitters.

Oily fish provides good levels of omega-3 fattyacids; try opting for wild salmon, mackerel,sardines or anchovies. Two portions weekly(about 100g per portion) provide an averagedaily intake of approximately 0.5g long-chainomega-3 (in line with guidance issued by theFood Standards Agency).

Be cautious, however, of larger fish such asmarlin or swordfish, which are known to be highin contaminants. Smaller short-lived fish are notonly ‘cleaner’ in terms of contaminants, but dueto their short lifecycles, also tend to be moresustainable. If consuming tinned fish, avoidthose that are stored in sunflower oil as theseare rich in short-chain omega-6. Tinned tunaalso tends to be a poor source of omega-3,because the fatty acids are removed during thecanning process.

Pure EPA supplements

Highly purified fish oils are a safe and convenient way oftopping up levels of long-chain omega-3 fatty acids, sincethese undergo processes which remove the contaminants.Sourcing the right supplement is of paramount importancewhen looking at treatment options for ADHD. In a 2011review of existing omega-3 trials, the EPA content withinsupplements was significantly correlated with supplementefficiency (Bloch & Qawasmi 2011). Vegepa E-EPA 70 is apatented and concentrated fish oil supplement containingclinical-grade marine EPA and plant GLA, providing cells withthe nutrients required for efficient cell signalling, integral tohealthy brain function, making it the ideal supplement forindividuals with ADHD. A 2012 pilot trial supplementingtreatment-resistant children (who have not responded toconventional treatment with Ritalin) with two Vegepa E-EPA-70 capsules daily showed statistically significantimprovements in both behaviour and academic learning. Forexample, of those children taking Vegepa E-EPA 70, 81.2%showed statistically significant improvements in restlessness,87.5% in aggressiveness and 70.8% in anger control.Furthermore, 83.3% showed statistically significantimprovements in cooperation with both parents and teachers,with 77.1% of children showing improved educationalfunctioning and academic performance. Whilst someimprovements were observed within three months, the mostmarked improvements were observed after six months ofsupplementation (Perera et al, 2012). This is the first studyof its kind to demonstrate the effectiveness of EPA and GLAin combination, in children with ADHD whose parentsreported no improvements in behaviour and learning withRitalin and standard behaviour therapy for six months ormore.

Not surprisingly, many practitioners, including Dr Robin Paucof the Tinsley House Clinic recommend Vegepa E-EPA 70 forchildren’s learning and behavioural problems. Recognisingthe importance of diet, and especially the role that omega-3splay in the aetiology and treatment of neurodevelopmental

disorders, theTinsley HouseClinic directlyadvocates theuse of VegepaE-EPA 70 aspart of theirtherapyprotocol, withextremelysuccessfulresults.

Vegepa E-EPA70 is availablein soft-gel aswell aschewablecapsules, andis free fromsugar, artificial colours and flavourings. For dosageguidelines, please visit the ADHD section of our website.

Vegetarian sources of omega-3

Vegetarians, and particularly vegans, have low levels of EPAand DHA in comparison to fish-eating populations. Goodsources of vegetarian omega fats include walnuts and tofu,while supplements can provide more concentrated amountsof these important nutrients, to promote the conversion to thebrain-boosting long-chain omega-3 fatty acid EPA.Stearidonic acid (SDA), found in Echium Seed Oil in ourproduct Echiomega, is a closer relative to EPA (being furtheralong the conversion pathway) than the omega-3 alphalinolenic acid (ALA) typically found in flaxseed oil. Indeed,studies suggest that SDA produces up to 5 times more EPAthan ALA.

Whilst increasing omega-3 is important for mood, it isadvisable to ensure that your short-chain omega-6 levels arenot excessive:

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What our customers say...“I would just like to say my son Myles aged 6, was reallystruggling at school throughout nursery and reception. I wasconstantly being pulled in for his lack of concentration, lack of

attention, difficulty staying on task. I started giving him Vegepa last summer,every day , gradually from September to December he got consistently betterand better at school . His writing and his ability to stay on task improved.”D.S., York

“There has been a sustained improvement in all aspects of my son'sbehaviour, concentration, reading age and general well-being andhappiness… I am convinced that Vegepa has very real benefits over cheaperformulations and have recommended it to several of my friends who havechildren with similar problems to my son’s.” Dr A.H.

• Replace corn or vegetable oil with olive or rapeseed oil.

• Use olive spread or ‘real’ butter over typical ‘low-fat’ spreadsrich in omega-6 and avoid processed foods with highsaturated or trans fat contents, as these interfere with themetabolism of omega-3 fatty acids.

• When choosing meat, opt for lean (low saturated fat content)and organic, where possible (organic meat from grass-fedlivestock is low in omega-6 whereas non-organic livestockare fed grains, producing meat which contains high levels ofomega-6).

• Evening primrose oil, when cold-pressed and unrefined, isan exception to the rule, since it contains the omega-6GLA, which has a synergistic effect with EPA to produceanti-inflammatory eicosanoids.

Vitamins and minerals

It is extremely common for children with ADHD to have lowlevels of B vitamins and essential minerals such as zinc,selenium and magnesium. As these essential micronutrientsare involved in all metabolic pathways, it is vital to ensurethese nutritional needs are met. These water-soluble vitaminsand minerals are not stored in the body and must beconsumed daily to avoid depletion.

Vitamin and mineral deficiencies can hinder the body’s abilityto utilise specific omega-3 fatty acids. Eating a good supplyof fruit, vegetables, seed and nuts will provide all the water-soluble vitamins and minerals the body requires. (Note tovegan families: marmite is a good source of B12, which is anessential vitamin usually sourced from animal products.)

10ADHDhelp pack

Support networkswww.livingwithadhd.co.uk

www.addiss.co.uk

Further readingGreen, C. & Chee, K. Understanding ADHD: A Parent'sGuide to Attention Deficit Hyperactivity Disorder in Children,1997, Vermillion Publishing, London. ISBN: 978-00-9181700-8.

Puri, B.K. Attention-Deficit Hyperactivity Disorder: A NaturalWay to Treat ADHD, 2005, Hammersmith Press Ltd, London.ISBN: 1-905140-01-0.

Timimi, S. & Leo, J. Rethinking ADHD: From Brain to Culture,2008, Palgrave Macmillan, Basingstoke. ISBN: 978-02-3050712-8.

ContactsThe Sunflower Trust

10 Guildford Park RoadGuildfordSurreyGU2 5ND

Telephone: 0845 054 7509

Email: enquiries@sunflowertrust.com

Website: www.sunflowertrust.com

Tinsley House ClinicMain RoadEast BoldreNr. BeaulieuHampshireSO42 7WT

Telephone: 01590 612432

Email: info@tinsleyhouseclinic.co.uk

Website: www.tinsleyhouseclinic.co.uk

ReferencesAntalis C.J., Stevens L.J., Campbell M., Pazdro R., EricsonK., Burgess J.R. (2006) Omega-3 fatty acid status inattention-deficit/hyperactivity disorder. ProstaglandinsLeukotrienes & Essential Fatty Acids. 75:299-308.

Bloch, M. H. & Qawasmi, A. (2011). Omega-3 fatty acidsupplementation for the treatment of children with attention-deficit/hyperactivity disorder symptomatology: systematicreview and meta-analysis. Journal of the American Academyof Child and Adolescent Psychiatry, 50, 991-1000.

Khan S.A., Faraone S.V. (2006) The genetics of attention-deficit/hyperactivity disorder: A literature review of 2005.Current Psychiatry Reports. 8:393-397.

Perera H, Jeewandara KC, Seneviratne S, Guruge BC. (2012)Effectiveness of combined omega-3 & omega-6 in childrenwith attention deficit hyperactivity disorder: a double-blindplacebo-controlled trial. Journal of Child Neurology 27: 747-753.

Richardson A. (2001) Fatty Acids in Dyslexia, Dyspraxia,ADHD and the Autistic Spectrum. Nutrition Practitioner. 3:18-24.

Richardson A.J., Puri B.K. (2000) The potential role of fattyacids in attention-deficit/hyperactivity disorder. ProstaglandinsLeukotrienes & Essential Fatty Acids. 63:79-87.

Rowland A.S., Lesesne C.A., Abramowitz A.J. (2002) Theepidemiology of attention-deficit/hyperactivity disorder: apublic health view. Mental Retardation and DevelopmentalDisabilities Research 8:162–170.

Sorgi P.J., Hallowell E.M., Hutchins H.L., Sears B. (2007)Effects of an open label pilot study with high-dose EPA/DHAconcentrates on plasma phospholipids and behaviour inchildren with attention deficit hyperactivity disorder. NutritionJ.6:16.

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