Imagine having difficulty getting to work on time, paying your bills, performing household chores and staying organized. Imagine letting yourself or letting your loved ones down, because you can’t cope with responsibilities. One explanation for this could be a condition often associated with children.
Attention deficit hyperactivity disorder (ADHD) affects approximately eight percent of children worldwide. Two-thirds of these children will continue to experience difficulties as adults. The overall prevalence of ADHD in adults is between four and five percent, or approximately eight million people. ADHD is a complex brain disorder. The neurobiological component of ADHD relates to the neurotransmitters dopamine and norepinephrine (see footnote). But there are other factors such as a strong genetic component and environmental vulnerabilities. In adults, ADHD often coexists with substance abuse problems or other psychiatric disorders.
Inattention, hyperactivity and impulsivity are the principle characteristics of ADHD. Individually or in combination, these characteristics are grouped into three patterns of disruptive behavior: predominantly hyperactive-impulsive type, predominantly inattentive type (sometimes called attention deficit disorder, ADD) and a combined type that incorporates both inattentive and hyperactive-impulsive behaviors. Adults typically possess either the inattentive or the combined type. According to the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition there are five diagnostic criteria used to make the diagnosis of ADHD. These include: current symptoms of inattention, impulsivity/hyperactivity, or both; onset of symptoms before the age of seven (this criteria is currently being reevaluated); chronicity, with at least six months of persistent symptoms; evidence of functional impairment; and impact in multiple areas of life, such as home, work and/or school.
The traditional Western medical approach to treatment relies heavily on medications. For many years, stimulants have been the mainstay of therapy. The combination of medications, education and psychotherapy can be effective in many people. Complementary therapies, including mindfulness meditation, Ayurveda and Reiki can also provide support for adults with ADHD.
Mindfulness Meditation
Mindfulness meditation involves a process of observing one’s thoughts, emotions and bodily states in a nonjudgmental way, remaining present and nonreactive. Typically, there is focus on the breath when sitting quietly, or focus on the soles of the feet when walking slowly. The goal of such meditation is to bring attention to the present moment, openly accepting one’s experiences. Mindfulness meditation has been incorporated into therapies for stress, depression, anxiety disorders and substance abuse. Those that advocate for this practice consider it a type of mental training that can regulate attention as well as brain function. Based on early studies, mindfulness meditation may positively impact the cognitive impairments and regulation deficits found in adults with ADHD, improving attention and ability to concentrate. The researchers involved in a recent pilot study (Zylowska, 2008) concluded that mindfulness meditation might improve attention and emotional regulation in some adolescents and adults with ADHD, as well as decrease symptoms of depression and anxiety. Although this was a pilot study, the results are encouraging and may offer another option for those with ADHD.
Ayurveda
Ayurveda (the science of life, which originated in India) is a system of healing that provides an integrated approach to health and wellness. Ayurvedic practitioners provide a comprehensive approach to nutrition, detoxification and nourishment of all layers of the body that facilitates a return to balance between the three doshas, or natural energetic humors of the body: vata (air element), pitta (fire) and kapha (water and earth).
The lifestyle of many adults is fast-paced either out of necessity or desire. Instead of focusing on one task at any given moment, it is easy to get into the habit of multitasking. This can cause restlessness and hyperactivity, particularly in those with a vata predisposition. Eating cold, dry foods, eating at irregular times, drinking ice-cold beverages or always being on the go – these are the perfect setup for throwing vata out of sync. One of the possible results of vata imbalance may be adult ADHD.
Ayurvedic Suggestions
Diet:
- Replace sugar-filled processed foods with whole grains including whole wheat, quinoa, brown rice and amaranth.
- Favor vegetables such as squashes, pumpkins, zucchini and okra which are more grounding than raw leafy vegetables.
- Replace cold fruit juices with fresh fruits.
- Favor nuts (unsalted) over candies.
- Choose warm foods over cold refrigerated foods when possible.
Lifestyle:
- Get an oil massage regularly or practice daily self-massage.
- Put five drops of sesame oil in both ears daily (if appropriate or no contraindications exist).
- Do some fun activities while sitting down, such as drawing, painting or knitting.
- Practice yoga and be sure to end with savasana (relaxation pose).
- Herbs such as brahmi (Bacopa monniera), shankhapushpi (Evolvulus alsinoides), jatamansi or spikenard (which is Nardostachys jatamansi, traditionally used but currently endangered) and valerian (Valeriana officianalis) are nerve tonics that can help calm the mind.
- Herbs like triphala [a mixture of three dried fruits: amalaki (Emblica officinalis), bibhitaki (Terminalia belerica) and haritaki
(Terminalia chebula)] or the vata-calming haritaki, help improve elimination and promote a feeling of calm. It is important
to follow the recommendations of an experienced Ayuervedic practitioner.
Reiki
Reiki was brought to the US from Japan in the 1930s. It is a natural vibrational healing practice that gently encourages balance and supports wellness and self-healing. Reiki practice is passed from master to student following a prescribed initiation. The practice itself involves gently placing hands in various positions on a clothed person. Reiki is offered in many outpatient and hospital settings, and people of all ages can learn to practice and benefit from daily Reiki self-treatment. Research on Reiki is just beginning and a number of small studies indicate that Reiki can be particularly useful for reducing anxiety and pain.
People with ADHD have a hypersensitive and disordered nervous system and frequently experience anxiety. Reiki has a calming influence, facilitating movement toward organization and integration. It is a relief for many to receive a treatment, as Reiki is non-judgmental and is not geared toward “correcting” problematic behavior. Recipients report feeling better about themselves, more calm and more centered.
Pamela Miles, Reiki Master and author of REIKI: A Comprehensive Guide states, “people with ADHD feel disordered so often that they tend to notice the Reiki’s balancing effects right away. All ages appreciate the sense of calm and inner connection that Reiki treatment brings, a centeredness that quickly improves functioning. First degree Reiki is learned in a 10-hour group class. Someone with ADHD can gain the ability to center him or herself through self-treatment on a daily basis, or more often when needed; brings a welcome sense of control and self-confidence.”
There are alternatives to pharmaceutical medication and many people with ADHD seek a variety of conventional and complementary therapies. Evidence-based studies of complementary therapies are sparse. However, there are small studies and anecdotal reports of successful intervention. For those who are open to complementary options, intelligent inquiry and thoughtful choice of a qualified practitioner may yield improvement when used in conjunction with the more traditional interventions.
Note:
Some of the genes associated with ADHD are involved in the dopaminergic pathways (e.g. dopamine transporter gene). In addition, the psychostimulants used to treat ADHD act primarily on dopaminergic and noradrenergic pathways, implicating both dopamine and norepinephrine in the pathophysiology of ADHD.
Kari Kassir MD is a wife and mother, aspiring yogini and pediatrician in Orange County.
References:
Attention Deficit Hyperactivity Disorder: Department of Health and Human Services, National Institutes of Health.
LA Adler. From childhood into adulthood: The changing face of ADHD. CNS Spectrums 2007; 12:12 (Suppl 23):6-9.
J Biederman, TE Wilens, TJ Spencer, LA Adler. Diagnosis and treatment of adults with attention-deficit/hyperactivity disorder. CNS Spectrums 2007; 12:4(Suppl 6):1-14.
Meditation:
LZ Zylowska, DL Ackerman, et al. Mindfulness meditation training in adults and adolescents with ADHD. J Att Dis 2008; 11(6):737-746.
Reiki:
Pamela Miles. Reiki: A Comprehensive Guide. Tarcher/Penguin Press, 2006.
Special thanks to Pamela Miles, Reiki Master, educator, and author in New York City (reikiinmedicine.org), and Shailah Hathiramani and Dr. Jay Apte of The Ayurveda Clinic in Foster City, CA (ayurvedainstitute.com).
By Kari Kassir, MD
