Alternative Therapies for ADHD: A Review of Diet, Meditation, and Medications, Lecture notes of Accounting

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NURS-FPX 4030

PICO(T) Questions and an Evidence-Based Approach Capella University NURS-FPX 4030 PICO(T) Questions and an Evidence-Based Approach The PICO(T) framework in an effective tool used to develop a plan of care for patients. PICO(T) is defined as Population/Patient, Intervention, Comparison, Outcome and Time and is best used to come up with a care plan for a patient that will ensure all their needs are being met, with the most up to date and appropriate research. This paper will use the PICO(T) question to research how diet, meditation and medications affect children with ADHD during the day. According to Lake et al, 2019, roughly 7%-8% of children have ADHD, which has significantly increased over the past 40-years. Finding an alternative to just stimulant medication administration is imperative, as children with ADHD may be in the hospital at some point and unable to take their medications as routinely prescribed. It is important for nurses (school nurse, pediatric nurse), advanced practicing nurse, or physicians to know alternate methods to help control behaviors of children with ADHD. Identification of Sources Sources used to answer the PICO(T) question were discovered using the CINAHL and Health Care Administration Database through Capella University. The search contained the phrases: Children with ADHA, Diet Modifications, and Controlling Behaviors. Peer reviewed articles are always the gold standard when doing research, but they also must be written within the last 5-years and come from scientific sources. Medication Alternative Findings for Children with ADHD

In an article by Lake et al. (2019) it is pointed out that scheduled medications are often limited to a small supply which may cause disruption in care when refills cannot be obtained. There are also adverse effects with ADHD stimulant medications such as insomnia, decreased appetite, weight loss, and abdominal pain. Lake noted that roughly 1/3 of hyperactive children may benefit from sort of elimination diet. While the diet that excludes certain food dyes was not found credible, children may still benefit from having certain foods eliminated from their diet. Regarding meditation/yoga practice, there was no significant difference in behaviors between the meditation group and the drug therapy group. However, children who continued stimulants while also continuing meditation and yoga experienced the greatest improvement in non-desirable behaviors. Yoga and regular massage therapy may also reduce the severity of ADHD symptoms. This source is credible, as it is peer reviewed and written within the past 5-years, however it is a .com source which isn’t always the most reliable. An article that was written by Verena et al. in 2017 appeared in the European Child and Adolescent Psychiatry journal and examines the efficacy of diet elimination on children with ADHD. It was noted that behavioral reactions are seen as possible adverse reactions to foods, and that is why elimination diets may sometimes be recommended. The author notes that the most common elimination diet used in children with ADHD is the food additive exclusion diet. There is a microbiome-gut-brain axis possibly involving complex interactions between multiple systems, including the metabolic, immune, endocrine and neural system. Although elimination diets can be recommended by some, it may only improve the behavior in a small subset of affected children. This article is credible as it is a peer reviewed journal article written within the past 5-years and it considered a reliable source as it is a scholarly journal. A Journal article written by C. Wang et al., 2020 investigates complementary and alternative medicine (CAM) in children with ADHD. Information in this article was obtained from a 2012 and 2017 National Health Interview Study. Five million children were reported to have ADHD, and almost one million of them used one or more CAM therapy in 2017, with the

most common being meditation. CAM therapies included chiropractic manipulation, meditation, deep breathing exercises, guided imagery, and yoga. Many parents have turned to a variety of complementary and alternative medicine therapies to help with their children’s ADHD, especially when they are concerned about the long-term effects from pharmacologic treatments or have had difficulties finding behavioral therapies. A potential mechanism by which meditation might affect ADHD symptoms is through the regulation of dopamine. “Since medications for ADHD primarily target Dopamine and Norepinephrine transporters to increase synaptic levels, there may be a possibility that meditation could exhibit similar effects to these medications by the same means” (Wang, et al. 2020). The advantage of using meditation is the lack of unwanted side effects, lesser cost, and accessibility to self-care. This final article is credible as it is a peer reviewed journal article written within the past 5-years and it considered a reliable source as it is a scholarly journal. It is the most credible source for this particular PICO(T) question as it had the most amount of information. Relevance of Findings The first study by Lake et al. (2019) was chosen as it provides explanation of why it is frowned upon to rely on medications alone to help control behaviors of children with ADHD. It had several alternative therapies that can be used in many different environments. When it came to the references made about diet, the results were not clear. “The American Academy of Pediatrics does not endorse elimination diets because of inconsistent efficacy findings as well as concerns that highly restrictive diets do not provide balanced nutrition” (Lake et al. 2019). Meditation was only seen as most beneficial when done in combination with drug therapy, which was not necessarily the goal of the study. While there are some benefits of medication alternatives, they were not strong enough to outweigh the use of medication to treat undesirable behaviors in children with ADHD. This article was relevant to the PICO(T) question as it pointed

out that alternatives to medication may not be best to treat ADHD, however they can be used simultaneously. The second article was chosen as it focused a great deal on diet, and how the gut works. It explained that an elimination diet may help as behaviors can sometimes be linked to food allergies. However, this is only proven to help a small number of children. The correlation between the microbiome-gut-brain axis and the systems in the body does demonstrate that foods may in some way affect behaviors. The article was scholarly; however, it did not contain a lot of information about alternative therapies. The final article was the most relevant and useful. It introduced several Complementary and Alternate Medicine (CAM) techniques that can be useful to curb behaviors when medication isn’t available or desirable. The concern with medication administration is stated as, “Possible benefits and mechanisms for substantial and increasing use of meditation in children with ADHD has not been well documented in the literature.” (C. Want, et al. 2020). This proves the relevance and importance of CAM. There were plenty of examples of alternatives, all of which were backed by recent research and statistics. One negative of this article was that the information they based the study on was collected in 2012 and 2017, which is outside of a desirable range. The article was both peer reviewed and recent. Conclusion It is necessary to come up with interventions outside of pharmacological approaches to curb behaviors of children with ADHD. While medications are useful in 90% of children with ADHD (Wang, et al. 2020), CAM interventions also serve a purpose in helping children. If nurses and advanced practitioners are aware of potential alternatives, children may be calmed when medications aren’t available or advisable. When researching the PICO(T) question, it was proven that medications cannot necessarily be replaced with CAM interventions, but they may improve outcomes when used in conjunction with prescribed medications. The article by Wang,

et al. (2020) provided the most reliable and relevant information in order to help come up with a successful plan of care when dealing with a child with ADHD. References Abbade, L. P., Wang, M., Sriganesh, K., Jin, Y., Mbuagbaw, L., & Thabane, L. (2017). The framing of research questions using the picot format in randomized controlled trials of venous ulcer disease is suboptimal: A systematic survey. Wound Repair and Regeneration , 25 (5), 892–900. https://doi.org/10.1111/wrr. Lake, J., MD, & Sarris, J., PhD. (2019). Complementary and Alternative Treatments for ADHD: What the Evidence Suggests. CINAHL. Retrieved July 18, 2021, from https://doi.org/www.psychiatrictimes.com Ly, V., Bottelier, M., Hoekstra, P. J., Arias Vasquez, A., Buitelaar, J. K., & Rommelse, N. N. (2017). Elimination diets’ efficacy and mechanisms in attention deficit hyperactivity disorder and autism spectrum disorder. European Child & Adolescent Psychiatry , 26 (9), 1067–1079. https://doi.org/10.1007/s00787-017-0959- Wang, C., Li, K., Seo, D.-C., & Gaylord, S. (2020). Use of complementary and alternative medicine in children with adhd: Results from the 2012 and 2017 national health interview survey. Complementary Therapies in Medicine , 49 , 102352. https://doi.org/10.1016/j.ctim.2020.