Objective: To review alternate treatments (Tx) of Attention-Deficit/Hyperactivity Disorder (ADHD)those other than psychoactive medication and behavioral/psychosocial Tx-for the November, 1998 National Institute of Health (NIH) Consensus Development Conference on ADHD.
Method: The literature was searched on Medline and PsychInfo 1963-1998 and investigators known to be interested in alternate Tx were contacted for unpublished data.
Results: Twenty-three alternate Tx were identified, ranging in scientific documentation from discrediting controlled studies through mere hypotheses to positive controlled double-blind clinical trials. Many of them are applicable only to a restricted etiological subgroup. The oligoantigenic or few-foods diet has convincing double-blind evidence of efficacy in multiple trials for a properly selected subgroup. Enzymepotentiated desensitization to foods, relaxation/EMG biofeedback, and deleading also have controlled evidence of efficacy. Glyconutritional supplementation, iron supplementation, magnesium supplementation, Chinese herbals, EEG biofeedback, meditation, mirror feedback, channel-specific perceptual training, and vestibular stimulation all have promising prospective pilot data. Single-vitamin megadosage has some intriguing pilot trial data. Zinc supplementation is hypothetically supported by systematic case-control data but has no systematic clinical trial. Laser acupuncture has promising unpublished pilot data. Essential fatty acid supplementation has promising systematic case-control data but clinical trials are equivocal. Recommended-Daily-Allowance vitamin supplementation, nonChinese herbals, homeopathic remedies, and antifungal therapy have no systematic data in ADHD. Megadose multivitamin combinations are probably ineffective for most patients and possibly dangerous. Simple sugar restriction and hypnosis seem ineffective. Amino acid supplementation, though mildly effective in the short term, is not effective beyond a few weeks. Thyroid Tx is effective in the presence of documented thyroid abnormality, but not otherwise.
Conclusion: Some alternate Tx of ADHD are effective or probably effective, but mainly for restricted etiologic subgroups. In some cases they are the Tx of choice, and initial evaluation should consider the relevant etiologies. A few have failed to prove effective in controlled trials. Most need research to determine whether they are effective and/or to define the applicable subgroup. Some of them, though not safer than standard Tx, may be preferable for an etiologic subgroup.
Get full access to this article
View all access options for this article.
References
1.
Agget, PJ., & Harries, J.T. (1979). Current status of zinc in health and disease states. Arch. Dis. Child, 54, 909-917.
2.
Aman, M.G., Mitchell, E.A., & Turbott, S.H. (1987). The effects of essential fatty acid supplementation by Efamol in hyperactive children. J. Abnormal Child Psychology, 15, 75-90.
3.
Anonymous. (1984). Vitamin B6 toxicity: A new megavitamin syndrome. Nutrition Reviews, 42, 44-46.
4.
Arnold, L.E. (1978). Megavitamins for MBD: A placebocontrolled study. J. American Medical Association, 20, 24-24.
5.
Arnold, L.E. (1995) Some nontraditional (unconventional and/or innovative) psychosocial treatments for children and adolescents: critique and proposed screening principles. J. Abnormal Child Psychology, 23, 1, 125-140.
6.
Arnold, L.E., Barnebey, N., McManus, J., Smeltzer, D., Conrad, A., Winer, G., & Desgranges, L. (1977). Prevention by specific perceptual remediation for vulnerable first-graders: Controlled study and follow-up of lasting effects. Archives of General Psychiatry, 34, 1279-1294.
7.
Arnold, L.E., Clark, D.L., Sachs, L.A., Jakim, S., & Smithies, C. (1985). Vestibular and visual rotational stimulation as treatment for Attention Deficit and Hyperactivity. American Journal of Occupational Therapy, 39 (2), 84-91.
8.
Arnold, L.E., Kleykamp, D., Votolato, N., Gibson, R.A., & Horrocks, L. (1994). Potential link between dietary intake of fatty acids and behavior: Pilot exploration of serum lipids in ADHD. J. Child & Adolescent Psychopharmacology, 4 (3), 171-180.
9.
Arnold, L.E., Kleykamp, D., Votolato, N.A., Taylor, W.A., Kontras, S.B., & Tobin, K. (1989). Gamma-linolenic acid for Attention-Deficit Hyperactivity Disorder: Placebo controlled comparison to d-amphetamine. Biological Psychiatry, 25, 222-228.
10.
Arnold, L.E., Votolato, N.A., Kleykamp, D., Baker, G.B., & Bornstein, R.A. (1990). Does hair zinc predict amphetamine improvement of ADHD/Hyperactivity?Inter. J Neuroscience, 50, 103-107.
11.
Baker, G.B., Bornstein, R.A., Rouget, A., Therrian, S., & van Muyden, J. (1991). Phenylethylaminergic mechanisms in Attention-Deficit Disorder. Biological Psychiatry, 29, 15-22.
12.
Bekaroglu, M., Yakup, A., Yusof, G., Orhan, D., Hilal, M., Erol, E., & Caner, K. (1996). Relationships between serum free fatty acids and zinc and ADHD. J. Child Psychol. Psychiat. 37, 225-227.
13.
Benton, D., & Buts, J.P. (1990). Vitamin/mineral supplementation and intelligence. Lancet, 335, 1158-1160.
14.
Benton, D., & Cook, R. (1991). Vitamin and mineral supplements improve the intelligence scores and concentration of six-year-old children. Personality and Individual Differences, 12, 1151-1158.
15.
Bernstein, A.L. (1990). Vitamin B6 in clinical neurology. Annals of the New York Academy of Sciences, 585, 250-260.
16.
Bhatara, V., Clark, D.L., Arnold, L.E., Gonsett, R., & Smeltzer, D.J.(1981). Hyperkinesis treated by vestibular stimulation: An exploratory study. Biological Psychiatry, 16 (3), 269-279.
17.
Blackburn, W.D. Jr. (1997). Eosinophilia myalgia syndrome. Seminars in Arthritis and Rheumatism, 26, 788-793.
18.
Boris, M., & Mandel, F.S. (1994). Foods and additives are common causes of the attention deficit hyperactive disorder in children. Annals of Allergy, 72, 462-468.
Breakey, J. (1997). The role of diet and behavior in childhood. J. Pediatrics and Child Health, 33, 190-194.
21.
Brenner, A. (1979). Trace mineral levels in hyperactive children responding to the Feingold diet. J. Pediatrics, 94, 44-44.
22.
Brenner, A. (1982). The effects of megadoses of selected B complex vitamins on children with hyperkinesis; controlled studies with long-term follow-up. J. Learning Disabilities, 15, 258-264.
23.
Brown, A., Mallett, M., Fiser, D., & Arnold, W.C. (1984). Acute isoniazid intoxication: reversal of CNS symptoms with large doses of pyridoxine. Pediatric Pharmacology, 4, 199-202.
24.
Bruner, A.B., Joffe, A., Duggan, A.K., Casella, F., & Brandt, J. (1996). Randomized study of cognitive effects of iron supplementation in non-anemic iron-deficient girls. Lancet, 347, 992-996.
25.
Burattini, M.G., Amendola, F., Aufierio, T., Spano, M., Di Bitonto, G., Del Vecchio, G.C., & De Mattia, D. (1990). Evaluation of the effectiveness of gastro-protected proteoferrin in the therapy of sideropenic anemia in childhood. Minerva Pediatrica, 42, 343-347.
26.
Burgess, J.R., & Stevens, L. (1998). Personal communication. Purdue University.
27.
Calhoun, G. Jr, & Bolton, J.A. (1986). Hypnotherapy: A possible alternative for treating pupils affected with Attention Deficit Disorder. Perceptual and Motor Skills, 63, 1191-1195.
28.
Carter, C.M., Urbanowicz, M., Hemsley, R., Mantilla, L., Strobel, S., Graham, PJ., & Taylor, E. (1993). Effects of a few food diet in attention deficit disorder. Archives of Disease in Childhood, 69, 564-568.
29.
Cobb, D.E., & Evans, J.R. (1981). The use of biofeedback techniques with school-aged children exhibiting behavioral and/or learning problems. J. Abnormal Child Psychology, 9, 251-281.
30.
Coleman, M., Steinberg, G., Tippett, J., Bhagavan, H.N., Coursin, D.B., Gross, M., Lewis, C., & DeVeau, L. (1979). A preliminary study of the effect of pyridoxine administration in a subgroup of hyperkinetic children: A double-blind crossover comparison with methylphenidate. Biological Psychiatry, 14, 741-751.
31.
Conners, C.K. (1980). Food additives and hyperactive children. London: Plenum.
32.
Crandall, M. (1991). A controlled trial of nystatin for the candidiasis hypersensitivity syndrome. (Letter to editor). New England Journal of Medicine.
Crook, W.G. (1989). The yeast connection (3rd ed.). Jackson, TN: Professional Books.
35.
Crook, W.G. (1991). A controlled trial of nystatin for the candidiasis hypersensitivity syndrome. (Letter to editor). New England Journal of Medicine.
36.
David, OJ., Hoffman, S.P., Clark, J., Grad, G., & Sverd, J. (1983). The relationship of hyperactivity to moderately elevated lead levels. Archives of Environmental Health, 38, 341-346.
37.
David, OJ., Hoffman, S.P., Sverd, J., & Clark, J. (1977). Lead and hyperactivity; lead levels among hyperactive children. J. Abnormal Child Psychology, 5, 405-416.
38.
David, O.J., Hoffman, S.P., Sverd, J., Clark, J., & Voeller, K. (1976). Lead and hyperactivity. Behavioral response to chelation: a pilot study. Amer. J. Psychiatry, 133, 1155-1158.
39.
Denkowski, K.M., & Denkowski, G.C. (1984). Is group progressive relaxation training as effective with hyperactive children as individual EMG biofeedback?Biofeedback and Self-Regulation, 9, 353-364.
40.
Denkowski, K.M., Denkowski, G.C., & Omizo, M.M. (1983). The effects of EMG-assisted relaxation training on the academic performance, locus of control, and self-esteem of hyperactive boys. Biofeedback and Self-Regulation, 8, 363-375.
41.
Denkowski, K.M., Denkowski, G.C., & Omizo, M.M. (1984). Predictors of success in the EMG biofeedback training of hyperactive male children. Biofeedback and SelfRegulation, 9, 253-264.
42.
Dismukes, W.E., Wade, J.S., Lee, J.Y, Dockery, B.K., & Hain, J.D. (1990). A randomized double-blind trial of nystatin therapy for the candidiasis hypersensitivity syndrome. New EnglandJournal ofMedicine, 323, 1717-1723.
43.
Dunn, F.M., & Howell, Rj. (1982). Relaxation training and its relationship to hyperactivity in boys. J. Clinical Psychology, 38, 92-100.
44.
Durlach, J., Durlach, V., Bac, P., Bara, M., & Guiet-Bara, A. (1994). Magnesium and therapeutics. Magnesium Research, 7, 313-328.
45.
Dykman, K.D., & Dykman, R.A. (1998) Effect of nutritional supplements on attentional-deficit hyperactivity disorder. Integrative Physiological and Behavioral Science, 33, 49-60.
46.
Dykman, K.D., & McKinley, R. (1997). Effect of glyconutritionals on the severity of ADHD. Proceedings of the Fisher Institute for Medical Researcb, 1 (1), 24-25.
47.
Egger, J., Carter, C.M., Graham, Pj., Gumley, D., & Soothill, J.F. (1985). Controlled trial of oligoantigenic treatment in the hyperkinetic syndrome. Lancet, 540-545.
48.
Egger, J., Stolla, A., & McEwen, L.M. (1992). Controlled trial of hyposensitization in children with food-induced hyperkinetic syndrome. Lancet, 339.
49.
Eisenberg, J., Asnis, G.M., van Praag, H.M., & Vela, R.M. (1988). Effect of tyrosine on attention deficit disorder with hyperactivity. J. Clinical Psychiatry, 49, 193-195.
50.
Feingold, B.F. (1975). Why your child is hyperactive. New York: Random House.
51.
Feingold, B.F. (1981). Refutes criticism of diet. (Reply to nutrition foundation report). Clinical Psychiatry News, 2-3.
52.
Field, T., Morrow, C., Valdeon, C., Larson, S., Kuhn, C., & Schanberg, S. (1992) Massage reduces anxiety in child and adolescent psychiatric patients. J. Am. Acad. Cbild Adolesc. Psychiatry, 31, 1, 125-131
Forsyth, P.D., & Davies, J.M. (1995). Pure white cell aplasia and health food products. Postgraduate MedicalJournal, 71, 557-558.
55.
Ghose, K. (1983). L-tryptophan in hyperactive child syndrome associated with epilepsy: A controlled study. Neuropsychobiology, 10, 111-114.
56.
Gittleman, R., & Eskanazi, B. (1983). Lead and hyperactivity revisited: An investigation of nondisadvantaged children. Arch. Gen. Psychiatry, 40, 827-833.
57.
Goldman, J.A., Lerman, R.H., Contois, J.H., & Udall, J.N. Jr. (1986). Behavioral effects of sucrose on preschool children. J. Abnormal Child Psychology, 14, 565-577.
58.
Gong, Z., & Evans, H.L. (1997). Effect of chelation with meso-dimercaptosuccinic acid (DMSA) before and after the appearance of lead-induced neurotoxicity in the rat. Toxicology & Applied Pharmacology, 144, 205-214.
59.
Hagerman, RJ., & Falkenstein, A.R. (1987). An association between recurrent otitis media in infancy and hyperactivity. Clinical Pediatrics, 26, 253-257.
60.
Halas, E.S., & Sandstead, H.H. (1975). Some effects of prenatal zinc deficiency on behavior of the adult rat. Pediatric Research, 9, 94-97.
61.
Hamazaki, T., Sawazaki, S., Itomura, M., Asaoka, E., Nagao, Y., Nishimura, N., Yazawa, K., Kuwamori, T., & Kobayashi, M. (1996). The effect of docosohexaenoic acid on aggression in young adults. A placebo-controlled double-blind study. J. Clinical Investigation, 97, 1129-1133.
62.
Haslam, R.H.A., Dalby, J.T., & Rademaker, A.W. (1984). Effects of megavitamin therapy on children with attention deficit disorders. Pediatrics, 74, 103-111.
63.
Hauser, P., Soler, R., Brucker-Davis, F., & Weintraub, B.D. (1997). Thyroid hormones correlate with symptoms of hyperactivity but not inattention in ADHD. Psychoneuroendocrinology, 22, 107-114.
Hibbeln, J.R., Linnoila, M., Umhau, J.C., Rawlings, R., George, D.T., & Salem, N. Jr (1998). Essential fatty acids predict metabolites of serotonin and dopamine in cerebrospinal fluid among healthy control subjects, and earlyand lateonset alcoholics. Biological Psychiatry (in press).
66.
Houben, G.F., & Penninks, A.H. (1994). Immunotoxicity of the colour additive caramel colour III: A review on complicated issues in the safety evaluation of a food additive. Toxicology, 91, 289-302.
Irving, W.C. III (1987). A comparison of biofeedbackassisted relaxation and psychostimulants in treating children with attention deficit disorder with hyperactivity. Dissertation Abstracts International, 48-04, Section A, 0876-0876.
69.
Izenwasser, S.E., Garcia-Valdez, K., & Kantak, K.M. (1986). Stimulant-like effects of magnesium on aggression in mice. Pharmacology, Biochemistry, and Behavior, 25, 1195-1199.
70.
Kahn, C.A., Kelly, P.C., & Walker, W.O. Jr (1995). Lead screening in children with ADHD and developmental delay. Clinical Pediatrics, 34, 498-501.
Kaplan, Bj., McNicol, J., Conte, R.A., & Moghadam, H.K. (1989b). Overall nutrient intake of preschool hyperactive and normal boys. J. Abnormal Child Psychology, 17, 127-127.
73.
Kavale, K.A., & Forness, S.R. (1983). Hyperactivity and diet treatment: A meta-analysis of the Feingold hypothesis. J. Learning Disabilities, 16, 324-330.
74.
Kershner, J., & Hawke, W. (1979). Megavitamins and learning disorders: A controlled double-blind experiment. Journal of Nutrition, 159, 819-826.
75.
Kozielec, T., & Starobrat-Hermelin, B. (1997). Assessment of magnesium levels in children with ADHD. Magnesium Research, 10, 143-148.
76.
Kozielec, T., Starobrat-Hermelin, B., & Kotkowiak, L. (1994). Deficiency of certain trace elements in children with hyperactivity. Psychiatria Polska, 28, 345-353.
77.
Kratter, J. (1983). The use of meditation in the treatment of attention deficit disorder with hyperactivity. Dissertation Abstracts International, 44, 1965-1965.
78.
Krieger, G.D.R. (1985). Reduction of hyperactivity using progressive muscle relaxation imagery and autogenic exercises with electromyographic biofeedback. Dissertation Abstracts International, 46-10, Section B, 3617-3617.
79.
Kruesi, Mj., Rapoport, J.L., Berg, C., Stables, G., & Bou, E. (1987). Seven-day carbohydrate and other nutrient intakes of preschool boys alleged to be behavior-responsive to sugar and their peers. In W.B. Essman (Ed.), Nutrients and brain function. Basel: Karger.
80.
Krummel, D.A., Seligson, F.H., & Guthrie, H.A. (1996). Hyperactivity: Is candy causal?Critical Reviews in Food Science and Nutrition, 36, 31-47.
81.
Lee, S.W. (1991). Biofeedback as a treatment for childhood hyperactivity: A critical review of the literature. Psychological Reports 1991, 163-192.
82.
Lester, M.L., Thatcher, R.W., & Monroe-Lord, L. (1982). Refined carbohydrate intake, hair cadmium levels, and cognitive functioning in children. Nutrition and Behavior, 1, 3-13.
83.
Linden, M., Habib, T., & Radojevic, V. (1996). A controlled study of the effects of EEG biofeedback on cognition and behavior of children with attention deficit disorder and learning disabilities. Biofeedback and Self-Regulation, 21, 35-49.
84.
Lipton, M.A., & Mayo, J.P. (1983). Diet and hyperkinesis-an update. J. Amer. Dietetic Assoc., 83, 132-134.
85.
Loo, M. (1998). Laser acupuncture treatment of ADHD. Preliminary personal communication re: NIMH grant. (phone 408-356-5977).
86.
Lubar, J.F. (1991). Discourse on the development of EEG diagnostics and biofeedback for attention-deficit/hyperactivity disorders. Biofeedback and Self-Regulation, 16, 201-225.
87.
Lubar, J.F., & Shouse, M.N. (1977) Use of biofeedback in the treatment of seizure disorders and hyperactivity. In: B.B. Lahey & A.E. Kazdin (Eds.), Advances in clinical child psychology (Vol. 1, pp. 203-265). New York: Plenum Press.
88.
Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O'Donnell, P.H. (1995). Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in TOVA scores, behavior ratings, and WISC-R performance. Biofeedback and Self-Regulation, 20, 83-99.
89.
Mann, C.A., et al. (1992). Quantitative analysis of EEG in boys with attention-deficit-hyperactivity disorder: Controlled study with clinical implications. Pediatric Neurology, 8, 30-36.
90.
Mattes, J.A. (1983). The Feingold diet: A current reappraisal. J. Learning Disabilities, 16, 319-323.
91.
McGee, R., Williams, S., Anderson, J., McKenzieParnell, J.M., & Silva, P.A. (1990). Hyperactivity and serum and hair zinc levels in 11-year-old children from the general population. Biol. Psychiatry, 28, 165-168.
92.
Mitchell, E.A., Aman, M.G., Turbott, S.H., & Manku, M. (1987). Clinical characteristics and serum essential fatty acid levels in hyperactive children. Clinical Pediatrics, 26, 406-411.
Moretti-Altuna, G. (1987). The effects of meditation versus medication in the treatment of Attention Deficit Disorder with Hyperactivity. Dissertation Abstracts International, 47, 4658-4658.
95.
Mulligan, S. (1996). An analysis of score patterns of children with attention disorders on the sensory integration and praxis tests. Amer. J. Occupational Therapy, 50, 647-654.
96.
National Institute of Health. (1982). NIH consensus development conference: Defined diets and childhood hyperactivity. Clinical Pediatrics, 21, 627-430.
97.
Needleman, H.L., Gunnoe, C., Leviton, A., Reed, R., Peresie, H., Maher, C., & Barrett, P. (1979). Deficits in psychologic and classroom performance of children with elevated dentine lead levels. New EnglandJournal of Medicine. 300, 689-695.
98.
Nemzer, E., Arnold, L.E., Votolato, N.A., McConnell, H. (1986). Amino acid supplementation as therapy for Attention Deficit Disorder (ADD). Journal of the American Academy of Child Psychiatry, 25 (4), 509-513.
99.
Neuringer, M. (1998). Overview of omega-3 fatty acids in infant development: Visual, cognitive, and behavioral outcomes. Presented at Sept. 2-3, 1998NIH Workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders, Bethesda, MD.
100.
Nsouli, T.M., Nsouli, S.M., Linde, R.E., O'Mara, F., Scanlon, R.T., & Bellanti, J.A. (1994). Role of food allergy in serous otitis media. Annals of Allergy, 73, 215-219.
101.
Omizo, M.M., & Michael, W.B. (1982). Biofeedbackinduced relaxation training and impulsivity, attention to task, and locus of control among hyperactive boys. J. Learning Disabilities, 15, 414-416.
102.
Pakes, G.E. (1978). Death and liquid protein. American Pharmacy, 18, 4-5.
103.
Palacios, H.J. (1976). Hypersensitivity as a cause of dermatologic and vaginal moniliasis resistant to topical therapy. Annals of Allergy, 37, 110-113.
104.
Palacios, H.J. (1977). Desensitization for monilial hypersensitivity. Virginia MedicalJournal, 393-395.
105.
Pollock, I., & Warner, J.O. (1990). Effect of artificial food colors on childhood behavior. Archives of Disease in Childhood, 65, 74-77.
106.
Previc, F.H. (1993). Do the organs of the labyrinth differentially influence the sympathetic and parasympathetic systems?Neuroscience and Biobehavioral Reviews, 17, 397-404.
107.
Prinz, R.J., Roberts, W.A., & Hantman, E. (1980). Dietary correlates of hyperactive behavior in children. I Consulting and Clinical Psychology, 6, 760-769.
108.
Reimherr, F.W., Wender, P.H., Wood, D.R., & Ward, M. (1987). An open trial of I-tyrosine in the treatment of attention deficit disorder, residual type. Amer. I Psychiatry, 144, 1071-1073.
109.
Rimland, B. (1983). The Feingold diet: An assessment of the reviews by Mattes, by Kavale & Forness, and others. J. Learning Disabilities, 16, 45-49.
110.
Rippere, V. (1983). Food additives and hyperactive children: A critique of Conners.
111.
Rovet, J., & Alvarez, M. (1996). Thyroid hormone and attention in school-age children with congenital hypothyroidism. J. Child Psychology & Psychiatry, 37, 579-585.
112.
Rowe, K.S. (1988). Synthetic food colorings and hyperactivity: A double-blind crossover study. Australian Pediatric Journal, 24, 143-147.
113.
Rowe, K.S., Rowe, K.J. (1994). Synthetic food coloring and behavior: A dose-response effect in a double-blind, placebo-controlled, repeated-measures study. J. Pediatr., 125, 691-698.
114.
Sandstead, H.H., Fosmire, GJ., Halas, E.S., Jacob, R.A., Strobel, D.A., & Marks, E.O. (1977). Zinc deficiency: Effects on brain and behavior of rats and rhesus monkeys. Teratology, 16, 229-234.
115.
Sandyk, R. (1990). Zinc deficiency in attention-deficit/ hyperactivity disorder. Intern. J. Neuroscience, 52, 239-241.
116.
Sato, K., Taguchi, H., Maeda, T., & Yoshikawa, K. (1993). Pyridoxine toxicity to cultured fibroblasts cause by nearultraviolet light. J. Investigative Dermatology, 100, 266-270.
117.
Schaumburg, H., Kaplan, J., Windebank, A., Vick, N., Rasmus, S., Pleasure, D., & Brown, Mj. (1983). Sensory neuropathy from pyridoxine abuse: A new megavitamin syndrome. New England Journal of Medicine, 309, 445-448.
118.
Schmidt, M.H., Mocks, P., Lay, B., Eisert, H.G., Fojkar, R., Fritz-Sigmund, D., Marcus, A., & Musaeus, B. (1997). Does oligoantigenic diet influence hyperactive/conduct-disordered children-A controlled trial. European Child & Adolescent Psychiatry, 6, 88-95.
119.
Sever, Y., Ashkenazi A., Tyano, S., & Weizman, A. (1997). Iron treatment in children with ADHD: A preliminary report. Neuropsychobiology, 35, 178-180.
120.
Shaywitz, B.A., Siegel, NJ., & Pearson, H.A. (1977). Megavitamins for minimal brain dysfunction: A potentially dangerous therapy. Journal of the American Medical Association, 238, 1749-1750.
Starobrat-Hermelin, B., & Kozielec, T. (1997). The effects of magnesium physiological supplementation on hyperactivity in children with ADHD: Positive response to magnesium oral loading test. Magnesium Research, 10, 149-156.
128.
Stein, T.P., & Sammaritano, A.M. (1984). Nitrogen metabolism in normal and hyperkinetic boys. Amer. J. Clin. Nutrition, 39, 520-524.
129.
Sternberg, E.M. (1996). Pathogenesis of L-tryptophan eosinophilia-myalgia syndrome. Advances in Experimental Medicine & Biology, 398, 325-330.
Stillman, M. (1998). Personal communication about preliminary data from Ball State.
132.
Swanson, J.M., & Kinsbourne, M. (1981). Food dyes and impairment of performance in hyperactive children. Science, 211, 410-411.
133.
Swedo, S.E., Leonard, H.L., Garvey, M., Mittleman, B., Allen, Aj., Perlmutter, S., Dow, S., Zamkoff, J., Dubbert, B.K., & Lougee, L. (1998). Pediatric autoimmune neuropsychiatric disorders associatedc with streptococcal infections: Clinical description of the first 50 cases. Am. J. Psychiatry, 155, 264-271.
134.
Sun, Y., Wang, Y., Qu, X., Wang, J., Fang, J., & Zhang, L. (1994). Clinical observations and treatment of hyperkinesia in children by traditional Chinese medicine. J. Traditional Chinese Medicine, 14, 105-109.
135.
Toren, P., Sofia, E., Sela, B.A., Wolmer, L., Weitz, R., Dov, I., Koren, S., Reiss, A., Weizman, R., & Laor, N. (1996). Zinc deficiency in ADHD. Biol. Psychiatry, 40, 1308-1310.
136.
Truss, C.O. (1991). A controlled trial of nystatin for the candidiasis hypersensitivity syndrome. (Letter to editor). New England Journal of Medicine.
137.
Valentine, J., Rossi, E., O'Leary, P., Parry, T.S., Kurinczuk, JJ., & Sly, P. (1997). Thyroid function in a population of children with ADHD. J. Pediatrics & Child Health, 33, 117-120.
138.
Vargas, S.L., Patrick, C.C., Ayers, G.D., & Hughes, W.T. (1993). Modulating effect of dietary carbohydrate supplementation on Candida albicans colonization and invasion in a neutropenic mouse model. Infection and Immunity, 61, 619-626.
139.
Voight, R.G., Llorente, A., Jensen, C.L., Berretta, M.C., Boutte, C., & Heird, W.C. (1998). Effect of dietary docosohexaenoic acid supplementation on children with ADHD: Preliminary unpublished data presented at NIH workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders, Sept. 2-3, 1998, Bethesda, MD.
140.
Wagner, K.R., Elmore, J.G., & Horwitz, R.I. (1996). Diagnostic bias in clinical decision making: An example of L-tryptophan and the diagnosis of eosinophilia-myalgia syndrome. J. Rheumatology, 23, 2079-2085.
141.
Wang, L.H., Li, C.S., & Li, G.Z. (1995). Clinical and experimental studies on tiaoshen liquor for infantile hyperkinetic syndrome. Chung-Kuo Chung Hsi i Chieh Ho Tsa Chih, 15, 337-340.
142.
Weiss, R.E., & Stein, M.A. (1998, in press). Thyroid function and attention deficit hyperactivity disorder. In P. Accardo, T. Blondis, B. Whitman, & M. Stein (Eds.), ADHD in children and adults. New York: Marcel Dekker.
143.
Weiss, R.E., Stein, M.A., & Refetoff, S. (1997). Behavioral effects of liothyronine (L-T3) in children with ADHD in the presence and absence of resistance to thyroid hormone. Thyroid, 7, 389-393.
144.
Weiss, R.E., Stein, M.A., Trommer, B., & Refetoff, S. (1993). Attention-deficit hyperactivity disorder and thyroid function. J. Pediatrics, 123, 539-545.
145.
West, S.A., Sax, K.W., Stanton, S.P., Keck, P.E. Jr, McElroy, S.L., & Strakowski, S.M. (1996). Differences in thyroid function studies in acutely manic adolescents with and without ADHD. Psychopharmacology Bulletin, 32, 63-66.
146.
Williams, J.I., & Cram, M.C. (1978). Diet in the management of hyperkinesis. Canadian Psychiatric Association Journal, 23, 241-248.
147.
Williamson, B.L., Tomlinson, Aj., Mishra, P.K., Gleich, GJ., & Naylor, S. (1998). Structural characterization of contaminants found in commercial preparations of melatonin: Similarities to case-related compounds from L-tryptophan associated with eosinophilia-myalgia syndrome. Chemical Research in Toxicology, 11, 234-240.
148.
Wolraich, M.L., Lindgren, S.D., Stumbo, P.J., Stegink, L.D., Appelbaum, M.I., & Kiritsy, M.C. (1994). Effects of diets high in sucrose or aspartame on the behavior and cognitive performance of children. N. Engl. J. Med., 330, 301-307.
149.
Wolraich, M.L., Stumbo, PJ., Milch, R., Chenard, C., & Schultz, F. (1986). Dietary characteristics of hyperactive and control boys. J. Am. Diet. Assoc., 86, 500-500.
150.
Wolraich, M.L., Wilson, D.B., & White, J.W. (1995). The effect of sugar on behavior or cognition in children. Journal of the American Medical Association, 274, 1617-1621.
151.
Wood, D.R., Reimherr, F.W., & Wender, P.H. (1985a).,Treatment of attention-deficit disorder with dl-phenylalanine. Psychiatry Research, 16, 21-26.
152.
Wood, D.R., Reimherr, F.W., & Wender, P.H. (1985b). Amino acid precursors for the treatment of attention-deficit disorder, residual type. Psychopharmacology Bulletin, 21, 146-149.
153.
Yates, Bj. (1992). Vestibular influences on the sympathetic nervous system. Brain Research Reviews, 17, 51-59.
154.
Zametkin, Aj., Karoum, F., & Rapoport, J. (1987). Treatment of hyperactive children with d-phenylalanine. Amer. J. Psychiatry, 144, 792-794.
155.
Zentall, S.S., Hall, A.M., & Lee, D.L. (1998). Attentional focus of students with hyperactivity during a word-search task. J. Abnormal Child Psychology, 26, 335-343.
156.
Zhang, H., & Huang, J. (1990). Preliminary study of traditional Chinese medicine treatment of minimal brain dysfunction: Analysis of 100 cases. Chung Hsi i Chieh Ho Tsa Chih [Chinese Journal of Modern Developments in Traditional Medicine], 10, 278-279.
