ADHD Attention Deficit HyperActivity Syndrome Part Two  by Jeffrey Dach

Susan is a 13 year old 8th grader with behavior problems.  Her parents have disciplined her frequently by confiscating her cell phone, restricting her activities, etc. However, none of this seems to help. Susan is frequently inattentive and fidgety in class.  Out of desperation, the parents took Susan to a psychiatrist who started her on Prozac after an extreme behavioral outburst.  In my office, on examination, Susan’s pupils are dilated and reflexes hyperactive, typical adverse effects from SSRI drugs. Susan’s labs show a low serum cholesterol and low ferritin levels. Above left image courtesy of Curious Mind Magazine “Renouned Psychiatrist Says ADHD is Largely a Fraud.”

I explained to Susan’s parents that SSRi drugs are not advisable, as they may lead to “mania and psychosis” with diagnosis of “bipolar syndrome “.(1)  This is a devastating outcome because Susan would then be placed on atypical antipsychotic medication which would destroy any possibility of having a normal life.(1)   However, the parents insist the SSRI drugs have calmed Susan down,  and her behavior has improved.

The Problem Child- ADD, ADHD

This brings us to the “problem child” whose parents look to the medical system for help with a “behavior problem” and are handed one or more psycho-active drugs for their child.  Amphetamines such as Ritalin, Adderal and Vyvanse are commonly handed out for the inattentive, or hyperactive child who is given the “rubber stamp” diagnosis of ADD, ADHD, a manufactured diagnosis used to create massive profits in the criminal marketing of amphetamines to children.  In reality, the behavioral outbursts are a “red flag” for an underlying biologic, metabolic or nutritional disorder.Left Image: Psychiatric Testing for ADD ADHD is an unreliable series of questions, Swami with crystal ball courtesy of James Greenblatt MD.

In part one of this series, we examined the criminal activities of the drug industry, marketing amphetamines to children and young adults under the guise of medication for a manufactured disease called ADD, ADHD.

James Greenblatt MD Integrative Psychiatrist

In part two, this article, we present to you the work of James Greenblatt MD, a child psychiatrist in the Boston area with an integrative approach to the ADD, ADHD child with behavior problems.

Dr Greeblatt spoke at the 2017 Toronto Orthomolecular Medicine Conference, and presented his material on the treatment of ADHD with a nutritional supplement called OPC- Pycnogenol.

Dr Greenblatt believes “biological and nutritional factors that often play a role.” in the ADHD child with behavior problems.  He draws attention to “food additives and nutritional deficiencies”. 

This is what Dr Greenblatt says about ADHD (8)

“Attention Deficit Hyperactivity Disorder (ADHD) is the most recent name for a complex neurobiological disorder that occurs in children, adolescents, and adults. Symptoms include difficulty with attention, concentration, memory, organization, and for some, impulsivity, hyperactivity, aggressiveness, and relationship problems. The scientific research has clearly documented that ADHD is a brain-based disorder.

There are many biological abnormalities in individuals suffering with ADHD. It is a medical disorder that affects behavior; it is not a “discipline problem.” Many untreated children with ADHD develop oppositional behavior and become a “discipline problem.” For some individuals, the right choice of medication can be an invaluable asset in treatment. Unfortunately, medications do not treat the biochemical or neurological imbalances underlying ADHD and many medications have side effects. When individuals are off medication the symptoms of ADHD return and frequently are worse than before medication.”(8)

Pycnogenol and the EEG in ADHD

Dr Greenblatt presented his case material on EEG findings in children before and after 3 months treatment with Pycnogenol, an antioxidant polyphenol supplement. (2)(9-11)  Dr Greenblatt’s many presentations on this topic can be seen on You-Tube.(3) and in his book available on Amazon.(4)

EEG Finding in ADD, ADHD

On the EEG (electroencehalogram), ADHD kids have increased theta waves associated with day dreaming and inattention.  At the same time they have reduced beta waves which are associated with focusing and paying attention.  In Dr Greenblatt’s experience these EEG findings normalize after 3 months of Pycnogenol supplementation. In addition, teachers and parents report improved behavior in the child.

A number of other interventions have been described by other authors.  Dr James Greenblatt reports a case of a child with absent lithium on a hair analysis who responded to low dose lithium orotate, a nutritional supplement. Others have found useful iron supplementation for low ferritin useful.(5)  As mentioned in part one, diet modifications such as avoiding food colorings, and sugar foods can often be helpful. Other causes to look for: Lead toxicity, Food Allergies, Vitamin deficiencies, organo-phosphate exposure, BPA depletes zinc, celiac disease, malabsorption, wheat gluten intolerance, sensitivity to red dyes

More studies on French Maritime Pine Bark Extract (Pycnogenol)

More recent studies show that Pine Bark Extract (PBE) is an effective replacement for amphetamines in treatment of Attention Deficit Disorder in children, with normalization of urinary catecholamines, and improvement in classroom behavior.  Efficacy of PBE was equal to amphetamines without the adverse side effects. (17-23)

Increased Oxidative Damage in ADD ADHD Children

Benefits of Polyphenol Anti-Oxidants

Could breathing oxygen be harmful?  Of course not. We breath oxygen 20 times a minute.  The reality is that the by-products of oxidative energy production (oxidative phosphorylation) are harmful.  We make energy by oxidation of carbon in the electron transport chain in our mitochondria.  The byproducts of this reaction are called reactive oxygen species (ROS) which can damage our cell membranes and our DNA.   We are protected by our anti-oxidant system which quenches these free radicals before they damage our cell structures.  What if our anti-oxidant system is defective ?  Research shows that this is the case for ADD, ADHD kids who have increased markers of oxidative damage.  In a research study, the anti-oxidant pycnogenol reduces these markers of oxidative damage in ADHD kids.   Perhaps this is the mechanism by which anti-oxidant polyphenols exert health benefits in these kids with behavioral problems. (10)

Neuropeptides in Food

Dairy – Casein – Casomorphin – morphine analog
Wheat- Gliadin- gliadorphin- morphine analog – found in OCD

Urine testing available for casomorphin and gliadomorphin from Great Plains.

HPHPA Clostridia Metabolite – elevation associated with psychiatric symptoms… Urine Testing (Organic Acids)  available at Great Plains William Shaw.

Testing Protocols

Dr Greenblatt finds these forms of testing useful:
Food Allergy Testing (IgG)
Organic Acids (Great Plains, William Shaw)
Hair Analysis (may show mineral deficiency)
Routine lab blood work (may show low ferritin, lead,gluten sensitivity)
Electroencephalogram (abnormal ratio of theta to beta waves)

Left Image: Chinese Skullcap flowering plant.

(Baicalin) Chinese Skullcap for ADD/ADHD

Chinese Skullcap (baicalin) is a botanical flowering plant with antiviral, anticancer, anti-inflammatory activity.  It is beneficial for the brain and nervous system.  In a mouse animal model of ADHD, chinese skullcap showed remarkable benefits. (6-7)

In 2019, Dr. Marzieh Moghadas reviewed Bacailin for ADD/ADHD animal models finding Baicalin more effective than amphetamines for improving Dopamine neurotransmitter system in the brain in animal studies. Dr. Marzieh Moghadas writes:

Baicalin can also improve the spatial learning ability in global ischemia/reperfusion rats…Baicalin distribution was very high in the DA [Dopamine] system. In fact, the DA system is known as the target brain system for baicalin. In addition, the literature shows that children with ADHD have low levels of DA in the brain, as is the case in mice, while baicalin protects and regulates the DA system and increases the level of DA [Dopamine].(23)

In 2019, Dr. Rongyi Zhou studied the therapeutic effects and mechanisms of baicalin in a spontaneously hypertensive rat (SHR) model of ADHD depending on the dopamine (DA) deficit theory. Mice were randomly divided to received Methylphenidate,  baicalin or saline controls, orally administered for four weeks. Motor activity, spatial learning and memory ability were measured with the open-field and Morris water-maze tests. Dopamine levels were measured in the prefrontal cortex and striatum. Methylphenidate significantly increased Dopamine levels in both the prefrontal cortex (PFC) and striatum, while baicalin significantly increased DA levels only in the striatum, and controlled the core symptoms of ADHD. Pharmacological effects of baicalin were associated with the synthesis, vesicular localization, and release of Dopamine and might be effective in ADHD. (27)

Phosphatidylserine for ADHD

A 2014 randomized study of 36 children ages 4-14, by Dr Hirayama gave the nutrient phosphatidylserine (PS) , a naturally occurring phospholipid, dosage of 200 mg day to 19 children for 2 months in a randomised, double-blind manner.  The remaining 17 children received placebo. The treated group showed significant improvement in ADHD symptoms with improvement in auuditory memory. Dr Hirayama writes:

PS significantly improved ADHD symptoms and short-term auditory memory in children. PS supplementation might be a safe and natural nutritional strategy for improving mental performance in young children suffering from ADHD.(24-26)

Buy Phosphatidyl Serine on Pure Encapsulations

Buy Chinese Skullcap (Scutellaria baicalensis) on Amazon

Buy Pycnogenol on Amazon

Buy Lithium Orotate on Amazon

Articles with Related Interest:

Attention Deficit Disorder Exposed as Drug Marketing Ploy

Lithium Orotate the great Protector

More on Anti-Inflammatory Effects of Chinese Skullcap

Reference Links

Mania and Psychosis from SSRI drugs

1) Preda, Adrian, Rebecca W. MacLean, and Malcolm B. Bowers. “Antidepressant-associated mania and psychosis resulting in psychiatric admissions.” The Journal of clinical psychiatry 62.1 (2001): 30-33.

Prozac is the only SSRI drug approved for use in adolescents and children, and carries a black box warning.   None of the others are approved for use in children.  The long term effect of this drug on the developing brain is largely unknown, which means that administration of such a drug to an adolescent or child represents an uncontrolled medical experiment, the outcome of which is largely unknown.

Mania and psychosis are known adverse effect of SSRI antidepressant drugs resulting in 8% of admissions to a general hospital psychiatric ward over 14 month study period. “Forty-three (8.1%) of 533 patients were found to have been admitted owing to antidepressant-associated mania or psychosis”.

2) Video: “Integrative Therapies for the Treatment of ADHD” by Dr. James Greenblatt

Adhd and the EEG
theta slow day dreaming – inattention
beta – paying attention-focus

Pycnogenol studies in ADHD

3) Videos on You Tube ADHD James Greenblatt

4) BOOK on Amazon  Finally Focused: The Breakthrough Natural Treatment Plan for ADHD That Restores Attention, Minimizes Hyperactivity, and Helps Eliminate Drug Side Effects Paperback – May 9, 2017  by James Greenblatt M.D. (Author), Bill Gottlieb CHC (Author)

5) dela Peña, June Bryan, et al. “Updates on the Use of Natural Treatments for Attention-Deficit Hyperactivity Disorder (ADHD).” ADHD-New Directions in Diagnosis and Treatment. InTech, 2015. Natural Treatments for Attention Deficit Hyperactivity Disorder ADHD dela Pena June Bryan InTech 2015

Oroxylin A – Chinese Skullcap -Baical

6) Yoon, Seo Young, et al. “Oroxylin A improves attention deficit hyperactivity disorder-like behaviors in the spontaneously hypertensive rat and inhibits reuptake of dopamine in vitro.” Archives of pharmacal research 36.1 (2013): 134-140.
oroxylin A improves ADHD-like behaviors in SHR via enhancement of DA neurotransmission and not modulation of GABA pathway as previously reported.

7) dela Peña, Ike C., et al. “5, 7-Dihydroxy-6-methoxy-4′-phenoxyflavone, a derivative of oroxylin A improves attention-deficit/hyperactivity disorder (ADHD)-like behaviors in spontaneously hypertensive rats.” European journal of pharmacology 715.1 (2013): 337-344.

Pycnogenol -OPC  for ADHD

8) Assessment, E. E. G. “Female, 47 years of age Case history: First consultation.” James Greenblatt MD
Attention Deficit Hyperactivity Disorder (ADHD) is the most recent name for a complex neurobiological disorder that occurs in children, adolescents, and adults. Symptoms include difficulty with attention, concentration, memory, organization, and for some, impulsivity, hyperactivity, aggressiveness, and relationship problems. The scientific research has clearly documented that ADHD is a brain-based disorder.

There are many biological abnormalities in individuals suffering with ADHD. It is a medical disorder that affects behavior; it is not a “discipline problem.” Many untreated children with ADHD develop oppositional behavior and become a “discipline problem.” For some individuals, the right choice of medication can be an invaluable asset in treatment. Unfortunately, medications do not treat the biochemical or neurological imbalances underlying ADHD and many medications have side effects. When individuals are off medication the symptoms of ADHD return and frequently are worse than before medication.

9) Oligomeric Proanthocyanidins for the Treatment of ADHD
by James Greenblatt | May 1, 2017 | Integration, Magazine

10) Chovanová, Zuzana, et al. “Effect of polyphenolic extract, Pycnogenol®, on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder.” Free radical research 40.9 (2006): 1003-1010. Pycnogenol in attention deficit hyperactivity disorder Chovanová Zuzana Free radical research 2006

11) Trebatická, Jana, et al. “Treatment of ADHD with French maritime pine bark extract, Pycnogenol®.” European child & adolescent psychiatry 15.6 (2006): 329-335. Treatment of ADHD with Pycnogenol Trebaticka Jana European child adolescent psychiatry 2006

EEG

12) Saad, Jacqueline F., et al. “Is the theta/beta EEG marker for ADHD inherently flawed?.” Journal of attention disorders (2015): 1087054715578270.

12) Poil, S-S., et al. “Age dependent electroencephalographic changes in attention-deficit/hyperactivity disorder (ADHD).” Clinical Neurophysiology 125.8 (2014): 1626-1638.

Age dependent electroencephalographic changes in attention-deficit/hyperactivity disorder (ADHD).  Poil SS1, Bollmann S2, Ghisleni C3, O’Gorman RL4, Klaver P5, Ball J6, Eich-Höchli D7, Brandeis D8, Michels L9.

Objective biomarkers for attention-deficit/hyperactivity disorder (ADHD) could improve diagnostics or treatment monitoring of this psychiatric disorder. The resting electroencephalogram (EEG) provides non-invasive spectral markers of brain function and development. Their accuracy as ADHD markers is increasingly questioned but may improve with pattern classification.
METHODS: This study provides an integrated analysis of ADHD and developmental effects in children and adults using regression analysis and support vector machine classification of spectral resting (eyes-closed) EEG biomarkers in order to clarify their diagnostic value.
RESULTS: ADHD effects on EEG strongly depend on age and frequency. We observed typical non-linear developmental decreases in delta and theta power for both ADHD and control groups. However, for ADHD adults we found a slowing in alpha frequency combined with a higher power in alpha-1 (8-10Hz) and beta (13-30Hz). Support vector machine classification of ADHD adults versus controls yielded a notable cross validated sensitivity of 67% and specificity of 83% using power and central frequency from all frequency bands. ADHD children were not classified convincingly with these markers.
CONCLUSIONS: Resting state electrophysiology is altered in ADHD, and these electrophysiological impairments persist into adulthood.
SIGNIFICANCE: Spectral biomarkers may have both diagnostic and prognostic value.

13) Mazaheri, Ali, et al. “Differential Oscillatory EEG between Attention Deficit Hyperactivity Disorder Subtypes and Typically Developing Adolescents.” Biological psychiatry 76.5 (2014): 422.

14) Verlaet, Annelies AJ, et al. “Effect of Pycnogenol® on attention-deficit hyperactivity disorder (ADHD): study protocol for a randomised controlled trial.” Trials 18.1 (2017): 145.

15) New York TImes Suicide from Aphetamines for ADHD

16)  Optimizing Attention Deficit Hyperactivity Disorder (ADHD) Treatment with Oligomeric Proanthocyanidins (OPCs) by James Greenblatt, MD, and Winnie T. Lee, RN Townsend Letter October 2017….pycnogenol (100mg/day)

17) Weyns, Anne-Sophie, et al. “Clinical Investigation of French Maritime Pine Bark Extract on Attention-Deficit Hyperactivity Disorder as compared to Methylphenidate and Placebo: Part 2: Oxidative Stress and Immunological Modulation.” Journal of Functional Foods 97 (2022): 105247.

Eighty-eight paediatric ADHD patients (70 % male, mean age 10.1 years) were randomised to placebo (n = 30), PBE (n = 32) or MPH (n = 26). Teachers reported significant improvement of total and hyperactivity/impulsivity ADHD-RS scores by PBE and MPH after 10 weeks compared to placebo. MPH also improved inattention. SEQ ratings support ADHD-RS results. Adverse effects were reported five times more frequently for MPH than for PBE.

PBE appears a good alternative for MPH in paediatric ADHD and especially in the primary school environment, a fortiori when considering its almost complete lack of adverse effects.

18) Hsu, Cheng‐Dien, et al. “Complementary effects of pine bark extract supplementation on inattention, impulsivity, and antioxidative status in children with attention‐deficit hyperactivity disorder: A double‐blinded randomized placebo‐controlled cross‐over study.” Phytotherapy Research 35.6 (2021): 3226-3235.

The purpose of this study was to investigate the complementary effects of polyphenolic compounds from pine bark extract (PE) as a strong antioxidative substrate on the symptoms of inattention and impulsivity in children with attention-deficit hyperactivity disorder (ADHD). This was a randomized, double-blind, crossover, placebo-controlled study that included two experimental units (4 weeks with PE supplementation and 4 weeks with placebo supplementation) separated by a 2-week washout period. ADHD participants were supplemented with 25 mg or 50 mg PE. We recruited 20 participants (17 boys and 3 girls) with a mean age of 10.0 ± 2.1 years. PE supplementation caused a significant reduction in the inattention and hyperactivity-impulsivity items of SNAP-IV. During the period of PE supplementation, the item of commissions in the Continuous Performance Test III (CPT III) significantly decreased, which was used to evaluate the symptoms of inattention and impulsivity. In addition, the erythrocytic reduced glutathione/oxidized glutathione ratio significantly increased, and the plasma TBARs level significantly decreased after 4 weeks of PE supplementation. However, there was no significant correlation between CPT III (commission) and antioxidative status indictors. PE supplementation may have potential effects of ameliorating inattention and impulsivity, and elevating the antioxidative status in children with ADHD.

19) Chen, Y. R., et al. “Effects of polyphenolic extract from pine bark on the improvement of attention deficit/hyperactivity disorder in children and adolescent.” Int. J. Clin. Nutr. Diet 3 (2017): 116-119.

20) Kean, James D., et al. “Reduced inattention and hyperactivity and improved cognition after marine oil extract (PCSO-524®) supplementation in children and adolescents with clinical and subclinical symptoms of attention-deficit hyperactivity disorder (ADHD): a randomised, double-blind, placebo-controlled trial.” Psychopharmacology 234 (2017): 403-420.

21) Dvořáková, Monika, et al. “Urinary catecholamines in children with attention deficit hyperactivity disorder (ADHD): modulation by a polyphenolic extract from pine bark (Pycnogenol®).” Nutritional neuroscience 10.3-4 (2007): 151-157.
Our study tested the hypothesis that treatment with a potent polyphenol complex not only reduces hyperactivity of children, but also catecholamine excretion and oxidative stress. Urine catecholamine concentrations were measured in attention deficit hyperactivity disorder (ADHD) children and healthy controls. ADHD children received either placebo (PL) or Pycnogenol (Pyc), a bioflavonoid extract from the pine bark, for one month. The study was performed in a randomized, double-blind, PL controlled design. Concentrations of catecholamines were higher in urine of ADHD patients compared to those of healthy children. Moreover, noradrenaline (NA) concentrations positively correlated with degree of hyperactivity of ADHD children. In ADHD patients, adrenaline (A) and NA concentrations positively correlated with plasma levels of oxidized glutathione. The treatment of ADHD children with Pyc caused decrease of dopamine (D) and trend of A and NA decrase and increased GSH/GSSG ratio. In conclusion, the data provide further evidence for the overactivity of the noradrenergic system in ADHD and demonstrate that A release may be increased, as well. Treatment of ADHD children with Pyc normalized catecholamine concentrations, leading to less hyperactivity, and, consequently, to reduced oxidative stress.

Last updated on November 26th, 2023 by Jeffrey Dach MD