Attention Deficit Hyperactivity Disorder (ADHD)
Attention Deficit Hyperactivity Disorder (ADHD) is a behaviour disorder characterized by levels of inattention, impulsivity, and overactivity that are well beyond what is expected and appropriate for a given student’s sex and age. Students with ADHD may have difficulty concentrating on schoolwork, frequently interrupt conversations or activities, and have difficulty remaining seated when required to do so.
ADHD is a prevailing issue and affects at least 1-2% of all school-age children according to the World Health Organization (WHO).
Children with ADHD typically first exhibit symptoms of this disorder during their preschool or early elementary school years, and it is highly likely that these symptoms will continue throughout their lives. Boys are three times more likely to be diagnosed with ADHD than girls. There are three subtypes of ADHD: individuals who exhibit problems only with inattention and concentration (ADHD Predominantly Inattentive Type); individuals who exhibit problems only with hyperactivity and impulsivity (ADHD Predominantly Hyperactive-Impulsive Type); and individuals who exhibit problems in both areas (ADHD Combined Type).
ADHD is not a learning disability nor is it a manifestation of bad parenting or an impoverished environment. The children with ADHD are not stupid, lazy, or spoiled. They are often quite intelligent but underachieving, creative but unable to complete a project, likeable but exasperating. Mozart probably had ADD/ADHD. He was impatient, impulsive, easily distracted, energetic, innovative, creative and emotionally needy. An irreverent, playful maverick, his flirting, flitting genius-mind was captured by the structure of music. Similarly: Albert Einstein, Salvador Dali, Edgar Allan Poe, George Bernard Shaw, Thomas Edison, Ben Franklin - you can add more to the list.
The Need for Natural Solutions for ADHD
Advances in medicine have been extremely forthcoming in treating and managing cognitive disorders like ADHD, but the need for natural solutions remains and appears to be increasing due to the incidence of side effects and stigma sometimes placed - especially with children - on stimulant prescription medication.
The use of stimulants, anti-depressants, beta-blockers, and tranquilizers is based on trial and error, guessing at the unknown. Estimates of "side effects" in successfully treated children range from 10-50%. Of course, these are only the gross effects that show up as an identifiable medical manifestation. Many more sub-clinical effects are below the threshold of conventional observation. Pre-sleep agitation is usually twice the normal duration in half of the ADHD children on medication and this worsens as the medication wears off. To avoid the stunting of growth, medications are often discontinued on weekends and during summer break--leaving the parents to contend with the problems as best they can. Lowest effective dosages must be determined to avoid adverse reactions such as nervousness, insomnia, abdominal pain, anorexia, erratic heartbeat, increased heartbeat, toxic psychosis, headache, blood pressure changes, weight loss, Tourette's syndrome, and others.
Children, especially adolescents, often oppose taking medication, especially at first. To take medication is to admit that "something is wrong with them." They feel embarrassed or humiliated. Edward Hallowell, M.D., author and psychiatrist specializing in child and adult ADHD says, *The decision to take medication should never be unilateral and should not be a struggle....no one should try medication without wanting to do so and without a full understanding of the benefits and risks involved." (1, 2)
Mechanisms of Action of Pycnogenol in ADHD
Pycnogenol is one of the few dietary antioxidants that readily crosses the blood-brain barrier to protect brain cells. The blood-brain barrier protects the brain from compounds that normally circulate in the blood. Brain cells are very sensitive to some compounds, even though they may not damage other cells in the body or even be needed by other cells.
Oligomeric proanthocyanidins (OPCs), the major constituent of Pycnogenol help Vitamin C work better in the brain. Vitamin C is needed for the synthesis of the neurotransmitters norepinephirine, dopamine and serotonin, which are involved with ADHD.
Pycnogenol is a potent vasodilator. People with ADHD have less blood flow directed to the part of the brain that helps to organize behavior. Iit seems probable that an imbalance of nitric oxide could be at the root of this common problem.
Proantocyanidins take part in mec hanisms which regulate enzymes that help control two crucial neurotransmitters -- dopamine and norepinephrine, chemicals that carry messages among brain cells and are involved in 'excitatory' responses. Pycnogenol does not increase production of neurotransmitters, which is the strategy of stimulants such as Ritalin.
Proanthocyanidins also help deliver nutrients to the brain, such as zinc, manganese, selenium, and copper, that are helpful in ADHD, according to recent research. Additionally, the strong antioxidant activity may help stabilize brain cells and improve th eir functioning by neutralizing damage from free radicals.
Pycnogenol also dampens the allergic histamine response, which may be a factor in ADHD for some children and adults (3-5)
Pycnogenol protected DNS from oxidation in children with ADHD
A randomized, double-blind, placebo controlled study evaluated the effect of Pycnogenol (Pyc) on the level of oxidized purines represented by 8-oxo-7,8-dihydroguanine (8-oxoG) and on the total antioxidant status (TAS) in children with ADHD. 61 children (50 boys and 11 girls aged 6-14, average age 11.5 years,) were treated with daily 1 mg/kg Pycnogenolt or placebo for one month. The children were examined at the beginning and at the end of treatmen as well as one month after its termination. Controll group consisted of 56 healthy children (average age 11.5 years).
The investigators found significantly increased damage to DNA in ADHD children when compared to controls. 8-oxoG was significantly lower after 1 month of Pyc administration in comparison to the beginning state and to placebo group. TAS in ADHD children was lower in comparison to controls. After Pyc administration, TAS was elevated but statistically significant increase was recorded after 1 month of termination of Pyc application.
Improvement of DNA damage and TAS after Pyc administration is associated with the improvement of attention in ADHD children. In conclusion, Pycnogenol reduced oxidative damage to DNA, normalized TAS and improved attention of children with ADHD.
The chart represents the level of 8-oxo-G in lymphocytes in in children with ADHD treated with
Pycnogenol (n = 39, green bars) and placebo (n = 17, gray bars) for one month
Values are mean ± standard deviation. Time periods: 0: baseline values (at the beginning of the trial) 1: at the end of one month of treatment, 2: one month after termination of treatment. (washout) *: significance level between values from 0 and 1 time periods in the Pycnogenol group (p <0.05); o: significance between between Pycnogenol and placebo group at the end of one month treatment (time period 1) (p <0.05) (6)
A Pycnogenol® decreased hiperactivity and improved attention in children with ADHD
A randomized, double-blind, placebo controlled study evaluated the effect of daily 1 mg/kg Pycnogenol (n=44) and placebo (n=17) on ADHD symptoms in 61 children over a period of 4 weeks. Patients were examined at start of trial, 1 month after treatment and 1 month after end of treatment period by standard questionnaires: CAP (Child Attention Problems) teacher rating scale, Conner's Teacher Rating Scale (CTRS), the Conner's Parent Rating Scale (CPRS) and a modified Wechsler Intelligence Scale for children.
One month of Pycnogenol teratment caused a significant reduction of hyperactivity, improved attention and visual-motoric coordination and concentration of children with ADHD. In the placebo group no positive effects were found. One month after termination of Pycnogenol administration a relapse of symptoms was noted.
The results of the trial point to an option to use Pycnogenol as a natural supplement to relieve ADHD symptoms of children. (7)
The chart represents the effect of treatment with Pycnogenol and placebo on ADHD symptoms evaluated by teachers with the CAP (Child Attention Problems) teacher rating scale. Time periods: 0: baseline values (at the beginning of the trial) 1: at the end of one month of treatment, 2: one month after termination of treatment. (washout). Significance level between values from 0 and 1 time: p <0.05; significance level between Pycnogenol and placebo group at the end of one month treatment (time period 1) : ooo p<0.01, oo p<0.05
Summary
Randomized, placebo controlled studies suggest that Pycnogenol is effective in managing the symptoms of ADHD. The effects are due to the following mechanisms of action:
- Supports neurotransmitter activity
- Very strong antioxidant which crosses the blood-brain barrier to protect brain cells
- Maintains the integrity of the circulatory system
- Reduces stress hormones
References
- An ADHD Primer. L. Weyandt. 2001. Boston: Pearson, Allyn, and Bacon.
- Attention deficit hyperactivity disorder: A handbook for diagnosis and treatment (2nd ed.). R. Barkley. 1998. New York: Guilford.
- Jean Carper, "Miracle Cures : Dramatic New Scientific Discoveries Revealing the Healing Powers of Herbs, Vitamins, and Other Natural Remedies"; HarperCollins Publishers (1998).
- Richard A. Passwater: User's Guide to Pycnogenol: Nature's Most Versatile Supplement. Jack Salem Series Editor, 2005
- Hanley JL: Pycnogenol is recommended for Attention Deficit Disorder (ADD). Attention Deficit Disorder, Impact Communications Inc, Greenbay, WI, USA 1999, 17-19 o.
- Chovanová Z et al. Effect of polyphenolic extract, Pycnogenol, on the level of 8-oxoguanine in children suffering from attention deficit/hyperactivity disorder. Free Radic Res. 2006 Sep;40(9):1003-10.
- Trebatická J. et al. Treatment of ADHD with French maritime pine bark extract, Pycnogenol. Eur Child Adolesc Psychiatry. 2006 Sep;15(6):329-35.