Understanding children’s hyperactivity and behaviour
Children’s behaviour can be affected by emotional and physical issues. Physical problems will often affect a child’s behaviour, and perhaps especially when they are not able to express themselves verbally, this may be interpreted as behavioural issues before the root of the behavioural change is discovered.
If changes to a child’s behaviour are observed over a prolonged period, it is advisable to seek professional help, to assist in assessing if there may be physical or emotional problems which are impacting on this.
Here we will look at lifestyle issues which may affect children’s behaviour, as well as the specific condition Attention Deficit Hyperactivity Disorder (ADHD), and how both of these can be supported holistically and with herbs.
How does children’s hyperactivity and behaviour work?
The foundation of children’s behaviour is largely formed through the input they receive from the environment surrounding them. This primarily consists of care-givers behaviour (this can include parents and other care-givers), including the type of nurturing, whether and how they communicate love to a child, provision of learning and play experiences, disciplinary techniques used, and behaviour as role models (1, 2).
Alongside this the dietary intake of a child has, in numerous ways, been shown to have an impact on their behaviour. For example, eating refined sugar products often leads to hyperactive or disruptive behaviour (3); a ‘sugar challenge’ of a high carbohydrate breakfast (consisting of sugar coated cereal, milk, and orange juice) has been shown to reduce the attention span of hyperactive children and those who were not previously labelled as hyperactive (4). There is also a suggestion that artificial flavours and additives in food may be a contributing factor for hyperactivity in children (3, 5).
This is just one small example of how children are prone to behavioural changes often due to external factors such as diet, and behavioural issues may be difficult to resolve unless appropriate changes to these underlying factors are also implemented.
ADHD is the most common disorder affecting behaviour, with a gender ratio of 2:1 (male: female) (6). It is estimated to affect between 5 – 15% of children, however many experts believe that it is over-diagnosed (7). Onset often occurs before age 4 and invariably before age 12. The peak age for diagnosis is between ages 8 and 10.
ADHD used to be considered a behaviour disorder, probably because children typically exhibit inattentive, impulsive, and overly active behaviour, whereas now it is considered a neurodevelopmental disorder. Neurodevelopmental disorders are neurologically based conditions that appear early in childhood typically before school entry. They impair development of personal, social, academic, and/or occupational functioning.
Conventional drug-based treatments for the symptoms of ADHD have side-effects, and doses often need to be adjusted to find a balance between reducing symptoms so that daily life is not disrupted but ensuring that medication side-effects also do not disrupt daily life.
ADHD is categorised in three types according to the prevalent behaviour involved:
Many patients will have more than one of these which is classed as combined ADHD.
It is important that children with hyperactive behaviour or ADHD receive support and treatment, because one factor which prevails for many children with ADHD is not being able to cope well with school and finding it difficult to connect with peers/ having difficulty making friends which can then lead to social isolation.
The long-term prognosis for untreated ADHD can result in loneliness and further social isolation, which can lead to substance abuse or self-medicating with medication or illegal substances as a coping strategy. Adults with ADHD are also more typically accident-prone (car accidents being one example), find it harder to hold down work, and are more likely to be involved in criminal activity (7, 8).
Understanding the root of children’s hyperactivity and behaviour
There is still no specific cause identified for ADHD, with a combination of genetic, biochemical, sensorimotor, physiologic, and behavioural factors being suggested, and it is also often associated with adverse childhood experiences.
Some risk factors for ADHD include (7):
- Low birth weight (< 1500 g)
- head trauma
- iron deficiency
- obstructive sleep apnoea
- lead exposure
- prenatal exposure to alcohol, tobacco, and cocaine
The nervous system can also be depleted by emotional stress, which can contribute to ADHD by increasing the body’s use of vital nutrients. Therefore, understanding if there are any factors which may be contributing to a child’s emotional stress is also important in getting to the root of the problem.
Links between accumulation of heavy metals in the body and ADHD have been hypothesised (3, 5), since diagnosis of the condition has become something of a phenomenon coinciding with the growth of global pollution of air, water, and food systems. Intoxication with certain heavy metals has been linked with neurological changes which result in increased impulsivity and addictive behaviour (8).
A study of over 2000 children in an area of Chile where there is reported heavy metal contamination, and arsenic in the water, found that children with higher levels of blood lead concentrations were significantly more likely to develop ADHD compared to children with lower levels of lead toxicity (9). This study is not conclusive evidence of heavy metal toxicity being a direct cause of ADHD due to potential other variables being involved, but certainly suggests that it may well be a contributing factor in the likelihood of developing ADHD.
It has long been clear that food allergies or intolerances are one frequent reason for behavioural changes in children which can result in trouble sleeping, temper tantrums, aggression, and mood swings. Hypoglycaemia (low blood sugar) can also cause mood swings and erratic behaviour in children, which can occur with the over-consumption of sugar and refined carbohydrates (3).
The gut-microbiome consists of natural bacteria which live in our digestive tract and help to keep our internal environment in harmony. There is now an increasing understanding of the important link between these gut-microbes and many aspects of health. The gut-microbiome is considered a part of the unconscious system regulating behaviour, having a major impact on cognitive function and behavioural patterns, and in their absence profound alterations in neurochemistry are observed (10).
Nutritional deficiencies are also a cause of disrupted nervous system function, which in themselves can also predispose to food allergies. Nutritional deficiencies often stem from a diet high in sugar, refined foods, and low in vegetables and fruit (3), an often typical ‘Western diet’.
Since the gut microbiome thrives on a variety of plant-based whole-foods (vegetables, fruits, grains, nuts, seeds, fermented foods such as sauerkraut, kimchee, kefir), this suggests a link between poor diet and nutrition, increased tendency for food intolerances and allergies which in turn will lead to inflammation. This causes further difficulties absorbing nutrients, and results in a lower level of gut microbes, all resulting in the greater likelihood of behavioural problems in children.
A study looking at the Mediterranean diet and ADHD diagnosis found that out of 120 children / adolescents (60 with an ADHD diagnosis and 60 in a control group without diagnosis), lower adherence to a Mediterranean diet was associated significantly with ADHD diagnosis. It also found that consuming less fruit, vegetables, pasta, skipping breakfast, and eating fast foods were associated with ADHD diagnosis. High consumption of eating sugar, candy, cola beverages and other soft-drinks, and low consumption of fatty fish were also associated with higher prevalence of ADHD diagnosis (11). This suggest that a balanced whole foods diet (rather than specific nutrients) is likely to be beneficial in preventing and / or treating ADHD.
Another study looked at eliminating food components by using the Oligoantigenic Diet (OD) which led to a reduction of ADHD symptoms for more than two-thirds of patients (6). The aim of this study was to reveal how to identify foods having an impact on ADHD symptomatology. After four weeks of elimination diet the individual food sensitivities were identified in a reintroduction phase. Twenty-seven food sensitivity reactions were identified. Most of the participants were sensitive to more than one food. In all patients, ADHD symptoms were intensified by various foods during the food challenge after elimination phase. An example is that 70% of children reacted to milk products, and of these 73% did not react to dairy products which were free from lactose. This sample size was small with only 16 participants completing the study, and whilst it does not identify specific allergens which may trigger ADHD, it does suggest that children with ADHD diagnosis and no previous sign of food intolerances (as in this study), would benefit from exploring elimination diets to understand if food may be causing reactions and stimulating ADHD symptoms.
This offers a perspective on ADHD which suggests that although root causes are not clear, there is great scope to potentially reducing symptoms with dietary adjustments towards whole food diets and through elimination diets to discover potential intolerances. This is particularly important because of the side effects of medication which do not really resolve the root cause of the condition, and also because of the potential long-term consequences going into adolescence and adulthood if the condition is left undiagnosed and / or untreated.
This is one area which herbalism can really offer hope in providing support.
Signs and symptoms
These criteria require more than 6 symptoms and signs from one or each group. Also, the symptoms need to:
- Be present often for ≥ 6 months
- Be more pronounced than expected for the child’s developmental level
- Occur in at least 2 situations (e.g., home and school)
- Be present before age 12 (at least some symptoms)
- Interfere with functioning at home, school, or work
- Does not pay attention to details or makes careless mistakes in schoolwork or with other activities
- Has difficulty sustaining attention on tasks at school or during play
- Does not seem to listen when spoken to directly
- Does not follow through on instructions or finish tasks
- Has difficulty organizing tasks and activities
- Avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort over a long period of time
- Often loses things necessary for school tasks or activities
- Is easily distracted
- Is forgetful in daily activities
Hyperactivity and impulsivity symptoms:
- Often fidgets with hands or feet or squirms
- Often leaves seat in classroom or elsewhere
- Often runs about or climbs excessively where such activity is inappropriate
- Has difficulty playing quietly
- Often on the go, acting as if driven by a motor
- Often talks excessively
- Often blurts out answers before questions are completed
- Often has difficulty awaiting turn
- Often interrupts or intrudes on others
The herbal treatment of ADHD and hyperactivity will need to be implemented alongside the relevant dietary and lifestyle changes such as eliminating junk food and replacing with nutritious whole foods diet, parental or care-giver support in how to implement and sustain this, as well as relevant emotional support for child and care-givers. It is recommended to seek professional guidance from a herbalist.
Nervous system support: supporting the nervous system would be the main herbal approach in cases of children experiencing behavioural problems, to help relieve the stress involved, and also nourish and support the nervous system to function well. Nourishing nervines and adaptogens will help and increase resilience to this stress, and reduce feelings of anxiety which may be present.
Nervous system tonics:
Vervain is helpful to re-establish healthy sleep patterns and is energetically grounding helping to calm energy down. It can be given throughout the day during periods when a child becomes run-down from lack of sleep (3), until a healthy sleeping pattern is re-established.
Skullcap is helpful in cases of overthinking or ‘busy head’. It can be taken as an infusion before bed for cases of insomnia.
Rose is particularly helpful for calming irritability and anger, is restores the nervous system and is helpful in insomnia. For children a strong infusion or essential oil can be added to a bath before bed.
Oats are nutrient for the nervous system, and a tonic nervine action, so toning and restoring the nervous system.
Liquorice will support adrenal gland function and so responses to stress, though caution must be taken if one has high blood pressure.
Ashwagandha for adaptogenic support, to increase resilience to stress, balance hormones and to nourish the nervous system.
Aid support of heavy metal elimination:
From an Ayurvedic perspective ADHD is likely a disorder associated with imbalance of Vata and Pitta, and so herbs will be given to support balance of these Doshas.
Sweet (Acorus calamus) is used by Indian doctors as a brain tonic and for memory problems (McIntyre). Interestingly from a western herbal perspective it is considered a healing tonic for the whole gastrointestinal tract where it has a soothing and toning effect, whilst also bitter components will promote digestive function and appetite, and digestive support may well be indicated in most cases of ADHD.
Pitta calming herbs are used in cases of aggression and anger, including gotu kola, chamomile, coriander, shatavari.
- Based on all the points discussed regarding diet and ADHD, paying attention to a balanced nutritious whole-foods diet is likely to be extremely beneficial in managing symptoms of ADHD or general hyperactivity.
- Ensuring regular meals to avoid hypoglycaemia and checking that the child is eating during the school day.
- Trying an elimination diet and reintroduction may also be helpful in establishing any connection between food intolerances or allergies and ADHD.
- Reducing or cutting out refined sugar and junk foods for one month initially may be beneficial to establish change in behaviour.
- A b-vitamin complex may also be beneficial for additional nervous system support. In a trial it has been shown to be more effective, safer, and less expensive than treatment with Ritalin (4).
Family support in the form of parenting style and behavioural management may be beneficial for the whole family in terms of finding strategies to help cope with the behaviours. Also sharing constructive creative activities between parent and children such as painting, crafts, singing, story-telling can be great to enforce positive behaviour and help build bonds between children and parents / care-givers (3).
Additional supportive practices such as physical exercise, Yoga, meditation, and breathing exercises may all help to calm the nervous system and relieve stress.
- Britannica. Human Behaviour, Development in Childhood. https://www.britannica.com/topic/human-behavior/Self-concept-or-identity. Accessed 21 August, 2022.
- Kopp CB, Self-Regulatory ProcessesIn: Haith MM, Benson JB, eds. Encyclopedia of Infant and Early Childhood Development. Elsevier Inc.2008: 102-117. https://doi.org/10.1016/B978-012370877-9.00140-7. Accessed 21 August, 2022.
- McIntyre A. Herbal Treatment of Children Western and Ayurvedic Perspectives. China: Elsevier; 2005.
- Minsky BC. Our Children’s Health. Connecticut: Vital Health Publishing; 2002.
- Hoffmann D. The New Holistic Herbal. 3rd Edition. Shaftesbury Dorset: Element Books Ltd; 1990.
- Yorgidis E, Beiner L, Blazynski N, Schneider-Momm K, Clement H-W, Rauh R, Schulz E, Clement C, Fleischhaker C. Individual Behavioral Reactions in the Context of Food Sensitivities in Children with Attention-Deficit/Hyperactivity Disorder before and after an Oligoantigenic Diet. Nutrients. 2021; 13(8):2598. https://doi.org/10.3390/nu13082598
- Attention-Deficit / Hyperactivity Disorder (ADD / ADHD). MSD Manual Professional Version website. Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) – Pediatrics – MSD Manual Professional Edition (msdmanuals.com). Accessed 19 August, 2022.
- Pizzorno J, Murray M, Joiner-Bey H, The Clinician’s Handbook of Natural Medicine. 2nd ed. St Loius, Missouri: Churchill Livingstone Elsevier; 2008.
- MP, Rubilarad P, Macarena Valdés, et al. Attention deficit hyperactivity disorder and its association with heavy metals in children from northern Chile. International Journal of Hygiene and Environmental Health: 2020;226;113483. https://doi.org/10.1016/j.ijheh.2020.113483
- Dinan TG, Stilling RM, Stanton C, Cryan JF. Collective unconscious: how gut microbes shape human behavior. J Psychiatr Res. 2015;63:1-9. doi:10.1016/j.jpsychires.2015.02.021.
- Ríos-Hernández A, Alda JA, Farran-Codina A, Ferreira-García E, Izquierdo-Pulido M. The Mediterranean Diet and ADHD in Children and Adolescents. Pediatrics. 2017;139(2):e20162027. doi:10.1542/peds.2016-2027