Research

The Effect of Physical Activity and Nutritional Interventions on a Child’s Mood and Behavioral Disorders: A Case Report

Naomi May, MS, RD, LD

 

Chris Caffery, DC

 

author email    corresponding author email   

Topics in Integrative Health Care 2015, Vol. 6(2)   ID: 6.2004



Published on
September 29, 2015
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Objective: Mood and behavior disorders in children can be very challenging for not only the well-being of the child, but all family members. When a child is evaluated in a conventional medical setting, children with mood disorders and Attention-Deficit/Hyperactivity Disorders (ADHD) are often encouraged to take medications which may cause adverse side effects in some individuals. This case demonstrates that symptoms of ADHD and other behavioral issues can be affected by simple lifestyle changes. The purpose of this case report is to discuss the outcome of a 4 year old child diagnosed with mood and behavior disorders when treated with lifestyle intervention, including physical activity and nutritional interventions, by a functional medicine practitioner.

Clinical Features: A 4 year old child presented to the clinic with his mother with recent evaluation and several mood and behavior diagnoses, including: Mood Disorder, Not Otherwise Specified; ADHD, combined Type; and Disruptive Behavior Disorder, Not Otherwise Specified. The patient was having severe violent outbursts regularly and was disruptive, inattentive, anxious, and hyperactive. He was also wetting the bed regularly.

Intervention and outcome: The patient was treated with an electronic fast (eliminating use of all electronic devices, including television and computers), 1 hour of physical activity per day, elimination diet, nutritional supplements, and proprioceptive and vestibular exercises. After just 1-2 months, patient was already doing really well behaviorally according to his mother. Conclusion: This case offers an example of promising, medication free options for optimizing mood and behavior disorders in children.

Introduction

The most common behavioral disorder in childhood is ADHD. It is found more often in boys than girls (7.9% prevalence rate compared to 1.8%). The typical signs and symptoms may include inattention, hyperactivity, behavioral issues at home and/or school, and impulsiveness.1, 2  Mood and behavior disorders in children can be very challenging for not only the well-being of the child, but all family members. When a child is evaluated in the normal conventional medical setting, children with mood disorders and ADHD are often encouraged to take medications, which can create adverse side effects in some individuals.

Functional Medicine can provide answers and options that are not pharmacological. Functional medicine focuses on identifying the root causes of disease and optimizing the bodies’ functioning in order to alleviate symptoms of disease. It is a great place to look to identify causes of issues and work to restore the body to optimal functioning through food, exercise, and other lifestyle interventions.

Promising non-pharmacological interventions for mood and behavior disorders have been reported in the literature. Physical activity is a commonly studied approach to symptom control in ADHD and it can be a very successful way to control behavior.2, 3, 4  Strict limitation to elimination of electronic viewing equipment is another way to improve attention problems. Sigman reports that when children watched television from a very young age (ages 1-3), by the time they were 7 years old, there was an increased risk for development of attention problems.5  On the other hand, if parents and children read picture books consistently, it was found that there is more neural activity in the children’s frontal lobes. Frontal lobe activity is necessary for development of attention, memory, socio-emotional development, language, and executive functions.6

A nutrition-focused intervention for behavioral issues may include implementation of an elimination diet along with fish oil supplementation.7, 8  Specific food triggers can be identified by testing for celiac disease, food sensitivities, and/or an elimination and re-introduction of suspected foods trial.

Clinical Findings



This case is about a 4 year old male who was enrolled in a pre-K education program 3 days per week. The patient presented to a chiropractic office with reports from mother of depression, anxiety, enuresis, and behavioral problems at school and home that could be very violent, with threats to kill family members. The mother reported the onset of these symptoms was approximately one year prior.  A neuropsychological assessment from a separate clinic completed a few months prior to the patient presenting to chiropractic office had diagnosed the patient with Mood Disorder, Not Otherwise Specified; ADHD, combined Type; Disruptive Behavior Disorder, Not Otherwise Specified; Sensory Integration Disorder; Family Problems, Social Problems, and Behavior Problems. Family history was significant for ADHD, depression, anxiety, obsessive compulsive behaviors, panic attacks, substance abuse, and bipolar disorder. The patient was living at home with both parents and two siblings.  Past interventions that failed to improve behavior included: minimizing sugar consumption, removal of food dyes, and elimination of all exposure to media violence, but the patient was still using electronics.  The mother reports strictly minimizing sugar consumption for 3 months, and maintaining elimination of the violent media beyond 3 months and leading up to the initial visit. 

Diagnostic Focus and Assessment



Initial assessment prompted a neurological examination and requisition for food antibody testing from Cyrex Laboratories. Array 3 and 4 from Cyrex Laboratories were ordered.  Array 3 and 4 measure combined IgG and IgA antibodies to wheat proteins and peptides, transglutaminase enzymes, dairy proteins, and other various foods.  Significant findings included an egg and gluten sensitivity. The neurological exam showed signs of frontal cortex delay (Myerson's sign, posterior center of pressure, inattention, hyperactivity, left sided bradykinesia) and signs of limbic escape (left sided dysdiadochokinesia, rapid alternating movements on left promoting oral/facial dyskinesia).

Therapeutic Focus and Assessment



This patient was primarily treated through lifestyle and nutrition interventions (See Table 1 & 2.) The patient eliminated all screen time usage, and incorporated 1 hour of physical activity per day along with vestibular rehabilitation exercises in which his mother would assist.  After one month, a gluten and egg free diet was initiated and dietary supplements were added to therapy. These dietary supplements included a broad spectrum chewable digestive enzymes (Klaire Labs Vital-zymes) with meals and a multi- species chewable probiotic (Klaire Labs Therbiotic Chewables), 2 per day with meals.  One month later, vetiver essential oil inhaled in the right nostril, twice per day and diffused in the room at night was added to treatment plan.  The following month, a transdermal cream primarily consisting primarily of tyrosine, licorice, and phosphatidyl serine (Apex Energetic Adrenastim) for adrenal support was added to the treatment plan. At one year follow-up, a DHA predominant omega-3 liquid (Nordic Naturals Children’s liquid DHA), 1 tsp was added to treatment plan. 
 
At one month follow up the child returned and the mother reported that he was doing “really well” and was sleeping better, had less anxiety and depression, no obsessive or raging behaviors and good reports from school on his behavior and interaction with others.  At a 2 ½ month follow-up after the initial appointment, improvement was sustained and nocturnal enuresis was diminished.  At 3 ½ months post initial appointment, the patient returned with parental reports of worsening behavior of about 40%. The child had undergone a change in his schedule due to starting summer camp, and he had increased sugar consumption in his diet.  At the following month’s visit, the mother reported improvement in nocturnal enuresis, sleep, and behavior.  The patient was no longer having behavioral problems at school, sleeping well most nights, with only intermittent outbursts of aggressive behavior. The patient continues to be followed on a regular basis.  The patient had no adverse effects related to the treatment interventions performed.


Table 1. Treatment plan.
   

Visit
Number
Electronic Fast
Physical
Activity
Infinity Exercises
Essential Oils
Initial Visit
Electronic fast
1 hour physical activity/day
Infinity Exercises-left leg
(passive)
Follow-up 1
Electronic fast
1 hour physical activity/day
Infinity Exercises-left leg & arm (passive)
Follow-up 2
Electronic fast
1 hour physical activity/day
Infinity Exercises-left leg & arm (passive) + vestibular rehabilitation exercises
Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 3
Electronic fast
1 hour physical activity/day
Infinity exercises-left leg & arm (passive) + vestibular rehabilitation exercises
Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 4
Electronic fast
1 hour physical activity/day
Infinity exercises-left leg & arm (passive) + vestibular rehabilitation exercises
Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 5
Electronic fast
1 hour physical activity/day
Infinity exercises-left leg & arm (passive) + vestibular rehabilitation exercises
Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 6
Electronic fast
1 hour physical activity/day
Infinity exercises left arm (active); vestibular rehabilitation exercises
Alternate peppermint/Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 7
Electronic fast
1 hour physical activity/day
Infinity exercises left arm (active); vestibular rehabilitation exercises
Alternate peppermint/Vetiver inhaled in right nostril 2/day + night diffusion
Follow-up 8
Electronic fast
1 hour physical activity/day
Vestibular rehabilitation exercises
Alternate peppermint/Vetiver/Cedarwood inhaled in right nostril 2/day + night diffusion



Table 2. Supplement intervention protocol.
 

Visit
Number
Enzymes
Probiotic
Adrenal Support
Essential Fatty Acids
Initial Visit
Follow-Up 1
 
 
Klaire Labs Vital-zymes 1 tablet with meals 1
 
 
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals 2
Follow-Up 2
Klaire Labs Vital-zymes 1 tablet with meals
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals
Follow-Up 3
Klaire Labs Vital-zymes 1 tablet with meals
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals
Apex Energetics Adrenastim 3
Follow-Up 4
Klaire Labs Vital-zymes 1 tablet with meals
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals
Apex Energetics Adrenastim
Follow-Up 5
Klaire Labs Vital-zymes 1 tablet with meals
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals
Apex Energetics Adrenastim
Follow-Up 6
Klaire Labs Vital-zymes 1 tablet with meals (as needed)
Klaire Labs Therbiotic Chewable 1 Tab, 2x/day with meals
Apex Energetics Adrenastim
Follow-Up 7
Klaire Labs Vital-zymes 1 tablet with meals (as needed)
Apex Energetics Adrenastim
Nordic Naturals Children’s DHA Liquid, 1 tsp/day 4
Follow-Up 8
Klaire Labs Vital-zymes 1 tablet with meals (as needed)
Apex Energetics Adrenastim
Nordic Naturals Children’s DHA Liquid, 1 tsp/day
 
1 Klaire Labs Vital-zymes, broad spectrum chewable digestive enzyme, carbohydrate, sugar, vegetable/plant fiber, protein, and fat digestive enzymes
2 Klaire Labs Therabiotic Chewable, multi-strain chewable probiotic, lactobacillus species (rhamnosus, casei, salivarius, paracasei) and bifidobacterium species (bifidum, longum, breve, infantis)
3 Apex Energetics Adrenastim, the main active ingredients include, tyrosine, glycyrrhiza glabra (licorice) root extract, and phosphatidylserine
4 Nordic Naturals Children’s DHA liquid, DHA, EPA, and other omega-3s
 

Discussion

ADHD and child behavior issues often lead to specialized education plans and medication recommendations from the health care team, which can be limiting to the child. The child may feel alienated and different from his peers. Identifying the root cause of ADHD takes time and can be challenging. Etiology of ADHD is not fully understood at this time, but genetic and neurological factors are found to play important roles.1  While there is a significant family history of mood disorders in this patient’s family history, it is still important to control lifestyle habits that may be contributors as much as possible. In this case, several modifiable lifestyle habits have appeared to improve this patient’s condition. These included adding in 1 hour of daily physical activity, elimination of gluten and eggs from the diet, extreme limitation of electronic device usage and addition of several supplements for digestive and adrenal support. Adrenal support was added to support more balanced cortisol activity and aid in better sleep. Per Fernandez-Mendoza, et al., “In children and adolescents, several studies have shown an association between objective sleep and cortisol with behavioral or mental health problems”.9

The main limitation of this case is the small sample size of one, but cited literature with larger child populations shows similar therapies to be effective.2-9  Strengths of this case include the length of follow-up time. From the time of this patient’s first visit to the write-up of the case, the patient has been seen for 1.5 years with consistent results and sustained improvement. The patient has also been able to lengthen follow-up time from 4 weeks to a visit every 3-6 months and is now able to view about 30-45 minutes of screen time per week with no change in behavior.

Conclusion

This case report demonstrates that non-pharmacological intervention may be used to control behavioral issues in children when evaluated by a skilled practitioner. Non-pharmacological intervention for childhood ADHD and other behavior disorders may include daily physical activity, elimination or extreme limitation of electronic equipment, an elimination diet trial of commonly known food allergies and sensitivities, and elimination of nutritional deficiencies through select nutrition supplementation.

Acknowledgements

This case report was prepared as part of the capstone project for the Master of Science in Human Nutrition and Functional Medicine program at the University of Western States.
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References

1.   

Felt BT, Biermann B, Christner JG, Kochhar P, Van Harrison R. Diagnosis and management of ADHD in children. Amer Family Physician. 2014;90(7):456--464.



2.   

Kamp CF, Sperlich B, Holmberg H. Exercise reduces the symptoms of attention-deficit/hyperactivity disorder and improves social behavior, motor skills, strength and neuropsychological parameters. Acta Paediatricia. 2014;103:709-14.



3.   

Hoza B, Smith A, Shoulberg E, Linnea K, Dorsch T, Blazo J, et al. A randomized trial examining the effects of aerobic physical activity on attention-Deficit/Hyperactivity disorder symptoms in young children. J Abnormal Child Psychol. 2014 Sep 10. [Epub ahead of print].



4.   

van der Niet AG, Smith J, Scherder EJA, Oosterlaan J, Hartman E, Visscher C. Associations between daily physical activity and executive functioning in primary school-aged children. J Science Med Sport. 2014 Sep 18. [Epub ahead of print].



5.   

Sigman A. Time for a view on screen time. Arch Dis Childhood. 2012;97(11):935-942.



6.   

Ohgi S, Loo KK, Mizuike C. Frontal brain activation in young children during picture book reading with their mothers. Acta Paediatr. 2010 02;99(2):225-9.



7.   

Millichap J, Yee M. The diet factor in attention-Deficit/Hyperactivity disorder. Pediatr. 2012;129(2):330-7.



8.   

Rytter M, Andersen L, Houmann T, Bilenberg N, Hvolby A, Molgaard C, et al. Diet in the treatment of ADHD in children-A systematic review of the literature. Nordic J Psychiatry. 2015; 69(1):1-18.



9.   

Fernandez-Mendoza J, Vgontzas A, Calhoun S, Vgontzas A, Tsaoussoglou M, Gaines J, et al. Insomnia symptoms, objective sleep duration and hypothalamic-pituitary-adrenal activity in children. European J Clin Invest. 2014;44(5):493-500.