Obsessive compulsive disorder (OCD) and concentration/attention symptoms in pediatrics

The development of new symptoms in pediatrics may have coexistent underlying events as an etiology, and supporting a child holistically with family and/or individual counseling, and other gentle modalities such as cranial sacral or Reiki may help to alleviate some emotional issues leading to symptoms.  In addition, if there are incidents at school related to the development of symptoms, it should be determined if these are items of concern, and if so meeting with the school counselor may be advisable as well.

 

There are also medical conditions which may manifest as some of these symptoms.  These include PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections), Tourette syndrome, and obsessive compulsive disorder among others. A visit with the general practitioner or a pediatric neurologist may be indicated for further workup to determine if one of these conditions is present if there is no improvement or a deterioration.  Attention and concentration symptoms may be associated with attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).  Occasionally basic bloodwork will show that there also is a frank anemia and vitamin D deficiency in conditions such as tic disorders and ADD.  If low or low normal vitamin D or ferritin levels are found, supplementation may be beneficial.

 

·         Jankovic J, Mejia NI. Tics associated with other disorders. Adv Neurol. 2006;99:61-8. http://tinyurl.com/o2nr6xo

·         Chen MH, Su TP, Chen YS, Hsu JW, Huang KL, Chang WH, Chen TJ, Bai YM.  Association between psychiatric disorders and iron deficiency anemia among children and adolescents: a nationwide population-based study.  BMC Psychiatry. 2013 Jun 4;13:161. http://tinyurl.com/kcd27nt

 

Magnesium supplementation may be beneficial if deficiency is shown.  Magnesium and B vitamins support normal detoxification pathways in the body, which may be overwhelmed if there are specifically related genetic polymorphisms involved and expressed.  Rather than the use of a magnesium capsule or tablet, a liquid may be better tolerated with pediatrics. A common side effect associated with magnesium supplementation is loose stool and therefore it is advisable to start with a lower dose and titrate to avoid any unwanted upset.  For treatment of ADHD, 6 mg/kg/day of magnesium aspartates and lactates for 6 months has been used in children 7-12 years old.  The upper tolerable limit of elemental magnesium supplementation in pediatrics aged 4 – 8 is 110 mg/day.  If oral supplementation is not desired or well tolerated, taking an Epsom salt baths or usage of topical magnesium products also may be supportive. You may prepare an Epsom salt bath with a tub of warm water and 2-4 cups of Epsom salt (magnesium sulfate).

 

·         Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Positive response to magnesium oral loading test. Magnes Res. 1997 Jun;10(2):149-56. http://tinyurl.com/mpk7z95

·         Magnesium.  Linus Pauling Institute.  Accessed 8/4/14.  http://tinyurl.com/omnuoey

 

Central nervous system (CNS) glutamate abnormalities have also been implicated in tic disorders, obsessive compulsive disorder, and attention deficit or hyperactivity disorder.  N-acetyl-cysteine (NAC, precursor to glutathione) is one antioxidant which has been shown to be useful in reducing symptoms of obsessive compulsive disorder, associated with modulation of CNS glutamate levels. In some cases NAC may have poor conversion, for a variety of reasons and the use of a reduced glutathione may produce more rapid results to encourage compliance and acknowledgement of this pathways relevance.  Testing of urinary derived organic acids may show where imbalances of neurotransmitters exist, and treatments may be more directed at these imbalances.  Organic acids can be tested with Genova test Organix Comprehensive Profile (urine) or similar - http://tinyurl.com/naeaqym . Erythrocyte glutathione testing also may be beneficial to show if there are deficiencies - http://tinyurl.com/mt8jlqd.  Glutathione levels can be modified by supplementation with NAC or the Allergy Research Group product Acetyl-Glutathione.

 

·         McGrath MJ, Campbell KM, Parks CR, Burton FH. Glutamatergic drugs exacerbate symptomatic behavior in a transgenic model of comorbid Tourette's syndrome and obsessive-compulsive disorder. Brain Res. 2000 Sep 15;877(1):23-30.  http://tinyurl.com/k7qzoay

·         Pittenger C, Bloch MH, Williams K. Glutamate abnormalities in obsessive compulsive disorder: neurobiology, pathophysiology, and treatment. Pharmacol Ther. 2011 Dec;132(3):314-32. http://tinyurl.com/nsb2lef

·         Carlsson ML.  On the role of cortical glutamate in obsessive-compulsive disorder and attention-deficit hyperactivity disorder, two phenomenologically antithetical conditions. Acta Psychiatr Scand. 2000 Dec;102(6):401-13. http://tinyurl.com/q3j3un2

·         Grant JE, Odlaug BL, Kim SW. N-acetylcysteine, a glutamate modulator, in the treatment of trichotillomania: a double-blind, placebo-controlled study. Arch Gen Psychiatry. 2009 Jul;66(7):756-63. http://tinyurl.com/oepm2xr

·         Egashira N, Shirakawa A, Abe M, Niki T, Mishima K, Iwasaki K, Oishi R, Fujiwara M. N-Acetyl-L-Cysteine Inhibits Marble-Burying Behavior in Mice. J Pharmacol Sci. 2012;119(1):97-101.  http://tinyurl.com/ofbd9y9

 

L-theanine, an amino acid derived from green and black tea, has an anxiolytic and calming effect and is potentially also useful for treating obsessive compulsive disorder as well as ADHD.  L-theanine can be found in the Allergy Research Group product 200mg of Zen, along with GABA which also is an inhibitor neurotransmitter in the CNS, regulating neuronal excitability. As this is a fast acting supplement and may produce a sense of mild separation, associated with a reduction in anxiety, it is not recommended to dose this without the guidance of a physician.

 

·         Lardner AL. Neurobiological effects of the green tea constituent theanine and its potential role in the treatment of psychiatric and neurodegenerative disorders. Nutr Neurosci. 2014 Jul;17(4):145-55. http://tinyurl.com/omwqlrz

 

Food sensitivities also may exist which are contributing to symptoms.  Symptoms including repetitive throat clearing and iteration may be worsened particularly in pediatrics by consuming certain foods.  Food sensitivities also may precede development of nutritional deficiencies, and subclinical or gross deficiencies may be linked to these symptoms.  Food testing can be done with a panel such as the Genova Diagnostics Allergix IgG4 Food Antibodies 90 - Serum - http://tinyurl.com/lg9yqan or similar. Numerous conditions associated with epithelial tissue aggravation and mucus stimulation have been improved with food avoidance practice.

 

If food sensitivities are found, products which support the mucosal health also may be beneficial to promote healing and normalize symptoms of anxiety.  Certain strains of probiotics support the reduction of anxiety and the stress response in the body, especially when taken on a longer term basis. 

 

  • Messaoudi M, Lalonde R, Violle N, Javelot H, Desor D, Nejdi A, Bisson JF, Rougeot C, Pichelin M, Cazaubiel M, Cazaubiel JM.  Assessment of psychotropic-like properties of a probiotic formulation (Lactobacillus helveticus R0052 and Bifidobacterium longum R0175) in rats and human subjects. Br J Nutr. 2011 Mar;105(5):755-64.  http://tinyurl.com/35cawey
  • Ait-Belgnaoui A, Colom A, Braniste V, Ramalho L, Marrot A, Cartier C, Houdeau E, Theodorou V, Tompkins T. Probiotic gut effect prevents the chronic psychological stress-induced brain activity abnormality in mice. Neurogastroenterol Motil. 2014 Apr;26(4):510-20.  http://tinyurl.com/pz3z7ya
  • Dinan TG, Cryan JF.  Regulation of the stress response by the gut microbiota: implications for psychoneuroendocrinology. Psychoneuroendocrinology. 2012 Sep;37(9):1369-78.  http://tinyurl.com/pl387g2