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Case Study: Liam, 11-Year-Old Boy with ADHD & Behavioral Dysregulation

While all case studies are based on actual patients, significant aspects of the case have been changed to conceal the patient’s original identity.

Initial Presentation

Liam was an 11-year-old boy with a history of ADHD, diagnosed at age seven. He struggled with focus, impulsivity, and emotional regulation, particularly in school and social settings. His parents reported frequent emotional outbursts, difficulty completing tasks, and struggles with frustration tolerance. Despite these challenges, Liam was bright, curious, and creative.

His parents were hesitant about medication and sought alternative solutions after trying behavioral therapy with minimal long-term improvement. Diet interventions, such as reducing processed foods and increasing whole foods, had been implemented with some success, but symptoms persisted.

Initial Relevant Labs

Comprehensive functional lab testing completed and revealed the following findings:

  • Hair Mineral Analysis (HTMA): Low magnesium, low zinc, and elevated copper
  • Organic Acids Test (OAT): Elevated markers for oxidative stress and low dopamine metabolites
  • Comprehensive Stool Analysis: Mild dysbiosis with low beneficial bacteria levels
  • Food Sensitivity Panel: Moderate reactivity to dairy and gluten
  • Nutritional deficiencies:
    • Low ferritin levels (common in ADHD)
    • Vitamin D levels (Vitamin D: 40) within range
  • Thyroid function: TSH, free T4, free T3 (to rule out hypothyroidism); Tests were negative
  • Blood glucose/insulin levels: Check for dysglycemia, as sugar imbalances can affect focus and mood. Tests were negative
  • Toxin exposure: Heavy metals (lead, mercury, arsenic) in urine or hair testing. Tests were negative.
  • Cortisol/DHEA: Assess for stress or HPA-axis dysregulation through saliva or urinary cortisol levels. Elevated cortisol levels at night.

Working Diagnosis

  • ADHD with behavioral dysregulation
  • Nutrient imbalances affecting neurotransmitter function
  • Gut dysbiosis contributing to systemic inflammation and mood instability

Initial Treatment for ADHD and Nutritional Imbalances

  • Magnesium Glycinate, 200 mg nightly
  • Zinc Picolinate, 15 mg daily
  • Omega-3 (DHA/EPA), 1,000 mg daily
  • Probiotic (Lactobacillus & Bifidobacterium blend), 10 billion CFUs daily
  • Gluten and Dairy Elimination Diet
  • Iron with vitamin C: take 30 mg daily with food
  • L-theanine, 100 mg as needed for emotional regulation
  • Chamomile tea:  Seep 5 minutes; drink 2 hours before bed

Explanation

Liam’s functional testing highlighted key imbalances that likely contributed to his ADHD symptoms. Elevated copper and low zinc levels suggested an imbalance affecting dopamine metabolism, which is crucial for focus and impulse control. Magnesium deficiency, commonly seen in children with ADHD, is linked to increased hyperactivity and difficulty with self-regulation (Starobrat-Hermelin & Kozielec, 1997).

His organic acids test indicated low dopamine metabolites, suggesting neurotransmitter imbalances. Omega-3 supplementation was introduced, as studies indicate DHA and EPA improve attention and cognitive function in children with ADHD (Bos et al., 2015). Additionally, his mild dysbiosis suggested a need for probiotic support to restore gut balance, as gut health influences neurotransmitter function and inflammation levels.

A gluten and dairy elimination diet was implemented based on his food sensitivity results, as both have been implicated in exacerbating ADHD symptoms in sensitive individuals (Piwowarczyk et al., 2020). L-theanine was added as a safe, natural aid for calming excessive excitability and emotional dysregulation.

Follow-up Presentation

After six weeks, Liam’s parents reported noticeable improvements. He was less irritable, had fewer emotional outbursts, and completed more schoolwork without excessive reminders. Sleep quality also improved, and he seemed less restless during the day. Teachers noted improved attention span and reduced classroom disruptions.

Follow-up labs revealed:

  • Hair analysis: Improved magnesium and zinc levels, but copper still slightly elevated
  • OAT: Normalized dopamine metabolites
  • Stool Analysis: Improved balance of gut bacteria

Follow-up Treatment

  • Continue previous interventions
  • Add N-acetylcysteine (NAC), 600 mg daily to further support oxidative stress reduction
  • Increase probiotic dose to 20 billion CFUs daily for ongoing gut microbiome balance
  • Behavioral therapy integration for further executive function support

Explanation

While Liam showed marked improvement, persistent mild copper elevation indicated the need for continued support in detoxification pathways. NAC was introduced to further support glutathione production and reduce oxidative stress, a known contributor to ADHD symptoms (Dean et al., 2011). Probiotic dosage was increased to sustain gut health improvements.

Behavioral therapy was recommended alongside nutritional and supplement support to reinforce emotional regulation strategies and executive functioning skills.

Case Summary

This case highlights the importance of a functional medicine approach to ADHD. Rather than relying solely on symptom management, Liam’s case underscores the significance of addressing underlying biochemical imbalances, nutritional deficiencies, and gut health.

His treatment plan focused on:

  • Correcting nutrient deficiencies (magnesium, zinc, iron and omega-3)
  • Supporting gut health (probiotics, elimination diet)
  • Enhancing neurotransmitter function (L-theanine, NAC)

Within months, Liam showed significant improvements in emotional regulation, attention, and behavioral stability, demonstrating the efficacy of a personalized, integrative approach.

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References

Bos DJ, Oranje B, Veerhoek ES, Durston S. Reduced Symptoms of Inattention after Dietary Omega-3 Fatty Acid Supplementation in Boys with and without Attention Deficit/Hyperactivity Disorder. Neuropsychopharmacology. 2015;40(10):2298-2306. doi:10.1038/npp.2015.73

Dean O, Giorlando F, Berk M. N-acetylcysteine in psychiatry: Current therapeutic evidence and potential mechanisms of action. J Psychiatry Neurosci. 2011;36(2):78-86. doi:10.1503/jpn.100057

Piwowarczyk A, Horvath A, Łukasik J, Pisula E, Szajewska H. Gluten- and casein-free diet and autism spectrum disorders in children: A systematic review. Eur J Nutr. 2020;59(5):1863-1875. doi:10.1007/s00394-019-01907-2

Starobrat-Hermelin B, Kozielec T. The effects of magnesium physiological supplementation on hyperactivity in children with attention deficit hyperactivity disorder (ADHD). Magnesium Res. 1997;10(2):149-156.