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Case Study: Carole, a 13-Year-Old Female, with Inattentive-Type ADHD

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

Carole sat fidgeting in my office, her mother’s concerned frown mirroring her daughter’s restlessness. As a thirteen-year-old, Carole struggled with everyday tasks, her focus flitting like a butterfly from flower to flower. Words tumbled out in an unending stream, her mind buzzing with an energy she couldn’t contain. School felt like a constant battle, a barrage of demands that left her overwhelmed and defeated. At other times, sneaking away from home became a game, a brief escape from the boredom she often experienced. Even quiet moments, like church services, did not hold her attention. A sudden impulse, a blur of movement, and she’d be dashing down the aisle, leaving a trail of startled faces in her wake. This impulsiveness came at a cost, however, as Carole was accident-prone, having broken both her arm and her leg previously.

Based on my clinical interview with Carole and her mother, we ordered several labs to better understand what might be contributing to Carole’s ADHD symptoms.

Initial Relevant Labs and Electroencephalogram Analysis

Initial laboratory testing ruled out major metabolic concerns, including copper-zinc imbalances, intestinal issues, nutritional deficits, or food sensitivities. With the results in hand, I brought Carole back for an additional evaluation with an electroencephalogram (EEG). EEG can be a powerful tool to delve deeper into an individual’s brain function, often highlighting areas of concern for ADHD patients.

The EEG revealed a telltale pattern of brain waves, a pattern frequently encountered in children with inattentive-type ADHD. Carole’s brain produced large amounts of slow-moving theta waves, characterized by frequencies between four and seven hertz,  associated with daydreaming, inattention, and distraction. Conversely, higher frequency beta waves linked to attention and focus, with frequencies above 14 hertz, were more scarce. The electrical imbalance in Carole’s brain clearly showed a typical theta/beta ratio imbalance.

Further tests confirmed the connection. Whenever Carole stumbled through a reading exercise or her attention drifted, her theta waves surged. This synchronized activity between the brain and real-world activities made clear the connection between theta activity and her behavioral challenges. Armed with this understanding, I prescribed Carole a supplement that contained a mixture of polyphenols, including OPCs (oligomeric proanthocyanidins) and curcumin.

Initial Treatment

  • Curcumasorb mind, 1 cap twice daily with meals

Explanation

Broadly speaking, OPCs and curcumin are polyphenols with a large array of potential benefits, from antioxidant and anti-inflammatory effects to improvements in neurotransmitter function. As a supplement, CurcumaSorb Mind combines polyphenols from turmeric, grape, blueberry, pine bark, and green tea.

The exact mechanism behind OPCs’ impact on brain function is complex, with animal and human research suggesting a number of possibilities:

  • Improving the regulation of norepinephrine and dopamine levels (Xu 2010), neurotransmitters that can help to improve the flow of information throughout the brain.
  • Decreasing the production of the excitatory neurotransmitter glutamate, a compound that is toxic to brain cells when produced in excess (Assis 2014).
  • Inhibiting the release of histamine (Choi 2017), an inflammatory molecule released during allergic reactions. Research shows that a subset of children with ADHD have genetic changes in the gene that breaks down histamine. In these children, allergic reactions to food dyes and additives can trigger ADHD symptoms (Stevenson 2010).
  • Protecting the fat-rich cells of the brain from lipid peroxidation, as the delicate fats can easily go rancid due to free radical exposure (Asha  2011). Free radicals are often formed by pollutants, diets high in fat and sugar, stress, smoking, and other factors. Antioxidants like OPCs stabilize free radicals, helping to prevent their damaging effects.
  • Strengthening the blood-brain barrier, helping to keep toxins from entering the brain (Ardid-Ruiz 2020).
  • Improving blood flow to the brain, thereby increasing the delivery of crucial brain-supporting nutrients, like zinc, omega-3 fatty acids, and others (Bowtell 2017).
  • Protecting from toxic heavy metals that can harm the brain (Liu 2014).
  • Boosting enzymes that decrease inflammation throughout the brain (Jiang 2017).

A recent trial even found that OPCs from pine bark were as effective as methylphenidate (Ritalin) for ADHD with fewer side effects (Weyns 2022).

While not studied specifically in clinical trials for ADHD, curcumin has also been shown to act in similar ways to OPCs. And research shows potential benefits for both depression and anxiety from curcumin (Fusar-Poli 2020). As a supplement, curcumin has both anti-inflammatory and neuroprotective benefits (Matias 2021).

Follow-up Presentation

Two months later, Carole returned to my office, a different child from the one I had first met. The constant chatter had quieted, replaced by a newfound focus. This positive change wasn’t confined to my office walls; it also extended to her school life.

“Her teachers are amazed,” Carole’s mother beamed. “They say she can now sit through an entire class without fidgeting or interrupting. One teacher even called her ‘totally focused’ — words I never thought I’d hear about Carole!”

Follow-up Testing

Fast forward, and it was time for Carole’s follow-up EEG. Upon analysis, it was clear that the once-dominant theta waves had quieted down significantly, mirroring her improved focus. As I monitored the brain waves while Carole read, drew, and listened attentively, it was clear that the decrease in theta activity aligned perfectly with her newfound ability to concentrate. Like many other children with ADHD in my practice, OPCs had created a profound change in her brain wave patterns.

Case Summary

Theta brain waves that oscillate between four and seven hertz are associated with daydreaming, inattention, and distraction. Higher frequency beta waves, above 14 hertz, occur during attention and focus. Research suggests that a subset of patients with ADHD have an increased theta/beta brain-wave ratio, with higher levels of theta and lower beta (Herrera-Morales 2023). EEG is a tool for analyzing brain-wave patterns and identifying individuals with elevated theta/beta ratios among other potential findings.

While the exact causes of difficulty focusing vary, brain function can certainly play a role. In cases like Carole’s with an elevated theta/beta ratio, symptoms often improve with a multi-OPC supplement. In my experience, many children with ADHD find relief and increased focus with OPCs, leading to positive changes in behavior.

Want to learn nutritional and functional medicine interventions like these to help your ADHD patients? Enroll in our comprehensive ADHD Intensive training! Book a private phone call to learn more today.

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References

Ardid-Ruiz A, Harazin A, Barna L, et al. The effects of Vitis vinifera L. phenolic compounds on a blood-brain barrier culture model: Expression of leptin receptors and protection against cytokine-induced damage. J Ethnopharmacol. 2020;247:112253. doi:10.1016/j.jep.2019.112253

Arns M, Conners CK, Kraemer HC. A decade of EEG Theta/Beta Ratio Research in ADHD: a meta-analysis. J Atten Disord. 2013;17(5):374-383. doi:10.1177/1087054712460087

Asha Devi S, Sagar Chandrasekar BK, Manjula KR, Ishii N. Grape seed proanthocyanidin lowers brain oxidative stress in adult and middle-aged rats. Exp Gerontol. 2011;46(11):958-964. doi:10.1016/j.exger.2011.08.006

Assis LC, Hort MA, de Souza GV, et al. Neuroprotective effect of the proanthocyanidin-rich fraction in experimental model of spinal cord injury. J Pharm Pharmacol. 2014;66(5):694-704. doi:10.1111/jphp.12177

Bowtell JL, Aboo-Bakkar Z, Conway ME, Adlam AR, Fulford J. Enhanced task-related brain activation and resting perfusion in healthy older adults after chronic blueberry supplementation. Appl Physiol Nutr Metab. 2017;42(7):773-779. doi:10.1139/apnm-2016-0550

Choi YH, Song CH, Mun SP. Proanthocyanidin-rich Pinus radiata bark extract inhibits mast cell-mediated anaphylaxis-like reactions. Phytother Res. 2018;32(2):290-297. doi:10.1002/ptr.5973

Fusar-Poli L, Vozza L, Gabbiadini A, et al. Curcumin for depression: a meta-analysis. Crit Rev Food Sci Nutr. 2020;60(15):2643-2653. doi:10.1080/10408398.2019.1653260

Herrera-Morales, W. V., Reyes-López, J. V., Tuz-Castellanos, K. N., Ortegón-Abud, D., Ramírez-Lugo, L., Santiago-Rodríguez, E., & Núñez-Jaramillo, L. (2023). Variations in Theta/Beta Ratio and Cognitive Performance in Subpopulations of Subjects with ADHD Symptoms: Towards Neuropsychological Profiling for Patient Subgrouping. Journal of personalized medicine, 13(9), 1361. https://doi.org/10.3390/jpm13091361

Jiang X, Liu J, Lin Q, et al. Proanthocyanidin prevents lipopolysaccharide-induced depressive-like behavior in mice via neuroinflammatory pathway. Brain Res Bull. 2017;135:40-46. doi:10.1016/j.brainresbull.2017.09.010

Liu CM, Ma JQ, Liu SS, Zheng GH, Feng ZJ, Sun JM. Proanthocyanidins improves lead-induced cognitive impairments by blocking endoplasmic reticulum stress and nuclear factor-κB-mediated inflammatory pathways in rats. Food Chem Toxicol. 2014;72:295-302. doi:10.1016/j.fct.2014.07.033

Matias JN, Achete G, Campanari GSDS, et al. A systematic review of the antidepressant effects of curcumin: Beyond monoamines theory. Aust N Z J Psychiatry. 2021;55(5):451-462. doi:10.1177/0004867421998795

Stevenson J, Sonuga-Barke E, McCann D, et al. The role of histamine degradation gene polymorphisms in moderating the effects of food additives on children’s ADHD symptoms. Am J Psychiatry. 2010;167(9):1108-1115. doi:10.1176/appi.ajp.2010.09101529

Weyns AS, Verlaet AAJ, Breynaert A, et al. Clinical Investigation of French Maritime Pine Bark Extract on Attention-Deficit Hyperactivity Disorder as compared to Methylphenidate and Placebo: Part 1: Efficacy in a Randomised Trial. Journal of Functional Foods. 2022;97:105246. doi:10.1016/j.jff.2022.105246

Xu Y, Li S, Chen R, et al. Antidepressant-like effect of low molecular proanthocyanidin in mice: involvement of monoaminergic system. Pharmacol Biochem Behav. 2010;94(3):447-453. doi:10.1016/j.pbb.2009.10.007