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Case: Johnny (8-year old male)

Diagnosis: ADHD

Johnny was an eight year-old boy with a diagnosis of ADHD when he and his mother came to our practice seeking help for his symptoms. For years, Johnny had struggled with aggressive, impulsive and oppositional tendencies. While he was highly intelligent, his school performance suffered due to struggles with emotional management.

As an infant, Johnny was colicky and was prescribed multiple rounds of antibiotics due to recurrent ear infections, ultimately needing tubes to help drain the middle ear. He also struggled with encopresis.

Upon a physical exam, it was noted that Johnny had an obvious and inflamed “lip-licking ring” around his mouth along with nasal congestion. A comprehensive battery of testing only found a few abnormalities. Johnny was heterozygous for a single nucleotide polymorphism of the methylenetetrahydrofolate reductase (MTHFR) enzyme at position 677 with a single C to T substitution. Trace metal hair and organic acid testing were all within normal limits. Based on the symptoms and a history of ear infections, dairy was removed from the diet. Lithium orotate, at one mg twice daily, was prescribed to help reduce his aggressive, impulsive and oppositional tendencies.

Upon follow-up, Johnny’s demeanor had dramatically improved. He was cooperative and emotionally engaging. The lip-licking ring had resolved. Both Johnny’s mother and Johnny were excited about the improvements and ready to continue integrative treatment.

Case Summary

Chronic ear infections are often a symptom of food allergies. While the research is not exhaustive, studies have found consistent correlations between cow’s milk allergy and middle ear infections in children (Bhombal 2006, Juntti 1999). Removing dairy products often results in a reduction or elimination of ear infections.

And while lithium is a well-known treatment for bipolar, it also has well-documented anti-aggressive effects (Müller-Oerlinghausen 2010). In children struggling with oppositional and aggressive tendencies, low-dose lithium can be a straightforward treatment to improve symptoms.

Want to learn nutritional and functional medicine strategies like these to help your patients? Enroll in our comprehensive Fellowship for mental health providers! Book a private phone call with Dr. James Greenblatt to learn more today.

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Bhombal S, Bothwell MR, Bauer SM. Prevalence of elevated total IgE and food allergies in a consecutive series of ENT pediatric patients. Otolaryngol Head Neck Surg. 2006;134(4):578-580. doi:10.1016/j.otohns.2005.11.041

Juntti H, Tikkanen S, Kokkonen J, Alho OP, Niinimäki A. Cow’s milk allergy is associated with recurrent otitis media during childhood. Acta Otolaryngol. 1999;119(8):867-873. doi:10.1080/00016489950180199