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Introduction

Attention deficit hyperactivity disorder(ADHD) is one of the most common neurodevelopmental dysfunctions of the childhood. Inattention, hyperactivity, impulsivity, poor impulse control, decreased self-inhibitory capacity, motor over activity and motor restlessness these are the symptoms of ADHD in children. Teenagers are well defined and they are usually noticeable before the age of 7.[1] The prevalence of ADHD in general population school age children is about 3-5% .[2] ADHD is 4-6 times more common in boys than in girls.[3 ]All the psychiatric diseases in Ayurveda have been described under the heading of ‘Manasvyadhi’. Due to aetiology of vitiation of dhee, dhriti, and  smriti that cause imbalance of kala and karma which results into Asatmendriya- samyoga and give rise to inattention, hyperactivity and impulsivity.[4] ADHD cause secondary problems in the child such as low academic achievement, retention in grade, emotion problems and impaired social competence as they grow. According to Acharya Charak, naming of disease is not as important as it serves only the purpose of communication. Symtoms of ADHD can co-related with Manovibhram, Buddhi vibhram , smriti vibhram, Anavasthit Chittatvam.[5] This term used collectively under the topic unnmada vyadhi.[6] Ayurveda describe etiopathogenesis of complete theories regarding unnmada vyadhi can collectively co-relate with ADHD and thus Ayurveda have it’s cure too. For the better future overall personality and quality of life of children it requires good learning capacities which depends on healthy mental status as Ayurveda described in definition of Swasth vyakti. According to classical Ayurvedic literature we can have standard treatment for ADHD which is safe and not having any side effects.

Causes of ADHD[7] –

Exact cause of (Attention Deficit Hyperactivity Disorder) ADHD is unknown although  following factors may cause ADHD.

1. Genetics
2. Brain function and structure
3. Preterm, LBW baby
4. Environment, diet and abuse
5. Social- poor education and social status

Types of ADHD[8]-

1. Predominantly inattentive :– Child has all symptoms with easy distraction, common forgetfulness. He also have difficulty in focusing on a particular task, become bored with a task within a few minutes. He has difficulty in learning something new, often loosing thing, he doesn’t listen parents. He struggles to fallow instruction have difficulty in understanding.
2. Hyper active – impulse: – child talks  non-stop, dash around, touch here and there, play with anything  and  everything have trouble with sitting silently, constant in a motion, very impatient, acts without regards of consequences often interrupt conversation.
3. Combined :- Both characters are found in the child inattentive and hyper active.

Diagnosis[9]

1. By assessment of child’s behavioral and mental development-  ADHD diagnosed by the feedbacks and observation from the parents, teachers and relatives about the behavior of the child.
2. By quantitative EEG

Management of ADHD

1. Modern Medication -  Methylphenidate, dexamfetamine, lisdexamfetamine, atomoetine this medication used for the treatment of ADHD, but don’t give permanent cure. They help children to concentrate better, be less impulsive, feel calmer, learn and practice new skills. 
2. Ayurvedic management of ADHD

Prophylactic measures :

‘Nidanaparivarjanm’ is first line of treatment in Ayurveda[10] means avoidance of the causative factors of disease. As causes of ADHD is genetic and antenatal etiopathogenesis this line of treatment is important.  The pregnant woman should follow all norms of health to keep herself and her body healthy. Follow all antenatal check up and medication. Mother’s physiological and psychological variation influence on the growing foetus. Perinatal CNS insults also cause ADHD, thus, Parichrya of Navjata in Jatakarmas, Balaparicharya should be fallowed. Suvarnaprashana, Medhya Rasayana,  Balguti should be done for healthy child.

Specific measures

Sattvavajaya Chikitsa[11] :This treatment can co-related with congnitive behavioural therapy used by modern medicine and it is major treatment protocol for the psychological disorder.

A sound mind dwells in the sound body.

• Counselling of the parents, family members, teachers and child itself is of great help.
• Yoga, Meditation, Vedic chanting are most important treatment of ADHD.
• Daily diet regulation and sleep time table of affected child should be done. Diet should be nutritious, proper amount and fallowed proper timing. Avoid spices, excess oil. Rich in vitamins, minerals, protein, antioxidant and immunity boosters. Sound sleep, proper amount of water also helpful.
• Shiroabhyanga (scalp massage), padaabhyanga (massage of soles of feet) with medicated oil also beneficial for ADHD child. 
• Daily work should be listed.
• Cow’s ghee, cod liver oil, vitamin D3 are helpful in developing brin activities.

Yuktivyapashraya Chikitsa

• Shaman Chikitsa – Medhya Rasayana yog(nootropic herbs), Dhoopan Chikitsa, Dietary management
• Shodhan Chikitsa – Panchakarma procedures, Abhyanga, Nasyakarma, shirobasti, shirodhara.

Shaman Chikitsa –

Medhya Rasayana Yoga- These herbs have possible actions on psycho- neurological deficits.[12]

• Bramhi – (Centella asiatica) It is a neuroprotective protect from nerve Degeneration. It effectively treats depression and epilepsy.[13] It can be taken powder or paste form with milk. Fresh leaves juice 10 ml once day.
• Shankhapushpi – (Convolvulus Pluricanlis) According Ayurveda it is good brain tonic used in brain weakness. It effectively improves memory and co-ordination. It is a psycho- stimulant, rejuvenator and transquilizer. It induces good sleep and keeps brain cool and calm.[14]
• Ashwagandha – (Withania somnifera) It is rasayana and general health tonic to the body. It helps strengthens the muscle and enhances the physical stamina. In ADHD, it strengthens the brain and corrects nervous breakdown keep mind calm and active.[15] 
• Vacha – ( Acorus calamus) Improve memory, learning, capabilities, as it is anti- epileptic and anti-hysteric herbs it is useful for depression and anxiety. It is very effective to treat the forgetfulness and inattention disorder of ADHD.[16]
• Jatamansi – ( Nardostachys Jatamansi) It is also a ayurvedic brain tonic helpful in calm and peace to the brain and strengthens mental ability. It effectively treats mental disorder, mental retardation. It reduces hyperactivity, aggressiveness, restlessness in children. It increases learning capabilities and treat memory disorder.[17]
• Kushmanda – ( White gourd, Benincasa hispida) It is useful treatment in epilepsy and insanity, juices of the fruit useful in mental disorder by Sushrut.[18]

Kalyanaka Ghrita useful unnmada patients which is co-related with ADHD.[19] Ashtmangal Ghrita useful in enhance dhee, dhriti, smriti.[20] Suvarnprashana is also useful treatment for ADHD as it enhances medha, smriti and overall development of brain.[21]                        

Dhoopan Chikitsa – Acharya Kashyapa described herbs used in dhoopan chikitsa useful for calmand peaceful mind thus helpful in ADHD patient.[22] Changes of environment, tranquil music at bedtime, decoration of rooms of children as per their likings also helpful for peaceful mind and behavior of children. 

Dietary management – proper nutrition is essential for growing children. Children who eat junk food, ice- cream in early childhood cause long-term nutritional imbalance.[23] These children are hyperactive and have low immunity which affects their brain development.

Shodhan Chikitsa: Panchakarma are most effective treatment for internal cleaning of the body for vitiation of dosha and nourish brain tissue. Panchakarma has a full therapy role as preventive, curative and promotive measure.

Following are the panchakarma useful for ADHD patients.   

Abhyanga, Nasya, shiro-basti, are effective panchakarma treatment indicated in neurological, and psychological disorder, it causes calm and peaceful mind. 

• Abhyanga- (oleation therapy) It is  the process of massaging of medicated oil ll over the body. Snehan therapy is useful for strengthens and nourishment of the body.[24] Oleating the whole body helps in maintaining of vata dosha which is responsible for hyperactivity in ADHD patients. The abhyanga with mahanarayan taila, bala taila, chandanbala-lakshadi taila stimulates the nervous system and improves their functions, therefore  useful treatment in ADHD.
• Nasya - Nasya  means put medicated in both nostrils directly acts on brain. As Nasa he Shirasodvarm.[25] Nasya treatment improves the cerebral function, enhance alertness and concentration abilities. Panchendriyavrdhan taila nasya useful in ADHD.
• Shirodhara – Shirodhara is the type of Murdhaa tarpan.[26] Medicated oil is continuously poured over the forehead and scalp from a specific height in prescribed time. Medicated oil with vatanashak drugs i.e. mahanarayana, bala taila useful for shirodhara in ADHD patients. Also helpful for alertness, calmness, and peaceful mind.[27]

Discussion

Increasing incidence of ADHD in school going children turns our attention to the fact that there is a necessity to study disease in details to promote positive mental health of children. Balachikitsaka are mandatory to have good knowledge of the concepts of manas and applied aspects in Kaumarbhritya. Psychiatric disorders in children are very common in India as in other countries. They affect mental activities of the children, which interfere with their development, slow down their education, compromise their future and affect their quality of life. Therefore, attention is being paid to child mental health. The shortcomings of the modern medicine have always placed greater responsibilities on the Ayurveda for providing effective management of ADHD. Medhya Rasayana and other remedies described in Ayurvedic text have the capacity to improve the higher cognition function of the brain

Conclusion

ADHD is neuro behavioural disorder,  which affect child whole behaviour, and these behaviours affect family, relations and also society. Some medicine used in ADHD by modern medicine but they have side effects too. Alternative treatment is Ayurveda. Medhya Rasayana, panchakarma are best remedies for ADHD child.  Ayurveda gives nice results in controlling the symptoms of ADHD. So, it can be concluded that ayurvedic treatment like, medhya-herb, panchakarma can safely  and effectively used in ADHD patients.