A Survey of Herbal Use in Children
Objective: To examine whether herbal medicines were given to children or adolescents receiving care for attention-deficit-hyperactivity disorder or depression.
Methods: Between October 2000 and July 2001, a 23-item questionnaire was administered in five community mental health centers in Texas. Parents or primary caregivers of children who received a psychiatric assessment were sought for participation. One hundred seventeen caregivers completed a questionnaire. The main outcome measure was primary caregivers' self-report of the use of herbal therapy in their children.
Results: The lifetime prevalence of herbal therapy in patients was 20% (23 patients). Eighteen patients (15%) had taken herbal medicines during the past year. Recommendations from a friend or relative resulted in the administration of herbal medicines by 61% of 23 caregivers. Herbal medicines were given most frequently for a behavioral condition, with ginkgo biloba, echinacea, and St. John's wort most prevalent. Almost 83% of caregivers gave herbal medicines alone, whereas 13% gave herbal medicines with prescription drugs. Most caregivers (78%) supervised the administration of herbal therapy in their children; the children's psychiatrists (70%), pediatricians (56%), or pharmacists (74%) typically were not aware of the use.
Conclusions: Most caregivers supervised herbal therapy in their children, without communication with a health professional. A need exists for better communication between health professionals and caregivers regarding the use of herbal therapy.
Alternative or unconventional therapy is defined as those practices neither taught widely in United States medical schools nor generally available in United States hospitals. Herbal therapy is a form of unconventional therapy. Among adults in the United States, use of herbal therapy is estimated to have increased from 3% in 1990 to 12% in 1997, a 5-fold increase; however, another study estimated use of herbal therapy to be as high as 34% in 1997.
Although one large national survey did not focus on herbal therapy specifically, the authors determined that the frequency of unconventional therapy in the United States is far higher than previously reported, estimating a rate of 25% of 1539 respondents. Herbal therapy was one of the top 16 forms of unconventional therapy most commonly practiced. However, only 3% of the total respondents had taken herbal medicines in the year before the study. Authors indicated the lack of communication between patients and physicians regarding herbal therapy and other forms of unconventional therapy. This is significant in that problems may develop because of potential drug interactions between conventional drugs and some herbal medicines.
Literature examining the reasons why patients seek therapies outside of conventional treatment is limited. Herbal therapy most frequently was sought as an adjunct to conventional therapy for treatment of anxiety, sprains, arthritis, and digestive problems. Those taking unconventional therapies such as herbal therapy were more likely to have a higher education, poorer health status, a holistic health philosophy, or a transformational experience that changed the person's world view. Neither dissatisfaction with conventional drugs nor racial or ethnic differences were significant predictors in this study.
Few large national surveys assessing unconventional therapies are available; however, a small number of studies examine herbal therapy exclusively. In one study, the authors surveyed 135 health maintenance organization members in a central Texas city on the use of herbal therapy. Health conditions in which more than 20% of respondents took herbal medicines consisted of the common cold, stress or anxiety, insomnia, weight loss, and other conditions (stomachache; sore throat; memory loss; bruises; urinary, yeast, or bladder infection; aging slowdown; sinusitis or allergies; inflammation; promote general health; iron supplementation; human immunodeficiency virus or acquired immunodeficiency syndrome; and chronic fatigue syndrome). A higher percentage of respondents took herbal medicines in place of versus as adjuncts to prescription or over-the-counter drugs. More than 50% of respondents were most influenced by friends and/or relatives, but other factors such as media, recommendations by herbologists, or adverse effects of conventional drugs swayed respondents' decisions to take herbal medicines. As seen in previous surveys, most of those taking herbal medicines were not supervised by a medical professional.
Little is known about herbal therapy in children, especially those with mental disorders. In the largest survey to date, the authors determined that 64% of 290 respondents in Western Australia had tried at least one alternative therapy, including herbal therapy, in children with attention-deficit-hyperactivity disorder (ADHD). Herbal medicines and multivitamin supplements were categorized as dietary manipulation, and the percentage of use was 9% and 13%, respectively. Examples of herbal medicines to treat patients with ADHD were primrose oil, bush flower drops, or lactobacilli. Both herbal medicines and mega-vitamins were recommended predominantly by providers of unconventional therapy or by family and friends.
Studies that focused on nutritional supplements may be important as well, considering that many commercial multivitamin supplements today also contain herbs as ingredients. A 1992 clinical trial with a stage 1 open study and stage 2 double-blind crossover trial determined that megavitamins were ineffective for treating ADHD and had potential serious adverse effects. Case studies and other trials documented the use and perceived benefits of other nutritional supplements such as oligomeric proanthcyanidins (e.g., pycnogenol from pine bark) in addition to glyconutritional supplements of naturally occurring, food-grade polysaccharides. However, these latter studies were not double-blind, placebo-controlled studies, indicating a lower quality of evidence.
Background literature searches of MEDLINE and PsycInfo databases retrieved minimal literature on herbal treatment specifically for depressive disorders in children. A 2001 multicenter postmarketing surveillance study in Germany examined St. John's wort for children with mild-to-moderate depressive symptoms. Physicians rated effectiveness as good or excellent in 72% of 101 children after 2 weeks and in 97% after 4 weeks. No adverse events were reported. Results suggested that St. John's wort was a potentially safe and effective treatment for children with depressive symptoms, though this study was not a double-blind, placebo-controlled trial. Because of the lack of well-controlled studies, data to support nontraditional therapies, such as herbal therapy, in childhood mental disorders are minimal.
Although data are lacking on the safety and efficacy of herbal therapy for psychiatric disorders in children, sufficient clinical evidence exists on the benefits of treatment with psychotropic drugs. The Texas Children's Medication Algorithm Project (CMAP) developed drug treatment algorithms for childhood psychiatric disorders and recently completed a feasibility study of their use in the Texas public mental health system. Algorithms were created from evidence-based medicine with the goal to decrease the variance in care and ultimately improve outcomes for children. Algorithms have been successfully developed for childhood major depressive disorder, ADHD, and their common comorbidities. A deficiency of evidence exists regarding the benefit of herbal therapy for childhood psychiatric disorders; hence, herbal therapy in these disorders may compromise the optimal outcomes of conventional pharmacotherapy.
Parents of children with a depressive disorder or ADHD (with or without comorbidities) are seeking alternative approaches, including herbal medicines, to treat their child's psychiatric and other medical conditions. Although some studies have reported the increasing use of alternative therapies, including herbal therapy specifically, to treat a variety of medical conditions, insufficient literature focuses on herbal therapy in the pediatric population, including herbal therapy in the mental disorders ADHD and childhood depression. We examined the use of herbal therapy in children or adolescents receiving care for a depressive disorder or ADHD (with or without comorbidities) in the Texas public mental health system.
Objective: To examine whether herbal medicines were given to children or adolescents receiving care for attention-deficit-hyperactivity disorder or depression.
Methods: Between October 2000 and July 2001, a 23-item questionnaire was administered in five community mental health centers in Texas. Parents or primary caregivers of children who received a psychiatric assessment were sought for participation. One hundred seventeen caregivers completed a questionnaire. The main outcome measure was primary caregivers' self-report of the use of herbal therapy in their children.
Results: The lifetime prevalence of herbal therapy in patients was 20% (23 patients). Eighteen patients (15%) had taken herbal medicines during the past year. Recommendations from a friend or relative resulted in the administration of herbal medicines by 61% of 23 caregivers. Herbal medicines were given most frequently for a behavioral condition, with ginkgo biloba, echinacea, and St. John's wort most prevalent. Almost 83% of caregivers gave herbal medicines alone, whereas 13% gave herbal medicines with prescription drugs. Most caregivers (78%) supervised the administration of herbal therapy in their children; the children's psychiatrists (70%), pediatricians (56%), or pharmacists (74%) typically were not aware of the use.
Conclusions: Most caregivers supervised herbal therapy in their children, without communication with a health professional. A need exists for better communication between health professionals and caregivers regarding the use of herbal therapy.
Alternative or unconventional therapy is defined as those practices neither taught widely in United States medical schools nor generally available in United States hospitals. Herbal therapy is a form of unconventional therapy. Among adults in the United States, use of herbal therapy is estimated to have increased from 3% in 1990 to 12% in 1997, a 5-fold increase; however, another study estimated use of herbal therapy to be as high as 34% in 1997.
Although one large national survey did not focus on herbal therapy specifically, the authors determined that the frequency of unconventional therapy in the United States is far higher than previously reported, estimating a rate of 25% of 1539 respondents. Herbal therapy was one of the top 16 forms of unconventional therapy most commonly practiced. However, only 3% of the total respondents had taken herbal medicines in the year before the study. Authors indicated the lack of communication between patients and physicians regarding herbal therapy and other forms of unconventional therapy. This is significant in that problems may develop because of potential drug interactions between conventional drugs and some herbal medicines.
Literature examining the reasons why patients seek therapies outside of conventional treatment is limited. Herbal therapy most frequently was sought as an adjunct to conventional therapy for treatment of anxiety, sprains, arthritis, and digestive problems. Those taking unconventional therapies such as herbal therapy were more likely to have a higher education, poorer health status, a holistic health philosophy, or a transformational experience that changed the person's world view. Neither dissatisfaction with conventional drugs nor racial or ethnic differences were significant predictors in this study.
Few large national surveys assessing unconventional therapies are available; however, a small number of studies examine herbal therapy exclusively. In one study, the authors surveyed 135 health maintenance organization members in a central Texas city on the use of herbal therapy. Health conditions in which more than 20% of respondents took herbal medicines consisted of the common cold, stress or anxiety, insomnia, weight loss, and other conditions (stomachache; sore throat; memory loss; bruises; urinary, yeast, or bladder infection; aging slowdown; sinusitis or allergies; inflammation; promote general health; iron supplementation; human immunodeficiency virus or acquired immunodeficiency syndrome; and chronic fatigue syndrome). A higher percentage of respondents took herbal medicines in place of versus as adjuncts to prescription or over-the-counter drugs. More than 50% of respondents were most influenced by friends and/or relatives, but other factors such as media, recommendations by herbologists, or adverse effects of conventional drugs swayed respondents' decisions to take herbal medicines. As seen in previous surveys, most of those taking herbal medicines were not supervised by a medical professional.
Little is known about herbal therapy in children, especially those with mental disorders. In the largest survey to date, the authors determined that 64% of 290 respondents in Western Australia had tried at least one alternative therapy, including herbal therapy, in children with attention-deficit-hyperactivity disorder (ADHD). Herbal medicines and multivitamin supplements were categorized as dietary manipulation, and the percentage of use was 9% and 13%, respectively. Examples of herbal medicines to treat patients with ADHD were primrose oil, bush flower drops, or lactobacilli. Both herbal medicines and mega-vitamins were recommended predominantly by providers of unconventional therapy or by family and friends.
Studies that focused on nutritional supplements may be important as well, considering that many commercial multivitamin supplements today also contain herbs as ingredients. A 1992 clinical trial with a stage 1 open study and stage 2 double-blind crossover trial determined that megavitamins were ineffective for treating ADHD and had potential serious adverse effects. Case studies and other trials documented the use and perceived benefits of other nutritional supplements such as oligomeric proanthcyanidins (e.g., pycnogenol from pine bark) in addition to glyconutritional supplements of naturally occurring, food-grade polysaccharides. However, these latter studies were not double-blind, placebo-controlled studies, indicating a lower quality of evidence.
Background literature searches of MEDLINE and PsycInfo databases retrieved minimal literature on herbal treatment specifically for depressive disorders in children. A 2001 multicenter postmarketing surveillance study in Germany examined St. John's wort for children with mild-to-moderate depressive symptoms. Physicians rated effectiveness as good or excellent in 72% of 101 children after 2 weeks and in 97% after 4 weeks. No adverse events were reported. Results suggested that St. John's wort was a potentially safe and effective treatment for children with depressive symptoms, though this study was not a double-blind, placebo-controlled trial. Because of the lack of well-controlled studies, data to support nontraditional therapies, such as herbal therapy, in childhood mental disorders are minimal.
Although data are lacking on the safety and efficacy of herbal therapy for psychiatric disorders in children, sufficient clinical evidence exists on the benefits of treatment with psychotropic drugs. The Texas Children's Medication Algorithm Project (CMAP) developed drug treatment algorithms for childhood psychiatric disorders and recently completed a feasibility study of their use in the Texas public mental health system. Algorithms were created from evidence-based medicine with the goal to decrease the variance in care and ultimately improve outcomes for children. Algorithms have been successfully developed for childhood major depressive disorder, ADHD, and their common comorbidities. A deficiency of evidence exists regarding the benefit of herbal therapy for childhood psychiatric disorders; hence, herbal therapy in these disorders may compromise the optimal outcomes of conventional pharmacotherapy.
Parents of children with a depressive disorder or ADHD (with or without comorbidities) are seeking alternative approaches, including herbal medicines, to treat their child's psychiatric and other medical conditions. Although some studies have reported the increasing use of alternative therapies, including herbal therapy specifically, to treat a variety of medical conditions, insufficient literature focuses on herbal therapy in the pediatric population, including herbal therapy in the mental disorders ADHD and childhood depression. We examined the use of herbal therapy in children or adolescents receiving care for a depressive disorder or ADHD (with or without comorbidities) in the Texas public mental health system.