Integrated approach to ADHD in clinical practice: role of supplements, phytotherapy, and microbiome balance

Abstract

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition characterized by inattention, impulsivity, and hyperactivity, often accompanied by sleep, emotional, and gastrointestinal disturbances. While pharmacological treatment with stimulants remains the mainstay, partial responses and adverse effects highlight the need for integrative approaches including nutraceuticals, phytotherapy, and microbiome-targeted interventions. An integrative ADHD management framework was analyzed based on the National Clinical Protocol PCN-368 (2022), WHO mhGAP guidelines, and clinical experience within Moldova’s community mental health network. The model combined psychoeducation, behavioral therapy, and targeted supplementation (omega-3 fatty acids, magnesium + vitamin B6, L-theanine, GABA, adaptogenic herbs, and pre/probiotics). Scientific evidence demonstrates that omega-3 fatty acids (EPA/DHA ≥ 500 mg/day, EPA:DHA ratio ≥ 2:1) can significantly improve attention and reduce hyperactivity, achieving 30–40% of the effect observed with methylphenidate in mild ADHD. Magnesium-B6 complexes support GABAergic activity, reducing irritability and emotional lability. L-theanine (200 mg/day) enhances calm focus and attention without sedation, while GABA supplementation improves emotional self-regulation and motor control. Phytotherapeutic agents such as Rhodiola rosea and Bacopa monnieri have shown neuroprotective and dopaminergic modulation effects, improving working memory and mental endurance. The inclusion of preand probiotics (e.g., Lactobacillus rhamnosus, Bifidobacterium longum, L. plantarum) supports the gut-brain axis, improving serotonin and dopamine synthesis, intestinal permeability, and neuroinflammatory balance. Double-coated probiotic formulations combined with fructooligosaccharides (FOS) and vitamins B6, C, and E ensure high bacterial viability, neuroimmune stability, and reduced behavioral dysregulation. Integrating these with structured parent training and classroom adaptation significantly enhances adherence and long-term outcomes. Integrative ADHD management should address neurochemical, immune, and psychosocial dimensions. The combination of psychopharmacology, behavioral therapy, nutraceuticals, and microbiome modulation represents a safe, evidence-based, and personalized strategy to improve attention, emotional regulation, and overall functioning in children and adolescents with ADHD.