( 1996) concluded, “zinc deficiency may play a role in aetiopathogenesis of ADHD.” Starobrat-Hermelin ( 1998) found a high rate of magnesium, zinc, iron, copper, and calcium deficiencies in 116 children with ADHD on the basis of serum, red cell, and hair analyses. ( 1996) reported mean serum zinc of 60.6 ± 9.9 mcg/dL in 33 boys and 15 girls with ADHD compared with 105.8 ± 13.2 mcg/dL in healthy volunteers (30 boys and 15 girls). In ADHD, zinc has been reported significantly ( p < 0.001) deficient compared with control subjects, though it is not clear how rigorously the diagnoses were made (Bekaroglu et al. Human zinc deficiency syndrome includes concentration impairment and jitters (Aggett and Harries 1979). 1996) and human findings suggest involvement of zinc deficiency in hyperactivity. Both animal data (Halas and Sandstead 1975 Sandstead et al. Specific to ADHD, the dopamine transporter has a zinc binding site that blocks transport (Lepping and Huber 2010). It contributes to structure and function of brain (Black 1998). 1996), many of them in the central nervous system. It is necessary for 100 different metalloenzymes and metal–enzyme complexes (Toren et al. Zinc is an important cofactor for metabolism relevant to neurotransmitters, prostaglandins, and melatonin, and indirectly affects dopamine metabolism. Thus, there is considerable room for improvement in stimulant response. Even with the careful medication management algorithm of the National Institute of Mental Health (NIMH) multisite Multimodal Treatment Study of ADHD (the MTA), the rate of excellent response was only 56%, and for the community-treated comparison group it was only 25% (Swanson et al. Many of those usually counted as responders in the typically quoted response rate of 2/3–3/4 have considerable room for improvement or have nuisance side effects at their optimal dose. However, the response rate at the individual patient level is often less than satisfactory. The best documented, most successful, and most widely used treatment is stimulant medication (methylphenidate and amphetamine), which shows a robust effect in group data, with placebo-controlled effect sizes (Cohen's d) from 0.7 to 1.5 on parent and teacher ratings of attention and behavior. A ttention-deficit/hyperactivity disorder (ADHD) is characterized by symptoms of inattention, distractibility, overactivity, and impulsivity excessive for developmental age, beginning by age 7, causing impairment in more than one setting, and not better explained by another disorder.
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