ADHD is an executive function disorder that can affect many aspects of the patient’s and patient’s family's lives. Beyond just basic focus concerns, ADHD can affect other domains including social, academic, economic, safety, physical, and/or emotional. Medications are helpful for some of the above concerns, but they are far from curative. As such, treatment often includes a multifaceted approach that sometimes include specialized changes or supports in the areas of diet, physical activity, various forms of therapy, school environment/supports, and parenting styles. Below are a basic list of resources that can begin to shed some light on how to conceptualize ADHD and the many ways it affects peoples’ lives, and then how to do everything we can to mitigate those issues.
There are many outside factors that, when addressed, can make a big dent in the symptoms related to ADHD. Each person's ADHD and comorbidities are different, so each of these ideas may have more or less benefits for your particular child.
-Good sleep hygiene— making sure to have a set bedtime that is consistent on weekdays and weekends (within a 20 minute window), and yields 9-12 hours of sleep for 6-12 year olds and 8-10 hours for teenagers. This means avoiding cell phones, computers, tablets, and video games for at least an hour prior to bedtime and assuring that none of these devices are accessible at night. The bed should be only for sleeping, not for studying, texting, or gaming. Studies show that a cooler bedroom environment (between 68 and 72 degrees) is more conducive to good sleep.
-Exercise & Sports— there are dozens of studies showing the benefit of regular exercise on ADHD symptoms. Benefits stem from getting excess energy out, learning to collaborate with teammates, listening to coaches, mindfulness implicit in all athletics, and in improvements in balance (see below for more on this). A good goal is at least 30 minutes of aerobic exercise per day, 6 days per week. Here is a good article on the benefits that may come from exercise.
-Balance training: Related to exercise, activities that incorporate some level of balance and coordination are especially helpful as well. There is growing evidence that strengthening the cerebellum (which is the part of the brain that governs balance) helps patients strengthen parts of their brain that help overcome some of the deficits in ADHD. Sports such as surfing, biking, soccer, ice skating, gymnastics, snowboarding, skiing, martial arts all have a great deal of balance involved. Additionally, here is a great way to practice balancing at home that is worth looking into.
That said, please be wary of any “balance’ or “cerebellar reset programs” that claim to be able to completely cure ADHD. Those claims are often exaggerated.
-Diet does play a major role in ADHD. Here is a post worth looking at that delves into one diet that cuts out many foods that may lead to inflammation. Some of the diets out there can be pretty stringent, but one general theme is to try to avoid processed and high sugar foods (I know, easier said than done in many cases!). Some parents find benefit in avoiding “red dye”, but that association has not been found in the larger studies.
-School accommodations are essential for many children & teens with ADHD. This must be done through your child's school and often involves psychoeducational testing, which is performed by a school psychologist. Here is an excellent overview of what schools use as a roadmap for the accommodations that are tailored specifically to each child.
Therapy is not indicated for many patients with ADHD. But various types of therapy can sometimes be helpful for many reasons. Here are just a few examples:
-Executive function coaching is a type of coaching/therapy that involves 1:1 work with the child, some family work, and even some group work. The better coaches help patients see the strengths in their ADHD while giving essential advice of how to maximize their abilities in both academic and social settings through one on one intervention, modeling, goal setting, and reviewing how the processes went.
-Neurofeedback treatment is an enhanced form of biofeedback that can help with executive function. Here is more information on this novel approach that can lead to positive, structural changes in the brain.
-Family Therapy is sometimes needed in cases where ADHD is comorbid with anger and/or oppositionality. There are many kinds of family therapy and if this is an issue, your clinician can help you find the right fit.
Here are some excellent websites on ADHD for parents worth looking at:
Here are some podcasts that are extremely helpful for parents of children with ADHD.
Here are some great books for parents — please read the summaries and reviews to see what might be a good fit for your situation:
For parents trying to find the right school for their child, this is an excellent podcast on what to ask.
Posted by David Danish MD