Over the past two decades, diagnoses of attention deficit hyperactivity disorder (ADHD) have continued to rise. According to Blair Hammond, M.D., Pediatric Clerkship Director in the Department of Pediatrics at Mount Sinai School of Medicine, New York, this increase is “in part because doctors are more aware of the diagnosis, and also because parents are more aware of the condition and bring up the issue more frequently with their doctors/teachers.” Predictably, prescriptions for ADHD medications have also seen a sharp increase. In fact, more than half of children diagnosed with ADHD receive some form of prescription medication. Currently, the Centers for Disease Control and Prevention (CDC) support the combination of behavioral intervention with prescription medication as the most optimal treatment for ADHD.
The specific class of medication most commonly prescribed for ADHD is stimulants. These stimulant medications are commonly prescribed, well-tolerated, act quickly, and in most people have few side effects. Stimulant medications commonly prescribed for attention deficit disorder include methylphenidate (Ritalin, Concerta, Metadate, Methylin) and certain amphetamines (Dexedrine, Dextrostat, Adderall). Other, newer kinds of drugs have also been approved for the treatment of ADHD . These non-stimulant medications include Strattera (atomoxetine, a selective norepinephrine reuptake inhibitor) and Vyvanse (lisdexamfetamine dimesylate). These drugs typically offer similar benefits to stimulants, but act in a different way on the brain. Some people may find they better tolerate these drugs.
These medications also have a robust research base supporting their effectiveness in treatment of ADHD. However, finding the combination with the highest efficacy and fewest side-effects can be difficult regardless of how well-researched a drug is. Children can vary a great deal in their response to medication, and what works for one child may not work for another. A child’s prescribing physician (preferably a child psychiatrist rather than a general practitioner or pediatrician) will aim to discover the medication and dose that is best for the child. If one medication does not appear to be working after a few weeks of treatment, a doctor will often try another medication. This is normal and most people will switch medications to find the one that works best for them at least once.
Although most ADHD medications have few side effects and many children may be able to take these medications without side effects, it is important to remember that there will be side effects for some children taking these medications. While most side effects will be mild, some children may experience more severe side effects. The side effects of stimulants may include reduced appetite, headache, a “jittery” feeling, irritability, sleep difficulties, gastrointestinal upset, increased blood pressure, depression or anxiety, and/or psychosis or paranoia in more extreme cases. If your child experiences any of these symptoms, you should talk to your child’s doctor immediately.
Many parents may be concerned about having stimulant medications prescribed to their child. This is a common concern amongst parents, but such medications do not produce a “high” in a person with ADHD who takes them (as long as the person truly does have ADHD). Researchers are still unclear as to why stimulant medications do not “over-stimulate” people with ADHD who take them, but it is hypothesized that people with ADHD have a problem with certain neurotransmitters in their brain that the medication helps correct. To date, there is not convincing evidence that children risk becoming addicted to these drugs when used for ADHD. In fact, a study at Massachusetts General Hospital and Harvard Medical School found that substance abuse rates were lower among teenagers with ADHD who stayed on their medication than those who stopped.
There is a significant amount of research demonstrating that medication alone is not sufficient to address many of the core issues of a child with ADHD. So, while medication may help with immediate relief from some of the symptoms, the person with ADHD still often must learn the skills needed to be successful while living with the disorder. Some non-medication strategies are listed below.
Biofeedback: The goal of this type of therapy is to permanently change the underlying abnormal electrical brain activity associated with ADHD. Children with ADHD spend more time in theta brainwaves (a daydream-like state) than beta brainwaves (the type that keep us alert). This therapy uses fun activities, such as video games, to help make children with ADHD aware of their own brainwaves and able to control them. “If they’re playing a racecar game, for example, the speed of the car slows down or even comes to a halt when the child’s brainwaves shift outside of the appropriate range,” said L. Eugene Arnold, MD, MEd, professor emeritus of psychiatry at Ohio State University and interim director of the university’s Nisonger Center. “But, if they’re in the right brainwaves, they can go as fast as they want.” This type of therapy is usually conducted in a weekly or bi-weekly session using one-on-one format with a trained biofeedback therapist (usually also a licensed clinical therapist) over the course of several months or years.
Relaxation Techniques, Including Meditation: Research has shown that relaxation techniques can help children with ADHD to calm their minds and bodies. “Similar to biofeedback, imagery can help soothe, calm and focus an impulsive brain,” said Donna Fremon-Powell, a certified guided imagery therapist and hypnotherapist in La Habra, California. “Plus, since ADHD children spend a lot of time in theta brainwaves, repetitive positive affirmations — both audible and subliminal (like on a CD while they sleep) — are readily accepted by the subconscious mind.”
Herbs and supplements: St. John’s wort is among the most commonly used herbs for ADHD, but the latest research shows that children who take St. John’s wort to control symptoms are no better off than those taking a placebo. In fact, there is no evidence to support the use of herbs in ADHD treatment, and there may be dangerous interactions for kids with ADHD taking herbs along with prescription medications. However, one supplement that may be effective is melatonin, a natural sleep hormone. “Melatonin probably has no direct effect on symptoms of ADHD,” claims L. Eugene Arnold, MD, MEd, professor emeritus of psychiatry at Ohio State University and interim director of the university’s Nisonger Center, “but it may help children with ADHD initiate sleep.”
Exercise and “Green Time”: Exercising is one of the easiest and most effective ways to reduce the symptoms of ADHD. Physical activity immediately boosts the brain’s dopamine, norepinephrine, and serotonin levels—all of which affect focus and attention. In this way, exercise and medications for ADHD such as Ritalin and Adderall work similarly. But unlike ADHD medication, exercise does not require a prescription and it is free of side effects. Activities that require close attention to body movements, such as dance, gymnastics, martial arts, and skateboarding, are particularly good for kids with ADHD. “Yoga, tai chi, or qi gong may be your best bets, but any form of exercise is likely to do the trick,” said Fremon-Powell. “It helps kids with ADHD release energy in a healthy, constructive way.” Multiple studies suggest that exercising in open, green spaces boosts brain function, so any exercise that takes place outdoors maybe particularly beneficial. Aim for at least 30 minutes of exercise in nature daily for optimum benefits.
Sleep: Regular quality sleep can lead to vast improvement in the symptoms of ADHD, yet many kids with ADHD have problems getting to sleep at night. Sometimes, these sleep difficulties are due to stimulant medications, and decreasing the dose or stopping the medication entirely will solve the problem. However, a large percentage of children with ADHD who are not taking stimulants also have sleep difficulties. To support good sleep habits, set a regular bedtime and enforce it, try a sound machine or a fan, turn off all electronics (TV, computer, video games, iPhone) at least an hour before bed, and limit physical activity in the evening.
Good Nutrition: Studies show that what, and when, you eat makes a difference when it comes to managing ADHD. Schedule regular meals or snacks no more than three hours apart; this will help keep your child’s blood sugar level steady, minimizing irritability and supporting concentration and focus. Try to include a little protein and complex carbohydrates at each meal or snack; these foods will help your child feel more alert while decreasing hyperactivity. In addition, check your child’s zinc, iron, and magnesium levels. Many children with ADHD are low in these important minerals, and boosting their levels may help control ADHD symptoms. Increasing iron may be particularly helpful. One study found that an iron supplement improved symptoms almost as much as taking stimulant medication. Finally, add more omega-3 fatty acids to the child’s diet. Studies show that omega-3s improve hyperactivity, impulsivity, and concentration in kids (and adults) with ADHD. Omega-3s are found in salmon, tuna, sardines, and some fortified eggs and milk products; however, the easiest way to boost a child’s intake may be through fish oil supplements.
Behavioral Support: Simple behavioral strategies can make all the difference in children with ADHD. First, create a routine. Try to follow the same schedule every day, from wake-up time to bedtime. Next, get organized and limit distractions. Put schoolbags, clothing, and toys in the same place every day so the child will be less likely to lose them. Turn off the TV, radio, and computer, especially when the child is doing homework. The way that you communicate and interact with your child is also crucial. During daily decision-making, offer a choice between two things (this outfit, meal, toy, etc., or that one) so that the child is not overwhelmed and over-stimulated. Similarly, avoid long-winded explanations and cajoling, and instead use clear, brief directions to remind the child of responsibilities. Next, use goals and rewards. Use a chart to list goals and track positive behaviors, then reward the child’s efforts. Be sure the goals are realistic and achievable. Children with ADHD often expect things to happen “right now,” so if you are using a long term goal that may take months to achieve (such as earning a trip to a theme park for achieving a good grade in English Language Arts), try to include shorter term goals as well (such as earning Legos for independent homework completion each day). Using a reward system like this also allows for more effective discipline; instead of yelling, spanking, or time outs, parents can use removal of privileges as consequences for inappropriate behavior. Finally, help the child discover a talent. All kids need to experience success in order to feel good about themselves. Finding out what your child does well — whether it is sports, art, or music — can boost social skills and self-esteem.