Medication can certainly help to manage symptoms of Attention-Deficit/Hyperactivity Disorder (AD/HD), but is not the best or only treatment option for every child. Although different medications are available, some individuals do not tolerate them well and the long-term benefits and side effects are still unclear (especially for young children). Also, while effective medications can substantially improve attention and impulse control, they often have less impact on weaknesses of executive functions (i.e. cognitive abilities underlying the coordination and regulation of mental processes) that contribute to problems with organization and self-management, academic work, and/or relationships. Here’s the good news: depending on your child’s age and individual needs, a combination of therapeutic and environmental supports, nutritional monitoring, and lifestyle modifications may help to control AD/HD symptoms as well (or better than) medication alone.
Behavior Therapy and Parenting Consultation: The American Psychological Association (APA) and the American Academy of Pediatrics (AAP) both recommend behavior therapy as the primary treatment approach for children under six years of age, and as part of a combined approach for older children. It involves helping parents and other caregivers to systematically encourage and reinforce desirable behaviors (e.g., paying attention, thinking before acting or speaking, controlling body movements, or asking for help when needed). In general, the most successful interventions support parents to identify positive and specific goals and provide immediate and consistent reinforcement of target behaviors whenever they occur. While older children are typically included in therapy sessions, parents of preschool-age children often attend alone to learn how to implement behavioral strategies at home.
School Interventions: School-age children with AD/HD often benefit from academic accommodations to address the impacts their symptoms can have on their learning and school performance. Appropriate supports may include preferential seating away from distractions, frequent check-ins to monitor engagement, extra time on timed tests, assistance to break down multi-step tasks or instructions, oral repetition and written copies or outlines of important information, frequent breaks, shortened work periods, help with organization, and prompts to check work or turn in homework. Positive behavior programs can also help students recognize and adjust their behaviors at school. Effective programs will identify specific and observable target behaviors, provide frequent feedback and incentives for meeting behavioral objectives, and allow for regular communication between parents and teachers (often by way of a daily chart or card) regarding a student’s progress.
Cognitive-Behavioral Therapy (CBT): CBT is a therapeutic approach that works to modify excessively negative or unrealistic thoughts and ineffective problem-solving behaviors that can increase stress or otherwise interfere with a young person’s ability to concentrate, complete tasks, or control impulses. Because older children and adolescents with ADHD can become self-critical, discouraged, and or perfectionistic, CBT can help them challenge unrealistic beliefs and ideas that often underlie these self-defeating tendencies.
Cognitive Training: Evidence-based brain training programs (such as CogMed) may help to improve a child's attention and working memory performance by helping them to regularly exercise parts of the brain that regulate these functions. Because there are a wide variety of cognitive training programs that claim to provide such benefits, however, parents should always seek to evaluate the scientific basis and research support for a particular product. Cogmed is the only cognitive intervention that has research demonstrating its’ long-term effectiveness. If other programs make such claims, the consumer is strongly advised to ask to view the research supporting such claims and seek additional information from experts. To learn more about Cogmed, you can contact our office, as one of our Providers, Scott Hammel, Ph.D., is a certified Cogmed provider. Additionally, more information about Cogmed is available on the Cogmed website www.Cogmed.com.
Mindfulness: Mindfulness training involves helping individuals with AD/HD improve focus, manage stress, and reduce emotional reactivity through daily activities (including meditation practice) designed to help them stay "in the moment" and enhance self-awareness. The clinical research supporting this approach is still developing but has yielded some promising results.
Exercise: Participating in 30 to 45 minutes of moderate cardiovascular exercise per day can help to reduce activity levels and improve focus and attention.
Diet: Ensuring adequate levels of dietary protein and fiber can help to regulate blood sugar levels and/or encourage the production of neurotransmitters that enable good focus and concentration. For children receiving medication treatment, a high-fat diet can slow down metabolic processes and reduce the effectiveness of some medications. Omega-3 fatty acids (including EPA and DHA) are important for effective brain and nervous system function and may help to lessen AD/HD symptoms. Other important vitamins and minerals that can be beneficial include vitamin C, iron, vitamin B6, and zinc.
Sleep: Children with AD/HD often have trouble maintaining regular sleep patterns, and the resulting fatigue can further affect their attention and self-control. Good sleep hygiene involves keeping a consistent bedtime, ensuring that sleeping areas are reserved only for sleep, limiting use of screen activities during the hour prior to bedtime, and creating a soothing routine of activities that help a child to relax and prepare for bed.