Can You Treat ADHD Without Drugs?

From the WebMD Archives

"Your child has ADHD."

For most families, that means the beginning of a long trek through the world of pharmaceuticals. Medications are the top treatment for ADHD, and they're effective for 80% of kids with the disorder.

But many parents worry about side effects and want to exhaust every other option before they put their child on medicine.

No matter what your decision is, you can help your child live a calmer, more successful life.

To Medicate, or Not to Medicate?

For some, like Sonia, it was a matter of age. "My son was just 5 years old when he was diagnosed with ADHD, and I thought that was too young for medication," she says.

In fact, the American Academy of Pediatrics agrees. They almost always recommend that, before age 6, you start with behavior therapy.

"Parents often ask if they can try other treatments first before they turn to medication, and there are several methods that are effective," says Richard Gallagher, PhD, of the Institute for Attention Deficit Hyperactivity and Behavior Disorders at the NYU Child Study Center. He encourages parents to try other things while they look into the risks and benefits of medications.

Gallagher says that behavior changes alone are most effective with kids who are only inattentive and unfocused, rather than those who are also impulsive and hyperactive. The most successful treatment for ADHD combines both meds and behavior management.

Parent and Teacher Help

Parents and classroom teachers play a starring role in helping a child learn to recognize and adjust his behavior, Gallagher says.

For parents, this means creating small, manageable goals for their child, such as sitting for 10 minutes at the dinner table, and then giving rewards for achieving them. It's also helpful for the teacher to send home a daily "report card," letting the parents know whether the child met his behavior goals at school that day.

Sonia's son is now 10 years old, and "Ever since he was in kindergarten, I've worked with his teachers to help him modify his own behavior," she says. "He gets graded every 20 minutes on three goals: staying seated, staying on task, and being respectful of others." When he does well, he's rewarded with extra time spent shooting hoops later that day -- which has been far more successful than punishing him for misbehaving.

A coach or tutor can work with older children to come up with a system for keeping track of their books, papers, and assignments, says Edward Hallowell, MD, the author of Delivered from Distraction. "This is more helpful than Mom or Dad trying to help organize, because with a parent, it can come across as nagging," he says.

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Sleep

Getting enough shut-eye can be a game-changer for kids with ADHD. Research shows that just an extra half-hour of sleep can help with restlessness and impulsivity.

"A lot of kids with ADHD also have sleep disorders, and each condition makes the other one worse," says Mark Stein, PhD, an ADHD specialist at the Seattle Children's Hospital.

One of the most common sleep issues for kids with ADHD is that they can't settle down and fall asleep; then their exhaustion the next day makes their symptoms worse. While some doctors recommend sleep aids such as melatonin, you should start by practicing good sleep habits:

  • Have a consistent bedtime, even on the weekend.
  • Keep the bedroom cool and dark.
  • Create a soothing winding-down ritual.

"We have bedtime broken down into 10 specific tasks, like taking a bath, putting on pajamas, reading for a half-hour," Sonia says. "He had trouble falling asleep before, but the routine really helps him settle down."

That also means no screens of any kind before bedtime. Take computers, TVs, phones, and video games out of the bedroom so your child isn't distracted or tempted.

Exercise

Make sure your child has plenty of opportunities to run and play (at appropriate times). Some recent studies found that after about 30 minutes of exercise, kids with ADHD can focus and organize their thoughts better.

Elise can confirm these results. "Like a lot of kids with ADHD, my son doesn't have very good coordination, but he's fallen in love with swimming," she says. "He enjoys the feel of the water and always feels calmer when he gets out of the pool."

If your child wants to play organized sports that require focus and concentration, like baseball or tennis, there's more to the equation. "Before they started medication, many of my patients were stuck playing the outfield, where they would just wander around chasing daisies," Stein says. "But the medication helped them play better and be part of the team."

Meditation and Mindfulness

A new line of research is exploring how mindfulness -- learning how to sharpen focus, raise awareness, and practice self-control through breathing and meditating -- may help manage the symptoms of ADHD.

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One small study found that when both children and their parents completed an 8-week mindfulness-training program, the kids had fewer symptoms. And their parents felt less of the stress that typically comes with their role.

This is promising news, but Gallagher points out there isn't yet enough solid evidence to fully recommend the strategy.

Elise's son has tried a few different meditation techniques over the years to control his anxiety and impulsivity. While they were helpful at the moment, she says he hasn't been able to stick with them.

Music Therapy

It can hone attention and strengthen social skills. It's rhythmic and structured. And playing music requires different parts of your brain to work together, as well as learning how to be a part of a group.

There's very little hard research specifically connecting music with ADHD symptoms, but scientists do know that when children play an instrument -- taking piano lessons at home, say, or playing cello with a school orchestra -- they do much better on tests of executive function than children who don't study music. That's the ability of the brain to organize and easily switch between tasks.

If your child would rather kick a soccer ball than pick up a flute, or can't sit still for lessons or practice, simply listening to her favorite playlist may calm her down long enough to finish her homework. When you listen to music you like, your brain releases dopamine, a chemical that also helps with focus.

More work needs to be done to connect ADHD to music, but it's certainly an area worth exploring, especially for music-loving families.

Omega-3 Fatty Acids

Over the years, several "ADHD diets" have been proposed and then dismissed by science. New research points to a connection between omega-3s and ADHD. These nutrients are found in fish such as salmon, in walnuts, flaxseeds, and soy products, in leafy greens, and in other foods. They're also available in over-the-counter supplements, as well as in the prescription Vayarin.

A study found that kids with ADHD have lower levels of omega-3s in their blood, which suggests bumping up the amount in their diet might reduce ADHD symptoms.

Although omega-3 supplements aren't widely recommended as a treatment, Hallowell points out that eating a balanced diet -- including fish, whole grains, and plenty of fruits and vegetables -- and cutting down on sugar and processed foods can certainly help your child live a healthier life.

WebMD Feature Reviewed by Smitha Bhandari, MD on 0/, 015

Sources

SOURCES:

Richard Gallagher, PhD, director of special projects, Institute for Attention Deficit Hyperactivity and Behavior Disorders, NYU Child Study Center.

Edward Hallowell, MD, founder, Hallowell Center for Cognitive and Emotional Health, Sudbury, MA, and New York; author, Delivered From Distraction.

Mark Stein, PhD, ADHD specialist, Center for Child Health, Behavior and Development, Seattle Children's Hospital.

CDC.

National Resource Center on AD/HD.

HealthyChildren.org: "Common ADHD Medications & Treatments for Children."

American Academy of Pediatrics: "ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents," 2011.

National Institutes of Health: "Attention Deficit Hyperactivity Disorder (ADHD)."

The MTA Cooperative Group. Archives of General Psychiatry, December 1999.

Langberg, J. F1000 Medicine Reports, 2009.

Gruber, R. Pediatrics, 2012.

Grassmann, V. Journal of Attention Disorders, March 2014.

van de Weijer-Bergsma, E. Journal of Child and Family Studies, 2011.

Shaffer, R. The American Journal of Occupational Therapy, March/April 2001.

Zuk, J. PlosOne, June 17, 2014.

Salimpoor, V. Nature Neuroscience, Jan. 9, 2011.

MedPage Today: "Low Dopamine Implicated in ADHD Symptoms."

Gow, R. Lipid Technology, January 2014.

Vayarin product label, January 2014.

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