The Full Range of Treatment Options for Children with ADHD
What constitutes an effective ADHD treatment plan for your child? That is a personal question to be answered alongside your doctor, who should consider medication, behavior therapy, a clean diet, vitamins and supplements, or all of the above. Learn more about these options here.
The best ADHD treatment strategies are multimodal ones — combinations of several different, complementary approaches that work together to reduce symptoms. For one child, this ideal combination may include medication, diet, exercise, and behavioral therapy. For another, it may mean taking supplements, practicing mindfulness, and spending lots of time outdoors in nature.
Finding the right treatments — and managing them — takes research, planning, organization, and persistence. Early on, talk with your child’s doctor about your options. If you use medication, speak with the prescribing professional about his or her expertise with complementary treatment options. If you choose not to give your child medication, find a professional who specializes in the types of treatments you want to use — for example, a dietician or psychologist specializing in behavior therapy.
With that in mind, begin by reading this overview of ADHD treatments for children to understand the options.
Medication is often the first line of defense against the symptoms of ADHD for one simple reason: studies show it to be most effective. “When [I’m asked] why they should try medication to manage ADHD, my answer always comes down to two words: Medication works,” says Russell A. Barkley, Ph.D., a clinical professor of psychiatry and pediatrics at the Medical University of South Carolina. “When you find the right medicine, you can experience substantial improvements in ADHD symptoms.” With the right drug and the optimal dosage, the success rate is high: Medication works for at least 80 percent of people with ADHD.
The clinical practice guidelines developed by the American Academy of Child and Adolescent Psychiatry (AACAP) recommend medication as the primary treatment for ADHD in school-age children, citing a formal review of 78 studies on the treatment of ADHD, which “consistently supported the superiority of stimulant over the non-drug treatment.”
Even the widely-cited Multi-Modal MTA Cooperative Group Study, which concluded that medication combined with behavior therapy is the optimal treatment of ADHD in children, conceded that “a pharmacological intervention for ADHD is more effective than a behavioral treatment alone.”
Though broadly effective, medication is not an easy answer. Before pursuing treatment with medication, parents should consider the following:
- Finding the right medication, dosage, and schedule can take months.
- Every medication has side effects for some individuals. Balancing those with the positive effects of medication is a trial-and-error process. It will take time for your child to find the optimal medication and dosage with minimal or zero side effects.
- To get the most out of medication, you must communicate with the prescribing doctor and follow his or her advice, especially during the initial phase of starting medication. This communication is needed to adjust dosage and control side effects in a timely manner.
- Medication isn’t a magic bullet. It helps manage some ADHD symptoms, but it does not cure the disorder.
- Supplementing medication with behavioral therapy, parent training, and coaching is often a more effective strategy than managing ADHD with one or the other alone, as studies have shown.1
Medicine alone is not sufficient treatment for most kids with ADHD. This is especially true for children and adolescents who face ADHD-related challenges in school, with peers, and/or at home with their families. While medication works on a neurological level to regulate the brain, behavior therapy addresses specific problem behaviors by teaching the child how to structure their time, establish predictability and routines, and increase positive outcomes. Behavior therapy can help change behavior through conditioning, which involves the following:
- Creating an environment conducive to suitable behavior
- Providing positive feedback and reinforcement for acceptable behavior and improvement
- Establishing clear consequences for unwanted behavior, which may entail withholding reward/praise, or enforcing negative consequences
- Being consistent about expectations and consequences, both positive and negative
Behavior therapy helps many children improve their attitudes and school performance. This type of therapy often involves training parents — and sometimes teachers — as well.
Cognitive Behavioral Therapy (CBT)
This approach, often used in combination with medication, is implemented by a therapist who works with your child to pinpoint problem behaviors and to develop strategies for changing them. CBT is a short-term, goal-oriented form of psychotherapy that aims to change negative patterns of thinking and change the way a patient feels about herself, her abilities, and her future. Here’s how it works:
- Choose one problem behavior — procrastination, say — to work on at a time.
- Understand the motivation for the behavior, and change the thoughts and perceptions that cause it
- Develop practical ways to change the behavior
- Implement the strategies, and try new ones if they don’t work
This approach is effective for most kids with ADHD. Exceptions to this rule are very young children — who are unable to articulate their thoughts and feelings — and those who need a more structured approach, such as children with oppositional defiant disorder who are unwilling to cooperate in managing their behaviors. Changing distorted thoughts, and the resulting change in behavior patterns, is effective in treating depression, anxiety, and other emotional problems, as well.
Alternative or Complementary Treatments
Some families choose to manage their child’s symptoms — in whole or in combination with medication and behavior therapies — through diet, physical activity, and alternative therapies like meditation or brain training.
Diet and Supplements
Changing your diet to increase the consumption of certain ADHD-friendly nutrients — fish oil, the minerals zinc, iron, and magnesium — as well as protein and complex carbohydrates, can help the brain function at optimal levels and control swings in mood and behavior. Limiting sugar, artificial preservatives, and artificial food coloring reduces hyperactivity in some children.
“Think of exercise as medication,” says John Ratey, M.D., an associate clinical professor of psychiatry at Harvard Medical School and author of Spark: The Revolutionary New Science of Exercise and the Brain. “Exercise turns on the attention system, the so-called executive functions — sequencing, working memory, prioritizing, inhibiting, and sustaining attention. On a practical level, it causes kids to be less impulsive, which makes them more primed to learn.”
A 2015 study published in the Journal of Abnormal Psychology found that 30 minutes of exercise before school can help kids with ADHD focus and manage moods. It can even decrease the need for stimulant medications used to treat symptoms.2
Walking for 30 minutes, four times a week, is enough exercise to yield benefits.
A daily dose of nature — a walk in the woods or spending time in a greenhouse — may reduce ADHD symptoms in both adults and children. This was solidified in a 2004 study where researchers found that “green outdoor activities reduced symptoms significantly more than did activities conducted in other settings.”3 Several experts suggest that patients use nature therapy in conjunction with prescription medications and behavioral therapy.
Mindful Meditation and Yoga
Mindful awareness, or mindfulness, involves paying close attention to your thoughts, feelings, and bodily sensations; in other words, developing a greater awareness of what’s going on with you from moment to moment. It can be used as a tool to foster wellness, especially psychological well-being. Similar techniques have been used to lower blood pressure and to manage chronic pain, anxiety, and depression.
A 2005 study at Arizona State University found that children who participated in mindfulness exercises had lower test anxiety and fewer ADHD symptoms, plus greater attention than kids who did not participate in the exercises.4
Brain-training therapies like neurofeedback and Cogmed are making a serious promise: increased attention and working memory without medication. The scientific community, however, is not yet convinced.5
“Working memory is the ability to hold information in your mind for several seconds, manipulate it, and use it in your thinking,” says Ari Tuckman, Psy.D., a clinical psychologist in West Chester, Pennsylvania. “It is central to concentration, problem solving, and impulse control.”
Children with ADHD can’t always hold on to information because their attention gets hijacked. Improving working memory capacity with brain training enables an individual to pay attention, resist distractions, manage emotions better, and learn.
Neurofeedback is a form of brain training that uses brain exercises to reduce impulsivity and increase attentiveness. The brain emits different types of waves, depending on whether we are in a focused state or daydreaming. The goal of neurofeedback is to teach kids to produce brain-wave patterns that reflect focus. The result: Some ADHD symptoms — namely, impulsivity and distractibility — diminish.
An ADHD coach knows about the specific, unique challenges facing people with the condition and can help them acquire the skills to overcome those problems. Part cheerleader, part taskmaster, part personal assistant, part teacher, a coach may help teens do the following:
- Develop structures for organizing
- Make plans and set goals
- Get and stay motivated
- Develop time and money-management skills
Some coaches meet with their clients weekly; others stay in regular contact by phone. Still others meet with clients in their homes to help with specific tasks, such as organizing papers or working on social skills.
How to Approach ADHD Treatments
Most families of children with ADHD try a variety of treatment programs to maximize symptom control. If you plan to do this, keep a log, so you can follow the progress of your efforts and understand the outcomes of each strategy you try. Don’t drop a treatment from your plan if changes aren’t happening as fast as you’d like. Change takes time. Before you stop — unless side effects are getting in the way of your child’s life — consult a professional. Look for ways to adjust the treatment before you give up on it.
1 “A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder.” Archives of General Psychiatry 56.12 (1999): 1073. Web.
2 Hoza, Betsy, Alan L. Smith, Erin K. Shoulberg, Kate S. Linnea, Travis E. Dorsch, Jordan A. Blazo, Caitlin M. Alerding, and George P. Mccabe. “A Randomized Trial Examining the Effects of Aerobic Physical Activity on Attention-Deficit/Hyperactivity Disorder Symptoms in Young Children.” Journal of Abnormal Child Psychology 43.4 (2014): 655-67. Web.
3 Kuo, Frances E., and Andrea Faber Taylor. “A Potential Natural Treatment for Attention-Deficit/Hyperactivity Disorder: Evidence From a National Study.” American Journal of Public Health 94.9 (2004): 1580–1586. Print.
4 Dr. Maria Napoli, Paul Rock Krech, and Lynn C. Holley. “Mindfulness Training for Elementary School Students.” Journal Of Applied School Psychology (2005).
5 GeladÃ©, Katleen, Tieme W. P. Janssen, Marleen Bink, Rosa Van Mourik, Athanasios Maras, and Jaap Oosterlaan. “Behavioral Effects of Neurofeedback Compared to Stimulants and Physical Activity in Attention-Deficit/Hyperactivity Disorder.” The Journal of Clinical Psychiatry (2016): n. pag. Web.