Where to Start with ADHD
ADHD is a complex condition that manifests differently in each individual. When you add in one or more of its various co-morbidities you’re then dealing with multiple difficulties and many parents wonder where on earth to start!
As you read through, make a note of the behaviours and any physical and emotional difficulties you have observed in your child so you have a complete and accurate picture of your concerns. The brain is connected to the rest of the body, so don’t discount physical ailments such as eczema or headaches as separate issues – they could all be connected!
Observe your child carefully and ask the questions below.
Ask your child’s teacher or other caregivers to answer similar questions.
Questions to ask:
- How well are they sleeping?
- Do they have any breathing issues?
- How is their digestive system working?
- Do they have any physical ailments such as allergies/headaches etc?
- How are they interacting with their peers and/or adults?
- How are their fine/gross motor skills?
- What are their academic challenges?
- How is their speech developing?
- Do they behave differently at home/school or with different people/ situations?
- Are there times when behaviour is much worse/better?
- What is their mood like?
- Are they sensitive to sounds, smells, touch etc?
What to do next
You should now have a clearer picture of what the issues are and can start to create an action plan to address your concerns.
Rule out any of the ‘easy’ causes of symptoms by getting basic vision and hearing tests performed.
Visit your GP with any other of your concerns to rule out further issues and get any referrals necessary. Be aware that many wonderful GPs will be looking to treat symptoms e.g. giving you a cream to treat the outward symptoms of eczema but won’t necessarily look at why the eczema is occurring.
Your specific list of challenges will determine which professional you contact next. There is a logical order in which you should seek treatments. For example, there’s no point having extra reading lessons if you have an unresolved vision problem or teaching new skills while sleep deprived. The pyramid below gives a rough idea of the order of importance for treatments.
ADHD Medications are something many parents wish to consider and should be discussed carefully with your practitioner. You can work through the stages with or without medication. The choice is yours.
Logical Order of ADHD Treatments
ADHD Treatments in Detail
2. Structural & Senses
- Auditory & Visual Processing
- Proprioception & Sensory Integration
- Reflexes – Primitive Integration
- Postural Emergence
- Motor Co-ordination
- Auditory & Visual Function & Integration
- Brain Function & Integration
4. Developmental – Skill Teaching
- Occupational Therapy
- Spatial & Sequential Therapies
- Vision Therapy
- Auditory & Speech Therapy
- Emotional & Behavioural - Psychological
- Social & Life Skills Training
- Teaching e.g. reading, comprehension, spelling, writing, maths
That’s ok and entirely up to you, as long as you can pinpoint your child’s challenges, help them appropriately and understand that, unfortunately in our current system, sometimes a ‘label’ equals funding for treatment or services.
The most commonly used form of treatment for ADHD is stimulant medication, though there are also a couple of non-stimulants available.
ADHD Support Australia aims to offer information on ALL treatments for ADHD.
Which treatment you decide on is a personal choice and ADHD Support Australia supports you, without judgment, whichever course you choose.
To make informed decisions you need to weigh up the pros and cons of each intervention or treatment, arm yourself with all the relevant information and assess all the facts before making a decision based on what best reflects your personal values.
Most parents don’t take the decision to medicate their child lightly and are very conflicted. Sometimes, medication may be necessary, short term while for others it might be a longer-term strategy.
Treatment options include:
- Stimulant/Non-stimulant medications
- Biomedical Treatment
- Parent Training
The advantage of this is the focus is not only on improving cognitive function, but on supporting and improving the health of the entire body.
Biomedical Treatment uses testing such as blood, urine, stool and hair to discover underlying causes of symptoms such as inattention, behavioural problems, moodiness, anxiety, depression, indigestion, skin irritation, headaches, joint pain etc rather than merely treating the symptoms. Those underlying causes are often found to be nutrient deficiencies, toxin overloads, food intolerances and gut dysbiosis.
This checklist is a useful guide to what a qualified practitioner will explore in order to ensure optimum healthy foundations in your child to see whether this resolves current issues.
- Are there food sensitivities and/or allergies?
- Are there any digestive issues?
- Does neurotransmitter function need support?
- Are there adequate fat-soluble nutrients for brain structure and function?
- Is there toxicity and heavy metal accumulation?
- Are there bacteria, yeast, viruses or parasites present?
- Are there nutritional deficiencies?
- Is blood glucose balanced?
- Is the diet healthy for this individual?
To understand how various ADHD treatments work you need to know a few brain chemistry basics.
- Our brain is an extensive communication network
- Millions of messages are sent from one brain cell (neuron) to the next
- Between each neuron is a gap (synapse)
- The synapse is filled with chemical messengers (neurotransmitters)
- Each neurotransmitter is responsible for a different function
- There must be enough neurotransmitters in the synapse for efficient messages
- Dopamine and norepinephrine are responsible for executive functioning
- In ADHD dopamine and norepinephrine are not working as they should
- Other mental health conditions rely on neurotransmitters such as serotonin
- Neurotransmitters are constantly created within our brain & our gut
- Neurotransmitters synthesised from nutrients - amino acids, vitamins & minerals
- Deficiencies in building blocks for neurotransmitters causes cognitive problems
- Advances in neuroscience and epigenetics has made us aware of the impact of nutrients on gene expression
- Biochemical treatments to correct brain chemistry are becoming better defined.
Because of genetic differences in the way each of us processes foods, even with a perfect diet, many of us are deficient in certain nutrients and overloaded in others.
Here are a few common examples:
- High Copper – changes in dopamine/norepinephrine levels - aggression, anger & other mood disorders
- Low B6 – co-factor for serotonin synthesis - prone to depression, low mood
- Low Zinc and B6 - explosive temper, emotional mood swings, poor short-term memory
- Low magnesium – co-factor for serotonin - anxiety and depression
- Low Vitamin D – common in children with ADHD – depression/mood disorders
- Low Iron – common in children with ADHD – fatigue, brain fog, irritability
- Essential Fatty Acids – neuroprotective – ADHD symptoms, depression
Nutrient deficiencies can occur because of malabsorption, which can occur for a variety of reasons, mainly to do with gut problems and can be fairly common.
This is an in-depth topic and an emerging area of science, but when you understand that approximately 90% of serotonin and 50% of dopamine are produced by the bacteria in your gut, it makes perfect sense that if this system is disrupted in some way then neurotransmitter production, and therefore brain function, mood and behaviour, will be impacted as a result.
A healthy gut micro biome is full of beneficial bacteria that break down, absorb, and assimilate nutrients from the foods you eat, which fuel every process in your body.
While a healthy micro biome contributes to good brain function, an unhealthy one full of ‘bad’ bacteria or yeast, and all the toxins associated with it, may contribute to poor brain function. The presence of yeast, for example, alters the ability to absorb nutrients and the toxic by-products cause reactions, which cause inflammation in the body, which in turn greatly contributes to depression, anxiety and poor mental function.
For example studies show an association between the MTHFR C677T mutation and depression, schizophrenia and bipolar disorder!
Whilst you can’t change your genes, you can support your body with lifestyle, diet and specific nutrients to allow the methylation cycle to function more efficiently.
This doesn’t cause behaviour disorders but can be an aggravating factor causing irritability, anxiety and intermittent poor focus and concentration.
By teaching you how to observe yourself and to focus on something it trains you to bring your wandering mind back into the moment when you get distracted.
Meditation is thought to help ADHD as it thickens the pre-frontal cortex and raises your brain’s level of dopamine. Several studies have demonstrated that mindfulness meditation helps increase focus and decrease anxiety and depression.
Similarly, yoga has been shown to have similar benefits by increasing dopamine and strengthening the pre-frontal cortex.
As these are believed to be drivers of the attention system a dose of exercise is similar to taking a small amount of medication. Exercise helps to increase the quantity of neurotransmitters as well as increasing the number of receptors that respond to the neurotransmitters. It also activates the pre-frontal cortex, responsible for executive functioning.
People with ADHD could benefit from an exercise break of 10-15 minutes every hour or so.
For those with ADHD who already have problems in these areas, it makes sense to always get a good night’s sleep of at least 8 hours.
Get more natural daylight and avoid blue and/or artificial light at night to optimise your sleep.
Most experts agree that taking a multimodal approach to treating ADHD is vital because:
- Medication only works while it is in your system
- When it wears off in the afternoon/evening you are not covered by it
- It does not teach skills and strategies required for lifelong management
- It does not treat all symptoms of ADHD
- It is not effective for everyone at all times
- Side effects may preclude some people from taking it
- There may be times in life when you are unable to take medication
The main focus should be on skilling your child with the strategies needed to help them across their lifetime.
They do not increase the amount of neurotransmitters in the synapse, but recycle what is already there.
The increase in neurotransmitters helps brain cells to communicate better with one another.
- Increases capacity to attend & learn
- Decreases impulsiveness
- Reduces hyperactivity
- Reduces distractibility
- Improves short-term memory
- Improves emotional regulation
- Improved behaviour with parents & peers
- Increased self-esteem due to the above benefits
Common side effects include:
- Decreased appetite
- Weight Loss/Reduced Growth Rate
- Stomach ache
- Irritability/emotional as drug wears off (less likely with modified release)
Less common side effects include (but are not limited to):
- Increases in heart rate
- Increases in blood pressure
- Mood swings
- Worsening of Symptoms
- Suicidal ideation
Sometimes negative side effects are only noticeable for the first few days and then disappear. If they don’t they may be reduced by lowering the dose or changing the type of medication in consultation with your doctor.
If your child is taking ADHD or other prescription medications, including ironically, anti-depressants, you should be aware that side effects can sometimes include anxiety, depression or suicidal ideation.
It is therefore crucial that you keep a careful eye on them and be alert to any changes in their mood when first taking medication or over the longer term. Any new symptoms should be reported to your prescribing doctor immediately.
You can find a comprehensive and up-to-date source of peer-reviewed, accurate and independent data on more than 24,000 prescription drugs, over-the counter medicines & natural products, including all possible side effects and drug interactions online at Drugs.com.
Your doctor can alter the medication or the dose in order to find the most effective treatment for you.
It may take some time for your doctor to establish the correct medication and dosage and will do this by titrating the dose up or down.
Your doctor will start you on either Ritalin (methylphenidate) or Dexamphetamine (usually Ritalin) on a small dose to see the results.
He/she will gradually titrate the dose to reach an optimum dosage for your child where there is a balance between good results and no side effects.
Once the dosage is stabilised and effective they will then recommend a modified release medication of the same type, which releases over time giving a smoother effect over a greater time period.
|Medication||Short Acting||Long Acting||Extended Release||Duration of Effect||Side Effects||Age|
|Ritalin (Methylphenidate)||X||4hrs||More info||6+|
|Ritalin LA (Methylphenidate)||X||6-8hrs||More info||6+|
|Concerta (Methylphenidate)||X||10-12hrs||More info||6+|
|Vyvanse (Lisdexamfetamine)||X||12-14hrs||More info||6+|
|Clonidine (Catapres)||X||4-6hrs||More info||6+|
|Intuniv (Guanfacine Hydrochloride)||X||24hrs||More info||6+|
|Strattera (atomoxetine) Non-Stimulant||X||24hrs||More info||6+|
There are extremely strict rules around the prescribing of ADHD medications and you need to be organised in ensuring you have an appointment booked with your paediatrician/psychiatrist in time to receive your next prescription.
You cannot collect a prescription before a certain time has elapsed since collecting the last one.
There is an app called Med Advisor that helps you remember when you need to a new script.
Be aware that there are some countries where you cannot travel with these medications or need a doctor’s letter so please check before travelling overseas.
Some ADHD medications contain gluten and lactose. If you wish to take the medication and also avoid these ingredients you can opt to have your prescription prepared for you at a compounding pharmacy such as Stenlake Compounding.
|Ritalin (Short Acting) (Methylphenidate)||Yes||Yes|
|Ritalin LA (Methylphenidate)||No||Yes|
It is of fundamental importance that parents are also included in this process.
ADHD is not caused by poor parenting, but it is widely recognised that parent training specifically aimed at parenting children with ADHD, can help improve symptoms for the child, parental stress and family life in general.
Behavioural Parent Training (BPT) therefore has a high rating value in an ADHD treatment protocol, where the aim is to inform and educate parents about the symptoms and associated co-morbidities of ADHD.
This is important as it enables parents to change their view on their child's challenging behaviour, thus helping them to embrace a positive attitude which is important for parent-child relationship building.
The parent training should help parents to set realistic expectations for their child and establish a positive parent-child relationship by recognising and supporting the child's strengths and talents and understanding the best way of communicating with their child.
BPT should also provide parents with the strategies and tools that work for the challenges they face with their ADHD children.
BPT is one of the empirically supported psychosocial treatments for ADHD. It has been shown over many years and studies to improve both child and adult behaviour as well as decreased parenting stress and improved classroom behaviour.
For example, one study found that parents who took a nine-session parent training program showed significant improvements in both child and parent functioning, which were maintained 2 months after treatment. It also found that the parent training reduced parenting stress and increased parenting self-esteem as well as seeing improvements in the overall severity of their child’s ADHD symptoms.
Head over to our section on Parenting Help to find out more about our Parenting Children with ADHD 6-week course.
The benefits of Behavioural Parenting Training (BPT) has already been discussed above.
Other therapeutic interventions are critical in order to treat the long-term issues that often go hand-in-hand with ADHD.
Whether a child or adult with ADHD, some psychological help is usually needed to cope with the effects of living with ADHD, at least for a period of time.
Psychological therapy for a child and/or the family group can offer strategies to manage consequences of ADHD and offer a solution to benefit the whole family.
There is years of research demonstrating the effectiveness of a wide range of psychotherapies for the treatment of ADHD in both children and adults.
There are many different types of psychological therapies. These are the two most common:
Cognitive Behavioural Therapy (CBT)
Here the therapist helps by:
- Talking through upsetting thoughts and/or feelings
- Exploring self-defeating patterns of behaviour
- Learning alternative ways of handling emotions
- Helping a client feel better about him or herself, despite the ADHD
- Identifying and building on strengths
- Combatting unhealthy/irrational thoughts
- Coping with day-to-day problems
- Controlling attention and/or aggressive behaviours.
Such therapy can also help a family to:
- Handle the disruptive behaviours
- Promote change and
- Develop coping techniques to improve their child’s behaviour.
This is a specific type of psychotherapy focussing more on ways to deal with immediate issues such as thinking and coping patterns without trying to understand their origins. The aim is for behaviour change such as:
- Organising tasks/schoolwork
- Dealing with emotionally charged events
Psychotherapy will also help a person with ADHD to boost self-esteem through improved self-awareness and compassion and can help limit any destructive consequences of ADHD.
Use our ADHD Directory to find a suitable practitioner.
This is possible as the brain produces measurable electrical signals, or waves. A practitioner of neurofeedback measures these waves using a device called an electroencephalograph (EEG).
This feedback allows practitioners to map out the brain and identify specific regions of the brain that are not working properly e.g. if they are over or under activated or dsyregulated in some way.
It can also provide information on how your brain compares to others of the same gender and age.
Once the assessment locates the cause of the symptom, then a variety of methods and equipment can be chosen, based on your specific needs and neurological issues.
The frontal lobe is linked with personality, behaviour and learning and the brain of a person with ADHD may display characteristic patterns.
The functioning of the brain and a person's behaviour are connected. Changes in behaviour can change the brain and changes in the brain can change behaviour. Neurofeedback aims to change a person's behaviour by changing their brain.
There are five types of brain wave: alpha, beta, gamma, delta, and theta. Each has a different frequency, which can be measured by an EEG.
Some research suggests that people with ADHD have more theta waves and fewer beta waves than people without the disorder.
In theory, neurofeedback aims to correct this difference.
The number of electrodes varies depending on the practitioner and the session. The electrodes do not hurt, and they will not deliver an electrical current. They are only there to measure the brain's activity.
Proponents claim that the process can slowly alter the brain's waves, impacting a person's behaviour and related ADHD symptoms.
- Avoid additives such as colourings, preservatives and flavourings
- Avoid highly processed food and opt for fresh produce
- Avoid sugary foods and refined carbohydrates to regulate blood sugar levels
- Eat plenty of fresh vegetables but limit fruit (organic where possible)
- Buy organic, grass fed meat, dairy and eggs
- Eat plenty of good fats
- Avoid excessive alcohol/recreational drugs
- Check your gut health
- Identify food sensitivities/allergies
- Correct nutritional deficiencies
- Check for environmental toxins
- Balance hormones
- Ensure optimal thyroid function
- Reduce sugar/carbohydrates
- Balance blood sugar by eating small, regular low GI meals
- Consider dietary interventions e.g. gluten/dairy-free/grain-free
- Eat adequate protein
- Consume high magnesium foods e.g. green vegetables, nuts & seeds
- Avoid excessive alcohol consumption
- Eat wild oily fish 2-3 x week and supplement with high quality Omega 3
- Consume flax and linseeds
- Avoid known food allergens
- Epsom Salt baths
- Essential Oils
- Optimise your sleep
- Regular exercise
- Spend time with friends & family
- Yoga, Tai Chi or other relaxing activities
- Practice deep breathing techniques
- Spend time in nature – preferably barefoot
- Get adequate sunlight
- Avoid overuse of screens & excessive exposure to artificial/blue light
- Avoid recreational drugs
- Kinesiology/Neuro-emotional techniques
- Keep a gratitude diary
Finding a practitioner that fits your criteria requires research, but you can view various practitioners in the ADHD Directory. It is recommended you make further enquiries of several before making your selection.
If you live in and around Sydney’s Northern Beaches please come along to one of our monthly ADHD speaker evenings to increase your knowledge. You can find more information or book one of our events here.
- Last Child in the Woods
- Nutrient Power
- Additive Alert
- The Anti-Anxiety Food Solution
- A Mind of Your Own
- Dirty Genes
- Gut & Psychology Syndrome
- Gratitude Diary
- Complete Gut Health Cookbook
- Gutalicious Cook Book
- Kultured Wellness – Gut Health Programme
- Life Changing Food
- ADHD: The Facts
- The Explosive Child
- Raising Difficult Children
- Managing Your ADD Child
- Healing ADD
- Late, Lost & Unprepared
- Finally Focused
- Getting Ahead of ADHD