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Dear Melissa,
My daughter is 7, and her teacher was concerned about her inability to focus in the classroom and generally “not meeting her potential”. I had my daughter evaluated by a child psychiatrist, and the doctor gave her a diagnosis of ADHD. I really don’t want to put her on medication at such a young age. Are there any non-prescription interventions that are proven to help?
I have frequently heard this question from parents. Often parents come and have their child evaluated for occupational therapy because the child is struggling in school, and they want to start the ball rolling to build success…even before the child has a diagnosis of ADHD. Actually it is not uncommon at all for the psychiatrist to have me, as the OT, provide input from my treatment sessions with the child in order to help the psychiatrist gain a complete picture of the child in multiple settings and make a more accurate diagnosis.
Prescription medications ARE a fantastic tool for treating ADHD. However, many parents, for various reasons, really want to avoid medications for ADHD. My personal philosophy is that ADHD needs to be treated. Period. No kid wants to be “that kid” who is bouncing off the walls and gets in trouble for not focusing, even when she is trying her best. BUT, I personally don’t like how medication is seen as the first line of defense. I want to see SOMETHING else tried first before we give medication to a young child. Below I have listed some options that are proven to generally help children with ADHD and other mental health disorders.
Rule out other medical diagnoses. This should always be first on the list. Poor attention can be the result of many other medical diagnoses including depression, anxiety, learning disabilities, Autism, dyslexia, visual/hearing problems, insomnia, etc. All the ADHD treatment/medication in the world won’t do your child a lick of good if there is an untreated underlying cause. Working with your child’s pediatrician is your best source for ruling out other causes of poor attention.
Occupational/behavioral therapy. A therapist who specializes in ADHD and other mental health disorders can work with your child and your family to help find the right techniques to reduce impulsivity, improve social skills, improve listening skills/following directions, and learn to refocus attention. In addition, occupational therapists can evaluate your child for any developmental “splinter skills” which may have not yet been met as a result of poor attention (ex. handwriting skills, auditory processing skills, self-care skills such as tying shoes, etc).
Reduce/Eliminate Electronics. Many years ago, there was a fantastic pediatric neurologist in the area who used to say, “Before you drug, UNPLUG!” And this was in the days before smart phones and iPads! Before she would prescribe ADHD medication for a child, the neurologist would require that the child eliminate all TV/video games/computer time for SIX WEEKS. Research shows that children with more screen time earlier in life have more attention difficulties later in life. In addition, children with more screen time have more sleep problems, which also contributes to poor attention.
Exercise. Elementary schools are cutting recess and PE time right and left. Fortunately, our teachers are finding ways to incorporate brief bursts of exercise into the classroom day to help their children focus. They know it works. For example, one study in Missouri compared three elementary schools using an ABC exercise program with two other schools not using it. Among the findings: Schools that adopted the exercise program for most of the academic year had a 33% decline in ADHD medications used by its students. That compared with a smaller, 7% decline in medication use in the schools not using the program. The side effect? More physically-fit children! Count me in!
Parenting techniques. A study published by the American Academy of Pediatrics in January 2013 showed that Parenting Behavior Training (PBT) was BETTER at improving symptoms of ADHD in preschool children than medication. In general, children with ADHD (as well as most children) respond well to clear boundaries and structure. Again, this is where an occupational therapist or behavioral therapist can help recommend techniques which work best for YOUR family.
Diet. This one is a bit more controversial. The CDC reports that there is NO link between sugar, artificial sweeteners, food additives (dyes, etc) and ADHD. However, can it hurt to feed a child more whole foods, more fruits and vegetables, and less processed foods? Simply go back to the food your grandma ate? Sounds good to me! Personally, if I eat fast food, I can feel my brain just turn down the fire power. That may be fine for a lazy Saturday, but not a great idea for a Monday night when homework needs to get done! Again, the biggest side effect is a child with a healthier diet. It can’t hurt!
Although I think occupational therapy is a valuable tool for treating ADHD, it is not the only option for a first treatment (as you can see above). Maybe the alternative treatment is not 100% effective, but it may help reduce the amount of medication a child may require. Unfortunately, in the American healthcare system (for ALL diagnoses), we are quick to offer pills, but very slow to try other treatments such as diet, lifestyle change, and exercise. In reality, many of these non-pharmaceutical practices actually work BETTER than pills.
Still not sure? Next week I will dive into the more controversial area of specific diets and supplements for treatment of ADHD. Send in your questions now, and we will try to get them addressed!
email: share@childrenstherapyteam.com
Resources:
ADHD Treatment: Where do you start? Monday’s with Melissa Blog, posted February, 2015
Interventions for Preschool Children at High Risk for ADHD: A Comparative Effectiveness Review, Pediatrics, American Academy of Pediatrics, Vol. 131, May 1, 2013.
A Research Model for Investigating the Effectsof Artificial Food Colorings on Children With ADHD, Pediatrics, American Academy of Pediatrics, Vol. 127, June 1, 2011.
Relative Effects of Drugs and Diet on Hyperactive Behaviors: An Experimental Study,Pediatrics, American Academy of Pediatrics, Vol. 61, June 1, 1978.
Media Useand Sleep Among Boys With Autism Spectrum Disorder, ADHD, or TypicalDevelopment, Vol. 132, December 1, 2013.
What is ADHD, National Institutes of Health, Accessed April, 2015.
ADHD, Center for Disease Control & Prevention, Accessed April, 2015.
Why French Kids Don’t Have ADHD, Psychology Today, March 8, 2012.
Exercise Helps Children with ADHD in Study, Wall Street Journal, September, 2014.
Diagnosing ADHD in Children, American Academy of Pediatrics, Healthchildren.org, updated January 9, 2015.