By the time Joan Chand’oiseau was diagnosed with ADHD, she was already an expert in the disorder. Her husband and two of her three children had already been diagnosed.
“Since then, all five of us have been diagnosed, yet each one of us has had a different journey,” says the Calgary mom. “Even how we treat each member of the family has been different.”
There are six elements in the Chand’oiseau family’s treatment plan: drugs, behavioural therapy, diet, sleep, exercise and being outside. But she says the emphasis on each aspect varies by family member.
Most experts say the optimal treatment for ADHD includes a combination of medications and other interventions. Here are some of the most popular options, and their pros and cons.
There are hundreds of clinical studies showing that medication can make a dramatic difference in the lives of people with ADHD. Drugs aren’t a cure—they don’t make disorder go away—but they can help kids manage the condition. Canadian guidelines advise doctors to avoid prescribing drugs to preschool-aged children. Other countries have stricter guidelines. In the United Kingdom, for example, medications are only advised for children with severe symptoms or kids who don’t improve with behavioural therapy.
Classes of pharmaceuticals There are four primary categories of drugs prescribed to help control ADHD symptoms: stimulants, non-stimulants, antidepressants and blood pressure medications.
The stimulant class has been used to treat ADHD symptoms for more 50 years. Stimulants seem to help kids with ADHD by increasing certain brain chemicals (including dopamine and norepinephrine), which helps the brain to function more like it would in typical kids.
Some of the more common stimulant drugs include Adderall (amphetamine), Ritalin and Concerta (methylphenidate), and Vyvanse (lisdexamfetamine dimesylate).
Non-stimulant drugs work in a similar way, by boosting brain chemicals. They also tend to be longer-lasting, which means a more even dose, but this also makes it harder for kids to take weekends off. Non-stimulants include Strattera (atomoxetine) and Intuniv (guanfacine). Some children for whom stimulant medications are not suitable—for example those with certain heart conditions—may be advised by their doctor to take non-stimulant meds.
Antidepressants and blood pressure medications are sometimes used as alternatives in the treatment of ADHD, especially when a patient has a secondary condition that prohibits the use of stimulants. These drugs have also been shown to help with inattention, impulsivity and hyperactivity. Parents should know that the US Food and Drug Administration warns that some antidepressants may increase suicide risk in children and teens.
There are several factors you and your physician will want to consider when assessing the use of pharmaceuticals.
Side effects Every drug has potential side effects. These range from irritability and insomnia to—in rare cases—heart problems and suicidal thoughts. Medications also affect children in distinct ways, so finding the right one can take months of trial and error. The goal is to find the drug and dose that delivers the most benefit with the fewest side effects.
How long it lasts If the drug is being prescribed primarily to help a child at school, a pill that lasts for six to eight hours may work best. When homework is a challenge, parents may want to ask about multiple doses of shorter-acting drugs.
How it can be taken Sometimes parents will decide to medicate their kids only on school days and not on weekends or vacations. If this is important to you and your child, it’s key to find a drug that doesn’t need time to build up or taper down.
Patricia Tomasi’s daughter Éva was diagnosed with ADHD when she was six. Her parents were keen to try anything that might help her—including medication. But despite their efforts, the meds route just didn’t work.
“We’re not against medication,” says the Barrie, Ont., mom. “We tried three different types of medication, but they all had awful side effects for her.”
Patricia believes the standard ADHD drugs may not have worked for her daughter because Éva is also on the autism spectrum. Without the drug option, Patricia spends more time dealing with her daughter’s school to ensure special considerations are in place. For example, Éva is free to walk around the classroom when other kids are having circle time. In addition, an educational assistant takes Éva out of the classroom three times each day and takes her to a sensory room.
Even when drugs are effective, ADHD symptoms can be better managed in conjunction with other approaches, including behavioural therapy, organizational skills building, nutrition, exercise and sleep.
Behavioural therapy and organization Behavioural therapy is designed to help kids overcome ADHD symptoms through a system of rewards and consequences. When they act appropriately, kids are rewarded with screen time or other privileges. When they don’t achieve their goals, there are consequences that usually involve losing something they enjoy.
Developing organizational skills can also be helpful for children with ADHD. A child with ADHD may be less inclined to write down homework assignments, but making a habit of such activities can be extremely helpful for keeping on track.
Nutrition Karen Ryan of Vancouver tried various ADHD drugs for her son Eddy but found the side effects too much to bear. On one drug, he wasn’t eating or sleeping; on another, he developed suicidal thoughts. Karen, a clinical and a holistic nutritionist, finally tried a non-medicinal approach, which included eliminating food dyes and taking supplements, such as magnesium, zinc and omega-3.
While some parents swear by a diet-based approach of supplements or food eliminations, many doctors are dismissive, saying the research is far from conclusive. A 2013 review of multiple research papers on diet and ADHD found two possible connections. Researchers said supplements of free fatty acids, such as Omega-3, produced “small but significant” reductions in ADHD symptoms, while exclusion of food colouring produced larger effects, particularly in children with food sensitivities.
“There’s no consensus of evidence to support a special diet in the treatment of ADHD. What we have seen is some very mild possible benefit from omega-3 fatty acid supplements,” says Ryan Chan, a child and adolescent psychiatrist at the BC Children’s Hospital.
Russell Schachar, a psychiatrist at Toronto’s Hospital for Sick Children, says he sometimes hears from parents who believe specific foods worsen a child’s ADHD symptoms. He tells them it can be difficult to establish a link between food and a behaviour without systematically removing and then reintroducing the potentially offending food.
“There are a lot of people who practically drag themselves into bankruptcy buying special foods for their kids,” Schachar says. “A lot of people go completely over the top without any evidence that it makes a difference.”
In rare situations, what initially appears to be ADHD actually turns out to be a food allergy or intolerance.
“Anything that’s bothersome or distracting to a child can have them present as bothered or distracted, and sometimes that is assumed to be hyperactivity or fidgetiness,” says Sarah Gander, a paediatrician with the Horizon Health Network in New Brunswick.
That’s why it’s important for doctors to do a complete medical assessment before assuming symptoms are caused by ADHD, Gander says.
Exercise While the jury is out on nutrition, the impact of exercise on ADHD is clear. A 2015 meta-analysis found that aerobic exercise had a “moderate-to-large” effect on all three core symptoms of ADHD: attention, hyperactivity and impulsivity. Exercise also improved related symptoms, including anxiety and social disorders. The study found yoga can be beneficial as well.
While many kids get their exercise through team sports like soccer and hockey, these aren’t always a good fit for kids with ADHD. Encourage your children to play outside and bike to school, and make sure you’re participating in active fun with them on weekends.
Sleep A 2009 research analysis concluded that kids with ADHD had many more sleep problems than typical children. They had a harder time falling asleep, woke up more often at night and were more tired during the day.
At the same time, it’s well established that sleep deprivation makes it harder for everyone to concentrate. Though it may be a challenge, helping your kids to get a good night’s sleep may prevent further impairment of their executive functioning abilities.
Sleep experts say a few simple steps can help anyone to sleep better. These include avoiding bright screens (such as phones, tablets and video games) an hour or two before bedtime, ensuring the bedroom is dark and not too warm, and eliminating caffeine intake.
Screen time Some parents notice kids become more impulsive or hyperactive after spending a long time in front of a screen. But others say electronic devices can be an important part of helping kids manage their ADHD.
Patricia Tomasi says it’s nearly impossible to bring her daughter Éva out for dinner unless she has an iPad to keep her occupied. Some experts say creative games like Minecraft can help kids with ADHD improve their focus, working memory and other executive functions.
Take a trial-and-error approach to treatment strategies, introducing one change at a time, so you can assess the impact it has on your kid’s symptoms. And remember, there’s no one-size-fits-all treatment, and most kids benefit from a combination of approaches.