Attention Deficit Hyperactivity Disorder (ADHD)
Last updated: November 2019
Our science and research team is compiling the most significant studies and information on an array of health topics, conditions, and diseases. If there is something you’d like them to cover, please email us at [email protected].
Attention Deficit Hyperactivity Disorder (ADHD)
Last updated November 2019
Our science and research team is compiling the most significant studies and information on an array of health topics, conditions, and diseases. If there is something you’d like them to cover, please email us at [email protected].
Do you often find yourself having trouble paying attention or following through on tasks? Do you feel a strong urge to move around or find yourself interrupting others while they’re talking? Have you struggled with issues like this since childhood? Attention deficit hyperactivity disorder (ADHD) begins in childhood but may persist throughout adulthood. Children and adults may experience both a lack of attention and hyperactivity or impulsivity. Or you might predominantly experience only one feature of the disorder. The symptoms of ADHD can be incredibly distracting and may disrupt work, school life, and personal relationships.
Primary Symptoms of ADHD
ADHD presents differently in adults and children. It may also look different depending on context—at work, at school, or in your personal life. While children may have the more classic features—running around, not paying attention to teachers—adults can have features of ADHD that may be less obvious. Lack of attention may look more like wandering off task at work while hyperactivity and impulsivity may show up as restlessness or making thoughtless decisions without considering the consequences.
How Many People Are Affected by ADHD?
Worldwide, around 5 percent of children and 2.5 percent of adults have ADHD. The rate of childhood ADHD has been steadily increasing in the United States: By some estimates, up to 11 percent of children ages four to seventeen have been diagnosed (CDC, 2018; Visser et al., 2014).
How ADHD Is Diagnosed
ADHD symptoms in children are usually spotted by their parents, teachers, or both, who can aid in the diagnosis process. A clinical interview from a licensed health care professional such as a psychiatrist or psychologist is needed to determine whether the patient meets the diagnostic features of ADHD from the DSM-5.
Attention deficit hyperactivity disorder is classified in the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) as a neurodevelopmental disorder. It is defined as a persistent pattern of lack of attention and/or hyperactivity or impulsivity that interferes with functioning in multiple settings (such as school, work, home, with friends, during sports) or development. People can have combined ADHD, with features of both inattention and hyperactivity or impulsivity, or they may just have predominantly inattentive ADHD or hyperactive ADHD.
According to the DSM-5, the lack of attention must persist for at least six months and include six or more of the following symptoms (in people seventeen or older, only five or more symptoms are required for diagnosis): failure to pay attention to details, difficulty sustaining attention, not listening when spoken to, not following through on instructions or finishing tasks, difficulty organizing, disliking tasks that require sustained attention, losing things, being distracted easily or forgetful. Hyperactivity or impulsivity must persist for at least six months and include six or more of the following symptoms (in people seventeen or older, only five or more symptoms are required for diagnosis): fidgeting, standing up at inappropriate times, running at inappropriate times, unable to engage in leisure activities quietly, always being on the go, talking excessively, blurting out an answer before a question is completed, difficulty waiting their turn, or interrupting others (American Psychiatric Association, 2013).
Potential Causes and Related Health Concerns
ADHD is thought to be caused by a combination of genetics (it runs in families), temperament, environmental factors, and upbringing. Very low birth weight is associated with an almost threefold increase in likelihood of developing ADHD, and exposure to environmental toxins, such as lead, has been associated with development of ADHD. Boys are twice as likely to have ADHD as girls are. Men are 1.6 times as likely to have ADHD as women are. Women have predominantly inattentive features of ADHD (American Psychiatric Association, 2013).
Co-occurring Psychological Disorders
Depression and anxiety are sometimes diagnosed alongside ADHD. For patients with both ADHD and a mood disorder, the mood disorder should be treated first, as that may help clear up the ADHD symptoms, too. About half of children with combined ADHD and a quarter of children with inattentive ADHD also have co-occurring oppositional defiant disorder: having an angry or irritable mood, displaying argumentative behavior, refusing to comply with rules, or being vengeful. Conduct disorder occurs in about a quarter of children with combined ADHD and is characterized by aggression to people or animals, destruction of property, lying, theft, or seriously violating rules (American Psychiatric Association, 2013).
Mediterranean diets have been shown to be associated with reduced risk of ADHD. A few foods diet (FFD) and caffeine consumption may be effective at reducing inattention and hyperactivity symptoms.
In pretty much every nutrition study you read, the Mediterranean diet is considered the gold standard of healthy eating. It’s been shown to reduce the risk of numerous health issues, such as heart disease and diabetes.
How to Follow a Mediterranean Diet
The Mediterranean Diet is rooted in countries such as Greece and Italy that have longer life spans. As such, it is recognized by many health agencies as the gold standard diet to prevent disease and promote health. The diet is high in vegetables, fruits, whole grains, beans, nuts, seeds, fish, and olive oil. It includes limited amounts of red meat and dairy. Healthy fats are a key aspect of the diet and are widely considered to confer health benefits. To try the Mediterranean way, eat at least five servings of fruits and vegetables per day; switch to whole-grain bread, cereal, and pastas; use olive oil instead of butter; eat more seafood; and reduce your red meat intake by substituting with fish, poultry, or beans.
A 2018 study found that low adherence to a Mediterranean diet was associated with ADHD diagnosis among Spanish children and adolescents. A low intake of pasta and rice (fewer than five times per week) was also associated with ADHD (San Mauro Martín et al., 2018). Another study from Spain found that lower adherence to a Mediterranean diet was associated with a 607 percent higher risk of ADHD diagnosis (that’s not a typo). The authors found that in particular, high consumption of sugar, candy, and soft drinks and low consumption of fatty fish were associated with ADHD (Ríos-Hernández, Alda, Farran-Codina, Ferreira-García, & Izquierdo-Pulido, 2017).
It seems obvious that a Mediterranean diet is the goal. What’s up for debate is whether the omega-3 fatty acids from fish are the hero ingredient or there’s something else that makes the Mediterranean diet effective. (Keep reading for more on omega-3 fatty acids for ADHD.)
Few Foods Diet (FFD)
Elimination diets have also shown promise for ADHD, including the few foods diet, in which you remove multiple foods, food groups, or additives that are suspected to cause a sensitivity or allergy. These could include just about anything from gluten to sugar to food colorings—it’s individual. The first step of an FFD is remove everything from your diet except for a few foods that no one is likely to have an allergy to. If you feel better, then you start to add back one food at a time, waiting up to two weeks after each addition to see if that food causes any problems. It’s important to work with a registered dietitian to avoid causing nutrient deficiencies.
A 2017 meta-analysis found that FFDs had a medium to large effect on ADHD symptoms; however, the studies varied depending on which foods were eliminated, so remember that diets and people’s responses are food is very individual (Pelsser, Frankena, Toorman, & Rodrigues Pereira, 2017).
A few studies have tried to determine whether consuming sugary beverages, such as sodas, is related to ADHD. The theory is that ADHD is caused by an altered dopamine-reward pathway. Dopamine is the feel-good neurotransmitter that is released in response to rewards as well as to sugar. So if sugar intake is consistently high, the dopamine receptors might wear themselves out and not be able to respond as well to natural rewards. This could result in classic symptoms of ADHD, such as problems with delaying gratification and inability to reinforce positive behaviors (Johnson et al., 2011). It’s an interesting theory, and some studies have found that children with ADHD do seem to drink more sugar-sweetened beverages than those without ADHD. However, it’s not clear whether the drinks are a cause of ADHD, a consequence, or if the apparent association is even real (Del-Ponte et al., 2019; Schwartz et al., 2015; Yu et al., 2016).
Although the research hasn’t drawn a clear relationship between sugar and ADHD or children’s behavior in general, ideally, of course, parents are cognizant of their child’s sugar intake and create healthy eating patterns that support the child’s health and sustained energy.
So many of us drink coffee and other energy drinks just to get through the day. It may seem impossible to imagine that we could focus without caffeine. One interesting thought experiment is to estimate how many additional cases of ADHD there would be if we all stopped drinking caffeinated beverages. Several studies have shown that caffeine has a therapeutic effect not only on inattention but, perhaps counterintuitively, also on hyperactivity. However, methylphenidate and amphetamines are still comparatively much more effective at improving ADHD symptoms than caffeine (Ioannidis, Chamberlain, & Müller, 2014; Leon, 2000).
Around 150 milligrams of caffeine seems to be the optimal dose, but more studies are needed to determine whether caffeine is a viable alternative for people with milder symptoms and whether caffeine in combination with prescriptions is safe and effective (Ioannidis et al., 2014). One reason for caution: A 2016 study linked energy-drink consumption to later development of ADHD, but this could be due to several things—the caffeine, the sugar, or the added preservatives and colorings—so more research in this field is still needed (Marmorstein, 2016).
Food Colorings and Preservatives
In recent years, there’s been increased interest in how some sensitivities and allergies to common foods and additives may lead to greater health effects downstream. In the 1970s, the Feingold diet was popularized; it eliminated food colorings and preservatives, which were believed to cause ADHD. The scientific literature has gone back and forth trying to determine whether or not this is indeed true. The European Union outlawed certain food additives in response to some preliminary studies, but overall, the evidence is limited and flawed. There may be a small benefit to removing food additives for some children, so if that’s something you’re passionate about and find it simple to do, then go ahead and try an elimination diet for you or your child (Nigg & Holton, 2014). Otherwise, you may consider waiting until there’s stronger evidence.
Nutrients and Supplements for ADHD
Omega-3 fatty acids may be beneficial for adolescents with ADHD.
Omega-3 Fatty Acids
Numerous studies have assessed the link between omega-3 polyunsaturated fatty acids from fish and ADHD: Many people with ADHD have lower-than-normal levels of omega-3 fats in their bodies. Does supplementing help? A 2018 meta-analysis verified that children and adolescents with ADHD had low levels of EPA and DHA and total omega-3s. And in multiple studies, omega-3 supplementation improved ADHD symptoms as well as cognitive performance in children and adolescents who were receiving no other form of treatment (Chang, Su, Mondelli, & Pariante, 2018). So it seems worthwhile to find a good fish oil supplement to take regularly that contains both DHA and EPA if you suspect that you or your child is not getting enough from food alone.
Lifestyle Changes for ADHD
Sleep and exercise are important for people with ADHD.
The importance of a good night’s sleep is never clearer than on days when you really need to be at your best—for a presentation, a test, a difficult conversation. Getting enough rest gives our brains time to recuperate. Researchers have found that getting a good night’s sleep can be beneficial for people with ADHD, who may have higher rates of insomnia than the general population (stimulant medications likely contribute to this lack of sleep) (Wynchank, Bijlenga, Beekman, Kooij, & Penninx, 2017). In one study, adolescents who slept for six and a half hours had poorer attention and greater sleepiness than when they were allowed to sleep for up to nine and a half hours a night; however, their symptoms of hyperactivity improved when they slept less, probably because they were so tired (Becker et al., 2019). Getting adequate sleep should be prioritized for all of us, but especially for those with ADHD, who may also want to be assessed by a clinician if insomnia is a concern.
Exercise—and the associated endorphins—is known to boost your mood and reduce stress. Could exercise help improve focus and hyperactivity in people with ADHD? A 2017 review article found that cardio exercise was effective in both the short term and the long term at improving impulsivity and attention in adults and children with ADHD, but the benefits weren’t as clear for non-cardio exercise (Den Heijer et al., 2017). A small but interesting study of men with ADHD found that riding a bike for twenty minutes improved their motivation and energy, while reducing confusion on memory and reaction-time tests (Fritz & O’Connor, 2016). The thought is that releasing pent-up energy through exercise can help with focus by effectively “getting the jitters out.”
It seems that short-term aerobic exercise has benefits for ADHD—so find a workout you enjoy that you can stick to, such as a spin class. It may help to exercise before you go to work or to break up your schedule with a midday workout and then get back on task, feeling refreshed and clear-headed. Encourage your children to stay active by enrolling them in a team sport or a complex activity that requires focus and concentration, such as ice-skating, martial arts, or rock climbing.
As you know: We’re constantly on our phones. New research has shown that this may have negative effects on our productivity, time, and mental health. Excessive internet use has been linked to anxiety and depression, which often co-occur with ADHD. Since smartphones give us such instant stimuli and rewards, they’re capable of capturing our attention and becoming a distraction. Is it possible that phone use leads to the development of ADHD? A 2018 study found that adolescents who used digital media more frequently also were more likely to develop symptoms of ADHD over the two years of the study (Ra et al., 2018). While this is just an association from one study, it’s another reminder to be mindful about our technology use. Hopefully continued research in this area can provide more clarity.
Handheld toys that you can spin, twist, and play with in one hand have become a source of obsession in the past few years—you’ve likely seen them at a gas station checkout or seen the internet memes about them. Originally created as occupational therapy toys for children with attentional difficulties, fidget spinners are advertised as a way to reduce stress and anxiety, while improving concentration. However, there has not been adequate scientific research on whether or not these sorts of toys result in any benefits for children or adults with ADHD. Some health care professionals and educators believe that they may cause further distraction. So don’t jump on the fidget spinner bandwagon yet, unless you find they seriously help with focus.
Conventional Treatment Options for ADHD
Treatment for ADHD is multifaceted and can include pharmacological, behavioral, and academic interventions.
ADHD Treatment Recommendations by Age
Treatment recommendations vary according to age. According to recommendations from the American Academy of Pediatrics (AAP), children who are four or five years old should be treated primarily with behavioral therapy and given the stimulant methylphenidate (Ritalin) only if symptoms are severe enough to warrant its use. For children ages six to eleven the recommendation is to begin taking stimulant medications, followed by behavioral therapy, or preferably a combination of both. For adolescents (those twelve to eighteen years old), stimulant medications are recommended because behavioral therapy is the least effective in this age group (Wolraich et al., 2011). For adults, stimulant medications are the front-line treatment, although cognitive behavioral therapy (CBT) or alternative therapies may be helpful to a lesser degree for this age group (Knouse, Teller, & Brooks, 2017).
Stimulant medications have consistently been shown to be effective for both children and adults with ADHD; they’re the gold standard for ADHD treatment. The most common stimulant medication for ADHD is methylphenidate (MPH), which is sold under the brand names Ritalin and Concerta. Other stimulant options include amphetamines, such as Adderall. While shown to be effective and safe, stimulants still come with side effects that can be unpleasant, such as appetite loss, insomnia, headaches, and nausea. Amphetamines may cause irritability in children (Stuckelman et al., 2017). People with ADHD may also have a higher risk of substance abuse and addiction, so carefully consider whether stimulants are right for you.
The Debate over Stimulant Use
Although national recommendations state that stimulant medications are the front-line treatment for people six and older, debates have been raised over whether this is too young to start children on a medication this intense, which they may likely need for the rest of their lives. Some parents may choose to start with behavioral interventions first before starting children on medication. Medication should always be carefully considered on a case-by-case basis, especially because stimulants prescribed for ADHD can be addictive, and withdrawal symptoms can be severe when discontinuing use.
Further, there is an issue, particularly among college students, with drug misuse and abuse. Some people may sell their prescriptions to other students, who then abuse these stimulant medications as “study” drugs or “party” drugs. Taking stimulant medication while drinking which can be dangerous and can lead to heart problems or alcohol poisoning.
Some people point to statistics showing that ADHD diagnosis has been on the rise in recent years and question if this is due to overdiagnosis rather than an actual increase in the disorder (CDC, 2018). An additional aspect of the overdiagnosis issue is the crucial role that teachers play as “disease-spotters,” as they are often called upon to speak to the child’s symptoms in the classroom during clinical interviews with a doctor for diagnosis. Teachers may be targeted by pharmaceutical companies to encourage medication use and ADHD diagnosis (Phillips, 2006).
For those who are concerned about the side effects of stimulants or are looking for other effective options, there are several ADHD-specific nonstimulant medications, including atomoxetine, clonidine, and guanfacine.
Two recent studies at UCLA assessed combining guanfacine and extended-release MPH medication for eight weeks, and one of these studies found that the combination was better than MPH alone at improving attention in children seven to fourteen years old. So combining stimulant and nonstimulant medication could be an effective option (Bilder et al., 2016; McCracken et al., 2016).
Other options that are used less frequently include blood pressure medications, which help with ADHD symptoms and the side effects of stimulant medications, as well as antidepressants for those who have coexisting mood disorders, such as depression and anxiety. Several clinical studies are underway to find new medications for ADHD; see the Clinical Trials for ADHDclinical trials section for some that are recruiting now.
Parental support is crucial for children, especially those struggling with ADHD who may need help in social and academic settings. Parent-training programs were developed to help reduce adolescent behaviors such as substance use, delinquency, and violence. They also help parents influence positive learning and self-esteem in children with ADHD. The two most popular evidence-based parental training programs are called The Incredible Years and Positive Parenting Program.
The Incredible Years uses group sessions of six to seven children along with their parents and sometimes teachers to encourage children’s social and emotional skills, while teaching parents how to encourage positive behavior and establish effective rules and punishments for misbehavior. Sessions are typically two hours long and take place twice a week for a minimum of twelve weeks.
The Positive Parenting Program, also called Triple P, aims to promote safe and engaging learning environments, effective discipline, clear expectations, and parental self-care. Parents learn how to teach skills to their children across the eight to ten weeks of the training by modeling, rehearsing, role-playing, and self-evaluating (Haggerty, McGlynn-Wright, & Klima, 2013).
Cognitive Behavioral Therapy (CBT) for Adults
While the conventional treatment for ADHD in adults is medication, cognitive behavioral therapy (CBT) is a popular alternative. The structure and goals of therapy vary from person to person depending on the issues in each area of their life. For example, someone who struggles with focus at their job may work with their therapist to develop organizational, planning, and time-management skills. Someone who faces challenges in their romantic relationships related to anxiety and ADHD may work on approaching interpersonal problems and stress more mindfully and working on an underlying mood disorder.
A 2017 meta-analysis found that CBT for adult ADHD is about as effective as behavioral treatments in children, so it may be a good option for those who don’t respond well to medications or who don’t want to take them (Knouse et al., 2017). CBT may also be used in adolescents, especially those who have co-occurring conduct disorder, anxiety, or depression. However, the most common behavioral therapies for children are family therapy and school interventions.
Every person learns differently. The optimal learning environment and teaching style for one student won’t necessarily be the same as the rest of the class, particularly if that student has ADHD. It’s important to determine whether your child can get some extra support from their school. You will need to submit a special education assessment request to your school which will be followed by the school’s assessment of whether or not your child is eligible for either an IEP or a 504 Plan. An IEP or Integrated Education Program is generally only for children diagnosed with both ADHD and another disability, such as a learning disability or a visual impairment. It allows for special services and accommodations from the school, such as computer-aided learning or special tutoring. For children who do not meet the requirements for an IEP, you may request a 504 Plan, which allows for things like extended time on tests, sitting in the front row in class, and other helpful accommodations.
Alternate Treatment Options for ADHD
While stimulant medications have consistently been shown to be safe and effective for children and adults alike, there are plenty of reasons to be interested in alternative therapy options for ADHD. For one, stimulants come with a range of side effects that may be unpleasant, and for many, being on a medication for the rest of your life is a less-than-ideal situation. And medications may not work for everyone and may result in only a slight improvement in symptoms. Unfortunately, there aren’t many evidence-based alternative treatments that have been shown to work for the “typical” case of ADHD, but keep in mind that treatment is highly individual, so what works for most may be different from what works for you.
Summer Treatment Programs for ADHD
One of the most promising new treatments for ADHD was developed at Florida International University by William E. Pelham, Jr. It’s essentially a combination of numerous evidence-based behavioral interventions for ADHD condensed into a six- to nine-week summer program for children and adolescents. The Summer Treatment Program (STP) is based on a reward-and-response economy in which points are given for adaptive behaviors (such as following instructions) while negative behaviors (such as interrupting others) are discouraged. Numerous studies have shown that children who undergo STP require lower doses of stimulant medications to achieve the same benefits as children on a higher-dose medication who did not undergo STP.
You can apply here for the Summer Treatment Program at Florida International University or see other STP programs around the country at the bottom of their page.
In people with ADHD, the frontal lobe of the brain may be functionally different, resulting in differences of personality, behavior, and learning. In the 1960s, neurofeedback became popularized as a treatment for ADHD based on the theory that these frontal lobe differences were due to underlying issues in brain activity. It was proposed that people with ADHD may have more theta brain waves and fewer beta brain waves that the general population. Neurofeedback involves measuring the patient’s natural brain waves using EEG technology (you may have seen the helmet of electrodes on someone’s head in a movie) and using various techniques to correct frontal-lobe brain activity to what’s considered optimal (Arnsa, Heinrichc, & Strehle, 2013).
A 2016 meta-analysis found that there wasn’t enough evidence to recommend neurofeedback as an effective treatment for ADHD (Cortese et al., 2016). Newer research has suggested that these proposed theta and beta brain wave differences may not be generalizable across the board for ADHD; it may be just a small subset of people (Arnsa et al., 2013). It seems that neurofeedback is probably useful only for certain people with ADHD who have altered brain waves, and even then, it may not necessarily be effective.
Yoga is a low-impact form of exercise with an emphasis on the mind and body. It may help people with ADHD improve concentration, self-control, and body awareness. A few small studies have assessed yoga programs for children with ADHD as an alternative to more-aggressive medication options or as an add-on to their regular treatment. Overall, the studies have found that yoga programs lasting anywhere from six to twelve weeks have benefits for attention and motor skills in elementary schoolers and perhaps even preschoolers (Chou & Huang, 2017; Cohen et al., 2018; Hariprasad, Arasappa, Varambally, Srinath, & Gangadhar, 2013; Jarraya, Wagner, Jarraya, & Engel, 2019). However, a 2018 review determined that there wasn’t enough high-quality evidence demonstrating the benefits of yoga for children with ADHD yet, although it is safe (Evans et al., 2018).
Mindfulness is the practice of observing the present moment as it is, without judgment. It is a skill that can be sharpened over time with continued practice through meditation, yoga, or simply going about your day with mindful awareness. Numerous studies have shown the benefits of meditation and mindfulness for people without ADHD, including increased focus and attentional skills, improved emotional regulation, and better executive function. It would seem that mindfulness is the optimal tool for people with ADHD as well because they often tend to have issues with reactivity and distraction (Mitchell, Zylowska, & Kollins, 2015).
Only a couple of studies have really looked at mindfulness therapy for ADHD, but they’ve shown promising results. A small 2015 study found that eight weeks of mindful awareness practices improved attention and mood in adults with ADHD. A 2017 study found that eight weeks of mindfulness meditation improved ADHD symptoms, executive function, and emotional regulation in adults (Bueno et al., 2015; Mitchell et al., 2017). While these studies are promising, much more research is needed to determine whether mindfulness is an effective intervention for ADHD, either as a stand-alone treatment or in combination with conventional treatment options. Regardless of the weight of the current evidence, anyone could begin a mindfulness practice to reap the other wonderful benefits for mood and health.
Holistic Treatment Approaches
Holistic approaches often require dedication, guidance, and working closely with an experienced practitioner. There are several certifications that designate an herbalist. The American Herbalists Guild provides a listing of registered herbalists, whose certification is designated RH (AHG). Traditional Chinese medicine degrees include LAc (licensed acupuncturist), OMD (doctor of Oriental medicine), or DipCH (NCCA) (diplomate of Chinese herbology from the National Commission for the Certification of Acupuncturists). Traditional Ayurvedic medicine from India is accredited in the US by the American Association of Ayurvedic Professionals of North America (AAPNA) and the National Ayurvedic Medical Association (NAMA). There are also functional, holistic-minded practitioners (MDs, DOs, NDs, and DCs) who may use herbal protocols.
There’s a need for alternative treatment options for ADHD that are as effective as stimulants but have fewer side effects. While holistic practitioners, such as acupuncturists or herbalists, may recommend a variety of solutions, there isn’t always scientific literature yet to back it up. This is due in large part to the wide variability in treatments person to person—every acupuncturist isn’t administering the same needle to the same spot and every herbalist isn’t prescribing the same blend of herbs for each person. Treatment tends to be highly individual, and for good reason as people’s bodies react differently and have unique needs. Also, most studies look only at short-term benefits, but it could be that positive benefits kick in with long-term use of herbs or after being on a protocol for a sustained period of time.
At this point, we can’t point to one herb as a cure-all for ADHD, but there is good evidence showing that some herbs can resolve certain relevant symptoms in healthy individuals—read on for options.
Herbs for Calming
Some great herbs with calming effects include chamomile, lemon balm, valerian, and passionflower. Only a few studies have assessed the effect of these herbs in people with ADHD.
In one study, eight weeks of passionflower use (0.04 milligrams per kilogram of body weight twice daily) was compared to methylphenidate use in thirty-four children with ADHD. The researchers found that they worked equally well: There was no significant difference between passionflower users and methylphenidate users on parent and teacher ratings of ADHD symptoms, and both groups improved over the treatment period (Akhondzadeh, Mohammadi, & Momeni, 2005).
In a pilot study of valerian use for children with ADHD, the researchers found that ten drops of a valerian mother tincture (as well as ten drops of a three-times-diluted tincture) three times daily for two weeks significantly improved children’s attention, anxiety, and impulsivity or hyperactivity (Razlog, Pellow, & White, 2012). However, some herbalists report that a small proportion of people may feel stimulant effects from valerian, including increased heart rate and irritability (Gardner & McGuffin, 2013).
Overall, there is a lack of sufficient evidence to determine whether these herbs are effective for ADHD, and it’s always best to work with a specialized herbalist to cater a treatment plan for you or your child.
Herbs for Focus and Cognition
Bacopa, also known as brahmi, is an herb that is commonly used for cognitive function and mood. A 2016 review found that bacopa improves memory in children and adolescents and also presented preliminary evidence from two studies that showed significant improvements in hyperactivity and attention in children with ADHD (Kean, Downey, & Stough, 2016). While more robust research is needed on bacopa, these are promising results that warrant further interest in bacopa for ADHD treatment.
Other herbs that have been studied for ADHD include gotu kola and ashwagandha. A 2010 study found that an herbal combination of gotu kola, ashwagandha, lemon balm, peony, and spirulina, called Nurture & Clarity, improved attention, cognition, and impulsivity in children with ADHD (Katz, Adar Levine, Kol-Degani, & Kav-Venaki, 2010). This formulation was developed by a team of herbalists based on clinical experience treating children with ADHD. A combination of herbs may be the optimal way to treat ADHD, at least from an herbalist’s perspective, but before this is accepted as an effective treatment, these findings need to be repeated with additional controlled research.
Cognitive enhancers, also known as nootropics, are becoming popular for their ability to improve concentration and performance. “Nootropic” is an umbrella term that can include anything from the herbs mentioned above to synthetic drugs that are banned in the US. There are a variety of supplements that are considered nootropics, with the most well-known and frequently used being caffeine. Studies have shown that caffeine in combination with L-theanine, an amino acid in tea, provides a powerful synergy that improves attention, accuracy, and alertness better than either ingredient alone (Haskell, Kennedy, Milne, Wesnes, & Scholey, 2008; Owen, Parnell, De Bruin, & Rycroft, 2008). There are various dietary supplements claiming to have nootropic effects, containing ingredients ranging from vitamins to herbs to amino acids. As these supplements generally don’t have clinical studies to back up their claims and have not been tested on populations with ADHD, please use caution.
New and Promising Research on ADHD
Researchers have begun to use engaging learning environments in virtual reality for ADHD treatment. New studies have shown that parental ratings of children’s symptoms, date of school enrollment, and epigenetics play a role in ADHD diagnosis and development.
How Do You Evaluate Research Studies and Identify Promising Results?
The results of clinical studies are described throughout this article, and you may wonder which treatments are worth discussing with your doctor. When a particular benefit is described in only one or two studies, consider it of possible interest and perhaps worth discussing, but definitely not conclusive. Repetition is how the scientific community polices itself and verifies that a particular treatment is of value. When benefits can be reproduced by multiple investigators, they are more likely to be real and meaningful. We’ve tried to focus on review articles and meta-analyses that take all the available results into account; these are more likely to give us a comprehensive evaluation of a particular subject. Of course, there can be flaws in research, and if by chance all of the clinical studies on a particular therapy are flawed—for example with insufficient randomization or lacking a control group—then reviews and meta-analyses based on these studies will be flawed. But in general, it’s a compelling sign when research results can be repeated.
Virtual Reality (VR)
Imagine a totally different classroom experience. You’re learning one-on-one with an engaging teacher—who is an avatar. Everywhere you turn your head, you’re in a private virtual classroom that is tailored exactly to your needs and learning objectives.
Virtual reality (VR) technology is shaping the future of schooling for children with ADHD. VR creates effective learning environments free from distractions. It can be used as a tool for therapists and health care professionals to accurately assess and diagnose the severity of ADHD. Additionally, numerous studies have shown that VR can improve memory, higher-level thinking, and attention in children with ADHD (Bashiri, Ghazisaeedi, & Shahmoradi, 2017). This field is growing quickly and gives hope that learning environments tailored to children’s specific challenges and needs will soon be developed. VR may soon be used to help children ignore distractions—there’s a clinical trial at University of California Davis in conjunction with the National Institute of Mental Health that’s recruiting subjects to study VR attention-management software.
Parental Rating of ADHD Symptoms and Race
Often, parents and teachers help diagnose ADHD by rating the child’s symptoms and reporting them to a clinician. Various studies have reported that African American and Latinx children have lower rates of ADHD diagnosis and treatment than Caucasian children, which may be due to access to medical care. But a recent study found that children’s symptom severity as rated by parents may be influenced by race. The researchers found that African American mothers rated boys higher for ADHD than Caucasian mothers did, suggesting that parents’ assessments may be influenced by cultural aspects of how ADHD symptoms are perceived. This could also mean that while African American children seem to be underdiagnosed with ADHD, those who are diagnosed may be classified as having more severe ADHD than Caucasian children. This could lead to setbacks academically or socially as children are not being rated with the same symptom severity across the board (Barrett & DuPaul, 2018).
The issue of birthday cutoffs for school enrollment in various states has been shown to have real consequences—from academic outcomes to sports. A new study from Harvard Medical School found that birthday cutoffs could also affect ADHD diagnoses. Children born in August who lived in states with a September 1 cutoff date were 30 percent more likely to be diagnosed with ADHD than their peers (who may be close to a year older) (Layton, Barnett, Hicks, & Jena, 2018). This could result in a younger child with less-developed self-control strategies being in the same classroom as more-developed children, which could create distraction. More research like this will hopefully follow to shed light on systematic ways to reduce and manage ADHD diagnoses in children and create avenues for future policy changes aimed at better childhood outcomes.
New research into the field of epigenetics has explored how our genes are affected by environmental exposures. Essentially, certain exposures can turn some genes on or off, causing certain phenotypes to be expressed. A recent preclinical study found that male mice exposed to nicotine had children and even grandchildren with increased hyperactivity and attentional difficulties, due to epigenetic modifications of certain genes in their sperm (McCarthy et al., 2018). This means your grandparents’ health choices affect your health in some way, big or small. The good news is that we’re starting to understand modifiable factors that can affect health for generations down the road and that the lifestyle choices you make can influence your epigenetics, giving you more control over your health and susceptibility to various diseases. .
Clinical Trials for ADHD
Clinical trials are research studies intended to evaluate a medical, surgical, or behavioral intervention. They are done so that researchers can study a particular treatment that may not have a lot of data on its safety or effectiveness yet. If you’re considering signing up for a clinical trial, it’s important to note that if you’re placed in the placebo group, you won’t have access to the treatment being studied. It’s also good to understand the phase of the clinical trial: Phase 1 is the first time most drugs will be used in humans so it’s about finding a safe dose. If the drug makes it through the initial trial, it can be used in a larger phase 2 trial to see whether it works well. Then it may be compared to a known effective treatment in a phase 3 trial. If the drug is approved by the FDA, it will go on to a phase 4 trial. Phase 3 and phase 4 trials are the most likely to involve the most effective and safest up-and-coming treatments.
In general, clinical trials may yield valuable information; they may provide benefits for some subjects but have undesirable outcomes for others. Speak with your doctor about any clinical trial you are considering.
Where Do You Find Studies That Are Recruiting Subjects?
You can find clinical studies that are recruiting subjects on clinicaltrials.gov, which is a website run by the US National Library of Medicine. The database consists of all privately and publicly funded studies that are happening around the globe. You can search for a disease or a specific drug or treatment you’re interested in, and you can filter by country where the study is taking place.
Tanya Froehlich, MD, a pediatrician at Children’s Hospital Medical Center in Cincinnati, is asking what a lot of parents are asking: What happens when my child with ADHD eventually stops taking Ritalin? Froehlich is recruiting children with ADHD to take methylphenidate for eight weeks and then be randomized to either quit or continue taking it. With the mounting concern over the effects of stimulants on children and the numerous side effects of these drugs, the researchers are trying to determine whether there are also brain changes that persist after the medication is discontinued. This clinical trial is currently recruiting and should help shed light on the side effects of Ritalin.
New Drug Trials
There is generally less risk assumed when you enroll in a phase 3 or phase 4 trial as safety has already been proven (in phase 2). There are several drug companies developing new medications for ADHD for adults and children alike.
Researchers at Supernus Pharmaceuticals are recruiting for a phase 3 clinical trial to determine the effectiveness of low doses of SPN-812 ER in adolescents ages twelve to seventeen.
KemPharm is conducting a clinical trial for a new ADHD. They are recruiting children ages six to twelve across the US to take part in a phase 3 study of KP415.
To find other drug trials recruiting for ADHD that are phase 3 or above, you can filter in the lefthand column on the search results page for ADHD on clinicaltrials.gov.
Teen Substance Abuse
People with ADHD are at increased risk of developing a substance abuse disorder. A clinical trial led by William E. Pelham, PhD, the director of the Center for Children and Families at Florida International University, is hoping to determine the most effective treatment for reducing substance use in teens with ADHD. The study is recruiting adolescents ages twelve to sixteen who are diagnosed with ADHD and at risk for substance use. The adolescents and their parents will undergo five sessions of either individual cognitive behavioral therapy combined with parental training or CBT and parental training along with stimulant medication.
Deep Transcranial Magnetic Stimulation (DTMS)
Because individuals with ADHD may have reduced activity in the prefrontal cortex of their brain, various techniques are being developed to alter these differences, such as neurofeedback and deep transcranial magnetic stimulation (DTMS). Brainsway, an Israeli company, has developed coils that administer noninvasive magnetic stimulation to the brain in order to treat mental disorders, such as depression, and potentially ADHD. The phase 1 study is recruiting adults to receive DTMS to various areas of their brain five days a week for three weeks. Hopefully the results give us better insight into noninvasive treatments for ADHD.
Autism and ADHD
Duke University child clinical psychologist Geraldine Dawson, PhD, knows that a combined diagnosis of ADHD and autism can be extremely difficult for children and their parents. Studies show that these children tend to have worse outcomes than children with either diagnosis alone. And parents may not know the best place to start in terms of treatment. This clinical trial aims to determine which is a better option: twenty-four weeks of parental therapy or parental therapy in combination with amphetamines.
The call for natural alternatives to stimulant medications has been heard by researchers in Brazil. Professor Eugenio Grevet, PhD, and his colleagues at Hospital de Clínicas de Porto Alegre are studying rhodiola as an herbal treatment for adult ADHD. Their clinical trial is in phase 4 and involves just a single dose of 800 milligrams of rhodiola. Grevet is also recruiting for another phase 4 clinical study that is a bit more involved. Patients will receive 200 milligrams of rhodiola four times a day for a month to determine its longer-term effects on ADHD symptoms. Fingers crossed for more evidence-based herbal treatments for ADHD.
Cognitive Behavioral Therapy (CBT) for Adolescents
The gold standard for ADHD treatment among adolescents is stimulant medications. There is not solid evidence for the effectiveness of any particular psychotherapy within this age group. Lily Hechtman, MD, FRCP, a professor of psychiatry and pediatrics at McGill University Health Center in Canada, is recruiting adolescents with ADHD for a clinical trial that may change this. Hechtman is trying to determine if CBT and skills training for twelve weeks can help improve ADHD symptoms while also strengthening social skills, time management, self-esteem, study skills, impulse control, and a range of other learning objectives. Developing unique therapy programs for ADHD treatment in this population is critical and will help create a larger portfolio of treatment options that children and parents can tailor to their specific goals and clinical needs.
•The Centers for Disease Control and Prevention (CDC) offers general information on ADHD symptoms, diagnosis, treatment, and statistics.
•CHADD offers information, resources, and support networks for people with ADHD and their parents.
•Understood provides educational resources for parents related to learning, school support, and empowering and parenting children with ADHD.
•Driven to Distraction by Edward M. Hallowell, MD, and John J. Ratey, MD, is a guide to understanding and living with ADHD and supporting loved ones with the diagnosis.
•Thriving with ADHD by Kelli Miller, LCSW, MSW, is an educational workbook for children with ADHD to better understand their diagnosis.
•Take Your Pills is a Netflix documentary about Adderall and stimulant use and abuse.
Reading on goop
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This article is for informational purposes only, even if and to the extent that it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The information and advice in this article is based on research published in peer-reviewed journals, on practices of traditional medicine, and on recommendations made by health practitioners, the National Institutes of Health, the Centers for Disease Control, and other established medical science organizations; this does not necessarily represent the views of goop.