Helping the estimated three to seven percent of school-age children and four percent of adults who have Attention Deficit Hyperactivity Disorder (ADHD) is a challenge. Medication—usually a stimulant—is routinely prescribed to manage symptoms. But it doesn’t help everyone and many people worry about side effects, such as a decreased appetite and sleep problems. So it’s no surprise that parents of children with ADHD and adults who have the condition search for alternative therapies. Here an overview of some of the more commonly used ones. While they may not rule out the need for medication, they may allow some people to reduce their dosage.
Structure, structure. This strategy involves sticking to a set bedtime and wakeup time; and organizing the household so school and office supplies, clothing and toys are in a specific place—and there’s less chance of misplacing them. “In general, people with ADHD have trouble creating internal structure,” says Ari Tuckman, a psychologist in West Chester, Penn., and former vice president of the Attention Deficit Disorder Association. Because creating schedules and being organized form an external structure, the person with ADHD doesn’t have the pressure of remembering things. “These external structures reduce the need for internal structure,” says Tuckman.
The verdict: People with ADHD also have trouble creating and sticking to an external structure. “It is an unfortunate irony that one of the things that could be helpful is one of the hardest for people with ADHD to do,” says Tuckman. Still, it’s worth a try.
Exercise. Restlessness and hyperactivity are common in people with ADHD. “Exercise is a good way to burn off that restlessness,” says Tuckman. Physical activity also boosts levels of dopamine, a brain neurotransmitter that affects working memory, says Dr. Chris D'Adamo,assistant director of medical education at theCenter for Integrative Medicineat Baltimore’s University of Maryland School of Medicine. Doing as little as 15 to 20 minutes of exercise will raise dopamine levels, he adds.
The verdict: Exercise has so many benefits that even if it doesn’t help ADHD symptoms, you can’t go wrong doing it. But you need to exercise regularly to keep reaping the benefits.
Special diets. ADHD has been blamed on food additives, dyes, preservatives and chemicals such as salicylates. Sugar has also been identified as a potential culprit. As a result, many people believe that following the Feingold Diet—which prohibits dyes, artificial flavors, preservatives and salicylates—eases ADHD symptoms. Many also avoid sugar and other natural sweeteners.
The verdict: “Good studies have consistently debunked the Feingold diet as having anything to do with ADHD,” says Tuckman. Sugar doesn’t cause ADHD either. Still, “everyone would do better if they consumed less sugar and fewer additives and chemicals,” he adds. D'Adamo says it can’t hurt to try the Feingold diet and watch sugar. “These foods may not cause ADHD, but they certainly can exacerbate problems among kids,” he explains. “Strictly following the Feingold diet might be difficult. But you can try to follow some of its tenets.”
Cognitive Behavioral Therapy (CBT). A form of talk therapy, traditional CBT helps people change the way they think and act. A variation on CBT is used to help people with ADHD. “ADHD is not the result of negative thinking,” says Dr. J. Russell Ramsay, co-director, Adult ADHD Treatment and Research Program at the University of Pennsylvania in Philadelphia. “But very often, negative or pessimistic outlooks can develop as a result of recurring difficulties or setbacks people with ADHD encounter.” In these instances, “cognitive behavioral therapy focuses on behavioral coping strategies,” explains Ramsay. “Most people will say, ‘I know what I need to do. I have a hard time doing it.’” During a CBT session, a therapist will help people with ADHD devise a daily planning system or deal with negative feelings that develop as a result of their inability to accomplish tasks. Usually, treatment consists of 12 to 20 hour-long sessions, either individually or in groups.
The verdict: “CBT is a very effective adjunct to medication,” says Ramsay, although people who don’t take medication may also benefit. Pay-offs may not be apparent until treatment ends and people may need booster sessions every few weeks.
Computer therapy. Cogmed Working Memory Training uses computer exercises to improve memory and, thus, attention in people with ADHD. It is also used to treat people who have a suffered a stroke or traumatic brain injury.
The verdict: Research is ongoing. “We can’t yet say this should be a treatment option but preliminary research warrants follow-up studies,” says Ramsay. Cogmed takes time—25 sessions focusing on tasks that target different aspects of memory. Each session, supervised by a coach, runs 30 to 45 minutes. Fees vary. For more information, visit cogmed.com.
Neurofeedback. Certain types of brain wave activity are associated with high levels of focus; others with low levels. Neurofeedback involves taping electrodes, which receive brain signals, to the head. The patient then engages in mental activities. By watching images on a screen that reflect brain wave activity, the patient can practice using brain waves that are associated with concentration.
The verdict: “We can train people to change their brain wave patterns in the office,” says Tuckman. However, research has not consistently shown that this translates into improvements in real life. The therapy is time-consuming, requiring up to 40 50-minute sessions, usually twice a week. Plus it’s pricey: Insurance usually doesn’t cover it.
Meditation. Being stressed and anxious, common in people with ADHD, has a negative effect on memory, attention span, impulse control and the ability to cope. Research published in the journal Current Issues in Education reported that after three months of practicing transcendental meditation twice a day, 10 middle school students with ADHD showed more than a 50 percent reduction in stress and anxiety. The result: The children experienced improvements in attention, working memory, organization and behavior regulation.
The verdict: “It can be tough to get someone with ADHD tosit still and quiet the mind,” says D'Adamo. He recommends trying different types of meditation such as walking meditation. “Meditation can be anything that takes your mind off a problem,” he adds.
Green play. Kids with ADHD who play outside in areas where there’s plenty of green—think grass and trees—may fare better than children who play indoors or in outdoor environments that are paved and/or near manmade structures. Researchers at the University of Illinois at Urbana-Champaign analyzed parents’ descriptions of their child’s play settings and symptom severity and found an association between regular play in green settings and milder symptoms of ADHD in the more than 400 children studied. Kids who had hyperactivity—associated with ADHD—had milder symptoms if they played regularly in an open green environment such as a soccer field or rolling lawn.
The verdict: More studies are needed. But “based on the research so far, it appears that playing in green spaces may provide some symptom relief,” says study leader Dr. Andrea Faber Taylor, a child environment and behavior researcher in the university’s Landscape and Human Health Laboratory. “All children experience developmental benefits from playing outdoors in natural spaces,” she adds. Adults benefit, too. “I strongly encourage parents to support their children’s play in green spaces and provide children with daily blocks of time to play outside.” While it’s not clear how much “green” time is enough or how long any benefits might last, “it appears even small amounts of time can produce immediate measurable differences in functioning,” she explains. That said, “more frequent experiences are likely better than infrequent ones,” she adds.