Ok, so you or your child have been diagnosed with ADD or AD/HD… now what!? The sheer volume of information floating around in the universe out there is overwhelming, intimidating and often contradictory. Adding to the confusion and frustration is the fact that everyone else out there seems to feel they have a moral obligation to express their opinion on the evils of using (or NOT using) medication to treat ADD. If you’re shocked that some people might have a negative response to not using medication, try telling a medical professional who treats ADD that you’re thinking of trying an alternative treatment method.
The bottom line in evaluating any treatment approach to ADD (or anything else for that matter) is whether or not it makes sense for YOU. With a minimal amount of effort, you can find pros and cons to every single treatment approach out there. You will find studies and statistics that will tell you medication is the single most effective treatment option and that not medicating yourself or your child puts you or them at risk for a laundry list of issues ranging from low self esteem to severe addictions. You will also be able to find horror stories about individuals who were over medicated or had adverse reactions as a result of taking ADD medication. Researching alternative treatments can be just as exasperating as you browse endless web pages promoting everything from nutritional supplements to manipulating your brain waves – a vast majority of them claiming to have the “silver bullet” to “curing” ADD.
After navigating the dense forest of information myself, and getting lost on more than one occasion, I became determined to blaze a trail for those who come along behind me. I made myself a promise to help other parents and adults find their way while hopefully avoiding the pitfalls that I landed in. It’s the reason I became and ADD Coach and the reason I started this blog, so this post is the product of my journey and hopefully it will reach the people who need it before they get lost in the wilderness.
The first suggestion I have, and probably the most important step, is learning all that you can about what ADD is and what it isn’t. You will run into people who believe ADD is a myth, that every child who can’t sit still or every adult who forgets appointments has an ADD label stamped on their forehead by a doctor that wants to pump them full of stimulant narcotics and send them on their merry way. Those are often the same people who tell you that your child just needs more discipline and you need to have more patience, or that adults who are labeled ADD just need more self-discipline and learn to be responsible. My advice when you encounter one of these individuals is to smile politely and walk away.
Attention Deficit Hyperactivity Disorder is a neuro-biological brain difference. What that means in plain English is that people with ADD have brains that are physically and chemically different from the brains of average people. Click here to read an article by Carol Bogart about how the ADD brain is different and see an image of a comparative brain scan between someone who has ADD and someone who doesn’t. The main thing that you need to know is that there is solid medical evidence to indicate that ADD brains produce less Dopamine and (in some cases) Seratonin and that there are abnormalities in the prefrontal cortex as well as two other areas of the brain. If you want to have any hope of truly understanding ADD and managing it for yourself or your child, then you need to gain at least a basic understanding of what that all means, so I’ll try to explain the most important facts I’ve learned in language that won’t put you to sleep. I have linked a lot of terms in this post leading to more in depth information for anyone who wants more technical explanations or is in desperate need of a nap. The links are in bold and are sometimes hard to see, so if you’re curious about a topic or want more information on a book or product I reference, try clicking on the bold typed words.
Neurotransmitters: Most people know that “commands” are sent out from your brain as electrical impulses. So, I always thought that brain cells were linked in an extensive and complex network not unlike all the cables required to connect my TV to the DVD player. I was surprised to learn that brain cells actually aren’t linked at all. Instead, there are tiny chemicals called neurotransmitters that act as messengers by transporting signals from one brain cell (synapse) to another. The key to understanding how it all works is realizing that our brains have many different TYPES of synapses (cells) that serve different purposes, therefore the brain makes different types of neurotransmitters which are specially designed to connect to specific types of cells. Some common examples of neurotransmitters are Dopamine, Seratonin, Adrenaline, Noradrenaline and Norepinephrine, just to name a few.
Blood Brain Barrier: Normally the tiny blood vessels (capillaries) supplying blood to our body have thin walls that highly “permeable” meaning they allow substances in our bloodstream to pass through the vessel walls and into other parts of our bodies. The capillaries in the brain, however, are different. They have thicker walls which don’t allow as many substances to leave the bloodstream and pass through the vessel walls into the brain. The blood brain barrier (BBB) is designed to help protect our sensitive brains from substances that could potentially harm it. Unfortunately, in some cases the same system prevents things that could help us, like certain medications, from crossing out of our bloodstream and into our brain.
Precursors: We’ve established that your brain can’t function properly without neurotransmitters, but what I haven’t yet mentioned is that some neurotransmitters cannot cross the blood brain barrier. The brain cannot get these necessary chemical messengers from food or even from our blood stream, instead it must manufacture the chemicals itself. It does this by using precursors that in some cases CAN cross the blood brain barrier. Precursors are basically ingredients used by the brain to cook up the neurotransmitters it needs in order to work smoothly. Different neurotransmitters require different types of precursors in the same way that making different types of food requires certain ingredients. If you want to make a soft, spongy bread you have to have yeast… if you want to make a chocolate cake you’re going to need chocolate.
Dopamine: The neurotransmitter Dopamine is in the same chemical family as Adrenaline and Noradrenaline. In fact, Dopamine is the precursor or “building block” of Adrenaline. It has a key role in the brain’s motivation and reward system as well as the central nervous system – the system responsible for controlling movement of our bodies, sensation, thinking, memory and speech. Not having enough Dopamine in your body can make anyone shaky, weak, confused and have difficulty focusing. Low levels of Dopamine have also been associated with cravings, low sex drive, depression, anxiety, psychosis, schizophrenia, Parkinson’s Disease and ADD/ADHD. Click here to read more about Dopamine and how it affects you. It’s also helpful to realize that Dopamine, Serotonin and Norepinephrine are all related neurotransmitters and there is a link between the production of Dopamine and Norepinephrine in the brain.
Dopamine is the primary chemical your brain produces to give you that “warm fuzzy” feeling as a reward for certain actions. For example; when you eat food, your brain produces Dopamine as a reward in order to motivate you to continue seeking out food so the body can survive. We don’t eat just to get rid of the uncomfortable sensation of hunger in our bellies, most of us enjoy eating and derive a certain measure of pleasure from having our favorite foods. Certain drugs can stimulate high levels of Dopamine production in the brain which result in a “high” feeling. When the Dopamine levels begin to drop it produces a sense of depression and sluggishness that can only be reversed with another spike in Dopamine. Through this mechanism, the brain quickly becomes conditioned to seek substances or activities that increase Dopamine production which can lead to an addiction to that substance or activity.
Understanding ADD behavior and treatment of ADD behavior requires that you have a good grasp of how Dopamine works in the brain. If my explanation above didn’t make sense, please seek out other resources until you feel like it makes reasonable sense to you. If a “silver bullet” for ADD exists, it’s in learning to regulate or manipulate the production of Dopamine in your brain as well as learning to recognize the behaviors that are produced by altered Dopamine levels and figuring out how to best manage them. It’s a simple matter of cause and effect: ADD is an inherited condition that affects several mechanisms in the brain. One of the primary mechanisms affected is the Dopamine system which does not produce enough of the neurotransmitter to support “normal” function. Even the average person’s brain is driven to seek out Dopamine, so in an individual with abnormally low levels of the chemical the drive is significantly stronger to repeat activities or consume substances that will help them function more normally and feel better by triggering their brain to produce Dopamine.
I can’t stress strongly enough that ANY substance or activity that causes the brain to produce Dopamine can become repetitive or addictive behavior for ANYONE, but especially those with ADD. So, the key question is: What activities and substances trigger the brain to produce Dopamine? The simplest answer is that ANYTHING that is pleasurable, such as food, sex, alcohol or shopping, can trigger the brain to produce Dopamine. Since Dopamine is involved in the production of Adrenaline, exciting activities like exercise, extreme sports, driving fast or even arguing can work towards trying to satisfy the brain’s desperate attempts to increase Dopamine levels. Beyond these few obvious examples, there is a much more subtle implication that you need to be aware of. What is pleasurable or exciting depends on the individual and the list of activities or substances that can be come addictive or enticing is literally infinite.
Addictive or Harmful Behavior: Eating, in and of itself, is not a problematic activity… we have to eat to survive, after all. The issue arises when activities are undertaken in a potentially harmful manner. It’s not alarming for a child to enjoy sweets, but it IS detrimental when a child craves sugary foods to the extent that she is constantly demanding them and is willing to steal them at every opportunity in order to satisfy an insatiable biological need for the pleasure sensation eating the sweets produces. As a side note, low blood sugar levels increases the production of Serotonin in the brain which in turn lowers the Dopamine live. It’s perfectly normal for a child to get hurt occasionally while playing. It is NOT normal for a child to repeatedly take physical risks that they are old enough to understand could likely result in injury in order to get Adrenaline rush their body needs. Flirting, caffeine, smoking, illegal drugs, conflict, perpetually starting new romantic relationships, cheating, stealing, gambling, playing video games… literally anything that gives pleasure or causes your heart to pound can become habitual and/or addictive to someone with ADD.
Treatment: The “treatment” of ADD really only falls into two categories; manipulating the Dopamine system or manipulating the habits of the individual. There are a myriad of options for both treatment approaches, but the most effective way to combat the negative affects of ADD is to make sure you use both approaches. The best success is achieved when the person with ADD increases the amount of Dopamine available to their brain, and works to break harmful habits associated with Dopamine-seeking behavior by creating new habits that are healthy and productive.
Recipe for Neurotransmitters: As a disclaimer, you should consult a doctor or nutritionist prior to starting any new dietary supplement. So, now that the legal drama is out of the way, here are the facts… the precursor or “ingredient” your brain uses to manufacture Dopamine is the natural amino acid Tyrosine (also called L-Tyrosine or 4-Hydroxyphenylalanine.) Dopamine doesn’t cross the blood brain barrier, so you can’t just take it in pill form. However, Tyrosine does cross the blood brain barrier and you can purchase Tyrosine supplements here (or at any natural food store) or click here to purchase Tyrosine in a cherry flavored spray if you’re using it for a child or have difficulty swallowing tablets. Additionally, consuming any type of protein first thing in the morning can help your brain to manufacture more of the Dopamine it needs.
To Medicate or Manipulate: It is not fully understood by the medical community exactly how ADD medication works. There are several theories: One guess is that ADD medication increases the amount of Dopamine and Norepinephrine the brain produces. Another proposes that ADD medication “activates” the neurotransmitter receptors so that Dopamine and Norepinephrine can be used more efficiently. Yet another theory is that ADD medication somehow regulates the flow of neurotransmitters much like a carburetor controls the flow of gasoline to an engine. All three theories are potential correct in part or in whole, but it’s the last one that should be of interest to someone with ADD. If theory #3 is correct in any way and the main function of ADD medication is to manipulate the neurotransmitters that already exist in the brain, then it stands to reason that the medication needs neurotransmitters to manipulate in order to work properly.
More Manipulation: One of the most effective natural treatments available for ADD & ADHD, depression and anxiety is exercise. It is a medical fact that exercise produces endorphins and raises Dopamine, Norepinephrine and Serotonin levels in the brain. According to Harvard trained psychiatrist Dr. John Ratey, walking for just 30 minutes is the chemical equivalent to a dose of Ritalin and a dose of Prozac. In his book Spark: The Revolutionary New Science of Exercise and the Brain, Dr. Ratey explains how and why exercise has such beneficial effects on the brain. Furthermore, he explains how exercise can be just as effective as Zoloft at controlling anxiety. To purchase “Spark” at Amazon.com click here. If you struggle to sit still and read or have a hectic schedule, you can click here to go to Audible and purchase “Spark” on audio book instead. One thing to keep in mind, is that the effects of exercise wear off in about the same amount of time that a standard release dose of Ritalin would… about 2-4 hours, depending on the individual.
Brain Health: In addition to taking steps to make active changes in the chemical makeup of you or your child’s brain, there are also a few simple things that can improve the overall health and function of the brain. The easiest thing you can do to improve cognitive performance is to drink enough water. Brain cells use water to flush away toxins and cellular waste, so dehydration inhibits the body’s natural means of detoxifying. Even mild dehydration can cause mental fatigue, memory problems and confusion. Another necessary component of a healthy brain is Omega 3 Fatty Acids. Among other things, Omega 3′s improve a brain cell’s receptiveness to neurotransmitters. Omega 3′s and Vitamin D3 both help keep inflammation in the body under control, which has been found to play a role in feelings of depression, a common co-existing condition of ADD. Click these links for information on Omega 3 or Vitamin D3 supplements. If you experience difficulties with fat malabsorbtion, click here for a specialized formula.
Reducing Interference: You will find a significant number of resources out there claiming that changes in diet will “cure” ADD. I find such claims annoying, mainly because it’s ludicrous to assert that eliminating certain foods from your diet can change the physical structure of someone’s brain. However, I do believe it is possible for certain foods and chemicals we consume to impact brain function, particularly in individuals with ADD. It is a fact that gluten and milk (casein) proteins (and possibly soy) do cross the blood-brain barrier. There is mounting evidence to indicate that these proteins can have a negative effect on the brain and a growing amount of support for gluten, soy and casein-free diets improving symptoms in individuals with ADD and Autism Spectrum Disorder. Casein in particular has been indicated in a number of health issues detailed in the book The China Study which is available as a paperback (click here) or on audio book (click here.)
Chemicals: Food dyes, artificial sweeteners and additives such as MSG have long been suspected of playing a role in behavioral problems in children and those claims have gained some credibility in the past few years. Most recently, the FDA was petitioned to ban food manufacturers from using artificial dyes and other additives. While we would all agree that it’s healthier to eat whole foods that are additive free, eliminating all of the potential problem ingredients from your family’s diet is a difficult and daunting task. Casein (milk protein) is found in all dairy products, but also shows up in the most unsuspecting places… like McDonald’s french fries. Wheat gluten is in everything from bread to noodles and requires a concerted effort to avoid consuming it. Food dyes and artificial sweeteners aren’t just limited to food but are also used in candy, gum and toothpaste. Worst of all, dyes show up almost across the board in medication in the form of colored liquids, coatings and capsules. It’s more than frustrating when the majority of the ADD medication out there designed to help your child focus also contain artificial dyes that can produce behavioral problems. If you or your child need medication to manage your ADD, ask your health care professional which ones come in granules. The capsules of some medications, such as Focalin XR and Adderall XR, can be opened and the granules sprinkled on the tongue or onto food and the dyed capsule can then be discarded.
Allergies: The main way that allergies may be a factor in exacerbating ADD symptoms is by causing a mental fog that inhibits alertness and concentration. We can all sympathize with the feeling of being groggy and “out of it” when we have a head cold, and a similar state of mind can be caused by allergies. New allergies can also develop as a we get older, so consider allergy testing if you have concerns.
Hormones: It is not well known by many health care providers that a drop in a woman’s estrogen levels can cause stimulant medication for ADD to be ineffective. Declining estrogen during menopause can produce foggy thinking and memory issues in all women, so the effects can be even more magnified for a woman with ADD. Similarly, adolescent girls frequently have hormone fluctuations that can render their ADD stimulants virtually useless at their usual dosage. Here are links to two articles about the relationship between hormones and ADD symptoms in women and girls: Article #1 & Article #2
Sleep Deprivation: It’s unclear why there is a relationship between ADD and sleep disorders, but the relationship exists nonetheless. Even children with ADD tend to have issues falling asleep, staying asleep and/or waking up from sleep. To make the matter more confusing, sleep deprivation produces ADD-like symptoms: difficulty concentrating, memory problems and mood issues. It’s not uncommon to find “experts” who claim that sleep disorders cause ADD & ADHD. My experience has been that treating insomnia can alleviate ADD-like symptoms in some individuals, but it does not cause the brain abnormalities responsible for life-long struggles with ADD. That said, lack of sleep certainly does make ADD symptoms worse for those of us who suffer from it! Addressing sleep issues should be part of any ADD management plan. There are safe, natural options for improving sleep (such as use of a Melatonin supplement) as well as relatively safe pharmaceutical options like Clonidine, Lunesta and others. If sleep is an issue for you or your child, talk to your treatment provider about options. Click here to read more about sleep disorders and ADD.
Habits and Behavior Modification: Improving the amount and availability of neurotransmitters in the brain, whether through medication or natural methods, is only half of the battle when it comes to ADD. It’s a condition that some people are born with and by the time it is diagnosed and treatment of any kind begins, most of us have already developed some habits and behaviors as a result of the way our ADD brains are built. Not all ADD traits are negative! We can be highly creative, energetic, extremely visual, have an excellent sense of humor, a natural understanding of technology and a higher than average I.Q. On the down side is the difficulty concentrating, lack of follow through, trouble with planning and organization, a poor sense of time and a tendency to be easily overwhelmed. Few people realize that individuals with ADD can also have trouble over focusing, a state called “hyper-focus” which causes the sufferer to have extreme difficulty stopping one task and switching to the next. They will tend to ignore everything else around them and get “stuck” doing one thing for hours on end… like spending all day writing a novel-length blog post about ADD!
Brain Training: While medication (or other means of manipulating the Dopamine system) will improve a fair number of ADD symptoms, some become ingrained in our personality as a mindset rather than a medical problem and most people find themselves or their children still struggling with some of the ADD behaviors that cause them heartache. This may in part be because of the physical differences in the way the prefrontal cortex of the ADD brain is constructed. Two studies conducted by the National Institute of Mental Health, called the MTA Studies, determined that children who received combined or “multi-modal” treatment of both medication and behavioral therapy showed the highest long-term improvement when compared with children who received only medication therapy or only behavioral therapy. Click here to view a summary of the studies.
While nearly all resources you’ll find on children with ADD will recommend some kind of behavior modification plan, I found it nearly impossible to find any guidance on how to develop one – particularly for young elementary school children. After searching extensively, I stumbled across a copy of ADD/ADHD Behavior-Change Resource Kit: Ready-to-Use Strategies & Activities for Helping Children with Attention Deficit Disorder at a used book store and was awestruck at the depth and detail of the information it offers. The link I provided will take you to Amazon.com where you can purchase your own copy, complete with checklists, questionnaires and forms to help walk you through developing a plan for your child.
Behavioral Therapy for Adults: Behavioral management plans might be effective for children, but what about adults? We struggle endlessly to hold ourselves accountable to changing our bad habits and modifying problematic behaviors. That’s where Coaching and/or Cognitive Behavioral Therapy (CBT) enter into the picture. The primary difference between the two is that a Coaching program is driven by the person being coached, whereas CBT tends to be directed more by the therapist and can be used for psychological disorders beyond the scope of ADD. Coaching offers the convenience of being able to have sessions over the phone as well as providing the extra structure of being accountable to someone for the goals you set. Whether to choose a coach or therapist depends on your individual goals and needs. ADD Coaches, like myself, will frequently offer a free initial session to help you determine if coaching is the best approach for you and to make sure that the client and coach are compatible.
Another “brain training” approach that has only recently achieved the status of being considered an “evidence based” treatment option is Neuro Biofeedback (NBF). Essentially, it involves monitoring the level of certain types of brainwave activity and using a feedback method, such as a video game or watching a movie, to helps children and adults learn to increase the types of brainwaves associated with attention and concentration. In short, it’s a type of focus training. There are even some games that use the technology like the Star Wars Science – Force Trainer and the Mindflex Game by Mattel. Several new studies have given credibility to NBF as a treatment option for ADD.
Supporting Common Sense: Now that you’ve had a crash course in ADD causes and treatments, it’s up to you to determine what the best approach is for managing ADD in yourself or your child. I won’t sugar coat it, it’s still a confusing, exhausting and often frustrating undertaking. But, when you gain a measure of control over the situation the reward is definitely worth it, and your brain will give you a satisfying little dose of Dopamine to encourage you to continue! The moral of the story is that the treatment options you choose have to make sense for you and your family. Finances, time and available resources may affect your choices and the results will likely be the product of a lot of trial and error. It’s important to know that you aren’t alone and to develop a support system of people who understand what you’re going through and can offer a sympathetic ear. There are message boards and forums all over the web and a nationwide organization called Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD) offers support groups in a number of areas across the country.
I’ll end with repeating my advice about taking the first, and most important, step: educate yourself as much as you possibly can. The more you know about ADD/ADHD the better your chances of coming up with a management plan that will work reasonably well for you. Just remember that it is an ongoing process, constantly in need of tweaks, reevaluations and a boatload of patience. This post was written to give you an overview of what you’re dealing with and a “quick-and-dirty” summary of some the options you have available.