Skills Without Pills: 3 Non-Medication Treatments for ADHD

Whether or not you've ever fought in the Ritalin wars -- those fierce disputes about whether it's safe or effective or moral to put seriously distracted children on medication -- there's good reason to think about non-pharmacological treatments for your child with Attention Deficit Hyperactivity Disorder (ADHD).

Granted, at least in the short-run, medications can help with ADHD symptoms for a majority of diagnosed children, and leading experts agree they're mostly safe. But they're no silver bullet. Pills don't help everyone, and they can come with a range of mild to, in rare cases, serious side-effects, like insomnia, irritability, tics, and severe changes in moods. Moreover, studies have shown that many kids eventually just stop using medication.

The good news is that other types of help are available -- and supported by lots of evidence.

3 Non-Medication Treatments

Below are brief descriptions for three particularly well-researched coping strategies for ADHD. For more information, detail is available in a new book I've co-authored with Stephen Hinshaw, an international expert on ADHD and vice-chair of psychology at the University of California, San Francisco,  "ADHD: What Everyone Needs to Know," (Oxford, 2015).

  • Regular, intense physical exercise is not only fun and often inexpensive, but backed by a surprising amount of evidence. It's good for the brain in general, and particularly helpful for the brains of people with ADHD. Send your kids outside if possible: peer-reviewed research has shown that children who enjoyed regular outdoor playtime in a green environment had milder ADHD symptoms than other children with ADHD who were stuck indoors.
  • Behavior therapy is another top-ranked intervention, substituting for or supplementing medication. It's important to be clear, however: this does not refer to one-on-one sessions with a therapist. Rather, a professional works directly with parents and teachers to develop a system of clear expectations and limits, potentially including explicit, frequent rewards, as well as occasional, non-emotional discipline. For children with mild to moderate symptoms, this support for teachers and parents can help quite a bit. An extreme case of this approach is known as "direct contingency management," in which a child's daily life is monitored and managed, at a summer camp, or in a special classroom. The trick here is to find a trusted, experienced professional and develop good relationships with teachers.
  • Parent-training (sometimes called parent management) has a great deal of evidence-based support that it can help restore peace in conflict-torn families. Parent training teaches parents how to keep their wits together when dealing with children and adolescents who often seem to be experts in pushing buttons and challenging every limit. Still, like that joke about how many psychiatrists it takes to change a light bulb (just one, but the light bulb really has to want to change), this route requires a willingness to keep an open mind and to work hard to change entrenched habits. Parent training can be a special challenge for families of children with ADHD because a large percentage of the parents have ADHD symptoms, themselves, and may find it more difficult to stay organized or control their reactions. The best professionals in this field will help parents understand their own psychological profile, including ADHD, anxiety, and depression, and also help parents communicate with each other (in two-parent families), given the high odds of marital conflict in families with ADHD. Sometimes, treatment for the parents' psychological issues may be a prerequisite for successful parent training.

To be sure, coaching for children and adults with ADHD is also quite helpful (so kudos to this site, which combines parent training and coaching!). The caveats here are: 1) There is still need for more good research in this field; and 2) not all coaches receive training or certification, so you need to look carefully to find the right one for you or your child. (See insert: “What to Look for in a Coach.”)

Another word of caution: if you're raising a child with ADHD, you've likely already encountered what I've come to call the ADHD Industrial Complex -- the increasingly brimming market of herbal supplements, exercise programs, computer games, and other supposedly sure-fire interventions designed particularly for people determined to avoid medication.

Two words: buyer beware. You can lose a lot of money and waste a lot of time looking for quick fixes, instead of teaching your child improved self-management. Limited research does show that some supplements, including iron and Omega-3s, and, less so, zinc and magnesium, may help if your child is deficient in them. Just please don't believe everything you read on the Internet. This market is unregulated, so check with your doctor when possible.

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