We’re back this week with a continuation of this fantastic conversation about ADHD with Dr. Staci Bolton. Today Dr. Bolton answers your questions about treatment alternatives to medication, how to help your teen develop stronger executive functioning skills, and how to discipline when ADHD is a factor. Don’t miss Dr. Bolton talking about how girls with ADHD Inattentive often fall through the cracks.

Links from today’s show:

Dr. Staci Bolton’s Atlanta area practice

Smart But Scattered by Dawson and Guare

Taking Charge of ADHD by Barkley

RussellBarkley.org

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Question 4: What treatment options besides (or in addition to) medication can be helpful for ADHD? CBD, play therapy, strict diets, etc.

Dr. Staci’s Answer: That’s definitely a common question in my office. The most effective treatment is usually multi-pronged and may even shift some over time. I am a strong proponent of skills training - for the child or adolescent and for the parents.  Even if a child or adult is taking medication with a positive impact, changes will need to take place. Many individuals with ADHD struggle with their sense of time, planning, getting started, seeing tasks through to completion, which are examples of executive functioning skills. These challenges typically need a targeted approach to see progress. Cognitive-behavioral therapy and behavioral modification strategies are typically most effective. Environmental changes are often necessary and usually helpful as well. For example, classroom management strategies for a child or removing certain distractions in the home or work environments. In other words, a child may need to be seated in the front of the classroom, closer to the teacher and intentionally separated from disruptive peers. An adult may need to establish a more organized workspace with less noise and develop an accountability system for producing work tasks or meeting other specific expectations like sales goals. For the highly active kids and adults, increased opportunities for movement breaks and regular exercise programs are critical. For example, the mom of Michael Phelps, the Olympic swimmer, has publicly shared about the gift swimming was for helping manage Michael’s ADHD symptoms while he was in middle school. There is a lot of information and several programs available about specifically teaching self-regulation strategies to alert and calm the body. 

A discussion of diet and ADHD could easily be a whole podcast. The websites I gave earlier address this question to some extent and there are nutritionists and naturopaths who are far more educated about nutrition and supplements than I am. A couple of simple strategies are to increase protein - the body uses protein to make neurotransmitters, which are the chemicals used for communication in the brain. Protein also helps with blood-sugar regulation, which can help with hyperactive and impulsive tendencies. I have been interested in the research regarding Omega 3s over the years. I have had several clients who have seen noticeable improvements in focus with Omega 3 supplementation. Nutritional deficiencies certainly can play a role as well. Some docs will suggest testing a child to see if he/she is low in zinc, magnesium, B vitamins, among others and offer supplementation recommendations as needed. I haven’t seen consistent evidence to support following a particular or strict diet, but I have worked with families who have found dietary changes very helpful. Of course, there are a lot of parents who assert that reducing sugar intake or avoiding certain processed foods improves their child’s self-control and behavior. In general, the common recommendation is the same as it is for all of us - to maintain well-balanced, healthy diets with reduced sugar and artificial preservatives and dyes. 

I also must briefly mention sleep. Many children with ADHD struggle with sleep. Improving sleep habits often yields significant gains in their behavior. If a person with or without ADHD is struggling with sleep, I highly recommend seeking professional support to establish healthy habits for the nighttime routine and sleep environment. We know fatigue decreases attention as well as emotional and behavioral self-regulation, but for some reason, the importance of sleep is often undervalued by families. 

This may be a good point to mention the value of spiritually-oriented treatment strategies as well. It is certainly important to understand how individuals view themselves to ensure that experiencing the challenges of ADHD does not negatively impact their view (or even their parents’ view) of how they were intentionally created by God in His image and their inherent worth. Again, this could be the topic of a whole episode, but I want to be sure I mention the importance of families sharing relevant scriptures and prayer time together as they navigate the other areas of treatment I mentioned. Many families I work with find direction, comfort, and sustaining hope through their relationships with God and practicing spiritual disciplines to grow their faith and trust in Him. There are certainly many faith-based skills that can be taught to help families cope better with their challenges with ADHD.  

Question 5:  Can Executive Dysfunction be separate from ADHD? What is the best way to help a teenage boy with this?

Dr. Staci’s Answer: ADHD is generally considered a disorder of executive functioning. Some researchers have even proposed changing the official name to focus more on the executive dysfunction construct and better explain the range of challenges individuals with ADHD experience. It is thought that ADHD essentially disrupts the brain’s executive system. There are different theoretical models to explain this that go beyond the scope of our discussion today. As a clinician, I think it is meaningful to assess what aspects of executive functioning are most challenging for an individual in order to help determine how to implement the best strategies to improve their daily functioning. For some individuals with ADHD, the emotional dysregulation piece can be a focal point, while others may struggle more with inhibiting impulsive behaviors or with planning and problem solving. While it is certainly possible that a teenager could struggle with one or more areas of executive functioning, most individuals with ADHD see disruptions in most areas, but to varying degrees.  It is important to keep in mind that all teens and young adults are developing their executive functioning skills. So, just because your teen may lack reasonable self-awareness or fail to plan well to meet a project deadline, it does not mean he or she has ADHD. As parents, we need to model and coach our teens to develop these important self-management skills. We can help equip them with systems and strategies to help them manage their time, organize their materials, plan their activities and study tasks... We can ask questions that prompt them to think and to plan. For example, instead of reminding your son what he needs to pack in his bag for his baseball game, ask him what he needs to bring in order to prompt him to brainstorm on his own. Or if your teen has two quizzes and a test the next day and a dance class that evening, ask her how much time she thinks she will need to study and when she plans to do it. So, you are modeling and showing them how to anticipate and plan rather than managing their time or their tasks for them. There is a series of books called Smart but Scattered by Dawson and Guare, and one of them is specific to teens. I expect this mom would probably find several helpful strategies there.  

Question 6:  Can you give me any information about or symptoms of ADHD - Inattentive. It's not as talked about because children aren't hyperactive so they present less overt behavioral problems. 

My daughter is the complete opposite of high energy. When she’s on meds, she’s very alert & engaged and focused but when her meds wear off she’s like a zombie and off in another world. She can’t remember something she was just told to do and just spaces out. Why does she need a stimulant to be normal & are there alternatives to the meds and loads of coffee?

Dr. Staci’s Answer: Unfortunately, inattentive girls can easily fall through the cracks. Because children without the hyperactive symptoms often don’t exhibit as many overt behavior problems, their challenges may be underestimated or even ignored, especially in a busy classroom where there are behavioral problems. As I mentioned before, some children are lacking adequate stimulation and may have a harder time activating themselves to start tasks or sustain the effort necessary to finish them. Struggling to initiate tasks and working memory deficits are two areas of executive functioning that often lead to academic stress and underperformance. Not being able to hold information in mind to follow through with multi-step directions, routines, or to complete sequential tasks often leads to frustration for both the child and their parents. These kids often need more routine, structure, or even physical checklists and charts to help them stay aware and engaged in their daily tasks. They tend to benefit from verbal prompts, written reminders or phone alarms, as well as increased accountability. I know I am repeating myself now, but it is very helpful to implement systems to reduce the tendency to forget things and lose things, and it is very important to maintain healthy habits like adequate sleep, increased physical activity, and adequate water and protein intake to improve the abilities to establish and sustain focus over time. 

Question 7:  What can we do discipline wise? We have tried sooooo many things and nothing promotes change. It’s exhausting. It alienates you. And fussing at them so many times a day damages our relationship. Three kids with ADHD in our home and it’s like being with one another amps them up by ten!!!!

Dr. Staci’s Answer: It certainly is exhausting, and unfortunately, disciplining children and teens can require a lot of trial and error. Then you may find strategies that work well but later realize you must shift them as your children mature and the needs and challenges begin to change. If you haven’t already, I would encourage you to seek cognitive-behavioral family therapy to learn additional strategies for facilitating family communication, fostering emotional connections, helping your children implement self-monitoring skills, and potentially changing your routines and environment. One well-respected book that may prove helpful is Taking Charge of ADHD by Russell Barkley. Dr. Barkley has many books that offer practical, research-based strategies related to ADHD and executive dysfunction in children. He also has books related to children, adults, and marriage as well. He has been a leading expert in ADHD research for decades. His website also offers many free articles that could expand upon several of the answers I have given today. It is www.russellbarkley.org. 

Show Credits: hosted by Karen Stubbs with Sunny Williams, written & produced by Katie Leipprandt, edited by Kyle Cummings

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