Monarch eTNS is a non-medication prescription device designed for overnight use in children with ADHD ages 7 to 12. The Monarch eTNS System is the first FDA-cleared device for ADHD with proven efficacy in alleviating ADHD symptoms, according to a small study.¹

How Does Monarch eTNS Work?

The Monarch eTNS (external Trigeminal Nerve Stimulation) System is an electronic device, about the size of a cell phone, that connects to a disposable patch placed on a child’s forehead at bedtime. Once turned on, the device sends low stimulating pulses to the trigeminal nerve through the patch overnight. The trigeminal nerve is the brain’s largest cranial nerve responsible for communicating sensations from the face to other parts of the nervous system — including brain areas involved in mood disorders, epilepsy, and attention.

Who Can Use Monarch eTNS?

Monarch eTNS is for patients ages 7 to 12 who are not currently taking prescription ADHD medication. The device should not be used by patients with an active implantable pacemaker or implantable neurostimulator, or in those with body-worn devices (e.g., insulin pumps).

What Studies Have Been Done on Monarch eTNS?

Two clinical trials compared the Monarch eTNS system’s efficacy in treating ADHD to a placebo device.

In 2014, 24 children with ADHD aged 7-14 years participated in an 8-week, open-label pilot feasibility study. After four weeks of nightly use, the Clinical Global Impression–Improvement (CGI-I) scale rated 64% of the study group as “improved” or “improved very much.” This trial showed a 47% decrease in the ADHD Rating Scale IV (ADHD-RS-IV) score and a responder rate of 71% on the Clinical Global Impressions Scale-Improvement (CGI-I) scale after eight weeks. Trial participants used the treatment as directed, side effects were minimal, and no child withdrew from the study due to adverse events, according to results published in Brain Stimulation.¹

A team of UCLA researchers published the results of the first double-blind, placebo-controlled trial examining the efficacy of the Monarch eTNS on ADHD in children in the Journal of the American Academy of Child and Adolescent Psychiatry in 2018. They concluded that more than half of the children (52%) who used the Monarch at bedtime for four weeks—under parent supervision—experienced significantly reduced impulsivity, hyperactivity, and inattention, as measured by clinician-administered ADHD rating scales compared to the placebo group (14%).

What Are the Side Effects of Monarch eTNS?

The most common side effects observed with eTNS included drowsiness, increased appetite, trouble sleeping, teeth clenching, headache, and fatigue. No serious adverse events were associated with device use.

Where Can I Learn More About Monarch eTNS?

You can learn more about Monarch eTNS at https://www.monarch-etns.com/.

Sources

^{1</supMcGough, J.J., Loo, S.K., Sturm, A., et al. (2015). An Eight-Week, Open-Label Pilot Feasibility Study of Trigeminal Nerve Stimulation in Youth with Attention-Deficit/Hyperactivity Disorder. Brain Stimulation. 8:299-304. https://doi.org/10.1016/j.brs.2014.11.013}

^{2</supMcGough, J.J., Sturm, A., Cowen, J., et al. (2019). Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 58(4):403-411. https://doi.org/10.1016/j.brs.2014.11.013}

Up to two-thirds of children with attention deficit hyperactivity disorder (ADHD) have used complementary and alternative medicine (CAM) to address their symptoms, according to a new study published in the Journal of Attention Disorders.

Nutrition modifications; natural products, such as herbs, vitamins, and minerals; and mind-body practices like mindful meditation were the most-reported CAMs. The use of alternative therapies was higher in families where the caregiver preferred natural therapies for ADHD and believed CAMs could synergistically boost conventional medicine.¹

In addition, researchers found two predictive factors for alternative therapy use: parents’ education level (the more educated the parents, the more likely alternative therapies were used) and female gender.

“It seems that parents with higher education are open-minded,” the researchers wrote. “Additionally, they usually try Internet sources, books, and even magazines and other information sources to treat their children.”

The study found that more females opted for complementary and alternative medicine than males. “One of the most important reasons for the higher CAM use in patients of the female gender is the fact that they usually employ more health services than males,” researchers said.²

For the study, researchers reviewed The Web of Science Core Collection, PubMed, and Scopus databases from inception to February 10, 2022, for reports of complementary and alternative medicine usage by patients with ADHD. Data came from 12 original papers, which included a total of 4,447 patients, all younger than 18 years old.

To the researchers’ knowledge, this is the first systematic review to examine the prevalence, possible determinants, and type of alternative therapies used by patients with ADHD.

They recommended training healthcare providers on the most common CAM therapies and possible adverse effects or interactions with conventional medications. “They [healthcare providers] should have a deeper and more informed dialog about this matter with ADHD patients, which encourages them to disclose their CAM use,” researchers said.

This study had several limitations, such as only including articles published in English, and that most studies were from the U.S. and Australia.

Sources

¹Wu, J., Li, P., Luo, H., & Lu, Y. (2022). Complementary and Alternative Medicine Use by ADHD Patients: A Systematic Review. Journal of Attention Disorders. doi.org/10.1177/1087054722111155

²Lorber, J., Moore, L. J. (2002). Gender and the Social Construction of Illness. Rowman Altamira.

Azstarys is a once-daily central nervous system (CNS) stimulant ADHD medication approved for the treatment of ADHD symptoms in patients 6 years of age and older. Formerly referred to as KP415, Azstarys comprises serdexmethylphenidate (SDX), KemPharm’s prodrug of d-methylphenidate (d-MPH), co-formulated with immediate-release d-MPH. Like all methylphenidate-containing products, Azstarys is a federally controlled substance (CII) because it can be abused or lead to dependence.

Azstarys Dosages Explained

Patients 6 to 12 years: The recommended starting dosage is 39.2 mg/7.8 mg orally once daily in the morning. Dosage may be increased to 52.3 mg/10.4 mg daily or decreased to 26.1 mg/5.2 mg daily after one week. Maximum recommended dosage is 52.3 mg/10.4 mg once daily.

Adults and Patients 13 to 17 years: The recommended starting dosage is 39.2 mg/7.8 mg orally once daily in the morning. Dosage may be increased after one week to 52.3 mg/10.4 mg once daily.

Azstarys can be taken with or without food. Patients may swallow capsules whole or open and sprinkle onto applesauce or add to water.

What are the Side Effects of Azstarys?

The most common side effects of Azstarys include:

• decreased appetite
• nausea or indigestion
• weight loss
• dizziness
• mood swings
• increased blood pressure
• trouble sleeping
• vomiting or stomach pain
• anxiety
• irritability
• increased heart rate

Azstarys and Heart Problems

If you or your child has heart problems, heart defects, high blood pressure, or a family history of these problems, your doctor should check you or your child before and during taking Azstarys; increases in blood pressure and heart rate may occur. Call your healthcare provider right away or go to the nearest hospital emergency room if you or your child experience chest pain, shortness of breath, or fainting while taking Azstarys.

Azstarys and Mental Illness

If you or your child has psychiatric problems, or a family history of suicide, bipolar illness, or depression, tell your doctor before starting Azstarys. New or worse behavior and thought problems may occur, as well as new psychotic or manic symptoms. Call your healthcare provider right away if there are any new or worsening mental symptoms or problems during treatment.

Azstarys and Circulation Problems

Talk to your doctor before starting Azstarys if you or your child has circulation problems in fingers and toes. Fingers or toes may feel numb, cool, painful, sensitive to temperature, and/or change color from pale, to blue, to red. Call your healthcare provider right away if any signs of unexplained wounds appear on fingers or toes while taking Azstarys.

Azstarys and Growth in Children

Let your doctor know if your child is having slowing of growth (height and weight) while taking Azstarys. His or her height and weight should be checked often while taking Azstarys.

Azstarys and Pregnancy

Let your doctor know if you or your child is pregnant or plan to become pregnant. It is not known if Azstarys may harm your unborn baby. Azstarys passes into breast milk – talk to your healthcare provider about the best way to feed your baby if you take Azstarys.

Precautions Associated with Azstarys

Do not take Azstarys if your or your child is allergic to any of the ingredients, including serdexmethylphenidate or methylphenidate. Azstarys should not be taken if you or your child is taking or have stopped taking within the past 14 days a medicine used to treat depression called a monoamine oxidase inhibitor (MAOI).

Interactions Associated with Azstarys

Those taking antihypertensive drugs in additional to Azstarys should have their blood pressure monitored. The use of Azstarys should be avoided on the day of surgery if halogenated anesthetics will be used.

Azstarys: Next Steps

• Free Download:A Parent’s Guide to ADHD Medications
• Free Download: Medication Monitoring Log
• Read: A Patient’s Primer on the Stimulant Medications Used to Treat ADHD
• Find: ADHD Specialists and Clinics Near You

• What is Qelbree?
• Qelbree Dosages Explained
• Side Effects of Qelbree
• Qelbree Interactions

What is Qelbree?

Qelbree (i.e. SPN-812) is a nonstimulant ADHD medication containing a serotonin norepinephrine modulating agent approved by the FDA to treat attention deficit hyperactivity disorder (ADHD or ADD) in patients 6 to 17 years of age. Its active ingredient, viloxazine hydrochloride, was previously marketed as an antidepressant in Europe. It is the first nonstimulant ADHD medication to receive FDA approval for use in children since Intuniv was approved in 2009.

Qelbree Dosages Explained

For patients 6 to 11 years of age, the recommended starting dosage of Qelbree is 100 mg once daily. This may be titrated in increments of 100 mg weekly to the maximum recommended dosage of 400 mg once daily. The recommended starting dosage for patients 12 to 17 years of age is 200 mg once daily. This may be titrated after 1 week, by an increment of 200mg, to the maximum recommended dosage of 400 mg once daily.

Qelbree capsules can be swallowed whole or opened and sprinkled onto food. Do not cut, crush, or chew the capsules.

What Are the Side Effects of Qelbree?

Qelbree can increase diastolic blood pressure and heart rate. These measures should be assessed before to starting treatment, following increases in treatment, and periodically during treatment.

Other commonly observed side effects of Qelbree include:

• drowsiness or somnolence
• decreased appetite
• fatigue
• nausea
• vomiting
• trouble sleeping
• irritability

Increased Risk of Suicidal Thoughts Associated with Qelbree

Qelbree may increase suicidal thoughts and actions in some children with ADHD, especially within the first few months of treatment or when the dose is changed. Caregivers should closely monitor any new or sudden changes in mood or behavior, and call the child’s doctor immediately if there are any new or sudden changes, or if there is development of suicidal thoughts or actions.

Qelbree and Mania or Hypomania in Patients with Bipolar Disorder

Noradrenergic drugs may induce a manic or mixed episode in patients with bipolar disorder. Before starting Qelbree, patients should be screened for bipolar disorder. Screening should include a detailed psychiatric history, including a personal or family history of suicide, bipolar disorder, and depression.

Qelbree and Somnolence or Fatigue

Activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, should be avoided until the patient knows how they will be affected by Qelbree.

Interactions Associated with Qelbree

Patients that take certain anti-depression medicines, especially those called a monoamine oxidase inhibitor or MAOI, or certain asthma medicines, should not take Qelbree.

Qelbree is a strong CYP1A2 inhibitor. Coadministration with moderately sensitive CYP1A2 substrates, such as clozapine and pirfenidone, is not recommended. Qelbree is a weak inhibitor of CYP2D6 and CYP3A4, which increases exposure of those substrates, such as dextromethorphan and alfentanil, when coadministered with Qelbree.

More Information on Qelbree and Other ADHD Medications:

A Parent’s Guide to ADHD Medications
FDA Approves New Nonstimulant ADHD Medication from Supernus Pharmaceuticals
Free Download: Take Charge of Your Child’s Medication
Free Resource: How Do We Know the Medication Is Working?
ADHD Specialists or Clinics Near You

Sources

“Supernus Announces FDA Approval of Qelbree (SPN-812) for the Treatment of ADHD.” Supernus Pharmaceuticals, Inc. (April 2021) https://ir.supernus.com/news-releases/news-release-details/supernus-announces-fda-approval-qelbreetm-spn-812-treatment-adhd

Qelbree label. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/211964s000lbl.pdf

Qelbree. Non-Scheduled ADHD Treatment | Qelbree HCP

Children with ADHD experience out-sized benefits from music. The rhythm, melody, tempo, and lyrics of music may be harnessed to help them activate focus, boost organizational skills, incentivize desired behaviors, improve ADHD symptoms, and more.

Whether it’s Mozart or Metallica, music benefits kids with ADHD, even if they’re not musicians. Here, learn creative activities your family can incorporate into daily life that turn up the volume on music’s healing powers.

The Benefits of Music for Kids with ADHD

1. Music improves attention and focus.

The temporal and rhythmic properties of music are thought to modulate some symptoms of inattentiveness. Playing, or learning to play an instrument, can also help develop skills needed for sustaining attention, alternating attention, impulse control, and decision-making. One study found that children who studied a musical instrument showed better auditory connectivity in the brain, which is often diminished in ADHD brains.

Music lessons also increase your child’s ability to work in a noisy environment, which is useful for coping with distractions.

[Click to Read: Music That Focuses the Brain]

2. Music reinforces memory.

Attaching information to lyrics and melody helps children — with and without ADHD — remember important items. Try teaching phone numbers, addresses, chores, and procedures (like washing hands or tying shoes) to the tune of your child’s favorite songs.

3. Music acts as a study aid.

For some students, listening to music while studying works well because it keeps the brain activated, focused, and less prone to distractions. There is no single musical genre that is best for studying – it is entirely individual. Whether the lyrics in your child’s preferred music are appropriate is another discussion, but don’t automatically rule out hip-hop or heavy metal; it might work to focus your child.

Encourage your child to explore genres, and to use headphones with comfortable volume levels.

4. Music helps keep track of time.

Time blindness is common with ADHD, and music helps build time perception and awareness skills. Rather than have your child do homework or chores to the beat of a timer, try playing a song or timed playlist. It may be easier for your child to keep pace with a favorite soundtrack rather than an unstimulating timer or clock. Music also teaches predictability – a certain point in a song or playlist can act as a marker, letting your child know that it’s time to move to the next step or wrap up.

[Read: 9 Hacks to “Beat” ADHD Symptoms with Music]

5. Music boosts energy.

A good tune can pump up the brain and body, upping dopamine levels and increasing your child’s motivation to tackle even the least desirable of tasks. As with study music, have your child listen to different genres to see what works best. Ask them how they feel listening to each type of music – Are they more anxious? More in the zone? Perhaps too amped up and energized?

If your child has excess energy, music and movement are great ways to channel it. Try enrolling your young child into a developmental music program (such as Music Together, Kindermusik, Musikgarten), which helps build a variety of skills through the experience of music. Older children may benefit from dance classes or other group music experiences.

6. Music promotes calm.

Just as music can boost our energy, it can also calm and soothe us, making it an effective tool for emotional regulation. Again, the choice in music is personal. Some children relax to an audio track of nature or a composition without lyrics. Others feel calm and happy while listening to an upbeat pop song.

7. Music improves self-esteem.

Too many children with ADHD experience low self-esteem. Creating music and learning to play an instrument can build self-confidence and a skill in which they can take pride. It can also teach children about the importance of practice and persistence in the process of crafting something special and enjoyable.

Music is also quite normalizing – your child can bond with peers by talking about music, the instruments they play, and their favorite bands. Joining an orchestra or band at school is great for building social skills while pursuing musical interests. As music and movement are joined at the hip, many children benefit from dance, or another movement experience that works with music.

If your child wants to learn how to play an instrument, make sure to explore a variety of them – piano, drums, guitar, cello, etc. – to find the one that truly sings.

8. Music reinforces desired behaviors.

If listening to or performing music is a rewarding activity for your child, use it to encourage follow-through. Offer a jam session or music video, for example, after your child completes their homework.

9. Music encourages introspection.

Songwriting promotes emotional expression and introspection – exercises that can help children better understand their feelings, themselves, and how to effectively communicate their feelings to others. School-aged children can benefit from partaking in songwriting activities. With teens, who are just beginning to build their sense of self and independence, songwriting can be especially fruitful for self-exploration. Parents can learn a lot about their child’s emotional state, priorities, and passions through these exercises.

There are many ways to explore songwriting, including fill-in-the-blank exercises where children swap out known lyrics to a familiar tune with their own.

10. Music teaches empathy.

Lyric analysis teaches children about point-of-view, the thoughts and feelings of others, and self-reflection. Open up a discussion with your child about a favorite song and ask them to think about what the lyrics mean. What might the artist be trying to say? What clues do the lyrics provide? Try having your child write out the lyrics on paper to truly probe them.

Benefits of Music for ADHD Brains: Final Notes

• Keep a listening log of songs and music that energize, calm, and dysregulate your child as a handy reference.
• Use music intentionally for the outcomes you’re seeking. Background music, even if your child insists they aren’t tuning in, can influence behavior and feelings.
• Do not overuse music. Children (and all of us) need quiet time, too. Too much music can lead to the point of habituation, where the benefits music may be muffled or softened.
• Music lessons? Be honest with the teacher about your child’s strengths and roadblocks so they can plan ahead (they may reorganize the studio, for example, to eliminate distractions). Look for a flexible instructor who will experiment with different methods for alternative learners. Talk to a board-certified music therapist, who may teach lessons or refer you to someone who is a good match for your child’s needs.

The content for this article was derived from the ADDitude Expert Webinar “How Music Sparks, Soothes, and Optimizes the ADHD Brain in Children” (ADDitude ADHD Experts Podcast episode #335) with Patti Catalano, MM, MT-BC, which was broadcast live on December 2, 2020.

Benefits of Music: Next Steps

• Read: Music Therapy – Sound Medicine for ADHD
• Download: Music for Healthy ADHD Brains
• Read: How Music Unlocked My Son’s ADHD Brain

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The Attention Arcade is a gaming platform from BrainLeap Technologies that includes a collection of nine PC games that, thanks to an eye-tracker device purchased separately, use eye movements to control the on-screen action. Built on the premise that eyes and attention move in tandem, Attention Arcade promises to improve and strengthen focus and attention skills. For children with attention deficit hyperactivity disorder (ADHD or ADD), heightened attentional skills can boost working memory, inhibitory control, and cognitive flexibility. The Attention Arcade is the only gaze-driven intervention designed to train attention.

How Does the Attention Arcade Work?

The Attention Arcade is built on the scientific premise that attention and gaze usually shift simultaneously and share much of the same brain circuitry. The games leverage this connection with challenges designed to train different aspects of attention. A player uses their eyes to control the games via an eye tracker.

BrainLeap recommends 20 minutes of gameplay in the Attention Arcade, 3 to 5 times per week, for 8 to 12 weeks, to achieve optimal eye-movement control and attention skills. BrainLeap says that attention may improve after as few as 4 weeks.

Who Should Use the Attention Arcade?

The Attention Arcade is marketed to children ages 7 to 12 who want to improve attention skills, reading, math, executive function, and life outcomes. These games are designed for use at home or in school to make frequent training accessible and easy. The games are not compatible with Mac or Chromebook computers.

How Much Does the Attention Arcade Cost?

The price to download and play the PC games is $39 per month. To access the eye-tracker required to play the games, consumers can bundle the eye-tracker and games for $49/month or purchase the tracker directly at Amzn.to/3aA37bX.

What Studies Have Been Done On the Attention Arcade?

The games were initially created and tested at the University of California, San Diego, and research was funded by the National Institutes of Health. The clinical trial included individuals aged 9-25. All participants who completed the at-home training study showed improvements in at least one measure of attention and most showed improvements on multiple measures.

Sources

https://brainleaptech.com/

NeuroTracker is a 3D visual exercise that trains the brain using a multiple-object tracking test. Weekly virtual training sessions aim to build fundamental cognitive abilities, including attention, executive function, working memory, and processing speed. Students with and without learning abilities — as well as professional athletes — use multiple-object tracking to heighten academic or physical performance.

How Does NeuroTracker Work?

Participants wear anaglyph glasses to visually track a set of targets moving dynamically in a 3D space, and attempt to avoid being distracted by a separate set of virtual objects moving within that space. Selecting the correct targets after tracking increases the speed at which the targets move, thereby increasing the difficulty. 18 minutes of training per week is suggested to optimally boost fundamental cognitive abilities. It takes about 3 months to complete the core training program, which comprises 30 sessions.

Who Can Use NeuroTracker?

NeuroTracker was designed to improve the attention and processing speed of athletes who have to remain aware of the quick and spontaneous movements of both opponents and teammates. It is also used by students seeking to improve executive functions, working memory, and processing speed

Can I try NeuroTracker?

NeuroTracker offers varying subscriptions, including personal, remote, and professional; prices vary.  Click here to try the NeuroTracker demo.

Sources

Neurotracker (2020). https://neurotracker.net/

Corbin-Berrigan, Laurie-Ann. Three-dimensional multiple object tracking in the pediatric population. NeuroReport (2018). https://pubmed.ncbi.nlm.nih.gov/29481522/

Corbin-Berrigan, Laurie-Ann.  Could Neurotracker be used as a clinical marker of recovery following pediatric mild traumatic brain injury? An exploratory study. Brain Injury Journal (2020) https://pubmed.ncbi.nlm.nih.gov/32013583/

Tullo, Domenico. The cognitive benefits of NeuroTracker training across neurodevelopmental disorders: Who benefits from training attention with multiple object-tracking? (2017) https://jov.arvojournals.org/article.aspx?articleid=2652173

Esteem is a mobile app for caregivers of children with attention deficit hyperactivity disorder (ADHD or ADD) and other behavioral challenges. The Esteem app allows a user to select the disorders and behavioral issues impacting their child, identify opportunities for improvement, and track progress. Esteem was developed by behavioral health professionals to provide a quick method for caregivers to monitor and manage their families’ mental health.

How does Esteem work?

An Esteem user may download the mobile app or use the web interface and create a free account and create a profile by completing a questionnaire about their child’s symptoms, diagnoses, and challenges. These challenges may range from lack of focus to poor school performance to inconsistent sleep to unpredictable mood and beyond.

This data is used to create a personalized plan that recommends specific parenting techniques to help the child improve behavior and self-regulation skills.

Esteem can also be used to find therapists and parenting coaches.

Who is Esteem for?

Esteem is for caregivers of children with ADHD and other behavioral disorders.  It can be helpful with children of all ages, but is particularly geared toward children aged 6 to 12.

How much does Esteem cost?

The Esteem app is free. It includes optional paid integrations with other parenting and health apps.

What studies have been done on Esteem?

There is no research specifically on Esteem. The creators of Esteem cite a series of studies that demonstrate the effectiveness of using web-based apps to track and share information between parents, teachers and doctors.

Several of these studies¹ were done by a team at the Cincinnati Children’s Hospital, which showed that web-based training and symptom monitoring² could significantly improve children’s ADHD symptoms as well as the quality of care³ provided by doctors.

Where can I learn more about Esteem?

You can learn more about Esteem at https://www.chooseesteem.com.

Sources

¹Epstein JN, Kelleher KJ, Baum R, et al. Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes. Pediatrics. 2016;138(2):e20154240. doi:10.1542/peds.2015-4240

²Epstein, Jeffery N et al. “The myADHDportal.com Improvement Program: An innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians.” Clinical practice in pediatric psychology vol. 1,1 (2013): 55-67. doi:10.1037/cpp0000004

³Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011;128(5):e1201

Despite a dearth of scientific consensus, implementing an “ADHD-friendly” nutrition plan is among the most popular natural treatment approaches among ADDitude readers, according to a 2017 survey of 4,000 adults and parents of children with ADHD. Roughly one quarter of survey respondents reported that they used dietary strategies ranging from avoiding sugars and artificial colors, to increasing protein, and following an elimination diet to try to treat ADHD symptoms.

Many respondents reported improvements in ADHD symptoms after making nutritional changes, but a great majority noted that changes in diet were only somewhat effective in addressing symptoms, despite their serious attempts to implement an ADHD nutrition plan.

Regardless of whether they saw positive results, nearly all survey respondents agreed: Eating healthy is hard, especially when your ADHD brain craves dopamine (i.e. sugar and carbs), when your child is a picky eater, when your appetite is suppressed by other treatments, when your child is sensitive to food textures, when your food budget is limited, when you’re a busy and/or single parent with scant time for grocery shopping, and when life gets in the way.

Popular books and articles offering ‘quick and easy fixes’ do nothing to help when these ADHD realities get in the way. In fact, they can do more harm than good but ratcheting up the guilt:

[Get This Free Download: What to Eat — And Avoid — to Improve ADHD Symptoms]

• “Enforcing an ADHD diet was awful,” one parent wrote. “It became a full time job to plan, maintain, shop for, etc. and there were no positive results to observe.”
• One adult reader wrote: “It was very helpful, but medication was still needed to manage behavior, and it was very restrictive and hard to maintain the diet. Small mistakes in eating would ruin all the hard work.”
• “It was extremely difficult because the foods we were trying to avoid were the ones she craved and would eat,” another parent wrote. “She had such a poor appetite at times that we would give in just to get her to eat anything.”

It’s true that dietary changes may improve symptoms in some cases, but eating healthy is not a guaranteed cure for ADHD by any stretch. Research confirms that nutrition is no substitute for medication and other proven therapies.

Eating Healthy by Cutting Sugar

Reducing sugar consumption was the most commonly-used approach by surveyed adults with ADHD and the second most common among caregivers. Many people with ADHD believe that sugar causes hyperactivity, inattention, and sluggishness, though the science here is thin.

“Sugar increases my fidgeting and my inability to pay attention,” wrote one adult survey-taker. Another said, “I have noticed a sharp decrease in my ability to focus when I drink beverages with processed sugar.” Parents of children with ADHD observed that consuming too much sugar contributed to their kids’ poor focus, and triggered hyperactivity, irritability, and “off the rails” behavior.

Some ADDitude readers found that decreasing sugar intake made a significant improvement in ADHD symptoms. Lowering sugar “keeps my energy levels even,” one person wrote, “which allows me to have sustained focus and concentration.” One parent reported that “limiting sugar helps with [my child’s] moodiness and impulsivity.”

[Click to Download: Your Free Guide to Delicious (and ADHD-Friendly!) Eating]

Many people who cut back on sugar in their diets often replace it with artificial sweeteners, but this was not the case with a lot of those surveyed. Instead, they avoided artificial sweeteners for the same reasons they avoided sugar. “I had better focus and better sleep after removing artificial sweeteners,” one person explained.

The hard reality of cutting sugar, however, was yet another struggle:

• “Sugar is a struggle to cut out,” one parent wrote to ADDitude. “Eliminating it makes my child very unhappy.”
• “Too hard to stay off sugar now — but will retry someday,” an adult survey-taker wrote.
• “It is very difficult for my child to stay away from sugar, but I definitely see behavioral changes when he has sugar” another parent wrote.

What Does Research Say About Sugar and ADHD?

Though many of the adults and caregivers surveyed seem convinced of sugar’s detrimental effects on ADHD symptoms, research on the topic is less black and white.

While some studies^{1 2} in the 1980s and 1990s found a link between sugar intake and hyperactivity, most were unable to show causality between sugar intake and hyperactivity in children.^{3 4}

Researchers even found in one study that parents rated their children as more hyperactive when told they were given sugar, regardless of whether they actually ate any sugar.⁵ A 2011 study, moreover, examined available research and concluded that “the inability to document an effect of added sugars on hyperactivity…has largely discredited the sugar hypothesis of ADHD.”⁶

This is not to say that sugar doesn’t have an effect on the body. It is well documented that diets high in excess sugar are associated with a greater risk of illnesses and unhealthy outcomes, including cardiovascular diseases, weight gain, diabetes and more⁷. Keeping sugar intake at healthy levels, therefore, is beneficial for all.

Eating Healthy by Increasing Protein

Protein is an essential macronutrient for healthy functioning of mind and body, one that is important to growth and development in children.

Many ADDitude readers who were surveyed reported that protein consumption optimizes the brain and sustains energy levels through the day. One survey respondent said that increasing protein consumption kept her child’s “extreme reactions more even.” Another parent noted that increasing protein while reducing sugar was a good strategy.

Most readers surveyed felt that a high-protein breakfast was critical to sustained focus during the school day. One parent saw a discernible “difference in behavior” in his son during the week, compared to weekends, when his diet is more lenient.

For one adult, increasing protein was a game changer. “It helps me maintain more stable blood sugar levels, which curbs impulsive behavior,” he said. Another survey-taker said that protein “offsets the midday crash and helps keep me and my family level throughout the day.” The relationship between protein and sugar was summed up by an adult survey-taker: “High protein and low sugar help my brain function at its best.”

Many survey-takers, however, also spoke to the difficulties in working in more protein in their diets.

• “When I do increase my protein, and eat fewer carbohydrates, it is very effective,” one adult wrote. “I just struggle with doing it for any significant length of time.”
• I think high protein with low unhealthy sugars is a healthy eating approach, [but] ADD people are notoriously bad at meal planning,” one parent wrote.

The Science on Protein and ADHD

Although some evidence supports the benefit of protein in treating ADHD symptoms and improving cognitive performance, more research is needed.

Some research, for instance, has suggested that a high-protein diet, especially a high-protein breakfast, can help with focus, mood, and alertness⁸. One study also found that a higher protein breakfast, compared to a high-carb one, was associated with better memory.⁹

Eliminating Artificial Dyes to Reduce Impulsivity

Many adults and caregivers surveyed worked to maintain diets with natural foods and avoided artificial colors and dyes. In fact, decreasing or eliminating artificial colors and dyes was the most common diet and nutrition approach among caregivers of children with ADHD, one pursued by 70 percent of survey respondents. Many parents reported that foods with artificial dyes worsened their children’s hyperactivity and irritability. One parent wrote, “When my son eats sugar, artificial colors, and junk food, his impulsivity is just around the corner.”

A dye-free diet, according to a number of parents, had dramatic and positive effects on their children. “When we removed artificial dyes, our child slept through the night, for the first time ever,” one parent said. “Food dyes changed [my daughter’s] personality,” another parent noted. By eliminating them, her behavior changed for the better.

[Click to Read: Change Your Diet, Find Your Focus]

Some parents singled out red dye as the culprit, saying, in one case, that red dye contributed to his child’s aggression and impulsivity. Just as many parents reported the negative effects of dyes on their children, many adults surveyed noted that eliminating foods with dyes had a positive effect on their mood.

But avoiding artificial dyes seemed impossible for many parents and adults, who lamented their near universal presence in foods. As one parent wrote:

• “We noticed a definite improvement when attempting to eliminate artificial colors and dyes.That being said, as our son grew older and was involved in school, church parties, and spent time with friends, we no longer had direct and total control over the foods and drinks he consumed. We have learned that restaurants, schools, churches, and even friend’s families don’t adhere to the same standards, and it feels like we are fighting a losing battle.”

The Research on Artificial Dyes

Recent studies have suggested an adverse relationship between hyperactivity and food dyes in children with and without ADHD.^{10 11} These studies even spurred changes in the United Kingdom’s policies toward food dyes, and prompted the FDA to hold hearings in 2011 on the subject.¹² Similar action, however, was not taken in the U.S. due to what the FDA deems a lack of unequivocal evidence on food dyes.

A 2012 analysis¹³, however, of more than 30 restriction diets (characterized mainly by the elimination of food dyes and other additives) concluded that about 30 percent of children with ADHD are responsive to them, and that as many as 8 percent of them have symptoms related to food colors. Referring to the FDA’s hearings, the researchers agreed that the current evidence is “too weak to justify action recommendations,” but is “too substantial to dismiss.”

A 2014 review¹⁴ of restriction and elimination diets in ADHD treatment said that the contrast between the few studies on the topic and the wide interest in the topic is striking. Needed are fresh contemporary trials of elimination diets with well-controlled double-blind procedures as were pioneered decades ago,” the review concluded.

Eating Healthy with the Feingold Diet

Several parents surveyed were enthusiastic about the effect of the Feingold diet on their children with ADHD. This well-known elimination diet, popularized in the 1970s by Benjamin Feingold, M.D., aims to decrease ADHD symptoms by eliminating artificial colorings, flavorings, and salicylates (naturally occurring compounds found in some fruits and vegetables). Dr. Feingold believed that some people with ADHD are sensitive to these foods, and that eliminating them will improve behavior.

While many studies and reviews have found little to no substance to Feingold’s theory, his diet has remained popular over the years.¹⁵ Survey responses from parents are a testament to the diet’s enduring influence, and may point to recent insights about the relationship between artificial dyes and ADHD.

“Within three months of starting the Feingold diet, my son’s medication needs decreased dramatically,” one parent wrote. “He went from taking 40 mg. of Vyvanse, clonidine, and allergy meds to less than 20 mg. of Vyvanse and no other meds. Sleep and allergy problems went away.”

Another survey-taker said that the diet was “life changing. The entire family eats that way now, after seeing the effect it has on our child.”

As with cutting sugar and dyes and increasing protein, sticking to the Feingold diet was no easy task. Parents wrote that:

• “Feingold seemed to work, but it was too hard to maintain.”
• “It isn’t always easy to follow a diet like Feingold, but it isn’t too bad after the first learning curve.”

Does the Feingold Diet Actually Work?

Recent research suggests that skepticism over the Feingold diet stems from outdated studies, and that new reviews, like the studies on artificial dyes that changed the U.K.’s policies, take a more nuanced understanding of synthetic food coloring and its effect on ADHD symptoms.¹⁶

Other Dietary Approaches for ADHD

Caregivers and adults surveyed also tried reducing dairy foods and gluten from their diets. “Eliminating gluten took our situation from unmanageable and crazy to functional,” one parent said.

A reduction in dairy and gluten, for one adult survey-taker, led to a “decrease in foggy brain and moodiness.”

For at least one parent, gluten was described as the single missing piece to a perfect ADHD nutrition plan. “This was the most difficult to do based on my daughter’s palate and food desires,” they wrote. ” Without that being eliminated, I feel the nutritional plan as a treatment tool had limitations.”

Research, however, hasn’t found conclusive evidence linking ADHD and gluten sensitivities, though they can co-occur. A 2016 study even advised against implementing a gluten-free diet to treat ADHD.¹⁷

The Bottom Line on Eating Healthy to Help ADHD

Though many adults and parents in the survey recommended a nutrition plan for managing ADHD symptoms, they also generally concluded that these approaches were only marginally effective for treating ADHD. The struggle to maintain ADHD-friendly nutrition also influenced results, with many concluding that an “ADHD diet” was not worth the effort:

• “We didn’t see much improvement with any diet changes, which are hard to maintain across environments and lifestyles,” one parent wrote.
• “Limiting diet is extremely hard,” one adult wrote. “You want to be able to eat the way you used to. But I feel better off off these items.”
• “I don’t think we gave it enough of a chance to make a difference,” another parent wrote. “It was really hard keeping non-compliant foods away from him during school or when he was at a party, etc. It’s expensive and not an easy thing to maintain.”

Still, according to small follow-up surveys conducted by ADDitude, adults and caregivers remain interested in using a diet and nutrition plan for ADHD after doing their own research on the topic. Researchers recognize the public’s strong interest in using dietary approaches, and stress the need for more and frequent analysis of the ADHD-nutrition link.¹⁸

“Using some of these nutritional approaches may help some people, not everyone,” says Joel Nigg, Ph.D., author of Getting Ahead of ADHD (#CommissionsEarned) and professor of psychiatry, pediatrics, and behavioral neuroscience at the Oregon Health & Science University. “But the nutrition strategies need to be combined with standard care for ADHD, such as ADHD medication.”

[Read This Next: Healthy Foods and Supplements for Kids & Adults]

Sources

¹Prinz, R. J., Roberts, W. A., & Hantman, E. (1980). Dietary correlates of hyperactive behavior in children. Journal of Consulting and Clinical Psychology, 48(6), 760–769. Retrieved from: https://doi.org/10.1037/0022-006X.48.6.760

² Jones, Timothy W. et al. (1995). Enhanced adrenomedullary response and increased susceptibility to neuroglycopenia: Mechanisms underlying the adverse effects of sugar ingestion in healthy children. The Journal of Pediatrics, Volume 126, Issue 2, 171 – 177. Retrieved from: https://www.jpeds.com/article/S0022-3476(95)70541-4/fulltext

³ White, J., Wolraich, M. (1995) Effect of sugar on behavior and mental performance. The American Journal of Clinical Nutrition, Volume 62, Issue 1, Pages 242S–247S. Retrieved from: https://doi.org/10.1093/ajcn/62.1.242S

⁴ Wolraich, M., Milich,R., et al. (1985). Effects of sucrose ingestion on the behavior of hyperactive boys. The Journal of Pediatrics. Volume 106, Issue 4, Pages 675-682. Retrieved from: https://doi.org/10.1016/S0022-3476(85)80102-5

⁵ Hoover, D.W. & Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Volume 22, Issue 4, pp 501–515. Retrieved from: DOI: 10.1007/bf02168088

⁶ Johnson, R., Gold, M., et. al. (2011). Attention-Deficit/Hyperactivity Disorder: Is it Time to Reappraise the Role of Sugar Consumption? Postgraduate Medicine, 123:5, 39-49, DOI: 10.3810/pgm.2011.09.2458

⁷ Yang, Q., Zhang, Z., Gregg, E.W., et al. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med.74(4):516–524. doi:https://doi.org/10.1001/jamainternmed.2013.13563

⁸ Zeng, Y. , Li, S. , Xiong, G. , Su, H. and Wan, J. (2011) Influences of protein to energy ratios in breakfast on mood, alertness and attention in the healthy undergraduate students. Health, 3, 383-393. doi: 10.4236/health.2011.36065.

⁹ Nabb, S., Benton, D. (2006): The influence on cognition of the interaction between the macro-nutrient content of breakfast and glucose tolerance. Physiology & Behavior. 87:16–23. https://doi.org/10.1016/j.physbeh.2005.08.034

¹⁰ Bateman B., Warner J., Hutchinson E., et al. (2004). The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood, 89:506-511. Retrieved from: https://adc.bmj.com/content/89/6/506

¹¹Mccann, Donna, et al. (2007). Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. The Lancet, vol. 370, no. 9598, pp. 1560–1567. Retrieved from: doi:10.1016/s0140-6736(07)61306-3.

¹² Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x

¹³ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

¹⁴ Nigg, J. T., & Holton, K. (2014). Restriction and elimination diets in ADHD treatment. Child and adolescent psychiatric clinics of North America, 23(4), 937–953. doi:10.1016/j.chc.2014.05.010

¹⁵ Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x

¹⁶ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

¹⁷ Ertürk, E., Wouters, S., Imeraj, L., &amp; Lampo, A. (2016). Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature. Journal of Attention Disorders. https://doi.org/10.1177/1087054715611493

¹⁸ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication

Brillia is a homeopathic supplement that is formulated to alleviate anxiety and hyperactivity, and to improve focus and attention by targeting the S-100 protein, which is released when the brain is under stress. Brillia is marketed as a holistic treatment; the manufacturer promotes guidelines for proper nutrition, adequate sleep, mindfulness, and controlled screen time along with use of their supplement.

The tablet comprises a Lapine S-100 immune globulin mixture of homeopathic dilutions 12C, 30C, and 50C.

How Does Brillia Work?

Brillia is a cumulative three-months-on, one-month-off program — it doesn’t have to be taken every month since the effects are cumulative. Month Four is considered a rest period wherein patients focus on the other four pillars of their program: nutrition, sleep, mindfulness, and screen time. Following that, a new three-month period begins.

How Much Brillia is Safe?

The recommended dose of Brillia is based on symptom severity:

Mild challenges: one pill, twice a day

Moderate challenges: one pill, three times a day

Severe symptoms: two pills, three times a day

Who Should Take Brillia?

Brillia is for children aged 5 through 18 years who experience challenges relating to attention, anxiety, irritability, and hyperactivity.

What Studies Have Been Done on Brillia?

The Brillia EU website details two studies: one in which Brillia was administered to children with ADHD and the other to children with anxiety.

How Much Does Brillia Cost?

A three-month supply of Brillia costs $114. A one-month supply costs $56.10.

Where Can I Learn More About Brillia?

Visit the manufacturer’s website at: https://discoverbrillia.com/

Sources:

https://discoverbrillia.com/

Melatonin is a hormone that is naturally produced in the brain in response to darkness. It helps our bodies maintain healthy sleep-wake cycles, where melatonin essentially tells the brain, “It’s time to start getting to sleep.”

The ADHD brain, however, has a delay in melatonin onset. Research shows that the onset of melatonin for most adults is roughly 9:30 pm, but in adults with ADHD it happens more than an hour later. In children with ADHD, the melatonin onset is similarly late — around 10:15 pm.¹

This delay in melatonin onset is also associated with late sleep onset — the time it takes for children and adults with ADHD to fall asleep.  It typically takes a neurotypical person up to two hours to fall asleep after melatonin onset. In adults with ADHD, it may take three hours.²

Melatonin’s delayed onset helps to explain, in part, why people with ADHD often experience sleep problems. Research shows that 25 to 50 percent of people with ADHD have a sleep disorder^{3 4}.

Taking melatonin as an ADHD supplement under the guidance of a pediatrician or primary care physician, therefore, can help children and adults with ADHD get to sleep safely and naturally.

[Download Now: Free Guide to Natural ADHD Treatment Options]

Is Melatonin Safe for Kids?

Short-term use of melatonin supplements appears to be safe for most people and effective in inducing sleep. According to one study, children with ADHD were able to sleep longer and fall asleep faster after taking melatonin daily combined with their ADHD medication over several weeks.⁵ Additionally, I have young patients who take melatonin on a daily basis, and I’ve also worked with kids and teenagers who take it regularly. Their doctors and pediatricians agree that it’s safe.

But data on the long-term safety of taking melatonin supplements is lacking, according to the National Center for Complementary and Integrative Health (NCCIH).⁶ There’s also not enough information yet about possible side effects, especially when taking doses higher than what the body normally produces. That’s why it is strongly recommended that parents of children with ADHD or adults with ADHD talk to their doctors about melatonin use, because it’s not one-size-fits-all. Overall, future research will continue to shed light on melatonin use, and it is important to be as up to date with the data as possible.

How Much Melatonin Can I Give My Child?

Melatonin usually comes in 3 mg or 5 mg tablets. Five milligrams is considered a relatively high dose for a young person — most children take a 3 mg or even a 1 mg dose.

[Download Now: Sound Sleep Solutions for Kids with ADHD]

In a study on melatonin for kids with ADHD, sleep onset advanced by 27 to 48 minutes with melatonin, and sleep duration increased by as much as 62 minutes.⁷ The children, between 6 and 12 years old, were given either a 3 mg or 6 mg dose of melatonin depending on their weight.

What Are the Negative Effects of Melatonin? Are There Any Side Effects?

Studies have not shown any danger with melatonin, including any risk of dependency. That said, some patients may experience reactions to melatonin, which may depend on the dose. The higher the dose, the greater the likelihood of experiencing any side effects. Possible melatonin supplement side effects reported in children have typically been mild, according to NCCIH ⁸, and include:

1. Drowsiness
2. Increased bedwetting or urination at night
3. Headaches
4. Dizziness
5. Agitation

When Should Melatonin Be Taken?

The best time to take melatonin is 90 to 120 minutes before you plan on going to bed. This allows the body to metabolize the melatonin and eventually set off the OK-we’re-now-going-to-sleep signals in your brain. Melatonin for kids or adults shouldn’t be administered as a “direct” sleep aid right at bedtime, which is one of the biggest misconceptions surrounding melatonin use.

If somebody with sleep difficulties is reporting that they’re sleeping better when taking melatonin right before bed, that’s probably not what’s getting them to sleep, since a two-hour window is generally needed for melatonin to work effectively. What may be happening is a type of placebo effect, where the thought of a sleep aid alone can feel really good and have a reinforcing effect. It can make the person feel calm, which may help them fall asleep.

The information in this article is based on Dr. Roberto Olivardia’s “Time for Bed! Sleep Solutions for the ADHD Brain” webinar, which was broadcast live on September 25, 2019. Dr. Olivardia is a member of ADDitude’s ADHD Medical Review Panel.

Melatonin for Kids: Next Steps

• Download: Top 5 Vitamins and Supplements for ADHD
• Read: Sleep, Interrupted: The ADHD-Insomnia Link in Children
• Read: Why Bedtime is Always a Battle When Your Child Has ADHD

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
2. Is ADHD medication right for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
   • What are the most effective natural ADHD treatments for kids?
   • What foods can help control ADHD symptoms?
   • What vitamins and supplements should my child take?
   • Does brain training help with ADHD?
   • How much and what type of exercise helps kids with ADHD?
   • What types of therapy help patients with ADHD?
5. What if the medication stops working?
6. How can I find an ADHD specialist near me?

Sources

¹Kooij, S. (2016, November 7). Are You a Night Owl? About ADHD and Late Sleep. Retrieved from: https://apsard.org/are-you-a-night-owl-about-adhd-and-late-sleep/

² Bijlenga, D. , Van Someren, E. J., Gruber, R. , Bron, T. I., Kruithof, I. F., Spanbroek, E. C. and Kooij, J. J. (2013), Body temperature, activity and melatonin profiles in adults with attention‐deficit/hyperactivity disorder and delayed sleep: a case–control study. J Sleep Res, 22: 607-616. doi:10.1111/jsr.12075. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12075 

³ Corkum P, Davidson F, Macpherson M. A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder. Pediatr Clin North Am. 2011;58:667–683. doi.org/10.1016/j.pcl.2011.03.004 Retrieved from: https://www.sciencedirect.com/science/article/pii/S0031395511000204?via%3Dihub

⁴ Owens JA. Sleep disorders and attention-deficit/hyperactivity disorder. Curr Psychiatry Rep. 2008;10:439–444. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/18803919

⁵ Mohammadi, M. R., et. al.  (2012). Melatonin effects in methylphenidate treated children with attention deficit hyperactivity disorder: a randomized double blind clinical trial. Iranian Journal of Psychiatry, 7(2), 87–92. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3428643/

⁶ Melatonin: What You Need To Know. (2019, October). Retrieved from https://nccih.nih.gov/health/melatonin. 

⁷ VAN der HEIJDEN, KRISTIAAN B. et al. Effect of Melatonin on Sleep, Behavior, and Cognition in ADHD and Chronic Sleep-Onset. Journal of the American Academy of Child & Adolescent Psychiatry, Volume 46, Issue 2, 233 – 241.doi.org/10.1097/01.chi.0000246055.76167.0d Retrieved from: https://jaacap.org/article/S0890-8567(09)61831-1/fulltext

⁸ Melatonin: What You Need To Know. (2019, October). Retrieved from https://nccih.nih.gov/health/melatonin

What Is the ADHD Medication Adhansia XR?

Adhansia XR (methylphenidate hydrochloride) is a once-daily, extended release ADHD medication approved to treat attention deficit hyperactivity disorder (ADHD or ADD) in patients six years and older. The medication is a central nervous system (CNS) stimulant, which may aid in increasing attention and decreasing impulsiveness and hyperactivity in people with ADHD.

According to the FDA, Adhansia XR is a controlled substance because it contains methylphenidate, which can be a target for people who abuse prescription medicines or street drugs. The stimulant has not been tested in children under six years of age.

How Does Adhansia XR Work to Treat ADHD Symptoms?

Adhansia XR capsules are made up of beads with immediate-release and controlled-released layers. The immediate-release layer carries about 20 percent of the methylphenidate dose, while the controlled-release layer contains the rest. The extended-release medication begins to act one hour after administration and lasts for approximately 16 hours post-dose.

Your healthcare provider may temporarily halt Adhansia XR treatment to check ADHD symptoms.

How Do You Use Adhansia XR to Treat ADHD?

Before starting or refilling an Adhansia XR prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

What Dosage of Adhansia XR Is Used to Treat ADHD?

As with all medications, follow your Adhansia XR prescription instructions exactly. The capsule is taken orally in the morning, with or without food, and is available in six dosage strengths: 25 mg, 35 mg, 45 mg, 55 mg, 70 mg, and 85 mg. Purdue Pharmaceuticals L.P., the medication’s manufacturer, recommends 25 mg once daily as the starting dose for patients.

The capsule may be taken whole, or its contents may be sprinkled onto a tablespoon of applesauce or yogurt. The entire mixture should be consumed by swallowing, not chewing, within 10 minutes, and cannot be stored afterward.

Do not administer Adhansia XR later in the day in the event of a missed dose.

Avoid alcohol while taking Adhansia XR, as consuming alcohol may result in a more rapid release of the methylphenidate dose.

What Are the Side Effects of Adhansia XR?

The most common side effects of Adhansia XR include trouble sleeping, dry mouth, decreased appetite, and decreased weight.

Other serious side effects include circulation problems in fingers and toes, priapism, slowing of growth in children, and allergic-type reactions if consuming the 45 mg capsules. Adhansia XR can also cause heart-related problems, including increased blood pressure, sudden death, stroke, and heart attacks. Your healthcare provider should check you or your child’s blood pressure and heart rate regularly during treatment.

Adhansia XR can also cause mental (psychiatric) problems including new or worse behavior and thought problems, new or worse bipolar illness, and new psychotic or manic symptoms. Tell your healthcare provider about any mental problems you or your child have, or about a family history of suicide, bipolar illness, or depression.

The medication, as is the case with other methylphenidate-containing medicines, has a high chance for abuse and can cause physical and psychological dependence. Your healthcare provider should check you or your child for signs of abuse and dependence before and during treatment.

What Precautions Are Associated with Adhansia XR?

Store Adhansia XR at room temperature and in a secure place out of the reach of children. Do not use the medication for a condition for which it was not prescribed. Do not share your Adhansia XR prescription with anyone, even if they have the same symptoms. Sharing prescription medication is unlawful and can cause harm.

Do not take Adhansia XR if you are allergic to methylphenidate hydrochloride or any of the ingredients in the medication. You should not take Adhansia XR if you are taking, or have stopped taking within the past two weeks, a monoamine oxidase inhibitor (MAOI) used to treat depression.

If you are thinking of having a child, discuss the use of Adhansia XR with your doctor. It is not known if the medication presents a potential risk of fetal harm. The National Pregnancy Registry for Psychosis has opened a registry for Adhansia XR to collect information about the health of females and babies exposed to the medication. Talk to your healthcare provider about registering.

Adhansia XR does pass into breast milk, so talk to your doctor about the best way to feed the baby during treatment if you are breastfeeding or plan to.

What Interactions Are Associated with Adhansia XR?

Discuss all other active medications with your doctor before taking Adhansia XR, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Especially tell your doctor if you or your child take an MAOI, as Adhansia XR can have a dangerous, possibly fatal interaction with it. Do not start any new medicine during treatments with Adhansia XR without consulting with your healthcare provider first.

The above is not a complete list of all possible drug interactions.

More Information on Adhansia XR and ADHD Medicaitons

• Read A Parent’s Guide to ADHD Medications
• Free Download: Take Charge of Your Child’s Medication
• Free Download: How Do We Know the Medication Is Working?
• Find: ADHD Specialists and Clinics Near You

Sources:

https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/212038Orig1s000lbl.pdf

https://www.businesswire.com/news/home/20190301005270/en/Adlon-Therapeutics-L.P.-Announces-FDA-Approval-Adhansia

ADHD medication use is connected to fewer instances of accidental injury among children and teenagers, irrespective of age and sex, according to a new study¹ recently published in the Journal of the American Academy of Child and Adolescent Psychiatry.

Researchers arrived at their findings by analyzing years of prescription claims data from a health database for more than 1.9 million individuals diagnosed with attention deficit hyperactivity disorder (ADHD or ADD) and/or receiving ADHD medications in the United States. They also tracked ADHD prescription refills per month, and looked at emergency department visits, or “events” for injuries with unintentional causes, including traumatic brain injuries, during the same period. Data was then compared at the population and individual level, keeping medicated and unmedicated months in mind.

Among the study’s participants, roughly 87,000 had at least one emergency department visit for an accidental injury. But in performing a population-level analysis, researchers found that ADHD medication use was linked to a lower risk for an ER visit in boys and girls with ADHD — 37.90 fewer events per 100,000  person-months in boys and 25.15 fewer events per 100,000 person-months in girls. Tests at the individual level revealed similar results, with 73.29 fewer events per 100,000 person-months observed in boys and 56.11 fewer events per 100,000 person-months in girls.

ER visits for unintended, traumatic brain injuries followed a similar pattern. Boys taking ADHD medication had 4.24 fewer events per 100,000 person-months, while girls taking ADHD medication had 1.87 fewer events per 100,000 person-months at the population-level scale. On an individual basis, boys saw 10.47 fewer events per 100,000 person-months, with girls experiencing 6.87 fewer events per 100,000 person-months while taking ADHD medication.

The researchers did note that the findings may be limited in their lack of ADHD specificity, as the study used data from a large sample of commercially insured people in the United States. The data also may not reflect less severe incidents, as only injuries that led to emergency room visits were considered in the study.

¹ Ghirardi, L., Larsson, H., Chang, Z., et al. “Attention-Deficit/Hyperactivity Disorder Medication and Unintentional Injuries in Children and Adolescents.” Journal of the American Academy of Child & Adolescent Psychiatry. (July 2019). https://doi.org/10.1016/j.jaac.2019.06.010

This is the finding of a small research report titled “Adherence to Attention-Deficit/Hyperactivity Disorder Medication During the Transition to College” published in the Journal of Adolescent Health. The study, which included just 10 college students with attention deficit disorder (ADHD or ADD), found five persistent and prevailing reasons for ADHD medication disruption in college:

• “Transitions to independence are often abrupt, and many adolescents lack critical self-management skills.” Because their parents managed their medication through middle and high school, the teens didn’t have strategies for refilling and taking their medications regularly.
• “Volitional nonadherence is high due to inaccurate disease beliefs, perceived academic demands, and medication side effects.” Many students stopped taking medication regularly because they wrongly believed they would outgrow their ADHD or they thought they only needed stimulants to study, not to manage their day-to-day lives.
• “Poor self-management negatively impacts school performance.” All 10 subjects expressed regret about their first-semester academic performance and blamed mismanaged ADHD symptoms for their problems.
• “Peer pressure to share medication affects social functioning and adherence.” All 10 subjects reported being pressured by peers to share or sell their ADHD medication, which made them more like to hide their diagnosis and treatment.
• “Social support is greatly needed.” Most students felt isolated from their peers and without significant support from their university, though only 4 out of 10 had registered for academic accommodations.

[Free Download: What Are Your Teen’s Weakest Executive Functions?]

How to Help Your Teen Avoid the ADHD Treatment Trap in College

No one goes to college to do poorly. Young adults are hopeful and excited about this next stage of their lives. They want to do well but many teens with ADHD flounder when trying to manage scenarios they’ve never faced alone: remembering to take medication, seeking out help when problems arise, and seeking social acceptance with a new group. College students (with and without ADHD) naturally share less about school and grades. Since confidentiality rules apply at college and most students are legally adults, you cannot access their school information without their explicit permission. This makes for complicated and frustrating parenting. You may not find out there’s a problem until you see a problematic post on Instagram.

College students with ADHD often succumb to a negative snowball effect. They miss a class because they overslept, then do poorly on one quiz or fall behind on turning in an assignment, then start to jump ship instead of seeking support to get back on track. Unlike in high school, no one is monitoring things or notices the imminent slide, which is only exacerbated when ADHD mediation is taken inconsistently — or not at all. Sometimes students genuinely forget to take their pills; or they don’t know how or where to renew their prescription. They may not like going to health services or to their new prescriber. Others secretly decide to stop taking medication that helps them because they want to “do it on their own.” Teens may hide their struggles from their parents because they don’t want to admit their mistakes or their inability to handle the independence they so desperately desired.

To avoid this scenario, start by collaborating with your son or daughter on a plan for communication, accountability, and trouble-shooting before the semester starts. It’s much harder to troubleshoot once you are in the midst of a crisis. Ask yourself if your teen is an accurate, forthcoming reporter. Can you regularly rely on what they tell you about their lives? Beyond poor grades and not going to classes, typical signs that things are amiss include:

• constantly feeling overwhelmed
• excessive or inadequate sleep
• inconsistency in medication refills (if they are still getting them from home prescriber)
• social isolation
• lack of motivation
• poor eating habits
• increased anxiety or depression
• an unwillingness to talk to you on the phone or have you visit

[Free Webinar Replay: The College Transition Guide for Teens with ADHD]

Talk to your teen about these warning signs, focus on being an ally, define your shared goals, and set up necessary scaffolding. Predict that there will be bumps in the road, but assure your child that you will weather them together, without judgment. The goal is building executive functioning skills to support your teen’s developing brain and growing independence. Engaging in clear and compassionate conversations now will set the tone for dealing with unexpected setbacks later on. This reduces shame and blame and orients everyone toward working together on a concrete plan for college success.

6 Steps to Ensure Consistent ADHD Treatment in College

1. Reflect on and accurately assess your child’s strengths and identify their challenges. It’s typical for a young adult to be strong in something like personal hygiene and setting up social plans, but weaker in organizing their room or remembering to set up (or attend) an appointment. Development is uneven. Consider what challenges they had last year in school and how those might reappear this year. Write down your ideas.

2. Pick a calm time (maybe after dinner) to talk with your teen about this coming year. Talk generally about what went well last year, what responsibilities they can now manage on their own, and what challenges they foresee. Share your observations neutrally by using language such as “I notice…” and “It seems like…” Write these down, too.

3. Make a master list of college life responsibilities, dividing things into categories such as medication (appointments, prescription renewals, usage), academic support services (appointments, meeting with professors, study periods), self-care (laundry, counseling, eating, exercise, etc.). Ask them what they would like to be responsible for and what you (or another specific person) can help them manage. Teach them about setting useful alerts on their phone.

4. Create agreements about how and when you will be in contact with each other. Talk about how you can check in weekly and schedule these times. Don’t barrage them with emails, texts, or phone calls outside of these times. Texting alone does not suffice as a check-in, so opt for FaceTime or a phone conversation. You can get a lot of information from tone of voice, but real-time words and images are even better.

5. Set up a back-up plan. Together, describe possible signs that would indicate he or she is struggling. Brainstorm options of what to do if things aren’t going well and strategize a course of action. Write this down too and email it to each other for easy reference.

6. Go with your college student to the academic support center and to the health center for initial appointments. Ask your son or daughter to sign releases and specify situations when you will make contact with these offices. You want to respect his or her privacy while also being available for emergencies.

Working together to think about concrete steps for living successfully with ADHD in college before the semester begins paves the way for building essential executive functioning skills, resilience and independence. When your son or daughter sees you as an ally, not a critic, they’ll feel less ashamed of their stumbles and more likely to ask for help to regain their footing.

[Good to Go (to College)]

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
2. Is ADHD medication right for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
5. What if the medication stops working?
   • How long will it take to get the medication and dosage right?
   • How do we know the medication is working?
   • When is it time to switch medications?
   • How can we safely treat ADHD alongside its comorbid conditions?
   • What should I do if my child stops taking their medication?
   • How can we solve medication rebound problems?
6. How can I find an ADHD specialist near me?

What Is the ADHD Medication Jornay PM?

Jornay PM, a methylphenidate stimulant medication used to treat ADHD symptoms in patients age 6 and older, recently won approval from the U.S. Food and Drug Administration (FDA) because it fills a significant consumer need: management of ADHD symptoms first thing in the morning and then throughout the day.

The Jornay PM delayed release as well as extended release formulation and delivery system is unique. The medication is taken at night; its outer layer delays the release of medication for 10 to 12 hours, so the patient wakes up the next morning with a full therapeutic blood level of methylphenidate. This opens the door to greater organization, efficiency, focus, and emotional control early in the morning when getting up and ready for school or work.  Subsequently, the extended release formulation releases medication in steady amounts throughout the day.

How Does the ADHD Medication Jornay PM Work?

Jornay PM (generic name: methylphenidate hydrochloride) is an extended release ADHD stimulant medication intended for children 6 years of age and older that can also be taken by adults with attention deficit hyperactivity disorder (ADHD or ADD). Jornay capsules are filled with microbeads, each of which has a delayed release and extended release layer. This technology keeps the medication from activating for 10 to 12 hours — meaning the effects are felt when a child wakes up — and then releases medication into the body in steady amounts throughout the day.

Studies suggest that Jornay PM significantly improves early morning behavior, plus attention and behavior in the classroom.

Jornay PM contains the same active ingredient as medications such as Ritalin and Daytrana. According to the FDA, Jornay PM is a federally controlled substance (CII) because it can be abused or lead to dependence. It has not been studied in children under the age of 6.

How Is Jornay PM Used to Treat ADHD Symptoms?

The effects of Jornay PM are first felt up to 12 hours after ingestion, so the drug manufacturer (Ironshore Pharmaceuticals) recommends taking it between 6:30 and 9:30 pm, under supervision from a physician. The pills should be taken at the same time every evening and can be taken with or without food but should be done so consistently.

Capsules can be opened and sprinkled onto applesauce or a similar food for children who have difficulty swallowing pills. The food and medicine mixture should be ingested completely right away and should not be chewed.

Before starting or refilling a Jornay PM prescription, read the medication guide included with your pills, as it may be updated with new information.

This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.

What Dosage of Jornay PM is Used to Treat ADHD Symptoms?

As with all medications, follow your Jornay PM prescription instructions exactly.

Jornay PM is a capsule available in five doses: 20 mg, 40 mg, 60 mg, 80 mg, and 100 mg — a doctor can help determine the best dose and time to take Jornay PM. Doses may be titrated weekly in increments of 20 mg. The optimal dosage varies patient by patient. It is not determined by age, weight, or height, but rather by how a person metabolizes the medication, and the condition treated. Your doctor may adjust your daily dosage until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

If a dose is missed, Jornay PM should be taken as soon as it’s remembered in the evening. If it’s not remembered until the next day, skip the dose and wait until that evening. Jornay PM should not be taken in the morning.

What Side Effects Are Associated with Jornay PM?

Taking methylphenidate medications such as Jornay PM poses potential serious side effects such as new or worse behavior and thought problems, new or worse bipolar symptoms, and new manic or psychotic symptoms. Children ages 6 to 12 with ADHD may experience the following side effects: trouble sleeping, nausea, decreased appetite, mood swings, restlessness, vomiting, headache, slowed growth.

What Precautions Are Associated with Jornay PM?

Store Jornay PM in a secure place out of the reach of children, and at room temperature. Do not share your Jornay PM prescription with anyone, even another person with ADHD. Sharing prescription medication is illegal, and can cause harm.

Avoid drinking alcohol while taking Jornay PM, as it will cause a more rapid release of the medication into the bloodstream. Children who are allergic to methylphenidate hydrochloride or any of the ingredients in Jornay PM, or are taking or have taken within the past 14 days an antidepressant called a monoamine oxidase inhibitor (MAOI) should not take Jornay PM.

Methylphenidate products and other stimulant medications have been known to cause heart-related problems, so a physician should be called right at the onset of any heart-related symptoms, such as chest pain, shortness of breath or fainting, new or worsening mental or new manic symptoms. Unexplained wounds on fingers or toes are another reason to call a doctor. Jornay PM can cause elevations in blood pressure and heart rate. Additionally, if a child has numbness, pain, skin color change, or sensitivity to temperature in the fingers or toes, a physician should be contacted.

CNS stimulants, like Jornay PM, have a high potential for dependence and abuse, so signs of those tendencies should be monitored for while the medication is being taken.

Jornay PM is contraindicated in patients with a history of hypersensitivity to methylphenidates.

If you’re thinking of becoming pregnant, discuss the use of Jornay PM with your doctor. The safety of Jornay PM for children under age 6 has not been established.

What Interactions Are Associated with Jornay PM?

Jornay PM should not be taken concomitantly with MAOIs or within 14 days after discontinuing MAOI treatment. Concomitant use of MAO inhibitors and CNS stimulants can lead to a life-threatening hypertensive crisis.

Tell your doctor if you are taking seizure medications, blood thinners, blood pressure medication, or any medication containing a decongestant.

Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, and let all doctors and physicians know you are taking Jornay PM before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions.

More Information on Jornay PM and Other ADHD Medications

• Free Download: Medication Tracking Log
• Free Download: A Parent’s Guide to ADHD Medications
• Read: Jornay PM: A New Methylphenidate Formulation Now Available In the U.S.
• Read: The Most Popular ADHD Medications: Comparison Chart
• Find: ADHD Specialists and Clinics Near You

Sources

https://www.jornaypm.com/

https://www.rxlist.com/jornay-pm-drug.htm#clinpharm

https://www.fda.gov/home

https://www.nimh.nih.gov/index.shtml