We asked ADDitude’s innovative readers what tricks they have up their sleeve to avoid the powerful pull of the couch and embrace exercise. Here’s what they said:

“I purchased a treadmill and put it in front of the TV. If I want to watch TV, I have to walk on the treadmill for at least 15 minutes.”

“I signed up for a workout class with a friend.”

“Finding someone local to go on a walk with can be a game changer, especially if you explain that you need support getting out of the house). Having the other person to help me “task initiate” is brilliant.”

[Read:Take It Outside! How to Treat ADHD with Exercise]

“When I put a load of laundry in, I do a yoga or walking video until the washing machine buzzer goes off. I get in exercise and feel productive.”

“I just got a VR (virtual reality) headset and am super into one of the fitness games in it. I don’t even realize I’m working out.”

“I tricked myself into liking the gym by getting a “black card” which gets me access to a hydro massage chair! I work out, I get a massage.” 

“My creative solution: accountability and competition. I don’t want to exercise, but I do want to keep my promise to play tennis with my friend (and I also want to destroy him).”

[Watch: “How to Leverage Sports Psychology to Benefit ADHD Brains”]

“Committing to just the warm-up portion of a video exercise helps. I usually feel like doing the rest once I’ve warmed up.”

“I have finally, after years of wanting to, got into doing yoga regularly —every single weekday morning. I’ve identified the barriers, and tried to address them. Number one is:  I have to work out straight away, as if I do anything else, my meds kick in and I’ll get focused on it too much.”

“Sign up for an intramural sports team. That way, you have people counting on you to show up to practice and for games.”

Workout Motivation with ADHD: Next Steps

• Read: 6 ADD-Friendly Tips for Starting and Maintaining an Exercise Program
• Download: Free Guide to Health & Fitness — Lifestyle Changes for Adults with ADHD
• Read: Exercise and the ADHD Brain -— The Neuroscience of Movement

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

The Clinicians’ Guide to Treating Complex ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when treating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: What should I consider when developing a comprehensive treatment plan for ADHD?
• DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
• DECISION 3: How can I decide which ADHD medication to prescribe first?
• DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
• DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
• DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
• DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

NOTE: This resource is for personal use only.

BEYOND MEDICATION: Which nonpharmacologic treatments are proven to benefit pediatric patients with ADHD?

A: Effective behavioral treatments for ADHD do not change ADHD symptoms, but they do help children learn how to manage them… | Keep reading on MDedge »

LIFESTYLE INTERVENTIONS: How can patients optimize nutrition, sleep, exercise, and other lifestyle factors to improve ADHD symptoms?

A: Regardless of whether a child’s treatment includes medication, maximizing exercise, sleep, and nutrition can effectively transform them into natural remedies for ADHD, and arguably establish the foundation… | Keep reading on ADDitude »

EXERCISE: How much and what type of physical activity will benefit a patient with ADHD, according to research?

A: With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas… | Keep reading on ADDitude »

SUPPLEMENTS: What supplements and/or vitamins can aid with ADHD symptom control?

A: Usually given in the form of fish oil, omega-3s are probably the best-researched supplement for ADHD. Numerous studies… | Keep reading on ADDitude »

PARENT TRAINING: How can Collaborative & Proactive Solutions parent training benefit an ADHD treatment plan, according to research?

A: CPS has been shown in randomized trials with both parent groups and in home counseling to be as effective as Parent Training in reducing oppositional behavior and reducing… | Keep reading on MDedge »

NEUROFEEDBACK: Is neurofeedback an effective ADHD treatment, according to research?

A: A body of research suggests that neurofeedback is a promising therapy for ADHD, but it should be considered a complement to medication and/or behavior therapy rather than… | Keep reading on ADDitude »

ENVIRONMENTAL CHANGES: Which accommodations and environmental changes have the greatest positive effect on children with ADHD?

A: Encourage parents and teachers to use clear and concise instructions with supplementary visual tools. When providing instructions in classrooms, teachers should look directly at the student… | Keep reading on MDedge »

RELATED RESOURCES

The Exercise Rx for ADHD: How Movement Improves Attention, Working Memory, and Executive Functions

Expert Webinar with John Ratey, M.D. | Listen now on ADDitude »

The Whole-Person Treatment Approach to ADHD

Expert Webinar with Lidia Zylowska, M.D. | Listen now on ADDitude »

How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally

Expert Webinar with J. Russell Ramsay, Ph.D., and David Giwerc | Listen now on ADDitude »

New Supplement Strategies: Using Trace Minerals and Plant Extracts to Treat ADHD in Children and Adults

Expert Webinar with James M. Greenblatt, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
>DECISION 6:What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

Online therapy sites and apps enjoyed a surge in popularity during COVID shutdowns, but they’ve remained appealing as a convenient, affordable, and flexible option. For people with ADHD, who may need check-ins more frequently than once a week, unlimited messaging has been a game-changer. Explained one ADDitude reader who used Better Help for their teen: “My child could send their provider a message whenever something was bothering them. They didn’t have to wait until the next scheduled appointment.”

Another essential tool in any mental health toolbox is meditation. Various studies have demonstrated the positive impact of meditation on everything from reducing stress and anxiety to promoting healthy sleep to improving symptoms of ADHD — and, thanks to a host of apps, the guided meditation have never been easier to access. A 2021 study published in Journal of Attention Disorders¹ revealed that meditation apps like Headspace significantly reduced anxiety and sleep problems in children with ADHD, no matter how much they meditated. The verdict is clear: meditation works, whether in app form, or otherwise.

But with hundreds of meditation and therapy apps promising life-changing results, how do you choose the one that meets your particular set of preferences and needs?

To ease the selection process, we asked ADDitude readers to share their favorite mental health apps, and to tell us what they loved about them. Here’s your top six.

[Read: Sleep Solutions in Your Back Pocket – Apps We Love]

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}

Here, we examine the effectiveness of three of these:

Lion’s Mane

Lion’s mane is a mushroom marketed as delivering “brain-boosting benefits.” As with many proposed alternative treatments, it claims to treat many symptoms and conditions, including anxiety, depression, Alzheimer’s, Parkinson’s disease, heart disease, and multiple sclerosis. Given the vastly different causes of these conditions, it is highly improbable that one intervention could provide universal benefit.

The websites we reviewed, which touted the shaggy white mushroom, acknowledged the dearth of published research studies examining the use of lion’s mane for ADHD. No research shows that it impacts the production or transmission of dopamine, the primary neurotransmitter involved in ADHD. Instead, the product’s marketers cite research done on animals or in test tubes that suggest the potential for general cognitive or health benefits and propose that it could benefit ADHD — without citing any clinical studies on humans for support.

More research is needed on humans to determine if lion’s mane has therapeutic effects.

Micro-Dosing Psychedelics

The use of very low (micro) doses of psychedelics, such as LSD and psilocybin, is gaining renewed interest for treating anxiety and depression. Some experts say these psychedelics might also show promise for treating symptoms of obsessive-compulsive disorder, cluster headaches, and ADHD. These treatments are not without risks, however, at least at higher doses. It is important to know that psychedelics can potentially exacerbate symptoms of bipolar disorder or lead to psychosis. These drugs are illegal unless they are administered in medical or research settings.

[Download: Best Natural Remedies for Managing ADHD Symptoms]

Some studies have examined micro-dosing psychedelics for ADHD, but the results involved self-reported benefits; there was no control group. A clinical trial is underway in Europe using a randomized, double-blind, placebo-controlled design, the gold standard for medication research. Results are expected in late 2023 and will offer much more helpful conclusions. The use of psychedelics over an extended period of time would also need to be studied, both for ongoing effectiveness (assuming short-term effectiveness is found) and also for safety.

Mega-Dosing Caffeine

Caffeine is the most popular brain-altering chemical that improves alertness, attention, and focus, at least briefly, for many people. Caffeine may improve memory, learning, complex problem-solving, mental stamina, and more. If you are sleep-deprived, mentally fatigued, or experiencing a mid-day dip in energy, caffeine may provide a temporary boost.

But the faster you consume caffeine, and the more concentrated it is, the quicker your blood levels of caffeine rise. Generally, caffeine has a six-hour half-life, meaning half of the blood levels are metabolized every six hours. Drinking more coffee than your system can tolerate may cause irritability, higher heart rate, jitteriness, headaches, anxiety, insomnia, or restless sleep. The combination of caffeine and prescription stimulants can worsen these side effects.

There is no research-supported evidence that caffeine is a valid treatment for ADHD. While it provides general cognitive benefits, caffeine doesn’t activate the parts of the brain that improve executive functioning, as prescription stimulants do.

[eBook: The ADDitude Guide to Treating ADHD Naturally]

Lion’s Mane, Psychedelics, & Caffeine: Next Steps

• Download: 5 All-Natural ADHD Supplements
• Readers Share: Favorite Non-Medical Therapies for ADHD
• Read: 10 Foods (and Supplements and Vitamins!) to Boost Your ADHD Brain

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Neurofeedback may not be an effective tool for treating ADHD in boys, according to research published in the American Journal of Psychiatry that studied whether functional MRI neurofeedback (NF) was a safe and effective alternative to pharmacological treatment for ADHD. Cognitive and clinical symptoms of ADHD did not significantly improve in subject who received fMRI-NF in this double-blind, sham-controlled randomized, controlled trial. ¹

Neurofeedback: Is It Effective?

The brain’s frontal cortex — responsible for attention, executive function, and organization — is impaired in people with ADHD. In this new trial, researchers studied the activation of the right inferior frontal cortex (rIFC) by neurofeedback training. Medication — a first-line treatment — activates or normalizes the IFC in many patients, but not all. ² Side effects are also commonly reported.

“Functional MRI neurofeedback, which enables self-regulation of brain activation in specific regions or networks by providing feedback of brain activity in real time, could be a novel alternative to pharmacological treatment,” the researchers wrote.

Participants were asked to complete a series of 15 “runs” over multiple visits and four one-hour fMRI-NF scans. Each run presented a video of a rocketeer flying in space. Its speed and direction (up or down) represented brain activity and increased or decreased activation of the rIFC, respectively. Participants in the sham group were shown neurofeedback from the last active participant instead of their own.

Compared to the sham group, the active fMRI-NF group showed improved activation in the rIFC across all sessions. But contrary to the study’s hypothesis, researchers found no improvement in ADHD-RS scores — their primary outcome measure. In other words, parents did not report an improvement in ADHD symptoms among children receiving fMRI-NF.

Additionally, the sham group showed comparatively less irritability and motor inhibition in the post-treatment assessment. Among subjects receiving fMRI-NF, researchers observed neither “progressively increasing upregulation across sessions or runs, nor correlations between changes in rIFC activation and ADHD-RS scores, nor transfer of learning, indicating no progressive training effects.”

“The findings do not suggest that fMRI-NF of rIFC is an effective treatment for ADHD,” the researchers wrote.

Editorial research by ADDitude similarly found neurofeedback ineffective at addressing ADHD symptoms over time, as reported by parents. In a 2017 survey of 2,495 caregivers, less than one-third of those who had tried NF found it effective. They rated it less effective than exercise, medication, behavioral therapy, and ADHD coaching or counseling, but more effective than mindfulness meditation or nutrition changes, at addressing ADHD symptoms.

The cost of treatment was cited as a common reason for neurofeedback’s small adoption rate; 29% of caregivers said they had not tried non-medication ADHD treatment options because of price or lack of insurance coverage.

New Study Limitations

Researchers relied on clinical, cognitive, and fMRI measures during seven participant visits between 2018 and 2020. This included baseline assessments, fMRI interventions, post-treatment assessment, and six-month follow up. Researchers had no direct interaction with participants but were unblinded to administer treatment.

This double-blind study expanded on a single-blind, proof-of-concept study conducted in 2017, which was limited by small sample sizes and no control group. However, the new research was limited by an all-male participant group (between ages 10 to 18), the majority (approximately 65%) of whom were active medication users. The study was ended prematurely due to COVID lockdowns.

“Future studies should investigate whether fMRI-NF of alternative regions of interest or networks implicated in ADHD may be more effective in improving clinical and cognitive problems.”

The results are nonetheless effective in informing parents and clinicians of the most effective treatment options on the market for children with ADHD.

Sources

¹Lam, S. L., Criaud, M., Lukito, S., Westwood, S. J., Agbedjro, D., Kowalczyk, O. S., Curran, S., Barret, N., Abbott, C., Liang, H., Simonoff, E., Barker, G. J., Giampietro, V., & Rubia, K. (2022). Double-Blind, Sham-Controlled Randomized Trial Testing the Efficacy of fMRI Neurofeedback on Clinical and Cognitive Measures in Children With ADHD. The American journal of psychiatry, 179(12), 947–958. https://doi.org/10.1176/appi.ajp.21100999

²Rubia, K., Alegria, A. A., Cubillo, A. I., Smith, A. B., Brammer, M. J., & Radua, J. (2014). Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biological psychiatry, 76(8), 616–628. https://doi.org/10.1016/j.biopsych.2013.10.016

From lead exposure and maternal stress during pregnancy to low birth weight, the list of prenatal and perinatal risk factors associated with ADHD seems to grow longer and longer with ongoing research. But there is much left to learn. The causal role of many exposures linked to ADHD is unclear; some appear to be artifacts of ADHD’s genetic element, while others are truly causal contributors. The other critical factor is that none of the risk factors cause ADHD every time; most children exposed to these risk factors do not develop ADHD.

Thus, it seems increasingly clear that genes and environments work together to shape development of the brain and behavior throughout life, but especially —and most dramatically — in very early life. ADHD, like other complex conditions, doesn’t have a single cause. Both nature and nurture influence its development.

Some prenatal and perinatal risk factors for ADHD are unavoidable and inevitable. Mothers grappling with their child’s ADHD diagnosis especially may place undue blame on themselves as they fixate on past events that could have contributed to their child’s ADHD. But science provides comforting truths: Exposure to risk factors does not guarantee ADHD, and early and effective treatment approaches can often mitigate the effects of previous complications and improve outcomes.

ADHD Risk Factors: What We Know

Prenatal Risk Factors

Teratogens: Alcohol, Smoking, and Other Substances

Teratogens are substances and agents that could harm a developing fetus during pregnancy. Some teratogens have been linked to ADHD, though association should not be mistaken for causality.

[Read: Is ADHD Genetic? Yes and No]

Alcohol

Children whose mothers consumed alcohol during pregnancy were at 1.55 times the risk for developing ADHD compared to children whose mothers did not consume alcohol while pregnant, according to a 2015 study of roughly 20,000 parents.¹ Other studies have found mixed evidence on prenatal alcohol exposure and ADHD risk.^{2 3}

Drinking alcohol during pregnancy can cause a group of conditions called fetal alcohol spectrum disorders (FASD), which are associated with some symptoms and features linked to ADHD, including behavioral challenges, inattention, learning disabilities, poor memory, hyperactivity, and impulsivity. ⁴

In many cases, FASD is overlooked altogether and even misdiagnosed as ADHD. ^{5 6}

Tobacco Use

Maternal prenatal smoking increases risk for ADHD in children by more than one and a half times, according to a 2020 review of 12 large studies.⁷ Other studies have found that paternal smoking before and during pregnancy increases risk for ADHD in offspring.^{1 8 9}

However, while smoking in pregnancy is a major correlate of ADHD, it’s probably not a causal factor. Studies that controlled for genetic effects found that the maternal smoking association to ADHD largely disappeared.

[Read: What Causes ADHD? Culture Vs. Biology]

Drugs and Other Substances

• Opioids: Children whose mothers used opioids during pregnancy had more than double the risk for ADHD compared to those whose mothers did not use the drug, according to a 2022 study of about 3,000 children.² The same study found that risk for ADHD increases with exposure to multiple substances, including tobacco and cannabis.
• Acetaminophen exposure in the womb may increase a child’s risk for ADHD.¹⁰ It’s unclear whether there are time periods when the developing brain may be most sensitive to acetaminophen exposure. The FDA urges pregnant parents to consult with a doctor before taking pain medication.

But, as with smoking, we do not yet know if these effects are causal independent of genetic effects.

Maternal Health Issues

Maternal Metabolic Syndrome

Maternal obesity, hypertension, diabetes, and related conditions before and during pregnancy are associated with increased risk for ADHD, autism, and other neurodevelopmental disorders in offspring.^{12 13} While researchers are still investigating the connection, the risk for these effects in isolation appears small, especially considering the prevalence of these conditions at large. Still, they are effects that helps us learn about mechanisms that are possibly tied to ADHD.

Emotional Stress and/or Trauma

Maternal exposure to stress or trauma, if it’s high, can influence offspring behavior and temperament. What’s more, chronic prenatal stress increases the likelihood that a child will have ADHD or other conditions.

One 2018 study found that mothers who experienced high levels of stress during their pregnancy were more than twice as likely as less-stressed mothers to have a child diagnosed with ADHD or conduct disorder.¹⁴

Birth Trauma and Delivery Complications

Oxygen Deprivation

Insufficient oxygen supply and blood flow in utero and during birth is associated with increased risk for ADHD in later life.

Birth asphyxia is associated with a 26% greater risk of developing ADHD, while neonatal respiratory distress syndrome is associated with a 47% greater risk for ADHD, according to a 2012 study of more than 13,500 children with ADHD.¹⁵

C-Section Delivery

Compared to babies born via vaginal delivery, babies born via cesarean delivery (whether elective or emergency) are at greater risk for ADHD, according to a 2019 review of 61 studies comprising more than 20 million deliveries.¹⁶ The link between the two – including whether C-section delivery plays a causal role in the development of ADHD – remains unknown.

Prematurity and Low Birth Weight

Low birth weight and prematurity do appear to have a significant causal influence on the development of ADHD. Extremely preterm babies and those with very low birth weight are about three times likelier than healthy babies to develop ADHD, according to a 2018 meta-analysis of 12 studies involving 1,787 participants.¹⁷ Studies that controlled for genetics found the association still held.

ADHD Risk Factors: Events and Exposures in Early Life

Lead and Other Pollutants

Research on lead as a developmental neurotoxicant is robust. Its correlation with ADHD is also well established.¹⁸ Even low levels of exposure have an effect on ADHD.

Recent evidence suggests that lead has a causal role in ADHD. In our 2016 study, we looked at the effect of a common gene mutation – HFE C282Y – on the relationship between blood lead levels and ADHD symptoms in children, and found that children with ADHD who had the gene mutation exhibited greater symptoms of hyperactivity and impulsivity than did children with ADHD without the mutation.¹⁹

Because the C282Y gene helps to control the effects of lead in the body, and the mutation was spread randomly in the children, it is difficult to explain these findings unless lead is, in fact, part of the cause of ADHD, not just associated with it. Numerous animal studies also support a link.

As far as other pollutants, early exposure to nitrous dioxide and persistent organic pollutants has also been linked to ADHD, among others.^{20 21}

Breastfeeding and ADHD

Breastfeeding is linked to decreased risk for ADHD in children.²² Mothers of children with ADHD are more likely than mothers of neurotypical children to report shorter breastfeeding duration.²³ What underlies the ADHD-breastfeeding link is unclear, like whether breastfeeding protects the developing brain from ADHD, or if infants who are going to develop ADHD are more difficult to breastfeed and are thus breastfed for a shorter period of time. We used advanced statistical methods to test this in one study, and found that the causality was reversed: child ADHD caused reduced breastfeeding duration.

Head Injuries

Head injuries, especially severe traumatic brain injuries, increase risk for ADHD, according to a 2021 review of 24 studies that included 12,374 children.²⁴

Head injuries and ADHD share a complicated chicken-and-egg relationship, as ADHD itself increases risk for head trauma.²⁵ Children with ADHD are twice or three times as likely to obtain serious head injuries and accidental head injuries through their impulsivity.

Childhood Trauma

Children who experience trauma and who are exposed to adverse childhood experiences (ACES) are at increased risk for ADHD. The inverse is also true: ADHD increases the risk of exposure to trauma.^{26 27}

Trauma is also known to exacerbate symptoms of ADHD. Compared to children without ADHD, children with ADHD who experience trauma are more reactive and sensitive to it, and need additional support.

Beyond a bi-directional relationship, trauma and ADHD share similar symptoms. It takes an experienced clinician to distinguish the conditions and understand if a child is experiencing a trauma effect or showing true signs of ADHD or both.

ADHD Risk Factors: The Bottom Line

Though research links a host of prenatal and early life risk factors to ADHD, it’s crucial to understand the following:

1. Few of these risk factors are yet known to be causal.

In most instances, we don’t yet know if risk factors have a causal effect or if it’s just artificial due to unmeasured correlates (in particular, genetic confounding). A key principle seems to be that the accumulation of multiple risk factors matters most in a child’s health. Genetic risk can be seen as one of the risk factors. But even a family history of ADHD doesn’t guarantee that a child will develop the condition.

2. Not all ADHD risk factors have equal influence.

Evidence for risk factors vary from “very strong” to “maybe.” Risk factors also tend to add up and occur in clusters, which ultimately makes it difficult to assess a factor’s relationship to ADHD. Some populations, including disadvantaged groups, may also be more vulnerable and sensitive to these risk factors or experience more of them.

3. To date, research has focused almost entirely on ADHD risk factors related to maternal health and pregnancy – but a dramatic shift is underway.

The history of psychiatry has unfortunately seen misguided blaming of mothers. It is important to realize that many of the risks are unavoidable, and that fathers are not off the hook. Paternal support, for one, can be a protective factor in maternal prenatal health and thus fetal health. But we are also learning more about how paternal exposures pre-pregnancy can affect sperm health and thus fetal health.

4. Exposure to a risk factor – even to a causal contributor of ADHD – does not guarantee an ADHD diagnosis down the line.

Most children who are exposed to these risk factors do not develop ADHD. There still has to be some other vulnerability or some other factors combined with these things in order for ADHD to emerge. In all, exposure to risk factors are rarely by themselves the entire explanation.

ADHD Risk Factors: What Parents Can Do

Exposure to ADHD risk factors may become a source of regret and second-guessing for parents. What I say to caregivers in this: Move forward; don’t belabor the past. Ultimately, at today’s level of knowledge, the cause of your child’s ADHD is not entirely known. More practical is to recognize that there is still a lot you can do to move forward positively.

If you are an expectant parent and/or the parent of a child with ADHD, follow these strategies below to minimize exposures, manage (and even reduce) your child’s ADHD symptoms, and protect your family’s health and wellbeing.

1. Engage in Behavioral Parent Training

ADHD can cause challenging behaviors that may overwhelm parents and lead to a negative parent-child dynamic — in itself a factor that can impact a child’s health and wellbeing. That’s why behavioral parent training (BPT) is an essential component of any child’s ADHD treatment. BPT teaches you how to respond to your child’s behaviors without inadvertently making those behaviors worse. Another benefit of BPT? It increases the chances that ADHD medication will work, and can lead to medication working at a lower dose.

2. Focus on Nutrition

Research has uncovered various links between nutrition and ADHD – some of which translate to actionable steps for your family.

• Eat healthy foods during pregnancy. A 2018 study of about 1,240 mother-child pairs found that children whose mothers had a healthy prenatal diet were less likely to exhibit symptoms of hyperactivity over time than were children whose mothers had an unhealthy prenatal diet.²⁸ Limit heavily processed foods and opt for whole, nutrient-dense foods.
• Consider omega-3 supplements (1000 mg EHA/DPA a day). Children with ADHD tend to have lower omega-3 levels compared to children without ADHD, and supplementation modestly improves ADHD symptoms.²⁹ Furthermore, prenatal omega-3 supplementation improved attention development in infants and toddlers in at least one controlled experiment.³⁰
• Try an elimination diet. Five percent to twenty-five percent of children with ADHD may see symptom improvement in response to a diet that eliminates common food allergens (cow-milk protein, soy, wheat, eggs, peanuts, seafood/shellfish) and additives (artificial food dyes and flavors).³¹ An elimination diet may be worthwhile if you suspect a dietary factor at play. But note that dietary changes are often difficult to implement. Your child may object, or the entire family may need to be involved. Adequate nutritional replacement also must be identified. Thus, only attempt this elimination plan in consultation with a behavioral counselor and nutritionist and/or your child’s pediatrician.
• Opt for whole, unprocessed foods. Shop the perimeter of the supermarket for fresh, nutrient-dense foods. Avoid added sugars and caffeine, and try to keep your kitchen stocked with only healthy food choices.
• Test for nutritional deficiencies. Children with ADHD are more likely than other children to have low levels of iron, zinc, and vitamin D.^{32 33 34} Supplementation can sometimes help with ADHD if nutrient levels are low. Recent evidence also suggests that specialized multi-nutrient supplements benefit important aspects of ADHD.³⁵

3. Encourage Good Sleep Habits

Behaviorally-related sleep problems — from going to bed to falling and staying asleep — are common among children with ADHD. (True endogenous sleep disorders also occur at above chance levels in ADHD, but still are present only in a minority.³⁶ ) Insufficient sleep, of course, worsens ADHD symptoms and functioning.

Create a bedtime routine, turn off or take away electronic devices before bed, and aim for your child to get 10 hours of sleep per night (depending on age). Talk to your child’s doctor to screen for potential co-occurring sleep disorders, or to get help with your child’s sleep problems.

4. Get Your Child Moving

Exercise improves health, mood, and ADHD symptoms.³⁷ Exercise may even reverse some of the biological effects of past traumatic events on the body, as shown in animal studies.³⁸ Children need at least one hour of moderate to vigorous exercise — be it sports, free play, or anything in between — on most days of the week.³⁹

Nutrition, sleep, and exercise are healthy lifestyle factors with the clearest effect on ADHD symptoms. While they usually will not substitute for professional treatment, they may well reduce the stimulant or psychotherapeutic dosage your child needs.

5. Reduce Exposure to Lead and Other Pollutants

A lead test —for your child and for yourself, especially if you are pregnant or planning for it — is worth doing if you live in an area of high lead exposure. However, note that common medical lead tests do not detect the low exposure levels that have now been associated with ADHD in scientific studies. Thus, even if your child does not have detectable exposure, it is prudent to minimize lead exposure.

A healthy diet and sufficient levels of iron and vitamin D can help minimize the effects of lead (because of the way lead is metabolized).

Consider the following steps to address potential pollutant exposures at home and school:

• Purchase a lead-removing water filter certified by an ANSI-accredited body.
• Install HEPA-quality air filters.
• If you live in home built before 1980, prevent and repair loose or chipped paint and do not let your child play in the soil right next to the house if possible.
• Learn about various sources of lead exposure and how to protect your family.

6. Limit Screen Time and Watch for Quality

Though still a new area of research, findings from screen time research are cautionary. In a 2018 study, teens who spent excessive time on social media were more likely to exhibit ADHD symptoms after a two-year follow-up compared to teens who did not use social media as frequently.⁴⁰

“Gaming addiction,” while still controversial, is receiving increased scrutiny. While more work is forthcoming, it remains possible that children with ADHD may be more susceptible to problematic video game play due to self-regulation challenges and the high-reward nature of gaming itself. Studies also link exposure to violent content with increased aggression in vulnerable children.⁴¹

7. Practice Self-Care

• Manage stress and reduce stressors in your life. The more stressed out you are, the more stressed out your child will be, and the more you’ll get into a negative cycle. Social support and self-compassion are among the key elements for managing stress.
• Recognize your own history of stress and trauma if present, and seek counseling and treatment if needed. Tell your doctor (and your child’s doctor) about your family’s experience with trauma, if any.
• Eat a healthy diet, practice good sleep hygiene, and get exercise daily.
• If you have ADHD, depression, or other mental health challenge yourself, stick to your treatment plan or talk to your doctor to see if an adjustment is necessary.

What Causes ADHD? Next Steps

• Read: Epigenetics and ADHD — How Environment and Lifestyle Impact ADHD
• Read: Beyond Genes  — Leveraging Sleep, Exercise, and Nutrition to Improve ADHD
• Free Download: Natural ADHD Treatment Options
• Resource Hub: What Causes ADHD?

The Clinicians’ Guide to Differential Diagnosis of ADHD from Medscape and ADDitude

• How can I better understand ADHD, its causes, and its manifestations?
• What is attention deficit hyperactivity disorder (ADHD)?
• What is the prevalence of ADHD?
• Which regions of the brain are involved in ADHD?
• What causes ADHD?
• What characterizes the inattentive ADHD subtype?
• Can ADHD be diagnosed before age 6?
• Free Webinar: How Our Understanding Has Evolved
• Free Webinar: Why Inattentive ADHD is Misdiagnosed
• Free Webinar: How Genes and the Environment Contribute to ADHD in Children
• What do I need to understand about ADHD that is not fully represented in the DSM?
• How can I avoid the barriers and biases that impair ADHD diagnosis for underserved populations?
• How can I best consider psychiatric comorbidities when evaluating a patient for ADHD?
• How can I differentiate ADHD from the comorbidities most likely to present at school and/or work?
• How can I best consider trauma and personality disorders through the lens of ADHD?
• What diagnostic criteria and tests are recommended for performing a differential diagnosis of ADHD?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children” [Video Replay & Podcast #433] with Joel Nigg, Ph.D., which was broadcast on November 30, 2022.

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Sources

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¹⁸ Nigg, J. T., Knottnerus, G. M., Martel, M. M., Nikolas, M., Cavanagh, K., Karmaus, W., & Rappley, M. D. (2008). Low blood lead levels associated with clinically diagnosed attention-deficit/hyperactivity disorder and mediated by weak cognitive control. Biological psychiatry, 63(3), 325–331. https://doi.org/10.1016/j.biopsych.2007.07.013

¹⁹ Nigg, J. T., Elmore, A. L., Natarajan, N., Friderici, K. H., & Nikolas, M. A. (2016). Variation in an Iron Metabolism Gene Moderates the Association Between Blood Lead Levels and Attention-Deficit/Hyperactivity Disorder in Children. Psychological science, 27(2), 257–269. https://doi.org/10.1177/0956797615618365

²⁰ Thygesen, M., Holst, G. J., Hansen, B., Geels, C., Kalkbrenner, A., Schendel, D., Brandt, J., Pedersen, C. B., & Dalsgaard, S. (2020). Exposure to air pollution in early childhood and the association with Attention-Deficit Hyperactivity Disorder. Environmental Research, 183, 108930. https://doi.org/10.1016/j.envres.2019.108930

²¹ Lenters, V., Iszatt, N., Forns, J., Čechová, E., Kočan, A., Legler, J., Leonards, P., Stigum, H., & Eggesbø, M. (2019). Early-life exposure to persistent organic pollutants (OCPs, PBDEs, PCBs, PFASs) and attention-deficit/hyperactivity disorder: A multi-pollutant analysis of a Norwegian birth cohort. Environment international, 125, 33–42. https://doi.org/10.1016/j.envint.2019.01.020

²² Soled, D., Keim, S. A., Rapoport, E., Rosen, L., & Adesman, A. (2021). Breastfeeding Is Associated with a Reduced Risk of Attention-Deficit/Hyperactivity Disorder Among Preschool Children. Journal of developmental and behavioral pediatrics : JDBP, 42(1), 9–15. https://doi.org/10.1097/DBP.0000000000000854

²³ Stadler, D. D., Musser, E. D., Holton, K. F., Shannon, J., & Nigg, J. T. (2016). Recalled Initiation and Duration of Maternal Breastfeeding Among Children with and Without ADHD in a Well Characterized Case-Control Sample. Journal of abnormal child psychology, 44(2), 347–355. https://doi.org/10.1007/s10802-015-9987-9

²⁴ Asarnow, R. F., Newman, N., Weiss, R. E., & Su, E. (2021). Association of Attention-Deficit/Hyperactivity Disorder Diagnoses With Pediatric Traumatic Brain Injury: A Meta-analysis. JAMA Pediatrics, 175(10), 1009–1016. https://doi.org/10.1001/jamapediatrics.2021.2033

²⁵ Liou, Y. J., Wei, H. T., Chen, M. H., Hsu, J. W., Huang, K. L., Bai, Y. M., Su, T. P., Li, C. T., Yang, A. C., Tsai, S. J., Lin, W. C., & Chen, T. J. (2018). Risk of Traumatic Brain Injury Among Children, Adolescents, and Young Adults With Attention-Deficit Hyperactivity Disorder in Taiwan. The Journal of adolescent health : official publication of the Society for Adolescent Medicine, 63(2), 233–238. https://doi.org/10.1016/j.jadohealth.2018.02.012

²⁶ Brown, N. M., Brown, S. N., Briggs, R. D., Germán, M., Belamarich, P. F., & Oyeku, S. O. (2017). Associations Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Academic pediatrics, 17(4), 349–355. https://doi.org/10.1016/j.acap.2016.08.013

²⁷ Lugo-Candelas, C., Corbeil, T., Wall, M., Posner, J., Bird, H., Canino, G., Fisher, P. W., Suglia, S. F., & Duarte, C. S. (2021). ADHD and risk for subsequent adverse childhood experiences: understanding the cycle of adversity. Journal of child psychology and psychiatry, and allied disciplines, 62(8), 971–978. https://doi.org/10.1111/jcpp.13352

²⁸ Galera, C., Heude, B., Forhan, A., Bernard, J. Y., Peyre, H., Van der Waerden, J., Pryor, L., Bouvard, M. P., Melchior, M., Lioret, S., de Lauzon-Guillain, B., & EDEN Mother-Child Cohort Study Group (2018). Prenatal diet and children’s trajectories of hyperactivity-inattention and conduct problems from 3 to 8 years: the EDEN mother-child cohort. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 59(9), 1003–1011. https://doi.org/10.1111/jcpp.12898

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³⁰ Colombo, J., Kannass, K. N., Shaddy, D. J., Kundurthi, S., Maikranz, J. M., Anderson, C. J., Blaga, O. M., & Carlson, S. E. (2004). Maternal DHA and the development of attention in infancy and toddlerhood. Child development, 75(4), 1254–1267. https://doi.org/10.1111/j.1467-8624.2004.00737.x

³¹ 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. https://doi.org/10.1016/j.chc.2014.05.010

³² Tseng, P. T., Cheng, Y. S., Yen, C. F., Chen, Y. W., Stubbs, B., Whiteley, P., Carvalho, A. F., Li, D. J., Chen, T. Y., Yang, W. C., Tang, C. H., Chu, C. S., Yang, W. C., Liang, H. Y., Wu, C. K., & Lin, P. Y. (2018). Peripheral iron levels in children with attention-deficit hyperactivity disorder: a systematic review and meta-analysis. Scientific reports, 8(1), 788. https://doi.org/10.1038/s41598-017-19096-x

³² Arnold, L. E., & DiSilvestro, R. A. (2005). Zinc in attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 15(4), 619–627. https://doi.org/10.1089/cap.2005.15.619

³⁴ Li, H. H., Yue, X. J., Wang, C. X., Feng, J. Y., Wang, B., & Jia, F. Y. (2020). Serum Levels of Vitamin A and Vitamin D and Their Association With Symptoms in Children With Attention Deficit Hyperactivity Disorder. Frontiers in psychiatry, 11, 599958. https://doi.org/10.3389/fpsyt.2020.599958

³⁵ Johnstone, J. M., Hatsu, I., Tost, G., Srikanth, P., Eiterman, L. P., Bruton, A. M., Ast, H. K., Robinette, L. M., Stern, M. M., Millington, E. G., Gracious, B. L., Hughes, A. J., Leung, B. M. Y., & Arnold, L. E. (2022). Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child and Adolescent Psychiatry, 61(5), 647–661. https://doi.org/10.1016/j.jaac.2021.07.005

³⁶ Hvolby A. (2015). Associations of sleep disturbance with ADHD: implications for treatment. Attention deficit and hyperactivity disorders, 7(1), 1–18. https://doi.org/10.1007/s12402-014-0151-0

³⁷ Seiffer, B., Hautzinger, M., Ulrich, R., & Wolf, S. (2022). The Efficacy of Physical Activity for Children with Attention Deficit Hyperactivity Disorder: A Meta-Analysis of Randomized Controlled Trials. Journal of attention disorders, 26(5), 656–673. https://doi.org/10.1177/10870547211017982

³⁸ Kashimoto, R. K., Toffoli, L. V., Manfredo, M. H. F., Volpini, V. L., Martins-Pinge, M. C., Pelosi, G. G., & Gomes, M. V. (2016). Physical exercise affects the epigenetic programming of rat brain and modulates the adaptive response evoked by repeated restraint stress. Behavioural brain research, 296, 286–289. https://doi.org/10.1016/j.bbr.2015.08.038

³⁹ Lobelo, F., Muth, N. D., Hanson, S., Nemeth, B. A., COUNCIL ON SPORTS MEDICINE AND FITNESS, & SECTION ON OBESITY (2020). Physical Activity Assessment and Counseling in Pediatric Clinical Settings. Pediatrics, 145(3), e20193992. https://doi.org/10.1542/peds.2019-3992

⁴⁰ Ra, C. K., Cho, J., Stone, M. D., De La Cerda, J., Goldenson, N. I., Moroney, E., Tung, I., Lee, S. S., & Leventhal, A. M. (2018). Association of Digital Media Use With Subsequent Symptoms of Attention-Deficit/Hyperactivity Disorder Among Adolescents. JAMA, 320(3), 255–263. https://doi.org/10.1001/jama.2018.8931

⁴¹ Anderson, C. A., Bushman, B. J., Bartholow, B. D., Cantor, J., Christakis, D., Coyne, S. M., Donnerstein, E., Brockmyer, J. F., Gentile, D. A., Green, C. S., Huesmann, R., Hummer, T., Krahé, B., Strasburger, V. C., Warburton, W., Wilson, B. J., & Ybarra, M. (2017). Screen Violence and Youth Behavior. Pediatrics, 140(Suppl 2), S142–S147. https://doi.org/10.1542/peds.2016-1758T

Intense children exhibit intense, often problematic, behavior with a frequency and severity that impacts everyone. Exhausted parents field regular phone calls from school administrators, frustrated teachers feel punishment (or leaving the profession) is their only option, and medical professionals assume medication is the only approach that truly works. No one benefits, certainly not the child.

Enter the Nurtured Heart Approach, a parent behavior training program developed from therapist Howard Glasser’s work with the most challenging and intense children. School and treatment centers report that it not only positively transforms “difficult” behaviors, but the Nurtured Heart Approach benefits all children by enabling and teaching adults how to channel their intensity into great qualities of character and leadership.

In this webinar, you will:

• Understand the dynamics of intense children and how to inspire success and greatness
• Understand why, despite sincere intention, conventional methods of parenting, education, and treatment often backfire with intense and challenging children
• Learn a methodology for inspiring success that is more powerful and encompassing than traditional approaches
• Understand how to uphold a great level of limits and accountability while avoiding the traps that make consequences backfire

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

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Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Positive Parenting and ADHD

• Download: Questions to Get Your Child Talking
• Read: “My Child Resists Everything! Will He Ever Open Up to New Experiences?”
• Read: Positive Charge: How to Reinforce Good Behavior

Obtain a Certificate of Attendance

If you attended the live webinar on March 29, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Creator of the Nurtured Heart Approach, Howard Glasser works in family treatment, clinical studies, and educational leadership. His formal studies, along with direct experience with the most intense and challenging children, form the basis of this approach. He has been referred to as one of the most influential persons working to reduce children’s reliance on psychiatric medications.

Howard is the author of 15 books, including Transforming the Difficult Child, a longstanding bestseller on intense and challenging children. (#CommissionsEarned)

Howard teaches Nurtured Heart Approach Certification Training Intensives at the Nurtured Heart Institute, the University of Arizona’s Integrative Medicine Program, and at the Zuckerman School of Public Health.

#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.

Listener Testimonials

“As a heart-centered practitioner, I appreciated this approach!”

“Glasser got to the core of the parent-child relationship in such a beautiful and compelling way.”

“Excellent presentation. I was affirmed in some of my current practices with my 5th & 6th grade classroom & want to explore this approach further!”

“Thank you! So rich and helpful.”

“Thank you, Howard was fantastic. Lots to think about, and to redirect the focus is something I’m going to try starting now! Inner wealth… I love this idea.”

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Here, we examine brain training programs — including neurofeedback and cerebellar (or movement/balance) interventions — and determine whether they effectively improve ADHD symptoms.

Brain Games for Adults and Kids with ADHD

Also called neurocognitive training, brain games are designed to train the brain to learn something. Many claim to improve focus, attention, and executive function skills impaired by ADHD, such as working memory. Working memory is the ability to remember information, use it for a task, and then dump it once you no longer need it. When playing brain games, either on a computer in a clinician’s office or at home, users are asked to complete tasks that may include sorting items by shape and color, recalling a sequence of shapes or objects, or remembering what items flashed on the screen.

ADHD Brain Games: Our Conclusion

Do brain games help reduce ADHD symptoms for the rest of your life, or just while doing the tasks involved in your training? This is the key question. After all, playing lots of Candy Crush will lead to higher scores, but not much else.

To that end, researchers have found that brain games don’t actually reduce ADHD symptoms.^{1 2 3} While players may improve their performance in a game, those skills likely won’t transfer to other areas, such as following directions for a class assignment at school. Furthermore, there is no evidence that you can train a brain to improve working memory, or any other executive function.^{1 2 4 5}

[Free Download: Learn the Facts About Neurofeedback]

Neurofeedback for ADHD

Neurofeedback is biofeedback that uses an electroencephalogram (EEG) to measure brain activity and train the user to produce brain wave patterns like those of a non-ADHD brain. Electrodes are placed on a person’s head to monitor brain activity while they play a video game in a clinician’s office. The hope is that the person will see improvements in attention, and a decrease in hyperactive or impulsive behavior, that will continue after the neurofeedback sessions are completed. Neurofeedback involves a significant investment of time (30-plus sessions total, multiple times per week) and can carry a price tag of up to $3,000. This intervention may not be covered by insurance.

EEG Neurofeedback: Our Conclusion

Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD. Also, there is little evidence that neurofeedback reduces ADHD symptoms long-term.^{6 7 8} It’s possible that future versions of neurofeedback may prove to be effective, but we cannot recommend this right now. Given the high cost in time and money, neurofeedback doesn’t seem to be worth the investment.

Cerebellar or Movement Exercises for ADHD

The so-called “cerebellar developmental delay” theory claims that different parts of the brain lack sufficient connections to coordinate the processing of information, resulting in symptoms of ADHD, dyslexia, and dyspraxia.⁹ Movement and balance exercises claim to “remediate” ADHD symptoms by improving the functions of the cerebellum through specific movements that involve crossing the body’s midline, such as touching your left shoulder with your right hand. The idea is that these exercises will integrate the two sides of the brain, resulting in cognitive improvements, such as in paying attention and processing information. But this premise is flawed, as it does not match up with established medical science regarding how the brain operates. (If this theory were valid, we would need to re-write much of neurological theory.)

Cerebellar Exercises: Our Conclusion

Cerebellar exercises do not reduce ADHD symptoms. Any benefits from movement and balance exercises likely come from the benefits of exercise in general. Exercise of any kind increases levels of certain neurotransmitters in the brain, some of which are naturally low due to ADHD. That’s why exercise has been shown to temporarily improve cognitive functioning and ADHD symptoms. As far as cerebellar exercises and “movement therapies,” there is nothing efficacious about them specifically.¹⁰

[Read: Exercise and the ADHD Brain — The Neuroscience of Movement]

ADHD Brain Training: The Bottom Line

Based on the research, we can’t personally recommend computerized brain training, neurofeedback, or cerebellar/movement/balance exercises to treat ADHD. If you are still considering any of these approaches for yourself or your child, remember that the placebo effect can be potent, meaning that a program may work simply because you expect it to work, at least initially. Keep in mind that any proposed intervention that is expensive and/or time-consuming must be able to make a much stronger case about its effectiveness.

You should also be aware of tactics companies use to sell such programs, along with other red flags:

• Is there sales pressure to sign up immediately, without time to do your own research into a program’s efficacy?
• Is the pitch about an approach’s effectiveness based on testimonials, not peer-reviewed journal articles or research?
• Is the intervention “radical” and brand new to the marketplace, and therefore hasn’t been out long enough to be fully evaluated?
• Does the program claim to be 100 percent safe and free of side effects (which might suggest it is also zero percent effective)?

If you or your children are benefiting from brain games, neurofeedback, or similar approaches, and it isn’t causing financial hardship or taking an unreasonable amount of your time, then it should be fine to continue. But know that there is no such thing as a miracle cure for ADHD.

Does Brain Training Work for ADHD? Next Steps

• Free Download: Unraveling the Mysteries of Your ADHD Brain
• Read: Can Neurofeedback Effectively Treat ADHD?
• Read: Like a Personal Trainer for Your Brain

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?

Stephanie Sarkis, Ph.D., is a psychotherapist and the author of Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse and Gaslighting: Recognize Manipulative and Emotionally Abusive People—and Break Free. Ari Tuckman, Psy.D., C.S.T., is a psychologist, international speaker, and author of four books on ADHD, including More Attention, Less Deficit and Understand Your Brain, Get More Done.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Sources

¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

³ Shipstead, Z., Hicks, K. L., & Engle, R. W. (2012). Cogmed working memory training: Does the evidence support the claims? Journal of Applied Research in Memory and Cognition, 1(3), 185–193. https://doi.org/10.1016/j.jarmac.2012.06.003

⁴ Melby-Lervåg, M., & Hulme, C. (2013). Is working memory training effective? A meta-analytic review. Developmental psychology, 49(2), 270–291. https://doi.org/10.1037/a0028228

⁵ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006

⁶ Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁷ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁸ Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁹ Bishop D. V. (2007). Curing dyslexia and attention-deficit hyperactivity disorder by training motor co-ordination: miracle or myth?. Journal of paediatrics and child health, 43(10), 653–655. https://doi.org/10.1111/j.1440-1754.2007.01225.x

¹⁰ Snowling, M. J., & Hulme, C. (2003). A critique of claims from Reynolds, Nicolson & Hambly (2003) that DDAT is an effective treatment for children with reading difficulties–‘lies, damned lies and (inappropriate) statistics’?. Dyslexia (Chichester, England), 9(2), 127–135. https://doi.org/10.1002/dys.245

Growing in lockstep with our scientific understanding of ADHD is our knowledge about epigenetics — the study of how lifestyle factors like nutrition, exercise, and sleep exert real, physical changes on a person’s DNA. ADHD is a genetic disorder, yes. But epigenetic changes to DNA do influence how strongly or weakly those ADHD genes get expressed in day-to-day life. In other words, you can positively impact ADHD symptoms by modifying your environment through sleep, exercise, and food changes.

In most cases, sleep, food, and exercise will not replace medication or therapy in a treatment plan, nor should they — they’re most effective as complementary treatments. It’s best to balance professional care with deliberate healthy lifestyle choices in an integrated approach to treatment. Here’s how to get started:

In this download, you will learn the following:

• What lifestyle changes can improve ADHD symptoms
• How to improve your sleep hygiene
• What to include in a bedtime routine
• How to start an exercise routine
• And more!

NOTE: This resource is for personal use only.

Physical activity can significantly reduce depressive symptoms in children and adolescents, according to a recent study published in JAMA Pediatrics. ¹

The meta-analysis of 21 studies involving 2,441 participants (47% boys and 53% girls) between the ages of 11-19 found that physical activity may help alleviate depressive symptoms in young patients. Twelve of the studies also demonstrated the benefits of physical activity for participants with a somatic or psychiatric disorder such as depression, obesity, ADHD, and diabetes.

The findings revealed that physically active teenagers experienced more notable reductions in depressive symptoms than did younger participants. “It is possible that younger children are sufficiently active to be desensitized to additional physical activity, whereas their older and more sedentary counterparts might be more responsive to the intervention,” researchers said.

After analyzing the frequency and duration of physical activity, researchers determined that engaging in three sessions of physical activity lasting at least 30 minutes yielded the greatest improvement in depressive symptoms.

“Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seeks or receives disorder-specific treatment,” researchers said. “Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression.” ²

Benefits of Physical Activity for Comorbid Conditions

The study suggests that physical activity may also alleviate comorbid symptoms of anxiety and ADHD, which impact 75% and 57% of children with depression, respectively.³,⁴

This finding echoes that of a 2017 ADDitude survey, which found that 37% of children with ADHD manage their symptoms with daily exercise. Roughly half of the respondents rated exercise as an “extremely” or “very” effective treatment — the highest rating of any ADHD treatment included in the survey.

“Any aerobic activity, especially outdoors, helps our daughter,” said one ADDitude reader recently surveyed on the impact of exercise. “Within a day or two of not doing anything, she gets depressed.”

“We see great improvements in our son after physical activity,” said another parent. “The depression can really take hold, even though he is only 10. We homeschool, so our son and I both have YMCA memberships and attend at least three times per week. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

Most ADDitude reader panelists called exercise an effective form of treatment, but many said that inducing their children to participate in physical activity is challenging.

“My teenage daughter has depressive symptoms, and we see her mood improve when she is active, but it took her a long time to start exercising,” said one parent. “She used to play tennis and soccer and ski, but when she went to college, she stopped exercising.”

Physical activities must be regular and consistent to maintain their mental-health benefits, according to ADDitude readers. “In just a few short months, I see the absence of physical activity in his life magnifying all his depressive symptoms,” one parent said.

“I see an improvement in her behavior with more physical activity, but I could not say I’ve noticed any direct correlation with her mood,” said another parent. “However, I notice that her mood and behavior deteriorate when she’s less active or getting too much screen time. She does martial arts once a week and seasonally participates in soccer or t-ball. We’re adding family yoga in a few weeks.”

“My son always does better when he moves but, unfortunately, it is very difficult to get him going,” wrote another parent. “I notice after shooting hoops he is much calmer and in a better mood, so I try to encourage him to get out and do it.”

However, exercise is not a universal cure. Of ADDitude survey respondents, 5% found exercise “not very” or “not at all affective” in addressing ADHD symptoms.

“Physical activity does not have a sustained effect on his depression or intense feelings,” said one ADDitude reader panelist. Said another, “The positive results of physical activity last as long as the activity occurs, then fade fast.”

One parent explained that physical activity negatively impacted her child’s symptoms. “Physical activity does not help her — it actually makes it worse. She needs more mental activities to help her, such as puzzles, card games, or workbooks. Those are things that help regulate and reduce her symptoms.”

Sources

¹Recchia F., Bernal J.D.K., Fong D.Y., et al. (2023). Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr. https//doi.org/10.1001/jamapediatrics.2022.5090

²Erskine H.E., Baxter A.J., Patton G., et al. (2017 ). The Global Coverage of Prevalence Data for Mental Disorders in Children and Adolescents. Epidemiol Psychiatr Sci. 26(4):395-402. https://doi.org/10.1017/S2045796015001158

³Angold, A., Costello, E.J. (1993). Depressive Comorbidity in Children and Adolescents: Empirical, Theoretical, and Methodological Issues. Am J Psychiatry. 150(12):1779-1791. https://doi.org/10.1176/ajp.150.12.1779

⁴Birmaher, B., Brent, D., Bernet, W.,  et al. (2007). AACAP Work Group on Quality Issues. Practice  Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders.  J Am Acad Child Adolesc Psychiatry. 46(11):1503-1526. https://doi.org/10.1097/chi.0b013e318145ae1

Research shows that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. Additional studies show that people who eat “clean” or “whole” diets high in vegetables, fruits, unprocessed grains, and lean meats are more likely to experience better emotional and brain health and are 25% to 35% less likely to experience mood disorders. ¹

In essence, the better you want your brain to perform, the more brain food, such as unprocessed foods, proteins, vegetables, and fruits) you should eat.

In this download, you will learn the following:

• How nutrition affects the ADHD brain.
• What are the best foods for optimal brain health?
• Foods people with ADHD should avoid.
• And more!

NOTE: This resource is for personal use only.

Source

¹ Selhub, E., Nutritional Psychiatry: Your Brain on Food. Harvard Health Blog. Harvard Health Publications, 17 Nov. 2015.

• Improved diet, exercise, or sleep: 11.9%
• Education services (e.g., tutoring, accommodations): 10.13%
• Behavioral therapy: 7.34%
• Limited screen time: 4.56%
• Supplements (e.g., omega-3s, magnesium, zinc): 2.53%
• Speech, occupational, or physical therapy: 2.53%
• Mindfulness exercises: 1.77%

Comments and questions submitted during the webinar, titled “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children,” centered on the lifestyle and environmental factors with the biggest impact on ADHD symptoms.

The Importance of Diet, Exercise, and Sleep in Managing ADHD

Diet, exercise, and sleep are the Big Three — the lifestyle changes with the most significant, most scientifically proven effect on ADHD. When these lifestyle factors are optimized, your child may require a lower dose of stimulant medication or may find their ADHD medication works better, according to Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University.

Next Steps to Optimize Diet, Exercise, and Sleep:

• Read: Exercise and Sleep – the Better Brain Therapies Your Child Needs
• Read: 5 Big Natural Remedies for ADHD
• Read: Leveraging Sleep, Exercise, and Nutrition to Improve ADHD

Q: “Are there specific foods or nutrients that we should increase to better manage ADHD symptoms?”

Omega-3 supplements have been shown to improve ADHD symptoms. Learn more about the benefits of omega-3s in these resources:

• Read: Omega 3s – the Ultimate (ADHD) Brain Food
• Free Download: 12 Surprising Sources of Omega-3 Fatty Acids
• Read: “How Do I Get My Sensory-Sensitive Child to Take Fish Oil Supplements?”

Q: “What, if anything, should we eliminate from our child’s diet?”

A portion of children with ADHD will respond positively to a diet that eliminates allergens, additives, and dyes. Consult with your child’s doctor and/or a nutritionist to safely follow an elimination diet.

Next Steps:

• Read: The Truth About Food Dyes and ADHD – What Science Tells Us
• Read: Eggs, Dairy, Nuts, and Soy – Testing for Food Sensitivities with an ADHD Elimination Diet
• Free Download: What to Eat — And Avoid — to Improve ADHD Symptoms

Q: “What about caffeine?”

The active ingredients in caffeine are clearly beneficial for attention, Nigg says, but it’s unknown what caffeine doses are safe for children. Too much caffeine can actually be harmful for development. It’s best to avoid caffeine (e.g., watch sports drinks and other sources of caffeine) until the late teenage years.

Next Steps:

• Read: The Truth About Caffeine and ADHD

Screen Time and Video Games

Q: “Do violent video games impact my child’s behavior?”

“There is quite a bit of evidence linking violent content with increased aggression in vulnerable children,” Nigg says. Monitor your child’s gaming activities and redirect if you notice signs of aggression, depression, and irritability.

Next Steps:

• Read: ADHD and Video Games – Is Your Child Hooked?
• Read: Do Video Games Exacerbate ADHD?
• Free Download: An “Ethics Manual” for Your Child’s Electronics

Stress and Family Conflict

Q: “My child’s ADHD has worsened since the pandemic. Do I need to adjust their treatment plan?”

“Scientific evidence supports your feeling that kids’ problems have gotten a lot worse in the last two and a half, three years,” Nigg says. In a chronically stressful situation, it’s normal for children to be (and act) stressed. As the stressful situation reduces, your child’s behaviors should go back to baseline. In the meantime, continue to support and coach your child and model appropriate coping behaviors. Talk to your child’s doctor if you notice concerning behaviors. There could be more than ADHD in the picture, which will influence your child’s course of treatment.

Next Steps:

• Read: How Do You Reassure Your Anxious Child When You’re Scared, Too?
• Read: How Trauma and Chronic Stress Affect Developing Brains
• Read: Does Trauma Cause ADHD? And Vice Versa?
• Read: Building Resilience Begins Here –  6 Motivation Strategies for ADHD Families

Remember, ADHD is Not Caused by “Bad Parenting”

Parents of children with ADHD can easily get caught in negative loops that may inadvertently reinforce challenging behaviors. (Parental ADHD can also complicate the dynamic.) Behavioral therapy is proven to help reduce difficult behaviors in children and create a positive family dynamic. Parental self-care is also important.

Next Steps:

• Read: Behavioral Therapy for ADHD – A Pragmatic Parent’s Guide
• Read: “None of Us Were Trained How to Be Good Parents” – An ADHD Guide to Behavior Therapy
• Read: A Survival Guide for Parents with ADHD – Strategies from Preschool to High School
• Read: Hey, ADHD Parents – Shoot for Progress, not Perfection
  

To learn more about how lifestyle and environmental factors impact ADHD symptoms in children, listen to the ADDitude ADHD Experts webinar, “Genes and the Environment: How Biology and Exposures Contribute to ADHD in Children” by Joel Nigg, Ph.D., which was broadcast live on November 30, 2022.

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?

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