FOLLOW-UP: How should a clinician follow up with a patient being treated for ADHD?

A: Like diabetes or hypertension, ADHD is not an illness for which one can hand the patient a prescription for pills and assume recovery is automatic… | Keep reading on Medscape »

COLLABORATIVE CARE: How can collaborative care models improve care for patients with ADHD?

A: This model – wherein primary care providers, case managers, and psychiatrists work as a team to care for and monitor patients – effectively resolves many common barriers to quality… | Keep reading on ADDitude »

DIVERSION: How can clinicians educate patients about the danger of drug diversion?

A: Doctors can provide printed or video material explaining the legal and health risks associated with sharing or selling stimulants… | Keep reading on ADDitude »

TREATMENT RELUCTANCE: Why might a child resist ADHD treatment, and how can clinicians address medication aversion?

A: When someone refuses to even consider change, your best strategy is to show him empathy and normalize the situation. Instead of driving him into an even more defensive posture… | Keep reading on ADDitude »

POSITIVE PSYCHIATRY: How does positive psychiatry benefit ADHD patients in the long run?

A: Incorporating positive psychiatry is best viewed as the creation of a supplementary toolbox that allows clinicians an expanded set of focus areas to help patients achieve a more robust and sustained response to treatment… | Keep reading on MDedge »

RELATED RESOURCES

How to Get, Afford, and Refill Your Prescriptions With Minimum Hassle

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

CBT and DBT for ADHD: How Talk Therapies Reduce Symptoms and Boost Confidence

Expert Webinar with John Mitchell, Ph.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?

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?

STIMULANT + NON-STIMULANT: How can combination therapy improve symptoms with fewer side effects?

A: The term refers to using a stimulant and a non-stimulant to reduce ADHD symptoms. There were no lectures in medical school on this therapy and no studies of it when… | Keep reading on ADDitude »

SLEEP: Stimulant use is associated with an elevated risk for sleep problems. How can clinicians address this side effect?

A: Clinicians should titrate while evaluating a patient’s environmental and familial conditions, screen for primary sleep disorders, and… | Keep reading on ADDitude »

MED CHANGES: When should a patient switch to a different medication and/or dosage?

A: If a stimulant is causing excessive irritability, restlessness, or seriousness throughout the day, a dose reduction… | Keep reading on MDedge »

ADHERENCE IN CHILDREN: How can clinicians improve medication adherence in children with ADHD?

A: ADHD medication initiation and adherence are increased when patients have a strong working alliance with their clinician and trust the health care system… | Keep reading on ADDitude »

ADHERENCE IN ADULTS: How can clinicians improve medication adherence in adults and adolescents with ADHD?

A: As clinicians, we must acknowledge how difficult it is take medications every day. And we must be proactive in asking our patients, “How many times did you skip a dose, and what impact did that have… | Keep reading on ADDitude »

RELATED RESOURCES

How to Optimize ADHD Medication: Strategies for Achieving Better Symptom Management

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

Why Adults with ADHD Abandon Medication — and How to Improve Treatment Outcomes

Expert Webinar with William Dodson, M.D., LF-APA | Listen now on ADDitude »

How to Optimize Stimulant Treatment for Children and Adults: Better Symptom Management Without Side Effects

Expert Webinar with Thomas E. Brown, Ph.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?

MEDICATION CHART: What are the similarities and differences between the most commonly prescribed ADHD medications?

A: This chart presents the most popular and most commonly prescribed medications used to treat ADHD in children and adults… | Keep reading on ADDitude »

METHYLPHENIDATE: How effective is methylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

AMPHETAMINE: How effective is amphetamine/dextroamphetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

DEXMETHYLPHENIDATE: How effective is dexmethylphenidate in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

LISDEXAMFETAMINE: How effective is lisdexamfetamine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

ATOMOXETINE: How effective is atomoxetine in the treatment of ADHD?

Dosing and uses, interactions, adverse effects, warnings, administration, images, and more. | See medication information on Medscape »

RELATED RESOURCES

Pills and Beyond: A Guide to the Formulations and Delivery Options of ADHD Medication

Expert Webinar with Laurie Dupar, PMHNP, RN, PCC | Listen now on ADDitude »

Medication Management: How to Use and Adjust Stimulants Safely

Expert Webinar with William Dodson, M.D., LF-APA | 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?

MEDICATION: What classes of medication have been shown to treat ADHD effectively?

A: Methylphenidate is the drug of choice approved by FDA for ADHD in children aged 6 years or older. It is the most commonly used drug… | Keep reading on Medscape »

BEST PRACTICES: How can a clinician determine a patient’s optimal dosage of the stimulant medications used to treat ADHD?

A: Many pediatricians are trained to give a certain number of milligrams per kilogram of a patient’s body mass, but there is no evidence that dose is affected by size, age, gender… | Keep reading on ADDitude »

THE MED DECISION: How should clinicians navigate parental concerns around treating children with ADHD medication?

A: While it’s important to educate parents on how medications work and why they might be used, it’s equally critical for clinicians to support… | Keep reading on ADDitude »

HEART HEALTH: Do cardiovascular risks exist for older adults taking ADHD medication?

A: A new meta-analysis concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD… | Keep reading on ADDitude »

ADHD & SUD: Does ADHD medication increase risk for future substance use problems?

A: No. What’s more, treatment with ADHD stimulant medication prior to age 9 may actually decrease a child’s likelihood of abusing drugs and alcohol later in life, according to research… | Keep reading on ADDitude »

RELATED RESOURCES

ADHD Medication Options and Benefits for Children

Expert Webinar with Walt Karniski, M.D. | Listen now on ADDitude »

Medicating Your Child with ADHD: How to Manage the Feelings of Guilt and Judgment, and Make Peace with Your Decision

Expert Webinar with Roberto Olivardia, Ph.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?

ADHD medication vacations are the biggest no-no that I can think of. I say that as a clinician with decades of experience treating children with attention deficit hyperactivity disorder (ADHD).

Often, parents are driven to give their child breaks from medication because of appetite reduction, sleep difficulties, and other side effects associated with taking stimulants. But medication vacations, even just on weekends, only increases the likelihood that side effects will occur.

[Read: ADHD Medication Vacation Pros and Cons]

Here’s why: The body and brain need to gradually adjust to the side effects of ADHD medication, if there are any. That can only happen if medication levels are constant. Side effects like appetite reduction and sleep difficulties tend to dissipate after a few steady weeks on medication. Children will begin to sleep better, and their appetite often improves to what it was before taking medication.

I can’t emphasize enough that this process takes time. If a child stops taking medication every weekend, then it is as if that child is newly starting on ADHD medication every Monday morning. The brain does not have a chance to adjust to medication treatment — an effect that is even greater with longer medication vacations. As a result, children experience fewer side effects if they take medication seven days a week, 365 days a year.

Medication adherence is a problem among teens, who commonly think they only need medication for school-related matters. But ADHD, as we know from research, affects practically all domains of life, from social relationships to driving. Consider the teen who wants to drive to meet their friends over the weekend. If they’re unmedicated, their risk for getting into an accident is two to six times greater than if they were on medication.

The bottom line: Think twice and talk to your physician before you stop your child’s treatment plan, even for a short break.

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?
   • How can I address appetite suppression caused by ADHD medication use?
   • How can I solve sleep problems associated with ADHD medication use?
   • What can I do if ADHD medication use causes tics?
   • How can I prevent the afternoon ‘medication crash?’
   • What if my child becomes a ‘zombie’ while taking meds?
   • Should my child take an ADHD medication vacation?
4. What natural treatments help kids with ADHD?
5. What if the medication stops working?
6. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

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.

#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.

This is a very common problem. ADHD medication only treats symptoms while the medication is at an effective level in the brain. Once the medication wears off, the benefits stop. That means that paying attention to how long a medication lasts, even if it is branded as long-lasting, is important.

If your child is on short-acting four-hour Ritalin, for example, a dose around lunchtime will wear off around 3:30 p.m. Not only that, but side effects like irritability might occur when the medication wears off too quickly. On the other hand, even if your child takes a 10-hour medication at 7 a.m., it will wear off at 5 p.m. — not good if your child does homework after dinner.

[Read: How to Survive the After-School Witching Hour]

Older children and teens may need medication that lasts even longer, often well into the evening hours. Otherwise, they’ll be attempting homework, tutoring, dance practice, soccer, and other activities without the benefit of ADHD medication.

As common as this issue is, there is almost always a solution that maximizes the benefits of the medication without introducing or worsening side effects. Clinicians typically solve the problem of medication wearing away too early by prescribing a short-acting medication to be taken in the evening, or whenever initial medication is wearing off. You might consider giving the short-acting medication to your child right after dinner so that it lasts for about four hours and wears off before bedtime. A low dose will also ensure that no sleep difficulties come from the added medication.

If you take this approach, you must use the same type of stimulant medication at all times. That is, if your child takes a methylphenidate in the morning, use a methylphenidate (not an amphetamine) in the evening. Download a complete chart of ADHD medications here.

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?
   • 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?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

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.

#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.

About 60% of children with attention deficit hyperactivity disorder (ADHD) will have a comorbid condition.¹ Comorbid means that one disorder often co-exists with a separate disorder. The most common comorbid conditions with ADHD include anxiety disorders, OCD, oppositional defiant disorder (ODD) and autism spectrum disorder. ADHD symptoms and symptoms of comorbid conditions may overlap, but they each require their own treatment.

Stimulant medications effectively treat the symptoms of ADHD, but they may worsen comorbid behaviors. For example, temper tantrums — common in ADHD and in other conditions — may worsen after taking medication, even if the same medication improves other ADHD symptoms.

[The ADDitude Symptom Checker: Use It to Scan for 17 Comorbid Conditions]

On the other hand, some of the medications commonly used to treat comorbid conditions like depression and anxiety — medications like Zoloft, Prozac, and Celexa, for example — are known to worsen ADHD symptoms.

As a result, the following scenario is common: Clinicians will start a child on a stimulant medication to control core ADHD symptoms. While the child’s ADHD symptoms improve, the same medication may cause them to experience more irritability and temper tantrums. So, the clinician adds a non-stimulant medication to address these worsening behaviors. But that second medication, in turn, worsens ADHD symptoms. In response, the clinician increases the dose of the stimulant — which helps improve the ADHD symptoms but worsens the tantrums and irritability.

At this point (and to stop the cycle), most clinicians will consider changing course and treating ADHD with a non-stimulant medication alone. Though not as effective as a stimulant, a non-stimulant will reduce the ADHD symptoms and at the same time, many symptoms of comorbid conditions as well.

Finally, it is important to note that many comorbid symptoms can be effectively treated with counseling as well. If the comorbid symptoms are mild to moderate, counseling may be the first treatment option before trying non-stimulant medication. But if the comorbid behaviors interfere with learning and social interaction, then a non-stimulant would be indicated.

[Read: What Is Complex ADHD?]

In all, the presence of comorbid conditions certainly complexifies ADHD. It can be difficult alone to determine whether a symptom like difficulty focusing stems from ADHD or anxiety – or both. Making the distinction between ADHD and other co-occurring conditions takes time, and comes from getting to know an individual patient.

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?
   • How can I address appetite suppression caused by ADHD medication use?
   • How can I solve sleep problems associated with ADHD medication use?
   • What can I do if ADHD medication use causes tics?
   • How can I prevent the afternoon ‘medication crash?’
   • What if my child becomes a ‘zombie’ while taking meds?
   • Should my child take an ADHD medication vacation?
4. What natural treatments help kids with ADHD?
5. What if the medication stops working?
6. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023. Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

#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.

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 Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860

Each clinician has their own way of determining the right ADHD medication and dosage for a patient. A common approach (and the one I use) is the following:

• Start patients on a low dose of a long-acting methylphenidate.
• If the patient is a young child or has difficulty swallowing a capsule, consider a liquid formulation, a chewable tablet, or a skin patch.
• If symptoms persist on the lower dose, consider increasing the dose.
• If methylphenidate is ineffective even at the higher dose and/or produces significant side effects, switch to a long-acting amphetamine.
• If either methylphenidate or amphetamine are effective but produce significant and intractable side effects, consider adding a non-stimulant.
• If either stimulant is ineffective, switch to a non-stimulant entirely.

[Get This Free Download: Comparison Chart of Stimulants & Non-Stimulants]

Why This Approach Works

Decades of research indicate that methylphenidate is as effective as amphetamine, but more easily tolerated as it comes with fewer side effects, which is why methylphenidate is commonly prescribed first.¹ Long-acting methylphenidate provides most patients with the all-day coverage they need, though I may prescribe a short-acting preparation during key points of the patient’s day, like in the morning to jump-start the beneficial effects of medication as the child gets ready for school, or as the medication is wearing off to extend the duration of the initial long-acting medication.

We start a patient with a low dose and adjust dose upward from there to ensure that there is optimum benefit with minimal or no side effects. We gradually increase the dose until the patient sees positive results (or even greater benefit).

Even if a patient, whether a child or an adult, sees benefits with the low dose of medication I started them on, I still encourage them to experiment with a higher dose of the medication. Parents of children who are newly diagnosed with ADHD are often resistant to the idea, but I explain to them that the benefits, even with a minimal dose increase, may be even greater than what they are currently seeing. If side effects do occur at a higher dose, then the dose can be lowered to the previous one. To further fine-tune a patient’s dose, I would consider a liquid preparation or a skin patch.

It is important to understand that while decades of scientific research establish the effectiveness of ADHD medications, a trial-and-error approach is often necessary when starting an ADHD medication, as each patient may respond differently to a given medication. Thankfully, the many different ADHD medication options available allow us to tailor treatment to the needs of each child or adult for maximum benefit with the least amount of side effects.

How to Treat ADHD in Children: Next Questions

1. What ADHD medications are used to treat children?
   • What are all of my ADHD medication options?
   • What are the most popular ADHD medications?
   • How does ADHD medication work?
   • How do stimulants and non stimulants differ?
   • How do short-acting and long-acting stimulants differ?
   • What are the benefits and risks of ADHD medication?
2. Are ADHD meds safe for my child?
3. What are common side effects associated with ADHD medication?
4. What natural treatments help kids with ADHD?
5. How can I find an ADHD specialist near me?

The content for this article was derived, in part, from the ADDitude ADHD Experts webinar titled, “ADHD Medication Options and Benefits for Children” [Video Replay & Podcast #438] with Walt Karniski, M.D., which was broadcast on January 19, 2023.
Dr. Karniski is the author of ADHD Medication: Does It Work and Is It Safe?

#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.

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 Cortese, S., Adamo, N., Del Giovane, C., Mohr-Jensen, C., Hayes, A. J., Carucci, S., Atkinson, L. Z., Tessari, L., Banaschewski, T., Coghill, D., Hollis, C., Simonoff, E., Zuddas, A., Barbui, C., Purgato, M., Steinhausen, H. C., Shokraneh, F., Xia, J., & Cipriani, A. (2018). Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The lancet. Psychiatry, 5(9), 727–738. https://doi.org/10.1016/S2215-0366(18)30269-4

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.

Download or Stream the Podcast Audio

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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ADHD prescriptions and medication use among 12^th grade patients hit an all-time high last year, according to a new study that found 15% of high school seniors reported stimulant or non-stimulant ADHD medication use in 2022 compared to 11% in 2021. The annual Monitoring the Future (MTF) survey published by the National Institute on Drug Abuse (NIDA) attributed this 36% increase in ADHD medication use to “more stress” or attention issues made “more salient to their parents” during the pandemic’s lockdowns and remote learning.¹

The legal, or medically supervised, use of ADHD medication was “one of the few substances with increasing prevalence during the pandemic,” according to the report, which found that lifetime use had increased for 8^th, 10^th, and 12^th graders in 2022. The 30-day use of stimulant and non-stimulant medication by 12th graders in 2022 was the highest ever recorded by NIDA’s survey. Notably, 11.2% of 12th graders had used a stimulant for ADHD in their lifetime and 5.6% in the past 30 days, according to 2022 data collected from 31,438 students across 308 schools.

The MTF survey is conducted annually by researchers at the University of Michigan. The use of ADHD medication was first recorded in 2001 (nonmedical) and 2005 (medical). Researchers collect data on self-reported use of various drugs over 30 days, 12 months, and lifetime from hundreds of schools across the U.S. It also measures attitudes and beliefs surrounding substance use.

Examining the Rise in ADHD Medication Use

Prior to the pandemic, legal use of ADHD medication had been trending downward for patients in the 8th, 10th, and 12th grades. Levels were at the lowest or near-lowest ever recorded by NIDA’s survey.

“It is possible that the need for treatment of ADHD increased during the pandemic due to adolescents experiencing more stress during the pandemic,” the researchers proposed.

That theory accurately reflects the experience of many caregivers surveyed by ADDitude in early 2023; 60% of the 370 parents surveyed reported a change in their child’s ADHD medication treatment plan during the pandemic. A 2021 survey of ADDitude readers found that 22% of adults and 17% of children had started ADHD medication for the first time since pandemic lockdowns began in March 2020.

“The emotional regulation piece made it very hard to create meaningful change,” said Jessie from Michigan, who first attempted to address her child’s ADHD symptoms with “elimination diets and nutritional supplements.”

“Our hope is that medication will bring equilibrium and allow us to address root causes long term.”

MTF researchers also posit that “sheltering at home during the pandemic may have made any attention issues of adolescents more salient to their parents, who then sought out medical care for their children.”

This reflects the experience of Catherine, whose three children were diagnosed with ADHD in 2022 after a lengthy wait for evaluations.

“They all started medications, and we immediately saw improvement in their schoolwork and home life,” she said. “One child went from a 2nd grade reading level to 4th grade within months.”

Illicit Drug Use Among Adolescents

NIDA’s study found that 11% percent of 8th graders, 21.5% of 10th graders, and 32.6% of 12th graders reported illicit drug use in the past year. It concluded that “adolescents and adults in their 20s fall into the age groups at highest risk” for illicit drug use. For teens and young adults with ADHD, the use of medically supervised stimulant medication may prevent illicit drug use, according to Walt Karniski, M.D., in a recent ADDitude webinar.

“ADHD affects substance abuse in both children and adults,” Karniski said. “Children with ADHD are more likely to smoke and to begin smoking at younger ages. They’re more likely to use alcohol at younger ages and more likely to abuse alcohol as adults. Adults with ADHD are two to three times more likely to abuse drugs, but less likely to abuse drugs if they’re taking medication for their ADHD… Multiple research studies have indicated that, when children and adults are treated with stimulant medication, they are less likely to abuse drugs in the future.”

Nonmedical use of ADHD medication also rose in 2022, according to the NIDA survey, which found the use of Ritalin without a doctor’s orders rose to 1.1% for 12th graders. Unprescribed Adderall use returned to near-2020 levels following a decrease in 2021. In contrast, the nonmedical use of amphetamines by 12th graders declined, and no significant changes were found for Ritalin use by 8th and 10th graders.

“As these varied patterns of use show, the overall proportion of U.S. adolescents using any substance in their lifetime has changed over the years, and the mix of drugs they use has changed even more.”

Research published by MTF has and continues to inform decisions regarding public debate and policy making. To learn more about NIDA’s survey results, visit monitoringthefuture.org.

Sources

¹https://monitoringthefuture.org/wp-content/uploads/2022/12/mtf2022.pdf

²https://nida.nih.gov/news-events/news-releases/2022/12/most-reported-substance-use-among-adolescents-held-steady-in-2022

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

• 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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