Counseling 101: Supporting your ADD/ADHD child.

Picture this: you’re driving your child to his third day of school. The day started off like most other days—you struggled to wake little Johnny, he stumbled aimlessly around his room for what seems like hours before you finally went in there to make sure he didn’t need help finding the kitchen. Miraculously, he made it to the breakfast table where he stood next to his chair and picked all the marshmallows out of his bowl of Lucky Charms. It was only when you were waiting in the carpool line that you realized he had two different shoes on. Oh well, you think to yourself. He was fine last time this happened! This sound familiar to anyone? I think it’s safe to say that 99% of parents have been in this situation with their child. However, when this type of inattentive or hyperactive behavior begins to interfere with a child’s academic, social, and family life, a larger problem may be to blame.

It seems as though every “difficult” kid is being diagnosed with ADD or ADHD these days. According to Healthline Network, the American Psychiatric Association (APA) says that 5% of American children have ADHD while the Centers for Disease Control and Prevention (CDC) puts that number at 11%. That’s an increase of 42% in only eight years. Crazy, right? So what the heck is going on? There are LOTS of theories about the prevalence of ADD/ADHD being on the rise in the U.S. including additives in our foods, air pollution, genetics, and my personal favorite, bad parenting (sarcasm…). I work with children who have been diagnosed with ADD/ADHD every day and their parents are some of the most attentive, nurturing, encouraging, and consistent parents that I’ve ever come across. Parenting has little to do with it if we’re talking about true Attention Deficit Disorder. It may, however, have something to do with it if a child doesn’t listen to mom because she never follows through on behavioral consequences. Now, I’ll step off my soapbox and throw some facts about ADD/ADHD at you…

• ADHD has a male to female incidence ratio of 6:1.
• Secondary problems of language learning, visual-motor skills, handwriting, and self-control often coexist with ADHD.
• Symptoms of ADHD typically first appear between the ages of 3 and 5.
• Boys and girls display very different ADHD symptoms. Boys’ symptoms often include acting out, hyperactivity such as running and hitting, lack of focus, and physical aggression. Girls’ symptoms often appear more internal: being withdrawn, low self-esteem, anxiousness, intellectual impairment and difficulty in the classroom, tendency toward daydreaming, and verbal aggression such as teasing or taunting.
• In early childhood, kiddos with ADHD often display a difficult temperament and sensitivity to typical stimuli. They also may have had a confused wake/sleep cycle.

Whatever your child’s specific situation may be, if you are concerned about him or her displaying symptoms/behaviors associated with ADHD, get it checked out! Many health care providers are able to diagnose ADHD, but use good judgement. We utilize standardized rating scales and computerized assessments, reports from teachers and other caregivers, a thorough developmental history, and a diagnostic interview with both the parents and the child in order to determine if a child has ADHD. Make sure that whomever evaluates your child obtains all the necessary information needed to make (or not) a diagnosis. In the mean-time, here are the 10 Golden Rules for Parents of Kids with ADD according to Dr. Russell Barkley:

1. Make the rules specific and clear—post them in writing.
2. Use rewards that are powerful and meaningful to the child.
3. Give feedback often… let them know how they’re doing!
4. Help them anticipate and plan for what’s coming up.
5. Expect that they will have good days and bad days.
6. Use positives and praise more than negatives… or punishments.
7. Keep in mind that we are dealing with a biological problem… NOT a character defect!
8. “Act—don’t yak!” don’t talk too much, respond with behavior.
9. Maintain a sense of humor… be patient!
10. Forgive your child AND yourself… you are all in this together, and trying your best.

Using Nutrition to Manage ADHD

My child was diagnosed with ADHD and I was told he needs to start conventional medication. I have seen a lot of information about alternative therapies, including different diets, but are they safe? Do they work? How do I know which one(s) to try?

Attention Deficit Hyperactivity Disorder, or ADHD, manifests as inattentiveness, hyperactivity and impulsivity, or some combination of these. While the exact cause of ADHD remains unknown, we do know several factors can lead to its development. As a result, treatment is highly individualized and often involves a combination of several approaches designed to alleviate associated symptoms. Treatment approaches include medication, behavioral counseling, education and training.

In addition to these treatment options, many recommendations have emerged as an alternative or supplemental therapy to help manage symptoms of ADHD. These dietary modifications can be confusing to both the caretaker and the individual. They are often complicated and difficult to apply. In an effort to clear up some of the confusion, here is a brief overview on some of the most popular recommendations and what research has to say about them.

*Before reading, please note that this information is not intended to replace medical recommendations and its application should be considered under the guidance of a registered dietitian.

• Sugar-restricted Diet: The theory behind this diet is that eating excessive amounts of refined sugar worsens symptoms of ADHD. Many individuals and caretakers report this to be true for themselves and/or their children. Surprisingly, some studies do not show a connection between excess sugar consumption and ADHD symptoms. However, there is plenty of anecdotal evidence that leads people to still give it a try! Take Home Message: This diet is safe to try with your child, but do not expect drastic changes in behavior simply from removing added sugars. Regardless of whether sugar does or does not affect ADHD symptoms significantly, it is beneficial to limit the amount of added sugars in our diets for general wellness.

• Additive/Preservative-free (The Feingold Diet): This modification requires avoiding certain foods thought to cause adverse reactions in children with ADHD. The foods in question are those containing dyes and preservatives, particularly red, orange, and yellow synthetic dyes. For example, you can recognize dyes such as red #40 or yellow #5 from food labels on the ingredients lists. You might also look to avoid preservatives, such as BHA, BHT and TBHQ. These types of additives are often found in processed foods and are listed on the nutrition facts label. Research provides inconsistent evidence about the effectiveness of this diet; however, some children do benefit from the elimination of these items. Take Home Message: Remember, making these adjustments may or may not alleviate your child’s ADHD symptoms. However, this diet is safe to try, and by eliminating or limiting the amount of packaged and processed foods in the home, you are making positive, healthy changes for your entire family.

• Oligoantigenic (Elimination Diet): This diet eliminates well known food antigens, which cause an immune response in the body, and allergens, which cause an allergic reaction, in hopes of identifying foods that might trigger ADHD symptoms. Symptoms are alleviated when the “problem-foods” (the antigens or allergens) are removed from the diet. Several foods are eliminated all at once in hopes that the symptoms subside. Then, foods are reintroduced one at a time to determine which one(s) are the culprit for influencing symptoms and therefore should be permanently eliminated. As with the previous two diets, research is mixed about the effectiveness of this approach in treating individuals with ADHD. Take Home Message: Eliminating certain foods from the diet may improve some symptoms associated with ADHD. However, if you are going to attempt this type of diet, it is imperative you work with healthcare professionals, including a dietitian, to ensure your child continues to meet their nutritional needs. If you have an interest in this, please ask our registered dietitians about the Lymphocytic Response Assay Testing (LRA) and read more about it here.

• Ketogenic Diet: This is a diet that is high in fat and low in carbohydrate and is sometimes used for the treatment of epilepsy. Not much is known about how the diet works, but it can have an anti-epileptic effect. What does this have to do with ADHD? Children with epilepsy often have ADHD symptoms and children with ADHD sometimes have epileptiform discharges in an electroencephalography (EEG). Please note, this is very rare and would be best diagnosed by a medical doctor. It is thought that if a child with ADHD experiences these epileptiform discharges, the ketogenic diet may be beneficial. There are few, if any, scientific studies testing this diet and its effects on a child with ADHD. Take Home Message: It is NOT recommended to use the ketogenic diet to alleviate symptoms associated with ADHD alone, but may be an effective approach if ADHD exists with epileptiform discharges in an EEG.

• Omega 3 and 6 Fatty Acid Supplementation: It is thought that children with ADHD may have lower levels of essential fatty acids (EFAs) compared to children without ADHD. As a result, several studies have looked at whether supplementing these fatty acids in children with ADHD would alleviate symptoms associated with the disorder. Surprise, surprise: results of the studies are inconclusive! Fatty acid supplementation is beneficial for some kids and was shown to be ineffective in others. This treatment approach is not always effective, but in most cases is not harmful to try and can have other health benefits for a child. Take Home Message: Essential fatty acids alone are not an effective tool for ADHD management. However, it might be beneficial to ensure adequate intake of these nutrients in children who are deficient. Consider talking with a registered dietitian about the amount and type of supplementation your child might need. You might consider adding foods that are high in these nutrients, including ground flax seed (make sure you store in a freezer or refrigerator!), walnuts, and high fat cold water fish (e.g., salmon, herring, mackerel, trout, chunk light tuna canned in water).

• Megavitamin Supplementation: This type of supplementation might refer to taking mega-doses of multivitamins, individual vitamins, and/or minerals to create an “optimal molecular environment” for the functioning of the mind. Research shows this type of therapy is not effective for management of ADHD and related symptoms. As a matter of fact, excessive intake of some vitamins can be toxic to our bodies and cause adverse reactions. Take Home Message: DO NOT use megavitamin supplementation as a means to manage ADHD. It is only recommended to consume vitamins and minerals in levels that exceed the RDA (recommended daily allowance) under the specific recommendations of a health care professional due to their potential toxicity.

You might be thinking, “Wow. This is a lot of information and I still feel confused. So, should I change my child’s diet to manage their ADHD or not?” Well, research shows that diet alone may not be an effective management tool for children with ADHD. Since the cause of the disorder is multifactorial, medical experts recommend using a combination of medication, supplementation, and/or behavioral therapies to treat the disorder. Since diet is a modifiable aspect that might affect the disorder, it could be worth adding it to that list to try as a supplemental therapy.

Initially, focus on regular meal times (i.e., encouraging your child to eat every 3-4 hours) to promote stable blood sugar levels. Aim for a well-rounded healthy diet since it is beneficial for any developing child. This would include focusing on lean meats, fruits, vegetables, whole grains and low-fat dairy products. In doing so, less emphasis is placed on added sugars and processed foods, thereby eliminating some of the potentially problematic foods. You never know: making these changes might lead to less reliance on conventional medications.

If you are serious about trying one of the aforementioned diets to manage ADHD symptoms, it is important to recognize that these types of diets can be complex, time-consuming, and disruptive to the rest of the family. They require a lot of patience and perseverance. It is vitally important to work with a registered dietitian who can help you with meal planning, stocking your pantry with safe items, and recommend supplements as needed. Find a team of healthcare professionals who support your decision and are able to provide their expertise along the way.

If you are interested in learning more about how ADHD might be related to diet or to schedule a nutrition consultation with a dietitian, please contact us at 713-365-9015 or email heritage@heritagebehavioral.com.

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Special thanks to Ms. Mara Mcguin for her assistance in creating the above article. Mara was a previous dietetic intern at Heritage Behavioral Health Consultants and is now a newly credentialed Registered Dietitian in the Colorado area.

References:

–  Center for Science in the Public Interest. Diet, ADHD & Behavior: A Quarter-Century Review (2009 Update).

–  Millichap JG, Yee MM. The Diet Factor in Attention-Deficit/Hyperactivity Disorder. Pediatrics. 2012;129:330-337.

–  Natural Medicines Comprehensive Database. Natural Medicines in the Clinical Management of Attention-Deficit/Hyperactivity Disorder. Document accessed 1/7/2013.

–  Stevens LJ, Kuczek T, Burgess JR, Hurt E, Arnold LE. Dietary Sensitivities and ADHD Symptoms: Thirty-five Years of Research. Clinical Pediatrics. 2011;50(4):279-293.

–  USDHHS, NIH, Nat’l Center for Complementary and Alternative Medicine (NCCAM) website. Attention-Deficit Hyperactivity Disorder at a Glance. http://nccam.nih.gov/health/adhd/ataglance; Updated 6/19/2013. Accessed 7/10/2013.

Is There a Tornado in the House?: Recognizing ADD/ADHD

What is ADD/ADHD?

When many people think of attention deficit disorder, they picture an out-of-control kid in constant motion, bouncing off the walls and disrupting everyone around. But this is not the only possible picture. 
Some children with ADD/ADHD are hyperactive, while others sit quietly—with their attention miles away. Some put too much focus on a task and have trouble shifting it to something else. Others are only mildly inattentive, but overly impulsive.

The three primary characteristics of ADD/ADHD

Children with ADD/ADHD may be:

▪    Inattentive, but not hyperactive or impulsive.

▪    Hyperactive and impulsive, but able to pay attention.

▪    Inattentive, hyperactive, and impulsive (the most common form of ADD/ADHD).

Children who only have inattentive symptoms of ADD/ADHD are often overlooked, since they are not disruptive. However, the symptoms of inattention have consequences: getting in hot water with parents and teachers for not following directions; underperforming in school; or clashing with other kids over not playing by the rules.

Is it really ADD/ADHD?

Just because a child has symptoms of inattention, impulsivity, or hyperactivity does not mean that he or she has ADD or ADHD. Certain medical conditions, psychological disorders, and stressful life events can cause symptoms that look like ADD/ADHD.

Before an accurate diagnosis of ADD/ADHD can be made, it is important that you see a mental health professional to explore and rule out the following possibilities:

▪    Learning disabilities or problems with reading, writing, motor skills, or language.

▪    Major life events or traumatic experiences (e.g. a recent move, death of a loved one, bullying, divorce).

▪    Psychological disorders including anxiety, depression, and bipolar disorder.

▪    Behavioral disorders such as conduct disorder and oppositional defiant disorder.

▪    Medical conditions, including thyroid problems, neurological conditions, epilepsy, and sleep disorders.

Positive effects of ADD/ADHD in children

In addition to the challenges, there are also positive traits associated with people who have attention deficit disorder:

▪    Creativity – Children who have ADD/ADHD can be marvelously creative and imaginative. The child who daydreams and has ten different thoughts at once can become a master problem-solver, a fountain of ideas, or an inventive artist. Children with ADD/ADHD may be easily distracted, but sometimes they notice what others don’t see.

▪    Flexibility – Because children with ADD/ADHD consider a lot of options at once, they don’t become set on one alternative early on and are more open to different ideas.

▪    Enthusiasm and spontaneity – Children with ADD/ADHD are rarely boring! They are interested in a lot of different things and have lively personalities. In short, if they are not exasperating you (and sometimes even when they are), they are a lot of fun.

▪    Energy and drive – When kids with ADD/ADHD are motivated, they work or play hard and strive to succeed. It actually may be difficult to distract them from a task that interests them, especially if the activity is interactive or hands-on.

Keep in mind, too, that ADD/ADHD has nothing to do with intelligence or talent. Many children with ADD/ADHD are intellectually or artistically gifted.

Helping a child with ADD/ADHD

Whether or not your child’s symptoms of inattention, hyperactivity, and impulsivity are due to ADD/ADHD, they can cause many problems if left untreated. Children who cannot focus and control themselves may struggle in school, get into frequent trouble, and find it hard to get along with others or make friends. These frustrations and difficulties can lead to low self-esteem as well as friction and stress for the whole family.

But treatment can make a dramatic difference in your child’s symptoms. With the right support, your child can get on track for success in all areas of life.

Don’t wait to get help for your child

If your child struggles with symptoms that look like ADD/ADHD, don’t wait to seek professional help. You can treat your child’s symptoms of hyperactivity, inattention, and impulsivity without having a diagnosis of attention deficit disorder.

Options to start with include getting your child into therapy, implementing a better diet and exercise plan, and modifying the home environment to minimize distractions.

If you do receive a diagnosis of ADD/ADHD, you can then work with your child’s doctor, therapist, and school to make a personalized treatment plan that meets his or her specific needs. Effective treatment for childhood ADD/ADHD involves behavioral therapy, parent education and training, social support, and assistance at school. Medication may also be used, however, it should never be the sole attention deficit disorder treatment.