ADHD… Now much more than 1, 2, 3.

OCTOBER 2020

Is the prevalence of ADHD higher now than at any point in history?

The evidence leans both ways on this one. In the UK it appears to have plateaued; in the US it is on the rise; in Japan and Finland rates of diagnosis are very low. Regardless of the debate on the ups or downs, we know ADHD is the most common brain-based challenge facing Australian children and adolescents.

Within this ever-expanding evidence can be found more than just data and demographics, there are thought provoking insights, helpful advice and new understandings regarding the most effective treatments for ADHD. Without a doubt ALL leading ADHD associations, organisations, and advisory groups recommend finding the right combination of options for each individual within what is known as a ‘multimodal’ treatment approach.

Lifestyle habits and choices have an impact on ADHD symptoms both for children and adults.

In a US study where children were assessed using an ADHD Lifestyle Index with 7 areas, results demonstrated children with ADHD were almost twice as likely to have fewer healthy behaviours in these areas. These findings are really interesting.

Let’s explore five key pieces of the lifestyle puzzle when putting together an effective multimodal treatment approach for an individual with ADHD: diet; exercise; screen time; reading; and sleep.

1. DIET

The Telethon Institute states: ‘The exact cause of ADHD is not known but researchers suspect that genetic and environmental factors that affect wiring in the brain play a role’. The Institute goes on to highlight that a significant link has been found between ADHD and an adolescent diet that is high in take away foods, processed meats, red meat, high fat dairy and confectionary – a diet like this can more than double the risk of ADHD compared with those with a healthy diet.

Ok, then, what are good choices for a healthy diet?

The exact effectiveness of a wide range of dietary recommendations for individuals with ADHD can vary considerably within recent and historic research. Many recommend assessment for sensitivities and deficiencies of key vitamins and minerals (things like iron and zinc), along with these safe and very well-founded tips:

increasing intake of water
decreasing refined sugar in the diet, in food and in drinks
taking care with consumption of food additives
increasing intake of vegetables
decreasing intake of saturated fats (take away and processed foods)
consuming oily fish, or supplementing omega 3
increasing the amount of prebiotic and probiotic foods
increasing dietary fibre

Overall the Mediterranean Diet ticks all of these boxes for ADHD diet recommendations, while also providing many other health benefits for the whole Family – including lowering risk of cardiovascular diseases and dementia.

2. EXERCISE

Exercise is a source of a surplus of benefits for every single one of us, we should all try and do some every day. Physical activity is known to be a protective factor against ADHD. One particular brain chemical raved about is BDNF – Brain Derived Neurotrophic Factor - and we make a heap of it when we exercise. BDNF promotes neuroplasticity, health-associated behaviours and quality of life. BDNF can be lacking in a brain with ADHD, exercise can be a way of remedying this. When weather permits exercise outside in green environments is best for brains.

3. SCREEN-TIME

Should be simple, but in 2020 we know just how difficult managing screen time can be. These three steps can help when approaching many aspects of life where moderation is required:

Set limits*.
All agree to them
Follow through consistently

So what are the Australian screen time guidelines ?

Under 2 years = ZERO hours
2 – 5 years = <1 hour per day
5 – 17 years = <2 hours per day

Does your child gobble while they game? It is interesting too to be aware of the links between ADHD and screen time snacking. Children with ADHD may be more likely to eat while using a smartphone or computer, even more likely to eat while using a computer at bedtime. Something to think about.

4. READING

Science has explored links between ADHD and reading disability, in both adults and children. For individuals with ADHD the challenges with reading are more likely related to attention, memory, planning, rather than the sound or language skills for reading.

Reading, and being read to, can help build the attention and memory skills that are making reading difficult. We might just need to approach the reading activity in a fun and different way, in order to break the feeling that reading might be ‘too hard’ or ‘too boring’.

Tips include:

read in chunks – for some 5 minutes will be enough, others up to 15 will work
reading the paper version helps with focus
if the reading is printed out (or photocopied) then you can also doodle, write or draw on the paper to assist with comprehension and visual memory
summarise each page or paragraph with just one word said out loud, funny can be fun and also boost memory
read in different places, doing different things – try it holding a bendy yoga pose, under a ‘reading tree’ or in a blanket cubby using a torch
Have a suitable fidget activity to do while reading

5. SLEEP

Sleep is essential for life. Sleep disorders can be serious enough to impact how a person is able to function physically, mentally, socially and intellectually. Well established relationships are known between insomnia and ADHD. Exhaustingly sleep onset insomnia seems to be the most likely challenge for children with ADHD – meaning they find it really hard just to get to sleep. Improvements in sleep might be found by trying these new sleep habits:

Go to bed and wake up at the same times every day
Wake up and get out into the sunshine in the morning
Getting a good amount of outdoor exercise during the day
Reducing stimulating foods and beverages – like caffeine and chocolate, not having them at all, or limiting them to before midday
Decrease evening blue light exposure by using settings, apps and glasses/screens
Being completely screen free in the 2 hours leading up to bedtime
Diming the lights through the home if sunset comes later ie. during summer season
Having a warm bath/shower then into a cool bed and bedroom
Being read to or reading a book in or before bed
Promoting and then riding the ‘wave of drowsyness’ when it comes (melatonin)
Make your bedroom ONLY about sleep and relaxation
Try a relaxation, mindfulness or meditation exercise

6.NEUROFEEDBACK BRAIN-TRAINING

ADHD is a brain-based disorder. In 2020 we all have access to detailed 2-D and 3-D maps of how our brains are working through QEEG brain scans. QEEG brain scans measure brainwaves and can detect unusual patterns of brain activity in specific areas of the brain. Different areas of the brain have different functions (such as regulating attention), and if a brain is not producing the right type of brainwave activity, it cannot do the job it was designed to do. In other words, these types of scans can help to pin-point problems in the brain and actually explain why someone has difficulty with attention or learning.

Neurofeedback is a drug-free treatment that uses a sophisticated brain-computer interface to ‘strengthen’ or ‘re-train’ the brain by training brainwaves, and has been the focus of considerable research for over 20 years. It is recognised by The American Academy of Paediatrics to be an effective treatment for ADHD and is featured in Dr Norman Doidge’s book: The Brain’s Way of Healing. A well-respected report published in 2020, that reviews all significant research on treatments for ADHD, concludes that neurofeedback has the highest (level 5) supporting evidence, stating: ‘Standard neurofeedback protocols in the treatment of ADHD can be considered as well-established and efficacious and specific.’ Efficacious and specific, in the language of research, means: ‘The investigational treatment (neurofeedback) has been shown to be statistically superior to credible sham therapy, pill, or alternative bona fide treatment in at least two independent research settings.’ So this simply means that for families looking for a drug-free treatment to help their child with ADHD neurofeedback is an effective alternative.

About the author - Ms. Emily Goss (Occupational Therapist, Senior Clinician, The Perth Brain Centre).