Low-Risk Interventions for Attention Deficit Disorder

This is not an anti-medication page. The reason meds won't be covered here is that they don't necessarily fall into the "low risk" category. Doctors will tell you that all medications carry risk. (If yours doesn't, consider finding a new M.D.) On the other hand, stimulants used to treat AD/HD have been studied for decades, so their side effects are pretty well understood by capable, careful prescribing docs. And depending on symptoms and severity, foregoing medication might itself increase some risks, like accidents and injuries, social problems, and substance abuse. A qualified clinician can help you analyze risks and benefits. I'm just a mom, not a doctor.

As someone who's struggled on and off with sleep my whole life, I can testify to its importance in regulating attention--not to mention immune function, mood, and even (believe it or not) maintaining a healthy weight.

For most of us adults circa 2009, 8 hours of sleep is like some quaint 1950s fantasy. We're all too busy and distracted to get that much, even if we should. But for kids and teens, 8 hours isn't even enough.

Doctors recommend 10 to 12 hours a day for 3- to 6-year-olds, 10 to 11 hours for 7- to 12-year-olds, and 8 1/4 to 9 1/2 hours for 12- to 18-year-olds. Are your kids getting that much? Mine aren't, at least not consistently. But we try to our best to hit those targets whenever we can. It pays off in so many ways.

Chronic inadequate sleep, say sleep experts like Marc Weissbluth, M.D., can actually look like AD/HD. So you probably want to rule out sleep problems before seeking a diagnosis and treatment.

How to improve poor sleep? Much of what's written tends to focus on bedtime rituals, and those do seem important: Establish a consistent bedtime, or phase one in. (Rome wasn't built in a day, and neither are consistent bedtimes.) Avoid screen time (TV, videogames, etc.) right before bed, as these are stimulating and energizing, not soothing for most kids. Read to or with your kiddo. (Think they're too old? You might be surprised. Our guys are 10, 10, and 11 and still like being read to at bedtime.) Leave a few minutes for talking, in case they want to. Lots of kids will hold stuff in all day and then spill it at bedtime. You want to be there for that.

But sleep isn't just about bedtime. The following strategies also relate.

It doesn't take a genius to figure out that kids, at least in the U.S., aren't moving enough. Just look at our soaring child obesity rates.

Part of this is bad food: Fried stuff, candy, soda is all okay in moderation (at least I hope so!), but beyond that it's messing our kids up bigtime.

The other part is that kids need to move more....all kids, but especially those who have trouble with focus. Losing recess should be a consequence of last resort--if it's even used at all--for an AD/HD kid who's acting out at school. If your school district has eliminated recess altogether, my sympathies. And look here.

How much exercise do they need? The National Institute of Health recommends 60 minutes a day. But even lesser amounts, say ADHD gurus like John Ratey, M.D., can boost attention and bust stress.

If your kid does a lot of organized sports, he or she probably gets enough movement that way. If not, you need to find other opportunities.

Homework consistently cuts into playtime at our house, making it hard to squeeze in enough activity on the weekdays. I try to deal with this in two ways: 1) Having the kids bike or walk to school--a dying art in many communities--at least a few times a week, even in the winter. (And believe me, it gets *cold* here. But I used to have to walk to school rain, shine, sleet, or snow--didn't you?) And 2) Requiring them to play outside for at least 15 minutes every day right after school. This provides not only exercise but also some fresh air, another tool for boosting focus. Bonus: Sunshine--especially early in the day--can improve sleep, among other benefits like preventing vitamin D deficiency.

On the weekend, our guys have a sport or physical activity class. Mostly we try and skate, sled, hike, bike, swim, whatever works. We crab less when we get out and move.

Some say rhythmic or patterned activities like swimming, walking, jogging, and karate are extra-helpful for AD/HD. (Swim team saved me as an attentionally challenged kid, and as an adult I can't function without a few runs a week.) If your winters are as cold as ours, finding a pool with family swim hours will pay off. Check your local YMCA, JCC, or park district.

As an aside: For our family, the best part of hitting the local pool might be the showers. With just 1 bathroom at home for the 5 of us, the hot water goes pretty fast. This does relate to AD/HD, because like swimming, showers and baths can both be therapeutic. Try having your overactive kid take a bath to calm down, or send your spacey kid to the shower to wake up.

Just like sleep and exercise, bad nutrition can mess with AD/HD kids even more than others. Some parents swear by elimination diets like the Feingold. We haven't tried those. I haven't seen enough empirical evidence to justify the stress it would likely cause both me and the kids. But I have no doubt it works for some families.

What we've tried to do, nutrition wise, is:

--Phase in more organic foods, especially milk and fruit, which our guys consume daily.

--Push food choices that are simple and "clean," with short ingredient lists. Our guys are picky eaters, so this is a tough one. I try to look for simple substitutions. Tortilla chips, for instance, made from just corn, lime, oil, and salt (reading right off the label here) over something like a Nutrigrain bar--which has a dozen ingredients, starting with high-fructose corn syrup.

--For drinks, offer water, milk, and limited amounts of all-fruit juice. Soda is for special occasions. (As an aside: One mom I know lets her kids keep the savings, if they choose water over soda at a restaurant. Cool idea, if you can budget for it.)

--When the kids are eating something not-so-healthy (which, I admit, is often...frozen pizza and chicken nuggets are still a big part of our lives), make it contingent on consuming some veggies alongside, either steamed or raw.

--Push protein in the morning. While most Americans are not hurting for protein, the timing can be important if you have issues with attention. You probably don't need a ton of protein before bed, but before school is another story.

Of our 3 kids, 1 hates eating in the morning, 1 eats very slowly, and 2 have attention issues. Taken together, this makes weekday breakfasts a real challenge.

After years of trial and error, I found something of a solution:

Get a blender. Fill it about halfway with (naturally) fruit-flavored yogurt, drinkable yogurt, or kefir. (Kefir is like drinkable yogurt, but heavier on probiotics. Many supermarkets now have it. Check with your pediatrician, because occasionally there might be someone for whom kefir isn't the best choice.) Throw in some frozen fruit and fresh banana. (I use about 1 small banana per kid.) Add a little milk, blend, serve.

This recipe has really saved us. It's fast, easy, hydrating, and relatively protein rich. For our not-a-morning eater kid, this is pretty much his whole breakfast. The other 2 supplement with frozen waffles. [ The Eggo "breakable" kinds work well syrupless. We haven't graduated yet to organic waffles ;) ]

(photo above: dried-fruits.net)

We do use a couple of nutritional supplements--a multivitamin, to try and offset the picky eating, and a purity-tested fish oil supplement. However, supplements aren't FDA-approved for AD/HD, and there's little data on their long-term safety, especially in the megadoses some kids are being given. All I can say is sometimes less is more, and it's important to think critically and be careful when it comes to kids' health.

Like all of us, kids with AD/HD need at least one good friend they can rely on. They may have to work harder than other kids to make and keep friends, though, because of attention-related issues like impulsivity or immaturity. As parents, all we can really do is try to:

--Help our kids, inasmuch as we can, find friends who "get" and accept them.

--Encourage our kids to be good friends, with all the give and take that involves. It's a tough balance, but we can understand and empathize without letting them off the hook because of their AD/HD.

and

--Make sure our kids have enough time to play with their friends.

But peer friendships are just one kind of connection that can nourish an AD/HD kid and help him or her through tough times. Kids can connect to special adults like aunts, uncles, teachers, and coaches who are trustworthy and who care. They can connect to pets. To charity/service projects. To family traditions and memories. Even to special places that have meaning to them. These are all reminders that while schoolwork, tests, etc., are important, there are other important things, too. And they help provide perspective: The world is bigger than a classroom, and school is just one part of life.

(Illustration, above: Sucie Stevenson, from Henry and Mudge Get the Cold Shivers by Cynthia Rylant)

We use these stickers on the wall calendar to mark school holidays. When the kids are feeling overwhelmed, they can see there's always a day off (or more) on the horizon.



And you can always count on Twain for an encouraging word ;)