ADHD Awareness
It’s global ADHD awareness month, which offers an opportunity to educate and share resources with those unaware of this disorder, as well as those diagnosed with it (or suspecting the diagnosis). The various media outlets and the internet have done a lot to misrepresent the truth behind ADHD, creating a stigma around this condition. While every individual is unique, it’s important to remember we’re all in this together, and there are many ways in which we can support each other in feeling noticed, appreciated, understood, and encouraged along life’s journey. To start the conversation about ADHD, we’re going to define and identify the distinct aspects of ADHD in childhood versus adulthood, and how the condition impacts someone’s life, discuss how common it is, and share some naturopathic and integrative health approaches to management.
Childhood ADHD
Attention-deficit/hyperactivity disorder (ADHD) is the most common behavioral disorder in children with a prevalence that varies from 6 – 16 percent depending upon the diagnostic criteria and the population studied. 2016 - 2019 statistics indicated that in school-age children aged 3 – 17 years of age, the prevalence of ADHD was 10 percent, which increased from 6 percent in 1997-98. ADHD is more common in males than females with a ratio of 4:1 for the predominantly hyperactive presentation and 2:1 for the predominantly inattentive presentation.
The evaluation for ADHD begins when parents or caregivers present to primary care physicians with concerns about behavior problems or poor school or social function. Assessment tools and observational information to support a diagnosis of ADHD should be derived from several different settings (home, school, community, and self-observation).
ADHD is a syndrome with two categories of core symptoms: hyperactivity/impulsivity and inattention. Symptoms of hyperactivity and impulsivity are typically observed by the time the child reaches four years of age, increasing during the next three to four years, and peaking in severity when the child is seven to eight years of age. They may include the following:
Excessive fidgetiness (eg, tapping the hands or feet, squirming in seat)
Difficulty remaining seated when sitting is required (eg, at school, work, etc)
Feelings of restlessness (in adolescents) or inappropriate running around or climbing in younger children
Difficulty playing quietly
Difficult to keep up with, seeming to always be "on the go"
Excessive talking
Difficulty waiting turns
Blurting out answers too quickly
Interruption or intrusion of others
Symptoms of the predominantly inattentive presentation of ADHD are characterized by reduced ability to focus attention, reduced speed of cognitive processing and responding, often described as sluggish cognitive tempo and daydream-like appearance. These observable symptoms of inattention typically are not apparent until the child is eight or nine years of age & may include:
Failure to provide close attention to detail, careless mistakes
Difficulty maintaining attention in play, school, or home activities
Seems not to listen, even when directly addressed
Fails to follow through (eg, homework, chores, etc)
Difficulty organizing tasks, activities, and belongings
Avoids tasks that require consistent mental effort
Loses objects required for tasks or activities (eg, school books, sports equipment, etc)
Easily distracted by irrelevant stimuli
Forgetfulness in routine activities (eg, homework, chores, morning routines, etc)
Children and adolescents with ADHD frequently have comorbid psychiatric and neurodevelopmental disorders, including (but not limited to) oppositional defiant disorder (ODD), conduct disorder, depression, anxiety disorder, sleep issues, autism spectrum disorder (ASD), and learning disorders, all of which require appropriate identification and supportive treatment.
Adult ADHD
ADHD affects 30 to 50 percent of adults who had ADHD in childhood and recent studies have found that a substantial proportion of those with adult ADHD did not have the condition in childhood. According to recent epidemiological studies, an estimated 8.7 million adults in the U.S. have ADHD with the likelihood of detectability in adults being much lower than in children partially due to a lack of daily contact with individuals adept at recognizing ADHD.
ADHD in adulthood can be associated with significant impairment in occupational, academic, and social functioning. The diagnosis of ADHD in adulthood can be complicated by a number of factors including the reliance upon the patient’s subjective report of symptoms and the high rates of self-diagnosis, as well as the overlap between symptoms of adult ADHD and those symptoms of other common psychiatric conditions including depression, anxiety, mood disorders, and substance abuse. ADHD in adults is characterized by symptoms of executive dysfunction, inattention, impulsiveness, restlessness, and emotional dysregulation. The predominant features of ADHD in adults differ from typical ADHD features in children. Symptoms of hyperactivity or impulsivity often present differently in adults (eg, impulsivity may be seen in verbalizations rather than physical behavior); symptoms of inattention are more prominent. Symptoms of inattention in adults with ADHD are also classified as deficits in executive function.
Deficits in executive function can manifest as:
Difficulty remaining focused in a task, especially for long periods
Difficulty organizing activities
Difficulty prioritizing tasks
Difficulty following through and completing tasks
Forgetfulness
Difficulty with time management (eg, missing appointments or deadlines)
A formal diagnosis of ADHD requires a structured clinical interview with a comprehensive medical, social, and family history and physical examination. Screening labs can be a useful addition to the diagnostic work-up and help rule out underlying biological conditions that could contribute to symptoms (e.g., hyper- or hypo- thyroidism), as well as provide a starting point for understanding how a person’s physiology can be supported. A couple of different validated behavioral questionnaires should be used to confirm that the symptoms of hyperactivity-impulsivity and/or inattention meet the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). To satisfy criteria for diagnosis, symptoms and/or behaviors must have persisted for longer than 6 months in more than one setting (e.g., school, home, church). Identifying and treating adult ADHD can have a dramatic and rapid improvement in the lives of the individuals with ADHD and the lives of those around them.
Naturopathic Lab Testing for ADHD
If you’re working with a physician that is able to order labs, the following could be a part of the diagnostic process and beneficial for a comprehensive approach to management.
Complete blood count + Ferritin
Serum B12
Lipid panel
Comprehensive metabolic panel
Salivary adrenal testing to evaluate cortisol rhythm
Common Treatments for ADHD
It's crucial to remember that an ADHD diagnosis is not all negative, and many individuals with ADHD have unique strengths and talents. With appropriate treatment and support, individuals with ADHD can learn to manage their symptoms effectively and thrive in various aspects of life. Treatment options often include behavioral therapy, medication, amino acid therapy (e.g., supplementation of tyrosine, tryptophan, or other essential amino acids), and lifestyle adjustments. Lifestyle activities can lay a foundation for better success if and when medications are started. Stimulant medications are often utilized to treat childhood and adult ADHD, but drug selection and dosing are determined on an individual basis and dependant on other medical conditions. Methylphenidate (e.g., Ritalin and Concerta) or Dextroamphetamine (e.g., Dexedrine or Xelstrym) are commonly the first choice of therapy, but there are also nonstimulant medications such as atomoxetine, bupropion, clonidine, and guanfacine that may be utilized when side effects of stimulate medications are unacceptable. Consult with your physician before starting or stopping any treatments.
Taking a high quality, comprehensive multivitamin and mineral supplement every day.
Obtaining 2,000 – 6,000 mg of high-quality fish oil (1,000 – 2,000 mg for children) through food as medicine or supplementation. Aim for fatty fish including wild caught salmon and sardines.
Eliminate (or at the very least minimize) food dyes, preservatives, and nicotine, which interfere with sleep and place a higher burden of nutrient & detoxification needs on the body.
Exercise daily for 30 – 45 minutes by engaging in a safe, non-contact sports activity to avoid accidental brain injuries.
Limit television, video games, and device time to no more than 30 minutes daily.
Use food as medicine, eating a diet rich in unprocessed fruits, vegetables, nuts/seeds, healthy fats, and protein derived from animal or plant sources. Most individuals with ADHD do best with a higher protein, lower simple carbohydrate diet, which helps stabilize blood sugar and provide adequate fuel for the demands placed on the brain.
Keep yelling to a minimum, especially if conflicts arise. Losing one’s temper on someone with ADHD can reinforce a negative reward system where they start to crave causing that type of response in others.
Test adults and children with ADHD for learning disabilities & address these with supportive activities/programs.
Do not deter people from seeking help & pursuing helpful resources and social support.
Helpful behavioral therapy and environmental changes that can be used by parents or teachers to shape the behavior of children with ADHD include:
Maintaining a daily schedule
Keeping distractions to a minimum
Providing specific and logical places for the child to keep his or her schoolwork, toys, and clothes
Setting small, reachable goals
Rewarding positive behavior
Identifying unintentional reinforcement of negative behaviors
Using charts and checklists to help the child stay "on task"
Limiting choices
Finding activities in which the child can be successful (eg, hobbies, sports)
Using calm discipline (eg, time out, distraction, removing the child from the situation)
It is important to know that ADHD does not go away, cannot be cured, but it can be managed with medication, behavioral modifications, and lifestyle counseling that focuses on gut health, diet, exercise, relationships, and household environment. When attention is harnessed correctly and underlying issues are solved, a child or adult with ADHD can be very creative, intelligent, productive, and optimize their “superpower”.
If you are concerned about ADHD and have questions, consider booking a consultation with one of our VWS providers or your primary care physician.
Resources
ADHD Awareness Month Coalition - a professional membership organization for ADHD coaches created to advance the profession of ADHD coaching worldwide. https://www.adhdawarenessmonth.org/aco/
Attention Deficit Disorder Association – the world’s leading adult ADHD organization that provides information, resources and networking opportunities to help adults with ADHD.
https://www.adhdawarenessmonth.org/adda/Children and Adults with Attention-Deficit/Hyperactivity Disorder – a resource that provides reliable, science-based information on the current medical research & ADHD management, offering educational and training programs and advocacy services at both the local and national level to those living with ADHD, their family members, educators, and healthcare professionals. https://www.adhdawarenessmonth.org/chadd/
National Alliance on Mental Illness - the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.
https://www.nami.org/HomeADHD Screening Assessments - file:///C:/Users/Julie/Downloads/adhd19-assessment-screeners-1.pdf
National resource center on ADHD – http://www.help4adhd.org
Therapist Aid – worksheets, interactive tools, guides, educational videos, and articles geared towards supporting individuals with ADHD and other mental-emotional concerns. https://www.therapistaid.com/search?query=ADHD
Citations
Chang JG, Cimino FM, Gossa W. ADHD in children: Common questions and answers. American Family Physician. November 15, 2020. Accessed September 17, 2023. https://www.aafp.org/pubs/afp/issues/2020/1115/p592.html.
Felt BT, Biermann B, Christner JG, Kochhar P, Harrison RV. Diagnosis and management of ADHD in children. American Family Physician. October 1, 2014. Accessed September 17, 2023. https://www.aafp.org/pubs/afp/issues/2014/1001/p456.html.
Post RE, Kurlansik SL. Diagnosis and management of attention-deficit/hyperactivity disorder in adults. American Family Physician. May 1, 2012. Accessed September 17, 2023. https://www.aafp.org/pubs/afp/issues/2012/0501/p890.html.
Searight HR, Burke JM, Rottnek F. Adult ADHD: Evaluation and treatment in Family Medicine. American Family Physician. November 1, 2000. Accessed September 17, 2023. https://www.aafp.org/pubs/afp/issues/2000/1101/p2077.html.
Schein J, Adler LA, Childress A, et al. Economic burden of attention-deficit/hyperactivity disorder among adults in the United States: A societal perspective. Journal of Managed Care & Specialty Pharmacy. 2022;28(2):168-179. doi:10.18553/jmcp.2021.21290