ADHD treatment, beyond medication

Charmaine Miranda, Ph.D., R.Psych., October 10, 2014

Many parents will ask me what they can do to treat ADHD outside of using medication.  While medication can be important for the treatment of ADHD, it should not be used in isolation.  To understand treatment of ADHD, we must understand what ADHD is.  ADHD is a deficit in executive functioning, the brain’s ability to self-regulate.  I generally explain ADHD with a picture of the brain.

brainhighdef.jpg

This is a side view of the brain, with the forehead towards the left.  Just behind the forehead is the pre-frontal cortex and it acts as the manager of the rest of the brain.

Let’s think  of the brain as a factory, and the prefrontal cortex as the manager. The manager is in charge of things such as organization, planning, time management, judgement, motivation, working memory, and self-regulation.  If the manager of the factory tells the workers to do something really fun like go eat ice-cream, the workers will say, “Yay!”  They will do the fun task, even if the manager is on coffee break.  But if the manager tells the workers to do something that is not much fun at all, something boring, perhaps something difficult or overwhelming such as doing a big pile of homework, the workers might say, “Ugh.  I’d rather eat ice-cream” or, “Can I do it later?” and you’ll need the manager to get onto the factory floor to help break down the task into manageable parts, get the workers interested and excited about doing the task, get them started and see them through task completion.  People with ADHD have a manager who is always on coffee break.  Therefore, they have no problem doing “ice-cream” tasks but lots of problems organizing and completing tasks that are not like “ice-cream”.

Successful treatment of ADHD involves a 3 pronged approach:

  1. Build External Systems of Support:  If the internal brain manager is not working, then we have to start giving people with ADHD, ways of implementing structure.  These may include lists, clocks, apps, and calendars.

  2. Make Tasks Seem More Like Ice-cream:  We may remember a teacher who made a seemingly boring subject more fun.  He may have used humour, a game-like approach, or incentives.  Perhaps he brought out the best in you, by making you feel more confident and motivated.  Always think, “How can I make this more like an ice-cream task for my child?”

  3. Train Communication between the Manager and the Workers:  In order to pay attention, we need to learn when we are attentive and when we are not, and then, we have to learn how to bring ourselves into a more attentive state.  Mindfulness training and self-regulation training help to do this.  Medication also helps the communication between the Manager and the Workers.

These are three broad ways to address ADHD.  These are areas where parents can support a child coping with ADHD and help to overcome it.

To help parents and families learn more about ADHD in this respect,  I am excited to bring your attention to the 6th Annual ADHD Conference by CADDAC.  This year, it is being held in Vancouver, November 1-2, 2014.   It is geared towards parents, adults with ADHD, families with ADHD, educators and medical professionals.  Registration is available at www.caddac.ca. The cost is very reasonable, $99 plus tax.

They have an excellent line up of speakers.  One of my favourite ADHD researchers, Dr. Russell Barkley, will be doing his last Canadian presentation prior to his retirement.  Dr. Barkley is a dynamic speaker and speaks not only from a strong research perspective but also a personal one.  His twin brother had ADHD for all of his life and died at the age of 56 from a car accident that was directly attributable to his ADHD.

The conference will addresses issues in children as well as adults, as well as comprehensive treatment approaches for the home, school, and the workplace.  Dr. Jake Locke will be speaking about mindfulness training.  One of the key ways to help ADHD is to learn to be mindful of when we are not paying attention and then learning to bring ourselves into a more attentive state.  Mindfulness and Self-Regulation are two sides of the same coin.

Dr. Shimi Kang is the author of the book, The Dolphin Way:  A Parent’s guide to Raising Healthy, Happy, and Motivated Kids Without Turning Into a Tiger.  She is an expert on motivational interviewing.  These are just some of the experts in the line-up.  I highly recommend this workshop and hope to see you there!

ADHD treatment has to look beyond just the pharmacological approach.  While medication can be important and has helped many people, the secret to successfully living with ADHD is to also address issues such as motivation, organization, and self-regulation.