The Basics of Non-Medicinal Treatment for ADHD

Many are curious about non-medicinal treatments for ADHD.  Here's a quick overview of the basics.

How They Fit Into "Optimized" Treatment

You can think of optimal ADHD treatment in three legs.  If you aren't doing multiple things in all three legs, you have not yet optimized your ADHD treatment.  The legs are:

Leg 1 - physiological changes to the brain - anything that changes the brain chemistry (typically increasing dopamine) or pathway training to improve focus and lessen symptoms.  Includes medication; sleep; nutrition, exercise, CogMed, possibly neurofeedback

Leg 2 - behavioral/habit changes made by the ADHD partner - all sorts of routines, plans and habit changes

Leg 3 - interaction changes with spouse - communication and coordination techniques, scheduling attentive time, spousal change in responses and more.

Non-medicinal treatment for ADHD, then, includes everything EXCEPT meds in Leg 1, and include the other two legs.  Today, however, I'm going to focus on the Leg 1 non-medicinal treatments, as that is what most people are interested in when they ask about non-medicinal treatments for ADHD.  Before continuing, I want to make clear that for those who can take medications without side effects, the best use of these non-medicinal Leg 1 treatments is as an addition to medication, not a replacement for it.  About 80% of adults can find a medication that helps them manage symptoms without significant side effects (the one "acceptable" side effect is appetite suppression for those who don't need to gain weight.)

The Basic Treatments

Fish oil - Adults can take up to 5,000 mg a day.  I usually suggest 3,000 mg or 4,000 mg a day for the adults with whom I work.  Many see improved memory after about two weeks of taking the fish oil (it takes a while to build up).  And, yes, you can take it all at once.  Look for fish oil that has been highly processed.  Both the Zone and OmegaBrite fish oils are pharmaceutical grade.  The Costco brand also seems to be of good quality, though I find it freezes faster than the Zone oil.  Freeze it to diminish fish burps (even if it doesn't freeze, this still seems to help.)  My husband recently ran out of fish oil, which created a mini-experiment to see what it was doing for him.  He says he felt decidedly less focused after a couple of weeks, which was improved after he returned to it (he also takes meds, which has an even greater impact than the fish oil - but the two together are best of all).  The scientific research on fish oil would support his experience - it has been shown to improve focus.  Note:  EVERYONE in the family should be taking at least some fish oil  (kids can take up to 2,500 mg, according to Dr. Hallowell)

Exercise - aim for a minimum of either 20 minutes of aerobic exercise every day or, better, 4 days a week at a minimum of 45 minutes.  You want to get heart rate up, so this means fast walking, bike riding, going to the gym, etc.  Exercise helps across a whole range of physical things:  mood stabilization; relieving depression (better than Zoloft in one study); lessening anxiety; improved heart and muscle function; maintaining bone density and keeping up basic health - so adding it into your routine is a great idea.  From a focus standpoint, exercise does two specific things:  improve focus for a period of time after the exercise (up to about three hours) and, over time, help you create new brain matter that can improve basic mental functioning.  So a good way to use exercise strategically is to exercise before something you need to focus on.  An example - kids sports before homework.  For more information about the amazing benefits of exercise to learning and the brain, see John Ratey's book "Spark."

Nutrition - Food is our least thought about, but one of our most powerful, "drugs."  The good diet for ADHD is one that levels (and cuts out) sugar highs and lows.  So, cut out all sugared sodas, create a diet that is small amounts of lean meat or fish or protein at each meal (3 oz) plus veggies (two servings per meal if possible) and fruits.  Cut out as much of the breads and processed grains as possible (including all cereals with fewer than 3 grams fiber in them, preferably no wheat cereals) because processed grains create sugar spikes in your system, too.  Try this for your entire family for a month and you will find everyone has more energy and also that the ADHD partner is more stable in energy and symptom control.  (Don't forget protein at breakfast)

Sleep - Many with ADHD have really significant challenges when it comes to sleep.  However, research suggests that adults who get less than about 8 hours of sleep a night underperform their potential (even 7 hours of sleep was shown to degrade performance).  Like nutrition, sleep is much more important than we typically think.  Start with "small" changes:  Set a regular bed time, then get into the bedroom with enough time to spare to prepare for bed.  Give yourself permission to not have everything done by the end of the day (sleep is more important!).  Set an alarm to notify you when it's time to disconnect from the computer or chores you may be doing.  Read a book or do some other calming activity to "transition" into sleep (listen to music, cuddle with your partner).  Remove the TV from your bedroom, if you have it, to create a quiet zone. 

I also encourage couples to try to create "sacred time" around bed for some partner togetherness.  Planning to spend half an hour of time together at the bed time can do wonders for how you feel about each other.

If none of these things help, then consider the possibility of sleep apnea or other physical sleep disorders and see a sleep specialist.

CogMed - This is a computerized working memory training program that you do with the help of a specialist that has been shown in sound research to improve memory and focus.  As you move through the exercises it adjusts to the answers you have - providing (presumably) more of what you need most.  It's not cheap, but it does seem to have a good track record, and takes only about 15-20 minutes a day.  You do CogMed under the oversight of a trained CogMed therapist.

What Else You Need to Know - Where the Rubber Meets the Road

You can do all of the things above - pick one or two at a time and add them cumulatively as you have the energy to introduce the next item (for example, focus on creating a new sleep routine and better nutrition, then as you master these things, add exercise, etc.)  In addition, medications should be considered for those who can take them (which is most of you).  They can really be life changers.  KNOW, however, that Leg 1 treatments like those above ARE JUST THE BEGINNING when it comes to improving your life and your marriage.  What's important in your job and in your marriage is what you DO with the improved focus you now have.  You may feel great, but if others don't benefit from the improved focus that is now inside you - i.e. if you don't let it out and SHARE it with others in the form of changed habits, then you don't benefit all that much from your gains.  So that's where the non-medicinal treatments in legs 2 & 3 come in - those are creating new behaviors, new support structures and the like that help you translate your physiological improvements into meaningful life improvements for you, your partner and your family.

So start with Leg 1 physiological changes.  But add in those all important habit changes.  You can transform your life - and thrive!


3 year old - meds ?

My grandson is 3 years, one month. I know that I have ADHD and his mother (my daughter). I also believe my son-in-law has ADHD. How young can my grandson be tested and how young can he take meds if necessary? He is very bright but exhibits many ADHD traits.


I'm no expert, but I have 4

I'm no expert, but I have 4 kids. They are all ADHD to a point! What is he doing that makes you think he is ADHD? Not to be indelicate, but is it possible that lack of structure could be making him act out?  I'm assuming if his care givers havE ADHD, he isn't getting much structure. Kids need routines, knowing what to expect next is comforting to them. My husband's ADHD makes one of my sons nuts, always has, even when he was an infant. He would be so fussy when my husband took care of him. My husband thought naps and feedings could wait until the baby was crying, sometimes hysterically. Trying to get him to keep to a schedule was a nightmare for all of us.

Three is too young

My understanding is that the earliest a diagnosis for ADHD would be recommended would be age five or six.  If there are other issues (such as autism, asbergers, etc) then earlier might be better.  Also, know that there has been research that suggests kids are more likely to be mis-diagnosed with ADHD if they are young for their cohort/grade.  So one option is to hold a child who seems immature back.

And, to the other poster's point, creating a good structure at home would likely be helpful for this child.

One of my ALL TIME favorite parenting tricks (ADHD or not) is using the phrase "tantrums don't work.  Come find me when you are ready to talk with me about what you need." each and every time a child starts to throw a tantrum.  Very early on they learn it isn't useful...

Thanks so much for the

Thanks so much for the helpful information Melissa, especially the tip about freezing the fish oil!  I'd heard various opinions about fish oil before, it's encouraging to hear that it can make a difference.  I'm waiting to be diagnosed and prescribed medication but until then it's worth taking at the dosage level you suggest.

Is whole wheat bread bread and flour ok or is it important to use an alternative? 

Also about Cogmed, are other brain training systems useful if you need something more affordable?  I read about some of the scientific tests on the effects of brain training on people with adhd.  It did seem to suggest that you have to keep doing them to retain the benefits, rather like exercise. 


Last thing, about medication itself.  You said it's worth taking medication for most people.  If I'm able to take medication, how long should you take it for?  In the UK, the recommendations are that you take it for a year, then you come off them for a short while, something like a week and see if it makes any difference.  If it doesn't, you come off them altogether.  I've heard some suggestions from experts here that it's meant to be temporary here, and few adults are prescribed medication at all.  If you take tablets long term, will you eventually have to increase the dosage or change the stimulants for different ones?



Response on meds and bread

Breads, even whole grain, are still highly processed and do affect blood sugar levels, so if you can stay away from them, great.  If not, whole grains in small amounts should be okay.

The meds change the chemistry in the brain by either increasing dopamine production or limiting elimination of dopamine already produced (among other things).  The reason that some people can stop taking the meds is that the meds have allowed them to create new habits that help them stay on task.  However, many still need the chemical boost to help them perform comfortably.  I know that in our household, my husband has been taking meds for probably 8 years and my daughter for 10.  She recently had to change to a different medication that didn't work so well and after a while her comment was "I really think I'm losing my memory, Mom!  It's really hard to get my brain to do what it's supposed to do."  She's back on her regular medication and things are going more smoothly.  Mind you, this is a girl who has many systems in place to help her.

Dr. Hallowell has patients who have been on medications for 30 years or so - and they still work well for them.  Others find over time that they prefer to stop (perhaps less stress in their lives, etc take some of the pressure off).  There has been some press lately about whether med doses need to be increased over time as the brain "adjusts" to medication.  Dr. Hallowell says that this has not been the experience in his clinic.  Sometimes someone reports that they feel the meds aren't working as well as they used these cases he recommends stopping a stimulant for a week, then going back onto it.  Typically, the patient sees that the meds really ARE working...and all moves back to what used to be.  (If you're on one of the meds that "builds" - don't just with your doctor first about how to stop.)

At different times, you may need to reassess dosage on meds, either higher or lower.  For example, in menopause, many women find that ADHD symptoms increase due to lowering levels of estrogen (which also lessens dopamine production) so medications may need to be increased.  Ditto with puberty - medication needs might change.  During extended times of extreme physical or mental stress you might need a higher dose, too.  Conversely, after the kids grow up or things calm down in your home, you might be able to cut back a bit.  Just stay in touch with your doctor to find the right balance.


Thanks, that was some useful information.  I'm reassured about medication now.

Fish oil

Great info! My husband did quit the medications, he took them just for a few months but he said that he did not feel any different and the secondary effects like insomnia was bothering him. Since he is on Fish oil, he feels more focus and in a better mood. Also he consumes less  sugar, breads and sodas. He uses  post-it (sticky note) at work to keep him organize and remember things.  For him works good!