If your child has recently been diagnosed with ADD/ADHD, you are likely facing a decision about whether medication is going to be part of the treatment plan. While pharmaceuticals are the mainstream course of action for reducing symptoms of ADD/ADHD, medication use is always accompanied by some inherent risk. Knowing the right questions to ask can be just as hard as making the best decision for your child. Here are the top 5 questions to ask before putting your child on ADD/ADHD meds.
Is it really ADD?
ADD is the most common diagnosis in children under the age of 12 irrespective of the fact that the condition and potential causes are very poorly understood (1). However, your medical provider will base their diagnosis on criteria outlined in the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth edition (DSM-5) and your child must meet a minimum number of reported behavioral symptoms to qualify for a diagnosis of ADD. Many of these symptoms may also be indicative of other imbalances or abnormalities such as trauma, high intelligence, food allergy, anxiety or other mood disorders (2,3). Your provider should crosscheck your child’s symptoms against other possible diagnosis to ensure that, together, you are building the most successful course of action for your child. In addition to observations, interviews and a clinical exam, a QEEG, or brain map has also been approved as a diagnostic tool for ADD. This traditional pattern that the FDA approved the brain for is a high daydreaming state and a low focus state, but many times we see patients diagnosed with ADD that do not have the traditional pattern and it is coming from other imbalances in the brain. This is where the value of the brain map is so high.
Is it biochemical vs. neurological?
In many cases, the answer may be both. Researchers have found in MRI imaging that the brain matter and activity in children exhibiting symptoms of ADD is different from children without symptoms (4). However, research supports that genetic variances affecting dopamine production are also affecting kids with ADD (5). That being said, dopamine production is influenced by more than genetics and can shift based on diet, exercise, gut flora, stress and more. With a growing body of evidence linking systems such as the gut and brain, it is difficult to parse out individual causes of behavioral symptoms. A trained professional can help identify your child’s unique biochemical and neurological abnormalities and design a plan to help balance irregularities and improve symptoms. With any program you start make sure that both the nutritional and neurological side are both being addressed.
What are the side effects of common ADD meds?
Stimulant and non-stimulant drugs are used to manage symptoms of ADD/ADHD. The effect of these drugs on developing brains is still unknown and may carry risks later in life. In addition to the potential for long-term neurological risk, other hazards include heart problems in children harboring unknown cardiac conditions, psychiatric troubles for kids with a family history of mental health conditions, and abuse of stimulants for weight-loss or enhanced focus. There are a variety of short-term physical, mental and behavioral side effects such as growth suppression, sleep problems, fatigue, appetite loss, stomach and headache, and increases in heart rate and blood pressure (6). It is important to discuss the side effects of the recommended medication with your doctor and learn about how medication may interact with your child’s unique behavior, genetics and family history.
Will meds fix ADD
Medications do not “fix” attention deficit, instead serve to reduce symptoms. Experts recommend that any pharmaceutical treatment is paired with behavioral therapy. Additionally, stimulants, which can lead to increased academic performance have only been shown to be effective for an average of up to 14 months (6). Another study compared Neurofeedback and Ritalin in the reduction of ADD symptoms. Both reduced the symptoms but after stopping both NFB and meds for 6 months the group that was using the meds fell back to the original symptoms, while the NFB group maintained the changes. Research is lacking in studies focused on the effects of medication and behavioral therapy for the long-term, although both can be effective short-term treatments (6). While medications can reduce challenges associated with ADD, medications do not modify the root cause of ADD symptom.
What are other tools that can help manage ADD?
You know your child best, so if you are concerned about using pharmaceuticals to manage ADD, discuss these alternatives with your healthcare provider
Emphasizing a healthy lifestyle can help to improve symptoms of ADD. Increasing physical activity, positive feedback and reward systems, decreasing screen time, creating a structured and calm environment at home are just a few of the methods that have been effective for reducing behavior issues.
There are multiple options for supporting a child through diet. Food allergies and inflammatory foods are linked to ADD and therefore, elimination diets have proven to be very successful in reducing symptoms and identifying the “problem” foods (7). Additionally, reducing processed foods and refined carbohydrates while increasing healthy fats and protein provide benefits to the brain and blood sugar regulation. Making sure that your child eats a low-carb breakfast rich with healthy fat and protein is a great way to prepare your child for successful day.
Many healthcare providers are trained to identify nutritional deficiencies that may be leading to difficult behavior and irregular neurological function. Many nutritional supplements have been shown to improve symptoms of ADD such as Omega-3 fatty acids, Magnesium, B-6, Iron, Zinc and L-Carnitine (8-11). Although micronutrient supplements are not prescriptions, they should be taken under the care of a healthcare provider because even supplements can have adverse reactions and affect other nutrient levels.
Behavior therapy can be very effective for long-term management of ADD/ADHD by improving self-control and self-esteem (12). The CDC reports that therapy is most effective when parents are trained to administer therapy to their children, especially when kids are under the age of six. If that is not possible, it is important to find a professional is specifically trained in behavior therapy pertaining to ADD.
In 2013 the FDA approved the QEEG or Brain map as a diagnostic tool for ADD, as those dealing with true ADD will have specific brain wave activity that is dysregulated in specific areas. Once abnormal brainwave activity is detected, a procedure called Neurofeedback can be used to bring brainwaves back into normal ranges. Neurofeedback is a noninvasive procedure in which electrodes placed on the scalp measure brain waves and display the waves on a computer monitor. While the patient watches TV or a movie, the practitioner observes the brainwave activity. When brain waves move out of normal range, the screen and sound turn off creating “neurofeedback” and turn back on when the brainwaves return to normal range.
Neurofeedback is conditioning for a brain and the benefits are often permanent. For over 40 years, research has supported the beneficial and positive effects of neurofeedback for children with ADD/ADHD citing improved alertness, attention, behavior, emotional regulation mental flexibility and cognitive function (13).
For most families, a combination of the approaches outlined above will compose your child’s treatment plan. There is not one stand-alone approach that has been shown to work in totality to resolve symptoms of ADD. By exploring and answering these important questions you will have the information needed to build a program that works best for your child.
Paediatr Child Health. 2015 May; 20(4): 200–202.
Neurosci Biobehav Rev. 2016 Dec;71:21-47. doi: 10.1016/j.neubiorev.2016.08.032. Epub 2016 Aug 30.
JAMA. 2002 Oct 9;288(14):1740-8.
J Psychiatry Neurosci. 2009 Mar; 34(2): 88–101
Psychol Res Behav Manag. 2013; 6: 87–99.
Crook WG. Can what a child eats make him dull, stupid or hyperactive? J Disabil 1980; 13: 281-286
J Atten Disord. 2013 May;17(4):347-57. doi: 10.1177/1087054711430712. Epub 2012 Jan 30.
Magnes Res. 2006 Mar;19(1):46-52.
Biol Psychiatry. 1996 Dec 15;40(12):1308-10.
J Lipids. 2017;2017:6285218. doi: 10.1155/2017/6285218. Epub 2017 Aug 30.