ADHD Treatment Options: more than ‘just’ meds.

The life of someone with ADHD feels like a series of constant ironic conflicts: we need to look beyond ‘just’ medication and include lifestyle and work/home adaptations - but we struggle to put them in place and keep them going without the medication.

Or is that just me?

Possibly my most honest blog yet.

I’m writing this in advance (a little) and am surrounded by dogs, books and a couple of empty coffee cups. When I decided to write a blog (and post daily during ADHD Awareness month), I created an amazing Notion page to track my progress, an outline of the posts, a template… and then the medication shortage hit the UK.

via GIPHY

Actual footage of my Q4 plans after the medication shortage started.

So I had a choice - which route did I choose?

Path 1: Adapt my plans - hot off the heels of Rich Webster’s ‘How to Work Less’ course, I should have focused on ONE platform cut way back and prioritised that.

Path 2: KEEP GOING and work late, speed up the content process and just white knuckle October, until I meet with my prescriber and organise a replacement…

(At this point, I’m pretty sure you know which one I chose.)

ADHD Coaches with ADHD are still ADHD

So what follows is a love letter to you - and the people you know and love with ADHD - and a reminder to myself that I know what works and what benefits I get from these strategies and a gentle, loving prompt to put them in place.

“An ADHD coach is a partner - someone beside you on your path - and fully human. That means we need a coach too - that accepting, reflective lens that helps us see where we need to adjust course.”

— Katherine Sanders

So are supplements the answer?

As you’d expect, I make no claim to be a dietician, doctor, counsellor, psychologist or psychiatrist.

The studies we have - which are limited and often low quality or sponsored by supplement companies - don’t show measurable, reliable changes in ADHD symptoms or traits using supplements apart from a Omega 3, most commonly found in fish oil.

There have been a few studies but THIS one is interesting: a 12 week randomised trial in children, they found that those who were deficient in Omega-3 had measurable improvements in ADHD traits - but “In contrast, we found that children in the EPA group with little or no omega-3 deficiency had a worsening in some ADHD symptoms, especially impulsivity. This further suggests that you can have “too much of a good thing”, and that an adequate amount of omega-3 is needed for optimal results.”

So if you are someone who struggles to eat oily fish or has a limited diet - which is very common in the ADHD/ASC population - yes, try an Omega 3 supplement but talk with your doctor first. Supplements like this can affect blood clotting and other types of medicine.

What about (insert name of supplement)?

The answer is - perhaps. Data is very limited and I’m sorry but I like some facts with my supplements - not least because they can be very expensive! This article summarises the results of many studies: PUFAs show some benefit but lots don’t and some can be positively harmful, especially in children.

So what does help?

• DIET: eat the rainbow - seeing a dietician will be a good place to start, and making sure that you get plenty of fruit and vegetables.

• INCLUDE PROTEIN: protein is incredibly important especially with ADHD. It helps with the creation of neurotransmitters (more on that next week) and starting the day with protein rather than skipping it will make a big difference to your energy and focus.

• GET YOUR VITAMINS & MINERALS: it’s unlikely that many of us get the full amount of vitamins and minerals that we need, especially iron and magnesium. Taking a simple multivitamin will be a big help to make sure that you’re meeting your needs. In fact, checking your iron status will be really helpful because the effect of anaemia can often feel like ADHD AND it can make pre-existing ADHD traits worse.

Other Tools to bring in:

Exercise:

yup, there is absolutely no doubt that exercise helps manage ADHD. I’ll come back to this in a few days.

Sleep:

sadly, although we know that sleep is something we struggle with there’s a lot of evidence that improving our sleep routines and making sure we get enough will improve our experience of ADHD traits during the day - as well as our general mental health.

Community:

again, it’s often the thing that we find hardest to manage. Finding a supportive, accepting group of people who really understand what life is like with ADHD can make a big difference in how we feel when things get tough or when we have a set back in our experience of making positive changes.

Manage your Internet:

one of the contradictions we have to face is that often we only meet other people with ADHD like us online - but there’s a lot of evidence too much online time, especially on social network sites - leads to very negative mental health outcomes. There’s evidence that specific CBT programmes can help us to reduce our online time and connect it to better mental health and wellbeing. Ways to reduce this can include blocking apps (Freedom for example) and actually putting your phone or computer out of sight (hooray for ADHD out of sight, out of mind).

Trans-cranial stimulation:

still not widely known and more expensive than a supplement, there is some evidence that this electrical device can help with things like attention.

Don’t despair

If you struggle to implement all of these. That’s normal, with or without ADHD. The important thing to do is focus on one that you can manage SOME of the time and gently increase the frequency or duration of the action you’ve chosen.

I’ll be looking at more of these for the rest of the month so make sure you come back regularly for more.

If you’re interested in a community, keep your eyes open - something new is coming in a few months.

Want to learn more?

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Together, let's uncover the secrets to living a fulfilling life with ADHD.

Warmly,

Katherine

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Further reading:

Bloch MH, Mulqueen J. Nutritional supplements for the treatment of ADHD. Child Adolesc Psychiatr Clin N Am. 2014 Oct;23(4):883-97. doi: 10.1016/j.chc.2014.05.002. Epub 2014 Aug 12. PMID: 25220092; PMCID: PMC4170184.

Chang, J.PC., Su, KP., Mondelli, V. et al. High-dose eicosapentaenoic acid (EPA) improves attention and vigilance in children and adolescents with attention deficit hyperactivity disorder (ADHD) and low endogenous EPA levels. Transl Psychiatry 9, 303 (2019). https://doi.org/10.1038/s41398-019-0633-0

Yager JY, Hartfield DS. Neurologic manifestations of iron deficiency in childhood. Pediatr Neurol. 2002 Aug;27(2):85-92. doi: 10.1016/s0887-8994(02)00417-4. PMID: 12213607.

Zhu F, Zhu X, Bi X, Kuang D, Liu B, Zhou J, Yang Y, Ren Y. Comparative effectiveness of various physical exercise interventions on executive functions and related symptoms in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis. Front Public Health. 2023 Mar 24;11:1133727. doi: 10.3389/fpubh.2023.1133727. PMID: 37033046; PMCID: PMC10080114.

Dimakos J, Gauthier-Gagné G, Lin L, Scholes S, Gruber R. The Associations Between Sleep and Externalizing and Internalizing Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Empirical Findings, Clinical Implications, and Future Research Directions. Child Adolesc Psychiatr Clin N Am. 2021 Jan;30(1):175-193. doi: 10.1016/j.chc.2020.08.001. Epub 2020 Oct 17. PMID: 33223061.

Young S, Adamo N, Ásgeirsdóttir BB, Branney P, Beckett M, Colley W, Cubbin S, Deeley Q, Farrag E, Gudjonsson G, Hill P, Hollingdale J, Kilic O, Lloyd T, Mason P, Paliokosta E, Perecherla S, Sedgwick J, Skirrow C, Tierney K, van Rensburg K, Woodhouse E. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry. 2020 Aug 12;20(1):404. doi: 10.1186/s12888-020-02707-9. PMID: 32787804; PMCID: PMC7422602.

Leffa DT, Grevet EH, Bau CHD, Schneider M, Ferrazza CP, da Silva RF, Miranda MS, Picon F, Teche SP, Sanches P, Pereira D, Rubia K, Brunoni AR, Camprodon JA, Caumo W, Rohde LA. Transcranial Direct Current Stimulation vs Sham for the Treatment of Inattention in Adults With Attention-Deficit/Hyperactivity Disorder: The TUNED Randomized Clinical Trial. JAMA Psychiatry. 2022 Sep 1;79(9):847-856. doi: 10.1001/jamapsychiatry.2022.2055. PMID: 35921102; PMCID: PMC9350846.

Weinstein AM. Problematic Social Networking Site use-effects on mental health and the brain. Front Psychiatry. 2023 Jan 19;13:1106004. doi: 10.3389/fpsyt.2022.1106004. PMID: 36741578; PMCID: PMC9893026.