Effective Interventions for Treating ADD Types, Including Diet, Exercise, Medications, Supplements, and Behavioral Interventions
The Amen Clinics ADD Brain Enhancement Program is geared toward optimizing brain function. The program includes diet, exercise, supplements, medications, neurofeedback, and behavioral interventions. Certainly not everyone needs all treatments, but I believe that it is important for people to know the options available and the pros and cons of each option.
Most people in America have their ADD treated with medication alone. However, research studies by Dr. James Satterfield of Oregon show that medication by itself does not make a lasting difference. To get the best results, the treatment needs to be targeted and comprehensive, including strategies geared toward enhancing brain function, and improving skills at home, at school, in the workplace, and in social situations. In other words, they need treatments geared toward optimizing the brain and reprogramming their lives.
As this book has shown, ADD has clear biological roots and serious psychological and social consequences when it is left untreated. I often use the following computer analogy with my patients. In order for a computer to effectively run any program, its hardware must be sufficient. It must have enough memory and processing speed. Trying to run complex programs on an old computer doesn’t work well. Yet many people with ADD do not have enough memory or processing speed in their brains because of the underactivity in the prefrontal cortex and temporal lobes. To run programs effectively you must first optimize the hardware—the brain. But once a computer’s hardware is optimized, it still has programming needs. Many people with ADD, because of the hardware (brain) problems, never fully learned the programs (information) they needed. Once the brain is optimized, it is important to input strategies that help people with ADD be more effective within their families, at school or work, and in social relationships.
Earlier we discussed how important it was to assess ADD in the four circles bio-psycho-social-spiritual. Treating ADD is best done in the same way. It is essential to optimize the ADD brain (biology), the mindset of an ADD person (psychology), the interactions between the ADD person and the people in his or her life (social), and developing a deep sense of meaning and purpose (spiritual). Ignoring any of these factors can cause treatment failure. Here is a brief summary of ADD treatments, many of which will be expanded upon in subsequent chapters.
Toxic substances can cause and exacerbate ADD-like symptoms. (For example, marijuana use can make someone appear as though they have Type 2 [Inattentive] ADD). Eliminate anything that is toxic to your brain. Given that more than 50 percent of ADD teenagers and adults have or have had problems with drug or alcohol abuse, treatment for abuse is essential to healing ADD.
Caffeine and nicotine have been shown in brain studies to decrease overall blood flow to the brain, which in turn will make ADD symptoms worse over time. In addition, in my experience both nicotine and caffeine decrease the effectiveness of medication and supplement treatments and increase the amount of side effects people have from medication. “But I feel so focused after my coffee in the morning,” you say. In the short run caffeine makes you feel more focused. It works on similar neurotransmitters in the brain as does Ritalin and Adderall. Unfortunately, it also decreases brain blood flow and over time can make the ADD symptoms worse. If possible, also stop any medications that contribute to ADD symptoms.
As we have seen, head injuries can cause severe ADD-like symptoms. And people who have ADD are more prone to head injuries due to their impulsive nature. Head injuries can take a mild case of Type 2 (Inattentive) ADD and turn it into a severe Type 4 (Temporal Lobe) ADD. Do everything you can to prevent these injuries. Make kids wear their helmets when riding bikes, snowboarding, or rollerblading. Wear your seat belt. Do not engage in activities, no matter how adrenal rewarding they are, if they put you at more risk for head injuries.
This is no small recommendation! As my friend and colleague Barry Sears, PhD (author of The Zone) says, “Food is a powerful drug. You can use it to help mood and cognitive ability or you can unknowingly make things worse.” All ADD types, except Type 3 (Overfocused) ADD, do better on a higher protein, lower carbohydrate diet, the exact opposite way that most people eat. I will explore dietary interventions for ADD Types in Chapter (19).
All ADD types benefit from exercise, especially Types 1, 2, 3, and 5. Exercise boosts blood flow to the brain. Exercise also increases serotonin availability in the brain, which has a tendency to calm cingulate hyperactivity. Tryptophan, the amino acid building block for serotonin, is a relatively small molecule. It does not compete well against the larger amino acids to cross the blood/brain barrier. With intense aerobic exercise the large muscles use the available supply of bigger amino acids to replenish tissue. This decreases competition for tryptophan, which ultimately leads to increased concentrations of it within the brain.
I recommend that my patients do the equivalent of walking for thirty to forty-five minutes four to seven days a week. Walk like you are late. To get the brain benefit, a stroll won’t do. Also, lift weights twice a week to optimize muscle mass and hormone function.
I recommend no more than thirty to forty-five minutes a day of computer or video games. If you are not careful, they can be harmful and addictive for people who have vulnerable brains. I have had two patients over the past several years who have had seizures while playing video games. They did not have prior seizures. It is a phenomenon called photophobic seizures, which happened to 730 children in Japan several years ago while they were watching the Nintendo Pokémon cartoon. I have had other patients who became violent after playing video games. Granted these cases may be extreme, but I cannot see much good that comes from playing these games for hours a day, and I believe they have the potential for harm. My best advice at this point is, be careful and limit the exposure.
Medication is an emotionally loaded issue for many people. There is a lot of controversy in this area. After doing the brain imaging work for the past twenty-two years it is very clear to me that medication can be very helpful for many patients. Medication is the best-studied and most effective treatment for ADD. Having said that, medication by itself is generally bad treatment. Unfortunately, most people just get medication and ignore the help needed for the psychological and social aspects of ADD. Medication for each ADD type will be discussed in Chapter 21.
Even more controversial than medication is using natural supplements for ADD. Much more research is needed in this area. However, our clinical experience has taught us that supplements can be useful when used properly. Yet, because supplements are “natural” people think of them as innocuous, which just isn’t true. I am not opposed to natural supplements and I often recommend them. I am opposed to a person being ineffectively treated. A rational, balanced approach to both medication and supplement treatment is needed. Supplement treatment for ADD will be discussed in Chapter 20.
A very exciting biological treatment for ADD is neurofeedback. With neurofeedback electrodes are placed on the scalp, electrical brain activity is measured, and the information is fed back to the patient. Areas of increased and decreased activity can be seen. Neurofeedback, like biofeedback, is based on the principle that if one knows the activity in a certain bodily function then one can use techniques to enhance or optimize the activity in the area. Neurofeedback for each ADD type is discussed in Chapter 22.
Sleep disturbances are very common in people with ADD. Many have trouble getting to sleep at night and getting up in the morning. Sleep deprivation leads to overall decreased brain activity. In order to optimize brain function, proper sleep is essential. Effective strategies for getting up and going to bed are given in Chapter 25.
Education about ADD—its impact on home, school, family, and the self—is the first step in treatment. The more accurate information you have the more likely you are to get the best help. Robert Pasnau, M.D., past president of the American Psychiatric Association, said that coping requires three things: information, self-esteem, and a sense of control. Obtaining accurate information is the critical first step in treating this disorder.
Negativity is one of the hallmark features of ADD. As I’ve said, many people with ADD use negative thoughts as a form of self-stimulation, but it predisposes them to depression and is harmful to their relationships. In Chapter 26, I will teach you how to identify and rid yourself of the negative thoughts (I call them ANTs—automatic negative thoughts) that invade your life.
For many people with ADD, there are a number of psychological issues that need to be addressed. Without the proper biological treatment, psychotherapy can be a fruitless and frustrating experience for both the therapist and patient. I have consulted with many ADD patients who have been in psychotherapy for years without much benefit. When they were placed on the right medication or supplements and diet, however, psychotherapy brought about dramatic improvement in just several weeks. I’m not dismissing psychotherapy as a necessary component of treatment for children, teens, and adults with ADD. It is often very helpful. It does, however, need to be in combination with the right biological treatment. The following are some psychotherapy themes that are essential in dealing with the ADD patient.
Many people with ADD may have erroneous, negative beliefs that prevent them from being successful in the present. For example, they may believe that they’ll fail in school (because that was their experience before they were treated) so they will not try. Or, they may believe that they are doomed to have poor relationships (again, because that was their experience before treatment), so they will engage in the same, repetitive behaviors that impair their ability to relate to others. Once medical treatment is successful, it is also important to correct these beliefs, because beliefs drive behavior.
Willie was impotent as an adult. In treatment, I hypnotized him back to the first time he lost his erection with his wife prematurely. He remembered feeling inadequate and ashamed. Still in the hypnotic trance, I asked him to remember the first time in his whole life that he felt inadequate and ashamed. He started to cry and told me of a time when he was six years old. His father was yelling at him and called him “stupid” because he was unable to learn to read! He transferred the feelings of shame and inadequacy to his sexual life as an adult and still felt incompetent. In the hypnotic trance, I educated his unconscious mind about ADD and the erroneous beliefs he carried into adulthood. I told him to rethink his basic assumptions and have his mind help him rather than hurt him. The impotence disappeared within a month.
Along similar lines, Adrianne never played cards. As a child and teenager, she had trouble learning card games because her attention span was so short. When she did play, her impulsiveness caused her to make bad decisions and she often lost, even though she was just as smart or smarter than her opponent. As an adult, she avoided social situations where card games were played. This caused turmoil in her marriage because her husband liked to play cards with other couples and she refused to go with him. After she was placed on medication, she still avoided playing cards until she began talking about this in therapy. When she made the connection between ADD and her underlying belief about card games, she was able to challenge herself to try again. She found that she really liked playing cards, and she began to go with her husband.
The emotional trauma of having ADD, and all that it entails, leaves many people with intense anxiety. I often have my patients undergo EMDR (eye movement desensitization and reprocessing) therapy to help them deal with the emotional pain of the past. EMDR is a specific treatment for patients who have post-traumatic stress disorder and I have found it helpful for many of my ADD patients. In EMDR the therapist has the patient move his eyes back and forth while a traumatic event is remembered. The therapist takes the patient through a series of steps to help relieve the trauma and rid the patient of the underlying beliefs associated with it. Traumas often hinder people from moving their lives forward. EMDR can be very helpful to deal with the psychological fallout of struggling for years with untreated ADD.
Biological interventions, such as medication, supplements, dietary interventions, or neurofeedback, often become a psychotherapy issue. Many people do not want to believe that there is anything wrong with them and taking the medication or supplements may make them feel, in some way, defective. It is critical to talk about these feelings. When these feelings are ignored, children, teens, and adults start missing doses of medication or supplements and then they lose their overall effectiveness.
Justine was an example of this. At age twenty-two, her life was falling apart. She had taken Ritalin as a teenager and it was very helpful for her. However, in the twelfth grade a friend teased her about the medication, and she stopped it. Within the next year, she had been arrested twice for shoplifting, started using drugs, and had dropped out of high school. The next four years were nothing but trouble. After she saw a special on television about adult ADD, she remembered how helpful the medication had been for her and she sought help. After she was placed back on the medication, she was able to start college, maintain stable work, and avoid antisocial behavior.
One technique that I have found very helpful for my ADD patients is diaphragmatic breathing. This technique helps impulse control, temper outbursts, anxiety, and clarity of thought. It is easy to learn and when practiced will help you feel in much better control of your own feelings and behavior. This will be discussed in Chapter 27.
One of the most helpful psychological treatments for ADD is personal coaching. Coaching helps a person develop good “internal supervision skills.” Coaching involves using another person (a coach) to help you develop goals and the specific skills to meet those goals. I have seen it be very powerful for people with ADD who, as a group, tend to struggle with issues of goal setting, organization, planning, and consistent performance. More on ADD Coaching in Chapter 28.
Obtaining support for yourself and your family is critical. Many people who have ADD or who have it in their family feel isolated and alone. It’s a relief to know there are other people like you. In addition, by interacting with other families with ADD you can share ideas on coping strategies for specific situations. For over a year I wrote a column for an online ADD support site, and was privileged to see the support ADD families offered each other. After I had been writing for about six months, I wrote a letter to the ADD group about a problem I had been having with my ADD son who could not get up in the morning. This was causing him to be late for school and also causing serious turmoil in the house every morning. The next morning I logged on to my e-mail to find seventeen e-mails from other people giving me suggestions on how to deal with this problem. There is no substitute for that kind of support.
There are many ways to get support for ADD. There are support groups online, including on our community site at amensolution.com. A word of caution about the Internet: Because anyone can write on the Internet, check out the information you obtain with your personal health care provider. I once treated a person who used high doses of a cough syrup to treat ADD on the suggestion of a website. He became psychotic and lost his job and his marriage over the bad advice.
Join a local community support group. There are support groups for ADD all over the country. They can be a source of great information. Here are some numbers to contact to get more information:
CHADD (Children [and Adults] with ADD)
(800) 233-4050
CHADD National Office
8181 Professional Place—Suite 150
Landover, MD 20785
chadd.org
LDA (Learning Disability Association of America)
4156 Library Road
Pittsburgh, PA 15234-1349
(412) 341-1515 (412) 344-0224 (FAX)
ldanatl.org
If there are not effective support groups in your area, get online.
As we have seen, ADD is a chronic, stressful medical condition that affects every member of a family. Intervening at a family level is essential to having a happy, healthy family life. In addition, I think of parent training as a primary intervention for ADD children and teenagers. These children are often the most challenging for parents, and parents need superior skills to help their children thrive. Parenting and family strategies are found in Chapter 23.
Children, teens, and young adults spend more than a third of their lives in school or working on schoolwork. Understanding ADD in a school situation and learning proper interventional strategies is an essential part of treatment. Thirty-five percent of untreated ADD teens never finish high school. I have heard it said that graduating from high school is the number one predictor of how a person will do in life. Chapter 24 lays out school intervention strategies for people with ADD.
Making and keeping friends is difficult for many people with ADD. It is estimated that at least half of all children and teens with ADD have problems with their peers and up to 75 percent of adults have interpersonal problems. In treating people with ADD of all ages, it is often important to include a social skill component to the treatment. The components of effective social skill treatment often need to include:
A good place to start social skill training is with the siblings at home. I believe it is essential to expect siblings to be civil and act appropriate with each other. Many psychologists say “let the children work out their own problems, don’t interfere.” I disagree. Remember what happened to Cain and Abel when their parents didn’t intervene? In sibling relationships, clearly state that you expect them to treat each other with respect. When they are positive and appropriate with each other, notice and praise them. When they are inappropriate, condescending, aggressive, or mean with each other, discipline them. When parents lay out the ground rules, siblings are much more likely to get along with each other, which may translate to them behaving more appropriately with others.
Beyond the biological, psychological, and social aspects of our lives, we are also spiritual beings. So to fully heal and recover, we must recognize that we are more than just our bodies, minds, and social connections, and we must ask ourselves deep spiritual questions, such as the following:
What does my life mean?
What is my purpose?
Why am I here?
What are my values?
Do I believe in God or a Higher Power?
What is my connection to past generations, future generations, and the planet?
Having a sense of purpose, as well as connections to past and future generations, allows us to reach beyond ourselves to affirm that our lives matter. Without a spiritual connection, many people experience an overriding sense of despair. Morality, values, and a spiritual connection to others and the universe are critical for many people to feel a sense of wholeness and connection, and a reason to get up in the morning and to take good care of themselves.