A diagnosis of ADHD can be difficult, not only for the child diagnosed, but also for the parents who need to learn how to manage this condition.
There are many side effects identified with the medications typically prescribed to treat ADHD that can add stress and additional issues to an already stressful situation.
Are there alternative ways to cope?
Sarah Paper, RDT, PsyD is here to discuss ADHD, the best ways for parents to cope and what can maybe be done without medication.
Selected Podcast
Managing ADHD Without Medication
Featured Speaker:
Sarah Paper, RDT, PsyD, LP - Psychology
Sarah Paper is a board-certified psychologist with professional interests in children and adolescents, ADHD, parenting, pregnancy, trauma, body image/eating disorders, self-harm, mood symptoms, delinquency and psychological evaluations. Transcription:
Managing ADHD Without Medication
Melanie Cole (Host): A diagnosis of ADHD can be difficult, not only for the child diagnosed but also for the parents who need to learn how to manage this condition. There are many side effects identified with the various medications that are typically prescribed to treat ADHD, and that can even add a little bit more stress and additional issues to an already stressful situation. Are there some alternative ways to cope with this? My guest today is Dr. Sarah Paper. She’s a board certified psychologist with professional interests in children, adolescents, and ADHD at Allina Health. Welcome to the show, Dr. Paper. Tell us a little bit about how is ADHD diagnosed, because sometimes that seems to be the sticking point is actually making that diagnosis.
Dr. Sarah Paper (Guest): Right. ADHD can be diagnosed by a primary care physician, the child’s pediatrician, but most often and especially recently, those doctors have been making referrals for psychologists to assess the child. That assessment includes a good clinical interview, oftentimes measures for teachers and parents to complete because we want to make sure that the child is presenting those symptoms at home and at school and even outside the school. We want to see it in multiple settings. Then also, sometimes, cognitive assessment is done to see if there are learning issues that might be impacting concentration and ruling out other diagnoses like depression and anxiety that can look like ADHD.
Melanie: Sometimes you hear a parent say, “Well, he’s just being a kid.” What are some red flags? You mentioned that the symptoms have to occur both in school and outside of school and all the different areas of the child’s life, but what are some red flags that might pop up that would say to the parent, “No, this is more than just kid energy”?
Dr. Paper: I think the most important thing is the teacher feedback because they’re dealing with multiple children and they’ve seen kids over time, and so they’re going to be the ones to notice impairment. An impairment is the most important part of recognizing ADHD versus an active child versus just your typical daydreamer, and all of us have qualities of different diagnoses. Some of us might wander off in our mind or tend to have more energy than others, but when it causes functional impairment, that’s when we start looking at a disorder. Teachers can notice this kid is daydreaming more than other kids and the daydreaming is affecting his or her learning, his or her relationships, behavior. The hyperactivity is causing problems in the classroom, problems on the playground. Oftentimes, I ask if the kid’s in trouble, if they even have difficulty at home sitting still for a meal and watching movies or reading books. Because some parents don’t have a good sense or they haven’t been around enough kids to know what normal kid activity even is. The kid feels active to them, but that might be typical energy or manageable energy.
Melanie: We hear about so many of the medications on the market. When a child is actually then diagnosed with ADHD, attention deficit hyperactivity disorder, what do you do first? Do you start with behavioral therapy? Do you start with medications? What is sort of the first line of defense?
Dr. Paper: What I do is first talk with the parent and the child present. I think that’s an important component of it, to make sure that the child is included in the discussion so that they don’t feel as if something is terribly wrong with them or that they should be ashamed of. I like to have a nice, open conversation, and I really feel like it’s up to the parents to make the decision. And I give them information on the different options, but you want the parents to buy into it, believe in it, trust in it. You want the kid to have some input if they’re old enough about what they think would be helpful. I talk to them about school accommodations that can be helpful versus medication, both things happening at the same time—looking at therapy as far as teaching skills to manage their distractibility, manage their hyperactivity, focus on what they’re doing, taking breaks often so that they don’t fatigue because it does take more energy for them to concentrate. Medication does tend to be the first line of treatment, but it’s not the only line of treatment.
Melanie: Tell us about some of the other lines of treatment, behavioral therapy. How does that work with the hyperactive child who is easily distracted or gets in trouble at school? How does this therapy help them to control those emotions that can sometimes get them to do things that they otherwise would be able to control?
Dr. Paper: There are skills that we teach in the office that they can then practice and then use in the classroom, ways to do things that come maybe more naturally for other kids. Some things I’ve done is teach kids to sit on their hands during circle time or find ways to fiddle with their shoes. Keep their energy contained as small as possible so that they can release it and not draw attention to themselves, not get in trouble. Talk to them about fidgets. Sometimes they bring gum to school so that they can chew on it and get that sensory input into their body. Do things like playing games, even at home. I encourage the parents with them things like “Red Light, Green Light,” “Mother, May I?” games that they have to freeze and be a statue. Sometimes I’ve done things where I have the kid maybe hold a bat or a ball and then have them wait, wait, wait and then time to go so that they’re working on that impulse control. So having them do things and then stop doing things and then try not to do things even when they want to so that they can build up that ability and then talk to them and teach them about how to apply that into the classroom. Another game some therapists use is called Pop and Stop, where they fill the room with bubbles and the kid has to pop them for a certain amount of time and then stop while there are still bubbles that they want to pop. Because that’s a hard thing, as silly as that sounds. For kids with ADHD, wanting to do something and stopping themselves from doing it is quite difficult. So that plays out in a classroom. Same thing, they’re poking their friend or tapping their pencil or making jokes.
Melanie: Will those impulse control issues that children tend to have that have ADHD, how long in these kinds of therapy should it take to start seeing results, maybe hearing some positive feedback from the teachers at school or caregivers or any of those? How long should this take to start seeing some of those results?
Dr. Paper: It depends on the severity of the ADHD and the other environmental issues, social issues. Some of it can be quite challenging. Or sometimes the kids do well in the office and then have trouble translating that out into a more stimulating environment like home and school. Other times I’ve seen kids pretty early on show a great deal of progress, but then they’re not able to sustain it for very long, almost like they run out of steam or it takes so much effort that they can’t maintain it. Over time, they make progress but then they develop and they have new challenges that they face with each grade. It’s a persistent disorder that’s going to affect them for quite a while, most of their life. Some people do tend to grow out of it, but a good percentage of people continue that symptom well into adulthood.
Melanie: How important do you find, Dr. Paper, sleep and diet to be in managing ADHD?
Dr. Paper: The research on that is questionable. There are some people who say it works really well. There are some theories out there that are being researched right now related to sugar sensitivity and that some kids seem to be more sensitive to sugar, some kids seem to be more sensitive to additives, and other kids, that’s not contributing to their symptoms at all. So parents are often encouraged to explore those things, if that’s something that they feel that they can do. There are issues with resources there, too. There are a lot of parents who aren’t able to provide that or even themselves have ADHD and can’t manage that type of diet and that type of structure in their day, and then financial limitations. So I think if parents are willing and able to try that, it’s something that is worth trying and some kids gain the benefit. There’s a good percentage of kids who that doesn’t seem to help.
Melanie: What about sleep?
Dr. Paper: Sleep is very important. There have been some kids who have come in for ADHD assessment, and I just work with them on sleep and said, “Once you’re sleeping, come back if you’re still having symptoms.” Because kids can’t concentrate. Adults can’t concentrate if their brain is not well rested. That can affect your objective functioning, the parts of your brain that are struggling with ADHD. It can look that way. Think about when you haven’t had enough sleep in that day, how well you concentrate or how well you self-regulate. I think that’s the first thing to look at if that hasn’t been addressed yet by the pediatrician is how to improve the sleep so that we can see their brain at its maximum potential and then decide how much impairment is there.
Melanie: In just the last minute, Dr. Paper, give your best advice to frustrated parents listening about ADHD and managing it, yes, with medications but sometimes without medications and the behavioral therapy that’s involved. Your best advice, please.
Dr. Paper: I think the most important advice is to remember that your kid is not doing this on purpose. This is not their fault and they don’t want to be acting this way—they don’t want to have these problems either—and to be patient and compassionate in validating and to talk to professionals if you’re really feeling frustrated. Kids with ADHD often experience adults as being frustrated with them and annoyed with them, and that can really damage a child’s self-esteem and create additional problems in addition to the ADHD.
Melanie: Thank you for such good advice. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks for listening.
Managing ADHD Without Medication
Melanie Cole (Host): A diagnosis of ADHD can be difficult, not only for the child diagnosed but also for the parents who need to learn how to manage this condition. There are many side effects identified with the various medications that are typically prescribed to treat ADHD, and that can even add a little bit more stress and additional issues to an already stressful situation. Are there some alternative ways to cope with this? My guest today is Dr. Sarah Paper. She’s a board certified psychologist with professional interests in children, adolescents, and ADHD at Allina Health. Welcome to the show, Dr. Paper. Tell us a little bit about how is ADHD diagnosed, because sometimes that seems to be the sticking point is actually making that diagnosis.
Dr. Sarah Paper (Guest): Right. ADHD can be diagnosed by a primary care physician, the child’s pediatrician, but most often and especially recently, those doctors have been making referrals for psychologists to assess the child. That assessment includes a good clinical interview, oftentimes measures for teachers and parents to complete because we want to make sure that the child is presenting those symptoms at home and at school and even outside the school. We want to see it in multiple settings. Then also, sometimes, cognitive assessment is done to see if there are learning issues that might be impacting concentration and ruling out other diagnoses like depression and anxiety that can look like ADHD.
Melanie: Sometimes you hear a parent say, “Well, he’s just being a kid.” What are some red flags? You mentioned that the symptoms have to occur both in school and outside of school and all the different areas of the child’s life, but what are some red flags that might pop up that would say to the parent, “No, this is more than just kid energy”?
Dr. Paper: I think the most important thing is the teacher feedback because they’re dealing with multiple children and they’ve seen kids over time, and so they’re going to be the ones to notice impairment. An impairment is the most important part of recognizing ADHD versus an active child versus just your typical daydreamer, and all of us have qualities of different diagnoses. Some of us might wander off in our mind or tend to have more energy than others, but when it causes functional impairment, that’s when we start looking at a disorder. Teachers can notice this kid is daydreaming more than other kids and the daydreaming is affecting his or her learning, his or her relationships, behavior. The hyperactivity is causing problems in the classroom, problems on the playground. Oftentimes, I ask if the kid’s in trouble, if they even have difficulty at home sitting still for a meal and watching movies or reading books. Because some parents don’t have a good sense or they haven’t been around enough kids to know what normal kid activity even is. The kid feels active to them, but that might be typical energy or manageable energy.
Melanie: We hear about so many of the medications on the market. When a child is actually then diagnosed with ADHD, attention deficit hyperactivity disorder, what do you do first? Do you start with behavioral therapy? Do you start with medications? What is sort of the first line of defense?
Dr. Paper: What I do is first talk with the parent and the child present. I think that’s an important component of it, to make sure that the child is included in the discussion so that they don’t feel as if something is terribly wrong with them or that they should be ashamed of. I like to have a nice, open conversation, and I really feel like it’s up to the parents to make the decision. And I give them information on the different options, but you want the parents to buy into it, believe in it, trust in it. You want the kid to have some input if they’re old enough about what they think would be helpful. I talk to them about school accommodations that can be helpful versus medication, both things happening at the same time—looking at therapy as far as teaching skills to manage their distractibility, manage their hyperactivity, focus on what they’re doing, taking breaks often so that they don’t fatigue because it does take more energy for them to concentrate. Medication does tend to be the first line of treatment, but it’s not the only line of treatment.
Melanie: Tell us about some of the other lines of treatment, behavioral therapy. How does that work with the hyperactive child who is easily distracted or gets in trouble at school? How does this therapy help them to control those emotions that can sometimes get them to do things that they otherwise would be able to control?
Dr. Paper: There are skills that we teach in the office that they can then practice and then use in the classroom, ways to do things that come maybe more naturally for other kids. Some things I’ve done is teach kids to sit on their hands during circle time or find ways to fiddle with their shoes. Keep their energy contained as small as possible so that they can release it and not draw attention to themselves, not get in trouble. Talk to them about fidgets. Sometimes they bring gum to school so that they can chew on it and get that sensory input into their body. Do things like playing games, even at home. I encourage the parents with them things like “Red Light, Green Light,” “Mother, May I?” games that they have to freeze and be a statue. Sometimes I’ve done things where I have the kid maybe hold a bat or a ball and then have them wait, wait, wait and then time to go so that they’re working on that impulse control. So having them do things and then stop doing things and then try not to do things even when they want to so that they can build up that ability and then talk to them and teach them about how to apply that into the classroom. Another game some therapists use is called Pop and Stop, where they fill the room with bubbles and the kid has to pop them for a certain amount of time and then stop while there are still bubbles that they want to pop. Because that’s a hard thing, as silly as that sounds. For kids with ADHD, wanting to do something and stopping themselves from doing it is quite difficult. So that plays out in a classroom. Same thing, they’re poking their friend or tapping their pencil or making jokes.
Melanie: Will those impulse control issues that children tend to have that have ADHD, how long in these kinds of therapy should it take to start seeing results, maybe hearing some positive feedback from the teachers at school or caregivers or any of those? How long should this take to start seeing some of those results?
Dr. Paper: It depends on the severity of the ADHD and the other environmental issues, social issues. Some of it can be quite challenging. Or sometimes the kids do well in the office and then have trouble translating that out into a more stimulating environment like home and school. Other times I’ve seen kids pretty early on show a great deal of progress, but then they’re not able to sustain it for very long, almost like they run out of steam or it takes so much effort that they can’t maintain it. Over time, they make progress but then they develop and they have new challenges that they face with each grade. It’s a persistent disorder that’s going to affect them for quite a while, most of their life. Some people do tend to grow out of it, but a good percentage of people continue that symptom well into adulthood.
Melanie: How important do you find, Dr. Paper, sleep and diet to be in managing ADHD?
Dr. Paper: The research on that is questionable. There are some people who say it works really well. There are some theories out there that are being researched right now related to sugar sensitivity and that some kids seem to be more sensitive to sugar, some kids seem to be more sensitive to additives, and other kids, that’s not contributing to their symptoms at all. So parents are often encouraged to explore those things, if that’s something that they feel that they can do. There are issues with resources there, too. There are a lot of parents who aren’t able to provide that or even themselves have ADHD and can’t manage that type of diet and that type of structure in their day, and then financial limitations. So I think if parents are willing and able to try that, it’s something that is worth trying and some kids gain the benefit. There’s a good percentage of kids who that doesn’t seem to help.
Melanie: What about sleep?
Dr. Paper: Sleep is very important. There have been some kids who have come in for ADHD assessment, and I just work with them on sleep and said, “Once you’re sleeping, come back if you’re still having symptoms.” Because kids can’t concentrate. Adults can’t concentrate if their brain is not well rested. That can affect your objective functioning, the parts of your brain that are struggling with ADHD. It can look that way. Think about when you haven’t had enough sleep in that day, how well you concentrate or how well you self-regulate. I think that’s the first thing to look at if that hasn’t been addressed yet by the pediatrician is how to improve the sleep so that we can see their brain at its maximum potential and then decide how much impairment is there.
Melanie: In just the last minute, Dr. Paper, give your best advice to frustrated parents listening about ADHD and managing it, yes, with medications but sometimes without medications and the behavioral therapy that’s involved. Your best advice, please.
Dr. Paper: I think the most important advice is to remember that your kid is not doing this on purpose. This is not their fault and they don’t want to be acting this way—they don’t want to have these problems either—and to be patient and compassionate in validating and to talk to professionals if you’re really feeling frustrated. Kids with ADHD often experience adults as being frustrated with them and annoyed with them, and that can really damage a child’s self-esteem and create additional problems in addition to the ADHD.
Melanie: Thank you for such good advice. You are listening to the WELLcast with Allina Health. For more information, you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks for listening.