As an integrative psychiatric nurse practitioner, I believe that a holistic approach to treatment is the most effective course of action for attention deficit hyperactivity disorder (ADHD). I avoid calling ADHD a "disorder", despite disorder being in the name. I view ADHD differently. Instead, the "D" to me, means divergent: "attention deficit, hyperactive, divergent". Maybe that's because I have ADHD or maybe it's because I think labeling things as a disorder sounds inherently negative. Whatever the case, I think ADHD should be celebrated as creative and unique, not eliminated from who we are. Now, working to manage ADHD is important, for sure. So for treatment, this means looking at ADHD in the context of the whole person, including their physical and emotional health, and tailoring treatment to their individual goals and needs.
Key Takeaways:
The most effective ADHD treatment is holistic in nature and include therapy, exercise, nutrition, and potentially medication.
ADHD should be thought of as a diversity, not a disorder.
Finding an interactive provider for ADHD can be more difficult, but I am here to help!
ADHD is a neurodevelopmental variation that can have a significant impact on a person's life, affecting their ability to focus, manage time, and regulate their behavior. There are various treatment options available to manage ADHD. The exact treatment plan truly depends on the individual's specific goals, symptoms, and needs.
Lifestyle changes can be tremendously helpful in managing ADHD symptoms. Certain lifestyle changes are actually proven to manage ADHD symptoms without any other treatment options. Here we are talking about getting regular exercise, eating nutritious food free of certain additives that increase symptoms of ADHD, getting enough sleep, and minimizing stress.
Holistic treatments for ADHD
Exercise, especially, has been shown to improve cognitive function and reduce symptoms of ADHD by increasing some of the same neurotransmitters that medications do. By doing so, exercise improves focus, concentration, reduces stress, and makes us more resilient to ADHD as a whole. I have talked about exercise and mental health in other articles, but it is important to mention here. The link between exercise and mental health is significant. We really should view exercise as a treatment intervention, not just for physical health.
Nutrition can provide the nutrients needed for optimal brain function, but it’s actually more than just good nutrients. Studies show that certain chemicals, dyes, and processed foods actually exacerbate symptoms of ADHD, especially in children. Again, the link between what we eat and how we feel is huge. In other articles I go more in depth about nutritional psychiatry. If you think of food as a fuel source, we want to be using the best fuel source possible. With ADHD, this can make all the difference in the world. Foods that spike blood sugar levels, for example, wreak havoc on our ability to balance hormones, including insulin (yes, insulin is a hormone). While I never endorse avoidance of food groups, I do endorse moderation of lesser quality foods. Often an elimination diet on a temporary basis is a good place to identify what nutritional triggers are at play. How inflammation can impact mental health is another consideration important to address, especially ADHD. How our bodies respond to what we eat and the internal processes at work can determine not just our ability to focus and concentrate but also our overall mood and happiness.
Adequate sleep is also important for maintaining good cognitive function. Sleep is the only time our brain gets to recharge and restore. Without good sleep, treating ADHD with medications, like stimulants, become an uphill battle. This is why the use of stimulants can be problematic if used to offset poor sleep patterns. Sleep is also when our brain manufactures many of our precious neurotransmitters. If we are not getting enough sleep, it can be difficult for our bodies to keep up with the demand. With ADHD, we may already in short supply of some of those neurotransmitters, making it evermore important to get plenty of sleep. And, by they way, plenty of sleep is 8 hours or more, even for adults.
In addition to exercise, and nutrition, other integrative treatments may be helpful in managing ADHD symptoms. These can include:
1. Nutritional supplements: Certain supplements, such as omega-3 fatty acids, zinc, and magnesium, may be helpful for managing ADHD symptoms. Also, by taking a look at each individual’s lab work, for example, we can help identify any deficits that may need to be corrected through supplementation. I remind folks that finding something that provides even a 5-10% improvement is huge, especially when combined with other treatments that also slightly improve symptoms. Effective holistic treatments, when combined, can be compounding in very formative ways.
2. Mind-body therapies: Mind-body therapies such as meditation, acupuncture, massage, or biofeedback can help individuals manage their stress levels and get in touch with the present. This may sound silly, but ADHD is often a vicious cycle of anxiety, procrastination, inattention, repeat! When we elicit a calm, present focused demeanor we are empowered to take charge of our minds, emotions, and behaviors. This is something anyone can do. I tell everyone, especially ADHD folks, to practice mindfulness at least 2-3 times per day for 5-10 minutes a day. Build it into your calendar and routine to make it second nature.
3. Other ADHD “hacks”: Some individuals learn to “hack” their ADHD by using it to their advantage. By doing things like timeboxing, individuals are empowered to unleash their creativity in ways that was blunted with other treatment approaches. If we look at mental health as a spectrum of colors, ADHD is just another color, not necessarily a disorder. This concept can be transformative in reshaping how we conceptualize ADHD, empowering those of us with ADHD to make a positive impact in the world.
Medication and therapy for ADHD
One of the most commonly used treatments for ADHD is medication. And for good reason – medication is quite good a helping manage ADHD. Stimulant medications such as methylphenidate (Ritalin) and amphetamines (Adderall) are often prescribed to help manage symptoms such as inattention, hyperactivity, and impulsivity. These medications are thought to work by increasing the levels of dopamine and norepinephrine in the brain, which can improve attention and reduce hyperactivity and impulsivity. Non-stimulant medications such as atomoxetine (Strattera) and guanfacine (Intuniv) may also be used, especially for people who cannot tolerate or do not respond well to stimulant medication.
While medication can be helpful for managing ADHD symptoms, it is should not be considered the only option. In fact, I believe medication-only approaches can be problematic, especially for ADHD. This is because over time the medication becomes less effective, and can have serious side effects. Treatment plans should never be “OR”, they should always include “AND”. By this I mean, if we use medication, we use medication AND other interventions.
A combination of medication, therapy, coaching, nutritional counseling, and exercise planning has been shown to be most effective. Therapy and coaching can help individuals with ADHD learn new behaviors and coping strategies to manage their symptoms. This can include techniques such as time management, ways to reduce frustration, and how to “hack” their specific presentation of symptoms. Procrastination is a common struggle for folks with ADHD. Learning to effectively cope with procrastination can be life changing for individuals with ADHD. Therapy also focuses on changing negative thought patterns, or social skills training, which helps individuals improve their interactions with others. Some studies have shown that therapy can be just as effective as medication for managing ADHD symptoms, and it has longer-lasting effects.
It's important to note that the most effective treatment for ADHD may vary from person to person, and a combination of treatments is the most effective approach. Again, I do not believe in a medication-only approach. Consultation with an integrative provider who is experienced in ADHD is recommended to determine the most effective treatment approach for each individual.
How do you get ADHD treatment?
Working with an integrative provider is the way to go, especially for ADHD, obviously I am biased. If you’re in Washington, DC, Maryland, Virginia, Missouri, or New York I am licensed to see you! If you’re not, please reach out anyway. I have a long list of providers in others states that I am happy to share with you.
Another good starting point for getting ADHD treatment is talking to your primary care provider. While they may not have an integrative focus, they will undoubtedly have suggestions for treatment as well as be able to provide you with referrals. Share with your primary care provider that your goals are to work with someone who has a holistic focus including therapy, coaching, and more.
One caution I have for individuals seeking ADHD care: be careful of large companies offering online services for ADHD treatment. Not only do these companies operate in a legal grey area because of their practice model, they often do not offer a comprehensive holistic approach. Moreover, controlled substances require at least one in-person appointment to be compliant with government regulation.
Summary: My effective ADHD treatment approach
In summary, ADHD is complex and can have a significant impact on a person's life. While medication is often used as the first line of treatment, it is not best practice to use a medication-only approach. Therapy, coaching, lifestyle changes, and integrative treatments, when used together, are the most helpful in managing ADHD symptoms. As an integrative provider, I believe in taking a holistic approach to treatment and tailoring treatment to each individual's specific needs – for any mental health concern. With the right treatment, individuals with ADHD can learn to manage their symptoms and lead fulfilling lives. Reach out to me directly, especially if in you’re in the area. I am happy to help point you in the right direction. You can also check with your primary care provider to help locate local treatment options for you.
If you have questions about anything related to integrative psychiatry or ADHD treatment in Washington D.C. , please reach out to me via email at ryan@proactivepsychiatry.com. I am working to spread the word about integrative psychiatry, so feel free to repost this blog!