One trademark of ADHD is low levels of dopamine, a neurotransmitter released by the brain that makes kids feel good and helps them focus. Increasing dopamine in the brain through medication is an effective treatment for ADHD. However, more than a year into a nationwide stimulant shortage, parents still struggle to fill prescriptions for their kids.

As the shortage stretches on, many caregivers are working to implement ADHD treatment tactics without medication. Here are some gut health strategies to consider.

Don’t Skip Meals

The way your child’s brain works is influenced by what they eat, and good nutrition is essential. Eating unhealthy, non-nutritious foods may contribute to inattention and problematic behaviors, while a diet with a variety of healthy foods nourishes the brain to pay attention and function optimally.

[Free Download: 5 Rules for an ADHD-Friendly Diet]

A study in Cell Metabolism found that dopamine release in the brain can occur at two different times: when food is swallowed and once the food reaches the stomach.¹ Skipping a meal robs the body of two potential releases of dopamine. If your child is not hungry, try to keep them on a regular meal schedule to help regulate opportunities for dopamine release. Healthy snacks help, too. A protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), can help increase dopamine levels.

Introduce Variety

Many kids with ADHD want to eat the same things every day, but doing so may mean they miss out on producing more of that feel-good hormone. Research has also found a strong connection between gut health and mental health. ² A healthy gut is best described as having a diverse microbiome, consisting of different types of microorganisms (bacteria, fungi, viruses, etc.) that coexist harmoniously in the digestive tract. Increasing the diversity of your child’s gut microbiome with a protein-rich diet, including fish, poultry, eggs, and legumes (e.g., beans, lentils, peas, etc.), ensures that dopamine can be adequately synthesized.

Introduce new foods slowly and in a variety of ways. For example, pick a vegetable your child usually eats and connect it to another vegetable or legume. So if your child eats raw carrots, pair them with a dip made of puréed red peppers or smooth refried beans. If your child prefers crunchy foods, make crunchy cooked veggies in the oven or air fryer. Experiment with spices, too. Offering your child small tastes (repeatedly) will build their acceptance of new foods. Kids are more likely to expand their taste and preference for new foods when given multiple chances to learn about and experience new food.

[Free Download: Meal-Planning Guide for ADHD Families]

Mindful Eating

Young children, especially those with ADHD, may be easily distracted during mealtimes. Make it a point to give your child a heads-up on what’s for dinner and when it will be served. Kids with ADHD do best when they know what to expect and follow a schedule. Then, turn off all electronic devices, including the TV, while eating to limit distractions. If possible, sit and eat together at the table. This lets your child know that during meals, it’s time to pause (even for a minute) and focus on eating. This is also a great time to share a moment with your child.

Gut Health Strategies for Treating ADHD: Next Steps

• Read: The ADHD Diet Plan: Healthy Foods and Supplements for Kids & Adults 
• Read: Food Therapy: The Right Nutrition for ADHD Symptoms
• Download: ADHD Brain Food: What to Eat, What to Avoid
• Watch: “What to Eat, What to Avoid: The ADHD Guide to Food and Nutrition for Children”

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The opinions expressed in ADDitude Guest Blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of ADDitude. Blogs are not reviewed by an ADDitude physician or any member of the ADDitude editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. ADDitude does not endorse any specific product, service or treatment.

Do not consider ADDitude Blogs as medical advice. Never delay or disregard seeking professional medical advice from your doctor or other qualified healthcare provider because of something you have read on ADDitude. You should always speak with your doctor before you start, stop, or change any prescribed part of your care plan or treatment. ADDitude understands that reading individual, real-life experiences can be a helpful resource, but it is never a substitute for professional medical advice, diagnosis, or treatment from a qualified health care provider. If you think you may have a medical emergency, call your doctor or dial 911 immediately.

Sources

¹Thanarajah, S.E., Backes, H., DiFeliceantonio, A.G., Albus, K., Cremer, A.L., Hanssen, R., Lippert, R.N., Cornely, O.A., Small, D.M., Brüning, J.C., Tittgemeyer, M. (2018) Food Intake Recruits Orosensory and Post-ingestive Dopaminergic Circuits to Affect Eating Desire in Humans. Cell Metabolism. https://doi.org/10.1016/j.cmet.2018.12.006

²Chen, Y., Xu, J., Chen, Y. (2021). Regulation of Neurotransmitters by the Gut Microbiota and Effects on Cognition in Neurological Disorders. Nutrients. https://doi.org/10.3390/nu13062099

We often live in a state of distracted autopilot, not paying close attention to what we are hearing or doing in the moment. We get caught up in habit and reactivity, saying and responding as we typically do without intention.

But there are concrete implications to not seeing what’s actually going on as it happens. With mindfulness, in contrast, you do your imperfect best to give moment-to-moment, unbiased, compassionate awareness to your life.

Mindfulness aims to increase your happiness and ease — with or without ADHD. It takes persistence to reinforce new cognitive habits, but intentional change is possible if you choose to try.

Mindfulness Practice Reduces Stress

Stress perpetuates stress when you elect to do nothing about that pattern. Stressful thoughts change your emotional state and affect how your body feels, which, in turn, affects your thoughts and emotions. Reactivity reigns in fight-or-flight mode. It’s hard to think clearly. This cycle can feel endless.

[Get This Download: Make Mindfulness Work for You]

However, practicing mindfulness during stressful moments can yield important benefits. Feeling settled helps you manage the stress-producing disorder of ADHD. You think more flexibly and stick to your plans better. You break the stress cycle, which leads to easier ADHD care.

Simply said: Practice managing stress, and you will feel less stressed.

Mindfulness Practice Builds Emotional Resilience

Emotional reactivity, ranging from anger and tears to frustration and shutting down, is inherently part of ADHD; conversely, mindfulness builds emotional awareness. You give yourself permission for a few minutes to notice whatever is happening and not get caught up in it (e.g., “I’m angry but not acting on my anger for now.”). Through that process, you build patience with emotions (and anything else that triggers you).

Mindfulness is not passive. It’s about intention. For the rest of the day, there may be problems to solve or things to do. But for 10 to 15 minutes, you resolve to notice emotions and aim not to fall back on your typical reactions to them.

Simply said: Train yourself to notice emotions, and you’ll manage emotions more easily.

Mindfulness Practice Increases Self-Compassion

People with ADHD struggle mightily at times to accomplish what they know they need to do. That struggle can impact an individual’s self-image. Since your mindset relates to your resilience, this not only changes how you feel, but it can undermine ADHD care itself, which requires effort and persistence.

[“Do I Have ADHD?” Take the ADD Symptoms Test for Adults]

Self-compassion is inherently part of mindfulness practice. You try your best yet get distracted. How would you advise a young child? “It’s okay; just try again.” Reinforcing this habit within yourself matters. You cannot eliminate your inner critic (which may say something like, “I always screw up”), but you can learn to relate to it differently: “Thanks for the feedback. I’m doing my best.” It sounds strange at first, but this response becomes intuitive.

Simply said: You can learn to relate to yourself as kindly as you would support a close friend.

How to Practice Mindfulness

Set aside short-term expectations. It is called mindfulness practice for a reason. The fundamental starting point is just do it. The bottom line is that, as uncomfortable as it might seem at first, you can meditate. You’ll strengthen traits like awareness, responsiveness, and compassion, and more easily break ineffective cognitive habits. Keep in mind that it takes a while to change lifelong mental habits.

Set your best intention and see what happens next. Stay patient when you forget to practice. That’s all part of the experience. It might seem hard to stick with, but it is valuable, nevertheless.

Simply said: Anyone can practice mindfulness. Try it and see what happens for you.

How to Practice Mindfulness: Next Steps

• Download: The ADDitude Guide to Alternative ADHD Therapies
• Listen: “Mindfulness for Adults Living with ADHD” 
• Read: Keep Calm and Breath Om: 7 ADHD Relaxation Techniques

Mark Bertin, M.D., is a developmental pediatrician in Pleasantville, New York, and the author of How Children Thrive (#CommissionsEarned)and Mindful Parenting for ADHD(#CommissionsEarned). His website is developmentaldoctor.com.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share.

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

EndeavorRx is a digital therapeutic authorized by the Food and Drug Administration for the treatment of children ages 8 to 12 with primarily inattentive or combined-type ADHD. In the U.S., EndeavorRx is indicated to improve attention as measured by computer-based testing and it is available by prescription from a licensed health care provider.

EndeavorRx is not intended to be used as a stand-alone therapeutic and is not a substitution for a child’s ADHD medication.

Developed by Akili Interactive, EndeavorRx is the first game-based digital therapeutic device to receive marketing and prescription authorization by the FDA for any type of condition. It has also received Conformité Européenne (CE) Mark certification in Europe.

How Does EndeavorRx Work?

Through its immersive video game experience, EndeavorRx presents specific sensory stimuli and simultaneous motor challenges designed to target neural systems in the brain related to attentional control. Children interact with EndeavorRx on mobile devices, and they typically play for 25 minutes per day, 5 days a week.

The EndeavorRx games, which challenge players to multitask and ignore distractions, are designed to target areas of the brain tied to attention control.

How Long Does EndeavorRx Take to Work?

A randomized, controlled clinical study conducted by parent company Akili Interactive showed improvement, as measured by the Test of Variable Attention (TOVA), on at least one measure of objective attention within four weeks of beginning treatment with EndeavorRx.¹ Akili reports that a more recent trial demonstrated that 68% of parents reported improvements in ADHD-related impairments after two months of treatment.¹

What are the Side Effects of EndeavorRx?

In EndeavorRx trials, fewer than 10% of participants experienced treatment-related adverse events including frustration, headaches, dizziness, emotional reactions, nausea, and aggression. All such events were transient and did not carry lasting effects.¹

What Precautions are Associated with EndeavorRx?

EndeavorRx may not be appropriate for patients with photo-sensitive epilepsy, color blindness, or physical limitations that restrict use of a mobile device; parents should consult with their child’s healthcare provider.

Learn more about EndeavorRx at https://www.endeavorrx.com/

What is EndeavorOTC?

EndeavorOTC is a video game app clinically designed to treat symptoms of inattentive ADHD in adults. It was developed by Akili using the same proprietary technology behind EndeavorRx. According to Akili, adults who participated in a clinical trial studying the app showed improved focus and attention, and reported a better quality of life, including completing tasks on time, multitasking, and keeping track of personal items. EndeavorOTC is available without a prescription for adults 18 and older through the iOS Apple store. Learn more about EndeavorOTC at https://www.endeavorotc.com/.

Sources

¹ Kollins, S. H., DeLoss, D. J., Cañadas, E., Lutz, J., Findling, R. L., Keefe, R. S. E., Epstein, J. N., Cutler, A. J., & Faraone, S. V. (2020). A novel digital intervention for actively reducing severity of paediatric ADHD (STARS-ADHD): a randomised controlled trial. The Lancet. Digital health, 2(4), e168–e178. https://doi.org/10.1016/S2589-7500(20)30017-0

² Kollins, S. H., Childress, A., Heusser, A. C., & Lutz, J. (2021). Effectiveness of a digital therapeutic as adjunct to treatment with medication in pediatric ADHD. NPJ digital medicine, 4(1), 58. https://doi.org/10.1038/s41746-021-00429-0

Xelstrym is a once-daily transdermal amphetamine patch used to treat ADHD in adults and children aged 6 and older. Xelstrym was approved by the FDA in March 2022 and can be used to increase attention and decrease impulsiveness and hyperactivity in people with ADHD. The patch comprises three layers: a printed backing, an acrylic adhesive matrix containing dextroamphetamine, and a release liner.

How Do You Use Xelstrym?

Xelstrym may be applied to the upper arm, upper back, hip, chest, or flank area. Patients should alternate between these placements each time a new Xelstrym patch is applied. Apply the patch two hours before the effects of the medication are needed and remove within nine hours. Do not use more than one patch in a 24-hour period.

Refer to the medication guide and full prescribing information, including the boxed warning, before taking Xelstrym. Patients or their caregivers should talk to a doctor to determine if Xelstrym is a good fit. The safety and effectiveness of Xelstrym for pediatric patients under 6 years of age is still unknown.

What Is the Typical Dosage for Xelstrym?

The optimal dosage varies from patient to patient. Your doctor may adjust your daily dosage by small increments until you or your child experiences the best response — that is, the lowest dosage at which you experience the greatest improvement in symptoms without side effects.

For updated information about dosages, interactions, and precautions, see the Xelstrym drug monograph on WebMD.

Patients should not substitute with other amphetamine products while using Xelstrym.

What’s the Difference Between Xelstrym and Daytrana?

Daytrana and Xelstrym are class II stimulants, and both are delivered via transdermal patches. Daytrana, an amphetamine-based patch, is available to children between the ages of 6 and 17 and is applied to the hip area. Xelstrym, a dextroamphetamine-based patch, may be prescribed to both adult and pediatric populations. Application sites include the hip, upper arm, upper back, chest, or flank area.

Adderall XR is an amphetamine/dextroamphetamine medication delivered via a once-daily, timed-release capsule.

What Are the Ingredients in Xelstrym?

Dextroamphetamine is the active ingredient used in Xelstrym. Inactive ingredients include acrylic adhesives, green ink, polyester/polyurethane backing, and polyester release liner. Xelstrym is manufactured by Noven Pharmaceuticals, Inc.

What Side Effects Are Associated with Xelstrym?

Among the most common side effects reported with Xelstrym are:

• trouble sleeping
• increased heart rate
• increased blood pressure
• irritability
• decreased appetite
• headache
• stomach pain
• nausea
• muscle twitching (tics)
• vomiting
• see the full list of possible side effects here

Serious heart-related problems may occur while taking Xelstrym, including sudden death, stroke, and heart attack in adults; or sudden death in children who have heart problems or heart defects. Increases in blood pressure and heart rate may also occur.

Patients may experience new or worsening psychiatric problems or bipolar illness, new psychotic symptoms, or new manic symptoms while taking Xelstrym. Any personal or family history of suicide, bipolar illness, depression, or other mental health problems should be disclosed.

Other serious side effects include:

• slowed growth in children, including height and weight
• circulation problems in fingers and toes, including Raynaud’s Phenomenon
• serotonin syndrome
• contact sensitization
• application site reactions, including pain, itching, burning feeling, redness, discomfort, or swelling at the application site.

Wait until you know how Xelstrym affects you before participating in potentially dangerous activities like driving or operating heavy machinery.

What Precautions Are Associated with Xelstrym?

Heart rate and blood pressure should be regularly monitored while taking Xelstrym. Patients with a personal or family history of high blood pressure, heart problems, or heart defects should share this with their HCP.

Dextroamphetamine is a federally controlled Class II substance. Abuse, physical dependence, or psychological dependence may occur. Talk to your provider about the risk of abuse prior to being treated with Xelstrym, including any history of abuse or dependence on alcohol, prescription medicines, or street drugs. When taking Xelstrym, monitor for signs of abuse and dependence.

The effects of Xelstrym on an unborn child are not yet clear. Tell your doctor if you are pregnant or breastfeeding before taking Xelstrym. Women exposed to Xelstrym during pregnancy or breastfeeding may participate in the National Pregnancy Registry for Psychiatric Medications to improve existing safety information.

Patients with severe renal impairment who take Xelstrym should not exceed a maximum dosage of 13.5mg, or 9mg for end stage renal disease.

What Interactions Are Associated with Xelstrym?

Do not use Xelstrym if you have a known sensitivity to amphetamines, or if you are taking a monoamine oxidase inhibitor (MAOI) or have within the past 14 days.

Tell your doctor if you are taking SSRIs, triptans, lithium, tramadol, buspirone, SNRIs, tricyclic antidepressants, fentanyl, tryptophan, or St. John’s Wort. A full list of current medicines, vitamins, and herbal supplements should be disclosed by the patient.

Patients may experience pain, redness, and other signs of discomfort around the Xelstrym application sites. Report any adverse reactions to a doctor.

This is not a complete list of all possible drug interactions. Refer to Xelstrym’s drug label information for consumers and health care professionals. Patients who are exposed to potentially dangerous levels of this medication should go to the nearest emergency room and/or call their doctor or a poison control center.

Sources

Noven Pharmaceuticals, LLC. (n.d.) Is it time to consider a patch to treat your ADHD? http://www.xelstrym.com

Noven Pharmaceuticals, Inc. (n.d.) Xelstrym. https://www.noven.com/xelstrym/

Daily Med. (2023, March 28). Label: Xelstrym. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=0862f02a-72a8-41cc-8845-57cf4974bb6f&audience=consumer

NATURAL TREATMENT: What natural treatments are proven to benefit ADHD symptoms?

A: Some natural remedies may ease some symptoms. Others have little effect. Among the proven therapies are… | Keep reading on WebMD »

NUTRITION: What dietary changes could improve my ADHD symptoms?

A: There’s no clear scientific evidence that ADHD is caused by diet or nutritional problems. But certain foods may play at least some role in affecting symptoms… | Keep reading on WebMD »

SUPPLEMENTS: What vitamins or supplements could improve my ADHD symptoms?

A: Besides being good for heart health, omega-3 fatty acids improve symptoms of ADHD, including behavior, cognitive skills, and focus… | Keep reading on ADDitude »

CAFFEINE: Can caffeine improve my ADHD symptoms?

A: A few studies have looked at how caffeine can affect ADHD, but the results have been mixed. Caffeine is a stimulant, but… | Keep reading on WebMD »

DIETARY BALANCE: How can I better understand the way nutrition affects ADHD brain functioning?

A: Research indicates that healthy eating supports a healthy ADHD brain. At the same time, science tells us that ADHD symptoms significantly impede and impair individuals’ ability to make positive choices around food… | Keep reading on ADDitude »

BRAIN FOODS: What foods should I eat (and avoid) to improve my ADHD symptoms?

A: Carbs affect brain function and mood. The rate at which sugar from a particular food enters brain (and other body) cells is called the “glycemic index.” Foods with the best brain sugars include… | Keep reading on ADDitude »

FIRST-PERSON: “I Keep My ADHD Symptoms Under Control By…”

“Watching what I eat helps. I function better when I eat healthy foods like lean protein, veggies, and fruits instead of processed foods.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: ADHD Brain Food: What to Eat, What to Avoid

Research shows that protein promotes alertness in the brain. Carbohydrates do the opposite. And artificial colors and flavors are even worse. | Download now on ADDitude »

FREE DOWNLOAD: ADHD Vitamins and Supplements

This guide outlines ADHD-friendly vitamins and supplements — like iron, zinc, and magnesium — that may help common ADHD symptoms. | Download now on ADDitude »

8-Part Guide to ADHD Treatment in Adults, from WebMD x ADDitude:

DECISION 1: How should I approach my ADHD treatment plan?
DECISION 2: Should I treat my ADHD symptoms with medication?
DECISION 3: How can I address the side effects associated with ADHD medication use?
> DECISION 4: How should I integrate nutrition into my ADHD treatment plan?
DECISION 5: How should I integrate exercise & mindfulness into my ADHD treatment plan?
DECISION 6: What therapies should I integrate into my ADHD treatment plan?
DECISION 7: How and when should I adjust my ADHD treatment plan for optimal benefit?
DECISION 8: How should I adjust my ADHD treatment plan if I have comorbid conditions?

Monarch eTNS is a non-medication prescription device designed for overnight use in children with ADHD ages 7 to 12. The Monarch eTNS System is the first FDA-cleared device for ADHD with proven efficacy in alleviating ADHD symptoms, according to a small study.¹

How Does Monarch eTNS Work?

The Monarch eTNS (external Trigeminal Nerve Stimulation) System is an electronic device, about the size of a cell phone, that connects to a disposable patch placed on a child’s forehead at bedtime. Once turned on, the device sends low stimulating pulses to the trigeminal nerve through the patch overnight. The trigeminal nerve is the brain’s largest cranial nerve responsible for communicating sensations from the face to other parts of the nervous system — including brain areas involved in mood disorders, epilepsy, and attention.

Who Can Use Monarch eTNS?

Monarch eTNS is for patients ages 7 to 12 who are not currently taking prescription ADHD medication. The device should not be used by patients with an active implantable pacemaker or implantable neurostimulator, or in those with body-worn devices (e.g., insulin pumps).

What Studies Have Been Done on Monarch eTNS?

Two clinical trials compared the Monarch eTNS system’s efficacy in treating ADHD to a placebo device.

In 2014, 24 children with ADHD aged 7-14 years participated in an 8-week, open-label pilot feasibility study. After four weeks of nightly use, the Clinical Global Impression–Improvement (CGI-I) scale rated 64% of the study group as “improved” or “improved very much.” This trial showed a 47% decrease in the ADHD Rating Scale IV (ADHD-RS-IV) score and a responder rate of 71% on the Clinical Global Impressions Scale-Improvement (CGI-I) scale after eight weeks. Trial participants used the treatment as directed, side effects were minimal, and no child withdrew from the study due to adverse events, according to results published in Brain Stimulation.¹

A team of UCLA researchers published the results of the first double-blind, placebo-controlled trial examining the efficacy of the Monarch eTNS on ADHD in children in the Journal of the American Academy of Child and Adolescent Psychiatry in 2018. They concluded that more than half of the children (52%) who used the Monarch at bedtime for four weeks—under parent supervision—experienced significantly reduced impulsivity, hyperactivity, and inattention, as measured by clinician-administered ADHD rating scales compared to the placebo group (14%).

What Are the Side Effects of Monarch eTNS?

The most common side effects observed with eTNS included drowsiness, increased appetite, trouble sleeping, teeth clenching, headache, and fatigue. No serious adverse events were associated with device use.

Where Can I Learn More About Monarch eTNS?

You can learn more about Monarch eTNS at https://www.monarch-etns.com/.

Sources

^{1</supMcGough, J.J., Loo, S.K., Sturm, A., et al. (2015). An Eight-Week, Open-Label Pilot Feasibility Study of Trigeminal Nerve Stimulation in Youth with Attention-Deficit/Hyperactivity Disorder. Brain Stimulation. 8:299-304. https://doi.org/10.1016/j.brs.2014.11.013}

^{2</supMcGough, J.J., Sturm, A., Cowen, J., et al. (2019). Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 58(4):403-411. https://doi.org/10.1016/j.brs.2014.11.013}

Up to two-thirds of children with attention deficit hyperactivity disorder (ADHD) have used complementary and alternative medicine (CAM) to address their symptoms, according to a new study published in the Journal of Attention Disorders.

Nutrition modifications; natural products, such as herbs, vitamins, and minerals; and mind-body practices like mindful meditation were the most-reported CAMs. The use of alternative therapies was higher in families where the caregiver preferred natural therapies for ADHD and believed CAMs could synergistically boost conventional medicine.¹

In addition, researchers found two predictive factors for alternative therapy use: parents’ education level (the more educated the parents, the more likely alternative therapies were used) and female gender.

“It seems that parents with higher education are open-minded,” the researchers wrote. “Additionally, they usually try Internet sources, books, and even magazines and other information sources to treat their children.”

The study found that more females opted for complementary and alternative medicine than males. “One of the most important reasons for the higher CAM use in patients of the female gender is the fact that they usually employ more health services than males,” researchers said.²

For the study, researchers reviewed The Web of Science Core Collection, PubMed, and Scopus databases from inception to February 10, 2022, for reports of complementary and alternative medicine usage by patients with ADHD. Data came from 12 original papers, which included a total of 4,447 patients, all younger than 18 years old.

To the researchers’ knowledge, this is the first systematic review to examine the prevalence, possible determinants, and type of alternative therapies used by patients with ADHD.

They recommended training healthcare providers on the most common CAM therapies and possible adverse effects or interactions with conventional medications. “They [healthcare providers] should have a deeper and more informed dialog about this matter with ADHD patients, which encourages them to disclose their CAM use,” researchers said.

This study had several limitations, such as only including articles published in English, and that most studies were from the U.S. and Australia.

Sources

¹Wu, J., Li, P., Luo, H., & Lu, Y. (2022). Complementary and Alternative Medicine Use by ADHD Patients: A Systematic Review. Journal of Attention Disorders. doi.org/10.1177/1087054722111155

²Lorber, J., Moore, L. J. (2002). Gender and the Social Construction of Illness. Rowman Altamira.

Azstarys is a once-daily central nervous system (CNS) stimulant ADHD medication approved for the treatment of ADHD symptoms in patients 6 years of age and older. Formerly referred to as KP415, Azstarys comprises serdexmethylphenidate (SDX), KemPharm’s prodrug of d-methylphenidate (d-MPH), co-formulated with immediate-release d-MPH. Like all methylphenidate-containing products, Azstarys is a federally controlled substance (CII) because it can be abused or lead to dependence.

Azstarys Dosage

The optimal dosage of Azstarys varies by patient. For updated information about dosages, interactions, and precautions, see the Azstarys drug monograph on WebMD.

Azstarys can be taken with or without food. Patients may swallow capsules whole or open and sprinkle onto applesauce or add to water.

What are the Side Effects of Azstarys?

The most common side effects of Azstarys include:

• decreased appetite
• nausea or indigestion
• weight loss
• dizziness
• mood swings
• increased blood pressure
• trouble sleeping
• vomiting or stomach pain
• anxiety
• irritability
• increased heart rate

Azstarys and Heart Problems

If you or your child has heart problems, heart defects, high blood pressure, or a family history of these problems, your doctor should check you or your child before and during taking Azstarys; increases in blood pressure and heart rate may occur. Call your healthcare provider right away or go to the nearest hospital emergency room if you or your child experience chest pain, shortness of breath, or fainting while taking Azstarys.

Azstarys and Mental Illness

If you or your child has psychiatric problems, or a family history of suicide, bipolar illness, or depression, tell your doctor before starting Azstarys. New or worse behavior and thought problems may occur, as well as new psychotic or manic symptoms. Call your healthcare provider right away if there are any new or worsening mental symptoms or problems during treatment.

Azstarys and Circulation Problems

Talk to your doctor before starting Azstarys if you or your child has circulation problems in fingers and toes. Fingers or toes may feel numb, cool, painful, sensitive to temperature, and/or change color from pale, to blue, to red. Call your healthcare provider right away if any signs of unexplained wounds appear on fingers or toes while taking Azstarys.

Azstarys and Growth in Children

There has been some concern that stimulants may cause a slowing of growth in children and adolescents, however research findings are mixed. Some studies show no impact on growth at all,¹ while others find what is considered “negligible” slowing of growth.² If you find evidence of suppressed growth in your child, talk to your doctor about what steps might help.

Azstarys and Pregnancy

Let your doctor know if you or your child is pregnant or plan to become pregnant. It is not known if Azstarys may harm your unborn baby. Azstarys passes into breast milk – talk to your healthcare provider about the best way to feed your baby if you take Azstarys.

Precautions Associated with Azstarys

Do not take Azstarys if your or your child is allergic to any of the ingredients, including serdexmethylphenidate or methylphenidate. Azstarys should not be taken if you or your child is taking or have stopped taking within the past 14 days a medicine used to treat depression called a monoamine oxidase inhibitor (MAOI).

Interactions Associated with Azstarys

Those taking antihypertensive drugs in additional to Azstarys should have their blood pressure monitored. The use of Azstarys should be avoided on the day of surgery if halogenated anesthetics will be used.

Azstarys: Next Steps

• Free Download:A Parent’s Guide to ADHD Medications
• Free Download: Medication Monitoring Log
• Read: A Patient’s Primer on the Stimulant Medications Used to Treat ADHD
• Find: ADHD Specialists and Clinics Near You

Sources

¹Pediatrics (2014.) “ADHD, Stimulant Treatment, and Growth: A Longitudinal Study.” https://publications.aap.org/pediatrics/article-abstract/134/4/e935/77034/ADHD-Stimulant-Treatment-and-Growth-A-Longitudinal

²Journal of the American Academy of Child & Adolescent Psychiatry. (2019.) “Trajectories of Growth Associated With Long-Term Stimulant Medication in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder.” https://www.jaacap.org/article/S0890-8567(19)31443-1/fulltext

Qelbree (Generic Name: viloxazine) is a non-stimulant ADHD medication containing a serotonin norepinephrine modulating agent approved by the FDA to treat attention deficit hyperactivity disorder (ADHD or ADD) in adults and children over six years of age. Its active ingredient, viloxazine hydrochloride, was previously marketed as an antidepressant in Europe. It is the first non-stimulant ADHD medication to receive FDA approval for use in children since Intuniv was approved in 2009.

Qelbree Dosages Explained

The optimal dosage of Qelbree varies by patient. For updated information about dosages, interactions, and precautions, see the Qelbree drug monograph on WebMD.

Qelbree capsules can be swallowed whole or opened and sprinkled onto food. Do not cut, crush, or chew the capsules.

What Are the Side Effects of Qelbree?

Qelbree can increase diastolic blood pressure and heart rate. These measures should be assessed before to starting treatment, following increases in treatment, and periodically during treatment.

Other commonly observed side effects of Qelbree include:

• drowsiness or somnolence
• decreased appetite
• fatigue
• nausea
• vomiting
• trouble sleeping
• irritability

Increased Risk of Suicidal Thoughts Associated with Qelbree

Qelbree may increase suicidal thoughts and actions in some patients, especially within the first few months of treatment or when the dose is changed. Closely monitor any new or sudden changes in mood or behavior, and call your doctor immediately if there are any new or sudden changes, or if there is development of suicidal thoughts or actions.

Qelbree and Mania or Hypomania in Patients with Bipolar Disorder

Noradrenergic drugs may induce a manic or mixed episode in patients with bipolar disorder. Before starting Qelbree, patients should be screened for bipolar disorder. Screening should include a detailed psychiatric history, including a personal or family history of suicide, bipolar disorder, and depression.

Qelbree and Somnolence or Fatigue

Activities requiring mental alertness, such as operating a motor vehicle or hazardous machinery, should be avoided until the patient knows how they will be affected by Qelbree.

Interactions Associated with Qelbree

Patients that take certain anti-depression medicines, especially those called a monoamine oxidase inhibitor or MAOI, or certain asthma medicines, should not take Qelbree.

Qelbree is a strong CYP1A2 inhibitor. Coadministration with moderately sensitive CYP1A2 substrates, such as clozapine and pirfenidone, is not recommended. Qelbree is a weak inhibitor of CYP2D6 and CYP3A4, which increases exposure of those substrates, such as dextromethorphan and alfentanil, when coadministered with Qelbree.

Studies on Qelbree

Data from two studies presented by Qelbree’s manufacturer, Supernus Pharmaceuticals, Inc., at Psych Congress 2023 showed improved efficacy in children aged six and older with ADHD when Qelbree was added to a stimulant, as well as in adults with ADHD who undergo long-term treatment with the medication.¹

An eight-week, Phase IV, open-label study found that when added to existing psychostimulants, Qelbree demonstrated a favorable safety and tolerability profile and improvement in ADHD symptoms in pediatric patients (6-17 years), regardless of the timing of dosing. For the study, children (ages 6-11) and adolescents (ages 12-17) took psychostimulants at least five days a week in the morning. They received Qelbree once daily in the morning through week four and then switched to evening dosing through week eight; children received 100mg per day of Qelbree at week one and were optimized to 100-400mg per day, and adolescents received 200mg per day of Qelbree at week one and were optimized to 200-600mg per day.

Results showed significant symptom improvement from baseline ADHD-RS-5 and CGI-S scores following both morning and evening dosing of Qelbree in combination with the morning psychostimulant. At baseline (N=56), mean (standard deviation) ADHD-RS-5 and CGI-S scores were 37.2 (8.35) and 4.4 (0.56), respectively, and improved at week four (N=54) by -13.5 (9.7) and -0.9 (0.92), respectively, and at week eight (N=48) by -18.2 (9.99) and -1.4 (1.10), respectively. Reported adverse events of the combination therapy included headache (17.9%), decreased appetite (12.5%), and upper respiratory tract infection (10.7%), and 3.6% of patients discontinued the combination treatment due to an AE.

The results from a long-term, open-label extension (OLE) trial of the double-blind pivotal Phase III study that led to the U.S. Food and Administration (FDA)-approval of Qelbree in adults with ADHD found that adult patients (N=159) saw improvement in ADHD symptoms and executive function with safety and tolerability similar to the initial trial.

For the study, adults received 200mg of Qelbree daily for one week, increased to 400mg, and optimized over twelve weeks up to 600mg per day (200-600mg per day). Patients in this open-label trial received Qelbree for 265 (254.9) days.

Patients ADHD symptoms improved from 37.9 (6.34) to 19.7 (12.16) on the Adult ADHD Investigator Symptom Rating Scale (AISRS), representing average symptom reduction of -18.2 (11.54). Patients executive function improved from 70.4 (10.94) to 58.3 (16.19) on the BRIEF-A Global Executive Composite scale, representing an improvement in executive function of -12.9 (13.48). Reported AEs were consistent with those seen in the short-term pivotal adult trial. The most commonly occurring AEs with the use of Qelbree were insomnia (11.3%), nausea (9.4%), headache (5.7%), and fatigue (10.1%). AEs led to discontinuation in 17.6% of patients.

Qelbree and Other ADHD Medications: More Information

• Read: A Parent’s Guide to ADHD Medications
• Read: FDA Approves New Nonstimulant ADHD Medication from Supernus Pharmaceuticals
• Download: Take Charge of Your Child’s Medication
• Download: How Do We Know the Medication Is Working?
• Find: ADHD Specialists or Clinics Near You

Sources

¹“Supernus Announces New Qelbree® Data Showing Improvement in ADHD Symptoms.” Supernus Pharmaceuticals, Inc. (September 2023) https://ir.supernus.com/news-releases/news-release-details/supernus-announces-new-qelbreer-data-showing-improvement-adhd

“Supernus Announces FDA Approval of Qelbree (SPN-812) for the Treatment of ADHD.” Supernus Pharmaceuticals, Inc. (April 2021) https://ir.supernus.com/news-releases/news-release-details/supernus-announces-fda-approval-qelbreetm-spn-812-treatment-adhd

Qelbree label. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/211964s000lbl.pdf

Qelbree. Non-Scheduled ADHD Treatment | Qelbree HCP

Children with ADHD experience out-sized benefits from music. The rhythm, melody, tempo, and lyrics of music may be harnessed to help them activate focus, boost organizational skills, incentivize desired behaviors, improve ADHD symptoms, and more.

Whether it’s Mozart or Metallica, music benefits kids with ADHD, even if they’re not musicians. Here, learn creative activities your family can incorporate into daily life that turn up the volume on music’s healing powers.

The Benefits of Music for Kids with ADHD

1. Music improves attention and focus.

The temporal and rhythmic properties of music are thought to modulate some symptoms of inattentiveness. Playing, or learning to play an instrument, can also help develop skills needed for sustaining attention, alternating attention, impulse control, and decision-making. One study found that children who studied a musical instrument showed better auditory connectivity in the brain, which is often diminished in ADHD brains.

Music lessons also increase your child’s ability to work in a noisy environment, which is useful for coping with distractions.

[Click to Read: Music That Focuses the Brain]

2. Music reinforces memory.

Attaching information to lyrics and melody helps children — with and without ADHD — remember important items. Try teaching phone numbers, addresses, chores, and procedures (like washing hands or tying shoes) to the tune of your child’s favorite songs.

3. Music acts as a study aid.

For some students, listening to music while studying works well because it keeps the brain activated, focused, and less prone to distractions. There is no single musical genre that is best for studying – it is entirely individual. Whether the lyrics in your child’s preferred music are appropriate is another discussion, but don’t automatically rule out hip-hop or heavy metal; it might work to focus your child.

Encourage your child to explore genres, and to use headphones with comfortable volume levels.

4. Music helps keep track of time.

Time blindness is common with ADHD, and music helps build time perception and awareness skills. Rather than have your child do homework or chores to the beat of a timer, try playing a song or timed playlist. It may be easier for your child to keep pace with a favorite soundtrack rather than an unstimulating timer or clock. Music also teaches predictability – a certain point in a song or playlist can act as a marker, letting your child know that it’s time to move to the next step or wrap up.

[Read: 9 Hacks to “Beat” ADHD Symptoms with Music]

5. Music boosts energy.

A good tune can pump up the brain and body, upping dopamine levels and increasing your child’s motivation to tackle even the least desirable of tasks. As with study music, have your child listen to different genres to see what works best. Ask them how they feel listening to each type of music – Are they more anxious? More in the zone? Perhaps too amped up and energized?

If your child has excess energy, music and movement are great ways to channel it. Try enrolling your young child into a developmental music program (such as Music Together, Kindermusik, Musikgarten), which helps build a variety of skills through the experience of music. Older children may benefit from dance classes or other group music experiences.

6. Music promotes calm.

Just as music can boost our energy, it can also calm and soothe us, making it an effective tool for emotional regulation. Again, the choice in music is personal. Some children relax to an audio track of nature or a composition without lyrics. Others feel calm and happy while listening to an upbeat pop song.

7. Music improves self-esteem.

Too many children with ADHD experience low self-esteem. Creating music and learning to play an instrument can build self-confidence and a skill in which they can take pride. It can also teach children about the importance of practice and persistence in the process of crafting something special and enjoyable.

Music is also quite normalizing – your child can bond with peers by talking about music, the instruments they play, and their favorite bands. Joining an orchestra or band at school is great for building social skills while pursuing musical interests. As music and movement are joined at the hip, many children benefit from dance, or another movement experience that works with music.

If your child wants to learn how to play an instrument, make sure to explore a variety of them – piano, drums, guitar, cello, etc. – to find the one that truly sings.

8. Music reinforces desired behaviors.

If listening to or performing music is a rewarding activity for your child, use it to encourage follow-through. Offer a jam session or music video, for example, after your child completes their homework.

9. Music encourages introspection.

Songwriting promotes emotional expression and introspection – exercises that can help children better understand their feelings, themselves, and how to effectively communicate their feelings to others. School-aged children can benefit from partaking in songwriting activities. With teens, who are just beginning to build their sense of self and independence, songwriting can be especially fruitful for self-exploration. Parents can learn a lot about their child’s emotional state, priorities, and passions through these exercises.

There are many ways to explore songwriting, including fill-in-the-blank exercises where children swap out known lyrics to a familiar tune with their own.

10. Music teaches empathy.

Lyric analysis teaches children about point-of-view, the thoughts and feelings of others, and self-reflection. Open up a discussion with your child about a favorite song and ask them to think about what the lyrics mean. What might the artist be trying to say? What clues do the lyrics provide? Try having your child write out the lyrics on paper to truly probe them.

Benefits of Music for ADHD Brains: Final Notes

• Keep a listening log of songs and music that energize, calm, and dysregulate your child as a handy reference.
• Use music intentionally for the outcomes you’re seeking. Background music, even if your child insists they aren’t tuning in, can influence behavior and feelings.
• Do not overuse music. Children (and all of us) need quiet time, too. Too much music can lead to the point of habituation, where the benefits music may be muffled or softened.
• Music lessons? Be honest with the teacher about your child’s strengths and roadblocks so they can plan ahead (they may reorganize the studio, for example, to eliminate distractions). Look for a flexible instructor who will experiment with different methods for alternative learners. Talk to a board-certified music therapist, who may teach lessons or refer you to someone who is a good match for your child’s needs.

The content for this article was derived from the ADDitude Expert Webinar “How Music Sparks, Soothes, and Optimizes the ADHD Brain in Children” (ADDitude ADHD Experts Podcast episode #335) with Patti Catalano, MM, MT-BC, which was broadcast live on December 2, 2020.

Benefits of Music: Next Steps

• Read: Music Therapy – Sound Medicine for ADHD
• Download: Music for Healthy ADHD Brains
• Read: How Music Unlocked My Son’s ADHD Brain

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The Attention Arcade is a gaming platform from BrainLeap Technologies that includes a collection of nine PC games that, thanks to an eye-tracker device purchased separately, use eye movements to control the on-screen action. Built on the premise that eyes and attention move in tandem, Attention Arcade promises to improve and strengthen focus and attention skills. For children with attention deficit hyperactivity disorder (ADHD or ADD), heightened attentional skills can boost working memory, inhibitory control, and cognitive flexibility. The Attention Arcade is the only gaze-driven intervention designed to train attention.

How Does the Attention Arcade Work?

The Attention Arcade is built on the scientific premise that attention and gaze usually shift simultaneously and share much of the same brain circuitry. The games leverage this connection with challenges designed to train different aspects of attention. A player uses their eyes to control the games via an eye tracker.

BrainLeap recommends 20 minutes of gameplay in the Attention Arcade, 3 to 5 times per week, for 8 to 12 weeks, to achieve optimal eye-movement control and attention skills. BrainLeap says that attention may improve after as few as 4 weeks.

Who Should Use the Attention Arcade?

The Attention Arcade is marketed to children ages 7 to 12 who want to improve attention skills, reading, math, executive function, and life outcomes. These games are designed for use at home or in school to make frequent training accessible and easy. The games are not compatible with Mac or Chromebook computers.

How Much Does the Attention Arcade Cost?

The price to download and play the PC games is $39 per month. To access the eye-tracker required to play the games, consumers can bundle the eye-tracker and games for $49/month or purchase the tracker directly at Amzn.to/3aA37bX.

What Studies Have Been Done On the Attention Arcade?

The games were initially created and tested at the University of California, San Diego, and research was funded by the National Institutes of Health. The clinical trial included individuals aged 9-25. All participants who completed the at-home training study showed improvements in at least one measure of attention and most showed improvements on multiple measures.

Sources

https://brainleaptech.com/

NeuroTracker is a 3D visual exercise that trains the brain using a multiple-object tracking test. Weekly virtual training sessions aim to build fundamental cognitive abilities, including attention, executive function, working memory, and processing speed. Students with and without learning abilities — as well as professional athletes — use multiple-object tracking to heighten academic or physical performance.

How Does NeuroTracker Work?

Participants wear anaglyph glasses to visually track a set of targets moving dynamically in a 3D space, and attempt to avoid being distracted by a separate set of virtual objects moving within that space. Selecting the correct targets after tracking increases the speed at which the targets move, thereby increasing the difficulty. 18 minutes of training per week is suggested to optimally boost fundamental cognitive abilities. It takes about 3 months to complete the core training program, which comprises 30 sessions.

Who Can Use NeuroTracker?

NeuroTracker was designed to improve the attention and processing speed of athletes who have to remain aware of the quick and spontaneous movements of both opponents and teammates. It is also used by students seeking to improve executive functions, working memory, and processing speed

Can I try NeuroTracker?

NeuroTracker offers varying subscriptions, including personal, remote, and professional; prices vary.  Click here to try the NeuroTracker demo.

Sources

Neurotracker (2020). https://neurotracker.net/

Corbin-Berrigan, Laurie-Ann. Three-dimensional multiple object tracking in the pediatric population. NeuroReport (2018). https://pubmed.ncbi.nlm.nih.gov/29481522/

Corbin-Berrigan, Laurie-Ann.  Could Neurotracker be used as a clinical marker of recovery following pediatric mild traumatic brain injury? An exploratory study. Brain Injury Journal (2020) https://pubmed.ncbi.nlm.nih.gov/32013583/

Tullo, Domenico. The cognitive benefits of NeuroTracker training across neurodevelopmental disorders: Who benefits from training attention with multiple object-tracking? (2017) https://jov.arvojournals.org/article.aspx?articleid=2652173

Esteem is a mobile app for caregivers of children with attention deficit hyperactivity disorder (ADHD or ADD) and other behavioral challenges. The Esteem app allows a user to select the disorders and behavioral issues impacting their child, identify opportunities for improvement, and track progress. Esteem was developed by behavioral health professionals to provide a quick method for caregivers to monitor and manage their families’ mental health.

How does Esteem work?

An Esteem user may download the mobile app or use the web interface and create a free account and create a profile by completing a questionnaire about their child’s symptoms, diagnoses, and challenges. These challenges may range from lack of focus to poor school performance to inconsistent sleep to unpredictable mood and beyond.

This data is used to create a personalized plan that recommends specific parenting techniques to help the child improve behavior and self-regulation skills.

Esteem can also be used to find therapists and parenting coaches.

Who is Esteem for?

Esteem is for caregivers of children with ADHD and other behavioral disorders.  It can be helpful with children of all ages, but is particularly geared toward children aged 6 to 12.

How much does Esteem cost?

The Esteem app is free. It includes optional paid integrations with other parenting and health apps.

What studies have been done on Esteem?

There is no research specifically on Esteem. The creators of Esteem cite a series of studies that demonstrate the effectiveness of using web-based apps to track and share information between parents, teachers and doctors.

Several of these studies¹ were done by a team at the Cincinnati Children’s Hospital, which showed that web-based training and symptom monitoring² could significantly improve children’s ADHD symptoms as well as the quality of care³ provided by doctors.

Where can I learn more about Esteem?

You can learn more about Esteem at https://www.chooseesteem.com.

Sources

¹Epstein JN, Kelleher KJ, Baum R, et al. Impact of a Web-Portal Intervention on Community ADHD Care and Outcomes. Pediatrics. 2016;138(2):e20154240. doi:10.1542/peds.2015-4240

²Epstein, Jeffery N et al. “The myADHDportal.com Improvement Program: An innovative quality improvement intervention for improving the quality of ADHD care among community-based pediatricians.” Clinical practice in pediatric psychology vol. 1,1 (2013): 55-67. doi:10.1037/cpp0000004

³Epstein JN, Langberg JM, Lichtenstein PK, Kolb R, Altaye M, Simon JO. Use of an Internet portal to improve community-based pediatric ADHD care: a cluster randomized trial. Pediatrics. 2011;128(5):e1201

Despite a dearth of scientific consensus, implementing an “ADHD-friendly” nutrition plan is among the most popular natural treatment approaches among ADDitude readers, according to a 2017 survey of 4,000 adults and parents of children with ADHD. Roughly one quarter of survey respondents reported that they used dietary strategies ranging from avoiding sugars and artificial colors, to increasing protein, and following an elimination diet to try to treat ADHD symptoms.

Many respondents reported improvements in ADHD symptoms after making nutritional changes, but a great majority noted that changes in diet were only somewhat effective in addressing symptoms, despite their serious attempts to implement an ADHD nutrition plan.

Regardless of whether they saw positive results, nearly all survey respondents agreed: Eating healthy is hard, especially when your ADHD brain craves dopamine (i.e. sugar and carbs), when your child is a picky eater, when your appetite is suppressed by other treatments, when your child is sensitive to food textures, when your food budget is limited, when you’re a busy and/or single parent with scant time for grocery shopping, and when life gets in the way.

Popular books and articles offering ‘quick and easy fixes’ do nothing to help when these ADHD realities get in the way. In fact, they can do more harm than good but ratcheting up the guilt:

[Get This Free Download: What to Eat — And Avoid — to Improve ADHD Symptoms]

• “Enforcing an ADHD diet was awful,” one parent wrote. “It became a full time job to plan, maintain, shop for, etc. and there were no positive results to observe.”
• One adult reader wrote: “It was very helpful, but medication was still needed to manage behavior, and it was very restrictive and hard to maintain the diet. Small mistakes in eating would ruin all the hard work.”
• “It was extremely difficult because the foods we were trying to avoid were the ones she craved and would eat,” another parent wrote. “She had such a poor appetite at times that we would give in just to get her to eat anything.”

It’s true that dietary changes may improve symptoms in some cases, but eating healthy is not a guaranteed cure for ADHD by any stretch. Research confirms that nutrition is no substitute for medication and other proven therapies.

Eating Healthy by Cutting Sugar

Reducing sugar consumption was the most commonly-used approach by surveyed adults with ADHD and the second most common among caregivers. Many people with ADHD believe that sugar causes hyperactivity, inattention, and sluggishness, though the science here is thin.

“Sugar increases my fidgeting and my inability to pay attention,” wrote one adult survey-taker. Another said, “I have noticed a sharp decrease in my ability to focus when I drink beverages with processed sugar.” Parents of children with ADHD observed that consuming too much sugar contributed to their kids’ poor focus, and triggered hyperactivity, irritability, and “off the rails” behavior.

Some ADDitude readers found that decreasing sugar intake made a significant improvement in ADHD symptoms. Lowering sugar “keeps my energy levels even,” one person wrote, “which allows me to have sustained focus and concentration.” One parent reported that “limiting sugar helps with [my child’s] moodiness and impulsivity.”

[Click to Download: Your Free Guide to Delicious (and ADHD-Friendly!) Eating]

Many people who cut back on sugar in their diets often replace it with artificial sweeteners, but this was not the case with a lot of those surveyed. Instead, they avoided artificial sweeteners for the same reasons they avoided sugar. “I had better focus and better sleep after removing artificial sweeteners,” one person explained.

The hard reality of cutting sugar, however, was yet another struggle:

• “Sugar is a struggle to cut out,” one parent wrote to ADDitude. “Eliminating it makes my child very unhappy.”
• “Too hard to stay off sugar now — but will retry someday,” an adult survey-taker wrote.
• “It is very difficult for my child to stay away from sugar, but I definitely see behavioral changes when he has sugar” another parent wrote.

What Does Research Say About Sugar and ADHD?

Though many of the adults and caregivers surveyed seem convinced of sugar’s detrimental effects on ADHD symptoms, research on the topic is less black and white.

While some studies^{1 2} in the 1980s and 1990s found a link between sugar intake and hyperactivity, most were unable to show causality between sugar intake and hyperactivity in children.^{3 4}

Researchers even found in one study that parents rated their children as more hyperactive when told they were given sugar, regardless of whether they actually ate any sugar.⁵ A 2011 study, moreover, examined available research and concluded that “the inability to document an effect of added sugars on hyperactivity…has largely discredited the sugar hypothesis of ADHD.”⁶

This is not to say that sugar doesn’t have an effect on the body. It is well documented that diets high in excess sugar are associated with a greater risk of illnesses and unhealthy outcomes, including cardiovascular diseases, weight gain, diabetes and more⁷. Keeping sugar intake at healthy levels, therefore, is beneficial for all.

Eating Healthy by Increasing Protein

Protein is an essential macronutrient for healthy functioning of mind and body, one that is important to growth and development in children.

Many ADDitude readers who were surveyed reported that protein consumption optimizes the brain and sustains energy levels through the day. One survey respondent said that increasing protein consumption kept her child’s “extreme reactions more even.” Another parent noted that increasing protein while reducing sugar was a good strategy.

Most readers surveyed felt that a high-protein breakfast was critical to sustained focus during the school day. One parent saw a discernible “difference in behavior” in his son during the week, compared to weekends, when his diet is more lenient.

For one adult, increasing protein was a game changer. “It helps me maintain more stable blood sugar levels, which curbs impulsive behavior,” he said. Another survey-taker said that protein “offsets the midday crash and helps keep me and my family level throughout the day.” The relationship between protein and sugar was summed up by an adult survey-taker: “High protein and low sugar help my brain function at its best.”

Many survey-takers, however, also spoke to the difficulties in working in more protein in their diets.

• “When I do increase my protein, and eat fewer carbohydrates, it is very effective,” one adult wrote. “I just struggle with doing it for any significant length of time.”
• I think high protein with low unhealthy sugars is a healthy eating approach, [but] ADD people are notoriously bad at meal planning,” one parent wrote.

The Science on Protein and ADHD

Although some evidence supports the benefit of protein in treating ADHD symptoms and improving cognitive performance, more research is needed.

Some research, for instance, has suggested that a high-protein diet, especially a high-protein breakfast, can help with focus, mood, and alertness⁸. One study also found that a higher protein breakfast, compared to a high-carb one, was associated with better memory.⁹

Eliminating Artificial Dyes to Reduce Impulsivity

Many adults and caregivers surveyed worked to maintain diets with natural foods and avoided artificial colors and dyes. In fact, decreasing or eliminating artificial colors and dyes was the most common diet and nutrition approach among caregivers of children with ADHD, one pursued by 70 percent of survey respondents. Many parents reported that foods with artificial dyes worsened their children’s hyperactivity and irritability. One parent wrote, “When my son eats sugar, artificial colors, and junk food, his impulsivity is just around the corner.”

A dye-free diet, according to a number of parents, had dramatic and positive effects on their children. “When we removed artificial dyes, our child slept through the night, for the first time ever,” one parent said. “Food dyes changed [my daughter’s] personality,” another parent noted. By eliminating them, her behavior changed for the better.

[Click to Read: Change Your Diet, Find Your Focus]

Some parents singled out red dye as the culprit, saying, in one case, that red dye contributed to his child’s aggression and impulsivity. Just as many parents reported the negative effects of dyes on their children, many adults surveyed noted that eliminating foods with dyes had a positive effect on their mood.

But avoiding artificial dyes seemed impossible for many parents and adults, who lamented their near universal presence in foods. As one parent wrote:

• “We noticed a definite improvement when attempting to eliminate artificial colors and dyes.That being said, as our son grew older and was involved in school, church parties, and spent time with friends, we no longer had direct and total control over the foods and drinks he consumed. We have learned that restaurants, schools, churches, and even friend’s families don’t adhere to the same standards, and it feels like we are fighting a losing battle.”

The Research on Artificial Dyes

Recent studies have suggested an adverse relationship between hyperactivity and food dyes in children with and without ADHD.^{10 11} These studies even spurred changes in the United Kingdom’s policies toward food dyes, and prompted the FDA to hold hearings in 2011 on the subject.¹² Similar action, however, was not taken in the U.S. due to what the FDA deems a lack of unequivocal evidence on food dyes.

A 2012 analysis¹³, however, of more than 30 restriction diets (characterized mainly by the elimination of food dyes and other additives) concluded that about 30 percent of children with ADHD are responsive to them, and that as many as 8 percent of them have symptoms related to food colors. Referring to the FDA’s hearings, the researchers agreed that the current evidence is “too weak to justify action recommendations,” but is “too substantial to dismiss.”

A 2014 review¹⁴ of restriction and elimination diets in ADHD treatment said that the contrast between the few studies on the topic and the wide interest in the topic is striking. Needed are fresh contemporary trials of elimination diets with well-controlled double-blind procedures as were pioneered decades ago,” the review concluded.

Eating Healthy with the Feingold Diet

Several parents surveyed were enthusiastic about the effect of the Feingold diet on their children with ADHD. This well-known elimination diet, popularized in the 1970s by Benjamin Feingold, M.D., aims to decrease ADHD symptoms by eliminating artificial colorings, flavorings, and salicylates (naturally occurring compounds found in some fruits and vegetables). Dr. Feingold believed that some people with ADHD are sensitive to these foods, and that eliminating them will improve behavior.

While many studies and reviews have found little to no substance to Feingold’s theory, his diet has remained popular over the years.¹⁵ Survey responses from parents are a testament to the diet’s enduring influence, and may point to recent insights about the relationship between artificial dyes and ADHD.

“Within three months of starting the Feingold diet, my son’s medication needs decreased dramatically,” one parent wrote. “He went from taking 40 mg. of Vyvanse, clonidine, and allergy meds to less than 20 mg. of Vyvanse and no other meds. Sleep and allergy problems went away.”

Another survey-taker said that the diet was “life changing. The entire family eats that way now, after seeing the effect it has on our child.”

As with cutting sugar and dyes and increasing protein, sticking to the Feingold diet was no easy task. Parents wrote that:

• “Feingold seemed to work, but it was too hard to maintain.”
• “It isn’t always easy to follow a diet like Feingold, but it isn’t too bad after the first learning curve.”

Does the Feingold Diet Actually Work?

Recent research suggests that skepticism over the Feingold diet stems from outdated studies, and that new reviews, like the studies on artificial dyes that changed the U.K.’s policies, take a more nuanced understanding of synthetic food coloring and its effect on ADHD symptoms.¹⁶

Other Dietary Approaches for ADHD

Caregivers and adults surveyed also tried reducing dairy foods and gluten from their diets. “Eliminating gluten took our situation from unmanageable and crazy to functional,” one parent said.

A reduction in dairy and gluten, for one adult survey-taker, led to a “decrease in foggy brain and moodiness.”

For at least one parent, gluten was described as the single missing piece to a perfect ADHD nutrition plan. “This was the most difficult to do based on my daughter’s palate and food desires,” they wrote. ” Without that being eliminated, I feel the nutritional plan as a treatment tool had limitations.”

Research, however, hasn’t found conclusive evidence linking ADHD and gluten sensitivities, though they can co-occur. A 2016 study even advised against implementing a gluten-free diet to treat ADHD.¹⁷

The Bottom Line on Eating Healthy to Help ADHD

Though many adults and parents in the survey recommended a nutrition plan for managing ADHD symptoms, they also generally concluded that these approaches were only marginally effective for treating ADHD. The struggle to maintain ADHD-friendly nutrition also influenced results, with many concluding that an “ADHD diet” was not worth the effort:

• “We didn’t see much improvement with any diet changes, which are hard to maintain across environments and lifestyles,” one parent wrote.
• “Limiting diet is extremely hard,” one adult wrote. “You want to be able to eat the way you used to. But I feel better off off these items.”
• “I don’t think we gave it enough of a chance to make a difference,” another parent wrote. “It was really hard keeping non-compliant foods away from him during school or when he was at a party, etc. It’s expensive and not an easy thing to maintain.”

Still, according to small follow-up surveys conducted by ADDitude, adults and caregivers remain interested in using a diet and nutrition plan for ADHD after doing their own research on the topic. Researchers recognize the public’s strong interest in using dietary approaches, and stress the need for more and frequent analysis of the ADHD-nutrition link.¹⁸

“Using some of these nutritional approaches may help some people, not everyone,” says Joel Nigg, Ph.D., author of Getting Ahead of ADHD (#CommissionsEarned) and professor of psychiatry, pediatrics, and behavioral neuroscience at the Oregon Health & Science University. “But the nutrition strategies need to be combined with standard care for ADHD, such as ADHD medication.”

[Read This Next: Healthy Foods and Supplements for Kids & Adults]

Sources

¹Prinz, R. J., Roberts, W. A., & Hantman, E. (1980). Dietary correlates of hyperactive behavior in children. Journal of Consulting and Clinical Psychology, 48(6), 760–769. Retrieved from: https://doi.org/10.1037/0022-006X.48.6.760

² Jones, Timothy W. et al. (1995). Enhanced adrenomedullary response and increased susceptibility to neuroglycopenia: Mechanisms underlying the adverse effects of sugar ingestion in healthy children. The Journal of Pediatrics, Volume 126, Issue 2, 171 – 177. Retrieved from: https://www.jpeds.com/article/S0022-3476(95)70541-4/fulltext

³ White, J., Wolraich, M. (1995) Effect of sugar on behavior and mental performance. The American Journal of Clinical Nutrition, Volume 62, Issue 1, Pages 242S–247S. Retrieved from: https://doi.org/10.1093/ajcn/62.1.242S

⁴ Wolraich, M., Milich,R., et al. (1985). Effects of sucrose ingestion on the behavior of hyperactive boys. The Journal of Pediatrics. Volume 106, Issue 4, Pages 675-682. Retrieved from: https://doi.org/10.1016/S0022-3476(85)80102-5

⁵ Hoover, D.W. & Milich, R. (1994). Effects of sugar ingestion expectancies on mother-child interactions. Volume 22, Issue 4, pp 501–515. Retrieved from: DOI: 10.1007/bf02168088

⁶ Johnson, R., Gold, M., et. al. (2011). Attention-Deficit/Hyperactivity Disorder: Is it Time to Reappraise the Role of Sugar Consumption? Postgraduate Medicine, 123:5, 39-49, DOI: 10.3810/pgm.2011.09.2458

⁷ Yang, Q., Zhang, Z., Gregg, E.W., et al. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med.74(4):516–524. doi:https://doi.org/10.1001/jamainternmed.2013.13563

⁸ Zeng, Y. , Li, S. , Xiong, G. , Su, H. and Wan, J. (2011) Influences of protein to energy ratios in breakfast on mood, alertness and attention in the healthy undergraduate students. Health, 3, 383-393. doi: 10.4236/health.2011.36065.

⁹ Nabb, S., Benton, D. (2006): The influence on cognition of the interaction between the macro-nutrient content of breakfast and glucose tolerance. Physiology & Behavior. 87:16–23. https://doi.org/10.1016/j.physbeh.2005.08.034

¹⁰ Bateman B., Warner J., Hutchinson E., et al. (2004). The effects of a double blind, placebo controlled, artificial food colourings and benzoate preservative challenge on hyperactivity in a general population sample of preschool children. Archives of Disease in Childhood, 89:506-511. Retrieved from: https://adc.bmj.com/content/89/6/506

¹¹Mccann, Donna, et al. (2007). Food additives and hyperactive behaviour in 3-year-old and 8/9-year-old children in the community: a randomised, double-blinded, placebo-controlled trial. The Lancet, vol. 370, no. 9598, pp. 1560–1567. Retrieved from: doi:10.1016/s0140-6736(07)61306-3.

¹² Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x

¹³ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

¹⁴ Nigg, J. T., & Holton, K. (2014). Restriction and elimination diets in ADHD treatment. Child and adolescent psychiatric clinics of North America, 23(4), 937–953. doi:10.1016/j.chc.2014.05.010

¹⁵ Arnold, L. E., Lofthouse, N., & Hurt, E. (2012). Artificial food colors and attention-deficit/hyperactivity symptoms: conclusions to dye for. Neurotherapeutics : The journal of the American Society for Experimental NeuroTherapeutics, 9(3), 599–609. doi:10.1007/s13311-012-0133-x

¹⁶ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

¹⁷ Ertürk, E., Wouters, S., Imeraj, L., &amp; Lampo, A. (2016). Association of ADHD and Celiac Disease: What Is the Evidence? A Systematic Review of the Literature. Journal of Attention Disorders. https://doi.org/10.1177/1087054715611493

¹⁸ Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. doi:10.1016/j.jaac.2011.10.015

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