High-intensity exercise treats depression as effectively as do cognitive behavior therapy (CBT) and medication, according to a new study that found combining SSRIs, a type of antidepressant, with exercise improved depressive symptoms more than medication alone.¹

The systematic review and meta-analysis led by a research team from the University of Queensland, Australia, found that the more intense the physical activity, the more effective it was at managing depression. More specifically, vigorous exercises (e.g., running, interval training, strength training, mixed aerobic exercise) reduced depression symptoms in participants more than light physical activity (e.g., walking and hatha yoga), although the latter did provide some benefit.

These findings emerged from examinations of 218 randomized controlled trials, including 14,170 participants diagnosed with depression, to determine the effectiveness of exercise, psychotherapy, and antidepressants in treating depression.

When the researchers narrowed their analysis by demographics, they discovered that strength training and cycling positively impacted more women than men, and yoga or qigong provided more benefits to men than women. Yoga appeared more effective among older adults, and younger adults received better results from strength training. The duration and frequency of exercise did not affect the results.

The study also suggested that men appeared to benefit more than women from combining yoga, Tai Chi, or aerobic exercise with psychotherapy. Yoga and aerobic exercise combined with psychotherapy seemed more effective among older adults.

Participants gained the most benefits from group classes or scheduled exercises. The more autonomy participants had over their exercise programs, the weaker the outcome. “When provided with more freedom, the low self-efficacy that is symptomatic of depression may stop patients from setting an appropriate level of challenge (e.g., they may be less likely to choose vigorous exercise),” the study’s authors wrote.

The researchers cautioned that definitive conclusions are impossible to draw, and more studies are needed. “Our review did not uncover clear causal mechanisms, but the trends in the data are useful for generating hypotheses,” they wrote. “It is unlikely that any single causal mechanism explains all the findings in the review.”

“Exercise should be considered alongside traditional interventions as a core treatment for depression,” report author Michael Noetel, Ph.D., said in a press release. “No matter how often people exercised, whether they had other health issues or how severe their depression was, in all scenarios, exercise had a meaningful impact on their depression. Of course, anyone getting treatment for depression should talk to their doctor before changing what they are doing, but most people can start walking without many barriers.”

Exercise and Depression

Members of ADDitude’s reader panel confirm several findings from the study published in The BMJ (British Medical Journal).

“Strenuous full-body aerobic activities like boxing, karate, swimming, or boulder climbing help me get my thoughts in the right place and boost my mood and energy,” one panelist wrote. “Physical activity also helps me fall asleep and feel less stressed overall.”

“Running helps with my anxiety and depression,” another reader said. “It’s like a vacation for my overstimulated brain.”

A recent retiree who goes to the gym six days a week for group fitness classes and strength training sessions with a personal trainer shares that physical activity helps him feel calmer and more focused. “Exercise gives me a sense of accomplishment and community,” he says. “It is truly my second medication.”

Exercise Benefits Children and Teens with ADHD

The benefits of physical activity are not limited to adults; exercise improves the mental health of children and adolescents with neurodevelopmental disorders (NDDs), including ADHD, learning and motor disorders, autism spectrum disorder (ASD), and intellectual disability, according to a recent systematic review and meta-analysis published in JAMA Pediatrics.²

The researchers found that high-frequency (more than 27) 40-minute sessions of physical activity significantly benefited cognitive function, psychological well-being (e.g., self-esteem, quality of life), internalizing (e.g., anxiety and depression), and externalizing (e.g., aggression and disruptive behavior disorders) behaviors in children and adolescents aged 5-17 years with NDDs. They examined 59 studies with more than 3,000 participants.

ADDitude caregivers recognized similar results from their children after participating in physical activities.

One reader takes their son to the YMCA at least three times per week. “Depression can really take hold of my 10-year-old son,” the parent said. “We see great improvements after physical activity. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

“My daughter has been playing hockey since she was young,” a reader said. “She says she can slow her brain down when she’s on the ice and think more clearly, and it’s as if her ‘ADHD evaporates.’”

“Intense cardio activities, like cross-country skiing and soccer, help my son burn off some of his boundless energy, and he gains self-confidence by being good at something nonacademic,” a reader said.

Another reader said, “My oldest is a distance runner. He is committed and gets up early to run his miles or workout. Running gives him that needed dopamine hit to keep his ADHD symptoms under control at the start of the school day.”

Incorporating Exercise in Depression Treatment Plans

A 2023 treatment survey of 11,000 ADDitude readers reaffirms both studies’ findings. Roughly half of the respondents who use this treatment rated exercise as “extremely” or “very” effective. A staggering 94% of caregivers and 95% of adults recommend exercise to treat ADHD symptoms. Yet only 13 % of these respondents said a doctor had recommended exercise to reduce symptoms, and only 37% of all respondents said physical activity was part of their treatment plan.

The BMJ study encourages clinicians to consider exercise a viable alternative to drug treatment or adjuvant for those already taking medication. “The findings support the inclusion of exercise, particularly vigorous exercise, in clinical practice guidelines for depression,” they wrote. “This may help bridge the gap in treatment coverage by increasing the range of first-line options for patients and health systems.”

Sources

¹Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D. et al. (2024). Effect of Exercise for Depression: Systematic Review and Network Meta-Analysis of Randomised Controlled Trials. BMJ. doi:10.1136/bmj-2023-075847.

²Liu C, Liang X, Sit CHP. (2024). Physical Activity and Mental Health in Children and Adolescents with Neurodevelopmental Disorders: A Systematic Review and Meta-Analysis. JAMA Pediatr. doi:10.1001/jamapediatrics.2023.6251.

Immersive virtual reality-based interventions (VR) can improve cognitive deficits associated with ADHD in children, according to a study published in 2023 in the journal Virtual Reality. Compared to active and passive control groups, children with ADHD experienced positive outcomes with large effect sizes global cognitive functioning, attention, and memory when using immersive VR therapies.¹

In a meta-analysis of seven randomized controlled trials (RCTs), 149 participants were assigned to the immersive VR group and 172 participants to the control group. The study found a significant difference in performance outcomes for attention (g = 0.94) and global cognition (g = 1.06) in favor of the immersive VR group. Only one RCT assessed for memory outcomes, but as with attention and global cognition, the VR group showed a significant advantage (g = 1.81). Improvements were greater for children who were not otherwise treated for ADHD.

Efficacy of Immersive VR

Virtual reality is increasingly used in healthcare, and evaluations by clinicians have been positive. ^{2, 3} Patients say that brain training — an umbrella term used to describe cognitive tools like VR — is effective at improving ADHD symptoms. In a 2024 treatment survey conducted by ADDitude, brain training ranked in the top three most effective ADHD treatment options according to caregivers and adults with ADHD.

XRHealth is the maker of one commercially available VR therapy for ADHD. “Applications for kids with ADHD include a boxing-like game in which players choose which stimuli to punch, which to avoid, and what distractions to ignore,” said Randy Kulman, Ph.D., in “A User’s Guide to Digital Therapeutics for ADHD.”

VR-based interventions may also be useful in the classroom, according to the researchers. “Given the positive association between global cognitive functioning and academic performance, and social functioning, VR-based interventions may benefit the daily life of children with ADHD in terms of school performance and peer relations.”

Yet, brain training was also one of the least utilized treatment options used by ADDitude survey respondents. Out of more than 12,000 respondents, only 6% of caregivers and adults reported having used it to treat ADHD for their child or personally. Lack of personalization to patient needs, treatment goals, and knowledge on the added value of VR have been cited as barriers to implementation.³Access to providers who have experience treating ADHD was the biggest overall barrier to care, according to survey respondents.

Potential Moderators

Researchers performed a second meta-analysis to identify potential moderators of the effect size of global cognitive functioning, for which there was significant substantial heterogeneity (I² = 71.23%). Improvements in global cognition were observed across all participant ages and intervention durations, regardless of diagnostic status (formal vs. informal), novelty of headsets (new vs. old), or control group intervention (passive vs. active). The study did not assess for moderators of attention alone, for which heterogeneity was also significant (I² = 68.26%).

The significance of moderators on immersive VR-based outcomes are mixed. Research has shown that longer interventions, younger participants, and passive control groups may lead to different outcomes, the researchers noted. Follow-up measurements could help “assess the long-term effects of VR interventions and whether improvements made on cognitive functioning outcomes from baseline to post-intervention are maintained after the intervention has ceased.”

Limitations and Future Research

The systematic review and meta-analysis was the first to address treatment adherence and safety of immersive VR in improving cognitive deficits in children with ADHD. Compared to control groups, drop-out rates were similar across groups, and there were no adverse effects. Researchers concluded that immersive VR “is feasible in terms of treatment adherence and a safe cognitive rehabilitation tool.”

A rigorous literature search was conducted for the current study according to PRISMA guidelines and the Cochrane Handbook, and improvements were observed even after correcting for publication bias. However, of the limited studies that were included, all were judged to have an unclear risk of bias based on randomization and selective reporting. Results should be interpreted cautiously.

Control group interventions included non-immersive VR, medication, psychotherapy, cognitive training, neurofeedback, hemoencephalographic biofeedback, being placed on a waiting list, or no treatment. Head-mounted displays were required to be considered an immersive VR-based intervention.

Learn about the current state of affairs in implementing VR technology in healthcare here.

Sources

¹Corrigan, N., Păsărelu, C.R., & Voinescu, A. (2023). Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis. Virtual Reality, 1-20. doi:10.1007/s10055-023-00768-1.

²Zangiacomi, A., Flori, V., Greci, L., Scaglione, A., Arlati, S., & Bernardelli, G. (2022). an immersive virtual reality-based application for treating ADHD: A remote evaluation of acceptance and usability. Digital Health, 8. doi:10.1177/20552076221143242

³Kouijzer, M., Kip, H., Bouman, Y., Kelders, S. (2023). Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings. Implement Sci Commun, 4(1):67. doi: 10.1186/s43058-023-00442-2.

Amphetamine and methylphenidate have been used to treat ADHD for at least 80 years, and their safety and efficacy have been studied relentlessly. But according to a recent ADDitude survey, less than half (42%) of parents opt to medicate their children in the months after a diagnosis, largely due to the risk of side effects like appetite suppression or sleep disruption — both possible impediments to growth.

In the end, 85%  of all people with ADHD end up taking medication and they rate its efficacy higher than any other treatment included in the survey, ADDitude’s largest to date. More than 11,000 adults with ADHD and caregivers of children with the condition participated in the survey from July to December 2023.

“We hesitated for a long time and tried diet changes first in an attempt to avoid medication,” said one respondent. “Although diet is very important, medication has given our child the opportunity to enjoy life by having more emotional control, better friendships, and the ability to complete work and think things through. Greater self-confidence flows from all of this.”

Most Popular ADHD Medications

To be clear, ADHD medication is not a quick fix. On average, children try 2.75 different medications and adults try 2.56 prescriptions before finding one that works for them. Even still, survey respondents said that 17% of children and 14% of adults cease treatment with medication for one reason or another — cessation rates lower than reported in other studies.

Biggest Impediments to ADHD Treatment

Access to treatment professionals with experience in ADHD is the biggest impediment to effective treatment, according to both caregivers and adults. Other barriers include side effects, long wait times, poor access to diagnosing clinicians, and comorbid conditions that complicate evaluation and treatment (82% of children and 92% of adults with ADHD report comorbid diagnoses).

ADHD’s Most Common Comorbid Conditions

The average age of ADHD diagnosis in children is 8 for boys and 9 for girls, according to survey respondents. On average, adults not diagnosed as children learn of their ADHD around age 39. Most of these late diagnoses are among women, who report years of struggle preceding their diagnosis.

“I wish I had been diagnosed and treated sooner,” wrote one survey respondent. “The struggle is so profound and deep. And the longer you go through it without help or knowing what you’re really struggling with, the harder it feels to get others to hear and see you. You feel alone.”

Persistence, flexibility, and self-advocacy are vitally important when working to find the right medication. Though the trial-and-error phase was described as frustrating by most survey respondents, research tells us the benefits of ADHD medication use — reduced risks of automobile accidents, substance abuse, unwanted pregnancy, sexually transmitted diseases, and self harm in teens — are worthwhile and meaningful.

“I wish I had known that ADHD medication helps prevent addictions to dangerous substances,” wrote one survey respondent, “and car accidents for people with ADHD.”

ADHD Medication Formulation, Duration & Satisfaction

Barely half of patients taking a long-acting medication are satisfied with its duration of coverage, which is 9.5 hours for children and 10 hours for adults, on average. This is a flunking grade, but it’s far superior to the satisfaction ratings for short-acting formulations. So why do up to 23 percent of children and 30 percent of adults take short-acting stimulants? Perhaps because clinicians are more likely to prescribe them, and some adults like the medications’ relative flexibility.

“Sometimes, in a social setting, I quite like taking only 5 mg of short-release (rather than my prescribed 10 mg),” wrote one survey respondent. “Other times, when working on something that I find really dull, I often take 15 mg (3 x 5 mg tablets).”

In the end, adults are more likely than children to take short-acting formulations, to be dissatisfied with their medications, and to be considering a switch.

ADHD Medication Side Effects

Caregivers are likely to try fish oil, eliminate food dyes, and sign up for karate before considering a prescription for their child. Once they decide to try medication, caregivers prioritize finding the one with the fewest side effects.

At the same time, 53% of children who end up taking medication try methylphenidate, 36% take amphetamine, and just 11% take a non-stimulant. So given its popularity, methylphenidate must deliver the fewest side effects, right?

No. According to caregiver reports, slightly more children reported side effects from methylphenidate than amphetamine, and those side effects were nearly identical, with appetite suppression being the most common by far; it impacted 61% of children taking any stimulant.

Adults use amphetamine for what they cite as their top priority in choosing a medication — symptom control. Yet they gave it an efficacy rating that was only slightly better than methylphenidate, which is associated with fewer side effects.

So should more adults consider trying Concerta, Ritalin, or a newcomer like Azstarys? One-quarter to one-third of adults said they are now considering some kind of medication switch.

ADHD Treatments Scorecard

Most Highly Recommended ADHD Treatments

ADHD Treatments with Highest Efficacy Ratings

Rated According to Effectiveness on ADHD Symptoms, Specifically

What Readers Say vs. What They Do

The most highly recommended ADHD treatment (exercise) has been used by less than half of ADDitude survey respondents. The second most recommended treatment among adults (ADHD coaching) has been adopted by only 17 percent of people. And the vitamins, minerals, and supplements used by 49 percent of people don’t even earn a passing grade. All of this hints at problems with availability, cost, and medical advice in the world of ADHD treatment.

Diet and Nutrition for ADHD Symptoms

What dietary changes move the needle?

At least half of caregivers and adults agree that the following dietary changes improve ADHD symptoms:

• Decreasing or eliminating artificial colors/preservatives/sweeteners
• Decreasing or eliminating sugar
• Increasing protein

Research supports these observations and reader efficacy ratings are high. So why are fewer than 30% of caregivers and adults making dietary changes to address ADHD? For one, 61% of children using stimulant medication to treat their ADHD experience appetite suppression as a side effect, according to their caregivers. Dietitians generally advise that children should focus on eating first and eating heathy second.

“We struggle to get enough calories into our child due to decreased appetite,” wrote one parent. “We are happy to have her eat, regardless of what or when, to keep energy levels up.”

Psychotherapy More Prevalent Than ADHD Coaching

Though the recommendation rates are nearly identical, far more people engage in psychotherapy than work with an ADHD coach. Therapy generally helps clients work through comorbid conditions like anxiety and depression, and negative beliefs or self-defeating behaviors. Coaching helps to strengthen skills to mitigate ADHD deficits and reach goals, but its benefits are short-lived, readers say.

“ADHD coaching helped me to narrow down my biggest challenges and work on practical solutions for the day-to-day things I struggle with,” said one survey respondent.

Parent Training or Behavioral Therapy for ADHD

This first-line treatment is used by less than 6 out of 10 study participants.

The American Academy of Pediatrics recommends parent training in behavior management as a first-line ADHD treatment for children diagnosed before age 7, and a complementary treatment thereafter. Despite this recommendation, and a high rate of reported satisfaction, just more than half of parents say they’ve ever used it. Possible reasons for this: Clinicians aren’t recommending parent training nearly enough; behavioral therapists versed in ADHD are difficult to find; and/or therapy is expensive and time-consuming. Likely, all of these reasons are true.

“Changing the way we parented was a game changer,” wrote one survey respondent. “It brought the stress in the house down significantly and meant we could focus on the lagging skills and promoting the behaviors we wanted to see versus punishing behaviors we didn’t want to see.”

Exercise for ADHD: Invaluable and Infrequent

Does exercise eradicate ADHD symptoms? Hardly. Readers rated its efficacy on ADHD just 2.4 out of 5, but they also called it invaluable — especially vigorous cardiovascular morning exercise. It aids sleep, mood, and hyperactivity, our readers say. So why isn’t exercise a universal component of treatment plans? As we know, the ADHD brain is easily bored and resists routine.

“When I get into a good stride with routine exercise, it almost always goes hand-in-hand with better eating habits, better focus, energy levels, mental clarity, and stronger relationships and productivity,” said one adult with ADHD. “Exercise is undoubtedly a crucial piece of the (treatment) puzzle.”

Most Impairing Symptoms of ADHD

ADHD Treatment Options: Next Steps

• Download: Share This Report with Your Doctor
• Read: ADHD Medication Reviews
• Get: The ADHD Treatment Guide for Adults

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.

ADDitude Reader Survey Reveals ADHD Treatment Trends & Barriers to Care

In mid-2023, the ADDitude editorial team designed an 85-question ADHD treatment survey and invited responses from 978,871 opt-in newsletter subscribers, 11,013 of whom answered the survey. Data were collected between July 30 and December 4, 2023, and analyzed by ADDitude editors.

Top 10 Research Insights

1. The greatest impediment to effective ADHD healthcare is access to treatment professionals with training and experience in ADHD.

2. At least 80% of children and 70% of adults taking stimulant medication experience persistent side effects, which are partly to blame for medication cessation.

3. Only 42% of parents opt to medicate their children within 6 months of diagnosis; however, waiting too long to medicate was the Number One regret expressed by caregivers.

4. 85% of people with ADHD end up taking medication and they rate its efficacy higher than any other treatment included in the survey.

5. Medication trial and error is seen as necessary but frustrating. On average, children try 2.75 different medications and adults try 2.56 prescriptions.

6. The first-line ADHD treatment recommended by the APA, parent training, is only reaching 57% of children. It is recommended by 93% of those who use it.

7. Complex ADHD is the norm, with 92% of adults and 82% of children reporting at least one additional diagnosis.

8. The top concern when choosing a medication is side effects for caregivers and symptom control for adults. On these measures, the differences between methylphenidate and amphetamine are miniscule.

9. Women diagnosed later in life cite years of misdiagnosis, frustrating medical interactions, and ineffective treatment.

10. Patients are not learning of the executive dysfunctions inherent in ADHD or the risks associated with NOT taking ADHD medication.

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”

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.

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

Pediatrics Research has retracted a paper on the effectiveness of using homeopathy to treat ADHD, citing “substantial concerns regarding the validity of the results presented in this article.” ¹

The original article “Is Homeopathy Effective for Attention Deficit and Hyperactivity Disorder? A Meta-Analysis” reported that “individualized homeopathy showed a clinically relevant and statistically robust effect in the treatment of ADHD.”¹ This retraction directly challenges those results and addresses the concerns of critics, who argue that science does not support the use of homeopathy for addressing ADHD symptoms.

The journal’s editor-in-chief issued the retraction after a review found four “deficiencies,” including the following:

• The authors’ overall allocation of Risk of Bias (ROB) did not align with guidance from the Cochrane Handbook of Systematic Reviews of Interventions.
• The article included a biased study where only children who showed improvements with homeopathy in the screening phase were selected for the trial. ²
• The article included misrepresented results; one study found the control group had more improvement than the homeopathy group, but the paper reported these results in favor of homeopathy.³
• The authors inaccurately averaged the effect size of three main outcomes from a study without indicating if they recalculated the effect sizes from the data in the study. ⁴

The paper’s retraction comes more than a year after critics first questioned the validity of the studies included in the meta-analysis. Shortly after the paper’s June 2022 publication, Edzard Ernst, M.D., Ph.D., MAE, FMedSci, FRSB, FRCP, FRCPEd, asked the editors of Pediatrics Research to add a caution notice or withdraw the paper.

“We conclude that the positive result obtained by the authors is due to a combination of the inclusion of biased trials unsuitable to build evidence together with some major misreporting of study outcomes,” he wrote.

In a follow-up letter sent in June 2023, Ernst wrote, “In our comment, we point out that the authors made a lot of errors — to say it mildly. They deny the doubtful quality of the studies they included in their meta-analysis; they did not stick to their own exclusion criteria, the data the authors report do not resemble the findings of the studies they were allegedly taken from, the one study setting the results is a mere pilot study… We ask you to review your decision, or better still, consider a retraction of the paper altogether.” A copy of both letters appears on Ernst’s blog.

Two of the paper’s authors — Harald Walach, Ph.D., of Change Health Science Institute, Berlin, Germany; and Michael Teut, M.D., of Charité Universitätsmedizin Berlin, Germany — agreed with the retraction. The paper’s third author, Katharina Gaertner, M.D., of the University of Witten/Herdecke, Institute for Integrative Medicine, Herdecke, Germany, disagreed.

“Homeopathy is a very controversial subject, so critics have looked closely at the work,” Teut told Retraction Watch. “Unfortunately, a transcription error was made in the data extraction, which is relevant to the overall result. From this, one can justify a retraction of the work. Ultimately, it is good that the error was made transparent; the scientific community worked here. However, we authors would have preferred a correction in the form of an amendment, which we asked the journal to publish. Three further points of criticism are, in our view, contentious and less relevant. The journal communicated professionally.”

What Is Homeopathy?

German physician Samuel Hahnemann invented homeopathy in 1796. It involves taking substances that cause undesired symptoms in healthy people — like arsenic or tuberculosis bacteria — and diluting them hundreds or thousands of times in alcohol or water until only minuscule amounts of the active ingredient remain. The final product, known as a homeopathic, is primarily water. According to Hahnemann’s theory, this small amount works similarly to a vaccine, triggering a symptom-reducing reaction in people who present with the disease.

Homeopathic preparations are dispensed without a doctor’s prescription and are available in natural foods stores or online. However, many in the international medical community consider homeopathy a pseudoscience. In 2009, the World Health Organization (WHO) issued an official statement specifically warning against the use of homeopathy for serious diseases like HIV, tuberculosis, or malaria. ⁵ The Australian National Health and Medical Research Council, the United Kingdom’s House of Commons Science and Technology Committee, and the Swiss Federal Health Office have all separately concluded that homeopathic remedies are ineffective and have recommended that they not receive government funding. The UK National Health Service no longer funds homeopathic medicine, declaring it a “misuse of resources.”

A randomized, double-blind, placebo-controlled trial conducted in a private homeopathic clinic in Seattle provided no evidence to support homeopathic remedies in children with ADHD, according to a 2005 study published in The Journal of Alternative and Complementary Medicine. ⁶  The authors of a 2007 study published in Cochrane Database of Systematic Reviews of Interventions found “little evidence for the efficacy of homeopathy for the treatment of ADHD.” ⁷

CHADD, a nonprofit organization serving people affected by ADHD, concluded that “No research to date has shown reliable peer-reviewed evidence that homeopathy offers the same benefits as proven treatments, including behavioral management and medication management” after reviewing 10 years of research on homeopathic remedies and ADHD symptoms. ⁸

“The effects that many people experience after homeopathic therapy are not due to the homeopathic remedy but to the usually long and empathetic therapeutic encounter, the placebo effect, and other non-specific effects,” Ernst wrote in a blog post. “To put it bluntly homeopathy is a kind of amateur psychotherapy.”

The American Academy of Pediatrics (AAP) recommends treating ADHD in children and adolescents aged 6 to 18 with FDA-approved medications, plus parent training in behavior modification and behavioral classroom interventions. Various research studies have found that “stimulant medications are most effective, and combined medication and psychosocial treatment is the most beneficial treatment option for most adult patients with ADHD.” All ADHD treatment decisions should be made in consultation and coordination with a licensed medical provider.

Sources

¹ Gaertner, K., Teut, M. & Walach, H. (2022).RETRACTED ARTICLE: Is Homeopathy Effective for Attention Deficit and Hyperactivity Disorder? A Meta-Analysis. Pediatr Res. https://doi.org/10.1038/s41390-022-02127-3

² Frei, H. et al. (2005). Homeopathic Treatment of Children with Attention Deficit Hyperactivity disorder: A Randomised, Double Blind, Placebo Controlled Crossover Trial. Eur. J. Pediatr. 164, 758–767.

^{23/sup> Jacobs, J., Jonas, W. B., Jimenez-Perez, M. & Crothers, D. (2003). Homeopathy for Childhood Diarrhea: Combined Results and Metaanalysis from Three Randomized, Controlled Clinical Trials. Pediatr. Infect. Dis. J. 22, 229–234.}

⁴ Oberai, P. et al. Homoeopathic Management of Attention Deficit Hyperactivity Disorder: A Randomised Placebo-Controlled Pilot Trial. Indian J. Res. Homoeopathy. 7, 158–167 (2013).

⁵ Mashta, O. “WHO Warns Against Using Homoeopathy to Treat Serious Diseases.” BMJ. vol. 339, 24 Aug. 2009, doi:10.1136/bmj.b3447.

⁶ Jacobs, J., Williams, A.L., Girard, C., Njike, V.Y., Katz, D. (2005). Homeopathy for Attention-Deficit/Hyperactivity Disorder: A Pilot Randomized-Controlled Trial. J Altern Complement Med. Oct;11(5):799-806. doi: 10.1089/acm.2005.11.799. PMID: 16296913.

⁷ Coulter, M.K., Dean, M.E. (2007). Homeopathy for Attention Deficit/Hyperactivity Disorder or Hyperkinetic Disorder. Cochrane Database Syst Rev. Oct 17;(4):CD005648. doi: 10.1002/14651858.CD005648.pub2. PMID: 17943868.

⁸ CHADD.“Homeopathy: Is It Effective for ADHD?” November 11, 2017. https://chadd.org/adhd-weekly/homeopathy-is-it-effective-for-adhd/

As this exciting new area of research and clinical development gains speed, my practice in St. Louis has been exploring more than a half-dozen digital technologies and measuring their impact on patients with certain mental health conditions, including ADHD and depression. We are encouraged by what we, and other practitioners and researchers, are seeing.

How Digital Technology Eases ADHD Symptoms

In a recent meta-analysis of 31 studies spanning more than 2,000 participants, digital interventions were found to significantly improve attention, executive function, and working memory in children ages 4 to 17 who had been diagnosed with ADHD. According to the analysis, published in Frontiers in Psychiatry, digital therapeutics had a larger effect on inattentive symptoms than on hyperactive-impulsive symptoms.¹

Here’s a glimpse into a few interventions, some of which I’ve been involved in developing, that have recently come to market or are being explored. Some of these interventions are supplements to ADHD medication therapy, and some are used to predict, diagnose, or monitor other health conditions.

[eBook: The ADDitude Guide to Brain Training for ADHD]

NeuroTrainer

This “mental fitness system,” which utilizes the Meta Quest virtual reality platform, was designed to improve focus, decision speed, and situational awareness. Initially developed to help improve performance in athletes — and currently used by professional sports leagues including the NBA, NHL, and MLB, as well as the National Collegiate Athletic Association and elite athletes — this technology is being explored to improve concentration, focus, and academic performance in academically at-risk high school and middle school students.

Revibe Technologies’ Wearable Reminder System

As a school psychologist, Rich Brancaccio saw firsthand the benefit of subtle reminders and cues to help improve attention and on-task performance for children with ADHD. What followed was his “light bulb” moment of utilizing wearable technology to offer digital cues and coaching reminders. Brancaccio founded Revibe Technologies, a digital therapeutics company that is exploring smartwatch technology that measures on-task behavior, concentration, focus and distractibility.

[ADDitude Directory: Find an ADHD Clinic]

This adaptive technology sends coaching reminders and cues during off-task behavior to help a child regain focus and, thus, bolster academic achievement. An initial study of 706 children with ADHD, ages 7 to 18, found a more than 25-minute increase in attention span and a 19 percent increase in on-task/focus behaviors after three weeks of using the Revibe watch. ^{2, 3} A subsequent larger study is in development to gauge and measure similar improvements in children with ADHD throughout their school day.

Brain Training Programs by Lumos Labs

To help improve cognitive performance through digital interventions, this San Francisco-based lab is leveraging a massive data set of tens of millions of adults who have played several billion gamified cognitive tasks on the lab’s Lumosity platform. The lab is also harnessing this large database of participants to develop digital biomarkers to predict, diagnose, or monitor cognitive challenges stemming from ADHD, multiple sclerosis, and other conditions.^{4, 5}

The lab’s first adult ADHD trial evaluated a series of cognitive-enhancing games to improve measures of attention on a continuous performance test, and assessed improvement in executive function and overall functional capacity in participants not receiving medication treatment. A second ADHD study is currently evaluating whether its technology can improve ADHD symptoms, cognitive performance, and quality of life in adults who are being treated with stimulant or non-stimulant medication.

Akilli’s EndeavorRx for Children

This FDA-authorized video game, available by prescription for children ages 8 to 17 with ADHD, is meant to be played for 25 minutes, five days per week, for four consecutive weeks. In clinical studies involving more than 600 children with ADHD, EndeavorRx improved objective measures of attention, focus, and distractibility.⁶

EndeavorOTC for Adults

EndeavorOTC uses the EndeavorRx technology modified for adults with ADHD, and it does not require a prescription. A study of 220 adults using EndeavorOTC found improvements in ADHD-related symptoms, functional difficulties, and quality of life, the company said.^{7, 8}

Many doctors, scientists, and researchers agree that these exciting new developments using technology to improve mental health are only the tip of the iceberg of what is to come. Harnessing digital therapeutics to expand working memory, and improve focus and concentration, is at the forefront of clinical development and research.

Digital Therapeutics for ADHD: Next Steps

• Download: Learn the Facts About Neurofeedback
• Read: A User’s Guide to Digital Therapeutics for ADHD
• Read: How to Leverage Video Game Psychology to Improve Your Child’s Behavior

Greg Mattingly, M.D., is an associate clinical professor at Washington University School of Medicine. He serves on the Scientific Advisory Board at Revibe and has been a principal investigator in trials for Akilli, Lumos Labs, and other digital therapeutics.

Sources

¹He, F., Qi, Y., Zhou, Y., Cao, A., Yue, X., Fang, S., & Zheng, Y. (2023). Meta-analysis of the efficacy of digital therapies in children with attention-deficit hyperactivity disorder. Frontiers Psychiatry, 16. https://doi.org/10.3389/fpsyt.2023.1054831

²Revibe Technologies. (2021). A fusion of technology and behavioral science. https://www.revibetech.com/our-science-backup-of-original

³Ayearst, L., Vaughn, D., &Brancaccio, R.. (2021, May 609). A non-pharmacological wearable treatment for ADHD in youth. [Poster presented at: Virtual 8th World Congress on ADHD]. https://static1.squarespace.com/static/61780bab935e6752c98168ea/t/618bf5169a3b8e6dbfd56f3a/1636562199345/ADHD_World_Congress_Poster_Ayearst2021.pdf

⁴Lumosity. (n.d.) Peer-reviewed published papers. https://www.lumosity.com/hcp/research/completed

⁵Lumos Labs. (n.d.) Digital medicine. https://www.lumoslabs.com/digital-medicine

⁶Kollins, S.h., DeLoss, D.J.,Cañadas, E., Lutz, J., Findling, R., Keefe, R.,Epstein, J., Cutler, A., & Faraone, S. (2020). A novel digital intervention for actively reducing severity of pediatric 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

⁷DiCarlo, J. (2023, May 3). Adults with ADHD see significant improvements in attention, ADHD symptoms, and quality of life in clinical trial of Akili’s EndeavorRx® video game-based therapeutic. [Press release]. Akili, Inc. https://investors.akiliinteractive.com/news/news-details/2023/Adults-with-ADHD-See-Significant-Improvements-in-Attention-ADHD-Symptoms-and-Quality-of-Life-in-Clinical-Trial-of-Akilis-EndeavorRxVideo-Game-Based-Therapeutic/default.aspx

⁸Endeavor OTC. (n.d.) FAQ. https://www.endeavorotc.com/faq/

Red Dye No. 3 is one of four food additives now banned by the landmark California Food Safety Act, the first law of its kind in the United States. The ban, which was signed on October 7 by Governor Gavin Newsom, cites research linking the additives to serious health risks but has drawn ire from some trade associations that accuse it of sidestepping the Food and Drug Administration (FDA).¹ , ² According to Food Safety magazine, the targeted chemicals are already banned in the European Union, in part, because studies have linked them to cancer, reproductive issues, and childhood behavioral and developmental problems.³

Known as the “Skittles ban,” the California law will take effect in 2027 and prohibit the manufacturing, selling, or distributing of food products containing potassium bromate, brominated vegetable oil, propylparaben, and Red Dye No. 3, a synthetic dye made from petroleum that is found in foods, drinks, and medications.⁴

Joel Nigg, Ph.D., director of the ADHD Research Program at Oregon Health and Science University, called food dyes a “public health concern” that affects children with and without ADHD.

“There is enough evidence that food dyes affect behavior in some sensitive children with ADHD (and other children without the condition) to justify warning labels on foods containing synthetic dyes,” Nigg told ADDitude.

Concerns about increasing rates of ADHD and other behavioral disorders prompted the California Legislature to ask the Office of Environmental Health Hazard Assessment (OEHHA) to conduct a food dye assessment in 2021. Its report, titled Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children, found links between several dyes and hyperactivity in children. The report argues that current federal levels for safe intake of synthetic food dyes may not sufficiently protect children’s behavioral health.

According to the OEHHA report, the FDA’s Acceptable Daily Intake levels (ADIs) for synthetic food dyes are based on 35- to 70-year-old studies that were not designed to detect the types of behavioral effects observed in children today. Comparisons with newer studies indicate that the current ADIs may not adequately protect children from the behavioral effects of some dyes, and suggest they should be lowered.²

Is Red Dye No. 3 a Health Risk?

Red Dye No. 3 was approved for use in food in 1907 but was banned in cosmetics in 1990 after studies found it caused cancer in lab animals. Food safety advocates, scientists, and doctors have urged the FDA to issue a nationwide ban on synthetic food dyes for years. (Red No. 3 is already banned in The European Union, Canada, Australia, New Zealand, China, and Japan.)

“The FDA considered the issue in 2011 and again briefly in 2019 but opted not to take action,” Nigg said. “Since 2011, several new literature reviews have converged supporting the conclusion that food dyes increase the risk of ADHD symptoms.”

The California law may exert new pressure on the FDA to act.

“The primary purpose of this bill was to protect kids and families and consumers in the state of California,” State Assemblyman Jesse Gabriel told The New York Times. “But a secondary purpose here was to send a message to Washington that the FDA process is broken, and hopefully to spur momentum in Washington D.C., for real, significant change.”

“We’re stuck in this regulatory quandary where you’re not allowed to apply it [Red No. 3] to your skin, but you can ingest it in food — so it’s completely illogical,” Brian Ronholm, director of food policy for Consumer Reports said in the same article.

In October 2022, the Center for Science in the Public Interest (CSPI), a consumer advocacy group, and 23 other organizations, filed a petition formally asking the FDA to ban Red No. 3 in foods.

An FDA spokesperson told NPR the agency is “actively reviewing” the petition and will assess whether there’s “sufficient data” to revoke its use. The FDA spokesperson added that the agency “evaluates and regulates ingredients added to food to ensure that the authorized use of these ingredients is safe. This includes the four ingredients included in the California bill.”

How to Avoid Red Dye No. 3

In the meantime, Nigg advises children with ADHD to avoid foods containing food dyes — an admittedly difficult task. According to the Environmental Working Group’s Eat Well Guide, Red Dye No. 3 is used in nearly 3,000 products, including sodas, juices, yogurts, snacks, candy, frostings, instant rice and potato products, cereals, and boxed cake mixes. It is also used in medications including Vyvanse. ⁵

“Parents are well-advised to remove food dyes from their child’s diet if they can,” Nigg said. “It is on the list of things to try to do — along with other health actions like a healthy diet, exercise, and lower stress. I encourage parents to do what they can knowing it’s hard to do it all. Every bit can help.”

To start, Nigg suggests steering clear of most processed and packaged foods.

“Eat whole foods found on the perimeter of the grocery store — eggs, milk, cottage cheese, meat and poultry, nuts and seeds, fresh fruits, vegetables, and legumes,” he said. “Families should also be cautious when buying seemingly ‘healthy’ foods, some of which contain synthetic dyes: pickles, flavored oatmeal, salad dressing, peanut butter, and microwave popcorn, for example. Synthetic dyes are also in toothpaste, medication, and cosmetics. Parents should read all product labels closely.”

To check for the presence of Red Dye No. 3, look at a product’s ingredient lists for “FD&C Red #3” and look for dyes in the “inactive ingredients” section for medications.

The American Academy of Pediatrics has also advised parents to limit foods that often contain synthetic dyes, such as sugary drinks, juices, and candy, that may affect children’s behavior and attention.

Sources

¹ McCann, D., Barrett, A., Cooper, A., Crumpler, D., Dalen, L., Grimshaw, K., Kitchin, E., Lok, K., Porteous, L., Prince, E., Sonuga-Barke, E., Warner, J.O., Stevenson, J. (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. Lancet. doi: 10.1016/S0140-6736(07)61306-3.

² California Office of Environmental Health Hazard Assessment. (2021) Health Effects Assessment: Potential Neurobehavioral Effects of Synthetic Food Dyes in Children. https://oehha.ca.gov/media/downloads/risk-assessment/report/healthefftsassess041621.pdf

³ Henderson, Bailee. (2023, October 9) California Food Safety Act Signed Into Law, Officially Banning Four Toxic Additives by 2027. Food Safety. https://www.food-safety.com/articles/8939-california-food-safety-act-signed-into-law-officially-banning-four-toxic-additives-by-2027

⁴  Osborne, Margaret. (2023, October 17). What to Know About California’s New Law Banning Food Additives, Including Red Dye No. 3. Smithsonian. https://www.smithsonianmag.com/smart-news/california-bans-food-additives-including-red-dye-no-3-180983082/

⁵ FD&C Red No. 3. drugs.com. https://www.drugs.com/inactive/fd-c-red-no-3-247.html

Mindfulness training, even when delivered digitally, reduces symptoms of attention deficit hyperactivity disorder (ADHD) in children, including inattention, executive dysfunction, and social difficulties, according to a new study published in the Journal of Psycholinguistic Research.¹

The study investigated the efficacy of digital cognitive mindfulness training, based on dialectical behavioral therapy (DBT), by measuring a host of symptoms in children diagnosed with ADHD aged 8-10.

The study’s 90 participants were divided into two groups: an experimental group, which received the digital training, and a control group, which did not. The training consisted of four hour-long weekly Zoom sessions of mindfulness training, conducted by a DBT-trained psychologist.

The participants’ ADHD symptoms were measured before the training, immediately after the training, and one month after the training was completed. Immediately after the study, there were no significant differences in the inattention and hyperactivity/impulsivity symptoms between the two groups. However, one month after the study, the experimental group showed significant improvements in attention, executive functioning, learning, emotion regulation, and peer relations.

“These results suggest that a DBT-based mindfulness program is a promising method of reducing ADHD symptoms in children,” conclude the authors of the study.

Mindfulness Practice: How It Works to Improve ADHD Symptoms

DBT helps symptoms of ADHD in a few ways, including by using mindfulness to push pause rather than impulsively react to an emotion, explains Sheri Van Dijk, MSW in “DBT Skills: The Go-To Treatment for ADD”. “Mindfulness meditation for ADHD focuses on doing one thing at a time, in the present moment, with one’s full attention. This is challenging for most people, and especially for the racing minds of people with ADHD,” Van Dijk says. “The goal is to over-learn the skills, so that these new ways of thinking become second nature.”

Van Dijk explains how mindfulness helped a client with ADHD who was interrupting others often: “Mindfulness has made her more aware of the urge to interrupt. We work on not acting when the urge to interrupt arises, and her behavior is slowly changing.”

A recent ADDitude survey found that 72% of parents have not tried any kind of behavioral therapy (DBT, CBT, or others) for their children with ADHD. But of the people who have tried it, a resounding 92% of them would recommend behavioral therapy to other families. The proven effectiveness of digitally taught DBT skills may help to increase access to these helpful interventions for a broader range of people, including those whose geographical location, schedule, or finances may not allow for access to in-person treatment.

“A mindfulness program helped me create new routines,” explained one ADDitude reader. “And my routines make me more healthy.” Another reader reported: “DBT-C has been exactly what our ADHD family has needed.”

Sources

^{1 Ponomarev, R., Sklyar, S., Krasilnikova, V. et al. Digital Cognitive Training for Children with Attention Deficit Hyperactivity Disorder. J Psycholinguist Res (2023). https://doi.org/10.1007/s10936-023-10003-2}

While no one can predict the scientific discoveries that lie ahead, three research areas are especially promising for improving our understanding of ADHD: neuroimaging, genetic research, and non-pharmacologic interventions, like transcranial magnetic stimulation and attention training.

3 Key ADHD Research Areas

1. Neuroimaging

   Advances in brain-imaging techniques may lead to a better understanding of the neural mechanisms underlying ADHD. There are caveats, however. It appears that single neuroimaging receptor or cellular studies have provided clues about differences in brain structure and functioning in individuals with ADHD, but the brain comprises billions of interacting cells, circuits, and networks that do or do not work together during specific tasks.

[Free Download: Learn the Facts About Neurofeedback]

These complex networks and connections vary by individual and by the specific tasks that are part of many neuroimaging studies. Researchers are asking:

• How do different individuals recruit different brain networks and connections to perform a specific task?
• How are additional connections used if the specific tasks are (or are not) related to emotional regulation, excitement, familiarity, fear, or task difficulty?

Slowly, the field is moving away from static representations of cellular or receptor activities in specific brain regions and looking instead at how the whole brain (rather than the simple sum of its single parts) functions. Neuroimaging tools (i.e., Brain SPECT, PET and CAT scans, and fMRI) cannot yet make an accurate diagnosis of ADHD, but we’ll look for important breakthroughs in this area.

2. Epigenetic Research

   Further exploration of genetic factors could shed light on the heritability of ADHD and pave the way for targeted therapies based on an individual’s genetic profile. While the study of genetic factors has provided important clues, we now know that there is no single gene or small set of genes that reliably predict whether someone will have ADHD. Moreover, the specific genes that put one individual at risk for ADHD may differ from those found in another person with ADHD.

This is where epigenetic research comes into play. Researchers are asking:

• Which genes might predispose a child to develop ADHD due to exposure to prenatal and perinatal tobacco smoke or a stressful environment?
• Are there ways to offset these influences by changing an individual’s environment, and at what period during development?

[New Class! The Adult’s Guide to ADHD Diagnosis]

As we discover more specific gene and brain developmental pathways, we should expect to find that different and precise interventions work for different ADHD subtypes, depending on the individual’s particular gene-environment mix and how factors unfold over time.

3. Non-pharmacologic Interventions

   Cognitive-behavioral therapies, neurofeedback, and computerized attention training programs have expanded our treatment options beyond medication.

Technologies using video game formats to provide specific brain exercises may lead to potential attentional benefits, presumably by strengthening specific brain circuits. Examples of brain training programs include EndeavorRX, Joon, Mightier, and Calmsie.

Neurostimulation devices offer new techniques for managing ADHD symptoms more effectively. Examples include the Monarch eTNS system, which uses an external wearable device that stimulates the Vagus nerve, as well as devices that deliver transcranial magnetic stimulation (TMS) to the brain through an externally applied device. While TMS has been approved for depression, anxiety, and obsessive-compulsive disorder, it has been studied but not yet approved for ADHD.

These new interventions are exciting; however, we do not have sufficient research data comparing the efficacy of any of these treatments with more established and efficacious pharmacologic interventions and cognitive behavior therapies.

ADHD Research Updates: Next Steps

• Get: The Clinicians’ Guide to Treating Complex ADHD
• Read: Could High-Tech Brain Scans Help Diagnose ADHD?
• Watch: How Brain Imaging Helps Us Understand and Treat Attention Deficit

Peter S. Jensen, M.D., is the founder of The REACH Institute, which trains clinicians to effectively diagnose and treat mental health conditions in children.

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Cannabis use is known to impair attention, inhibition, memory, and motivation. Studies have found that it worsens ADHD symptoms or has no effect at all.² What’s more, individuals with ADHD are at greater risk of developing a substance use disorder, including cannabis misuse.^{3 4} Finally, a lack of robust research leads many doctors to dismiss cannabis as a valid ADHD treatment option.

At the same time, public perception of medical cannabis has improved ⁵ as more states have chosen to legalize it. When consumed in moderation, cannabis can deliver positive effects including improvements in sleep, anxiety, and emotional dysregulation, according to some ADDitude readers.

In a recent ADDitude survey, we probed more deeply, asking the following questions:

• If you self-medicate with marijuana (or have a history of doing this), what made you first try it?
• What form do you take it in (e.g., smoking, vaping, edibles)?
• Do you use marijuana alongside ADHD medication?
• How does it affect your ADHD symptoms? Your mood and functioning?

See what readers with ADHD had to say about their experiences with cannabis:

“I self-medicated with weed for many years for mood swings, PMDD, endometriosis, and ADHD before I was diagnosed. I have a medical card now for my PMDD and other chronic pain issues. It can be a very helpful tool, but I am mindful of my use. If I’m not, it is easy to watch my day — and my energy — slip from my grasp.” — An ADDitude reader

[Self-Test: Could You Have a Substance Use Disorder?]

“I find marijuana exacerbates my inattentive symptoms. The first time I tried it, I took too much; it felt like my ADHD ‘sped up,’ as in I forgot what I was doing more than usual. It helps ease my comorbid anxiety, however, precisely for this reason. It’s impossible to ruminate on anything. I try to keep my intake to a minimum because I read that chronic use may impede executive functioning, which is the opposite of what I want. It’s great to keep in my back pocket for when I’m especially stressed, overwhelmed, and need to unwind.” — An ADDitude reader

“Before my official ADHD diagnosis during perimenopause, I had used marijuana for decades to slow down or to make boring tasks more interesting (so I’d actually do them). In my younger days, I couldn’t stick with routine and mundane household chores or sit through movies and lectures at university. I liked the novelty of being stoned, as my thoughts would stop racing and I could focus on one topic like designing a floor plan or garden. Since being diagnosed and medicated four years ago, I’ve stopped smoking marijuana, which is better for my health. Being medicated properly stopped my inner critic — and the chaotic inner tornado that had lived in my head for decades.” — An ADDitude reader

“I smoke weed and am prescribed Vyvanse. Overall, my ADHD symptoms have not improved overall [from weed], but I can concentrate better because it is so good at combatting emotional dysregulation, rejection sensitivity, and, in my case, GAD and PTSD.” — Matt, New York

“I have recently begun trying marijuana edibles about an hour before bedtime since recreational marijuana was legalized in my state this year. I have found that a nano-dose of 2 to 3 milligrams of THC clears my head of the usual noise and lets me drop into a deep and restful sleep. I am 45 and (insufficiently) manage my ADHD with non-stimulant medication only.” — An ADDitude reader

[Download: Sleep Disorders Linked to ADHD]

“Originally, trying it had nothing to do with my ADHD, but taking edibles occasionally at night helps calm my mind and helps me stay asleep during the night. I use ADHD medication during the day.” — An ADDitude reader

“I smoke cannabis to help manage my anxiety — mostly once in the afternoon and again in the evening. I also take Vyvanse and a B-complex. I will often use a bong or pipe before leaving home to help me keep calm while out. (I work from home.) As for how it affects my ADHD symptoms, it depends on what strain of cannabis I use. Overall, it helps calm my overactive brain enough to get into a flow more easily and maintain productivity when the Vyvanse wears off, which is the desired effect. It also increases my appetite when Vyvanse does the opposite.” — Crystal, Canada

“I have self-medicated with marijuana to reduce physical pain caused by severe scoliosis and disintegrating cervical discs for 13 to 14 years now… I quit for almost two years, but the pain just increased… I’m also managing my ADHD with stimulant medication… If I was still working or attending university, I could see the concerns about marijuana canceling out the positive effects of stimulant medication. For me, I need the pain relief that comes with marijuana, in addition to having a quiet mind. I function well enough to read and retain information. I’m not disorganized or as forgetful as I used to be. And I’m grateful for it.” — Suzanne, California

“I have a medical marijuana card in my state, and I first tried it with family encouragement and influence. I take THC gummies at night to help me sleep. While it doesn’t always work right, it usually helps me fall asleep more easily and without nightmares. It doesn’t do much for my ADHD, but it makes my sensory joys better, my sensory issues smaller, and decreases my anxiety. I’ve gone without it in the past and get by fine but sleeping becomes more difficult and nightmares are more frequent. For me, weed makes bedtime easier — and that makes my life better — so I’ll keep using it as long as I’m able to.” — Atlas, Michigan

“Before getting diagnosed, I used weed at night to help quiet my brain. I attributed my chatty brain to anxiety but now understand it to be ADHD. I first tried smoking it in college when I was friends with many potheads. Now I prefer edibles or vaping occasionally after my child has gone to bed. It helps lessen distractions, quiet my brain, and allow for better sleep. I am often in a better mood the next day. It has helped me focus on tasks like painting or reading a book. I take Adderall XR and haven’t noticed any interference, but I usually use marijuana products later at night.” — Sarah, Michigan

“I first tried cannabis during the early months of the pandemic… I use it alongside Strattera. I do not consume cannabis while working, but I do occasionally use CBG and/or CBD. THC helps with my symptoms a great deal. Sativa strains are energizing; they help me get up and get things done around the house that I would otherwise procrastinate, such as chores and yard work. Indica strains are relaxing; they help quiet my inner chatter and make it easier for me to meditate and do gentle forms of yoga… Some strains amplify my hyperactive/impulsive tendencies… [but] with the right strains, cannabis can help a great deal with ADHD symptoms.” — An ADDitude reader

The Effects of Cannabis on ADHD Symptoms: Next Steps

• Learn: The Damaging Effects of Cannabis on the ADHD Brain
• Download: How to Sleep Better — A Guide for Adults
• Read: CBD Oil for ADHD? Despite Scarce Research, Patients Are Trying It
• Read: Cannabis Use Benefits ADHD Symptoms in Adults, According to Self-Reports

Sources

¹ Loflin, M., et. al. (2014). Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use. Substance Use & Misuse, 49(4), 427-434, DOI: 10.3109/10826084.2013.841251

² Francisco, A.P., Lethbridge, G., Patterson, B., Goldman Bergmann, C., & Van Ameringen M. (2023). Cannabis use in attention-deficit/hyperactivity disorder (ADHD): A scoping review. J Psychiatr Res, 157, 239-256. doi: 10.1016/j.jpsychires.2022.11.029. Epub 2022 Nov 25. PMID: 36508935.

³ 1 Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric Clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8

⁴ 2 Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019

⁵ Mansell, H., Quinn, D., Kelly, L.E., & Alcorn, J. (2022). Cannabis for the treatment of attention deficit hyperactivity disorder: A report of 3 cases. Med Cannabis Cannabinoids, 5(1), 1-6. doi: 10.1159/000521370. Erratum in: Med Cannabis Cannabinoids, 5(1), 128. (2023). PMID: 35224434; PMCID: PMC8832253.

Before buying dietary or herbal supplements, ask your prescriber about possible risks or interactions with your current medications. If you are given the okay to try a supplement, first check the brand’s quality by visiting a site such as consumerlab.com. A product label might say something like “follows FDA good manufacturing practices,” however, the FDA does not have the authority to approve dietary supplements for safety and effectiveness.

It should also be noted that a label calling a product “natural” does not mean it is safe or risk-free. Some studies have found large variations in the concentration of a supplement, even in capsules taken from the same bottle. And some capsules have been found to contain none of the ingredients on the label and may even harbor substances that pose health risks. Some companies don’t follow the FDA’s guidance about making claims and correctly labeling supplements. A supplement could contain little to none of the listed ingredients, or it may have a component that could cause harm to certain people. ¹, ²

Here is our take on supplements’ claims to improve ADHD symptoms.

Herbal Supplements

In double-blind, placebo-controlled studies, the following supplements were ineffective in reducing the severity of inattentive and hyperactive/impulsive ADHD symptoms: kava, valerian root, St. John’s wort, and Ginkgo biloba. ³, ⁴, ⁵, ⁶ Worse, many herbal supplements impact the central nervous system. Side effects can include drowsiness, agitation, slowed breathing, confusion, and a lack of coordination. Herbal supplements can also affect the way your body absorbs medication.

Our Conclusion: The potential side effects of these herbal supplements outweigh the potential benefits. Make sure you disclose any use of herbal supplements to your prescriber.

[Get This Free Resource: Fish Oil Treatments for ADHD Symptoms]

Omega Supplements

People with ADHD may have a significantly lower level of omega-3 fatty acids in their blood than do those without ADHD. ⁷ Low omega-3 levels can produce ADHD-like symptoms, including inattention, lack of focus, mood swings, and working memory problems. Omega-3 and omega-6 supplements have been found to boost blood levels and moderately decrease the severity of ADHD symptoms. ⁸Omegas may improve neural efficiency, improving an individual’s overall cognitive performance. ⁹, ¹⁰

Omegas have potential side effects, as do all medications or supplements. Omegas can act as blood thinners and cause stomach upset. Make sure you consult with your prescriber before taking omegas or other supplements.

Our Conclusion: Omegas can augment (but not replace) ADHD medication with prescriber approval. Many foods, such as fatty fish, walnuts, almonds, flaxseed, eggs, and tofu contain high levels of omegas and can be part of a healthy diet.

Vitamins and Minerals

Results are mixed as to whether supplementing a diet with certain vitamins and minerals improves ADHD symptoms. One study found that multivitamins did not boost scores on an executive function performance task. ¹¹Other studies have suggested that magnesium provides some benefits. ¹²Clearly, more research is needed. It’s important to note that, unlike water-soluble vitamins, fat-soluble vitamins are not excreted in the urine, so high doses may lead to health risks.

[Free Resource Here: Guide to Natural ADHD Treatment Options]

Our Conclusion: If you are eating a generally healthy and balanced diet, you are most likely reaching your daily requirement of vitamins and minerals without supplements. However, there is likely little harm in taking an inexpensive multivitamin if you check with your prescriber first. If you are concerned about possible low vitamin B or D levels, ask your prescriber to order a blood test. When it comes to managing ADHD, we can’t recommend any specific vitamins or minerals at this time.

Melatonin

Melatonin, a hormone secreted by the pineal gland, helps your body get ready for sleep. People with ADHD tend to have inhibited melatonin release and more difficulty preparing their bodies for rest. ¹³Melatonin supplements are either made from the pineal glands of animals or are synthetically produced. They can come in tablet, liquid, or gummy form. A French study found melatonin to help adults with sleep disorders and comorbidities, such as ADHD. ¹⁴However, improvements in sleep from melatonin supplements may result from the placebo effect: If you think something might help you, it probably will.

Our Conclusion: Sleep is important for good cognitive functioning, so putting away electronic devices well before bedtime and establishing a routine can be helpful. Mindfulness or relaxation exercises can also help quiet a busy mind.

Bottom line: If you are considering taking any supplement, consult with your prescriber first and learn about potential side effects and drug interactions. If you decide to take a supplement, ensure it is of good quality. In numerous research studies, prescription medication was found to be much more effective than supplements in treating ADHD.

Melatonin, Omega-3, Dietary Supplements: Next Steps

• Download: Free Guide to the Top Vitamins and Supplements for ADHD
• Listen: “Non-Medical Interventions to Manage ADHD Symptoms” 
• Learn: 6 Natural Supplements to Manage Symptoms

Stephanie Sarkis, Ph.D., is a psychotherapist and the author of Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism(#CommissionsEarned), and Emotional Abuse and Gaslighting: Recognize Manipulative and Emotionally Abusive People — and Break Free(#CommissionsEarned).

Ari Tuckman, Psy.D., C.S.T., is a psychologist, international speaker, and author of four books on ADHD, including More Attention, Less Deficit Success Strategies for People with ADHD(#CommissionsEarned), and Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook(#CommissionsEarned).

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

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Sources

¹ Cohen, P.A., Avula, B., Katragunta, K., Travis, J.C., Khan, I. (2023) Presence and Quantity of Botanical Ingredients With Purported Performance-Enhancing Properties in Sports Supplements. JAMA Netw Open. 6(7):e2323879. https://doi.org/10.1001/jamanetworkopen.2023.23879

²Cohen, P.A., Avula, B., Wang, Y., Katragunta, K., Khan, I. (2023) Quantity of Melatonin and CBD in Melatonin Gummies Sold in the US. JAMA. 329(16):1401–1402. https://doi.org/10.1001/jama.2023.2296

³Salehi, B., Imani, R., Mohammadi, M.R., Fallah, J., Mohammadi, M., Ghanizadeh, A., Tasviechi, A.A., Vossoughi, A., Rezazadeh, S.A., Akhondzadeh, S. (2010) Ginkgo Biloba for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Double Blind, Randomized Controlled Trial. Prog Neuropsychopharmacol Biol Psychiatry. https://doi.org/10.1016/j.pnpbp.2009.09.026

⁴Weber, W., Vander Stoep, A., McCarty, R.L., Weiss, N.S., Biederman, J., McClellan J. (2008). Hypericum Perforatum (St John’s Wort) for Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: a Randomized Controlled Trial. JAMA 299:2633-41. https://doi.org/10.1001/jama.299.22.2633

⁵Müller, S. F., and S., Klement. (2006) A Combination of Valerian and Lemon Balm Is Effective in the Treatment of Restlessness and Dyssomnia in Children. Phytomedicine, vol. 13, no. 6, pp. 383–387. https://doi.org/10.1016/j.phymed.2006.01.013

⁶He, S., Wang, M., Si, J., Zhang, T., Cui, H., Gao, X. (2018) Efficacy and Safety of Ginkgo Preparations for Attention Deficit Hyperactivity Disorder: A Systematic Review Protocol. BMJ Open. 8(2):e020434. https://doi.org/10.1136/bmjopen-2017-020434

⁷ Hawkey, E., Nigg, J.T. (2014). Omega-3 Fatty Acid and ADHD: Blood Level Analysis and Meta-Analytic Extension of Supplementation Trials. Clin Psychol Rev. 34(6):496-505. https://doi.org/10.1016/j.cpr.2014.05.005

⁸Derbyshire, E. (2017). Do Omega-3/6 Fatty Acids Have a Therapeutic Role in Children and Young People with ADHD? J Lipids. https://doi.org/10.1155/2017/6285218

⁹Dighriri, I.M., Alsubaie, A.M., Hakami, F.M., Hamithi, D.M., Alshekh, M.M., Khobrani, F.A., Dalak, F.E., Hakami, A.A., et al. (2022) Effects of Omega-3 Polyunsaturated Fatty Acids on Brain Functions: A Systematic Review. Cureus. 14(10):e30091. https://doi.org/10.7759/cureus.3009

¹⁰Bauer, I., Hughes, M., Rowsell, R., Cockerell, R., Pipingas, A., Crewther, S., Crewther, D. (2014) Omega-3 Supplementation Improves Cognition and Modifies Brain Activation in Young Adults. Hum Psychopharmacol. 29(2):133-44. https://doi.org/10.1002/hup.2379

¹¹Johnstone, J., Hatsu, I., Tost, G., Hughes, A., Leung, B., Arnold, E., et al. (2021) Micronutrients for Attention-Deficit/Hyperactivity Disorder in Youths: A Placebo-Controlled Randomized Clinical Trial. Journal of the American Academy of Child & Adolescent Psychiatry https://doi.org/10.1016/j.jaac.2021.07.005

¹²Baza, Farida El, et al. (2016). Magnesium Supplementation in Children with Attention Deficit Hyperactivity Disorder. Egyptian Journal of Medical Human Genetics.vol. 17, no. 1, pp. 63–70. https://doi.org/10.1016/j.ejmhg.2015.05.008

¹³ Bijlenga, D. , Van Someren, E. J., Gruber, R. , Bron, T. I., Kruithof, I. F., Spanbroek, E. C. and Kooij, J. J. (2013). Body Temperature, Activity and Melatonin Profiles in Adults with Attention‐Deficit/Hyperactivity Disorder and Delayed Sleep: A Case–Control Study. J Sleep Res. 22: 607-616. doi:10.1111/jsr.12075. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1111/jsr.12075

¹⁴Geoffroy, P.A., Micoulaud Franchi, J.A., Lopez, R., Schroder, C.M. (2019). The Use of Melatonin in Adult Psychiatric Disorders: Expert Recommendations by the French Institute of Medical Research on Sleep (SFRMS). Encephale. https://doi.org/10.1016/j.encep.2019.04.068

Amid the ongoing shortage of prescription stimulants used to treat ADHD, the Food and Drug Administration (FDA) and Drug Enforcement Administration (DEA) issued a joint letter this week urging key stakeholders, including manufacturers, distributors, pharmacies, and payors, to work together to resolve drug shortages as quickly as possible. The letter calls for the development of ADHD diagnostic criteria for adults, re-evaluation of drug quota allotments, adoption of non-stimulant and digital therapeutics where appropriate, and the thoughtful and responsible prescription of stimulant medications.

Since the FDA first reported a shortage of Adderall (the brand name for the immediate-release formulation of amphetamine mixed salts used to treat ADHD) in October 2022, 38% of ADDitude readers say they have experienced problems accessing ADHD medication, according to a recent survey of 10,044 caregivers and adults. Patient advocates and legislators have called on federal agencies to do more to combat the nationwide Adderall shortage since late last year.

In December 2022, Rep. Abigail Spanberger (D-Va.) called on the FDA to coordinate a response with the DEA that addresses artificially low production quotas for stimulant medication, among other roadblocks to accessing care. In March 2023, 20 other members of Congress wrote a letter urging the DEA to formulate new telemedicine and prescription rules and take seriously increases in demand when setting production quotas, and to better map supply chains. And Maia Szalavitz, a leading commentator on substance abuse issues, suggested in a column published in The New York Times that the FDA should assume oversight of ADHD medication from the DEA.

This week’s joint letter stated that the DEA is “committed to reviewing and improving” the quota process. According to the agency, “manufacturers only sold approximately 70% of their allotted quota for the year, and there were approximately 1 billion more doses that they could have produced but did not make or ship” in 2022. Data for 2023 show a “similar trend.”

“The FDA and DEA do not manufacture drugs and cannot require a pharmaceutical company to make a drug, make more of a drug, or change the distribution of a drug,” FDA commissioner Robert M. Califf, M.D., and Drug Enforcement Administration leader Anne Milgram wrote. “That said, we are working closely with numerous manufacturers, agencies, and others in the supply chain to understand, prevent, and reduce the impact of these shortages.”

The agency leaders have requested that manufacturers either confirm they are working to increase stimulant production or relinquish their quota allotment so that it may be redistributed to other manufacturers.

Califf and Milgram also call on professional groups and healthcare providers to “accelerate efforts to support appropriate diagnosis and treatment,” including additional clinical guidelines for ADHD in adults and the development of alternative treatment options, such as non-stimulants and digital therapeutics. The letter cited the 2020 FDA approval of EndeavorRx, the first prescription-only game-based device to improve ADHD symptoms in children, as an example.

The letter also addressed concerns about medication misuse, addiction, and overdose. Earlier this year, the FDA began requiring updates to Boxed Warning labels and prescribing information on stimulants, such as Adderall and Ritalin, to include information about the risks associated with the drugs and to instruct providers to watch for signs of abuse and addiction.

Ongoing manufacturing delays, supply-chain issues, and record-high prescription rates for stimulant medications were among the “many factors” contributing to the Adderall shortage, according to the letter.

In a recent interview with WebMD’s John Whyte, M.D., Califf claimed that telehealth providers were largely responsible for driving a “tremendous” increase in ADHD diagnoses and stimulant prescriptions over the last few years and, in his words, not all of them are warranted.

“If only the people that needed these drugs got them, there probably wouldn’t be a [stimulant medication] shortage,” Califf said. “There’s a large amount of use which is on the margins.”

The letter by Califf and Milgram displayed more empathy for the millions of Americans with ADHD who have been unable to access reliable treatment, and it assured them that federal agencies take ADHD and its treatment seriously.

“We recognize the important role of prescription stimulants in treating conditions such as ADHD, binge-eating disorder, and uncontrollable episodes of deep sleep (narcolepsy). The lack of availability of certain medications in recent months has been understandably frustrating for patients and their families,” Califf and Milgram wrote. “We want to make sure those who need stimulant medications have access. However, it is also an appropriate time to look closely at how we can best ensure these drugs are prescribed thoughtfully and responsibly.”

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.