In this article I abbreviate some of the literate surrounding Attention Deficit Hyperactivity Disorder and point toward a solution for people seeking treatment for themselves or their children. This guide serves as an introduction to the topic and provides a realistic and simple plan of action for the reduction or elimination of symptoms.
I assume you understand that this piece is in no way an attempt to replace the advice of a qualified medical professional. The medical community favors many solutions that are not effective in the long term. This piece highlights the most effective long-term solutions to ADHD.
I start with an overview of ADHD and some related psychological disorders. Next I discuss the methods of diagnosis and their potential errors.. Following the discussion of diagnosis are the current and popular methods of treatment along with their results. Finally I highlight the methods of treatment that work best and discuss why these methods have garnered less attention then they deserve.
What Is Attention Deficit Hyperactivity Disorder
Attention deficit Hyperactvity Disorder is a DSM qualified disorder that encompasses a number of related symptoms that fall under two main umbrellas. Those two categories of symptoms are hyperactive and inattentive.
The symptoms having to do with hyperactivity mostly have to do with an inability to sit still or attend to any one activity outside of those the individual has a particular proclivity for. The symptoms that fall under the inattentive umbrella have to do with those behaviors related to an inability to manually control cognition.
Inattentive symptoms are basically internal manifestation of the external hyperactivity symptoms. The chart displayed below outlines the symptoms of ADHD and some of the other psychological disorders that share those symptoms.
One interesting aspect of ADHD is the realatively inconsequential attitude the medical industry takes toward their lack of conclusiveness on the causes and treatments for ADHD. When discussing potential causes for ADHD, the NIH’s official stance is as follows:
“No one knows for sure. ADHD probably stems from interactions between genes and environmental or non-genetic factors.”
This wasn’t exactly comforting when I first read it. Any time a medical authority as monolithic as the NIH includes “probably” or “no one knows” in a causative description, a serious red flag should be going up in just about everyone’s head. It’s going to get a little worse before it gets better though, so brace yourself.
The NIH also admits that:
“Despite being the most commonly studied and diagnosed psychiatric disorder in children and adolescents, the cause is unknown in the majority of cases.”
I am highlighting these points to demonstrate the lack of concrete information about ADHD. This lack of certainty is present at the highest levels of the medical communities governing bodies. The takeaway from this section is that some of the largest and most powerful medical organizations accept the fact that they have no idea what exactly is causing ADHD.
According to The World Health Organization 39 million people have ADHD. Males are three times as likely as females to have this disorder.
Classifying The Types of ADHD
The presence of one or more of the symptoms realated to one of the three sub-types of ADHD needs to be present for a positive diagnosis. The three sub-types of ADHD are primarily hyperactive, primarily inattentive and combination. Using the DSM diagnostic criteria an individual has ADHD under the following circumstance:
“symptoms must be present for six months or more to a degree that is much greater than others of the same age and they must cause significant problems functioning in at least two settings (e.g., social, school/work, or home). The full criteria must have been met prior to age 12 in order to receive a diagnosis of ADHD.” – Diagnostic and Statistical Manual of Mental Disorders(5th ed.)
The best outline of symptoms comes from Wikipedia’s ADHD entry. It combines the symptoms listed in both the Diagnostic and Statistical Manual of Mental Disorders (DSM) and The National Institute of Health. A combine symptoms list is shown below, courtesy of Wikipedia.
Defining symptoms for ADHD primarily inattentive type:
- Easily distracted, easily misses things, often switches from one thing to another
- Maintaining focus on one thing is difficult
- Slow movements, daydreaming, easily confused
- Have difficulty processing information as quickly and accurately as others
- Problem with following instructions
- Easily become bored with tasks unless performing an enjoyable task or one freely undertaken
- Trouble with organizing and completing tasks or learning something new
- Seems to be inattentive or not listening when spoken to
- Difficulty in understanding very detailed aspects of something or very nuanced details.
Someone who has ADHD primarily hyperactive will have most or all of the following symptoms:
- They will act impulsively, show their emotions without restraint or “blurt” things out
- constantly in motion
- Doing things quietly or performing tasks requiring silence is difficult
- Difficulty with delayed gratification or otherwise waiting for things they want
- Interrupt other people’s conversations or activities at the wrong time
- They will move around when sitting or otherwise not be able to sit still
- Non-stop talking
- Running around playing with things or otherwise interacting with all stimuli in the nearby area
A Short History of Diagnosis
ADHD and it’s related symptoms were discovered as early as 1902. Dr. George Still gave a series of lectures to the Royal College of Physicians. In his discussion he gave an overview of the condition we now call ADHD. At the time he attributed the symptoms to an “inhibition of the will” noting that sufferers were unable to manage their own motivation and behavior.
As early as 1936 patients with ADHD like symptoms were treated with benzedrine which caused marked improvements in symptoms. In 1937 psychiatrist Charles Bradley, one of the first psychiatrists to use this treatment reported his findings.
“In 1937, psychiatrist Charles Bradley administered Benzedrine sulfate, an amphetamine, to “problem” children at the Emma Pendleton Bradley Home in Providence, Rhode Island, in an attempt to alleviate headaches; however, Bradley noticed an unexpected effect upon the behavior of the children: improved school performance, social interactions, and emotional responses.” – NCBI
In 1955 another central nervous system stimulant Methylphenidate (Ritalin) was developed and used alongside benzedrine for the treatment of ADHD. In 1960 the inattention was added to the diagnoses of what would eventually become ADHD.
While the diagnoses for ADHD was largely universal, the origin of the disease and the best method of treatment was hotly disputed. Some scientists believed the disease was largely organic resulting in physiological deficiencies in the patient. Other scientists and physicians believed that the disease was developed or amplified by learned behaviors and patterns of activity.
Common Treatments for Attention Deficit Hyperactivity Disorder
Medication, in the form of Ritalin or other central nervous system stimulants is the most common for m of treatment for ADHD. The upside of medication is that it is effective in clearing up 70-80% of symptoms in the majority of cases. However, once medication is discontinued symptoms will return. Medication is also expensive and needs to be taken on a daily basis. Anotehr important consideration is that medication will do little to nothing in the way of improving social interactions. If a child or adult has trouble interacting with others, they will still need to learn coping skills.
Psychotherapy has been used primarily in the treatment of children with ADHD. Psychotherapy is used because of it’s effectiveness in treating some of the symptoms related to ADHD such as depression. Unfortunately, psychotherapy does little to directly alter the most significant issues sufferers of ADHD face. Psychotherapy in group settings can be used to give sufferers practice and feedback interacting in a social setting which can be beneficial.
Cognitive Behavioral Therapy:
In this type of therapy, patients are asked to look at the way they relate to problems in order to actively develop their problem solving skills. The aim of this type of treatment is helping patients improve their ability to plan and manage their time. Cognitive behavioral therapy works by getting patients to look at their behaviors and the results of those behaviors to form new strategies to product better results.
As an example Mary V. Solanto, author of Cognitive Bahavioral Therapy for adult ADHD, advises patients in her adult CBT class to follow a simple routine of planning and checking in with their plans.
“Solanto advises her participants to enter into their ADHD-friendly plannersevery task they have to do in a given day — from important appointments to everyday errands. She asks clients to link checking the planner to routine activities, like brushing your teeth, eating lunch, walking the dog, and so on. This helps someone with ADHD stay on task throughout the day, and prioritizes the things to get done” – Additudemag
Collaborative Problem Solving (CPS):
Collaborative problem solving is an approach that is used primarily in children with ADHD, though it can be used in patients in any age range. Collaborative problem solving or (CPS) involves using empathy to gain buy in from the patient. This is important as the patient needs to be actively engaged in the process for it to work.
Once the patient is actively engaged, you can identify a problem the patient is likely to face in the future. Once a problem is identified the patient and the “coach” will walk through the problem identifying all potential obstacles. The patient is then coached through the problem and assisted in finding the best solution.
Collaborative problem solving is an important practice in the treatment of ADHD as it has the ability to induce neurological development. Unlike behavioral therapy which focuses on the results of actions, CPS focuses on the thought process used to work through actions. CPS is effective in the long term as it build the neural processing ability that is needed in the future. By addressing problems before they are present, CPS allows patients to build up their problem solving abilities over time.
Brain Exercise Therapy (BET):
Brain exercise therapy is a method of developing the neuronal archatecture that was developed by Dr. Aaron Gimpel. This method of treatment involves using a combination of brain developing activities for 20-45 minutes 6 days per week. While that recommendation is to perform no less then 20-45 minutes 6 days per week, there is no upper limit to the amount of time you can spend performing brain exercise.
Brain exercises come in a number of different types. Anything that has been shown to increase the number of neurotransmitter receptors in the pre-frontal cortex is counted as a “brain exercise” activity. These activities include listening to foreign language audio tapes, playing chess, practicing martial arts, carefully tracing pictures or writting foreign language characters or even practicing puzzles like Sedoku.
Meditation is another common type of mental training that fits into the brain exercise therapy model of mental development. The point of these exercises is to develop the cognitive structures that are deficient in ADHD sufferers.
Which ADHD Treatments Are Effective? (description)
The type of ADHD treatment that is most effective is the one that has both short and long term effects. This means that a combine approach to the treatment of ADHD using collaborative problem solving (CPS), Brain Exercise Therapy (BET) and medication will yield the fastest and longest lasting results.
The reasons for this are twofold. First, medication is one of the only treatments that has immediate impacts. while you might not need to treatment to have an immediate effect, it maes sense to at least have an immediately active option at your disposal.
The second reason is that the other two types of treatment CPS and BET have lasting effects on the brain by developing the neurotransmitters in the pre-frontal lobe of the brain.
Brain development is becoming an increasingly large part of the treatment for ADHD as physicians are becomming familiar with the latest developments in the world of neuroscience. The idea that the brain can re-model in response to training is fairly mainstream information at this point.
Brain Exercise Therapy and Collaborative problem solving both work to increase the density of neurotransmitters on the pre-frontal lobe of the brain. These two types of training do this by forcing the brain to develop the ability to function in a manner it is not accustomed to.
For example, in collaborative problem solving, and individual who usually rushes into making decisions will be forced to slow down and consider alternative options to their decision. This process of consideration will call on parts of the brain that are relatively underdeveloped in the ADHD sufferer. In order to compensate for this deficiency, the brain will reinforce the section of the brain that controls this aspect of functioning that previously went un-used.
The types of functioning that are trained in CPS and BET are the ones that require the pre-frontal lob to exert a “tonic” inhibition on the sub cortical structures of the brain. For example, this inhibition is what allows someone to pause and weigh options before acting.
The goal of CPS and BET are to strengthen under-developed sections of the brain in a non-stressful environment. Once these structures have been strengthened the patient should be able to utilize their newfound executive functioning skills in a more stressful or demanding environment.
Medications such as Ritalin can be extremely useful if someone will not be able to maintain their non-stressful environment indefinitely. If a child needs to go to school, or an adult needs to maintain performance on the job, it helps to have the immediate effects of medication on hand. When a patient has free time, they can utilize CPS or BET in a less stressful environment.
Which ADHD Treatments Are Effective? (perscription)
If you are an adult that is suffering from ADHD I would suggest utilizing a combination of medication, Adderall, Ritalin ect…. with Brain Exercise therapy. The best way to utilize medication is with the help of a qualified physician. Much of the benefit of medication comes from the increase of dopamine seen with amphetamine based prescriptions.
If you have ever suffered through a long class or lecture, you know it is like torture trying to maintain your attention. For this reason, many people will begin self medicating using just about anything they can to get their dopamine levels up. Some people do this with caffeine recreational drugs or food. In the long run it’s better to use a measured dose of a substance so you are at least conscious of what you are using to get you through periods of focused work.
If you are already using some type of medication or you don’t need it, the next thing you need to concern yourself with is long term brain development. Since you most likely will not have anyone coaching you, using CPS is probably not going to be too realistic. Adults need to focus on integrating Brain Exercise Therapy into their lives.
As mentioned above, there are many types of activities that develop the pre-frontal cortex. Some of the best options for quick results are language tapes like the Pimsleur auido programs.
These programs take you through a conversation and then introduce one element of the conversation at a time. When I was studying language in school I feel in love with these programs as they were head and shoulders above any of the other programs I had used. The graded nature of the programs is perfect for people suffering from ADHD as they will not make you discouraged as most language programs tend to do.
I also recommend some type of athletic endeavor. Generally athletics benefit people with ADHD in two ways. Doing cardiovascular exercise has been shown to enhance blood flow to the brain and increase the concentration of neuroprotetive substrates like BDNF.
The second way that athletics can help people with ADHD is by increasing the density of neurotransmitters at the synapse. This happens when you practice complex movements like those seen in gymnastics or marital arts. So make sure to do at least two types of physical activity. One type where you exert yourself and one type where you practice some types of complex skill.
The final thing you should do as an adult is participate in some type of un-structured learning. This should be something where you can do it when you have free time. Good options for un-structured learning include learning web design , blogging, coding or any type of tradition school subject such as art or science. As long as you are learning new things that challenge your brain in some way beyond normal reading you are doing it right.
Meditation or attention training is another type of activity that can be extremely beneficial to adults. As mentioned in the post on how to stress less fell better and relax, meditation enhances the pre-frontal cortex and allows for better control over the amygdala and autonomic nervous system (ANS). This control over the ANS can have profound effects on your physiology and ability to think clearly.
In summary, you should try to create a workable combination of the above Brain Exercise Therapy activities. In my case I use a number of these because they interest me in general, not simply because I am trying to enhance my brain. As you may have noticed many of these activities are simply things that can be used to live a better life.
In a typical week I will do some type of physical activity where I exert myself 3 days per week. Another 1-2 days per week I will do some type of skill based practice such as kickboxing or juijitsu. Whenever I am getting ready to do a trip overseas I will use the Pimsleur language program and some type of attention training is nearly a daily practice for me.
Generally I like to do a longer session of heart rate variability training sometime in the morning and at night. I also tend to do shorter sessions if I feel like I need them through out the day or when I am going to be typing for a long time on my laptop. Its a nice way to maintain some body awareness while you work and make you more alert.
If you are attempting to help a child recover from ADHD then many of the same principles used for adults will be effective. the main difference in helping children recover from ADHD is that you will be able to utilize Collaborative Problem Solving on a regular basis. This will allow you another important opportunity to get the child to slow down the thinking process and learn how to interpret options.
This method can be particularly effective in young children as they are more used to being led to conclusions. I was lucky enough to have a friend that was a nurse and was going through a block of instruction on CPS. Repeatedly I watched her skillfully navigate her friends little brother through planning and executing various chores and homework assignments.
Personally I find it pretty boring to walk anyone through any task, let alone basic chores, so thank god there are people with that kind of patience around while the rest of us are learning to be minimally functioning members of society. Anyway, if you are fortunate enough to have that kind of patience, you are a godsend to the child you are trying to teach. CPS can work wonders once you become proficient in walking people through the problems solving process.
This video does a fantastic job of explaining what Collaborative Problem Solving is and how it differs from the standard behavioral therapy approaches to behavioral change.
This video does a great job of demonstrating a scenario where collaborative problem solving could be used. In the video the man takes on the role of the “difficult child” and the woman takes on the role of the compassionate listener. I think they do a pretty good job of explaining the process. It starts slow, but starts to warm up about one minute into the video.
An important thing to remember is that the above two videos are designed to explain collaborative problem solving rather then collaborative problem solving as it would be used for children with ADHD. Though the application in both videos is aimed at difficult children, the process of walking a child through their thought process is equally important.
Overall, you should be combining the BET techniques mentioned in the adult sections with a physician recommended dose of medication if needed and as much CPS as possible. For children CPS and blocked out time for BET are going to form the crux of their development.
Personally I benefited from a number of BET activities as my parents had me learning to play an instrument and participating in sports and martial arts from a young age. In hindsight it would have been great to have someone dedicated to walking me through CPS though.
There you have it. Just about all the basics you need to start making informed decisions about your chosen methods of treatment, or what resources you are going to pursue next for more information. Personally, I would recommend learning about the brain developing aspects of attention training or meditation. I cannot overstate the difference in my personal life this has made and how much I would recommend it to anyone interested in improving their mental functioning.
If you are interested in finding out more about the physiological basis for inattention, weight gain and distraction I have written about the pre-frontal cortex’s role in mediating nervous system activity. In that article I highlight how the same types of symptoms that ADHD sufferers experience can have negative impacts on the autonomic nervous system and ruin your chances at pulling off a successful diet.
If you are interested in finding out more about specific treatment protocols for ADHD I would check out some of the books linked to above. I really enjoyed what those authors had to say about training the brain and it’s impact on children and adults alike.
“Attention Deficit Hyperactivity Disorder (Easy-to-Read)”.National Institute of Mental Health. 2013. Retrieved 5 March2016.