The researchers cautioned that immediate consequences in this case, reward are associated with positive effects on behavior in ADHD children.  They stated that it may be difficult for parents and teachers to provide rewards immediately.  However, other research shows than children with attention deficit hyperactivity disorder actually respond as well or better to social reinforcement such as a smile as they do to tangible reinforcers like points, tokens or money.  This means that a smile or a brief word of encouragement may achieve significant benefits and could reduce or eliminate the need for medication for some children.

Years of research and current professional guidelines indicate that behavioral interventions should be tried first before medication except of children with severe symptoms.  However, many parents find it difficult to find an effective, affordable and user friendly option for behavioral interventions.  Total Focus is a comprehensive behavioral program using evidence-based techniques to improve behavior, learning, self-esteem and social skills.  Parents and children work together as a team to bring about real lasting change involving activities that are fun and require less than an hour per day.  Total Focus costs less than one visit to a mental health professional.

There were 118 with ADHD (ages 7-14 years). While Conduct Problems and Anxiety were associated with lower zinc levels, increased Hyperactivity scores were related to both lower zinc and iron levels. It is known that these two minerals as involved with dopamine metabolism, one of the two neurotransmitters related to ADHD.

Parents may want to ask their child’s physician to check these levels and recommend supplements if they are found to be out of the normal range. Parents should be cautioned however, to not rush to some the supplement products on the market containing zinc and/or iron. Unless a child’s level is low for either of these two minerals, there is no evidence that boosting normal levels would be beneficial and could be harmful.

It is known that a healthy diet and regular exercise is good for brain development for all children and certainly beneficial for children with attention deficit hyperactivity disorder. With the exception of fish oil with Omega 3 antioxidants, no other supplements containing mega doses of vitamins, minerals or other “natural” substances have been proven through rigorous scientific research to be beneficial for kids with ADHD.

Parents concerned about their child’s ADHD symptoms should rely on treatment recommended by professional organizations which are (1) behavioral interventions, (2) school interventions and (3) stimulant medication for severe symptoms that do not respond to the first two approaches.

Many parents find it difficult to find an effective, affordable and user friendly option for behavioral interventions. Total Focus is a comprehensive behavioral program using evidence-based techniques to improve behavior, learning, self-esteem and social skills. Parents and children work together as a team to bring about real lasting change involving activities that are fun and require less than an hour per day. Total Focus costs less than one visit to a mental health professional.

“All crop protection products are extensively reviewed by regulatory agencies before approval for market use. Many scientific factors are examined by government pesticide regulators, based on extensive laboratory testing, all of which are intended to guarantee safety for the environment and people, including children,” the statement reads. “The class of crop protection compound that is the subject of this study has been approved and registered by the US EPA, and when used according to the label, the EPA has determined it to be safe.”

In the meantime, what can parents do to minimize pesticide exposures?  All fruits and vegetables should be washed thoroughly, consider buying certified organic vegetables, purchase baby foods that are prepared from certified organic sources and  minimize the use of insecticides around the home.

While their are few studies on this subject and the studies that exist have some research methodology limitations, the author of the study concluded that Melatonin along with behavior modification and good sleep hygiene can be beneficial to children and teens with this problem.

Melatonin, a hormone produced by the brain regulates circadian rhythm sleep disorders such as sleep-onset insomnia, is often prescribed for various sleep disorders.  The article concluded, when given at doses ranging from 3 to 6 mg within a few hours of a scheduled bedtime, melatonin was associated with improvement in sleep onset and sleep latency in 4 studies in children aged 6-14 years with ADHD and insomnia. Adverse events were transient and mild in all studies.

Parents should discuss this solution to sleep with their child’s physician.  For more tips see Healthy Sleep Tips from Akron Children’s Hospital

What a difference one word can make.  Suppose we changed the last D in ADHD from “disorder” to “difference.”  We could then say that a child with ADHD has some significant differences in his cognitive ability, emotional sensitivity and activity level when compared to other children.  This difference is probably inherited.  His “skill set” is different from 95% of the children in his class.

Unfortunately, the environment in which he spends most of his time is geared toward the other 95%.  However, we then could look at helping him to adapt successfully to this environment, using his own set of strengths rather than helping him to  with this environment due to his weaknesses.  We then might say that this child may need psychostimulants and/or psychological intervention to enable him to concentrate on boring tasks and control spontaneity in a highly regimented environment.

The above in some ways reflects the ongoing debate about whether ADHD is a valid mental health condition that requires appropriate medical and psychological intervention OR that ADHD is a mythical disease state, manufactured by the medical community in order to make huge profits and is promoted by educational bureaucrats and abusive parents desiring to tranquilize unruly kids. I believe that, as a society, we have created a monster with ADHD. We perceive it as a diagnosis that will forever change or even taint the course of our child’s life. And we are no longer surprised by the number of school-age children who are now diagnosed with ADHD. In fact, we have come to regard it as a norm, and it has fueled our perception that medicating our children can solve all their problems—and ours.

The facts, as in most debates, point to the truth being somewhere in the middle of these perceptions.  ADHD is a condition worthy of future study to provide answers to scientific questions that will result in more accurate diagnosis and more effective methods of treatment. In the meantime, ADHD left untreated leads to a higher likelihood of depression, suicide and substance abuse later in life.  ADHD appropriately treated leads to a higher likelihood of success in life because it can help the child properly channel his increased sensitivity, creativity and high energy.

On a more personal level, as a parent of a son who was diagnosed with ADHD at the age of five, I can identify with parents who may lean toward either the denial or victim mentality.  When my wife and I were concerned about our son’s behavior and emotional well-being, the last thing I thought of was that he had ADHD.  Sometimes, I was probably a bit on the overprotective side.  But on the whole, once our whole family accepted that he was a child with an attention deficit hyperactivity difference who needed medication, along with psychological support (provided by us at home), the situation turned around completely.  He responded well to the medication, and the crisis of emotional turmoil was over.  Over the years, we continued to provide consistent structure (as best we could) and encouragement as well as teaching him how to relax, learn necessary social skills and how to “stop and think.”  It all paid off.  He has been off medication since middle school.  He graduated with honors from a highly regarded university and is now pursuing a successful career in TV and film.  He has a great sense of humor and lots of friends.

I encourage parents not be afraid of the diagnosis, give it undue weight and importance or use the label as a crutch for your child. Instead, I believe we need to accept it as the first step in turning a difficult situation around to a positive direction.  Helping a child with ADHD succeed requires a team approach that often needs to continue over many years.  That team includes the family, health professionals, teachers and, of course, the child.  Children may need medication, but treatment guidelines indicate that psychological interventions are also important.  In some cases, psychological interventions may be sufficient to bring about desired results. In other cases, they address symptoms medication alone does not help and may also actually reduce the dosage of medication necessary to achieve desired results.

Effective psychological interventions include parent education, behavior modification, home-school contracts, cognitive behavioral therapy, social skills training, relaxation training and mental exercises to improve cognitive functioning.   Recent research indicates that many or all of these interventions may be most effective when implemented at home with the parents and the child working as a team.  Not only does this approach appear to improve the short-term effectiveness of the interventions, it also results in positive parenting techniques and an open and supportive parent/child relationship that becomes a way of life that is consistent and enduring over time.

So, ADHD can be perceived as a label to be dreaded, used as an excuse to avoid difficult situations or it can be perceived as the identification of the problem underlying a child’s difficulties at home and at school which can be successfully addressed.  On the one hand, it is a curse. On the other, it is an opportunity to make things better. The basic tenet of cognitive behavioral therapy is that how we think determines how we feel, which then determines how we behave.  If we want to change how we feel and how we behave as the result of those feelings, we need to change how we think.   ADHD: Think of it as an opportunity.

Here’s a way to understand what’s happening in your ADHD child’s brain: Many experiences of kids with ADHD are amplified or more intense than those of average kids. So when the word “No” is heard by a child with ADHD, it registers a “10” on their emotional scale while it probably would be a “5” or less for the average kid. Quite a few of them also have a lower-than-average tolerance for any departure from what they consider to be fair, whether it’s rules for a game or requests for doing something around the house. Added to this is the fact that most of these kids are also not known for their patience or low-volume voices!

To help your child learn better coping and communication skills, the first step is to have a discussion about the level of arguing in your home. Now, doing this in the middle of an argument—or even right afterward—is certainly not the best time.  Pick a moment when things are peaceful. Be sure to include all involved parties: the child with ADHD, any siblings and your spouse.  Start the conversation by discussing how each person feels about the constant arguing.  The goal here is to get everybody to agree on these three basic concepts:

1. The Importance of Good Listening. Discuss what you’ll do together when your child interrupts you to argue, or vice versa. You could use a phrase such as, “Please let me finish my thought, and then it will be your turn to talk.” If you tell an ADHD child to stop arguing, many will come back with, “I’m not arguing, I’m just disagreeing with you.” This just prolongs the argument—or starts a new one! A good solution for this problem is to agree ahead of time on a nonverbal prompt to remind your child to listen and not interrupt. Because your ADHD child is already in the arguing mode and starting to escalate emotionally, nonverbal gestures often work better than words. A neutral sign you’ve agreed upon ahead of time is perfect because it won’t get them more upset. An example of a nonverbal prompt you could use would be to hold up three fingers or to make the peace sign. Make coming up with the prompt into a fun exercise you and your child do together.

2. It’s OK to Disagree. You can “agree to disagree” on various topics with your child. You might even discuss what examples of these might be. With teens, this could include not supporting the same presidential candidate. For younger kids, you can explain how it’s OK for two people to disagree on their favorite flavor of ice cream, for example, to get the point across. It’s healthy to allow these kinds of disagreements in your home because it teaches your child that his or her opinions matter, and that people can love each other even if they don’t see everything the same way. Practicing healthy disagreements at home also helps ADD kids learn how to master this skill in the outside world.

3.  Mom and Dad are in Charge: It’s essential for kids to realize who’s in charge. I tell the ADHD teenagers with whom I work, “When you get a job, what’s going to happen when you argue with your boss? They’ll just fire you.” Explain to your child that you’re responsible for their health and well-being. Remind them that you are the boss. You can say, “You don’t have to like it, but that’s the way it is. It’s the same way at work when you have a supervisor you don’t like. You still have to do what they say because they’re the one in charge.”

The next step is to define the problem that prompted your discussion about arguing in the first place.  Is it not taking “no” for an answer, not wanting to comply with reasonable requests, or always having to be right? Once you have agreed on what the problem is, you can move on to the solution phase.  Here are some basic suggestions on how to handle these three types of arguing:

Not taking “no” for an answer: If the problem is not taking “no” for an answer, you can start with a system to reward the child for improving their ability to accept the answers they do not want to hear.  Why “reward,” you may ask?  Well, you have probably been rewarding the opposite behavior from time to time by giving in.  Now you need to stand your ground and say something like, “I know you don’t like my answer, but you need to take a deep breath and accept it because I believe this is the best decision.”  If the child accepts this without the prompt, they should be given praise such as, “Thanks for accepting my answer without arguing. It helps us to get along and makes it easier for me to say ‘yes’ sometimes.”  If this simple approach works, great!  If not, move on to saying that for every day that goes by without an argument, your child will get a star on his chart.  When all 30 squares are filled, he will receive an agreed upon reward.  If this does not resolve the problem you may have to “kick it up a notch” and add a time-out for arguing or have him write, “ I will calmly take no for an answer even though I don’t like the answer” five times. This works well for ADHD kids because it’s shorter and takes less time than writing out a few paragraphs on what they did wrong, an effective approach for non-ADHD kids. With a child who has ADHD, they’re apt to write a paragraph explaining why you’re wrong! All in all, having them write sentences helps you avoid a power struggle.

“I won’t do it!” If the problem is noncompliance with a reasonable request, make your child a member of the “First Time Club”. This is similar to the reward chart above. In the First Time Club, your child is given a point or star each time they comply with a request without an argument the first time they are asked.  When the thirty squares are filled, give them a reward. Periodically, give verbal praise or a pat on the back when your child complies the first time they are asked. You can do this while they are on the reward chart system, and keep it up less frequently after the chart has been completed.

I’m Right, You’re Wrong: Finally, for kids who always have to be right and feel the need to have everyone agree with them on every issue, some coaching on listening skills is in order.  Practice discussing issues with your child, teaching them how to be a good listener, and showing them how to understand others points of view by asking questions such as, “That’s interesting, what made you think of that?”  Practice phrases that show respect for others even when you have a different point of view.  For example, “That’s an interesting point of view and I can tell you feel strongly about it. I think I understand what you’re saying, but I have a different take on it.”  Coach your child by saying that if the other person asks for his or her “take” they can briefly share it.  If they don’t ask for it, tell your child that they need to let the subject drop.

Your ADHD child may like to argue, but it doesn’t have to become the main method of communication between the two of you. As a psychologist and the father of a child with ADHD, I’ve used these techniques to teach hundreds of kids how to stop arguing and communicate more effectively. Remember that the point is not to stifle individuality or assertiveness, but to teach our children how and when to exercise these qualities in a positive, appropriate way.

During my years as a child psychologist, I have been able to help many children with mild to moderate symptoms of ADHD do well at home and school without medication using psychological interventions. However, children with more severe symptoms benefit greatly from medication. Current guidelines now state that behavioral interventions should be tried first for mild to moderate symptoms and also should be used for more severe manifestations along with medications which may reduce the dose needed to control symptoms and may reduce the length of time required to remain on medication.

With any physical or mental condition, a thorough work-up should be completed by a competent physician or psychologist. All possible physical and mental causes for the symptoms should be considered and ruled out prior to making the diagnosis of ADHD.

Medication should be monitored closely and growth and blood pressure should be monitored periodically as well as routine blood work performed annually. Stimulant medications when used appropriately are the most effective and safe of all psychiatric medications. For complete information on risks versus benefits please see Parent’s Medication Guide and Medline Plus Searchable Drug Data Base.

Probably at least 30% of children on medication would be fine with comprehensive behavioral treatment. Unfortunately, parents often are enticed by advertising to try very expensive supplements and programs using various electronic devices with no scientifically proven benefit. (I am often asked about alternatives, which is why I developed the Total Focus Program.) For more information on psychological interventions please see go to CHADD or ADHD.

Diets seem to help a few kids who react adversely to certain foods and food additives. While these kids may have ADHD-like symptoms, their true diagnosis is food allergy. The manufacture of supplements is not well controlled and while there is no proof of effectiveness for these substances there is, more importantly, NO PROOF OF SAFETY for any of the recommended substances. “Natural” is a poorly defined term and a number of “natural” products in wide distribution have been pulled off the market due to serious side effects including death or for unsubstantiated claims of effectiveness. For a more thorough discussion of alternative treatments please go to the National Resource Center for ADHD.

I hope this information is helpful. I frequently check the scientific and professional literature and will update this post when warranted. For now, parents must make decisions that are well informed and that meet the short-term and long-term needs of their children. These decisions should always be made with the assistance of a trusted healthcare professional.

It is encouraging to see the growing interest in and availability of funding for research dedicated to the investigation of non-medication interventions for ADHD.  Actually, relaxation training has been known for some time to provide benefits, and I have been using this technique along with others since the ’80s to help kids with ADHD.  When combined with parent training, behavior modification and several other evidence-based techniques, I have found that children with mild to moderate symptoms can achieve significant improvement at home and at school without medication.

Published professional guidelines recommend that children with mild to moderate symptoms receive behavioral interventions, ie, some kind of behavioral help, training or modification, prior to moving on to medication.  In the MTA study conducted by the NIMH, 30% of the children in the behavioral-only group normalized after 14 months, which means they were able to function on a normal level without medication. After 3 years, all of the children in the behavioral-only group demonstrated the same improvement in symptoms as those receiving medication and those receiving a combination of medication and behavioral intervention.

Unfortunately, even with this information, the rate of inclusion of behavioral intervention has been limited due to financial and time constraints.  After years of working with kids with ADD and ADHD, I developed The Total Focus Program to help parents and families learn how to manage the behaviors that come along with the disorder. It can be used with or without medication as part of a total treatment program. Whether you try Total Focus or another program, I encourage you to seek out some kind of behavioral training program for your child with ADHD.