ADHD Treatment Options, Pt 1

Whether your child has been diagnosed with ADHD or you are wondering if what you’re seeing will lead to a diagnosis later, the inevitable discussions lead to questions of treatment. I recently learned of a database that helps families compare evidence-based treatment options. You can explore it here: https://ebiadhd-database.org/ Here’s the thing: It’s not a safe option not to treat ADHD. Research continues to show that people with untreated ADHD have a lower life expectancy than the general population (O’Nions et al., 2024). With that in mind, let’s focus on the treatment options I recommend the most—medication, dietary changes/supplements, occupational therapy, executive functioning skills training, parent training, and cognitive-behavioral therapy. For this email, we are going to focus our attention on the first three treatment options.

MEDICATION

By far, stimulant medications are the most efficacious treatment we have available and the most controversial, so let’s discuss what the research tells us. Stimulants are recommended for kids 6 years old and older and provide a reduction in symptoms in 70-80% of patients, depending on age and medications tried (Cortese et al., 2018). There is a long-standing belief that stimulant medications can be abused or begin addictions to other substances. More often, people are self-medicating with caffeine, alcohol, and drugs when they are not treating their ADHD with medication. The ADHD brain craves dopamine and typically runs low on dopamine. The fastest and most reliable sources of dopamine come from addictions of many kinds—drugs, shopping, gambling, sex, work, etc.  The research shows that consistent stimulant use in children actually prevents, and does not cause, addiction in teens and adults (Hallowell & Ratey, 2021).

DIETARY CHANGES & SUPPLEMENTS

Most families I work with want to make dietary changes first, which I understand. Many kids with ADHD tend to be described as “picky” eaters, mostly due to some sensory issues. If your child has only a few (less than 5-10) “safe” or reliable food choices, please consult with your pediatrician and a dietician to rule out ARFID (Avoidant Restrictive Food Intake Disorder).

Due to the low dopamine discussed earlier, the ADHD brain tends to crave sugar, leaving little room for nutritious foods to fill the belly and fuel the body. Limiting sugary foods can provide some improvement in symptoms (Pinto et al., 2022), but most restrictive or avoidance diets aren’t shown to be effective treatments on their own and are not recommended for most children. Please consult your child’s pediatrician or dietician to discuss any food-limiting diet you are considering. Research does show some improvement in ADHD symptoms with Vitamin D supplements (Kitaneh et al., 2024), which seems to be the most promising option so far. Magnesium, iron, zinc, Omega 3/ 6 supplements are showing limited improvement in symptoms (Pinto et al., 2022).

OCCUPATIONAL THERAPY

When I read ADHD 2.0 (Hallowell & Ratey, 2021), I was introduced to the idea that balance exercises can literally strengthen the brains connection to itself, creating neural pathways that allow the brain to work more efficiently. Shortly after, I was introduced to an occupational therapist in my area that does this exact work with children for emotional and impulse control. Hallowell and Ratey (2021) caution that this work can be useful for milder cases of ADHD, but may not be the only option required for more severe cases. For very young children whose brains are very malleable and who are not eligible for medication, occupational therapy might be a good treatment option.

Citations: 

• Cortese S, Adamo N, Del Giovane C, Mohr-Jensen C, Hayes AJ, Carucci S, Atkinson LZ, Tessari L, Banaschewski T, Coghill D, Hollis C, Simonoff E, Zuddas A, Barbui C, Purgato M, Steinhausen HC, Shokraneh F, Xia J, Cipriani A. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018 Sep;5(9):727-738. doi: 10.1016/S2215-0366(18)30269-4.

• Hallowell, E. M., & Ratey, J. J. (2021). ADHD 2.0: New science and essential strategies for thriving with distraction—from childhood through adulthood. Ballantine Books.

• Kitaneh R, Jalilian-Khave L, Ysrayl BB, Borelli A, Funaro MC, Potenza MN, Angarita GA. The Relationship Between Vitamin D and the Development and Treatment of Attention-Deficit Hyperactivity Disorder: An Overview of Systematic Reviews. Curr Behav Neurosci Rep. 2024 Sep;11(3):164-181. doi: 10.1007/s40473-024-00278-7.

• O'Nions E, El Baou C, John A, Lewer D, Mandy W, McKechnie DGJ, Petersen I, Stott J. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. Br J Psychiatry. 2025 Jan 23;226(5):1-8. doi: 10.1192/bjp.2024.199.

• Pinto S, Correia-de-Sá T, Sampaio-Maia B, Vasconcelos C, Moreira P, Ferreira-Gomes J. Eating Patterns and Dietary Interventions in ADHD: A Narrative Review. Nutrients. 2022 Oct 16;14(20):4332. doi: 10.3390/nu14204332.