The ADHD Homestead

Create the life you want with the mind you have.

Month: February 2016

Supplements & natural remedies for ADHD

Recently, I received a reader email asking about supplements and natural remedies for ADHD.

My short answer: buyer beware.

People have many reasons to try supplements: older adults may have concerns about taking stimulants with heart problems. Parents may yearn for an alternative to stimulant medications for their children.

Maybe supplements just feel more “natural.”

Natural they may be, but supplements aren’t necessarily safer or healthier than prescription drugs. Some may even be less safe.

ADHD supplements 101

Supplements: safety not guaranteed

The FDA treats drugs and supplements very differently. From aspirin to amoxicillin, medicines are vetted before hitting the market. Manufacturers must prove their drugs are not only safe, but effective for the conditions they claim to treat.

Compare that to the FDA’s treatment of supplements:

Although FDA has oversight of the dietary supplement industry, it is the supplement manufacturers and distributors that are responsible for making sure their products are safe before they’re marketed…FDA does not review supplements for effectiveness (as it does for prescription and OTC medications) before they enter the market. If the dietary supplement contains a new dietary ingredient, the manufacturer must submit for FDA’s review data on that ingredient’s safety—but not its effectiveness.

source: FDA.gov

Vetting is up to the manufacturer, who profits from selling these products. But that’s okay because it’s natural, right?

Wrong.

“Natural” doesn’t always mean “safe.” Remember: arsenic, cyanide, and lead are natural substances, too. Consumers often mix and match supplements, unaware of how those substances will affect their unique body chemistry.

Getting too much of anything, even an essential nutrient, can harm your body. Some supplements will even alter the effectiveness of other medications.

If you’d like to learn more, the FDA provides a Dietary Supplements 101 overview on their website. NIH also offers guidance on using supplements wisely.

Big Pharma isn’t the only agenda in town

For all the conspiracy theories about “Big Pharma,” many consumers seem to trust supplement manufacturers implicitly. However, they’re also big businesses trying to make a profit. And they’re less accountable for the quality of what they sell.

We, as consumers, need to read everything with a skeptic’s eye. Where there’s money to be made, there’s often bias.

For example: I recommend Dr. Daniel Amen’s Healing ADD from the Inside Out to anyone interested in using supplements to help with ADHD. I also suggest reading with a grain of salt.

Dr. Amen is very knowledgeable and his book contains valuable insights. He’s also selling his own line of specialty supplements (among other things). It’s easy to read the literature and feel like the right combination of dietary supplements will solve all our problems.

Dr. Amen isn’t the only one to discover this niche. Sales of dietary supplements in the U.S. totaled over $30 billion last year. A savvy entrepreneur can put a line of supplements on the market quickly, without the research and development overhead of a drug manufacturer.

Are supplements a no go for ADHD?

Hop online or pick up Healing ADD and you’ll find plenty of anecdotal support for supplements. Maybe you’ll even discover they help ease your own symptoms. How we treat a chemical imbalance in our body is always up to us. I’ve written on this blog about my own experience taking a GABA supplement for migraines and mood swings.

However, we lack evidence that supplements can meet or exceed the effects of traditional ADHD medication for the average person. If something sounds too good to be true, it probably is.

As always, it’s important to look at where various messages are coming from, and who stands to profit from us believing what we read.

Have you tried supplements for ADHD? What was your experience?

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Of course behavior therapy helps kids with ADHD…for now.

When I see ADHD trending on social media, I perk up my ears. Today, it’s the release of new study results supporting behavior therapy as a first-line treatment for children with ADHD.

NY Times behavior therapy ADHD thumbnail

This raises important questions. It also fans the flames of controversy among those opposed to medicating ADHD in children.

I see this study as an incomplete answer to a complex question: what’s the best course of treatment for childhood ADHD?

Interpreting results: why start with behavior therapy?

Starting with behavior-based interventions may emphasize the importance of teaching coping mechanisms. I’ve long said that neither medication nor behavior therapy can do it alone. Medication balances our brain chemistry, making coping mechanisms easier — or possible — to implement.

Starting meds with no therapy or parent training may set the wrong expectation: that meds can do all the work. Starting with behavior therapy, then adding medication, allows families to compare and contrast the difference.

Taking an example from my personal life, I talk a lot about David Allen’s Getting Things DoneI swear by it. Did you know I’ve only been able to maintain it while taking medication? Without it, I can’t keep up.

However, medication in no way alleviates my need for such a rigid system.

We should teach children this symbiosis from the beginning. Offering medication alone is like offering eyeglasses to a near-sighted child and expecting those glasses to teach him to read.

Why I’m skeptical about behavior therapy’s long-term benefits

I’m not jumping on the behavior modification bandwagon just yet. I think we need a longitudinal study to evaluate the effects well into adulthood, when we’re expected to create our own structure and motivation.

Behavior modification therapies, as explained in Stephen P. Hinshaw and Katherine Ellison’s book ADHD: What Everyone Needs to Know, require “clear expectations and explicit, frequent rewards, as well as occasional, nonemotional discipline.” Think sticker charts to help kids earn a reward for improving target behaviors.

My own parents promised me a TV in my bedroom if I could produce a few second-grade report cards with no failing grades in the ‘behavior’ column. My burning desire for that television supported the herculean effort required to stay out of trouble. I got the TV.

Looking at this one academic year, anyone could conclude that behavior-based interventions improved my most problematic symptoms. However, as Hinshaw and Ellison point out in their book, “the difficulty for children is to maintain their progress once they’re out of the tightly managed environment.”

My third-grade reports reflect missed homework, inconsistent effort, and frequent run-ins with other students.

Should we expect parents to maintain a highly structured environment indefinitely? What happens when children grow too old for sticker charts? What happens when parents aren’t there to light a fire under a kid’s butt?

I’ll tell you what happened to me: my life spiraled out of control. My desk at work was covered 8-12 inches deep all around with papers, and I frequently lost important documents. I fought with my husband all the time. I suffered wild mood swings. Bills went unpaid. It took so long for me to take checks to the bank, they often expired before I could deposit them. My house was a mess. The list goes on.

Does behavior therapy prepare kids with ADHD for the future?

I’m not surprised to see a study confirming the effectiveness of behavior therapies — that is, rigid systems of externalized rewards and consequences — in the short term. We’re talking months, or even a few years.

I worry that we’re failing to teach kids true independence and long-term coping mechanisms. As Vicki Hoefle explains so effectively in her lovely book Duct Tape Parenting, parents should measure success not by how kids behave right now, but whether they’re ready to fledge at age 18. Childhood gives kids an opportunity to learn crucial skills in a safe, supportive environment.

Creating a system of made-up consequences robs them — and us — of that opportunity. Sure, I was able to control my outbursts to earn that TV. What did I learn about myself during that time? What tools did I put in my mental toolbox, to be carried into adulthood?

Yes, this study addresses an important issue. I hope it reinforces the symbiotic relationship between medication and other interventions. I hope fewer parents, teachers, and doctors see medication as a way to make ADHD an open-and-shut case.

Parents need to ask: what’s our goal here? Do we want the best of both worlds? To refuse medication for our kids while putting a stop to failing grades and uncomfortable parent-teacher conferences?

Or do we want to deepen our relationship with our kids while teaching them how to succeed as adults?

For that, we need to examine the effectiveness of behavior therapy once the subjects reach age 25, 30, and 35.

What do you think we’d find? I’m curious about others’ reactions. Did you read about this study? Have you had any first-hand experience with behavior modification? Please chime in with a comment below!

Ditching video games: more than making time & space

Around the turn of the new year, something amazing happened in our house: we got rid of most of our video games. This means less clutter, and I’m excited about the benefits for our family’s energy and willpower.

Mind you, no one really played these games, but my husband wished he could play them. I call this psychic drag, and it’s one reason I love decluttering.

When we hold onto certain kinds of things we don’t use — books, musical instruments, craft supplies, even video games — we don’t just hold onto the thing itself. We hold onto the idea of the thing, and our expectations for how it should be used.

video games

In The Life-Changing Magic of Tidying Up, organizing expert Marie Kondo illustrates how excess stuff hinders self-awareness: “We aren’t sure what would satisfy us or what we are looking for. As a result, we increase the number of unnecessary possessions, burying ourselves both physically and mentally in superfluous things.”

Video games usually harbor less emotional baggage than, say, once-cherished musical instruments or a box of old love letters. That makes them a great place to start. Letting go is a learned skill. As we practice (and start reaping the rewards), we get better. We gain confidence to say goodbye to more things, and figure out what we want to make space (and time and money) for.

As Kondo says, “the best way to find out what we really need is to get rid of what we don’t.”

Leaving our willpower in the bank.

Removing temptation from our home — be it video games or candy — also sets us up for success with other challenges.

That’s because willpower is a finite resource, just like money in the bank. As Stanford University professor Kelly McGonigal writes in The Willpower Instinct, “people who use their willpower tend to run out of it.” Dozens of studies have confirmed this. “Trying to control your temper, stick to a budget, or refuse seconds all tap the same source of strength,” explains McGonigal. “Because every act of willpower depletes willpower, using self-control can lead to losing control.”

Knowing this, I don’t bring cable television or candy into our house. Getting rid of the video games was another big step in the right direction.

Visible, easily-accessible temptations give us a choice. Choosing not to indulge spends a precious resource. I’d rather use that self-control elsewhere: not yelling at my kid, for example.

Everyone can benefit from learning about the science of willpower. I’m especially mindful because people with ADHD start with a lower balance in our willpower bank. We can thank the prefrontal cortex: the part of our brain responsible for “controlling what you pay attention to, what you think about, even how you feel.” In the end, it controls what you do.

This area of the brain — the home of our so-called executive functions — is also where ADHD wreaks its havoc.

The big takeaway for me: more than the average family, it’s critical for us to define our priorities, then systematically remove distractions. Remove the option of channel-surfing or using the television as background noise. Remove the option of playing video games instead of board games with friends. Make sugary snacks unavailable. Strive, as much as possible, for a minimalist lifestyle.

Remove temptation, but also clutter, noise, and distraction. Make choosing the right thing just a little easier.

Science, not edicts.

When it comes to managing our household — setting routines, creating the weekly menu, decorating, deciding which possessions may stay and which must go — I try to back up my decisions with brain science. It’s harder to argue with science than a declaration of “I don’t want you wasting time on video games.”

The video games felt like low-hanging fruit: removing temptations and clutter at the same time? That’s what I call making room for what matters. It’s a simple change with a nice payoff, not to mention extra cash in my pocket after I sell them.

How about you? What have you let go of lately? Is it time to say goodbye to something that siphons off your time, money, or willpower?

For a better to-do list, just add context.

I hate knowing I have tons to do, yet blanking when I try to think of specific tasks. This feeling defined my mid-20s, just before I started learning about and treating my ADHD.

I existed in a constant state of stress and anxiety, but I couldn’t articulate — even to myself — what exactly I needed to do.

Medication helped settle my thoughts. Next, I needed a system to organize them.

My salvation came in the form of David Allen’s Getting Things Done. If you haven’t tried GTD or if you find the whole system too rigid, allow me to share one of the most important concepts:

Context is everything.

Why traditional lists and planners failed me

To-do lists never worked for me until I sorted them by context — that is, the location or resources they require. This was a major paradigm shift. I spent years struggling with calendar-based personal planners and daily to-do lists, recopying incomplete tasks from one day to the next.

Of course, some tasks need to happen on a specific day, like paying rent or turning in kids’ summer camp registrations. I still write those on my calendar. Others just require the right environment: a phone, a quiet room, a computer, or a specific person. For those, I keep context-based to-do lists in an app called Toodledo. Toodledo’s web and mobile apps keep my lists at my fingertips everywhere I go. Here are my contexts:

I also generate contexts as needed for my mom, husband, grandmother, and anyone else I converse with regularly.

If you dislike apps, try a sheet of loose leaf paper or a page in a notebook for each context. Anything that keeps your lists separate will do just fine.

Still wondering how this beats one neat, centralized list?

Allen claims, and I agree, that a single list would make it “too difficult to see what you need to see; each time you got any window of time to do something, you’d have to do unproductive re-sorting.”

Consider this alongside ADHD’s inherent working memory weaknesses. As Russell Barkley explains in Taking Charge of Adult ADHD, we use working memory to organize and prioritize tasks, hold multiple things in mind, and figure out what to do next.

For someone with unreliable working memory, a poorly-organized to-do list isn’t just “unproductive,” it’s paralyzing.

to-do list context graphic“It’s not that you’re incapable of logical analysis or you lack intelligence…” Barkley writes, “it’s just that you need to make the process tangible and external…so your emotions don’t erupt with the frustration of trying to do it all in your head.”

Externalizing tasks into contextual ‘buckets’ takes a huge load off your working memory. This makes it easier to get into your productivity groove (sometimes known as hyperfocus).

Hyperfocus for good

Hyperfocus has a bad reputation in our household. It makes it hard for ADHD’ers to change gears and switch tasks. However, with context-based to-do lists, we can use hyperfocus to our advantage.

I may put phone calls off as long as possible, but by the time I force myself to do it (usually a deadline is looming), I settle in and finish them all at once. My husband calls this “task inertia.”

Here’s the thing: I’d freak out if I tried to comb through my to-do list (usually 60+ items long) for the three phone calls I need to make. A separate, ready-to-roll, phone-calls-only list enables me to make more than one of the dreaded calls. It removes obstacles to task inertia.

Reclaiming lost time

In Getting Things Done, Allen stresses the importance of capturing “weird little windows” of time. Most of us use 10 minutes in a waiting room to cruise our smart phone. What if you check two small items off your to-do list instead? My “any computer” (a definition that includes my phone) list contains tasks like “make dinner reservations” (easy with the OpenTable app), “look at calendar for game night dates,” and “use quilt tutorial to make a list for the fabric store.”

These are the baby steps that move me from Point A to Point B, from “we should get together soon” to “see you on Friday night for dinner and board games.” They’re also the details that can slip through my fingers and make me feel like a major flake. ADHD doesn’t change society’s expectations, but it sure makes it tough to keep up.

Experience has taught me, when I receive one of those “weird little windows,” I need to be ready. I need to know what one tiny thing I can get done with the resources at hand. Organizing my to-do list by context has been the key to making that happen — and to tricking people into thinking I have it together.

How do you organize your to-do list? Does it work for you? Please share in the comments!

Book Review: The Insider’s Guide to ADHD

Full disclosure: I received a copy of this book in exchange for my honest review.

The Insider’s Guide to ADHD presents a unique perspective on parenting young ADHD’ers. Through a  survey of 95 ADHD adults, author Penny Williams shares dos and don’ts from those who should know best.

penny williams book review

I expected Insider’s Guide to read like a collective memoir, but it’s more informed by survey responses than driven by them. You won’t find case studies or lengthy anecdotes. Direct quotes from the survey are generally short.

Williams has built a successful brand by writing from her perspective: a dedicated mom without ADHD, learning obsessively through research and real-life experience. She retains that voice in Insider’s Guide, drawing heavily on her own experiences along with survey responses.

Insider’s Guide teaches solid parenting strategies and steers readers away from the old-school parenting style many of us grew up with.

Williams offers these critical messages for parents of kids with ADHD:

  • Even lovely, supportive parents can unwittingly leave their kids feeling doomed to failure.
  • All kids need to learn self-sufficiency, and helicopter parenting sabotages future success.
  • Shame and punishment aren’t effective for creating long-term positive change.
  • Figuring out the right medication and dosage can be a life-changer.

Depending your current parenting and communication skills, Insider’s Guide may or may not help you. It’s a crash course, and Williams covers many of the same points as previous books I’ve reviewed — How to Talk So Kids Will Listen & Listen So Kids Will Talk and Duct Tape Parenting — but in slightly less depth.

These books pack more concrete examples, high-impact testimonials, and quotes from parenting experts, but Insider’s Guide makes an excellent sell to the skeptical or uninitiated. Williams offers testimony from real people who’ve lived through a childhood with ADHD. There’s overwhelming consensus on what works.

I especially appreciated this quote from a mom with ADHD: “I never liked the thought of medication for my child, but it made such a difference in my own life, I could not hold that back from maybe giving my child a chance to feel like days can be easier.” Parents are faced with overwhelming, complex choices. This illustrates beautifully what ADHD adults bring to the table.

One cautionary note: Williams represents survey results with visual aids throughout the book, but don’t extrapolate these to all adults with ADHD. The survey’s sample size is relatively small, at 95, and overwhelmingly female (78.1%). While it’s great to see women with ADHD represented, this doesn’t reflect the overall demographics of ADHD adults.

That’s not to discredit the insights Insider’s Guide has to offer. It’s just important to consider sample size and methods used when applying survey results to the population at large.

Insider’s Guide starts a necessary conversation. Awareness of ADHD is growing, and those of us who attended elementary school in the 1980s and 1990s — when ADHD and stimulant medications really became household names — now have children of our own. It’s time to explore how our childhood experiences can influence our parenting. I’m glad to see a book on this topic, and I hope it opens the door to bigger and more ambitious projects in the future.

Bottom line: if you’re stuck in a negative parenting rut and haven’t enjoyed books targeting neurotypical kids, Insider’s Guide is a great place to start. If you’ve already read How to Talk and Duct Tape Parenting, expect a repackaging of those ideas through the ADHD lens.

How about you? Have you read Insider’s Guide, or do you have another book to recommend? Please share your thoughts!

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