The Clinicians’ Guide to Treating Complex ADHD is a clinical compendium from Medscape, MDEdge, and ADDitude designed to guide health care providers through the difficult, important decisions they face when treating pediatric and adult patients for ADHD and its comorbid conditions. This guided email course will cover the following topics:

• DECISION 1: What should I consider when developing a comprehensive treatment plan for ADHD?
• DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
• DECISION 3: How can I decide which ADHD medication to prescribe first?
• DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
• DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
• DECISION 6: What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
• DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

NOTE: This resource is for personal use only.

BEYOND MEDICATION: Which nonpharmacologic treatments are proven to benefit pediatric patients with ADHD?

A: Effective behavioral treatments for ADHD do not change ADHD symptoms, but they do help children learn how to manage them… | Keep reading on MDedge »

LIFESTYLE INTERVENTIONS: How can patients optimize nutrition, sleep, exercise, and other lifestyle factors to improve ADHD symptoms?

A: Regardless of whether a child’s treatment includes medication, maximizing exercise, sleep, and nutrition can effectively transform them into natural remedies for ADHD, and arguably establish the foundation… | Keep reading on ADDitude »

EXERCISE: How much and what type of physical activity will benefit a patient with ADHD, according to research?

A: With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas… | Keep reading on ADDitude »

SUPPLEMENTS: What supplements and/or vitamins can aid with ADHD symptom control?

A: Usually given in the form of fish oil, omega-3s are probably the best-researched supplement for ADHD. Numerous studies… | Keep reading on ADDitude »

PARENT TRAINING: How can Collaborative & Proactive Solutions parent training benefit an ADHD treatment plan, according to research?

A: CPS has been shown in randomized trials with both parent groups and in home counseling to be as effective as Parent Training in reducing oppositional behavior and reducing… | Keep reading on MDedge »

NEUROFEEDBACK: Is neurofeedback an effective ADHD treatment, according to research?

A: A body of research suggests that neurofeedback is a promising therapy for ADHD, but it should be considered a complement to medication and/or behavior therapy rather than… | Keep reading on ADDitude »

ENVIRONMENTAL CHANGES: Which accommodations and environmental changes have the greatest positive effect on children with ADHD?

A: Encourage parents and teachers to use clear and concise instructions with supplementary visual tools. When providing instructions in classrooms, teachers should look directly at the student… | Keep reading on MDedge »

RELATED RESOURCES

The Exercise Rx for ADHD: How Movement Improves Attention, Working Memory, and Executive Functions

Expert Webinar with John Ratey, M.D. | Listen now on ADDitude »

The Whole-Person Treatment Approach to ADHD

Expert Webinar with Lidia Zylowska, M.D. | Listen now on ADDitude »

How CBT and ADHD Coaching Help Adults Manage Their Symptoms Naturally

Expert Webinar with J. Russell Ramsay, Ph.D., and David Giwerc | Listen now on ADDitude »

New Supplement Strategies: Using Trace Minerals and Plant Extracts to Treat ADHD in Children and Adults

Expert Webinar with James M. Greenblatt, M.D. | Listen now on ADDitude »

7-Week Guide to Treating ADHD, from Medscape x MDedge x ADDitude:

DECISION 1: What should I consider to develop a comprehensive ADHD treatment plan?
DECISION 2: What medications and other approaches should I turn to as first-line treatments for ADHD?
DECISION 3: How can I decide which ADHD medication to prescribe first?
DECISION 4: What challenges and side effects should I anticipate from ADHD medications, and how should I address them?
DECISION 5: How can I improve treatment outcomes for patients with ADHD and comorbid diagnoses?
>DECISION 6:What dietary, behavioral, or other complementary interventions should I recommend to patients with ADHD?
DECISION 7: How should I follow up with patients with ADHD, and what should we discuss during these checkups?

I have another therapist whom I see on my phone, too. But unlike Stephanie, this therapist starts a session by asking if I would like to “get help with a problem,” “work on my goal” (which has been decided for me), or “track and journal.” Also unlike Stephanie, this therapist is available 24/7 — but doesn’t remember my big parties, my book launches, my successes, or my failures.

This therapist is named Woebot, and it’s a therapeutic chatbot powered by artificial intelligence (AI).

A free app available for both Apple and Android devices, Woebot serves “tens of thousands” of users daily, said its founder and president, psychologist Allison Darcy, in The New York Times in 2021. Based on principles of cognitive behavioral therapy (CBT) and “natural language processing,” Woebot engages users in text-based conversations, and is designed to help people cope with stress, anxiety, and depression in a growing field of mental health tools.

Woebot tells me during our chats that it can also help with my anger, procrastination, and guilt — common issues for people living with attention deficit hyperactivity disorder (ADHD). It sounds useful: America is plagued by a therapist shortage and long wait times for care. The high cost of therapy can also be a barrier. If you can’t find a therapist and you need one fast, a free chatbot built on sound CBT-based science sounds tempting.

My advice: Resist.

[Read: The Top 6 Mental Health Apps, According to ADDitude Readers]

WoeBot Woes

Woebot assumes neurotypicality. It expects that all brains can be retrained to cope with negative emotions using the same therapeutic model. But ADHD brains process information and emotions differently.

For example, Woebot doesn’t understand that people with ADHD have big, all-consuming emotions. When I told it I was mad, Woebot told me to “imagine my emotions had a voice.” Wait, what? I was in total rage mode when it asked me to write down three of my angry thoughts. So I did, albeit poorly. It then asked me to identify my “cognitive distortions” — i.e., thought patterns that aren’t based on facts.

But when I’m mad, I am too flooded with hot emotion to stop and look for cognitive distortions. Something is wrong; I need to calm down, but the opposite is now happening.

Woebot also claimed it could help with procrastination. But it offered such a complicated mathematical equation about the merits of doing something now or later that I couldn’t (and still can’t) understand. Maybe it could assist in a pinch — if I remembered it existed. But Woebot did not intervene when I began tumbling through TikTok rather than washing dishes.

[Read: The Emotional Resilience Playbook for People with Big Emotions]

Woebot was no match for my negative self-talk, either. When I told it I felt sad because I don’t have any friends — social issues are a common problem in women with ADHD — it launched an ineffective CBT round-and-round that had me fill in blanks and flag “unhelpful” thoughts. Eventually, I avoided my negative thoughts by watching TV instead. (Avoidance is not an acceptable tactic for coping with negative thoughts, of which I had several regarding Woebot.)

We Need More Than AI Chatbot Therapy

At least Woebot comes with safeguards: Certain words trigger suggestions for immediate clinical intervention. During one conversation, Woebot told me, “I can’t comment on the content of your thoughts, just the process. If you’re looking for guidance around content, this might best be done with a human.” I still don’t know what triggered that response, so how would someone in serious trouble understand it, and how could it help those people using Woebot in place of that therapist with availability in October?

No matter how poor my efforts or how ineffective our sessions, Woebot always told me that making an effort was the important part. Unfortunately, mental illness doesn’t get bonus points for effort. We need effective help to improve our lives. And that means a human therapist, not a bot.

AI Chatbot Therapy and ADHD: Next Steps

• Find: Psychologists and Therapists Who Understand ADHD
• Free Download: Emotional Regulation & Anger Management Scripts
• Read: “How Therapy Helped Me”
• Read: How Cognitive Restructuring Reframes Failure and Erases ADHD Self-Doubt

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.

Monarch eTNS is a non-medication prescription device designed for overnight use in children with ADHD ages 7 to 12. The Monarch eTNS System is the first FDA-cleared device for ADHD with proven efficacy in alleviating ADHD symptoms, according to a small study.¹

How Does Monarch eTNS Work?

The Monarch eTNS (external Trigeminal Nerve Stimulation) System is an electronic device, about the size of a cell phone, that connects to a disposable patch placed on a child’s forehead at bedtime. Once turned on, the device sends low stimulating pulses to the trigeminal nerve through the patch overnight. The trigeminal nerve is the brain’s largest cranial nerve responsible for communicating sensations from the face to other parts of the nervous system — including brain areas involved in mood disorders, epilepsy, and attention.

Who Can Use Monarch eTNS?

Monarch eTNS is for patients ages 7 to 12 who are not currently taking prescription ADHD medication. The device should not be used by patients with an active implantable pacemaker or implantable neurostimulator, or in those with body-worn devices (e.g., insulin pumps).

What Studies Have Been Done on Monarch eTNS?

Two clinical trials compared the Monarch eTNS system’s efficacy in treating ADHD to a placebo device.

In 2014, 24 children with ADHD aged 7-14 years participated in an 8-week, open-label pilot feasibility study. After four weeks of nightly use, the Clinical Global Impression–Improvement (CGI-I) scale rated 64% of the study group as “improved” or “improved very much.” This trial showed a 47% decrease in the ADHD Rating Scale IV (ADHD-RS-IV) score and a responder rate of 71% on the Clinical Global Impressions Scale-Improvement (CGI-I) scale after eight weeks. Trial participants used the treatment as directed, side effects were minimal, and no child withdrew from the study due to adverse events, according to results published in Brain Stimulation.¹

A team of UCLA researchers published the results of the first double-blind, placebo-controlled trial examining the efficacy of the Monarch eTNS on ADHD in children in the Journal of the American Academy of Child and Adolescent Psychiatry in 2018. They concluded that more than half of the children (52%) who used the Monarch at bedtime for four weeks—under parent supervision—experienced significantly reduced impulsivity, hyperactivity, and inattention, as measured by clinician-administered ADHD rating scales compared to the placebo group (14%).

What Are the Side Effects of Monarch eTNS?

The most common side effects observed with eTNS included drowsiness, increased appetite, trouble sleeping, teeth clenching, headache, and fatigue. No serious adverse events were associated with device use.

Where Can I Learn More About Monarch eTNS?

You can learn more about Monarch eTNS at https://www.monarch-etns.com/.

Sources

^{1</supMcGough, J.J., Loo, S.K., Sturm, A., et al. (2015). An Eight-Week, Open-Label Pilot Feasibility Study of Trigeminal Nerve Stimulation in Youth with Attention-Deficit/Hyperactivity Disorder. Brain Stimulation. 8:299-304. https://doi.org/10.1016/j.brs.2014.11.013}

^{2</supMcGough, J.J., Sturm, A., Cowen, J., et al. (2019). Double-Blind, Sham-Controlled, Pilot Study of Trigeminal Nerve Stimulation for Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adolesc Psychiatry. 58(4):403-411. https://doi.org/10.1016/j.brs.2014.11.013}

Intense children exhibit intense, often problematic, behavior with a frequency and severity that impacts everyone. Exhausted parents field regular phone calls from school administrators, frustrated teachers feel punishment (or leaving the profession) is their only option, and medical professionals assume medication is the only approach that truly works. No one benefits, certainly not the child.

Enter the Nurtured Heart Approach, a parent behavior training program developed from therapist Howard Glasser’s work with the most challenging and intense children. School and treatment centers report that it not only positively transforms “difficult” behaviors, but the Nurtured Heart Approach benefits all children by enabling and teaching adults how to channel their intensity into great qualities of character and leadership.

In this webinar, you will:

• Understand the dynamics of intense children and how to inspire success and greatness
• Understand why, despite sincere intention, conventional methods of parenting, education, and treatment often backfire with intense and challenging children
• Learn a methodology for inspiring success that is more powerful and encompassing than traditional approaches
• Understand how to uphold a great level of limits and accountability while avoiding the traps that make consequences backfire

Watch the Video Replay

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Download or Stream the Podcast Audio

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More on Positive Parenting and ADHD

• Download: Questions to Get Your Child Talking
• Read: “My Child Resists Everything! Will He Ever Open Up to New Experiences?”
• Read: Positive Charge: How to Reinforce Good Behavior

Obtain a Certificate of Attendance

If you attended the live webinar on March 29, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Creator of the Nurtured Heart Approach, Howard Glasser works in family treatment, clinical studies, and educational leadership. His formal studies, along with direct experience with the most intense and challenging children, form the basis of this approach. He has been referred to as one of the most influential persons working to reduce children’s reliance on psychiatric medications.

Howard is the author of 15 books, including Transforming the Difficult Child, a longstanding bestseller on intense and challenging children. (#CommissionsEarned)

Howard teaches Nurtured Heart Approach Certification Training Intensives at the Nurtured Heart Institute, the University of Arizona’s Integrative Medicine Program, and at the Zuckerman School of Public Health.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“As a heart-centered practitioner, I appreciated this approach!”

“Glasser got to the core of the parent-child relationship in such a beautiful and compelling way.”

“Excellent presentation. I was affirmed in some of my current practices with my 5th & 6th grade classroom & want to explore this approach further!”

“Thank you! So rich and helpful.”

“Thank you, Howard was fantastic. Lots to think about, and to redirect the focus is something I’m going to try starting now! Inner wealth… I love this idea.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Treatment that combines dialectical behavioral therapy (DBT) with transcranial direct current stimulation (tDCS) may deliver the greatest improvement in cognitive and emotional symptoms of ADHD in adults, according to a new study published in the Journal of Attention Disorders. Researchers investigated the effects of tDCS and DBT alone and together, and found that the combined multimodal treatment worked best at managing ADHD symptoms.¹

“Optimization of the clinical effects of DBT combined with tDCS represents a potential avenue to focus on brain plasticity and enhance the therapeutic effects,” researchers said.

tDCS is a non-invasive brain modulation method where weak electrical currents pass through two electrodes placed over the scalp.² DBT is a cognitive behavioral therapy that was initially used to treat chronic suicidal behaviors and borderline personality disorder (BPD).³

Study participants included 80 adults with ADHD (63 females, 17 males) aged 18-45. They were randomly sorted into control, DBT-only, tDCS-only, and combined groups.

The tDCS-only and combined groups received ten 20-minute sessions of anodal (excites neuron activity) and cathodal (inhibits or reduces neuronal activity) stimulation over 30 days. The DBT-only and combined groups received ten individual DBT therapy sessions once weekly, for 1 to 1.5 hours.

The study found that DBT and tDCS used in isolation improved selective attention and response inhibition, sustained attention, and emotion regulation in adults with ADHD. However, the DBT-only group did not reflect increased attention on the ADHD self-report scale (ASRS), while the tDCS-only group did. The tDCS-only group did not report improvements in hyperactivity on the ASRS, while the DBT-only group did.¹

Researchers concluded that the most promising results occurred using tDCS concurrently with DBT. “Our findings showed that merely applying tDCS or DBT alone might not improve cognitive and behavioral functioning. tDCS, thus, might act as a ‘restoration’ tool to benefit from DBT intervention,” they said.

The lack of research surrounding the effectiveness of integrated interventions and the increased interest in non-medication interventions for ADHD treatment served as impetuses for the study. “Even though the effects of tDCS and cognitive training have been investigated separately, the effects of integration of these interventions are only beginning to be explored,” researchers said.

Limitations of the study included the lack of a sham tDCS group and blinded assessments. “Clearly, further comparisons with sham-controlled groups and blinded assessment are required for the robust demonstration of the efficacy of any protocol with tDCS,” researchers said.

Sources

¹ Basiri, N., and Hadianfard, H. (2022) Adult ADHD Treatment Based on Combination of Dialectical Behavior Therapy (DBT) and Transcranial Direct Current Stimulation (tDCS) as Measured by Subjective and Objective Scales.Journal of Attention Disorders. https://doi.org/10.1177/10870547221118527

²Thair H., Holloway A.L., Newport R., and Smith A.D. (2017) Transcranial Direct Current Stimulation (tDCS): A Beginner’s Guide for Design and Implementation. Front. Neurosci. 11:641. https://doi.org/10.3389/fnins.2017.00641

³Fullen T., Jones S. L., Emerson L. M., Adamou M. (2020). Psychological treatments in adult ADHD: A systematic review. Journal of Psychopathology & Behavioral Assessment. 42(3), 500–518.https://link.springer.com/article/10.1007/s10862-020-09794-8

Though this approach has produced improved outcomes for patients and clinicians, it is still largely underutilized. Following a recent ADHD Experts webinar titled “Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team,” ADDitude editors provided answers (and relevant resources) to commonly asked questions on collaborative care. Find those responses below.

Q1: “Why center integrated ADHD care around primary care doctors when you have access to mental health professionals?”

A primary care provider (PCP) is one of few medical professionals with a whole-person approach to care. In many cases, the PCP has already established an in-depth, trusting relationship with the patient and family. They also act as an opportune gateway to additional healthcare services.

Rather than starting from scratch elsewhere, involving a PCP when seeking ADHD diagnosis and treatment options may save families time (and money). PCPs can initiate diagnostic assessments using validated screeners, exams, and patient history. In an integrated care model, they can also collaborate with psychiatrists and behavioral health care managers to develop, implement, and adjust treatment plans.

Next Steps:

• Download: Who Can Treat ADHD?
• Read: Care Coordination: Forming an ADHD Treatment Team for Children
• Read: How Pediatricians Can Help School-Age Kids

Q2: “Does integrated care include help for children who experience social challenges associated with their ADHD? If so, who leads that effort?”

Both the physical and behavioral needs of patients are addressed in an integrated care approach. Addressing social struggles in children with ADHD might fall first on the behavioral health care manager (BHCM), who acts as a linchpin between the medical care team and the child’s daily life. The BHCM partners with parents to outline goals and develop a plan while networking with schools and community agencies to provide accommodations and evidence-based treatment. Throughout this process, the BHCM is routinely updating the care team and monitoring patient progress.

Next Steps:

• eBook: The ADHD Guide to Making & Keeping Friends
• Read: The Social Executive Function Skills That Elude Kids with ADHD
• Read: “Collaborative Care” Improves ADHD Symptoms in Children

Q3: “How do I find an integrated care practice in my area?”

Integrated care models are not standard, but they are becoming more common around large children’s hospitals and academic centers. If you live near a large children’s hospital, approach the primary care practice and ask if behavioral health is embedded in their pediatric clinics. Otherwise, talk to your pediatrician’s office to determine potential opportunities for collaborative care.

Next Steps:

• Search: The ADDitude Directory
• Research: ADDitude’s Top ADHD Clinics
• Read: Picking ADHD Professionals to Treat Your Child

Q4: “Are there specific, evidence-based training programs available for parents?”

BHCMs may provide brief, evidence-based training for parents with the goal of teaching skills and reducing barriers to care. Check out these resources available through Seattle Children’s Hospital and its First Approach Skills Training (FAST) Program.

Next Steps:

• Understand: Is Parent Training a Key to ADHD Symptom Control?
• Read: Behavioral Parent Training for ADHD: Strategies That Work
• Sign Up: ADDitude’s Free Parenting Class

Q5: “How does the billing process work in an integrated care model?”

Though billing varies by state and by insurance plan, CPT codes are available to collaborative care practices. Watch this video for information on effective billing and coding strategies. Visit the AIMS Center online to learn more.

The content for this article was based on questions submitted by live attendees during the ADDitude ADHD Experts webinar titled, “Integrated Care for Children with ADHD: How to Form a Cross-Functional Care Team” [Video Replay & Podcast #411] with Leslie F. Graham, MSW, Douglas Russell, M.D., Sheryl Morelli, M.D., which was broadcast live on July 12, 2022.

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.

Behavioral interventions like healthy sleep hygiene, calming visualization, and reliable sleep and wake times are effective at improving ADHD-related sleep issues in children, according to a meta-analysis published in the Journal of Attention Disorders¹. Though the study does not recommend specific interventions, its findings are a promising addition to a growing body of research surrounding behavioral interventions for correcting sleep difficulties.

The researchers’ analyses, which considered 11 studies, focused on children between the ages of 5 and 15 diagnosed with ADHD who had at least one sleep problem and received some form of behavioral sleep intervention. Interventions included educating parents on sleep hygiene, establishing a proper sleep environment, and setting proper wake and sleep time, as well as using positive reinforcement, bedtime fading, and calming visualization for the children involved in the study.

Though researchers found that individualized interventions that targeted the child’s specific sleep difficulty proved more effective and time-efficient than did standardized approaches. In all studies analyzed, behavioral interventions led to positive effects on sleep quality.

The study suffered from a marked gender imbalance: male participants far outnumbered their female counterparts. Knowing that ADHD can affect girls differently, the lack of gender balance raises concerns over the generalizability of the results. The study authors recommend further research to better understand effective interventions and how other factors such as medication or comorbid conditions may affect intervention results.

Sources

¹Malkani, M. K., Pestell, C. F., Sheridan, A. M. C., Crichton, A. J., Horsburgh, G. C., & Bucks, R. S. (2022). Behavioral Sleep Interventions for Children With ADHD: A Systematic Review and Meta-Analysis. Journal of Attention Disorders. https://doi.org/10.1177/10870547221106239

Rarely do primary care providers, behavioral health professionals, and school officials involved in the diagnosis and treatment of children and teens with ADHD and co-existing conditions collaborate on the care of their shared patients. Yet evidence shows that outcomes improve when they do. In an integrated care model, behavioral care managers — often trained as social workers and pediatric therapists — are embedded in primary care practices where they work with families, school teams, and medical providers to accurately diagnose children and ensure they receive the effective care and resources they need to succeed.

In this webinar, we will introduce integrated behavioral health as an effective model for the diagnosis and treatment of children and adolescents with ADHD and its comorbidities. We’ll discuss why this model enables us to make early diagnoses more effectively and we’ll share the positive outcomes we have seen over the years for children and adolescents in our practice.

In this webinar, you will learn…

• How integrated care models work
• The benefits of an integrated behavioral health care approach to the diagnosis and treatment of ADHD
• How parents and behavioral care managers set up systems with school officials to monitor students’ academic performance
• How providers and behavioral health care professionals can work together to implement integrated care services in their practices

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on ADHD and Integrated Care

• Download: Who Can Treat ADHD?
• Read: Is Your Child’s Treatment the Total Package?
• Read: “Collaborative Care” Improves ADHD Symptoms in Children

Obtain a Certificate of Attendance

If you attended the live webinar on July 12, 2022, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speakers:

Leslie F. Graham, MSW, graduated from the University of Washington (UW) and is a licensed clinician in the state of Washington. She has spent the last decade partnering with UW and Seattle Children’s medical teams to develop a pediatric integrated behavioral health program in South King County, Washington.

Douglas Russell, M.D., is a child and adolescent psychiatrist and assistant professor at the University of Washington School of Medicine. He received his medical degree from Jefferson Medical College and completed both his psychiatry residency and child psychiatry fellowship training at the University of California, Los Angeles.

Sheryl Morelli, M.D., is a pediatrician and professor at the University of Washington School of Medicine. She received her medical degree from Wright State University and completed her pediatric residency at Wright State University Integrated Pediatric Residency Program. Dr. Morelli currently serves as the Chief Medical Officer for Seattle Children’s Care Network.

Listener Testimonials

“I’m an adult-diagnosed ADHD patient who wishes this care model was in place for me when I was evaluated in 4th grade. Thank you for sharing!”

“This panel was very organized and professional.”

“If my daughters had access to this type of system early on, they’d each be struggling with far fewer psychosocial comorbidities now. Thank you for giving me the information to advocate and inform others in my various spheres of influence!”

Webinar Sponsor

The sponsor of this ADDitude webinar is…

Brain Balance is an integrative cognitive development program designed to help kids with ADHD, Learning Differences, Anxiety & beyond. An exploratory study with Harvard’s McLean Hospital found the Brain Balance Program to be as effective as low-dose stimulant medication in alleviating ADHD symptoms in children. Visit brainbalance.com to learn more about Brain Balance today.

ADDitude thanks our sponsors for supporting our webinars. Sponsorship has no influence on speaker selection or webinar content.

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Akili Interactive, the developer behind the first FDA-approved game-based prescription treatment for ADHD, announced this week that it is partnering with TALi Digital, an Australian-based digital health company, to license its attention-improving game software in the U.S. provided FDA approval.

Under the deal, the two companies will work together to execute clinical trials of TALi’s video game-based technology — designed to screen for and improve early childhood attention impairments — in pediatric ADHD and pursue FDA regulatory clearance. Upon securing FDA approval, Akili will lead the treatment’s U.S. commercialization and roll-out.

The agreement complements Akili’s own flagship product, EndeavorRx, a game-based digital therapeutic to improve attention function in children with ADHD that received FDA approval last year.

TALi’s technology, marketed under TALi DETECT® and TALi TRAIN® (screening and attention training video games, respectively) has been shown to improve attention in neurodiverse and neurotypical children, especially in areas like numeracy skills, selective attention, and classroom behavior. The technology is currently available in Australia, India, Singapore, and Hong Kong.

These are some of the statements I hear from clients diagnosed with ADHD. To help them see themselves the way I see them — and to notice all the ways in which they are successful — I use a therapy technique called cognitive restructuring.

What is Cognitive Restructuring?

Cognitive restructuring is one of the primary techniques used in cognitive behavioral therapy (CBT). The premise of CBT is that our thoughts and beliefs influence our feelings, which in turn influence our behavior. So if we think crappy things about ourselves, we will feel crappy and be less able to do the things necessary to live well with ADHD. Cognitive restructuring is a fancy way of saying, “Change the way you think.”

How do you change the way you think? You can try choosing to believe the opposite of your negative thoughts: I am successful. I can do anything I set my mind to. I am normal. Affirmations like these have their place in your positive-thinking repertoire, but there’s likely to be a part of you that says, “Yeah, right.”

Cognitive Restructuring Tip #1: Seek Out a Different Perspective

One way to change the way you think is to actively seek out a different perspective. What is another way of looking at it? A guy I met at a party said to me, “Everyone has issues. Everyone.” Of course, I argued with him (we with ADHD are pretty good at arguing any point). But I couldn’t meet his challenge to name one person who is without issues. This is now one of my mantras when I’m feeling down on myself. I feel less alone, less of a victim.

[Read This Next: How Cognitive Behavioral Therapy Works]

You can also use evidence gathering, another staple of CBT. Think about all those times when you were successful, when you didn’t fail. The more examples you come up with, the more you will be able to start to believe that it isn’t true that you fail at everything. You can believe you are successful some of the time.

Cognitive Restructuring Tip #2: Use Metaphor

Using metaphor in cognitive behavioral therapy is an approach I’m especially fond of — and it is effective for my clients. CBT founder Aaron T. Beck, M.D., championed the use of metaphor early on. He saw it as a powerful way to generate alternative ways of thinking. A metaphor applies a concept we understand to something harder to grasp, in a vivid, catchy way. A good metaphor is paradigm altering; you can’t un-see it once you’ve seen it.

To be therapeutically effective, you want the metaphor to be strength-based. You could equate ADHD to quicksand, but that’s likely to keep you stuck. You want the metaphor to suggest a new, positive way of thinking about the situation.

Edward Hallowell, M.D., a leading authority on ADHD and co-author of the best-selling Driven to Distraction, likens ADHD to having a race-car brain and bicycle brakes. He explains to his newly diagnosed patients that their brain is very powerful and capable of winning races (doing well in life). But they have bicycle brakes, so they can’t slow down very well; they are impulsive on many fronts. He describes himself as a brake specialist.

[Click to Read: The Success Mindset for ADHD Procrastinators, Dreamers & Survivors]

Cognitive Restructuring Tip #3: Reframe Distractions

I like to share the “paperweight metaphor” with my clients. Imagine you and a colleague decide to go to the park and get some work done. You each go to a picnic table and spread out your papers (there are no electronics in this metaphor). You arrange them in neat stacks. You look over and notice that your colleague has done the same. But she puts a paperweight on each of her stacks.

Paperweights, brilliant! But you don’t have any paperweights. The wind blows and your papers fly away. Your colleague looks up for a moment, smiles at the breeze, and gets right back to work, her papers safely secured. You have to track down your papers. You finally gather them up, lay them out, and start to work again. And the wind blows again and you’re back to chasing papers, because you don’t have any paperweights.

You and your colleague are equally smart, equally talented, equally capable. She gets more done because she isn’t affected by the wind (distractions). You are not “less than” just because you weren’t given paperweights at birth like 95 percent of the population.

Cognitive Restructuring Tip #4: Make Sure Your “On” Switch Isn’t Turned “Off”

Another metaphor I like to use with clients with ADHD is the circuit and the switch. Everyone, neurotypical or not, can be compared to a simple electrical circuit. Current runs through the circuit and powers equipment such as a light bulb. Everyone’s circuit has a switch in this metaphor. Turn on the switch and the light comes on. Turn off the switch and the light goes out. The current in people with ADHD is just as strong as anyone’s, and our light just as bright. But our switch is not reliable. It turns itself off when we get distracted or overwhelmed and our light goes out.

We have to keep an eye on the switch and be ready to turn it back on. That means we have to use our coping strategies without fail. Structure, good sleep, diet, exercise — those are the things that keep the switch on. It seems unfair that some people have more reliable switches. But it’s just the switch. There’s nothing wrong with our basic circuitry. That’s the point I want my clients to get.

With metaphor, we can move from “It’s a given that I’m (insert negative belief here)” to the ability to challenge that assumption and generate hope. We can make sense of the problem. We come out of that dark place of feeling alone and misunderstood. There’s a sense of “Ah, that’s a thing.”

[Relax! It’s Part of Your Treatment Plan]

Another good thing about metaphors in therapy is that they help clients remember what was said in the session. Information is more likely to be remembered if it’s accompanied by vivid imagery.

Some clients use metaphors to help the therapist fully understand their experience. They can be used to describe a feeling, a thought, or a belief that may be too complex to describe in simple sentences. This shared understanding leads to improved rapport and therapeutic alliance. Metaphors that come from the client are more likely to resonate with them, so I encourage them to do it.

Sometimes in sessions I find the client and I will pass a metaphor back and forth, each expanding on it as we gain clarity. We use it as shorthand: “What happened to your switch?” “What do you want to use as a paperweight?” or “Yeah, there go my bicycle brakes again.” The ADHD community feels misunderstood. Shared metaphor lets them know they are understood, accepted, and valued.

Cognitive Restructuring and ADHD: Next Steps

• Download: Everything You Need to Know About CBT
• Learn: How CBT Dismantles ADHD Negativity
• Read: Putting a Stop to Negative Thoughts

Beth Main, LCPC, BCC, is an ADHD coach, therapist, and founder of ADHDSolutions.net. She specializes in using a cognitive-behavioral approach to helping people with ADHD overcome their challenges and achieve success.

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The Emotional Symptoms of ADHD

The prefrontal cortex is a busy intersection through which attention, behavior, and emotions zoom. In ADHD brains, this intersection is unregulated, causing runaway emotions to barrel right through, slamming into the other cars on the road. This dysregulated emotion could look like rejection sensitive dysphoria, extreme anger, frustration, or any other strong feeling of the moment.

How Inflow Helps

Inflow is the #1 app to help you better manage ADHD. It is based on the principles of cognitive behavioral therapy (CBT) and combines psychoeducation, habit development as well as community support.

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ADHD does not exist only in the brain. Like other mental health disorders, ADHD affects (and is affected by) the whole person. Stress levels, physical health, lifestyle, sense of self, relationships, and environment are important to consider when formulating and adjusting ADHD treatment. Many patients find it helpful to combine integrative or holistic strategies alongside conventional psychiatric treatments to cultivate physical and emotional wellbeing in ADHD.

In this presentation, you will learn about the benefits of integrative treatments, such as lifestyle and nutrition modification, supplements, acupuncture, or a consultation with a holistic clinician. We will also look at how the “neurodiversity perspective” — along with mindfulness, self-compassion, and positive psychology — can decrease the stigma associated with ADHD and comorbid disorders, and foster acceptance and resilience.

In this webinar, you will learn:

• The whole-person framework for mental health
• Fundamental wellness strategies for ADHD
• The value of mindful awareness, self-acceptance, and compassion in ADHD care
• How diverse integrative medicine approaches can be combined with conventional ADHD care
• How to use a gradual and collaborative approach when implementing a multi-component treatment

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Read More on ADHD and Wellness

Natural Remedies for ADHD: ADD Treatment Without Medication
6 Natural Supplements to Manage Symptoms

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Meet the Expert Speaker:

Lidia Zylowska, M.D., is an associate professor at the University of Minnesota Department of Psychiatry and Behavioral Sciences, and a faculty member of the University of Minnesota Earl E. Bakken Center for Spirituality and Healing. She is an internationally recognized expert in adult ADHD and mindfulness-based therapies. Her research work pioneered the application of mindfulness in ADHD, developed the Mindful Awareness Practices (MAPs) for ADHD program, and helped co-found the UCLA Mindful Awareness Research Center. Dr. Zylowska is also a Diplomate of the American Board of Integrative Holistic Medicine, and the author of two books, The Mindfulness Prescription for Adult ADHD and Mindfulness for Adult ADHD – A Clinician’s Guide.

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Parents of children with ADHD experienced improvements in over-reactivity, impulsivity, self-compassion, and overall mental health after participating in an 8-week, family mindfulness based intervention (MBI) called MYmind, according to a study published in the Journal of Child Psychiatry and Psychology.¹

Participants with ADHD, ages 8 to 16 years, were divided into two groups: 48 received care as usual (CAU) and 55 also participated in MYmind sessions for 90 minutes once a week with at least one parent. The randomized control trial, called MindCamp, was used to compare both groups. Assessments conducted immediately following treatment and at two- and six-month follow-ups showed modest improvements among child participants but lasting gains among their caregivers.

The MYmind with CAU group did not outperform the CAU-only group in reducing caregiver ratings of self-control deficits, though teacher-rated self-control deficits and parent-rated inattentiveness and hyperactivity-impulsivity did improve among the MBI participants. Of greater note, participating parents experienced long-term improvements in mindfulness, self-compassion, and mental-health that persisted for at least six months after the training.

“Many families reported important improvements in family relationships and insight in and acceptance of ADHD,” said Corina Greven, psychologist at the Radboud Center for Mindfulness. “We need to go broader than just looking at whether an intervention reduces symptoms, and include additional outcomes that families find important.”²

Sources

¹ Nienke M. Siebelink, Susan M. Bögels, Anne E. M. Speckens, Janneke T. Dammers, Thomas Wolfers, Jan K. Buitelaar, Corina U. Greven. A randomised controlled trial (MindChamp) of a mindfulness-based intervention for children with ADHD and their parents. The Journal of Child Psychology and Psychiatry (May 2021). https://acamh.onlinelibrary.wiley.com/doi/10.1111/jcpp.13430

² Families with a child with ADHD can benefit from mindfulness training. Eurekaalert.org (May 2021) https://www.eurekalert.org/pub_releases/2021-05/rumc-fwa052721.php

Relationship-strengthening therapies, such as parent training and social skills training, effectively treat the emotional symptoms of ADHD in children, while cognitive behavioral therapy (CBT) mitigates common emotional symptoms in adults with ADHD, according to a new meta-analysis published in the Journal of Attention Disorders.¹

The study, which aimed to evaluate the efficacy of non-pharmacological interventions on comorbid emotional symptoms of ADHD in adults and children, included 44 randomized control trials of studies. These studies reported on common emotional symptoms — such as those associated with mood disorder, anxiety, and emotional dysregulation — which were evaluated by each participant, or the participant’s caregiver or an independent observer. Participants below the age of 18 were classified as children; older than 18 were classified as adults.

CBT demonstrated efficacy in the improvement of emotional symptoms in adults with ADHD at post-intervention and follow-ups. It specifically helped in alleviating symptoms of depression, anxiety, and emotional dysregulation. Therapies targeting the relationship between children and others (such as parenting training and social skills training) were shown to effectively mitigate emotional symptoms in children, specifically those associated with depression and emotional dysregulation. Participation in sports was also found to improve depression in children at post-intervention.

Researchers concluded that “while adults might benefit from more complex forms such as CBT, children with ADHD will benefit from more intuitive non-pharmacological interventions involving social relationships and interaction skills.”

Sources

¹ Guo C, Assumpcao L, Hu Z. Efficacy of Non-pharmacological Treatments on Emotional Symptoms of Children and Adults with Attention-Deficit/Hyperactivity Disorder: A Meta-Analysis. Journal of Attention Disorders. March 2021. doi:10.1177/10870547211001953