Genesis Counseling Center
Attention Deficit Hyperactivity Disorder (ADHD)

ADHD Addendum
ADHD Overview by Dr. Amaya Rucker
ADHD Recommendations for Children by Dr. Jeffrey Olrick
ADHD Recommendations for Adults by Dr. Jeffrey Olrick

General Information About ADHD

Brian is a warm and caring child who has a lot of energy. He often plays very rough with his little sister and seems unable to share or take turns. He is very excitable and finds it hard to settle down. 

            Sue is a very talented artist. However, rather than taking notes and making eye contact with the boss during meetings, she often doodles and daydreams. Sue seems flighty, as if she has a million things on her mind.  She is unorganized, and often loses things.

            Both Brian and Sue have Attention Deficit Hyperactivity Disorder, or ADHD.  It is sometimes also called ADD or Attention Deficit Disorder. Attention Deficit Hyperactivity Disorder or ADHD is commonly diagnosed in childhood. However, ADHD affects adults also. Many children and adults with ADHD don’t even know they have it. Yet a proper diagnosis and treatment could mean a better quality of life for the individual and those around him or her. ADHD consists of a group of symptoms such as an inability to pay attention and constantly being on the go.

If you think you or someone you know has ADHD, here are four easy steps to take toward living a more productive and fulfilling life:

            The first step to managing ADHD is a proper diagnosis. Although there is no one test for ADHD there are various assessments which help in determining if the symptoms experienced are primarily from ADHD or from another disorder.
Second, seek individual counseling. Behavior modification, a type of counseling technique, has proven to be effective in helping both children and adults with ADHD become more productive and live happier, healthier lives.

Third, ask your counselor or your doctor for more information about the medications which are used to treat ADHD. These medications can help to manage the symptoms of ADHD by helping one to focus, concentrate and slow down.  

Lastly, consider attending a group. Educational and support groups for parents or caregivers of children with ADHD can be very helpful. These groups can provide a place to feel supported, get questions answered and discover new ways of dealing with the symptoms of ADHD. Groups are also available for children who have ADHD. These groups help children diagnosed with ADHD learn to socialize, empathize and interact better with their peers.

Dr. Amaya Rucker

ADHD Recommendations for Children

Research indicates that individuals with ADHD are best served when they receive intensive and ongoing expert care, not only for the purpose of addressing current symptoms, but to reduce future risk factors.  Untreated, children with ADHD are at greater risk for depressive symptoms, drug and alcohol abuse, school delinquency, academic failure, and accidents (including motor vehicle accidents).   While medication management is the most research-proven intervention consistently shown to reduce the symptoms of ADHD, there is emerging research evidence that neurofeedback provides significant therapeutic benefit, meeting the standards for being considered clinically “effective” by the medical and psychological community.  Parents should be aware that symptom response is likely to be more gradual with neurofeedback techniques (though they may result in more permanent improvements). The research that has been done shows that neurofeedback is effective in reducing impulsivity and hyperactivity, as well as increasing the ability to focus. For more information about neurofeedback, EEG Spectrum International (www.eegspectrum.com) and EEG Info (www.eeginfo.com) are recommended resources.  If you are interested in exploring this option further, you are encouraged to seek a consultation or an initial training session with Amanda Trent, M.A. at Genesis Counseling Center in our Hampton location by calling (757) 827-7707.

It is recommended that you be aggressive in establishing and maintaining adequate sleeping, eating, and exercise habits as a basic first step in the treatment of your child’s attention symptoms.  The number of hours of sleep generally necessary for optimum brain functioning depends on your child’s age, but can be established using the following guidelines: 11-13 hours for pre-schoolers; 10-11 hours for pre-adolescents; and 9-10 hours for adolescents.  To get the required sleep, follow these basic rules: follow a consistent bedtime routine and schedule; transition to sleep with a quiet and relaxing activity such as 15-30 minutes of reading; avoid foods or drinks that contain caffeine 3 hours prior to bedtime; do not go to bed hungry, but don't eat a big meal before bedtime either; and, the bedroom should be quiet, dark and a little bit cool.  If these steps do not result in an improvement in your child’s ability to fall asleep, he may be experiencing a disruption in his body’s natural production of the hormone melatonin, which aids in sleep, and you may wish to consider, in consultation with his pediatrician, the use of melatonin before bedtime.  If anxiety is a key aspect of your child’s sleep problems, you are strongly encouraged to meet with your therapist to discuss cognitive and behavioral strategies for reducing bedtime stress.  If sleep remains a problem, further consultation with a therapist and possibly a sleep specialist is recommended.

In regards to diet, while research has demonstrated that sugar and artificial food coloring and additives (AFCAs) can amplify behaviors associated with ADHD, these potential effects are insufficient as a causative explanation for ADHD broadly.   Nonetheless, it is prudent to assess to what extent dietary or environmental factors may be exacerbating your child’s symptoms.  You may wish to meet with a registered dietician and/or allergist to develop a plan for ruling out potential irritants and improving functioning generally.  In the meantime, monitor any notable behavioral changes that consistently occur subsequent to specific environmental, and especially dietary, exposures (e.g., caffeine, red dye, sodium benzoate).  In terms of diet generally, follow a principle of reducing intake of simple carbohydrates (sugar, corn syrup, refined flours, pasta) and increasing intake of protein (found in lean meats, fish, and low-fat dairy products) and fiber (found in whole grains, nuts, and fruits and vegetables) as much as possible.  Lastly, there is some evidence that decreasing the ratio of omega-6 fatty acids (found in vegetable oils) to omega-3 fatty acids (found in coldwater fish, or taken in supplement form, and many nuts), reduces symptoms relating to poor attention and concentration (as well as having significant health benefits relating especially to cardiovascular health).  At a minimum, be mindful to pair carbohydrates with fat and protein whenever feeding your child.  The quick absorption and breakdown of carbohydrates into glucose by the body results in the sugar “rush” seen when kids eat candy or soda (thereby contributing to or exacerbating hyperactivity) while the subsequent release of insulin by the body to lower sugar levels results in a “crash” (thereby contributing to or exacerbating attention difficulties due to lethargy).  The addition of some protein and/or fiber (e.g., a slice of cheese or some nuts), with a snack or meal, slows down absorption of the carbohydrates as well as providing a delayed energy source (the body breaks down fat and protein, as well, but more slowly), thereby reducing both the “rush” and the “crash” effects.  A secondary environmental effect to be aware of is excessive television viewing (defined as more than 2 hours daily for elementary-age children and more than 3 hours daily for teenagers), as it is associated with elevated risk for attention difficulties, academic difficulties, and classroom boredom.

In regards to exercise, a daily 20-30 minute period of physical activity which elevates one’s heart rate is a well established baseline for therapeutic benefit.  This can be accomplished simply by a brisk walk or bike ride.  If your child enjoys videogames, having him play Dance Dance Revolution, or other physically interactive video games, as a creative way to incorporate exercise into his day (as well as being a fun family activity). 

It is recommended that you schedule a medical consultation with a child psychiatrist.  Finding a medication and dosage that provides your child with the maximum therapeutic benefit with the fewest medical risks or side effects may take time and expertise beyond the training or experience of your child’s general practitioner.  Research studies indicate that children under

expert medical care for their ADHD symptoms are more likely to have improved functioning then children under general medical care.  In preparation for your appointment, you are strongly encouraged to download from
http://www.parentsmedguide.org a copy of “The ADHD Parents Medication Guide” produced by the American Academy of Child and Adolescent Psychiatry.

Beyond symptom reduction, individuals with ADHD have been shown to benefit from environmental accommodations and specialized behavioral plans which take into account the neurological realities of the disorder.  You are strongly encouraged to have follow-up consultations with a clinical psychologist to learn and develop a plan tailored to your child’s specific strengths and weaknesses. 

Research indicates that individuals with ADHD show improved focus and attention when exposed to mild extraneous stimuli.  While counter-intuitive, strategies such as allowing your child to listen to music through headphones or manipulate a squeeze ball during activities that require sustained attention, such as homework, should be investigated and implemented consistently if found to be beneficial.  While students may protest in the classroom setting if your child is given special permission to complete work with headphones or a manipulative, his teacher can explain that the manipulative is necessary for him in the same way that glasses are necessary for someone who needs glasses to read.

If your child does not currently have an educational plan in place at his school, and there is sufficient evidence that your child’s ADHD symptoms are significantly affecting his academic performance, you are encouraged to initiate a thorough Child Study through the public school system as he may be eligible for a 504 Plan.  A 504 Plan will formalize specific academic accommodations appropriate to your child’s ADHD difficulties (such as increased time for taking tests).  You are also encouraged to access resources from the Learning Disabilities Association of America (LDA: http://www.ldanatl.org) and specifically to purchase “The LDA Advocacy Handbook: A Parent’s Guide for Special Education” to help guide them through the Child Study and 504 Plan process.

With or without a 504 Plan in place, you and your child’s teachers are encouraged to develop specific educational goals, strategies, and accommodations for your child.  Examples of strategies and accommodations for students with ADHD that may be beneficial at school include: preferential seating close to the teacher to limit peer distractions, utilizing hands-on and interactive exercises whenever possible, and trying techniques that introduce mild stimulation to aid in concentration (e.g., allowing your child to manipulate a squeeze ball, or listen to headphones, while he works or to move around at his desk instead of sitting).  School-based interventions may also consist of individualized remedial tutoring as well as academic study skills training aimed at improving organizational skills and strategies related to successful academic performance.  “The PREPARE Curriculum” by Arnold Goldstein is a resource that may be helpful in addressing anger control issues, if an issue, in the classroom.  Also, daily communication should take place between you and your child’s teachers.  This can be accomplished through a simple chart with notes highlighting academic and behavioral successes for the day and homework expectations.  Teacher feedback about problematic behaviors should be communicated to you directly (and not through your child) via e-mail, text-message, or phone.

In lieu of services accessed through the public school system, or as an adjunct to them, you may wish to seek a consultation from a private educational specialist, such as through the National Institute for Learning Development (NILD: http://www.nild.net) or Sylvan Learning (http://www.sylvanlearning.com).

You are encouraged to educate yourselves in-depth about ADHD and Learning Disorders.  Two recommended resource books are: “Parenting Children with ADHD” by Dr. Vincent Monastra, and “Healing ADD” by Dr. Daniel Amen.  They are also encouraged to seek social support from other caregivers of children with ADHD and Learning Disorders.  Parenting a child with ADHD is especially tiring and frustrating and can lead to social isolation due to their child’s behavioral difficulties.  This is often exacerbated by the fact that parents of children with ADHD frequently struggle themselves with attention, concentration, organization, and impulse control difficulties.  Support groups offer parents a means for expressing their frustration, discovering new parenting strategies, and experiencing community with others who understand the challenges of parenting a child with ADHD and learning difficulties.  Support groups and educational resources can be found through an organization called Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD: http://www.chadd.org) and, for adults specifically, through an organization called the Attention Deficit Disorder Association (ADDA: www.add.org). The University of Michigan Health System (http://www.med.umich.edu/1libr/yourchild/adhd.htm) and LDOnline (http://www.ldonline.org) both provide excellent resource materials for both ADHD and Learning Disorders.

Lastly, children with ADHD typically suffer with low self-esteem due to the near constant negative feedback they receive for failing to meet others’ behavioral and academic expectations.  Over time, failure and disappointment become thematic for their interpersonal relationships.  As a buffer to this, you are strongly encouraged to make it a daily habit to spend some uninterrupted one-on-one time with your child. 

Dr. Jeffrey Olrick

ADHD Recommendations for Adults

Research indicates that individuals with ADHD are best served when they receive intensive and ongoing expert care.  While medication management is the most research-proven intervention consistently shown to reduce the symptoms of ADHD, there is emerging research evidence that neurofeedback provides significant therapeutic benefit, meeting the standards for being considered “clinically effective” by the medical and psychological community.  You should be aware that symptom response is likely to be more gradual with neurofeedback techniques (though they may result in more permanent improvements). The research that has been done shows that neurofeedback is effective in reducing impulsivity and hyperactivity, as well as increasing the ability to focus.  For more information about neurofeedback, EEG Spectrum International (www.eegspectrum.com) and EEG Info (www.eeginfo.com) are recommended resources.  If you are interested in exploring this option further, you are encouraged to seek a consultation or an initial training session with Amanda Trent, M.A. in our Hampton location by calling (757) 827-7707.

It is recommended that you be aggressive in establishing and maintaining adequate sleeping, eating, and exercise habits as a basic first step in the treatment of your attention difficulties.  The number of hours of sleep generally necessary for optimum brain functioning should generally fall in the 7-8 hour range.  To get the required sleep, follow these basic rules: follow a consistent bedtime routine and schedule; transition to sleep with a quiet and relaxing activity such as 15-30 minutes of reading; avoid foods or drinks that contain caffeine 3 hours prior to bedtime; do not go to bed hungry, but don't eat a big meal before bedtime either; and, the bedroom should be quiet, dark and a little bit cool. 

In regards to diet, while research has demonstrated that sugar and artificial food coloring and additives (AFCAs) can amplify behaviors associated with ADHD, these potential effects are insufficient as a causative explanation for ADHD broadly.   Nonetheless, it is prudent to assess to what extent dietary or environmental factors may be exacerbating your symptoms.  You may wish to meet with a registered dietician and/or allergist to develop a plan for ruling out potential irritants and improving functioning generally.  In the meantime, monitor any notable behavioral changes that consistently occur subsequent to specific environmental, and especially dietary, exposures (e.g., caffeine, red dye, sodium benzoate).  In terms of diet generally, follow a principle of reducing intake of simple carbohydrates (sugar, corn syrup, refined flours, pasta) and increasing intake of protein (found in lean meats, fish, and low-fat dairy products) and fiber (found in whole grains, nuts, and fruits and vegetables) as much as possible.  Lastly, there is some evidence that decreasing the ratio of omega-6 fatty acids (found in vegetable oils) to omega-3 fatty acids (found in coldwater fish, or taken in supplement form, and many nuts), reduces symptoms relating to poor attention and concentration (as well as having significant health benefits relating especially to cardiovascular health).

In regards to exercise, a daily 20-30 minute period of physical activity which elevates one’s heart rate is a well established baseline for therapeutic benefit.  This can be accomplished simply by a brisk walk or bike ride.  If you enjoy videogames, playing Dance Dance Revolution, or other physically interactive video games, is a creative way to incorporate exercise into your day. 

It is recommended that you schedule a medical consultation with a psychiatrist.  Finding a medication and dosage that provides you with the maximum therapeutic benefit with the fewest medical risks or side effects may take time and expertise beyond the training or experience of a general practitioner.  If you choose to use your general practitioner, be sure to ask their experience and comfort level treating ADHD.

Beyond symptom reduction, individuals with ADHD have been shown to benefit from environmental accommodations and specialized behavioral plans which take into account the neurological realities of the disorder.  You are strongly encouraged to have follow-up consultations with a clinical psychologist to learn and develop a plan tailored to your needs. 

Research indicates that individuals with ADHD show improved focus and attention when exposed to mild extraneous stimuli.  While counter-intuitive, strategies such as listening to music through headphones or manipulating a squeeze ball during activities that require sustained attention should be investigated and implemented consistently if found to be beneficial.

You are encouraged to educate yourself in-depth about ADHD.  Two recommended resource books are: “Taking Charge of ADHD” by Dr. Russell Barkley and “Healing ADD” by Dr. Daniel Amen.  Support groups and educational resources can be found through an organization called Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD: http://www.chadd.org) and, for adults specifically, through an organization called the Attention Deficit Disorder Association (ADDA: www.add.org).

Resources: