ADHD INTERVENTIONS 1

Non-Pharmacological Approach for ADHD

Emma Ericson, Jaden Barton, Breanna Koper, Elizabeth DeSalle

Centofanti School of Nursing, Youngstown State University

3749 Nursing Research

Ms. Heasley

April 9, 2023
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Non-Pharmacological Approach to ADHD

Throughout the past decade, society has seen an increase in the diagnosis of cognitive

disorders. One of these disorders is attention deficit hyperactivity disorder (ADHD). It affects

many young children and adolescents. Although there are no physical abnormalities, if left

undiagnosed or untreated, this can lead to further health and social problems later in life. Two

major symptoms involved with ADHD are the inability to concentrate and impulsive behavior.

Many children may struggle with learning in school or creating social connections. The most

common treatment is medication. This may be seen as the easiest way to control ADHD, but

non-pharmacological interventions may be just as effective, and safer. If given to adolescents,

medications like Ritalin can have a potential negative effect. Ritalin is a central nervous system

stimulant acting on the brain and its dopamine receptors. Even as an adolescent, the brain is still

growing and developing. There are controversies on the topic of ADHD medications altering the

development of the brain. Non-pharmacological interventions include cognitive/behavioral

therapies and lifestyle changes for the child and parent. A great example is the parents creating a

reward chart at home for the child to complete tasks. The child completes the same task as

others, but the extra enforcement is important. After exploring the varieties of treatment, we

come to the question: in adolescence, what is the effect of non-pharmacological interventions for

the treatment of ADHD compared to the pharmacological interventions?

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Attention Deficit Hyperactivity disorder, ADHD, is a condition which heavily impacts

the neurodevelopmental aspect of the body and can be manifested in many ways. Due to this, it

can cause hardships, especially in adolescents, when trying to regulate emotions, behavior, and

formulating reactions. One that is a major factor and is an indicator of ADHD is emotional

dysregulation and the aggression that accompanies. Emotional Dysregulation is the inability to

respond emotionally, appropriately, and adequately to a given situation or circumstance. Even

though emotional dysregulation is the major concern, many other problems and difficulties can

arise from this broad category and in turn, can create developmental, communicative, and social

delays. It is important to consider the emotional, behavioral, and responses within this disease to

target and help treat these areas.

One new program researchers are gearing their attention to is Cognitive Behavior

Therapy, CBT. Many studies have proposed that CBTs (Cognitive Behavioral Therapy) are

feasible and that they fabricate major strides when measuring anxiety. The purpose of CBT is to

help adolescents learn new techniques to manage emotions. In this manner, it will help emotions

and the regulation of the emotions to become more concrete and controlled. Due to the element

of aggression and the correlation with ED (Emotional Dysregulation), CBT deems to be useful

only when this therapy is geared towards both parents and child. In this way, the parents can

learn what is best for their adolescent children and they will be able to help them work through

emotional situations or feelings. One study looked at CBT and worked out a specific program

called “How to improve anger and frustration management”. This program geared the content on

anger coping and the reduction or decrease in aggressive behavior. Researchers wanted to

evaluate the initial response to the therapy versus the results six months after the therapy to see

the true effectiveness of the program. Due to the creation of new techniques and in-depth
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learning programs, CBT is becoming more useful and effective when addressing the emotional

and behavioral aspects of ADHD and an adolescent’s way of coping.

Another program that was measured up against Cognitive Behavioral Therapy was

Theatre Based Intervention, TBI (Theatre Based Interventions). This therapy helps to further

improve social skills. This may be as specific as interacting with other children or as broad as

improving the socio-cognitive functioning as a whole. When taking a deeper look into TBI, it

differs from CBT in the fact that it is mainly a role play activity and is more gauged towards

skills. In the same study as the CBT, the TBI group did not have a specific program followed. It

was a one-hour session that was based upon existing acting techniques. Also during that hour

were several sensory games, imitation activities, and other means of expression exercises. The

goal of this group is to put these adolescents into an environment that would help them develop a

better understanding of communication and being able to express themselves along with a better

representation of self-esteem. Although this method did seem to help and was somewhat useful,

it did not prove as effective as CBT when looking at the results six months later. Due to the lack

of teaching and more expression and loosely set objectives, this therapy did not seem to stick to

the degree CBT was able to. Even though these were the results from this study, TBI therapies

are still being used and developed alongside other options and programs to continue to help

adolescents with ADHD develop appropriate expression and communication skills.

When looking into these non-pharmacological methods to help manage these emotional

and behavioral difficulties, it is not only important to stick to a regimen and be consistent, but to

also indoctrinate these interventions among parents as well. Not only will this increase the

adolescent’s responses to these interventions, but it will also help parents better understand their

children and be more equipped when handling some adverse or out of the ordinary behavior. Not
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only are these interventions proving to be useful, but they are also opening up more opportunity

and revealing more of a need for additional research. As time continues, the results from this

study will become more influential, negatively, or positively, due to the extended and prolonged

time with using these interventions. While these may prove to be useful, they are not the only

things that can help with the regulation of this disease.

Lifestyle Changes to Treat ADHD

When it comes to nonpharmacological interventions for ADHD, Cognitive Behavioral

Therapy is the most common choice; however, not the only choice. Different forms of integrative

medicine and dietary interventions can be used. Integrative medicine consists of lifestyle changes

and a more holistic approach to treatment. There are five forms of integrative medicine. Out of

those five, mind-body interventions are the main choice when it comes to treating ADHD.

Dietary interventions are another source that provides an added form of treatment to those with

this disorder. “About 50% to 64% of parents of children with ADHD report using integrative

medicine to treat ADHD symptoms” (Shrestha et al., 2020, p.118).

Mind-Body Interventions

Mind-body interventions consist of meditation, mindfulness, yoga, tai chi, hypnotherapy,

prayer, and different forms of therapy including music and pets. These forms of treatment have

been shown to have a positive effect on stress and anxiety. They also improve attention levels.

Meditation is a formal practice where an individual focuses on themselves. Mindfulness is being

fully present and aware of your surroundings. Often those with ADHD struggle to focus on one

thing, and meditation and mindfulness focus on this area. Meditation and mindfulness have

shown positive impacts on those with inattentive symptoms. Yoga includes the act of being

mindful but also being attentive to your body through physical exercise. According to Shrestha et
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al. (2020), “Yoga offers strategies to increase attention regulation and emotion regulation skills,

which are core to ADHD” (p. 118). Tai chi is a form of Chinese medicine. It has similar benefits

to meditation, mindfulness, and yoga but is also shown to improve hyperactivity symptoms,

whereas the others do not. The rest of the mind-boy interventions have similar impacts. They all

work to improve attention through mental, emotional, physical, and spiritual means.

Dietary Interventions

The main focus of dietary interventions is to reduce the number of stimulant foods

ingested and increase dietary intake that improves cognitive function. An individual with ADHD

may want to cut out artificial food coloring. The current data on this is limiting and does rely on

parent reports (Shrestha et al.,2020). Options to increase would include Vitamin D, omega-3

fatty acids, and free fatty acids. Vitamin D and omega-3 fatty acids are known to improve

cognitive function; however, more research is needed to determine their full benefits. Drechsler

et al. (2020), stated, “free fatty acid supplementation has been described to bring about small but

significant reductions in ADHD symptoms …” (p. 327). Several research studies back up free

fatty acid supplementation’s reduction in ADHD symptoms. As with integrative medicine,

dietary interventions are a great addition to treatment but should not be the sole source.

Conclusion on Lifestyle Changes to Treat ADHD

Integrative medicine and dietary changes have a variety of interventions that are used to

treat ADHD. These types of interventions consist of lifestyle changes, holistic therapies,

supplements, and dietary restrictions. The full benefit of lifestyle changes does depend on the

severity of ADHD symptoms. With mild ADHD, these may be enough. With moderate to severe

symptoms, an individual will need other forms of treatment. All in all, these interventions should
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not be the only treatment used to treat ADHD symptoms. They are beneficial additions to other

forms of treatment for ADHD but do not have enough of an impact to be the only form of

treatment. They are beneficial in decreasing stress and improving focus during the moment.

Scientific research lacks in this area, and there are not enough studies showing the full effect of

these forms of treatment for ADHD.

Attention deficit disorder is one of the most common neurological disorders that

adolescents are diagnosed with. Symptoms can include hyperactivity, lack of attention, and

impulsiveness. This can affect adolescents in the classroom, which can affect their learning.

When nonpharmacological treatments have not worked, stimulants should be the first choice of

medication. If the adolescent's symptoms are having adverse effects on their life, a psychiatrist or

doctor will prescribe this medication. Individuals with ADHD have lower levels of

neurotransmitters firing in the brain, such as dopamine, which is associated with the reward

center of the brain. Considering this, doctors prescribe methylphenidate and amphetamines,

which work by restoring a chemical imbalance by inhibiting presynaptic dopamine reuptake.

(Santosh 2017). With this, there is an increased amount of dopamine in the brain. Before starting

medication, a full health history and a physical examination need to be taken, along with the start

of a growth chart.

Different stimulants may need to be trialed before landing on the correct one for the

person. There are two classes, such as amphetamines and methylphenidate. Within the

methylphenidate category, there is a brand called Ritalin. With this, multiple doses might be

needed to control symptoms throughout the day. This drug is very useful during school and can

be sprinkled into yogurt if the adolescent has trouble swallowing pills. The amphetamine most

commonly talked about is Adderall, and this medication can reverse dopamine uptake and
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transport proteins to increase dopamine levels in the brain. (Santosh, 2017). This medication is

also useful during school because it controls the symptoms well and lasts as long as 7 to 12

hours. There are similarities between the two classes, such as releasing dopamine from neurons

and stopping the dopamine transporter, which increases dopamine reuptake (Santosh 2017). But

with amphetamines, dopamine is released at a rate four times higher than that of

methylphenidates. If psychosis were to occur, there would be a much higher risk with a drug like

Adderall than with Ritalin in adolescents with ADHD. (Moran LV; Ongur D; Hsu J; Castro VM;

Perlis RH; Schneeweiss S);

The medications can have some adverse effects on the individual's well-being. These

include dry mouth, loss of appetite, and sleeping problems. It is advised not to take stimulants

after 4 p.m. because there might be an inability to fall asleep and wind down before bed. These

can also cause a reduction in growth, so it is not advised to administer them to a short adolescent

because growth will slow down even more (Santosh, 2017). Since the medications are

stimulants, they can raise blood pressure and heart rate, which can lead to cardiac issues. This

needs to be monitored closely because comorbidities must be avoided as much as possible.

Blood pressure and heart rate should be checked frequently during and after the medication

treatment. There are a few contraindications when using stimulants, including schizophrenia,

hyperthyroidism, and cardiac arrhythmias (Santosh 2017). Some other rare side effects include

seizures and suicidal ideation. Depression and suicidal tendencies should be monitored, and if

detected, the medication should be stopped immediately, and the adolescent needs to return to

the psychiatrist. Because the long-term effects of stimulants have limited effectiveness, it is

advised to continue treatment as long as symptoms have no adverse effect on the quality of life.

These medications do not produce an addiction when used appropriately and as prescribed by
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physicians. Treatment-free periods can also be suggested to deter adverse side effects, such as

holidays and weekends if the adolescent is using this primarily for school (Santosh, 2017).

To summarize, the pharmacological interventions for adolescents with ADHD vary from

person to person depending on their needs. The treatment can be complex, and new therapies are

being developed every year. And the rates of diagnoses have increased greatly over the past

couple of years. The pharmacological treatments do have some adverse side effects, such as

weight loss and insomnia. But with education and symptom management, adolescents can

improve in the classroom and wherever else they need help to have the maximum quality of life.