caregiver day alternative treatments
TRANSCRIPT
PRINCIPLES OF ADHD TREATMENT
Dr. Paul Soper MD FRCPCChild and Adolescent Psychiatrist
Glenrose ADHD Program
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ADHD Child
EmotionallyHealthy
Adult
Developmental Perspective
?Better FocusBetter GradesLess HyperLess Impulsive
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What Do Children with ADHD need?
1.LOVE2.EMPATHY3.CONNECTION
Hallowell and Jensen, 2010Saturday, 21 September, 13
ADHD Child
EmotionallyHealthy
Adult
Developmental Perspective
Emotional Nutrition1. LOVE2. EMPATHY3. CONNECTION
Saturday, 21 September, 13
ADHD Child
EmotionallyHealthy
Adult
Developmental Perspective
Emotional Nutrition1. LOVE2. EMPATHY3. CONNECTION
ADHD Sx:HyperactivityDistractionOppositionForgetfulnessDisorganizationImpulsivity Irritability
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Finding Balance
LoveEmpathyConnection
Side EffectsCosts
Every treatment decision should be based on how much Emotional Nutrition is increased vs the side effects/costs.
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Finding Balance
Number of StudiesQuality of StudiesAmount of Improvement
Side EffectsCosts
One must also consider the science that is behind each treatment recommendation.
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Finding BalancePros vs Cons Checklist
Pro ConsGreatly Improves ADHD Mildly Improves ADHDFew Side Effects Many Side EffectsTolerable Side Effects Barely Tolerable Side EffectsMildly Changes Personality Dulled PersonalityWorks Quickly Takes Weeks to WorkAffordable Difficult to AffordMany Studies Few StudiesWell Done Studies Poorly Done StudiesFamily Will Accept Family Won’t Accept
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Websitehttp://edmontonadhdsociety.org
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Principles of TreatmentCADDRA Guidelines (www. CADDRA.ca)
Treatment Should be Multimodal and include:
Parental Education (You are doing this today)
Lifestyle Optimization (Sleep, Diet, Exercise)
Parent Training (Priscilla will cover this)
Medication (Dr. Wincott will cover this)
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Lifestyle Optimization
Sleep
Diet
Exercise
Social Connections
Other
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Lifestyle Optimization
Sleep
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Lifestyle Optimization
Sleep• Sleep - Average Sleep Per Age
• 6-12 (10 hours)
• 12-18 (9 1/2 hours)
• If child wakes on their own/with little difficulty without sleepiness during day they are probably fine.
• No study has shown improvement in ADHD symptoms with improvement in sleep.
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Lifestyle Optimization
Sleep• Should consult with your health care provider.
• Generally, sleep hygiene is an effective strategy in up to 30% of children with sleep problems.
• Melatonin usually works for the rest of kids who do not respond to sleep hygiene.
• If sleep problems persists, the health care provider should be consulted.
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Pros vs Cons ChecklistSleep
Pro ConsSleep is Good Mildly Improves ADHDFew Side Effects Takes Weeks to WorkTolerable Side Effects Tough to Implement (Teens)Mildly Changes PersonalityOK Number of StudiesOK quality of Studies Family Will AcceptAffordable
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Lifestyle Optimization
Diet
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Lifestyle Optimization
DietA balanced diet based on Health Canada’s Guidelines is most important
Most common strategies include:
Use of Omega 3s (EPA 400 - 600mg)
Elimination Diets (0.51) - Pelsser, Feingold
Food Coloring Exclusion (0.42)
Adding zinc, iron, vitamins... (Poorly studied)
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Lifestyle Optimization
Exercise
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Exercise
One hour of daily rigorous exercise results in a multitude of long term benefits for health.
“The acute effects of exercise have been associated with reductions in negative behaviors and improvements in acceptable behaviors and cognitive functions in children with clinical disorders categorized by poor impulse control and attention.”
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Lifestyle Optimization
Connection
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Lifestyle Optimization
ConnectionTo ensure a child’s emotional growth, it’s important for kids to feel like they belong.
I’ve never found a study that relates to a specific program.
Programs that are frequently helpful:
Sports: Tae Kwon Do/Hockey....
Clubs: Cubs/Scouts/Girl Guides/Church
Lego club, Computer Club....
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Lifestyle Optimization
Other
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Lifestyle Optimization
Others
Cogmed
“In the studies we reviewed, training involved a variety of working memory tasks, and such training generalizes to other equivalent measures of working memory, but there is no evidence of a transfer to other less directly related tasks.”Melby-Lervåg 2013
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Lifestyle Optimization
OthersNeurofeedback
“The standardized mean differences for all psychological interventions dropped considerably, to nonsignificant levels, when analyses were restricted to trials with probably blinded assessments.” Sonuga-Barke 2013
Herbal Products - there are many...
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Conclusions
Optimizing Sleep, Diet and Exercise is good.
The evidence thus far suggests some mild benefit to improve symptoms of ADHD especially with dietary strategies.
Like any treatment, one must decide whether there is an adequate improvement in emotional nutrition to justify the cost/difficulties with implementing a treatment.
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