ADHD: What is it and tips to help

ADHD (Attention-deficit / hyperactivity disorder) is a neurological condition. This means that it originates in the brain; ADHD is not a behavioral disorder, a mental illness, or a learning disability. ADHD falls into the category of “neurodivergent.”

ADHD significantly impacts the parts of the brain that control executive functioning - things like planning, attention, organization, and self-awareness. There is a gap between ABILITY and PERFORMANCE - meaning that an individual with ADHD has the ability to complete a variety of tasks, but is often unable to perform them. For example, a child with ADHD may have the ability to plan and build a Lego structure, however due to symptoms of ADHD such as challenges with initiation, attention, and sequencing, they are unable to perform the actions.

Additionally, ADHD can impact an individual across their lifespan, beginning in childhood and affecting them in adulthood - creating challenges in academics, social situations, and daily self-care tasks. However, the symptoms of ADHD often change as the individual ages - they may struggle more with hyperactivity as a child, inattention as an adolescent, and combined-type in adulthood.

ADHD is often seen in combination with other conditions or disorders. An individual with ADHD may also have a learning disability, anxiety, depression, Sensory Processing Disorder (SPD), or may be Autistic. However, one does not automatically equal the other.

What causes ADHD?

There is no one determining factor that has been identified to “cause” ADHD. Some studies have shown that ADHD is highly hereditary - ADHD is known to run in families and occurs more often in identical twins than in fraternal twins.

Studies have also shown that exposure to certain chemicals and toxins can have an impact on ADHD. One study specifically found that, “in the case of the phthalates which have been observed to increase psychological disorder, specifically attention-deficit hyperactivity disorder (ADHD).” Another study found that, “Attention deficit hyperactivity disorder (ADHD) is associated with heavy metal exposure during adolescent development.”

Some studies have shown that ADHD may appear after a child suffers a traumatic brain injury (TBI). One study showed a connection between maternal autoimmune disease and ADHD among children. Other studies have shown that ADHD is more likely to occur if there were complications during pregnancy, if the child was exposed to alcohol or tobacco in utero, or if the birth was traumatic. It’s important to note that ADHD is a brain based condition and research has shown that the brains of individuals with ADHD do have physiological differences.

Symptoms of ADHD

ADHD symptoms can vary person to person, but they often share similar symptoms, such as:

• Sleep challenges
• Emotional dysregulation
• Low self esteem
• Sensory overload

ADHD can be broken down into 3 different types:

1. Primarily Hyperactive and Impulsive ADHD
2. Primarily Inattentive ADHD (formally ADD)
3. Combined Type ADHD

Hyperactive and Impulsive ADHD

This is when the individual needs to be moving - constantly fidgeting, squirming, sensory seeking. They may talk non-stop and interrupt during conversation as well as struggle with self-control / impulse control. This type is often what we see with children and is often seen more in boys.

This child will be constantly “on the go,” is unable to sit still for focus tasks such as in the classroom or for a meal, and can’t seem to control their impulses. They struggle to wait in line and seem to have no patience for quiet-time tasks.

Inattentive ADHD

This is when the individual struggles to focus on tasks - they have difficulty with attention and focus. They may make careless mistakes and struggle to follow multi-step instructions. This type is most often seen in adults and more often in girls.

This adult will struggle to follow a conversation and may appear bored or “spaced out.” Working memory is very difficult, they are easily distracted, and they lose or misplace things frequently. Any task that requires sustained attention is difficult - reading a book, sitting for a lecture, or cooking a complex meal. Organization is often poor and forgetting appointments happens frequently.

Combined Type

This is when an individual displays symptoms from both above types.

Diagnosing ADHD

ADHD begins in childhood and in order for a diagnosis, symptoms will have appeared at a young age. Keep in mind that children often exhibit symptoms of ADHD due to other factors, such as SPD, sleep deprivation, nutritional deficiencies, or even just due to their age - a toddler may seem “hyperactive” when in reality, a toddler is supposed to be on-the-go frequently. Therefore, when diagnosing ADHD, the symptoms must be seen in multiple environments over a period of at least 6 months, and must significantly impact daily functioning.

A physician will assess the symptoms and will use the DSM-V (Diagnostic and Statistical Manual of Mental Disorders) to identify if the symptoms match ADHD.

Executive Functioning

Executive functioning is a set of skills that help to plan, execute, and monitor tasks and goals. There are 7 areas of executive functioning:

1. Self-awareness
2. Inhibition (impulse control)
3. Working memory
4. Emotional regulation
5. Motivation and initiation
6. Planning
7. Problem solving

These executive functioning skills are necessary for daily tasks such as showering, cooking a meal, and following a routine; work and school related tasks such as following directions, planning and executing a project, and sustaining attention for a lecture; and maintaining social relationships which includes holding meaningful conversations, planning hang-outs with friends, and establishing boundaries and managing emotions. For children, executive functioning skills are also required for play - planning and imagining play activities, completing building activities (including drawing or writing), and controlling their body for physical activities.

Executive functioning is a key factor in ADHD - an individual with ADHD will often show symptoms of executive dysfunction. An individual with Primarily Hyperactive and Impulsive ADHD may struggle significantly with self-awareness, inhibition (impulse control), working memory, and emotional regulation. An individual with Primarily Inattentive ADHD (formally ADD) may struggle significantly with self-awareness, motivation and initiation, planning, and working memory.

ADHD and Sensory Processing

Sensory processing is the ability to organize and understand sensory information - this includes the things that you see, hear, feel, taste, and smell. It also includes your ability to organize and understand movement and emotions. There are eight senses in your sensory system:

1. Tactile (sense of touch)
2. Visual (sense of vision; not how well you see, but how you understand what you see)
3. Auditory (sense of hearing; not how well you hear, but how you understand what you hear)
4. Olfactory (sense of smell)
5. Gustatory (sense of taste)
6. Proprioception (sense of how your body moves through space; aka kinesthesia)
7. Vestibular (sense of movement and balance; directly related to head position changes)
8. Interoception (sense of internal workings - hunger, illness, emotions, etc.)

ADHD and sensory processing challenges often go hand-in-hand. For example, an individual with Primarily Hyperactive and Impulsive ADHD may be very sensory seeking - they seek out specific types of sensory input, specifically vestibular and/proprioception (movement and heavy work activities). An individual with Primarily Inattentive ADHD (formally ADD) may fall on the other side of sensory processing - sensory avoiding. Additionally, individuals with ADHD may often feel a sense of sensory overload - the sensory input in their environment is “too much” and they feel anxious and overwhelmed, and are unable to utilize strategies that help (due to the symptoms of ADHD such as challenges with initiation and problem solving).

You can learn more about sensory processing challenges here.

Tips and Tricks to Help

First, it’s best to seek out a trained professional to help if you or your child is struggling with ADHD. This may be a therapist or counselor, an occupational therapist, or another professional with experience and training in helping ADHD individuals. Research is showing that a combination of specific, personalized strategies and treatment works best.

For the purpose of this article, we will focus on tips and tricks for children with ADHD. However, these strategies can also be adapted for adults!

Neuroplasticity and neurofeedback training

Neuroplasticity is defined as “the ability of the nervous system to change its activity in response to intrinsic or extrinsic stimuli by reorganizing its structure, functions, or connections” (NIH). Think of it as a “growth mindset” - the ability to change your brain! This can be especially helpful for individuals with ADHD, since ADHD is a neurological condition.

Some ideas for teaching a growth mindset:

• Empathize with the struggle - verbalize that you understand that your child is struggling and that it’s ok to have challenges; normalize the struggle!
• Encourage your child to complete challenging activities and talk about the benefits of “doing hard things.”
• Model doing hard things and overcoming challenges. How can you set an example for your child to try new, challenging things?
• Vocalize positive self talk. Instead of “I can’t do this, it’s too hard,” try “This is hard and I can’t do this YET. But I’ll keep trying and get better!”
• Develop strategies for challenging situations. This will be very personalized to each individual and each situation.

Along with neuroplasticity and teaching a growth mindset, look into neurofeedback training. Research is growing in this area and demonstrating positive results in relation to helping those with ADHD. One study found that “Standard neurofeedback protocols in the treatment of ADHD can be concluded to be a well-established treatment,” while another stated that, “The thought is held that frequent use of neurofeedback will strengthen neural networks needed to sustain focus and improve executive function.”

Learn more from Michael Klinkner, LCSW by listening to this podcast episode - All Things Sensory Podcast Episode 80.

Environmental strategies

Changing the environment (home) and setting up specific strategies throughout the day can be a game changer. The trick - individual each strategy to fit the child AND be consistent.

Sleep and the bedtime routine

Setting up a consistent bedtime routine to ensure good quality sleep is a huge factor. Sleep is when we recharge after a long day, our body can rest, and our brain can repair itself. Without good quality sleep, ADHD symptoms will be magnified and the day will be extra difficult.

Set up the bedroom for quality sleep by using black-out curtains, decreasing the clutter (put toys away in the closet, use bins, etc.), changing the night light to a red light, and using a noise machine if necessary.

Set up the bedtime routine with a few key strategies to help prepare the brain and body for sleep:

• First, meet the child’s sensory threshold 1-2 hours before bedtime. This means providing them with the sensory input they are seeking out. Learn more about meeting the sensory threshold here.
• After the child’s sensory threshold has been met, utilize calming strategies such as heavy work, deep touch pressure, dimming the lights, listening to calm music, and using calming scents like lavender.
• Be sure to limit food, water, and screen time 1-2 hours before bedtime.
• Additionally, ensuring that the child gets enough outside time and movement throughout the day will help the brain and body feel more calm at bedtime.

Screen time

Overall reducing the amount of screen time during the day can help with ADHD symptoms. Oftentimes, extended amounts of screen time can play a role in challenges with emotional regulation and impulse control.

Try these tricks with screen time:

• Set firm and consistent boundaries. Don’t give in if you’ve established screen time rules.
• Use movement before and after screen time.
• Get outside before and after screen time. Try to include more outside time when your child has been using a screen during the day.
• Limit screen time before bed.
• Go on a screen detox once a week.
• Model healthy screen time boundaries - the more you are on a screen (that includes your phone), the more your child will want to be on a screen.

Nutrition

“One of the earliest treatments for ADHD comes from Hippocrates, who described patient with features similar to ADHD as having “quickened responses to sensory experience, but also less tenaciousness because the soul moves on quickly to the next impression”. His treatment suggested various dietary interventions and physical activities (69). Modern day dietary interventions for ADHD include restricted elimination diets (eliminating food associated with hypersensitivity), avoidance of artificial food color and supplementation of free fatty acid.” (NIH)

Take some time and look at your child’s diet. Are there any nutritional deficiencies? Are they getting enough protein? Do they have any food sensitivities or allergies? What types of chemicals are in the foods they’re eating? Do you notice an increase in ADHD symptoms after eating certain foods? It can be helpful to work with a functional nutritionist.

Clutter and organization

One of the symptoms of ADHD is often challenges with organization. This can lead to a messy space - challenges with keeping materials organized and decluttered. This also leads to losing and forgetting materials often.

First step - declutter! Do a purge of your child’s bedroom and donate anything that your child hasn’t used in the past 6 months. It can be helpful to do this on a regular basis. Don’t forget to do the same for your own room *wink wink.*

Additionally, because toys are the often-most purchased gifts for children, identify other gift ideas that don’t include buying MORE toys that will be donated 6 months later. What about a gift certificate to your child’s favorite ice cream shop or book store? Or a ticket to your child’s favorite amusement park. Experiences often last longer (in memory) than toys. Plus, they don’t add to a cluttered bedroom.

As for organization of materials, take pictures of the space when it is organized and use it as a reference when cleaning and organizing. For example, a picture of the bathroom sink or drawer when it is cleaned and organized. Or a picture of your child’s clothes closet or desk. This can also be a helpful strategy at school - a picture of your child’s school desk when it is organized. Following a visual example for cleaning and organizing is especially helpful for a child with ADHD who already struggles with this.

Use visuals

Do you use a visual schedule, like a calendar? Maybe it’s a calendar on your phone, or a large family calendar on the wall. Why do you use a calendar? To keep track of activities and appointments most likely.

A child with ADHD likely struggles with planning, initiating, and organizing daily tasks. This is where a visual schedule is helpful. Identify what daily tasks are challenging and create step-by-step visual schedules for each. For example, if your child struggles with the daily morning routine of getting ready for school, you can create a visual schedule (written or pictures, or both!) of each task they need to complete each morning.

Some tips when creating and using a visual schedule:

• Include your child in the process of making the visual schedule and talk about WHY it will be helpful. Try to avoid blaming your child - “we have to use this because you can’t stay focused in the morning.” Instead try saying “we’re making this so that the morning routine is easier for both of us!”
• Make it fun and motivating. Does your child like checking off boxes? Or would they prefer a velcro schedule where they can remove each item as they finish it?
• Practice and be consistent. Your child may not “get it” the first couple of mornings. Be sure you practice it with them, stay consistent, and help facilitate success and independence. Patience is key here.

Additionally, visual timers are often helpful for the child to see how long they have left for a task. This can help them improve their attention to a task in order to complete it in a certain period of time. It can also help with tasks that are non-preferred; they are able to visually see how long the task will last and may be more motivated to complete it if they know it will end soon.

Calm down corner

Create a space in your home where your child can go to “calm down” or decompress. Children with ADHD often get overloaded with too much information and they can easily shut down or explode. A calm down corner (or name it something that works for your family) is a place where your child can go when they feel overloaded with too much information. This is especially helpful after school or after an event, like a birthday party.

Some tips when creating a calm down corner:

• It should be enclosed in order to decrease the amount of visual stimulation.
• The items in the calm down corner should be calming for your child: pillows and weighted blankets, twinkle lights, soft music, fidget toys, etc. It will be very personalized.
• Have your child help you make the calm down corner.
• Talk about what it is for and role play different situations.
• Do not use it as a punishment.

Watch this YouTube video for more tips on creating a calm down corner.

Caregiver training

If your child is struggling with ADHD, or if you know of a caregiver with a child, participating in caregiver training can be especially helpful. First, learning more about ADHD is essential. Then, learning different strategies to help your child will provide great benefits to the entire family.

Learn how to:

• Co-regulate. When your child is experiencing a very challenging moment, it’s important to know how to co-regulate and be their safe space.
• Set them up for success. This includes teaching them strategies that they can use independently.
• Set clear and consistent expectations. This can be difficult when your child is struggling, but it’s very important.
• Provide positive reinforcement over negative reinforcement. This includes rewarding the small things and building up over time, as well as rewarding effort over results.

Emotional regulation and stress management

“A 2018 systemic meta-analysis of RCTs (49) found that “meditation-based therapies” (which included mindfulness, vipassana, yoga, among many others) resulted in a moderate effect size in improving childhood ADHD symptoms, with higher benefits in inattention than in hyperactive-impulsive symptoms.” (NIH)

“A 2017 systemic review (66) attempted to look at benefits of mindfulness in both children and adults who had ADHD, and found that in adults, mindfulness-based interventions had significant improvement in attention.” (NIH)

Learning more about mindfulness techniques, yoga for kids (and adults!), and other types of self-awareness strategies can be very helpful. This might include reaching out to a trained professional who can provide services. There are many apps available that are geared towards teaching children mindfulness techniques. Find the one that works best for your family.

Another strategy is looking into an emotional regulation program. This program should include teaching your child about different emotions and what events or activities elicit certain emotions, as well as personalized strategies to incorporate into the daily routine, and in-the-moment strategies.

Sensory strategies

As briefly discussed in the section above about sensory processing, a child with ADHD is likely to also struggle with sensory processing. They may fall into the category of “sensory seeking” or “sensory avoiding.” It’s likely that your child falls into both categories, for different sensory systems. For example, your child may be “sensory seeking” of movement, while simultaneously “sensory avoiding” of tactile input. Or your child may be “sensory seeking” of tactile input while simultaneously “sensory avoiding” of visual input.

When looking into using sensory based strategies (which is recommended!), be sure to take these into consideration:

• Always meet your child’s sensory threshold (sensory needs) during the day. This means including specific sensory input that your child seeks out and enjoys.
• Use calming proprioceptive sensory input to help calm the nervous system.
• Fidgets and oral motor tools are a great way to help provide proprioceptive input and improve attention to certain tasks (it’s important to teach your child the benefits and the “why” behind using these strategies).
• Get outside. The benefits of being outdoors have been researched in numerous studies and the benefits are extraordinary.
• Use frequent sensory breaks. Movement has been shown to improve learning outcomes, therefore frequent movement/sensory breaks should be incorporated into the daily routine, especially at school.

Movement and exercise

Going along with sensory strategies, including movement and exercise into the daily routine has numerous benefits. Many different types of movement and exercise have been studied in relation to ADHD and they seem to have positive outcomes.

Some different types of exercise to look into for your child:

• Martial arts
• Yoga (as previously discussed, this also helps with mindfulness)
• “Yoga offers strategies to increase attention regulation and emotion regulation skills, which are core to ADHD.” (NIH)
• Bal-A-Vis-X
• Brain Gym

Primitive Reflexes

If you’re not familiar with primitive reflexes, read this article to learn more.

One study in particular found that primitive reflexes and ADHD are linked. Another study found a link between inattention and retained primitive reflexes in preschoolers. And another study found a link between 2 specific primitive reflexes and ADHD symptoms (as well as balance deficits).

If your child is struggling with ADHD, it can be helpful to learn more about primitive reflexes and seek out a professional trained in primitive reflex integration.

Accommodations at school

Some accommodations that can be utilized in the school setting for children with ADHD:

• Frequent sensory breaks
• Noise canceling headphones during focused tasks
• Visual timers and visual schedules
• Gain eye contact and have the child repeat back the instructions

Medication

It’s important to talk with your pediatrician about medications for ADHD symptoms. Be sure to carefully weigh the pros and the cons of putting your child on medication. Also make sure you understand all of the risks and side effects.

• Weigh the pros and cons
• Know the risks and side effects

“ADHD is a chronic condition that impacts functioning throughout the span of life. It requires multimodal interventions and though medications approved by FDA form the cornerstone of treatment of ADHD, many studies have shown non-pharmacological interventions also have become helpful to overall management of ADHD. Though many parents use some form of integrative medicine in ADHD, there are mixed results from studies. More research is needed in the mind-body, herbal and other integrative interventions for ADHD.” (NIH)

Final thoughts

If you or your child is struggling with ADHD, try one strategy at a time. Identify where the greatest need is and implement a consistent strategy for a couple of weeks. Reevaluate to identify if the strategy is helping to improve quality of life. Work with a professional who can help with this.

Watch our video on 6 Strategies for ADHD