caregiver day alternative treatments

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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