First, this is what ADHD actually is…
“It stands for attention deficit hyperactivity disorder and child ADHD is a complex neurodevelopmental disability that often continues into adulthood. A child with ADHD may have difficulty sustaining attention, be hyperactive and behave impulsively. Left untreated, these symptoms can affect a child’s success at school, create behavioural difficulties and cause problems at home. ADHD affects millions of children worldwide and typically appears in early childhood. If your child has ADHD, you may start to notice symptoms before they reach the age of six.” – Dr Jenna Vyas-Lee, clinical psychologist & co-founder of mental healthcare clinic Kove
Lucinda Miller, NatureDoc
What nutrients are children with ADHD most likely to be deficient in?
The nutrient that crops up most often as a deficiency in children with ADHD is omega-3 DHA is an essential omega-3 fatty acid for the brain that is gained through diet and helps with neurodevelopment as well as eye development. Over 90% of the omega-3 in our brain is made up of DHA, which you can mainly get from eating oily fish and seafood. DHA feeds the frontal lobes, which enables executive function such as sustained attention, planning and problem solving. Omega-3 is also a key nutrient for the prefrontal lobe of the brain, which is important for social, emotional and behavioural development.
Minerals such as iron, zinc, and magnesium are also important for the synthesis and release of the ADHD brain hormone dopamine and these nutrients are frequently low in children with ADHD. Iron is abundant in foods like red meat and beans. Zinc is also available in meat, as well as shellfish, nuts and seeds. Good sources of magnesium include green vegetables, dark chocolate and nuts. Additionally, there are usually shortfalls in other key vitamins such as vitamin D and a broad spectrum of B vitamins, all vital brain nutrients derived from a balanced diet and in the case of vitamin D, from summer sunlight. These all support optimal brain cell nourishment.
Why are these nutrients depleted?
There are several theories. One is that children with ADHD may have a compromised ability to digest and assimilate nutrients efficiently, which can result in inadequate absorption of these nutrients even when eating a healthy diet.
Additionally, many children are drawn towards ultra-processed and convenient foods that provide a short-term ‘blissful’ dopamine boost. Unfortunately, most of these foods lack the nutrients needed for optimal cognitive function. If children consume lots of these sugary and carbohydrate-rich foods, they may end up not eating enough nutrient-dense foods. This can result in a lack of key vitamins, minerals and fats in their diet.
Why are they so important for children with ADHD in particular?
When genetic testing is performed on people with ADHD, inherited difficulties with making and synthesising dopamine and norepinephrine are often identified. Nutrients such as magnesium and zinc are necessary building blocks for creating these brain hormones. Therefore, if a child is genetically predisposed to slow dopamine production or excessive norepinephrine production, they may require higher levels of these nutrients than other children to support their production and synthesis. This, in turn, can help manage lack of focus, impulsivity, procrastination, and other symptoms associated with ADHD. Research has also found that many of these nutrients work alongside ADHD medications to work better in combination and can also help to reduce the side effects of the medication.
How can you test for deficiencies?
At NatureDoc, we conduct comprehensive laboratory tests to determine a child’s specific nutrient needs. These tests typically involve urine, saliva, and hair analysis, and in some cases, blood tests, but we try to be as non-invasive as possible.
What are the signs a parent can look out for to spot deficiencies?
Start by keeping a food diary and asking yourself whether your child is eating foods that contain omega-3 (oily fish, walnuts, chia seeds, and organic whole milk); iron and B vitamins (red meat, liver, pulses, and green vegetables); zinc (seafood, nuts, seeds, meat, and dairy); and magnesium (nuts, leafy greens, and dark chocolate). If your child is not consuming these foods regularly, there may be shortfalls in their nutrient intake that could be contributing to their ADHD.
Some omega-3 deficiency signs to look for include bumpy ‘chicken skin’ at the tops of the arms and on their cheeks; paleness and lethargy with difficulty in learning for iron and B vitamin deficiency; emotional dysregulation, white flecks on the nails, and being a picky eater alongside slow growth for low zinc; and finally twitches, tics, restless legs, growing pains, constipation, and light sleep for low magnesium.
How important is the brain/gut connection?
In addition to consuming the right fats, vitamins, and minerals to maintain a healthy balance of dopamine and norepinephrine, it’s important to maintain a healthy balance of beneficial bacteria in the intestine. These gut microbes are building blocks for producing a wide range of neurotransmitters, which is why the gut is sometimes referred to as our second brain. Once made in the gut, these neurotransmitters travel to the brain via the vagus nerve, a ‘superhighway’ connecting the gut and the brain. It’s been suggested that 90% of the signals along the vagus nerve are transmitted from our gut to our brain, and only 10% from our brain to our gut. Therefore, nourishing our gut bacteria is crucial if we want to optimise dopamine and norepinephrine levels.
How can it be improved?
Gut microbes thrive on a diverse range of fruits, vegetables, salads, nuts, seeds, pulses, and beans, as well as cultured foods like live yoghurt, kefir, vinegar, miso, and pickles. It is also recommended that children take a probiotic supplement containing live bacteria to support the microbiome. This is particularly important after taking antibiotics. Probiotics may also be of benefit if your child has ongoing gut issues, eats a very limited diet or doesn’t consume dairy products.
What kind of diet should children with ADHD follow?
Focus on incorporating nutrient-dense foods into every meal. It is best to aim for a diet that is high in protein and healthy fats, with a lower carbohydrate content, as this helps to balance blood sugar levels, regulate energy and focus, and can prevent ‘hangry’ moments, meltdowns, and overwhelm. It may seem like a difficult task, especially as many children with ADHD can be picky or set in their ways.
Are there any foods to avoid?
The key dietary changes to aim for is to cook from scratch where possible and cut right back on eating shop-bought ultra-processed foods, as these tend to contain inadequate nutrients as well as additives. They are also often high in starches, which when consumed on their own can set up a tricky rollercoaster ride of highs and lows in terms of mood, focus and energy over the day.
Can you share three recommended supplements?
You can’t go far wrong with supplementing a good quality omega-3 fish oil as well as additional zinc and magnesium.
NatureDoc is launching its first online Nutrition for ADHD and ADD Course on 17th April. Book here.
Ben Isaacson, ADHD Confident
How can children with ADHD benefit from coaching?
The problems affecting children with ADHD vary, which is why understanding the distinction between the types of support available is so important. Several elements of ADHD coaching and therapy overlap, however there are some notable differences to bear in mind. While therapy is a highly effective and powerful means of facilitating emotional change, its prime focus is on deeper underlying issues, such as emotional trauma.
Coaching focuses on the future with a key emphasis on goals, creating change and empowering clients with behaviours and strategies for everyday situations. It is ‘action-based’ – which means it helps to address practical problems. ADHD coaches have a specialist knowledge of ADHD, which is something many practitioners, coaches and clinicians are not familiar with, particularly in areas such as RSD (Rejection Sensitive Dysphoria) and emotional dysregulation. The biggest distinction is the role of the ADHD coach as the child’s own advocate. An ADHD coach takes the role of mentor, teacher, role model and personal cheerleader. Many ADHD children grow up with a huge lack of confidence and self-esteem, so providing this positive energy is crucial to their progress.
What would a typical session or programme include?
Some children respond well to a structured coaching programme, however, it's important to emphasise that some ADHD kids won’t respond well to this type of structure, so it’s important parents and coaches approach each session with a willingness to adapt to the child’s individual needs. That said, the coaching sessions tend to be about 45 minutes long and are scheduled on a weekly basis. Most children will struggle to stay focused for longer than this. Generally, the amount of coaching required will vary. While some children will require several months of coaching to get through their studies, others are better suited to a long-term relationship. Our coaching packages start off with a minimum period of three months, followed by a reassessment.
At what age should coaching start?
There has to be a certain level of maturity – so usually from the age of 11. Bear in mind, the child has to want to be there. If the child isn’t engaging, it’s never sensible to force them to participate. This is why we tailor coaching towards the child's ‘interest based’ nervous system.
Do parents ever get involved?
My coaching style is always ‘child’ led, so I don’t teach parents how to bring up their children. The reason for this is because ADHD kids don’t respond well to being told what to do. From my experience, the only way to change a child’s behaviour is for them to find the motivation to do so. My coaching sessions aim to help them find that path, which is what leads to sustainable lasting change. Each week, we spend time exploring the child’s challenges through an ADHD lens and finding ways to make useful changes.
Sol Matossian, Integrative Child & Adolescent Psychotherapist At The Soke
Is therapy suitable for a child with ADHD?
The short answer is yes, but it depends on the age of the child. For children under six, an ADHD diagnosis is rare. Therapy for children younger than 12 is therefor usually more focused on training the parents in behaviour management, teaching and equipping them with the skills and strategies to support the child. Learning and practicing behavioural strategies require time, openness and dedication, but it can have long-term positive outcomes.
Is there a particular type of therapy that's best?
Behavioural therapy for both children and parents should aim at supporting the child in the family setting and school environment. Cognitive Behavioural Therapy (CBT) focused on ADHD specifically should be delivered by a trained psychotherapist or psychologist. Dependent on the age of the child, therapy varies: from role-play to play therapy, and utilising senses depending on what the child responds to, be it a more tactile approach or drawing. The agreed treatment plan will include strategies based on the child and is outcome-driven. Working collaboratively with the school there will be a focus on current challenges the child is navigating to devise suitable behavioural strategies.
How does it work, what happens in the sessions and is there 'homework’?
Homework comes in the form of applying strategies between sessions, which is then reviewed in the sessions to find out what worked, and what didn’t. There can be frustration (often from parents) that stems from the fact that children with ADHD sometimes don’t respond to classical behavioural strategies like reward and punishment, which means interventions will have to be altered. Parents may have unrealistic expectations which need to be adjusted to allow for flexibility if progress is slower than expected.
For children between ten and 12, session time is usually split 50/50. This means that there will be a session spent alone with the child and a separate session with the parents to gauge their feedback. This arrangement may vary depending on the family’s dynamics e.g. if there are siblings. The session will look at current behaviour that the parents may want to change, for example playing fewer video games. The therapist, child and parents may look for clues to see what it is that the child is engaging with, reinforcing, and harnessing the positives of the behaviour. It may be that the child is highly effective at problem-solving and executive functions when playing video games, which can be useful if transferred to real-life experiences. It is about empathising with the parents and the child and ensuring that boundaries are more flexible to ensure success for both.
How often would you expect to see them?
Depending on the age of the child, it is useful to have weekly sessions, especially in the first two months and then perhaps moving to a fortnightly schedule. Every child is unique, and the process will be different for everyone, so finding a structure that works is paramount. Furthermore, therapy can be augmented with the help of various off-session support, such as groups for parents with ADHD children, or resources to further educate parents.
Dr Jenna Vyas-Lee, Clinical Psychologist & Co-Founder Of Kove
When might a child need to start medication to help manage their ADHD?
Medication is the first line of intervention for ADHD. Both therapy and medication can help children manage it, and often, a combination of the two works best.
How would this be assessed?
For your child to receive an ADHD diagnosis, they need to be formally assessed by a child ADHD specialist. This could be a clinical psychologist, a psychiatrist or a paediatrician. A GP can’t formally diagnose ADHD, but they can refer you to a specialist. There isn’t one simple test for ADHD. A health professional can only reach a diagnosis after a detailed assessment. Assessment for medication is a collaborative approach and decision by all the key stakeholders i.e. parents, doctors, teachers and the child. A psychiatrist is who will eventually prescribe medication.
What are the most common types of medication available?
Medications available to treat ADHD include methylphenidate, lisdexamfetamine, dexamfetamine, atomoxetine, and guanfacine. Which one is best will come down to the psychiatrist, who will look at a range of factors including symptoms and other health conditions. Dosage is also determined by specific symptoms and health conditions. Once a child starts taking medication, it’s a good idea to take it regularly – even daily to begin with – so you can understand the impact. Many children only take it during term time, or in the week, but it really depends on symptoms and any potential side effects. Some take it every day.
Can you explain the side effects?
As with all medications there are a range of side effects that the psychiatrist will discuss with you so you can make an informed decision. The main one is potential issues with appetite and making sure the child stays a healthy weight, as many of the medications act as an appetite suppressant.
What else does the medication actually do?
It brings up their level of stimulation to a typical level so they are no longer needed to constantly seek stimulation. This means they have the capacity to attend to the stimuli in front of them for longer periods.
Heather Welch, International Brand Manager At Edx Education
How do traditional teaching environments hinder a child with ADHD?
Traditional teaching methods can be austere and based on archaic ideas of strict classroom rules and conformity, with a heavy emphasis on memorisation. For children with ADHD, this can be problematic as they often struggle with memorisation and find it hard to focus. Children with ADHD often have difficulty with attention and regulation, too. They demonstrate emotional dysregulation, hyperactivity, hyperfocus and impulsivity, which can affect planning, organising, communicating and managing behaviour from the teacher’s perspective.
In what ways can a classroom be adapted to help children with ADHD?
Just as the teachers will adapt to different children, classrooms must be adaptable for a range of children to pass through its doors. For example, some children fare better if placed in the back corner to sit on the communal carpet. Others may need to be sat on a chair nearest to the teacher so the teacher can intervene if needed. Children may need a fidget toy, a wobble cushion, or even chair leg bands on the bottom of the chair. Research also says that children with neurodivergent brains, including ADHD, are twice as likely to have other conditions to watch out for, including physical problems such as hypermobility. For some, even sitting still on a carpet can cause issues. For others it’s crossing their legs or W-sitting, so these are things that need to be considered.
How should the teacher adapt their process to engage a child with ADHD?
All children need to be engaged in learning. Teachers of students with ADHD need to understand how to engage, motive and enthuse these class members, just as much as other class members. Teachers can adapt their lessons and make a task look achievable from the outset. Children can be given easy tasks to complete, which work towards a long-term goal. One of the quick wins a teacher can have in a class with an ADHD child is to allow for movement. Maybe a fidget toy, maybe running an errand in between tasks, maybe it’s moving to a ‘safe place’ when they’re unsettled. Direct, clear instructions, peppered with praise for effort has always worked – especially for children with ADHD.
What kind of specific educational support would be helpful?
Emotional Literacy Support Assistants (ELSA) are becoming more prevalent in primary schools and can be very helpful for children struggling in classroom environments. While extra resources are not always available, there are many other types of educational support teachers can give children with ADHD. One-to-one assistance is key for children who are falling behind in specific areas like reading, maths or science, as are individual learning plans with strategies and tactics to help a child grow within the class environment.
What should parents be asking teachers for if they think their child is falling behind?
Most teachers will mention if the child is having issues. Some mainstream schools can be large, bureaucratic and cumbersome, so parent-teacher evenings provide the opportunity to find out what your child is learning and where their strengths, weaknesses and opportunities lie. Parents need to ask teachers directly if their child needs support. Teachers will happily explain how individual learning plans – with strategies and tactics – will help a child.
Which types of reward system can help kids with ADHD?
Reward systems are an effective way to engage and inspire all children within school environments, especially children with ADHD. The best reward systems that lead most effectively to behaviour change are the same that build relationships. And the best method to promote behaviour change will be through frequent, lightweight rewards. ‘Gamification’ is a reward system often used in primary school settings, where game elements are woven into teaching methods to promote and reward good behaviour, making learning fun, engaging and encouraging enthusiasm and passion within the classroom environment. In primary schools, the reward systems need to be clear, realistic, fair, engaging and most of all help build a relationship between the child and person implementing the reward system, whether that be the teacher, the parent or the caregiver.
What’s one piece of advice you'd give a parent of an ADHD child who is struggling at school?
A child with diagnosed ADHD who is struggling to focus is a child who will not be happy. The most important piece of advice anyone can give to the parent of this child is simple: listen. It’s easy to give advice, but really, it is difficult to listen. As parents, we need to seek out and listen to that one great teacher who might not directly influence our children but will have sound ideas.