ADHD stimulant medications such as Ritalin and Adderall are a common treatment for the disorder, but they come with certain risks, such as abuse and negative side effects.
Recently, several techniques have been developed in schools and homes to help children with ADHD behave and perform better without medication. They range from daily report cards to added stimulation to regular exercise, and many are research-supported. Ideally, these treatments should be combined in more than 1 setting to ensure the best outcome.
What is ADHD?
Attention-deficit hyperactivity disorder (ADHD) is a condition that leads to trouble paying attention, hyperactivity, and difficulty controlling impulses. It can affect a child’s thinking, behavior, and relationships and lead to failure in school, depression, and an increased risk of accidents. The disorder can continue into adulthood and cause poor performance at work.1
According to data published by the National Center for Health Statistics, in 2011–2013, 9.5% of children aged 4–17 years had been diagnosed with attention-deficit hyperactivity disorder (ADHD). Prevalence was 2.7% for those aged 4–5, 9.5% for those aged 6–11, and 11.8% for those aged 12–17.2 About 4.1% of adults struggle with the disorder.3
Common Medications and Concerns
Stimulant medications are commonly used to treat ADHD because they increase dopamine levels in the brain and help to improve attention, concentration, and self-control.1,4
The most common ADHD medications are:
Even though these medications work well when used properly, people who do not have ADHD sometimes abuse them to improve performance and lose weight since the drugs lower appetite and boost energy.4 In 2015, about 1.7 million people aged 12 or older—or 0.6% of this population—had abused stimulants in the past month.5
There is also the question of whether these medications are overprescribed. Stimulant prescription use increased from 0.6% among youth in 1987 to 2.7% in 1997. The rate leveled off at 2.9% in 2002; however, 1 survey found that prescription use of stimulants among 6- to 12-year-olds increased from 4.2% in 1996 to 5.1% in 2008. Among 13- to 18-year-olds, the rate increased from 2.3% in 1996 to 4.9% in 2008.6
The rise in prescriptions may have to do with a study published in 1999 in the Archives of Psychiatry. It found that medication alone worked better than intensive behavioral treatment, standard community care, and an approach that combined behavioral treatment and medication.
But a number of follow-up studies, including one published in 2007 in the Journal of the Academy of Child and Adolescent Psychiatry, found that groups who received different treatments didn’t significantly differ in results when viewed over a longer period of time.7
Further, these medications can lead to side effects such as slowed growth, blurred vision, decreased appetite, seizures (mostly in people with a history of seizures), trouble sleeping, nervousness, and headaches.8
Studies have also shown that children have trouble taking the medication on a regular schedule. One study found that children with ADHD who were prescribed methylphenidate missed a quarter of their doses in a 3-month period. Also, 20% stopped taking medication by the fourth month, 44% stopped taking it by the 10th month, and only 22% were still taking it after 2 years.9
Concerns about over-prescribing and abuse of ADHD medications have led experts to focus on alternative ways to manage ADHD symptoms.
Creative Teaching Approaches
One of the approaches to managing ADHD without medication involves training teachers in specific techniques that help keep students focused and engaged. Some of these techniques include:7,9-13
- Immediate feedback: ADHD students get instant gratification after they complete a task. For example, teachers write the answers in invisible marker on worksheets, and students can color over the space as soon as they finish the question to find out what the answer is. A similar approach is to give students daily report cards that show them how well they met certain goals.
- Optimal stimulation theory: This theory, developed by Sydney S. Zentall, a professor of special education at Purdue University, states that children with ADHD need a higher level of stimulation in their environment than other children. Techniques for implementing this theory in the classroom include allowing children to make spontaneous verbalizations and using colors to highlight important information.
- Exercise: Studies have found that children with ADHD perform better after they exercise. Teachers can allow students with ADHD to exercise before, during, and after academic activities. For example, teachers can have students learn words by getting them to stand up when they say vowel sounds and sit down on consonant sounds.
- Novelty: Zentall’s research also discovered that children with ADHD are drawn to novelty (i.e., they pay attention to what is bigger, brighter, more intense, more colorful, and louder). Any strong type of stimulation can grab and hold their interest and help them focus. Ideas for incorporating novelty into classrooms include using gadgets, lights, shapes, and colors in the background while students are working. Her research found that students could look at visual stimulation and then return to their work with an increased ability to pay attention. Teachers can also use novel activities such as films and free time to break up lectures and seated activities. Other studies found that allowing students to look in mirrors and watch themselves do schoolwork improves performance.
- Music and sound: Research shows that elementary and junior high ADHD students perform better when there is music playing, as opposed to silence or conversation in the background. Constant, low-level sounds (e.g., white noise or music the students prefer) appear to work better for ADHD students than spoken words.
- Tasks: Breaking 1 task into smaller parts to complete at different times, using fewer words when explaining tasks, and decreasing the repetitiveness of tasks all help students be more productive.
- Seating: Seating ADHD children away from distractions and next to good role models, having them work in a quiet part of the room, and seating them closer to the teacher have helped children focus better and produce better results in some situations.
What are Behavioral Interventions?
Other options include behavioral interventions, which have proven highly effective, including:7,13
- Parent programs: Teaching parents strategies they can use with their children with ADHD, such as praising them when they are on track, can serve as positive reinforcement for desired behavior. Other forms of reinforcement include tokens and point systems. Parents are also taught how to provide clear, specific commands; how to establish consistent rules and expectations; and how to use “when/then” reward systems, such as allowing a child to use an electronic device after they complete their homework. In addition, parents can use negative consequences when a child doesn’t follow the rules, such as not being able to engage in an activity they like or having to give up some of their tokens.
- Recreational programs: These programs bring ADHD children together at camps and similar locations where they participate in crafts, sports, and other activities in addition to interventions such as social skills training. The programs last for several weeks, during which children learn how to work with others and be a member of a team.
- Peer programs: These programs teach children with ADHD skills in a group setting with instruction, modeling, rehearsal of skills, feedback, and rewards for positive behaviors. Targeted skills include academic, study, and organizational skills; self-care and daily living skills; and social skills such as good sportsmanship, assertiveness, dealing with teasing, and how to make friends.
Merging these approaches seems to yield the most benefits. When parent training is combined with school interventions, teachers report fewer ADHD symptoms. And when parent training is combined with child programs, children improve organizational, social, and academic skills.14
How to Modify Your Lifestyle
Finally, lifestyle modifications can help children focus and perform better in school.1,7,15
- Exercise: Letting children exercise more may improve their ability to sit still before they do homework or other tasks that require concentration. In one study, elementary school–aged children with and without ADHD performed better on math and reading comprehension tests after spending 20 minutes on a treadmill. Youth sports teams can give them a regular outlet for their energy and also help them learn how to cooperate with others.
- Sleep: Research suggests that even an extra half hour of sleep can help kids be less restless in school and behave better. Less sleep results in the opposite: frustration and throwing fits.
- Diet: Other lifestyle treatments include keeping ADHD children on a healthy diet that avoids sugars and food additives and giving them megavitamins and herbal and mineral supplements. A diet rich in protein that includes omega–3 fatty acids and minerals such as zinc and magnesium, may also help.
- Complementary alternative medicine (CAM): CAM treatments include meditation, yoga, homeopathy, vision training, electroencephalogram feedback, and applied kinesiology. Research has not confirmed that these treatments work, however, and they are not covered by insurance.
When it comes to your child, you understandably want what’s best for them. Collaborating with their pediatrician, natural health practitioner, or other treatment professional can help you formulate the best ADHD treatment approach, which may include some combination of non-medical and medical therapies.
- Krull, K. (2017). Patient education: Treatment of attention deficit hyperactivity disorder in children (Beyond the Basics). UpToDate.
- Pastor, P. et al. (2015). Association Between Diagnosed ADHD and Selected Characteristics Among Children Aged 4-17 Years: United States, 2011-2013. Centers for Disease Control and Prevention, National Center for Health Statistics.
- National Institute of Mental Health. (n.d.). Attention-Deficit/Hyperactivity Disorder Among Adults.
- National Institute on Drug Abuse. (2014). Stimulant ADHD Medications: Methylphenidate and Amphetamines.
- Center for Behavioral Health Statistics and Quality. (2016). Key substance use and mental health indicators in the United States: Results from the 2015 National Survey on Drug Use and Health (HHS Publication No. SMA 16-4984, NSDUH Series H-51).
- National Institute of Mental Health. (2011). Prescribed stimulant use for ADHD continues to rise steadily.
- Clay, R. (2013). Easing ADHD without meds. Monitor on Psychology, 44(2), 44.
- Food and Drug Administration. (2013). Medication Guide: Ritalin.
- Zentall, S. (2005). Theory- and Evidence-Based Strategies for Children with Attentional Problems. Psychology in the Schools, 42(8), 821–836.
- Armstrong, T. (2017). The Myth of the ADHD Child: 101 Ways to Improve Your Child’s Behavior and Attention Span Without Drugs, Labels, or Coercion. London: Penguin.
- Armstrong, T. (2012). Kids with ADHD Benefit from Physical Exercise. American Institute for Learning and Human Development.
- Vostal, B., Lee, D., & Miller, F. (2013). Effects of Environmental Stimulation on Students Demonstrating Behaviors Related to Attention Deficit/Hyperactivity Disorder: A Review of the Literature. International Journal of Special Education, 28(3).
- Dunne, D. (2007). How Can Teachers Help Students With ADHD? Education World.
- Pfiffner, L. & Haack, L. (2014). Behavior Management for School Aged Children with ADHD. Child and Adolescent Psychiatric Clinics of North America, 23(4), 731–746.
- ADDitude. (n.d.). Why Sugar Is Kryptonite for ADHD Brains.