If you’re the parent of a child or teen with ADHD—or if you’ve received a diagnosis yourself—trying to figure out how to support your brain in the chaotic world we live in can feel overwhelming. At Brainy Moms, we like to recommend a holistic approach to ADHD intervention, as we discussed on this episode of the Brainy Moms podcast.
Brainy Moms host Dr. Amy Moore is a cognitive psychologist and researcher who specializes in ADHD and other cognitive differences. But beyond that, she is an ADHD mom and a mom with ADHD, so she understands the struggles (and strengths!) of people with this diagnosis.
Why do we need these five pillars to address ADHD?
“I think that we need to take a holistic approach to ADHD, which is why I’ve developed these five pillars,” explains Dr. Moore. “Because if we only hit it from one side, we miss the opportunity to really give our kids a leg up.”.
It’s worth noting that these five pillars are applicable across the board, not just with ADHD, but also with any neurodevelopmental disorder and cognitive struggles.
“These are not five pillars of intervention,” explains Dr. Moore. “These are five pillars of looking at ADHD holistically. So, not only how do we intervene, but how do we determine if ADHD is really what’s going on as well. So it’s kind of from the assessment angle, as well as the intervention angle.”
What are the 5 pillars of ADHD Intervention and Support?
Pillar #1: Sleep.
As Dr. Moore explains, when a parent asks, “Do you think my child might have ADHD?”, one of the first questions she asks is how well they sleep and how long they sleep for.
“Because children 6 to 13 need 10 hours of sleep a night to function well, and teens need 9 to 10 hours of sleep in order to function well,” explains Dr. Moore. “And so if our children are sleep deprived, that will show up in terms of their ability to focus and pay attention in school the next day. We know what it looks like in the classroom the next day. We know that the inability to manage emotions shows up with lack of sleep as well. So you get some of that oppositional behavior in addition to that inability to focus.”
She continues, explaining sleep “is like putting your brain through a car wash.” This is how this works:
“When we fall asleep, there’s like a valve system in our brains. So we fall asleep and this valve opens and releases cerebrospinal fluid that washes our brain. Why do our brains need to be washed while we sleep? Well, as we go about our day, we use up neurotransmitters. And neurotransmitters are those chemicals that help our neurons communicate. And as we use them up, they leave behind toxins. This cerebral spinal fluid rush that happens when we sleep cleanses the brain of those toxins left behind from using up neurotransmitters and from that beta amyloid that’s collecting in the brain.”
So it’s not just about a kid not getting enough sleep and being “cranky.” The right quality and quantity of sleep helps ensure our brain is functioning well.
Pillar #2: Physical activity.
While the word “exercise” often produces a visceral response in some people, physical exercise doesn’t always have to be a structured Zumba class or 60 minutes on the treadmill. For kids, it could be climbing, running, walking—just being active on the playground, at a park, or in the backyard. The goal is simply to get the heart rate up.
“If we can get our heart rate up and get into the aerobic zone, then our brains produce a protein that we have abbreviated, BDNF, that’s short for brain derived neurotrophic factor,” explains Dr. Moore. “And simply, it’s like ‘MiracleGro’ for our brain. In that aerobic zone, our brains are producing this BDNF, and that actually helps our neurons communicate and grow. So, physical activity is super important, especially for kids with ADHD, because we know that neurotransmitter function is compromised in ADHD. And remember, neurotransmitters are those chemicals that help our neurons communicate with one another. And so BDNF helps that communication.”
Pillar #3: Nutrition.
When it comes to diet, Dr. Moore says it’s less about how much the child eats but rather what they consume.
“We know that sugar is inflammatory and creates inflammation in the body, including the brain,” says Dr. Moore. “Inflammation in the brain makes it harder for neurons to communicate with one another.”
Dr. Moore says gluten, too, can impede neurons’ ability to communicate with one another effectively—even for people without Celiac disease or a true gluten intolerance.
“Whether it’s actually ADHD or just symptoms that look like ADHD, reducing gluten and sugar in the diet might make them improve,” she says. “And so I always suggest follow a 90-10 rule: 90% of the time, eat low sugar, low grain; 10% of the time, let them eat cake, right? I mean, because unless they have gluten intolerance or celiac disease, there’s no reason to not let them have treats once in a while for sure. And if you haven’t had your child tested for food sensitivities or food allergies, and you’re seeing symptoms that look like ADHD, I would absolutely say, ask your doctor about being tested. Because when we eat foods that we are allergic to, it creates an inflammatory response in the body, and then that shows up as lack of focus, lack of concentration, low energy, things that look like ADHD, but might not be.”
Pillar #4: Chronic stress management.
Dr. Moore says she doesn’t even need to ask parents if they’re child is under chronic stress because she knows ALL kids are.
“It’s the way of childhood,” she laments. “The amount of homework that schools assign to young children creates stress. The busyness that we create for our own kids by having them in activities every single day creates stress. And if your child is struggling to learn with either a diagnosed or undiagnosed learning disability or just learning struggles, that creates stress.”
Why is chronic stress a concern? As Dr. Moore explains, the brain responds the exact same way to this chronic stress as it does to trauma.
“We know that our brain has this really cool threat-detection system,” she explains. “Humans have to be able to run from the bear, fight the bear, or play dead in front of the bear to maximize our survival. We don’t think about that same process occurring in our brains from chronic stress, but it does. Our children are hurried, because they have too much to do and not enough time to do it in right? Their little brains get stuck in that fight, flight, or freeze mode. They’ve got cortisol and adrenaline coursing through their veins. It shrinks their hippocampus. It interrupts the connections in their brain and really makes it that much harder to learn, to focus, to pay attention, to make good decisions.”
So what do we do for our kids to help increase their resilience to this kind of stress?
According to Dr. Moore, one of the ways is to teach them mindfulness and grounding and breathing exercises that help regulate their nervous systems.
“We can get our kids in a state where they can regulate themselves. Or until they can, we have to help them along by co-regulating them, staying calm ourselves, modeling breathing exercises. And so, when we can get them into a regulated state, then we can assess whether those ADHD symptoms are real ADHD symptoms or just the result of living in a chronic stress state.”
Pillar #5: Cognitive skills.
Our underlying brain skills—including working memory, long-term memory, processing speed, visual and auditory processing, attention, and logic & reasoning—are what we use to think, read, learn, and remember. Most of us have one or more cognitive skills that need to be strengthened and if we have a weakness in one or more of those cognitive skills that we need to use all day, every day, we struggle to think, learn, process information quickly, read, etc.
But while you might be quick to assume that the weakest cognitive skill in people who have been diagnosed with ADHD is attention, that’s not necessarily the case. In fact, in a study of more than 4,000 people (ages 4 to 40) with ADHD, Dr. Moore and her colleagues found that attention was average.
“Working memory, long-term memory, and processing speed were the lowest cognitive skills across the lifespan in ADHD,” explains Dr. Moore. “And so what that says to us is that when we only look at interventions that target attention, we are missing the opportunity to really impact what’s happening in the ADHD brain. It’s not just about attention. As cognitive training researchers, as cognitive training clinicians, we know that we need all of those cognitive skills right in order to impact thinking and learning. I always encourage parents to get their kids cognitive skills tested and when they discover that there’s a weakness in something besides attention, then we have to come up with an intervention that strengthens those weak cognitive skills. In our world, that’s brain training.”
What exactly is personal brain training?
“We work one on one across the table with every client, children and adults,” says Dr. Moore. “And we have over 100 different training exercises and those hundred different training exercises have 10 to 12 different variations each. So we have a thousand different hands on activities that we can do to help strengthen and remediate those cognitive skill weaknesses. And we make it fun! I mean, it’s hard work, but we make those activities game-like so that it keeps kids engaged. You know, we set them to timers or metronomes so that we can gradually increase processing speed, really engage those attention skills, and here’s the cornerstone, I think, of how this helps kids with ADHD. Not only are we remediating those other skills besides attention that are weak, but we don’t remove distractions.”
How does having distractions present help boost cognitive skills?
“What is the first thing that schools do on an IEP or 504 plan for kids with ADHD?” asks Dr. Moore. “They put them in a quiet room for testing, give them preferential seating that removes distractions, or stick them right in front of the teacher so that they don’t interact with the other kids. Well, then they get out in the real world and they haven’t learned how to pay attention amidst distractions. We don’t live in a vacuum. Our kids don’t go to school in a vacuum. We don’t work in a vacuum. And so what we do in our programs is we train in big rooms. Lots of people, lots of different training stations, lots of different metronomes ticking, voices moving, so that kids can learn how to pay attention amidst distractions. Because that’s what the real world is.”