Managing ADHD Symptoms Without Medication

A current shortage of the attention deficit hyperactivity disorder (ADHD) medication Adderall is affecting thousands of families and children across the country. While there are several alternative medications that can be substituted for Adderall, some parents may be looking at ways to manage ADHD symptoms without the use of pharmaceuticals.

Jacob Wolf, ND, LAc, a naturopathic doctor and licensed acupuncturist with University Hospitals Connor Whole Health, says families who desire a more natural approach to ADHD management should start with the foundational elements of a healthy lifestyle.

“These ground-level elements have the most research evidence, and they are tools that are available for everyone,” says Dr. Wolf.

These foundational elements include:

• Healthy diet. A balanced and healthy diet can improve your overall well-being and can have an impact on attention as well. Make sure you child is eating plenty of fruits and vegetables, and reduce intake of refined sugar, simple carbohydrates and ultra-processed foods. Some children also have sensitivity to things such as food dyes, so minimizing these can be helpful for those children.
• Supporting sleep. Poor sleep has been known to cause attention problems. Making sure your child gets enough sleep can improve ADHD symptoms. Improve sleep hygiene by reducing screen time, especially in the evenings, and sticking to a good sleep schedule with consistent sleep/wake times.
• Stress management. Addressing stressors and learning how to manage stress in a healthy way are valuable actions that can help improve a child’s well-being while reducing ADHD symptoms.

David W. Miller, MD, LAc, medical director of Family & Child Life Services and pediatric integrative medicine at UH Connor Whole Health, says working on these cornerstones of health is a great first step because they have benefits without risk.

“We should take every opportunity to optimize lifestyle. The worst that can happen is that even if symptoms don’t improve, you will still be eating better and have better quality of life overall,” Dr. Miller says.

Dietary Supplements

When it comes to supplements for ADHD symptoms, some are more evidence-based than others. You should always talk to your child’s provider before starting them on any supplement regimen in order to discuss safety, dosage and other instructions. Some of the supplements with the most research behind them include:

• Fish oil/omega 3 fatty acids: Studies have shown that omega-3 supplements can improve attention and other symptoms in ADHD patients. While not a short-term fix, a high-quality fish oil supplement with a good mix of EPA and DHA fatty acids can foster optimal brain health over a period of months and years. Fish oil can come in liquid or capsule form and should be kept refrigerated to keep it fresh, Dr. Wolf suggests.
• Melatonin: Melatonin is a hormone that is naturally produced by the brain to help regulate sleep. Studies have shown that taking a low dose (0.5 – 3 mg) melatonin supplement a half hour before bed can help children fall asleep faster and improve sleep quality. Melatonin can be used safely in short-term bursts to reestablish a sleep pattern, but the safety of long-term use has not been fully established. Good sleep hygiene will also optimize the body’s own melatonin production.
• Caffeine: Small amounts of caffeine (such as the amount in green tea) have been shown to increase attention in ADHD patients. Though not usually recommended for younger children, it can be a useful tool for late middle school and high school-aged children, says Dr. Wolf. Unlike coffee, green tea also contains the amino acid L-theanine, which offers cognitive support and lessens the negative effects of caffeine.
• Iron and zinc: These supplements can be helpful if the child is deficient in these nutrients. Children can obtain a sufficient amount of these minerals through proper diet, and if a child is eating nutrient rich foods, supplementing may not have any additional benefit. A blood test can detect low levels of these and other vitamins and minerals.

There are a few different herbal supplements that are thought to improve attention in children with ADHD. Because they are often not backed by big studies, you should always speak with your provider before giving them to your child.

Popular herbal supplements include:

• Bacopa monnieri: Also known as brahmi, this herb that can improve blood flow to the brain and enhance micro-circulation, which can help with memory and attention.
• Ginkgo biloba: Another herbal supplement that has been found to improve memory and increase mental sharpness.
• Pycnogenol: This supplement made from pine bark extract has been shown to reduce hyperactivity and improve attention and concentration.
• Chinese herbs: Certain herbs used by Chinese medicine practitioners can be helpful for ADHD. Dr. Miller says if you want to go this route, be sure to find a provider who is certified in Chinese herbal medicine.

Complementary Therapies and Lifestyle Modifications

The practice of mindfulness, or paying attention to the present moment, is an evidence-based practice that has proven benefits for ADHD patients. Studies have shown that it can improve attention and focus, as well as regulate emotions and decrease stress.

Dr. Miller says mindfulness is a practice we can all benefit from.

“Our brains have plasticity (or ‘neuroplasticity’), which is the ability to grow and change in specific ways depending on how we direct our thoughts and use our minds,” says Dr. Miller. “Just like learning to play a musical instrument, we can develop our ability to focus and control our attention with practice. The more we do this, the better we get at it without medication.”

Additional therapies that may be effective for some children include acupuncture and yoga therapy.

Sometimes, small changes in the learning environment at school and at home and other lifestyle adjustments can have a big impact on a child’s attention and focus as well. Optimizations can include:

• Moving a child’s desk to the front of the classroom to minimize distractions
• Using white noise or appropriate music when studying, and creating a stable, organized study setting for the child at home
• Providing structure and predictability to the day can be beneficial in helping many children regulate behavior, anxiety and attention; this includes creating a stable study schedule
• Ensure adequate exercise and “time off” as well as expected study time
• Contain use of electronics, including social media and gaming, to minimize these as distractions

Short-Term and Long-Term Strategies for ADHD

Dr. Miller notes that some children may still need medication to manage ADHD in the short-term, even if the long-term goal is to manage symptoms without pharmaceuticals. In these cases, parents should work closely with their provider to find a medication that is available and effective. Dr. Miller says there are many other stimulant and non-stimulant drugs that can be as effective as Adderall in some patients.

He stresses that parents shouldn’t panic if their child’s usual medication is unavailable. Instead, they should gauge the severity of the symptoms and help their kids as much as they can.

“These situations are reminders to go back and revisit the bigger plan: What are we doing to help our kids manifest as healthily and robustly as possible? Every crisis also contains opportunity.”

Related Links

Our pediatric integrative health team works with other UH Rainbow pediatric specialists to provide a holistic approach to treating a broad range of childhood conditions and symptoms, including ADHD and other developmental and behavioral issues.