Interventions and behaviour management

According to the NICE (2008) guidelines, the first stages of intervention for school-aged children are group-based education programmes and parent-training sessions. This may include psychological interventions such as social skills training and/or cognitive behavioural therapy. Younger children will often respond quicker to intervention so early intervention is always recommended. Drug treatment is advised to only be reserved for those young people with more severe symptoms and impairment, or those with moderate severity who have declined other non-drug treatments and have not responded sufficiently to group psychological treatment or parent-training/education programmes (see NICE, 2008). It is now recommended that before drug intervention is begun an electrocardiogram is carried out if there is any history of serious cardiac disease in the family or of sudden death syndrome. There are many ways improvements in behaviour can be made both at home and school. Ideally, support should be tailored according to the individual needs of the child. This is because ADHD is extremely variable and there is not a “one size approach that fits all”. Working with an ADHD coach or a highly skilled ADHD professional may be the best approach to consider interventions that will work best for your child and family. The book I am currently writing (In preparation) addresses alternative intervention options in greater detail but some potentially useful intervention options are listed below:

Dietary changes: Assessing for celiac disease and removing all gluten containing foods including wheat, barley, rye, and possibly oats. Celiac disease is thought to affect behavior in similar ways to the symptoms present in ADHD.

• Replacing industrially produced seed oils including soybean oils with coconut oil or olive oil. Soybean oil is thought to be consumed in excessive amounts in the Western diet and too much omega-6 can affect the balance or ratio between omega-3 and 6 fats in the brain. Excessive amounts of omega-6 fatty acids are implicated in inflammation and play a role in the endogenous endocannabinoids system. Endocannabinoids are a group of neuromodulatory lipids which have “marijuana” type effects in the brain and are implicated in appetite/obesity, addiction and pain.
• Following a Mediterranean style diet naturally elevates omega-3 status via the inclusion of olive oil, green leafy vegetables, fish and seafood.
• Eliminating all artificial food additives, preservatives and chemicals [35].
• Reducing sugar intake and avoiding processed foods and those containing high fructose corn syrup.
• Assessing for allergies to wheat and dairy products.
• Preparing meals from scratch using fresh, preferably free-range/cage free, organic fruit, vegetables, meat and fish.

Physical Exercise Physical exercise has well-known health benefits including the reported ability to improve stress, anxiety, depression [36, 37] in addition to improving cognitive and motor functions [38-40]. These improvements are thought to be mediated via both the secretion of BDNF (brain-derived neurotrophic factor) and the release of a group of hormones called endorphins which act as an analgesic and help produce an overall feeling of well-being. The release of endorphins is also associated with the term runner’s high due to their ability to reduce the perception of pain. They are described as our body’s natural anti-depressant due to their capability to induce an increased sense of euphoria. Other neurotransmitters such as adrenaline, serotonin, and dopamine are also released during exercise and work synergistically with endorphins to elevate mood.

Considerations to help promote exercise, motor control and mental well-being:

• Introduce a structured exercise routine into your child’s week. For example, trips to the park after school on set days.
• Consider signing up for as many after-school activities as possible which involve physical exercise. These can include activities and sports such as athletics, football/soccer, tennis, martial arts, boxing, gymnastics, ballet, dance or trampolining.
• Encouraging the SENCO or teaching assistant at school to permit short-bouts of exercise which may include a brisk jog around the playground or a short game of basket-ball to refocus attention. 5-15 minutes of exercise has been shown to reduce both classroom behavioural disturbance and hyperactivity [41].
• It may be helpful to teach your child Brain Gym techniques which are based on kinesiology (the study of human movement). These exercises can be especially useful for children with dyspraxia or under-developed poor hand-eye and motor co-ordination. These techniques are thought to help improve communication between the left and right hemispheres of the brain. For further details see their website: http://www.braingym.org/about
• Consider yoga, meditation and/or the practise of mindfulness to help promote relaxation and mental well-being.