Inattentive ADHD Treatment: Begin Here!

How do you begin Inattentive ADHD treatment?  What do you do first, second, etc?  Do you try ADHD vitamins and supplements?  Do you try behavioral therapy?

Many of you have just been diagnosed with ADHD Inattentive (ADHD-PI) or have just been told by your child's doctor that your child has a diagnosis of ADHD-PI or Sluggish Cognitive Tempo (SCT). The most frequent question that I receive from parents and patients is, "Where do I begin?”

I thought that I would write this post to answer that question as succinctly as possible. You should, of course, discuss any treatment plan that you start for yourself or your child with your doctor. I have numbered my treatment recommendations in sequential order.

1. Diet

The ADHD-PI diet (anyone's diet for that matter) needs to be as free of junk food as possible. If there is any chance that the person has even a mild allergy to milk, wheat, eggs, seafood or nuts, those food items should be eliminated.

Diet supplements such as a multivitamin with iron and an additional Omega-3 fatty acids, Neptune Krill Oil is my choice, should be taken. The multivitamin needs to have zinc, iron and magnesium.

A cup of caffeinated coffee or tea in the morning and again at 3pm is helpful. You will need to avoid this if you have sensitivity to caffeine (for some people caffeine causes their heart to race or causes stomach upset). The exact dose of caffeine is about 100 mg and that is the amount of caffeine in one 8 oz cup of American Coffee. The caffeine content in teas varies a bit but a 16 oz cup of iced tea has about that same amount. You can find the caffeine content of most beverages my searching the internet.

2. Sleep

All individuals with ADHD-PI will need to be sleeping a minimum of 8 hours a day. Many people with ADHD have sleep problems. The remedies that have helped these issues include taking an Epson salts bath prior to sleep, drinking a cup of Sleepy time tea, avoiding caffeine and exercise within 3 hours of bedtime, and using a white noise MP3s or relaxation CDs at bedtime. If none of the above work, one 3 mg Melatonin, 1 hour before sleeping will help the person sleep.

3. Exercise

Exercising and preferably aerobic exercise is essential and extremely beneficial for treating ADHD. Begin with 20 minutes of brisk walking. If this is a child, go with the child. Bring along flash cards or school notebooks and quiz the child as you walk. Do not come up with an excuse for not exercising. Try to increase the amount of exercise time to at least 40 minutes, 4-5 times a week. There is no need to invest in any expensive equipment. All you need is a pair of comfortable shoes.

4. Additional Supplements

The best data we have for improvement of inattention with supplements is for:

• Omega-3 fatty acids (If you are doing the above you will be getting that in the Krill Oil). 
• Iron, Zinc and Magnesium (If you are doing the above, the multivitamin and Epson salts includes these).
• Caffeine (If you are doing the above, this has been done). 

There is some evidence that a few other supplements may help. They include:

• Pcynogenol, You can see this post on ADHD Inattentive and Pycnogenol for more Information 
• Bacopa Monnieri. You can see this post on Bacopa Monnieri for ADHD Inattentive for more information. 

There are no studies done specifically on the following supplements but some folks swear that they help Inattention and you may want to give them a try. They include:

• Ginseng Energy, Ginseng has stimulant properties and it has been shown to improve cognitive performance in normal subjects in a few medical trials. 
• Ginkgo. There is research indicating that Ginkgo Biloba is helpful for the treatment of Dementia and a few studies have shown in to improve cognition. 

5. A More Thorough Medical Evaluation

If none of the above measures have made a dent in the inattention, then a more thorough evaluation is in order. This evaluation will include psychological testing as well as medical and laboratory testing. There are many medical problems that can cause ADHD like symptoms but that are not caused by ADHD. A thorough medical evaluation is the best way to insure that there is not another diagnosis causing the ADHD symptoms.


6. Therapy and Training

Cognitive Behavioral Therapy (Free Cognitive Therapy site here), Brain Training (Free Brain Training), Organizational Training, Life Sills Training and Social Skills Training have all been shown to be very helpful for treating the symptoms of ADHD and ADHD-PI. This therapy and training becomes imperative if there are symptoms of depression, anxiety or other social, emotional or psychiatric problems. The most appropriate training and therapy will depend on the particular symptoms that the person is experiencing.

7. Medication

If none of the above measures have helped, a trial of a stimulant of non-stimulant medication is in order. Your doctor can help you decide what medicine may work best for the particular symptoms that you or your child is experiencing. There have been years of studies performed on the stimulants. While they seem invasive, addicting and unsafe, the many studies performed on these drugs have found just the opposite.

The stimulants do not cause heart problems, the stimulants when appropriately prescribed for ADHD do not cause addiction and in fact my lessen the risk of substance abuse in people with ADHD and the stimulants do not cause any long term medical problems. This post answers some of the questions that you may have about the safety of stimulants treatment for ADHD.

To outline, the best way to begin the treatment of ADHD is to do the following:

1. Insure that the person’s diet is adequate. 
2. See to it that they are getting enough sleep and exercise 
3. Supplement their diet with an Omega-3 fatty acid and a multivitamin. 
4. Test them more thoroughly to rule out other medical problems that look like ADHD but are not. 
5. Provide counseling and training 
6. Initiate a trial of ADHD medication. 

Taking this step wise approach to the treatment of ADHD will allow patients and parents to start with the most minimally invasive interventions for ADHD and ADHD-PI and to only move on to more invasive therapies as needed.

There are several excellent books on the treatment of ADHD and the books that I  use the most can be found at the bottom of the Primarily Inattentive ADD resource page.

If at any point in the process the person’s symptoms worsen, an appointment with the medical provider will be necessary. It is important that patients and parents inform their doctors of the plan of action. Working as a team, you and your doctor will best be able to treat the symptoms that can be so disruptive for people living with ADHD, ADHD Inattentive and Sluggish Cognitive Tempo.