Caregiver day alternative treatments


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The PDF is a copy of the slides Dr. Soper presented on September 20, 2013 for the first CAMH ADHD Caregiver Day.

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Caregiver day alternative treatments

  1. 1. PRINCIPLES OF ADHD TREATMENT Dr. Paul Soper MD FRCPC Child and Adolescent Psychiatrist Glenrose ADHD Program Saturday, 21 September, 13
  2. 2. ADHD Child Emotionally Healthy Adult Developmental Perspective ? Better Focus Better Grades Less Hyper Less Impulsive Saturday, 21 September, 13
  3. 3. What Do Children with ADHD need? 1.LOVE 2.EMPATHY 3.CONNECTION Hallowell and Jensen, 2010 Saturday, 21 September, 13
  4. 4. ADHD Child Emotionally Healthy Adult Developmental Perspective Emotional Nutrition 1. LOVE 2. EMPATHY 3. CONNECTION Saturday, 21 September, 13
  5. 5. ADHD Child Emotionally Healthy Adult Developmental Perspective Emotional Nutrition 1. LOVE 2. EMPATHY 3. CONNECTION ADHD Sx: Hyperactivity Distraction Opposition Forgetfulness Disorganization Impulsivity Irritability Saturday, 21 September, 13
  6. 6. Finding Balance Love Empathy Connection Side Effects Costs Every treatment decision should be based on how much Emotional Nutrition is increased vs the side effects/costs. Saturday, 21 September, 13
  7. 7. Finding Balance Number of Studies Quality of Studies Amount of Improvement Side Effects Costs One must also consider the science that is behind each treatment recommendation. Saturday, 21 September, 13
  8. 8. Finding Balance Pros vs Cons Checklist Pro Cons Greatly Improves ADHD Mildly Improves ADHD Few Side Effects Many Side Effects Tolerable Side Effects Barely Tolerable Side Effects Mildly Changes Personality Dulled Personality Works Quickly Takes Weeks to Work Affordable Difficult to Afford Many Studies Few Studies Well Done Studies Poorly Done Studies Family Will Accept Family Won’t Accept Saturday, 21 September, 13
  9. 9. Website Saturday, 21 September, 13
  10. 10. Principles of Treatment CADDRA Guidelines (www. Treatment Should be Multimodal and include: Parental Education (You are doing this today) Lifestyle Optimization (Sleep, Diet, Exercise) Parent Training (Priscilla will cover this) Medication (Dr. Wincott will cover this) Saturday, 21 September, 13
  11. 11. Lifestyle Optimization Sleep Diet Exercise Social Connections Other Saturday, 21 September, 13
  12. 12. Lifestyle Optimization Sleep Saturday, 21 September, 13
  13. 13. Lifestyle Optimization Sleep • Sleep - Average Sleep Per Age • 6-12 (10 hours) • 12-18 (9 1/2 hours) • If child wakes on their own/with little difficulty without sleepiness during day they are probably fine. • No study has shown improvement in ADHD symptoms with improvement in sleep. Saturday, 21 September, 13
  14. 14. Lifestyle Optimization Sleep • Should consult with your health care provider. • Generally, sleep hygiene is an effective strategy in up to 30% of children with sleep problems. • Melatonin usually works for the rest of kids who do not respond to sleep hygiene. • If sleep problems persists, the health care provider should be consulted. Saturday, 21 September, 13
  15. 15. Pros vs Cons Checklist Sleep Pro Cons Sleep is Good Mildly Improves ADHD Few Side Effects Takes Weeks to Work Tolerable Side Effects Tough to Implement (Teens) Mildly Changes Personality OK Number of Studies OK quality of Studies Family Will Accept Affordable Saturday, 21 September, 13
  16. 16. Lifestyle Optimization Diet Saturday, 21 September, 13
  17. 17. Lifestyle Optimization Diet A balanced diet based on Health Canada’s Guidelines is most important Most common strategies include: Use of Omega 3s (EPA 400 - 600mg) Elimination Diets (0.51) - Pelsser, Feingold Food Coloring Exclusion (0.42) Adding zinc, iron, vitamins... (Poorly studied) Saturday, 21 September, 13
  18. 18. Lifestyle Optimization Exercise Saturday, 21 September, 13
  19. 19. Exercise One hour of daily rigorous exercise results in a multitude of long term benefits for health. “The acute effects of exercise have been associated with reductions in negative behaviors and improvements in acceptable behaviors and cognitive functions in children with clinical disorders categorized by poor impulse control and attention.” Saturday, 21 September, 13
  20. 20. Lifestyle Optimization Connection Saturday, 21 September, 13
  21. 21. Lifestyle Optimization Connection To ensure a child’s emotional growth, it’s important for kids to feel like they belong. I’ve never found a study that relates to a specific program. Programs that are frequently helpful: Sports: Tae Kwon Do/Hockey.... Clubs: Cubs/Scouts/Girl Guides/Church Lego club, Computer Club.... Saturday, 21 September, 13
  22. 22. Lifestyle Optimization Other Saturday, 21 September, 13
  23. 23. Lifestyle Optimization Others Cogmed “In the studies we reviewed, training involved a variety of working memory tasks, and such training generalizes to other equivalent measures of working memory, but there is no evidence of a transfer to other less directly related tasks.”Melby-Lervåg 2013 Saturday, 21 September, 13
  24. 24. Lifestyle Optimization Others Neurofeedback “The standardized mean differences for all psychological interventions dropped considerably, to nonsignificant levels, when analyses were restricted to trials with probably blinded assessments.” Sonuga- Barke 2013 Herbal Products - there are many... Saturday, 21 September, 13
  25. 25. Conclusions Optimizing Sleep, Diet and Exercise is good. The evidence thus far suggests some mild benefit to improve symptoms of ADHD especially with dietary strategies. Like any treatment, one must decide whether there is an adequate improvement in emotional nutrition to justify the cost/difficulties with implementing a treatment. Saturday, 21 September, 13
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