The ATTEND Approach: Natural Support for ADHD

Nov 23, 2019

 Timothy Culbert, MD, IFMCP

Many families are looking for more natural options to manage ADHD and attention issues (e.g., distractibility, impulsive behavior, disruptive behavior, restlessness, and hyperactivity). ATTEND is a pneumonic device to remember the six key strategies to consider.

ATTEND: Natural Support for ADHD

A | Arousal Management

Some studies suggest that ADHD symptoms may represent a dysregulation of the internal 24-hour clock (aka circadian rhythm), which controls the balance of alertness and drowsiness of our brain throughout the day and night. Over 55% of people with ADHD have sleep disturbances. Sleep is foundational for good attention and emotional regulation. Be sure to receive the appropriate amount of sleep each night. For example, kids and teens need 8-10 hours of sleep each night.

Read this article on ADHD & sleep to learn more.

T | Training the Brain

Mind-body skills can be very helpful for kids and teens to help condition their nervous system to be quieter, calmer, and more efficient at sustaining attention. Effective skills in this category include yoga, mindfulness, breath-work, imagery and various forms of psychotherapy/behavioral support.

Try this restorative yoga sequence.

T | Technology

A few technologies are emerging as very safe, effective non-drug options for improving ADHD core symptoms:

  • Neurofeedback involves measuring electrical brain activity using sticky pads on the scalp and then learning to control those brain waves. In kids with ADHD, we are typically training them to decrease excess amounts of low frequency brainwave activity (called theta waves, which are associated with daydreaming) while learning to increase higher frequency brain waves (called beta waves, which are associated with active problem solving and thinking). Neurofeedback results take about 30-40 sessions.
  • Electrical trigeminal nerve stimulation (eTNS). Gentle stimulation of this nerve while kids are sleeping, each night for 4-6 weeks, can improve symptoms of inattention, impulsivity, and hyperactivity.
  • Transcranial magnetic stimulation (TMS) was initially widely utilized to treat depression resistant to standard pharmacological treatments and psychotherapies. It is now also used to treat ADHD. It involves applying repetitive electromagnetic field energy to brain areas in ADHD that might be under-aroused and need activating.
  • Cranial Electrotherapeutic Stimulation (CES) involves low level electrical currents being passed over the cranium via a small clip on each ear. 40-60 minute session each can help with ADHD symptoms as well as sleep and anxiety.

E | Exercise

Daily aerobic physical activity (~30 minutes) can greatly reduce core ADHD symptoms throughout the school day for kids. When people exercise and increase their heart rate through cardiovascular activity, their brains release the two main chemicals identified as being deficient in the ADHD brain, norepinephrine and dopamine.

N | Nutraceuticals

Foundational Supplements For ADHD (speak with your doctor before adding any supplements): 

Targeted ADHD Supplements: Phosphatidylserine, Pycnogenol, Theacrine, Tyrosine, Mucuna Pruriens, Oligemeric Proanthocyanidins (OPC’s)


D | Diet 

A basic dietary approach for ADHD should include shifting to a dietary style with less refined carbohydrates (white flour, white rice, etc.), less refined sugar, and lower levels of chemical additives like artificial dyes and flavors. Focus on including the following at each meal:

  • Complex carbohydrates
    • Examples: brown rice, whole wheat, quinoa, amaranth, oatmeal, etc.
  • Fruits
    • Include a wide variety of seasonal fruit.
  • Vegetables
    • Include a wide variety of seasonal vegetables.
  • Healthy proteins 
    • Beans, legumes, tofu, tempeh, etc.

Recommended Reading

ADHD Without Drugs, Dr. Sanford Newmark

Finally Focused, Dr. James Greenblatt

Getting Ahead of ADHD, Dr. Joel Nigg

Mental Health, Naturally, Dr. Kathi Kemper

Mental Health For The Whole Child, Dr. Scott M. Shannon  is a website containing interactive activities for kids and teens to improve executive functions and organizational skills which are commonly deficient in ADHD.



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This content is for informational and educational purposes only. It is not intended to provide medical advice and is not a replacement for advice and treatment from a medical professional. Consult your doctor or other qualified health professional regarding specific health questions. Individuals providing content to this website take no responsibility for possible health consequences of any person or persons reading or following the information in this educational content. It is also essential to consult your physician or other qualified health professional before beginning any diet change, supplement, or lifestyle program.