Timothy Culbert, MD, IFMCP

Impulsivity, or acting without thinking, can be a real problem for kids (and yes, for adults too).

What does impulsivity look like? When it happens once in a while, it can look like everyday kid behavior. When it happens a lot, though, it looks like what it actually is: Trouble with self-control. Impulsivity doesn’t appear the same way in every child. And the behaviors can change as kids get older. 

When kids are impulsive, they might:

• Do silly or inappropriate things to get attention.
• Have trouble following rules consistently.
• Be aggressive toward other kids (hitting, kicking, or biting is common in young kids).
• Have trouble waiting their turn in games and conversation.
• Grab things from people or push in line.
• Overreact to frustration, disappointment, mistakes, and criticism.
• Want to have the last word and the first turn.
• Not understand how their words or behavior affect other people.
• Not understand the consequences of their actions....

First: Are US Kids Worse Off?

11% of US children have an ADHD diagnosis. In France, the prevalence of an ADHD diagnosis is 0.5%. Part of this spread has to do with the US health care system's practice of readily pathologizing children's behaviors. Many behaviors may just be normal developmental variations or reflect behaviors brought on by stress, trauma, learning style issues, chaotic family situations, inadequate educational environments, or suboptimal lifestyle practices. 

Kids Are Not to Blame

There are many reasons for the difference in ADHD rates between kids in the US and France. One key reason has to do with the US mental health care system. 

Over the past few decades, psychiatry has become more biologically-based causing pharmaceutical companies and the field of psychiatry to focus almost exclusively on the "neurotransmitter deficiency model" of mental illness. For example, biologically based studies on ADHD...

 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...

by Henry Emmons, MD

We are Living with an Epidemic of Mental Health Problems

The numbers are staggering. 

The percentage of people in the US suffering from depression, anxiety, and poor focus/memory are historically high and increasing by more than 10% each decade. The rise is even faster among adolescents. If you are struggling with one of these common mental health problems, you are most definitely not alone!

Currently available treatments often don’t work well over the long term. 

Antidepressant medications still form the mainstay of treatment for depression and anxiety, while stimulants are the primary treatment for ADD. Consumers and professionals alike are realizing the limitations of conventional treatments and desperately looking for more natural, safe yet effective alternatives.

Natural approaches to mental health treatment are too often disorganized and unscientific.

There is no unified theory explaining the epidemic of disorders, either in the...

Timothy Culbert, MD, IFMCP

What Kids, Teens and Parents Should Know About CBD Oil for Mental Health

By now you have probably heard of the potential health benefits of the natural plant-based remedy, CBD oil. It is derived from the cannabis plant, the same plant-type that provides marijuana. Cannabis plants have actually been utilized for millennia all over the world for their healing properties.

Understandably, there is some confusion about the differences between CBD oil and marijuana products. CBD oil that is hemp-based is legal in all 50 states. On the other hand, marijuana products vary by state in terms of their legality for medical versus recreational. CBD oil and marijuana both differ in their safety and efficacy for mental health symptoms in kids, teens, and adults.

I know, it's confusing. Let’s try to sort this all out...  

The Chemical Components of CBD, Marijuana, and Hemp

The term cannabis is used to identify a genus of flowering plants in...

Timothy Culbert, MD, IFMCP

Does CBD Oil Help Relieve Symptoms of ADHD?

There is sparse evidence that CBD oil can improve the core symptoms of ADHD, and the evidence that exists is mostly anecdotal. Nonetheless, that isn’t stopping patients from trying it.

The current concern is that consumer/patient use has sped past scientific evidence for use and regulation on product quality. That means long-term effects are virtually unknown and snake-oil companies continue to pop up with CBD products that are not pure. 

An article in ADDitude magazine summarized this:

“During [a person’s] development, I worry about cannabinoids, both CBD and THC,” says UCLA’s Evans. “There are adenosine receptors (and CB2 receptors) on the microglia that are critical for brain development, and CBD inhibits adenosine uptake. This may be a beneficial factor for epilepsy and autoimmune and inflammatory diseases, but who knows for ADHD.” 

The article...

 Timothy Culbert, MD, IFMCP

[Read Part 1 of this series for more on melatonin and its relationship with ADHD.]

First: Is Melatonin Safe? 

I've found melatonin to be quite helpful for kids and teens with ADHD for both sleep onset and sleep maintenance issues. However, some concerns have popped up about kids and teens using melatonin for long periods of time (more than 6 months) or at high-doses. However, little has been substantiated through research studies. 

A recent systematic review of 13 RCTs assessed the safety and efficacy of melatonin for pediatric patients with ND disorders (e.g, ADHD and Autism). Studies included a total of 632 children who took either regular melatonin or controlled release melatonin. The review found that:

• Kids who took the melatonin fell asleep faster and slept longer compared to those given a placebo pill (Abdelgadir).
• No major side effect concerns were apparent in any of the studies.

Second: How Should You Use...

 Timothy Culbert, MD, IFMCP

Good [and bad] Sleep Is Contagious 

Creating a culture of healthy sleep in a household requires a “whole family” behavioral approach to sleep. That means you'll need everyone in your home to opt-in to healthy sleep hygiene practices.

• Sleep hygiene refers to sleep practices (I call them routines and rituals) that are conducive to sleeping well on a regular basis.
• Sleep routines and rituals are done at the same time and sequence each night as a way of winding down and giving your mind and body time and cues to move into a more calm and quiet mode to ease the transition into sleep.

No matter if your family consists of just you, twelve cats, or lots of humans, you'll want to consider all the beings and environmental influences that can be optimized for sleep. Short-term assists like melatonin can be helpful, but it's really the establishment of healthy sleep practices that bring the lasting benefits. 

Some of the...

 Timothy Culbert, MD, IFMCP

The Connection Between ADHD and Sleep 

Many of the same brain regions that regulate sleep and arousal also control attention. You've likely felt that firsthand when trying to focus on a task after a rough night of [no] sleep. It's a losing battle.

The relationship between ADHD and sleep is becoming more clear as new research has identified that:

• Between 55 and 75% of kids and adults with ADHD also suffer from sleep related issues.
• Even just a little sleep deprivation can lead to mental fog, inefficiencies, and can mimic the symptoms of ADHD.
• The symptoms of insomnia and ADHD may be related to the dysregulation of the 24-hour clock (AKA your circadian rhythm). 

Though not always done in usual care, it's vital that sleep issues are explored in any child, teen, or adult with complaints of inattention, impulsivity, or hyperactivity. If you're a patient or parent who can relate, don't be shy to bring up the topic of sleep with your...

By, Elly Hollenhorst

200-Hour Yoga Alliance Certified Teacher

Practice this 5-pose restorative yoga sequence to find calm, connect inwards, and refocus. This sequence can be practiced anytime; upon waking, during your lunch break, or before bed.

Props

• A yoga mat or other comfortable surface.
• Pillow or blanket(s).

Instructions

1. Once you are comfortable in each posture, close your eyes and focus on your breath.
2. Remain as still and unmoving as possible.
3. Let gravity do the work. Do not pull your body into the positions.*
4. Rest in each pose for 1-5 minutes resulting in a 5-25 minute practice, depending on how much time you have available. It is helpful to use a timer.

*If a posture feels painful, find another position to better suit your body's needs.

Child's Pose

Spread your knees as wide as the mat, bring your big toes to touch. Reach your arms out far in front of you. Rest your forehead on the mat. Let gravity guide your hips towards your heals.

Optional: You can bring a...