Cognitive-aerobic exercise improves working memory more than aerobic exercise alone in children and adolescents with ADHD, according to a new study¹ published in Frontiers in Psychology. 

Previous research has shown that exercise relieves ADHD symptoms by increasing endorphins and neurotransmitters in the brain. This new study is the first network meta-analysis to evaluate the efficacy of various exercise interventions on working memory in children with ADHD.

The study’s results indicate the following impacts of various types of exercise on children with ADHD:

• Cognitive-aerobic exercise demonstrates the most significant effect on working memory, or the capacity for holding and using information over a short period of time.
• Ball sports follow closely behind with a moderate to high improvement effect.
• Mindy-body exercises and interactive games display a moderate improvement in working memory.
• Simple aerobic exercise and interactive games exhibit the smallest improvement effect on children with ADHD.

“For developing children, aerobic exercise expands the growth of brain connections, the frontal cortex, and the brain chemicals (such as serotonin and dopamine) that support self-regulation and executive functioning,” said Joel Nigg, Ph.D., a clinical psychologist and a professor in the departments of psychiatry and behavioral sciences at Oregon Health & Science University. “These surprisingly specific findings in typically developing children have led to excitement about the possibility that the right kind of exercise can help ADHD.”²

Further analysis suggests that the effectiveness of cognitive-aerobic exercise in improving working memory in children with ADHD may depend on higher intervention frequency and longer cumulative intervention duration.

Cognitive-Aerobic Exercise for Working Memory

“Cognitive-aerobic exercise,” as defined by the researchers, combines physical activity with mentally stimulating tasks like decision-making and problem-solving, e.g., dual-task exercises, strategy-based games, and exergaming. It may involve activities with rules and objectives that increase the load on the prefrontal cortex, which is closely associated with working memory.

The researchers propose that cognitive-aerobic exercise is particularly powerful because it requires quick decision-making, memory retrieval, and cognitive switching in addition to physical activity, thus “working out” the working memory.

Ball Sports for Working Memory

Ball sports exert a positive impact on working memory, perhaps due to their reliance on strategy and social skills.  “Sports such as soccer or basketball typically require children to remain highly focused while also remembering and analyzing the actions of teammates and opponents, which places a high demand on task memory,” the researchers wrote. “In ball sports, children not only need to plan and execute movements but also continuously adjust strategies and predict the opponent’s actions. These multitasking and real-time adjustment characteristics directly exercise their working memory load, information storage, and response speed.”

This seems consistent with one ADDitude reader’s experience with her son, who has ADHD and plays sports like football and lacrosse.

“The strategizing required when playing these sports is helpful,” said Deborah from New York. “He is receiving many different stimuli at one time, helping him to decipher information and build his executive function skills.”

Mind-Body Exercise for Working Memory

Mind-body exercises (e.g., yoga, Tai Chi) only moderately affect working memory and “may be more significant in improving attention and emotional regulation but… may lack the high cognitive load stimulation required for direct improvements” in working memory, the researchers said.

Interactive Games for Working Memory

Sports-based interactive games primarily enhance social and cooperative skills by motivating children to engage in collaborative tasks or fun competitions in virtual environments. “Although these games have a positive impact on the social behavior and emotional regulation of children with ADHD, the cognitive challenges in these games are limited and generally do not involve high-intensity memory tasks or complex decision-making, making their direct impact on working memory relatively modest,” the researchers wrote.

Traditional Aerobic Exercise

Traditional aerobic exercise involves “repetitive and rhythmic movements, such as swimming or cycling, aimed solely at improving physical endurance and fitness.”

Due to its more straightforward physical activity format, traditional aerobic exercise had the smallest impact on working memory, the researchers proposed.

“Activities like running and skipping, while improving overall physical fitness and stimulating dopamine secretion, can help children with ADHD maintain attention in the short term,” the researchers wrote. “However, since they lack demands for memory and multitasking, they are often insufficient to activate the prefrontal cortex’s executive function areas. As a result, their direct impact on working memory is relatively small.”

The study’s overall findings suggest that “when designing exercise interventions for children with ADHD, priority should be given to exercise types with higher cognitive load,” the researchers wrote.

The meta-analysis analyzed data from 17 studies, which collectively had 419 participants with ADHD, ages 3 to 18. Studies included structured aerobic exercise (e.g., running, swimming), strength training (e.g., resistance training), cognitive exercise, and balance or coordination exercises. The intervention periods ranged from one to 13 weeks, with exercise frequency ranging from one to five times per week and lasting 10 to 90 minutes.

According to researchers, the study had several limitations, including a disproportionately small percentage of female participants. Further research is needed to explore how different kinds of exercise may impact people of various genders and why these types of exercise have different efficacy levels.

The researchers caution that their findings do not mean that children should treat their ADHD exclusively with exercise. According to the American Academy Of Pediatrics (APA), the most effective treatment for ADHD is parental behavior therapy paired with ADHD medication for children over age 6.

Sources

¹ Song, X., Hou, Y., Shi, W., Wang, Y., Fan, F., & Hong, L. (2025). Exploring the impact of different types of exercise on working memory in children with ADHD: a network meta-analysis. Frontiers in Psychology, 16. https://doi.org/10.3389/fpsyg.2025.1522944

² Best, J.R. (2010). Effects of Physical Activity on Children’s Executive Function: Contributions of Experimental Research on Aerobic Exercise. Dev Rev; (4):331-551. https://doi.org/10.1016/j.dr.2010.08.001

Calls to Action: MAHA Commission Testimony & Advocacy

• Submit your testimony to the MAHA Commission by contacting MAHA Commission Chair Robert Kennedy, Jr. at https://x.com/SecKennedy, and media@hhs.gov
• Join the advocacy efforts organized by CHADD
• Contact your national, state, and local representatives to share your testimony and the evidence-based research on ADHD below

February 26, 2025

Dear Secretary Kennedy,

As the Make America Healthy Again Commission begins its evaluation of published research on the chronic health conditions impacting American children, we urge it to consult with the esteemed clinicians associated with the American Professional Society of ADHD and Related Disorders (APSARD), the American Academy of Pediatrics (AAP), and the World Federation of ADHD regarding the established science on ADHD causes and treatments. Consensus within these groups, and among ADHD researchers worldwide, is strong and consistent regarding the following evidence-based findings:

• ADHD is a chronic neurodevelopmental condition characterized by inattention, impulsivity, executive dysfunction, and/or hyperactivity that persists into adulthood for approximately 90% of patients.¹
• ADHD is a highly genetic condition.^2,3,4 Lifestyle factors such as nutrition, exercise, and sleep exert epigenetic changes on DNA that influence how strongly or weakly ADHD genes are expressed. However, diet, physical activity, sleep, or screen use alone do not cause — and have not been shown to “cure” — ADHD.
• The 16% increase in ADHD diagnoses over the last decade is due, in large part, to revised diagnostic criteria published in the DSM-5, which changed the maximum age of onset from 7 to 12 and added the first-ever qualifier symptoms for ADHD in adulthood. This wider net, along with improved education, training, and symptom recognition, particularly in historically overlooked girls and women, account for much of the diagnostic uptick, according to studies.^{5, 6}
• Scientific research has established no causal link between excessive screen time, video game play, or social media use  and ADHD.⁷ Some studies suggest these habits may exacerbate inattention and impulsivity.^{8, 9}
• Scientific research has established no causal link between consumption of sugar, food additives, or food dyes and ADHD, though some studies show a heightened sensitivity among children with ADHD to these foods, which may exacerbate existing symptoms.¹⁰
• Scientific research shows that prenatal and/or childhood exposure to tobacco, lead, pesticides, and polychlorinated biphenyls (PCBs) may increase the odds of ADHD in some children, however the studies do not find direct causality.^{11,12, 13,14}
• Several research studies have shown that consumption of a Western diet high in processed foods, fats, sugars, and salt is associated with higher rates of ADHD, however these studies demonstrate an association rather than causality.¹⁵
• ADHD shortens an individual’s life expectancy by 7.5 years, on average.¹⁶ It is serious, potentially lethal, and associated with elevated risks for comorbid conditions ^{17, 18} including anxiety, depression,¹⁹ substance use disorder,²⁰ eating disorders,^{21, 22} obesity, and oppositional defiant disorder,²³ which commonly derails treatment plans and parenting strategies. People with ADHD are more likely to get into car accidents,²⁴ become hospitalized, and engage in self-harm than are their neurotypical peers.^{25, 26, 27}
• In patients with the condition, ADHD medication use reduces the risk of death by 19%, the risk of overdose by 50%,²⁸ the risk of substance abuse by 50%,²⁹ and the risk of motor vehicle accidents by at least 38%.³⁰ Its effective symptom management improves patients’ self-esteem and efficacy, thereby reducing the risk of self-harm and suicide, as well as negative life outcomes such as unwanted pregnancy, incarceration, unemployment, and interruption of education.
• The medications used to treat ADHD have been studied rigorously and used safely for 88 years. Amphetamine and methylphenidate safely and effectively reduce ADHD symptoms, with methylphenidate reducing symptoms by 70% to 90% in children and adults with the condition.^{31, 32} The effect sizes for ADHD medication are .8 to 1.0,³³  which are among the strongest in all of psychiatry. Clinical practice guidelines recommend medication as the first-line treatment for ADHD due to its overwhelming efficacy; for children with ADHD ages 4 to 6, parent behavior training is recommended by the AAP.³⁴
• According to the CDC, just 53.6% of all children and teens with ADHD reported they were actively treating their symptoms with medication in 2022. Because stimulant medications are classified as Schedule II drugs under the Controlled Substances Act, they are tightly regulated; supplies are limited to 30 days and prescribing clinicians must authorize monthly refills. The widely reported ADHD medication shortage has disrupted treatment for millions of patients across the country since 2022.³⁵
• Caregivers and adults with ADHD surveyed by ADDitude rate medication as the most effective treatment for ADHD, however less than half of parents report that they chose to medicate their children within 6 months of diagnosis. They report changing diet, limiting screen time, supplementing with fish oil, and increasing physical activity before ultimately using medication to achieve the symptom improvement necessary for academic and social success.
• The mild to moderate side effects associated with ADHD medication include appetite suppression, irritability or moodiness, sleep problems, and headaches. There is no evidence that ADHD medication use leads to dependency or broader substance abuse; in fact, research shows that ADHD medication use is protective against substance use disorder in individuals with ADHD.³⁶
• The non-stimulant medications used to treat ADHD, such as atomoxetine, guanfacine, and clonidine, have an effect size of .4 to .7 and are considered a second-line treatment appropriate for patients who do not tolerate or cannot take stimulants.^{37, 38, 39}
• Clinical guidelines promote the use of multimodal treatment plans that pair prescription medication with complementary approaches to ADHD management. The nonpharmacological interventions shown to be most effective at reducing ADHD symptoms in children are behavioral therapy (effect size of .5 to.8 when used on its own),⁴⁰ exercise (effect size of .4 to .6 when used on its own),⁴¹ sleep hygiene and interventions (effect size of .5 to .8 when used on their own),⁴² and dietary interventions (effect size of .2 to .5 when used on their own).⁴³
• Behavioral therapy, principally parent training, has an elevated and improved effect when used in conjunction with ADHD medication.⁴⁴ Behavioral therapy is used by just 44% of pediatric patients, in part because it’s not always covered by medical insurance and knowledgeable providers are scarce.
• One meta-analysis of randomized, placebo-controlled trials showed that supplementation with high doses of omega-3 fatty acids has a small positive impact on attention and hyperactivity in children.⁴⁵
• Research suggests that restricting the consumption of synthetic food dyes does benefit some children with ADHD, though aggregate effects are quite small.⁴⁶
• When engaging in vigorous cardiovascular exercise, the brain releases endorphins. Levels of dopamine, norepinephrine, and serotonin also increase with exercise, thus improving focus, working memory, and mood to enable better learning.
• Cognitive behavioral therapy (CBT), though more commonly prescribed to adult patients, has been shown to improve core ADHD symptoms in adolescents when used in conjunction with ADHD medication.⁴⁷
• Neurofeedback uses an electroencephalogram (EEG) to measure brain activity and train the patient to produce brain wave patterns like those of a non-ADHD brain. Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD and there is little evidence that neurofeedback reduces ADHD symptoms long-term. In addition, neurofeedback is seldom covered by insurance and involves a significant investment of time and money.^{48, 49, 50}
• According to research, brain training does not reduce ADHD symptoms. There is no evidence that a patient can train a brain to improve working memory, or any other executive function.^{51, 52, 53}

Thank you for reviewing the evidence-based research highlighted above. We welcome follow-up questions from the Commission as it devises recommendations based on science that may benefit the health and wellbeing of the 22 million Americans with ADHD, whom ADDitude has served for the last 26 years. We support their personal liberty to pursue and maintain the treatments that benefit their ADHD brains, which are a tremendous asset to this nation.

Sincerely,
Anni Rodgers
General Manager, ADDitude

Sources

¹Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032

²Faraone, Stephen V. et al. Molecular Genetics of Attention-Deficit/Hyperactivity Disorder, Biological Psychiatry, Volume 57, Issue 11, 1313 – 1323

³Liuyan Zhang, Suhua Chang, Zhao Li, Kunlin Zhang, Yang Du, Jurg Ott, Jing Wang, ADHDgene: a genetic database for attention deficit hyperactivity disorder, Nucleic Acids Research, Volume 40, Issue D1, 1 January 2012, Pages D1003–D1009, https://doi.org/10.1093/nar/gkr992

⁴Gizer, I.R., Ficks, C. & Waldman, I.D. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 126, 51–90 (2009). https://doi.org/10.1007/s00439-009-0694-x

⁵Mowlem, F.D., Rosenqvist, M.A., Martin, J. et al. Sex differences in predicting ADHD clinical diagnosis and pharmacological treatment. Eur Child Adolesc Psychiatry 28, 481–489 (2019). https://doi.org/10.1007/s00787-018-1211-3

⁶Abdelnour E, Jansen MO, Gold JA. ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis? Mo Med. 2022 Sep-Oct;119(5):467-473. PMID: 36337990; PMCID: PMC9616454.

⁷Nikkelen, S. W., Valkenburg, P. M., Huizinga, M., & Bushman, B. J. (2014). “Media use and ADHD-related behaviors in children and adolescents: A meta-analysis.” Developmental Psychology, 50(9), 2228-2241.

⁸Madigan S, Browne D, Racine N, Mori C, Tough S. Association Between Screen Time and Children’s Performance on a Developmental Screening Test. JAMA Pediatr. 2019;173(3):244–250. doi:10.1001/jamapediatrics.2018.5056

⁹Yifei, P, Xuechun, L,Yu, Y. (2023). Screen use and its association with ADHD symptoms among children: a systematic review. MEDS Public Health and Preventive Medicine, 3.10.23977/phpm.2023.030301

¹⁰Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

¹¹Huang L, Wang Y, Zhang L, Zheng Z, Zhu T, Qu Y, Mu D. Maternal Smoking and Attention-Deficit/Hyperactivity Disorder in Offspring: A Meta-analysis. Pediatrics. 2018 Jan;141(1):e20172465. doi: 10.1542/peds.2017-2465. PMID: 29288161.

¹²Goodlad JK, Marcus DK, Fulton JJ. Lead and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms: a meta-analysis. Clin Psychol Rev. 2013 Apr;33(3):417-25. doi: 10.1016/j.cpr.2013.01.009. Epub 2013 Jan 29. PMID: 23419800.

¹³Nigg JT, Nikolas M, Mark Knottnerus G, Cavanagh K, Friderici K. Confirmation and extension of association of blood lead with attention-deficit/hyperactivity disorder (ADHD) and ADHD symptom domains at population-typical exposure levels. J Child Psychol Psychiatry. 2010 Jan;51(1):58-65. doi: 10.1111/j.1469-7610.2009.02135.x. Epub 2009 Nov 23. PMID: 19941632; PMCID: PMC2810427.

¹⁴Eubig PA, Aguiar A, Schantz SL. Lead and PCBs as risk factors for attention deficit/hyperactivity disorder. Environ Health Perspect. 2010 Dec;118(12):1654-67. doi: 10.1289/ehp.0901852. Epub 2010 Sep 9. PMID: 20829149; PMCID: PMC3002184.

¹⁵Howard AL, Robinson M, Smith GJ, Ambrosini GL, Piek JP, Oddy WH. ADHD is associated with a “Western” dietary pattern in adolescents. J Atten Disord. 2011 Jul;15(5):403-11. doi: 10.1177/1087054710365990. Epub 2010 Jul 14. PMID: 20631199.

¹⁶O’Nions E, El Baou C, John A, et al. Life expectancy and years of life lost for adults with diagnosed ADHD in the UK: matched cohort study. The British Journal of Psychiatry. Published online 2025:1-8. doi:10.1192/bjp.2024.199

¹⁷Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature. World J Clin Cases 2019; 7(17): 2420-2426 [PMID: 31559278 DOI: 10.12998/wjcc.v7.i17.2420]

¹⁸Kessler, Ronald & Adler, Lenard & Barkley, Russell & Biederman, Joseph & Conners, C & Demler, Olga & Faraone, Stephen & Greenhill, Laurence & Howes, Mary & Boye, Kristina & Spencer, Thomas & Ustun, Tevfik & Walters, Ellen & Zaslavsky, Alan. (2006). The Prevalence and Correlates of Adult ADHD in the United States: Results From the National Comorbidity Survey Replication. The American journal of psychiatry. 163. 716-23. 10.1176/appi.ajp.163.4.716.

¹⁹Babinski DE, Neely KA, Ba DM, Liu G. Depression and Suicidal Behavior in Young Adult Men and Women With ADHD: Evidence From Claims Data. J Clin Psychiatry. 2020 Sep 22;81(6):19m13130. doi: 10.4088/JCP.19m13130. PMID: 32965804; PMCID: PMC7540206.

²⁰Katelijne van Emmerik-van Oortmerssen, Geurt van de Glind, Wim van den Brink, Filip Smit, Cleo L. Crunelle, Marije Swets, Robert A. Schoevers, Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis, Drug and Alcohol Dependence, Volume 122, Issues 1–2, 2012, Pages 11-19, ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2011.12.007.

²¹Nazar BP, Bernardes C, Peachey G, Sergeant J, Mattos P, Treasure J. The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Int J Eat Disord. 2016 Dec;49(12):1045-1057. doi: 10.1002/eat.22643. Epub 2016 Nov 15. PMID: 27859581.

²²Curtin, Carol & Pagoto, Sherry & Mick, Eric. (2013). The association between ADHD and eating disorders/pathology in adolescents: A systematic review. Open Journal of Epidemiology. 3. 193-202. 10.4236/ojepi.2013.34028.

²³Nock MK, Kazdin AE, Hiripi E, Kessler RC. Lifetime prevalence, correlates, and persistence of oppositional defiant disorder: results from the National Comorbidity Survey Replication. J Child Psychol Psychiatry. 2007 Jul;48(7):703-13. doi: 10.1111/j.1469-7610.2007.01733.x. PMID: 17593151.

²⁴Curry AE, Yerys BE, Metzger KB, Carey ME, Power TJ. Traffic Crashes, Violations, and Suspensions Among Young Drivers With ADHD. Pediatrics. 2019 Jun;143(6):e20182305. doi: 10.1542/peds.2018-2305. Epub 2019 May 20. PMID: 31110164; PMCID: PMC6564068.

²⁵Ward JH, Curran S. Self-harm as the first presentation of attention deficit hyperactivity disorder in adolescents. Child Adolesc Ment Health. 2021 Nov;26(4):303-309. doi: 10.1111/camh.12471. Epub 2021 May 3. PMID: 33939246.

²⁶Hinshaw SP, Owens EB, Zalecki C, Huggins SP, Montenegro-Nevado AJ, Schrodek E, Swanson EN. Prospective follow-up of girls with attention-deficit/hyperactivity disorder into early adulthood: continuing impairment includes elevated risk for suicide attempts and self-injury. J Consult Clin Psychol. 2012 Dec;80(6):1041-1051. doi: 10.1037/a0029451. Epub 2012 Aug 13. PMID: 22889337; PMCID: PMC3543865.

²⁷Ping-I Lin, Weng Tong Wu, Enoch Kordjo Azasu, Tsz Ying Wong, Pathway from attention-deficit/hyperactivity disorder to suicide/self-harm, Psychiatry Research, Volume 337, 2024, 115936, ISSN 0165-1781, https://doi.org/10.1016/j.psychres.2024.115936.

²⁸Li L, Zhu N, Zhang L, Kuja-Halkola R, D’Onofrio BM, Brikell I, Lichtenstein P, Cortese S, Larsson H, Chang Z. ADHD Pharmacotherapy and Mortality in Individuals With ADHD. JAMA. 2024 Mar 12;331(10):850-860. doi: 10.1001/jama.2024.0851. PMID: 38470385; PMCID: PMC10936112.

²⁹Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64 Suppl 11:9-13. PMID: 14529324.

³⁰Chang Z, Quinn PD, Hur K, et al. Association Between Medication Use for Attention-Deficit/Hyperactivity Disorder and Risk of Motor Vehicle Crashes. JAMA Psychiatry. 2017;74(6):597–603. doi:10.1001/jamapsychiatry.2017.0659

³¹Spencer, Thomas et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder, Biological Psychiatry, Volume 57, Issue 5, 456 – 463

³²Barbaresi WJ, Katusic SK, Colligan RC, Weaver AL, Leibson CL, Jacobsen SJ. Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: results from a population-based study. J Dev Behav Pediatr. 2006 Feb;27(1):1-10. doi: 10.1097/00004703-200602000-00001. PMID: 16511362.

³³Faraone, S. V., & Buitelaar, J. (2010). “Comparing the efficacy of stimulants for ADHD in children and adolescents using meta-analysis.” European Child & Adolescent Psychiatry, 19(4), 353-364.

³⁴Centers for Disease Control and Prevention. (2022, March 8). Treatment recommendations for healthcare providers. https://www.cdc.gov/adhd/hcp/treatment-recommendations/index.html.

³⁵Grossi, G. US ADHD Stimulant Shortage Highlights Growing Challenges in Adult Treatment. AJMC. 2024 Nov. https://www.ajmc.com/view/us-adhd-stimulant-shortage-highlights-growing-challenges-in-adult-treatment

³⁶Quinn PD, Chang Z, Hur K, Gibbons RD, Lahey BB, Rickert ME, Sjölander A, Lichtenstein P, Larsson H, D’Onofrio BM. ADHD Medication and Substance-Related Problems. Am J Psychiatry. 2017 Sep 1;174(9):877-885. doi: 10.1176/appi.ajp.2017.16060686. Epub 2017 Jun 29. PMID: 28659039; PMCID: PMC5581231.

³⁷Newcorn, J. H., Kratochvil, C. J., Allen, A. J., Casat, C. D., Ruff, D. D., Moore, R. J., & Michelson, D. (2008). “Atomoxetine and osmotically released methylphenidate for the treatment of attention deficit hyperactivity disorder: acute comparison and differential response.” American Journal of Psychiatry, 165(6), 721-730.

³⁸Sallee FR, McGough J, Wigal T, Donahue J, Lyne A, Biederman J; SPD503 STUDY GROUP. Guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder: a placebo-controlled trial. J Am Acad Child Adolesc Psychiatry. 2009 Feb;48(2):155-65. doi: 10.1097/CHI.0b013e318191769e. PMID: 19106767.

³⁹Connor DF, Findling RL, Kollins SH, Sallee F, López FA, Lyne A, Tremblay G. Effects of guanfacine extended release on oppositional symptoms in children aged 6-12 years with attention-deficit hyperactivity disorder and oppositional symptoms: a randomized, double-blind, placebo-controlled trial. CNS Drugs. 2010 Sep;24(9):755-68. doi: 10.2165/11537790-000000000-00000. PMID: 20806988.

⁴⁰Fabiano GA, Pelham WE Jr, Coles EK, Gnagy EM, Chronis-Tuscano A, O’Connor BC. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev. 2009 Mar;29(2):129-40. doi: 10.1016/j.cpr.2008.11.001. Epub 2008 Nov 11. PMID: 19131150.

⁴¹Cerrillo-Urbina AJ, García-Hermoso A, Sánchez-López M, Pardo-Guijarro MJ, Santos Gómez JL, Martínez-Vizcaíno V. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev. 2015 Nov;41(6):779-88. doi: 10.1111/cch.12255. Epub 2015 May 18. PMID: 25988743.

⁴²Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World J Clin Pediatr. 2022 Mar 15;11(3):239-252. doi: 10.5409/wjcp.v11.i3.239. PMID: 35663001; PMCID: PMC9134149.

⁴³Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁴A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999 Dec;56(12):1073-86. doi: 10.1001/archpsyc.56.12.1073. PMID: 10591283.

⁴⁵Richardson, A. J., Puri, B. K. (2002). “A randomized double-blind, placebo-controlled study of the effects of supplementation with highly unsaturated fatty acids on ADHD-related symptoms in children with specific learning difficulties.” Progress in Neuro-Psychopharmacology & Biological Psychiatry, 26(2), 233-239.

⁴⁶Nigg JT, Lewis K, Edinger T, Falk M. Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. J Am Acad Child Adolesc Psychiatry. 2012 Jan;51(1):86-97.e8. doi: 10.1016/j.jaac.2011.10.015. PMID: 22176942; PMCID: PMC4321798.

⁴⁷Ojinna BT, Parisapogu A, Sherpa ML, Choday S, Ravi N, Giva S, Shantha Kumar V, Shrestha N, Tran HH, Penumetcha SS. Efficacy of Cognitive Behavioral Therapy and Methylphenidate in the Treatment of Attention Deficit Hyperactivity Disorder in Children and Adolescents: A Systematic Review. Cureus. 2022 Dec 17;14(12):e32647. doi: 10.7759/cureus.32647. PMID: 36660538; PMCID: PMC9845961.

⁴⁸Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁴⁹ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁵⁰Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁵¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

⁵² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

⁵³ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006

Dialectical behavior therapy (DBT) is an evidence-based treatment designed to help individuals who struggle with emotional dysregulation, aggression, self-harm, and other problem behaviors. DBT is an intensive, highly structured program that was originally created for adults in the 1970s and has since been adapted for children and adolescents. It can be an effective treatment for ADHD because it aids in the development of skills that support emotional regulation, problem-solving, and self-acceptance.

DBT works by helping children develop skills that decrease unwanted feelings and unhelpful behaviors, as well as skills that help them to accept difficult feelings about themselves and others without judgment. DBT patients participate in one-on-one therapy, group skills training, and/or phone coaching from their therapist. Parents learn the same skills as their children so that they can reinforce those skills outside of therapy.

In this webinar, you will learn:

• About the conditions that DBT treats in children and adolescents, and who would be a good fit for this therapy
• About DBT as a treatment model and how it works
• How DBT can support children and adolescents in managing mood, impulsivity, and anxiety
• About DBT strategies to support children in distress

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Audacy; Spotify; Amazon Music; iHeartRADIO

DBT for ADHD: More Resources

• Download: What Is Dialectical Behavior Therapy (DBT)?
• Read: Overview of ADHD Therapies
• Q&A: Why Deficient Emotional Self-Regulation is Central to ADHD
• eBook: The Parents’ Guide to Raising a Teen with ADHD

Obtain a Certificate of Attendance

If you attended the live webinar on November 19, 2024, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker

Lauren Allerhand, Psy.D., is Co-Director of the Dialectical Behavior Therapy Programs and a psychologist for the Mood Disorders Center at the Child Mind Institute in the San Francisco Bay Area. She specializes in the evidence-based assessment and treatment of youth struggling with depression, anxiety, trauma, eating disorders, ADHD, and oppositional defiant disorder. She has extensive training in cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). Dr. Allerhand is particularly passionate about providing DBT to improve the lives of high-risk, diagnostically complex youth who struggle with emotion dysregulation, suicidality, and self-injury.

Dr. Allerhand’s clinical practice also emphasizes supporting parents of children and teens with emotion dysregulation, oppositional behavior, or ADHD through evidence-based intervention. She has specialized trained in a DBT parenting intervention and Parent Management Training for parents of older children and teenagers. Dr. Allerhand is also certified in Parent Child Interaction Therapy (PCIT), an evidence-based intervention for families with preschool-aged children.

Listener Testimonials

“Praise to the speaker for her clarity. Excellent delivery.”

“The speaker was excellent, and the presentation outlined exactly the things I was hoping to find out about DBT. Thank you!”

“I really liked the specific examples that she provided. It was very helpful. Thank you!

Webinar Sponsor

The sponsor of this ADDitude webinar is…

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Immersive virtual reality-based interventions (VR) can improve cognitive deficits associated with ADHD in children, according to a study published in 2023 in the journal Virtual Reality. Compared to active and passive control groups, children with ADHD experienced positive outcomes with large effect sizes global cognitive functioning, attention, and memory when using immersive VR therapies.¹

In a meta-analysis of seven randomized controlled trials (RCTs), 149 participants were assigned to the immersive VR group and 172 participants to the control group. The study found a significant difference in performance outcomes for attention (g = 0.94) and global cognition (g = 1.06) in favor of the immersive VR group. Only one RCT assessed for memory outcomes, but as with attention and global cognition, the VR group showed a significant advantage (g = 1.81). Improvements were greater for children who were not otherwise treated for ADHD.

Efficacy of Immersive VR

Virtual reality is increasingly used in healthcare, and evaluations by clinicians have been positive. ^{2, 3} Patients say that brain training — an umbrella term used to describe cognitive tools like VR — is effective at improving ADHD symptoms. In a 2024 treatment survey conducted by ADDitude, brain training ranked in the top three most effective ADHD treatment options according to caregivers and adults with ADHD.

XRHealth is the maker of one commercially available VR therapy for ADHD. “Applications for kids with ADHD include a boxing-like game in which players choose which stimuli to punch, which to avoid, and what distractions to ignore,” said Randy Kulman, Ph.D., in “A User’s Guide to Digital Therapeutics for ADHD.”

VR-based interventions may also be useful in the classroom, according to the researchers. “Given the positive association between global cognitive functioning and academic performance, and social functioning, VR-based interventions may benefit the daily life of children with ADHD in terms of school performance and peer relations.”

Yet, brain training was also one of the least utilized treatment options used by ADDitude survey respondents. Out of more than 12,000 respondents, only 6% of caregivers and adults reported having used it to treat ADHD for their child or personally. Lack of personalization to patient needs, treatment goals, and knowledge on the added value of VR have been cited as barriers to implementation.³Access to providers who have experience treating ADHD was the biggest overall barrier to care, according to survey respondents.

Potential Moderators

Researchers performed a second meta-analysis to identify potential moderators of the effect size of global cognitive functioning, for which there was significant substantial heterogeneity (I² = 71.23%). Improvements in global cognition were observed across all participant ages and intervention durations, regardless of diagnostic status (formal vs. informal), novelty of headsets (new vs. old), or control group intervention (passive vs. active). The study did not assess for moderators of attention alone, for which heterogeneity was also significant (I² = 68.26%).

The significance of moderators on immersive VR-based outcomes are mixed. Research has shown that longer interventions, younger participants, and passive control groups may lead to different outcomes, the researchers noted. Follow-up measurements could help “assess the long-term effects of VR interventions and whether improvements made on cognitive functioning outcomes from baseline to post-intervention are maintained after the intervention has ceased.”

Limitations and Future Research

The systematic review and meta-analysis was the first to address treatment adherence and safety of immersive VR in improving cognitive deficits in children with ADHD. Compared to control groups, drop-out rates were similar across groups, and there were no adverse effects. Researchers concluded that immersive VR “is feasible in terms of treatment adherence and a safe cognitive rehabilitation tool.”

A rigorous literature search was conducted for the current study according to PRISMA guidelines and the Cochrane Handbook, and improvements were observed even after correcting for publication bias. However, of the limited studies that were included, all were judged to have an unclear risk of bias based on randomization and selective reporting. Results should be interpreted cautiously.

Control group interventions included non-immersive VR, medication, psychotherapy, cognitive training, neurofeedback, hemoencephalographic biofeedback, being placed on a waiting list, or no treatment. Head-mounted displays were required to be considered an immersive VR-based intervention.

Learn about the current state of affairs in implementing VR technology in healthcare here.

Sources

¹Corrigan, N., Păsărelu, C.R., & Voinescu, A. (2023). Immersive virtual reality for improving cognitive deficits in children with ADHD: a systematic review and meta-analysis. Virtual Reality, 1-20. doi:10.1007/s10055-023-00768-1.

²Zangiacomi, A., Flori, V., Greci, L., Scaglione, A., Arlati, S., & Bernardelli, G. (2022). an immersive virtual reality-based application for treating ADHD: A remote evaluation of acceptance and usability. Digital Health, 8. doi:10.1177/20552076221143242

³Kouijzer, M., Kip, H., Bouman, Y., Kelders, S. (2023). Implementation of virtual reality in healthcare: a scoping review on the implementation process of virtual reality in various healthcare settings. Implement Sci Commun, 4(1):67. doi: 10.1186/s43058-023-00442-2.

BEHAVIORAL THERAPY: Can behavioral therapy improve my child’s ADHD symptoms?

A: Behavioral therapy isn’t psychotherapy or play therapy. It focuses on actions, not emotions. It can teach your child how to turn disruptive energy into positive thoughts… | Keep reading on ADDitude »

PARENT TRAINING: Can parent training improve my child’s ADHD symptoms?

A: Also called behavioral parent training (BPT), parent training can improve the way your child acts, help them gain self-control, and boost their self-esteem. For young children… | Keep reading on ADDitude »

EF SKILLS: How can I use behavioral parent training to improve my child’s executive functions?

A: BPT provides insight into difficulties with executive functions, such as working memory deficits or poor response inhibition. It offers specific strategies for responding in a way that helps your child… | Keep reading on ADDitude »

OT: Can occupational therapy improve my child’s ADHD symptoms?

A: An occupational therapist, or “OT,” helps kids with ADHD improve certain skills, such as organization, physical coordination… | Keep reading on ADDitude »

THERAPY: Can family therapy improve my child’s ADHD symptoms?

A: Family therapy can help your household — and all the people in it — run more smoothly. Treatment can be parent-directed or include your child in sessions… | Keep reading on ADDitude »

HEALTHY LIFESTYLE: What natural ADHD treatments are most highly rated by other parents?

A: Diet, exercise, and sleep are the Big Three — the lifestyle changes with the most significant, most scientifically proven effect on ADHD. When these lifestyle factors are optimized… | Keep reading on ADDitude »

FIRST-PERSON: “How Occupational Therapy Changed My Son’s Life…”

“…and taught me how to better parent a child with special needs. Part of this is recognizing that my parental instincts are not always going to be right. From time to time, I’m going to face tough choices and will need to rely on my skills from therapy to guide me in the right direction.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Parent Training Programs

In this free resource, we outline how these programs work, what skills parents will learn, and how long it will take to see better behavior. | Download now on ADDitude »

EXPERT WEBINAR: The Best Kind of Discipline

Expert webinar with Carla Counts Allan, Ph.D. | Listen now on ADDitude »

8-Part Guide to ADHD Treatment in Children:

Q 1: How should I approach my child’s ADHD treatment plan?
Q 2: Is ADHD medication right for my child?
Q 3: How can I address side effects associated with my child’s ADHD medication?
Q 4: How can I integrate nutrition & supplements into my child’s ADHD treatment?
Q 5: How can I integrate exercise & mindfulness into my child’s ADHD treatment?
> Q 6: What therapies should I integrate into my child’s ADHD treatment plan?
Q 7: How should I adjust and optimize my child’s ADHD treatment plan over time?
Q 8: How can my child’s treatment plan safely address comorbid conditions?

EXERCISE: Will exercise improve my child’s ADHD symptoms, according to research?

A: In studies, kids with ADHD who exercised performed better on tests of attention, and had less impulsivity, even if they weren’t taking stimulant… | Keep reading on ADDitude »

SPORTS: What sports are the best options for my child with ADHD?

A: The sport should be one that will hold your child’s interest. Baseball involves a lot of time standing in the outfield, and that invites distraction. Soccer, on the other hand… | Keep reading on ADDitude »

SLEEP: Does sleep affect ADHD symptoms in any way? How much sleep do kids with ADHD need?

A: Sleep may be the most important tool nature uses to grow a child’s brain. During sleep the brain makes new connections, stores memories, and repairs cells. One striking scientific finding is called sleep-dependent learning… | Keep reading on ADDitude »

MINDFULNESS: Could mindfulness improve my child’s ADHD symptoms?

A: When you learn to calm your mind and be in the present moment, your working memory can improve. This might help… | Keep reading on ADDitude »

BRAIN ACTIVITY: How can I understand the neurological effects of exercise on my child’s ADHD brain?

A: By showing that exercise sparks the master molecule of the learning process, BDNF, the study author nailed down a biological connection between movement and cognitive function… | Keep reading on ADDitude »

MEDITATION: What mindfulness exercises work best children with ADHD?

A: At school or at home, practice yoga poses in the morning, and meditation at the end of the day. Start with the “Take 5” method where children take five slow breaths inhaling through the nose, then exhaling… | Keep reading on ADDitude »

FIRST-PERSON: “Sports Gave My Son a Way to Channel His Energy”

“‘As a teen, I felt that everyone hated me,’ he recalls. ‘I was always doing something wrong, it seemed. It’s hard to feel good about yourself when everyone is complaining about you. Sports turned those negative feelings into positive ones.'” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Easy Mindfulness Exercises for Kids

Mindfulness is possible at any age. In this guide, learn how to teach meditation exercises that will help your child calm their body and mind. | Download now on ADDitude »

FREE DOWNLOAD: Sports & Activities for Kids with ADHD

Use this list to determine which activities will showcase and strengthen your child’s abilities so she can shine on the court, in the field, or in the pool. | Download now on ADDitude »

8-Part Guide to ADHD Treatment in Children:

Q 1: How should I approach my child’s ADHD treatment plan?
Q 2: Is ADHD medication right for my child?
Q 3: How can I address side effects associated with my child’s ADHD medication?
Q 4: How can I integrate nutrition & supplements into my child’s ADHD treatment?
> Q 5: How can I integrate exercise & mindfulness into my child’s ADHD treatment?
Q 6: What therapies should I integrate into my child’s ADHD treatment plan?
Q 7: How should I adjust and optimize my child’s ADHD treatment plan over time?
Q 8: How can my child’s treatment plan safely address comorbid conditions?

NUTRITION: What should my child eat (and avoid) to improve their ADHD symptoms?

A: There’s no clear scientific evidence that ADHD is caused by diet or nutritional problems. But certain foods may play at least some role in affecting symptoms… | Keep reading on ADDitude »

SUPPLEMENTS: Which vitamins and supplements can improve my child’s ADHD symptoms?

A: Several studies have shown a drop in hyperactivity and impulsivity with zinc supplements. The same research, though, reports no change in inattentiveness… | Keep reading on ADDitude »

ADDITIVES: Should my child with ADHD avoid food dyes?

A: A study of nearly 300 children by the United Kingdom’s Food Standards Agency in 2007 showed that the consumption of foods containing dyes could increase hyperactive behavior… | Keep reading on ADDitude »

FISH OIL: Should my child with ADHD take a daily fish oil supplement?

A: Our brains use omega-3s in the hippocampus, the memory center of the brain. If you are low in omega-3 fatty acids, it may be… | Keep reading on ADDitude »

OMEGA-3s: Should my child with ADHD eat foods rich in omega-3 fatty acids?

A: A deficiency of omega-3s is bad news for a child’s or adult’s brain. Our hunter-gatherer ancestors ate a diet with a ratio of about 2 to 1 omega-6s to omega-3s. Today, we eat a diet with the ratio… | Keep reading on ADDitude »

CLEAN EATING: Should I remove all sugar and inorganic foods from my child’s diet?

A: Although not every child with ADHD reacts to sugar in an adverse way, it is best for all parents to limit sugar as much as possible. Soda, if offered at all, should be an occasional treat. Fruit juice should be limited to… | Keep reading on ADDitude »

FIRST-PERSON: “I’ve Become a Food Cop for My Son”

“Our insufferable food rules: no dairy, no gluten, no food dye. None. No trace amounts. No cheating. No “just-one-bite.” We tell the disbelievers that if they’d like to feed it to our kids, they will be parenting the kids for the next two days.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: Alternative ADHD Treatment Guide

Lean about the benefits and risks of alternative treatment options like neurofeedback, nutrition, supplements, and more. | Download now on ADDitude »

FREE DOWNLOAD: ADHD Vitamins and Supplements

This guide outlines ADHD-friendly vitamins and supplements — like iron, zinc, and magnesium — that may help common ADHD symptoms. | Download now on ADDitude »

8-Part Guide to ADHD Treatment in Children:

Q 1: How should I approach my child’s ADHD treatment plan?
Q 2: Is ADHD medication right for my child?
Q 3: How can I address side effects associated with my child’s ADHD medication?
> Q 4:  How can I integrate nutrition & supplements into my child’s ADHD treatment?
Q 5: How can I integrate exercise & mindfulness into my child’s ADHD treatment?
Q 6: What therapies should I integrate into my child’s ADHD treatment plan?
Q 7: How should I adjust and optimize my child’s ADHD treatment plan over time?
Q 8: How can my child’s treatment plan safely address comorbid conditions?

OPTIONS: What ADHD treatment options should I consider for my child?

A: Together with the doctor, you’ll develop a plan that meets your child’s specific needs. It may include medications, behavioral therapy, or both… | Keep reading on ADDitude »

MEDICATIONS: What medication classes are used to treat ADHD in children?

A: Your child’s doctor will probably try a low-dose stimulant first. Stimulants have been used for a long time and are well-tested. They’re often helpful for children and teens who… | Keep reading on ADDitude »

CHOOSING A MED: How do I find the best ADHD medication for my child with so many options?

A: There’s no set formula for which medication works best for which child. It’s a process of trial and error. One major decision is whether to use a short- or long-lasting pill. Depending on the prescription… | Keep reading on ADDitude »

BEYOND MEDS: Can I treat my child’s ADHD without medication?

A: Alternative treatments for ADHD include elimination diets, omega-3 supplements, parent training, exercise, yoga, meditation,… | Keep reading on ADDitude »

MED CLASSES: How can I better understand all of the ADHD medication options and their risks and benefits?

A: The medications most widely used to treat ADHD include stimulants, non-stimulants, and antidepressants. Side effects include… | Keep reading on ADDitude »

NONSTIMULANTS: What other medication options and classes are used to treat ADHD in children?

A: If you’re thinking about nonstimulant options, your doctor might suggest a drug called a serotonin-norepinephrine reuptake inhibitor, or SNRI… | Keep reading on WebMD »

FIRST-PERSON: “The Amazing Day I Saw My Son Medicated”

“I noticed the house was… quieter than usual. Lucas absorbed himself in drawings and books and running around the way he would any other day, but the big difference was the lack of what I call nonsense-noise — those random outbursts of sound that defy categorization.” | Keep reading on ADDitude »

RELATED RESOURCES

FREE DOWNLOAD: ADHD Medications: Comparison Chart

Quickly compare the formulation, duration, and more for the most popular ADHD medications. | Download now on ADDitude »

QUIZ: Myths and Facts About ADHD Medication

Test your knowledge: Does medication cure ADHD? Does it change your personality? | Take the quiz now on WebMD »

8-Part Guide to ADHD Treatment in Children:

> Q 1: How should I approach my child’s ADHD treatment plan?
Q 2: Is ADHD medication right for my child?
Q 3: How can I address side effects associated with my child’s ADHD medication?
Q 4: How can I integrate nutrition & supplements into my child’s ADHD treatment?
Q 5: How can I integrate exercise & mindfulness into my child’s ADHD treatment?
Q 6: What therapies should I integrate into my child’s ADHD treatment plan?
Q 7: How should I adjust and optimize my child’s ADHD treatment plan over time?
Q 8: How can my child’s treatment plan safely address comorbid conditions?

Dietary Disguises

“My 6-year-old is a super smeller and taster with texture issues. I put 1/2 teaspoon of orange sherbet-flavored fish oil in orange juice. I mix a capsule of supplements in a peanut butter and honey sandwich. I sprinkle a probiotic in a sports drink.”

“Eating a popsicle before taking any medicine or supplement freezes the taste buds so the taste isn’t as strong.”

“Thick chocolate milkshakes work for us. In a blender, pour in milk, the powder or liquid supplement, and chocolate ice cream. Blend until no longer chunky.”

“Homemade waffle and pancake mix can hide protein powder and flax seeds.”

[Download: Free Guide to ADHD Brain Food]

“There are vegan alternatives to fish oil that provide omega-3 nutrients, like chia seeds and hemp. I use these in smoothies, yogurt, and oatmeal.”

“I drip the liquid from a fish oil capsule into a shot of fruit juice, then have my kids eat dinner to overshadow any lingering tastes.”

“My son loves the protein café latte shakes and they’re loaded with vitamins and minerals. They also have caffeine, which I think helps him.”

“Protein powders, spinach, and hemp, flax, and chia seeds go in smoothies with frozen fruit and non-dairy almond or coconut milk.”

[Read: ADHD and Fish Oil Supplements — What’s a Safe Dosage?]

“My child is autistic and has gut issues. He needs to take a laxative daily. I mix the powder in flavored water to make it taste better.”

“I put fish oil in smoothies and make popsicles out of the smoothies.”

“I always put powdered supplements in applesauce. For the ones that taste bad, I give a juice chaser afterward.”

“I have my own challenges with supplements and find that using yogurt with a drizzle of honey helps.”

“I sprinkle my son’s capsules into a small spoonful of pre-made cake frosting. A spoonful of sugar makes the medicine go down!”

“I put powder or liquid supplements in banana smoothies, chocolate milk, and pudding.”

“I give my kids gummies.”

“I mix liquid fish oil into tea with lemon and sugar.”

Picky Eaters with ADHD: Next Steps

• Download: Everyday Foods Filled with Omega-3s
• Read: The Parent’s Guide to Mealtime with Picky Eaters
• Read: ARFID, SPD, & Other Conditions Linked to Feeding Difficulties in Kids

SUPPORT ADDITUDE
Thank you for reading ADDitude. To support our mission of providing ADHD education and support, please consider subscribing. Your readership and support help make our content and outreach possible. Thank you.

Intense children exhibit intense, often problematic, behavior with a frequency and severity that impacts everyone. Exhausted parents field regular phone calls from school administrators, frustrated teachers feel punishment (or leaving the profession) is their only option, and medical professionals assume medication is the only approach that truly works. No one benefits, certainly not the child.

Enter the Nurtured Heart Approach, a parent behavior training program developed from therapist Howard Glasser’s work with the most challenging and intense children. School and treatment centers report that it not only positively transforms “difficult” behaviors, but the Nurtured Heart Approach benefits all children by enabling and teaching adults how to channel their intensity into great qualities of character and leadership.

In this webinar, you will:

• Understand the dynamics of intense children and how to inspire success and greatness
• Understand why, despite sincere intention, conventional methods of parenting, education, and treatment often backfire with intense and challenging children
• Learn a methodology for inspiring success that is more powerful and encompassing than traditional approaches
• Understand how to uphold a great level of limits and accountability while avoiding the traps that make consequences backfire

Watch the Video Replay

Enter your email address in the box above labeled “Video Replay + Slide Access” to watch the video replay (closed captions available) and download the slide presentation.

Download or Stream the Podcast Audio

Click the play button below to listen to this episode directly in your browser, click the symbol to download to listen later, or open in your podcasts app: Apple Podcasts; Google Podcasts; Stitcher; Spotify; Amazon Music; iHeartRADIO.

More on Positive Parenting and ADHD

• Download: Questions to Get Your Child Talking
• Read: “My Child Resists Everything! Will He Ever Open Up to New Experiences?”
• Read: Positive Charge: How to Reinforce Good Behavior

Obtain a Certificate of Attendance

If you attended the live webinar on March 29, 2023, watched the video replay, or listened to the podcast, you may purchase a certificate of attendance option (cost: $10). Note: ADDitude does not offer CEU credits. Click here to purchase the certificate of attendance option »

Meet the Expert Speaker:

Creator of the Nurtured Heart Approach, Howard Glasser works in family treatment, clinical studies, and educational leadership. His formal studies, along with direct experience with the most intense and challenging children, form the basis of this approach. He has been referred to as one of the most influential persons working to reduce children’s reliance on psychiatric medications.

Howard is the author of 15 books, including Transforming the Difficult Child, a longstanding bestseller on intense and challenging children. (#CommissionsEarned)

Howard teaches Nurtured Heart Approach Certification Training Intensives at the Nurtured Heart Institute, the University of Arizona’s Integrative Medicine Program, and at the Zuckerman School of Public Health.

#CommissionsEarned As an Amazon Associate, ADDitude earns a commission from qualifying purchases made by ADDitude readers on the affiliate links we share. However, all products linked in the ADDitude Store have been independently selected by our editors and/or recommended by our readers. Prices are accurate and items in stock as of time of publication.

Listener Testimonials

“As a heart-centered practitioner, I appreciated this approach!”

“Glasser got to the core of the parent-child relationship in such a beautiful and compelling way.”

“Excellent presentation. I was affirmed in some of my current practices with my 5th & 6th grade classroom & want to explore this approach further!”

“Thank you! So rich and helpful.”

“Thank you, Howard was fantastic. Lots to think about, and to redirect the focus is something I’m going to try starting now! Inner wealth… I love this idea.”

Follow ADDitude’s full ADHD Experts Podcast in your podcasts app:
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Here, we examine brain training programs — including neurofeedback and cerebellar (or movement/balance) interventions — and determine whether they effectively improve ADHD symptoms.

Brain Games for Adults and Kids with ADHD

Also called neurocognitive training, brain games are designed to train the brain to learn something. Many claim to improve focus, attention, and executive function skills impaired by ADHD, such as working memory. Working memory is the ability to remember information, use it for a task, and then dump it once you no longer need it. When playing brain games, either on a computer in a clinician’s office or at home, users are asked to complete tasks that may include sorting items by shape and color, recalling a sequence of shapes or objects, or remembering what items flashed on the screen.

ADHD Brain Games: Our Conclusion

Do brain games help reduce ADHD symptoms for the rest of your life, or just while doing the tasks involved in your training? This is the key question. After all, playing lots of Candy Crush will lead to higher scores, but not much else.

To that end, researchers have found that brain games don’t actually reduce ADHD symptoms.^{1 2 3} While players may improve their performance in a game, those skills likely won’t transfer to other areas, such as following directions for a class assignment at school. Furthermore, there is no evidence that you can train a brain to improve working memory, or any other executive function.^{1 2 4 5}

[Free Download: Learn the Facts About Neurofeedback]

Neurofeedback for ADHD

Neurofeedback is biofeedback that uses an electroencephalogram (EEG) to measure brain activity and train the user to produce brain wave patterns like those of a non-ADHD brain. Electrodes are placed on a person’s head to monitor brain activity while they play a video game in a clinician’s office. The hope is that the person will see improvements in attention, and a decrease in hyperactive or impulsive behavior, that will continue after the neurofeedback sessions are completed. Neurofeedback involves a significant investment of time (30-plus sessions total, multiple times per week) and can carry a price tag of up to $3,000. This intervention may not be covered by insurance.

EEG Neurofeedback: Our Conclusion

Neurofeedback has not shown enough effectiveness in studies to be recommended as a “stand-alone” treatment for ADHD. Also, there is little evidence that neurofeedback reduces ADHD symptoms long-term.^{6 7 8} It’s possible that future versions of neurofeedback may prove to be effective, but we cannot recommend this right now. Given the high cost in time and money, neurofeedback doesn’t seem to be worth the investment.

Cerebellar or Movement Exercises for ADHD

The so-called “cerebellar developmental delay” theory claims that different parts of the brain lack sufficient connections to coordinate the processing of information, resulting in symptoms of ADHD, dyslexia, and dyspraxia.⁹ Movement and balance exercises claim to “remediate” ADHD symptoms by improving the functions of the cerebellum through specific movements that involve crossing the body’s midline, such as touching your left shoulder with your right hand. The idea is that these exercises will integrate the two sides of the brain, resulting in cognitive improvements, such as in paying attention and processing information. But this premise is flawed, as it does not match up with established medical science regarding how the brain operates. (If this theory were valid, we would need to re-write much of neurological theory.)

Cerebellar Exercises: Our Conclusion

Cerebellar exercises do not reduce ADHD symptoms. Any benefits from movement and balance exercises likely come from the benefits of exercise in general. Exercise of any kind increases levels of certain neurotransmitters in the brain, some of which are naturally low due to ADHD. That’s why exercise has been shown to temporarily improve cognitive functioning and ADHD symptoms. As far as cerebellar exercises and “movement therapies,” there is nothing efficacious about them specifically.¹⁰

[Read: Exercise and the ADHD Brain — The Neuroscience of Movement]

ADHD Brain Training: The Bottom Line

Based on the research, we can’t personally recommend computerized brain training, neurofeedback, or cerebellar/movement/balance exercises to treat ADHD. If you are still considering any of these approaches for yourself or your child, remember that the placebo effect can be potent, meaning that a program may work simply because you expect it to work, at least initially. Keep in mind that any proposed intervention that is expensive and/or time-consuming must be able to make a much stronger case about its effectiveness.

You should also be aware of tactics companies use to sell such programs, along with other red flags:

• Is there sales pressure to sign up immediately, without time to do your own research into a program’s efficacy?
• Is the pitch about an approach’s effectiveness based on testimonials, not peer-reviewed journal articles or research?
• Is the intervention “radical” and brand new to the marketplace, and therefore hasn’t been out long enough to be fully evaluated?
• Does the program claim to be 100 percent safe and free of side effects (which might suggest it is also zero percent effective)?

If you or your children are benefiting from brain games, neurofeedback, or similar approaches, and it isn’t causing financial hardship or taking an unreasonable amount of your time, then it should be fine to continue. But know that there is no such thing as a miracle cure for ADHD.

Does Brain Training Work for ADHD? Next Steps

• Free Download: Unraveling the Mysteries of Your ADHD Brain
• Read: Can Neurofeedback Effectively Treat ADHD?
• Read: Like a Personal Trainer for Your Brain

Stephanie Sarkis, Ph.D., is a psychotherapist and the author of Healing from Toxic Relationships: 10 Essential Steps to Recover from Gaslighting, Narcissism, and Emotional Abuse and Gaslighting: Recognize Manipulative and Emotionally Abusive People—and Break Free. Ari Tuckman, Psy.D., C.S.T., is a psychologist, international speaker, and author of four books on ADHD, including More Attention, Less Deficit and Understand Your Brain, Get More Done.

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Sources

¹ Gathercole S. E. (2014). Commentary: Working memory training and ADHD – where does its potential lie? Reflections on Chacko et al. (2014). Journal of child psychology and psychiatry, and allied disciplines, 55(3), 256–257. https://doi.org/10.1111/jcpp.12196

² Chacko, A., Bedard, A. C., Marks, D. J., Feirsen, N., Uderman, J. Z., Chimiklis, A., Rajwan, E., Cornwell, M., Anderson, L., Zwilling, A., & Ramon, M. (2014). A randomized clinical trial of Cogmed Working Memory Training in school-age children with ADHD: a replication in a diverse sample using a control condition. Journal of child psychology and psychiatry, and allied disciplines, 55(3), 247–255. https://doi.org/10.1111/jcpp.12146

³ Shipstead, Z., Hicks, K. L., & Engle, R. W. (2012). Cogmed working memory training: Does the evidence support the claims? Journal of Applied Research in Memory and Cognition, 1(3), 185–193. https://doi.org/10.1016/j.jarmac.2012.06.003

⁴ Melby-Lervåg, M., & Hulme, C. (2013). Is working memory training effective? A meta-analytic review. Developmental psychology, 49(2), 270–291. https://doi.org/10.1037/a0028228

⁵ Hulme, C., & Melby-Lervåg, M. (2012). Current evidence does not support the claims made for CogMed working memory training. Journal of Applied Research in Memory and Cognition, 1(3), 197–200. https://doi.org/10.1016/j.jarmac.2012.06.006

⁶ Gevensleben, H., Moll, G. H., Rothenberger, A., & Heinrich, H. (2014). Neurofeedback in attention-deficit/hyperactivity disorder – different models, different ways of application. Frontiers in human neuroscience, 8, 846. https://doi.org/10.3389/fnhum.2014.00846

⁷ Arnold, L. E., Lofthouse, N., Hersch, S., Pan, X., Hurt, E., Bates, B., Kassouf, K., Moone, S., & Grantier, C. (2013). EEG neurofeedback for ADHD: double-blind sham-controlled randomized pilot feasibility trial. Journal of attention disorders, 17(5), 410–419. https://doi.org/10.1177/1087054712446173

⁸ Ramsay, J. R. (2010). Neurofeedback and neurocognitive training. In J. R. Ramsay, Nonmedication treatments for adult ADHD: Evaluating impact on daily functioning and well-being (pp. 109–129). American Psychological Association. https://doi.org/10.1037/12056-006

⁹ Bishop D. V. (2007). Curing dyslexia and attention-deficit hyperactivity disorder by training motor co-ordination: miracle or myth?. Journal of paediatrics and child health, 43(10), 653–655. https://doi.org/10.1111/j.1440-1754.2007.01225.x

¹⁰ Snowling, M. J., & Hulme, C. (2003). A critique of claims from Reynolds, Nicolson & Hambly (2003) that DDAT is an effective treatment for children with reading difficulties–‘lies, damned lies and (inappropriate) statistics’?. Dyslexia (Chichester, England), 9(2), 127–135. https://doi.org/10.1002/dys.245

Physical activity can significantly reduce depressive symptoms in children and adolescents, according to a recent study published in JAMA Pediatrics. ¹

The meta-analysis of 21 studies involving 2,441 participants (47% boys and 53% girls) between the ages of 11-19 found that physical activity may help alleviate depressive symptoms in young patients. Twelve of the studies also demonstrated the benefits of physical activity for participants with a somatic or psychiatric disorder such as depression, obesity, ADHD, and diabetes.

The findings revealed that physically active teenagers experienced more notable reductions in depressive symptoms than did younger participants. “It is possible that younger children are sufficiently active to be desensitized to additional physical activity, whereas their older and more sedentary counterparts might be more responsive to the intervention,” researchers said.

After analyzing the frequency and duration of physical activity, researchers determined that engaging in three sessions of physical activity lasting at least 30 minutes yielded the greatest improvement in depressive symptoms.

“Depression is the second most prevalent mental disorder among children and adolescents, yet only a small proportion seeks or receives disorder-specific treatment,” researchers said. “Physical activity interventions hold promise as an alternative or adjunctive approach to clinical treatment for depression.” ²

Benefits of Physical Activity for Comorbid Conditions

The study suggests that physical activity may also alleviate comorbid symptoms of anxiety and ADHD, which impact 75% and 57% of children with depression, respectively.³,⁴

This finding echoes that of a 2017 ADDitude survey, which found that 37% of children with ADHD manage their symptoms with daily exercise. Roughly half of the respondents rated exercise as an “extremely” or “very” effective treatment — the highest rating of any ADHD treatment included in the survey.

“Any aerobic activity, especially outdoors, helps our daughter,” said one ADDitude reader recently surveyed on the impact of exercise. “Within a day or two of not doing anything, she gets depressed.”

“We see great improvements in our son after physical activity,” said another parent. “The depression can really take hold, even though he is only 10. We homeschool, so our son and I both have YMCA memberships and attend at least three times per week. He enjoys the elliptical, rower, spin bikes, automatic stepper, and treadmill.”

Most ADDitude reader panelists called exercise an effective form of treatment, but many said that inducing their children to participate in physical activity is challenging.

“My teenage daughter has depressive symptoms, and we see her mood improve when she is active, but it took her a long time to start exercising,” said one parent. “She used to play tennis and soccer and ski, but when she went to college, she stopped exercising.”

Physical activities must be regular and consistent to maintain their mental-health benefits, according to ADDitude readers. “In just a few short months, I see the absence of physical activity in his life magnifying all his depressive symptoms,” one parent said.

“I see an improvement in her behavior with more physical activity, but I could not say I’ve noticed any direct correlation with her mood,” said another parent. “However, I notice that her mood and behavior deteriorate when she’s less active or getting too much screen time. She does martial arts once a week and seasonally participates in soccer or t-ball. We’re adding family yoga in a few weeks.”

“My son always does better when he moves but, unfortunately, it is very difficult to get him going,” wrote another parent. “I notice after shooting hoops he is much calmer and in a better mood, so I try to encourage him to get out and do it.”

However, exercise is not a universal cure. Of ADDitude survey respondents, 5% found exercise “not very” or “not at all affective” in addressing ADHD symptoms.

“Physical activity does not have a sustained effect on his depression or intense feelings,” said one ADDitude reader panelist. Said another, “The positive results of physical activity last as long as the activity occurs, then fade fast.”

One parent explained that physical activity negatively impacted her child’s symptoms. “Physical activity does not help her — it actually makes it worse. She needs more mental activities to help her, such as puzzles, card games, or workbooks. Those are things that help regulate and reduce her symptoms.”

Sources

¹Recchia F., Bernal J.D.K., Fong D.Y., et al. (2023). Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents: A Systematic Review and Meta-analysis. JAMA Pediatr. https//doi.org/10.1001/jamapediatrics.2022.5090

²Erskine H.E., Baxter A.J., Patton G., et al. (2017 ). The Global Coverage of Prevalence Data for Mental Disorders in Children and Adolescents. Epidemiol Psychiatr Sci. 26(4):395-402. https://doi.org/10.1017/S2045796015001158

³Angold, A., Costello, E.J. (1993). Depressive Comorbidity in Children and Adolescents: Empirical, Theoretical, and Methodological Issues. Am J Psychiatry. 150(12):1779-1791. https://doi.org/10.1176/ajp.150.12.1779

⁴Birmaher, B., Brent, D., Bernet, W.,  et al. (2007). AACAP Work Group on Quality Issues. Practice  Parameter for the Assessment and Treatment of Children and Adolescents with Depressive Disorders.  J Am Acad Child Adolesc Psychiatry. 46(11):1503-1526. https://doi.org/10.1097/chi.0b013e318145ae1