Alternative therapies for ADHD, in the UAE
Consider meditation, brain training and other therapies that can help
“If you have a physical illness, you take medicines for it,” Rakhi, whose name has been changed upon request, recalls her son telling her. “So why is it that if you have a mental ailment, you won’t take the treatment?” She’s referring to the conversation that accompanied his previous admission; he is on medication for Attention-deficit/hyperactivity disorder (ADHD).
While we don’t know what causes ADHD, it is one of the most prevalent disorders that affect the world; it’s diagnosed at varied ages; and it can be a symptom of – or accompaniment to – other disorders. On average, 8.4 per cent of kids and 2.5 per cent of adults have ADHD, says American Psychiatric Association (APA). It also seems more common in boys than in girls, according to the association.
ADHD is characterised by the inability to concentrate or retain focus, hyperactivity and impulsiveness.
Symptoms of ADHD
The APA divides ADHD into three types: inattentive type, hyperactive/impulsive type or combined type. A diagnosis is based on the symptoms that have occurred over the past six months.
It lists symptoms of the inattentive type as:
- Doesn’t pay close attention to details or makes careless mistakes in school or job tasks.
- Has problems staying focused on tasks or activities, such as during lectures, conversations or long reading.
- Does not seem to listen when spoken to (i.e., seems to be elsewhere).
- Does not follow through on instructions and doesn’t complete schoolwork, chores or job duties (may start tasks but quickly loses focus).
- Has problems organising tasks and work (for instance, does not manage time well; has messy, disorganised work; misses deadlines).
- Avoids or dislikes tasks that require sustained mental effort, such as preparing reports and completing forms.
- Often loses things needed for tasks or daily life, such as school papers, books, keys, wallet, cell phone and eyeglasses.
- Is easily distracted.
- Forgets daily tasks, such as doing chores and running errands. Older teens and adults may forget to return phone calls, pay bills and keep appointments.
It lists symptoms of the hyperactive/impulsive type as:
- Fidgets with or taps hands or feet, or squirms in seat.
- Not able to stay seated (in classroom, workplace).
- Runs about or climbs where it is inappropriate.
- Unable to play or do leisure activities quietly.
- Always ‘on the go’, as if driven by a motor.
- Talks too much.
- Blurts out an answer before a question has been finished (for instance may finish people’s sentences, can’t wait to speak in conversations).
- Has difficulty waiting his or her turn, such as while waiting in line.
- Interrupts or intrudes on others (for instance, cuts into conversations, games or activities, or starts using other people’s things without permission). Older teens and adults may take over what others are doing.
Dealing with ADHD
There are medications that have been proven to help with the disorder. However, for those, like Rakhi, wanting to go down the alternative treatment route, we asked the experts for recommendations.
But first, here’s a disclaimer… there aren’t too many studies to confirm the efficacy of the treatments and the experts warn of expectation management for the parents. Some have however, anecdotally at least, proven to be helpful.
Ross Addison, Managing Director and Consultant Child and Adolescent Cognitive Behavioural Therapist at UAE-based Reverse Psychology, confirms, “There are some alternative therapies that don't carry any risk and have been shown to help someone with ADHD.” He lists them as:
Meditation: The process of being in a state of relaxation can provide some relief to the daily activity the brain endures. This can help to regulate blood pressure, reduce overthinking and calm the body to feel more at ease.
Martial arts: While it sounds counterproductive, the training involved in martial arts requires attention, focus, dedication, restraint and repetition. “All of which can be difficult for someone with ADHD to master, but with the right environment, I've seen very positive outcomes from young people engaging in this type of physical exercise,” says Addison.
While it sounds counterproductive, the training involved in martial arts requires attention, focus, dedication, restraint and repetition. All of which can be difficult for someone with ADHD to master, but with the right environment, I've seen very positive outcomes from young people engaging in this type of physical exercise.
Biofeedback: There are not many clinicians in Dubai who provide this, but if you want to become more at one with your body and recognise the signs and symptoms of stress such as increased heart rate, muscle tension and other subtle changes in your body, this could be useful. “With ADHD I always spend time helping the patient to better understand their body and changes in how it feels; awareness of these changes are critical to intervening early when ADHD symptoms may become more heightened,” he adds.
Mealtime management: This is of course extremely important for managing symptoms of ADHD. This doesn't necessarily mean exploring intolerances, unless you want to, but limiting caffeine at night is particularly important if you want to sleep. It is also not ideal to eat food for up to two hours before you plan to sleep. The energy in the food can really interfere with quality of sleep, especially in those with ADHD. Being mindful of sugar intake can help to curb the symptoms of hyperactivity and impulsivity.
Brain Training: There are a few centres in Dubai that offer this and I have seen some success stories, he adds. However, it does require introducing brain training activities into your everyday life, which can be difficult to maintain. But, they can work to improve attention, concentration, focus and executive function tasks.
Maida Kajevic, Clinical psychologist at UAE-based German Neuroscience Center says a multi-modal approach that includes the use of various psychosocial and psychoeducational techniques involving the child, parents, school and any other important people in a child’s life combined with the use of medication has been shown to be effective.
Treatment usually starts with various psychological techniques. The so-called behavioural techniques first assess the child's behaviour and environmental conditions that encourage these behaviours and advise changes in the environment that could improve the child’s behaviour.
Kajevic explains: “Treatment usually starts with various psychological techniques. The so-called behavioural techniques first assess the child's behaviour and environmental conditions that encourage these behaviours and advise changes in the environment that could improve the child’s behaviour.
Consistency is key
“Children with ADHD need rules and expectations that are clear and consistent, as well as consequences for certain behaviours that are predetermined and consistent. Better results are achieved when rewards and compliments are numerous and frequent, and negative feedback is minimal.”
One of the most famous alternative therapies is the Fiengold's diet, explains Kajevic, which excludes salicylates, artificial colours and additives from the diet. The programme was created by an American allergy specialist called Dr Ben Feingold in the 1970s and is said to help with hyperactivity. “It is also recommended to exclude sugar, cow's milk, and carbonated beverages. Vitamin B6, zinc, multivitamins and omega-3 fatty acids are considered useful, as are mild stimulants like caffeine and theobromine.”
She adds, “One of the newer programmes is edufeedback, a mindfulness training technology called Play Attention.”
Source: PlayAttention.com
Write things down
Priyanka Dang, Clinical psychologist, Open Minds Psychiatry, Counselling and Neuroscience Centre, Dubai, also speaks of Sensory Integration Training.
“The term ‘integration’ refers to the process of merging or blending two or more things. When the brain receives too many sensory messages (what is heard, seen, felt, tasted and smelled), it is unable to respond appropriately. Sensory integration training is a sort of therapy that aims to educate the brain on how to respond more effectively to the various sensory messages it receives. Before this treatment can be said to help symptoms of ADHD, more research must be done however.
“Keeping a log and writing down the changes in behaviour is one of the recommended strategies to track improvements with these treatments. Journal what you notice during the day in terms of irritability, impulsivity, etc. among other concerns within a particular time frame to see if things are getting better or worse and report them to the professional concerned.
“Finally, we must keep in mind that each person with ADHD has unique treatment requirements. Each person's needs must be assessed appropriately and met by the treatment or therapies used. The majority of ADHD health specialists agree that multimodal treatment is the best option,” says Dang.
Cognitive rehabilitation
Carla Chedid, Clinical Psychologist at Open Minds Psychiatry, Counselling and Neuroscience Centre, Dubai, adds that one sort of therapy proven to increase attention span is cognitive rehabilitation, which can be done by a psychomotor therapist.
“It should be started as early as possible - at five years of age or younger. A psychomotor therapist works on the triangle of ADHD which is, attention, problem-solving and inhibition. Through cognitive exercises, weekly sessions are recommended to help the client build his/her attention span. Some platforms are also known to be very helpful for enhancing attention such as Lumosity, and cognifit.”
Marc Linton, Occupational Therapist (OT), Priory Wellbeing Centre, Abu Dhabi: “A psychiatrist will likely refer a patient to other healthcare professionals - usually a psychologist, who may work with a person with ADHD using behaviour therapy. Similarly, they may also be referred to an occupational or speech and language therapist who specialise in and work with individuals with ADHD.
Occupational therapy and speech and language therapy can address physical, social, educational, and organisational deficits with a plan focused on individual skills, needs and activities.
“Occupational therapy and speech and language therapy can address physical, social, educational, and organisational deficits with a plan focused on individual skills, needs and activities. It is common for individuals with ADHD to have learning disabilities. Others need help with social skills. OTs and speech and language therapists (SLTs) can help in these areas. They can help your child learn how to plan and organise to get tasks done. It may be that turn taking or paying attention when someone is talking is difficult for someone with ADHD, and an SLT and OT can also work on these areas. These professionals will also work with your child's school to find ways to help in class through appropriate classroom or curriculum modifications.”
Frederick van Wyk, Counselling Psychologist at UAE-based American Center for Psychiatry and Neurology, says, “All people need to work on their executive skills, more so children or adults with ADHD. Executive skills are skills like keeping focus, shifting focus to what needs our attention and then bringing it back to what we are doing, starting and completion of tasks, emotional regulation, planning and organising. These skills mature for many people only in their 20s.
All people need to work on their executive skills, more so children or adults with ADHD. These skills mature for many people only in their 20s. However, children need to work on them and build them from a young age. Therefore, therapies could focus on how to help a child with these.
"However, children need to work on them and build them from a young age. Therefore, therapies could focus on how to help a child with these. Rewards for attaining and growing in these skills help them in their journey. Asking, ‘What worked’ or ‘What did not work?’... ‘How could you do it differently next time?’ are great questions."
As with most disorders, early intervention will reap you greater dividends. Best not to be scared of the prognosis – it’s easier to focus on the (alternative) solutions that way.
Have a topic you'd like discussed? Write to us at parenting@gulfnews.com