Alternative therapies for ADHD, in the UAE

“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.

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:

It lists symptoms of the hyperactive/impulsive type as:

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.

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.

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.

“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.”

Priyanka Dang, Clinical psychologist, Open Minds Psychiatry, Counselling and Neuroscience Centre, Dubai, also speaks of Sensory Integration Training.  

“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.

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.  

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. 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.

"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.

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