The PDF is a copy of the slides Dr. Soper presented on September 20, 2013 for the first CAMH ADHD Caregiver Day.

1. PRINCIPLES OF ADHD
TREATMENT
Dr. Paul Soper MD FRCPC
Child and Adolescent Psychiatrist
Glenrose ADHD Program
Saturday, 21 September, 13

2. ADHD
Child
Emotionally
Healthy
Adult
Developmental Perspective
?
Better Focus
Better Grades
Less Hyper
Less Impulsive
Saturday, 21 September, 13

3. What Do Children with
ADHD need?
1.LOVE
2.EMPATHY
3.CONNECTION
Hallowell and Jensen, 2010
Saturday, 21 September, 13

4. ADHD
Child
Emotionally
Healthy
Adult
Developmental Perspective
Emotional Nutrition
1. LOVE
2. EMPATHY
3. CONNECTION
Saturday, 21 September, 13

5. ADHD
Child
Emotionally
Healthy
Adult
Developmental Perspective
Emotional Nutrition
1. LOVE
2. EMPATHY
3. CONNECTION
ADHD Sx:
Hyperactivity
Distraction
Opposition
Forgetfulness
Disorganization
Impulsivity
Irritability
Saturday, 21 September, 13

6. Finding Balance
Love
Empathy
Connection
Side Effects
Costs
Every treatment decision should be based on how much
Emotional Nutrition is increased vs the side effects/costs.
Saturday, 21 September, 13

7. Finding Balance
Number of Studies
Quality of Studies
Amount of Improvement
Side Effects
Costs
One must also consider the science that is behind each
treatment recommendation.
Saturday, 21 September, 13

8. Finding Balance
Pros vs Cons Checklist
Pro Cons
Greatly Improves ADHD Mildly Improves ADHD
Few Side Effects Many Side Effects
Tolerable Side Effects Barely Tolerable Side Effects
Mildly Changes Personality Dulled Personality
Works Quickly Takes Weeks to Work
Affordable Difficult to Afford
Many Studies Few Studies
Well Done Studies Poorly Done Studies
Family Will Accept Family Won’t Accept
Saturday, 21 September, 13

9. Website
http://edmontonadhdsociety.org
Saturday, 21 September, 13

10. Principles of Treatment
CADDRA Guidelines (www. CADDRA.ca)
Treatment Should be Multimodal and include:
Parental Education (You are doing this today)
Lifestyle Optimization (Sleep, Diet, Exercise)
Parent Training (Priscilla will cover this)
Medication (Dr. Wincott will cover this)
Saturday, 21 September, 13

11. Lifestyle Optimization
Sleep
Diet
Exercise
Social Connections
Other
Saturday, 21 September, 13

12. Lifestyle Optimization
Sleep
Saturday, 21 September, 13

13. Lifestyle Optimization
Sleep
• Sleep - Average Sleep Per Age
• 6-12 (10 hours)
• 12-18 (9 1/2 hours)
• If child wakes on their own/with little difficulty
without sleepiness during day they are probably fine.
• No study has shown improvement in ADHD
symptoms with improvement in sleep.
Saturday, 21 September, 13

14. Lifestyle Optimization
Sleep
• Should consult with your health care provider.
• Generally, sleep hygiene is an effective strategy in
up to 30% of children with sleep problems.
• Melatonin usually works for the rest of kids who
do not respond to sleep hygiene.
• If sleep problems persists, the health care
provider should be consulted.
Saturday, 21 September, 13

15. Pros vs Cons Checklist
Sleep
Pro Cons
Sleep is Good Mildly Improves ADHD
Few Side Effects Takes Weeks to Work
Tolerable Side Effects Tough to Implement (Teens)
Mildly Changes Personality
OK Number of Studies
OK quality of Studies
Family Will Accept
Affordable
Saturday, 21 September, 13

16. Lifestyle Optimization
Diet
Saturday, 21 September, 13

17. Lifestyle Optimization
Diet
A balanced diet based on Health Canada’s Guidelines is
most important
Most common strategies include:
Use of Omega 3s (EPA 400 - 600mg)
Elimination Diets (0.51) - Pelsser, Feingold
Food Coloring Exclusion (0.42)
Adding zinc, iron, vitamins... (Poorly studied)
Saturday, 21 September, 13

18. Lifestyle Optimization
Exercise
Saturday, 21 September, 13

19. Exercise
One hour of daily rigorous exercise results in a
multitude of long term benefits for health.
“The acute effects of exercise have been associated
with reductions in negative behaviors and
improvements in acceptable behaviors and cognitive
functions in children with clinical disorders categorized
by poor impulse control and attention.”
Saturday, 21 September, 13

20. Lifestyle Optimization
Connection
Saturday, 21 September, 13

21. Lifestyle Optimization
Connection
To ensure a child’s emotional growth, it’s important for
kids to feel like they belong.
I’ve never found a study that relates to a specific
program.
Programs that are frequently helpful:
Sports: Tae Kwon Do/Hockey....
Clubs: Cubs/Scouts/Girl Guides/Church
Lego club, Computer Club....
Saturday, 21 September, 13

22. Lifestyle Optimization
Other
Saturday, 21 September, 13

23. Lifestyle Optimization
Others
Cogmed
“In the studies we reviewed, training involved a
variety of working memory tasks, and such training
generalizes to other equivalent measures of working
memory, but there is no evidence of a transfer to
other less directly related tasks.”Melby-Lervåg 2013
Saturday, 21 September, 13

24. Lifestyle Optimization
Others
Neurofeedback
“The standardized mean differences for all
psychological interventions dropped considerably, to
nonsignificant levels, when analyses were restricted
to trials with probably blinded assessments.” Sonuga-
Barke 2013
Herbal Products - there are many...
Saturday, 21 September, 13

25. Conclusions
Optimizing Sleep, Diet and Exercise is good.
The evidence thus far suggests some mild benefit to
improve symptoms of ADHD especially with dietary
strategies.
Like any treatment, one must decide whether there is
an adequate improvement in emotional nutrition to
justify the cost/difficulties with implementing a
treatment.
Saturday, 21 September, 13