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Holistic approach to ADHD during COVID-19

With COVID-19 hitting everyone pretty hard and seemingly dragging on for a while to come, a lot of children has been home schooled via online platforms. According to Unesco, the education of nearly 1.6 billion pupils in 190 countries has so far been affected – that's 90% of the world's school-age children. We potentially have an entire generation of children that will grow up with a vastly different educational landscape that we have never experienced before, and we still don't know what the effects this will have on a growing child's neurodevelopment.

What I've observed from the perspective of a mental health profession is that children who already have difficulty focusing in classrooms are finding it even harder to muster up the motivation and perseverance to sit in front of a computer 8 hours a day. No breaks. No chit chatting with your classmate sitting next to you. No teacher coming around to breathe down your neck to make sure you stay on task. And plenty of home noises such as the vacuum cleaner, the dog barking, other siblings fighting over toys, and parents also working from home. No wonder a lot of children are struggling.

Some of you may have heard of the neurotransmitter "dopamine". It's what we believe is involved in helping our front part of the brain to focus, plan ahead and make executive decisions. It's also involved in the reward circuit in our pleasure pathways. Classically, we think of ADHD as a deficiency in dopamine, so the medications boost the levels of ADHD in the brain and powers up the brain.

But some of these children are already on ADHD medications - Ritalin, Concerta, Vyvanse etc. But with a very different "lockdown" lifestyle now, even these medications aren't able to force more concentration out of children. So we need to start looking at this whole ADHD thing differently and treat root causes, not just symptoms.

The analogy I use is like a toilet - you take a pill which is like pressing the button on the toilet. It "flushes" out the dopamine, then you need to wait for the water tank to refill before you can flush again. If it water tank is only half full, the flush isn't going to strong enough. So what we should focus on is, how can we help our brain and body fill up with more dopamine? Where does dopamine come from? How can we make more of it?

We make dopamine from the foods we eat (it doesn't come from thin air!). We need tyrosine as an amino acid building block, then vitamins and minerals along the way serve as cofactors for the enzymes that converts one thing to another until, voila! Dopamine is made. Then it keeps moving along to make noradrenaline, adrenaline, and eventually gets peed out of the body. So think of it as a production line - raw materials (tyrosine), workers (enzymes) with tools (cofactors), series of transformation to end product (dopamine), and this happens in the brain (the factory):

Rule #1 - you need to eat and absorb these ingredients to make dopamine. Eating a balanced diet, with lots of colourful vegetables with an adequate intake of protein is immensely important. Particularly important ones are B vitamins, zinc, magnesium and lithium. Lithium?! Isn't that used for treating mania? At high doses yes, but at nutritional doses (5-10mg in orotate form), it's a trace mineral that is crucial for brain health in everyone. We used to get lithium from mineralised water, but in the advent of distilled water and soil depletion, the lithium content in water in certain parts of the world are very low. Lithium may help with the hyperactivity, irritability and aggressive behaviour in kids with ADHD. Fun fact: lithium used to be an ingredient in 7-up the soda drink, and was sold as a tonic with health benefits. The "7" in 7-up comes from the atomic mass of lithium which is 6.941, which was rounded up to 7. And "up" is for the energy!

Rule #2 - make sure your gut is happy, and see a healthcare professional if you suspect there is any gut dysbiosis or other absorption issues that may affect your nutritional status. Gut dysbiosis means there are little bugs in the gut that aren't supposed to be there, at least not in large quantities, and they produce waste products that can be harmful to use, creating inflammation in the body and brain. Then the brain's factory won't work as well in producing dopamine. Have the kids make fermented foods at home - kefir, kombucha, sauerkraut, and start warming up their palates to these foods. Nothing better than a kitchen science experiment and naming their pet SCOBY!

Rule #3 - reducing intake of refined sugars and processed foods that hijack the brain is also important. Our brain gets a "high" when we eat these foods because they boost our, you guessed it, dopamine! So in a way we are self-treating the dopamine deficiency by eating these foods. But they also create an imbalance in dopamine regulation and makes it harder to feel balanced. Plus, these foods are generally poor in nutritional content, so eating it will take up the quota for eating more healthy options. Now that everyone is eating more at home due to restrictions in gatherings, parents have more control over what their children are consuming, and there is also more time to cook and bake together as an activity to make delicious, healthy meals.

Rule #4 - get enough good quality sleep. It's especially hard for ADHD children to sleep well because they are a buzzball of energy, and getting them to wind down in the evening is often a battle of the titans between parents and children. Try and set up a soothing bedtime routine that helps to regulate circadian rhythm and train the body to learn to feel sleepy. As for supplements that may be helpful, a randomised, double-blind, placebo-controlled trial of 98 boys aged 8 to 12 using L-theanine (Suntheanine®) at 400 mg daily is safe and effective in improving some aspects of sleep quality in boys diagnosed with ADHD. (Speak to your doctor before taking anything, even if it's a supplement)

Rule #5 - movement and exercise are essential for well-being, especially for those with a lot of energy to spare! Exercise gives you a natural dopamine boost and helps with focus and attention. There's also "nature deficit disorder" when we are stuck indoors all the time (thanks COVID), which reduces our exposure to sunlight (vitamin D is a cofactor in the manufacturing of dopamine), the wonderful organic chemistry of phenols and terpenes that boosts our immune system, and the space and clean air for our bodies to flow. Being outside will also reduce screen time which was already an issue before we sat our kids in front of Zoom for another 8 hours a day! If you have little kids, make tunnels and caves from cardboard boxes and get them to wriggle around in it. Older kids can take their scooters out to a quiet park nearby and sweat it out. Get the children to muck about in the soil and grass, or help with some home gardening.

Rule #6 - mindfulness meditation can increase the ability to suppress task-unrelated thoughts and distractions resulting in improved attention and completion of tasks. When we meditate, the front part of our brain is strengthened while at the same time improving self-regulation and impulse control. Yes, we all know the importance of meditation, but how do you get a hyperactive kid to sit still enough to meditate!? Here is an easy guide from ADDitutde that you can try with your little ones.

I tell my patients "ADHD is your superpower!" You just have to harness it properly and it will bring you great rewards." We don't often hear people speak about the positive attributes of those diagnosed with ADHD, but focus on how their grades are poor, are disruptive in class, they can't hold down a job, and various other negative consequences of a character trait that hasn't been used effectively. It is like going to X-men academy for the gifted - learn strategies that help you manage the challenges that comes with ADHD traits, but really shine through with great qualities such as having lots of great ideas, making quirky and unusual connections that helps you think outside the box, oozing bundles of energy to try new things, being really adventurous and not backing down when something looks daunting, being upbeat, charming and sociable, and generally being a fun person to hang around with. COVID-19? Bring it on and we'll find a way out of this together!

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