No treatment plan for attention deficit hyperactivity disorder (ADHD) is complete if it doesn’t harness the power of nutrition, exercise, and sleep to improve wellbeing. What we eat, our physical activity levels, our sleep habits, and lifestyle factors ranging from stress management to screen time have a tremendous effect on health – a fact that’s amplified for ADHD brains and bodies.
Regardless of whether your child’s treatment includes medication, maximizing exercise, sleep, and nutrition can effectively transform them into natural remedies for ADHD, and arguably establish the foundation upon which to build other interventions.
Mounting research suggests that eating well contributes positively to the performance and abilities of any child with ADHD.1
When working to improve your child’s wellbeing, begin by considering the glycemic index (GI), or how fast the body converts carbohydrates into sugar.
All carbohydrates turn into sugar, but some are converted faster (high glycemic index) and some slower (low GI). These rates of conversion affect a child’s energy levels over the day; anything that causes blood sugar levels to quickly spike (like sugary, processed foods) means that the body will work hard to quickly drop that sugar, actually bringing it below normal levels. The result is often an irritable, fidgety, or nervous child who can’t focus as well.
To maintain steady, normal blood sugar levels, ensure that your child’s meals, especially at the start of the day, are balanced:
A significant percentage of children with ADHD are sensitive (not allergic) to some kind of food. In one study that placed children with ADHD on a restricted elimination meal plan, more than half of subjects saw a 40% improvement on ADHD rating scale performance.4 The same results appeared in an older study, where hyperactive children saw improvement in behavior after being placed on a “few foods” plan.5
In my practice, I estimate that about 30% to 50% of children I see do have some food sensitivity.
Not sure what food sensitives your child may have? Try this technique I use with my patients: eliminate a whole set of foods – dairy, wheat, corn, soy, eggs (common culprits) – for three weeks.
Eliminating foods, in my experience, tend to work on children who primarily present symptoms of hyperactivity rather than inattentiveness. This method also works on children who already have a history of allergies, eczema, gastrointestinal issues, and other allergic-type manifestations.
Several studies show that artificial colors, flavors, and preservatives tend to increase hyperactivity in a sizable portion of children, ADHD or not.6 In addition, studies suggest that a subset of children with ADHD are sensitive to food dyes, and may see symptoms worsen.7
Opt for whole foods to avoid synthetic dyes, and, as with food sensitivities, try to detect through a process of elimination if your child is sensitive to a particular dye.
This is the most common supplement used by patients with ADHD. Why? Studies show that omega-3 fatty acids (with high doses of EPA) are modestly effective in treating ADHD in children.8 Fish oil, which is associated with few/mild side effects, helps to increase levels of omega-3s that are often naturally lacking in children with ADHD, which in turn helps with brain functioning. Although dosing amounts are not established, I recommend 1000mg a day of combined EPA+DHA for children ages 5 to 8, 1500 mg a day for children ages 8 to 12, and 2000 mg a day for older children.
Can’t get your sensory-sensitive child to take fish oil supplements? Click here for tips.
Many children with ADHD are relatively iron (serum ferretin) deficient9, which may explain irregular dopamine regulation in the brain10. One small study showed that children with ADHD who took iron supplements saw an improvement in ADHD symptoms compared to children who took a placebo.11 Have your child’s doctor measure their serum ferritin levels to see if an iron supplement is necessary. For non-anemic patients, I recommend up to 40 mg of chelated iron a day. (The chelated form is associated with fewer gastrointestinal side effects.)
Talk to your child’s doctor before starting any supplement.
Multiple research studies shows that many children with ADHD clearly benefit from exercise.15 Even a single, 20-minute bout of aerobic exercise improves attention and academic performance in this group, according to one study.16 Another small study of children with ADHD found that acute exercise normalizes arousal and alertness levels, based on findings from EEG readings.17
Exercise can be so therapeutic for ADHD symptoms that I recommend against sacrificing exercise time for tutoring or because of poor grades. In fact, research seems to indicate that exercise improves academic scores perhaps better than spending the equivalent amount in class or study time.18
The American Academy of Pediatrics (AAP) recommends at least one hour of moderate to vigorous exercise a day for children and adolescents.19 I recommend five days a week of exercise for my patients. (Physical education in school can count, so long as it increases heart rate and works up a sweat.) Interestingly, how much exercise helps any particular person may depend on genetics, with brain-derived neurotrophic factor (BDNF) playing a major role in the relationship.20
Some children with ADHD may prefer individual sports, like swimming, tennis, or cycling, as opposed to team sports. Some studies show that martial arts, especially taekwondo, benefit children with ADHD.21
If your child resists exercise, consider tying it to something virtually all children want: screen time. They can have an hour of tablet time, for example, only if they’re on a stationary bike or treadmill during that time. Some adolescents may benefit from working with a personal trainer to keep them accountable and motivated.
Don’t forget about time in nature. According to one study, green outdoor activities reduce ADHD symptoms in children more than activities conducted in other settings.22
Unstructured play is not the same as exercise, but it is just as important for all children. Unstructured, creative play is crucial for normal development, as it is where young children learn to work things out independently and forge social relationships23 — important skills for children with ADHD especially. So, let your child ride their bike, run around, or play outside with other children if it is safe to do so. Leave them be if they are on a play date. Find programs that emphasize and maximize independent play.
Adequate sleep is crucial for children with ADHD, who are already at a higher risk for a variety of sleep disturbances, like difficulty falling asleep, compared to children without ADHD.24 Inadequate sleep affects ADHD symptoms and overall functioning.
The American Academy of Sleep Medicine (AASM) establishes the following guidelines for daily sleep amounts in children, which are supported by the AAP:27
If sleep problems persist, consult with your child’s medical providers. They may be able to run a sleep study to test for disorders. Behavioral professional psychologists and counselors can also help with implementing healthy sleep routines. Ask the pediatrician to check your child’s serum ferritin levels, as low levels are associated with restless sleep.31
By far, screen time/digital media use is the most difficult and argument-producing problem among the many families I help. Many studies link excessive screen time to issues like poor sleep quality, poor mental health, emotional dysregulation, lower academic achievement, lower levels of physical activity, and even developmental delays in children and teens.32 33
Studies correlate increased screen time with symptoms of ADHD. According to a study of preschool-age children, those who had more than two hours of screen time a day were more likely to exhibit clinically significant symptoms of inattention compared to children with less than 30 minutes of screen time per day.34 Another study found that higher frequency of digital media use was associated with subsequent symptoms of ADHD in adolescents after a two-year follow-up.35 Note, however, that research does not establish a causal link between screen time and ADHD.
There also appears to be a subset of children with ADHD whose symptoms are worsened by even small amounts of screen time.36
For children 2 to 5 years of age, the AAP recommends one hour a day at most of co-viewed high-quality programming.37 For older children, it recommends a personalized media use plan that considers the individual child’s age, health, temperament, and developmental stage.38 Additional recommendations include the following:
In addition to the above guidance, I also encourage families to think of the following for managing screen time:
Stress is a natural part of life. But some children with ADHD, in my experience, are very sensitive to stress. Part of it is that these children – more than neurotypical children – can be exposed to a great deal of negative feedback on a regular basis which affects self-esteem and wellbeing.40 Use the following strategies to mitigate your child’s stress:
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1 Del-Ponte, B., Quinte, G. C., Cruz, S., Grellert, M., & Santos, I. S. (2019). Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis. Journal of Affective Disorders, 252, 160–173. https://doi.org/10.1016/j.jad.2019.04.061
2 Cooper, S., Bandelow, S., Nute, M., Morris, J., & Nevill, M. (2012). Breakfast glycaemic index and cognitive function in adolescent school children. British Journal of Nutrition, 107(12), 1823-1832. doi:10.1017/S0007114511005022
3 Roberts, J. R., Dawley, E. H., & Reigart, J. R. (2019). Children’s low-level pesticide exposure and associations with autism and ADHD: a review. Pediatric Research, 85(2), 234–241. https://doi.org/10.1038/s41390-018-0200-z
4 Pelsser, Lidy M et al. (2011). Effects of a restricted elimination food plan on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): a randomised controlled trial. The Lancet, Volume 377, Issue 9764, 494 – 503. https://doi.org/10.1016/S0140-6736(10)62227-1
5 Carter CM, Urbanowicz M, Hemsley R, et al.(1993). Effects of a few food plan in attention deficit disorder. Archives of Disease in Childhood, 69:564-568.
6 Nigg, J. T., & Holton, K. (2014). Restriction and elimination food plans in ADHD treatment. Child and adolescent psychiatric clinics of North America, 23(4), 937–953. doi:10.1016/j.chc.2014.05.010
7 Nigg, J. T., Lewis, K., Edinger, T., & Falk, M. (2012). Meta-analysis of attention-deficit/hyperactivity disorder or attention-deficit/hyperactivity disorder symptoms, restriction diet, and synthetic food color additives. Journal of the American Academy of Child and Adolescent Psychiatry, 51(1), 86–97.e8. https://doi.org/10.1016/j.jaac.2011.10.015
8 Bloch, M., Qawasmi, A. (2011). Omega-3 Fatty Acid Supplementation for the Treatment of Children With Attention-Deficit/Hyperactivity Disorder Symptomatology: Systematic Review and Meta-Analysis. Journal of the American Academy of Child and Adolescent Psychiatry, 50(10), 991-1000. https://doi.org/10.1016/j.jaac.2011.06.008
9 Konofal, E., Lecendreux, M., Arnulf, I., & Mouren, M. C. (2004). Iron deficiency in children with attention-deficit/hyperactivity disorder. Archives of pediatrics & adolescent medicine, 158(12), 1113–1115. https://doi.org/10.1001/archpedi.158.12.1113
10 Wang, Y., Huang, L., Zhang, L., Qu, Y., & Mu, D. (2017). Iron Status in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. PloS one, 12(1), e0169145. https://doi.org/10.1371/journal.pone.0169145
11 Konofal, E., Lecendreux, M., et.al. (2008). Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatric Neurology, 38(1), 20-26. https://doi.org/10.1016/j.pediatrneurol.2007.08.014
12Gan, J., Galer, P., Ma, D., Chen, C., & Xiong, T. (2019). The effect of vitamin d supplementation on attention-deficit/hyperactivity disorder: A systematic review and meta-analysis of randomized controlled trials. Journal of Child and Adolescent Psychopharmacology, 29(9), 670–687. https://doi.org/10.1089/cap.2019.0059
13Li, H. H., Yue, X. J., Wang, C. X., Feng, J. Y., Wang, B., & Jia, F. Y. (2020). Serum levels of vitamin a and vitamin d and their association with symptoms in children with attention deficit hyperactivity disorder. Frontiers in Psychiatry, 11, 599958. https://doi.org/10.3389/fpsyt.2020.599958
14Granero, R., Pardo-Garrido, A., Carpio-Toro, I. L., Ramírez-Coronel, A. A., Martínez-Suárez, P. C., & Reivan-Ortiz, G. G. (2021). The role of iron and zinc in the treatment of ADHD among children and adolescents: A systematic review of randomized clinical trials. Nutrients, 13(11), 4059. https://doi.org/10.3390/nu13114059
15Christiansen, L., Beck, M. M., Bilenberg, N., Wienecke, J., Astrup, A., & Lundbye-Jensen, J. (2019). Effects of exercise on cognitive performance in children and adolescents with ADHD: potential mechanisms and evidence-based recommendations. Journal of Clinical Medicine, 8(6), 841. https://doi.org/10.3390/jcm8060841
16Pontifex, M. B., Saliba, B. J., Raine, L. B., Picchietti, D. L., & Hillman, C. H. (2013). Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder. The Journal of Pediatrics, 162(3), 543–551. https://doi.org/10.1016/j.jpeds.2012.08.036
17Huang, C. J., Huang, C. W., Hung, C. L., Tsai, Y. J., Chang, Y. K., Wu, C. T., & Hung, T. M. (2018). Effects of acute exercise on resting EEG in children with attention-deficit/hyperactivity disorder. Child Psychiatry and Human Development, 49(6), 993–1002. https://doi.org/10.1007/s10578-018-0813-9
18McPherson, A., Mackay, L., Kunkel, J., & Duncan, S. (2018). Physical activity, cognition and academic performance: An analysis of mediating and confounding relationships in primary school children. BMC Public Health, 18(1), 936. https://doi.org/10.1186/s12889-018-5863-1
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20Hopkins, M. E., Davis, F. C., Vantieghem, M. R., Whalen, P. J., & Bucci, D. J. (2012). Differential effects of acute and regular physical exercise on cognition and affect. Neuroscience, 215, 59–68. https://doi.org/10.1016/j.neuroscience.2012.04.056
21Kadri, A., Slimani, M., Bragazzi, N. L., Tod, D., & Azaiez, F. (2019). Effect of taekwondo practice on cognitive function in adolescents with attention deficit hyperactivity disorder. International Journal of Environmental Research and Public Health, 16(2), 204. https://doi.org/10.3390/ijerph16020204
22 Kuo, F. E., & Taylor, A. F. (2004). A potential natural treatment for attention-deficit/hyperactivity disorder: Evidence from a national study. American Journal of Public Health, 94(9), 1580–1586. https://doi.org/10.2105/ajph.94.9.1580
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