Managing ADHD Through Talk Therapy (Non-Medication Strategies)

Neurodevelopmental disorders are conditions that affect the development of the nervous system and how the brain functions, which can impact learning and behaviour. Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders (other examples include speech disorders, autism, and cerebral palsy).

According to the Center for ADHD Awareness, Canada (CADDACC), ADHD affects 4-6% of adults and 5-7% of children—approximately 1.8 million Canadians, or 1 in every 21 people. 

If you think you might have ADHD, it’s important to seek the help of a licensed professional to diagnose mental illness, and to avoid assuming you or someone else has ADHD. 

If you or someone you know has been diagnosed with ADHD, remember this is a common neurological condition affecting millions of people. A diagnosis can be a huge relief for many, empowering them to move forward and learn how to manage their symptoms. 

There are three types of ADHD:

• Hyperactive-impulsive
• Inattentive
• Combined (most common)

Symptoms or presentation of ADHD can look different for each individual, and for kids and adults, but can include:

• Hyperactive-impulsive: Excessive or fast-paced talking, difficulty making decisions or rash decision-making, difficulty playing quietly, interrupting and being unable to wait their turn.
• Inattentive: Difficulty sustaining attention in tasks or play, or a lack of focus, which can lead to frequent mistakes, avoiding tasks that require sustained mental effort (paperwork) or other struggles with any day-to-day tasks.

Kids tend to start showing behavioural issues at school. They may struggle to complete assignments, paying attention in class, interrupting, or frequently lose their belongings. ADHD is often diagnosed in school-aged children because that’s when symptoms can become more noticeable as there are new demands for attention and impulse control.

Adults with ADHD may struggle with similar symptoms, like time management and attention to detail, which can impact work performance and interpersonal relationships. 

Kids or adults with ADHD may also have difficulty managing stress, and may experience emotional challenges.

ADHD management often involves a combination of therapy and medication. Dr. Nisha Sangwan, Ph.D (Social Work) and Registered Clinical Counsellor, says, “The medication helps to regulate the central nervous system and therapy aids to help the patient regulate emotions, thoughts, and behaviours.” 

Any treatment plan should be considered with the input of licensed and trained professionals who can address someone’s specific and unique needs. If you or someone you know struggles with ADHD, finding the right therapist can make all the difference. Explore therapists on First Session to find your perfect match. 

The Importance of Therapeutic Intervention

Dr. Sangwan added that without medication or therapy, people could see long-term challenges, and find it difficult to deal with life tasks. However, both approaches differ. “Therapy also works wonders for ADHD,” she added. “The research findings suggest adults with ADHD show great outcomes with specialized CBT interventions. This finding supports the growing consensus that combining therapy and medication works well for ADHD.” 

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While medications are a typical treatment option for ADHD, it’s important to understand any risks and potential side effects, and not underestimate the impact of therapy. 

Generally, there are two types of medications for ADHD: stimulant and non-stimulant. Side effects for each could include:

• Stimulant medications (e.g., Methylphenidate, Amphetamine-based medications): Insomnia, appetite changes, upset stomach, increased heart rate or blood pressure, heightened anxiety, headaches.

• Non-stimulant medications (e.g., Atomoxetine): These can also cause insomnia or sleep-related issues, appetite changes and upset stomach, as well as mood changes like irritability, fatigue, and in some cases sexual side effects like decreased libido.

Not everyone will experience side effects, and some side effects can lessen over time. Working with licensed mental health and medical professionals can help determine if the risks outweigh the potential benefits, and if there are alternative options before or instead of medication.

In Canada, psychiatrists and psychologists are trained and licensed to assess and diagnose mental health disorders and illnesses. Psychiatrists are the only mental health practitioner licensed to prescribe medication. Counselling therapists, psychotherapists, and social workers can be trained to provide therapeutic care for those with ADHD, but not diagnose the condition.

Different provinces and territories have their own regulations and licensing requirements, so be sure to check the credentials for practitioners where you live. 

When considering how to manage ADHD outside of medication, there are psychotherapy approaches (working with a licensed counsellor or therapist) and behavioural interventions (boundary establishment, routine changes, skill-building). 

These can both help with associated mood or emotional challenges around ADHD, and help develop executive function skills (planning, organizing) that are otherwise not easy for those with ADHD. 

For children, a core component of ADHD management is parental training and education. Caregivers are critical to helping kids through their own plans, and to ensure they’re managing anxiety or stress for their own wellbeing and their kids’.

Not sure where to start? First Session can help connect you with a therapist who specializes in ADHD treatments.

Dietary and Nutritional Interventions

The relationship between diet and ADHD is still relatively unknown—some studies show a correlation between diet and ADHD and others prove inconclusive. 

For example, there is some new evidence that the gut microbiome (bacteria, fungi, viruses and other microorganisms that live in the intestines) can impact ADHD symptoms. The gut microbiome helps regulate the immune and nervous systems, and what we eat shapes the function of the gut microbiome. However, current research is limited and more studies are required for professionals to make a definitive connection. Similarly, some small studies have shown omega-3 fatty acids (found in fish oil) might have a promising correlation to managing ADHD symptoms. 

While this is exciting progress, it’s important to collaborate with your health professionals on any treatment plans, especially when it comes to emerging science.

Still, diet can be part of managing overall mental and physical wellbeing. Limiting or eliminating food additives and preservatives, sugar and refined carbohydrates, or alcohol may help manage challenges related to symptoms of ADHD. Considering that alcohol is shown to impact sleep, and difficulty sleeping could already be challenging with ADHD symptoms. 

Support from a therapist can help with maintaining good diet and activity habits, especially if those skills are difficult due to symptoms of ADHD. Some examples of how therapy can be a helpful resource in navigating challenges with food include:

• Psychological factors: Therapists can help explore the relationship with food and emotional responses, and uncover psychological factors that might contribute to food sensitivities. 

• Emotional support: Dealing with food sensitivities or diet management can be emotionally draining. Therapy is a safe and supportive space to express and explore fears, feelings and frustrations around food or lifestyle changes.

• Behavioural techniques: Therapy can help with behavioral strategies to cope with change, learning how to recognize or avoid triggers or patterns, and manage motivation and commitment to a plan.

• Mindfulness and stress reduction: Mindfulness-based approaches can be helpful for becoming more aware of how the body responds to different foods, understand which foods impart a stress response, and help navigate food as a coping mechanism for stress.

• Support for eating disorders: Therapists can be trained in helping individuals develop a healthy relationship to food, or navigate challenges leading to or associated with eating disorders.

• Relationship or family dynamics: Food can be cultural, or inform a large part of people’s relationships to one another. Changes in diet can impact changes in those interpersonal relationships. A therapist can help navigate new social situations and relationship challenges.

Regular therapy sessions can also help individuals track their progress in managing food sensitivities, making adjustments to lifestyle and habits, and providing a source of accountability, stress release and motivation.

Neurofeedback, Brain Mapping, and the Therapist's Role

Research is always changing and evolving around brain science and mental health. Newer technologies have opened the door for alternative treatments for ADHD (and other neurological conditions).

Through a process called EEG (electroencephalogram), trained practitioners can measure activity in the brain using small wires and discs attached to the skin of the scalp. This provides real-time feedback on brain activity, and is used to help professionals diagnose certain disorders, such as epilepsy. 

In a therapeutic context, a trained therapist can use such technology to “train” people to recognize triggers and learn self-control. During a session, a therapist will attach the sensors and give feedback when brain activity is in a desired range. Over time, this can help people with ADHD gain better control over their attention, focus, and impulse control. 

Brain mapping differs slightly from EEG; whereas EEG measures brain activity in waves (think the scribbling lines of a lie detector test), brain mapping uses quantitative EEG (qEEG). This is a sophisticated computer technology that gives the therapist or practitioner something that looks like a heat map picture of the brain’s activity and functioning.

This can help qualified therapists diagnose neurological disorders by identifying where the brain is over- or under-active, and use that to inform treatment plans or strategies, and tailor them for that person’s self-regulation needs.

It’s essential to work with licensed and qualified professionals for diagnosis and treatment of mental health conditions and illness. A qualified therapist’s role in managing ADHD with neurofeedback and brain mapping would include:

• Assessment: Conducting a comprehensive assessment including clinical interviews, behavioural assessments and other tests like brain mapping. 

• Education: They play a crucial role in educating individuals and families in managing ADHD and they can discuss the various aspects of treatment and care, including how such technologies can help with modulating brain activity.

• Providing an action plan: A trained therapist who is licensed to assess and diagnose mental illness and use technologies like EEG or qEEG can integrate these assessments into a comprehensive treatment approach to ADHD. This can be especially important if you’re interested in non-pharmaceutical options. 

While neurofeedback has shown promise, evidence is still evolving and individual responses to treatment plans will always vary, making it even more essential to work with experienced and qualified professionals who can monitor progress and recommend new approaches to meet the needs of an individual.

Neuromodulation and the Therapeutic Process

Recently, neurostimulation has emerged as a technology-focused alternative treatment. It uses electrical or magnetic stimulation to alter nerve activity. One example of how it’s used is in spinal cord stimulation to help with chronic pain management—tiny low-voltage electrical pulses modulate the signals that transmit pain to the brain.

Many types of neuromodulation are being used in the context of ADHD; one of them is transcranial magnetic stimulation (TMS). This uses short magnetic pulses to stimulate the nerve cells in the brain. TMS has also been used as a tool to diagnose ADHD.

By using magnetic pulses, a trained practitioner can stimulate the messengers in the brain (neurons) to give a little “boost” to the brain. This can help with regulation and impulse control.

These treatments are showing promise, but evidence is still somewhat inconclusive and more research is needed. If you’re interested in exploring alternative options like neuromodulation, consult a licensed and qualified mental health professional, and your regular medical doctor or health support team.

Lifestyle, Behavioral Changes, and Ongoing Therapeutic Support

While ADHD is a neurological disorder, lifestyle and behavioural changes can be crucial in symptom management. 

Adopting new skills and practicing them, learning how to regulate emotions, reinforcing positive behaviours, and building self-esteem and coping skills can lead to overall greater wellbeing. It can also be very challenging to do this on our own. Finding a therapist who is the right fit can be incredibly beneficial through such change.

It’s important to consider your own unique needs when choosing a mental health professional. There are therapists who specialize in ADHD, as well as in child therapy or family therapy. 

Therapy can be useful as individuals, parents and other family members navigate their roles and emotional health through challenges. Child therapy can be helpful if kids need support managing their own emotions with a parent or sibling who is diagnosed with ADHD.

A quick recap of how therapy can be valuable for individuals and families managing ADHD:

• Skill development: Therapy can help individuals develop and strengthen skills like planning, organizing, time management to improve their ability to manage daily tasks and responsibilities.

• Behavioural strategies: Therapists can work with individuals to identify unwanted or unhelpful behaviours, implement strategies to modify or reinforce positive behaviours, and even set new goals.

• Emotional regulation: The cornerstones of ADHD are inattention and hyperactivity, and along with that can be the need for emotional regulation. Therapy can help individuals recognize emotions and then better regulate them through impulse control. 

• Self-esteem and coping: Living with ADHD can be challenging and isolating, particularly if it’s creating challenges at school, in social groups, with relationships, or at work. Therapy can be a support system to explore and address these challenges to foster a greater sense of self.

Overall, there is no one-size-fits-all approach for managing ADHD. A collaborative relationship with a qualified professional, within family units, and in school or work settings is a key ingredient for working toward positive outcomes in managing ADHD.

The Imperative Fit Between Client and Therapist

In any therapeutic situation, studies show that a good relationship with a therapist leads to better outcomes. With ADHD, there may be a variety of treatment options to consider and try. So, when working with a therapist through ADHD management, it’s important the relationship is based on trust, confidence and collaboration. 

You can consider some key characteristics to assess whether or not a therapist will be a good fit, such as:

• Specializations in ADHD: A therapist who is knowledgeable about ADHD can provide recommendations aligned with the unique needs of those clients. They’ll understand the neurological aspects and how that impacts daily functioning and the behavioural and emotional challenges that can come along with ADHD. 

• Tailoring recommendations: A therapist who is a good fit will tailor their recommendations to suit each individual or family vs. only offer a one approach with inflexibility.

• Communication is smooth: Those with ADHD may struggle with aspects of communication, including attention, organizing thoughts, managing impulsivity (like a tendency to interrupt). A therapist who is a good fit will be able to adapt communication styles and navigate those unique needs.

• Environment feels supportive: A therapist’s approach and environment should always feel non-judgemental and safe. Those with ADHD may struggle with emotional regulation, so a supportive environment will be one that encourages a client to try strategies and be trusting in the process.

It’s also important to assess a therapist’s educational background, training, and qualifications to operate where you live. Those who offer counselling therapy for ADHD will be licensed appropriately in your province and territory, and belong to credible associations or colleges in their field.

Outside of education, training, specializations, and their approach, it’s important to consider how you feel with them. A successful therapy relationship can come down to many factors, from the tone of their voice to the cadence of how they speak.

Conclusion

We are continuing to learn more about how the brain works, and why it may work differently for some people. There is still a long way to go, but social awareness and acceptance around neurodiversity is growing, making ADHD management more accessible and possible for individuals and families.

Currently, there is no cure for ADHD, but behavioural therapy, lifestyle changes and skills training, and medication can be helpful in managing the condition and its symptoms.

While the efficacy of non-drug treatments are still being researched, there are several ways to help manage ADHD without medication, or in combination with medication, such as:

• Work with a trained therapist: a therapist can help guide an individual and their family through behavioural skills training. This can include learning how to positively reinforce good behaviour, how to schedule and tackle organizational tasks, how to interact with school and work, etc. They can also help with emotional stress that can come along with the challenges of navigating ADHD

• Exercise regularly and eat well: A healthy lifestyle can be helpful in managing or reducing challenges with ADHD symptoms. While the correlation of diet and ADHD is still being researched, paying attention to which foods might be more irritating to symptoms, including affecting energy levels and sleep, and ensuring a well balanced nutrient diet can help the brain and body function at its best, in general.

• Build new skills: Those who receive an ADHD diagnosis may feel great relief. Understanding how the brain works can help point someone to the skills they may want to develop, and open up new ways of working and staying focused.

• Look for support systems and groups: Engaging with schools can be challenging for parents and kids with ADHD; not all schools are prepared and enabled to support different needs in learning. However, you can still ask about any available special programs and engage your child’s teachers in the conversation. Look for any support groups online or in your area; community and collaboration is key in coping and thriving.

The advice of a licensed medical and mental health professional is important in deciding on a treatment plan for ADHD.  If you’re ready to reach out to a mental health professional, start with First Session and find a therapist who can guide and support you every step of the way

The content provided in this blog is intended for informational and educational purposes only. It does not serve as a replacement for professional medical advice, diagnosis, or treatment. Our discussion does not imply a stance on the efficacy or appropriateness of medication-based treatment, nor does it advocate for or against this treatment option.