Like many adults with ADHD, Justin Ruotolo took a stimulant (Adderall XR in his case) for his symptoms. Then about 11 years ago he started meditating. Shortly after this she started trembling after taking the pill. Ruotolo’s doctor reduced the dose, but after 6 months it happened again. He decided to get off the drug and since then there has been no looking back.
Ruotolo largely credits meditation for calming his brain and giving him the focus that he no longer gets the boost from medication. She read a lot about her condition and received training from an ADHD coach.
There are many reasons why a person with ADHD may stop taking medication or may never start. Some hate side effects. Others struggle to pay for medicine. Or, like Ruotolo, they find that nondrug strategies work quite well for them.
In the US, there are no official treatment guidelines for adults with ADHD. But, says Craig Surman, MD, a neuropsychiatrist and researcher at Harvard Medical School, “the best practice is to treat true ADHD with a stimulant, unless there is a contraindication.” surman co-authored FastMinds: How To Thrive If You Have ADHD (Or Think You Might), That said, he notes that not everyone with ADHD has a serious problem.
“Some people have ADHD symptoms rather than a full diagnosis,” he explains. Even people who check every box for ADHD may find that their symptoms are better in certain situations. For example, a graphic designer may have no trouble concentrating in a firm where a boss is breathing down her neck. But if that graphic designer goes freelance, it won’t be that easy to stay on the job while managing his/her schedule. “People with ADHD live on deadlines,” Surman says.
If you’re doing well on medication, it can be hard to tell whether you still need it. Surman often advises high-functioning people who have been on stimulants for some time, sometimes to take a “drug vacation.” That is, stay off the drugs for a short period of time to see if they still need them. It’s probably a good idea to check with your doctor if you want to try it.
Whether you take medication or not, nondrug approaches are important for managing ADHD. “They are not mutually exclusive,” Surman says.
Ruotolo knows this from personal experience and from working with others who have ADHD. She became an ADHD coach soon after she was diagnosed. She earned a master’s degree in clinical psychology and went on to become a licensed marriage and family therapist (LFMT) in addition to being a coach. Some of her clients thrive on a combination of drug and nondrug strategies. Others find that they can function well without medication and rely entirely on drug-free methods such as exercise, meditation, and counseling.
Going without meds won’t provide enough symptom relief for all people with ADHD. But some non-drug strategies, either in addition to or in lieu of medication, include:
“It’s important to understand your ADHD,” says Surman. He recommends visiting CHADD.org to educate yourself about the causes and symptoms of the condition. “You need to understand which of your challenges are due to ADHD and which are something else,” says Surman, who serves on the board of CHADD (Children and Adults with ADHD). He also recommends exploring resources provided by ADDA (Attention Deficit Disorder Association). She adds that support groups are another good way to learn from your peers about the condition.
cognitive behavioral therapy (CBT)
CBT is a highly focused and result-oriented form of talk therapy. It helps with anxiety and depression, two conditions that often co-exist with ADHD. Even if ADHD is your only concern, there is a good chance that CBT will help.
CBT can help adults with ADHD change their patterns of thinking and develop skills that make living with ADHD easier. “It focuses on behaviors that help people take charge of their situation and stay organized,” Surman says. But, organizational strategies are only part of it. CBT also helps to retrain your way of thinking. You learn to recognize the automatic negative thoughts that you have in challenging situations. You learn to respond more positively and effectively in the future.
(Note: If you have another mental health condition and it’s not already under control, Surman suggests seeking treatment for it first. Depression, anxiety, substance abuse, and autism spectrum disorders often overlaps with ADHD.)
Unlike CBT, coaching focuses solely on your actions and organizational strategies (rather than how you feel about these things). “Some people will say, ‘I want someone to think through everything with me and decide what to do first.’ That’s where coaching can be very helpful,” says Surman.
As a coach, Ruotolo meets the needs of the client. “We talk about specific organization strategies, like how to clean your desk and your house and how to live your life in an organized way,” says Ruotolo. Add Land: The Gift of Addition,
Mindfulness—which focuses on living in the present moment rather than letting the past haunt you or worrying about the future—is the foundation of Ruotolo’s practice. She says, ‘Our mind is such that thoughts keep coming and going.’ “With mindfulness, you simply look at a thought and observe it, but you don’t cling.” Over time, this practice alters the connections in your brain so that you react differently to the world around you, Ruotolo says.
Everyone should stay physically active, eat healthy and get enough sleep. But these basic self-care tips are important for anyone struggling with ADHD. Lack of sleep can hinder cognitive function, says Surman. Adequate exercise and proper nutrition benefit your brain. While simple changes like these alone are unlikely to be enough to treat full-blown ADHD, they are an important part of any self-care regimen.