The primary symptoms of Attention Deficit/ Hyperactivity Disorder (ADHD)
include:
Difficulty maintaining attention
Hyperactivity
ADHD
is primarily categorized into three types:
Inattentive Type
Hyperactive -Impulsive Type
Combined Type
ADHD can coexist with other conditions, such as Oppositional Defiant Disorder (ODD), learning disabilities, autism, emotional and anxiety disorders. These comorbidities can increase the risk of substance abuse, alcoholism, and drug addiction. Therefore, prompt treatment is essential.
01
ADHD
Inattentive Type:
Individuals with this type of ADHD are easily distracted, have difficulty paying attention to details, struggle to focus on tasks, frequently misplace items, lack organizational skills, and are often forgetful.
They may find it difficult to notice details, focus on a single task for a long period of time, listen attentively, or organize and plan their activities.
They often misplace items and are easily distracted by their surroundings, which are characteristic symptoms of inattention.Frequently misplacing items and being easily distracted by their surroundings are common symptoms of inattention.
02
ADHD
Hyperactive-
Impulsive
Type:
This type is characterized by restlessness, impatience, excessive movement, frequent interruptions, impulsive behavior, acting without considering the consequences
Individuals with this type of ADHD find it challenging to engage in quiet, sedentary activities. They may talk excessively, interrupt others before a question is fully asked, struggle with waiting for their turn, and frequently disrupt conversations. In inappropriate situations, they may run around or fidget excessively in their seats, and they find it difficult to remain seated when they are required to do so.
03
ADHD
Combined
Type:
This type is characterized by restlessness, impatience, excessive movement, frequent interruptions, impulsive behavior, acting without considering the consequences
The behaviors associated with this type can lead to academic difficulties, poor academic performance, strained family relationships, and emotional problems. Interpersonal relationships may be adversely affected, leading to frequent conflicts. The stress from these challenges can make some individuals more prone to substance or alcohol abuse.
Possible symptoms at different life stages
Professional Assessment Plans
How do we assess Attention Deficit/ Hyperactivity Disorder(ADHD)?
1) Screening Assessment 2) Comprehensive Assessment
ADHD Screening Assessment
Assessment Scope:
ADHD screening
Contents:
1.SWAN ADHD Screening: Conducted by professional (15-30 minutes)
2.qEEG Brainwave Analysis: Using qEEG analysisequipment to analyze brain waves
3.Report analysis and Physical Examination conducted by Pediatrician: The pediatrician analyzes the reports, performs a physical examination to rule out other diseases, and conducts a comprehensive interview with parents and the child to discuss further diagnostic and treatment options
ADHD Comprehensive Assessment
Assessment Scope:
Detailed ADHD Diagnosis
Contents:
1.SWAN Questionnaire Assessment: Conducted in 15-30 minutes
2.qEEG Brainwave Analysis: Using qEEG analysis equipment to analyze brain waves
3.Test of Everyday Attention for Children, Second Edition (TEA-Ch2): A 45-60 minute assessment of children’s everyday attention
4.Pediatrician Consultation: The pediatrician conducts a detailed interview with parents and the child, using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) criteria to diagnose ADHD, and discusses further diagnostic or treatment plans
ADHD is typically diagnosed in children around the age of 5. However, many parents often ask, “My child is only 4 years old, but their behavior and symptoms seem to match those of ADHD. What should I do?” In such cases, it is generally acceptable for a 4-year-old to have a consultation with a pediatrician and a psychiatrist. This meeting allows for an initial screening and evaluation. Although a formal diagnosis might not be made at the age of 4, we can still conduct a preliminary assessment to determine whether the child is at risk for ADHD. Early identification allows for the timely initiation of training and treatment.
Assessment Tools
1. The SWAN Rating Scale for ADHD
(Strengths and Weaknesses of ADHD Symptoms and Normal Behaviors – SWAN)
The SWAN Rating Scale is a tool designed to evaluate attention and self-regulation. It assesses 18 symptoms related to ADHD, allowing for further analysis to determine the type of ADHD a patient may have. By completing this questionnaire, healthcare providers can calculate a score that helps in the preliminary identification of ADHD.
1.More than 60 studies have demonstrated the SWAN’s high validity and accuracy in assessing and diagnosing ADHD (Burton et al., 2018; Collett, Ohan, & Myers, 2003).
2.Moreover, local research by the Chinese University of Hong Kong has confirmed that the SWAN Rating Scale is a reliable and effective tool for diagnosing or assessing ADHD in Hong Kong children.
2. Test of Everyday Attention for Children | Second Edition (TEA-Ch2)
Since attention is an abstract concept and can be subjectively interpreted in various ways, a reliable tool like the TEA-Ch2 is necessary to objectively assess whether a child has hyperactivity or attention deficits. The TEA-Ch2 distinguishes between different types of attention deficits, such as selective attention, sustained attention, and task-switching attention. The test takes approximately 45 to 55 minutes and is divided into two versions based on age: Version for children aged 5-7 years and Version for children aged 8-15 years.
Selective Attention
1.More than 60 studies have demonstrated the SWAN’s high validity and accuracy in assessing and diagnosing ADHD (Burton et al., 2018; Collett, Ohan, & Myers, 2003).
Sustained Attention:
The capability to maintain focus over a certain period to accomplish a goal-oriented activity.
Task-Switching Attention:
The ability to stop a current task easily and switch to a new one.
3.Quantitative Electroencephalogram (qEEG)
The qEEG tool collects quantitative brainwave data and compares it to a brainwave activity database. This scientific approach allows for the analysis of various emotional disorders in children and provides personalized 3D brain training images. The qEEG tool is recognized by multiple authoritative bodies and is clinically effective in supporting our medical team in conducting more detailed assessments, diagnoses, and treatments.
During the assessment, the patient wears a headset equipped with 19 sensors that collect brainwave activity from different parts of the brain. These brainwaves, transmitted through the skull to the sensors, are analyzed by comparing them with a database of brainwave activity. This comparison helps identify abnormalities in brainwave patterns associated with emotional issues and disorders. It enables our pediatricians and psychiatrists to conduct more effective evaluations, screenings, and provide further treatment.
Research indicates that the prefrontal cortex is primarily responsible for attention and behavioral inhibition, and children with ADHD often exhibit abnormal brainwave patterns in this area, such as an increased Theta-to-Beta ratio. When the prefrontal cortex functions abnormally, children may have difficulty concentrating and may exhibit hyperactivity. The QEEG brainwave analysis offers scientific and objective data to support our diagnostic and assessment processes. The relationship between QEEG brainwaves and ADHD was first identified by scientists in the 1970s, and in 2012, the American Academy of Pediatrics recognized brainwave training as a Level 1 Best Support for ADHD.
Treatment Approaches
1.Medication
2.qEEG （Neurofeedback）
3.Applied Behavior Analysis (ABA)
4.Occupational Therapy
5. Psychologist Counseling Services
6.Nutrition
6.Transcranial magnetic stimulation (TMS)
Medication
The qualified person to make a diagnosis is a psychiatrist
Medications can help ADHD patients correct the imbalance of dopamine and noradrenaline in the brain, thereby improving impulse control, hyperactivity, and attention regulation. This helps restore the brain’s ability to filter external distractions. Commonly used medications are central nervous system stimulants, which stimulate the secretion of dopamine which is responsible for transmitting brain signals, thereby increasing concentration.
If stimulants are not suitable, non-stimulant central nervous system medications may be considered—specifically, Selective Norepinephrine Reuptake Inhibitors (SNRIs). Traditional ADHD medications are short-acting, requiring patients to take them 2 to 3 times a day. Parents may also consider long-acting medications, which only need to be taken once daily. These medications release their effects slowly, maintaining efficacy for up to 12 hours, allowing the body more time for gradual absorption. This enhances the stability of the medication’s effects and reduces discomfort due to fluctuations in drug concentration.
qEEG for Neurofeedback
The qEEG device operates by collecting quantitative brainwave data and comparing it with a brainwave activity database. Using scientific principles, it analyzes the child’s emotional status and provides personalized 3D blueprints for brain training. Through brainwave analysis, this tool also aids pediatricians and psychiatrists in more effective assessment, screening
Beyond traditional Cognitive Behavioral Therapy (CBT) and medications, qEEG has gained recognition in various professional fields and international literature over the past decade. In 2012, the American Academy of Pediatrics rated neurofeedback as a Level 1 Best Support treatment for attention deficit hyperactivity disorder (ADHD), and it has been endorsed and promoted by the International Society for Neurofeedback and Research (ISNR).
During qEEG sessions, personalized training parameters are set using QEEG. Through neuroplasticity, the connections within neural networks are improved during training. Patients are required to focus and respond to visual tasks or computer commands. When their brainwaves indicate a state of high concentration, the task is completed; otherwise, it is not. The device repeatedly provides feedback, training, and learning through visual tasks, gradually teaching the brain the correct operational modes to improve the child’s actual symptoms.
Arns, M., Drinkenburg, W., & Leon Kenemans, J. (2012). The effects of QEEG-informed neurofeedback in ADHD: an open-label pilot study. Applied psychophysiology and biofeedback, 37(3), 171-180.
Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice. Current psychiatry reports, 21(6), 46.https://doi.org/10.1007/s11920-019-1021-4
Koberda, J. L., Akhmatova, N., Akhmatova, E., Bienkiewicz, A., Nowak, K., & Nawrocka, H. (2016). Masgutova Neurosensorimotor Reflex Integration (MNRI) neuromodulation technique induces positive brain maps (QEEG) changes. J Neurol Neurobiol, 2(4).
Sadeghi Bajestani, G., Sheikhani, A., Hashemi Golpayegani, S. M. R., Ashrafzadeh, F., & Hebrani, P. (2016). A systematic review, on the application of quantitative EEG for characterizing autistic brain. Journal of Modern Rehabilitation, 9(6), 10-28.
Applied Behavior Analysis (ABA)
Applied Behavior Analysis (ABA) is a scientific approach to studying human behavior and learning patterns. It is an evidence-based instructional method. ABA emphasizes early intervention in children, where various intensities of ABA sessions or training help children learn how to express themselves correctly, make requests, and develop communication and conversational skills, thereby reducing problematic behaviors.
• Enhance Positive and Meaningful Behaviors and Skills， While simultaneously reducing negative behaviors and skills that may cause harm or hinder learning, ABA offers both immediate and long-term benefits to the learner.
• Promote Individualized Education Plans: Each child’s learning skills and activities are uniquely planned and tailored to their specific needs.Each learner’s individual curriculum is customized according to their characteristics.
• Natural Teaching Process: ABA encourages children to explore different experiences and develop language skills. When children make even slight progress, rewards and encouragement are used to affirm and further reinforce their learning motivation and advancement.
• Focuses on behavior modification, active learning skills, language and communication skills, self-care abilities, social and play skills，practicing gross and fine motor endurance, emotional management skills, and reducing related behavioral issues—such as non-compliance, tantrums, or violent tendencies. This helps children communicate more easily and integrate into school life and society.
Occupational Therapy
Occupational Therapy (OT) involves using “purposeful activities” to treat or assist individuals with physical, psychological, developmental, or social functional impairments, helping them achieve maximum independence in daily life.
Occupational therapists assess children’s individual needs, set training goals, and strengthen their foundational abilities in sensory-motor functions, postural control, sensory information processing, fine motor skills, visual perception, cognition, and social development through therapeutic activities, adaptive strategies, assistive devices, and home-based training.
Visual Perception Assessment and Training:
Includes:Seven categories—visual discrimination, visual memory, visual-spatial relationships, object constancy, visual sequential memory, figure-ground discrimination, and visual closure.
• Difficulty distinguishing similarities and differneces between pictures
• Inability to replicate simple shapes
• copying errors, missing or adding strokes, reversing letters, or poor proportion of components.
Sensory Processing and Integration Assessment and Training:
Includes:Tactile, vestibular, proprioceptive, visual, auditory, olfactory, gustatory, and oral senses.
• Uncoordinated or clumsy gross and fine motor movements.
• Poor muscle tone (e.g., poor posture control). Poor bilateral coordination (e.g., difficulty in coordinating movements at or across the midline.
• Poor motor ability (e.g. difficulty in navigating obstacles, disorganized behavior).
• Frequent bruising or injury from collisions.
• Extreme liking or disliking of being touched.
• Preference for knocking over or pushing objects.
• Fear of bathing, hair washing, cutting, or grooming.
• Extreme liking or disliking of swings.
• Picky eating with a preference for certain textures.
• Avoidance of eye contact or strong preference for looking at fluorescent lights or flashlights.
• Hypersensitivity to sounds such as those of hairdryers or vacuum cleaners.
Cognitive Assessment and Training:
Includes:Attention, memory, executive functioning, working memory, and processing speed.
• Frequent inattention to details Careless mistakes.
• Difficulty maintaining focus on homework or play.
• Not listening when spoken to.
• Inability to complete assigned tasks.
• Easily distracted by external stimuli.
• Frequently forgetting daily activities.
• Constant fidgeting.
• Inability to sit still.Frequent walking or running around.
• High energy levels with difficulty calming down.
• Frequent interruption of others or conversations.
Psychologist Counseling Services
Children with emotional, social, behavioral, or learning problems
Counseling/ family therapy provided by psychologists is one of the effective methods to help children with emotional, social, behavioral, or learning problems. In family therapy, parents learn how to create a system that reinforces target behaviors and eliminates problem behaviors. Because immediate feedback is necessary, the therapist works with the parents to create a system that helps the child succeed. In addition to managing behavior and helping children develop school and home skills, family therapy also strengthens the relationship between parents and children. This allows children to express their feelings to their parents when they are upset, rather than acting out.
Services Offered:
Structural Family Therapy
Addiction Counseling
Child-Centered Play Therapy
Mindfulness, Hypnosis, and Relaxation Stress-Relief Counseling
Counseling for Children with Special Educational Needs
Grief Counseling
Inappropriate Diets Can Increase the Risk and Symptoms of ADHD
It is crucial for families caring for children with ADHD to learn how to eliminate unhealthy eating habits! A diet high in saturated fats, refined sugars, and processed foods, and low in fruits and vegetables, is strongly associated with ADHD or symptoms of inattention.
saturated fat
refined sugar
processed food
lack of fruits and vegetables
Therefore, when selecting foods at the supermarket, it’s wise to check the nutrition and ingredient labels first. Avoid products containing phosphates, even though some are legal food additives. The simpler the ingredients and the less processed the food, the better.
Psychologist Counseling Services
Many people believe that the primary methods for treating Attention Deficit Hyperactivity Disorder (ADHD) are medications and behavioral therapy. However, from a nutritional perspective, there are specific diets that can help alleviate the symptoms of many diseases. While there is currently no specific diet that can cure ADHD, numerous studies suggest that cultivating proper eating habits is one method to address issues with focus. Furthermore, some experts have found that certain foods can exacerbate symptoms of hyperactivity or inattention in children, while others can bring about positive improvements.
1. Protein and Complex Carbohydrate-Based Diet:
Research indicates
That children with ADHD tend to prefer “high-fat, high-sugar” foods
such as fried pork chops, sodas, snacks, and processed foods,while consuming fewer vegetables，fruits, and protein-rich foods.
Excessive sugar intake can worsen hyperactivity in children with ADHD. High sugar consumption leads to spikes in blood glucose levels, which can increase hyperactivity. Additionally, high-sugar foods pose health risks for children, such as diabetes, obesity, and even tooth decay, so it’s best to limit these foods.
“Provide children with ADHD withprotein and complex carbohydratesto replace refined sugars and refined flour.
Refined sugar
Refind flour
White Bread
White Rice
Protei
Complex Carbohydrates
Refined sugars and refined flours (such as white rice and white bread) are high glycemic index (GI) foods, which are quickly digested and cause a rapid rise in blood glucose levels. When blood glucose levels spike, insulin secretion increases, accelerating the absorption of glucose by cells and converting it into glycogen, causing a rapid drop in blood glucose levels.
The brain needs glucose to provide energy in order to maintain its functions. When blood sugar levels are too low, we feel tired, irritable, and unable to concentrate, which is actually similar to the symptoms experienced by individuals with ADHD
Complex carbohydrates help balance blood glucose levels, reducing spikes. Because complex carbohydrates are low GI, the body takes more time to digest these structurally complex foods, slowing down the nutrient absorption process and stabilizing blood glucose levels. Avoiding sharp fluctuations in blood glucose levels ensures that the brain has a steady supply of glucose to maintain its functions. Additionally, consuming quality protein can also help maintain blood glucose balance, and amino acids contribute to the brain’s neurotransmitters.
Examples of Complex Carbohydrates:
Brown rice, wild rice
Root vegetables
Whole wheat bread, whole wheat pasta
Beans
Examples of Quality Proteins:
Fresh meats, chicken, fish, and seafood
Eggs
Beans, tofu
Nuts
2. Adequate Mineral Intake to Enhance Focus:
The commonly used ADHD medication “Ritalin” has various side effects, such as loss of appetite and picky eating.
As a result, patients taking this medication tend to be underweight and may even suffer from malnutrition.
Additionally, children with ADHD may have difficulty sitting still for meals and focusing on their food, frequently moving around and burning excess energy, which increases the risk of nutritional deficiencies.
high-salt, high-sugar, and processed foods—”junk food”
can worsen ADHD symptoms.
Being underweight or malnourished can exacerbate the condition. Some parents, seeing their child’s small size, may resort to giving them milkshakes, fries, and other “junk food” to try to increase calorie intake and promote weight gain.
However, these “junk foods” fail to provide the vitamins and minerals
ultimately weakening their immune system and making them more susceptible to colds.
Nutritional deficiencies can lead to fatigue, irritability, and an inability to concentrate at school, affecting academic performance.
Nutritional deficiencies can lead to a lack of iron,
which can cause anemia, fatigue, difficulty concentrating, and behavioral problems.
Moreover, studies have shown that children with ADHD tend to have lower levels of certain nutrients in their blood, such as iron and zinc, so it’s essential for children with ADHD to supplement their intake of these minerals.
Iron and zinc help regulate dopamine levels in the body, a neurotransmitter that enhances our ability to learn and process information, thereby improving focus. Some studies also suggest that taking iron supplements can reduce ADHD symptoms and improve cognitive and behavioral outcomes.
However, many experts recommend getting iron from food rather than supplements, as supplements can cause constipation and affect digestive function. Additionally, excessive iron in the body can increase the risk of arthritis and cardiovascular disease, so obtaining sufficient iron from food is the best approach. Furthermore, vitamin C not only boosts immunity but also enhances the body’s ability to absorb iron. Therefore, in addition to supplementing iron and zinc, it is also important to ensure adequate intake of vitamin C.
3. Improve ADHD symptoms by supplementing Omega-3 Fatty Acids
Capitalize have confirmed that Omega-3 affects the concentration of dopamine and serotonin, both of which are crucial neurotransmitters for focus.
Literature indicates that children with ADHD tend to have lower average concentrations of Omega-3 fatty acids in their blood compared to children without the condition.
Research also shows that regular consumption of Omega-3-rich fish can reduce the risk and symptoms of Alzheimer’s disease by 60%. A deficiency in Omega-3 fatty acids can lead to other cognitive impairments, with more problems in learning, expression, and behavior.
Since DHA is a type of Omega-3 fatty acid that helps construct and repair the brain cell membranes, it is crucial for maintaining communication between brain cells. Therefore, it is recommended to consume more fatty fish or take Omega-3 supplements to alleviate symptoms.
However, it’s important to note that fish liver oil and fish oil are two different supplements. Fish liver oil primarily contains fat-soluble vitamins A and D, and excessive intake may pose a risk of toxicity. It’s advisable to consult a pediatrician or nutritionist before supplementing.
Foods rich in omega-3
Salmon
Tuna
Mackerel
Flaxseeds
Patients often experience distractibility, difficulty paying attention to details, trouble focusing on one task, frequently losing items, lack of organization, and forgetfulness.
Several types of professionals can diagnose ADHD, each with different evaluation perspectives.
Diagnosis typically involves a clinical interview combined with gold-standard and internationally recognized assessment tools, along with the use of scientific instruments to provide an objective diagnosis.
ADHD treatment usually adopts a comprehensive approach, including medication, behavioral therapy, and may also involve psychological therapy, family therapy, and school interventions to improve symptoms and enhance the quality of life and learning.
ADHD patients do not necessarily need to undergo medication treatment. However, appropriate non-medication treatment options should be chosen based on individual circumstances (e.g., severity of symptoms, personal needs, and living environment). If symptoms severely affect daily life, medication may be necessary. It is recommended to discuss with our professional healthcare team to develop the most suitable treatment plan.
ADHD treatment is also suitable for younger children (under 6 years old), but the treatment approach needs to be adjusted based on the child’s age, severity of symptoms, and individual needs. Below are some ADHD treatment methods suitable for young children:
Behavioral therapy, psychological therapy, lifestyle adjustments, and comprehensive therapy. Medication is usually considered for young children only when behavioral therapy and other non-medication treatments have limited effectiveness. Doctors will assess the need for medication based on the child’s specific situation. If you have any questions, it is recommended to discuss with our professional team.
6.How does Neurofeedback therapy help patients with Attention Deficit Hyperactivity Disorder (ADHD)?
