Reviewed by Brunilda Nazario, MD on March 19, 2021
Like many adults with ADHD, Justine Ruotolo took a stimulant (in her case Adderall XR) for her symptoms. Then, about 11 years ago, she started meditating. Shortly after that, she began to shake after taking her pill. Ruotolo’s doctor lowered the dose, but 6 months later it started happening again. She decided to go off the medication and hasn’t looked back since.
Ruotolo largely credits meditation for calming and focusing her brain enough that she no longer warranted a boost from medication. She also did a lot of reading about her condition and received training from an ADHD coach.
There are many reasons why someone with ADHD might stop taking medication or never start in the first place. Some hate the side effects. Others struggle to pay for the medication. Or, like Ruotolo, they find that nondrug strategies work well enough for them.
In the U.S., there aren’t any official treatment guidelines for adults with ADHD. But, “the best practice is to treat true ADHD with a stimulant unless there are contraindications,” says Craig Surman, MD, a neuropsychiatrist and researcher at Harvard Medical School. 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 severe problems.
“Some people have what I’d call ADHD traits rather than the full diagnosis,” he explains. Even people who check every box for ADHD might find that their symptoms are better in certain situations. For example, a graphic designer may have no trouble staying focused in a firm where a boss breathes down his neck. But if that graphic designer goes freelance, it might not be so easy to stay on task when he’s managing his own schedule. “People with ADHD live on deadlines,” Surman says.
If you’re doing well on medication, it might be hard to tell whether you still need it. Surman often advises high-functioning people who’ve been on stimulants for a while to take an occasional “drug holiday.” That is, go off the drugs for a short period to see whether they still need them. It’s probably a good idea to check with your doctor if you want to try this.
Alternatives to Medication
Whether you take medication or not, nondrug approaches are important for managing ADHD. “They’re not mutually exclusive,” Surman says.
Ruotolo knows this both from personal experience and from working with other people who have ADHD. She became an ADHD coach shortly after her diagnosis. She went on to get a master’s in clinical psychology and became a licensed marriage and family therapist (LFMT) in addition to a coach. Some of her clients thrive on a combination of medication and nondrug strategies. Others find that they can function well without medication and rely solely on medication-free approaches like exercise, meditation, and counseling.
Going without meds won’t provide enough symptom relief for everyone with ADHD. But some nondrug strategies, either in addition to or in lieu of medicine, include:
“Understanding your ADHD is crucial,” Surman says. 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 the resources provided by ADDA (Attention Deficit Disorder Association). Support groups are another good way to learn about the condition from your peers, he adds.
Cognitive behavorial therapy (CBT)
CBT is a highly focused and results-oriented form of talk therapy. It helps with anxiety and depression, two conditions that often coexist with ADHD. Even if ADHD is your only concern, there’s a good chance CBT would help.
CBT can help adults with ADHD change their thinking patterns and develop skills that make living with ADHD easier. “It focuses on behaviors that help people take charge of their condition and stay organized,” Surman says. But, organizational strategies are only part of it. CBT also helps retrain the way you think. You learn to recognize automatic negative thoughts you tend to 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 frequently overlap 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 need someone to think things through with me to decide what to do first.’ That’s where coaching can be very helpful,” Surman says.
As a coach, Ruotolo homes in on a client’s needs. “We talk about specific organization strategies, like how to clean up your desk and your house and how to live your life in an organized way,” says Ruotolo, who is the author of A.D.D Land: The Gift of ADD.
Mindfulness — which focuses on living in the present moment rather than harping on the past or worrying about the future — is the foundation of Ruotolo’s practice. “Our brains are such that the thoughts just keep going and going,” she says. “With mindfulness, you just notice a thought and observe it, but you’re not engaging.” Over time, this practice changes the connections in your brain so that you react to the world around you differently, Ruotolo adds.
Everyone should stay physically active, eat healthfully, and get adequate sleep. But these basic self-care measures are vital for anyone struggling with ADHD. Lack of sleep can interfere with cognitive function, Surman says. Adequate exercise and proper nutrition benefit your brain. While these kinds of simple tweaks alone are unlikely to be enough to treat full-blown ADHD, they are an important part of any self-care regimen.