Environmental interventions (++)

Parent training

• Parent training seems to be helpful for children with ADHD.¹ This is particularly true for children with ODD² and young children.³
• Parent training can also be effective as an online course.⁴

Interventions in school/kindergarten (-)

• One meta-analysis reported that classroom interventions/school interventions were found to be partly ineffective and partly effective only as long as the interventions lasted.⁵

Environmental adaptation

• Suitable job (++)
  • Arousing enough interest to activate hyperfocus
  • Enough variety to keep your attention alert⁶
  • ADHD-HI: often with physical exercise
  • ADHD-I: no quick decisions
• Suitable working environment (+)
  • According to the needs of the person with ADHD
    • Background noise
      • Everyone needs their own specific level of arousal (excitement, stimulation).⁷⁸
    • Even if novelty seeking and curiosity behavior correlate (also genetically) with impulsivity,⁹ it is probably important for most people with ADHD-HI to reduce arousal, but for people with ADHD-I to increase arousal.
• Stimulate arousal
  • Targeted (quiet) background music
    • Some people can only learn with it
  • TV running in the background
    • If noises / images are distracting: switch off
  • Motivational elements
    • Very important, as people with ADHD can basically concentrate just as intensely as others. The only difference is that they are unable to generate this concentration in a controlled manner, let alone control it. This is not carelessness or laziness.
    • Intrinsic motivation instead of extrinsic motivation: the central key
    • Rewards
    • Competition with others
      • Communicate goals to others (create commitment / self-commitment)
    • Don’t make people with ADHD feel guilty
      • None: You can if you want to
      • None: You just have to try harder
        • Friedmann reports of people with ADHD who lost their ADHD symptoms after finding a working environment that suited their constitution: short attention spans, frequent activation, independent work organization. We also know of cases that blossomed in an environment that suited them perfectly. This does not mean that only every person with ADHD has to find the right environment in order to no longer have ADHD. ADHD means that the choice of which environment is suitable is extremely limited. Very few people with ADHD will be able to build their world in this way. In our opinion, however, one more element must be added: genuine interest. Only when this genuine interest of their own kicks in will people with ADHD be able to resolve their attention problems. Friedmann points out that the reduced number of dopamine D2 and D3 receptors in the reward center of the brain in people with ADHD means that fewer things are found (rewarding), i.e. sufficiently exciting, than in people without ADHD. The choice of an exciting environment therefore necessarily requires that it is something that is of (such) high interest to the person with ADHD that the reward center “jumps” and the attention of the person with ADHD is aroused. The sentence “You can do it if you want to” is absolutely correct, but not in the way it is usually misunderstood. ADHD can only be understood if one is prepared to accept that the will of the person with ADHD is not completely free to choose, but depends on the subject being so interesting that the shortcoming of the reduced number of D2 and D3 dopamine receptors no longer comes into play. Only with the appropriate intrinsic interest can people with ADHD manage to “be able to do” what they want: by doing something that really really interests them. This mechanism explains well why extrinsic motivation (external pressure) does not help if something is not interesting enough. External pressure can do a lot - but it does not make dopamine receptors grow. From this perspective, ADHD could also be defined as an extreme narrowing of interests.
          And yet this is not a justification that your ADHD is not that bad, you just haven’t found what interests you.
  • Secondary employment
    • Knit
    • Draw
    • Listen to music
      • Some people have to “do” something on the side in order to be able to concentrate. This relieves inner tension. The secondary activity serves to optimize arousal. This is not a sign of disinterest or disrespect, but a means of increasing attention and concentration

Reduce distraction

• Avoiding situations that are too loud, hectic, stressful and intense.
  • If you are sensitive to stress, you should avoid stress-inducing situations. This obvious-sounding fact is surprisingly often disregarded, whether due to a lack of knowledge or a guilty conscience. It’s like the temperature: you shouldn’t be cold when the thermometer says so, but when you’re cold:
  • Brightness
    • Lower the roller shutter
  • Temperature
    • Regulate according to your own needs
  • Reduce noise / voices / ..
    • Very quiet surroundings
    • Earplugs
    • Noise protection headphones
  • Own workspace¹⁰
    • No open-plan office!
    • No through room!
    • No open office!
  • Mails
    • Restrict retrieval to certain times
    • Deactivate pop-ups for incoming messages
    • Mails and other messages on cell phone only visible after active retrieval, not automatically on screen
  • Seat alignment at the workplace
    • (Closed) door in view
    • No windows in the back
    • Hide events in the room / in the window in the line of vision using curtains / transparent privacy film
    • Plenty of daylight¹¹
    • Closed room

Optimize / adapt learning methods

• Short learning sections with frequent breaks
• E.g: Learning vocabulary;
  • Max. 10 pieces, as often as necessary until they fit securely, only then more
  • Use all senses: read quietly, read aloud, copy, etc.
  • Further vocabulary only after a break
• Walk while learning
  uniform movement significantly optimizes receptivity in some people; movement reduces stress and increases neurotrophic factors in the brain that are necessary for neuroplasticity (formation of new synapses, learning)
• 30 minutes of physically intensive exercise before learning (esp. ADHD-HI)
• Suitable working methods
  • Independence
    for interesting activities, some people with ADHD-HI do better as self-employed persons than as employees, because intrinsic motivation optimizes arousal
    for less interesting activities, however, this would be rather disadvantageous because the individual’s own drive / structure is too low
  • Interesting activity
    The lack of extrinsic motivation makes it many times more important for persons with ADHD to find a task that is really exciting for them than for people without ADHD
  • ADHD-I: structured work tasks, clear instructions, tight controls
    Example:
    One person with ADHD retired at the age of 50 after a glittering career in the US Marines. He couldn’t cope in civilian life and failed. A year after leaving, he was diagnosed with ADHD.
  • A well-structured daily routine with regular alternation of activity and relaxation can support stabilization of the noradrenaline balance through self-activation (see below: take enough breaks)

Avoid / eliminate sources of stress

• Even in the case of personality disorders, a long-term study (n = 733) surprisingly found a reduction in symptoms within 2 years for a period of more than 12 months in more than 50% of people with ADHD. In the case of borderline, this was observed in 10% of people with ADHD within 6 months, usually after massively stressful current life circumstances (stressful relationship) were eliminated. Nevertheless, significant diagnostic criteria remained very constant (more so than with severe depression), but they no longer reached the required severity for a diagnosis.¹²

Promote stress reduction

• Just one hour longer sleep reduces morning cortisol levels by 21%¹³¹⁴
• For sleep disorders:
  • Shift your sleep rhythm backwards
    Postpone falling asleep and getting up
    This could be worth a try for people with ADHD with high stress levels immediately on waking (e.g. anxiety)
    Early awakening correlates with high cortisol levels¹³¹⁴
  • More about sleep problems here

Moving to a low-stress environment

• People who live in poor neighborhoods are said to have a higher body weight due to stress than people who live in more affluent neighborhoods.
  • When moving house, the body weight adapts to the new environment.¹⁵
  • This could be interpreted as a consequence of a stress response or stress reduction, but can also be understood as an adaptation to the main environment.