TCM Support for Children with ADHD

As families and school assemblies prepare for the new school year, some will be participating in Individual Education Plans (IEPS). These plans help educators and families work together to individualize the education process for a child that needs accommodations for learning. Attention Deficit-Hyperactivity Disorder (ADHD) is the most common diagnosis for which IEPs are made (Glassgow et al., 2020). Attention deficit disorder (with or without hyperactivity) has exponentially increased in diagnosis in the last 10 years (Abdelnour et al., 2020). Recent studies have shown that 1 in 9 children have received an ADHD diagnosis. This means that 7 million children in the United States ages 3 to 17 have an ADHD diagnosis. What used to be thought of as an “American Cultural Disorder”, ADHD has now developed into a universal phenomenon (Faroane et al., 2003) and is considered a neurodevelopmental disorder that influences the way children process information. A celebrated perspective of ADHD neurodivergence considers this presentation as a gift. While ADHD can be challenging, it is not a deficit but rather an asset in many ways, allowing for a child’s unique strengths to be identified and supported to maximize their developmental potential. Children with ADHD can be creative, passionate and energetic. Children with ADHD who are supported can grow to be free thinkers who assist in the progress of humanity in ways like entrepreneurship, athleticism, the arts, science and more. Families and school assemblies can work together to find adaptations in the classroom and at home to support a child’s success. This article offers recommendations for Traditional Chinese Herbal Medicine (TCHM) to address common symptoms of ADHD and gives entry level information on parent-led therapies to reduce the symptoms of ADHD in children.

First, it is important to note that life circumstances can contribute to ADHD behavior in children and should be evaluated in tandem with Traditional Chinese Medicine (TCM) diagnosis for better treatment outcomes. Sudden life changes, like a new sibling, parent’s separation, death in the family, stress at home or bullying, can present with symptoms of ADHD (Chadd.org). Other exogenous factors in a child’s environment that influence behaviors like those seen in ADHD are food and water quality, culture of the home, social and economic pressures, and more. In terms of food for children, ideally it should be whole and without pesticides. Foods that are processed, fried or dairy-based should be limited to less than 15% of the diet. Processed sugars and food coloring act as neurotoxins and can cause adverse behavior in children with effects that can last for days. Sugars should be saved for celebrations and offered to the child with sour and salty foods to balance digestion. It is important that a child has at least five 8 oz glasses of water a day, as chronic dehydration will also contribute to ADHD symptoms. If the family drinks water from a well, the well should be tested annually, and there is often state financial assistance for well testing if needed. Aside from food and water, other co-occurring conditions that influence the presentation of ADHD are hours spent in “screen time” per day, language barriers, sleep disorders, gastrointestinal conditions, chronic sinusitis, asthma, depression or anxiety, migraines, eczema, lead poisoning, or other environmental influences that may be present in or outside the home. Inquiry as to these co-factors are a part of the initial intake and considered alongside the primary treatment principles at the onset of care for a child with ADHD.

An important similarity presented in recent research equates ADHD symptoms and the symptoms of Nature Deficit Disorder, which is the theory that spending less time outdoors with nature results in behavioral changes for humans, and particularly for children. The two presentations have nearly the same symptom profile (Dickinson, 2013). Time in nature can help to reduce anxiety, resolve stress in the nervous system and enhance the immune system. For optimal brain development, children should be exploring, creating, and problem-solving in their native environment. Nature episodes and learning applications on the TV, phone or computer are not equal to the neuroprotective properties of being in the sights and sounds, feels and tastes of nature. It is noteworthy to mention that the introduction of technology for children (and subsequent omission of time spent in nature) can have negative effects on brain development. Without proper stimulus from meaningful relationships or from natural environments, the volume of the amygdala and the development of the prefrontal cortex can be reduced, which can mean that a child will have less ability to manage the body’s stress response (more fight or flight), less ability to read emotion on faces, less capability for decision making, and less goal-directed behavior. The American Pediatric Association (APA) recommends that children aged 2 and under should have no interactions with screens for proper bonding in relationships and for optimal language development, that children 2-5 years view no more than 1 hour of supervised educational screen time per day, and that children 5- 17 years spend no more than 2 hours per day on media. To have a balanced biorhythm, it is optimal for children to eat without screens and discontinue use of screens 90 minutes before bedtime.

Wherever possible, natural lighting should be offered for children in the home or classroom. The natural cycle of light and dark within the changing seasons is important to maintain in daily practice, as well. As an example, a child will sleep more in winter with an earlier bedtime and in summer the child will stay up later and rise earlier with the light of the sun. When possible, support children to be in active engagement during the light cycle and in quiet resting phase during the dark cycle. Humans are isomorphic, our biorhythm mimics nature. Like a newborn assimilating their breath rate to their mother for survival, humans need a relationship with nature for health.

To define ADHD, there are three types to consider: inattentive type, hyperactive-impulsive type, and combined type. Female children tend to present with less pronounced symptoms or are underdiagnosed with ADHD and more often diagnosed with inattentive ADHD, but this is not always the case. Further definition of the three types of ADHD are presented here with recommendations for support.

Inattentive type ADHD can make it difficult to focus on tasks and activities. A child with inattentive type ADHD may appear not to be listening, lose things easily, forget a directive mid-task, or seem aloof. This child may benefit from having short spurts of a task; with the focus on developing a skill rather than always finishing the task. During class time this child may benefit from having a fidget in their hands or a wobble board for their feet. Having hands or feet occupied can help a child’s mind to focus longer during a lecture or on a task. Doodling may also help this child sustain more attention during a long lecture. Noise cancelling headphones could help to reduce distracting stimulus for this child during homework or test taking. Having verbal and written directives for a task, offered simply and one at a time, helps with task completion. Visual timers, like sand in an hourglass, can help this child to conceptualize time and further focus efforts for “task chunking”. Praise for a child’s effort is a must. Example, “I see how well you did with problem number one; do you see your organization here?!”. This type of praise is superior, as the child will more fully understand what the “good job” is for and feel validated for skill building. Creating a positive feedback loop within a warm relationship is crucial for any child, especially a child who may interpret their gifts as a source of stress. In traditional Chinese medicine, inattentive ADHD may be defined as an accumulation of Phlegm in the orifices, Spleen Qi deficiency, Yang deficiency with or without somnolence, or Liver Qi stagnation.

A hyperactive-impulsive child may need to be more physically active than their peers and may also have the tendency to act without thinking first. In the classroom this child may present as disruptive, with behaviors like making noise even after being told to quiet, talking without stopping, grabbing things from others’ without asking, or difficulty with taking turns.

Historically, this child might have had recess taken away for “not listening”. The intention of the instructor may have been behavior modification or setting a classroom standard. In truth, punitive action for this child’s case would make symptoms in the classroom worse. Running outside, yelling, and gross motor playing will be therapy for a child with ADHD as they need to reduce excess energy. This child would benefit from standing at times during lectures, taking additional breaks than peers, visiting the therapy dog during the school day, or sitting on a yoga ball when working at their desk. Hand and feet fidgets at the desk would also help to promote focus for a child with hyperactive-impulsive ADHD. Test taking may be best in a private room with soft music playing. In Traditional Chinese medicine, this pattern of ADHD could be associated with turbid Dampness, Heart/Pericardium Heat, Kidney Yin deficiency, and Liver Fire or Liver Yang rising with irascibility.

The third type of ADHD is the combined type that would include any variation of the sensitivities and any combination of TCM patterns. No matter the Western medical differentiation of ADHD type, the child’s individual presentation of Yin/ Yang balance should be evaluated. Once the individual presentation is identified, treatment can be offered according to the 5-element theory, with the addition of herbal formulas if appropriate. Earth Dampness or Spleen deficiency should be addressed first, followed by efforts to free stagnant Liver Wood Qi and/or subdue Yang rising. Equally important is to address Kidney Water weakness of Yin or Yang function. Spleen Qi must be strengthened to balance overarching stress from Liver. Kidney function must be engendered to promote the best relationship between Spleen and Liver. If the tongue is enlarged and pale with an empty pulse, there may be weakness in the digestion and a base formula of Liu Jun Zi Tang, with higher doses of Bai zhu / Rhizoma Atractylodis Macrocephalae and Hou po / Cortex Magnoliae Officinalis added for Phlegm conditions. If the tongue is yellow coated with red tip or red body and the pulse is rapid and/or wiry, dredge the Liver with formulas like Xiao Yao Tang or Long Dan Xie Gan Tang with modifications for Damp Heat like Fu ling / Sclerotium Poriae Cocos or Zhu ling / Sclerotium Polypori Umbellati to drain Dampness down and out, or with Chuan Mu tong / Caulis Clematidis Armandii and Tong cao / Medulla Tetrapanacis Papyriferi for anxiety conditions exacerbated by Phlegm. If the tongue is red with a yellow coat and further cracking and the pulse is rapid and thready, support Kidney function with Jin Gui Shen Qi Tang for Yang deficiency or Liu Wei Di Huang Tang for Yin deficiency. Zhi Bai Di Huang Tang could be chosen for conditions of Yin deficiency compromising the Lung.

Shi chang pu / Acori tatarinowii rhizoma and Yuan zhi / Polygala tenuifolia are two herbs that can assist with ADHD symptoms when combined with Ren shen / Radix ginseng) and Fu ling / Poria. This formula will tonify while improving mental clarity. The formula is anti-inflammatory, has anti-oxidative properties and has been shown to reduce anxiety (Wen et al., 2023). Chang Pu Yi Zhi Pian (Acorus Tablets) is another formulation to calm Spirit, resolve Phlegm, clear Heat, and nourish Yin. An Shen Ding Zhi Ling is a twelve-constituent prepared formula used with success in China to support children with ADHD (Laqun et al, 2022). This formula will nourish and engender Blood and Yin to calm the Spirit. Mai men dong / Tuber Ophiopogonis Japonici can be added to any formula to sedate Heart Fire and relieve Shen disturbance. Yu jin (Radix curcumae) can be added to further clear Heart Heat and opens the orifices. Zhi gan cao (Radix glycyrrhizae preparata) will nourish the Heart and can be added to any formula or taken alone. The herbs suggested here will balance the central nervous system and relieve hyperactivity, reduce toxins and allergens which will then improve overall health for children with ADHD. Seek the assistance of a trained herbalist whenever starting an herbal regimen for a child. Some of these herbs listed should not be taken alone, not be taken long term and must be mixed at a certain ratio for optimal health. Most premade formulas in TCM are dosed for adults. A general rule for childhood dosage of an herbal formula would be 1/3 the adult dose.

In addition, or in lieu of herbal formulas, parent/caregiver-led touch therapies can be offered to help engage the limbic system of a child. The parent-led therapies mentioned here encourage dopamine and oxytocin in a child’s brain and are defined as “neuro-protective” (Li et al.,2022) These neuroprotective therapies can help to restore the volume of the amygdala and develop the prefrontal cortex. Parents and family members/caregivers can help a child with ADHD throughout the day by using acupressure points on the child’s body with gentle to moderate pressure. These points will help to calm the child’s mind, soothe the central nervous system and assist in reducing hyperactivity to improve focus. The first point, An Mian 安眠 is found on both sides of the neck. To find it, place a finger behind the earlobe and move the fingers just behind the bony protrusion. This point is traditionally used for insomnia or headache and has a strong calming effect. To start, ask the child to lie or sit in a chair. Once the point is found, ask what pressure is comfortable for the child. Use counterclockwise circles at An Mian 32 times, if possible. The auricular point, Shen Men 神门, the next point for autonomic support, is in the upper triangle of the ear. Shen Men is known as the “Gate of Consciousness” and reduces stress and anxiety by calming the mind. Gently massage this point by applying light pressure with the thumb in the triangular fossa with the index finger supporting the back of the ear to maintain pressure. Hold the point for a count of 32 seconds. If the child accepts this pressure, move fingers in a clockwise motion to further activate the point 32 times. After this pressure at Shen Men (and if the child allows) increase the point’s function by cupping the hand over the whole ear and circling the ear in a forward motion 32 times. Another set of points that help to reduce excess and calm energy are Ba Xie 八邪, on the hands and Ba Feng 八风 on the feet. These points are located at the knuckles in the webbing of the fingers and thumb and toes. Care providers can use their fingers to apply pressure down on the child’s hands and feet in a raking motion back and forth 32 times. Lastly, Kidney-1 /Yong Quan 涌泉 is located at the underfoot next to the ball between the 2nd and 3rd toes. This point will support the “rooting” function of the body and help to ground the child’s mentality. Apply pressure up towards the head flexing the foot of the child 32 times. End by holding pressure if the child is responsive to this. For ADHD, ending the point prescription at the feet is preferrable to reduce the rising Yang energy and enhance the vitality of Yin to house the mind. That said, any of these points can be used alone to benefit a child’s recovery from stress. Parents should take a moment of quiet self-reflection or meditation before offering this therapy for their children. Caregivers can experience great fatigue caring for others and should prioritize their own health management and seek support for their own stressors to effectively provide proper care for their children.

ADHD is growing in community awareness. Children with ADHD can be at higher risk for anxiety, depression and substance abuse as adults due to social dissonance that occurs when they are unsupported. Families with ADHD should seek support from mental health professionals, care providers, and school officiates to offer comprehensive wrap-around care in their child’s life. Learning happens within the context of relationships. Adults can model healthy compassionate living for children and make lifechanging differences. The diagnosis of ADHD can be an opportunity to celebrate individual expressions of neurology. Adults are charged with the responsibility to see their own neurological profile while helping children understand their own neurological Yin/Yang balance. Balance can be restored within nature and community.

About the Author

Lola Burmeister has a Bachelor of Science in Human Development from UW Madison. She has completed master's and doctoral-level studies in Traditional Chinese Medicine and is currently in her second year of PhD study in Infant Mental Health. Lola is executive director at Drops of Kindness, Inc., a non-profit wellness project that offers support for maternal-infant welfare to reduce outcomes of pervasive developmental disorders in children. Lola has a private practice in Madison, Wisconsin and can be reached at dropsofkindness.lola@gmail.com or 831.234.5299

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