Product Condition: NeuroVance Syrup

How can I improve my child’s concentration?

All children are different and change according to their age and what is going on in their lives. Periods of emotional stress, discouragement and a busy lifestyle can leave them demotivated and unable to concentrate. At the same time, children naturally vary in their ability to concentrate and keep motivated. Your child’s ability to focus and do well is therefore a complex interplay of many factors. Children’s attention span naturally increases with age. According to educational psychologists, a child’s attention span increases between 2 and 5 minutes every year. This means that a 5 year old should be able to stay focussed for between 10 and 25 minutes, and a ten year old twice that. If your child sometimes cannot concentrate for this long it doesn’t mean that anything is wrong, but that they may need some extra attention. If you child consistently cannot focus, no matter the task, they may be suffering from more serious concentration difficulties and should see an educational psychologist. In general, however, children can become easily distracted and ill-motivated, whether just for a specific subject, like maths, or school in general. So how can you help make sure your child is able to stay motivated and concentrate on the tasks which matter?

Set a daily routine

Children who have difficulty concentrating or starting work do better if they know when it is expected of them. Learning to live according to a schedule will also help them cope with an increasingly busy life as they grow up. How this schedule is laid out will depend on your child and the activities that they take part in. Perhaps they work better as soon as they get home or later on after some recreation or sport. Try out different study routines to see which they are best able to cope with, and make sure it remains consistent.

Give your child choices in their daily lives

Allowing your child to choose increases motivation to stick with decisions and complete tasks because they are invested in how and why they are achieving a goal. This includes setting up their schedule and routine, what they would like to eat for breakfast and what clothes they would like to wear. Children are also more aware of when they can study best or what environment or learning styles suit them, and so may come up with solutions to problems which may not have been obvious to their parents or teachers. Play an active role in steering these decisions to keep you children productive, and they will learn independence in making the right choices in life.

Find out when your child is best able to complete certain tasks

Some people can concentrate better in the morning, others at night or after a meal. Monitor your child’s activity and concentration levels and try to fit their schedule to take this into account.

Use a clock or timer during study time

This will improve your child’s awareness of how long they have worked for and how much longer they need to go until they can have a break, helping them stick to a schedule and be more conscious of their attention span.

Try to discover which style of learning best suits your child

Not everyone learns in the same way, and this can be frustrating, discouraging and boring if not taken into account. Some people do better with different learning styles depending on the subject, their mood or may prefer a combination of learning styles. Try to incorporate a range of these but focus on those with which your child does best. The major learning styles are:

1. Visual (spatial): Uses pictures, images, and spatial understanding.
2. Aural (auditory-musical): Incorporates sound and music.
3. Verbal (linguistic): Spoken and written words are more easily understood.
4. Physical (kinesthetic): Prefer to use body, hands and sense of touch.
5. Logical (mathematical): Learn best with logic, reasoning and systems.
6. Social (interpersonal): Learn in groups or with other people.
7. Solitary (intrapersonal): Work alone and use self-study.

Identify and incorporate your child’s interests into their work

The key to motivation and focus is interest in a task. Try aligning subjects that a child is not interested in with projects and goals that they find engaging. This will help them see the practical relevance of a particular subject, and keep them motivated to complete their work. For example, if your child likes cars, explain to them how maths and science help us make cars, or if they like movies, how English will help them write scripts one day. It is also important that you put at least as much effort into helping them develop their interests and hobbies as you do subjects that they may not be showing particular zest for. Their interests are the tasks and subjects that they will always perform better in, will carry through to adulthood, and that will allow them to attain a happy, productive and successful career and life.

Praise effort, not just achievement

Praising your children when they behave well and focus, rather than scolding them when they don’t, is extremely important. People are much quicker to respond to positive than negative stimuli, and children are easily discouraged if they feel they are incapable of achieving results. At the same time, praising only achievement can lead children to become discouraged when they fail to reach their goal. Instead, encouragement and praise for effort appears to be the most important factor in teaching them to work hard and be resilient. Verbal praise and reward is often more important than gifts as they will start to believe that if there is no physical incentive for them to perform it is not worth it.

Teach them that failure is a part of learning

If children see failure as only a bad thing, reflecting on them as a person, they will quickly become discouraged, lose interest and motivation, and start to believe they are not good enough. This goes hand-in-hand with encouraging effort. If they are able to see that they did well on something because they worked hard, or didn’t because they procrastinated, they are more likely to correct the problem than just believe they aren’t good enough. Teach them an optimistic mind-set, focussing on solutions rather than worrying about setbacks.

Remove distractions during study time

These include TV, radio, video games, cell-phones, tablets, speaking and loud noises. Music can help with concentration, but should not be too loud, and depending on the genre, task and person, can enhance or retard focus. Research suggests that music is best for boring or repetitive tasks (like building a model or doing a collage for school) but silence is best during tasks that need a lot of brain power, like maths. Importantly, music without lyrics is best, as our brains naturally try to listen to any words around us, dividing attention.

Introduce short breaks during study time

Don’t expect study sessions to be too long between breaks. How often and how long will depend on your child, so experiment to see what works best for them. Let them do some physical activity, have a snack or play an educational game during the break. This will help them collect their thoughts, relax and recover some mental energy for the next session. Steer away from activities that can further exhaust concentration like TV and video games.

Keep things interesting

Change regularly between subjects that interest them and ones that don’t. Relate your child’s interests back to what they are working on. Try to incorporate games into their work, and encourage concentration games and exercises during free time.

Break down larger tasks into smaller goals

This will make seemingly impossible tasks easier and quicker to finish. The resulting feeling of accomplishment is key to motivation.

Identify why they are discouraged or not able to concentrate

One of the biggest contributors to poor focus and motivation is discouragement. Positive self-esteem and a ‘can-do’ attitude naturally result in better performance, but feelings of inadequacy or low mood lead to children believing there is no point in trying. Speak to your child and their teachers about why they might dislike a particular subject or even school in general. Once you better understand what is behind their low motivation or poor concentration it will be much easier to take steps to correct it.

Promote a healthy lifestyle

Mental and physical health are often thought of as separate, but they are highly interlinked. Poor health leads to tiredness, difficulty concentrating, stress, demotivation and more serious problems like depression.

1. Focus on diet

Breakfast is important as it provides the brain with most of the energy it will use during the day. Focus on complex carbohydrates, healthy proteins and as many plant-based sources of nutrients as possible. These will keep your child’s energy levels stable until their next meal, improve their immunity, mood and mental function. Contact expert@mnilifestyle.co.za for healthy diet tips for you and your children.

1. Drink plenty of water

Many people are constantly dehydrated, which has an impact on their ability to concentrate.

2. Encourage exercise and regular movement

Exercise benefits concentration, motivation and focus in many ways. It increases oxygenation in the brain, and positive neurotransmitters which improve mood and brain function. Exercise also increases energy levels and helps reduce restlessness and hyperactivity. Instead of watching TV or playing video games during study breaks, encourage children to do some physical activity.

3. Ensure your child is getting enough sleep

Primary school children need between 9 and 11 hours of sleep, while teenagers need between 9 and 10 hours. Ensure regular bed time and wake up time are part of their routine or schedule. Minimize highly stimulating activities like TV or video games an hour before bed. Rather have them read, play with toys or board games, or do art before bed time. Getting enough exercise will also help them go to sleep easier.

4. Use supplements

A few natural compounds have been shown to improve symptoms associated with ADHD, while causing few side-effects. Of these, two of the most effective are Rhodiola rosea (Roseroot) and inositol. Both of these ingredients are well backed by science and are known to have positive effects on a range of factors associated with mental function.

Rhodiola rosea has been used for thousands of years in northen European countries to improve mood and combat stress. Recent research has uncovered its ability, in addition to these uses, to enhance mental function, memory and attention span, in part through increasing neurotransmitters such as dopamine in the brain. This is reflected in its wide use and recognition as an assistive therapy in Russia, Scandinavia, the UK and Sweden.

Inositol is a naturally occurring B vitamin which is present in the body and a number of food sources, especially fruit, beans and nuts. The molecule plays a role in a number of pathways in the brain, especially during the biosynthesis of norepinephrine. Low levels of inositol have been associated with some psychological conditions characterised by low mood, motivation and anxiety, and supplementation of inositol has been shown to alleviate these symptoms.

NeuroVance, a unique blend of the above scientifically endorsed plant-based ingredients, has been developed by The Medical Nutritional Institute to safely and effectively improve mental functioning. The individual ingredients (Rhodiola rosea, inositol, magnesium and zinc) target multiple biological pathways recognised to reduce stress, improve concentration and focus and promote calmness in both children and adults. As an assistive therapy, NeuroVance can therefore help to improve concentration, brain function and focus and assist you or your child in reaching your full potential.

What is Attention Deficit Hyperactivity Disorder?

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterised by a suite of symptoms which collectively result in trouble paying attention, difficulty controlling behaviour and excessive activity^1-3. Although ADHD is often thought of as a childhood disorder, adults also suffer from the condition. Symptoms, however, may be different during adulthood due to the increased growth of the brain, different societal pressures and the implementation of coping mechanisms over a person’s lifetime. ADHD in children can result in poor school performance and social impairment, while in adults it can cause job and relationship related difficulties¹. Despite this, many features of ADHD are associated with positive traits. This means that while someone with ADHD may struggle to function in particular environments, they can excel in others.  Persons with ADHD can, therefore, lead a somewhat normal life and exhibit good attention spans if their symptoms are effectively treated, especially for tasks they feel interested in. For more information and support, you can contact the ADHD Association of South Africa (ADHASA).

What are the symptoms of ADHD?

The symptoms of ADHD are complex and must occur in combination and be persistent to reach a diagnosis. Many of the symptoms overlap with other disorders or are particularly difficult to define as ‘unusual’ as, for example, whether someone is abnormally overactive will depend on the setting, other aspects of their personality and societal pressures. If you notice any of the symptoms in yourself, your children or those around you, it is therefore important to seek professional advice. Major symptoms of ADHD include inattention, hyperactivity or restlessness, disruptive behaviour and impulsivity. Girls with ADHD are more likely to have intellectual issues. Problems with keeping motivated and goal-oriented tasks can be experienced as ADHD predisposes sufferers to focus on short-term rather than long-term rewards. Emotional issues such as anger, anxiety and depression are also more common in ADHD sufferers. ADHD is often associated with drifting off during conversations, as well as language issues, both verbal and non-verbal, causing social cues to be missed. These symptoms often result in poor academic and job-related performance, as well as problems in relationships and social interaction. As children age, symptoms often change, both due to the development of coping mechanisms and the changing brain. For example, hyperactivity may transform into inner restlessness and constant mental activity. Depending on the exact symptoms, ADHD can be divided into three subtypes: ADHD inattentive type, ADHD hyperactive-impulsive type and ADHD combined type ADHD inattentive type is characterised by difficulty in staying focused and completing tasks, and is best described by the following symptoms:

• Easily distracted, misses details, forgets or loses things, frequently switches from one activity to another and struggles to follow instructions
• Difficulty focusing attention on, organizing and completing, or becoming easily bored with tasks
• Struggling to learn new things and difficulty processing information as quickly and accurately as others
• Seems to not be listening when spoken to, daydreams or becomes easily confused

ADHD hyperactive-impulsive type is characterized by restlessness, hyperactivity and childish or destructive behaviours, including:

• Fidgeting, having trouble sitting still and doing quiet tasks or activities
• Talking nonstop, interrupting conversations or others’ activities, blurting out inappropriate comments and showing emotions without restraint
• Constantly moving around, touching or playing with anything and everything in sight, acting without regard for consequences
• Being very impatient

ADHD combined type exists as a combination of symptoms of the other two types.

What causes ADHD?

The underlying causes of ADHD are, in the majority of cases, unknown. This is because ADHD is a complex disorder, caused by interactions between genetic and environmental factors^1,9. ADHD is therefore not exactly the same for each person in terms of the presence and severity of symptoms and their causes. ADHD is often inherited in families, suggesting underlying genetic causes in two-thirds of cases^10,11. A number of contributing genes have also been discovered, which largely play a role in neurotransmission^12,13. Environmental factors may also result in the syndrome or exacerbate the underlying genetic causes. The major environmental factors which can lead directly to ADHD are alcohol intake and exposure to tobacco smoke during pregnancy^1,2,14,15, extremely premature birth or low birth weight and exposure to certain toxic substances such as lead and polychlorinated biphenyls¹⁶. Traumatic brain injury and infection of the brain by certain viruses and bacteria during early childhood may also result in ADHD^17. Underlying genetic and environmental causes lead to abnormalities in neurotransmitter systems – the chemicals and signalling systems in your brain which facilitate communication, pleasure-seeking, motivation, activity and decision-making. These are primarily the dopamine and norepinephrine systems^18,19. Due to imbalances in these pathways, people with ADHD struggle with controlling their behaviours in the same way as others, and medications primarily attempt to correct these imbalances.

Is the prevalence of ADHD increasing and how common is it?

According to the diagnostic criteria used in South Africa, ADHD affects between 5 and 7% of children and 2 and 5% of adults. More boys are diagnosed with ADHD, most likely due to them exhibiting more disruptive symptoms than girls. This effect seems to decline in adulthood, possibly due to girl’s symptoms becoming more obvious as intellectual demands increase with age. Although diagnosis has been increasing since the 1970’s, it is not believed that this shows an increase in the frequency of the disorder, but rather reflects better diagnosis strategies, awareness and acceptance, as well changing societal pressures toward busier and focussed lifestyles.

Can environmental factors make ADHD worse?

Some environmental factors, although not supported as leading to ADHD, may worsen symptoms or make it harder for sufferers to focus on tasks at hand^2,22. Stress is a large contributor, making concentrating, sleeping and staying focused more difficult. Many ADHD like symptoms can also cause stress, resulting in a cycle which only makes ADHD worse. Effective stress management is therefore essential to living with ADHD. Overstimulation can also worsen symptoms and usually occurs when a person is in a loud and busy environment, such as in crowds. In these circumstances, it becomes difficult for the brain to decide which stimuli are meaningful and which are not, resulting in worsening of ADHD symptoms, especially in terms of the ability to focus. Other contributing factors to worsening of ADHD symptoms include sleep deprivation and the presence of distractions such as TV, cell phones and loud music.

Is ADHD associated with any other psychological conditions?

The symptoms and causes of ADHD overlap with a number of other psychological conditions. Due to this, ADHD can be associated with other disorders. These include:

• Sleep disorders such as insomnia and restless leg syndrome^23,24
• Learning disabilities, including speech, language and academic skills disorders²⁵
• Anxiety disorders²⁶
• Mood disorders, including bipolar and depression^1,6
• Obsessive-compulsive disorder²⁷
• Substance use disorders, both as an attempt to cope with symptoms and difficulty in balancing risk versus rewards²⁸
• Tourette syndrome²⁹
• Some other non-psychological issues such as obesity, asthma and migraine³⁰

How is ADHD diagnosed?

Diagnosis of ADHD should be carried out by a qualified professional. Diagnosis can be difficult due to the complexity of the condition, ranges of severity of each separate symptom and difficulty in quantifying ‘normal’ versus ‘abnormal’ ranges of each. In order for a diagnosis to be made, symptoms must^3,31:

• Appear between the ages of 6 and 12 and be present for more than 6 months
• Not be appropriate for children of that age
• Occur and cause problems in at least more than one setting (e.g. work, school, home)

Specifically, diagnosis takes place via a number of routes which assess behavioural and mental development. In children, this is based on feedback from teachers and parents, self-rating scales and other tests designed to assess goal orientation, concentration and activity levels³². Associated conditions are also taken into account. The procedure for adults is mostly the same, although it is necessary to question persons, such as parents or guardians, who knew the individual between the ages of six and 12 to confirm that symptoms were present at this stage³³.

Can I or my child live a normal life and still be successful with ADHD?

ADHD can be a lifelong condition, with between 30 and 50% of children diagnosed presenting symptoms into adulthood^21,34. Adolescents with ADHD are most likely to experience trouble due to increased social pressures, changing demands at school, and a rapidly developing brain³⁵. Despite this most people learn how to deal with the condition and develop coping skills, allowing them to lead a more normal life³⁶. Treatment strategies are essential to developing healthy coping mechanisms as well as reducing symptoms. Unhealthy coping strategies such as avoidance of work or relationships and procrastination are more likely to result in deviant behaviour, substance use and poor social functioning and self-esteem³⁷. With proper treatment, however, those with ADHD can improve over time and develop healthy coping mechanisms, behaviour, good self-esteem and productive social relationships. This is especially true if they pursue a career which they express interest in.

How is ADHD treated?

ADHD treatment revolves around both behavioural and medicinal interventions. Depending on the severity, symptoms and age, approaches can vary, and may be either in isolation or a combination of the two. There is, however, no known cure for ADHD³⁸.

Behavioural therapy

Behavioural therapies are best for candidates with mild symptoms or who are not eligible for drug treatment (such as pre-school aged children), and those with behavioural and emotional issues³⁹. Behavioural therapies can also improve self-esteem, compliance to treatment, lessen the likelihood of substance abuse and other deviant behaviours as well as generally improve functioning at school, work, home and in social situations through teaching sufferers to better recognise and control their own behaviour. These therapies become more effective with age, possibly due to an increased awareness of one’s self and increasing the ability to consciously adopt these strategies²⁰. Exercise, especially aerobic, has been shown to have significant benefit for ADHD⁴⁰. This includes significantly improved behavioural control, memory and self-esteem. Mood-related disorders are also benefitted. This is thought to be because exercise causes an increase in neurotransmitters in the brain. Together with this, exercise appears to improve the effectivity of stimulant medications.

Medication

In most cases, stimulant medications such as methylphenidate (Ritalin/Concerta) and amphetamines are prescribed⁴¹. These generally affect the dopamine and norepinephrine pathways within the brain, increasing the availability of these signalling molecules⁴². Non-stimulant medications, such as atomoxetine (an anti-depressant) may also be administered⁴¹, but do not appear to affect academic performance and concentration to the same extent⁴³. Methylphenidate appears to better symptoms in the majority of people⁴⁴, and stimulants may reduce abnormalities in brain structure and function, at least while the medication is being administered⁴⁵.

Are there side effects to ADHD treatments?

While stimulant medications offer a number of benefits, there are some documented side-effects to their use. These should be discussed with your doctor.

Are there any other solutions to ADHD?

While the side-effects of medication might cause parents and sufferers to seek alternative treatments, they should not ignore the advice of their healthcare provider. Behavioural therapies and medication can offer significant benefit, but in cases where additional support is required, some herbal supplements can help reduce the severity of symptoms. A few natural compounds have been shown to have improved symptoms which are associated with ADHD while causing few side-effects. Of these, two of the most promising is Rhodiola Rosea (Roseroot) and inositol. Both of these ingredients are well backed by science and are known to have positive effects on a range of factors associated with the mental function. Rhodiola Rosea has been used for thousands of years in northern European countries to improve mood and combat stress. Recent research has uncovered its ability, in addition to these uses, to enhance mental function, memory and attention span, in part through increasing neurotransmitters such as dopamine in the brain⁴⁷. This is reflected in its wide use and recognition as an assistive therapy in Russia, Scandinavia, the UK and Sweden. Inositol is a naturally occurring B vitamin which is present in the body and a number of food sources, especially fruit, beans and nuts. The molecule plays a role in a number of pathways in the brain, especially during the biosynthesis of norepinephrine. Low levels of inositol have been associated with some psychological conditions characterised by low mood, motivation and anxiety^48,49, and supplementation of inositol has been shown to alleviate these symtoms^49,50. NeuroVance, a unique blend of the above scientifically endorsed plant-based ingredients, has been developed by The Medical Nutritional Institute to safely and effectively improve mental functioning. The individual ingredients (Rhodiola Rosea, inositol, magnesium and zinc) target multiple biological pathways recognised to reduce stress, improve concentration and focus and promote calmness in both children and adults. As an assistive therapy, NeuroVance can, therefore, help to lessen symptoms of ADHD and assist you or your child in reaching your full potential.

What about diet?

Diet in itself is not likely to cause ADHD, but poor eating habits can worsen symptoms and impair proper brain development. Refined carbohydrates, simple sugars and some food colourants and additives are known to negatively affect mental function and worsen hyperactivity. Furthermore, ADHD sufferers are more likely to crave and binge eat these foods due to their ability to increase reward signalling in the brain, leading to other health and eating-related disorders, such as obesity. A healthy, well-balanced diet is also essential to proper development of the brain, and lack of many nutrients can cause impairments in brain development. If you feel a particular food-stuff is negatively affecting your or your child’s ADHD, remove this from the diet and see if symptoms are improved. This should, however, not be done to an extreme – it can be difficult to pick out the true causative factors and removing too many foods from anyone’s diet can result in negative health consequences. It is most important to ensure that you or your child are eating a healthy, well-balanced diet based on plant-based sources of nutrients and which avoids junk foods and processed carbohydrates. For more advice on healthy eating in general and with regards to ADHD, email our dietician at dietician@mnilifestyle.co.za .

How can I manage my or my child’s ADHD?

First of all, it is essential to seek professional advice and treatment. There are, however, a few strategies which you can begin to include in your daily life:

• Organise your or your child’s day, set a routine and create structure. When major changes occur, like a holiday or a visit from a relative, make sure you are aware and prepared for them.
• Remove distracting stimuli from the environment, especially during times when the focus is required. Ensure that you or your child know that activities such as TV watching are only allowed after work is complete.
• Do regular aerobic exercise.
• Set a good example, put rules, structure and discipline strategies in place in both day to day life and before activities. Make sure you or your child understand these and do not deviate from what you have set in place. Consistency is key to maintaining productive behaviour.
• Talk with teachers and other guardians to ensure they employ these strategies and to understand how your child acts in situations when you are not present.
• Focus on positive reinforcement, praise and rewards more than punishment. People with ADHD are more likely to perform if they feel that an experience will be pleasurable than to avoid something because of possible negative consequences.
• Involve your child in the above processes, especially as they age. This will help them develop the ability to implement their own coping strategies, improve their self-esteem and make compliance more likely as they will feel they are actively trying to better themselves.

Taking NeuroVance alongside the above behavioural interventions can also safely and effectively assist you or your child in improving mental function, concentration and motivation, allowing you to live a more productive life and helping you to excel in the activities you see as important.

Sources:

Attention Deficit Hyperactivity Disorder. National Institute of Mental Health. Acessed 04 August 2017; https://www.nimh.nih.gov/health/topics/attention-deficit-hyperactivity-disorder-adhd/index.shtml

Attention-Deficit / Hyperactivity Disorder (ADHD).  Centers for Disease Control and Prevention. Accessed 04 August 2017; https://www.cdc.gov/ncbddd/adhd/facts.html

American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®).  (American Psychiatric Pub, 2013).

Gershon, J. & Gershon, J. A meta-analytic review of gender differences in ADHD. Journal of attention disorders 5, 143-154 (2002).

Modesto-Lowe, V., Chaplin, M., Soovajian, V. & Meyer, A. Are motivation deficits underestimated in patients with ADHD? A review of the literature. Postgraduate medicine 125, 47-52 (2013).

Shaw, P., Stringaris, A., Nigg, J. & Leibenluft, E. Emotion dysregulation in attention deficit hyperactivity disorder. American Journal of Psychiatry 171, 276-293 (2014).

Coleman, W. Social competence and friendship formation in adolescents with attention-deficit/hyperactivity disorder. Adolescent medicine: state of the art reviews 19, 278-299, x (2008).

Kooij, S. J. et al. European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD. BMC psychiatry 10, 67 (2010).

Thapar, A., Cooper, M., Eyre, O. & Langley, K. Practitioner review: what have we learnt about the causes of ADHD? Journal of Child Psychology and Psychiatry 54, 3-16 (2013).

Neale, B. M. et al. Meta-analysis of genome-wide association studies of attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry 49, 884-897 (2010).

Franke, B. et al. The genetics of attention deficit/hyperactivity disorder in adults, a review. Molecular psychiatry 17, 960 (2012).

Gizer, I. R., Ficks, C. & Waldman, I. D. Candidate gene studies of ADHD: a meta-analytic review. Human genetics 126, 51-90 (2009).

Kebir, O., Tabbane, K., Sengupta, S. & Joober, R. Candidate genes and neuropsychological phenotypes in children with ADHD: review of association studies. Journal of psychiatry & neuroscience: JPN 34, 88 (2009).

Burger, P. et al. How does maternal alcohol consumption during pregnancy affect the development of attention deficit/hyperactivity syndrome in the child. Fortschritte der Neurologie-Psychiatrie 79, 500-506 (2011).

Abbott, L. C. & Winzer-Serhan, U. H. Smoking during pregnancy: lessons learned from epidemiological studies and experimental studies using animal models. Critical reviews in toxicology 42, 279-303 (2012).

Eubig, P. A., Aguiar, A. & Schantz, S. L. Lead and PCBs as risk factors for attention deficit/hyperactivity disorder. Environmental health perspectives 118, 1654 (2010).

Eme, R. ADHD: an integration with pediatric traumatic brain injury. Expert review of neurotherapeutics 12, 475-483 (2012).

Schultz, W. Neuronal reward and decision signals: from theories to data. Physiological Reviews 95, 853-951 (2015).

Jamkhande, P. G. & Khawaja, A. Role of norepinephrine reuptake inhibitors in attention deficit hyperactivity disorder: A mechanism-based short review. International Journal of Nutrition, Pharmacology, Neurological Diseases 6, 146 (2016).

Brahmbhatt, K. et al. Diagnosis and treatment of attention deficit hyperactivity disorder during adolescence in the primary care setting: A concise review. Journal of Adolescent Health 59, 135-143 (2016).

Thomas, R., Sanders, S., Doust, J., Beller, E. & Glasziou, P. Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 135, e994-e1001 (2015).

Identifying Your ADHD Triggers. Healthline. Acessed 04 August 2017; http://www.healthline.com/health/adhd/adhd-trigger-symptoms

Corkum, P., Davidson, F. & MacPherson, M. A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder. Pediatric Clinics of North America 58, 667-683 (2011).

Tsai, M.-H. & Huang, Y.-S. Attention-deficit/hyperactivity disorder and sleep disorders in children. Medical Clinics of North America 94, 615-632 (2010).

DuPaul, G. J., Gormley, M. J. & Laracy, S. D. Comorbidity of LD and ADHD: Implications of DSM-5 for assessment and treatment. Journal of Learning Disabilities 46, 43-51 (2013).

Bériault, M. et al. Comorbidity of ADHD and anxiety disorders in school-age children: impact on sleep and response to a cognitive-behavioral treatment. Journal of attention disorders, 1087054715605914 (2015).

Abramovitch, A., Dar, R., Mittelman, A. & Wilhelm, S. Comorbidity between attention deficit/hyperactivity disorder and obsessive-compulsive disorder across the lifespan: a systematic and critical review. Harvard review of psychiatry 23, 245 (2015).

Ortal, S. et al. The Role of Different Aspects of Impulsivity as Independent Risk Factors for Substance Use Disorders in Patients with ADHD: A Review. Current drug abuse reviews 8, 119-133 (2014).

El Malhany, N., Gulisano, M., Rizzo, R. & Curatolo, P. Tourette syndrome and comorbid ADHD: causes and consequences. European journal of pediatrics 174, 279-288 (2015).

Instanes, J. T., Klungsøyr, K., Halmøy, A., Fasmer, O. B. & Haavik, J. Adult ADHD and comorbid somatic disease: a systematic literature review. Journal of attention disorders, 1087054716669589 (2016).

Steinau, S. Diagnostic criteria in attention deficit hyperactivity disorder–changes in DSM 5. Frontiers in psychiatry 4 (2013).

Subcommittee on attention-deficit/hyperactivity disorder, steering committee on quality improvement and management. ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, peds. 2011-2654 (2011).

De Crescenzo, F., Cortese, S., Adamo, N. & Janiri, L. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review. Evidence-based mental health 20, 4-11 (2017).

Ginsberg, Y., Quintero, J., Anand, E., Casillas, M. & Upadhyaya, H. P. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. The primary care companion for CNS disorders 16 (2014).

Molina, B. S. et al. The MTA at 8 years: prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry 48, 484-500 (2009).

Gentile, J. P., Atiq, R. & Gillig, P. M. Adult ADHD: diagnosis, differential diagnosis, and medication management. Psychiatry (Edgmont) 3, 25 (2006).

Harpin, V., Mazzone, L., Raynaud, J.-P., Kahle, J. & Hodgkins, P. Long-term outcomes of ADHD: a systematic review of self-esteem and social function. Journal of attention disorders 20, 295-305 (2016).

Shaw, M. et al. A systematic review and analysis of long-term outcomes in attention deficit hyperactivity disorder: effects of treatment and non-treatment. BMC medicine 10, 99 (2012).

Fabiano, G. A. et al. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clinical psychology review 29, 129-140 (2009).

Den Heijer, A. E. et al. Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. Journal of Neural Transmission 124, 3-26 (2017).

Markowitz, J. S. & Yu, G. in Applied Clinical Pharmacokinetics and Pharmacodynamics of Psychopharmacological Agents     303-327 (Springer, 2016).

Rubia, K. et al. Effects of stimulants on brain function in attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Biological Psychiatry 76, 616-628 (2014).

Prasad, V. et al. How effective are drug treatments for children with ADHD at improving on-task behaviour and academic achievement in the school classroom? A systematic review and meta-analysis. European child & adolescent psychiatry 22, 203-216 (2013).

Parker, J., Wales, G., Chalhoub, N. & Harpin, V. The long-term outcomes of interventions for the management of attention-deficit hyperactivity disorder in children and adolescents: a systematic review of randomized controlled trials. Psychology research and behavior management 6, 87 (2013).

Spencer, T. J. et al. Effect of psychostimulants on brain structure and function in ADHD: a qualitative literature review of MRI-based neuroimaging studies. The Journal of clinical psychiatry 74, 902 (2013).

Watson, S. M. R., Richels, C., Michalek, A. P. & Raymer, A. Psychosocial treatments for ADHD: A systematic appraisal of the evidence. Journal of attention disorders 19, 3-10 (2015).

Hung, S. K., Perry, R. & Ernst, E. The effectiveness and efficacy of Rhodiola rosea L.: a systematic review of randomized clinical trials. Phytomedicine 18, 235-244 (2011).

Kim, H., McGrath, B. M. & Silverstone, P. H. A review of the possible relevance of inositol and the phosphatidylinositol second messenger system (PI‐cycle) to psychiatric disorders—focus on magnetic resonance spectroscopy (MRS) studies. Human Psychopharmacology: Clinical and Experimental 20, 309-326 (2005).

Mukai, T., Kishi, T., Matsuda, Y. & Iwata, N. A meta‐analysis of inositol for depression and anxiety disorders. Human Psychopharmacology: Clinical and Experimental 29, 55-63 (2014).

Akhondzadeh, S., Gerbarg, P. L. & Brown, R. P. Nutrients for prevention and treatment of mental health disorders. Psychiatric Clinics of North America 36, 25-36 (2013).