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Improve Focus With Behavioral Tools & Medication for ADHD | Dr. John Kruse

Episode 219 Mar 10, 2025 2h 38m 31 insights
My guest is Dr. John Kruse, M.D., Ph.D., a psychiatrist specializing in treating people with attention-deficit/hyperactivity disorder (ADHD). We discuss the many stimulant and nonstimulant ADHD medications available, covering both their potential benefits and risks. We also explore behavioral approaches to managing ADHD, the key role of maintaining a consistent sleep-wake schedule, and the impact of exercise, fish oil supplementation, and video games on ADHD. Additionally, we examine the genetic and environmental factors contributing to the rise in adult and child ADHD diagnoses and offer various options to consider if you or someone you know is struggling with focus. Read the full episode show notes at hubermanlab.com.
Actionable Insights

1. Prioritize Foundational Health Basics

Consistently prioritize and regularize four essential aspects of daily life: sleep, eating, exercise (or movement), and ‘me time’ (relaxation/meditation), as these are critical for overall well-being and particularly impactful for managing ADHD symptoms.

2. Establish Consistent Sleep Timing

Maintain regular bed and wake-up times, even if they deviate from conventional hours, because the consistency of sleep timing is as crucial as duration for restorative sleep, especially for individuals with ADHD who often have a night owl chronotype.

3. Implement a Personal Scheduling System

Develop a daily schedule that includes essential tasks and blocks of time, aligned with your larger life goals, as this external structure is vital for the ADHD brain which struggles to provide its own internal organization.

4. Maintain Regular Meal Schedule

Adhere to a consistent meal schedule (e.g., breakfast, lunch, dinner) to prevent forgetting to eat or allowing meals to fragment throughout the day, which is a common challenge for individuals with ADHD.

5. Practice Cyclic Sighing for Sleep

Perform cyclic sighing for about five minutes (roughly 20-25 reps with longer exhalations) before bed to engage the parasympathetic nervous system, reduce arousal, and improve both the ability to fall asleep and stay asleep.

6. Eliminate Phone from Bedroom

Remove your phone from the bedroom entirely, as its mere presence, even if turned off, can increase cognitive arousal and disrupt sleep quality, a critical factor for overall attention and focus.

7. Limit Social Media Immersion

Consciously limit time spent immersed in social media, as constant exposure to barrages of information and interruptions can train the brain to be more distracted and impair sustained attention, making individuals more ADHD-like.

8. Engage in Regular Physical Exercise

Incorporate consistent physical exercise into your routine, as it can acutely improve executive functions like attention and concentration, and regular activity can help maintain focus and effective attention switching.

9. Consider Cognitive Behavioral Therapy (CBT)

Explore Cognitive Behavioral Therapy (CBT) specifically adapted for ADHD, potentially in combination with medication, as it teaches actionable techniques for managing symptoms, structuring tasks, and changing brain wiring and chemistry.

10. Prioritize Tasks with A-B-C System

Use a simple triaging system for your task list: ‘A’ for urgent and important tasks (to be done today), ‘B’ for important but not urgent tasks, and ‘C’ for all others, to ensure critical activities are completed and avoid procrastination on less important items.

11. Proactively Structure Your Workspace

Take deliberate steps to structure your physical workspace to minimize distractions and support focus, recognizing that spontaneous organization is often difficult for individuals with ADHD.

12. Use Digital Distraction Blockers

Employ apps or physical lockboxes to restrict access to distracting digital devices and social media during specific hours, providing external control when personal willpower to avoid distractions is challenging.

13. Segregate Social Media to Dedicated Device

Consider using a dedicated, old phone solely for social media apps, making it more difficult to access and helping to limit and segregate this activity from other aspects of life.

14. Choose Interest-Driven Work

Seek out careers and tasks that are genuinely interesting and compelling to you, as the ADHD brain is primarily interest-driven, making it easier to engage and sustain focus on such activities.

15. Embrace Varied Career Trajectories

Recognize that for many interest-driven individuals, particularly those with ADHD, a career path may involve multiple shorter-term roles (e.g., 10 five-year careers) rather than a single long-term one, which can be optimal for their engagement and contribution.

16. Collaborate with Partner for Sleep Routine

Discuss and agree upon a sleep routine with a partner or family members, allowing them to provide supportive reminders for bedtime, as external structure can be beneficial for individuals with ADHD, provided both parties are on board.

17. Avoid Late Evening Exercise

Refrain from exercising too late in the evening, as physical activity can elevate body temperature and arousal, potentially disrupting the ability to fall and stay asleep.

18. Consider Bright Light Therapy for ADHD

Explore bright light therapy by exposing yourself to bright lights early in the morning, as studies suggest it can measurably improve a broad range of ADHD symptoms by helping to resynchronize internal circadian rhythms.

19. Consume a Varied Diet for Gut Health

Support your gut microbiome by consuming a varied diet and eating at somewhat regular intervals, recognizing the complex but important relationship between gut health and mental well-being.

20. Supplement with Fish Oil (EPA/DHA)

Consider supplementing with fish oil, aiming for approximately 1,000 mg of EPA daily (potentially doubling if more benefit is desired), ideally with a natural 2:1 EPA to DHA ratio, for potential benefits in depression and some ADHD symptoms.

21. Combine L-Theanine with Caffeine

If using caffeine, consider combining it with L-theanine, as some studies suggest this combination can reduce jitters while offering cognitive benefits, without significant risks across a broad range of dosages.

22. Ensure Consistent Caffeine Dosing

Be aware that caffeine content in commercial beverages can vary widely; if using caffeine, strive for consistent sources or forms to better manage its effects, as inconsistent dosing can lead to unpredictable arousal or jitters.

23. Discuss Guanfacine/Clonidine with Doctor

Consult a doctor about guanfacine or clonidine (alpha-2 agonists) for ADHD treatment; these medications work slowly (2-4 weeks) by strengthening prefrontal synaptic connections and may be taken at bedtime to mitigate sedating side effects.

24. Discuss Modafinil/Armodafinil for Alertness

Consult a doctor about modafinil or armodafinil for improving alertness, wakefulness, attention, and concentration, as these medications are designed to promote wakefulness without the overstimulation associated with traditional stimulants.

25. Consider Vyvanse for Smooth Stimulant Delivery

If considering a long-acting amphetamine-based stimulant, discuss Vyvanse with your doctor, as it is designed for slow, consistent delivery and a less abrupt offset, often described as a ‘smoother’ experience compared to other stimulants.

26. Stimulants May Reduce Addiction Risk in Kids

For children with diagnosed ADHD, discuss stimulant medication with a doctor, as studies suggest it can paradoxically normalize their risk of substance addiction later in life, rather than increasing it.

27. Avoid Amphetamine Stimulants with Psychosis Risk

If there is a personal or family history of schizophrenia or psychosis, absolutely avoid amphetamine-based stimulants due to the rare but severe risk of amphetamine-induced psychosis, which can lead to long-term psychotic states.

28. Discuss Stimulant Drug Holidays for Growth (Kids)

For children on stimulant medication, discuss with a doctor the possibility of taking long breaks (e.g., during summer months) to mitigate potential growth suppression, a known side effect of long-term stimulant use in growing years.

29. Focus on Dampening Arousal for Insomnia

When struggling with insomnia, shift focus from trying to force sleep to actively dampening the daytime arousal system, as the sleep system is typically intact but overridden by persistent wakefulness signals.

30. Explore Nicotine for Focus (Non-Carcinogenic Forms)

If seeking improved focus and reduced anxiety, nicotine (in non-carcinogenic forms like pouches or gum) may be considered, as research shows it can improve executive functions and offers a unique combination of arousal and calming effects.

31. Experiment with Early Morning Adrenaline Activities for Sleep

Consider experimenting with early morning adrenaline-raising activities, such as a 1-3 minute cold plunge, or low-dose Wellbutrin (under medical supervision), as these may paradoxically improve nighttime REM sleep and overall sleep quality.