Create the Foundation: Supporting Attention
By Keili Mistovich, MD, MPH, FAAP, FABPS, Zest Co-Founder and Chief Medical Officer, Zest Pediatrics of Beachwood
By October, the school year is in full swing. The first-week excitement has worn off, the homework has picked up, and teachers have had enough time to notice patterns with kids. This is often when the conversations start – the email from the teacher, the first progress report, the conference that leaves you with more questions than answers.
“He can’t sit still during reading.”
“She only finishes her work when someone sits next to her.”
“Homework takes three hours when it should take thirty minutes.”
“I know he’s smart. It just doesn’t show up on paper.”
October is also ADHD Awareness Month, which makes it a good time to talk about attention – what it is, what supports it, and what gets in its way.
ADHD is a neurodevelopmental difference in how the brain regulates attention, activity, and impulse control. When concerns arise about attention and an ability to focus, step one is always a thorough evaluation and then a conversation about evidence-based treatment, including behavioral therapy and medication when appropriate. However, even with the best resources in place, parents know that sustaining attention is a constantly moving target. Every child’s ability to focus, with or without ADHD, rests on a foundation of sleep, movement, nutrition, and environment. When that foundation is shaky, focus suffers. When it’s strong, every other intervention works better.
How to best build the foundation
Sleep comes first. Interestingly in kids, sleep deprivation often doesn’t look like sleepiness. It looks like hyperactivity, impulsivity, and really big emotions – which can look a lot like ADHD. But did you know that even modest sleep loss worsens attention, and some children referred for attention concerns turn out to have an underlying sleep problems, such as snoring, sleep apnea, or restless leg or arm syndrome impacting their ability to sleep.
School-age kids need 9 to 12 hours a night, and teens need 8 to 10. Be sure to protect consistent bed and wake times, keep screens out of the bedroom, and keep evenings dim. If your child snores regularly, wakes up still feeling tired and groggy, or complains that their body just can’t relax at night, please bring it up with your doctor. Getting the right amount of sleep can make a huge difference.
Movement primes the brain. Physical activity increases dopamine and norepinephrine, the same brain chemicals that many ADHD medications work on. Research shows that even a single session of moderate exercise, like sports or bike riding, can improve attention and executive function. Kids who move before school, at recess, and before homework are starting with a brain that is primed for focus. Let’s protect recess, build in twenty minutes of outdoor play before homework starts, and even let kids fidget. For many children, a wiggle cushion or a standing desk isn’t a distraction – it’s how their brain stays engaged.
Breakfast sets the tone for the day. The hardest academic work of the day usually happens mid-morning. A breakfast of sugary cereal, toaster pastries, or juice spikes blood sugar quickly and brings it crashing down right around that time. Building breakfast around protein and fiber gives the brain steadier fuel. Eggs, Greek yogurt, nut butter on whole-grain toast, or even last night’s leftovers all count.
Iron and Vitamin D levels are important. Two nutrients are worth checking in most kids, but especially those with attention concerns. The first is iron. The brain needs iron to make dopamine, and low iron stores have been linked to more attention symptoms and more restless sleep. The second is vitamin D. Children with ADHD tend to have lower vitamin D levels than their peers, and a handful of small trials suggest that adding vitamin D to standard treatment can modestly improve attention and behavior. In winter, when we get much less sun exposure, levels tend to drop. Make sure to know your child’s vitamin D and iron levels to ensure we are proving them with the right amount of iron and vitamin D supplementation.
Supplements worth knowing about. A few supplements have been studied in children with ADHD. None of them replace evaluation or treatment, but they can be a reasonable supportive layer for some kids.
Omega-3 fatty acids, especially DHA and EPA, are building blocks of brain cell membranes. Children with ADHD tend to have lower omega-3 levels, and supplementation has shown modest benefit for attention in some kids. Fatty fish, chia, flaxseed, and walnuts are good food sources, and a high-quality fish or algae oil can fill the gap.
Saffron – yes, the spice – has been studied as well. In a small six-week trial, children taking a saffron supplement improved about as much on parent and teacher ratings as children taking methylphenidate, one of the most commonly prescribed ADHD medications. While this is hopfeul, it’s important to remember, it comes from a small, short study, and it needs to be confirmed in larger and longer trials before we can lean on it.
Always remember that supplements aren’t regulated the way medications are, so quality and dosing vary widely, and some supplements can change how medications work. Be sure to talk with your doctor before starting any supplement at all, especially if your child already takes medication.
Thoughtful screen use. Fast-paced, constantly rewarding content trains the brain to expect something new every few seconds. A page of math problems can’t compete with that. Studies following teens over time have found that frequent digital media use is associated with more attention symptoms down the road. This isn’t about eliminating screens. Screens are here to stay and it’s important that we teach our children how to make wise decisions about when and where screen are used. When it comes to attention and focus, it’s about keeping phones out of the room during homework, creating screen-free time before bed, and leaning toward slower-paced content when kids do watch.
Get outside. Vitamin N for the win. Children with attention difficulties have shown better concentration after a walk in a park compared with a walk in a more urban setting. October is a beautiful month to take advantage of this – a walk after school, homework on the porch, or a weekend hike all help to support focus and concentration in kids – and adults!
Structure the environment, not just the child. Kids who struggle with attention do better with support from the outside: a consistent homework spot, a visual checklist, big tasks broken into small chunks, a timer, and planned breaks. Clear the clutter from the workspace. Notice and name effort, not just results. These strategies form the backbone of behavioral approaches to ADHD, and they help every child.
When to Ask for More
If attention concerns are showing up in more than one setting – at home and at school – have been going on for months, and are getting in the way of learning, friendships, or family life, that is the time for a formal evaluation. Anxiety, learning differences, sleep disorders, and even vision or hearing problems can all look like attention problems, and a good evaluation helps sort that out.
A diagnosis is not a sign that the foundations failed. Many kids need both a strong foundation and targeted treatment, and the foundation makes treatment work better.
