Adult ADHD · 4:43
The three pillars of health in adult ADHD
Sleep, exercise and diet as foundations of adult ADHD care, with attention to the daily conditions that make them possible.
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0:00Three pillars
I normally talk about three pillars of health: sleep, exercise and diet. They are really, really important in ADHD. Familiarity can make us overlook them. We know the recommendations, so we assume the foundations are there. Then we ask someone to concentrate, organise themselves and regulate their emotions without examining whether they are sleeping, eating or moving in a way that supports that work.
0:27A living body
My starting point is that we mustn't separate ADHD out from basic cellular metabolism and cellular health. Attention happens in a living body. So do motivation, restlessness and the capacity to stay with something difficult. That body is using energy, digesting food, moving between activity and rest, and responding to the demands around it. I want to know how the person is actually living through the day, because the diagnosis alone cannot give us that account.
0:59Physical health
There is a substantial bodily picture here. A Swedish register study involving nearly five million people found that diagnosed ADHD was associated with a wide range of physical conditions across adulthood. This gives us a strong reason to examine physical health as part of ADHD care. A person may bring an attention difficulty to an appointment while also living with pain, disturbed sleep, breathing problems or another condition that needs its own attention. Those experiences all meet in the same day.
1:33Sleep and treatment
Sleep is usually the first thing I want to improve when it is clearly going wrong. If your sleep is bad and you expect medication to carry the whole situation, that is counterproductive. We need to give sleep a proper place in treatment. Small adult studies show poorer attention after substantial sleep loss, and observed daytime sleepiness has been associated with missed responses beyond ADHD symptom severity. Medication can still help when sleep is poor; improving sleep belongs alongside ADHD treatment. The next useful question is specific: are you sleepy, mentally overloaded, physically exhausted, or some combination? Each answer opens a different piece of work.
2:20The actual pattern
Exercise, food and water belong in this same assessment. Movement gives the body physical activity after hours of sitting. Food supplies energy and a range of nutrients. Hydration supports ordinary bodily functioning. We should ask when these things happen, how reliable they are and what gets in the way. “I eat well” might mean a nourishing evening meal after barely eating all day. “I exercise” might mean an ambitious plan that has become another source of disappointment. Clinical work begins with the actual pattern.
2:56Conditions meet
The pillars affect one another through very ordinary sequences. A difficult night can leave shopping and cooking beyond reach. Missing lunch may leave someone ravenous when there is little energy to prepare food. Work that extends into the evening takes away the time intended for movement and winding down. Caffeine can help carry the tired day into another late night. These are useful sequences to understand because changing one condition may create room for another change. We do not need to improve everything simultaneously.
3:30Follow the pattern
This is how I use SEEDS thinking. Look around a repeated difficulty and examine the body, the activity, relationships, surroundings and wider demands together. If meals are being missed at work, we might need food within reach, a real break and permission to stop. If movement never happens, we might need company, a manageable route and less preparation. If bedtime keeps slipping, we need to understand what the evening is providing that the rest of the day has not. The intervention should follow that understanding.
4:06Making change possible
Knowing what to do on paper and making changes are different things. These routines ask for planning, remembering, transitions and repetition, precisely the functions that may need support in ADHD. An occupational therapist can help make the sequence visible, reduce decisions and find an achievable entry point. Psychological work matters too, especially when a failed routine immediately becomes “I am lazy”. Start where you are, with one part of the pattern and enough support to learn what makes it repeatable.