Every year, 6% of children entering school-going age will be diagnosed with ADD. These figures can seem alarming, particularly because there has been no promising lead in cure research. However, certain measures might help you, or your loved one living with ADD, to have as pleasant and normal a life as anyone else.
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The most effective ADD treatment strategies focus on tackling symptoms. Through medication, therapy, and nutritional changes, most individuals living with ADD can experience considerable appeasement of their symptoms. For many, this means pursuing careers, performing tasks, and engaging in activities they may have struggled with before.
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This article guide will take you through all tried ADD management tactics, highlighting the most successful strategies. You may need to gain more insight into the physiological processes that lead to the expression of ADD symptoms, to best understand the practices that can assuage them. Here’s everything you need to know about ADD and how to live a happy, healthy life with the condition.
Diagnosing an Attention Deficit Disorder
Before you incorporate any of the tips discussed below into your life, you may want to be certain that the ADD diagnosis applies to you, or the person concerned. Generally, you will need a professional examination, usually prescribed by your MD, through a specialist. However, you’ll want to watch out for certain symptoms, which can be indicators that you may be suffering from a chronic disorder. You may have an attention-deficit disorder if you frequently experience some of the following:
- A lack of self-regard
- A tendency to interrupt others as they speak
- A short temper and frequent anger flashes
- Risk-taking tendencies
- A short attention span, characterized by an inability to focus long enough to complete tasks
- Struggle integrating instructions
- Losing possessions or carelessness in watching over them
- Inability to organize tasks and carry them through
- Rapidly changing activities and interests
It is important to note that ADD (Attention Deficit disorder) should not be confused with ADHD (Attention Deficit Hyperactivity Disorder). ADHD characterizes itself in bouts of energy peaks, often making children unable to sit or stand in place, and constantly craving activity or stimulation. ADD is considered an attentiveness problem, while ADHD entails constant, hyperactive impulses. It isn’t infrequent for patients with ADD to be diagnosed with both disorders, in which case their condition will be termed as ADHD.
Strategies That Can Help You Manage Your ADD Symptoms
A number of simple, accessible ADD treatment strategies have been created by mental health professionals over the years, to make sure every child and adult suffering from the disorder can pursue and enjoy a normal life. Each practical tip may improve your mental health by tackling the cognitive, psychological dependence, behavioral, and nutritional aspects of ADD. These strategies are as follows:
Tip 1: Using the most effective medication options
Tip 2: Using therapy to manage ADHD
Tip 3: Using behavioral interventions and practices in accordance with AAP guidelines
Tip 4: Altering your diet to avoid ADD-triggering foods
Tip 5: The use of External Trigeminal Nerve Stimulation or ETNS (A high-end treatment option for pediatrics)
Depending on your age, lifestyle, and the severity of your disorder, your doctor may prescribe one of the aforementioned treatments or a combination of approaches.
1. Using the Most Effective Medication Options
Medication is the core of the ADD treatment because it creates the hormonal balance required for patients to experience more measured impulses, and greater ease focusing. Several different drugs, featuring mildly different effects, are currently available on the market. Part of your physician’s work will be establishing, with your informed input, the type of drug best suited to your specific ADD symptoms and experiences. Therefore, the appropriate diagnosis must have been established first. Sometimes, this can mean completing several visits to your doctor before medication can be prescribed. Once you have both agreed on a drug that can best help your symptoms, you will likely be prescribed one of the following FDA-approved medications:
- Central Nervous System Stimulants
- Non-stimulant drugs
Each type of medication targets a different functionality of your brain and is characterized by different biological processes and experienced side effects.
1) Central Nervous System Stimulants: Types, Advantages, Effects, and Side Effects
Brain neurotransmitters or hormones such as dopamine and norepinephrine improve brain pathways to facilitate the transmission of signals that make up co-ordination requiring activities. The better these pathways, the easier signals are transmitted, and the more productive cognitive behavior can be observed. Generally, this will mean greater ease of learning, memorizing information, and maintaining concentration when performing complex tasks. Central nervous system (CNS) stimulants are divided among short-acting stimulants, intermediate-acting stimulants, and long-acting stimulants.
Short-acting stimulants are prescribed to be taken throughout the day, 2 to 3 times a day. This is a popular treatment option among both adults and children because they ensure all symptoms are appeased while you work, study, complete house chores, pursue hobbies such as drawing or crafts, and even while you rest.
Intermediate-acting stimulants such as amphetamine sulfate and methylphenidate can be taken up to twice a day, usually in the morning after breakfast, and in the evening after dinner. Like short-acting stimulants, they help to promote attentiveness using a consistent approach. They are effective for several consecutive hours (6-10).
Long-acting stimulants can be the ideal option for busy individuals who may not be able to take their tablets several times a day. It is also a more discreet solution, because they only need to be taken once a day, and can easily be incorporated into your morning routine.
The main advantages of stimulant medication as an ADD treatment include:
- Rapid effectiveness (due to the potency of the medication)
- Ease of measuring doses (prescribed in a pill-format)
- Limited side-effects
- Non-habit forming
Research is yet to find significant evidence that stimulant medication is addictive. This means that they can safely be prescribed even to young children. However, they can have a few side effects, such as:
- Digestion problems and gastric disorders
- Insomnia or restless sleep
- Heightened blood pressure
- Low appetite
- Weight loss
If you suffer from nervousness, anxiety, bi-polar disorder or hypertension, have a history of psychosis, have experienced Parkinson-like symptoms, or glaucoma, you are not compatible with stimulant medication. Therefore, you will need to be transparent with your doctor about your medical status and history to obtain a safe prescription.
2) Non-Stimulant Drugs: How They Work, Notable Examples, Side and Adverse Effects, Benefits, and Disadvantages
Non-stimulant ADD medication is often considered the second line of action when patients aren’t compatible with stimulant medication. This is because the full range of their mechanism is yet to be established. However, there is sufficient evidence to suggest it is a reliable and effective treatment for people with ADD.
As opposed to stimulant medication, which boosts dopamine levels, giving patients the impression of “greater mental energy,” non-stimulant drugs work to build up attention span and memory. They increase the levels of norepinephrine in the brain, which gradually increases a person’s ability to retain information and practice prolonged “focus” (attentiveness or concentration).
Atomoxetine and Nortriptriptyline are the most common non-stimulant drugs used to encourage memory and attentiveness improvements. Guanfacine and Clonidine are similar chemical compounds, which have been found to appease symptoms of ADD specifically.
Non-stimulants are often considered safer for both adults and children because they do not impact your brain’s dopamine supply, or your transmitters’ ability to respond to it. However, they have been found to have potential (though relatively rare) side effects in adults, adolescents, and children, including:
Rare adverse effects of non-stimulant ADD medication include:
- Hallucinations and suicidal thoughts
Non-stimulant medication is generally considered less habit-forming than stimulant medication. While the evidence doesn’t suggest that stimulant medication leads to any form of chemical dependence, it isn’t uncommon for ADD patients to abuse these drugs. Non-stimulant medication, however, is ruled to be non-addictive, and has recorded less resulting cases of insomnia and appetite loss.
Nevertheless, you will likely have to be screened for any underlying condition which may respond poorly to non-stimulant drugs before they are prescribed by your doctor. The latter will want to watch out for liver problems, specific drug allergies, a glaucoma diagnosis, or current use of antidepressants.
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3) Anti-Depressants: Their Impact On ADD, Benefits And Notable Risks
Anti-depressants are generally prescribed to help patients tackle depression, bi-polar disorder, and PTSD. Anti-depressants can improve your attentiveness by helping your brain to access serotonin and dopamine, which are both essential to your well-being (feeling of comfort, ease sleeping, energy levels) and to your ability to focus on the tasks in front of you. Anti-depressants are often considered the “functionality” drugs because they diminish the sentiment of lethargy and fatigue depression engenders.
Notable examples of anti-depressants include Desipramine, Imipramine, Nortriptyline, Venlafaxine, and Bupropion. All these drugs are considered safe and non-addictive and can be prescribed as an alternative to stimulant or non-stimulant medication in patients clinically cleared for prolonged (3 months+) use.
Anti-depressants have been popular across mental health sectors because they do not impede a patient’s appetite, and have been reported to facilitate sleep. Their effects are mild and gradual (some drugs requiring up to several weeks to have a noticeable impact), which limits the likelihood of abuse or physical dependence.
However, anti-depressants still have some reported side-effects. For example, Bupropion may cause digestion problems; Venlafaxine can cause anxiety, nausea, and a more rapid heartbeat. Tricyclics, which are often considered the more potent (and effective) anti-depressants, can lead to constipation, dry mouth, hypotension, shaking or tremors, urinary retention, drowsiness, and blurred vision.
It should also be noted that some anti-depressants (Tricyclics) have been linked, when consumed in high doses, to cardiac activity problems. A Tricyclic overdose can be fatal; therefore, it is imperative to monitor your heart rate whilst on this medication frequently.
Fortunately, medication isn’t the only effective, tried, and tested treatment for ADD.
2. Using Therapy To Manage ADD Symptoms
A common misconception of the mental health sector is that it relies solely on medicating to provide effective results. For those allergic to commonly used drugs, or skeptical about their potential long-term health effects, it can seem impossible to find alternative methods of focusing enough to go about your work and responsibilities. However, therapy, as we know it, has made considerable advancements over the past few decades, maximizing trials and studies to assert the effectiveness of each method. Therapy uses a pro-active approach: therefore, while patients are guided towards healthy psychological responses and behaviors, they are also encouraged to pursue self-treatment tactics actively. Generally, these will include changing the way you respond to stimuli, process impulses, consider your emotions, and act upon your urges and desires. The most commonly used forms of therapy for ADD include:
- Cognitive Behavior Therapy
- Talk Therapy
- Social-Skill Training
- Support Groups
Your doctor may suggest that you undergo several of these therapy styles to maximize your chances of long-term improvement.
1) Psychotherapy: How, When and Why
Psychotherapy is one of the natural remedies for ADHD. You will not be required to ingest anything during the process, and your body will not be subjected to any medically-created stimuli. Psychotherapy targets the emotional responses which often cloud an adult, adolescent, or child’s ability to focus on their activities. These responses can often lead to anxiety, which then encourages procrastination and the pursuit of instant gratification.
Psychotherapy considers the fact that procrastination and depression can interact in a vicious circle; the guilt engendered by the act of constantly pushing responsibilities and duties until later can make people feel down. This sinking of spirits can then lead to harmful coping mechanisms, such as substance abuse or “reckless” behavior, which then heighten emotional responses and lead to further procrastination.
Psychotherapy will often be suggested by mental health professionals when patients have developed unhealthy coping behaviors, and your doctor can sense the potential to reverse these habits. Psychotherapy is increasingly suggested for adolescents and children, whose development may be stunted by the heavy use of chemicals. It is also the preferred treatment method for people suffering from addiction issues, who will need to find a healthier means of managing the daily challenges ADD poses. Procrastination-tacking and Strength-based are the two most common psychotherapy methods.
Procrastination-tackling relies on a common human trait: the desire for reward. Patients are asked to consider important daily tasks, either at work, school, or home. They are then asked to consider all the challenges they may face completing these tasks, without shying away from these intimidating thoughts. Often, psychotherapists will find that patients with ADD are unable to focus on the stages and efforts certain tasks or activities entail, and will become distracted when thinking of them. This is often due to performance anxiety or the fear of being incapable of completing the task effectively. It can also be a desire for instant gratification or pleasurable stimuli, and the awareness that the completion of certain tasks poses an obstacle between the present time, and the next opportunity to experience non-demanding enjoyment.
Patients will be asked to confront the mental and physical demands of the task ahead, but also to consider how each stage must be completed. This will help you to dispel the impression of difficulty you get from objectively achievable tasks, such as finishing up a report at work or handing your dissertation in on time. You will then be asked to focus on the after of the event, or the psychological (and sometimes physical) reward of completing the task. Moving your mind from difficulty to reward helps you build the motivation you need to complete your pending work, chores, or other responsibilities.
The strength-based approach is more inspirational because it focuses on a patient’s abilities and competence. It encourages patients to consider why they are equipped to perform certain tasks, why they are talented, skilled, or determined enough. This is often a more suitable approach for adults in professional fields, whose daily duties mostly entail work they are already good at, or trained for. The strength-based approach pushes people to imagine all the effective and exciting ways in which they can perform set tasks. As a psychotherapy patient, you will be asked to focus on what you can do well, and why you will succeed and be rewarded for it, as opposed to why things may be too difficult for you.
2) Cognitive Behavior Therapy: Who It is Best Suited For, How It Is Done, And Why It Will Help
ADD, like other psychiatric disorders, can be triggered or heightened by a variety of factors, such as emotional or familial troubles, individual situations and developed traits, behaviors such as risk-taking and substance abuse, and extra-familial circumstances. In such cases, patients will need to learn to cope with their triggers, which neither medication nor therapy can reduce. This is the approach pioneered by Cognitive Behavior Therapy (CBT): learning healthy analysis and responses
CBT is used for an array of psychiatric disorders outside of ADD because it can help patients to control excessive anger, mood swings, attention problems, and self-restraint (for instance, when confronted with an intoxicating substance). CBT is often advised for children because their developmental potential allows them to integrate this form of therapy’s teachings into their responses, with greater ease than adults.
CBT approaches will vary depending on the age group of the patient. Children are often offered parental therapy sessions, and multimodal therapy and interventions, while adults will usually be offered multimodal therapy and organization-skill coaching. Multimodal therapy will entail the manipulation of how behaviors are perceived and consequent responses.
Behavioral management, which can often be observed in parenting methods, offers the following options:
- Positive or Negative Reinforcement
- Modeling or mimicking behavior
With the increasing levels of stress working parents experience, it can be difficult to always opt for the healthiest behavioral management technique. For parents, this often means turning to punishment whenever children behave poorly. CBT will help parents learn to respond more encouragingly to their kids’ behavior, even when their past actions have been frustrating. Therapists will often advise parents to help their children consider the “why” of their behavior, rather than be faced with immediate consequences.
Adults and adolescents, who are less likely to receive parent therapy, will be asked to analyze the causes of their harmful behavior, and their immediate responses. They will be asked to use more positive reinforcements to deal with procrastination or past failures. They will also need to discern how past behaviors may have perpetuated a cycle of poor choices and to establish the factors that triggered them. They will then work, with the help of their therapist, to come up with healthier means of dealing with such factors. In the long term (8 or more sessions), CBT has been found to help both adults and children manage impulsive behavior, make more beneficial (healthier) choices, and avoid the situations and environments which may trigger them.
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3) Social Skill Training: Understanding the Basics and How It May Benefit You
Social skills are essential to human interaction. In many people living with ADD, there is a disconnect between societal expectations and perceived performance potential. This means that adults and children with ADD will often avoid others or tasks involving group work. This avoidance can be particularly harmful in adolescence and adulthood, where an increasing amount of group work will require you to be more comfortable with others.
Social skill training focuses on creating social memory, which patients can refer to when confronted with difficult situations. An example of social memory would be a child remembering the last time they completed a drawing or puzzle with a therapist, parent or teacher, and the types of behaviors that garnered the most positive results. To carry out such therapy on children, therapists may ask them to select an interesting activity to focus on for an entire hour. During this hour, the therapist will use the following tactics:
- Display of positive behavior, such as patience and empathy
- Role Playing
- And the settling of a patient’s self-disputes
Therapists will encourage patients to mimic the positive behavior they have exhibited, for example, by being patient and kind when passing them drawing crayons, or waiting their turn to place a piece onto the puzzle. They will also engage in role-playing, during which the patient will be encouraged to place themselves in somebody else’s shoes and anticipate their reactions and feelings. Children will then be encouraged to share self-disputes, such as inner conflicts between playing and paying attention in class, and to arrive at a fair, measured conclusion of which behavior will be most fruitful.
In adults, social-skill training will help people cope with stressful work environments and interactions with people whose words or behavior might trigger them. It provides a safe environment to practice tasks requiring team cooperation, communal focus, and the integration of outside ideas.
4) Support Groups: What They Target and How They Can Help
Support groups are most common among those struggling with addiction issues, life-threatening conditions, and the loss of a loved one. However, the same principle is fruitfully applied to ADD sufferers. As mentioned earlier, many of the factors that amplify a person’s inability to focus, complete tasks, and make responsible choices are environmental and experience-based. It isn’t uncommon for people with ADD to report feelings of loneliness, social alienation, and even hopelessness. Sharing those feelings with people who can relate and learning from their experiences can be highly beneficial.
Support groups also rely on a communal sense of responsibility to encourage patients to actively pursue an improvement on their condition. Bonds are formed between participants, and each is encouraged to show their support for one another. Participants also frequently observe similarities between their interpersonal conflicts, career, and educational challenges, and social behaviors. Therefore, one person’s social memories can serve to teach several attendees what to expect from certain scenarios and circumstances and how to cope with them (or what not to do.)
Support groups are moderated by a leader, who can be a person with ADD, but who must have demonstrated viable evidence of improvement. They will need to have a long-term familiarity with therapy techniques, and often will obtain basic counseling training and accreditation to guide the group into healthy, productive communication. This also has been found to remove some of the stigma, or even shame adults and adolescents can associate with seeking therapy, which can make them more responsive to treatment programs.
In the long run, support groups provide both the theory of impulse management and its practice. By offering a real-life setting in which people are encouraged to learn to interact positively, support groups provide social experiences that may guide you through the rest of your relationships, associations, and interactions. There is no pressure placed on participants to share at support groups, and they can wait until they’re ready to do so.
3. Behavioral Interventions Per the New American Academy of Pediatrics Guidelines
In order to protect the welfare of children diagnosed with ADD and ADHD, the American Academy of Pediatrics has created guidelines to provide a treatment foundation for American clinicians. Treatment methods offered by health professionals need to be under the following:
- The diagnosis of behaviors with “lesser” functional or psychological problems can only be made for patients of 17 years and above.
- To establish a diagnosis, there must be substantial evidence that patients experienced symptoms of the condition before the age of 12
- Behavioral therapy should be the first-in-line treatment solution for preschoolers
Fortunately, patients and clinicians can easily create behavioral intervention solutions in adherence to each standard. The AAP standards mostly ensure that children are not subjected to harsh chemical treatments, or given a potentially false diagnosis that will follow them their whole lives. Instead, it encourages self-treatment through healthy, natural habits.
Behavioral interventions can be tailed to each treated party. Therefore, clinicians will often encourage patients to provide their twist on a proposed behavioral intervention in order to feel pro-actively involved in their recovery. Effective tactics of behavioral intervention include:
- Creating a productivity schedule
- Creating accessible home rules
If you feel that any of the following treatment tactics will help you cope with your ADD symptoms, consider an adjacent rewarding system that will encourage you to keep up with each practice as needed.
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Creating A Productivity Schedule
A lack of physical accountability is the enemy of most procrastinators. ADD makes the completion of tasks challenging because it makes people find excuses or distractions to avoid facing attention-requiring duties. This procrastination often occurs through avoidance, which makes individuals deny the scale of the work they are putting off till later, or how determined they initially were to complete it.
By creating a productivity schedule, you will jot down the tasks you expect yourself to complete each day. For many people with ADD, this can be therapeutic, as it removes the element of consideration and choice adults must face before they decide on completing a task. Instead, you will need to motivate yourself to complete all listed activities, and only reward yourself if a considerable effort is observable. For children and teenagers, a productivity schedule can entail home chores, the completion of homework, time for self-care (reading an inspirational book, jamming to some music or baking their favorite cake), and even minor tasks like calling a grandparent and sending an important email.
Bullet journaling involves creating short, bulleted lists of tasks you must perform over the course of a week, or month. This requires the use of a calendar to spread out active time evenly. For some, bullet-journaling can feel more therapeutic than productivity schedules, because the briefness of provided records allows you to complete tasks as you see fit on scheduled days, without the guilt of not adhering to the standards you have established for yourself.
Journals are also more adaptable to changing circumstances because they provide room for interpretation when faced with individual tasks. For instance, you may want to “get a haircut” at some point this week. While productivity schedules will involve breaking down this task into a hair salon appointment, a style selection, and sometimes, completing a deposit payment, a journal will merely require that you have your hair cut by the time you said you would. If it turns out that your aunt with scissor experience is in town around that time, you can easily switch to getting a cut from her, as opposed to having to alter several schedule entries.
Creating Accessible Home Rules
The critical thing about rules that can be followed is that they must be accessible. Therefore, you will want to set up rules that help you practice attitudes and behaviors which you believe you can stick to in the long run. Examples of accessible home rules can include:
Step 1: Maintaining A Positive Attitude
Attitude is more behavioral than many think. Having a positive attitude often requires pushing yourself to be open to new information, to consider the positive aspects of every experience, and to practice kindness and empathy with strangers. You can try to stick to “rules of positivity” by putting a coin in a jar every time you engage in negative thinking, and mentally “step outside of yourself” to observe how your behavior affects others.
Step 2: Always Being on Time
Being on time starts at home. This often requires discipline and sticking to set plans. You can create your own penalties for being late (for instance, when getting ready for class or work in the morning) and rewards for days of effective time-keeping. Time-keeping allows you to focus on performance and task completion, which can help you manage your ADD with greater ease, as you get more used to punctuality and discipline.
Step 3: Make Small Compromises
No matter how determined you are to stick to your rules, you may find that life, or the disorder itself, can make certain plans hard to achieve. When failing to complete a task, you will need to think critically of where you fell short, and whether or not you applied your best effort. Rather than allow failures outside of your control to dampen your mood, you will want to practice tolerance with yourself. One minor slip or shortcoming isn’t the end of the world, and need not threaten your stability.
4. Nutritional Changes to Help Manage ADD
All our bodily reactions and brain performances are linked to nutrition. Therefore, the consumption of certain foods, or lack of specific vitamins, can amplify ADD symptoms. It is important to note that the food you ingest is directly related to your hormonal releases, which are at the core of your impulses, and even thoughts. To make positive nutritional changes that could decrease your ADD symptoms, you will want to understand more about the relationship between ADD and nutrition.
Book an appointment with a mental health expert and discuss nutritional options for a stronger mental health!
Foods That May Heighten ADD Symptoms
ADD, and ADHD are often linked to omega-3 deficiency. Omega-3 is a fatty acid, which promotes the transmission of neurotransmitters (or brain signals). However, the common American diet has been found to lack in Omega-3 supply. People experiencing Omega-3 deficiency will share physical symptoms with people diagnosed with ADHD in particular, such as a dry mouth and frequent need to urinate. The consumption of “junk food” and wheat-based products may both heighten omega 3 deficiency, lead to poor reactions to gluten (most of which are not diagnosed), and sugar peaks and crashes. If you have ADD, you may want to avoid the following:
- Corn Syrup (high fructose)
- Frozen fruits and vegetables
- Wheat flour
- Fish (with high mercury content)
- Artificial dyes and food coloring
Research has also shown that a lot of people diagnosed with ADD and ADHD also have celiac disease, which is characterized by an intolerance to gluten. Gluten intolerance can lead to anxiety, trouble focusing, and mood swings.
Diets That Can Appease ADD symptoms
Protein-rich foods are essential because their protein content is used to create neurotransmitters, which facilitates the sharing of signals between brain cells. Protein-rich foods are linked to greater hormonal balance and overall improved well-being. Examples of protein-rich foods that may help you combat ADD include:
- Lean beef
- Poultry (chicken and turkey)
- Fish (preferably with a low mercury content)
By learning to incorporate more natural, healthy components in your diet, you can be certain to observe improvements on both your physical health and your ADD symptoms. You will also want to make sure that you remain appropriately hydrated, as even minor dehydration has been found to diminish people’s ability to focus.
5. The Monarch external Trigeminal Nerve Stimulation (eTNS)
The eTNS device has recently been approved by the FDA, after it was found to pose no health risks for children. The eTNS operates as a safe, non-stimulant treatment, which requires the placement of a device (about the size of a mobile phone) on your child’s forehead while they sleep. This treatment method is used for children aged 7 to 12 and requires about 8 hours of sleep to be effective.
As your child sleeps, the device transmits mild electrical impulses, and these impulses are received by the trigeminal cranial nerve, which then sends signals to the brain to boost wave function in several pathways catering to attention, positive thinking and mood-stability.
This brand-new treatment option still has a long way to go in terms of adult trials. While it has been found safe for use on children, there is no evidence that this treatment can be as effective on fully-developed brains.
The eTNS device has been found to have occasional, mild side-effects which include:
However, the FDA maintains that this treatment poses no lasting health risks to its users.
Book an appointment with a mental health expert and discuss nutritional options for a stronger mental health!
A Concluding Word
There currently exist several treatment methods for ADD, which aim to tackle every aspect of the condition. While drugs may be the go-to option in several cases, this treatment can also be combined with natural solutions, such as therapy and dietary changes. In the long run, living with ADD is no different than living with any other manageable health condition: it requires effort, consistency, and a positive attitude. For more information on accessing or implementing any of these treatment methods, make sure to reach out to your mental health professional at Mango Clinic.