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Data do not support most nonpharmacologic ADHD treatments
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Nonpharmacologic treatment methods used to reduce ADHD symptoms in children 17 years of age and younger, including behavioral modifications, complementary medicines and herbal supplements such as ginkgo biloba, are not supported by data from clinical studies, according to a review published in Pediatrics.
“Many options exist for treating ADHD beyond commonly used psychostimulant drugs,” Adam P. Goode, DPT, PhD, from the Duke University Clinical Research Institute and Duke Orthapaedic Surgery, and colleagues wrote. “Nonpharmacologic approaches either alone or in combination with psychostimulants might improve ADHD symptoms and reduce the risk associated with psychostimulants by decreasing their use.”
To compare the efficacy of ADHD treatment methods that do not include the use of medications for those aged 17 years and younger, Goode and colleagues conducted a systematic review that included studies written in English and published between Jan. 1, 2009, and Nov. 7, 2016. These studies assessed any treatment method that did not use medication in comparison to a placebo, pharmacologic method or other nonpharmacologic method.
According to the researchers, nonpharmacologic treatments for ADHD may include neurofeedback, cognitive training, cognitive behavioral therapy (CBT), child or parent training, dietary omega fatty acid supplementation and other dietary approaches such as herbal supplements.
The researchers then examined the characteristics of patients included in these studies, as well as study design, intervention approaches, timing of follow-up and outcomes of the research. A random-effects meta-analysis was conducted to create pooled estimates for comparisons between at least three studies with similar outcomes.
Of the 54 studies identified that observed the use of nonpharmacologic treatments, Goode and colleagues found no updated guidance on the efficacy of these treatment methods in comparison to pharmacologic treatments. Additionally, studies examined by the researchers were determined to have low-quality evidence to support their findings.
When the efficacy of omega fatty acids for the treatment of ADHD symptoms was assessed from pooled results, Goode and colleagues observed that no significant changes in overall symptoms were reported by parents (n = 411; SD, –0.32; 95% CI, –0.80 to 0.15; I2, 52.4%). No additional changes in symptoms were observed by teachers of these children (n = 287; SD, –0.08; 95% CI, –0.47 to 0.32; I2, 0.0%).
Data collected from one study examining cognitive training against other nonpharmacologic treatment methods demonstrated no significant differences when children were tested using the Wide Range Achievement Test 4 Progress Monitoring Version. No studies were available to compare the efficacy of this treatment against pharmacologic treatment methods.
Goode and colleagues noted that children included in one study assessing the effects of CBT on ADHD symptoms experienced less anxiety and depression when compared with a control group receiving nonpharmacologic treatment after 3 months. This benefit was maintained at a 12-month follow-up. Children who received CBT also had higher ADHD scale scores. No studies compared the efficacy CBT with pharmacologic treatments.
Although findings were consistent for most nonpharmacologic treatment methods, the researchers observed that child or parent training demonstrated mixed results. Three studies included in the analysis compared this method with other nonpharmacologic treatments. Data from one study demonstrated improvements in the ADHD rating scale IV after 3 months when compared with psychoeducation and clinical counseling. A separate change was observed in another study regarding child life and attention skills at 13 weeks and 7 months.
Furthermore, a significant change in symptoms was observed in a third study when using the Child Behavior Checklist Change in Attention Problems Subscale at 6 months.
“The studies we included have limited generalizability because they do not reflect patients seen in the primary care setting, where most ADHD treatment occurs, and have short durations of follow-up,” Goode and colleagues wrote. “To better determine the effectiveness of treatment and address generalizability to primary care, there is a need for pragmatic randomized trials that, ideally, manage subjects for years.” – by Katherine Bortz
Disclosures: Goode reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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