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 Researchers examined results from 54 studies of non-pharmaceutical
ADHD treatments like cognitive behavioral therapy, parent training,
special diets, and supplements like omega-3 fatty acids. Overall,
these studies were too small, brief or varied in how they measured
results for researchers to draw firm conclusions about which
approaches might actually work for kids with ADHD.
"Just because we did not find scientific evidence, does not mean
that these treatments are ineffective," said senior author Dr. Alex
Kemper of Nationwide Children's Hospital in Columbus, Ohio.
More than 1 in 10 U.S. kids are diagnosed with ADHD, which is
characterized by social and behavioral problems as well as
challenges in school like difficulty with focusing or sitting still.
Stimulant medications can help with some behavior and attention
issues.
Almost two-thirds of these kids are prescribed stimulants, which
should be among the first treatments tried for the condition, Kemper
said by email.
The American Academy of Pediatrics, which advises most primary care
providers for kids, recommends that doctors prescribe stimulants or
behavior therapy, or both.
Because it's difficult to diagnose ADHD in children younger than 4
years old, many doctors recommend behavior therapy as a first
approach with preschoolers, particularly if parents or teachers can
work with children to help improve focus, concentration and
interactions with other kids. With older children, medication may be
the first approach, alone or in combination with behavior therapy.
Some forms of behavior therapy for ADHD are designed to help kids
improve focus, attention and organization, while others concentrate
on reducing disruptive behavior that can make it hard for children
to make friends or do well in school.
In the current analysis, the small studies of cognitive training
showed no benefit at all or only a short-term improvement in ADHD
symptoms, researchers note in the journal Pediatrics. These studies
were too small, however, to draw broad conclusions about how well
cognitive training might really work.
Similarly, studies looking at child or parent training programs
yielded mixed results, measuring different types of interventions in
different ways, which made it hard to determine how well these
approaches might work.
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In addition, the studies that tested supplements containing omega-3
fatty acids also failed to show meaningful changes in ADHD symptoms
based on assessments of children done by their parents or teachers.
Because ADHD can mean different symptoms from one kid to the next,
children need an accurate and comprehensive diagnosis before it's
really possible to decide which treatments might work best in their
situation, said Dr. Timothy Wilens, chief of the division of child
and adolescent psychiatry at Massachusetts General Hospital in
Boston.
"It is important to assess the level of impairment related to the
ADHD, as well as contributing factors to the child's problems that
will ultimately need to be addressed," Wilens, who wasn't involved
in the study, said by email.
"For children over age 6 years, medications should be considered
first line therapy for ADHD and nonpharmacological treatments should
be considered adjunct to medication in specific groups," Wilens
added.
Given the lack of clear evidence to recommend alternatives to
treatment with medication, parents may want to consider cost as a
way to decide what options they try first, advised Aaron Seitz,
director of the Brain Game Center at the University of California,
Riverside.
"Don't spend your life-savings on some non-traditional approach that
promises the world but charges an arm and a leg," Seitz, who wasn't
involved in the study, said by email.
"However, it is worth trying out various lower-cost solutions that
might complement existing treatment," Seitz added. "It is likely
that a combination of medicine and behavioral interventions will be
best suited for many and it is worth finding a doctor who can help
monitor and guide you through the path of evaluating how some of the
non-pharmacological approaches could be beneficial and to
potentially experiment with the approach that works best."
SOURCE: https://bit.ly/2H4c64S Pediatrics, online May 30, 2018.
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