Non-Drug ADHD Treatments Lack Supportive Evidence

Alex R. Kemper, MD, MPH, MS

Dietary supplements, neurofeedback, and other non-drug treatments for young people with attention deficit hyperactivity disorder (ADHD) are not supported by clinical data, a review of recent studies suggests.

“Unfortunately, we did not find the kind of scientific evidence that could help inform patients, families, or clinicians,” senior author Alex R. Kemper, MD, MPH, MS, Division Chief, Ambulatory Pediatrics at Nationwide Children's Hospital in Columbus, Ohio, told MD Magazine.

Kemper and a team including researchers from Duke and Wake Forest universities set out to evaluate the comparative effectiveness and safety of nonpharmacologic ADHD treatment strategies for patients under age 18. “There are many approaches other than medications to treat ADHD,” said Kemper, a pediatrician. “We wanted to find out how they work.”

A previous review published in 2011 did not consider dietary or complementary medicine treatments. That study suggested that nonpharmacologic interventions alone were not as effective as approved ADHD drugs. It also showed a slight advantage in combining drug therapy with behavioral interventions.

The current review analyzed 54 studies published from January 1, 2009, through November 7, 2016. The papers compared any ADHD non-drug treatment with a placebo, pharmacologic, or another nonpharmacologic approach.

The non-drug therapies included behavioral interventions, such as parent and child training, cognitive behavioral therapy, and herbal and dietary supplements, such as omega fatty acid. This recent review yielded no new evidence to guide treatment with nonpharmacologic methods compared to drug-based approaches — even though behavioral and dietary therapies are gaining ground.

“Despite wide use, there are significant gaps in knowledge regarding the effectiveness of ADHD nonpharmacologic treatments,” the authors wrote in a paper published in Pediatrics.

“Overall, there was a low strength of evidence (SOE) for the impact of nonpharmacologic treatments,” they said. The results for omega fatty acids, for example, showed that neither parents nor teachers saw improvement of ADHD symptoms in young people taking that supplement, the team wrote.

“We did identify studies of omega fatty acid supplementation which suggest that it is not effective for ADHD symptoms,” Kemper said.

The current review did not consider whether there are specific, highly effective ADHD treatments that should be used routinely. It also did not focus on the effectiveness of pharmacologic treatments, he said.

The team noted that their investigation might be limited by a short follow-up periods and small sample sizes, as well as inconsistent reporting across the studies. Kemper stressed the need for continuing research.

“Just because we did not find scientific evidence, does not mean that these treatments are not effective,” he said. “We need more studies to know how best to treat ADHD.”

Ongoing research is important because ADHD is common, yet highly variable in how it impacts children and teens. The US Centers for Disease Control and Prevention estimates that approximately 9.4% of children 2-17 years old, or 6.1 million, have been diagnosed with the disorder. About 60% of them are taking medication, Kemper said.

“It is really important to understand the safety and effectiveness of all available approaches to care,” Kemper said. “It is also important to study the combination of treatments that are often used in clinical care.”

In Kemper’s view, the best way to treat ADHD in young people is to personalize their care. “We know that for most children and teens, stimulant medications can make a meaningful improvement in symptoms,” Kemper said.

“Other approaches, with or without medications, might be helpful,’’ he said. “The key thing in ADHD care is to closely monitor symptoms and adjust treatment as needed.”

The study, “Nonpharmacologic Treatments for Attention-Deficit/Hyperactivity Disorder: A Systematic Review,” was published in Pediatrics.