ADHD Treatments - The Good, the Bad, and the Ineffective

In Part One of this series on ADHD, we looked at whether ADHD is actually a real condition. Having established that it most certainly is, we move now to a quick summary of treatments. Some are effective, some not so much ... but parents of kids with ADHD may be vulnerable to misinformation because they want so badly to do the best thing for their child. And in the face of so much conflicting information, it is hard to make decisions about treatments. While I can summarise the state of the scientific literature here, my top recommendation is that you get support from a paediatrician, psychiatrist or clinical psychologist who specialises in ADHD and can help you navigate the minefield of treatment information you're likely to encounter. 

• Medication - Stimulant medication is the number one, gold standard treatment for ADHD. It significantly reduces symptoms and improves long-term functioning in approximately 80% of cases.  Long-term safety studies have found that, overall, medications such as Ritalin are very safe, with few concerning side effects. While some parents worry that the use of stimulant medication places their child at risk of later drug abuse, meta-analysis shows that ADHD medication actually reduces the long term risk of drug and alcohol abuse (possibly as children and adolescents may be less likely to self-medicate or associate with antisocial peers - see Wilens, Faraone, Biederman & Gunawardene, 2003 for more on this subject).

• Psychological Therapies - While medication is the gold standard, there are a number of psychological therapies and interventions that may be beneficial, particularly alongside medication (see Oord, Prins, Oosterlaan, & Emmelkamp, 2008 for meta-analysis). Cognitive and behavioural interventions may include parent training, behavioural therapy, and social/emotional skills training. In particular, there is strong evidence for the use of behavioural therapies and teaching parents how to manage dysregulated and oppositional behaviour. Psychologists can work with families to assist them in developing a positive parenting approach that focuses on reinforcing desired behaviours and effectively managing misconduct. 

• School-Based Interventions - The child with ADHD is likely to struggle in a school setting and their behaviour frequently draws negative attention from teachers. Parents may feel that the school doesn't understand their child's needs or manage their developmental and behavioural issues appropriately. Sometimes, the relationship between home and school completely breaks down. I try to support both parents and teachers to work together in the child's interests. Psychologists can provide teachers and learning support aides with information and support to help them understand more about a child's particular difficulties (for example, poor attention, specific learning difficulties, slow processing speed, or memory issues). We can then work together to develop an effective behaviour management plan to help school manage problem behaviours and learning difficulties.

• Dietary Interventions - You may have heard some people say that ADHD is just a symptom of too much junk food and therefore treatment should simply involve a change in diet! However, there is limited evidence for dietary interventions in ADHD. A minority of children (particularly those with food sensitivities) may benefit from restricted exposure to artificial food colourings (although more research is needed in this area due to the poor quality of some of these studies). There is also some evidence to suggest small beneficial effects for some children who are supplemented with Omega 3 and Omega 6 fatty acids. However, the current scientific evidence does not support the idea that ADHD symptoms are related to sugar or aspartame (see Rytter et al., 2014 for a recent meta-analysis of dietary interventions for ADHD). Any benefits from dietary interventions are negligible when compared to the positive effects of medication.

• Cognitive Training - An increasing number of practitioners (some psychologists included) are offering cognitive training for ADHD. This is also sometimes called 'brain-training' or 'neurotherapy'. This usually involves having the child or adolescent engage in some of kind of task (often computer/tablet-based games) with the supposed goal of improving brain functions related to attention, processing or memory. These types of therapies are often expensive and, frankly, the evidence to support them is very poor. However, those who are selling the therapies may refer to studies that they claim show benefits. Those studies tend to be of poor quality and may even have been conducted by the practitioner or agency selling the therapy! So far, the evidence suggests that cognitive training does not lead to significant or meaningful improvements in ADHD functioning (see Cortese et al, 2015, for the most recent meta-analysis on this topic)

 
So, in short, medication is where it's at for ADHD, and psychological therapies may be a useful adjunct. If you have to choose only one approach, give due consideration to medication. But if there is an option of using both approaches, they may be complementary. Psychologists can also help schools to address issues in that setting. If parents want to explore dietary interventions, many paediatricians are happy to support them to do this, although it's unlikely that limiting sugar is going to change things for your child. And if offered an expensive quick-fix, like cognitive training, it may pay to be sceptical and stick with evidence-based therapies. 

The treatment of ADHD is such a controversial topic and this makes it even more difficult for parents to deaI with the issue. I am always happy to discuss issues related to ADHD with parents at any stage in their ADHD journey; whether that is at the point of initial assessment and diagnosis, or further down the track. For more information or support for your child with ADHD, contact me here



Dr Rosalind Case
PhD, PGDipPsych(Clin), MSocSc, BSocSc(Hons), MAPS
Melbourne, Australia