October 6, 2006
Eugene Arnold, MD, professor emeritus of psychiatry in the Department of Psychiatry at The Ohio State University, has written an in-depth review of the research on alternative treatments for ADHD. Arnold’s previous research on this topic was presented at the National Institute of Health’s ADHD Consensus Conference in November 1998.
Arnold describes 24 of these treatments in a recent article titled “Alternative Treatments for Adults with Attention Deficit Hyperactivity Disorder,” published in the Annals of the New York Academy of Sciences.
Among his discoveries:
- Some alternative treatments for ADHD are effective or probably effective, but primarily for specific subgroups.
- Essential fatty acid supplementation has promising systematic case-control data, but requires more research.
- Diets that eliminate certain foods and food additives may be effective for specific groups of properly selected children, but such diets do not appear promising for adults. Restricting sugar or candy alone is not an effective treatment for ADHD in children or adults.
Despite hundreds of studies and decades of use, ADHD medications remain a controversial topic. So I wasn’t too surprised when I read this email, sent by a concerned reader:
“It is extremely obvious that this magazine is ‘pro-medication’ when it comes to children diagnosed with ADD/ADHD… You are doing a disservice to people with ADD/ADHD by saying that medicine is the only way to control this behavior!
I don’t know if I would say I’m “pro-drug.” No one likes the idea of using psychotropic medications on a child. In fact, I’ve been criticized because I tend to view medications as a last resort, to be used after other options have been exhausted, and not as a first-choice treatment for every fussy child at their desk at school.
I would prefer to think that ADDitudeMag.com is “pro-science,” meaning we rely on scientific medical research on attention deficit disorder. Research shows that the best treatment for ADHD, as we currently understand it, is behavior modification, therapy, and medication. Medications are only part of the equation.
For more information about recommended medical treatment for ADHD, please see Frequently Asked Questions About ADHD Medications.
Some alternative treatments appear promising but lack sufficient research. Arnold includes popular alternative treatments such as essential fatty acid supplementation, EEG biofeedback, herbal remedies, and homeopathic remedies in this group, as well as other less common treatments like mirror therapy and acupuncture in this group. band.
“A few of the proposed alternatives have probably proven to be ineffective or even dangerous,” says Arnold, who believes that multiple megavitamin combinations have enough evidence to warn doctors and the public about their indiscriminate use.
A rose is a rose is a rose…right?
The reason drugs like Ritalin or Adderall are so popular is because they work. Medicines are manufactured to tightly controlled specifications, making them very predictable. A five mg tablet of methylphenidate will always be a five mg tablet of methylphenidate.
Many alternative treatments do not meet this same quality standard. Search by Consumer Reports (December 2000) found that the amount of some key ingredients in some herbal products can vary significantly between brands. Other sources claim that doses are inconsistent from batch to batch, with variations occurring even between tablets or pills contained in the same bottle. The Federal Drug Administration has no control over these products. The consumer is left strictly at the mercy of the manufacturer.
Arnold cites European studies of St. John’s wort (hypericum) for depression that found it more effective than placebo. Many people with ADHD and depression claim to have been helped by using this medication. Other studies, not cited by Arnold, seem to contradict these results. This uncertainty, combined with a lack of regulation and quality control, makes some doctors hesitant to recommend the herbal antidepressant.
One size does not fit all
Some treatments are not suitable for everyone with ADHD. For example, there has been speculation that thyroid treatments might also help control ADHD symptoms. But Arnold’s research does not support such a link: “For the 2 to 5 percent of ADHD patients who have a thyroid abnormality, correcting the thyroid problem should logically be the first line of treatment, but is not indicated for the majority of patients with a normal thyroid. function.”
The same goes for patients with a specific nutrient deficiency: “For patients with demonstrated deficiencies in a nutrient (e.g., zinc, iron, magnesium, vitamins), correction of this deficiency is the logical treatment of first intention. » Arnold maintains that although dietary therapies are not effective for most people with ADHD, they may be appropriate. “in the small food-sensitive subgroup” (emphasis in the original text).
Other treatments, Arnold says, cost nothing, pose no risks and show promise. He cites research on meditation that he says has shown a significant benefit in classroom behavior, but not in parent ratings or psychological tests. Mirrors should help children with ADHD self-monitor and better control their behavior. Arnold acknowledges that these products haven’t been proven to help ADHD, but believes there is enough research to show that they can be helpful for children and adults with the disorder.
It should be noted that these interventions are not “cures” for ADHD, but tools that might be helpful.
Further studies are needed
“The most fundamental recommendation for future research into treatment alternatives in ADHD is that there should be more of them,” says Arnold. “Most alternatives have been relatively neglected by most mainstream researchers – particularly for adults with ADHD – and by peer-reviewed funding, despite the fact that some of them could be tested at relatively low cost. costs.” Arnold believes this lack of research means potentially useful treatments are overlooked and potentially ineffective, or even dangerous, treatments are sold without the data needed to debunk them.
“Dogmas (both established and anti-establishment) fill the void left by the absence of data,” says Arnold. “This research gap requires our scientific attention. »
THE The American Academy of Pediatrics (AAP) recommends treating ADHD in children and adolescents ages 6 to 18 with FDA-approved medications., as well as parent training on behavior modification and classroom behavioral interventions. Research studies like this one led by scientists from McGill University found that “stimulant medications are most effective and that the combination of medication and psychosocial treatment is the most beneficial treatment option for most adult patients with ADHD.” All ADHD treatment decisions should be made in consultation and coordination with a licensed medical provider.
Updated July 17, 2023
