Many options other than the use of pharmaceutical products exist for the treatment of attention-deficit/hyperactivity disorder (ADHD). By far, the most common medications used are psychostimulants.

Alternative medications are so-called non-stimulant products — a class of medications which is becoming increasingly popular, likely because side-effects affecting appetite and sleep are far less common.

But what can families expect when choose to avoid medications altogether and opt instead for nonpharmacological approaches such as neurofeedback, cognitive training, cognitive behavioural therapy (CBT), child or parent training, dietary or herbal remedies or fatty acid supplementation?

In the June 2018 edition of Pediatrics, research conducted by the Duke Evidence-based Practice Center looked at this specific question by doing a comprehensive systematic review of 54 studies of nonpharmacologic treatments.

These studies were all published between Jan. 1, 2009, and Nov. 7, 2016, and sourced from comprehensive databases including PubMed, Embase, PsycINFO and the Cochrane Database of Systematic Reviews for relevant English-language studies.

Cognitive bias is a term used by social psychologists which essentially discuss why humans pick and choose the narrative they believe in the most. (One of the best books I have ever read on this important behavioural pattern is Mistakes Were Made (but not by me), written by Carol Tavris and Elliot Aronson). Doctors and the public fall prey to cognitive biases and, as the above book so convincing shows, they are quick to deny that.

The strength of evidence (SOE) is what makes the Duke study one of the milestone studies ever undertaken. The authors were very meticulous to dig deep in terms of how all the papers published between 2009 and 2016 met high standards — or not.

Here are some of the main highlights and take-home messages:

When a preschooler is diagnosed with ADHD, parent behaviour training as the first-line treatment had a high result in contrast to pharmacological intervention. (Academically that makes sense, but in real life, many pediatricians struggle to find the appropriate parent behaviour training programs for those who often cannot afford it or attend all the classes).
Neurofeedback generally provided very good results when compared to pharmacological treatment, placebo or other nonpharmacological interventions.
Cognitive behavioural therapy (CBT) was particularly useful in patients who also had anxiety and depression in addition to ADHD. It was found that depression score improvements were maintained for as long as 12 months. Out of 54 studies, surprisingly, there was not a single study in which CBT interventions were compared to pharmacologic interventions. …read more



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Nieman: Treating ADHD without the use of drugs

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