ON THIS PAGE
- ADHD treatment using stimulant medications
- ADHD treatment using non-stimulant ADHD medications
- Side effects of ADHD medications
- Neurofeedback – a new promising ADHD treatment
- Behavioral therapy for ADHD
- ADHD treatment using psychotherapy
- Herbal medicine and ADHD therapy
- Diet and ADHD
- Nutrient supplementation in ADHD
There’s no cure for attention deficit hyperactivity disorder (ADHD). However, treatment involving a combination of medications, psychotherapy and natural therapy can help control many ADHD symptoms. This article focuses on the most effective methods in ADHD therapy.
ADHD treatment options
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects behavior.
Although uncurable, various modes of treatment are available such as:
- Psychosocial (e.g. behavioral or psychotherapy)
- Pharmaceutical (stimulant and non-stimulant drugs)
- Nutritional (e.g. elimination diet and supplements)
- Herbal medicine
A combination of prescription medication and behavioral therapy has been shown to be the most effective method in ADHD treatment.
The aim of the pharmaceutical ADHD treatment is to reduce the core symptom (hyperactivity) and improve concentration, while behavioral therapy focusses on more subtle symptoms, such as improving social and organizational skills.
While this combination has the best outcome, other therapies have also been investigated and used.
The following article lists common modes of ADHD treatment.
- The most effective treatment for ADHD is to combine medication with behavioral therapy.
- There are other complementary modes of ADHD therapy, such as other psychosocial therapies, diets, nutritional supplements, neurofeedback and herbal medicine.
- Most of these therapies need more studies.
ADHD treatment using stimulant medication
Although ADHD medication treatment is very effective, most ADHD sufferers don’t adhere to the medication regime since 30-50% stop following it in the first year and 66-80% within 3 years.
Scientist haven’t found the specific brain defect related to ADHD, but it is thought that it is linked to a genetic fault that affects the metabolism of dopamine and norepinephrine neurotransmitters.
This uncertainty makes it difficult to design drugs specifically for the ADHD treatment. Medications are currently only designed to control ADHD symptoms.
Stimulant medication helps to improve attention and reduce hyperactivity.
70% of ADHD patients improve their symptoms with stimulants and 80%-90%, if two stimulants are used consecutively. (1)
The main problem with this therapy is its side effects which, in some cases, can be severe (see section below).
Since drugs are chemically different, some people may react better to one or other or by taking two types simultaneously.
- Stimulant drugs are very effective in treating ADHD symptoms. However, their side effects affect over 30% of people taking them.
- Stimulant drug effects are short lasting (up to about 12 hours).
Side effects of ADHD medications
While the benefits of ADHD stimulants are short lasting, their side effects, such as with methylphenidate, can be short or long lasting.
The side effects of ADHD medications are not well studied, particularly in young children ( under six years old). Therefore, it is advisable to try other therapies first. (4)
- Sleep difficulties (10)
- Restricted growth. ADHD medications may impact height and weight in growing children, although the reason is still unknown.
- Increased blood pressure (mainly stimulants). (11)
- Small increase in heart rate (both stimulant and non-stimulant drugs) (12)
- Loss of appetite (5)
- Development of ticks and worsening of existing ones (more studies needed to confirm) (1)
- May suppress divergent thinking (thought process that allows you to create new ideas)
- May suppress flexibility, planning and creativity
- Irritability and nervousness
- Abdominal discomfort
- Lethargy and fatigue
- Stimulant induced psychosis (mainly stimulants)
- Sudden death (very rare but some cases were reported from taking stimulant medications) (12)
- Although information on the drugs, such as methylphenidate, cautions about suicide being a possible adverse effect, the evidence of suicidal behavior is very weak. (12)
- There are many side effects of ADHD medications, ranging from mild to severe.
- Stimulants tend to have a stronger and wider range of side effects.
- The side effects of ADHD medication treatment in young children are not well-known.
- Young children under six years of age should be treated with behavioral therapy, before medications can be applied.
ADHD treatment using non-stimulant ADHD medication
In cases where stimulants are not effective, or the side effects are too severe, nonstimulants can be used to treat the symptoms.
The side effects of stimulant and non-stimulant medications are similar. However, the side effects of stimulants tend to be stronger.
Non-stimulant ADHD medication increases the production of norepinephrine in the brain, which is helpful in improving attention and memory.
The non-stimulant ADHD medication list includes: (1)
- Tricyclic anti-depressants
- Non-tricyclic anti-depressants
- Specific norepinephrine re-uptake inhibitors
- Alpha-2 noradrenergic agonists
- Non-schedule stimulants
- Beta blockers
- Non-stimulant drugs can be used in cases, where stimulant drugs are not effective or cause severe side effects.
Neurofeedback – a new promising ADHD treatment
Neurofeedback is a relatively new ADHD therapy technique, where the affected individuals are trained to achieve a calmer state through computer control of their brain activity.
Although neurofeedback has some potential, studies still show conflicting results.
The results depend on the participants’ age, length of training, or whether they are taking medications along with the training.
Neurofeedback in ADHD therapy appears to have durable effects, that last for at least six months following the treatment. However, it is not recommended as a treatment on its own. (13, 14, 15, 16, 17, 17)
- Neurofeedback is a new ADHD therapy technique that involves computer control of brain activity.
- Studies on neurofeedback show promising results, with effects lasting six months after the treatment, although evidence is still weak
Behavioral therapy for ADHD
The aim of this therapy in ADHD treatment is to replace negative behaviors with positive ones. It applies to both affected children and adults.
Cognitive-behavioral therapy for ADHD in adults
It focuses on the core ADHD symptoms, such as improving attention and reducing hyperactivity and impulsivity.
Combining CBT with medications improves secondary symptoms, such as reducing depression and anxiety and improving the general level of functioning in life.
The combination of both treatments has been shown to be more effective, than just taking medications or CBT. However, evidence of the effectiveness is still not very strong and more long-term studies are needed. (20)
Behavioral therapy for ADHD in children
The most effective type of behavioral therapy (BT) in young children, is if parents are trained in BT and use their skills to help their children to manage ADHD behavioral symptoms. (21)
The training can be run by a psychologist, pediatrician, or a specialized mental-health worker. As part of the therapy, parents and (if possible) teachers are trained so that they are be able to apply the methods on the affected children.
Children in families who have been trained in BT, observe behavioral improvements for many years after the treatment. (21)
Parents need to understand how ADHD affects their child’s behavior. They are trained to improve the relationship between them and their child and to help their child manage their own behavior.
It is beneficial if teachers, day-care providers and other caregivers are trained and involved in the therapy.
The therapy is based on a rewards and consequences system, in which the child gets rewarded or praised to support positive behavior and, for instance, loses points in the case of negative behavior.
For children under six years of age with ADHD, it is recommended to use BT before medication. The reason is that there are many known side effects of medications and their long-term consequences are not known. (21)
This method is as effective as medication in managing ADHD symptoms in children.
- Behavioral therapy in children and cognitive-behavioral therapy in adolescents and adults have been effective in ADHD treatment.
- When combined with ADHD medications, behavioral therapy has better results than on its own.
ADHD treatment using psychotherapy
Psychotherapy is not an effective treatment for ADHD symptoms, but rather for secondary issues that people with ADHD may be affected with.
People with ADHD are more likely to have mood and anxiety disorders, personality disorders, anti-social personality disorders and other mental conditions.
Psychotherapy is used to treat secondary symptoms associated with the ADHD state, such as disturbances in sense of identity, low self-esteem, difficulties in personal relationships and dealing with criticism and rejection. (22)
It has been shown to be effective in children and adolescents, but the results are not as positive as in behavioral therapy. (23)
- Psychotherapy can be used in the treatment of secondary conditions that often accompany ADHD, such as anxiety and personality or anti-social disorders
Herbal medicine and ADHD therapy
ADHD is a condition with unknown causes.
It is, therefore, risky to use some herbs, especially if they are taken in combination with pharmaceuticals, due to the possible danger of herb-drug interactions. (24)
Gikgo bilboa, for instance, is effective in reducing inattention, while chamomile shows improvements in hyperactivity and inattention.
You will find a comprehensive list of the most studied herbs such as in this review of safety and efficacy of herbal medicines in ADHD therapy. There you will also find evidence-based treatment results, as well as the adverse effects of the studied herbs.
Some of the herbs helpful in the treating of secondary conditions that often occur alongside ADHD are (27):
- For anxiety disorder: Piper methysticum (Kava), Passiflora spp. (passionflower) and Galphimia glauca (galphimia)
- For depressive disorder: Hypericum perforatum (St John’s wort) and Crocus sativus (saffron)
- Some herbs seem to be effective in ADHD therapy. However, more studies are needed.
- Since it is unknown exactly what causes ADHD symptoms, it may be risky to use herbs, since some contain compounds that may worsen the symptoms.
- Some herbs may interact with medications, so special care must be taken.
Diet and ADHD
Elimination diets have been studied and used in ADHD therapy. The most effective method is the “Few foods diet.” However, it is also very complex and may not be suitable for some patients. This method aims to reach a balanced diet that provides the best results in reducing ADHD symptoms.
Eliminating artificial additives (e.g. artificial food colors) can also be effective, but only for a small number of people with ADHD.
There is no evidence on sugar or artificial sweeteners worsening ADHD symptoms, even though sugar decreases attention due to insulin and blood glucose imbalance and soft drinks (sodas) increase hyperactivity.
There is no evidence that other diets, such as the Ketogenic diet, have any significance in ADHD therapy.
- The elimination diet is the most effective dietary intervention in ADHD treatment. However, it is difficult to manage.
- Artificial additives may affect a small number of people with ADHD, so can be worth testing it.
Nutrient supplementation in ADHD
The evidence on nutritional supplements is still insufficient and results are conflicting.
Some ADHD patients might benefit from using supplementation of omega 3 fatty acids such as DHA and EPA (possibly together with omega 6) or minerals, but more long term, quality clinical trials are needed.
Supplementing with individual vitamins shows no results in the ADHD treatment, as with amino acids.
The biggest benefit from supplementation are for ADHD sufferers who also have nutrient deficiencies.
- Broad spectrum minerals, zinc and DHA and EPA supplements seem to have better results, than other types of supplements in ADHD therapy.
- The evidence is still weak and more good quality long term studies are needed.
- Some supplements are potentially beneficial and with low risk, so may be worth considering in ADHD therapy.
NUTRITION FACTS VS NUTRITION MYTHS
You will find a summary of the most common nutrition myths and evidence-based nutrition facts here.