Are there non-medication alternatives for ADHD treatment?

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[Photo: robert_rex_jackson, Flickr]

The Question: While more than two-thirds of youth diagnosed with attention-deficit hyperactivity use prescription medication to control their symptoms, it’s not uncommon for both parents and children to want a non-drug alternative. The guidelines recommend evidence-based behavior therapy as the primary treatment for pre-school age children; older students are advised to try ADHD medication alone or in combination with behavior therapy. Despite these clear recommendations, clinicians and parents may not know that alternative treatments exist, or how to access them.

The Alternatives: Three types of non-medication interventions have been demonstrated as effective for ADHD.

  • Parental training is designed to help caretakers improve their own communication and discipline practices. The goal is to better manage a child’s behavior by encouraging positive behavior and deterring what might be seen as classic ADHD conduct. Four parent training programs have been shown to reduce disruptive behavior: Triple P; Incredible Years; Parent-Child Interaction Therapy; and, the New Forest Parenting Program.
  • A mental health professional typically delivers psychosocial therapy, counseling a patient and his or her family on a regular basis about how to manage ADHD symptoms. These therapists, however, may not know the latest evidence-based techniques for working with children who have ADHD.
  • Behavioral therapy focuses on teaching children important skills, such as organizing, socializing, and problem solving. Showing parents and teachers how to help manage behavior and symptoms is an essential aspect of behavioral therapy as well. Some of this training may take place in the classroom, depending on the school’s resources, but it can also occur at sites where therapists have been specifically trained in evidence-based ADHD interventions. Two such examples are the Summer Treatment Program at Florida International University’s Center for Children and Families and the Challenging Horizons Program at the Center for Intervention Research in Schools at Ohio University.

These treatment types can overlap. For instance, some therapists use behavioral modification while behavioral therapy programs often have a parent-training component. For more information about the types of treatment and their costs, see this brochure (PDF) produced by the Agency for Healthcare Research and Quality.

A Note on Trauma: None of the behavioral

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Research reveals new ways of understanding ADHD

AbrainsMore than 6.4 million U.S. children have received a diagnosis of attention-deficit/hyperactivity disorder, according to the Centers for Disease Control and Prevention. Despite the prevalence of ADHD, researchers continue to search for answers about what causes the disorder, why it affects children differently, and how to best treat each individual case.

Related Story: How childhood trauma could be mistaken for ADHD

Three very different studies show the potential for scientific research to offer fresh insight into these unanswered questions.

  • The first study, published in a recent issue of the Journal of Child Psychology and Psychiatry, found that the condition might be influenced by a child’s socioeconomic environment.
  • Meanwhile, in 2012, scientists looked at how parenting style affected behavior in children who possessed genotypes associated with ADHD. Their findings, published in the Journal of Abnormal Child Psychology, revealed that negative parenting predicted inattention symptoms in certain children.
  • Finally, in the third study, which is currently unpublished, U.C. Berkeley researchers tracked and analyzed long-term outcomes for girls who were both diagnosed with ADHD and experienced severe abuse or neglect. The results indicate that experiencing ADHD and trauma may put some youth at an increased risk for eating disorders, depression and suicide later in life.

Study #1: Dr. Ginny Russell and her colleagues at the University of Exeter set out to better understand how a child’s socioeconomic standing might play a role in the development of ADHD. Russell firmly believes that ADHD is indeed a brain disorder with genetic underpinnings, but she also worries that it has been characterized as a “context-free condition.” Time and again, studies have shown that poor or disadvantaged children are more likely to have ADHD, and this fact struck Russell.

Some researchers have argued that this increased likelihood could be the result of reverse causality, or in other words, that the difficulty of parenting a child with behavioral problems might lead to economic hardship and divorce. In Russell’s study, which used data from a longitudinal study of more than 19,000 children in the United Kingdom, low-income families were more likely to have a child with ADHD – but that couldn’t be traced back to reverse causality. In fact, household income for families with an ADHD-diagnosed child didn’t decline over a period of several years compared to families without a diagnosis. Both sets of families had matching earnings at the start.

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How childhood trauma could be mistaken for ADHD

 

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[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,” she said of treating her patients according to guidelines for ADHD. “I began hypothesizing that perhaps a lot of what we were seeing was more externalizing behavior as a result of family dysfunction or other traumatic experience.”

Considered a heritable brain disorder, one in nine U.S. children—or 6.4 million youth—currently have a diagnosis of ADHD. In recent years, parents and experts have questioned whether the growing prevalence of ADHD has to do with hasty medical evaluations, a flood of advertising for ADHD drugs, and increased pressure on teachers to cultivate high-performing students. Now Brown and other researchers are drawing attention to a compelling possibility: Inattentive, hyperactive, and impulsive behavior may in fact mirror the effects of adversity, and many pediatricians, psychiatrists, and psychologists don’t know how—or don’t have the time—to tell the difference.

Though ADHD has been aggressively studied, few researchers have explored the overlap between its symptoms and the effects of chronic stress or experiencing trauma like maltreatment, abuse and violence. To test her hypothesis beyond Baltimore, Brown analyzed the results of a national survey about the health and well-being of more than 65,000 children.

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