[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
treatments for ADHD are designed specifically for traumatized children; however, training for parents can help strengthen their relationship with a child and reduce harmful discipline and communication practices.
Related Story: How childhood trauma could be mistaken for ADHD
The Research: In 2011, the AHRQ published a comprehensive review of both prescription and non-drug ADHD treatments in different age groups. For pre-school youth, several studies showed that Triple P, Incredible Years, Parent-Child Interaction Therapy, and the New Forest Parenting Program reduced disruptive behavior, enhanced parenting skills, and in some cases, improved ADHD symptoms. The review included a single study that compared medication and parent training and found similar effectiveness, but it was too limited to draw any conclusions.
In 5- to 12-year-old patients, studies have shown that combining psychosocial and behavioral therapy for children with medication – even very low doses – is as effective as medication by itself, and superior to non-drug treatments on their own. Measuring improvement across treatment types has been difficult because key studies have evaluated different outcomes; some focus on symptom severity while others look at daily functioning.
In a Clinical Psychology Review paper published in April, several researchers analyzed 15 years of studies on pharmacological and psychosocial treatments and found that medication and behavioral therapy produce a “similar range of therapeutic effects” in adolescents with ADHD. This view, the authors pointed out, contradicts guidelines from the American Academy of Pediatrics (PDF) and American Academy of Child and Adolescent Psychiatry (PDF), which describe prescription medication as the preferred treatment.
The federal Substance Abuse and Mental Health Services Agency (SAMHSA) includes both the Summer Treatment Program and Challenging Horizons Program in its registry of evidence-based practices. The eight-week summer program, which is offered at other sites around the country, targets behaviors like impulsivity and concentration, and teaches campers positive academic and interpersonal skills. Instructors also prepare parents for reinforcing these traits long after their children leave camp. The Challenging Horizons Program is a middle and high school-based intervention that targets areas of impairment and focuses on strengthening numerous skills, including studying, goal setting and group cooperation. Parents are involved in treatment through group training sessions and weekly reports. While studies of the STP and CHP found positive results for adolescents, the effects may wane once the intervention is no longer practiced on a daily or regular basis.
For more information about ADHD treatment, visit the Centers for Disease Control and Prevention and the National Institute of Mental Health.
Some medications can have an unpleasant side effects (as far as I know)… And I’ve read that hemp (especially CBD) can be used as a treatment to alleviate symptoms of ADHD… There are some promising results from studies, but definitely more research is needed.
I am a lay person who reads this blog out of a general interest in psychology and trauma recovery. I am a 42-year-old woman. I have ADD. My brother has ADHD.
Stating that non-medication adjunct therapies help someone with ADD live better…is like stating that providing a wheelchair, ramps, handicap-accessible sidewalks, and a carefully designed series of workarounds like lower cabinet heights and wider bathroom doors helps someone with a below-the-knee amputation live better. Of course they will. But if the goal is to provide that person with a full adaptation to a bipedal world, the only “treatment” is a prosthetic leg.
For me (and many like me), behavioral therapy and self-awareness are helpful adjunct therapies. They are accommodations. They are work-arounds. Medication is the prosthetic leg.
After two years of trying different medications, I have a functional mix: I get by with microscopic doses of Wellbutrin (35 mg/day) and short-acting Adderall (5 mg/day). That’s my floor. With that dose I remember credit card payments and my grocery list and to check that my keys are in my hand when I get out of the car. I can juggle three people talking to me at work without losing track of the email I was writing. I don’t walk away from boiling food or put my dinner in a cold oven to bake. I don’t walk into the living room to find the front door open.
I don’t have terrifying gaps in my memory, as if someone hit the fast-forward button and jumped me forward fifteen minutes. (As a child, these were so bad that I was tested for seizures. Twice. And meningitis once. Yay, spinal tap.) My family doesn’t constantly snap “You didn’t hear a word I said!” or angrily demand I repeat their last sentence or yank books out of my hand so I can hear them; I am not mistaken for a Deaf person in public. (Yes, more than once people have started signing to me because they assume only a Deaf person could be so utterly oblivious to someone standing in their face asking questions like ‘Where is your passport?”)
I grew up when only children had ADD and those children were only boys. But because my brother was diagnosed at age 6, I was – quite ironically – given the exact same behavioral training and diet, because my mother didn’t want to make him feel like there was something wrong with him. Therefore, we both got homework supervision and family therapy. We both at the Feingold diet. We both had restricted TV hours and limited sugar. Every single adjunct therapy that was available in the late 70s and early 80s, my mother practiced on both of us.
These “helped.” (Except the Feingold diet, which is crap.)
I have no hard statistics on whether children are over-medicated or over-diagnosed. I have given up being furious at constant sloppy reporting, like “Sugar causes ADD!” (Sorry, only ADD causes ADD. Sugar causes a child to temporarily exhibit ADD-like symptoms. See the difference?) But my heart does not stop breaking over children who struggle, like I did and my brother did, to overcome a neurological gap so profound that it has taken me 20 years to even come up with (barely) adequate analogies, and are denied the therapy that could change their life.
Behavioral training gave me a brilliant bag of tricks (most of which were self-taught after I learned what it could do for me). I count the breaths people take in conversations so I’m less likely to interrupt them. I make notes and lists like a fiend. I live and die by my calendar pop-up reminders. I would live a much less organized, more frantic and self-blaming life without my behavioral modification. But why does every conversation have to include an either-or proposition?
People who say that ADHD is not real have OBVIOUSLY never had to deal with an ADHD child. I have a Son with ADHD, When he was small we didn’t think anything of his little forgetful moments, but as time went on it began to affect his school work and we were afraid that he may be held back. Justin is a VERY intelligent child but he could not focus. We finally broke down and took him to see a Doctor and our fears were confirmed ADHD 😦 . He was prescribed Adderall 5mg to start, I REFUSED to give him this horrible medication and searched for natural alternatives. After about 3 months we put him on a routine. A half cup of coffee in the morning, and after school we do a session of http://assistance4adhd.com . He seems to enjoy it and his ability to focus and remember is improving along with his grades … 🙂 , so far so good … fingers x’ed…
I just felt the need to share Thanks for Listening
I think it’s worth including discussion of nutritional deficiencies/sensitivities & the role they play in behavior, mental states, and brain development.
Here’s another perspective on why children do or don’t “pay attention” in school: Sir Ken Robinson’s excellent talk on the paradigm of education. https://www.youtube.com/watch?v=zDZFcDGpL4U