Non-drug treatment of ADHD

Parents often ask how their children’s symptoms of ADHD can be treated without “stimulant” medication such as Focalin or Adderall.

In fact, we know that treatment of ADHD with stimulant medication has a stronger research basis, and more data, than any other treatment.  But often parents rightly ask, “Isn’t there treatment besides drugs?”

Certainly, “alternative” therapies such as herbal treatments, dietary manipulations, and chiropractic treatment for ADHD work no better than placebo.  But there are some important strategies that parents can and should try, before (or along with) a trial of stimulant medications.

Note that each of these suggestions is thought to have a long-term effect, if the intervention is sustained.  This is different than the impact of medication, which works quickly but wears off by the end of the day.

–  Sleep deprivation impairs judgment and memory, and increases impulsiveness and irritability.  So not getting sufficient sleep mimics and exacerbates the symptoms of ADHD.  ADHD patients must be sure to get enough hours of sleep.  Just as importantly, poor quality of sleep should be addressed.  ADHD patients should get to bed at a reasonable hour, and electronics and “screen time” should be restricted within an hour or so of bedtime.  Quality-of-sleep issues, such as insomnia, sleep apnea or snoring, must also be addressed.

–  A study this past July demonstrates that teens who increase their physical activity, such as joining a sports team, helps improve their ADHD behavior 3 years later.  (J Am Acad Child Adolesc Psychiatry, 2015 July; 54:565-70. http://www.jaacap.com/article/S0890-8567(15)00288-9/abstract

–  Excessive “screen time” is well known to stimulate subsequent ADHD symptoms, even as early as age 1.  It is recommended to limit total TV and movie watching, video games, “smart phone” and tablet use to 1-2 hours per day.  Pleasure reading, hobbies, and family activities such as cooking together are good alternatives.  (Pediatrics April 2004; Vol 113(4):708-713) http://pediatrics.aappublications.org/content/113/4/708

–  Pediatricians recommend good nutrition for all our patients, such as encouraging milk, fruits and vegetables, and grains over a diet high in fat, salt, sugars and processed starches.  There is some research to suggest that these recommendations may also help improve ADHD symptoms, though it is hard to prove.

–  Musical training seems to cause more rapid development in the areas of the brain related to “executive functions” such as motor planning, and emotion and impulse regulation.  This development was measured by noting thickening of the brain cortex on MRI.  (J Am Acad Child Adolesc Psychiatry, November 2014, 53(11): 1153–1161.) http://www.jaacap.com/article/S0890-8567(14)00578-4/abstract

–  Early evidence suggests that long-term dietary supplementation with Omega-3‘s, like those found in fish oils, might improve ADHD symptoms.  The benefit is “modest” compared with that of traditional stimulant treatment for ADHD, and the optimal dose is unknown, but there is probably no harm and might be some benefit.  (J Am Acad Child Adolesc Psychiatry, October 2011: 50(10):991–1000.) http://www.jaacap.com/article/S0890-8567(11)00484-9/abstract

Other studies suggest that more complex interventions such as mindfulness training, behavioral training, and even Canine-assisted therapy might be of some benefit; parents must balance the effort involved (for both them and the affected student) against the suggestion of benefit for these interventions.  Other therapies, such as chiropractic treatment and vision exercises, have been shown not to carry any benefit.

One particular intervention that has been shown NOT to be helpful is the accommodation of extended time for school exams.  Neither the patient’s score on tests, nor their learning, have been shown to improve by giving ADHD students extra time to complete their exams.  (J Atten Disorders, February 2015, (19)2:167-172 ) http://jad.sagepub.com/content/19/2/167.abstract