Non-Drug ADHD Treatments Don't Pan Out in Study01/30/13
WEDNESDAY, Jan. 30 (HealthDay News) -- Many parents pursue
costly and time-consuming treatments to help their children with
attention-deficit/hyperactivity disorder. Now, a new study finds
little evidence that non-drug interventions reduce key symptoms of
A multinational team of experts identified no positive effects
from psychological treatments including mind exercises (cognitive
training), neurofeedback and behavioral training (positive
reinforcement). And the researchers discovered only small benefits
associated with dietary treatments: supplementation with omega-3
and omega-6 free fatty acids, and elimination of artificial food
Still, parents shouldn't be discouraged, said study co-author
Dr. Emily Simonoff.
"I think our findings allow a much more informed discussion than did previous work because we've been able to demonstrate that what we once thought worked is more limited and more questionable," said Simonoff, a professor of child and adolescent psychiatry at King's College London.
Simonoff thinks the study conclusions need to be interpreted in
the context of a child's particular situation.
"I think people need to talk with their child's clinician," she said. "Evidence is never a substitute for having a discussion about your own child and what is right for your child and your family."
ADHD diagnoses are on the rise. Between 1997 and 2007, diagnoses
among U.S. children and teens increased between 3 percent and 6
percent a year, according to the U.S. Centers for Disease Control
and Prevention. According to the American Psychiatric Association,
between 3 percent and 7 percent of U.S. children have the
condition, which makes it hard to focus in school and to sustain
friendships. Currently, a combination of medication and behavior
therapy is the recommended treatment, according to the CDC.
The new review, an analysis of 54 studies by the European ADHD
Guidelines Group, compared "blinded" and "unblinded" ratings for
several dietary and psychological treatments. "Blinded" raters are
unaware of the treatment used, while "unblinded" judges know of the
therapy. It is thought that blinded ratings eliminate bias.
The study, published online Jan. 30 in the
American Journal of Psychiatry, found that treatments were
rated more effective in the unblinded tests, which appears to
invalidate the conclusions.
Even after learning of the study findings, some people might say
it can't hurt to try a particular therapy. But Simonoff warned of
potential negative side effects.
"Adverse effects are often associated with pharmacological therapies, but other interventions can have them as well," she said. "For example, does a highly selective diet limit the way a child can play and socialize, making them feel different from their friends? And for parents, if a child doesn't improve under these therapies, does it affect how the parents feel about themselves?"
Dr. Andrew Adesman, chief of developmental and behavioral
pediatrics at Steven and Alexandra Cohen Children's Medical Center
of New York in New Hyde Park, agreed: "The danger in saying it
won't hurt [to use non-drug therapies] is, where do you draw the
line and what's the rationale?"
Attempting other therapies "instead of something that works," he
said, results in lost time and money, false hopes, and missed
Adesman said, however, that he was surprised that behavioral
therapy was not found to be effective. "Unlike neurofeedback,
elimination diets or attention training, the American Academy of
Pediatrics does recommend behavioral therapy for ADHD in children,"
he said. "It involves psychologists working with parents to elicit
better behavior in their kids, using positive and negative
reinforcement, like time-outs."
Even if therapy doesn't improve the core symptoms of ADHD, such
as attention span and impulsiveness, it may provide other benefits
to the child and family, such as teaching effective communication
strategies, Adesman said.
He also encourages parents to be open to the potential benefit
drug therapy may provide.
"When I hear parents say they'll consider medicine only as a last resort, that's dangerous," he said. "Parents should confer with their child's pediatrician and discuss a range of treatment approaches and recognize that often the reason a medicine is suggested is not because of a physician's bias but rather because the data is generally stronger than for other treatments."
The European ADHD Guidelines Group received support for the
study from Brain Products GMBH and drug makers Janssen-Cilag,
Lilly, Medice, Shire and Vifor Pharma.
Learn more about ADHD from the
Centers for Disease Control and Prevention.
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