Alternative Treatments for Adults with AD/HD
A new report compares and considers choices in treatment for ADHD.
Eugene Arnold, M.D., Professor Emeritus of Psychiatry at Ohio State University Department of Psychiatry, has written an extensive review of the research on alternative treatments for AD/HD. Previous research by Arnold on this topic was presented at the ADHD Consensus Conference held by the National Institute of Health in November, 1998.
Arnold describes 24 such treatments in a recent article titled “Alternative Treatments for Adults with Attention Deficit Hyperactivity Disorder,” published in the Annals of the New York Academy of Science.
Among his findings:
- Some alternative treatments of ADHD are effective or probably effective, but mainly for specific subgroups.
- Essential fatty acid supplementation has promising systematic case-control data but needs more research.
- Diets that eliminate certain foods and food additives may be effective for specific groups properly selected children, but such diets do not appear promising for adults. Sugar or candy restriction alone is not an effective treatment for ADHD in children or adults.
Despite hundreds of studies and decades of use, medication for ADHD remains a controversial topic. So, I wasn’t too surprised when I read this email, sent by a concerned reader:
“It’s extremely obvious that this magazine is ‘pro-medication’ when it comes to children diagnosed with ADD/ADHD… You are doing a disservice to people who have ADD/ADHD by saying medicine is the only way to control this behavior!”
I don’t know that I would say that I am “pro-medication.” No one likes the idea of using psychotropic medications on a child. In fact, I’ve been criticized because I tend to view medication as a last resort, for use after other options have been exhausted, and not as a first choice of treatment for every kid who ever fidgeted in his desk at school.
I would prefer to think that ADDitudeMag.com is “pro-science,” meaning that we rely on scientific medical research about attention deficit disorder. Research shows that the best treatment for AD/HD, as we currently understand it, consists of behavior modification, therapy and medication. Medication is only part of the equation.
For more information about the recommended medical treatment of AD/HD, please see Frequently Asked Questions about AD/HD Medications.
Some alternative treatments look promising but lack sufficient research. Arnold includes such popular alternative treatments as essential fatty acid supplementation, EEG biofeedback, herbals, and homeopathic remedies in this group, along with other, less common treatments like mirror therapy and acupuncture in this group.
“A few of the alternatives proposed have been demonstrated to be probably ineffective or possibly dangerous,” says Arnold, who believes that megavitamin multiple combinations have enough evidence to warn physicians and the public away from their indiscriminate use.
A rose is a rose is a rose… or is it?
The reason medications like Ritalin or Adderall are so popular is because they work. Medications are manufactured according to tightly controlled specifications, which makes them very predictable. A five mg tablet of methyphenidate will always be a five mg table of methylphenidate.
Many alternative treatments are not held to this same standard of quality. Research by Consumer Reports (December, 2000) found that the amount of certain key ingredients in some herbal products can vary considerably from brand to brand. Other sources claim that doses are inconsistent from batch to batch, with variations occurring even among tablets or pills in the same bottle. The Federal Drug Administration has no control over these products. The consumer is left strictly at the mercy of the manufacturer.
Arnold cites European studies on St. John’s Wort (hypericum) for depression that found it more effective than placebo. Many people with ADHD and depression claim to have been helped by using the medication. Other studies, which are not cited by Arnold, appear to contradict these results. This uncertainty, combined with the lack of regulation and quality control, make some doctors hesitant about recommending the herbal antidepressant.
One size does not fit all
Some treatments are not appropriate for all people who have AD/HD. For example, there has been some speculation that thyroid treatments could also help control AD/HD symptoms. But Arnold’s research does not support any such connection: “For the 2-5% of patients with ADHD who have thyroid abnormality, correction of the thyroid problem should logically be the first line of treatment, but is not indicated for the majority with normal thyroid function.”
The same is true of patients with a deficiency of specific nutrients: “For patients with demonstrated deficiencies of any nutrient (e.g., zinc, iron, magnesium, vitamins), correction of that deficiency is the logical first-line treatment.” Arnold maintains that while dietary therapies are not effective for most people who have AD/HD, they may be appropriate “in the small subgroup with sensitivity to foods” (emphasis included in the original text).
Other treatments, according to Arnold, cost nothing, pose no risk, and show some promise. He cites research on meditation which he says showed significant advantage in classroom behavior but not in parent ratings or psychological tests. Mirrors have to help children with ADHD to self-monitor and better control their behavior. Arnold acknowledges that these have not been proven to help ADHD, but believes there is sufficient research to show that they may be helpful for children and adults who have the disorder.
It should be noted that these interventions are not “cures” for ADHD, but are tools that could be helpful.
More study is needed
“The most basic recommendation for future research on treatment alternatives in ADHD is that there should be more,” says Arnold. “Most of the alternatives have been relatively neglected by most mainstream investigators — especially for adults with ADHD — and by peer-reviewed funding, despite the fact that some of them could be relatively cheaply tested.” Arnold believes that this lack of research has meant that potentially useful treatments are being overlooked and that possibly ineffective or even dangerous treatments are being sold without the data necessary to debunk them.
“Dogma (both establishment and anti-establishment) fills the void left by absence of data,” says Arnold. “This research void requires our scientific attention.”
The American Academy of Pediatrics (AAP) recommends treating ADHD in children and adolescents aged 6 to 18 with FDA-approved medications, plus parent training in behavior modification and behavioral classroom interventions. Research studies like this one conducted by scientists at McGill University have found that “stimulant medications are most effective, and combined medication and psychosocial treatment is the most beneficial treatment option for most adult patients with ADHD.” All ADHD treatment decisions should be made in consultation and coordination with a licensed medical provider.