Assessing Complementary and/or Controversial Interventions For ADHD

Written by HealthyPlace.com Staff Writer

In an effort to treat ADHD, some turn to alternative therapies. How do you know if these alternative treatments for ADHD work or are they a hoax?

In the past decade, there has been a tremendous upsurge of scientific and public interest in attention-deficit/hyperactivity disorder (AD/HD). This interest is reflected not only in the number of scientific articles, but also in the explosion of books and articles for parents and teachers. Great strides have been made in the understanding and management of this disorder. Children with AD/HD who would have gone unrecognized and untreated only a few short years ago are now being helped, sometimes with dramatic results.

There are still many questions to be answered concerning the developmental course, outcome and treatment of AD/HD. Although there are several effective treatments, they are not equally effective for all children with AD/HD. Among the most effective methods to date is the judicious use of medication and behavior management, referred to in the scientific literature as multimodal treatment. Multimodal treatment for children and adolescents with AD/HD consists of parent and child education about

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diagnosis and treatment, specific behavior management techniques, stimulant medication, and appropriate school programming and supports. Treatment should be tailored to the unique needs of each child and family.

In an effort to seek effective help for AD/HD, however, many people turn to treatments that claim to be useful but have not been shown to be truly effective, in agreement with standards held by the scientific community.

The following terms are important in understanding treatment interventions:

1. Medical/medication management of AD/HD refers to the treatment of AD/HD using medication, under the supervision of a medical professional. See CHADD Fact Sheet #3, "Evidence-based Medication Management for Children and Adolescents with AD/HD," for more information.

2. Psychosocial treatment of AD/HD refers to treatment that targets the psychological and social aspects of AD/HD. See CHADD Fact Sheet #9, "Evidence-based Psychosocial Treatment for Children and Adolescents with AD/HD," for more information.

3. Alternative treatment is any treatment — other than prescription medication or standard psychosocial/behavioral treatments — that claims to treat the symptoms of AD/HD with an equally or more effective outcome. Prescription medication and standard psychosocial/behavioral treatments have been "extensively and well reviewed in the extant literature, with undoubted efficacy."¹

4. Complementary interventions are not alternatives to multimodal treatment, but have been found by some families to improve the treatment of AD/HD symptoms or related symptoms.

5. Controversial treatments are interventions with no known published science supporting them and no legitimate claim to effectiveness.

Before actually using any of these interventions, families and individuals are encouraged to consult with their medical doctors. Some of these interventions are targeted to children with very discrete medical problems. A good medical history and a thorough physical examination should check for signs and symptoms of such conditions as thyroid dysfunction, allergic history, food intolerance, dietary imbalance and deficiency, and general medical problems that may mimic symptoms of AD/HD.

How are Treatments Evaluated?

There are two ways that treatments may be evaluated: (1) standard scientific procedure or (2) limited case studies or testimonials. The scientific approach involves testing a treatment in carefully controlled conditions, with enough subjects to allow researchers to be comfortable with the "strength" of their findings. These studies are repeated a number of times by various research teams before arriving at a conclusion that a particular treatment helps a particular problem.

The studies need to include techniques that decrease the chance of reaching incorrect conclusions. These techniques include comparing the particular treatment to placebo or other treatments, assigning people to the particular treatment or the comparison treatment in a random fashion, and when possible, not letting families or researchers know which treatment the person is receiving until the study is finished, or at least having people evaluate the outcomes of the study who are not associated with the study and are unaware of what each person received. It is also important that the people in the study have the same diagnosis, which is obtained using a clearly defined process, and that sound scientific measures are used to assess outcomes.

Good scientific studies are often published in scientific journals, and must go through a peer review before they are published. Peer review is the analysis of research by a group of professionals with expertise in a specific scientific or medical field. Findings are not considered substantive until additional studies have been conducted to reaffirm (or refute) the findings.

In the second method of evaluation, conclusions are drawn from a limited number of patients and are often based solely on testimonials from doctors or patients. A treatment that is evaluated only in this manner is not necessarily a harmful or ineffective treatment. However, the lack of standard scientific evaluation raises questions about the effectiveness and safety of a treatment.

How Do I Assess Alternative Treatments for ADHD?

Alternative treatment approaches are usually publicized in books or journals that do not require independent review of the material by recognized experts in the field. Often, in fact, the advocate of a particular treatment approach publishes the work himself. Measurement techniques and statistical means of evaluation are usually not present, and "proof" of the effectiveness of the treatment often comes in the form of single case studies or descriptions of the author's clinical experience with a large number of patients.

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