Drug and Therapeutics Bulletin | 2019
Limited evidence for non-drug treatment of childhood ADHD
Abstract
Overview This systematic review looked at studies, conducted between 2009 and 2016, of non-pharmacological treatments for ADHD in children aged 17 years or younger. It identified 54 studies of treatments including neurofeedback, cognitive training, cognitive behavioural therapy (CBT), child or parent training, omega fatty acid supplements and herbal or dietary approaches. Studies were included if they compared the non-pharmacological intervention with another non-pharmacological treatment, a pharmacological treatment, or usual care/ placebo/waiting list controls. Several different scales for rating children’s behaviour were used to measure outcomes across the studies. Overall, the data did not provide any convincing evidence of effectiveness for these treatments in ADHD alone or in combination with pharmacological therapy. There was little new evidence to guide their use in this context, and the strength of evidence across the different studies was generally insufficient to draw conclusions about efficacy. CBT appeared to show some benefit in one study (judged as fair quality) involving 159 children. The CBT group had greater improvement in depression and anxiety scores at 3 months, with sustained effects on depression at 12 months. CBT was also superior on ADHD scale scores. Trials that compared child or parent training with non-pharmacological and pharmacological interventions showed some benefit on different ADHD rating scales. However, when compared with placebo, waiting list or usual care, findings were limited. Pooled analysis of studies of omega fatty acid supplements compared with placebo did not show statistically significant changes in overall symptoms reported by parents (standardised mean difference [SMD] −0.32, 95% CI −0.80 to 0.15; 411 participants) or by teachers (SMD −0.08, 95% CI −0.47 to 0.32; 287 participants).