Non-pharmacological therapy can be beneficial in some patients with ADHD.1 A meta-analysis provided strong evidence that behavioural interventions are highly effective for the treatment of ADHD in children;2 and structural and functional brain changes have also been observed in response to behavioural therapies.3,4 Clinical guidelines, including the NICE guideline on diagnosis and management of ADHD in children, young people and adults, and the European clinical guidelines for hyperkinetic disorder, recommend non-pharmacological interventions in conjunction with medication, as part of a comprehensive treatment plan for patients with ADHD.1,5 Non-pharmacological therapies for ADHD may include behavioural interventions, educational approaches and more holistic approaches, such as lifestyle and diet changes (Figure).1,5
Non-pharmacological interventions for the treatment of ADHD1,5-8
Behavioural therapy for ADHD can include behavioural interventions, cognitive behavioural therapy (CBT) and neurofeedback.1,5,7,8 Examples of behavioural interventions include teaching parents and teachers strategies to cope with disruptive behaviour and address problematic behavioural habits at home or at school.1,5 CBT is administered directly to patients, particularly adolescents or adults, on an individual or group basis to help patients recognise patterns of problem behaviour and manage their own actions.1 Meanwhile, neurofeedback typically involves computer-based exercises, which provide feedback regarding attention levels to promote self-regulation and enable behavioural training.7,8
Educating patients, their families/carers and teachers about ADHD is also important to ensure appropriate management. Psychoeducation, the provision of information regarding ADHD to patients, their families and teachers, can be given by the clinician on an individual basis to the patients and their family, or provided on a group basis.1,5,9 The education of teachers is also very important to enable them to identify the disorder early and provide adequate support to children and their families.
Lifestyle & diet
Changes to lifestyle and diet have also been suggested as possible approaches to the treatment of ADHD; for example, increasing levels of physical activity10,11 and removing or adding certain foods to the diet.12,13 However, evidence is limited for many of these interventions.1,5,6
- NICE (2008) Attention Deficit Hyperactivity Disorder: Diagnosis and Management of ADHD in Children, Young People and Adults. NICE clinical guideline 72. Available at www.nice.org.uk/CG72 [NICE guideline]. Last accessed May 2015.
- Fabiano GA, Pelham WE Jr., Coles EK, et al. A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder. Clin Psychol Rev 2009; 29: 129-140.
- Hoekzema E, Carmona S, Tremols V, et al. Enhanced neural activity in frontal and cerebellar circuits after cognitive training in children with attention-deficit/hyperactivity disorder. Hum Brain Mapp 2010; 31: 1942-1950.
- Hoekzema E, Carmona S, Ramos-Quiroga JA, et al. Training-induced neuroanatomical plasticity in ADHD: a tensor-based morphometric study. Hum Brain Mapp 2011; 32: 1741-1749
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder – first upgrade. Eur Child Adolesc Psychiatry 2004; 13 (Suppl 1): I7-30.
- Sonuga-Barke EJ, Brandeis D, Cortese S, et al. European ADHD Guidelines group. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry 2013; 170: 275-289.
- Steiner NJ, Frenette EC, Rene KM, et al. In-school neurofeedback training for ADHD: sustained improvements from a randomized control trial. Pediatrics 2014; 133: 483-492.
- Meisel V, Servera M, Garcia-Banda G, et al. Neurofeedback and standard pharmacological intervention in ADHD: a randomized controlled trial with six-month follow-up. Biol Psychol 2013; 94: 12-21.
- Montoya A, Colom F, Ferrin M. Is psychoeducation for parents and teachers of children and adolescents with ADHD efficacious? A systematic literature review. Eur Psychiatry 2011; 26: 166-175.
- Chang YK, Liu S, Yu HH, et al. Effect of acute exercise on executive function in children with attention deficit hyperactivity disorder. Arch Clin Neuropsychol 2012; 27: 225-237.
- Verret C, Guay MC, Berthiaume C, et al. A physical activity program improves behavior and cognitive functions in children with ADHD: an exploratory study. J Atten Disord 2012; 16: 71-80.
- Johnson M, Månsson JE, Ostlund S, et al. Fatty acids in ADHD: plasma profiles in a placebo-controlled study of Omega 3/6 fatty acids in children and adolescents. Atten Defic Hyperact Disord 2012; 4: 199-204.
- Huss M, Völp A, Stauss-Grabo M. Supplementation of polyunsaturated fatty acids, magnesium and zinc in children seeking medical advice for attention-deficit/hyperactivity problems – an observational cohort study. Lipids Health Dis 2010; 9: 105.
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NEW Childhood/adolescent ADHD and treatment effects in the brain. By Dr Mitul Mehta
New eLearning Module on the treatment of Child, Adolescent and Adult ADHD, is now available.
Patient-centred management: every patient is different with unique needs – a Spanish perspective. Part 2: Treatment plans
ADHD is often a lifelong neurobehavioural disorder, which may persist from childhood into adulthood.
Guidelines for the diagnosis, treatment and management of ADHD are available on an international, European and national level