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Drug-Free Approaches to Managing ADHD
These Treatment Techniques may ease ADHD symptoms
For decades, Ritalin and similar stimulants have reigned over other treatments for attention deficit hyperactivity disorder, also known as ADHD or ADD. The meds are seemingly tried and true, with numerous studies backing their effectiveness.
However, the latest results from the Multimodal Treatment Study of Children with ADHD, the largest investigation of the benefits of medication against behavioral therapy, found that stimulants' effects wane over time. In addition, the study found that more than 60 percent of the children on stimulants stopped taking the medication within eight years. What's more, the medications used in the study might have stunted participants' growth, researchers concluded.
The vast majority of kids respond positively to one or more of the approved medications for ADHD, according to
Mina Dulcan, head of child and adolescent psychiatry at
Experts have a lengthy list of techniques other than prescription drugs that may help manage ADHD symptoms. Here's a quick look at some of them:
Authors of a review published last year in Clinical Pediatrics wrote that parents of kids with ADHD are often more controlling and disapproving of their children, are more likely to reprimand, and are less supportive than parents of kids without the disorder. Training programs can teach parents how to reward good behavior by, for example, awarding points or privileges to kids for focusing on their homework. Considerable scientific evidence indicates that receiving training in key parenting skills helps parents manage their kids' behavioral problems, although studies showing the long-term benefits of the treatment are lacking. "Absolutely essential to any treatment program for ADD should be positive relationships," both at home and at school, says Edward Hallowell, psychiatrist and author of Superparenting for ADD.
Along with parent training sessions, summer programs for kids were examined in the MTA study. As behavioral therapeutic interventions, summer programs and parent training initially were found to be less effective than medication in children with ADHD. But these behavioral therapies are recommended by the
Also called EEG biofeedback, this treatment tries to train patients to control brain waves typically associated with focus and attention. Unlike medication, which must be taken for years, neurofeedback is said to work permanently after the training sessions are completed. It seems to be safe. Numerous studies of the technique "all have some flaws, but it looks like a promising treatment," says Eugene Arnold, professor emeritus of psychiatry at
Interactive Metronome training.
Many kids with ADHD can't form and execute a plan one step at a time, as other kids do. Interactive metronome training, which employs a computerized tool, was developed to help kids with ADHD improve their motor skills and ability to plan. Users tap their hands or feet in time to a beat they hear through headphones, and the technology records their accuracy. In a study that included 56 boys with ADHD, the training seemed to focus attention and improve motor control, reading, and other skills in the patients, compared with those who either got no treatment or played video games.
In general, rhythmic activities can improve attention in certain children, according to Stanley Greenspan, clinical professor of psychiatry and pediatrics at
A pilot study that appeared in a 2008 issue of Current Issues in Education suggests that transcendental meditation may help improve attention and behavior in kids with ADHD. The results can't be generalized to all forms of meditation since each technique works differently, says Sarina Grosswald, a medical education consultant and lead author of the study. TM affects the brain by reducing stress and anxiety, which allows the prefrontal cortex -- the part responsible for attention and focus -- to function more efficiently, Grosswald says. Research at the
A natural environment.
In a 2004 study in the
A study that appeared in March in the journal Sleep concluded that kids with ADHD slept for less time on average than their healthy counterparts, suggesting that sleep problems may be associated with ADHD. "Up to 25 percent of children who have been diagnosed with ADHD may not have ADHD, [but rather] they may have sleep-disordered breathing," says Julie Wei, associate professor of otolaryngology at the
A few years ago, Wei and a team of researchers assessed the behavior of 71 patients (the majority of whom did not have ADHD) after their tonsils and adenoids (lymph tissue behind the nose) were removed. Six months after surgery, the group showed significant improvement in four measures of behavior: inattention, hyperactivity, oppositional behavior, and a measure called the ADHD index. While the ADHD index eventually returned to presurgery levels, hyperactivity, inattention, and oppositional behavior stayed down for at least 2½ years, Wei's team found. Wei tells parents to pay attention to their kids' sleep, especially if a child snores habitually, which may be a sign of sleep-disordered breathing.
The Feingold diet, in which patients abstain from food additives and naturally occurring salicylates, has been hyped since the '70s, even though subsequent research hasn't been very successful at replicating initial findings that the diet eased ADHD symptoms. And sugar has caught blame for causing hyperactivity. "The scientific literature is confusing," says Greenspan. The problem is that all children are different, and the research has not created subgroups that would tell us which children are sensitive to dyes or additives in food, according to Greenspan. For that reason, parents have to be very good detectives, he says. If you're concerned that sugary juices, for example, are worsening problems, try removing them from your kid's diet for two weeks and watch the effect, Greenspan recommends. Some experts also advise children to take omega-3 supplements if they're not getting adequate amounts in their diet. Omega-3s, found in fatty fish and other foods, may improve brain function and focus.
There's increasing evidence that physical activity is good for the brain as well as the heart, Arnold says.
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