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Complimentary, Alternative and Controversial Treatments for ADHD Print

There has been a veritable explosion of proposed intervention and treatments claiming successful treatment, even preposterously suggesting a ‘cure’ for ADHD. As was discussed in the series reviews of assessment and treatment options, it is a difficult and complex process attempting to evaluate the different types of supports required to and may support the type of difficulties arising from ADHD, which you are currently experiencing, in yourself, your child, or someone you know.
Calling these treatments 'alternative' therapies is somewhat ambiguous, and it encompasses a wide variety of non-western traditions to experimental interventions.
The treatments reviewed here do not represent a comprehensive account of all possible alternative therapies. Those reviewed are considered controversial or alternative, because the research does not support it as an effective treatment, the research doesn’t exist or is inconclusive. Alternatively, it treats co-existing conditions or difficulties and not the ADHD.  However, keep in mind that progress is made by building on findings, creatively solving problems, and developing   new and innovative ideas.  As such, while these treatments are not considered evidence-based today, no one knows what tomorrow may bring.
It needs to be noted at the outset that this final instalment in the series is written from a more subjective stance than the others. For the simple reason that alternative treatments, by definition are not supported by empirical findings, and as such, subjective inferences are required for discussion.

Why alternative treatments?

I suppose a more reasonable question would be, well why not?
There are a number of reasons why someone may choose to consider alternative treatments. There are individuals and parents who have concerns about using medication, especially with young children, without knowing how they will react, or for how long they might be on it. Others have read or heard about problems with traditional treatments, and so have fears about going down that road themselves.
There are others who simple want all the information before making a fully informed decision. There is also the possibility that you or your child have not responded well to the 'traditional' ADHD treatments, and so need to explore other alternatives. Perhaps you are considering adding a complimentary treatment to your current treatment plan.
Whatever your reasons behind exploring alternatives, self-education is always advisable. Beyond the point that the earlier the intervention is implemented the better, there are no serious problems keeping your options open and experimenting with different ways to manage ADHD.

Take Precautions

When you are considering alternative treatments there are a number of ways you can protect yourself and be a cautious and informed consumer. Much of this section came for recommendations made by CHADD (2008).

Evidence-base

The major question to ask is what evidence is provided to support the claims that this is an effective treatment from ADHD?
Be careful when a single case study or only testimonials (i.e., comment from satisfied customers) are the evidence support their claims. If the treatment claims to work for everyone with ADHD, this is probably not true, because no treatment works for everyone.
Ask about clinical trails (scientific studies with human participants), and their results. Remember that one study does not represent an evidence-based treatment.

Professional credibility

Another important question to ask is how credible is the source and the treatment.

•    Who is promoting the treatment, what are their credentials?
•    Is the source and/or the treatment supported by a respected professional body?

All Natural or Herbal Supplements

Be advised the European Medical Agency (EMA) (2012) does not evaluate non-pharmacological substances, such as food supplements. It is important to remember that any supplement, synthetic or natural, including herbal remedies comes with a risk of side-effects. The medicinal properties in drugs are often a naturally occurring substance.
If you come across a product claiming to be all ‘natural’ without any side-effects, you need to proceed with extreme caution, because it is just not possible.  Make sure that whatever you are taking comes with a list of its ingredients and possible side effects.

Alternative Treatments for ADHD

A full and comprehensive account of all the possible alternative treatments and the research is not possible. This represents a brief overview of some of the more commonly discussed therapies.

•    EEG biofeedback or neuro-retraining.
•    Sensory integration therapy.
•    Dietary manipulation, megavitamins, & mineral supplements.
•    L-tyrosine (it’s an amino acid that’s supposed to increase dopamine in brain).
•    Craniosacral therapy or cranial therapy.
•    Optometric vision training.
•    Treatment of yeast infections.
•    Medicine for motion sickness.
•    Anti-depressant medication.
•    Meditation.
•    Exercise
•    Yoga.

This represents a non-exhaustive list, and some will be covered briefly, however, you may need to go online or to the library if you would like in-depth information.

Neuro-feedback / Brain Training

Some regard brain training with scepticism, as a little farfetched or even borderline science fiction. Somewhat conversely, the brain is not viewed as a static fixed entity, and there is a general acceptance of neural plasticity based on new experiences and across the life span (Carr-Fanning, 2012).
Brain training is known by numerous pseudonyms, including neuro-feedback and neuro-retaining. It is based on an operant condition paradigm, and is in effect brainwave biofeedback; since it is premised on the belief that conscious awareness of bodily mechanisms facilitates their self-regulation. Thereby, resolving any doubt in the old fallacy of a mind/body dichotomy. During a typical session electrodes fixed to the scalp collect EEG (electroencephalogram) signals; and these appear within milliseconds on a computer screen. This sensory feedback about brain activity brings it from an inaccessible level to conscious awareness. Not all brain training approaches require the expense of EEG machines. All brain training, however, targets presumed underlying neural deficits, and it is reasonable to assume that if these improve so too will behavioural symptoms.
A group of dedicated researchers around the globe believe that such intervention can lead to the enhancement of mental performance, normalize behaviour, and stabilize mood. However, academics debate the efficacy of the method. Some vehemently argue that it should be included as an evidence-based treatment for ADHD (Arns et al., 2009). However, a follow up meta-analysis by Grant Willis and colleagues (2011) suggest that this claim was premature; and they reaffirmed the positions taken by an earlier review which concluded “... we cannot recommend the use of EEG in a clinical setting based on current empirical data ...” (Loo & Barkley, 2005; p. 74).
A significant issue, it seems, is whether or not gains are visible at a behavioural as well as a cortical level.  This appears largely based on the issue of the generalizeability of effects, in the treatment of mental disorders (Grant-Willis et al., 2011) or improving overall cognitive functioning (Stephenson, 2010). According to a researcher in the area (Ogrim, 2011), such conflicting stances can be explained by the fact that despite some promising preliminary results, the research is either absent or fraught with methodological problems. This is not a point of contention, since regardless of the source, they all appear adamant (and it does appear evident) that further research is needed.

Diets & Supplements

Elimination diets refer to a process where an individual stops consuming certain foods, such as sugar or artificial food colouring or additives. The most well-known of these is the Feingold Diet (Feingold, 1976).
Arnold (2002) reviewed the literature on elimination diets and concluded that there was no credible evidence to suggest them as efficacious treatments. However, he does go on to say that for a small subset of children with ADHD who have coexisting food allergies, their use as complimentary treatments is of benefit. Erick Taylor (2011) claims that while in generally diets and supplements are not advisable, elimination of citric acids (e.g., lemons) has shown some promise.
The inclusion of essential fatty acids(e.g., omega-3 and omega-6) has not yet been ruled out. However, they are not to be considered as evidence-based (Arnold, 2002; Brown, 2006), but further research is warranted.
There is no research suggesting that this is the case, however, I have often wondered about the effects of parent’s behaviour when strictly monitoring their child’s diet. For example, if a mother must prepare a special meal for one of their children, while the others receive the typical dinner. As the parent watches eagerly to see if symptoms improve, does the child pick up on this, and are they responding to the additional attention and expectations rather than the effects of their diet?
Homeopathy was born more than 200 years ago when a German doctor S. Hahneman suggested that illness was the result of an imbalance in 'vital forces' such as negative states of mind (or miasms). The evidence base for homeopathy as a treatment for any condition is seriously lacking, indeed, the NHS suggest that the dilution of the chemicals actual mean that very little to no traces remain in the supplements. That said, I did come across an articleby Frei et al (2005), and whileit is only a single study with some methodological problems, it makes me inclined to not write off the approach completely, however, I certainly remain very sceptical.

Meditation, Yoga, & Exercise

Mindfulness meditation is a cognitive exercise, and self-regulatory practice which is multifaceted but appears to improve self-regulation of attention and emotion (Bishop et al., 2004). While it is early days, findings suggest it may be an effective treatment with children (Arnodl, 2001), adolescents and adults (Zylowska et al., 2008). Given my personal interest in the area of self-advocacy and the emphasis I place on self-awareness research into this approach holds great promise in my humble opinion.
Exercise regiments or yoga practices have been discussed with regards to treatment of ADHD symptoms and a range of other learning difficulties. However, beyond the common sense view that exercise (along with a healthy diet) is required for optimal human functioning, I am inclined to agree with Brown’s (2006) assertion that arguing for their use as even a complimentary therapy represents a misunderstanding and/or over-simplification of the biological basis of ADHD.

Antidepressants

Apart from the logical assumption that medication targeting dopamine and serotonin would be of benefit in treating ADHD, findings do not support its use (NICE, 2008). Indeed, their successful use appears to be due to treating coexisting depression and anxiety disorders, rather than ADHD symptoms (Brown, 2006). However, the co-occurance of ADHD with depression and other forms of internalizing psychological problems (e.g., anxiety) is well documented (Barkley, 2010).

Summary & Conclusion

While there is no harm in considering all of your options, make sure that you know the risks associated with any alternative or traditional form of treatment. Be advised that early intervention is recommended, and the earlier the better.

Authors of the article: Kate Carr-Fanning and Conor Mc Guckin, the School of Education, Trinity College Dublin, 2012.

References

Arnold, L. E. (2001). Alternative treatments for adults with attentiondeficit hyperactivity disorder (ADHD). Annals of the New York Academy of Science, 931, 310-341.
Arnold, L.E. (2002). Treatment Alternatives for Attention-Deficit/Hyperactivity Disorder. In P.J. Jensen, & J. Cooper (Eds.), Attention-Deficit/Hyperactivity Disorder: State of the Science and Best Practices. Kingston, NJ: Civic Research Institute.
Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., et al. (2004). Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice, 11(3), 230-241.
Brown, Thomas E. (2005). Attention Deficit Disorder: The Unfocused Mind in Children and Adults. New Haven, CT: Yale University Press.
Children and Adults with Attention-Deficit / Hyperactivity Disorder (CHADD) (2008).Complementary and Alternative Treatments. Retrieved from: http://www.help4adhd.org/documents/WWK6.pdf
European Medical Agency (2012).Evaluation of Other Substances. Retrieved from: http://www.ema.europa.eu/ema/index.jsp?curl=pages/about_us/q_and_a/q_and_a_detail_000114.jsp&mid=WC0b01ac058035b2b0#section4
Feingold, Ben F. (1976). Hyperkinesis and learning disabilities linked to the ingestion of artificial food colors and flavors. Journal of Learning Disabilities 9(9), 551–559. Retrieved from: http://www.feingold.org/Research/PDFstudies/Feingold75.pdf
Frei H., Everts R., von Ammon K., et al. (2005) Homeopathic treatment of children with attention deficit hyperactivity disorder: a randomised, double blind, placebo controlled crossover trial. European Journal of Paediatrics, 164(12), 758-767.
National Health Service (2012).Issues Surrounding Homeopathy. Retrieved from: http://webarchive.nationalarchives.gov.uk/+/www.nhs.uk/Conditions/Homeopathy/Pages/Issues.aspx
Zylowska, L., Ackerman, D.L., Yang, M.H. et al. (2008). Mindfulness Meditation Training in Adults and Adolescents With ADHD A Feasibility Study. Journal of Attention Disorders, 11(6), 737-746.






















 



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