Non-pharmacological treatments for ADHD may involve behavioural, psychological, social, educational and lifestyle interventions.1-6
Non-pharmacological treatments for ADHD
A lifespan approach
Non-pharmacological interventions should become increasingly focused on the individual as patients mature and become ‘agents of implementation’ in their care.7
Non-pharmacological treatments: a lifespan approach. Reproduced with kind permission.7
Parent-led behavioural therapy
Parent-led behavioural therapy aims to treat the core symptoms of ADHD and associated oppositional and non-compliant behaviour.8,9 It combines behaviour management techniques with novel therapeutic elements based on developmental models of social and cognitive development.3,8
Classroom-based behavioural therapy
Classroom-based behavioural therapies are delivered in a real-world situation that provides training on the expected behaviour, within the context in which it is required.10 These interventions can be delivered by mainstream teachers following appropriate training, and combine behaviour modification and cognitive behavioural modification techniques.10,11
Cognitive behavioural therapy (CBT)
CBT consists of self-instructional training administered on an individual or group basis.3 It helps the patient to:
- Develop a more planned and reflective approach to thinking and behaving, including social interactions3,6
- Adopt a more reflective, systematic and goal-oriented approach to everyday tasks, activities and problem solving, including academic functioning.3,12,13
Regular sessions of CBT have been shown to reduce ADHD symptoms in children, adolescents and adults.14-22
Psychoeducation can be viewed as the provision of information regarding ADHD to individuals with the disorder and their families/people close to them.23-25
Often seen as an important early step in the treatment of patients with ADHD,6 psychoeducation may help improve treatment adherence,23,26,27 promote satisfaction with treatment27 and increase positive functioning outcomes.28
Psychoeducation – overview
Types of psychoeducation23
Neurofeedback typically involves computer-based exercises, which provide feedback regarding attention levels to enable behavioural training.2,5
Patients’ brain activities are measured by electroencephalogram whilst performing a task, usually a computer game, in which patients receive points when their brain activity shows positive changes.2,29
This gives immediate feedback to patients on their level of attention during a task.5 Patients are then trained to monitor and change their brainwave patterns.5
Exercise and diet
There is some evidence that physical exercise and dietary interventions may be beneficial for individuals with ADHD, however more research is needed in this area.3,4,30-36
- Daley D, van der Oord S, Ferrin M, et al. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry 2014; 53: 835-847.
- 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.
- National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/cg72/resources/attention-deficit-hyperactivity-disorder-diagnosis-and-management-975625063621. Last updated 2016. Accessed 05 January 2017.
- Sonuga-Barke EJ, Brandeis D, Cortese S, et al. 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.
- Taylor E, Döpfner M, Sergeant J, et al. European clinical guidelines for hyperkinetic disorder — first upgrade. Eur Child Adolesc Psychiatry 2004; 13(Suppl 1): I/7-I/30.
- Young S, Amarasinghe JM. Practitioner review: non-pharmacological treatments for ADHD: a lifespan approach. J Child Psychol Psychiatry 2010; 51: 116-133.
- Daley D, O’Brien M. A small-scale randomized controlled trial of the self-help version of the New Forest Parent Training Programme for children with ADHD symptoms. Eur Child Adolesc Psychiatry 2013; 22: 543-552.
- Thompson MJ, Laver-Bradbury C, Ayres M, et al. A small-scale randomized controlled trial of the revised new forest parenting programme for preschoolers with attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 2009; 18: 605-616.
- Miranda A, Presentación MJ, Soriano M. Effectiveness of a school-based multicomponent program for the treatment of children with ADHD. J Learn Disabil 2002; 35: 546-562.
- Hodgson K, Hutchinson AD, Denson L. Nonpharmacological treatments for ADHD: a meta-analytic review. J Atten Disord 2014; 18: 275-282.
- Prevatt F, Yelland S. An Empirical Evaluation of ADHD Coaching in College Students. J Atten Disord 2015; 19: 666-677.
- Sibley MH, Smith BH, Evans SW, et al. Treatment response to an intensive summer treatment program for adolescents with ADHD. J Atten Disord 2012; 16: 443-448.
- Vidal R, Castells J, Richarte V, et al. Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry 2015; 54: 275-282.
- Pettersson R, Söderström S, Edlund-Söderström K, et al. Internet-Based Cognitive Behavioral Therapy for Adults With ADHD in Outpatient Psychiatric Care: A Randomized Trial. J Atten Disord 2014; Epub ahead of print.
- Safren SA, Sprich S, Mimiaga MJ, et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA 2010; 304: 875-880.
- Virta M, Vedenpaa A, Gronroos N, et al. Adults with ADHD benefit from cognitive-behaviorally oriented group rehabilitation: a study of 29 participants. J Atten Disord 2008; 12: 218-226.
- Solanto MV, Marks DJ, Mitchell KJ, et al. Development of a new psychosocial treatment for adult ADHD. J Atten Disord 2008; 11: 728-736.
- Solanto MV, Marks DJ, Wasserstein J, et al. Efficacy of meta-cognitive therapy for adult ADHD. Am J Psychiatry 2010; 167: 958-968.
- Fehlings DL. Attention deficit hyperactivity disorder: does cognitive behavioral therapy improve home behavior? J Dev Behav Pediatr 1991; 12: 223-228.
- 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.
- Ferrin M, Taylor E. Child and caregiver issues in the treatment of attention deficit-hyperactivity disorder: education, adherence and treatment choice. Future Neurol 2011; 6: 399-413.
- Ferrin M, Moreno-Granados JM, Salcedo-Marin MD, et al. Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial. Eur Child Adolesc Psychiatry 2014; 23: 637-647.
- Ferrin M, Perez-Ayala V, El-Abd S, et al. A Randomized Controlled Trial Evaluating the Efficacy of a Psychoeducation Program for Families of Children and Adolescents With ADHD in the United Kingdom: Results After a 6-Month Follow-Up. J Atten Disord 2016; Epub ahead of print.
- Corkum P, Rimer P, Schachar R. Parental knowledge of attention-deficit hyperactivity disorder and opinions of treatment options: impact on enrollment and adherence to a 12-month treatment trial. Can J Psychiatry 1999; 44: 1043-1048.
- 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.
- McCleary L, Ridley T. Parenting adolescents with ADHD: evaluation of a psychoeducation group. Patient Educ Couns 1999; 38: 3-10.
- Bink M, van Nieuwenhuizen C, Popma A, et al. Behavioral effects of neurofeedback in adolescents with ADHD: a randomized controlled trial. Eur Child Adolesc Psychiatry 2015; 24: 1035-1048.
- Pontifex MB, Saliba BJ, Raine LB, et al. Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder. J Pediatr 2013; 162: 543-551.
- Abramovitch A, Goldzweig G, Schweiger A. Correlates of physical activity with intrusive thoughts, worry and impulsivity in adults with attention deficit/hyperactivity disorder: a cross-sectional pilot study. Isr J Psychiatry Relat Sci 2013; 50: 47-54.
- Cerrillo-Urbina AJ, Garcia-Hermoso A, Sanchez-Lopez M, et al. The effects of physical exercise in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis of randomized control trials. Child Care Health Dev 2015; 41: 779-788.
- Konofal E, Lecendreux M, Deron J, et al. Effects of iron supplementation on attention deficit hyperactivity disorder in children. Pediatr Neurol 2008; 38: 20-26.
- Rucklidge JJ, Frampton CM, Gorman B, et al. Vitamin-mineral treatment of attention-deficit hyperactivity disorder in adults: double-blind randomised placebo-controlled trial. Br J Psychiatry 2014; 204: 306-315.
- Johnson M, Mansson 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.
- Stevenson J, Buitelaar J, Cortese S, et al. Research review: the role of diet in the treatment of attention-deficit/hyperactivity disorder–an appraisal of the evidence on efficacy and recommendations on the design of future studies. J Child Psychol Psychiatry 2014; 55: 416-427.