Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents.

Margaret H Sibley, Alisha M Bruton, Xin Zhao, Jeanette M Johnstone, John Mitchell, Irene Hatsu, L Eugene Arnold, Hana H Basu, Laura Levy, Pooja Vyas, Fiona Macphee, Erin Schoenfelder Gonzalez, Megan Kelley, Morgan L Jusko, China R Bolden, Courtney Zulauf-McCurdy, Maychelle Manzano, Gabriela Torres

Journal: The Lancet. Child & adolescent health 2023;7(6):415-428

PMID: 36907194

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Abstract

Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.

Address: Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA. Electronic address: [email protected].; Department of Psychiatry, Oregon Health Sciences University, Portland, OR, USA.; Department of Medicine, University of California-Irvine, Irvine, CA, USA.; Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, USA.; Department of Human Sciences, Ohio State University, Columbus, OH, USA.; Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, OH, USA.; Department of Psychology, University of Washington, Seattle, WA, USA.; Department of Medicine, Oregon Health Sciences University, Portland, OR, USA.; Division of Psychiatry and Behavioral Medicine, Seattle Children's Hospital, Seattle, WA, USA.; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, WA, USA.; Department of Psychology, Florida International University, Miami, FL, USA.

DOI: 10.1016/S2352-4642(22)00381-9

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MeSH Terms: Humans, Child, Adolescent, Attention Deficit Disorder with Hyperactivity, Cognitive Behavioral Therapy