Towards an Evidence-based Taxonomy of Nonpharmacologic Treatments for ADHD

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Key points

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    Some parents seek nonpharmacologic treatments for their children with attention-deficit/hyperactivity disorder (ADHD).

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    Research about nonpharmacologic treatments has grown rapidly in recent years.

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    An evidence-based approach can help clinicians explain to parents the relative utility of ADHD treatments.

Abbreviations

ADHDAttention-deficit/hyperactivity disorder
OCEBMOxford Center for Evidence-Based Medicine

Attention-deficit/hyperactivity disorder (ADHD) is perhaps the most well-known of all

Level of evidence and magnitude of treatment efficacy

Figs. 1 and 2 summarize the relative efficacy of treatments based on meta-analyses in the literature4, 5 and information provided in this issue. Fig. 1 provides the OCEBM level of evidence for each treatment. The levels have been scaled so that larger numbers indicate a higher level of evidence. The levels are defined as follows:

  • 1.

    Mechanism-based reasoning

  • 2.

    Case series, case-control studies, or historically controlled studies

  • 3.

    Non–randomized controlled studies

  • 4.

    Single randomized trial or observational

A meta-algorithm for the treatment of ADHD

Although this issue is about nonpharmacologic treatments for ADHD, it is not an antipharmacotherapy treatise. Any competent practitioner incorporates both pharmacologic and nonpharmacologic approaches as warranted by the clinical picture of the patient and the preferences of patients and parents. Treatment algorithms are useful because they provide a concise guide to help clinicians choose among many treatment options. However, treatment algorithms are worthless if applied blindly, without

Summary

In summary, the past decade has seen many advances in nonpharmacologic treatments for ADHD. There are new approaches such as working memory and neurofeedback training and more research on older treatments (eg, diet, TCM, behavior therapy) that allows a more systematic evaluation of their efficacy. Perhaps, more importantly, nonpharmacologic interventions have embraced an evidence-based approach that motivates quality research and makes it easier for clinicians to make recommendations to their

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All authors of this article have seen and approved the submission of this version of the article and take full responsibility for the article.

In the past year, Dr S.V. Faraone received consulting income, travel expenses, and/or research support from Ironshore, Shire, Akili Interactive Labs, Alcobra, VAYA, and Neurovance; and research support from the National Institutes of Health (NIH). His institution is seeking a patent for the use of sodium-hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programs sponsored by: Shire, Alcobra, Otsuka, McNeil, Janssen, Novartis, Pfizer, and Eli Lilly. Dr S.V. Faraone receives royalties from books published by Guilford Press (Straight Talk about Your Child’s Mental Health) and Oxford University Press (Schizophrenia: The Facts).

Dr K.M. Antshel has no conflicts of interests or financial relationships to disclose.

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