Unfortunately, the answer appears to be, “not really.” Several sources of data suggest that there is not strong evidence to support the use of non-pharmacological interventions to treat core ADHD symptoms. Core symptoms refers to the central problems of impulse control (including low frustration tolerance and impatience) and inattention (including difficulties with distractibility, task completion, sustained focus and forgetfulness).
A recent meta-analysis* examining the effectiveness of non-medication based treatment found that there was no strong evidence indicating that treatments other than medication are helpful in alleviating core ADHD symptoms. This study examined a wide range of interventions, from behavioral to dietary. The authors carefully examined the findings of the study and distinguished findings based on more and less stringent criteria. Specifically, the authors noted when findings were based on blind evaluators (evaluators who did not know what intervention a child received) versus when finding were based on not-blind evaluators (evaluators who were aware of the intervention the child was receiving and possibly had an investment finding that the intervention was helpful). When more stringent criteria was used, blind evaluators, the authors concluded that there was little evidence to support non-pharmacological interventions. Specifically, the authors concluded that, “Most notably, the standardized mean differences for all psychological interventions dropped considerably, to non-significant levels, when analyses were restricted to trials with probably blinded assessments.” In other words, there is no clear evidence to support non-pharmacological interventions as helpful in reducing core ADHD symptoms.
A second source of data questioning the value of non-pharmacological interventions was a recent meta-analysis** of Working Memory. This analysis found that interventions based on efforts to strengthen working memory, e.g., CogMed, showed no real benefit. This study is discussed in detail in two previous posts in this Blog.
However, these findings do not mean that medication is the only intervention to consider for children with ADHD. First, the findings of these meta-analyses focused on core ADHD symptoms. Many children with ADHD present with multiple problems and symptoms ranging from oppositional behavior to anxiety and low self-esteem. These problems are far more amenable to psychological interventions. Second, families with ADHD often do not fully understand the implications of the diagnosis of the child with ADHD, and are stressed by the child’s behavioral difficulties. Thus, psychological interventions, include parent education and training, are often quite useful for children and families with ADHD.
References
“Nonpharmacological Interventions for ADHD: Systematic Review and Meta-Analyses of Randomized Controlled Trials of Dietary and Psychological Treatments.” American Journal of Psychiatry. Volume 170, No. 3. March, 2013. by Edmund J.S. Sonuga-Barke, Ph.D.; Daniel Brandeis, Ph.D.; Samuele Cortese, M.D., Ph.D.; David Daley, Ph.D.; Maite Ferrin, M.D., Ph.D.; Martin Holtmann, M.D.; Jim Stevenson, Ph.D.; Marina Danckaerts, M.D., Ph.D.; Saskia van der Oord, Ph.D.; Manfred Dopfner, Ph.D.; Ralf W. Dittmann, M.D., Ph.D.; Emily Simonoff, M.D.; Alessandro Zuddas, M.D.; Tobias Banaschewski, M.D., Ph.D.; Jan Buitelaar, M.D., Ph.D.; David Coghill, M.D.; Chris Hollis, M.D.; Eric Konofal, M.D., Ph.D.; Michel Lecendreux, M.D.; Ian C.K. Wong, Ph.D.; Joseph Sergeant, Ph.D.; European ADHD Guidelines Group.
** Melby-Lervag M, & Hulme, C. “Is working memory training effective? A meta-analytic review.” Developmental Psychology. Advance online publication. (May 21, 2012.)