Diet changes, behavioral therapies and many other non-medical treatments exist for ADHD. But research on whether or not these treatments work is scarce.
Researchers reviewed published trials that tested non-medical treatments for ADHD. They looked at studies involving dietary changes, nutritional supplements, cognitive training and behavioral programs.
Results showed that diet and nutritional changes were most consistently effective.
The main conclusion, however, was that there is just not enough research on these types of treatments to provide a good understanding of whether or not they work.
The study, led by Edmund Sonuga-Barke, PhD, at the Developmental Brain-Behaviour Laboratory of the University of Southampton in the UK, combined data from studies that used non-medical ADHD treatments to see which ones seemed to work.
The researchers identified 54 studies on kids ages 3 to 18. Some studies used treatment methods such as avoiding food coloring additives, restricting certain foods and taking free fatty acid supplements. Other studies used methods such as cognitive training or programs to change behaviors.
In these studies, researchers measured ADHD symptom scores before treatment and after treatment. ADHD symptom scores are created by asking about core symptoms, like trouble paying attention and fidgeting, and rating them for severity. Scores for each symptom were added together to create an overall symptom score.
The researchers noticed that some studies had teachers or parents rating whether or not the child improved. In other studies, children were assessed by a person that did not know what treatment the child was receiving.
The researchers then grouped the studies based on whether or not the people rating a child’s behavior were aware of the type of treatment. The researchers grouped the studies in this way because ideas about how a treatment works could color the way the child’s response is rated.
The researchers found that restricting certain foods, cognitive training and behavioral programs improved behavior when parents and teachers were rating symptoms. But, in studies where the person rating symptoms did not know the child’s treatment, ADHD symptoms were not improved by these treatments.
In eight trials, researchers tested the removal of food coloring additives. All of these trials had raters who did not know what treatment the kids were getting.
Removing food coloring additives improved ADHD symptoms. But in some of the studies, kids were also taking ADHD medications to control their symptoms.
So the researchers looked at the studies where kids were not taking medication separately. Taking out food colorings didn’t appear to help ADHD symptoms when kids were not taking medication. In light of this finding, the authors suggested that it was not clear if removing food coloring additives alone could improve symptoms.
There were 11 trials in which kids were given free fatty acid supplements, including omega 3, omega 6 or a combination of both. All of these trials involved a rater who was blind to the child’s treatment.
Results showed that these supplements improved ADHD symptoms. When researchers looked at nine of the studies in which kids were not taking medicines, the free fatty acid supplements still worked to improve symptoms.
The authors concluded that free fatty acid supplements and removing food coloring additives improved ADHD symptoms. Other treatments improved symptoms when parents or teachers were rating the child’s behavior but not when the rater was unaware of the treatment.
The authors said that it is possible that cognitive and behavioral programs may offer a benefit that is not measured by the symptom questions used in these studies. So, those programs may help with other behaviors, which is why parents and teachers are seeing a difference in kids.
Overall, the authors said that there is a need for more studies of these types of treatments. Without more research, it is hard to know which ones work and which ones don’t.
"Better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training, and restricted elimination diets before they can be supported as treatments for core ADHD symptoms,” the authors said.
The study was published January 30 in The American Journal of Psychiatry. Dr. Sonuga-Barke receives royalties from New Forest Parent Training self-help manual. The authors reported financial affiliations with multiple pharmaceutical companies. Funding for this review and meta-analysis was provided by Brain Products GMBH, Janssen-Cilag, Lilly, Medice, Shire and Vifor.