Debate Continues Over How Best to Treat Attention Deficit Hyperactivity Disorder

With the emergence of alternative methods for treating Attention-Deficit Hyperactivity Disorder, many are questioning whether popular prescription medications are still the best choice. 

"I am always trying to help my patients understand the cause and options for treating their ADD/ADHD," said Dr. Tasneem Bhatia, author and integrative health expert. "While some patients do need medication, we have seen attention and hyperactivity improve with alternative regimens. Spending time educating patients about prevention has proven effective in our practice."

More than six million American kids have been diagnosed with ADHD, reported U.S. News & World Report. That represents a 41 percent jump in the last decade. And for years, the go-to treatment for ADHD has been stimulant medications. A New York Times analysis of U.S. Centers for Disease Control and Prevention data, cited by U.S. News, revealed that two-thirds of diagnosed kids take stimulant medications.

The most popular medications include Ritalin® (methylphenidate) and Adderall® (amphetamine/dextroamphetamine). Antidepressants are also used to combat ADHD, but are generally less effective. According to Mayo Clinic, stimulants boost and balance levels of neurotransmitters, key brain chemicals that influence what's called "executive functioning."

The United States has a particularly strong preference for this type of treatment. Daniel Goleman, in a New York Times blog post, reviewed research by the University of California - Los Angeles which showed that teens in Finland have almost identical rates of ADHD as American teens. Yet relatively few Finnish teens take medication for the disorder.

Researchers also have reported that while most young people with ADHD benefit from medications in the first year, these effects generally wane by the third year. “There are no long-term, lasting benefits from taking ADHD medications,” James M. Swanson, a psychologist at the University of California - Irvine, told The Times.

These medications can have troubling side effects ranging from insomnia and weight loss to heart problems and suicidal thoughts. The meds--popular as a "study drug" on college campuses and even in high schools nationwide--also have a potential for abuse, Bhatia said.

For these reasons, Mayo Clinic has provided guidelines for parents regarding dispensing prescription drugs to children. These include administering the medications carefully (children and teens should not be in charge of their medication), keeping the medication out of kids' reach and giving it to the school nurse for distribution to the child. 
 

Alternatives to Medication

"The concept of this perfectionist-driven, overachieving society pushing medications on children...just doesn't correspond with what we hear from parents, who will try almost any alternative to giving their children psychiatric medications," Susan Caughman, editor in chief of the magazine ADDitude, told U.S. News.

Indeed, a growing number of non-medication treatment strategies have emerged. Bhatia's practice recommends correcting irregular sleep cycles, keeping insulin stable, correcting nutritional deficiencies, implementing morning exercise, and limiting the use of electronic devices such as tablets, smartphones and laptops. 

Mayo Clinic suggests additional strategies such as yoga or meditation; special diets that limit or eliminate sugar, wheat, milk or eggs; and vitamin or herbal supplements.

In addition, Anthony Rostain, professor of psychiatry at the Hospital of the University of Pennsylvania and the Children's Hospital of Philadelphia, told U.S. News he sees promise in newer techniques like biofeedback, a neurological exercise that helps patients strengthen cognitive skills.

Experts say alternative methods have yet to show any substantial impact, so what do they mean for the future of ADHD treatment? According to Rostain, it is up to patients and prescribers to be more selective in the methods used to treat the disorder. "Effective treatment hinges on meeting the unique needs of each child."

Medications, while not a "cure," will likely always be a popular form of treatment. They provide kids with "a short-term ability to focus" so they can employ other long-term treatments, Caughman told U.S. News.

Related resources

Teaching Children With ADHD: 10-Part Series
How Can Teachers Help Students with ADHD?
ADHD: Misunderstood, Misinterpreted and Misdiagnosed
Closing the Achievement Gap for Students with ADHD
 

Article by Navindra Persaud, EducationWorld Contributor
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