ADHD Treatments:

A review between traditional

drug treatments and alternative treatments

Raman Nazari, Michael Cvetich, Stephanie Valenzuela

University of California, Merced December

7, 2009

Introduction Recent surveys demonstrate general public concern with

increase of ADHD diagnosis and the prescriptions of psycho-stimulant medications in children between the ages of three to eighteen.

All subjects must have met the Diagnostics and Statistics Manual (DSM-IV) criteria for ADHD.

Drug therapy is the common method of treatment. Parents of children prefer alternative natural

treatments.

Reviewed traditional and alternative treatments for ADHD in children. Focus more on the controversial alternative

treatments

Traditional Drug Treatments

Two classes of drug treatments that are FDA approved Psychostimulants Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Psychostimulants are most popular drug treatments: Methylphenidate Dexmethylphenidate Amphetamine Dextroamphetamine

SNRI’s Atomoxetine Fluoxetine

Methylphenidate Most commonly prescribed

medication. FDA approved

Pharmaceutical name Ritalin.

Prior studies show rapid improvement of core and associated ADHD symptoms (Shachar, Tannock, Cunningham and Cokhum, 1997).

Study that showed increase of compliance in activities with different dosage amounts (Barkley, 1988).

Reference: MedScape CME, 2009.

Fluoxetine Fluoxetine is an SSRI

Pharmaceutical name is Prozac. Not FDA approved for ADHD

Originally created as an anti-depressant. However, recent studies have discovered to that are beneficial effects on ADHD (Barrickman, Kuperman, Noyes, Schumacher and Verda, 1991).

Barrickman and colleagues have discovered positive impacts towards ADHD symptoms.

Although there is promise in future, there are a number of adverse side effects. Reference: Mail Online UK, 2009

Atomoxetine Non-stimulant, pharmacotherapy

FDA approved

Acts as an Serotonin-Norepinephrine Reuptake Inhibitor (SNRI).

Proven to reduce anxiety and depressive symptoms, however, it has a negative side effect of increased blood pressure and pulse.

Atomoxetine is a safe and well tolerated drug treatment that should be considered as a method of therapy for children with ADHD (Kratochvil, Newcorn, Arnold, Duesenberg, Emslie, Quintana, et al., 2005).

Reference: Time Magazine, 2009.

Alternative Treatments Though prescription medication has shown to be an

effective method of treatment, there has been an increase in the demand for alternative treatments. Dietary interventions Interactive Metronome Training EEG Neurofeedback Yoga Massage Homeopathic remedies

Dietary Interventions Unclear whether or not diet can

improve behavior, hyper activity, and inattention.

Researchers believe that children are sensitive to certain foods they consume. (Rojas and Chan, 2005).

Feingold Diet is most widely known dietary intervention. Sensitive to artificial sugars, added

coloring, flavors, and preservatives.

Supplementation No controlled studies support this

claim.

Reference: How To Do Just About Everything, 2009.

Interactive Metronome Training

New training program that emerged in the early 1990’s. Help improve ability to selectively attend to

activities for extended periods of time without disruption.

53 of 58 variables affecting ADHD were found significantly improved (Shaffer, Jacokes, Cassily, Greenspan, Tuchman and Stemmer, 2001). Attention, motor control, language, and

processing

Promising future Limited number of preliminary trials. Further

controlled studies with larger sample sizes are needed.

Reference: Interactive Metronome Training, 2009

EEG Neurofeedback New ground breaking technique

Challenges brain to function better as a whole by performing brain exercises

Applying electrodes to brain scalp to measure brainwave activity

Recent study consisting of 23 subjects measured both subjective and objective conditions (Lubar, Swartwood, Swartwood, and O’Donnell, 1995). Found to be appropriate and

efficacious treatment for ADHD

Reference:Hirani Wellness Medical Center, 2009

Yoga Hindu discipline that targets the

training of human consciousness to a state of perfect spiritual insight and tranquility.

Children with ADHD and other concentration disabilities report a greater ability to focus, balance, and compose their daily lives after practicing yoga.

Only one controlled study showed effects on ADHD symptoms. Sessions included respiratory, relaxation, postural, and concentration training (Jensen and Kenny, 2004).

Reference: Family Education, 2009

Massage Involves manual manipulation

to the soft tissue in the body promoting blood flow and relief of muscular tension.

Recent study shows children who received massage therapy for a two week period reported themselves as less fidgety, happier, and more on task (Field, Quintino, Hernandez-Rief and Koslovsky, 1998).

Due to small sample sizes, study results are still considered preliminary.

Reference: North Texas Spinal Health & Wellness, 2009

Homeopathic Remedies

Founded by German physician, Samuel Hahnemann over 200 years ago.

Homeopathic medicine comprises of treatments that involve small doses of natural substances in order to counter symptoms of disease.

Even though homeopathic substances are deemed to be safe, liquid remedies containing alcohol are not suitable for children (Rojas et al., 2005).

When a child with ADHD seeks homeopathic treatment, not only will attention improve, but also physical problems, such as headaches, allergies, and asthma.

Reference:

How To Do Just About Everything, 2009

Conclusion Drug treatments used for ADHD were found more popular.

Some of the effective drugs were Methylphenidate and Fluoxetine. However, there are many adverse side effects.

Through the use of alternative treatments, such as dietary interventions, yoga, and homeopathic remedies, there is hope that ADHD symptoms will be diminished.

There are numerous clinical trials needed in order to successful demonstrate that alternative methods help children with ADHD.

Overall, we believe that the medical drug treatments have better results but alternative therapies are safer.

We believe that the best method of treatment in ADHD with children is a mix combination of drug treatments and alternative treatments.

References Barkley, R.A. (1988). The effects of methylphenidate on the interactions of

preschool ADHD children with their mothers. Journal of American Academy of Child & Adolescent Psychiatry, 27(3), 336-341.

Barrickman, L., Kuperman, S., Noyes, R., Schumacher, E., & Verda, M. (1991). Treatment of ADHD with Fluoxetine: A preliminary trial. Journal of the American Academy of Child & Adolescent Psychiatry, 30(5), 762-767.

Field, T.M., Quintino O., Hernandez-Reif, M., & Koslovsky, G. (1998). Adolescents with attention deficit hyperactivity disorder benefit from massage therapy. Journal of Adolescence, 33(1), 103–108.

Jensen, P.S., & Kenny, D.T. (2004). The effects of yoga on the attention and behavior of boys with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 7(4), 205-216.

Kratochvil, C.J., Newcorn, J.H., Arnold, L.E., Duesenberg, D., Emslie, G.J., Quintana, H., Sarkis, E.H., Wagner, K.D., Gao, H., Michelson, D., & Biederman, J. (2005). Atomoxetine alone or combined with Fluoxetine for treating ADHD with co-morbid depressive or anxiety symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 44(9), 915-924.

References Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O’Donnell, P.H. (1995).

Evaluation of the effectiveness of EEG neurofeedback training for ADHD in a clinical setting as measured by changes in T.O.V.A. scores, behavioral ratings, and WISC-R performance. Journal of Applied Psychophysiology and Biofeedback, 28(1), 83-99.

Rojas, N.L., & Chan, E. (2005). Old and new controversies in the alternative treatment of attention deficit hyperactive disorder. Journal of Mental Retardation and Developmental Disabilities, 11(2), 116-130.

Shaffer, R.J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., & Stemmer, P.J. (2001). Effect of interactive metronome training on children with ADHD. American Journal of Occupational Therapy, 55(1), 155-162.

Schachar, R.J., Tannock, R., Cunningham, C., & Corkum, P.V. (1997). Behavioral, situational, and temporal effects of treatment of ADHD with Methylphenidate. Journal of the American Academy of Child & Adolescent Psychiatry, 36(6), 754-763.

Contributions Raman – I helped contribute to the presentation by

compiling key points from the literature review, come up with visuals, videos, cite references for the photos, and edit the PowerPoint.

Michael – I helped contribute to creating and formatting the power presentation. I helped come up with key points and revised the entire presentation.

Stephanie – I helped find find some of the references for the paper and citing the reference page. I did some of the research and I found a few of the photos for the PowerPoint presentation.