Drug or non-drug ADHD Treatment, What is Best?

Drug or non-drug ADHD Treatment, What is Best?

Many people in the ADHD community insist that non-Drug ADHD Treatments simply do not work.  When a study is published indicating a positive effect from taking Zinc or from computerized working memory training, most ADHD authorities insist that the study was small, or poorly done, or that it did not have a good control group.  These concerns are all valid but they apply to the research performed on drug treatment as well.

The U.S. Department for Health and Human Services Agency for Healthcare Research and Quality (AHRQ) set out to critically review all the studies that had been performed, from 1980 to 2010, on the benefits of behavioral therapy and stimulant ADHD treatment.

AHRQ is this country's healthcare watch dog agency and they have been asked to look at diseases and their treatments to determine what interventions really work.  As the amount of money spent on health care increases, questions such as, “What ADHD treatment really works?”, become critically important.

According to the AHRQ webpage, their mission is to improve the quality, safety, efficiency, and effectiveness of health care for all American by generating the knowledge and tools required to improve the quality of life, save lives, and gain value for the health care dollars that we spend.

When the AHRQ looked at 30 years worth of ADHD research, what they found was pretty amazing.  The agency published their findings in an October of 2011 report.  Their report states that many of the studies performed over the last 30 years did not meet the criteria necessary to deem them 'good' studies, (for all the same reasons that I mention above regarding the non-drug treatment studies), but from the few good studies that were performed, there were only able to conclude that, in terms of long term benefits for ADHD symptoms:

1.      Parent training worked well for diminishing the ADHD behaviors of preschoolers

2.      Primary school age boys with ADHD combined type, showed improvements in behavior when they were treated with methylphenidate (Ritalin) or Atomoxetine (Strattera). 

That’s it!  Those were the only two conclusions that they were able to make.

Studies haves shown that 50% of adults and children prescribed a stimulant for ADHD will discontinue the medication within 12 months.  The reasons for discontinuation are varied and include side effects, unmet expectations or simply a discomfort with taking a controlled substance.  

When stimulant medication is stopped, parents of children with ADHD and adults with ADHD symptoms may look to alternatives only to be told by their health care provider that the benefits of these therapies are questionable or short lived.

Given the findings of Agency for Healthcare Research and Quality it appears that, unless you are a preschooler or a 10 year old boy with combined type ADHD, the same can be said for drug therapy.

So the next time you question your health care provider about the merits of a non-drug therapy and they report that therapies such as working memory training, social skills training or fish oil supplements do not work, you should mention the above study and remind our learned ADHD specialist that apparently, for most people with ADHD, not much does.

Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].
Charach A, Dashti B, Carson P, Booker L, Lim CG, Lillie E, Yeung E, Ma J, Raina P, Schachar R.
Rockville (MD): Agency for Healthcare Research and Quality (US); 2011 Oct. Report No.: 12-EHC003-E
AHRQ Comparative Effectiveness Reviews.