There are many nonmedicinal methods available for treating ADHD, but not all of them are equally effective. In some cases, treatments are marketed with only minimal or no clinical trial evidence for their effectiveness in ADHD. Patients do not want to waste their money or their time on treatments that are not likely to work, or that may not be safe. At the same time, however, it is not uncommon for patients to try traditional therapies or alternative therapies with strong clinical trial evidence of efficacy and have incomplete responses, intolerable side effects, or no response at all. In these cases, it may be worthwhile adding other approaches to the mix that have a suggestion, if not absolute proof, of benefit.
Worth trying if medication or other methods have failed.
Neurofeedback. This involves monitoring your brain’s signals and using that information to alter your level of attention. There are many different ways of administering this type of treatment, so its not surprising that clinical trials have varied in whether they have demonstrated effectiveness. It is also difficult to design a good control treatment group so its not certain that the changes demonstrated are due to neurofeedback or some other factor. There is usually a significant time commitment (usually twice a week for at least a few months). Insurance coverage varies. No trial has demonstrated any significant side effects, but many trials have not monitored for side effects.
Take Vayarin. A major advantage of Vayarin is that there are not many side effects. However, the dose of omega 3 is low and there is no evidence that it is more effective than fish oil. It does contain blue dye, which some patients find makes their symptoms worse. Patients who have not tolerated fish oil may be able to tolerate this.
Feingold and other salicylate elimination diets. The Feingold diet eliminates certain additives, colors and salicylates. It is not completely certain that the entire diet is necessary or if its effectiveness comes from dye elimination. If you are going to try this diet, it is well worth your time to get the food list. In other countries, simpler salicylate elimination diets which do not allow a lot of variety have been associated with a high rate of complications, so if you find you are unable to add many foods back to your diet, you should probably see a dietician for advice.
Weighted vest. In one medium sized trial, weighted vests were shown to help reduce hyperactive behaviors and inattention in children with ADHD. However, they were not effective for impulsive or verbal behaviors such as excessive talking. Side effects can include problems with posture and discomfort from the vest, as well as using the vest or its weights as a projectile, but no side effects were long term. It is best to seek the guidance of an occupational therapist when using a weighted vest, particularly if difficulties arise or if there is a question about fit.
EMPowerplus. While this combination supplement recently made the news with a randomized placebo controlled non-industry sponsored trial with positive results showing effectiveness in treating ADHD in adults, the fact is that the trial was very small–only one hundred participants and improvements were only noted in self reports, not in clinician reports. The size of the trial also was too small to get an idea of possible side effects. It is also expensive, with the baseline treatment costing $65-75/bottle. With effectiveness questionable and side effects uncertain, this should be tried only if other, more proven methods have failed, and only in adults.
Worth trying only in certain circumstances.
Iron, zinc, calcium, and/or magnesium. Mineral deficiencies may cause or worsen symptoms of ADHD. A classic example is restless legs syndrome, caused by iron deficiency, leading to restless sleep and daytime sleepiness. Some medications may not work as well if there is a deficiency. However, too much iron can lead to diabetes and cirrhosis of the liver. Zinc in excess can cause vomiting and diarrhea. Too much calcium may lead to kidney stones, and too much magnesium can lead to headaches and muscle weakness. The best thing to do is ask for a blood test for these mineral deficiencies before taking mineral supplements on your own.
Essential oils. There are no clinical trials of essential oils used for treatment of ADHD specifically, though some oils have been effective in small trials for anxiety, depression, and concentration in normal adults. Using these for occasional breakthrough symptoms or insomnia is unlikely to have major side effects other than allergic reactions in the skin if the oils are applied to the body, and headaches, if the aromas are too strong. However, lavender reduced accuracy in arithmetic reasoning in one small trial. Long term side effects are mostly unknown, but lavender oil applied to the skin has been shown to induce growth of breast tissue in boys due to estrogen like activity.
Other diets. Other diets that work for some patients include gluten and/or dairy free diets. There is no clinical trial evidence to show that these diets work for most patients with ADHD. The AAP recommends against these diets as treatments for ADHD because of the risk of complications, including malnutrition and eating disorders. It is possible in the real world that children with dietary sensitivities could be misdiagnosed with ADHD. If you suspect dietary sensitivities are the real issue, then the first step is to keep a diet diary and see if you can identify any triggers before eliminating whole classes of food. Because these diets can be very restrictive and can omit some key nutrients, its important to consult with a dietician if you have any doubts about whether your diet is adequate.
Homeopathy. You can buy homeopathic remedies over the counter, however, they have the best chance of working if you see a reputable homeopath. However, a Cochrane review of randomized controlled trials of homeopathy for ADHD found very little clinical trial evidence evaluating homeopathy for ADHD, and that evidence did not indicate that homeopathy was definitely effective. The FDA broadly classifies homeopathic remedies as unlikely to have significant side effects.
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. “ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics128.5 (2011): 1007-022. Print.
Millichap, J. G., and Michelle M. Yee. “The Diet Factor in Attention-Deficit/Hyperactivity Disorder.” Pediatrics 129.2 (2012): 330-37. Print.
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