1. Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents.
- Author
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Sibley MH, Bruton AM, Zhao X, Johnstone JM, Mitchell J, Hatsu I, Arnold LE, Basu HH, Levy L, Vyas P, Macphee F, Gonzalez ES, Kelley M, Jusko ML, Bolden CR, Zulauf-McCurdy C, Manzano M, and Torres G
- Subjects
- Humans, Child, Adolescent, Attention Deficit Disorder with Hyperactivity drug therapy, Cognitive Behavioral Therapy
- Abstract
Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment., Competing Interests: Declaration of interests MHS receives royalties from Guilford Press and has received honoraria from Supernus Pharmaceuticals, and serves as the secretary of the American Professional Society for ADHD and related disorders. JMJ's research received donated products from Hardy Nutritionals and Truehope. JM receives royalties from Guilford Press and consulting fees from Myndlift. JM also receives research funding from the Templeton Foundation and the Duke Center for AIDS research. LEA receives research funding from Roche, Axial, Syneos, Supernus, and Myndlift, and the Foundation for Mental Health. LEA has received consulting fees and support for meeting attendance from Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). LEA's research has received an equipment loan from Myndlift and donated products from Hardy Nutritionals. All other authors report no competing interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)
- Published
- 2023
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