Other methods of treating ADHD
Many researchers and families have long suspected that multimodal treatment (medication used together with multiple psychosocial interventions in multiple settings) should be more effective than medication alone. To determine whether multimodal treatment is indeed effective, the recent NIMH Multimodal Treatment Study of ADHD (called the MTA Study) examined three experimental conditions: medication management alone, behavioral treatment alone, and a combination of both types of treatment. The study compared the effectiveness of these three treatment modes with each other and with standard care provided in the community (the control group). The MTA Study was also designed to determine the relative benefits of these treatments over time. All 579 subjects were treated for 14 months and then followed for an additional 22 months.
The results show that at 14 months, medication and the combination treatment were generally more effective than the behavioral treatment alone or the control treatment (medication management alone). Notably, the combined treatment resulted in significant improvement over the control condition in six outcome areas - social skills, parent-child relations, internalizing (e.g., anxiety) symptoms, reading achievement, oppositional and/or aggressive symptoms, and parent and/or consumer satisfaction - whereas the single forms of treatment (medication or behavior therapy) were each superior to the control condition in only one to two of these domains. The conclusions from this major study are that carefully managed and monitored stimulant medication, alone or combined with behavioral treatment, is effective for ADHD over a period of 14 months. Incorporating behavioral treatment yields no additional benefits for core ADHD symptoms but appears to provide some additional benefits for non-ADHD-symptom outcomes.
A number of diets have been suggested for people with ADHD. The most popular is the Feingold diet, a salicylate- and additive-free diet, which requires rigorous vigilance over a child's eating habits. Although some parents report great success with this diet, it is very difficult to impose it on any child, particularly one with ADHD. Any minor deviation in the diet presumably throws the child immediately into hyperactive mode. One study that reported its efficacy suggested, however, that it might not provide enough nutritive value. It is certainly wise to avoid food with high sugar content and artificial colors and flavors, but the imposition of too rigorous a diet can easily reinforce the ADHD child's sense of alienation from his or her peers. Parents would do better to provide a healthy balance of fresh, natural foods and to try other treatment methods before forcing the Feingold diet on their children.
Neurofeedback is an experimental approach that uses electronic devices to speed up or slow down brain wave activity. In one study, children given this treatment were taught certain high-level mental activities when feedback information indicated that they were fully concentrating. They attended four 50-minute sessions, usually twice a week. At the end of the study, Ritalin use had dropped from 30% to 6%. Significant improvement was reported in inattention, impulsivity, and response time, and IQs increased by an average of 12 points. It should be noted that this was not a controlled study and other factors, such as attention given the children, may have contributed to their improvement. Nevertheless, the positive results from this and other studies warrant research.
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