ADHD sufferers may have alternatives to medication

A team of York University researchers has conducted a review which suggests that individuals with attention deficit hyperactivity disorder (ADHD) may have alternatives to medication-based treatments.

Researchers from York’s LaMarsh Centre and Department of Psychology in the Faculty of Health, reviewed 26 major studies of patients with ADHD, undertaken between March 1981 and May 2007. Some of their findings call into question the conventional wisdom that cognitive, cognitive-behavioural or neural-based treatments are ineffective.

"The conventional treatments for ADHD have tended to focus very much on pharmacological interventions," says York psychology Professor Maggie Toplak, who headed up the review. "Unfortunately, medication isn’t a cure for the disorder – it only works as long as you’re taking it, and in 20 to 30 per cent of cases, children respond unfavourably."

Right: Maggie Toplak

Toplak’s group looked at studies which utilized neural, cognitive and cognitive-behavioural (CBT) treatment methods. They found that the majority failed to take into account patients’ use of stimulant medications at the time of evaluation.

"Past studies seemed to demonstrate that CBT, in particular, was ineffective," Toplak says. "We’re seeing now that more research is needed in order to determine its efficacy as a treatment."

CBT instructs patients in behaviour modification and skill-based training, whereas cognitive therapies involve training patients with repeated exposure to cognitive stimuli. Neural or "biofeedback" treatments endeavor to identify abnormal brain-wave patterns and then train individuals to normalize these frequencies.

While there is a strong literature to suggest that some cognitive-behavioural methods may be ineffective, Toplak believes there is an important role for cognitive and cognitive-behavioural approaches for treating ADHD. 

"Some recent work suggests that cognitive-based treatments have a demonstrated effect after a three-month follow-up," she says.

Toplak’s group also found other problems with research methods in the studies they reviewed. "Many of the studies failed to control for expectancy effects," says Toplak. "Parents especially may have expectancies of performance which can colour their evaluation, given their knowledge of the treatment." She suggests this might be addressed in future research by asking patients’ teachers to complete behavioural ratings.

Toplak also cited the need to consider alternative control groups. "A parent may rate their child’s behaviour differently from the mere investment of attending 60 sessions, in comparison to a parent who is in the wait-list control group."

She says the study highlights the importance of constantly updating and evaluating our knowledge, so that basic cognitive research is applied to refining treatment approaches. "There is a real need for families to have alternative treatment options for ADHD, whether to supplement medication or instead of medication."

The study, "Review of cognitive, cognitive-behavioral, and neural-based interventions for Attention-Deficit/Hyperactivity Disorder (ADHD)", is currently in press and available online in Clinical Psychology Review.