European Guidelines Group questions non-drug treatment; John Hopkins Center (U.S.) finds ineffectiveness of medication
An important study for the European ADHD Guidelines Group questions the effectiveness of non-pharmaceutical ADHD treatment on the main symptoms. At the same time an American study by the John Hopkins Children's Center finds that young children hardly benifit from medication or combined treatment. These studies were respectively published in The American Journal of Psychiatry and in the Journal of the American Academy of Child & Adolescent Psychiatry (both March 2013).
The European research group has revealed by a meta-analysis that behavioural interventions, neurofeedback, cognitive training and restricted eliminations diets do not have a significant effect on the main symptoms of ADHD when a blind assessment (probably) is used (Sonuga-Barke, et al., 2013). However, the psychological forms of therapy can be useful for alleviating secondary problems. Professor Eric Taylor of King's College (London) supported these conclusions during his lecture at the ESCAP 2013 Congress in Dublin; Taylor said that cognitive and behavioral training do not seem to be effective and that a deeper insight in the different types of attention problems will be needed.
The review, an analysis of 54 studies by the European ADHD Guidelines Group, was titled 'Non-pharmacological interventions for Attention-Deficit/Hyperactivity Disorder: systematic review and meta-analyses of randomised controlled trials of dietary and psychological treatments' and drew the following conclusions: free fatty acid supplements produced small but significant reductions in ADHD symptoms even with probably blinded assessments, although the clinical significance of these effects remains to be determined. Artificial food color exclusion produced larger effects but often in individuals selected for food sensitivities. The study says that better evidence for efficacy from blinded assessments is required for behavioral interventions, neurofeedback, cognitive training and restricted elimination diets before they can be supported as treatments for core ADHD symptoms.
Co-author Dr Emily Simonoff, child and adolescent psychiatrist at King's College, said to a HealthDay reporter: “I think our findings allow a much more informed discussion than did previous work because we've been able to demonstrate that what we once thought worked is more limited and more questionable.”
Simultaneously, an American study found that nine out of ten young children (3 - 5 years old) with moderate to severe attention-deficit/hyperactivity disorder continue to experience serious to severe symptoms and impairment long after their original diagnoses, and in many cases, despite treatment. Children taking ADHD medication had just as severe symptoms as those who were medication-free.
This study, led by investigators at Johns Hopkins Children’s Center (Baltimore, Maryland), is said to be the largest long-term analysis to date of preschoolers with ADHD (186 children were followed during six years from diagnosis).
The American Journal of Psychiatry, VOL. 170, No. 3
Journal of the American Academy of Child & Adolescent Psychiatry, 2013; DOI: 10.1016/j.jaac.2012.12.007.
Professor Jan Buitelaar (Nijmegen, Netherlands) comments on ADHD medication at the ESCAP 2015 Congress in Madrid.
NICE maintains a guideline for attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults (CG72). The UK National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care.
The ADHD expert group of the Dutch Knowledge Centre for Child and Adolescent Psychiatry has developed an evidence-based protocol for diagnosis and treatment of ADHD.
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