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Sept. 11, 2000 -- When Pat Patterson, a school counselor from Atlanta, learned four years ago that his daughter, Bess, had ADHD, he hoped she could avoid taking strong stimulant drugs. Patterson has ADHD himself, and had experienced side effects after several years of taking Ritalin.
Vitamins and other dietary supplements didn't help Bess. But, with the approval of her doctors, her parents put her on a behavioral regimen. They learned how to give her easy-to-follow instructions, and created a daily routine for her in which "homework always comes first," Patterson says. They also signed her up for tae kwon-do, a form of karate that teaches her to focus her attention and take instruction.
So far, Bess has been able to avoid stimulants. She is now 11, and undergoing a medical evaluation. And if the doctors think drugs are needed, Bess will take them. "I want her to have a healthy life," says Patterson, 47. "If it takes medication to do that, then it takes medication to do that."
When it comes to treating their kids with ADHD, many parents are balking at Ritalin and other stimulant medications. Instead, they are trying alternative treatments ranging from social skills training to biofeedback, to nutritional and herbal supplements and meditation -- and even Bible studies.
Some of these methods, like behavioral therapy, are tried and true. But psychologists warn that most of the others have not been thoroughly studied, and some have not been studied at all. Some dietary supplements can even be dangerous, they say.
"There are lots of people who have feelings against medication, against Ritalin," says Ann Abramowitz, PhD, an associate professor of psychiatry and behavioral science at Emory School of Medicine in Atlanta. "It's valid that they don't want to medicate their children, that they want to try other things first. It's OK. But the summary of the [research evidence] shows that medication is the most effective treatment.
"However, it isn't the only treatment," she says. "There are other things people can try in conjunction and probably should -- and that often gets overlooked."
In fact, many believe that with better parenting, there would not be so many cases of ADHD. "There are certainly people in the medical community, pediatricians, who think it's a parenting issue," Abramowitz says.
Parent training, behavioral therapy, and behavioral interventions in the classroom are "mainstream, well-documented treatments," says Abramowitz. Most often, they are used in conjunction with medication. In some cases, they can replace medication, she tells WebMD.
"It's very reasonable that parents consider a good behavioral therapy program, because we know there are data to support that," says Peter Jensen, MD, a child and adolescent psychiatrist who is director of the Center for the Advancement of Children's Mental Health at Columbia University in New York. "I wouldn't advise them to consider ... say, blue-green algae ... because there aren't data to support that. And we don't know if it's necessary, safe, or effective."
But what about the lesser-known alternatives? What are they, and what do the experts think about them?
Social Skills Training: Especially in group sessions, this can be useful, Abramowitz tells WebMD. "Kids who have ADHD, especially when it's not well treated, tend to be intrusive with peers; they tend to be impulsive in their actions," she says. "They turn other people off. They have a tendency to be somewhat aggressive, overly talkative, don't keep hands to themselves ... even if it's not aggressive, it's a bothersome kind of thing.
"There are really mixed reviews as to the effectiveness of social skills training with those kids with garden-variety ADHD," she says. "Some kids have more social skills deficits than others -- and it's certainly not a deficit limited to kids with ADHD."
Biofeedback and Neurofeedback: Biofeedback, in which patients learn to control electrical patterns in their own brain, has been used for nearly 30 years as a treatment for ADHD, says Joel F. Lubar, PhD, one of the original biofeedback researchers.
Lubar says that in early studies, electroencephalograms (EEGs) showed different brain wave patterns in ADHD patients. He adds that another study showed that when children learned to change their brain wave patterns to more normal ones, they improved not only in the laboratory setting but also in school. Later, some of the children were phased off their stimulant medications and "did very well," says Lubar, who is professor of psychology and co-director of the Southeastern Biofeedback Institute at the University of Tennessee in Knoxville.
"There are some 1,500 practitioners in the world using our techniques and get very nice results if they do it properly," Lubar tells WebMD. He says that studies have repeatedly confirmed its effectiveness.
More recently, Lubar and colleagues have been working with "neurofeedback," which he says "works best for the inattentive form and mild hyperactive forms of ADD." Their neurofeedback program involves a video display featuring puzzles, mazes, and patterns of all kinds. Electrodes attached to the patient's scalp measure changes in the brain waves, and these changes control what happens on the screen.
"Essentially, they are playing a video display with their brains rather than with their hands," Lubar says. "They control it with how they're focusing. Things happen depending on their brain wave pattern. They keep the display active by producing the right pattern; if they produce the inappropriate pattern associated with poor focusing or inattention, then the whole thing stops until they produce the right pattern again."
With the program, "We're trying to train them to be relaxed, very centered and attentive at the same time, and intruding thoughts are not interfering with your ability to do the task. So when they're doing homework, they're only doing homework; they're not thinking about going to the movies or other things that are happening in their lives," says Lubar.
Lubar says neurofeedback "helps 40-80% of children who are on medication to reduce medication. It is dramatic." But he adds that it may not be useful for children who are on multiple medications and not responding to them. "Those are extremely severe cases," he says.
And now, video game technology has been applied to the neurofeedback concept, says Olafur S. Palsson, PsyD, an assistant professor of psychiatry and family medicine at Eastern Virginia Medical School in Norfolk.
"One of the main advantages of this technique, which was developed by NASA, is we can use off-the-shelf video games," he says. Basically, it blends biofeedback with already existing video games. The child's brain activity "changes the way the video game operates," he says. "The game becomes more rewarding and children do better at the game when they are showing the right shifts in brain activity."
But neurofeedback is an unproven treatment for ADHD, Abramowitz says. "The mainstream field has not accepted neurobiofeedback. ... I'm not telling you that it is or isn't beneficial, but I don't think anybody should pay for it until we know it's an effective treatment."
She and Jensen agree that more studies of biofeedback are also needed.
Nutritional Supplements: Magnesium and mixtures of herbs (silymarin, pycnogel, bilberry, hawthorn, gingko biloba) have been marketed for ADHD, but these are unproven, say Abramowitz and Jensen.
In fact, one supplement, ephedra, "has been linked to several deaths," Jensen tells WebMD. "That's a stimulant but has not been tested for safety and efficacy. ... You hear people say they want to go to natural solutions, but arsenic is natural. All kinds of things are natural; it doesn't make them better. Like anything else, it has to be tested to see if it's safe and effective."
Jensen says there's "a tiny bit of evidence that trace mineral supplements, a tiny bit of evidence that fatty acids, may help with ADHD." This means that the findings of studies of these supplements were mixed, he says. Abramowitz agrees that one dietary supplement that seems promising in the research so far is alpha omega-3 fatty acids.
Food Restriction Diets: Abramowitz says some research has suggested that there are a few children who are very sensitive to some foods, such as corn and wheat, but not necessarily sugar.
"Definitive studies haven't been done," she says. "My own personal belief is that there's a subset of children who have sensitivities. I don't currently consider this a first treatment or most likely one to help every child. But it's possible it could help some children."
Jensen agrees. "It's possible there is a small effect for some children," he says. "The problem is, not enough studies have been done. Most studies show no effect or a small effect in some children. What parents have to consider is that they're gambling." Trying a food restriction diet is unlikely to do much harm, he says, unless it means a parent is delaying effective treatment for a child in crisis.
But, Abramowitz says, trying to find a diet that improves the child's symptoms without driving the parent crazy is very difficult.
Meditation: Although Abramowitz says she is not aware of any studies in which meditation was used to treat ADHD, relaxation training has helped some of the kids with ADHD she has treated. "It's certainly not a primary treatment for ADHD, but it's a very helpful adjunct treatment for tension or anxiety," she says. "But kids are not going to use it on their own. They have to be prompted to use it when things get tense."
Says Jensen: "Meditation had a couple of very small, controlled studies 20 years old that showed it for some children to be a little bit helpful. It would be very interesting to get more research on it."
Interactive Metronome: This is a computer-based technology that combines the principles of the traditional musical metronome with the precision of a personal computer to create interactive training exercises. During this training, kids wear headphones and hand and foot sensors to coordinate their movements to computer-generated musical beats. The system progressively challenges kids to improve their basic motor planning, sequencing, and rhythmic timing skills.
Jensen says he has seen one study on this method recently. "Again, one study doesn't mean it works," he says. "Let's see more data."
Bible Studies: Devotionals focus on helping children understand authority and deal with frustration and anger, and helping parents discipline the ADHD child.
"Bible study programs and karate, those kinds of things, how can they do much harm?" says Jensen. "As a treatment for ADHD, it's not something I'd recommend. But if it's in line with the family's values, who can argue? To be used in lieu of other treatments, there's just no data to support that."
Homoeopathy: This method uses highly diluted extracts of plants, animals, and minerals, as well as other chemicals. And "there's no scientific basis for that, period," says Abramowitz. "That's just fiction."
So the jury is still out on many of the alternative options out there. Medication and/or behavioral therapy are proven options. And some of the alternatives may even place your child in danger. Can you hope that your kid will eventually grow out of ADHD?
"It depends on the kid," says Jensen. "Maybe one-third to one-quarter may grow out of it. But still, the estimates are that 50-80% won't. It doesn't mean they will always be taking the same treatment. They may learn to manage it better as they get older. Maybe they won't need to use medication."
For more information, visit WebMD's Diseases & Conditions page on ADD/ADHD.