If your child is one of the 6.4 million American kids diagnosed with attention deficit hyperactivity disorder (ADHD), he or she is probably being treated with medication or behavior modification therapy—or both. Studied extensively, these first-line ADHD treatments have been found to reduce the symptoms or negative effects of ADHD on a child’s daily functioning.
You may have also heard about alternative treatments for ADHD, such as biofeedback or special diets. But what do we really know about these treatments? Do they improve symptoms and functioning? What evidence do we have? The following brief review will help answer these questions for several different treatments.
Addressing organization, time management, and planning (OTMP) skills: In school settings, teaching OTMP skills in groups has been found to be effective for middle and high school students. In clinical settings, the only program that has been tested and found effective was created at NYU Langone Medical Center’s Child Study Center. Clinical intervention improved children’s OTMP skills and academic productivity and performance, and decreased homework problems and family conflict.
Neurofeedback: Also called biofeedback, neurofeedback is a self-regulation technique in which an individual is taught to alter his or her brain’s electrical activity in an attempt to stay focused and attentive. The American Academy of Pediatrics (AAP) does not recommend neurofeedback in its recently revised clinical guidelines for diagnosis and management of ADHD. On top of concerns about its efficacy, neurofeedback is extremely expensive and time-intensive, and may not be covered by insurance.
Cogmed: A commercially available, proprietary neurocognitive training program, Cogmed is marketed as a computer-based solution for attention problems caused by poor working memory. A 2011 study concluded that Cogmed does lead to memory improvement, but does not improve function in the area of the brain associated with ADHD symptoms.
Feingold diet: Restricted in sugar and free of additives and salicylate, this diet shows no significant benefit for ADHD except for those children with related food sensitivities.
Elimination/oligoantigenic diet: An oligoantigenic diet eliminates most known sensitizing food antigens or allergens, such as cow’s milk, eggs, wheat cereals, nuts, and more. Although the AAP does not recognize dietary interventions as effective ADHD treatments, a 2012 meta-analysis of 14 studies suggests that an elimination diet can benefit some children with ADHD.
Ketogenic diet: A diet high in fat and low in carbohydrates does not help with ADHD; however, it may offer some benefit to reducing hyperactivity in epileptic patients.
Poly-unsaturated fatty acid supplements: Some children may be helped by doses of 300 to 600 mg/day of omega-3 and 30 to 60 mg/day of omega-6 fatty acid supplements. These supplements can be continued for two or three months, or longer if indicated, as a complement to medication and behavior treatment.
Other diet considerations: Sugar does not usually affect the behavior or cognitive performance of children, but a small effect on subsets of children cannot be ruled out or proven. Iron deficiency is not linked to ADHD. Any effects of food dyes or artificial food coloring on hyperactivity are inconsistent and moderate. Herbal supplements, such as ginko biloba and kava kava, have shown no positive effects on ADHD.
Exercise: A 2011 review found exercise to have positive effects on the behaviors of children with ADHD, but not necessarily on ADHD symptoms. Exercise can be used as a supplemental—but not stand-alone—treatment.
Occupational therapy techniques: There is not enough evidence to support either the wearing of a weighted vest or the use of an interactive metronome to increase on-task behavior.
If you are considering alternative ADHD treatments for your child, be sure to talk with your doctor about evidence of their efficacy, potential costs and benefits (including side effects), what concerns the treatment will address, and how to measure those concerns.
Richard Gallagher, PhD, is a clinical psychologist and neuropsychologist who directs the Selective Mutism Program and Organizational Skills Training Program at NYU Langone Medical Center’s Child Study Center. He also is an associate professor of clinical psychiatry, as well as child and adolescent psychiatry, at the NYU School of Medicine. With a PhD from Temple University, Dr. Gallagher focuses on selective mutism, disruptive behavior disorders, attention deficit disorders in children and adults, organizational skills, and parenting.
At Hassenfeld Children’s Hospital at NYU Langone, we understand that caring for infants, children, and teenagers is a special privilege. That’s why we partner with our young patients and their families to offer expert medical and surgical care. Our specialists treat children with conditions ranging from minor illnesses to complex, more serious issues at locations throughout the New York metropolitan area.