Treatment of ADHD
(3-6-14)

Medication

CNS Stimulant [approximate 75% effect rate, slightly higher with higher symptom thresholds for diagnosis]

improvement, usually not remission

Ritalin (methylphenidate)

Concerta [same drug, different delivery system]

Adderall

extended release versions

Dexedrine (d-amphetamine)

Cylert (pemoline) [use largely discontinued due to health concerns]

non-stimulant medication for ADHD

Strattera (atomoxetine)

Tricyclics (often used as antidepressants) [possibly app. 66% effect rate]; largely replaced today by SSRI's

Tofranil (imipramine)

Norpramin (desipramine)

Clonidine (an antihypertensive)

May differentially target impulsive symptoms.

Selective Serotonin Reuptake Inhibitors (SSRI's) (often used as antidepressant and anxiolytic agents)

Prozac (fluoxetine)

Paxil

Zoloft

Anticonvulsant medications (applicability may be more in undiagnosed cases of bipolar disorder in youth)

Tegretal

gabapentin (Neurontin)

Dilantin

Mood stabilizers (antimania drugs) (applicability may be more in undiagnosed cases of bipolar disorder in youth)

Lithium

Atypical antipsychotic medications (neuroleptics), may be added to attempt increased control of temper/rage and/or stabilize mood

Risperdal

Geodon

Zyprexia

Behavioral Treatments [app. 75% effect rate]

Home contingency management programs

School contingency management programs

Cognitive behavior modification for impulse control (data mixed on effectiveness)

Social skill training (date mixed on effectiveness)

Special Education [for relief of comorbid learning disabilities]

Combinations of pharmacological and behavioral treatments

The MTA Study

The Multimodal Treatment Study undertaken by the NIMH was a major investigation of treatment approaches for children diagnosed with ADHD (combined type).

This was a large scale study (almost 600 children from several cities) and yielded a large set of data, which will undoubted continue to be analyzed for several years. Initial publications appeared in 1999. A modest summary overview would include the following:

Reasonably managed medication intervention was an effective intervention for ADHD and had more of an impact on reducing core ADHD symptoms than a standardized, intensive behavioral intervention.

Medication and intensive behavioral intervention was more effective than routine psychosocial treatment.

The combination of medication and behavior intervention did not appear to dramatically improve on the effectiveness of medication alone (possibly, in part, because medication alone did a pretty good job: a ceiling effects) on ADHD symptoms. The combination, however, did seem more effective in improving oppositional behavior, social adjustment, parent-child relations, and reading achievement; and was associated with higher levels of family and teacher satisfaction.

Some previous studies have yield evidence supporting a combination of pharmacological and behavioral treatment, but the added benefit from behavioral treatments have been modest at best. Part of the difficulty in drawing "simple" conclusions (e.g., "medication is better than behavior modification", "medication and behavior mod is better than medication alone") is that the real questions are not simple, and the answers are very dependent on the questions you ask.

Controversial treatments

Larry Silver (2000), a psychiatrist, provides a nice discussion of "Alternative treatments for ADHD" in B.P. Guyer (Ed.), ADHD: Achieving success in school and in life. Boston: Allyn & Bacon.

dietary: "chemical changes"

"Chemical changes refers to the concept of orthomolecular medicine. This is a term introduced by Linus Pauling, Referring to the treatment of mental disorders and other disorders by the provision of the optimum concentrations of substances normally present in the human body (Pauling, 1968)." (Silver, 2000)

Food additives: benefit for very small group (app. 1% of diagnosed cases)

Refined sugars--restricting sugar in diet: no merit

Megavitamins: no merit

Trace elements: no evidence and probably no merit

Herbs: no evidence and probably no merit

experiential: "physiological changes"

"Physiological changes refers to the concept that by stimulating specific sensory inputs or exercising specific motor patterns, one can retrain, recircuit, or in some way improve the functioning of a part of the central nervous system." (Silver, 2000)

Neurotherapy (EEG biofeedback treatment of ADHD): ?

While a number of previous published studies have reported efficacy, a number of methodological challenges have remained; Gevensleben et al. (2009) appears to address many of these. While questions still remain, neurofeedback appears to be emerging as an empirically supported treatment of ADHD

Patterning: no merit; demands on family may be harmful

Vestibular dysfunction--treatment with anti-motion-sickness medication: no merit

other:

chiropractic/homeopathic/alternative medicine: I am aware of no supporting empirical literature

allergies: there may be a relationship between allergies and brain functioning, this is still be investigated, but--to date--treatment programs based on allergy models (other than food additive allergies) have not proved productive