Complementary and Integrative Treatments for Attention-Deficit/Hyperactivity Disorder in Youth

Editorial: Grappling With the Relationships of Attention-Deficit/Hyperactivity Disorder and Obesity

In this issue of the Journal, Reed and colleagues1 explore the intersection of 2 important public health problems: overweight/obesity and attention-deficit/ hyperactivity disorder (ADHD), both having a high population prevalence and tending to start in childhood. They analyzed data cross-sectionally and longitudinally from a UK birth cohort of 7,908 youth, including 442 with ADHD by either actual diagnosis or parent-rated threshold score. This epidemiologic ADHD prevalence was comparable to those in other countries, although the actual diagnosis rate was lower. They added a cross-lagged longitudinal perspective to previous reports showing a small association of obesity with ADHD, especially in adults. Their clinically important findings include the following. (1) Both disorders are associated with slightly lower birth weight, presumably reflecting a generally less favorable gestation. (2) The shift from underweight to overweight for those with ADHD occurred in preschool years, at 3 to 5 years of age. (3) ADHD symptom severity predicted overweight: for girls, "higher ADHD symptoms at ages 7, 11, and 14 predicted higher body mass index (BMI) at 11, 14, and 17, respectively." For boys, higher ADHD symptoms at age 11 predicted higher BMI at 14 years. (4) Girls had earlier onset of obesity/overweight (not necessarily a higher rate than boys with ADHD). These have numerous clinical and research implications cutting across many areas of inquiry.

Novel and complementary treatment approaches in attention-deficit/hyperactivity disorder

PURPOSE OF REVIEW

To provide an updated review of novel and complementary treatment approaches for children and adolescents with attention-deficit/hyperactivity disorder.

RECENT FINDINGS

The evidence for complementary attention-deficit/hyperactivity disorder treatments is often promising, but limited to small, unblinded studies. Recent evidence from larger, more rigorous studies reveals that most of these treatments have modest efficacy. Omega-3 polyunsaturated fatty acids, saffron, broad spectrum micronutrients, and physical exercise have potential benefits that seem to outweigh known risks. However, neurofeedback, cognitive training, and trigeminal nerve stimulation need further research to determine whether specific sub-groups of children/adolescents with attention-deficit/hyperactivity disorder would benefit long-term with their associated tolerable risks.

SUMMARY

There is not sufficient evidence for complementary treatments to be recommended as substitutes for first-line pharmacological and psychosocial treatment options. Nonetheless, some adjuvant therapies to currently recommended attention-deficit/hyperactivity disorder treatments can be safe. Physicians should be familiar with existing and emerging complementary treatments to help guide families.

Settling a distracted globe: An overview of psychosocial and psychotherapeutic treatment of attention-deficit/hyperactivity disorder

While the currently prevailing theory of ADHD postulates a neurobiological background and core deficits of behavioural inhibition and executive functioning as the basis of ADHD symptoms, our current conceptualisation also acknowledges the essential contributory role of psychosocial, ecological, and cognitive factors. Considering the multifactorial background of ADHD, its treatment equally needs to be multifactorial involving, besides pharmacotherapy, skill development and psychotherapy as well, especially if we postulate the increasing contribution of social factors in the background of the increasing burden of ADHD. Pharmacotherapies, including stimulants and non-stimulant ADHD medications applied as first-line treatments have a positive effect on core behavioural symptoms, however, they often do not sufficiently remediate several other symptoms and comorbid disorders, which are consequences of ADHD, especially considering that ADHD persists into adulthood and is present over the whole life span. Furthermore, pharmacological treatment is not sufficient to substitute for the skills needed to manage symptoms and adapt well to the environment. As part of a multimodal treatment approach, psychological therapies for ADHD target, besides core ADHD symptoms, other associated features including emotional dysregulation, personality development, neurocognitive dysfunction, depression, anxiety, and sleep problems. Insufficiently treated ADHD may contribute to psychological and personality developmental problems in children, as well as increased health costs and decreased productivity warranting multimodal treatment to address the areas not sufficiently targeted by ADHD-specific pharmacotherapy.