TY - JOUR
T1 - Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents
AU - Sibley, Margaret H.
AU - Bruton, Alisha M.
AU - Zhao, Xin
AU - Johnstone, Jeanette M.
AU - Mitchell, John
AU - Hatsu, Irene
AU - Arnold, L. Eugene
AU - Basu, Hana H.
AU - Levy, Laura
AU - Vyas, Pooja
AU - Macphee, Fiona
AU - Gonzalez, Erin Schoenfelder
AU - Kelley, Megan
AU - Jusko, Morgan L.
AU - Bolden, China R.
AU - Zulauf-McCurdy, Courtney
AU - Manzano, Maychelle
AU - Torres, Gabriela
N1 - Publisher Copyright:
© 2023 Elsevier Ltd
PY - 2023/6
Y1 - 2023/6
N2 - Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.
AB - Attention-deficit hyperactivity disorder (ADHD) affects approximately 5% of children and adolescents globally and is associated with negative life outcomes and socioeconomic costs. First-generation ADHD treatments were predominantly pharmacological; however, increased understanding of biological, psychological, and environmental factors contributing to ADHD has expanded non-pharmacological treatment possibilities. This Review provides an updated evaluation of the efficacy and safety of non-pharmacological treatments for paediatric ADHD, discussing the quality and level of evidence for nine intervention categories. Unlike medication, no non-pharmacological treatments showed a consistent strong effect on ADHD symptoms. When considering broad outcomes (eg, impairment, caregiver stress, and behavioural improvement), multicomponent (cognitive) behaviour therapy joined medication as a primary ADHD treatment. With respect to secondary treatments, polyunsaturated fatty acids showed a consistent modest effect on ADHD symptoms when taken for at least 3 months. Additionally, mindfulness and multinutrient supplementation with four or more ingredients showed modest efficacy on non-symptom outcomes. All other non-pharmacological treatments were safe; clinicians might tolerate their use but should educate families of childrenand adolescents with ADHD on the disadvantages, including costs, burden to the service user, absence of proven efficacy relative to other treatments, and delay of proven treatment.
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U2 - 10.1016/S2352-4642(22)00381-9
DO - 10.1016/S2352-4642(22)00381-9
M3 - Review article
C2 - 36907194
AN - SCOPUS:85150367989
SN - 2352-4642
VL - 7
SP - 415
EP - 428
JO - The Lancet Child and Adolescent Health
JF - The Lancet Child and Adolescent Health
IS - 6
ER -