Non-pharmacological approaches for adult ADHD show limited effectiveness

Although gaining in popularity, non-pharmacological interventions to treat the symptoms of Attention Deficit Hyperactivity Disorder (ADHD) offer limited benefits to patients, according to a meta-analysis that compared some 50 treatments for adult ADHD. The authors of the study, published in the Lancet, concluded that amphetamine- and methylphenidate-based psychostimulants, as well as atomoxetine, a second-line non-stimulant medication, remain the only interventions to date to offer short-term benefits in reducing symptoms associated with ADHD.ADHD affects about 5% of school-age children. However, in 75% of cases, the symptoms associated with ADHD will continue into adulthood. The prevalence of adult ADHD is between 2%-and-5% worldwide. Some guidelines, notably those of the U.K., recommend turning to non-pharmacological methods when medication is considered ineffective or poorly tolerated, or when adherence to medication represents a challenge for the patient. The possible effects of psychostimulants on cardiovascular health also raise concerns and may be a motivation to turn to alternative methods to medication.In response to the growing willingness of patients and healthcare professionals to try non-pharmacological approaches, a group of researchers carried out a meta-analysis of 113 randomized controlled trials involving almost 15,000 participants.They were able to compare 50 pharmacological, psychological and neurostimulant interventions used to reduce ADHD symptoms in adults. These different types of treatment were then classified according to their efficacy over 12 weeks, as well as their acceptability and tolerance, based on patient and clinician assessment scales.Some symptom reductionBoth patients and healthcare professionals observed a reduction in symptoms with psychostimulants and atomoxetine, which proved superior to placebo. Psychological interventions such as cognitive-behavioural therapy, cognitive remediation, mindfulness or psychoeducation were found to reduce some ADHD symptoms compared with placebo. However, these improvements were reported by clinicians only. Self-evaluations revealed that patients did not perceive the benefits. Transcranial direct current stimulation also outperformed placebo, but also from the clinicians’ point of view only.While atomoxetine has been shown to reduce symptoms, this medication has the lowest acceptability among patients, and therefore a high drop-out rate from all causes. Psychostimulants and most other pharmacological and non-pharmacological treatments had superior acceptability to placebo.However, tolerance analyses revealed that atomoxetine (formerly sold under the brand name Strattera), modafinil, guanfacine and psychostimulants were associated with higher rates of medication discontinuation due to adverse effects compared with placebo. “There was a high rate of concomitant physical conditions in the participants, for example obesity, which may contribute to poor overall tolerance of stimulants in adults,” said the British researchers.The researchers do not deny the potential beneficial effects of non-pharmacological approaches, but studies of longer-term effects are needed.

Non-pharmacological approaches for adult ADHD show limited effectiveness

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