March 2, 2015, by David Daley
Greater clarity about the evidence for non-pharmacological interventions for ADHD
For several years some CANDAL members have been working with the European ADHD Guidelines Group on a series of meta-analysis exploring the evidence base for non-pharmacological interventions for ADHD. The first review Songua-barke et al (2013) published in the American Journal of Psychiatry showed a very clear pattern of results across three psychological interventions ( Behavioural Interventions; Neurofeedback and Cognitive ) and three dietary interventions (restricted elimination diets, artificial food colour exclusions, and free fatty acid supplementation) and focused on ADHD symptoms outcomes only moderate to large effect sizes from unblinded ratings from respondents closest to the receipt to treatment reduced to small non-significant effect sizes when the views of probably blinded informants and sources were explored.
The second review Daley et al (2014) published in the Journal of the American Academy of Child and Adolescent Psychiatry focused exclusively on behavioural interventions and looked beyond symptom control to other important outcomes. Results demonstrated the same pattern of results for ADHD as Sonuga-barke et al (2013) but also showed that behavioural interventions lead to reductions in conduct problems and improvements in parenting on both unblinded and probably blinded outcomes.
The third meta-analysis published this week in the Journal of the American Academy of Child and Adolescent Psychiatry (Cortese et al 2015) updated the Sonuga-barke et al (2013) meta-analysis for cognitive training by adding a considerable number of new studies published in the last two years. Results showed that despite improving working memory performance, cognitive training had limited effects on ADHD symptoms according to assessments based on probably blinded measures.
Collectively these three sets of meta-analyses demonstrate that both researchers and clinicians need to be very clear and transparent about what non-pharmacological interventions are being recommended and used for.
Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W. Holtmann,M., Santosh, P., Stevenson, J, Stringaris, A. zudas, A., Sonuga-barke, E.J.S & European ADHD Guidelines Group. (2015). Cognitive Training for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials. Journal of the American Academy of Child & Adolescent Psychiatry. 54:164–174
Daley, D., Van der Oord, S., Ferrin, M., Danckaerts, M., Doepfner, M., Cortese, Sonuga-barke, E.J.S., & European ADHD Guidelines Group. (2014). Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. Journal of the American Academy of Child & Adolescent Psychiatry, 53(8), 835-847.
Sonuga-Barke, E.J.S., Brandeis, D., Cortese, S., Daley,D., Ferrin, M.T., Holtmann,M., Stevenson, M., Danckaerts,M., van der Oord, S., Döpfner, M., Dittmann, R., Simonoff, E., Zuddas, A., Banaschewski, T., Buitelaar, J., Coghill, D., Hollis,C., Konofal, E., Lecendreux, M., Wong, I & Sergeant, J. (2013). Non-pharmacological interventions for Attention-Deficit Hyperactivity Disorder: Systematic review and meta-analyses of randomised controlled trials of dietary and psychological treatments. American Journal of Psychiatry, 170, 275 – 289.