NON MEDICATION WAYS OF THE ADHD TREATMENT
Kids with ADHD require ongoing development and education, but sometimes for parents and teachers it’s very expensive and complicated that’s why more and more ofter the work with a child replaced with medication. But there are other options which help kids to self-control them and to learn how to come down and relax or how to keep their attention during the lesson. There are nonpharmacologic treatments for Attention-Deficit/Hyperactivity Disorder:
✔ Behavioral and psychosocial treatments;
✔ Cognitive training;⠀
✔ Neurofeedback.
Behavioral and psychosocial treatments
Behavioral interventions are used to identify and provide positive reinforcement of adaptive coping behaviors to reduce problem behaviors. Behavior parent training and social skills training are some of the primarily recommended alternatives to medication management of ADHD. They are usually regarded as first-line treatments for very young children or those with mild to moderate ADHD. They are also the standard addon to medication treatment for severe presentations at any age. In summary, most guidelines recommend behavioral interventions for ADHD in any situation, either alone or in combination with medication treatment and these are the most frequently used nonpharmacological treatment among children and adolescents. The efficacy of behavioral therapy in the treatment of ADHD is a matter of controversy. Current appraisals of the available evidence do not agree on whether the balance of evidence supports or refutes the efficacy of psychosocial treatments for ADHD. One meta-analysis concluded that behavioral treatments were effective for ADHD, and a review for the Agency for Health Care Research and Quality concluded that the A. Caye et al. evidence for positive effects of behavioral treatment on preschool children was strong enough to guide clinical practice. However, a Cochrane systematic review and meta-analysis of randomized trials concluded that while BPT may have a positive effect on the behavior of children and adolescents with ADHD, the evidence is not strong enough to guide clinical practice. A separate Cochrane meta-analysis concluded that the evidence was insufficient to support social skills training for adolescents. Several clinical guidelines have recommended both BPT and social skills as behavioral treatments. Some of these discrepancies may be explained by the type of rater considered by reviews. Two recent meta-analyses identified a moderate and statistically significant pooled effect size for behavioral therapies on ADHD symptoms when all probably unblinded raters were included but that this effect was not maintained when considering only probably blinded raters. The same group did, however, confirm that behavioral therapies were effective in improving positive parenting and conduct problems of children with ADHD, even on blinded ratings.
Cognitive training
Cognitive training strategies aim to reduce ADHD symptoms by improving performance in specific neuropsychological functions associated with ADHD (e.g., attention, inhibitory control, and working memory). Cognitive training programs are usually delivered through electronic interfaces such as computers or mobile phones and are designed to be appealing to the user (i.e., resembling videogames). Performance is continually reassessed so that training is adaptive. A recent meta-analysis evaluated the effects, across 16 randomized clinical trials, for probably blinded and potentially unblinded raters separately. The conclusions match those of previous meta-analyses, indicating moderate efficacy in improving the neuropsychological functions targeted by the intervention but a less clear effect on symptoms. The effect size for total ADHD symptoms and inattentive symptoms was moderate and significant when rated by a potentially un-blinded rater. The estimates decreased when outcomes were rated by a probably blinded rater. Of note, the effect size was much larger for programs that included multiple process training (i.e., targeting more than one executive functioning) compared to those that focused on just on the cognitive process. However, for the multiple process studies only potentially unblinded ratings were available. In summary, the evidence so far available suggests that cognitive training has no effect on core ADHD symptoms or other functional outcomes for ADHD patients.
Neurofeedback
Neurofeedback (NF), or electroencephalogram (EEG) biofeedback, is a relatively new, non-invasive approach for treating multiple brain-related conditions. To date, EEG — NF has the most supportive evidence for the treatment of ADHD in children.
Neurofeedback works via the classical operant conditioning mechanisms of learning which train participants to regulate their brain activity by providing them with real-time feedback about their EEG.
The changes in brain wave patterns are presented on a computer screen for visual or auditory feedback. Participants learn to alter their brainwaves to achieve a goal, reinforcing the state of attention.
Most NF protocols for children with ADHD focus on two types of training: theta/beta training to lower the theta /beta ratio, and slow cortical potential training (SCP) to gain control over cortical activation and deactivation.
NF (theta/beta training) is based on the theoretical foundation that EEG of children with ADHD usually show an increased theta /beta ratio compared to children without ADHD.
The theta wave reflects the inattentive state, while the beta wave reflects an attentive state. Repeated training is thought to foster automatization of the learned process with subsequent changes at the behavioral level.
Finally, a recent meta-analysis that included RCTs and specifically looked at long-term effects of neurofeedback, compared to active treatments (including psychostimulants) and semi-active treatments (e.g., cognitive training), found that after on average 6 months followup, the effects of neurofeedback were superior to semiactive control groups and no different from active treatments including methylphenidate. Interestingly, this meta-analysis confirmed the trend for medication effects to diminish with time, and the effects of neurofeedback — without additional sessions being conducted — to increase with time.
Noninvasive, the treatment involves attaching electrodes to the head. It’s important to note that there’ll be no pain. If your child is not independent enough, he needs trainer assistance. By the way, children can receive remote supervising through an online platform that connects them with neurofeedback trainers.
It is estimated that in the US around 10% of children and adolescents with ADHD have received neurofeedback interventions.
PIGPUG helps kids with ADHD get systematical neurofeedback therapy which shows successful results after 5–6 sessions. We created a convenient neurofeedback headset especially for sensitive children and we work on AI telemedicine platform which will be available for all kinds of families.
Anastasiya Kuzniatsova M.D., Child Neurologist
Polina Santsevich CMO
Caye, A., Swanson, J. M., Coghill, D., & Rohde, L. A. (2018). Treatment strategies for ADHD: an evidence-based guide to select the optimal treatment. Molecular Psychiatry. doi:10.1038/s41380–018–0116–3 Razoki, B. (2018). Neurofeedback versus psychostimulants in the treatment of children and adolescents with attention-deficit/hyperactivity disorder: a systematic review. Neuropsychiatric Disease and Treatment, Volume 14, 2905–2913. doi:10.2147/ndt.s178839 Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a Treatment Intervention in ADHD: Current Evidence and Practice. Current Psychiatry Reports, 21(6). doi:10.1007/s11920–019–1021–4
