Transcript ADHD Treatments: A review between traditional drug

ADHD Treatments:
A review between traditional
drug treatments and alternative treatments
Raman Nazari, Michael Cvetich, Stephanie Valenzuela
University of California, Merced
December 7, 2009
Introduction

Recent surveys demonstrate general public concern with increase of
ADHD diagnosis and the prescriptions of psycho-stimulant
medications in children between the ages of three to eighteen.
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All subjects must have met the Diagnostics and Statistics Manual
(DSM-IV) criteria for ADHD.
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Drug therapy is the common method of treatment.
 Parents of children prefer alternative natural treatments.

Reviewed traditional and alternative treatments for ADHD in
children.
 Focus more on the controversial alternative treatments
Traditional Drug
Treatments
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Two classes of drug treatments that are FDA approved
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Psychostimulants
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Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Psychostimulants are most popular drug treatments:
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Methylphenidate
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Dexmethylphenidate
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Amphetamine
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Dextroamphetamine
SNRI’s
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Atomoxetine
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Fluoxetine
Methylphenidate

Most commonly prescribed
medication.

Reference: MedScape CME, 2009.
FDA approved
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Pharmaceutical name Ritalin.

Prior studies show rapid
improvement of core and
associated ADHD symptoms
(Shachar, Tannock,
Cunningham and Cokhum,
1997).
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Study that showed increase of
compliance in activities with
different dosage amounts
(Barkley, 1988).
Fluoxetine
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Fluoxetine is an SSRI
 Pharmaceutical name is Prozac.
 Not FDA approved for ADHD

Originally created as an anti-depressant.
However, recent studies have discovered
to that are beneficial effects on ADHD
(Barrickman, Kuperman, Noyes,
Schumacher and Verda, 1991).

Barrickman and colleagues have
discovered positive impacts towards
ADHD symptoms.

Although there is promise in future,
there are a number of adverse side
effects.
Reference: Mail Online UK, 2009
Atomoxetine
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Non-stimulant, pharmacotherapy
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Reference: Time Magazine, 2009.
FDA approved
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Acts as an Serotonin-Norepinephrine Reuptake
Inhibitor (SNRI).

Proven to reduce anxiety and depressive
symptoms, however, it has a negative side effect
of increased blood pressure and pulse.

Atomoxetine is a safe and well tolerated drug
treatment that should be considered as a method
of therapy for children with ADHD (Kratochvil,
Newcorn, Arnold, Duesenberg, Emslie,
Quintana, et al., 2005).
Alternative Treatments

Though prescription medication has shown to be an effective
method of treatment, there has been an increase in the demand
for alternative treatments.
 Dietary interventions
 Interactive Metronome Training
 EEG Neurofeedback
 Yoga
 Massage
 Homeopathic remedies
Dietary Interventions
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Unclear whether or not diet can
improve behavior, hyper activity, and
inattention.
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Researchers believe that children are
sensitive to certain foods they consume.
(Rojas and Chan, 2005).
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Feingold Diet is most widely known
dietary intervention.

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Sensitive to artificial sugars, added
coloring, flavors, and preservatives.
Supplementation
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No controlled studies support this claim.
Reference:
How To Do Just About Everything, 2009.
Interactive Metronome Training
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New training program that emerged in the early
1990’s.

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53 of 58 variables affecting ADHD were found
significantly improved (Shaffer, Jacokes, Cassily,
Greenspan, Tuchman and Stemmer, 2001).
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Reference:
Interactive Metronome Training, 2009
Help improve ability to selectively attend to
activities for extended periods of time without
disruption.
Attention, motor control, language, and processing
Promising future
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Limited number of preliminary trials. Further
controlled studies with larger sample sizes are
needed.
EEG Neurofeedback
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New ground breaking technique

Reference:
Hirani Wellness Medical Center, 2009
Challenges brain to function better as
a whole by performing brain
exercises

Applying electrodes to brain scalp to
measure brainwave activity
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Recent study consisting of 23 subjects
measured both subjective and objective
conditions (Lubar, Swartwood,
Swartwood, and O’Donnell, 1995).
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Found to be appropriate and
efficacious treatment for ADHD
Yoga
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Hindu discipline that targets the training
of human consciousness to a state of
perfect spiritual insight and tranquility.
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Children with ADHD and other
concentration disabilities report a greater
ability to focus, balance, and compose
their daily lives after practicing yoga.
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Only one controlled study showed effects
on ADHD symptoms. Sessions included
respiratory, relaxation, postural, and
concentration training (Jensen and Kenny,
2004).
Reference: Family Education, 2009
Massage
Reference: North Texas Spinal Health & Wellness, 2009

Involves manual manipulation to
the soft tissue in the body promoting
blood flow and relief of muscular
tension.
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Recent study shows children who
received massage therapy for a two
week period reported themselves as
less fidgety, happier, and more on
task (Field, Quintino, HernandezRief and Koslovsky, 1998).
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Due to small sample sizes, study
results are still considered
preliminary.
Homeopathic Remedies
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Founded by German physician, Samuel
Hahnemann over 200 years ago.
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Homeopathic medicine comprises of treatments
that involve small doses of natural substances in
order to counter symptoms of disease.
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Even though homeopathic substances are
deemed to be safe, liquid remedies containing
alcohol are not suitable for children (Rojas et al.,
2005).
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When a child with ADHD seeks homeopathic
treatment, not only will attention improve, but
also physical problems, such as headaches,
allergies, and asthma.
Reference:
How To Do Just About Everything, 2009
Conclusion
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Drug treatments used for ADHD were found more popular. Some of
the effective drugs were Methylphenidate and Fluoxetine. However,
there are many adverse side effects.
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Through the use of alternative treatments, such as dietary interventions,
yoga, and homeopathic remedies, there is hope that ADHD symptoms
will be diminished.
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There are numerous clinical trials needed in order to successful
demonstrate that alternative methods help children with ADHD.
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Overall, we believe that the medical drug treatments have better results
but alternative therapies are safer.

We believe that the best method of treatment in ADHD with children is
a mix combination of drug treatments and alternative treatments.
References

Barkley, R.A. (1988). The effects of methylphenidate on the interactions of preschool ADHD
children with their mothers. Journal of American Academy of Child & Adolescent Psychiatry, 27(3),
336-341.
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Barrickman, L., Kuperman, S., Noyes, R., Schumacher, E., & Verda, M. (1991). Treatment of
ADHD with Fluoxetine: A preliminary trial. Journal of the American Academy of Child &
Adolescent Psychiatry, 30(5), 762-767.

Field, T.M., Quintino O., Hernandez-Reif, M., & Koslovsky, G. (1998). Adolescents with
attention deficit hyperactivity disorder benefit from massage therapy. Journal of
Adolescence, 33(1), 103–108.

Jensen, P.S., & Kenny, D.T. (2004). The effects of yoga on the attention and behavior of boys
with attention-deficit/hyperactivity disorder. Journal of Attention Disorders, 7(4), 205-216.

Kratochvil, C.J., Newcorn, J.H., Arnold, L.E., Duesenberg, D., Emslie, G.J., Quintana, H.,
Sarkis, E.H., Wagner, K.D., Gao, H., Michelson, D., & Biederman, J. (2005).
Atomoxetine alone or combined with Fluoxetine for treating ADHD with co-morbid depressive
or anxiety symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 44(9),
915-924.
References
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Lubar, J.F., Swartwood, M.O., Swartwood, J.N., & O’Donnell, P.H. (1995).
Evaluation of the effectiveness of EEG neurofeedback training for
ADHD in a clinical setting as measured by changes in T.O.V.A. scores,
behavioral ratings, and WISC-R performance. Journal of Applied
Psychophysiology and Biofeedback, 28(1), 83-99.
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Rojas, N.L., & Chan, E. (2005). Old and new controversies in the alternative
treatment of attention deficit hyperactive disorder. Journal of Mental
Retardation and Developmental Disabilities, 11(2), 116-130.

Shaffer, R.J., Jacokes, L.E., Cassily, J.F., Greenspan, S.I., Tuchman, R.F., &
Stemmer, P.J. (2001). Effect of interactive metronome training on children
with ADHD. American Journal of Occupational Therapy, 55(1), 155-162.

Schachar, R.J., Tannock, R., Cunningham, C., & Corkum, P.V. (1997).
Behavioral, situational, and temporal effects of treatment of ADHD with
Methylphenidate. Journal of the American Academy of Child & Adolescent
Psychiatry, 36(6), 754-763.
Contributions

Raman – I helped contribute to the presentation by compiling key points
from the literature review, come up with visuals, videos, cite references
for the photos, and edit the PowerPoint.

Michael – I helped contribute to creating and formatting the power
presentation. I helped come up with key points and revised the entire
presentation.

Stephanie – I helped find find some of the references for the paper and
citing the reference page. I did some of the research and I found a few of
the photos for the PowerPoint presentation.