Attention deficit Hyperactivity Disorder (ADHD) is the commonest childhood neurodevelopmental disorder, affecting 3 to 9% by school age, and often persists into adulthood. ADHD in children and young people (CYP) has wide ranging multi-modal impacts on the affected CYP, their carers and the society. Co-morbidity with other neurodevelopmental, behavioural and emotional disorders is the rule rather than exception. Pharmacological treatment is not recommended as the sole therapeutic intervention, and several other non-pharmacological interventions have been advocated within a framework of Multi-modal strategy as the norm, to address both the core symptoms as well as the behavioural and other related difficulties. All paediatric professionals need to be familiar with the principles of different modalities of non-pharmacological or behavioural interventions for managing ADHD in CYP. Most published up-to-date evidence for behavioural interventions both for the core ADHD symptoms and other outcome measures are summarized in this article, including the peculiar problems related to their research. The most effective evidence-based strategies for controlling ADHD core symptoms are combination of stimulant medications with Behavioural therapy (BT) or Cognitive behaviour therapy (CBT), as well as group-based parental Psychoeducation. Standalone BT, CBT, Mindfulness, Neurocognitive training and Neurofeedback cannot currently be recommended for controlling core symptoms due to limited evidence. Other Behavioural interventions could lead to improvements in ADHD-related outcomes, including parenting skills, CYP's social skills, academic performance and disruptive behaviours. School-based non-pharmacological interventions have been shown to reduce disruptive behaviours. Executive skills are also significantly improved with use of computer-based Neurocognitive training and regular physical Cardio exercises. It is disappointing that combinations of different types of psychosocial interventions have low efficacy on both the core ADHD symptoms and other related outcomes. The readers are welcome to test their knowledge and learning efficacy through an accompanying quiz.
Citation: Michael O Ogundele, Hani F Ayyash. ADHD in children and adolescents: Review of current practice of non-pharmacological and behavioural management[J]. AIMS Public Health, 2023, 10(1): 35-51. doi: 10.3934/publichealth.2023004
Attention deficit Hyperactivity Disorder (ADHD) is the commonest childhood neurodevelopmental disorder, affecting 3 to 9% by school age, and often persists into adulthood. ADHD in children and young people (CYP) has wide ranging multi-modal impacts on the affected CYP, their carers and the society. Co-morbidity with other neurodevelopmental, behavioural and emotional disorders is the rule rather than exception. Pharmacological treatment is not recommended as the sole therapeutic intervention, and several other non-pharmacological interventions have been advocated within a framework of Multi-modal strategy as the norm, to address both the core symptoms as well as the behavioural and other related difficulties. All paediatric professionals need to be familiar with the principles of different modalities of non-pharmacological or behavioural interventions for managing ADHD in CYP. Most published up-to-date evidence for behavioural interventions both for the core ADHD symptoms and other outcome measures are summarized in this article, including the peculiar problems related to their research. The most effective evidence-based strategies for controlling ADHD core symptoms are combination of stimulant medications with Behavioural therapy (BT) or Cognitive behaviour therapy (CBT), as well as group-based parental Psychoeducation. Standalone BT, CBT, Mindfulness, Neurocognitive training and Neurofeedback cannot currently be recommended for controlling core symptoms due to limited evidence. Other Behavioural interventions could lead to improvements in ADHD-related outcomes, including parenting skills, CYP's social skills, academic performance and disruptive behaviours. School-based non-pharmacological interventions have been shown to reduce disruptive behaviours. Executive skills are also significantly improved with use of computer-based Neurocognitive training and regular physical Cardio exercises. It is disappointing that combinations of different types of psychosocial interventions have low efficacy on both the core ADHD symptoms and other related outcomes. The readers are welcome to test their knowledge and learning efficacy through an accompanying quiz.
| [1] | Xia W, Shen L, Zhang J (2015) Comorbid anxiety and depression in school-aged children with attention deficit hyperactivity disorder (ADHD) and self-reported symptoms of ADHD, anxiety, and depression among parents of school-aged children with and without ADHD. Gen Psychiat 27: 356-367. |
| [2] |
Cortese S (2020) Pharmacologic Treatment of Attention Deficit-Hyperactivity Disorder. N Engl J Med 383: 1050-1056. https://doi.org/10.1056/NEJMra1917069 
|
| [3] | National Institute for Health and Care ExcellenceAttention deficit hyperactivity disorder: diagnosis and management [NG87] (2018). |
| [4] |
Segenreich D (2022) The Impact of the COVID-19 Pandemic on Diagnosing and Treating Attention Deficit Hyperactivity Disorder: New Challenges on Initializing and Optimizing Pharmacological Treatment. Front Psychiatry 13: 852664. https://doi.org/10.3389/fpsyt.2022.852664
|
| [5] |
Catalá-López F, Hutton B, Núñez-Beltrán A, et al. (2017) The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS ONE 12: e0180355. https://doi.org/10.1371/journal.pone.0180355
|
| [6] |
Goldman LS, Genel M, Bezman RJ, et al. (1998) Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. JAMA 279: 1100-1107. https://doi.org/10.1001/jama.279.14.1100
|
| [7] |
Graham J, Coghill D (2008) Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. Cns Drugs 22: 213-337. https://doi.org/10.2165/00023210-200822030-00003
|
| [8] |
Ng QX, Ho CYX, Chan HW, et al. (2017) Managing childhood and adolescent attention-deficit/hyperactivity disorder (ADHD) with exercise: A systematic review. Complement Ther Me 34: 123-128. https://doi.org/10.1016/j.ctim.2017.08.018
|
| [9] |
Wigal T, Greenhill L, Chaung S, et al. (2006) Safety and tolerability of methylphenidate in preschool children with ADHD. J Am Acad Child Adolesc Psychiatry 45: 1294-1303. https://doi.org/10.1097/01.chi.0000235082.63156.27
|
| [10] |
Greenhill L, Kollins S, Abikoff H, et al. (2006) Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry 45: 1284-1293. https://doi.org/10.1097/01.chi.0000235077.32661.61
|
| [11] |
Chacko A, Kofler M, Jarrett M (2014) Improving Outcomes for Youth with ADHD: A Conceptual Framework for Combined Neurocognitive and Skill-Based Treatment Approaches. Clin Child Fam Psych 17: 368-384.
|
| [12] |
Krain AL, Kendall PC, Power TJ (2005) The role of treatment acceptability in the initiation of treatment for ADHD. J Atten Disord 9: 425-434. https://doi.org/10.1007/s10567-014-0171-5
|
| [13] |
Cortese S (2022) Treatment of ADHD in preschool children. Lancet Child Adolesc Health 6: 830-831. https://doi.org/10.1016/S2352-4642(22)00312-1
|
| [14] |
Satapathy S, Choudhary V, Sharma R, et al. (2006) Nonpharmacological Interventions for Children with Attention Deficit Hyperactivity Disorder in India: A Comprehensive and Comparative Research Update. Indian Journal of Psychological Medicine. Indian J Psychol Med 38: 376-385. https://doi.org/10.4103/0253-7176.191382
|
| [15] |
Sonuga Barke E, Brandeis D, Cortese S, et al. (2013) Non-pharmacological interventions for attention-deficit/hyperactivity disorder: systematic review and meta-analyses of randomised controlled trials of dietary and psychological treatments. Am J Psychiatr 170: 275-289. https://doi.org/10.1176/appi.ajp.2012.12070991
|
| [16] |
DuPaul GJ, Eckert TL, Vilardo B (2012) The effects of school-based interventions for attention-deficit/hyperactivity disorder. School Psychol Rev 41: 387-412. https://doi.org/10.1080/02796015.2012.12087496
|
| [17] |
Coelho LF, Barbosa DL, Rizzutti S, et al. (2015) Use of Cognitive Behavioral Therapy and Token Economy to Alleviate Dysfunctional Behavior in Children with Attention-Deficit Hyperactivity Disorder. Front Psychiatry 6: 167. https://doi.org/10.3389/fpsyt.2015.00167
|
| [18] |
Ferrin M, Moreno-Granados JM, Salcedo-Marin MD, et al. (2014) Evaluation of a psychoeducation programme for parents of children and adolescents with ADHD: immediate and long-term effects using a blind randomized controlled trial. Eur Child Adolesc Psychiatry 23: 637-647. https://doi.org/10.1007/s00787-013-0494-7
|
| [19] |
Zhang J, Díaz-Román A, Cortese S (2018) Meditation-based therapies for attention-deficit/hyperactivity disorder in children, adolescents and adults: a systematic review and meta-analysis. Evid Based Ment Health 21: 87-94. https://doi.org/10.1136/ebmental-2018-300015
|
| [20] |
Daley D, van der Oord S, Ferrin M, et al. (2014) European ADHD Guidelines Group. Behavioral interventions in attention-deficit/hyperactivity disorder: a meta-analysis of randomized controlled trials across multiple outcome domains. J Am Acad Child Adolesc Psychiatry 53: 835-747. https://doi.org/10.1016/j.jaac.2014.05.013
|
| [21] |
Shrestha M, Lautenschleger J, Soares N (2020) Non-pharmacologic management of attention-deficit/hyperactivity disorder in children and adolescents: a review. Transl Pediatr 9: S114-S124. https://doi.org/10.21037/tp.2019.10.01
|
| [22] |
Shuai L, Daley D, Wang YF, et al. (2017) Executive Function Training for Children with Attention Deficit Hyperactivity Disorder. Chin Med J 130: 549-558. https://doi.org/10.4103/0366-6999.200541
|
| [23] |
Den Heijer AE, Groen Y, Tucha L, et al. (2016) Sweat it out? The effects of physical exercise on cognition and behavior in children and adults with ADHD: a systematic literature review. J Neural Transm 124: 3-26. https://doi.org/10.1007/s00702-016-1593-7
|
| [24] |
Cortese S, Comencini E, Vincenzi B, et al. (2013) Attention-deficit/hyperactivity disorder and impairment in executive functions: a barrier to weight loss in individuals with obesity?. BMC Psychiatry 13: 286. https://doi.org/10.1186/1471-244X-13-286
|
| [25] |
Smith SD, Vitulano LA, Katsovich L, et al. (2020) mized Controlled Trial of an Integrated Brain, Body, and Social Intervention for Children With ADHD. J Atten Disord 4: 780-794. https://doi.org/10.1177/1087054716647490
|
| [26] |
Steeger CM, Gondoli DM, Gibson BS, et al. (2016) Combined cognitive and parent training interventions for adolescents with ADHD and their mothers: A randomized controlled trial. Child Neuropsychol 22: 394-419. https://doi.org/10.1080/09297049.2014.994485
|
| [27] |
Mautone JA, Marshall SA, Sharman J, et al. (2012) Development of a Family-School Intervention for Young Children With Attention Deficit Hyperactivity Disorder. School Psych Re 41: 447-466. https://doi.org/10.1080/02796015.2012.12087499
|
| [28] |
Fresson M, Meulemans T, Dardenne B, et al. (2019) Overdiagnosis of ADHD in boys: Stereotype impact on neuropsychological assessment. Appl Neuropsychol Chil 8: 231-245. https://doi.org/10.1080/21622965.2018.1430576
|
| [29] |
Young S, Adamo N, Ásgeirsdóttir BB, et al. (2020) Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/ hyperactivity disorder in girls and women. BMC Psychiatry 20: 404. https://doi.org/10.1186/s12888-020-02707-9
|
| [30] |
Daley D, Van Der Oord S, Ferrin M, et al. (2018) Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. J Child Psychol Psychiatry 59: 932-947. https://doi.org/10.1111/jcpp.12825
|
| [31] |
Qian X, Loo BR, Castellanos FX, et al. (2018) Brain-computer-interface-based intervention re-normalizes brain functional network topology in children with attention deficit/hyperactivity disorder. Transl Psychiat 8: 149. https://doi.org/10.1038/s41398-018-0213-8
|
| [32] |
Muris P, Roodenrijs D, Kelgtermans L, et al. (2018) No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD. Child Psychiat Hum D 49: 974-992. https://doi.org/10.1007/s10578-018-0812-x
|
| [33] |
Cortese S, Ferrin M, Brandeis D, et al. (2015) Cognitive training for attention-deficit/hyperactivity disorder: meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. J Am Acad Child Adolesc Psychiatry 54: 164-174. https://doi.org/10.1016/j.jaac.2014.12.010
|
| [34] |
Vidal R, Castells J, Richarte V, et al. (2015) Group therapy for adolescents with attention-deficit/hyperactivity disorder: a randomized controlled trial. J Am Acad Child Adolesc Psychiatr 54: 275-282. https://doi.org/10.1016/j.jaac.2014.12.016
|
| [35] |
Van Doren J, Arns M, Heinrich H, et al. (2018) Sustained effects of neurofeedback in ADHD: a systematic review and meta-analysis. Eur Child Adoles Psy 28: 293-305. https://doi.org/10.1007/s00787-018-1121-4
|
| [36] |
Cortese S, Ferrin M, Brandeis D, et al. (2016) European ADHD Guidelines Group (EAGG). Neurofeedback for Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Clinical and Neuropsychological Outcomes From Randomized Controlled Trials. J Am Acad Child Adolesc Psychiatry 55: 444-455.
|
| [37] |
Duric NS, Assmus J, Gundersen D, et al. (2012) Neurofeedback for the treatment of children and adolescents with ADHD: a randomized and controlled clinical trial using parental reports. BMC Psychiatry 12: 1-8. https://doi.org/10.1186/1471-244X-12-107
|
| [38] |
Flisiak-Antonijczuk H, Adamowska S, Chladzinska-Kiejna S, et al. (2015) Treatment of ADHD: comparison of EEG-biofeedback and methylphenidate. Arch Psychiatr Psych 17: 31-38. https://doi.org/10.12740/APP/60511
|
| [39] | Özcan CT, Oflaz F, Türkbay T, et al. (2013) The Effectiveness of an Interpersonal Cognitive Problem-Solving Strategy on Behavior and Emotional Problems in Children with Attention Deficit Hyperactivity. Nöro Psikiyatri Arşiv 50: 244-251. |
| [40] |
Gaastra GF, Groen Y, Tucha L, et al. (2016) The Effects of Classroom Interventions on Off-Task and Disruptive Classroom Behavior in Children with Symptoms of Attention-Deficit/Hyperactivity Disorder: A Meta-Analytic Review. PLoS ONE 11: e0148841. https://doi.org/10.1371/journal.pone.0148841
|
| [41] |
Pontifex MB, Saliba BJ, Raine LB, et al. (2013) Exercise improves behavioral, neurocognitive, and scholastic performance in children with attention-deficit/hyperactivity disorder. J Pediatr 162: 543-551. https://doi.org/10.1016/j.jpeds.2012.08.036
|
 publichealth-10-01-004-s001.pdf |
 |
Michael O Ogundele, Hani F Ayyash. ADHD in children and adolescents: Review of current practice of non-pharmacological and behavioural management[J]. AIMS Public Health, 2023, 10(1): 35-51. doi: 10.3934/publichealth.2023004
DownLoad: