Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents

Sibley, Margaret H.; Bruton, Alisha; Zhao, Xin; Johnstone, Jeanette M.; Mitchell, John T.; Hatsu, Irene; Arnold, L. Eugene; Basu, Hana H; Lévy, Laurence; Vyas, P. R.; Macphee, Fiona L.; Gonzalez, Erin Schoenfelder; Kelley, Megan; Jusko, Morgan L.; Bolden, China R; Zulauf, Courtney; Manzano, Maychelle; Torres, Gabriela

doi:10.1016/s2352-4642(22)00381-9

Cited by 15 publications

(11 citation statements)

References 60 publications

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“…Coders did not observe change in ADHD symptoms in play situations (i.e., the only observation outcome in the included studies). Our results on different rater types are in line with the methodological concerns in measuring outcomes mentioned by Sibley et al (2023). Moreover, the findings also align with research…”

Section: Discussionsupporting

confidence: 90%

Sustained improvements by behavioural parent training for children with attention‐deficit/hyperactivity disorder: A meta‐analytic review of longer‐term child and parental outcomes

Doffer,

Dekkers,

Hornstra

et al. 2023

JCPP Advances

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BackgroundBehavioural parent training is an evidence‐based intervention for children with attention‐deficit/hyperactivity disorder (ADHD), but little is known about the extent to which initial benefits are maintained.AimsThis meta‐analytic review investigated longer‐term (i.e., more than 2 months post‐intervention) child and parental outcomes of behavioural parent training for children with ADHD.Materials & MethodsWe searched for randomized controlled trials and examined ADHD symptoms, behavioural problems, positive parenting, negative parenting, parenting sense of competence, parent‐child relationship quality, and parental mental health as outcomes. We included 27 studies (31 interventions; 217 effect sizes), used multilevel random‐effects meta‐analyses for between‐ and within‐group comparisons (pre‐intervention to follow‐up and post‐intervention to follow‐up), and explored twelve predictors of change.ResultsBetween pre‐intervention and follow‐up (M = 5.3 months), we found significant small‐to‐moderate between‐group effects of the intervention on ADHD symptoms, behavioural problems, positive parenting, parenting sense of competence and parent‐child relationship quality. Within‐group findings show sustained improvements in the intervention conditions for all outcome domains. There were few significant changes from post‐intervention to follow‐up. Additionally, the large majority of the individual effect sizes indicated sustained outcomes from post‐intervention to follow‐up. There were seven significant predictors of change in child outcomes, including stronger reductions in ADHD symptoms of girls and behaviour problems of younger children. In contrast with some meta‐analyses on short‐term effects, we found no differences between masked and unmasked outcomes on ADHD symptoms at follow‐up.Discussion & ConclusionWe conclude that behavioural parent training has longer‐term benefits for children's ADHD symptoms and behavioural problems, and for positive parenting behaviours, parenting sense of competence and quality of the parent‐child relationship.

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Section: Discussionsupporting

confidence: 90%

Sustained improvements by behavioural parent training for children with attention‐deficit/hyperactivity disorder: A meta‐analytic review of longer‐term child and parental outcomes

Doffer,

Dekkers,

Hornstra

et al. 2023

JCPP Advances

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“…CBT was used as the active evidence-based comparison as CBT is recommended in current guidelines (e.g., NICE guideline) for children and adolescents with ADHD [43]. This is supported by findings from a recent review demonstrating that CBT has mild to moderate effect size for children and adolescents with ADHD [1]. In addition to comparing MYmind with an evidence-based control, this is also one of the very few studies that were conducted in a non-Caucasian population.…”

Section: Discussionmentioning

confidence: 99%

“…Attention-deficit hyperactivity disorder (ADHD) affects a substantial number of children worldwide and is among the top 3 neuropsychiatric disorders among children with a global prevalence of 5% [ 1 ]. Children affected with ADHD show symptoms of inattention, hyperactivity, and impulsive behavior which are inappropriate for their age.…”

Section: Introductionmentioning

confidence: 99%

“…Mindfulness-based interventions are becoming popular with emerging findings supporting its role in improving ADHD outcomes, reducing parenting stress and improving youth emotional functioning [ 1 , 11 – 13 ]. Although a number of randomized controlled trials (RCTs) have been conducted [ 11 , 14 – 16 ], all have limited sample size with the largest one consisting of 103 participants.…”

Section: Introductionmentioning

confidence: 99%

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The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial

Wong,

Chan,

Yip

et al. 2023

Psychother Psychosom

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Introduction: There is a lack of studies evaluating mindfulness-based interventions for children with attention-deficit hyperactivity disorder (ADHD) compared with an evidence-based control. This randomized controlled trial (RCT) evaluated the effects of mindfulness for youth (MYmind) in improving children’s attention, behavior, and parent-related outcomes versus cognitive behavioral therapy (CBT). Methods: A total of 138 families of children with ADHD aged 8–12 years were recruited from the community with 69 randomized to MYmind and 69 to CBT. Participants were assessed at baseline, immediately after intervention, at 3 months and 6 months. The primary outcome was the attention score of the Sky Search subtest of the Test of Everyday Attention for Children (TEA-Ch). Secondary outcomes were child behavior and parent-related assessments. Linear mixed models were used to assess the efficacy of MYmind compared with CBT. Results: Both MYmind and CBT significantly improved children’s attention score at 6 months (MYmind: β = 1.48, p = 0.013, Cohen’s d = 0.32; CBT: β = 1.46, p = 0.008, d = 0.27). There were significant within-group improvements in most secondary outcomes. No significant difference was shown for both primary or secondary outcomes between the two arms at any time point. Conclusions: Both MYmind and CBT appeared to improve children’s attention and behavior outcomes, although no difference was found between these two interventions. This is the largest RCT so far comparing MYmind and CBT although there was loss of follow-up assessments during the pandemic. Further RCTs adopting a non-inferiority design are needed to validate the results.

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“…The exclusion criteria were as follows: (1) Patients suffered from other serious diseases, such as epilepsy or systemic lupus erythematosus; (2) Antioxidant drugs were obtained from daily diet rather than drug supplements; (3) Antioxidant drugs combined with other non-drug treatments were taken as an intervention (e.g. behavioral therapy, mindfulness intervention [ 29 ]); (4) Self-control study, review or mechanistic study.…”

Section: Methodsmentioning

confidence: 99%

Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis

Zhou,

Yu,

Song

et al. 2024

PLoS ONE

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Objective To systematically evaluate the safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder (ADHD). Methods Randomized controlled trials and prospective studies on antioxidant therapy in children and adolescents with ADHD were searched in PubMed, Embase, and Cochrane Library from the inception of databases to November 12, 2022. Two investigators independently screened the literature, extracted data, and evaluated the quality of the included studies. Network meta-analysis (PROSPERO registration number CRD 42023382824) was carried out by using R Studio 4.2.1. Results 48 studies involving 12 antioxidant drugs (resveratrol, pycnogenol, omega-3, omega-6, quercetin, phosphatidylserine, almond, vitamin D, zinc, folic acid, ginkgo biloba, Acetyl-L-carnitine) were finally included, with 3,650 patients. Network meta-analysis showed that omega-6 (0.18), vitamin D (0.19), and quercetin (0.24) were the top three safest drugs according to SUCRA. The omega-3 (SUCRA 0.35), pycnogenol (SUCRA 0.36), and vitamin D (SUCRA 0.27) were the most effective in improving attention, hyperactivity, and total score of Conners’ parent rating scale (CPRS), respectively. In terms of improving attention, hyperactivity, and total score of Conners’ teacher rating scale (CTRS), pycnogenol (SUCRA 0.32), phosphatidylserine+omega-3 (SUCRA 0.26), and zinc (SUCRA 0.34) were the most effective, respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Parent, the optimal agents were phosphatidylserine (SUCRA 0.39), resveratrol+MPH (SUCRA 0.24), and phosphatidylserine (SUCRA 0.34), respectively. In terms of improving attention, hyperactivity and total score of ADHD Rating Scale-Teacher, pycnogenol (SUCRA 0.32), vitamin D (SUCRA 0.31) and vitamin D (SUCRA 0.18) were the optimal agents, respectively. The response rate of omega-3+6 was the highest in CGI (SUCRA 0.95) and CPT (SUCRA 0.42). Conclusion The rankings of safety and efficacy of the 12 antioxidants vary. Due to the low methodological quality of the included studies, the probability ranking cannot fully explain the clinical efficacy, and the results need to be interpreted with caution. More high-quality studies are still needed to verify our findings.

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Non-pharmacological interventions for attention-deficit hyperactivity disorder in children and adolescents

Cited by 15 publications

References 60 publications

Sustained improvements by behavioural parent training for children with attention‐deficit/hyperactivity disorder: A meta‐analytic review of longer‐term child and parental outcomes

Sustained improvements by behavioural parent training for children with attention‐deficit/hyperactivity disorder: A meta‐analytic review of longer‐term child and parental outcomes

The Effects of Mindfulness for Youth (MYmind) versus Group Cognitive Behavioral Therapy in Improving Attention and Reducing Behavioral Problems among Children with Attention-Deficit Hyperactivity Disorder and Their Parents: A Randomized Controlled Trial

Safety and efficacy of antioxidant therapy in children and adolescents with attention deficit hyperactivity disorder: A systematic review and network meta-analysis

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