The Cochrane Library and Non‐Pharmacological Treatments for Attention Deficit Hyperactivity Disorder in Children and Adolescents: An Overview of Reviews

Abstract

AbstractBackgroundAttention deficit hyperactivity disorder (ADHD) is a chronic behavioural disorder that affects 5–8% of children. It is characterized by age‐inappropriate levels of inattention, hyperactivity and impulsivity that cause functional impairment in multiple settings. The most common treatment of ADHD involves prescription of stimulant medications, which often cause undesirable side effects and pose unknown long‐term health risks. Therefore, alternative treatment options for ADHD are becoming increasingly popular and need to be further investigated.ObjectivesThis overview of reviews aims to synthesize evidence from the Cochrane Database of Systematic Reviews (CDSR) on the efficacy and safety of non‐pharmacologic treatments to improve symptoms of ADHD in children and adolescents.MethodsIssue 12, 2010 of the CDSR was searched using the terms “attention deficit hyperactivity disorder”, “hyperkinetic disorder” and “ADHD” restricted to the title, abstract or keywords, and all systematic reviews examining non‐pharmacologic treatments for ADHD in children and adolescents were identified. Data were extracted, complied into tables and synthesized using qualitative and quantitative methods.Main ResultsThree systematic reviews (containing ten trials and 594 participants) were identified for inclusion in this overview. Children assigned to Hatha yoga versus a non‐specific physical activity control condition showed significantly less symptoms of inattention when measured using both parent ratings (MD: − 0.73; 95% CI: − 1.25, − 0.21) and child‐completed tests (MD: − 4.01; 95% CI: − 6.23, − 1.79). There was no significant benefit of homeopathy compared to homeopathy placebo in decreasing symptoms of ADHD. There was also no significant difference between family therapy and standard treatment for parent and teacher ratings of inattention and hyperactivity/impulsivity; however, when overall symptoms were judged by a blinded third party observer in the classroom setting, standard treatment was significantly more effective (MD: 0.11; 95% CI: 0.05, 0.17). There was no significant difference between meditation therapy compared to both drug therapy and standard treatment without drugs for decreasing symptoms of inattention, hyperactivity, impulsivity, distractibility or overall symptoms.Authors' ConclusionsThe three Cochrane reviews suffered from a lack of high‐quality, adequately powered randomized controlled trials using standardized tools to measure clinically important outcomes over adequate periods of time. Therefore, the trials included in this overview are not sufficient to provide evidence of no positive benefit of treatment, nor are they sufficient to recommend the use Hatha yoga, family therapy, meditation therapy or homeopathy for the treatment of ADHD in children and adolescents. Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. The Cochrane Collaboration