COMMENTARY

Treating ADHD in Children: It's Not All About Medication

Hansa Bhargava, MD

Disclosures

December 07, 2016

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Hi. I am Dr Hansa Bhargava, a practicing pediatrician and medical editor with Medscape. Have you ever had a parent of a child with attention-deficit/hyperactivity disorder (ADHD) ask about ways to treat it without medication? I seem to be getting this question more and more.

When treating ADHD in children, the more typical practice in the United States is to opt for medication. In fact, even though guidelines[1] recommend behavioral therapy as first-line therapy for the youngest kids, the Centers for Disease Control and Prevention (CDC) reported that almost 1 in 2 preschoolers with this diagnosis get no behavioral therapy.[2] It seems that the majority are treated with medications.

There is growing evidence that the first approach in addressing ADHD should be either nonpharmacologic therapy, especially in younger children, or a combination of medication and lifestyle changes. Studies suggest that by using some of these other methods when children are young and newly diagnosed, ADHD problems may improve faster and these therapies may have a more lasting impact than medication. Conjunction treatments that may be beneficial include getting more sleep, staying hydrated, exercising to help focus, playing soothing music, and even teaching the child to meditate. For instance, in the case of sleep, the National Sleep Foundation reported that as many as 80% of teens do not get enough sleep.[3] Parents may not realize the importance of teaching good sleeping habits to their children. Sleep-deprived kids often lack focus and may have symptoms of hyperactivity, which can mistakenly be attributed to ADHD.

Another practice to consider is to look at a child's hydration status. Recognizing that the brain is 73% water, it makes sense that dehydration may have effects on a child's ability to control some of their ADHD symptoms. In general, dehydration can affect ability to concentrate, memory, and is associated with mood swings and fatigue. Just as is the case with the overlap between ADHD symptoms and those caused by poor sleep hygiene, symptoms of ADHD also overlap with those seen with dehydration. Keeping hydrated is key.

What about meditation? Although an older Cochrane review published in 2010 was unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD,[4] some more recent, although small, studies have suggested that children with ADHD who practice meditation may be able to concentrate better.[5,6] They also seem to have less depression and anxiety. More evidence is needed and will hopefully be provided by an ongoing randomized controlled trial.[7] Meditation is something to consider for kids and families that want to try alternative strategies.

Finally, another practice that has been proven to help increase focus is good old-fashioned exercise. Exercise is well established as important for overall physical fitness, growth, mood, and possible prevention of overweight, but it turns out that it may be particularly helpful in kids with ADHD. A recently published systematic review concluded that exercise, particularly cardiovascular exercise like running and cycling, had beneficial effects on executive functioning, response inhibition, cognitive control, and behavior.[8] A number of studies that were reviewed provided good evidence for the effects of cardiovascular exercise based on parent or teacher ratings and a broad range of socioemotional outcomes. Bottom line: Keeping a child with ADHD active is a strategy for all ages.

Children are being diagnosed with ADHD at younger and younger ages. Instilling good behavior and lifestyle habits as they grow will help them control their ADHD better as they move into adolescence and adulthood. Medication should not be ruled out and is clearly an important therapy for many kids, but it may not be the best first therapy, nor should it be the only therapy for the majority of children. From Medscape and WebMD, I am Dr Hansa Bhargava.

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