Media

HKU’s collaborative study finds limited efficacy of
non-pharmacological treatment for attention deficit hyperactivity disorder （ADHD）

01 Feb 2013

Supplementation with omega-3/omega-6 free fatty acids such as cod liver oil, elimination of artificial food colorings and psychological treatments are often regarded as treatments for children with attention deficit hyperactivity disorder (ADHD).  Some parents may prefer non-pharmacological interventions for their children with ADHD.  However,  a recent research study, with participation by the Department of Pharmacology and Pharmacy of The University of Hong Kong Li Ka Shing Faculty of Medicine and conducted by The European ADHD Guidelines Group, points out that there is insufficient evidence to show that the efficacy of these non-pharmacological treatments were small or restricted.  The study was published online in The American Journal of Psychiatry (AJP).

It is recognized that non-pharmacological interventions are currently widely used in clinical practice in ADHD management.  Some patients and caregivers may wish to try non-pharmacological interventions.  However, this study shows that there is still limited evidence on the efficacy of non-pharmacological interventions. Parents should be made aware of the results of the current study. This analysis provides an important reference about ADHD management for clinicians. 

This study was conducted by a group of ADHD experts from different countries, including Professor Ian Wong Chi-kei, the Head of Department of Pharmacology and Pharmacy, HKU Li Ka Shing Faculty of Medicine.  As one of the co-authors of the paper, Professor Wong comments on the results, “Comparing the results from previous studies on pharmacological treatments, non-pharmacological treatments generally show only little improvement of ADHD symptoms.  The results support current recommendations, such as UK National Institute for Health and Clinical Excellence guideline on use of medications in children with severe ADHD as first-line treatment, which avoids the negative impact on the treatments’ efficacy and progress.  The Department of Pharmacology and Pharmacy of HKU will continue to work with the European ADHD Guidelines Group to research into effective treatments for ADHD. ” 

Dr. Sonuga-Barke, the study coordinator of this research and Professor of the University of Southampton states, “Having reliable evidence about existing treatments is the first step in developing better ones.  Our analysis has provided new insights into ADHD treatments, the full clinical implications of which now need to be worked through carefully.  Clinicians and basic scientists need to work together to find ways to implement current treatments more effectively and to use our understanding of ADHD pathophysiology to find more effective non-pharmacological interventions. ”

This ADHD non-pharmacological treatments research concluded the past 54 related research analyses.  Researchers discovered that many of the past studies were conducted under circumstances in which assessors were aware of the types of non-pharmacological treatment patients had received.  Patients would then receive observation and assessment. The research thus reflected 6 non-pharmacological treatments, including dietary and psychological treatment, show positive effects on ADHD symptoms if assessors were aware of the treatment.  However, if the analyses were restricted to only those studies that used unbiased assessments by  assessors unaware of the treatment allocation;  then only supplementation with omega-3/omega-6 free fatty acids or elimination of artificial food colorings show positive effects on ADHD symptoms, but effects are relatively small and/or restricted to food sensitive individuals.  Furthermore, effects are even more limited with other non-pharmacological treatments on ADHD symptoms, namely cognitive training, neurofeedback, behavioural interventions, and exclusion of foods associated with hypersensitivity.

The study also shows that most of the 54 studies in the analysis incorporated a medication element.  Limiting the studies to those where medication was not used in either the treatment or control arm, or only used by a small number of, reduced the advantage for artificial food color restriction, but the small effect of omega-3/omega-6 fatty acids remained.

The analysis was conducted by the European ADHD Guidelines Group, a multidisciplinary and multinational group of ADHD experts with The Department of Pharmacology and Pharmacy, HKU Li Ka Shing Faculty of Medicine’s participation.  Professor Ian Wong Chi-kei is one of the co-authors of this study which was published online in The American Journal of Psychiatry (AJP).  AJP is the official journal of the American Psychiatric Association, a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention, and research of mental illnesses including substance use disorders.  Visit the APA at www.psychiatry.org  and www.HealthyMinds.org.

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Professor Ian Wong Chi-kei, the Head of Department of Pharmacology and Pharmacy, HKU Li Ka Shing Faculty of Medicine is one of the co-authors of the paper on limited efficacy of non-pharmacologic treatment for attention deficit hyperactivity disorder