Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway, Primary Care – Alternative and Complementary Therapies for ADHD

Attention-Deficit/Hyperactivity Disorder (ADHD) Clinical Pathway — Primary Care

Alternative and Complementary Therapies for ADHD

  • Existing evidence does not support the following therapies in improving ADHD symptoms
  • Providers should consider the individual child/adolescent and family preferences
  • Use mutual decision-making to include possible benefits and risks of the modalities
Category Treatment Description Evidence Side Effects/Additional Comments
Brain Stimulation Transcranial direct current stimulation (TDS)
  • Small electrical current sent to scalp stimulating dorsolateral prefrontal cortex of brain
  • Can be done at home
  • Some evidence of efficacy for some psychiatric disorders
  • Studies in ADHD demonstrate small to no effects
  • Transient scalp discomfort, headache
  • Tolerated slightly better than TMS
  • No studies of impact of this amount of stimulation on developing brain
Transcranial magnetic stimulation (TMS)
  • Pulses of magnetic stimulation sent to scalp that alter electrical activity in the brain
  • Better than TDS at targeting specific brain regions
  • Requires more highly trained clinician and more expensive technology than TDS
 Transient scalp discomfort, headache, possible seizures
Trigeminal nerve stimulation (TNS)
  • Sends current to brain via stimulation of trigeminal nerve
  • Electrode patch on forehead is worn overnight
  • EEG changes, improvement in clinician ratings of ADHD symptoms reported
  • No significant changes in parent or teacher-rated ADHD symptoms
  • Increases in weight, appetite, heart rate, fatigue, headache
  • Discoloration of skin under patch in darker-skinned participants
  • Monarch eTNS Device, FDA approved, requires prescription
Neurofeedback Multiple forms Uses EEG biofeedback to teach child to improve patterns associated, improve attention
  • Can be successful in changing EEG pattern
  • Somewhat conflicting results on ADHD symptoms, but best designed studies tend to show limited benefit in real-world situations
 Cost and time associated with pursuing this treatment
Nutritional Feingold diet
  • One of many elimination diets
    for ADHD
  • Eliminates artificial food colors, flavorings, sweeteners, preservatives, and some salicylates (naturally occurring compounds found in some fruits and vegetables)
 May benefit a small number of children with specific sensitivities to foods eliminated in this diet
  • Very restrictive diet
  • Hard to implement
  • Could result in nutritional deficiencies
Polyunsaturated fatty acids (PUFA)
  • Supplement with Omega-3 PUFA
  • Some use Omega-3 and Omega-6 PUFA
  • 2023 Cochrane review   found some evidence of improvement in supplemented group
  • No difference in parent or teacher-rated ADHD symptoms
 Dyspepsia
Vitamin D and magnesium Varying doses
  • Some evidence of improvements in behavior generally but less evidence for ADHD symptoms
  • Some studies suggest more benefit in those with deficiencies
  • Toxicity from Vitamin D reported with very high doses over long periods of time
  • High doses of magnesium can result in diarrhea and abdominal pain
Video Game Endeavor RX game, FDA approved, requires prescription
  • Video game that requires player to manage multiple tasks and filter out distractions
  • As child does better, game becomes harder
  • Some improvement in laboratory-based measures of ADHD symptoms
  • No improvement (vs. sham game) in parent or teacher-rated ADHD symptoms
  • Frustration, emotional reaction, dizziness, nausea, headache, eye-strain, or joint pain
  • May not be appropriate for children with photosensitive epilepsy, color blindness, or physical limitations that restrict use of a mobile device