Why Treat ADHD Without Medication?

A clinician specializing in ADHD argues for non-pharmaceutical alternatives, such as better nutrition and parenting, in treating the condition.

I have spent the last 15 years of my medical career treating children with attention-deficit/hyperactivity disorder (ADHD) using an integrative approach, with medication as a last, rather than a first, option.

Although many families and a few physicians see that as a rather rational approach, believing that it is usually best to avoid using long-term psychotropic medications, others might disagree.

They might ask: “Why bother? These medications obviously work and therefore they should be the first line of treatment for any child with ADHD.” In fact, the American Academy of Pediatrics supports this viewpoint, although with lip service to concurrent behavioral intervention.

There are at least three very good reasons for not jumping straight to medications.

1) The research evidence so far supports only the fact that stimulant medications (the mainstay of ADHD treatment) work well over the short term, about 70% of the time. The long-term research we have so far — and there is very little of it — fails to show long-term benefit. In fact, the largest long term study showed that the benefits of medication noted after one year disappear by a three-year follow-up.

2) There are significant side effects in many children. Some are clear physical and psychological effects like hallucinations, tics, and weight loss. There are also more subtle effects, like low-grade depression or a “loss of joy.” I have had many parents tell me the medication was working but he or she “just wasn’t my child.”

How do you approach treatment in patients with ADHD?

3) We don’t know what the long-term effects of stimulant medication are on the developing brain. When psychotropic medications, which have significant effects on neurotransmitter balance, are given to a developing brain, there is going to be an effect on how that brain develops. Although we know that there do not seem to be dramatic long-term effects, like kidney or liver damage or psychosis, there is really no research on subtler effects. The interesting question is whether children who take stimulant medications from ages 6 to 18 are more or less likely to have ADHD once they stop their medications. The answer to this is unknown.

The next logical question is whether there are effective non-pharmaceutical interventions for ADHD? The answer is an unequivocal yes. They are not effective for every child or adult with ADHD, but they are effective for many of them.