Survey of 2500 families finds what ADHD treatments seem to work/ not work as applied in the real world

Cred­it: CDC Vital Signs

While care­ful­ly con­trolled clin­i­cal tri­als are essen­tial for estab­lish­ing sci­en­tif­ic sup­port for dif­fer­ent ADHD treat­ments, it is also impor­tant to exam­ine how par­ents feel about the treat­ments they actu­al­ly select for their child.

How par­ents feel about ADHD treat­ments they have tried for their child pro­vides an impor­tant com­ple­ment to pub­lished clin­i­cal tri­als data, and can also help guide par­ents’ treat­ment choices.

Results from a sur­vey con­duct­ed by ADDi­tude Mag­a­zine of near­ly 2500 par­ents pro­vides help­ful data on this ques­tion. In this sur­vey, par­ents were asked about how help­ful they had found the treat­ment strate­gies they were using cur­rent­ly, or had used in the past.

How often are different treatments used? 

Despite being infre­quent­ly rec­om­mend­ed by physi­cians and oth­er clin­i­cians, a wide-range of non-med­ical treat­ments were being used by parents.

Below are data on 10 dif­fer­ent treat­ment approach­es report­ed by par­ents in descend­ing order of fre­quen­cy. The per­cent­ages sum to more than 100% because many chil­dren were receiv­ing mul­ti­ple treat­ments and/or had pre­vi­ous­ly used dif­fer­ent treatments.

• 67% — Pre­scrip­tion medication
• 37% — Exercise
• 36% — Vit­a­mins, min­er­als, or supplements
• 29% — Diet/nutrition plan
• 26% — ADHD coaching/counseling
• 13% — Mind­ful­ness meditation
• 10% — Behav­ior ther­a­py/­par­ent-train­ing classes
• 5% — Neu­ro­feed­back with a clinician
• 3% — Home-based brain training

It is not sur­pris­ing that med­ica­tion treat­ment, which cur­rent­ly has the strongest research sup­port of any ADHD treat­ment, was clear­ly the most com­mon treat­ment uti­lized.

How­ev­er, behav­ior ther­a­py is gen­er­al­ly regard­ed as the oth­er ADHD treat­ment with the strongest research sup­port and it was used less often than many treat­ments that have less sup­port­ive research. This may reflect chal­lenges that par­ents face in access­ing this treat­ment in their community.

How well do parents feel different treatments work? 

Below is the per­cent of par­ents who report­ed that each treat­ment type was either ‘Extreme­ly or Very Effec­tive’.

• 49% — Exercise
• 41% — Pre­scrip­tion medication
• 33% — ADHD coaching/counseling
• 33% — Behav­ior man­age­men­t/­par­ent-train­ing classes
• 30% — Neu­ro­feed­back with a clinician
• 27% — Mind­ful­ness meditation
• 24% — Diet/nutrition plan
• 24% — Home-based brain training
• 14% — Vit­a­mins, min­er­als, or supplements

Below is the con­verse of this data, i.e., the per­cent of par­ents who found each treat­ment ‘Not very effec­tive or Not at all effec­tive’.

• 5% — Exercise
• 13% — Behav­ior man­age­men­t/­par­ent-train­ing classes
• 19% — ADHD coaching/counseling
• 19% — Mind­ful­ness meditation
• 26% — Pre­scrip­tion medication
• 27% — Diet/nutrition plan
• 27% — Neu­ro­feed­back with a clinician
• 33% — Home-based brain training
• 42% — Vit­a­mins, min­er­als, supplements

Sev­er­al aspects of these results are noteworthy.

First, exer­cise was the ADHD treat­ment approach most like­ly to be rat­ed as effec­tive and least like­ly to be seen as inef­fec­tive. What par­ents per­ceive about exer­cise is ahead of the cur­rent sci­ence, as research on exer­cise as an ADHD treat­ment is rather lim­it­ed; I expect we will begin see­ing a num­ber of stud­ies on this top­ic appear­ing over the next sev­er­al years.

Sec­ond, although med­ica­tion is wide­ly regard­ed as the ADHD treat­ment with the strongest research sup­port, only a minor­i­ty of par­ents felt it was very effec­tive for their child. And, 26% of par­ents felt it was not effec­tive. This high­lights the lim­i­ta­tions of even well-researched treat­ments for ADHD.

Third, no treat­ment was regard­ed as very effec­tive by a major­i­ty of par­ents, and all treat­ments were rat­ed as very effec­tive by at least some par­ents. Thus, while there is is no sin­gle approach that is like­ly to be seen as very effec­tive for the major­i­ty of chil­dren there are many approach­es that par­ents felt were quite help­ful to their child.

This sug­gests although the ini­tial treatment(s) imple­ment­ed not be suf­fi­cient­ly help­ful, oth­er approach­es may yield results that par­ents see as quite ben­e­fi­cial. Access­ing those treat­ments can be chal­leng­ing, how­ev­er, and many treat­ments are not cov­ered by insurance.

Summary and implications

Results from this sur­vey com­ple­ment evi­dence from clin­i­cal tri­als of ADHD treat­ment by indi­cat­ing how par­ents feel about the dif­fer­ent treat­ments they try.

While it is dis­cour­ag­ing that no treat­ment was felt to be very effec­tive by most par­ents, it is encour­ag­ing that mul­ti­ple treat­ments were report­ed to work well by some par­ents. The chal­lenge thus remains find­ing a treat­ment approach — or com­bi­na­tion of treat­ments — that is most effec­tive for indi­vid­ual chil­dren. That is not easy and is high­light­ed in this quote from one of the sur­vey participants:

“It is over­whelm­ing at times to try to do all of these treat­ments,” wrote one care­giv­er. “I feel par­ents are on their own… We would have ben­e­fit­ed from an inter­dis­ci­pli­nary team includ­ing pedi­a­tri­cian, ther­a­pist and teacher meet­ing once a year at least and have some­one coor­di­nate with us through­out the year to check in.”

Sev­er­al lim­i­ta­tions to this type of study should be noted.

First, this is not a nation­al­ly rep­re­sen­ta­tive sam­ple of par­ents but a con­ve­nience sam­ple of par­ents who chose to com­plete the sur­vey. The extent to which their expe­ri­ence gen­er­al­izes to all par­ents of chil­dren with ADHD is not known.

Anoth­er chal­lenge is that it is not pos­si­ble to know the details of the treat­ments actu­al­ly pro­vid­ed. A ben­e­fit of con­trolled clin­i­cal tri­als is that the treat­ment is clear­ly spec­i­fied, i.e., you know with con­fi­dence what treat­ment actu­al­ly entailed. That is not true for a study like this. For exam­ple, results indi­cate that 49% of par­ents felt exer­cise was effec­tive for their child. What exer­cise-based inter­ven­tions includ­ed is unknown, how­ev­er, and would almost cer­tain­ly be high­ly vari­able across chil­dren. The same would be true for any of the treat­ments that were rated.

A final issue is that par­ents’ reports about the effec­tive­ness of their child’s treat­ment may be biased, as par­ents who devote time and mon­ey for a par­tic­u­lar treat­ment may be inclined to view it as effec­tive, even if ‘more objec­tive’ out­come data would not sup­port this. This is why clin­i­cal tri­als go to great lengths to obtain out­come infor­ma­tion from indi­vid­u­als who are ‘blind’ as to whether study par­tic­i­pants are in a treat­ment or con­trol group. While this is an impor­tant con­cern, dis­count­ing par­ents’ per­cep­tions of treat­ment response is prob­lem­at­ic giv­en their inti­mate knowl­edge of their child. And, because no treat­ment was rat­ed as very effec­tive by most par­ents, it is not the case that par­ents are biased towards see­ing any­thing they try as beneficial.

In sum­ma­ry, results from this sur­vey may help inform par­ents seek­ing effec­tive ADHD treat­ment for their child that com­ple­ments what has been learned from research-based clin­i­cal trials.

Although cur­rent treat­ment rec­om­men­da­tions would focus on stim­u­lant med­ica­tion and behav­ior ther­a­py as the ADHD treat­ments with strongest research sup­port, these find­ings high­light oth­er options that par­ents have found to be helpful.

In par­tic­u­lar, it is evi­dent that no treat­ment is like­ly to pro­duce ben­e­fits that most par­ents will be sat­is­fied with. As a result, per­sis­tence in find­ing what works best for one’s child — although chal­leng­ing — will often be required.

– Dr. David Rabin­er is a child clin­i­cal psy­chol­o­gist and Direc­tor of Under­grad­u­ate Stud­ies in the Depart­ment of Psy­chol­o­gy and Neu­ro­science at Duke Uni­ver­si­ty. He pub­lish­es the Atten­tion Research Update, an online newslet­ter that helps par­ents, pro­fes­sion­als, and edu­ca­tors keep up with the lat­est research on ADHD.

The Study in Context:

• What should come first to treat ADHD in chil­dren, behav­ior ther­a­py or stim­u­lant medication?
• A brief sleep inter­ven­tion can bring mea­sur­able and sus­tained ben­e­fits to chil­dren with ADHD
• Study finds com­bined phar­ma + non-phar­ma treat­ment most ben­e­fi­cial to help youth with ADHD address long-term aca­d­e­m­ic difficulties
• Hav­ing ADHD costs $1.1 mil­lion in low­er life­time earn­ings, even when “treat­ed”
• What are cog­ni­tive abil­i­ties and how to boost them?