Section Free - Video Lectures

07. An Overview of Standard Treatment vs CAM for ADHD

Published on January 1, 2023 Certification expiration date: January 1, 2026

Amelia Villagomez, M.D.

Assistant Professor of Psychiatry - University of Arizona

Key Points

In the United States, 9.4% of children have been diagnosed with ADHD.
Although many children respond to standard treatments, one-third remain symptomatic.
Parents often inquire and try alternative treatments for ADHD.
Increasing evidence supports the use of BSMs for the treatment of ADHD.

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Slides and Transcript

Slide 1 of 11

There are several studies of broad-spectrum micronutrients for the treatment of ADHD which we’re about to discuss.

An Overview of Standard Treatment vs CAM for ADHD Slide 1 of 11

Slide 2 of 11

But before we do that, let’s review conventional treatment for ADHD. 9.4 percent of children in the US have been diagnosed with ADHD. As we know, standard treatments include stimulant medication and behavioral therapy. At least 23% of children receive neither treatment unfortunately.

References:

Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J. (2018). Prevalence of parent-reported ADHD diagnosis and associated treatment among U.S. children and adolescents, 2016. Journal of Clinical Child and Adolescent Psychology, 47(2), 199–212.

An Overview of Standard Treatment vs CAM for ADHD Slide 2 of 11

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Slide 3 of 11

The MTA or Multimodal Treatment of ADHD study was a multisite study of nearly 600 children designed to evaluate the leading treatments for ADHD. Participants were randomly assigned to one of four treatment modes. In the MTA study, the percent of children who met the study definition of successfully treated were as follows: 56% in the medication management group, 34% in the behavioral therapy group, and 68% in the combined group.

References:

Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., Clevenger, W., Davies, M., Elliott, G. R., Greenhill, L. L., Hechtman, L., Hoza, B., Jensen, P. S., March, J. S., Newcorn, J. H., Owens, E. B., Pelham, W. E., Schiller, E., Severe, J. B., Simpson, S., … Wu, M. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40(2), 168–179.

An Overview of Standard Treatment vs CAM for ADHD Slide 3 of 11

Slide 4 of 11

Now, some families prefer to use non-standard treatments. The estimated use of complementary and alternative therapies to treat ADHD symptoms by families is between 12% to 68% depending on the study.

References:

Kemper, K. J., & O'Connor, K. G. (2004). Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics, 4(6), 482–487.

An Overview of Standard Treatment vs CAM for ADHD Slide 4 of 11

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Slide 5 of 11

And when surveyed, about 87% of pediatricians reported they had been asked about complementary and alternative medicine by a patient or parent in the prior three months. However, fewer than 5% of pediatricians reported that they felt very knowledgeable about complementary and alternative therapies.

References:

Kemper, K. J., & O'Connor, K. G. (2004). Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics, 4(6), 482–487.

An Overview of Standard Treatment vs CAM for ADHD Slide 5 of 11

Slide 6 of 11

Although many children respond to the standard treatments of stimulants and behavioral therapy, approximately 1/3 are still symptomatic even after these treatments. The other concern that I’m sure you’ve seen is that there are some people who would rather not use medications at all. Additionally, parents often inquire and try alternative treatments for ADHD Many would invest a great deal of money in supplements and therapies without really any evidence for efficacy.

References:

Kemper, K. J., & O'Connor, K. G. (2004). Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics, 4(6), 482–487.
Hurt, E. A., Arnold, L. E., & Lofthouse, N. (2011). Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: Current research support and recommendations for practitioners. Current Psychiatry Reports, 13(5), 323–332.

An Overview of Standard Treatment vs CAM for ADHD Slide 6 of 11

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Slide 7 of 11

For this reason, I became really interested in trying to better serve these children and families. It has been with great interest that I’ve followed the literature on micronutrients over the past decade. And my practice, as the research base has become stronger; more patients and parents have elected to try micronutrient therapy as monotherapy or in combination with stimulants. I found in clinical practice that micronutrients are extremely helpful for managing symptoms of irritability and emotional regulation and help some with focus and attention.

References:

Kemper, K. J., & O'Connor, K. G. (2004). Pediatricians' recommendations for complementary and alternative medical (CAM) therapies. Ambulatory Pediatrics, 4(6), 482–487.
Hurt, E. A., Arnold, L. E., & Lofthouse, N. (2011). Dietary and nutritional treatments for attention-deficit/hyperactivity disorder: Current research support and recommendations for practitioners. Current Psychiatry Reports, 13(5), 323–332.

An Overview of Standard Treatment vs CAM for ADHD Slide 7 of 11

Slide 8 of 11

In May of 2022, the prestigious Journal of the American Academy of Child and Adolescent Psychiatry published the second randomized controlled trial of broad-spectrum micronutrients for the treatment of ADHD showing improvement in emotional regulation for those with ADHD. This combination of things has inspired this talk in which we’ll now cover the evidence for broad-spectrum micronutrients and in part two how to use them in clinical practice.

References:

Johnstone, J. M., Hatsu, I., Tost, G., Srikanth, P., Eiterman, L. P., Bruton, A. M., Ast, H. K., Robinette, L. M., Stern, M. M., Millington, E. G., Gracious, B. L., Hughes, A. J., Leung, B., & Arnold, L. E. (2022). Micronutrients for attention-deficit/hyperactivity disorder in youths: A placebo-controlled randomized clinical trial. Journal of the American Academy of Child and Adolescent Psychiatry, 61(5), 647–661.

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Slide 9 of 11

Key points. 9.4% of children in the U.S. have been diagnosed with ADHD. Although many children respond to the standard treatments of stimulants and behavioral therapy, approximately 1/3 are still symptomatic even after these treatments.

An Overview of Standard Treatment vs CAM for ADHD Slide 9 of 11

Slide 10 of 11

Parents often inquire and try alternative treatments for ADHD, many of which are costly and not evidence based. There is increasing evidence that supports the use of broad-spectrum micronutrients for the treatment of ADHD.

An Overview of Standard Treatment vs CAM for ADHD Slide 10 of 11

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Slide 11 of 11

An Overview of Standard Treatment vs CAM for ADHD Slide 11 of 11

Next Section

08. Evidence of BSMs for Pediatric ADHD and Emotional Dysregulation

Learning Objectives:

After completing this activity, the learner will be able to:

Describe the connection between dietary patterns and mental health.
Discuss the available evidence about using BSMs for mental health conditions.
Recognize patients who can benefit from BSM supplementation.

Original Release Date: January 1, 2023

Review and Re-release Date: March 1, 2024

Expiration Date: January 1, 2026

Expert: Amelia Villagomez, M.D.

Medical Editor: Paz Badía, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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Medical Academy designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.