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This article compiles the non-drug treatment and therapeutic approaches that we are aware of.
The + and - in parentheses reflect our assessment of benefit in ADHD.
ADHD should definitely be treated with medication, especially at the beginning of therapy.
Sufferers who have never felt what it is like to live without these distressing symptoms cannot relate to the goal of non-drug therapy from their own perception. Edel/Vollmoeller argue in a comparable way.1
A large metastudy of 190 studies involving 26,114 participants with ADHD found that stimulants appeared to be superior to behavior therapy, cognitive training, and non-stimulants. Stimulants in combination with behavioral therapy appeared to be most effective.2
(Endurance) sports seem to be the best non-drug treatment for ADHD.345
Several metastudies found that exercise can help improve attention and hyperactivity/impulsivity symptoms in ADHD and is a useful treatment adjunct.67 Also improved were executive functions and sleep quality.8 The magnitude of improvement was small to moderate9
For many sufferers, especially of the ADHD-HI and ADHD-HI-C subtypes, regular intense exercise (working out) is essential.
Calorie consumption
Contrary to previous assumptions, exercise does not appear to increase calorie consumption. Among the Hadza people, active hunter-gatherers in Africa, women walk an average of 8 km and men an average of 14 km daily, but use no more energy each day than sedentary office workers in the U.S.10111213 Hadza are active and fit into their 70s and 80s and are said to have neither diabetes nor heart disease.
However, high caloric expenditure from exercise shuts down stress systems and inflammatory responses, reducing the caloric expenditure that would have caused the stress responses.12Acute physical stress hardly increases cerebral blood flow, but there is a redistribution to brain regions involved in motor control and coordination (e.g., vestibular) and transport systems (respiratory, circulatory).14 This could be the nutritional equivalent of the long-standing finding that exercise has a stress-regulating effect.
This sheds a whole new light on the common side effect of stimulants of decreased appetite. We hypothesize that this may be an adaptive response to the decreased energy expenditure of the body due to the decreased stress responses. Further, we wonder whether hyperactivity as a symptom of the externalizing ADHD subtypes might be a (misdirected) compensatory response of the body, since inflammation is more common in the externalizing stress phenotype than in the internalizing ADHD-I subtype.
Buffering acute as well as habitual physical activity can buffer negative effects of stressful events on physical and mental health
Resource Strengthening
When sport is included in options for action, sport itself is available as a stress-reducing tool
Group sports bring about social bonding
Reduces stressor of social isolation, especially in mental patients18
Response Reduction
in trained people negative stress reactions do not even occur to their full extent
Cognitive
Affective
Behavioural
Biological
Trained men show on psychological stressors (TSST) compared to untrained men19
Significantly lower cortisol stress response (with the same basal cortisol level)
Significantly lower heart rate increase
Significantly higher calmness, better mood, and tended to have lower anxiety responses to mental stress exposure
Compensating
negative stress reactions that have occurred are reduced or balanced out again through sport and exercise
Sport reduces cortisol
Depression
Exercise improves mood
Even for people who find exercise unpleasant, a half-hour walk has a mood-lifting effect
Endurance sports have an antidepressant effect.2021
Fear
Endurance exercise has anxiolytic (anxiety-reducing) effects.2221
Exercise increases dopamine23 and norepinephrine in brain regions relevant to ADHD24
Exercise (like MPH) can induce tyrosine hydroxylase (TH) expression25 and increase TH levels. TH is a precursor for dopamine. Thus, sport can support dopamine synthesis.
As a rule, exercise can support treatment, but is likely to be sufficient on its own only in very mild cases
Reduces stress hormones
(during sports competitions the above three values are increased)
Increases telomerase activity in humans and mice, counteracting behavioral changes caused by stress-induced telomere shortening.
Cognitive performance
Endurance exercise significantly improved cognitive performance in ADHD272829
One-time training has statistically significant, but small in effect size, improvements in cognitive performance during, immediately after, and time-delayed after the training session.30
A metastudy of eight randomized trials found improvements with areoben sports in children with ADHD in terms of31
Attention (SMD = 0.84)
Anxiety (SMD = 0.66)
Social disorders (SMD = 0.59)
Executive function (SMD = 0.58)
Hyperactivity (SMD = 0.56)
Impulsivity (SMD = 0.56)
One (very small) study found significant improvement in ADHD symptoms overall with exercise training.32
A metastudy found a small but not statistically significant improvement in attention and hyperactivity/impulsivity with physical training in ADHD.21 Nevertheless, there was a significant improvement in cognitive problems (“thought problems”), social problems and aggressive behavior, and problems overall in ADHD.
One study found a 21% decreased propensity to exercise in children with ADHD.33 Another study found a 3.23-fold increase in excessive exercise in children with ADHD compared to non-affected individuals.34
According to the experience of those affected, weight training, in contrast to endurance sports, is apparently much less suitable for combating ADHD symptoms in the long term
One study reports improvements with sports training in children with ADHD regarding35
Memory accuracy
Selective attention
Inhibition
Lower omission errors
Reduced interference errors
One study reported improvements with swimming training in 9-12 year old children with ADHD in terms of:36
Behavior
Academic achievement
Inhibition
One study reported that a single bout of aerobic exercise (30 minutes of cycling) improved inhibition ability, particularly in ADHD sufferers with poor impulse inhibition, but otherwise did not improve behavior.37
One metastudy reported improvements in executive function (organizational ability) with a single 30-minute exercise session.3839
One study reported comparable improvements in orientation behavior and social behavior in SHR (a rat breeding line showing ADHD symptoms) with exercise training, MPH, and atomoxetine.41
The benefits of exercise can accumulate over time. Exercise improves executive function over the long term. Aerobic exercise seems to lead to an increase in neurotransmitters such as serotonin, dopamine, BDNF and cerebral blood flow.42
A metastudy found a significant and marked (SMD = 0.78) improvement in inhibition with exercise in children with ADHD. 60 minutes of open training 2 x / week showed the best effect on improving inhibition.43
Immediately during exercise, working memory and inhibition were worsened in ADHD sufferers compared to non-affected individuals.44 Thus, it seems that it is not the sporting activity per se that triggers the improvement, but a subsequent process triggered by the sport.
A comprehensive review showed that medication treatment is superior to treatment with behavioral therapy or clinical care. Multimodal treatment (combined treatment with medication and behavioral therapy or clinical care) seems most promising.45
A large metastudy of 190 studies involving 26,114 participants with ADHD similarly found behavioral therapy to be effective for ADHD. Stimulants were superior to behavioral therapy, cognitive training, and non-stimulants. Stimulants in combination with behavioral therapy appearedeb to be most effective.2
1.1.3.1.1. Mindfulness Based Cognitive Therapy (MBCT) (+++)¶
According to a meta-study, each of the 13 studies analyzed found improvements in ADHD symptomatology with mindfulness-based interventions.46 Other studies found comparable results.4748
Combined MBCT / MBSR therapy produced increased activity and connectivity of the PFC, cingulate cortex, insula, and hippocampus in stressed, anxious, and healthy individuals after only 8 weeks. The improvements were consistent with what can be achieved with prolonged meditation practice. The functional activity of the amygdala decreased and the connectivity of the amygdala with the PFC was improved. In addition, deactivation of the amygdala occurred more rapidly after emotional stimuli.49 Further studies confirmed these results.5051
Additional MBCT treatment produced significantly greater symptom improvement than conventional treatment alone 6 months after cessation of therapy.52
Mindfulness meditation decreased cortisol and inflammation levels and increased telomerase, which counteracts behavioral changes due to stress-induced telomere shortening.53
Mindfulness-based treatment improved core symptoms of attention problems and hyperactivity in ADHD.54
A meta-study of 32 studies found evidence for effectiveness of mindfulness-based behavior therapy (there: mindfulness) for ADHD.55
A metastudy of 32 studies found positive results for cognitive behavioral therapy for ADHD in the majority.55
A metastudy found benefits of cognitive behavioral therapy for ADHD in parenting assessments but less so in reducing functional symptoms.7
According to Barkley, cognitive behavioral therapy does not work for children with ADHD.56
In young children, treatment of the parents is much more effective.
Patients between 7 and 6 years of age with ASD and anxiety or compulsivity were 4 times more likely to respond to cognitive behavioral therapy when comorbid ADHD was present, according to one study.57
Cognitive behavioral therapy is most likely to be appropriate with regard to self-esteem problems caused by ADHD58 and with deficits in social behavior.
Different forms of therapy improved different symptoms in ADHD according to a meta-study (SMD: standard mean difference; higher is better: up to 0.5 low to medium, up to 1 medium to high, above 1 high)59
Depression
Cognitive behavioral therapy (moderate to greater effect size)
0.52 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively slightly more effective than Cognitive Behavioral Therapy
DBT
Ineffective in group comparison
Subjectively moderately effective, worse than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, even worse than DBT
Anxiety symptoms
Cognitive behavioral therapy (moderate to greater effect size)
0.73 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Self-worth
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective in group comparison
1,404 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Quality of life
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective to slightly effective in group comparison
0.57 SMD in follow-up subjective for affected person
MBSR
Subjectively very good in the short term
DBT
In group comparison very good in the short term, ineffective in the long term
Subjectively moderately effective in the short term, weakly effective in the long term
Emotional dysregulation
Cognitive behavioral therapy (moderate to greater effect size)
0.64 SMD at follow-up in group comparison
0.73 SMD in follow-up subjective for affected person
MBSR
In group comparison weakly effective in the short term, not known in the long term
Subjectively very effective in the short term, not known in the long term
A metastudy of 32 studies found evidence of benefit from group-based DBT for ADHD.55
One study found that DBT skills training worked particularly well for externalizing sufferers.62
Different forms of therapy improved different symptoms in ADHD according to a meta-study (SMD: standard mean difference; higher is better: up to 0.5 low to medium, up to 1 medium to high, above 1 high)59
Depression
Cognitive behavioral therapy (moderate to greater effect size)
0.52 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively slightly more effective than Cognitive Behavioral Therapy
DBT
Ineffective in group comparison
Subjectively moderately effective, worse than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, even worse than DBT
Anxiety symptoms
Cognitive behavioral therapy (moderate to greater effect size)
0.73 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Self-worth
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective in group comparison
1,404 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Quality of life
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective to slightly effective in group comparison
0.57 SMD in follow-up subjective for affected person
MBSR
Subjectively very good in the short term
DBT
In group comparison very good in the short term, ineffective in the long term
Subjectively moderately effective in the short term, weakly effective in the long term
Emotional dysregulation
Cognitive behavioral therapy (moderate to greater effect size)
0.64 SMD at follow-up in group comparison
0.73 SMD in follow-up subjective for affected person
MBSR
In group comparison weakly effective in the short term, not known in the long term
Subjectively very effective in the short term, not known in the long term
Elements of a DBT:
Inner mindfulness
Improve self-awareness and learn to trust it
Feel safe in situation without judging or devaluing it
Control, being able to participate in situations while maintaining distance
Reconcile feelings and mind.
Interpersonal skills
Establish and maintain relationships
Balancing and integrating relationship maintenance with own legitimate needs, opinions, and self-respect
Dealing with feelings
Recognize different feelings, name them, grasp their meaning
Controlling anger and resentment
Reduce vulnerability
Promote pleasant feelings
Release emotional suffering
Strengthen trust in your own feelings
Stress tolerance
Accept the fact of being under stress at the moment
Taking a step back (inwardly taking a step back)
Limit thinking to the now and the next minutes
Focus (distraction) through self-exposure to strong sensory stimuli
Ice cube
Ball with spikes
Breathing exercises
“easy smile”
Mindfulness exercises
Learning to endure unchangeable unpleasant events and feelings (“radical acceptance”).
Self-worth or self-acceptance
Healthy self-acceptance
Healthy self-confidence
Healthy sense of self-worth
Structured psychotherapy
Very suitable for ADHD
Based on Dialectical Behavioral Therapy of Borderline Personality Disorder according to Linehan63
Many sufferers spent their entire lives under (inaccurate) accusations such as “their lack of drive was an expression of laziness,” or “their inability to behave in a socially appropriate manner was malice” (because the power of impulsive breakthroughs was misunderstood). The fear of being further misunderstood makes it much more difficult to engage in a therapeutic relationship.64
EMDR
In the therapy of trauma, EMDR is a recognized therapeutic option.66 EMDR uses bilateral (alternating) activation of the two halves of the body through horizontal eye movements, alternating auditory signals to the left/right ear, or touch on the left and right sides of the body. A study proves that bilateral activation of the body leads to a decrease in activation of the PFC.67
Since EMDR-like therapies such as Emoflex have been reported to produce good results in ADHD, these results from the aforementioned study may be transferable to ADHD.
Preparation and positive stabilization
What good things are aware of today, what bad things / burdens?
Evaluation
The stressful memory is assigned a present negative paraphrase (e.g., I am defenseless) and a future positive paraphrase (e.g., I can protect myself).
Desensitization
The stressful perception is called up and worked through under the accompaniment of bilateral stimulation (usually 24 items of rapid right/left alternating stimulation, visual - eye movements left/right/left, auditory - acoustic signal left/right ear, sensory - body touch on left/right side of body) with free association until the physical/mental stress is no longer perceptible. The speed is adapted to the patient’s reactions.
Anchoring
Instead of the negative previous ones, a positive new thought base is anchored and trained. Slow bilateral movements, about 60 / minute.
Body test
Ensuring that negative sensations no longer occur when the stressful situation is remembered.
Final meeting
among other things, indicate that aftereffects can occur, e.g. in dreams.
Success control and future orientation
For a detailed account of EMDR therapy using example cases, see Schubbe.69
Emoflex70
Note: Emoflex is a protected trademark. Reports on forms of therapy that are marketed with property rights should always be viewed particularly critically, as marketing interests may play a role here.
Emoflex is an adaptation of the EMDR technique for ADHD.
Branded therapy methods
Trademark protection on therapy methods may make economic sense for the trademark owner. However, the effectiveness of EMDR (also) for ADHD is independent of whether the therapy bears a trademark name or “merely” uses the underlying therapeutically effective methods (which can never be protected under trademark law).
For children with learning disabilities and ADHD, mentoring showed improvements in self-confidence and social relationships, and prevented the development of depressive behavior.72
A small study found that training with time estimation tasks improved cognitive symptoms in adults with ADHD-HI. Cortical activity in areas related to attention and memory increased significantly.73
Especially suitable in relation to family and group problems in ADHD. Suitable in relation to family conflicts in ADHD affected younger children.
With regard to the causes of ADHD symptoms in the affected persons themselves hardly effective.
Conditionally to poorly suitable for ADHD without comorbidities
Suitable for ADHD sufferers in whom formative experiences from childhood clearly drive the stress level. In addition to ADHD, these patients usually have comorbid traumas or problems from the borderline spectrum, etc. In these cases, a depth psychological reappraisal can be very useful.
Conditionally suitable for ADHD
Talk therapy can help manage ADHD sequelae.
In contrast, it is unlikely to be effective with respect to the causes of ADHD symptoms themselves.
Case study at Krause.74
1.1.3.11. Working Memory Training / Cognitive Working Memory Training (CWMT) (-)¶
A large-scale meta-study found insufficient evidence of effectiveness of cognitive training for ADHD.75 Another study confirmed this.76
Another meta-study of 18 studies of cognitive training in school-age children and adolescents with ADHD found positive effects in 13 of 18 studies. 7 of 9 studies also found these at follow-up, suggesting long-term improvements.77
Another meta-study found evidence of possible benefits of cognitive training on working memory, but predominantly no improvements in ADHD symptomatology in parent or teacher ratings.7
Several small studies found evidence that working memory training could help reduce ADHD symptoms.7879808182
High intensity training (a total of 14 hours over 5 weeks) was reported to increase the density of D1 dopamine receptors in the PFC,83 leading to a significant reduction in symptoms of attention and impulsivity.84
In ADHD, working memory residing in the dlPFC is impaired by reduced dopamine levels. The inhibitory dopamine transporters D2 to D4 are primarily affected. ⇒ Neurophysiological correlates of working memory problems in ADHD
Working memory uses different brain areas for different content (number sequences, faces, names, goals). Training a specific working memory area (e.g., number sequences) therefore has little effect on working memory performance for names.
Research found no benefit of executive function training in ADHD.85 Another executive function training (EXAT) worked better for ADHD than for epilepsy, according to one study.86
2 different executive, attentional, and motor trainings in children 4 to 5 years of age were found to be equally effective.87
A meta-study of executive function training in preschool children reports no benefits for unaffected individuals, but mentions benefits for ADHD sufferers.88
Mindfulness techniques are very good for treating ADHD. A meta-analysis found positive results in 11 of 12 studies in relation to the treatment of ADHD.91 One meta-analysis found improvements in inattention in adults, while there was still too little data for children.92 One review found MBSR to be a useful supportive treatment for ADHD.93
Procrastination-inhibiting9697 (which is only natural, since procrastination is a symptom of stress)
Mindfulness-based treatment improves the core symptoms of attention problems and hyperactivity in ADHD.54
Mindfulness training targets the vegetative nervous system
Stress management decreased basal DHEA levels and increased cortisol levels in one study. The change in the cortisol-DHEA ratio achieved was stress resistance-promoting.98
It should be noted that depending on the disturbance pattern, the cortisol/DHEA ratio may be imbalanced in either direction. ⇒ DHEA/cortisol imbalance in stress
Psychological stress therapy should always influence the ratio in the direction of the healthy balance. In the case of drug treatment, it must first be determined in which direction the balance is shifted.
Internal / external
internal: it’s up to me personally (me, my)
external: it’s because of the circumstances (the others, out there)
Stable / variable
stable: it is unchangeable (always, never)
variable: I can influence it
Global / specific
global: it is always and everywhere like this (everywhere, regularity)
specific: the cause lies in this case itself (here, this time)Mindfulness trains a change of perception. It is trained that the perceived event is no longer immediately attributed, but that it is left to stand on its own. This enables a less frightening and threatening perception, which can massively reduce stress.
Different forms of therapy improved different symptoms in ADHD according to a meta-study (SMD: standard mean difference; higher is better: up to 0.5 low to medium, up to 1 medium to high, above 1 high)59
Depression
Cognitive behavioral therapy (moderate to greater effect size)
0.52 SMD in follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively slightly more effective than Cognitive Behavioral Therapy
DBT
Ineffective in group comparison
Subjectively moderately effective, worse than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, even worse than DBT
Anxiety symptoms
Cognitive behavioral therapy (moderate to greater effect size)
0.73 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Self-worth
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective in group comparison
1,404 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Quality of life
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective to slightly effective in group comparison
0.57 SMD in follow-up subjective for affected person
MBSR
Subjectively very good in the short term
DBT
In group comparison very good in the short term, ineffective in the long term
Subjectively moderately effective in the short term, weakly effective in the long term
Emotional dysregulation
Cognitive behavioral therapy (moderate to greater effect size)
0.64 SMD in follow-up in group comparison
0.73 SMD in follow-up subjective for affected person
MBSR
In group comparison weakly effective in the short term, not known in the long term
Subjectively very effective in the short term, not known in the long term
Mindfulness meditation reduced ADHD symptoms (hyperactivity and inattention), but breathing techniques did not, while both techniques reduced stress.99
Mindfulness training still showed positive effects on children with ADHD in parent assessment 6 months later100
A meta-study concluded that mindfulness techniques are a helpful adjunct in the treatment of ADHD.101
How mindfulness works
The technique of mindfulness includes - roughly formulated - the establishment of a virtual distance to perceived circumstances. Mindfulness means - to put it simply - a separation of perception and its immediate evaluation for oneself. It is trained to perceive very consciously what is happening and at the same time not to refer the events to oneself, i.e. not to take them as a reason for a reaction, but to observe the effect of the events on oneself with interest. This stops the automatism of the immediate impact of perceptions on one’s own state of mind.
In other words
You realize that everything still happens in the same way, but that it no longer directly threatens your existence. It happens, and yet you go on living. The subjective threatening nature of what happens is reduced.
This technique makes sense if the automated stress regulation has previously been misdirected in such a way that events are attributed too directly to oneself.
Attribution styles
There are different attribution styles,102 how perceived circumstances are explained. Example:
A student fails an exam.
The following reaction possibilities (i.e. attribution styles) are conceivable:
I am just too stupid. (Internal - stable - global)
I really didn’t learn anything for this exam. (Internal - variable - specific)
This time I was just unlucky. (External - variable - specific)
They always give me the most stupid tasks. (External - stable - global)
Summarized attribution dimensions yield specific interpretations:103
Internal-stable: ability
Internal-variable: effort
External-stable: task difficulty
External-variable: luck/bad luck
Pessimistic attribution style: failures are attributed internally, globally, stably
Optimistic attribution style: failures are attributed externally, specifically, unstably
We hypothesize that a global internal attributional style makes one prone to perceive experiences as threatening and fearful.
Anxious and threatening perceptions quickly lead to cortisol stress.
1.1.4.1. Neurophysiological mechanisms of action of mindfulness techniques (here: MBSR)¶
Mindfulness training is able to sustainably reduce cortisol levels.104
In generalized anxiety disorder, there is overactivation of the amygdala in response to ambivalent signals and a deficient functional connection between the amygdala and ventrolateral PFC. MBSR reduces amygdala overactivation for neutral faces more than stress management. MBSR, but not stress management, caused greater activation of the ventrolateral PFC and also improved the connection between ventrolateral PFC and amygdala. All changes coincided with improvements in anxiety symptoms, suggesting causal effects. The previously negative coupling of the amygdala with ventrolateral PFC activity, as known in emotion reduction, changed to a positive coupling. MBSR appears to produce substantial changes in brain regions relevant to emotion regulation.105
The functional activity of the amygdala decreased and the connectivity of the amygdala with the PFC is improved. In addition, deactivation of the amygdala occurred more rapidly after emotional stimuli.49
Since MBSR has been shown to be very effective for ADHD, we assume that there is an analogous improvement in communication between different brain areas.
Further research demonstrates effects of MBSR on neural activity.106
Mindfulness-based meditation technique may be superior to relaxation training in terms of long-term normalization of cortisol response.107
MBSR appears to be able to improve emotional self-regulation in ADHD sufferers.108
MBSR may improve ADHD symptoms not so much through improved mindfulness skills or improved self-compassion, but through improved inhibition.109
Zen Meditation
increased the level of serotonin in the brain in the long term
Experienced meditators have been shown to have an increase in cortical thickness in the right insula and frontal lobes.114
In mindfulness meditation, more gray matter was observed in brain areas typically used in meditation in intensive meditators (2 hours daily for more than 8 years). The right insula, which is involved in introspective attention (“interoceptive awareness”), the left inferior temporal gyrus and the right hippocampus are affected.115
A meta-study found evidence of effectiveness of meditation techniques in children, adolescents, and adults.116 The results are said to indicate a stronger effect on inattention than on impulsivity/hyperactivity.
Biofeedback
Relaxation massages
Massage therapy produced a 31% reduction in the cortisol response to stress and an increase in dopamine and serotonin of about 30%.117
Massage therapy is said to be able to surpass the effect of methylphenidate.118
Shiatsu
Qigong
Tai chi chuan
One meta-study found consistently positive effects of Tai chi on ADHD symptoms, although the quality of the studies was rather low.7
Respiratory therapy
Progressive muscle relaxation according to Jacobson
Feldenkrais
Sound massages
Archery or other shooting sports (with mild positive effects on ADHD)119
Mindfulness Apps
also for the cell phone, which you always have with you anyway to take advantage of small breaks.120
Example of a mindfulness exercise: letting go of 100 breaths
Procedure:
Seek out a quiet place where you can be undisturbed
Comfortably lie down / sit down
Close eyes
Paying attention to your own breath
With each breath release, count backwards from 100, to zero, for each breath release a number.
Each time you let go of the breath, make sure that the abdomen lets go in a completely relaxed way. And starting from the abdomen, following him, the whole body relaxes with the release of breath.
(There are two types of breath: Active inhaler and active exhaler; the respective passive side is to let go of the breath)
Each time you let go of the breath, focus on feeling the belly relax
Recap the exercise text (below) during the exercise
If necessary, background noise of the sea (this also masks possible street noise); if necessary, headphones with audio recording of the spoken text, if necessary earplugs, if alone for yourself, and remember text silently
In group: leader speaks meditation text;
Length: participants keep eyes closed as long as it works; whoever stops opens eyes, waits silently or, if necessary, reads something until (most) others have finished; leader then finishes reciting meditation text
Exercise Text:
You are here
Feel your body
You do not have to do anything now
You may be with you
You may only feel yourself now
You do not have to do anything else
Nobody wants anything from you
Feel your breath
Relax your belly while releasing the breath
and with the belly all the rest of the body
Feel how it feels when your belly relaxes
Try to let go completely, with each release of breath
There are thoughts
Let them come
Perceive them
Do they have a color, a shape?
Look at her come
Do not follow them
Let them go again
Watch them disappear
You are here
You feel your body
You feel yourself
If trouble comes, watch it
Become aware of her desire. What does she want? To have to do something? Want to think? To look at problems? What does the desire that is there want?
Feel him
Do not deny him, do not follow him
Look at him, watch him
Feel the desire
How does this urge feel?
Does it have a sound, a smell?
What does it feel like outside of that desire?
You are relaxed
And let go of your belly every time you let go of your breath
And observe what you are feeling or thinking right now
Feel your body
Feel your feelings
Observe what you feel
Do not follow the feeling, just observe it
And let it go again
When unrest comes, observe how it comes
Do not call them here
If it is there, perceive it, feel it
Do not follow her
How does it feel?
Does it have a sound, a movement?
Look at them
She may be
She has no right to determine you
Let them go again
You are here
Feel your body
You do not have to do anything now
You may be with you
You may only feel yourself now
You do not have to do anything else
Nobody wants anything from you
All thoughts that come can wait
when they are important, they come back
Now you are the most important
Everything else has its time later
(continue)..
..
..
The exercise aims at not denying = not suppressing feelings/thoughts/inner turmoil.
It is easier not to follow something that is not suppressed. This, by its very nature, requires an inner position outside of the pressure.
I want the feeling/thought to be there - and they don’t define me.
I am beside them, not through them.
Feelings / thoughts are there and they are not me.
You are a part of me, and only a part.
I am not these thoughts and feelings, I have them.
I have them, not they have me.
The questions of color, form, sound aim at viewing feelings and thoughts as something from outside, as something third, thereby separating them from oneself and not being controlled by them.
The learning steps should / could be:
Learning to perceive, to feel, to sense oneself alternatively and separately from these thoughts and feelings. Learning to feel this “me” as an alternative safely.
Learning to safely evoke the alternative.
Strengthen the alternative until it is bigger option.
Grow the alternative to the point where you can feel it as a base, sense it, and eventually live it permanently.
Training path:
(Introducing transformation in daily routine)
First times with optimal medication
Increase in difficulty according to progress with less and less / at the edge / end of drug efficacy
To without medication (if possible)
At the beginning in own ritual, at a certain, quiet place, if necessary at fixed time
Later less and less isolated, also sometimes spontaneously
In our opinion, the only form of therapy with a healing character, as the self-control mechanisms of the brain can be permanently improved
In our opinion, longer treatments are required than typically recommended
In particular, a combination of frequency band training followed by SCP training seems to produce very good results.
Neurofeedback training types
SMR Training
acts on relaxed attention, hyperactivity, impulsivity
Theta Beta Training
acts on concentration, tense attention
Alpha Training
acts on relaxation, sleep problems
SCP Training
Slow cortical potentials marriage
acts on activation (in ADHD-I) and down-regulation (in ADHD-HI)
very exhausting, but also very helpful when carried out
Neurofeedback improved visual memory, auditory short-term memory, and auditory working memory in a small study, but not perceptual organization.124
However, neurofeedback is not a substitute for treatment with medication (especially in the early years), but an adjunct to therapy that can reduce the need for medication.
Different forms of therapy improved different symptoms in ADHD according to a meta-study (SMD: standard mean difference; higher is better: up to 0.5 low to medium, up to 1 medium to high, above 1 high)125
Depression
Cognitive behavioral therapy (moderate to greater effect size)
0.52 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively slightly more effective than Cognitive Behavioral Therapy
DBT
Ineffective in group comparison
Subjectively moderately effective, worse than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, even worse than DBT
Anxiety symptoms
Cognitive behavioral therapy (moderate to greater effect size)
0.73 SMD at follow-up in group comparison
0.74 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Self-worth
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective in group comparison
1,404 SMD in follow-up subjective for affected person
Neurofeedback
Ineffective in group comparison
Subjectively more effective in the long term than cognitive behavioral therapy
MBSR
Ineffective in group comparison
Subjectively moderately effective, ineffective in the long term
DBT
Totally ineffective
Quality of life
Cognitive behavioral therapy (moderate to greater effect size)
Ineffective to slightly effective in group comparison
0.57 SMD in follow-up subjective for affected person
MBSR
Subjectively very good in the short term
DBT
In group comparison very good in the short term, ineffective in the long term
Subjectively moderately effective in the short term, weakly effective in the long term
Emotional dysregulation
Cognitive behavioral therapy (moderate to greater effect size)
0.64 SMD at follow-up in group comparison
0.73 SMD in follow-up subjective for affected person
MBSR
In group comparison weakly effective in the short term, not known in the long term
Subjectively very effective in the short term, not known in the long term
Parent training seems to be helpful for children with ADHD.126 This probably concerns especially children with ODD127 and young children.128
Interventions in school/kindergarten (-)
One meta-study reported that classroom interventions/school interventions were found to be partly ineffective and partly effective only as long as the interventions lasted.7
Each person needs his or her specific level of arousal (excitement, stimulation).130131
Even though Novelty Seeking and Curiosity Behavior correlate (also genetically) with Impulsivity,132 it is likely to be important for most ADHD-HI sufferers to reduce Arousal, whereas for ADHD-I sufferers to increase Arousal.
Stimulate arousal
Targeted (soft) background music
Some people can only learn with it
TV running in the background
If sounds / images are distracting: switch off
Motivational elements
Very important, because ADHD sufferers can basically concentrate just as intensively as others. It’s just that they can’t evoke this concentration in a controlled manner and certainly can’t control it. This is not negligence or laziness.
Intrinsic motivation instead of extrinsic motivation: the central key
Rewards
Competition with others
Communicate goals to others (create commitment / self-commitment)
Do not make those affected feel guilty
None: You can if you want
None: You just have to try harder
Friedmann reports of sufferers who lost their ADHD symptoms after finding a work environment that suited their constitution: short attention spans, frequent activation, independent work organization. We also know of cases who flourished in the environment that was just right for them. This does not mean that only each affected person has to find his or her suitable environment and then no longer have ADHD. ADHD means that the choice of which environment is suitable is extremely limited. Very few people with ADHD will be able to build their world in this way. In our opinion, however, another element must be added: genuine interest. Only when this genuine interest of one’s own kicks in are ADHD sufferers able to remedy their attention problems. Friedmann points out that the reduced number of dopamine D2 and D3 receptors in the brain’s reward center in ADHD sufferers results in fewer things being found (be)rewarding, i.e., sufficiently exciting, than in non-affected individuals. The choice of an exciting environment therefore necessarily requires that it is something that is of (such) high interest to the respective affected person that the reward center “kicks in” and the attention of the affected person is aroused. The sentence “You can if you want to” is quite correct, but not in the way it is usually misunderstood. ADHD can only be understood if one is willing to accept that the will of the affected person is not completely free to choose, but depends on the occupational topic being so interesting that the deficiency of the reduced number of D2 and D3 dopamine receptors no longer comes into play. Only with the appropriate intrinsic interest can sufferers manage to “be able” to do what they want: by doing something that really really interests them. This mechanism explains well why extrinsic motivation (external pressure) does not help if something is not interesting enough. External pressure can do a lot - but it does not make dopamine receptors grow. From this point of view, ADHD could also be defined as an extreme narrowing of interest. And yet this is also no justification that one’s own ADHD is not so bad, one has just not found what one is interested in.
Sideline
Knitting
Draw
Listen to music
Some people need to “do” something on the side in order to concentrate. This diverts the inner tension. The side activity serves to optimize the arousal. This is not a sign of disinterest or disrespect, but a means to increase attention and concentration
Reduce distraction
Avoidance of too loud, hectic, stressful, intense situations.
Anyone who is sensitive to stress should avoid situations that trigger stress. This fact, which sounds self-evident, is surprisingly often disregarded, whether due to a lack of knowledge of the correlations or a guilty conscience. It is like the temperature: you should not freeze when the thermometer says so, but when you are cold:
Max. 10 pieces, so often, until they sit quite securely, only then further
Using all senses: reading quietly, reading aloud, copying, etc.
More vocabulary only after break
Walk while learning
uniform movement significantly optimizes receptivity in some people; movement reduces stress and increases neurotrophic factors in the brain, which are necessary for neuroplasticity (formation of new synapses, learning)
30 minutes of intensive physical exercise before learning (esp. ADHD-HI)
Appropriate working methods
Self-employment
for interesting activities some affected persons (esp. ADHD-HI) cope better as self-employed than as employees, because intrinsic motivation optimizes arousal
in the case of less interesting activities, however, this would be rather disadvantageous, because self-drive / self-structure is too low
Interesting activity
The lack of extrinsic motivability makes it many times more important for ADHD sufferers than for non-affected people to find a task that is truly exciting for them
ADHD-I: structured work tasks, clear announcements, tight controls
Example:
One individual retired at age 50 after an illustrious career in the U.S. Marines. In civilian life, he couldn’t cope and failed. A year after leaving, he received his ADHD diagnosis.
Well-structured daily routine with regular alternation of activity and relaxation can support stabilization of norepinephrine balance through self-activation (see below: take enough breaks)
Avoid / eliminate sources of stress
Even in personality disorders, a long-term study (n = 733) surprisingly found a decrease in symptoms within 2 years for a period of more than 12 months in more than 50% of those affected. In borderline, this was observed in 10% of sufferers within 6 months, mostly after massively stressful current life circumstances (stressful relationship) were removed. Nevertheless, significant diagnostic criteria remained very constant (stronger than in major depression), but they no longer reached the required severity for a diagnosis.135
Promote stress reduction
Just one hour of extended sleep reduces morning cortisol levels by 21136137
For sleep disorders:
Shift sleep rhythm backwards
Move falling asleep and getting up to the end of the day
This might be worth a try for sufferers with high stress levels immediately upon waking (e.g. anxiety)
Early awakening correlates with high cortisol levels136137
self-help groups (if necessary, professionally led/supervised)
Books, seminars, lectures
Knowledge about ADHD helps sufferers in several ways
Who am I, what about me is ADHD?
Recognizing which symptoms stem from ADHD, and that they are treatable, makes it easier to determine one’s own personality: who one “actually” is without this ADHD. This differentiation helps to learn to accept oneself and to understand the ADHD symptoms as something given, but not unchangeable. This is helpful for the often very impaired sense of self-worth of those affected.
Handling requires knowledge
Understanding the symptoms, their causes, and their effects allows for helpful management, especially:
The choice of appropriate treatment methods
Environment interventions (see above)
Understanding others
Knowing what constitutes ADHD, how it affects perception and action, helps in understanding other people. ADHD sufferers who have known all their lives that it is normal to feel and act this way can see why other people feel and act differently when they do not have ADHD symptoms.
Knowledge facilitates renewal of self-concept
A person who has experienced a lifetime of rejection for not being who he or she is supposed to be can begin to rebuild a sense of self-worth that has usually been completely destroyed by then, by understanding that most of the negative reactions were not caused by him or her, but by ADHD140
Limit: Avoid negative bias
The danger of self-fulfilling prophecies should be recognized and avoided.
Unthinking identification with ADHD symptoms can be harmful.
One is not ADHD - one has ADHD.
No ADHD sufferer has all the symptoms of the cluster.
Take advantage of ADHD
Under some specific circumstances and aspects, ADHD sufferers have an advantage over non-affected people. One can only use this advantage if one knows the conditions under which the advantages take effect.
Sleep problems should be treated with special priority in ADHD, as they can act as a vicious cycle to increase ADHD symptoms and ADHD symptoms can cause sleep problems.
Sleep reduces the stress hormone cortisol. 1 hour longer sleep improves cortisol reduction by 21136
All ADHD symptoms are also stress symptoms.
On the possible measures to improve sleep as well as sleep medications specifically for ADHD: ⇒ Sleep problems with ADHD
Food intolerances address the stress regulatory systems as does psychological stress or disease.
There are no specific foods that trigger ADHD. However, if an individual food intolerance exists, it can exacerbate an existing ADHD (as well as other mental disorders) because it represents an additional source of stress/strain for the organism. Dietary treatment of an existing food intolerance therefore contributes to an improvement of an ADHD symptomatology. The mean effect size is approx. 0.25.
In addition, there are indications that omega-3/omega-6 fatty acids can support a treatment of ADHD. However, this does not affect all sufferers and the effect strength is so low that this can only be recommended as an augmentation (supplement) to a treatment with a strong effect.
See ⇒ for more details Nutrition and diet for ADHD as well as at ⇒ Effect size of different forms of treatment for ADHD.
One study found that 47% of students with ADHD and 33% of students without ADHD regularly did not eat a balanced breakfast. One hour after eating a balanced breakfast, both groups showed improvements in 4 cognitive domains.141
Although thirst is not described as a typical ADHD symptom, increased thirst and therefore increased water intake are commonly observed symptoms of stress.142 Since stress aims to increase blood pressure in order to optimally prepare the body for fight or flight, increased fluid intake is an immediately useful tool.143 Fluid intake significantly reduces the stress response.144
Breaks are not just for recovering and letting the amount of stimuli you’ve been exposed to drain away:
A clearly structured daily routine, in which activity and breaks are sensibly alternated, can train the noradrenergic system and normalize the production of noradrenaline again.145
This follows on from Scheidtmann’s suggestion that noradrenergic drugs (e.g., antidepressants) do not help in motor rehabilitation (if) they are used as permanent medication, since tricyclic antidepressants permanently stimulate noradrenergic receptors and this leads to the sensitivity of the receptor (especially with regard to learning processes) being lost as a result.146
This is consistent with experience with the use of noradrenergic tricyclic antidepressants in ADHD. Here, it is often reported that initially there is a very good response, which, however, decreases with continued medication.
Breaks can counteract the hyperactivity of ADHD.133
In recent years, the topic of computer games for the purpose of therapeutic use has come into scientific focus.
Basically, ADHD symptoms should be able to be improved by therapy computer games, e.g. attention,147
A therapy computer game has already been approved by the FDA for ADHD.
The FDA (U.S. Food and Drug Administration) approved the first ever doctor-prescribable video game in June 2020. It is used to treat ADHD.
180 children between 8 and 12 years of age played EndeavorRx for 25 minutes each 5 days/week for 4 weeks, and 168 children played a game other than placebo. The mean change (SD) from baseline on the TOVA-API was 0.93 in the treatment group and 0.03 in the control group.148 It is skeptical that the study was sponsored by the software manufacturer. On the other hand, Faraone, one of the authors, is a very renowned scientist in the field of ADHD and The Lancet is a very renowned scientific journal.
A preliminary study also found evidence of a positive effect.149
The manufacturer further describes:
“EndeavourRx was granted clearance based on data from five clinical trials involving more than 600 children diagnosed with ADHD, including a prospective randomized controlled trial published in the Lancet Digital Health Journal that showed EndeavourRx improved objective measures of attention in children with ADHD. After four weeks of EndeavourRx treatment, one-third of children no longer had a measurable attention deficit on at least one measure of objective attention. In addition, after one month of treatment with EndeavourRx, about half of the parents noted a clinically significant change in their child’s daily impairments. This increased to 68% after a second month of treatment. The improvement in ADHD-HI impairments after one month of treatment with EndeavourRx was maintained up to one month.”150
Another study, probably still ongoing, is investigating the efficacy of the game at a longer application duration of 2 months and to what extent improvements persist after the end of treatment.
The therapy computer game “Plan-It Commander” was / is developed by the authors of the studies mentioned below themselves,151 so that the assessment of its effectiveness by independent studies is to be awaited. The symptoms that are said to have been improved by it in non-blinded studies are as follows
A very small preliminary study showed that the higher their ADHD symptoms, the better autism spectrum disorder sufferers completed the game portions of Empowered Brain.155 The software seems to be developed more from a diagnostic perspective.
1.1.11.5. AR-Therapist: Augmented Reality - Behavioral Therapy - Game Concept¶
A study describes a concept of an augmented reality game for the purpose of behavioral therapy in ADHD including measurement of ADHD-relevant parameters.156
Elude aims to raise awareness and provide information about depression. It is intended to be used in a clinical context as part of a psycho-education to improve friends’ and relatives’ understanding of people suffering from depression, of what the sufferers are going through.
It is disputed whether this reduces the brooding phases in depression sufferers166167
Tetris
Trauma Prevention
Non-therapy game
Use within the first 6 hours after a potentially traumatizing experience, after players were asked to recall the event, reduced risk of traumatization168
However, according to our (unverified) hypothesis, any mental occupation and media consumption that provides a light (!) mental occupation (entertainment programs, entertainment movies without dramas, light video games without social or violent components) could be suitable as trauma prophylaxis, provided that they are used before the first sleep after the event. Of course, the content must not be thematically tangential to the event.
According to our conception, subsequent “light” media consumption (at least partially) “overwrites” or “relativizes” the potentially traumatizing experiences in working and short-term memory before they can be transferred to long-term memory via the hippocampus during sleep. With this in mind, it may be beneficial to delay the first sleep after a potentially traumatizing event as long as possible, to encourage abundant low-significance media consumption, and, if necessary, to give medication that reduces hippocampal activity.
A computer-based cognitive training program improved focused attention and working memory better than conventional training in a proportion of subjects (responders). ADHD-I and ADHD-C were more likely to benefit than ADHD-HI.169
A meta-study found 10 studies, 6 of which showed a positive effect of web-based support tools for young ADHD sufferers. The 4 studies that found no positive benefit each involved apps.170
1.1.13. Chess training / Go training / Board games¶
A small study found an improvement in ADHD symptomatology related to IQ with 11 weeks of chess training.171 The effect size was 0.85 with parent assessment. Parent-only assessment should always be treated with caution.
Another study found a comparable effect of GO, improving inattention but not hyperactivity.172 The results of other studies could not be converted into effect sizes.173174
1.1.14. Transcranial magnetic stimulation / Transcranial direct current stimulation (o/+)¶
Several studies address the effect of transcranial stimulation in ADHD.175176177
Transcranial direct current stimulation was better evaluated than repetitive transcranial magnetic stimulation in one review.178
The majority view is that evidence of positive effects predominates,179180181182183184
One meta-study found a significant positive effect in 8 (n = 133) of 13 studies (n = 308) rather in children and adolescents for inattention, impulsivity, and overall symptom level, with a concomitant delayed onset of effect with respect to hyperactivity.185. Another metastudy found significant improvements in attention, inhibition, working memory, and brain connectivity in 11 studies.186
One study reported an improvement in omission errors in ADHD sufferers with transcranial stimulation that was accompanied by an improvement in P 300 amplitude.191 In a placebo-controlled double-blind study, subjects received either anodal transcranial direct current stimulation (tDCS) over the left dorsolateral prefrontal cortex (dlPFC) or transcranial random noise stimulation (tRNS) while undergoing cognitive training. The improvements in ADHD from transcranial magnetic stimulation were enhanced when combined with cognitive training.192
Two reports of a single case in an adult with ADHD indicated improvement in hyperactivity but not attention.193194 In contrast, a small placebo-controlled study in adults with ADHD found improvement in attention with no improvement in mood, anxiety, or hyperactivity.195
Two studies of children with ADHD found improvements of:196
Inattention in the school context
Hyperactivity/impulsivity at home
oppositional defiant behavior
One study found increased dopamine levels in the striatum during TMS application. The increase was similar to that seen with administration of D-amphetamine,197 Repeated TMS of the left dlPFC increased extracellular dopamine in the left dorsal caudate nucleus, compared with repeated TMS of the left occipital cortex. Unchanged was dopamine in the putamen, nucleus accumbens, or right caudate198
TCM usually combines various treatment methods, as does Western “multimodal” therapy. Among them are herbal treatments, which can be assumed to interfere with the neurotransmitter structure in the same way as conventional medication. The risk is less knowledge of the pathways, side effects, and cross effects with conventional medication.
A meta-analysis found a surprisingly good effect of TCM with regard to ADHD (equally good or better than MPH), but at the same time poor to very poor quality of the individual studies, including a risk of significant bias, which is why TCM cannot yet be recommended as a treatment for ADHD.1997
A very small study with n = 29 adults found positive effects of early morning light therapy in autumn/winter months on objective and subjective ADHD symptoms, mood and an advance of the circadian rhythm.200 The advance of the circadian rhythm seemed to have the greatest influence on the improvement of ADHD symptoms. Another, even smaller study on 16 adults came to comparable results.201
A third placebo-controlled study comparing cordian rhythm with melatonin or melatonin plus light therapy also found that light therapy (here: as an adjunct to treatment with melatonin) could shift the circadian rhythm forward and that this had positive effects on ADHD symptomatology. Melatonin alone had a stronger effect than light therapy, light therapy improved the outcome of melatonin treatment.202
A review confirmed these findings.203
ADHD sufferers who heard white noise during cognitive tasks performed better.
Moderate noise facilitates stimulus discrimination and cognitive performance (stochastic resonance). Computational modeling showed that more noise is required in ADHD for stochastic resonance to occur in dopamine-deficient neural systems. This prediction was supported by empirical data, he said.204205206207
The first positive results have been obtained for trigeminal stimulation.208 The effect size is said to be 0.5.209 Trigeminal stimulation is said to improve executive dysfunction (organizational problems) in particular in children with ADHD.210
A first-of-its-kind trigeminal stimulation device (Monarch eTNS System) was approved by the FDA. In a double-blind placebo study, the device significantly improved ADHD symptoms within 4 weeks in children aged 8 to 12 years.211
Whether neurostimulation can be reliably used as a treatment tool for ADHD and whether the improvements persist after the end of treatment remains to be observed212
1.2. Therapeutic approaches for ADHD whose effect is not proven¶
Occupational Therapy
The effectiveness of occupational therapy for ADHD is limited to school-preparatory treatment of fine motor skills, he said.213
A study reports positive effects of equine-assisted occupational therapy in school-aged children with ADHD.214
Hemoencephalography Training
Effect not yet recognized, initial studies.175
listening to (classical) music to improve the mood
One study found that listening to Mozart for 10 minutes (Mozart piano sonata for four hands, KV 440) improved mood in both ADHD sufferers and non-affected subjects, in contrast to subjects who completed 10 minutes of silence.216 This does not prove an ADHD-specific treatment method.
App-supported attention and organization training
One study reported a cell phone app-based training of attention and organization led to relevant improvements in one-third of adults with ADHD.217
A 2019 meta-analysis found no other research on ADHD treatment using specific apps218
Organizational skills training
In SCT, training in organizational skills did not result in any improvement of SCT symptoms from the perspective of the affected persons themselves. Only from the perspective of the parents did improvements occur, with an effect size of approximately 0.5.219
Parent assessments are highly susceptible to being biased toward desired outcomes. This bias is stronger the greater the effort invested.
Homework support
In SCT, homework support did not result in any improvement of SCT symptoms from the perspective of the affected persons themselves. Only from the perspective of the parents did improvements occur, with an effect size of approximately 0.5.219
Parent assessments are highly susceptible to being biased toward desired outcomes. This bias is stronger the greater the effort invested.
Social Behavior Training
A meta-analysis found no confirmed effect of non-drug training methods (coaching and others) in improving social behavior toward peers.220
One meta-study found weak evidence of benefits from peer-based interventions for ADHD,7 which are primarily aimed at strengthening social support among peers.
Another meta-analysis of 15 studies found evidence of moderate effectiveness of social skills training in children with ADHD.221
Transcutaneous vagus nerve stimulation
One report cites transcutaneous vagus nerve stimulation as a possible treatment for ADHD.222
Acupuncture
One metastudy reports a high efficacy of acupuncture on hyperactivity.223 Another metastudy also intends to investigate the effect of acupuncture for the treatment of ADHD.224
How effectiveness of acupuncture is controversial. So far, no conclusive medical explanatory models exist.
However, two German double-blinded studies, which conclude that only a placebo effect can be demonstrated for Acupucture so far, show in the figures that Acupucture achieved 20% better results compared to sham acupuncture.225. 226 Other studies reported an effect beyond placebo.227228229230
Homeopathy
A metastudy reports benefits of additional individual homeopathy treatment for ADHD.231
Fidgets
One study observed significant improvement in sustained attention in students with ADHD who used Fidgets during class.232
Random Noise
Random Noise treatment uses any form of energy (e.g., light, mechanical, electrical, or acoustic) with unpredictable intensity to stimulate the brain and sensory receptors, aiming to improve sensory, motor, and cognitive functions. Random Noise treatment originally used mechanical sounds for auditory and cutaneous stimuli. Today, electrical energies are increasingly used to affect the brain or skin. Recent evidence shows that transcranial random noise stimulation can increase corticospinal excitability, improve cognitive/motor performance, and have positive after-effects at behavioral and psychological levels.233
Spinal manipulation / spinal mobilization
A meta-analysis found no evidence of efficacy of spinal manipulation/mobilization for ADHD234
1.3. Therapeutic approaches that are proven ineffective¶
Certain foods/food additives certain substances as sole causal cause of ADHD
However, food intolerances in general (individually incompatible substances in each case) can increase the stress level in such a way that latent mental disorders (e.g. also ADHD) can appear or existing disorders are intensified.
See more at ⇒ Nutrition and diet for ADHD
Multimodal therapy is a combination of relevant treatment options. In the case of ADHD, a combination of medication, psychotherapy and, if necessary, other treatment options is used. Multimodal treatment improves ADHD symptoms.235 This is not surprising. Only a comparison with purely psychotherapeutic and drug treatment would be relevant.
Group therapy manual “Psychotherapy of ADHD in Adulthood” (Hesslinger et al., 2004)
Adaptation of the Dialectical-Behavioral-Borderline Therapy Concept to ADHD
“Treatment Manual for ADHD in Adulthood” (Lauth, Minsel, 2009)
For individuals and groups
“Psychoeducation and Coaching Manual ADHD in Adulthood” (D’Amelio et al., 2009),
Practical guidance on the treatment of ADHD and family groups
“Training for ADHD in Adulthood (TADSE)” (Baer & Kirsch, 2010)
“Therapy Program Cognitive Behavioral Therapy of Adult ADHD” (Safren et al.,2009)
Cognitive techniques for individual therapy
Interdisciplinary evidence- and consensus-based (S3) guideline “ADHD in children, adolescents, and adults”237
To date, few treatment approaches are known that distinguish between the different subtypes of ADHD - ADHD-HI and ADHD-C (with hyperactivity) on the one hand, and ADHD-I (without hyperactivity) on the other.
In our view, ADHD-HI and ADHD-C suffer from the HPA axis stress system being permanently over-activated and not shutting down again due to too low a cortisol response to acute stress or poor addressability of glucocorticoid receptors, whereas the ADHD-I subtype suffers from an over-intense neurotransmitter and stress hormone response to acute stress, which leads to a regular shutdown of the HPA axis due to the high cortisol response, but at the same time shuts down the PFC due to the parallel excessive norepinephrine release, thus triggering thought blocks and decision-making incapacity.
In ADHD-HI, we believe that mindfulness is particularly important in order to achieve a therapeutic ability in the first place. The permanently elevated stress level in ADHD-HI (with hyperactivity) is so greatly increased that mindfulness (MBCT, MBSR, meditation, yoga …) is downright aversive, which correlates with an inability to recover.
Treating children alone overlooks the fact that the influence of ADHD-affected parents has a significant impact on children’s development.
Treatment and support of ADHD-affected mothers showed positive consequences for the children, although higher intensity treatment of ADHD-affected mothers (here: with DBT) showed a benefit for the children only for a limited time compared to less intensive treatment.238
Children of mothers with high neuroticism and low conscientiousness should benefit more from behavioral therapies than other children. In contrast, children of mothers with moderate neuroticism and moderate conscientiousness or low neuroticism and high conscientiousness are expected to benefit more from a multimodal treatment consisting of therapy and medication or medication alone than from behavioral therapy alone.239
