Suitable non-drug treatments for ADHD

This section summarizes the non-drug treatment and therapy approaches known to us.
The (+) and (-) in the headings of the following articles reflect our personal assessment of the benefits for ADHD.

In our experience, drug treatment is the most important and sensible form of therapy for severe and moderate forms of ADHD.
Among the thousands of people with ADHD that we got to know through the forum, those who thought that they had achieved sufficient symptom improvement with psychotherapy were not only clearly in the minority, but even more clearly: barely represented.
in our opinion, (suitable) ADHD medications deem effective (or suitable) are given an efficacy label of (+++++).

• ADHD should definitely be treated with medication - at least temporarily - especially at the beginning of therapy.
  People with ADHD who have never felt what it is like to live without these distressing symptoms cannot understand the goal of non-drug therapy from their own perception. Edel/Vollmoeller argue in a similar way.¹ In addition, dopamine is a neurotrophic factor, which means that it is required for learning processes in the brain. The dopamine deficiency typical of ADHD therefore prevents learning success and should be remedied before psychotherapeutic treatment.
• A large meta-analysis of 190 studies involving 26,114 participants with ADHD found that stimulants appeared to be superior to behavioral therapy, cognitive training, and non-stimulants. Stimulants in combination with behavioral therapy appeared to be the most effective.²
• Medications show a much greater Effect size on ADHD symptoms than non-pharmacological treatments.³
• Presentation of the drug treatment at ⇒ Medication for ADHD - Overview.

Non-pharmacological treatments are important supportive measures which, in combination with medication, can lead to relevant additional improvements.
Psychoeducation, self-help groups, sports, psychotherapy, mindfulness techniques and neurofeedback are particularly noteworthy.

• 1. Multimodal therapy approach
• 2. Subtype-specific treatment
• 3. Multi-generational treatment for ADHD

1. Multimodal therapy approach¶

Multimodal therapy is a combination of relevant treatment options. A combination of medication, psychotherapy and possibly other treatment options is used to treat ADHD. Multimodal treatment improves ADHD symptoms.⁴ However, this is not surprising. Only a comparison with purely psychotherapeutic and drug treatment would be relevant.

In adults with ADHD, combined treatment with medication and cognitive behavioral therapy was only superior to medication alone after the first 3 months. There was no difference after 6 and 9 months.⁵

2. Subtype-specific treatment¶

To date, few treatment concepts are known that differentiate between the various subtypes of ADHD - ADHD-HI and ADHD-C (with hyperactivity) on the one hand and ADHD-I (without hyperactivity) on the other.

In our opinion, ADHD-HI and ADHD-C suffer from the fact that the stress system of the HPA axis is permanently overactivated and is not shut down again due to an insufficient cortisol response to acute stress or insufficient addressability of the glucocorticoid receptors, while 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 release of noradrenaline, thereby triggering mental blocks and an inability to make decisions.

In our opinion, mindfulness is particularly important in ADHD-HI in order to achieve therapeutic ability in the first place. The permanently elevated stress level in ADHD-HI (with hyperactivity) is so strongly increased that mindfulness (MBCT, MBSR, meditation, yoga …) is downright aversive, which correlates with an inability to recover.

3. Multi-generational treatment for ADHD¶

Treating the children alone overlooks the fact that the influence of parents with ADHD has a significant impact on the development of the children.
Treatment and support for mothers with ADHD showed positive Consequences for the children, whereby a higher intensity of treatment for mothers with ADHD (here: with DBT) only showed a temporary advantage for the children compared to less intensive treatment.⁶

Children of mothers with high neuroticism and low conscientiousness should benefit more from behavioral therapies than other children. In contrast, children of mothers with medium neuroticism and medium conscientiousness or low neuroticism and high conscientiousness should benefit more from a multimodal treatment of therapy and medication or from medication alone than from behavioral therapy alone.⁷