Unsafe non-drug treatments for ADHD

Non-drug therapy approaches for ADHD whose effect is not proven

• 1.2.1. Occupational therapy
• 1.2.2. Hemencephalography training
• 1.2.3. Self-instructions
• 1.2.4. Listen to (classical) music to improve your mood
• 1.2.5. App-supported attention and organization training
• 1.2.6. Organizational skills training
• 1.2.7. Homework support
• 1.2.8. Social behavior training
• 1.2.9. Transcutaneous auricular vagus nerve stimulation (taVNS)
• 1.2.10. Acupuncture (?)
• 1.2.11. Homeopathy
• 1.2.12. Fidgets
• 1.2.13. Random Noise
• 1.2.14. Spinal manipulation / spinal mobilization
• 1.2.15. Ultrasound stimulation with low intensity
• 1.2.16. Quiet Eye Training
• 1.2.17. Animal-assisted therapy
• 1.2.18. Parent management training
• 1.2.19. Attention process training

1.2.1. Occupational therapy¶

The effectiveness of occupational therapy for ADHD is limited to the treatment of fine motor skills in preparation for school.¹
A study reports positive effects of equine-assisted occupational therapy for schoolchildren with ADHD.²

1.2.2. Hemencephalography training¶

Effect not yet recognized, initial studies.³

1.2.3. Self-instructions¶

Effect is disputed.⁴

1.2.4. Listen to (classical) music to improve your mood¶

One study found that listening to Mozart for 10 minutes (Mozart piano sonata for four hands, KV 440) improved the mood of people with ADHD as well as people without ADHD, in contrast to subjects who listened to 10 minutes of silence.⁵ This does not prove an ADHD-specific treatment method.
However, music seems to be helpful for ADHD.⁶

1.2.5. App-supported attention and organization training¶

One study reports that cell phone app-based training in attention and organization led to relevant improvements in a third of adults with ADHD.⁷
A meta-analysis from 2019 found no further studies on the treatment of ADHD using specific apps⁸

1.2.6. Organizational skills training¶

Organizational skills training (OST) was shown in an RCT to be helpful for children with ADHD.⁹
In SCT, training in organizational skills did not lead to any improvement in SCT symptoms from the perspective of the people with ADHD themselves. Only from the parents’ perspective were there improvements with an Effect size of approx. 0.5.¹⁰
Parent assessments are highly susceptible to being biased towards desired outcomes. The greater the effort invested, the stronger this bias is.

1.2.7. Homework support¶

In the case of SCT, homework support did not lead to any improvement in SCT symptoms from the perspective of the people with ADHD themselves. Only from the parents’ perspective were there improvements with an Effect size of approx. 0.5.¹⁰
Parent assessments are highly susceptible to being biased towards desired outcomes. This bias is all the stronger the greater the effort invested.

1.2.8. Social behavior training¶

A meta-analysis found no proven effect of non-drug training methods (coaching, etc.) in terms of improving social behavior towards peers.¹¹
A meta-analysis found weak evidence of benefits of peer-based interventions for ADHD,¹² 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.¹³

1.2.9. Transcutaneous auricular vagus nerve stimulation (taVNS)¶

Transcutaneous auricular vagus nerve stimulation (taVNS) is a newly developed, non-invasive procedure. Stimulation of the cutaneous receptive field of the auricular branch of the vagus nerve in the outer ear is intended to activate the vagal connections to the central and peripheral nervous system.¹⁴
One report cites transcutaneous vagus nerve stimulation as a possible treatment for ADHD.¹⁵
So far, there are not even any individual studies that show a benefit in ADHD, let alone a reliable overall picture. taVNS is therefore only relevant as a research topic in relation to ADHD
One study found no effect of taVNS on locus coreuleus noradrenergic-controlled) sustained attention, but attenuation of cortisol reduction over time by active taVNS and interindividual effects of taVNS on alpha-amylase and salivary cortisol levels as indirect markers of locus coreuleus-noradrenaline.¹⁶
Similarly, taVNS did not show a general improvement in performance on reversal tasks, but worsened performance on distractor stimuli. taVNS did not lead to an increase in tonic pupil and alpha-amylase. The drop in cortisol was flattened by taVNS. taVNS lowered the respiratory rate but had no effect on cardiac vagus activity.¹⁷

In rats, a two-week VNS intervention significantly increased extracellular noradrenaline levels in PFC and hippocampus and enhanced tonic activation of postsynaptic α2A in pyramidal neurons¹⁸
In mice, taVNS significantly increased c-Fos protein expression in the NST and locus coeruleus nuclei and reduced the heroin-induced anxiety response.¹⁹

The treatment approach should be considered against the background of the possible connection between the gut-brain axis and ADHD. In our understanding, however, if the cause of the ADHD is present, treatment with probiotics and dietary changes should be considered first. More on this under Gut-brain axis and ADHD

1.2.10. Acupuncture (?)¶

The effectiveness of acupuncture is controversial. To date, there are no conclusive medical explanatory models.

• Positive results

  • A meta-analysis reports a high effectiveness of acupuncture on hyperactivity²³
  • A meta-analysis of k = 14 studies with n = 1,185 patients found that acupuncture as an adjunct to conventional medication supported the improvement of behavioral problems, learning problems, hyperactivity-impulsivity, and hyperactivity symptoms in ADHD patients, and as a sole treatment improved learning problems, hyperactivity-impulsivity, and hyperactivity symptoms in ADHD patients. The risk of bias in the included studies was generally concerning, so the evidence for the effectiveness of acupuncture for ADHD is currently too limited to recommend its use.²⁴
  • Some studies report an effect that goes beyond placebo.^25262728

• Unclear results
  However, two German double-blind studies, which conclude that so far only a placebo effect can be proven for acupuncture, show in the figures that acupuncture achieved 20% better results compared to sham acupuncture ²⁹³⁰

• No improvements

  • Another meta-analysis of 5 studies found no robust evidence that acupuncture improves ADHD.³¹

Another meta-analysis intends to investigate the effect of acupuncture for the treatment of ADHD³²

1.2.11. Homeopathy¶

A meta-analysis that had reported benefits of additional individual homeopathic treatment for ADHD was retracted due to erroneous interpretation in favor of homeopathy ³³³⁴
One RCT reported symptom improvements with homeopathy, but only in parental reports.³⁵ Parent reports are systematically biased and are generally more positive than teacher reports or physician evaluations.

1.2.12. Fidgets¶

One study observed significant improvement in sustained attention in students with ADHD who used Fidgets during class.³⁶

1.2.13. Random Noise¶

Random Noise treatment uses any form of energy (e.g. light, mechanical, electrical or acoustic energy) with unpredictable intensity to stimulate the brain and sensory receptors with the aim of improving sensory, motor and cognitive functions. Random Noise treatment originally used mechanical sounds for auditory and cutaneous stimuli. Today, electrical energy is increasingly used to stimulate 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 on a behavioral and psychological level.³⁷

1.2.14. Spinal manipulation / spinal mobilization¶

A meta-analysis found no evidence of efficacy of spinal manipulation/mobilization for ADHD.³⁸

1.2.15. Ultrasound stimulation with low intensity¶

Low-intensity ultrasound stimulation has been shown to improve abnormal brain function in SHR. We do not have studies on clinical ADHD treatment use in humans.³⁹

1.2.16. Quiet Eye Training¶

Source⁴⁰

1.2.17. Animal-assisted therapy¶

Animal-assisted therapy is said to be helpful for ADHD.⁴¹
A study reports positive effects of equine-assisted occupational therapy for schoolchildren with ADHD.²

A meta-analysis of k = 17 RCTs found an effectiveness of animal-assisted treatment compared to non-animal-assisted treatment groups in children with ADHD:⁴²

• 0.77 Motor skills
• 0.69 Learning and cognitive problems
• 0.42 Attention
• 0.46 Self-esteem

The pooled effect of animal-assisted treatment on the severity of ADHD symptoms did not differ significantly from the effect of conventional treatments in the control group.
As an ADHD treatment strategy that complements gold-standard approaches such as medication or multimodal interventions, animal-assisted therapy does not appear to be more effective in improving most of the core ADHD outcomes in children.⁴²

Animal-assisted treatment had no significant positive effects on⁴²

• social interaction
• social skills
• problematic behavior
• emotional problems, including depression and anxiety

1.2.18. Parent management training¶

Parent management training and attention process training were compared in three groups of children with ADHD of n = 15 each, all of whom were treated with methylphenidate.
Educational methods (parent management training) plus MPH proved to be more effective than MPH alone, but less effective than attention process training plus MPH.⁴³

1.2.19. Attention process training¶

Parent management training and attention process training were compared in three groups of children with ADHD of n = 15 each, all of whom were treated with methylphenidate.
Educational methods (parent management training) plus MPH proved to be more effective than MPH alone, but less effective than attention process training plus MPH.⁴³