Treating Attention-Deficit/Hyperactivity Disorder in U.S. Children with Complimentary Alternative Medicine Therapies: How Effective are They?

Abstract

Introduction:  The American Academy of Pediatrics (AAP) recommends pharmaceutical treatment for children diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD) (Hodgkins, Shaw, Coghill, & Hechtman, 2012).  Complimentary alternative medicine (CAM) treatments are becoming more popular as an alternative to medications.

Background and Significance:  Worldwide, 5% of children are diagnosed with ADHD (Pelsser et al., 2011).  An estimated five to ten percent of children are diagnosed in the United States as having ADHD (Calarge, Farmer, DiSilvestro, & Arnold, 2010).   Current medication treatments involve multiple adverse side effects (Laver-Bradbury, 2013).  Parents are seeking CAM treatments as an alternative to medication (Belanger et al., 2009).    Research from Europe and Canada have indicated dietary changes and supplementation with essential fatty acids may have significant effects on behavior outcomes (Pelsser et al., 2009).  The United States is lacking research in this area.  Nurses have been called to step forward and fill the gaps in primary care for communities (National Academy of Sciences [IOM (Institute of Medicine)], 2011).  Nurses have a responsibility to provide education to families regarding the effectiveness or ineffectiveness of desired treatments and therefore need to be aware of CAM treatments and current research.  The purpose of this study is to determine how effective CAM therapies are in behavior outcomes of children diagnosed with ADHD compared to pharmaceutical treatment alone.

A comprehensive review of literature was conducted using CINAHL and PubMed databases from 2009 to 2014.  Search terms were ADHD, complimentary alternative medicine, children, evidence-based treatment, best practice, and nursing.  Two-hundred and seven articles were located.  Of the 207 articles, 18 were selected based on content of random-controlled trials (RTCs), background information, and nursing involvement.   Four articles reported systemic research studies focusing on dietary and supplemental effects on behavior in children diagnosed with ADHD (Belanger et al., 2009; Howard et al., 2011; Pelsser et al., 2009; and Pelsser et al., 2011).

Methodology:  A pilot study using a quasi-experimental design will be used to answer the research question “In children diagnosed with ADHD in the United States, is there a significant difference in behavior outcomes when utilizing complimentary alternative medicine therapies compared to pharmaceutical treatment?”.  Sixty-seven children volunteering to participate between the ages of six and ten years will be selected locally and randomly assigned to control or intervention groups.  Informed consent from parents and/or guardians as well as child assent will be obtained.  The control group (Group A) will not change dietary habits or take supplements.  Group B will be administered a restricted diet and Group C will be administered the restricted diet plus a supplement of n-3 polyunsaturated fatty acids.  The Conners’ Teacher/Parent Rating Scale-Revised S (with permission) will be used pre-study, to evaluate ADHD behaviors, and at the end of weeks 4, 8, and 12 for changes in behavior.

Conclusions:  Based on the review of studies conducted in Europe and Canada, utilization of a restricted diet with omega-3 EFA supplementation may prove beneficial in the treatment of ADHD in children.