ADHD is a loosely defined behavioral syndrome. It is a common mistake to assume it has single cause implying common treatments will work for all diagnosed with ADHD. Many factors including being the youngest in a school class can result in a child being diagnosed with ADHD. Some children have basically nothing wrong with them others have wide variety of problems. 

In short-term research trials pharmacological interventions invariably appear more effective than non-drug treatments for two reasons. First, drugs alter behaviour much faster than non-drug treatments, and trials most often measure improvements by short-term symptom management (often for no longer than a few weeks). Second, while the behaviour-altering effects of stimulants are almost universal, other forms of treatment are not. Family counselling, for example, will be of little or no benefit if the underlying cause of behavioural problems is exposure to environmental toxins.

In many cases there is nothing to ‘treat’. Many children are naturally inattentive, impulsive and hyperactive. In these cases normal childhood behaviour is pathologised and healthy children are ‘medicated’. Perhaps subconsciously for many busy, stressed adults, being able to control their child’s challenging behaviour is their main concern. If so, stimulant medication wins hands down.

You may be interested in this analysis of a field research report on ADD/ADHD carried out in Canada:

https://www.omicsonline.org/open-access/critical-analysis-of-a-field-research-report-on-add-and-adhd-2090-4908-1000142.pdf

Thanks dear Andre. I read your valuable paper but couldn't find anything about treatments of ADD/ADHD other than stimulant drugs.

Dear Vahid,

The problem is difficult once the child is in difficulty, but from Chauchard's conclusions, it would seem that if children learn to read with ease before the age of 7, this problem is prevented.

When children have not completely mastered reading by the age of 7,  ease of reading becomes more difficult to complete, and this seems to be what discourages them and they become easily distracted from learning, with all the consequences that ensue.

So maybe supplementary training to increase their level of ease in reading could help these children so reading becomes easy, which will re-ignite their interest for learning.

This other paper may shed more light on this specific problem:

https://www.omicsonline.org/open-access/intelligence-and-early-mastery-of-the-reading-skill-2155-6180-1000327.pdf

I am not expert in ADD/ADHD, but I heard that cognitive therapy and mindfulness are effective, but it depends on each case.

Behavioural interventions, atomoxetine and bupropion have all been used pharmacologically for long term management of ADD in adults.

ADHD is a loosely defined behavioral syndrome. It is a common mistake to assume it has single cause implying common treatments will work for all diagnosed with ADHD. Many factors including being the youngest in a school class can result in a child being diagnosed with ADHD. Some children have basically nothing wrong with them others have wide variety of problems. 

In short-term research trials pharmacological interventions invariably appear more effective than non-drug treatments for two reasons. First, drugs alter behaviour much faster than non-drug treatments, and trials most often measure improvements by short-term symptom management (often for no longer than a few weeks). Second, while the behaviour-altering effects of stimulants are almost universal, other forms of treatment are not. Family counselling, for example, will be of little or no benefit if the underlying cause of behavioural problems is exposure to environmental toxins.

In many cases there is nothing to ‘treat’. Many children are naturally inattentive, impulsive and hyperactive. In these cases normal childhood behaviour is pathologised and healthy children are ‘medicated’. Perhaps subconsciously for many busy, stressed adults, being able to control their child’s challenging behaviour is their main concern. If so, stimulant medication wins hands down.

Dear Randy Boddam, thanks a lot for the nice suggestions.

A second question is that I guess both atomoxetine and bupropion are stimulants; I looked them up, one was NRI, the other one was NDRI. So they can be contraindicated in patients with amphetamines or SNRIs contraindication, right?

Dear Andre

Thanks for your paper. I finally got some time to read your paper.

I still couldn't find alternative treatments for ADD/ADHD, except early education of reading learning. Though thank you very much.

Dear Martin

Thanks for your input. A neurologist once told me that there remains no geniuses anymore, because us neurologists and psychiatrists treat them!!

Hi Vahid

The short answer is "no".  They can be used in conjunction and sometimes are.  

One of the neurobiological mechanisms proposed for understanding syndromal ADD is that the DLPFC is underdeveloped and that stimulants work by upregulating other parts of cortex as a compensatory mechanism.

Now, in truth, I treat adults and not children.  I can tell you that the adult dosing is, on a per kg body weight basis, higher than that used for children (eg child max dose for methylphenidate is 1 mg/kg whereas it is 1.5 mg/kg for adults)

cheers, randy

Dear Vahid,

You wrote "I still couldn't find alternative treatments for ADD/ADHD, except early education of reading learning."

I found that even belated acquisition of a taste for reading, tends to resorb the issue, because the person develops interests in issues he/she reads about and finds interesting, inducing further reading in said issues or literature type, which does miracles for concentration acquisition.

I found that a few months of intensive training is generally sufficient.

Hi Vahid,

Effective and long-lasting treatments of ADHD, or any behaviorial/neurological issue, will not be found in symptom-masking or symptom suppressing drugs. I am pleased to see you asking about alternatives. As with all medical issues, the cause is the cure. Or rather the "causes" point to the cures because as with cancer, there is no one culprit, but a host of G x E, genetic times environment, interactions beginning with the parents and continuing through life. It can take 17 years for medical and scientific discoveries to find their way into practice, but in the age of easy access to data, mothers of this world have not waited. They were the first to pay attention to the gut-brain-axis and utilize the principles, changing diet, supplementing nutrients, clearing toxins, reducing toxins and other harmful exposures.

The discovery in 2016 that the lymphatic system is physically connected to the brain is revolutionary. And it validates the gut-brain-axis approach to healing.

A few papers:

https://www.ncbi.nlm.nih.gov/pubmed/28428763

https://www.ncbi.nlm.nih.gov/pubmed/28190137

https://www.ncbi.nlm.nih.gov/pubmed/28242200

https://www.ncbi.nlm.nih.gov/pubmed/28289903

https://news.virginia.edu/illimitable/discovery/theyll-have-rewrite-textbooks

And an example of what mothers are reading that leads them to PubMed and deeper research:

http://kellybroganmd.com/adhd-medications-for-kids-a-new-perspective/

~ Bernadette