Treatments Other Than Diet

In considering dietary interventions, it is important to note that there are two other forms of treatment with proven efficacy. These are stimulant medications and behavior modification. Considerations about dietary interventions have to be considered in the context of these other interventions. The nature of the main beneficial treatments, stimulant medication and behavioral interventions, makes the issue of diagnostic criteria for ADHD extremely important. Both of these treatments are not specific for the disorder so that the determination about which children are treated is very dependent on who is diagnosed.

The stimulant medications consist of methylphe-nidate (Ritalin), dextroamphetamine (Dexedrine), and pemoline (Cylert). They are particularly popular in the United States because they represent safe, effective, and low-cost treatment. A review of numerous studies has shown that stimulants improve the core behaviors of inattention, impulsiveness, and hyperactivity for the duration of action of the medication, as well as providing temporary improvement of associated features including aggression, social interaction, and academic productivity. The margin of safety is very high, and the side effects on appetite, sleep, and, infrequently, tics or bizarre behavior are all reversible when the medication is stopped. The concern about growth has proved to be insignificant, and although abused by adults, the stimulants are rarely abused by the children who take them because they usually do not find taking the medication pleasurable. While there is no long-term evidence that the use of stimulant medication or behavioral interventions on their own have any long-term benefits, there is evidence of long-term benefits when they are used in combination.

Effective behavioral interventions have generally consisted of direct contingency management programs (e.g., point or token programs or a response cost program) and social skills training. Like stimulant medication, these interventions are not specific to ADHD and have no proven long-term benefit when used in isolation. Other approaches, such as traditional psychotherapy and play therapy, have not been found to be effective with this group of children. Likewise, cognitive behavioral techniques, where a therapist teaches a child to control his or her behavior, have usually not been effective for children with ADHD because of the difficulty these children experience in generalizing the techniques beyond the therapeutic sessions.

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