• Alternative Medicine Treatments for ADHD (and why they are bunk)

    This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course during Spring 2014. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare two 1,000ish word posts on a particular class of mental disorders, with one of those focusing on evidence-based treatments for those disorders and the other focused on a particular myth or misunderstanding about mental illness.

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    Alternative Medicine Treatments for ADHD (and why they don’t work) by Hunter Holder

    Attention Deficit/Hyperactivity Disorder (ADHD) is a mental disorder that is characterized by inattention, hyperactivity, and impulsive behavior. Like many mental disorders, ADHD is very treatable. Many decades of empirical evidence has shown that with pharmacological treatments, psychotherapy, or a combination of the two, adults and children diagnosed with ADHD can have fairly typical lives. In fact, there are several options available for each kind of treatment because some medications may be harmful to certain individuals or some therapies may be more suitable for some than others. However, in an age where doctors, therapists, and big medicine are endlessly perceived as the bad guys that can’t and shouldn’t be trusted, there are alternative treatments as well. Things like chiropractic medicine, acupuncture, and message therapy. Naturopathic “doctors” even suggest that things like herbs, homeopathic medicine, and supplements can cure the symptoms of ADHD, citing that natural remedies “add more to the healing process” than western medicines.

    A lot of the proponents of these alternative treatments promote them by stating that the side effects of recommended medication are too dangerous or that the medications themselves are intrinsically unsafe. While it is true that all medications have side effects and can be potentially dangerous, the primary medications for ADHD (commonly known as Ritalin and Adderall) have far more benefits than disadvantages. In fact, along with behavioral treatment, they are the most effective treatments available. Nevertheless, in an age where “all natural” and alternatives reign among the general population, people still buy in to the atypical treatments out there. This begs the question: do these treatments really work?

    (Note from Dr. Lack – this sort of thing makes me so angry that I literally want to punch someone. Maybe this guy in the blue shirt, for instance.)

    The American Chiropractic Association (ACA) recommends that children and adults diagnosed with ADHD be treated by chiropractic medicine. The organization makes some pretty typical pseudoscientific claims. First, they make claims that there is something wrong with the disorder itself. They claim that perhaps some kids just can’t learn some subjects as well or others and that some teachers just don’t know how to teach these kids in a way that they can understand. This is somewhat misleading because while ADHD can certainly hinder learning and academic performance, the disorder itself is not a learning disorder. Second, they claim that the diagnosis is invalid and that it is based on a questionnaire. In reality, diagnosis is a longitudinal process that comes from assessment, observation, and interviews or reports from teachers and parents. Third, they claim that the treatments with actual evidence supporting them are insufficient because they do not cure the disorder. However, it is well understood that pharmacological treatments for most mental disorders are for short-term benefit and long-term results are far more likely to come from behavioral therapy. It is also understood that ADHD isn’t something that can be cured in the same way that a bacterial infection can. The organization goes on to say things that imply that they are the ones focusing on the source of the problem, which they claim is lack of postural muscle development (the exact cause of ADHD is fairly unknown and is likely caused by several factors), instead of just the symptoms like trained mental health professionals do. Finally, the organization makes what may be one of the most defining traits of pseudoscience, anecdotal claims that their treatment works as good or better than western medicine. Of course, they are claims that have no actual experimental empirical evidence.

    Perhaps someone is looking for alternative treatments for ADHD in their child because the child had an adverse reaction to Ritalin. If they found themselves at the ACA website, they would probably believe that this treatment is a viable option. The website overall is very official looking, they use big words like “chiropractic neurologist” and “musculoskeletal imbalance”, and all of the evidence and claims come from so-called doctors. Plus, who hasn’t heard of going to the chiropractor to get your back cracked? Maybe they could help with this too. In reality, these people should look to a clinical psychologist or psychiatrist because there are plenty of other options besides Ritalin, both pharmacological and psychological, to effectively treat ADHD. However, they may not because they have read the negative things that the ACA has to say about the effective medications. In reality, chiropractic medicine could never treat ADHD or even help with symptoms more than a placebo could. As a whole, chiropractic medicine is nothing more than a pseudoscience that was created by a grocer and, to be honest, a scam, and a dangerous one at that. There is no empirical scientific evidence to support the use of chiropractic medicine as a treatment for ADHD or, for that matter, any other ailment that it may claim to treat except for back pain possibly.

    The same case could be made for the number of other alternative treatments that are available for ADHD. Things like acupuncture and homeopathy have their basis in pseudoscience as much as chiropractic treatments do. Acupuncturists claim that their form of therapy is the ideal primary treatment for children suffering from ADHD. In fact, acupuncture has not been shown to provide anything more than a simple placebo effect. Proponents of homeopathic medicine make the same claims. They say that western medicines like Ritalin and Adderall are too dangerous and that their treatment is far more desirable. In reality, homeopathic medicine is absurd. It is based on the concepts “like cures like” and “less is more” (sounds ridiculous already, huh?). So those that create homeopathic medicines take a substance that they believe would normally cause the ailment (e.g., poison ivy oil for an itch) and then dilute it over and over again. When then finished product hits the shelves, it is nothing more than a ridiculously overpriced (and lucrative) dropper full of water.

    It’s important to stay aware of these kind of pseudoscientific treatments not just for ADHD, but for any illness. Researching and having a skeptical mind is key to finding out if what you’re doing is actually accomplishing something or if you’re just wasting your time and money. There are plenty of resources out there that take these kinds of subjects, break them down, and get to the truth about their effectiveness and validity. However, if something is called alternative medicine, it probably doesn’t really work. Alternative medicine that works is just called medicine.

    Category: MedicineMental HealthParentingPseudosciencePsychologySkepticismTeaching

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    Article by: Caleb Lack

    Caleb Lack is the author of "Great Plains Skeptic" on SIN, as well as a clinical psychologist, professor, and researcher. His website contains many more exciting details, visit it at www.caleblack.com

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    • saijanai

      EEG power ratios of theta/beta has been established as highly correlated with ADHD in kids and there’s even an FDA-approved test for ADHD based on detecting an abnormally high ratio: http://www.fda.gov/newsevents/newsroom/pressannouncements/ucm360811.htm

      Both mindfulness and Transcendental Meditation practice have been found to reduce the EEG theta/beta power ratio in kids with ADHD, as well as to reduce anxiety and other symptoms associated with ADHD.

      [the question of which form of meditation is better for which types of people with ADHD awaits well-desiigned head-to-head studies comparing the two therapies -not holding my breath on that one as meditation researchers generally refuse to test anything other than their own favorite style of meditation]

      Does meditation practice for the treatment of ADHD fit the definition of alternative medicine treatment?

      • http://adhdcommunity.boards.net/ Amtram

        EEG is not yet considered an adequate diagnostic tool, according to the American Academy of Pediatrics, it’s just been approved for clinical testing to see the results on a larger scale.

        As for mindfulness meditation, results with people who are on the Hyper or Combined spectrums are not terribly good. You see, you have to be able to turn off the brain chatter, and that takes a really, really long time, and ADHD makes you tend to want to give up if you go too long without noticeable success. Plus, once you get the hang of it, you have to remember to do it every day, because once you stop doing it, it stops working. Sticking to a schedule – also not a strong suit with ADHD.

        It can be beneficial in other ways, but it’s not going to help ADHD nearly as much as finding the right medication. In fact, if you get the right medication, it might finally make it possible for you to practice mindful meditation.

      • http://www.caleblack.com/ Caleb W. Lack

        As I replied on r/skeptic, NEBA is a supplementary tool that (at least based on the study the manufacturer did) adds incremental validity to diagnoses when combined with more traditional types of assessment. Much more research needs to take place, by someone not affiliated with the manufacturer.

        As far as meditation, I think this Cochrane review (http://www.ncbi.nlm.nih.gov/pubmed/20556767) sums up quite nicely my stance on the current literature:

        “As a result of the limited number of included studies, the small sample sizes and the high risk of bias, we are unable to draw any conclusions regarding the effectiveness of meditation therapy for ADHD. The adverse effects of meditation have not been reported. More trials are needed.”

        • http://adhdcommunity.boards.net/ Amtram

          I hate, hate, hate “more trials are needed,” especially when it’s patently clear that they are not. It’s at the end of every abstract from a chiropractic or naturopathic “journal” and every study of acupuncture, homeopathy, or reiki.

          • http://www.caleblack.com/ Caleb W. Lack

            Sometimes more trials are needed, though, especially when initial trials are poorly conducted or underpowered. In the examples you cite, however, the literature is pretty clear :)

    • http://adhdcommunity.boards.net/ Amtram

      OMG, I so wish that I could post this on a particular ADD forum that avidly promotes this sort of woo, but instead I will share it on http://adhdcommunity.boards.net/, which I started to counter the pseudoscience of the other forum. And twitter. And facebook. Because it can’t be said enough. And if you want, I can tell you a whole bunch of other things they say will work at that first place if only so you can point and laugh. . .

      • http://www.caleblack.com/ Caleb W. Lack

        Unfortunately, I’m afraid that I’ve likely heard them all. The sheer amount of woo and nonsense that gets peddled to parents of kids with problems like ADHD or autism is infuriating. Thanks for sharing the evidence-based stuff around!

        • http://adhdcommunity.boards.net/ Amtram

          Tell me that you’ve heard of crawling therapy, and I’ll believe you! Heh.

          • http://www.caleblack.com/ Caleb W. Lack

            Well, you’ve got me there. Crawling therapy?

            • http://adhdcommunity.boards.net/ Amtram

              Oh, snap! Yes, you see, infants who don’t crawl for long enough have missed a crucial part of brain development – but it’s never too late! Even adults can regain what they lost by crawling around on all fours (with the supervision of a trained crawling therapist, of course!) And kids with ADHD and autism tend to dislike crawling because they don’t like being on their bellies on the floor. So obviously, they need to catch up in order to cure their conditions.

              The more you know. . .

            • http://www.caleblack.com/ Caleb W. Lack

              I feel much like my father must have, when during his first viewing of the movie “Elf,” this scene came up:

              http://youtu.be/Fig956-MuVA

              He literally threw his hands in the air, exclaimed “Gawdammit!” and walked out the room.

            • http://adhdcommunity.boards.net/ Amtram

              Well, I did share this over there, which will probably get me in trouble because it conflicts with the dominant paradigm. I hope it does not attract too many woo proponents to the conversation, but it had to be done.

            • http://www.caleblack.com/ Caleb W. Lack

              Let them come with their anecdotes and nonsense!

            • http://adhdcommunity.boards.net/ Amtram

              They don’t allow outside links to “commercial” sites – you advertise a book here. Now, if that book were about the paleo diet, they might let it slide. . .so I used your title, your blog name, removed all the links from the text. . .dedicated people will find it. But I’ll forward you any responses that are particularly amusing!

            • http://www.caleblack.com/ Caleb W. Lack

              That sounds great, thank you :)

            • http://adhdcommunity.boards.net/ Amtram

              So far all we’ve got is “But it worked for me!”

            • http://adhdcommunity.boards.net/ Amtram

              I can’t even. Here. All I can do is let you see for yourself: http://www.addforums.com/forums/showthread.php?t=160894

            • http://www.caleblack.com/ Caleb W. Lack

              “Arguing with those who have denounced the use of reason is like administering medicine to the dead.” – Thomas Paine

            • http://adhdcommunity.boards.net/ Amtram

              I know – and yet I still do it. I guess I’m inherently masochistic. At least I schooled them on epigenetics.

    • http://adhdcommunity.boards.net/ Amtram

      Here’s the thread I have dedicated to giving you some well-deserved traffic. I hope it works: http://adhdcommunity.boards.net/thread/141/read-article-on-alternative-treatments?page=1&scrollTo=381

      • http://www.caleblack.com/ Caleb W. Lack

        Aw, thanks, that’s very nice of you. We’ve had a pretty good flow since it came up, thanks to shares and reddit posts, and this will be very helpful!

    • Grace

      Dear author,
      Given the increase in the use of non-traditional remedies for ADHD, I found your post to
      be timely and provocative. First, with regards to your statement that “if
      something is called alternative medicine, it probably doesn’t work,” allow me
      to note that some have shown significant therapeutic potential. For instance, a study led by Dr.Andrew Vickers proved that acupuncture is successful in relieving chronic pain and alleviating migraines. Second, while you group chiropractic and acupuncture into one
      category, let me call attention to the fact that the latter may be more
      effective. I agree with you that the American Chiropractic Association (ACA) makes several skeptical remarks that are not supported by evidence, including the statement that the disorder is caused by a “lack of postural muscle development.” Research conducted by the National Institutes of Health indicates that the brains of individuals with ADHD show a delayed maturation by three years in regions involved in thinking, paying attention, and planning. Though the exact cause of the neuropsychiatric condition remains unclear, my judgment is that it is more genetic and neurological, rather than muscular, as claimed by the above-mentioned organization. In addition, I applaud you for acknowledging that
      the diagnosis requires a “longitudinal process.” According to the DSM-V criteria, individuals must show six or more symptoms of inattention or hyperactivity for at least six months for physicians to conclude that they have ADHD. Thus, the ACA’s argument that the process of arriving at the diagnosis is invalid suggests that it lacks a holistic understanding of the illness.

      However, unlike chiropractic, many parents including Karaszi, report improvement in their
      children’s behavior after they receive acupuncture. Though the mechanism of action
      remains unknown, literature suggests that it works through a placebo effect and improved body circulation. Ellison notes that spending quality time with her son during weekly meetings could have also contributed to the reduced hyperactivity and better focus. With regards to the question you raise on whether the aforementioned treatments really work, my response is, does it matter? I agree with you that these complementary options
      lack randomized, control trials that demonstrate their effect, but this does not mean that they do not necessarily work. If parents observe positive change and there are no adverse side effects, I argue that the natural remedies can and should be used. Furthermore, the highly personal nature of acupuncture as well as the wide array of types renders it difficult for scientists to conduct a large-scale experiment demonstrating its benefits. This is the case for neurofeedback and many other natural options as well. Thus, nonconventional cures may never become “evidence-based treatments,” but this should not hinder their
      use, provided that their organizations do not make blatant pseudoscientific
      claims. For alternative medicine, subjective report of improvement should
      qualify as a legitimate indicator of treatment effectiveness. So, what is at
      stake if patients continue to rely on Ritalin as the primary means of coping?
      Children as young as three years old will become dependent on the drug. However,
      natural options offer something Western medications cannot provide; when patients
      take the time to go to therapy sessions and do their best to control their brain
      activity during neurofeedback, they will realize that there is something they
      can do and learn to overcome ADHD step by step. Alternative medicine may be
      alternative, but it is still medicine nonetheless.

    • Laura Marie Roberts

      I am so excited to have found this article! My son is turning 21 and has terrible ADD! He has a wonderful job, and if his father doesn’t wise up to our sons need for Western Medicine” to give him the attention needed for his job, he will be out of a job! But no. Even after our sons boss told him he needs to slow down and think before he does stuff, the Ex is finally convinced, but doesn’t want our sons brain controlled by chemicals. “Mind control” he calls it. He’s looking into homeopathic alternatives. smh

      • http://www.caleblack.com/ Caleb W. Lack

        Well, the homeopathy nonsense certainly won’t do much, even if it is “natural” (and by natural, I mean “water”). I hope he can find some help and improve his quality of life. ADHD can be very, very problematic in the workplace.

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    • Fnordian72

      Acupuncture actually has been shown to be more than placebo, despite Skepdic’s false writeup about it.

      • http://www.caleblack.com/ Caleb W. Lack

        Not in double blind, placebo controlled studies that use sham acupuncture procedures. Take the case of pain, for example. See this review (http://www.ncbi.nlm.nih.gov/pubmed/21440191) or a single study (http://www.ncbi.nlm.nih.gov/pubmed/19433697).

        Further, as as Colquhoun & Novella (2013) write, “The
        best controlled studies show a clear pattern, with acupuncture the outcome does
        not depend on needle location or even needle insertion. Since these variables
        are those that define acupuncture, the only sensible conclusion is that
        acupuncture does not work.”

        • Fnordian72

          I’m quite familiar with Dr. Novella and his particular brand of Scientism.

          But how, exactly, do you propose a double blind study involving needle insertion to begin with? How would you purport to make the acupuncturist “blind” to the treatment?

          Double blind works great with pills and such. How so with acupuncture?

          That said, there are plenty of trials which show an appreciable effect of real vs. sham acupuncture. They also tend to show that both are more effective than no treatment.

          I have no qualms about saying that belief may be a part of the effectiveness of acupuncture – even hard Western medical science – the kind endorsed by Novella, for example – knows that belief and state of mind can produce powerful healing effects (just ask any oncologist ).

          But I don’t think placebo alone explains it, and I think there’s plenty of evidence to support my position. It may not be the so-called “gold standard” of double-blind, randomized, placebo – controlled studies that many reductionists are after, however.

          • http://www.caleblack.com/ Caleb W. Lack

            Try these links: http://www.ncbi.nlm.nih.gov/pubmed/21440191 and http://www.ncbi.nlm.nih.gov/pubmed/19433697 – the second in particular is a damn good study (the first is a review).

            As far as your assertion that CAM can’t be tested by our gold-standard methods – that makes no sense. If it works, then it should work, regardless of the rigor applied to testing. Your statement about meridian theory or qi (ch’i, traditionally) really makes any argument fall apart, given that there is absolutely zero evidence that such things are real and not just someone’s imagination at work.

            • Fnordian72

              Let me get this straight – you’re suggesting that because there’s “absolutely zero” evidence (by your standard) that something is “real”, it somehow makes an argument fall apart? Do explain how that is the case, please.

              Regarding the “gold-standard methods” comment you made: yes, if it works, it works. This is correct. But you’re asserting that “double-blind, randomized, placebo-controlled studies are the only way to determine if something works” – which in itself is quite an assumption, and is characteristic of reductionist thinking. It smacks of Scientism, to boot.

              If you set the standards for what qualifies as evidence and proof, and which tests can or cannot produce these results, you’re essentially stacking the deck in your favor and rigging the game. In some cases, this makes sense- skepticism about certain religious claims, for example, which are easily disproven by biology and other studies of science. But qi isn’t one of those things – lack of evidence (again, even if the standard of evidence is defined by you) doesn’t mean it doesn’t exist, nor does it somehow invalidate arguments. It just means that you haven’t seen evidence that meets your standard.

              Even if that is the case, however, you’re still not showing it’s placebo. The second study you cited above even states as such – it “calls into question” the purported mechanism of action, and, to boot, says it “remains unclear” if acupuncture represented placebo. You’re turning “we can’t really tell, let’s keep studying this” into “it’s placebo”, and that isn’t justified by the study you cited.

              We should expect contradictory and confusing results from acupuncture studies when we take the difficulty of designing good (in the sense of DB/R/PC trials) studies and the obvious risk of bias into account (and, as I’ve already stated, it’s extraordinarily difficult to remove bias with acupuncture entirely because you can’t blind the acupuncturist). But saying “oh, that means it’s just placebo” isn’t warranted yet. At best, you can say “based on the so-called ‘gold standard’ of Western medicine, the DB/R/PC trial, the results aren’t clear. We just don’t know yet.”

              That’s a far cry from “because we haven’t satisfied our standards and criteria, we’ll call it placebo”

        • Fnordian72

          I couldn’t access your links for some reason- they don’t pull anything up.

          It appears there are some “double blind, placebo-controlled studies” that have been done and they do show a significant difference. Examples:

          http://www.ncbi.nlm.nih.gov/pubmed/22943846

          http://www.sciencedirect.com/science/article/pii/S041564120800026X

          http://onlinelibrary.wiley.com/doi/10.1002/lary.25252/abstract

          Some of the problems associated with using double-blind, placebo-controlled studies for TCM in general are that many of the methods employed by TCM practitioners don’t lend themselves well to a reductionist sort of mentality. The idea of “let’s isolate the effective part and use that as treatment” works in some cases, but TCM, meridian theory, qi and other such ideas are better viewed in a “whole is greater than the sum of its parts” framework.
          At any rate, there are studies and a multitude of trials that show the efficacy of acupuncture – including for use as anesthesia – and I stand by my statement that there’s more than placebo at work there.