ADHD – A GLOBAL CHALLENGE. ARE WE CLOSER TO THE IDEAL THERAPY?
Abstract
Introduction and objective: The treatment of ADHD remains a topic of global discussion among researchers and clinicians. Stimulant medications are the primary therapy, but concerns about side effects, addiction, and misuse have led to growing interest in alternative methods, such as behavioral therapy, cognitive training, neurofeedback, and dietary interventions. This review aims to compile data on ADHD treatment and assess whether alternative therapies can replace stimulants.
Brief description of the state of knowledge: Numerous studies describe individual therapeutic methods, but a lack of definitive conclusions persists due to uncertainties and isolated evaluations. More comparative research and studies on combined treatments are needed to determine the most effective approaches. Particularly, there is a shortage of studies on integrating pharmacological and alternative therapies, highlighting the need for future research.
Methods: A literature review was conducted using PubMed and Google Scholar with search terms like “ADHD - diagnostic criteria and symptoms”, “Stimulant medications in the treatment of ADHD”, “Alternative treatment methods for ADHD”, “Dietary treatment and supplementation in ADHD”. Articles published within the last five years were prioritized.
Conclusions: Stimulants remain the most effective ADHD treatment but are associated with side effects such as sleep disturbances, appetite loss, and addiction concerns. In response, alternative therapies are gaining popularity, though evidence of their standalone effectiveness is limited. Further comparative and combination therapy studies are necessary to develop a more comprehensive treatment approach that optimizes symptom reduction while minimizing risks. At present, stimulant medications are a safe first-line treatment with proven efficacy.
References
Faraone, S. V., Asherson, P., Banaschewski, T., Biederman, J., Buitelaar, J. K., Ramos-Quiroga, J. A., Rohde, L. A., Sonuga-Barke, E. J., Tannock, R., & Franke, B. (2015). Attention-deficit/hyperactivity disorder. Nature Reviews Disease Primers, 1, 15020. https://doi.org/10.1038/nrdp.2015.20
Faraone, S. V., & Larsson, H. (2019). Genetics of attention deficit hyperactivity disorder. Molecular Psychiatry, 24(4), 562–575. https://doi.org/10.1038/s41380-018-0070-0
Mucci, F., Carpita, B., Pagni, G., Vecchia, A. D., Bjedov, S., Pozza, A., & Marazziti, D. (2021). Lifetime evolution of ADHD treatment. Journal of Neural Transmission, 128(7), 1085–1098. https://doi.org/10.1007/s00702-021-02336-w
Doernberg, E., & Hollander, E. (2016). Neurodevelopmental disorders (ASD and ADHD): DSM-5, ICD-10, and ICD-11. CNS Spectrums, 21(4), 295–299. https://doi.org/10.1017/S1092852916000262
Nazarova, V. A., Sokolov, A. V., Chubarev, V. N., Tarasov, V. V., & Schiöth, H. B. (2022). Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Frontiers in Pharmacology, 13, 1066988. https://doi.org/10.3389/fphar.2022.1066988
Mucci, F., Avella, M. T., & Marazziti, D. (2019). ADHD with comorbid bipolar disorders: A systematic review of neurobiological, clinical and pharmacological aspects across the lifespan. Current Medicinal Chemistry, 26(38), 6942–6969. https://doi.org/10.2174/0929867326666190805153610
Molina, B. S. G., Hinshaw, S. P., Swanson, J. M., Arnold, L. E., Vitiello, B., Jensen, P. S., Epstein, J. N., Hoza, B., Hechtman, L., Abikoff, H. B., Elliott, G. R., Greenhill, L. L., Newcorn, J. H., Wells, K. C., & Wigal, T.; MTA Cooperative Group. (2009). The MTA at 8 years: Prospective follow-up of children treated for combined-type ADHD in a multisite study. Journal of the American Academy of Child & Adolescent Psychiatry, 48(5), 484–500. https://doi.org/10.1097/CHI.0b013e31819c23d0
Brown, K. A., Samuel, S., & Patel, D. R. (2018). Pharmacologic management of attention deficit hyperactivity disorder in children and adolescents: A review for practitioners. Translational Pediatrics, 7(1), 36–47. https://doi.org/10.21037/tp.2017.08.02
Catalá-López, F., Hutton, B., Núñez-Beltrán, A., Page, M. J., Ridao, M., Macías Saint-Gerons, D., Catalá, M. A., Tabarés-Seisdedos, R., & Moher, D. (2017). The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS ONE, 12(7), e0180355. https://doi.org/10.1371/journal.pone.0180355
Nejati, V. (2021). Balance-based Attentive Rehabilitation of Attention Networks (BARAN) improves executive functions and ameliorates behavioral symptoms in children with ADHD. Complementary Therapies in Medicine, 60, 102759. https://doi.org/10.1016/j.ctim.2021.102759
Steiner, N. J., Frenette, E. C., Rene, K. M., Brennan, R. T., & Perrin, E. C. (2014). Neurofeedback and cognitive attention training for children with attention-deficit/hyperactivity disorder in schools. Journal of Developmental & Behavioral Pediatrics, 35(1), 18–27. https://doi.org/10.1097/DBP.0000000000000009
Liang, X., Qiu, H., Wang, P., & Sit, C. H. P. (2022). The impacts of a combined exercise on executive function in children with ADHD: A randomized controlled trial. Scandinavian Journal of Medicine & Science in Sports, 32(8), 1297–1312. https://doi.org/10.1111/sms.14192
Bos, D. J., Oranje, B., Veerhoek, E. S., Van Diepen, R. M., Weusten, J. M., Demmelmair, H., Koletzko, B., de Sain-van der Velden, M. G., Eilander, A., Hoeksma, M., & Durston, S. (2015). Reduced symptoms of inattention after dietary omega-3 fatty acid supplementation in boys with and without attention deficit/hyperactivity disorder. Neuropsychopharmacology, 40(10), 2298–2306. https://doi.org/10.1038/npp.2015.73
Arnsten, A. F., & Pliszka, S. R. (2011). Catecholamine influences on prefrontal cortical function: Relevance to treatment of attention deficit/hyperactivity disorder and related disorders. Pharmacology Biochemistry and Behavior, 99(2), 211–216. https://doi.org/10.1016/j.pbb.2011.01.020
López, F. A., & Leroux, J. R. (2013). Long-acting stimulants for treatment of attention-deficit/hyperactivity disorder: A focus on extended-release formulations and the prodrug lisdexamfetamine dimesylate to address continuing clinical challenges. Attention Deficit and Hyperactivity Disorders, 5(3), 249–265. https://doi.org/10.1007/s12402-013-0106-x
Cascade, E., Kalali, A. H., & Weisler, R. H. (2008). Short-acting versus long-acting medications for the treatment of ADHD. Psychiatry (Edgmont), 5(8), 24–27. https://doi.org/
Stevens, J. R., Wilens, T. E., & Stern, T. A. (2013). Using stimulants for attention-deficit/hyperactivity disorder: Clinical approaches and challenges. Primary Care Companion for CNS Disorders, 15(2), PCC.12f01472. https://doi.org/10.4088/PCC.12f01472
Wilens, T. E. (2006). Treatment and assessment of ADHD in children and adolescents. In J. B. Biederman (Ed.), ADHD across the lifespan: An evidence-based understanding from research to clinical practice (pp. 176–206). Veritas Institute for Medical Education. https://doi.org/
Charach, A., Ickowicz, A., & Schachar, R. (2004). Stimulant treatment over five years: Adherence, effectiveness, and adverse effects. Journal of the American Academy of Child & Adolescent Psychiatry, 43(5), 559–567. https://doi.org/10.1097/00004583-200405000-00009
Faraone, S. V., Biederman, J., Spencer, T. J., & Aleardi, M. (2006). Comparing the efficacy of medications for ADHD using meta-analysis. MedGenMed, 8(4), 4. https://doi.org/
The MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Archives of General Psychiatry, 56(12), 1073–1086. https://doi.org/10.1001/archpsyc.56.12.1073
Conners, C. K., Epstein, J. N., March, J. S., Angold, A., Wells, K. C., Klaric, J., Swanson, J. M., Arnold, L. E., Abikoff, H. B., Elliott, G. R., Greenhill, L. L., Hechtman, L., Hinshaw, S. P., Hoza, B., Jensen, P. S., Kraemer, H. C., Newcorn, J. H., Pelham, W. E., Severe, J. B., & Vitiello, B., Wigal, T. (2001). Multimodal treatment of ADHD in the MTA: An alternative outcome analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 40(2), 159–167. https://doi.org/10.1097/00004583-200102000-00010
Matthijssen, A. M., Dietrich, A., Bierens, M., Kleine Deters, R., van de Loo-Neus, G. H. H., van den Hoofdakker, B. J., Buitelaar, J. K., & Hoekstra, P. J. (2019). Continued benefits of methylphenidate in ADHD after 2 years in clinical practice: A randomized placebo-controlled discontinuation study. American Journal of Psychiatry, 176(9), 754–762. https://doi.org/10.1176/appi.ajp.2019.18111296
Lensing, M. B., Zeiner, P., Sandvik, L., & Opjordsmoen, S. (2013). Four-year outcome in psychopharmacologically treated adults with attention-deficit/hyperactivity disorder: A questionnaire survey. Journal of Clinical Psychiatry, 74(1), e87–e93. https://doi.org/10.4088/JCP.12m07714
Toomey, S. L., Sox, C. M., Rusinak, D., & Finkelstein, J. A. (2012). Why do children with ADHD discontinue their medication? Clinical Pediatrics, 51(8), 763–769. https://doi.org/10.1177/0009922812446744
Baumeister, A. A., Henderson, K., Pow, J. L., & Advokat, C. (2012). The early history of the neuroscience of attention-deficit/hyperactivity disorder. Journal of the History of Neurosciences, 21(3), 263–279. https://doi.org/10.1080/0964704X.2011.595649
Coghill, D. (2022). The benefits and limitations of stimulants in treating ADHD. Current Topics in Behavioral Neurosciences, 57, 51–77. https://doi.org/10.1007/7854_2022_331
Olfson, M., Blanco, C., Wang, S., & Greenhill, L. L. (2013). Trends in office-based treatment of adults with stimulants in the United States. Journal of Clinical Psychiatry, 74(1), 43–50. https://doi.org/10.4088/JCP.12m07975
Advokat, C. D., Guidry, D., & Martino, L. (2008). Licit and illicit use of medications for attention-deficit/hyperactivity disorder in undergraduate college students. Journal of American College Health, 56(6), 601–606. https://doi.org/10.3200/JACH.56.6.601-606
Jaeschke, R. R., Sujkowska, E., & Sowa-Kućma, M. (2021). Methylphenidate for attention-deficit/hyperactivity disorder in adults: A narrative review. Psychopharmacology, 238(10), 2667–2691. https://doi.org/10.1007/s00213-021-05946-0
Hennissen, L., Bakker, M. J., Banaschewski, T., Carucci, S., Coghill, D., Danckaerts, M., Dittmann, R. W., Hollis, C., Kovshoff, H., McCarthy, S., Nagy, P., Sonuga-Barke, E., Wong, I. C., Zuddas, A., & Rosenthal, E., Buitelaar, J. K.; ADDUCE Consortium. (2017). Cardiovascular effects of stimulant and non-stimulant medication for children and adolescents with ADHD: A systematic review and meta-analysis of trials of methylphenidate, amphetamines and atomoxetine. CNS Drugs, 31(3), 199–215. https://doi.org/10.1007/s40263-017-0410-7
Carucci, S., Balia, C., Gagliano, A., Lampis, A., Buitelaar, J. K., Danckaerts, M., Dittmann, R. W., Garas, P., Hollis, C., Inglis, S., Konrad, K., Kovshoff, H., Liddle, E. B., McCarthy, S., Nagy, P., Panei, P., Romaniello, R., Usala, T., Wong, I. C. K., Banaschewski, T., Sonuga-Barke, E., Coghill, D., & Zuddas, A.; ADDUCE Consortium. (2021). Long term methylphenidate exposure and growth in children and adolescents with ADHD. A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 120, 509–525. https://doi.org/10.1016/j.neubiorev.2020.09.031
Torres-Acosta, N., O’Keefe, J. H., O’Keefe, C. L., & Lavie, C. J. (2020). Cardiovascular effects of ADHD therapies: JACC review topic of the week. Journal of the American College of Cardiology, 76(7), 858–866. https://doi.org/10.1016/j.jacc.2020.05.081
Reiersen, A. M. (2018). Occurrence of psychotic symptoms during treatment of ADHD with methylphenidate: Clinical significance and the need for further research. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology, 6(1), 1–3. https://doi.org/10.21307/sjcapp-2018-007
Chen, Q., Sjölander, A., Runeson, B., D’Onofrio, B. M., Lichtenstein, P., & Larsson, H. (2014). Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: Register based study. BMJ, 348, g3769. https://doi.org/10.1136/bmj.g3769
Rice, K. M., Peltzman, T., Gottlieb, D., Shiner, B., & Watts, B. V. (2024). Stimulant medication and suicide mortality in attention-deficit hyperactivity disorder. BJPsych Open, 10(1), e33. https://doi.org/10.1192/bjo.2023.643
Chang, Z., Lichtenstein, P., Halldner, L., D’Onofrio, B., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2014). Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry, 55(8), 878–885. https://doi.org/10.1111/jcpp.12164
McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E. (2016). Age of onset, duration, and type of medication therapy for attention-deficit/hyperactivity disorder and substance use during adolescence: A multi-cohort national study. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 479–486. https://doi.org/10.1016/j.jaac.2016.03.011
Stein, M. A., Weiss, M., & Hlavaty, L. (2012). ADHD treatments, sleep, and sleep problems: Complex associations. Neurotherapeutics, 9(3), 509–517. https://doi.org/
Hvolby, A. (2015). Associations of sleep disturbance with ADHD: Implications for treatment. Attention Deficit and Hyperactivity Disorders, 7(1), 1–18. https://doi.org/10.1007/s12402-014-0151-0
Pliszka, S. R. (2003). Non-stimulant treatment of attention-deficit/hyperactivity disorder. CNS Spectrums, 8(4), 253–258. https://doi.org/10.1017/s1092852900018460
Garnock-Jones, K. P., & Keating, G. M. (2009). Atomoxetine: A review of its use in attention-deficit/hyperactivity disorder in children and adolescents. Paediatric Drugs, 11(3), 203–226. https://doi.org/
Michelson, D., Adler, L., Spencer, T., Reimherr, F. W., West, S. A., Allen, A. J., Kelsey, D., Wernicke, J., Dietrich, A., & Milton, D. (2003). Atomoxetine in adults with ADHD: Two randomized, placebo-controlled studies. Biological Psychiatry, 53(2), 112–120. https://doi.org/10.1016/s0006-3223(02)01671-2
Robe, A., Dobrean, A., Cristea, I. A., Păsărelu, C. R., & Predescu, E. (2019). Attention-deficit/hyperactivity disorder and task-related heart rate variability: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 99, 11–22. https://doi.org/10.1016/j.neubiorev.2019.01.022
Hanwella, R., Senanayake, M., & de Silva, V. (2011). Comparative efficacy and acceptability of methylphenidate and atomoxetine in treatment of attention deficit hyperactivity disorder in children and adolescents: A meta-analysis. BMC Psychiatry, 11, 176. https://doi.org/
Yildiz, O., Sismanlar, S. G., Memik, N. C., Karakaya, I., & Agaoglu, B. (2011). Atomoxetine and methylphenidate treatment in children with ADHD: The efficacy, tolerability and effects on executive functions. Child Psychiatry & Human Development, 42(3), 257–269. https://doi.org/10.1007/s10578-010-0212-3
Yang, L., Cao, Q., Shuai, L., Li, H., Chan, R. C., & Wang, Y. (2012). Comparative study of OROS-MPH and atomoxetine on executive function improvement in ADHD: A randomized controlled trial. International Journal of Neuropsychopharmacology, 15(1), 15–26. https://doi.org/10.1017/S1461145711001490
Roh, H., & Kim, B. (2021). A brief replication study comparing stimulants and non-stimulants for attention-deficit/hyperactivity disorder treatment with a focus on the compliance, efficacy, and satisfaction. Soa Chongsonyon Chongsin Uihak, 32(1), 10–16. https://doi.org/10.5765/jkacap.200024
Cerrillo-Urbina, A. J., García-Hermoso, A., Pardo-Guijarro, M. J., Sánchez-López, M., Santos-Gómez, J. L., & Martínez-Vizcaíno, V. (2018). The effects of long-acting stimulant and nonstimulant medications in children and adolescents with attention-deficit/hyperactivity disorder: A meta-analysis of randomized controlled trials. Journal of Child and Adolescent Psychopharmacology, 28(8), 494–507. https://doi.org/10.1089/cap.2017.0151
Jensen, C. M., Amdisen, B. L., Jørgensen, K. J., & Arnfred, S. M. (2016). Cognitive behavioural therapy for ADHD in adults: Systematic review and meta-analyses. Attention Deficit and Hyperactivity Disorders, 8(1), 3–11. https://doi.org/10.1007/s12402-016-0188-3
Young, Z., Moghaddam, N., & Tickle, A. (2020). The efficacy of cognitive behavioral therapy for adults with ADHD: A systematic review and meta-analysis of randomized controlled trials. Journal of Attention Disorders, 24(6), 875–888. https://doi.org/10.1177/1087054716664413
William, S., Horrocks, M., Richmond, J., Hall, C. L., & French, B. (2024). Experience of CBT in adults with ADHD: A mixed methods study. Frontiers in Psychiatry, 15, 1341624. https://doi.org/
Cortese, S., Ferrin, M., Brandeis, D., Buitelaar, J., Daley, D., Dittmann, R. W., Holtmann, M., Santosh, P., Stevenson, J., Stringaris, A., Zuddas, A., & Sonuga-Barke, E. J. (2015). Cognitive training for attention-deficit/hyperactivity disorder: Meta-analysis of clinical and neuropsychological outcomes from randomized controlled trials. Journal of the American Academy of Child & Adolescent Psychiatry, 54(3), 164–174. https://doi.org/10.1016/j.jaac.2014.12.010
van der Donk, M., Hiemstra-Beernink, A. C., Tjeenk-Kalff, A., van der Leij, A., & Lindauer, R. (2015). Cognitive training for children with ADHD: A randomized controlled trial of Cogmed working memory training and ‘paying attention in class’. Frontiers in Psychology, 6, 1081. https://doi.org/10.3389/fpsyg.2015.01081
Enriquez-Geppert, S., Smit, D., Pimenta, M. G., & Arns, M. (2019). Neurofeedback as a treatment intervention in ADHD: Current evidence and practice. Current Psychiatry Reports, 21(6), 46. https://doi.org/10.1007/s11920-019-1021-4
McGough, J. J. (2022). Neurofeedback for ADHD: Time to call it quits? American Journal of Psychiatry, 179(12), 888–889. https://doi.org/10.1176/appi.ajp.20220861
Alegria, A. A., Wulff, M., Brinson, H., Barker, G. J., Norman, L. J., Brandeis, D., Stahl, D., David, A. S., Taylor, E., Giampietro, V., & Rubia, K. (2017). Real-time fMRI neurofeedback in adolescents with attention deficit hyperactivity disorder. Human Brain Mapping, 38(6), 3190–3209. https://doi.org/10.1002/hbm.23584
Neurofeedback Collaborative Group. (2021). Double-blind placebo-controlled randomized clinical trial of neurofeedback for attention-deficit/hyperactivity disorder with 13-month follow-up. Journal of the American Academy of Child & Adolescent Psychiatry, 60(7), 841–855. https://doi.org/10.1016/j.jaac.2020.07.906
Lange, K. W., Lange, K. M., & Nakamura, Y. (2023). Nutrition in the management of ADHD: A review of recent research. Current Nutrition Reports, 12(3), 383–394. https://doi.org/
Pinto, S., Correia-de-Sá, T., Sampaio-Maia, B., Vasconcelos, C., Moreira, P., & Ferreira-Gomes, J. (2022). Eating patterns and dietary interventions in ADHD: A narrative review. Nutrients, 14(20), 4332. https://doi.org/10.3390/nu14204332
Mohammadpour, N., Jazayeri, S., Tehrani-Doost, M., Djalali, M., Hosseini, M., Effatpanah, M., Davari-Ashtiani, R., & Karami, E. (2018). Effect of vitamin D supplementation as adjunctive therapy to methylphenidate on ADHD symptoms: A randomized, double blind, placebo-controlled trial. Nutritional Neuroscience, 21(3), 202–209. https://doi.org/
Pärtty, A., Kalliomäki, M., Wacklin, P., Salminen, S., & Isolauri, E. (2015). A possible link between early probiotic intervention and the risk of neuropsychiatric disorders later in childhood: A randomized trial. Pediatric Research, 77(6), 823–828. https://doi.org/10.1038/pr.2015.51
Views:
24
Downloads:
6
Copyright (c) 2025 Karina Grzesik, Katarzyna Pilarczyk, Aleksandra Rabęda, Antoni Gawor, Natalia Klepacz
This work is licensed under a Creative Commons Attribution 4.0 International License.
All articles are published in open-access and licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0). Hence, authors retain copyright to the content of the articles.
CC BY 4.0 License allows content to be copied, adapted, displayed, distributed, re-published or otherwise re-used for any purpose including for adaptation and commercial use provided the content is attributed.
