Podcast Transcript
Complementary and Alternative Interventions for ADHD
Summary: In this podcast episode, Margaret Sibley, PhD, and Eugene Arnold, MD, MEd, discuss nonpharmacological and pharmacological treatments for ADHD in children and adults. They define the terms nonpharmacological, alternative, and complementary treatments, and discuss the different categories of treatments available. They also highlight the importance of evidence-based research in evaluating the effectiveness of these treatments. The doctors discuss various treatments such as digital therapeutics, neurofeedback, brain stimulation, physical activity interventions, mindfulness meditation, dietary interventions, and sensory tools. They emphasize the need for better research on these treatments and the importance of patient empowerment in decision-making. They also discuss the challenges and potential risks associated with standard medication treatments for ADHD and the potential role of complementary treatments in addressing these challenges. The doctors provide recommendations for healthcare providers and educators in supporting patients and students with ADHD who are using complementary treatments. They also mention resources such as CHADD (Children and Adults with Attention Deficit Hyperactivity Disorder) and various websites for further information on ADHD treatments. Overall, the podcast highlights the importance of individualized treatment approaches and the need for informed decision-making based on evidence and patient preferences.
Margaret H. Sibley, PhD
Margaret H. Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and Seattle Children's Research Institute. Her work focuses on the diagnosis and treatment of ADHD in adolescents and young adults. She developed a parent-teen therapy for ADHD (Supporting Teens’ Autonomy Daily) that combines motivational interviewing and skills training for parents and teens. She has authored or coauthored more than eighty scientific papers on ADHD and published a book with Guilford Press on treating executive functioning and motivation deficits in teens. She is a member of CHADD’s professional advisory board.
L. Eugene Arnold, MD, MEd
L. Eugene Arnold, MD, MEd, is professor emeritus of psychiatry at The Ohio State University, where he formerly was the director of the division of child and adolescent psychiatry and vice-chair of psychiatry. He is a co-investigator in the OSU Research Unit on Pediatric Psychopharmacology. He has forty-five years of experience in child psychiatric research, including the multi-site NIMH Multimodal Treatment Study of Children with ADHD (“the MTA”), for which he was executive secretary and chair of the steering committee. For his work on the MTA, he received the NIH Director’s Award. A particular interest is alternative and complementary treatments for ADHD. His publications include nine books, seventy chapters, and more than three hundred articles.
Learning objectives:
- Identify the complementary and alternative ADHD treatments that have a higher level of evidence for their effectiveness.
- Understand how providers can engage in conversation with patients who are interested in trying alternative treatments.
- Understand the challenges with using standard medication treatments that motivates people to seek alternative treatments.
- Learn how educators can support students who are using complementary treatments.
Announcer: You are listening to Pocket MD: Training on ADHD in Children and Adults.
Dr. Margaret Sibley (00:07):
Welcome to another episode of the Pocket MD podcast. I am Dr. Maggie Sibley, and I am a professor of psychiatry and behavioral sciences at the University of Washington School of Medicine. I'm also a clinical psychologist and an author of a book on treating ADHD. I'm using cognitive behavioral treatment approaches. Today we have with me Dr. Gene Arnold, and we are going to be talking about nonpharmacological and pharmacological treatments for ADHD and in comparison to alternative and complementary treatments for ADHD. Dr. Arnold, do you want to introduce yourself to our listeners?
Dr. Eugene Arnold (00:43):
I’m Dr. Gene Arnold, board-certified child and adolescent psychiatrist, professor emeritus of psychiatry at Ohio State University, and I'm CHADD's resident expert, CHADD, of course being Children and Adults with ADHD, the advocacy group. Maggie, you have authored an article on nonpharmacological treatments for ADHD in Lancet Pediatrics and I'm wondering if you could first define some of the terms, the differences between nonpharmacological, alternative, complementary, behavioral. What is specified under those different terms?
Dr. Margaret Sibley (01:28):
Sure. So, medications are the primary category of treatment for ADHD and we consider any nonmedication treatment, a nonpharmacological approach. So that's a really wide umbrella with a lot of different possible treatments underneath it. And we'll talk a little bit about what some of those are. Treatments are standard evidence-based treatments with a lot of research behind them, and those are generally behavioral or cognitive behavioral approaches depending on the age of the person. There's also a whole host of other treatments that we might consider either complementary, which means there are treatments that aren't our standard treatments but might be used in addition to our standard treatments and then alternative treatments, which would be used instead of a standard treatment. And so we will be talking a little bit about different categories of treatments, but they may be used in different ways by different people either instead or in addition to treatments that are normally used, whether that's medication or a cognitive behavioral or a behavioral approach.
Dr. Eugene Arnold (02:32):
Yes, I'd like to add to that, that there's a double standard in evaluating the standard treatments versus the complementary and alternative treatments. And it's biased both ways. There are people who hold the alternative and complementary treatments to a higher standard, and there are those who are so enthusiastic that they hold them to a lower standard. Ideally, they should be judged the same way with evidence-based randomized clinical trials, meta-analysis and other systematic approaches to evaluating the evidence. And the evidence varies rather widely between different complementary treatments, and we'll discuss those as we go along. So, Maggie, within the realm of alternative and complementary treatments, which practices or therapies do you think demonstrate promise, and what level of evidence supports their efficacy?
Dr. Margaret Sibley (03:35):
I think we should go over what is out there, and sort of help people understand what some of the different treatments that they might be hearing about are. And then I can definitely highlight those that seem to have a higher level of evidence. So, one of the categories that we are hearing a lot about right now is digital therapeutics, sometimes called cognitive training. These are computer games designed to help improve mental efficiency. We also see in the community folks offering neurofeedback or biofeedback. So, this is a form of treatment where basically they place electrodes on people's heads and they are able to depict their brain activity on a screen. And then sometimes there's a feedback or a game aspect to it, where you get rewards for demonstrating brain activity that's sort of within a good functioning range. Another form of treatment that sounds a lot like neurofeedback, but it's different, is our brain stimulation treatments that are emerging.
(04:34):
So, here, you actually would place a device directly on a person's head, and that's going to electrically stimulate part of the brain or a nerve to presumably improve the functioning of a person's cognition and may be associated with that region of the brain.
Some others might be more familiar to people: physical activity interventions, mindfulness meditation, and body therapies like massage, chiropractic, acupuncture. There are dietary interventions where people restrict the foods they eat, trying to help with their cognition, nutrient supplements, we'll talk a little bit about some of those. We also see sensory tools being marketed, like fidget toys, scented pens, and musical tracks that are supposed to help people focus. So, I think those are some of the treatments that we've seen some testing and research on and we can comment on a little bit. But there are also complementary treatments that actually are out there being marketed and there really isn't much research on them at all,
(05:33):
so we just don't know. And that might be things like apps and planners that are being marketed; maybe they use evidence-informed ideas, but they haven't been directly tested. And another important one that people are hearing about a lot right now is coaching, often working with a person with lived experience related to ADHD to try to work on things like goals and strategies to manage their ADHD. So, it's a big landscape. And Gene, you mentioned that we did a review with a team of authors to understand where the evidence is for some of these. So what we were able to find is that the most promising, and at least in our review that seemed to have some repeated evidence behind them, are some of the nutrient supplements, specifically some of the polyunsaturated fatty acids, some formulations of multi-nutrients that have multiple ingredients in them, and mindfulness meditation. Those sort of rose to the top, whereas others maybe didn't have enough evidence yet, but maybe one day there will be more. And then we had some that kind of showed actually that there was evidence that they didn't work very well; some that fall under that are neurofeedback sensory tools and most of the digital therapeutics that have been tested. I don't know if you want to add to any of that, Gene.
Dr. Eugene Arnold (06:49):
I think one thing to keep in mind here is that we need better research on a lot of these things, particularly the ones that look promising. We have enough evidence on some of them to make a conclusion, but what do we do in the meantime? The amount of evidence we have is what we have. People read advertisements for these things, the social media talk about them, and people try them. You don't need a doctor's prescription for most of these things, so they'll tend to try them. So, we need some guide in the meantime. And one thing that I kind of like is the SECS versus RUDE rule. SECS is sensible, easy, cheap, and sensible. If something does not cost much or doesn’t cost anything, maybe like exercise and if it’s safe, generally accepted as safe, you don’t need as much evidence to go ahead and try it as you would if you had something that was expensive or very risky or didn’t make much sense. Things like chelation, for example, have a big risk and don’t have very much evidence of effectiveness. On the other hand, something like eating a well-balanced diet, or say the Mediterranean diet or avoiding excessive additives and highly processed foods, doesn't cost much [and] is probably good for your general health. Even if it doesn't help the ADHD, the odds favor allowing someone to go ahead and try it or even recommending it.
Dr. Margaret Sibley (08:36):
I agree with that. I think that especially when we're talking about eating a healthy diet, increasing physical activity, it should be a recommendation for everyone to do that. And if people with ADHD are struggling in those areas, that's a clear possible point of intervention for them to just increase their quality of life possibly even if it's not a direct impact on their ADHD symptoms. And you could probably say the same thing about some of the apps. Sure, we don't know if there's evidence that the app is definitely going to improve your ADHD management, but if you think it feels helpful to you, usually they're free or not very expensive, why not use it? I think it could only help.
Dr. Eugene Arnold (09:14):
Okay. Dr. Sibley, in exploring these different therapies, different alternative therapies, what role does patient empowerment play in that, and particularly in ethnic, diverse communities and language preferences and so forth?
Dr. Margaret Sibley (09:31):
Yes, I think it's really important to help patients make informed decisions, so one of our first duties is to help them understand what is known and what is not known about the different treatments that they might be hearing about or seeing marketed so that they have all the information available to them to make their own decision about what's right for them. And when you are working with a population or a person who has a different background than you do in some way or another, it is tough because we don't always understand all of that person's pros and cons and all of that person's considerations and so we can't possibly make a decision for them. But if we can provide our good information and they can take their worldview to the table with that information, then we're jointly putting ourselves in the best possible place to make sure that a good decision is made, especially when we're working with kids and we're really feeling like the parent and the provider have to work together to do what's in the best interest of the use. But I think we also have to have conversations about things like cost, safety burden, side effects, how long it's going to take for the treatment to work, how long it will last after you stop using it, because that's all part of what we mean by information. It's not just about efficacy. I'm curious, Gene, how you have those kinds of conversations.
Dr. Eugene Arnold (10:51):
One thing to consider in this is placebo response, because any treatment, including the standard, evidence-based treatments, have as part of their effectiveness the placebo response, the natura medica, the healing power of nature, the benefit of believing that something's going to help. And there are actual brain imaging studies that show that something goes on in the brain in response to a placebo. So, we need to respect that and enhance it where possible. Clinically it's a problem when you're doing a scientific study that you have to sort out that and try to control for it, but clinically it's a blessing and we should make use of that. So when we're talking about an ethnic minority community that has a belief in a certain system, it makes sense to go along with that even if there's not much scientific evidence for it because of this profound placebo response. We have to remind ourselves that some of the things that we call complementary and alternative, such as traditional Chinese medicine and Ayurvedic medicine, some herbals, almost cults, the so-called medicine men of some societies, that those are not alternative or complementary in that culture, that is their standard; so that we need to respect that and make use of it where it makes sense.
Dr. Margaret Sibley (12:32):
Yes, I couldn't agree with that more. I think there are certain treatments that have actually been tested from some of those backgrounds, especially traditional Chinese medicine where there could be potential effects, but we just don't have enough to be able to make conclusions in the way we do in western medicine. I agree that if it's highly valued treatment for a certain culture that it wouldn't be the place of western medicine to discourage it if we don't see it doing harm.
Dr. Eugene Arnold (12:59):
And, in fact, there's developing research using scientific methods on some of these treatments and some of them are showing promise. But we have to remember that many of the meds that we currently use were derived from plants to begin with, so that the relationship between herbs and FDA-approved medication is mainly one of purification and standard good manufacturing procedures and things like that.
Dr. Margaret Sibley (13:28):
A minute ago I mentioned that some of the evidence was behind some of the nutrient supplementation, and you've done some of that work and been involved in it. I wondered if there's anything because I think people are very curious about that, and I'm wondering if there's anything you specifically want to share about how you talk to your patients about those options.
Dr. Eugene Arnold (13:45):
As you mentioned, things like exercise and nutrition should be recommended for everybody. They're compatible with all the standard treatments, certainly, and they are good for general health as well as brain health. Typically, I would recommend to anybody with ADHD to begin taking an omega-3 fatty acid in a modest dose, one milligram maybe up to two milligrams, but not more, because anything that's strong enough to help is strong enough to hurt also. And these are actually what's used in the varnish industry as drying oils, the polyunsaturated fatty acids, as they oxidize they form of protective film, but you don't want a protective film in your brain. It's important to have adequate vitamins and minerals along with it, because things like selenium help prevent that oxidation. So that brings me then to the next thing, which is micronutrients, vitamins and minerals. And it's important in selecting one of those to make sure they have enough different ones.
(14:56):
There are about thirty different vitamins and essential minerals, and that's just what's known. There may be more in some foods that we haven't yet discovered, but you want to read the label and make sure that whatever it is that they're buying has at least two dozen; it could be a store brand, it could be a major brand, but not the gummies, the chewable ones, they only have about eleven different ones. You want at least two dozen different vitamins and minerals in whatever the supplement is. And the dose, of course is important, and the research that we've done has used a supplement that takes twelve capsules to include everything that's needed in a daily dose, but if it works, it's worth the nuisance and the expense. About half of a sample of children with ADHD will have a good response to this level of dosage that's above the recommended daily allowance and below the lowest adverse event level, that is the lowest level that causes problems, side effects or toxicity, and that's compared to 18% of the placebo group.
(16:11):
So it's about triple the response rate and highly significant. It's best to do this under a physician's supervision and also [monitor] their interactions with medication. So, this is one of the complementary treatments that does have interactions with standard treatment, so it needs to be closely supervised in that sense. Ordinary things like Centrum Junior or even Centrum Silver and store brands that are equivalent to that would not need as much supervision or monitoring. Exercise, of course, not only helps the muscles, the body, but also the brain. It increases the dopamine in the body, and of course raising dopamine neurotransmission is the way the stimulant drugs work, one of the standard treatments for ADHD. This gives you a more natural dosage of that and also has other effects. And there's some suggestion that doing it in organized sports may be even better than just doing workouts and getting exercise, but playing things like hide and seek dodgeball, things like that can be both fun and help general health and brain health.
Dr. Margaret Sibley (17:35):
The other one I want to mention is mindfulness meditation, which actually that does come from an eastern tradition. I think that's a really good example of how something that has come from maybe indigenous roots ends up a treatment that it's a fit for a lot of people. I think there is sometimes a challenging learning curve for a person with ADHD to start programs like that, if you can think about it. There's a lot of mindfulness apps out there and meditation programs, but there are actually specific meditation programs for people with ADHD that have been modified to help with people struggling with attention span. So, I think it's also really important that to be communicated with patients, that if you feel like, oh, meditation's not for me, it's been really tough. I've tried it in the past. If they haven't tried a program that's been modified for ADHD, it wouldn't be surprising that they had such a tough time getting started. I think that's an interesting one for people, and most of the work is done with adults. There's also been some work with parents of children with ADHD to help them with mindfulness practices to accept and deal with the stress of parenting a child with ADHD. I think that research is really interesting as well.
Dr. Eugene Arnold (18:48):
Yes. I think somewhat related to mindfulness and meditation is hypnosis, which works very well with people who don't have ADHD to do things like dental work, anesthesia for minor surgical procedures, blood draws, and removing warts and things like that. But it's very difficult for people with ADHD to do, because it requires close attention to various sensations and directing your attention to imagery and other things that are challenging for many people with ADHD. Okay. Well, Dr. Sibley, you've probably seen a lot of fad treatments come and go, but how can healthcare providers engage in conversations with patients and parents of children interested in alternative treatments without dismissing their concerns, especially considering potential cultural stigmas? Some people are reluctant to even admit that they have ADHD because of perceived stigma.
Dr. Margaret Sibley (19:55):
Yes, I think that's really important question. I think it's important to ask questions to the people you're working with about how they view ADHD and try to use the language that they use to talk about their disorder. I know some people who might be listening to this are educators. I've done a lot of work in school settings and sometimes we don't even talk about ADHD as a disorder in that setting and just sort of talk about the key behaviors that are causing somebody to have some troubles. And so I think we really have to try to adjust our discussion to the worldview of the person and how they think about and talk about ADHD. I think it's really important for us to be able to make sure we are informed about the kind of research and best practices on treatments for ADHD, so that when people ask us questions and they want to know what the research says on something they may have seen advertised, that we can do right by them and be able to provide them with accurate information as well. I'm wondering, Gene, how you think, Dr. Arnold, about our standard medication treatments and whether there are any challenges with them that could open up an opportunity for a complementary or an alternative approach to be appropriate if people are struggling with medication in some way? How do you think about those two classes of treatments?
Dr. Eugene Arnold (21:18):
Together? Yes, there are a lot of challenges, particularly with the stimulant medications right now. There's a shortage of them, which is an unexpected challenge. But beyond that, and before that even there was a problem because they're classified as dangerous drugs by the DEA, the Drug Enforcement Administration, and require special considerations in prescribing them. This was kind of a nuisance for physicians who have to write a new prescription every month instead of being able to write refills for a year, and also for the public who may be concerned about the fact that they're called dangerous drugs. They're called dangerous because of the addicting potential more so than because of any side effects that they have. We know that some of the side effects are actually desirable in some cases. The appetite suppression, which tends to leave after a while, can be concerning for parents of growing children.
(22:26):
And we know that taking the medication chronically over a lifetime, for example, in the MTA, starting at age eight and then followed up for sixteen years to age 24, 25, that there was about a one to one-and-a-half-inch decrease in the ultimate height growth. And, by the way, in our recent study of the multinutrients, the micronutrients for ADHD in Youth study, there was actually an increase in height growth noted in the group that got the multinutrients compared to placebo, just the opposite of the stimulant drugs. Whether one is concerned about the height loss partly depends on how tall people in the family are. If it tends to be a rather short family, they're more concerned about that. If they're all six-footers, then maybe they don't worry about that. And as Paul Wender used to ask, would you rather have a five-foot-five college graduate or a six-foot school dropout?
(23:34):
It's not quite that dark a choice, but all of those things need to be balanced. Another problem is the expense. Even if you have prescription coverage, there's usually a copay for many families; that's month after month and shelling out the money for that is a problem. And so it's not surprising with considering the side effects, the social stigma about the drugs, the expense that so many people stop the medication, they take it for a year or two and then sort of drop off and a lot of prescriptions are not even refilled the first time. They take it for a month and then stop. So different treatments, additional treatments are really needed. Whether any particular complementary treatment could substitute for medication is an open question, but taken together, if you add together adequate sleep, exercise, good nutrition, good educational adjustments, and behavioral treatments, a lot of people might be able to get by without the medication. And that's kind of a family choice, a patient and family choice. So part of what a clinician needs to do is to provide facts and data to families on the benefits of each treatment, the risks of it, the expense, and then be a consultant to the family in choosing what makes sense for them.
Dr. Margaret Sibley (25:11):
I think one of the messages here has been, don't be afraid to tolerate something even if you know that it's not probably the most evidence-based treatment, if the family seems interested in engaging with it and it doesn't really seem to have a lot of downsides. But is there ever a situation where there might be a red flag for a provider, where they should really be a little bit more forceful with something someone is trying or talking about? Do you ever run into a situation like that?
Dr. Eugene Arnold (25:38):
Some of the treatments that have been advocated in the past do carry some risks. I think they tend to fall out. If they're not providing good benefits, they'll drop by the wayside. If someone is substituting alternative treatment that's not working for evidence-based treatments or for traditional or conventional treatments, then the problem there is the delay, the loss of opportunity, the timing, particularly for children in school as they progress along the educational path, one grade builds on another. If you didn't learn the alphabet in kindergarten, you're going to have trouble learning to read in the first grade. If you didn't learn how to add and subtract, you're going to have trouble with multiplication. And if you don't know multiplication, you're going to have trouble with division. All these things assume that you've learned what was in the previous steps in the previous grades. So, if you miss out on some of that because you delayed treatment, trying something that's not working, then that's an opportunity cost that isn't usually factored in, but needs to be.
Dr. Margaret Sibley (26:59):
Yes. The other one that bothers me—I talked to a lot of families who are considering very costly treatments. There is an industry of folks who are marketing treatments that are appealing for ADHD that cost a lot of money and don't really have evidence backing. And I always feel a little bit of an ethical dilemma when I know the family was really struggling to make ends meet. People are really looking for hope. If they're being given hope by something that feels like it's a long shot that it's going to help them, I feel like at least we have a burden on us to help people understand that, look, it's not impossible that this could help you, but based on what we know, it's probably a long shot. So, you should really ask yourself, do I have the money to spend on this that might be really different than a family who has a lot of money and is happy to try things out because it really doesn't hurt them in any way to spend that money here and there on something that may be a long shot. And I think talking about people in different walks of life, I do think we have to tailor our conversations to what their resources are and think about that.
Dr. Eugene Arnold (28:01):
I agree completely with that. It goes back to the SECS versus RUDE criterion and the expense part is relative according to family resources. How can educators support students with ADHD who are using complementary treatments? What strategies can be implemented in educational settings?
Dr. Margaret Sibley (28:23):
This is a good question. I think some of the ones educators probably are most familiar with are some of the ones that actually don't have a lot of research, like the apps and the planners and even ADHD coaching, because some of that's being delivered in school settings. Sometimes you'll hear of executive function coaches, and so I think educators are in a similar position as mental healthcare or healthcare providers when working with people with ADHD, with executive function coaching, for example. There really is no randomized control trial of that. We just don't know. It could be a really great treatment. We just don't know. And so what I tell people when I get that question about coaching is the best we can do right now is understand individual people in our community that might have a really good reputation with other families as being very helpful.
(29:16):
I would be more likely to put my trust in saying, try that, go for it. There seems to be a consensus there that this is helpful, than with someone that we don't have any background information on that's calling themselves a coach. Because some of the coaches are able to just call themselves a coach without any formal training, any formal certifications, and so it's just a question mark about whether they would be good or not. That's one thing that I think educators might run into. Again, I think there's no reason not to go for those apps and those planners, they can't hurt. They're usually cheap. And again, I think we can use word of mouth from other people to hear good apps that might be worth checking out, check them out for yourself. If there seems to be a consensus, if people are saying, Hey, this is really helpful, none of that's going to really hurt. I think I doubt that people in the education community are running into some of these other ones like neurofeedback or cognitive training as much. But again, I think we're always trying to send the message to just make sure people have good information. So, if you’re an educator and somebody asks you, Hey, are these things effective? You can direct them if you aren't sure yourself to CHADD'S website or places where there is some information for families about whether there's evidence and what the pros and cons are of some of these approaches.
Dr. Eugene Arnold (30:34):
Okay. Given how ADHD is expressed differently, how can healthcare providers customize complementary treatments to align with the unique needs of each patient considering diverse ethnic backgrounds and ages and languages? I think we've touched some on that already.
Dr. Margaret Sibley (30:54):
I think the only thing that we could add here is don't be afraid to take a trial-and-error approach with families. So if families seem interested in something and we just aren't sure if it's going to help or not teaching them how to monitor self-monitor how they're doing and pay attention to whether this seems to be helping them, having follow-up conversations a few months later to sort of look back and see how that treatment's helping or not helping could facilitate. I think for people on maybe day one, they're not sure if it's helping them or not, but you could make a good decision long-term after trying it for a while too. So I think that's really important. I think in terms of working with people with diverse backgrounds, obviously we all have to be humble when working with people that aren't coming from a similar background to ourself because we just have to know that we can't fully know what their experience is like. And one thing we want to advocate for in general in medicine and other patient-centered professions is just having more people, more diversity in our providers, so that there's a greater likelihood that people can find someone that they relate as best to as possible in their communities. So maybe I would add that to the conversation.
Dr. Eugene Arnold (32:01):
Yes, I think there are two principles here that might be helpful to keep in mind. Number one is that practice makes perfect. If you repetitively practice some good strategy, it'll come more naturally and you'll get better at it. And this could include things like executive function skills. The second closely related to that is that good habits are the friend of a person with ADHD, because once you have the habit, you don't have to pay attention to it anymore. You just do it naturally without thinking. One strategy is to pick one habit to work on and develop one at a time and develop a good habit and then move to another habit and so forth, and gradually build up those up over time.
Dr. Margaret Sibley (32:54):
Yes, I think that's really good advice, especially when we talk about trying to stay compliant with whatever it is that you've committed to for your treatment plan, whether that's just standard treatments or also standard treatments plus some complementary treatments. Like physical activity, for example, is a perfect case there where it's only going to work as consistent as you are with it. So you really have to be able to try a treatment for a while before you can finally make a conclusion, draw a conclusion about whether it's helping you or not. And we see people who kind of start something—I think I saw that the average amount of time for engagement in an app for something like ADHD is like four days—so if people are downloading an app using it for four days and then not using it anymore, I don't know that we can draw a conclusion that the app wasn't helpful. Maybe it wasn't interesting, but we do have to make sure we don't confuse those two things for folks.
Dr. Eugene Arnold (33:48):
That's one of the problems, the desire for novelty, how ADHD symptoms interfere with the treatment of ADHD symptoms.
Dr. Margaret Sibley (33:57):
Exactly. Are there resources, Dr. Arnold, that you know about that you think people should be directed to for learning more about this?
Dr. Eugene Arnold (34:07):
Glad you asked about that, because CHADD has a number of resources that's C-H-A-D-D. They specialize in providing information on the internet and otherwise; you can access fact sheets on things like coaching, nutrition, fish oil supplements, neurofeedback, digital intervention software, brain training. One link to get to that would be CHADD.org/about-adhd/complementary-and-other-interventions/. If you just Google CHADD, you should be able to get to their website and they have an online library database with articles, conference presentations, books, videos, and podcasts like this. This is open to anybody to tap into even for non-members. There's also a website at the University of Arizona that has some good information, some good tips, and also at Florida International University. Do you happen to know the link for that offhand, Dr. Sibley, you were there.
Dr. Margaret Sibley (35:24):
No, I don't know the link offhand, but I think if people Google the Center for Children and Families at Florida International University, that's where they would find that collection of resources on nonpharmacological treatments for ADHD.
Dr. Eugene Arnold (35:39):
I think New York University Langone, Dr. Andy Adeson's website, also has some good information, and Dr. Ned Hallowell has a website with good tips for adults with ADHD. He's the author of the books Driven to Distraction and Delivered from Distraction.
Dr. Margaret Sibley (36:01):
That's great. One important sort-of take home here is that there isn't one single way that is the best practice for treating ADHD. Everyone's different, and everyone can benefit from different combinations of forms of help. And we're really in a lucky age, where there's a lot of great resources freely available to people through the internet at the same time. That same blessing can be a curse, because people sometimes don't know what information is good and what information is not good. And so when you have something like CHADD, or some of these other resources, that is not making a profit off of anything and is just dedicated to making clear what we know from the science and from the opinion of professionals who've been doing things for a very long time, it sort of does help see something that is trustworthy from within a very big sea of lots of information that sometimes people don't know what to trust,
Dr. Eugene Arnold (36:55):
I guess you would say, don't get your information from social media or from advertisements, but rather go to unbiased sources like CHADD or a university website to get your information.
Dr. Margaret Sibley (37:11):
Social media is great for finding out about things, but then do your homework on the things that are on there, because some of them are probably really good. I know there are some really talented medical professionals-turned-influencers in the ADHD space who actually are putting out really great information, but there are, for every one person like that, there's also people who might not have the best information and they can seem very credible as well. And so it is good to just double check what you're hearing with some of the more neutral sources. They're not going to be as interesting as the people on social media are making it, but hey, you can trust it. So, it's good to have both sources of information and check them against each other.
Dr. Eugene Arnold (37:53):
Well, it's been a pleasure talking with you, Dr. Sibley, and I think we could summarize here by saying that there's a wide diversity of alternative and complementary treatments. The complementary ones are compatible with standard treatments and often can augment, enhance the effect of the standard treatment by combining it with them. The amount of evidence for them varies widely from good randomized clinical trials and meta-analysis, systematic reviews to an occasional open study or observation or a hypothesis that somebody has that sounds sensible but hasn't been tested. It's good to do your homework on it, and particularly be careful for those that are expensive or carry some risk to make sure that there's enough evidence to justify that expense and risk.
Dr. Margaret Sibley (38:58):
Yes, I think you summed that up really well. Thank you for this conversation, Dr. Arnold. This was really interesting.
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