ADHD Weekly, August 21, 2025

From an early age, and even into their teens, children who have ADHD may struggle with impulse control. Difficulties with sitting still in class, paying attention, and talking out of turn can get in the way of a child’s success, not just at school but in their relationships and everyday life.

Behavior therapy and medication, the recommended treatments for ADHD, target impulse control and can help support the development of executive function skills like organization, problem-solving, and time management. But families are often searching for more than these interventions can do, especially when medication side effects arise or therapy doesn’t produce results quickly enough for them.

Parents look for alternatives

Medication prescribed for ADHD may not work for everyone, and it can cause side effects, including trouble with sleeping, poor appetite, headaches, and rebound symptoms or behaviors when the medication wears off. Some parents may become frustrated if medication doesn’t decrease their child’s symptoms. Some insurance plans do not cover all or even any of the costs for the prescription.

“I think part of it is dissatisfaction with treatment,” said L. Eugene Arnold, MD, MEd. “The side effects of medication, the expenses of medications, and the effort and time it takes toward obtaining treatment are concerns.”

A dedicated researcher who examined the effectiveness of alternative treatments for ADHD, Dr. Arnold was professor emeritus at Ohio State University and served as CHADD’s resident expert for many years. He understood that some parents may look beyond medication to help ease their child’s symptoms and looked for approaches that could be effective for them.

Effects of non-medication therapies

Cognitive training, neurofeedback, mindfulness, and physical exercise are some of the non-medication therapies that parents may consider for their child. A new meta-analysis, a study which reviewed multiple prior studies, found that some non-medication therapies were not effective in reducing ADHD behaviors long-term in children and adolescents.

Researcher Jingyi Zhou and her colleagues examined how well non-medication therapies, including the ones mentioned earlier and board games, EMG feedback, and meditation helped improved ADHD symptoms like impulse control over the long term.

They noticed that most research on non-medication therapies for ADHD only reviewed short-term effects and not long-term results, and that most researchers didn’t follow up with research subjects to see if the effects of these therapies continued over time. Zhou and colleagues found that most studies didn’t evaluate which of the non-medication therapies are most helpful. Because of these research gaps, they decided to look at only long-term non-medication treatments that targeted impulse control in children and adolescents. They also ranked the effectiveness of these therapies based on previous study results.

The study evaluated existing research on behavior therapy that involves teaching parent strategies to help strengthen their child’s impulse control through building structure and routine at home, reinforcing good behaviors, and improving communication between the parent and child.

While some of the results reviewed were promising, none led to strong, consistent improvement in ADHD symptoms.

“Existing evidence shows that physical exercise, behavior therapy, cognitive training, and neurofeedback can effectively improve the inhibitory control of children and adolescents with ADHD,” Zhou writes. “However, meditation, EMG feedback, and board games did not significantly affect inhibitory control. Physical exercise has the best effect among all non-pharmacological treatments, but its impact will be weakened after intervention. Behavior therapy and cognitive training had a slightly lower effect, but they have a better maintenance effect.”

Traditional board games and games requiring physical skills, such as Battleship, Operation, and chess are often considered by some parents and therapists as alternative therapy to help children strengthen impulse control. These games require skills like turn taking, planning, and strategy. However, in their study, Zhou and her colleagues found both board games and meditation haven’t been studied long enough to determine if they will be helpful with ADHD symptoms.

Don’t change your child’s treatment plan just yet

ADHD experts warn parents not to change their child’s current treatment plan without discussion with their child’s specialist or prescriber based on studies reviewing alternative or complementary ADHD interventions.

“There’s a thread that runs through a lot of these alternative treatments,” said Dr. Arnold when discussing non-standard and complementary interventions for ADHD. “You have to weigh what is known against the risks of doing or not doing it. There’s a lot of ‘real news’ [regarding medications or alternative approaches] that may be over-interpreted that you need to look into first.”

CHADD reached out to well-known ADHD expert Stephen Faraone, PhD, to review Zhou’s study.

He says it suggests that some non-medication interventions can help some children and teens with symptom management. Dr. Faraone is a professor of psychiatry at Norton College of Medicine at SUNY Upstate Medical University and president of the World Federation of ADHD.

“Some methods, like physical exercise, work well at first but may fade once the activity stops,” he says. “Other methods, like behavioral therapy and cognitive training, may take a little longer to show results but can last longer and make a bigger difference over time.”

His takeaways from the study include encouraging parents to proceed with caution when choosing non-medication therapies and not to drop current treatments based on these study results alone.

“Importantly, because this work did not study the symptoms of ADHD or its real-world impairments, it provides no reason to change current treatment practices for ADHD,” says Dr. Faraone.

Further Reading:

• ADHD Diagnosis and Treatment in Children and Adolescents
• Complementary and Other Interventions
• New Studies Examine Effective Treatments for ADHD
• Be Wary of Alternatives in the Age of ADHD Medication Shortages
• A Fishy Idea Omega-3 Supplements as a Replacement for Medication
• Executive Function in Impulsive Children
• New Guidelines for ADHD and Complex ADHD

Join the conversation: what complementary supports have helped your child better manage ADHD symptoms?