Non-drug approaches and adaptations in classrooms can help children diagnosed with ADHD to succeed, according to a systematic review of studies published in Health Technology Assessment. However, it is not yet clear how much these approaches help, or which types of techniques are most effective or cost-effective.
The review involved researchers from Kings College London and the Hong Kong Institute of Education, and examined studies published between 1980 and 2013. A press release summarized that, “The team found 54 studies (39 randomised controlled trials and 15 non-randomised studies) that tested many different ways of supporting these children, such as having daily report cards filled in by teachers and parents to give consistent and regular feedback, or study and organisational skills training, which can help children achieve better attainment levels, reduce hyperactive behaviour and increase attention.”
The researchers determined that, overall, these approaches seemed to be able to have positive impacts on children’s success in school. However, the press release summarized, they “found so many different types of strategies, often combined in different ways and so many different ways of measuring whether they worked, that it was impossible to clearly identify what works best.”
“Findings suggest some beneficial effects of non-pharmacological interventions for ADHD used in school settings, but substantial heterogeneity in effect sizes was seen across studies,” the researchers stated in their conclusions. “Future work should consider more rigorous evaluation of interventions, as well as focus on what works, for whom and in which contexts.”
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Simple classroom measures may reduce the impact of ADHD (University of Exeter press release on MedicalXpress, July 1, 2015)
Richardson M, Moore DA, Gwernan-Jones R, Thompson-Coon J, Ukoumunne O, Rogers M, et al.Non-pharmacological interventions for attention-deficit/hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2015;19(45) (Abstract)
This report should come as no surprise, especially considering the overuse of the ADHD diagnoses, with no evidence that ADHD is anything but some children’s behavioural response to life conditions that don’t fit their needs. A major problem with this report and the studies it is based on is the way people tend to interpret research. As research tends to look at one modality of intervention at a time, no research in mental health should be interpreted as if one is trying to find the best single modality as compared to others. Research always has to be evaluated in the light of other research and people’s real life experience. So we can take all the research on ADHD and be able to say that together exercise, proper sleep, teaching methods that don’t chain children to desks and expect them to be robots. good family environment and good teacher-child relationships are all important, and should be promoted for all children. Any individual piece of research can never represent the whole picture or solution. Empirically based practices need to include holistic interpretations of all evidence.
This kind of study really emphasizes the absolute idiocy of diagnosing kids (or adults) with a “disorder” based only on symptoms. The authors write that “substantial heterogeneity in effect sizes was seen across studies,” seemingly blind to the fact that “substantial heterogeneity” is seen across the cohort who receive this subjective and socially-derived diagnosis! It should surprise no one that different interventions implemented by different people toward different students would have a range of different results. The real lesson is that EACH CHILD IS DIFFERENT and that we should be creative in finding out WHAT WORKS FOR EACH SPECIFIC CHILD!!!! To think that ONE approach will always work for EVERY child who doesn’t like sitting still or doing boring repetitive work is the height of scientific stupidity. Unless you know WHY they aren’t sitting still, you are simply lumping together kids who are irritating to the adults, and you will never find a single solution that will help all of them, because they each need different things.
Of course, this kind of blunt and crude “diagnosis” does grant a huge advantage to the drug intervention, because it is aimed only at the symptoms and is completely unconcerned with causes or long-term effects. As long as we utilize these reductionistic and inane labels to classify kids, research will always show that drugs “work” best (at least in making the kids less annoying), because they are the crudest and most simplistic tools that attack the identified “symptoms” directly while doing absolutely nothing about the wide variety of possible causes and needs that are not being addressed, hence assuring a steady flow of customers over time.
— Steve
Given that ADHD meds don’t seem to have a positive effect over the long term maybe we should stick to classroom adjustments?
I agree, and it’s absurd and sad to live in a society where the grown ups within the medical and educational communities believe it is acceptable behavior to defame children with fictitious diseases and force medicate small children with amphetamines, or other mind altering drugs.